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

{"title":"Acute Haemophilus influenzae infection complicating a closed humeral shaft fracture in a pregnant young female: A case report","authors":"Arjun Malhotra ,&nbsp;Brent Norris","doi":"10.1016/j.injury.2025.112684","DOIUrl":"10.1016/j.injury.2025.112684","url":null,"abstract":"<div><h3>Background</h3><div>Humeral shaft fractures are common in young adults following high-energy trauma. While open fractures often result in infections, infections in closed fractures are rare, making such cases particularly challenging to manage when they occur.</div></div><div><h3>Case Presentation</h3><div>We report a unique case of a 25-year-old pregnant female who sustained a closed humeral shaft fracture after a high-energy injury. Although there was no initial open wound, a purulent infection was discovered at the fracture site during surgery a few days after the injury. Cultures identified <em>Haemophilus influenzae</em> as the causative organism. This report details the management of the fracture and associated infection, highlighting the diagnostic challenges and therapeutic steps taken to address this acute osteomyelitis-like infection in a closed fracture.</div></div><div><h3>Discussion</h3><div>This case represents the first documented instance of an acute <em>Haemophilus influenzae</em> infection in a closed adult humeral fracture, a pathogen traditionally associated with pediatric respiratory infections. Contributing factors may have included the patient’s complex medical and social background, including pregnancy, polysubstance abuse, homelessness, and the use of immunomodulatory medications. This case highlights the importance of heightened vigilance, the need for modifications in surgical decision-making, and possibly revised empirical antibiotic protocols in the management of closed fractures in immunocompromised patients.</div></div><div><h3>Conclusion</h3><div>Acute infections in closed humeral fractures, though rare, pose significant diagnostic and therapeutic challenges, particularly in immunocompromised individuals. This case prompts a reconsideration of management strategies in similar contexts, advocating for a broad differential diagnosis and tailored antimicrobial strategies to address atypical pathogens in complex clinical scenarios.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 10","pages":"Article 112684"},"PeriodicalIF":2.0,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144890371","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":"Should displaced tibial eminence fractures in adults be treated with arthroscopic reduction (ARIF) or an open reduction (ORIF)?","authors":"C Ryan Martin ,&nbsp;Philippe Beauchamp-Chalifour ,&nbsp;Richard Buckley","doi":"10.1016/j.injury.2025.112681","DOIUrl":"10.1016/j.injury.2025.112681","url":null,"abstract":"","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 10","pages":"Article 112681"},"PeriodicalIF":2.0,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144878873","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 severity of sacral dysmorphism and implications for safe transsacral screw placement in the Indigenous and non-Indigenous Australian population: A retrospective matched cohort study","authors":"James Virgin ,&nbsp;Claudia Paul ,&nbsp;Tim Cheok ,&nbsp;Kanishka Williams ,&nbsp;Mark Rickman ,&nbsp;Lucian Bogdan Solomon ,&nbsp;Boopalan Ramasamy","doi":"10.1016/j.injury.2025.112667","DOIUrl":"10.1016/j.injury.2025.112667","url":null,"abstract":"<div><h3>Objective</h3><div>To compare prevalence and severity of sacral dysmorphism in Indigenous and non-Indigenous Australian populations.</div></div><div><h3>Methods</h3><div>We performed a single centre retrospective matched cohort study in consecutive Indigenous and non-Indigenous Australian patients who received a CT scan of the pelvis between January and March 2024 at our institution. Patients were excluded if they were under the age of 18 at the time of the scan or had a history of pelvic fractures or fixation. CT scans were assessed for both qualitative and quantitative features of sacral dysmorphism. The primary outcome of interest was the prevalence and severity of sacral dysmorphism in Indigenous and non-Indigenous Australian populations.