Injury最新文献

{"title":"Adapting and implementing a pre-hospital trauma program for community health responders: A pilot study from rural Nepal.","authors":"Ramu Kharel, Mandeep Pathak, Derek Lubetkin, Timmy Lin, Roshan Paudel, Logan Brich, Camille Lubetkin, Janette Baird, Bibhav Acharya, Adam R Aluisio, Michael J Mello","doi":"10.1016/j.injury.2025.112229","DOIUrl":"https://doi.org/10.1016/j.injury.2025.112229","url":null,"abstract":"<p><strong>Introduction: </strong>Effective pre-hospital care is critical for improving trauma outcomes, yet pre-hospital systems are underdeveloped in low-and middle-income countries (LMICs) like Nepal, where trauma-related deaths are rising. Community health responders (CHRs) have the potential to reduce time to post-injury care in rural settings, where other health infrastructure may be unavailable. This pilot study assessing the feasibility and preliminary impact of CHR based program in rural Nepal.</p><p><strong>Methods: </strong>This quasi-experimental study adapted and implemented a trauma training intervention for CHRs in Achham, Nepal. The program adapting the trauma portion of the World Health Organization's (WHO) Basic Emergency Care (BEC) course for the Achham context through a modified Delphi process. The final implemented program included three items: initial two-day skills-based training, a pictorial guide handbook for CHR's quick reference, and a one-day refresher training at three months. Two rural municipalities of Achham district were assigned into intervention or control. All CHRs from the intervention municipality underwent the training program. Assessment includes the program's impact on CHRs' knowledge and confidence, and impact on pre-hospital trauma care metrics, which was assessed through pre-, immediately, and six-months post-course evaluations, and pre-hospital service metrics data, respectively. A repeated measures ANOVA was used to assess change in knowledge over time by study groups. Bivariate analysis was performed to explore differences in pre-hospital patient metrics of trauma care by study group.</p><p><strong>Results: </strong>The intervention group showed a significant increase in knowledge and confidence immediately post-course and sustained over six months. There was no significant difference in mean patient age (26.5 years versus. 22.1) and trauma mechanism (p = 0.14) across two groups. The most common mechanism was falls (n = 165, 77.5 %). Intervention municipalities had higher rates of pre-hospital care provision, including fracture immobilization (51.4 % versus. 17.1 %, p < .001) and cervical collar use, compared to controls.</p><p><strong>Conclusion: </strong>This study adapted and implemented a contextual trauma training program for CHRs in rural Nepal. Results shows early feasibility and appropriateness in this context. The program leverages existing community networks and offers a potential approach in LMICs to bridge the existing critical gaps in rural pre-hospital trauma care that requires further investigation.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"112229"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143589007","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":"Implementing enhanced recovery protocol to improve trauma laparotomy outcomes: A single-center pilot study.","authors":"Hayaki Uchino, William Davalan, Kosar Khwaja, Evan Wong, Jeremy Grushka","doi":"10.1016/j.injury.2025.112238","DOIUrl":"https://doi.org/10.1016/j.injury.2025.112238","url":null,"abstract":"<p><strong>Introduction: </strong>Enhanced Recovery Protocols (ERPs) are designed to improve postoperative recovery. Since their inception, ERPs have become the standard of care across multiple surgical specialities, with numerous guidelines established for elective procedures. While ERP principles have been extended to emergency abdominal surgeries, their application in trauma laparotomy remains limited. This study details the development of an ERP tailored for trauma laparotomy patients and evaluates outcomes following its implementation.</p><p><strong>Methods: </strong>A multidisciplinary team developed an ERP, termed the Trauma Laparotomy Care Pathway (TLCP), grounded in best available evidence and adapted to our clinical setting through a rigorous consensus process. Following implementation, we conducted a single-center pilot study as part of a quality improvement initiative, comparing trauma laparotomy patients managed with TLCP from February to July 2024 to a historical cohort as the baseline group. We analyzed adherence to five key postoperative components and assessed impacts on postoperative outcomes.