Injury-International Journal of the Care of the Injured最新文献

{"title":"Management of post-injury anticoagulation in the traumatic brain injury patient: A scoping review","authors":"Michael Keirsey,&nbsp;Grace M Niziolek","doi":"10.1016/j.injury.2025.112159","DOIUrl":"10.1016/j.injury.2025.112159","url":null,"abstract":"<div><div>Traumatic brain injury (TBI) remains a leading cause of morbidity and mortality among trauma patients. The care of these patients continues to be a complex endeavor with prevention of associated complications, often requiring as much attention as that of the treatment of the primary injury. Paramount among these are venous thromboembolic events (VTE) due to their high incidence, additive effect on the risk of morbidity and mortality, and the careful balance that must be utilized in their diagnosis and treatment to prevent progression of the brain injury itself.</div><div>In this review, we have synthesized the most recent major studies detailing the ideal choice of chemoprophylactic agent, the timing of initiation, and continued monitoring and management strategies through the hospital course and beyond. Additional discussion is provided for subpopulations in which management can vary significantly, including the elderly, critically ill, and obese. Ultimately, current literature supports the use and safety of low molecular weight heparin over unfractionated heparin, especially when dosed using newer assays including anti-Xa levels. The timing of prophylaxis remains important, as the risk of VTE increases with each day that prophylaxis is held. Consensus findings favor initiation within 24–72 h, in the absence of documented progression, life threatening bleeding, or need for major surgical intervention. Despite available data, there continues to be significant variability in practice patterns which we hope to address with this review.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112159"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment and outcome after hip fracture for patients on oral anticoagulation","authors":"Alexander Wilton,&nbsp;Ayman Sorial,&nbsp;Tanzeelah Jamadar,&nbsp;Martyn Parker","doi":"10.1016/j.injury.2024.112072","DOIUrl":"10.1016/j.injury.2024.112072","url":null,"abstract":"<div><h3>Aims</h3><div>An increasing number of patients with hip fracture are taking oral anticoagulation medication including direct oral anticoagulants (DOAC). The management of these patients regarding the timing of surgery and occurrence of complications remains contentious. The aim of this study was to compare treatment and outcomes for hip fracture patients taking anticoagulation.</div></div><div><h3>Methods</h3><div>Data from a consecutive series of 3,707 hip fracture patients admitted to a single centre was collected over a seven-year period.</div></div><div><h3>Results</h3><div>The proportion of patients taking warfarin fell slightly over the study period (6.1 % to 4.7 %) whilst the proportion taking DOAC increased greatly (1.4 % to 11.4 %). Patients on oral anticoagulation were slight older (mean age 83 years for warfarin, 85 years for DOAC versus 80 years for those not on anticoagulation), more likely to have atrial fibrillation, less likely to take anti-platelet medication and less likely to have spinal anaesthesia. Patients taking oral anticoagulant had an increased delay to theatre (mean hours admission to theatre 37.9 for warfarin, 39.5 for DOAC, 31.1 for no anticoagulation). There was no difference in the number of patients transfused, wound complications, post-operative haemoglobin or 30 -day mortality between groups.</div></div><div><h3>Conclusion</h3><div>Current policies on the timing of surgery and anticoagulation are safe.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112072"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conservative tangential excision instead of escharotomy in the treatment of compartment syndrome","authors":"Jun Liu ,&nbsp;Zhi Hui Liu ,&nbsp;Ruo Nan Lu","doi":"10.1016/j.injury.2024.112069","DOIUrl":"10.1016/j.injury.2024.112069","url":null,"abstract":"<div><h3>Purpose</h3><div>One of the primary causes of heat-induced compartment syndrome is the loss of elasticity of the body surface eschar itself, we have recently replaced escharotomy with conservative tangential excision in the treatment of compartment syndrome caused by heat and achieved good results.</div></div><div><h3>Methods</h3><div>Since 2019, our burn center has applied conservative tangential excision and heterogeneous dermal coverage technology for decompression treatment of 16 patients with thermal-induced compartment syndrome, involving 19 parts of the limbs and 5 parts of the chest and abdomen. All cases were treated with decompression under general anesthesia within 12–48 h after burn.