Injury最新文献

{"title":"Minimally invasive total thoracoscopic fixation versus open fixation for multiple Rib fractures: Systematic review and meta-analysis of clinical outcomes.","authors":"Abdullah Altamimi, Imran Musawa, Mohammed A Alshahrani, Majed Atiah Alghamdi, Sultan M Almugharrid, Taha Osama Alsayed, Fahad Alansari, Ali Eissa ALHarthi, Abdulrahman Almahmoud, Abdulrahman Aljunidi, Amer Abdul Hadi Tajo, Norah Abdullah Alodhaib","doi":"10.1016/j.injury.2026.113336","DOIUrl":"https://doi.org/10.1016/j.injury.2026.113336","url":null,"abstract":"<p><strong>Background: </strong>Multiple rib fractures cause substantial morbidity through severe pain, impaired ventilation, and pulmonary complications. While open rib fixation is well established, thoracoscopic fixation may reduce soft-tissue trauma and enhance recovery, but comparative evidence remains unclear. This systematic review and meta-analysis aimed to compare thoracoscopic versus open fixation for multiple rib fractures in terms of effectiveness and safety outcomes.</p><p><strong>Methods: </strong>We conducted a systematic literature search across PubMed, Scopus and Web of Science to retrieve comparative studies comparing thoracoscopic fixation versus traditional open fixation for multiple rib fractures regarding pain, perioperative outcomes and safety outcomes. Risk of bias of included studies was assessed using the ROBINS-I tool. A meta-analysis was conducted using a random-effects model in R (version 4.5.0).</p><p><strong>Results: </strong>Nine comparative studies were identified (total participants = 751). Meta-analysis revealed that thoracoscopic fixation was associated with improved postoperative pain compared with open fixation. Pain was significantly lower with thoracoscopy on postoperative day (POD) 1 (SMD= -1.12, 95% CI -1.64 to -0.61) and POD7 (SMD= -1.90, 95% CI -3.08 to -0.73), while POD3 was not significant (SMD= -1.49, 95% CI -3.52-0.54). Thoracoscopy reduced incision length (MD= -4.19 cm) and blood loss (MD= -18.56 mL) and shortened hospital stay (MD= -2.05 days), with no difference in operative time (MD= 9.66 min). Pleural effusion was less frequent (OR 0.32, 95% CI 0.10-1.00) on thoracoscopic fixation.</p><p><strong>Conclusion: </strong>There may be clinically significant benefits of thoracoscopic rib fixation over open fixation for multiple rib fractures. These benefits may include less early postoperative pain, smaller incisions, less blood loss, shorter hospital stays, and no increase in operative time. Overall complication rates were similar, but thoracoscopic fixation was associated with fewer pleural effusions. Due to significant heterogeneity and the predominance of observational studies, there is a need for more rigorous prospective trials.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":"57 7","pages":"113336"},"PeriodicalIF":2.0,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"All-terrain vehicle related urethral injuries: An evaluation of the National Trauma Database.","authors":"Alexandria Hertz, Maia VanDyke, Steven Hudak","doi":"10.1016/j.injury.2026.113294","DOIUrl":"https://doi.org/10.1016/j.injury.2026.113294","url":null,"abstract":"<p><strong>Background: </strong>U.S. Consumer Product Safety Commission reported that from 2018 to 2020 there were 94,700 off-highway vehicle accidents with 92% of those injuries related to all-terrain vehicles (ATV). An estimated 300 deaths were in children less than age 16. There has not been any previous evaluation of urethral injuries resulting from ATV accidents. We sought to define the volume and demographics of ATV-related urethral injuries.</p><p><strong>Methods: </strong>Data was obtained from the National Trauma Database (NTDB) Trauma Quality Program over a 7-year period (2016-2022). ICD-10 codes were used to identify patients who sustained urethral injury in ATV-related accidents. Injury and patient related demographic data was reviewed. R: A Language and Environment for Statistical Computing was used for data review and statistical analysis. Data were presented and analyzed using standard statistical methods RESULTS: During this time frame, there was a total of 7679,101 injuries recorded in the NTDB. There was a total of 7398 urethral injuries (0.1%), with 181 (2.5%) of those being related to ATV-accidents. 90.6% of patients were male, and there was a median age of 30 (range 5-76, IQR 29). The median injury severity score (ISS) was 17 (range 4-50, IQR 15). There was no association between age and higher ISS (r = 0.07, p = 0.36). Passengers were more likely to be less than age 16 (p = 0.001). Interestingly, 17% (26/153) of drivers were less than age 16. Non-traffic ATV accidents were associated with higher ISS (medians 21.5 versus 17, p = 0.003).