</div></div><div><h3>Results</h3><div>120 patients were included in the study - 60 Indigenous and 60 non-Indigenous Australians. All patients exhibited at least one characteristic of sacral dysmorphism. There was no difference in the prevalence of qualitative sacral dysmorphism between the two groups. Compared to their non-Indigenous counterpart, Indigenous patients demonstrated a lower S1 transsacral corridor coronal diameter (20.50 vs. 21.85 mm, <em>p</em> = 0.005), S1 oblique corridor axial diameter (17.90 vs. 19.60 mm, <em>p</em> = 0.028), S1 pelvic width (144.85 vs. 158.70 mm, <em>p</em> &lt; 0.001), S2 transsacral corridor coronal diameter (13.70 vs. 14.95 mm, <em>p</em> = 0.013), S2 transsacral corridor axial diameter (10.60 vs. 11.55 mm, <em>p</em> = 0.013), and S2 pelvic width (126.60 vs 136.00 mm, <em>p</em> &lt; 0.001). Additionally, in Indigenous patients, S1 and S2 transsacral and oblique S1 iliosacral fixation lengths were shorter. Where an S1 trans-sacral osseous corridor was not present, the S2 corridor was significantly larger in coronal, axial measurements across both groups (<em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Indigenous Australian patients exhibited more severe forms of sacral dysmorphism when compared to their non-Indigenous counterparts. Additionally the overall prevalence of sacral dysmorphism across this Australian population was amongst the highest reported in the literature. This may present significant technical challenges and warrants consideration when performing percutaneous iliosacral screw fixation.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 10","pages":"Article 112667"},"PeriodicalIF":2.0,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144887574","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":"Articular involvement impacts unplanned reoperation rates in floating knee injuries","authors":"Sarah Kurkowski ,&nbsp;Sean Catlett ,&nbsp;Samuel Gerak ,&nbsp;Andres Mor Huertas ,&nbsp;Michael Beltran","doi":"10.1016/j.injury.2025.112679","DOIUrl":"10.1016/j.injury.2025.112679","url":null,"abstract":"<div><h3>Objectives</h3><div>To compare the rate of unplanned reoperation to address fracture-related complications between extraarticular floating knee fracture patterns and those involving the articular surface of the knee, and to assess the impact of concomitant patella fracture on outcomes.</div></div><div><h3>Methods</h3><div><em>Design</em>: Retrospective study of patients with a floating knee injury treated at a single level 1 trauma center from 2012-2022.</div><div><em>Setting</em>: Single, urban, level 1 trauma center.</div><div><em>Patient selection criteria</em>: Patients ≥18 years old with a floating knee injury treated at a single urban level 1 trauma center from 2012-2022, with at least 3 months of followup.</div><div><em>Outcome measures and comparisons</em>: The primary outcome measure was the rate of unplanned reoperation to treat infection, obtain union, or surgically address knee stiffness.</div></div><div><h3>Results</h3><div>Reoperation to address fracture-related complications was high in both extra and intraarticular floating knee patterns, with a trend toward more surgery to address knee stiffness in those with articular involvement (p = 0.078). Concomitant patella fracture and open fracture were present in 12 and 46 of the 64 patients, respectively; the presence of open fracture was significantly associated with reoperation to address either nonunion or infection (p &lt; 0.001). An associated patella fracture was significantly associated with requiring surgery to address knee stiffness (p = 0.009).</div></div><div><h3>Conclusions</h3><div>Floating knee injuries with at least one articular fracture, especially when the patella is involved, had higher rates of surgery for knee stiffness. Intraarticular floating knee injuries are challenging, often requiring reoperation for infection, nonunion, or stiffness. Surgeons should be proactive with early motion protocols, supervised therapy, and tools like continuous passive motion to reduce knee stiffness risk.</div></div><div><h3>Level of evidence</h3><div>III</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 10","pages":"Article 112679"},"PeriodicalIF":2.0,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144841393","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":"Can we improve early readmission after hip fracture of the adult? A retrospective analysis of 57.544 patients from SNHFR","authors":"G. Gálvez Márquez ,&nbsp;A. Muñoz Pascual ,&nbsp;C. Ojeda Thies ,&nbsp;G. García Cruz ,&nbsp;M.P. Sáez López ,&nbsp;J Cordero Ampuero","doi":"10.1016/j.injury.2025.112680","DOIUrl":"10.1016/j.injury.2025.112680","url":null,"abstract":"<div><div>Hip fractures in the older persons are associated with high morbidity and mortality rates, with a growing incidence due to an aging population. Early readmission increases dependence and healthcare costs, and identifying the factors associated with readmission could improve care. This study aims to identify factors associated with 30-day readmission following hip fracture in patients aged 75 and older, as well as to explore the relationship between various clinical variables.