</div></div><div><h3>Results</h3><div>All patients were treated with conservative tangential excision for decompression. After limb decompression, the peripheral blood supply was restored, and the obvious pulse could be touched. No further fasciotomy was performed, and no secondary damage of deep muscle, nerve and vascular tissue was found in the follow-up treatment; After thoracic and abdominal decompression, there was no respiratory restriction and circulatory disorder.</div></div><div><h3>Conclusion</h3><div>Conservative tangential excision represents an effective method for both the prevention and treatment of heat-induced compartment syndrome, it can be used as an alternative method for escharotomy.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112069"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142815303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modeling, experiment, and validation of a piglet head","authors":"Rui Li ,&nbsp;Dapeng Li ,&nbsp;Zhongqing Su ,&nbsp;Zhigang Li ,&nbsp;Huiqing Lan ,&nbsp;Chunyu Bai ,&nbsp;Xulong Xi ,&nbsp;Xiaocheng Li","doi":"10.1016/j.injury.2024.112068","DOIUrl":"10.1016/j.injury.2024.112068","url":null,"abstract":"<div><h3>Introduction</h3><div>Traumatic brain injury (TBI) is a prevalent type of disabling and fatal injury in infants/toddlers, which is usually caused by falls or traffic accidents. Considering that it is difficult to collect realistic material properties and validation data of child heads due to ethical reasons, experiments on the piglet heads and the finite element (FE) models are generally used as a substitute for the investigations of child TBI.</div></div><div><h3>Methods</h3><div>In this study, first, a high-quality FE model of a 4-week-old piglet head, including brain (cerebrum, cerebellum, brainstem), skull, soft tissue, cerebrospinal fluid, dura matter, pia matter and mandible, is developed. Then, test for the material properties of the piglet head and that for the global validation data are conducted. For the former, the mechanical properties of the brain, overlying soft tissue and skull of the 4-week-old piglet head are tested, and the constitutive models and corresponding parameters are further defined. For the latter, the quasi-static compression test and dynamic impact test (free-fall drop impact test, drop-hammer impact test) are performed on the piglet head. Finally, the piglet head FE model was validated against tests in terms of the contact force and intracranial pressure (ICP) under eight conditions (one for the compression condition, four for the free-fall impact condition, and three for the drop-hammer impact condition).</div></div><div><h3>Results</h3><div>The trends of simulated curves are consistent with the experimental results under all conditions. For the contact force, the average error of the peak values between simulations and tests is about 12.9 %, and the average error of time durations is about 6.8 %. For the ICP, the average errors of peak values and time durations between simulations and tests are about 8.9 % and 9.9 %.</div></div><div><h3>Conclusions</h3><div>The results show that the piglet head model has high bio-fidelity, which can be used to predict the head global response and the ICP, and further to assist the investigation of child TBI. The model provides another effective way to evaluate the modeling strategies and material constitute models suitable for child head FE model, and can better to understand the inducement and mechanism of child TBI under different external loading conditions.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112068"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plasma transfusion and hospital mortality in moderate-severe traumatic brain injury","authors":"Shayan Rakhit ,&nbsp;Areg Grigorian ,&nbsp;Erika L Rivera ,&nbsp;Francisco A Alvarado ,&nbsp;Mayur B Patel ,&nbsp;Amelia W Maiga","doi":"10.1016/j.injury.2024.112040","DOIUrl":"10.1016/j.injury.2024.112040","url":null,"abstract":"<div><h3>Background</h3><div>Prior research suggests that plasma may improve outcomes in traumatic brain injury (TBI). We examined the association between plasma administration and mortality in moderate-severe TBI in a large retrospective cohort, hypothesizing plasma is associated with decreased mortality after accounting for confounding covariates.</div></div><div><h3>Materials and Methods</h3><div>Patients from the 2017–2020 Trauma Quality Improvement Program (TQIP) dataset ≥18 years with moderate-severe TBI were included. We excluded patients with comorbidities associated with bleeding or sensitivity to volume (antiplatelet or anticoagulation medications, bleeding disorders, cirrhosis, congestive heart failure, chronic obstructive pulmonary disease). Multivariable logistic regression examined the association between plasma volume transfused in the first four hours and hospital mortality, adjusting for sociodemographics, severity of injury/illness, neurologic status, and volume of other blood products. We also adjusted for and included interactions with hemorrhage markers (shock; need for hemorrhage control).