</p><p><strong>Results: </strong>In the first six months post-implementation, 31 patients were managed using TLCP. The median age was 32.0 years, with males comprising 87.1 % of patients. Stab wounds were the most frequent injury mechanism, followed by motor vehicle-related accidents and falls. Isolated abdominal injuries accounted for 64.5 % of cases. Adherence to key pathway components ranged from 54.5 % to 67.7 %. The hospital length of stay was significantly shorter for the TLCP group, showing a two-day reduction compared to the historical cohort (4.0 days [3.5, 6.5] vs 6.0 days [4.0, 10.0], p = 0.002). There was no significant difference in in-hospital complications or 30-day readmission rates between the groups.</p><p><strong>Conclusion: </strong>Following TLCP implementation, a reduction in hospital length of stay was observed, with no apparent increase in complications or 30-day readmission rates. These findings suggest that ERPs may be applicable to selected trauma laparotomy patients, with the potential to improved clinical outcomes. Further large-scale studies are warranted to validate these results.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"112238"},"PeriodicalIF":0.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143589010","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":"Using a simulation-based approach to evaluate a contextually appropriate, non-internet dependent mobile navigation tool for emergency medical dispatch (EMD) of lay first responders (LFRs) in Sierra Leone: A multi-cohort feasibility trial.","authors":"Peter G Delaney, Zachary J Eisner, Haleigh Pine, Alfred Harun Thullah, Nicholas Agostin, Jared Sun, Krishnan Raghavendran, Brendan M Patterson, Heather Vallier, Nathanael Smith","doi":"10.1016/j.injury.2025.112222","DOIUrl":"https://doi.org/10.1016/j.injury.2025.112222","url":null,"abstract":"<p><strong>Introduction: </strong>Despite disproportionately bearing the global injury burden, low- and middle-income countries often lack emergency medical services(EMS). Equipping lay first responders(LFRs) with emergency medical dispatch(EMD) is a critical next step for formal EMS development. However, few context-appropriate mobile dispatch solutions are available for LFRs, and implementation feasibility and impact on response intervals are not well understood MATERIALS AND METHODS: A simulation-based feasibility trial assessed a novel EMD tool, previously used for shipping in resource-limited settings without formal addresses. Two cohorts of 10 non-EMD enabled LFRs trained in 2019 in Sierra Leone were recruited. 100 total simulations were launched in randomized order over 6 months(Cohort 1 distributed along 10 kms of highway(n = 50), Cohort 2 distributed across 24 square-kilometers of an urban setting(n = 50)). On-scene first aid skill performance was assessed under direct observation with a standardized patient actor using checklists. Participants were blinded to randomized dispatch timing/scenario to assess response intervals, replicating real-world conditions, and compared with two-sample t-tests. At six-month follow-up, participants were surveyed on tool ease-of-use and appropriateness, confidence, and ranked dispatch variable relative importance.</p><p><strong>Results: </strong>Median total response interval (initial notification to LFR arrival on scene) for Cohort 1 for linearly-plotted highway simulations was 6 mins 33 ss(IQR: 2m27 s; 10m48 s), while Cohort 2 for dispersed urban simulations was 6m41s(IQR:3m59 s;14m47 s) (p = 0.720). Median distance between simulated emergency and LFR at the time of notification acceptance=1.675 km(IQR:1.13 km;2.47 km) and 1.73 km(IQR:0.82 km;2.28 km). Mean completion percentage of all discrete first aid steps across all 10 simulation scenario types for Cohort 1 = 89.8 %(IQR: 80 %;100 %) and Cohort 2 = 94.9 %(IQR: 88.89 %;100 %) (p = 0.017). Mean confidence was 9.4/10(median=10) and 9.5/10(median=10)(p = 0.889). 75 % of LFRs (15/20) used the compass feature for navigation while 25 % used turn-by-turn directions (5/20). 70 % LFRs (14/20) reported no unexpected data costs. Emergency location was considered the most important dispatch variable factor, followed by nature/severity of injury.</p><p><strong>Discussion: </strong>A novel mobile navigation tool for EMD accurately dispatches LFRs to simulated emergency incidents across linear/dispersed settings without significant difference in response interval. Equipping LFRs with EMD tools may facilitate efficient dispatch in resource-limited settings to trauma while expanding emergency care access, meriting further study.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"112222"},"PeriodicalIF":0.