</div><div>A multicentric, retrospective observational study was conducted using data from the National Hip Fracture Registry (NHFR) involving 57,544 patients admitted from January 1, 2017, to December 31, 2022. Patients were excluded if they had died during acute hospitalization or were lost to follow-up. Key demographic, clinical, and surgical variables were collected and analysed. Statistical analyses were performed using RStudio, employing both univariate and multivariate regression models to identify predictors of 30-day readmission.</div><div>The study revealed a 30-day readmission rate of 5.18 %. Factors significantly protective against readmission included female gender (OR 0.84 p &lt; 0.001), intertrochanteric (OR 0.81 p &lt; 0.008) and subtrochanteric (OR 0.74 p &lt; 0.007) fracture type, neuraxial anaesthesia (OR 0.82 p &lt; 0.015), and increased length of stay (OR 0.98 p &lt; 0.001). Conversely, ASA IV (OR 1.93 p &lt; 0.05), ASA V (OR 5.59 p &lt; 0.05) and discharge to residential care were associated with increased readmission risk. Notably, patients discharged home showed a reduced risk of readmission compared to those transferred to other care facilities such as residential care (OR 1.26 p &lt; 0.001), acute hospitalization (OR 35.46 p &lt; 0.001) and long-term care hospital(OR 2.36 p &lt; 0.001).</div><div>The readmission rate observed was lower than the reported by comparable registries. Identifying patients at high risk of early readmission following hip fracture is critical for enhancing patient care, and specific variables can serve as effective predictors, enabling targeted interventions to reduce readmission rates.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 10","pages":"Article 112680"},"PeriodicalIF":2.0,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144887543","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":"Epidemiology of board-related incidents in the Portuguese National Maritime Authority’s Jurisdiction (2020-2023): a cross-sectional study","authors":"Matilde Ourique ,&nbsp;Tatiana Alves ,&nbsp;Carlos Aniceto ,&nbsp;Carlos Matias Dias ,&nbsp;Pedro Marques Mendes ,&nbsp;João Ferraz Fernandes ,&nbsp;Diana Martins Correia ,&nbsp;Vânia Gaio","doi":"10.1016/j.injury.2025.112656","DOIUrl":"10.1016/j.injury.2025.112656","url":null,"abstract":"<div><h3>Background</h3><div>Portugal’s favourable conditions for water-based recreational activities (WRA) often lead to incidents requiring intervention by the National Maritime Authority (AMN). Despite being documented in the SEGMAR database, participant profiles and severity factors, particularly for water-board-related incidents (BRIs), remain underexplored. This study aims to profile individuals involved in BRIs, identify determinants of severe incidents, and examine key clusters within the AMN's jurisdiction from 2020 to 2023.</div></div><div><h3>Methods</h3><div>A cross-sectional observational study analysed 14,456 WRA incidents from the SEGMAR database. BRIs included activities involving water-boards (e.g., surfing, bodyboarding, kitesurfing) and collisions with water-boards. Severe BRIs were defined as incidents causing injuries, fatalities, or disappearances. Sociodemographic, temporal, and spatial factors were analysed using descriptive analysis and Quasi-Poisson regression to estimate frequency ratios (FR). Cluster analysis identified at-risk groups, and the severe to non-severe BRIs ratio was mapped by captaincy and municipality. Statistical significance was set at p&lt;0.05.</div></div><div><h3>Results</h3><div>BRIs made up 11.9% of all incidents, occurring more often among men, individuals aged 15–55, and foreigners, especially outside the bathing season and in unsupervised areas (p&lt;0.001). Severe BRIs were linked to winter (FR 1.92; 95% CI 1.15–3.19), nighttime (FR 2.0; 95% CI 1.6–2.6), dawn (FR 1.6; 95% CI 1.3–2.0), and the bathing season (FR 1.9; 95% CI 1.3–2.7). Clusters revealed at-risk groups: children under 14 at patrolled beaches in summer evenings, men over 55 at unpatrolled areas in autumn, and young females at unpatrolled beaches in winter. Seven captaincies and 20 municipalities had a severe to non-severe BRIs ratio above 1.</div></div><div><h3>Conclusion</h3><div>BRIs predominantly affect men, young adults, and foreigners. Key risk factors include extreme ages, non-summer seasons, unsupervised areas, and low-light conditions. Targeted interventions, such as adjusting lifeguard schedules to cover high-risk times, promoting safety campaigns for children and older adults, and reinforcing safety infrastructure at unpatrolled beaches, might be important to mitigate risks and reduce incident severity.