</p><p><strong>Conclusions: </strong>Urethral injuries are uncommon, however over 2% of these are related to ATV accidents alone. A high proportion of these injuries are severe, involving young patients, speaking to significant potential long-term morbidity.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"113294"},"PeriodicalIF":2.0,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147825109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges and learning curve in adopting resuscitative endovascular balloon occlusion of the aorta for trauma patients: A retrospective multicenter study.","authors":"Kyounghwan Kim, Byung Hee Kang, Dong Hun Kim, Byungchul Yu, Sung Wook Chang, Pil Young Jung, Yoonjung Heo, Wu Seong Kang","doi":"10.1016/j.injury.2026.113304","DOIUrl":"https://doi.org/10.1016/j.injury.2026.113304","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to assess the learning curve of REBOA from the first case in trauma centers using cumulative sum (CUSUM) analysis.</p><p><strong>Materials and methods: </strong>This study enrolled consecutive trauma patients who visited five trauma centers from December 2015 to December 2021. To monitor the effectiveness of REBOA, we performed risk-adjusted cumulative sum (RA-CUSUM) analysis for mortality due to exsanguination. For individual risk adjustment, we implemented the least absolute shrinkage and selection operator (LASSO) logistic regression model. We then calculated the CUSUM for: (1) the time from common femoral artery (CFA) access to confirmation of REBOA placement (RP-CUSUM), (2) the total occlusion time (OT-CUSUM), (3) door-to-balloon time (DB-CUSUM), and (4) the time from injury to admission (IA-CUSUM). To determine whether observed deviations were statistically significant, a V-mask was superimposed on the CUSUM curve.</p><p><strong>Results: </strong>A total of 251 patients were enrolled. The overall mortality rate was 67.7% (170/251), and the mortality rate due to exsanguination was 49.0% (123/251). The RA-CUSUM model was developed using a LASSO logistic regression approach. In three hospitals, the RA-CUSUM showed an improvement after 5-34 procedures. However, the RA-CUSUM showed fluctuations with deterioration in the other two hospitals. The RA-CUSUM fluctuations exceeded the V-mask control limits. RA-CUSUM charts for five hospitals deviated beyond the V-mask boundaries, indicating that the processes were out of control. Other CUSUM charts-such as RP-, OT-, DB-, and IA-CUSUM-exhibited fluctuations limited within V-mask boundaries, which suggests no significant change.</p><p><strong>Conclusion: </strong>CUSUM analysis demonstrated that a reduction in risk-adjusted mortality may be achieved with experience. Nevertheless, trauma surgeons should exercise caution due to a potential decline in the performance of REBOA, particularly the rate of mortality due to exsanguination.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"113304"},"PeriodicalIF":2.0,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency medical services response times to motor vehicle crashes increased in the USA over the period 1987-2020.","authors":"Sacha Dubois, Patrick Gravelle, David W Savage, Hillary Maxwell, Michel Bédard","doi":"10.1016/j.injury.2026.113300","DOIUrl":"https://doi.org/10.1016/j.injury.2026.113300","url":null,"abstract":"<p><strong>Introduction: </strong>The timing of Emergency Medical Services (EMS) notification, crash scene arrival, and hospital arrival may impact motor vehicle fatalities. We examined EMS response time intervals over the past three decades, considering the effects of weather, vehicles involved, time of day, and location.</p><p><strong>Methods: </strong>We used the Fatal Accident Reporting System to compute and describe annual (1987-2020) EMS response time intervals. This included total time (i.e., crash-to-hospital), as well as the intervals between four key timepoints: crash, crash notification, crash scene arrival, and hospital arrival. We examined the proportion of fatal crashes with total intervals under 60 min (i.e., the \"golden hour\"), and where the crash arrival-to-hospital interval was under 30 min (the \"beneficial timeframe\"). Additionally, analyses were stratified by crash factors including weather (poor/clear) number of vehicles involved (single/multiple), time of day (early morning/rest of the day), and location (urban/rural).</p><p><strong>Results: </strong>A total of 310,001 fatal crashes were analyzed. Between 1987-1994 total median response times ranged between 40 and 42 min. By 1999, intervals had increased to 45 min; elevated intervals were evident through 2009. By 2020, observed intervals had returned to 41 min. Paralleling this pattern, crashes with \"golden hour\" intervals decreased from 77.0% in 1987 to 72.4% in 2009 and increased to 78.0% by 2020. Similarly, crashes with a \"beneficial timeframe\" decreased from 60% in 1987 to 52% in 2009 and increased to 56.0% by 2020. The largest discrepancies for crash strata were evident for location: rural crash total response time intervals were 15-23 min longer than urban.