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525620","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":"Traumatic strabismus in Franz Josias Duke of Saxe-Coburg-Saalfeld'portraits (1697-1764).","authors":"Andrei Ionut Cucu, Amelian Madalin Bobu, Raffaella Bianucci, Claudia Florida Costea, Antonio Perciaccante, Andreas Georg Nerlich","doi":"10.1016/j.injury.2025.112223","DOIUrl":"https://doi.org/10.1016/j.injury.2025.112223","url":null,"abstract":"<p><strong>Objective: </strong>A case of traumatic strabismus was painted in two portraits of Franz Josias, Duke of Saxe-Coburg-Saalfeld (1697-1764). Both canvases are held by the Art Collection of Veste Coburg (Accession numbers: M.076 & M.363).</p><p><strong>Methods: </strong>Resorting to the \"Guidelines for Iconodiagnosis\", a careful comparison of the portraits of the Duke pre-dating an accident with those showing evidence of an ocular trauma afterwards, was performed. An analysis of the historical and biographical written sources was carried out as well.</p><p><strong>Results: </strong>At the age of 32 years, while playing battledore and shuttlecock (in French \"jeu de volant\", a forerunner of badminton), Duke Franz Josias sustained a traumatic left eye injury. This did not heal with time and was depicted in contemporary paintings of the Duke.</p><p><strong>Conclusion: </strong>Combining both biographical and artistic sources, a diagnosis of post-traumatic strabismus due to injury of the left inferior rectus muscle was proposed with an Iconodiagnosis level of evidence II.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"112223"},"PeriodicalIF":0.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143532270","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 of houselessness and outcomes after traumatic injury: A retrospective, matched cohort study at an urban, academic level-one trauma center.","authors":"Brendin R Beaulieu-Jones, Sophia M Smith, Anna J Kobzeva-Herzog, Maia R Nofal, Monica Abou-Ezzi, Miranda Melici, Priya Desai, Ann Fefferman, Tracey A Dechert, Megan G Janeway, Sabrina E Sanchez","doi":"10.1016/j.injury.2025.112214","DOIUrl":"https://doi.org/10.1016/j.injury.2025.112214","url":null,"abstract":"<p><strong>Background: </strong>Houselessness is associated with increased mortality and unmet health needs. Current understanding of traumatic injury in houseless patients is limited.</p><p><strong>Methods: </strong>This is a retrospective matched cohort study among houseless and housed adults, admitted to an urban, safety net, level I trauma center from 1/1/2018-12/31/2021. Houseless patients were matched with their housed counterparts 1:2 based on age, sex, injury severity score (ISS) and nature of injury. The primary outcome was in-hospital adverse events. Secondary outcomes included hospital length of stay (LOS), outpatient follow-up, emergency department (ED) utilization post-injury, and readmission. Conditional multivariable regression was used to determine associations between the exposure and outcomes.</p><p><strong>Results: </strong>1413 patients were included; 471 houseless patients and 942 matched controls. Median [IQR] age was 42 years [31-58] and median [IQR] ISS was 9 [5-13] for all patients. About 30 % of traumatic injuries were violent in nature. Median [IQR] total LOS was longer for houseless patients (4.4 days [2.0-8.3] vs. 3.1 days [1.4-6.5], p < 0.001). Houseless patients were more frequently admitted to the ICU (5 % versus 3 %, p = 0.045). The rate of any in-hospital adverse event was similar (houseless 17 % vs. housed 16 %, p = 0.537). Adjusting for age, sex, language, insurance, ISS, nature of injury, injury mechanism, ICU admission, and operative intervention, houselessness was inversely associated with outpatient follow-up (OR 0.60, 95 % CI 0.46-0.79) and positively associated with ED representation (OR 2.49, 95 % CI 1.64-3.78) and hospital readmission (OR 4.35, 95 % CI 3.19-5.92).</p><p><strong>Conclusions: </strong>Housing status was not associated with increased in-hospital morbidity or mortality in trauma patients in a single institution cohort of trauma patients. Unhoused patients had lower odds of completing outpatient injury-specific follow-up and higher odds of utilizing the ED within 30 days of discharge. These findings highlight gaps in post-discharge care coordination and underscore opportunities to improve discharge services for this population.