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 10","pages":"Article 112656"},"PeriodicalIF":2.0,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144831143","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":"Train-related injuries in a developing country setting: Epidemiology and management","authors":"Arvin Khamajeet,&nbsp;Ahmed Diab,&nbsp;Paresh Keshaw,&nbsp;Sanju Sobnach,&nbsp;Andrew Nicol,&nbsp;Pradeep Navsaria","doi":"10.1016/j.injury.2025.112659","DOIUrl":"10.1016/j.injury.2025.112659","url":null,"abstract":"<div><div>Train-related injuries represent a significant yet underreported public health challenge in developing countries, particularly in sub-Saharan Africa, where contemporary data are scarce. This study characterizes the epidemiology, clinical presentation, and outcomes of train-related trauma at a South African Level I trauma center, with a focus on identifying predictors of severe outcomes and informing context-specific interventions for this high-risk population.</div></div><div><h3>Method</h3><div>A retrospective analysis was conducted on 63 patients presenting to Groote Schuur Hospital between April 2008 and June 2013. Data collected included demographics, injury mechanisms, clinical findings, and outcomes. Multivariable logistic regression was performed to evaluate the association between key severity markers (GCS ≤8, hypotension, mangled extremities) and ICU admission.</div></div><div><h3>Results</h3><div>The cohort was predominantly male (96.8 %) with a median age of 26 years (IQR: 22–33). Injuries clustered during winter months (April–October), with 62 % occurring between 4:00 PM and midnight. The most common mechanisms were boarding or alighting from moving trains (46.2 %) and interpersonal assault (33.3 %). Lacerations were the most frequent soft tissue injury (69.8 %), while lower (25.4 %) and upper limb (22.2 %) fractures were the predominant orthopedic injuries. The amputation rate was 20.6 %, strongly associated with mangled extremities. Median hospital stay was 6 days (IQR: 1–17), extending significantly for patients with spinal trauma. Severe traumatic brain injury (GCS ≤8) was independently associated with ICU admission (adjusted OR 15.0; 95 % CI: 2.7–82.4; <em>p</em> &lt; 0.001). Mangled extremities and hypotension were not significantly associated with ICU requirement.</div></div><div><h3>Conclusion</h3><div>Young male commuters are more likely to sustain severe, preventable train-related injuries. Significant musculoskeletal trauma, head, and spinal injuries increased hospital stay, underscoring the need for comprehensive assessment to reduce morbidity and improve outcomes. Our findings support protocolized neurosurgical and orthopaedic triage and targeted prevention strategies in resource-limited settings.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 10","pages":"Article 112659"},"PeriodicalIF":2.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144895004","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":"Management and outcomes of open pelvic injury -a retrospective analysis of 30 patients","authors":"Harish Mahesan ,&nbsp;Ramesh Perumal ,&nbsp;Nagashree Vasudeva ,&nbsp;Devendra Agraharam ,&nbsp;Dheenadayalan Jayaramaraju ,&nbsp;Rajesekaran Shanmuganathan","doi":"10.1016/j.injury.2025.112658","DOIUrl":"10.1016/j.injury.2025.112658","url":null,"abstract":"<div><h3>Introduction</h3><div>Open pelvic fractures, though rare, are associated with high morbidity and mortality due to severe soft tissue damage, hemorrhage, and associated injuries. This retrospective study aimed to assess injury patterns, management strategies, complications, and outcomes of open pelvic fractures at a Level 1 trauma center</div></div><div><h3>Materials and Methods</h3><div>A retrospective analysis of 30 patients with open pelvic fractures treated between 2014 and 2021 was conducted. Data included demographics, injury mechanism, fracture pattern (Jones-Powell classification), soft tissue injury (Faringer classification), hemodynamic status, transfusion requirements, associated injuries, surgical interventions, and functional outcomes (Merle de Au Binge score)</div></div><div><h3>Results</h3><div>The mean age was 35.7 years, with a male predominance (28 males, 2 females). Road traffic accidents were the most common injury mechanism. Most patients (<em>n</em> = 28) sustained multiple injuries. Fracture patterns were: Class 1 (<em>n</em> = 2), Class 2 (<em>n</em> = 7), and Class 3 (<em>n</em> = 21). Faringer classification revealed 22 Zone 1, 4 Zone 2, and 4 Zone 3 injuries. The mean transfusion requirement was 5.63 units within 24 h. Emergency external fixation was performed in 15 patients. Definitive fixation (internal or external) was performed at a mean of 11.27 days post-injury. Complications included urinary incontinence (<em>n</em> = 5), rectal incontinence (<em>n</em> = 2), and infections. The mortality rate was 20 % (<em>n</em> = 6). Functional outcomes showed 3 excellent, 8 good, 8 fair, and 5 poor results</div></div><div><h3>Conclusion</h3><div>Open pelvic fractures are complex injuries requiring multidisciplinary management. Early haemorrhage control, aggressive soft tissue management, and appropriate fracture stabilization are crucial for improving outcomes. Delayed internal fixation after thorough debridement and soft tissue healing may reduce infection risk. High transfusion requirements and unstable fractures were associated with increased mortality. <strong>Level of Evidence:</strong> III.