</div></div><div><h3>Results</h3><div>Of 63,918 patients included, hospital mortality was 37.0 %. 82.8 % received no plasma. Each unit of plasma was associated with greater unadjusted mortality, with odds ratio (OR): 1.13 (95 % confidence interval: 1.12–1.14), but after confounder adjustment, plasma units were not associated with greater mortality, with OR: 1.01 (0.99–1.03). While the overall adjusted effect of plasma was not significant, significant interactions between hemorrhage markers and plasma were present (<em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Administration of plasma within the first four hours after hospital presentation was not associated with decreased or increased mortality in adult patients with moderate to severe TBI after confounder adjustment. Interaction analysis suggests the presence of hemorrhage improves the effect of plasma on mortality in TBI. This important clinical question should be answered with a prospective randomized study of plasma for nonbleeding patients with TBI.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112040"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of interventions for psychological distress following traumatic injury: A systematic review","authors":"Ellie Grant ,&nbsp;Alan Bowman ,&nbsp;Louise Johnson","doi":"10.1016/j.injury.2024.112090","DOIUrl":"10.1016/j.injury.2024.112090","url":null,"abstract":"<div><h3>Background</h3><div>Traumatic injury poses significant physical and psychological challenges, often resulting in psychological distress, encompassing symptoms of anxiety, depression and post-traumatic stress. Despite the recognised need for psychological care in trauma rehabilitation, there is limited empirical evidence of effective interventions tailored specifically for individuals with traumatic injuries, leading to a practice-evidence gap.</div></div><div><h3>Objectives</h3><div>This review aimed to evaluate the effectiveness of psychological and behavioural interventions for reducing psychological distress in adults following traumatic injury.</div></div><div><h3>Methods</h3><div>This systematic review followed a published protocol (CRD4202342946) and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and the Synthesis Without Meta-analysis (SWiM) in systematic reviews reporting items. Peer-reviewed studies were identified through searches of MEDLINE, APA PsycInfo, CINAHL and Embase databases. Eligible studies involved adults aged 18 and older who had experienced physical trauma requiring immediate medical attention. Studies involving participants with neurological injuries and/or military personnel were not included. Both English- and non-English-language articles were considered. Effect direction was employed as the method of synthesis and risk of bias was assessed using the Cochrane Effective Practice and Organisation of Care (EPOC 9) nine-item assessment tool.</div></div><div><h3>Results</h3><div>A total of six studies met the review eligibility criteria. There was considerable heterogeneity across the interventions in terms of their nature, timing and duration, however all interventions were delivered within 3-months post-injury. Most studies reported positive intervention effects, with no adverse effects reported. Cognitive Behavioural Therapy (CBT) was the most reported intervention across the studies.</div></div><div><h3>Conclusions</h3><div>The review findings highlight the preliminary evidence supporting CBT as a viable option for reducing psychological distress following traumatic injury. However, this may be explained by the dominance of CBT in the literature due to its structured nature, availability and suitability for research, potentially limiting the visibility of alternative therapeutic approaches. Further, these findings are constrained by study limitations, including small sample sizes, heterogeneity of injury types and severity, reliance on self-reported outcomes, and limited follow-up data. Future research should aim to include longitudinal follow-up assessments and explore alternative therapeutic approaches to contribute to our understanding of meaningful trauma rehabilitation methods.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112090"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and determinants of unintentional injuries and violence among high school students in Turkey: A cross-sectional study","authors":"Hasan Hüseyin Çam ,&nbsp;Fadime Ustuner Top","doi":"10.1016/j.injury.2025.112150","DOIUrl":"10.1016/j.injury.2025.112150","url":null,"abstract":"<div><h3>Introduction</h3><div>Injuries and violence are among the most prominent public health problems in the world. As well as being a leading cause of mortality – particularly among children and young adults – many of the millions of non-fatal injuries result in life-long disabilities and health consequences. The aim of this study was to estimate the prevalence of unintentional injuries and violence, and their associated factors among high school students.