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"112214"},"PeriodicalIF":0.0,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451186","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":"An analysis of transfers into designated trauma centers from referring institutions - the potential for virtual consultation to reduce transfers.","authors":"Larissa Garza, Michael D April, Julie A Rizzo, Brian J Kirkwood, Andrew D Fisher, Steven G Schauer","doi":"10.1016/j.injury.2025.112202","DOIUrl":"https://doi.org/10.1016/j.injury.2025.112202","url":null,"abstract":"<p><strong>Introduction: </strong>Trauma care frequently happens in emergency departments (ED) outside of major trauma centers. Many injuries often exceed the specialty capabilities of referring hospitals, requiring transfer to larger trauma centers. However, the proportion of patients discharged home without admission from receiving facilities remains unclear, suggesting potential overutilization of transfers. We sought to determine the proportion of transfer patients that are discharged home from the receiving ED.</p><p><strong>Methods: </strong>We studied patients ≥15 years captured in the Trauma Quality Improvement Program (TQIP) database who were transferred from a referring institution and were subsequently discharged home from the receiving ED without additional services planned.</p><p><strong>Results: </strong>From 2020 to 2022, there were 744,623 patients ≥15 years of age, of which, 82,316 (11 %) were discharged home with (1 %) or without (99 %) additional services planned. The median age was 40 (26-60), and 70 % were male. The most common mechanism of injury was a collision (40 %), followed by falls (30 %). The median composite injury severity score was 5 (1-5). Serious injury by body region was most frequent for the craniomaxillofacial (11 %) followed by the thorax (5 %). Most of the transfers were to level 1 centers (85 %). The most frequently performed procedures were CT brain followed by a CT cervical spine, abdominal ultrasound, MRI cervical spine, hand laceration repair, ocular evaluation, scalp repair, forearm fracture reduction, assessment of ocular pressure, and MRI of the lumbar spine. The most frequent diagnoses were nasal fracture, orbital floor fracture, macular fracture, subdural hematoma, dental fracture, pneumothorax, rib fracture, hand laceration, burns, and vertebral fracture.</p><p><strong>Conclusions: </strong>We found that approximately 1 in 9 patients transferred to a higher level of care are discharged home from the ED, with most requiring neurosurgical, ophthalmologic, dental and craniomaxillofacial services. These findings suggest that virtual communication technology could reduce unnecessary transfers and associated costs.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"112202"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143371459","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":"Current challenges and future opportunities in on-scene prehospital triage of traumatic brain injury patients: A qualitative study in the UK.","authors":"Naif Alqurashi, Steve Bell, Adnan Alzahrani, Fiona Lecky, Christopher Wibberley, Richard Body","doi":"10.1016/j.injury.2025.112203","DOIUrl":"https://doi.org/10.1016/j.injury.2025.112203","url":null,"abstract":"<p><strong>Introduction: </strong>Traumatic brain injury (TBI) presents significant challenges in prehospital care, particularly during on-scene triage, where accurate decision-making is crucial for improving patient outcomes. This study, part of a mixed-methods project, aims to explore these challenges and identify gaps in current on-scene triage practices. Additionally, it seeks to understand paramedics' perspectives on potential diagnostic tools such as brain biomarkers, near-infrared spectroscopy, and decision aids.</p><p><strong>Methods: </strong>This study involved conducting semi-structured interviews by video conference, including interviews with paramedics of various experience levels who were recruited from UK ambulance trusts. The interviews were guided by a predeveloped and piloted topic guide. The interviews were audio-recorded, transcribed, and analysed using a thematic analysis approach.</p><p><strong>Results: </strong>Between June and December 2022, twenty participants (15 males and 5 females) with 4 to 24 years of experience were interviewed. Four key themes were identified. Theme 1, \"Challenges in TBI Recognition,\" highlighted difficulties in identifying non-obvious TBI, especially in older adults or patients with comorbidities, and differentiating TBI from other conditions. Theme 2, \"Need for Specific Triage and Diagnostic Tools,\" emphasised paramedics' need for a simple, evidence-based head injury-specific triage tool, as they felt that current tools lack the necessary specificity. Participants also highlighted the potential of new diagnostic technologies to improve decision-making. Theme 3, \"Need for Evidence to Support Diagnostic Tools,\" stressed the importance of clinical effectiveness, feasibility, and cost before implementing new diagnostic technologies. Theme 4, \"Implementation Requires Planning and Training,\" highlighted the need for effective implementation strategies, as well as adequate and ongoing training to ensure proficiency and proper use in the prehospital setting.