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 10","pages":"Article 112658"},"PeriodicalIF":2.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144878840","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":"Severity of mountain accidents in Catalonia over the period 2011 to 2021: An ordinal regression analysis","authors":"Albert Martínez ,&nbsp;Angel Blanch ,&nbsp;Carles Comas","doi":"10.1016/j.injury.2025.112672","DOIUrl":"10.1016/j.injury.2025.112672","url":null,"abstract":"<div><div>Mountain accidents have increased over the last decade all around the globe mostly due to a raise of mountain activity practitioners. Outcomes of accidents usually imply evacuation, traumatic injuries or even cardiovascular events. Sex, age, activity, altitude, experience, and equipment adequacy relate to accidents as direct causes or moderators of accident severity. This study focuses on the mountain accidents in Catalonia with descriptive and ordinal regression analysis aiming to characterize a victim vulnerability profile, which remains largely unexplored. The current sample includes 3257 mountain rescue operations from the Catalan Fire Department records between 2011 and 2021. Descriptive analysis showed that the most common profile was being hiker (63 %), climber (11.6 %), mountain biker (10.2 %), man (60.3 %), going in group (84.3 %), occurring in weekends (53.7 %), and suffering traumatic events (61.4 %) or needing technical support (20.4 %). Moreover, the main causes of fatality were falls and cardiovascular issues with the latter showing the higher fatality rate (55.5 %). Ordinal regression analysis explained a modest amount of variance (Nagelkerke R² = 0.12), suggesting that predictors of higher severity were Group, Altitude, Male, Gathering, Mountain Biking and other practices such as Hunting. Recommendation to rescue teams comprise standardizing and potentiate data collection, conducting awareness campaigns targeted mainly to hikers, mountain bikers and elderly men, and to reinforce awareness campaigns and rescue teams during weekends.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 10","pages":"Article 112672"},"PeriodicalIF":2.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144831141","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":"How mode of evacuation, roadway environment, and traffic conditions relate to injury severity score? Untangling the role of pre-hospital time in road crashes","authors":"Zia-ur- Rehman ,&nbsp;Numan Ahmad ,&nbsp;Afzal Ahmed ,&nbsp;Syed Kamran Hussain Shah ,&nbsp;Dr.Izza Anwer","doi":"10.1016/j.injury.2025.112668","DOIUrl":"10.1016/j.injury.2025.112668","url":null,"abstract":"<div><div>This study explores the effects of some of the key factors, including emergency response measures, roadway and environment, traffic-related attributes, and crash-specific factors, on the Injury Severity Score (ISS) of Road Traffic Crashes’ (RTCs) victims, both directly and through pre-hospital time (PHT), using rigorous path analysis. Data for 298,654 crashes, compiled by the Road Traffic Injury Research and Prevention Center (RTIRPC) in Karachi (Pakistan), were used for analyses. Owing to the corner-solution distribution of the response variables (PHT and ISS), two Tobit regression models are estimated after accounting for missing values through synthetic data generation. Marginal effects from these models are used in the path analysis. The findings suggest that ISS increases by 0.01 units with a unit increase in PHT, highlighting the critical need for rapid evacuation of crash victims to medical facilities. The mode of evacuation emerged as a crucial factor, with ambulances resulting in increased PHT and ISS compared to private or public transport, underscoring the improvement needed in the dedicated ambulance-based emergency response. PHT and ISS were found to be higher in nighttime crashes, necessitating better emergency medical services (EMS) response during the night. Intersection crashes were associated with lower PHT and ISS; whereas, crashes on undivided roads and those involving multiple or large vehicles increased PHT and ISS. The path analysis revealed that the overall effects of some of the key variables on ISS were higher than their direct effects – something that could not be explored without the path analysis. These insights can help policymakers develop strategies to improve emergency response and road safety, ultimately reducing the number of RTC-related injuries and fatalities.</div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"56 10","pages":"Article 112668"},"PeriodicalIF":2.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144831142","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}