</div></div><div><h3>Methods</h3><div>This cross-sectional study included a total of 1218 high-school students in Turkey. Data were collected through a facilitated self-administered questionnaire with questions adapted from the Global School-based Student Health Survey instrument. Data were analyzed in IBM SPSS Statistics 28.0 using chi-square test to find statistical significance if any. The significant variables from the chi-square test were selected for multiple logistic regression analysis.</div></div><div><h3>Results</h3><div>The overall prevalence of physical attack, physical fighting, and serious injuries were 8.3 %, 14.8 %, and 11.7 %, respectively. In a multiple regression analysis, student truancy and lateness, worry, suicide attempts, and not having close friends were found to be associated with physically attacked, physical fight, and serious injuries.</div></div><div><h3>Conclusion</h3><div>This study demonstrated that the prevalence of unintentional injuries and violence among high school students is a major public health problem in Turkey. This study results can have important implications for school administration, parents, and policymakers alike to plan appropriate anti-violence strategies and interventions.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112150"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative frozen section analysis for detection of fracture-related infection in nonunion of the upper limb. Diagnostic accuracy study","authors":"Ezequiel Fernando Martínez ,&nbsp;Fernando Holc ,&nbsp;Pedro Bronenberg Victorica ,&nbsp;Gerardo Luis Gallucci ,&nbsp;Mariano Oscar Abrego ,&nbsp;Pablo De Carli ,&nbsp;Pablo Daniel Roitman ,&nbsp;Jorge Guillermo Boretto","doi":"10.1016/j.injury.2024.112139","DOIUrl":"10.1016/j.injury.2024.112139","url":null,"abstract":"<div><h3>Introduction</h3><div>During revision surgery for the management of patients presenting with long-bone upper extremity nonunion, it is crucial to rule out fracture-related infection (FRI). This is especially true if there are clinical signs suggestive of FRI, or if there is a history of prior FRI, open wound fracture, or surgery. This study aimed to determine the efficacy of frozen section analysis (FSA) in providing real-time diagnosis of FRI in patients with upper-limb long-bone nonunion undergoing revision surgery.</div></div><div><h3>Patients and Methods</h3><div>We included previously surgically treated patients who underwent revision surgery for chronic/late-onset nonunion of the long bones of the upper limbs over a 9-year period. We retrospectively applied the FRI criteria to identify eligible patients and recorded their clinical features and demographic characteristics. In all included patients, samples for microbiological analysis and FSA were collected simultaneously during revision surgery. Patients were categorized according to intraoperative culture results as having aseptic or infected nonunion. The sensitivity, specificity, positive and negative predictive values, and accuracy of FSA test were calculated and compared using microbiological analysis as the reference standard test. The concordance rate between FSA and definitive histopathology was also determined.</div></div><div><h3>Results</h3><div>Sixty-two patients who were surgically treated for nonunion of the arm or forearm were included in this study. Septic nonunion was diagnosed intraoperatively in 9 patients based on FSA findings, while microbiological analysis confirmed septic nonunion in 8 patients. The sensitivity and specificity of FSA were 88 % (95 % confidence interval [CI] [47, 100]) and 96 % (95 % CI [87, 100]), respectively. Positive and negative predictive values were 78 % (95 % CI [47, 93]) and 98 % (95 % CI [89, 100]), respectively, with an overall test accuracy of 95 % (95 % CI [87, 99]). Cohen's Kappa coefficient between FSA and definitive histopathology was 0.74 (95 % CI [0.5, 1]).</div></div><div><h3>Conclusions</h3><div>FSA showed high sensitivity and specificity for the detection of active infection during revision surgery for nonunion of the upper limb. Owing to its high negative predictive value, it can reliably rule out active infections during revision surgery. Since the results are obtained immediately during revision surgery, this approach offers the significant advantage of enabling real-time decision-making.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112139"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pelvic fractures and thoracolumbar spine injury: A critical overlook in high-impact vehicular trauma management","authors":"Zachary A. Mohs ,&nbsp;Nathaniel Albrecht ,&nbsp;Anthony J. Duncan ,&nbsp;Li Cao ,&nbsp;Mentor Ahmeti","doi":"10.1016/j.injury.2024.112050","DOIUrl":"10.1016/j.injury.2024.112050","url":null,"abstract":"<div><h3>Introduction</h3><div>Pelvic fractures (PF) occur in up to 9 % of trauma cases, primarily from high-impact events, and are associated with increased morbidity and mortality due to frequent concomitant injuries. Thoracolumbar (TL) spinal fractures, particularly at the T10-L2 junction, are also common in high-energy trauma but are less frequently examined in association with PF. Missed TL fractures can lead to serious neurological deficits. Although Advanced Trauma Life Support (ATLS) recommends screening for TL fractures in trauma patients, no standardized guidelines exist. This study aims to explore the relationship between PF and TL fractures in trauma patients and to identify key variables associated with these injuries.