</p><p><strong>Conclusions: </strong>From 1987-2020, the total time response interval following a fatal crash remained relatively stable. However, steady increases in intervals between crash notification and both crash scene and hospital arrival are evident.</p><p><strong>Practical applications: </strong>Future research should focus on approaches to reduce response time intervals.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"113300"},"PeriodicalIF":2.0,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147825068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between social vulnerability, urbanicity, and post-injury outcomes following nonfatal motor vehicle crashes.","authors":"Marissa K Grossman, Anthony J Rink, Lisa D Foley, Rachel L Ott","doi":"10.1016/j.injury.2026.113303","DOIUrl":"https://doi.org/10.1016/j.injury.2026.113303","url":null,"abstract":"<p><strong>Background: </strong>Motor vehicle crashes (MVCs) are a leading cause of injury and death in the United States. Community-level factors, such as social vulnerability and urbanicity, have been associated with risk of death; less is known about how these factors impact nonfatal, post-injury outcomes. This study examined the association between social vulnerability and urbanicity with hospital length of stay (LOS) and hospital discharge disposition among MVC patients.</p><p><strong>Methods: </strong>Patients aged 18 years and older who were admitted to a Montana regional trauma center with a non-fatal injury following an MVC from 2016 to 2024 were included in the study. The CDC Social Vulnerability Index (SVI) was used to quantify social vulnerability at the census tract level and scores were divided into tertiles representing low, medium, and high vulnerability. Urbanicity was defined using RUCA codes based on patient residence. Generalized estimating equations with a binomial distribution were used to estimate the joint association between SVI and urbanicity with discharge disposition (home vs. facility) and prolonged LOS (≥7 days), controlling for injury severity, patient demographics, and comorbidities.</p><p><strong>Results: </strong>Of the 668 patients, 529 (79%) were discharged home and 179 (27%) had a prolonged LOS. Among metropolitan patients, higher SVI rankings were associated with increased odds of discharge home; patients with medium and high SVI had respectively 2.6 and over 3 times greater odds of being discharged home than low SVI (medium aOR: 2.64; 95% CI: 1.96, 3.57; high aOR: 3.26; 95% CI: 2.52, 4.23). This association was not observed for non-metropolitan patients; however, patients from non-metropolitan had 2 times the odds of a prolonged LOS than those from metropolitan areas regardless of SVI (aOR: 2.03; 95% CI: 1.38, 2.98).</p><p><strong>Conclusion: </strong>The association between social vulnerability and discharge disposition following a MVC differed by urbanicity, and urbanicity was also associated with prolonged LOS. Further research to better understand how sociodemographic factors impact nonfatal injury outcomes can help reduce disparities in care.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"113303"},"PeriodicalIF":2.0,"publicationDate":"2026-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interhospital variation in highest-level trauma activation and its association with mortality: A 37-center cohort study of level I and II trauma centers in the US.","authors":"Alessandro Orlando, Harun Mazumder, Stefan Leichtle, Michaela A West, Bellal Joseph, Haytham Kaafarani, John P Hunt, Yan Shen, Samir M Fakhry","doi":"10.1016/j.injury.2026.113295","DOIUrl":"https://doi.org/10.1016/j.injury.2026.113295","url":null,"abstract":"<p><strong>Background: </strong>Trauma team activation protocols are critical for mobilizing resources in the care of severely injured patients. In the US, the American College of Surgeons (ACS) specifies minimum criteria for the highest-level (full) trauma activation (fTA), but hospitals retain discretion to add criteria, potentially leading to variability in activation practices and resource utilization. The extent of this variation and its impact on patient outcomes is unknown. The aim of this study was to quantify inter-hospital variability in fTA use and its relationship to mortality.</p><p><strong>Methods: </strong>We conducted a multicenter, retrospective cohort study of adult trauma patients treated at 37 Level I and II trauma centers across the United States from 2017 to 2019; transfers were excluded. Mixed-effects logistic regression models were used to quantify inter-hospital variability in fTA utilization and total mortality (death+hospice), adjusting for 12 patient and hospital-level characteristics. Correlation analyses assessed the relationship between adjusted hospital-specific fTA rates and adjusted total mortality.