</p><p><strong>Conclusions: </strong>This study provides critical insights into the complexities of on-scene prehospital triage for patients with suspected TBI. Key recommendations include developing specific triage tools, exploring advanced technologies to support on-scene decision-making, enhancing paramedic training on TBI recognition, and addressing both barriers and facilitators to the implementation of new diagnostic technologies.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"112203"},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392820","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":"Criteria to clear polytrauma patients with traumatic brain injury for safe definitive surgery (<24 h).","authors":"Yannik Kalbas, Yannik Stutz, Felix Karl-Ludwig Klingebiel, Sascha Halvachizadeh, Michel Paul Johan Teuben, John Ricklin, Ivan Sivriev, Jakob Hax, Carlos Ordonez Urgiles, Kai Oliver Jensen, Markus Florian Oertel, Hans-Christoph Pape, Roman Pfeifer","doi":"10.1016/j.injury.2025.112149","DOIUrl":"https://doi.org/10.1016/j.injury.2025.112149","url":null,"abstract":"<p><strong>Introduction: </strong>Optimizing treatment strategies in polytrauma patients is a key focus in trauma research and timing of major fracture care remains one of the most actively discussed topics. Besides physiologic factors, associated injuries, and injury patterns also require consideration. For instance, the exact impact and relevance of traumatic brain injury on the timing of fracture care have not yet been fully investigated.</p><p><strong>Methods: </strong>In this retrospectively cohort study at a level one trauma center, patients requiring trauma team activations from 2015 to 2020 were screened. Patients with an injury severity score >16 and at least one body region requiring operative fixation were included. Patients who underwent their first definitive surgery <24 h were stratified as group SDS (Safe Definitive Surgery) and >24 h as group DFC (Delayed Fracture Care). Outcomes were early mortality (<72 h), SIRS and sepsis, timing to first definitive surgery and completed reconstruction, total number of surgeries, and factors influencing the surgical strategy (e.g., unstable physiology). Odds ratios for treatment strategies and influencing factors were calculated using the Fisher`s exact test with conditional maximum likelihood estimate.</p><p><strong>Results: </strong>From a total of 901 patients screened, 239 were included in the analyzes (Group DFC: 151, Groups SDS: 88). Groups did not significantly differ regarding early mortality, SIRS and sepsis. Group SDS had a significantly lower mean number of operations (4.3 vs. 5.3; p = 0.037) and a significantly shorter mean time until completion of reconstructive operations (10 days vs. 15 days; p = 0.013). Unstable physiology and intracranial trauma sequelae with the necessity for neurosurgical interventions (NSI) were identified as most significant factors for delaying definitive fracture care (OR: 2.85; 95 % CIs: 1.56 to 5.33 and OR: 5.59; 95 % CIs: 1.63 to 29.85), while the presence of intracranial bleeding (IB) without NSI did not have a significant influence (OR: 1.21; 95 % CIs: 0.63 to 2.34).</p><p><strong>Conclusion: </strong>The necessity of NSI and unstable physiology are highly relevant factors for delaying definitive fracture care in polytrauma patients, while the presence of IB without NSI had less impact. In this cohort, early definitive fracture care in physiologically stable patients without NSI, was not associated with increased patient morbidity.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"112149"},"PeriodicalIF":0.0,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143049300","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":"Frailty index predicts adverse short- and long-term outcomes in older adults with rib fractures.","authors":"Jochem H Raats, Devon T Brameier, Detlef van der Velde, Houman Javedan, Michael J Weaver","doi":"10.1016/j.injury.2025.112144","DOIUrl":"https://doi.org/10.1016/j.injury.2025.112144","url":null,"abstract":"<p><strong>Background: </strong>Older adults with rib fractures pose an increasing clinical and financial burden on healthcare. Identifying and addressing the increased risk of adverse outcomes has been a key objective in geriatric co-management of surgical patients. The Comprehensive Geriatric Assessment-based Frailty Index (FI-CGA) is a useful predictor of complications and mortality in older adults, but its value in rib fracture management remains unclear. This study investigates the association between FI-CGA and short- and long-term outcomes of older adults with rib fractures.