</div></div><div><h3>Methods</h3><div>This retrospective cohort study analyzed data from the 2021 National Trauma Data Bank (NTDB), focusing on patients with PF resulting from high-impact blunt trauma. Patients were identified using ICD-9 codes for pelvic fractures, and those under 18 years of age or with penetrating trauma were excluded. We collected demographic data, injury grading (Injury Severity Score [ISS], Abbreviated Injury Scale [AIS]), and patient outcomes, comparing those with isolated pelvic fractures (IPF) to those with concomitant pelvic and TL fractures (PTLF).</div></div><div><h3>Results</h3><div>Of the 37,987 patients with PF, 32.4 % (n = 12,318) had concomitant TL fractures. PTLF patients were older (mean age 44.12 vs. 40.12 years, p &lt; 0.001) and exhibited higher ISS and AIS scores compared to IPF patients. The PTLF group had longer hospital stays (14.51 days vs. 9.4 days, p &lt; 0.001) and higher rates of ICU admission (41.4 % vs. 24.0 %, p &lt; 0.001) and mortality (9.5 % vs. 4.3 %, p &lt; 0.001). PTLF patients were less likely to be discharged home (29.5 % vs. 43.5 %, p &lt; 0.001) and more likely to be transferred to rehabilitation or long-term care facilities. Motor vehicle collisions were the most common mechanism of injury, but auto-pedestrian accidents were more frequent in the PTLF group (17.3 % vs. 11.1 %, p &lt; 0.001). Lumbar spine fractures accounted for 70.2 % of TL injuries.</div></div><div><h3>Conclusion</h3><div>Pelvic fractures from high-impact trauma are strongly associated with concomitant TL fractures, which lead to worse clinical outcomes. Routine TL spine screening in these patients is recommended to ensure timely diagnosis and treatment</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112050"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the impact of perioperative anticoagulant continuation on DVT/PE rates in trauma patients","authors":"Armarion Stegall,&nbsp;J. Tracy Watson,&nbsp;Heidi Israel","doi":"10.1016/j.injury.2025.112143","DOIUrl":"10.1016/j.injury.2025.112143","url":null,"abstract":"<div><h3>Introduction</h3><div>In the United States, deep vein thrombosis (DVT) and pulmonary embolism (PE) ranked high in terms of possibly preventable hospital deaths. Victims of trauma were at a higher risk of developing thromboembolic complications, and thus various agents were used for prophylaxis. Multiple studies recommended holding these agents in the perioperative period to decrease the potential complications of additional bleeding, wound issues, hematoma etc. However, the data regarding the timing and duration of withholding these agents was not consistent and at times surgeon specific. The aim of this study was to compare the incidence of DVT/PE in trauma patients before and after a June 2022 policy intervention to operate through prophylactic anticoagulation at an academic trauma center.</div></div><div><h3>Methods</h3><div>We compared DVT/PE rates in trauma patients requiring surgery prior to and following policy change at our institution. The query included charts from January 1, 2018, through December 31, 2023. Clinical information relating to trauma date, surgery date, injury type, anticoagulant administration, DVT/PE development, and death, if applicable, was obtained from patient charts. We conducted a chi-square post hoc analysis to evaluate the incidence of DVT or PE before and after a policy change. The analysis focused on two categories: the presence or absence of DVT/PE.</div></div><div><h3>Results</h3><div>DVT/PE development was 14.553 times more likely pre-policy change when anticoagulation was held prior to surgery compared to post-policy change when anticoagulation was administered before surgery (X² (3, N = 374) =14.553, <em>p</em>=.002). Mortality related to DVT/PE showed no significant difference between pre-policy and post-policy groups (X² (1, N = 374) = 0.130, <em>p</em> = .718). After excluding patients over age 65, analysis of MVA blunt trauma charts showed no statistical difference in blood transfusions pre policy v. post policy (X² (1, N = 174) = 0.2198, <em>p</em> = .639).</div></div><div><h3>Conclusion</h3><div>Findings suggested that DVT/PE rates have significantly decreased post policy change without a significant increase in mortality and bleeding risk.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 2","pages":"Article 112143"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}