</p><p><strong>Results: </strong>Overall, 158,696 patients were included, with 34,374 (21.7%) receiving a fTA. The median age was 53 yrs, with 59% male, 71% White, 88% blunt, and a median Injury Severity Score of 9. Use of fTA varied widely (3.3% to 54.1%, median [IQR]=19.3% [13.6-27.3%]) and the adjusted odds of fTA varied significantly across hospitals (SD=0.88; coefficient of variation [CV]=0.53), with 83.7% of hospitals differing significantly from the average hospital. In contrast, adjusted odds of total mortality showed lower inter-hospital variation (SD=0.31; CV=0.22), with 35% of hospitals differing significantly from the average hospital. Overall, no statistically significant correlation was found between adjusted hospital-level fTA rates and total mortality (r = 0.07, b=0.01, p = 0.69). Age-stratified sensitivity analyses also confirmed substantially greater inter-hospital variability in fTA rates compared to mortality rates.</p><p><strong>Conclusions: </strong>Substantial variation in fTA utilization exists across this sample of U.S. trauma centers. Importantly, higher fTA rates were not associated with improved mortality outcomes. These findings suggest that discretionary activation practices may lead to inconsistent resource utilization without measurable benefit on total mortality. Standardized evidence-based criteria for fTA may improve resource stewardship and trauma system efficiency.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"113295"},"PeriodicalIF":2.0,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrated surgical management of forequarter lateral implosion injury: Technical considerations and early outcomes.","authors":"Shaun Kai Kiat Chua, Sunder Balasubramaniam, Peter A Cole, Bryan Yijia Tan","doi":"10.1016/j.injury.2026.113292","DOIUrl":"https://doi.org/10.1016/j.injury.2026.113292","url":null,"abstract":"<p><p>Concomitant ipsilateral fractures of the clavicle, scapula, and ribs, termed forequarter lateral implosion injury, represent a severe but underrecognized injury pattern resulting from high-energy lateral shoulder trauma. While the surgical indications for isolated chest wall and shoulder girdle injuries are well described, guidance on the integrated management of this combined injury complex remains limited. We describe a reproducible multidisciplinary approach for the concurrent surgical fixation of clavicle, scapula, and rib fractures, illustrated through two cases of forequarter lateral implosion injury resulting from high-energy road traffic accidents. Preoperative planning incorporated CT three-dimensional (3D) reconstructions and patient-specific 3D printed models to facilitate pre-operative planning, with a multidisciplinary team involved for incision planning and fixation sequencing. Surgery was performed in a single setting with the patient in the lateral position, utilizing muscle-sparing approaches and a staged fixation strategy to address the clavicle, scapula, and ribs through coordinated exposures. Simultaneous osseous stabilization allowed restoration of the superior shoulder suspensory complex integrity and chest wall mechanics, enabling immediate postoperative shoulder mobilization and aggressive pulmonary rehabilitation. Both patients demonstrated early pain resolution, functional shoulder range of motion, radiographic union, and return to work within months and without major complications. In the setting of combined chest wall and shoulder girdle disruption, the cumulative biomechanical instability may justify a judicious relaxation of traditional surgical thresholds to permit concurrent surgical stabilization to facilitate earlier rehabilitation and recovery. This study characterizes the underrecognized entity of a forequarter lateral implosion injury, highlights practical management considerations, and supports an integrated surgical strategy to optimize functional recovery.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"113292"},"PeriodicalIF":2.0,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alternative trials of recipient site vessel in maxillomandibular reconstruction with multisegment fibular flaps including only one pedicle anastomosis.","authors":"Ercan Akbay, M İhsan Gülmez","doi":"10.1016/j.injury.2026.113287","DOIUrl":"https://doi.org/10.1016/j.injury.2026.113287","url":null,"abstract":"<p><strong>Backgrounds: </strong>The objective of this study is to closely examine the preferred anastomoses of the superior thyroid artery, facial artery, lingual artery, maxillary artery, and superficial temporal artery anastomoses for the reconstruction of maxillomandibular defects caused by firearm injuries. The study will also examine the reasons for choosing these arteries, their advantages and disadvantages, surgical techniques, complications, and their postoperatively clinically and scintigraphically assessable viability.