</p><p><strong>Methods: </strong>Rib fracture patients ≥65 years, with a FI-CGA score available, were retrospectively identified from a single level-I trauma center between 2018 and 2022. FI-CGA scores were categorized as pre-frail (<0.20), mild frailty (0.20-0.29), moderate frailty (0.30-0.39), and severe frailty (≥0.40). Outcome measures included mortality up to two years, length of stay (LOS), complications, and 30-day readmission.</p><p><strong>Results: </strong>288 patients were included for analysis (57 pre-frail; 66 mildly frail; 61 moderately frail; 104 severely frail). Compared to the pre-frail group, only severely frail patients were at higher risk of 90-day (OR 5.71 [CI 1.29 - 52.67]) and 1-year mortality (OR 6.66 [CI 2.18 - 27.37]), while 2-year mortality was higher in mild (OR 3.77 [CI 1.30 - 12.57]), moderate (OR 4.28 [CI 1.46 - 14.51]) and severe (OR 6.42 [CI 2.43 - 20.11]) frailty groups. Hospital (p=0.183) and ICU LOS (p=0.131) was similar across groups. Severely frail patients were at risk of pneumonia (OR 3.50 [CI 0.95 - 19.48]) and delirium (OR 4.16 [CI 1.33 - 17.40]), while other complications were similar between groups (p=0.679). Adjusted proportional hazard ratios for mortality were significantly higher for moderate frailty (HR 1.99 [CI 1.02 - 3.89]) and severe frailty (HR 2.66 [CI 1.10 - 3.73]). FI-CGA was also a significant predictor if used per 0.01 point (HR 1.03 [CI 1.01 - 1.04)]) and per 0.1 point (HR 1.29 [CI 1.12 - 1.47]).</p><p><strong>Conclusion: </strong>FI-CGA can identify vulnerable rib fracture patients at risk of in-hospital complications, and short- and long-term mortality. Continuous FI-CGA scores provide a granular and individualized risk assessment. In severely frail patients with rib fractures, FI-CGA may assist in aligning treatment with individual patients' needs and goals of care.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"112144"},"PeriodicalIF":0.0,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974078","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":"Factors associated with anxiety and depression one year after trauma critical care admission: A multi-centre study.","authors":"Victoria Nicholson, Elaine Cole, Robert Christie","doi":"10.1016/j.injury.2024.112080","DOIUrl":"https://doi.org/10.1016/j.injury.2024.112080","url":null,"abstract":"<p><strong>Background: </strong>Recovery after severe injury may be impacted by a range of psychological factors. This multi-site study investigated the prevalence and impact of anxiety and depression at one year after trauma critical care admission.</p><p><strong>Methods: </strong>Adult trauma patients admitted to four Level 1 Critical Care Units were prospectively enrolled over 18 months. Survivors were followed-up at one year post discharge using EQ-5D-5L questionnaires. Multivariable logistic regression analysis was used to evaluate factors associated with anxiety and depression at follow up.</p><p><strong>Results: </strong>Of the 657 patients consented and alive at follow-up, 290 questionnaires were completed (44 % response rate). Two-thirds (63 %) reported anxiety or depression (AoD) at follow up, and this was associated with a worse overall health state (EQ-VAS No AoD: 80 vs. AoD: 60, p < 0.0001). Median ISS in both groups was 25 but those with AoD were younger (53 years vs. 60 years, p = 0.033), had previous psychological morbidities (16 % vs. 5 %, p = 0.0056) and longer hospital stays (32 vs. 24 days, p = 0.0027). All physical EQ-5D-5 L domains were worse in the presence of AoD and problems increased as anxiety or depression became more severe. Factors associated with anxiety and depression were younger age (OR 0.98 [95 % CI 0.96-0.99] p = 0.004), previous psychological morbidity (OR 3.30 [95 % CI 1.51-7.40] p = 0.004), penetrating injury (OR 10.10 [95 % CI 1.90 - 44.4] p = 0.007), ongoing pain (OR 1.61 [95 % CI 1.10-2.30] p = 0.003) or difficulties carrying out usual activities (OR 1.40 [95 % CI 1.02-2.29] p = 0.04).</p><p><strong>Conclusion: </strong>Anxiety and depression are significant longer-term impacts after severe injury. Younger age, penetrating injury and psychological comorbidities may be identifiers of longer-term anxiety and depression following trauma critical care. Pain at one-year had a strong association and represents a modifiable target to improve psychological outcomes.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"112080"},"PeriodicalIF":0.0,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873695","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}