</p><p><strong>Methods: </strong>The present study encompasses a cohort of ten patients who sustained maxillomandibular injuries and underwent surgical intervention employing a multisegment fibular flap. In all cases, following bone fixation, microvascular anastomoses were sutured under a microscope using 9-0 nylon sutures. Flap viability was initially assessed clinically; in addition, all patients underwent a bone scan on the fifth day after surgery using an intravenous infusion of Tc-99m methylene diphosphonate (MDP).</p><p><strong>Results: </strong>In the study, 10 patients who underwent maxillomandibular multisegment flap surgery received the most appropriate microvascular anastomosis for their pathology. Of these patients, the six most demonstrative cases, which best represent the relevant artery used for anastomosis, have been detailed.</p><p><strong>Conclusions: </strong>Although the aim of this study was not to establish a definitive algorithm based on the 10 cases presented, it is hypothesised that the findings may provide some guidance to surgeons working in this field.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"113287"},"PeriodicalIF":2.0,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Palliative and end of life care in older major trauma - A point prevalence evaluation in England, Wales and Scotland.","authors":"Elaine Cole, Heather Jarman","doi":"10.1016/j.injury.2026.113199","DOIUrl":"https://doi.org/10.1016/j.injury.2026.113199","url":null,"abstract":"<p><strong>Introduction: </strong>Traumatic injury in older people is a significant health burden with higher mortality rates than younger cohorts. Survival following older trauma may be complicated by the patients pre-injury state and clinical uncertainty. Timely identification of palliative and end-of-life care needs may be challenging for acute clinical teams, and treatment escalation planning is not routinely embedded in trauma care. This point prevalence snap-shot aimed to evaluate treatment escalation discussions and palliative/end of life care (EoLC) practice in older major trauma patients at a national level.</p><p><strong>Methods: </strong>A one-day point prevalence \"flash-mob\" audit was conducted across Major Trauma Centres (MTCs) and Trauma Units (TUs) in England, Wales and Scotland. All trauma patients aged ≥ 65 years in hospital were eligible for inclusion. Patients with and without treatment escalation plans (TEPs) and those on care pathways were analysed.</p><p><strong>Results: </strong>Data from 957 patients in 49 hospitals were included and median time from injury was 11 days (interquartile range 4-24). A TEP or equivalent was documented in 393 patients (41.0%). Among patients with a TEP, there were more aged > 85 years (165/393 (41.9%), than in those without a TEP (167/564 (29.6%), p < 0.001). Clinical frailty scoring was performed in 657 patients (68.6%), and where recorded, TEPs were associated with increased frailty (CFS ≥5 TEP: 68% [207/304] vs. No TEP: 46.4% [164/353], p < 0.001). Polytrauma predominated over any single site injury (TEP: 140/393, 35.6% vs. No TEP: 197/564, 34.9%). Admitting specialty teams differed between groups and those with a TEP were more likely to be under the care of a medical consultant (92/393, 23.4%) compared to only 60/564, 10.6% of the no-TEP patients (p < 0.001). A fifth of those with a TEP were on a documented palliative, time-limited or end-of-life care pathway (20.3%). Care pathways were more likely in those with older age (p < 0.001) and severe frailty (CFS≥7) (p = 0.03) rather than injury type, clinical specialty or advance care plans.</p><p><strong>Conclusion: </strong>This national snapshot demonstrates limited and variable use of treatment escalation planning with low rates of recorded palliative and EoLC need discussions in older major trauma patients. Greater integration of frailty assessment and early goals-of-care discussions are required to improve care for this growing population.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"113199"},"PeriodicalIF":2.0,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial letter regarding the letter by McLean AL concerning \"Biomechanical analysis of odontoid and transverse atlantal ligament in humans with ponticulus posticus variation under different loading conditions: A finite element study\".","authors":"Ayhan Kanat","doi":"10.1016/j.injury.2026.113275","DOIUrl":"https://doi.org/10.1016/j.injury.2026.113275","url":null,"abstract":"","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"113275"},"PeriodicalIF":2.0,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147701287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}