Injury最新文献

{"title":"Status of state trauma registries 2025: Have we made progress?","authors":"Elizabeth C Lendrum, Haley Hayes, Meera Kotagal, Taunya Kessler, Brad Sobolewski, David Schnadower","doi":"10.1016/j.injury.2025.112678","DOIUrl":"10.1016/j.injury.2025.112678","url":null,"abstract":"<p><strong>Background: </strong>High-quality, granular, accessible, and timely data are essential for evaluating regional trauma ecosystems and implementing programs to improve trauma care. State trauma registries play a crucial role in collecting, disseminating, and sharing data for clinicians, researchers, implementation scientists, and policymakers. This study aimed to assess the status and progress of statewide trauma registries in the United States over the past 20 years.</p><p><strong>Methods: </strong>A structured electronic survey was administered to eligible and consenting state trauma registry managers or emergency medical services personnel between July 2024 and November 2024. The survey gathered information on registry infrastructure, data collection and reporting processes, and data quality assurance measures. Findings were compared with those from a similar survey conducted in 2004.</p><p><strong>Results: </strong>All 50 states and the District of Columbia participated in the survey. Forty-seven states (92 %) reported an active trauma registry, an increase of 15 since 2004. Four states have never had a statewide registry, though two are planning to develop one. Among states with registries, only 18 (38 %) mandate data submission from all hospitals. While many registries have transitioned to web-based systems and updated software over the last two decades, 34 registries (72 %) still rely on manual data abstraction, and 28 (60 %) lack integration with electronic health records. Additionally, only 20 (43 %) state registries contribute data to national collection efforts.</p><p><strong>Conclusions: </strong>Although progress has been made in establishing and modernizing state trauma registries since 2004, significant gaps remain, particularly in the absence of comprehensive mandatory reporting, the reliance on manual data entry, and the lack of integration with electronic health records and national databases. Addressing these challenges is essential for reducing the burden on registry teams and providing accurate, actionable, and timely data for improving trauma care.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"112678"},"PeriodicalIF":2.0,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144877613","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":"Is skull fracture associated with post-traumatic benign paroxysmal positional vertigo? An observational study.","authors":"Abigail Newdick, Bethany Kenny, Lisa Fowler, Katherine Elliot, Vassilios Tahtis, Jenna Beattie, Caroline Burgess, Jonathan Marsden, Barry M Seemungal, Rebecca M Smith, Philip Sedgwick","doi":"10.1016/j.injury.2025.112677","DOIUrl":"https://doi.org/10.1016/j.injury.2025.112677","url":null,"abstract":"<p><strong>Background: </strong>Vestibular dysfunction (resulting in dizziness and imbalance) is common in acute traumatic brain injury (aTBI). The most frequently diagnosed cause of peripheral vestibular dysfunction in aTBI is benign paroxysmal positional vertigo (BPPV). However, post-traumatic BPPV is often undiagnosed and left untreated in these patients.</p><p><strong>Objectives: </strong>To investigate clinical risk factors for BPPV in patients experiencing aTBI.</p><p><strong>Methods: </strong>Patients were recruited from three Major Trauma Centres in London. Logistic regression was used to derive the adjusted odds ratio (aOR) of diagnosed BPPV for sex, categorised age, severity of traumatic brain injury (TBI), and site of skull fracture.</p><p><strong>Results: </strong>166 patients with aTBI were included. Approximately a third (n = 55; 33.1 %) tested positive for BPPV. Compared to patients aged less than or equal to 40 years, those aged 41 to 64 years were more likely to experience BPPV (aOR=3.86; 95 % CI: 1.47 to 10.16; p = 0.006), as were those aged 65 years and above (4.41; 1.52 to 12.81; p = 0.006). Patients that experienced both facial and cranial skull fracture were more likely to experience BPPV than those that didn't have a skull fracture (23.64; 6.36 to 87.89; p < 0.001).</p><p><strong>Conclusion: </strong>The risk of post-traumatic BPPV increased with increasing age, plus in those with combined skull and facial fractures when compared to those without a skull fracture. We advocate routine BPPV screening of those with aTBI, especially in older adults and those with combined facial and skull fractures.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"112677"},"PeriodicalIF":2.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144983892","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":"From prediction to precision: The emerging impact of artificial intelligence in trauma care.","authors":"Sukriti Prashar, Sanjan Kumar, Youssef Nasef, Adel Elkbuli","doi":"10.1016/j.injury.2025.112661","DOIUrl":"https://doi.org/10.1016/j.injury.2025.112661","url":null,"abstract":"","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"112661"},"PeriodicalIF":2.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144877635","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":"Understanding experiences, contextual factors and implementation outcomes of a major trauma service: A qualitative study.","authors":"Frances Williamson, Jessica Killey, David Rodwell, Kamila Davidson, Jacelle Warren, Michael Handy, Martin Wullschleger, Zephanie Tyack","doi":"10.1016/j.injury.2025.112651","DOIUrl":"https://doi.org/10.1016/j.injury.2025.112651","url":null,"abstract":"<p><strong>Introduction: </strong>The delivery of optimal trauma care requires an interdisciplinary team approach. However, the composition of these teams often varies across health services and systems. Moreover, different models of care exist which impact the way trauma teams operate, including consultative models and admitting models. This study aimed to explore contextual factors (e.g., barriers and facilitators) influencing trauma service model optimisation, propose strategies to address the factors, and understand implementation outcomes of the model.</p><p><strong>Methods: </strong>Staff and patients within a large public, major trauma referral centre with statewide outreach were interviewed, and data were analysed using a hybrid qualitative inductive and deductive design. The predominantly inductive approach used interpretive description methodology to produce a narrative and themes related to the interviews. The deductive approach used the Consolidated Framework for Implementation Research (CFIR 2.0) to understanding the influence of multi-level factors on implementation, and mapped data to five implementation outcomes. Finally, strategies addressing the factors were mapped to the nine domains of Expert Recommendations for Implementing Change (ERIC) to inform future research and service redesign.</p><p><strong>Results: </strong>Twelve staff and six patient interviews were conducted. 'Connecting with people' was a concept that underpinned all three themes of caring for the patient as a whole person; coming together to create a cohesive team identity; and securing a place in the bigger health system. The findings suggest that the Trauma Service improved continuity and enabled patient-centred care, but its perceived effectiveness was hindered by hospital attitudes, leadership changes, staff shortages, and dependence on key individuals. Participants highlighted acceptability and sustainability as key implementation outcomes, with patients viewing the Trauma Service positively while staff had mixed opinions. Fourteen implementation strategies were identified, including restructuring the Trauma Service for continuity of care, pre-planning with stakeholders, using cohorted trauma wards and advocating for funding to ensure sustainability.</p><p><strong>Conclusions: </strong>The themes highlighted that optimal trauma care delivery is focussed on connecting with people; recognising and caring for the trauma patient as a whole person; and knowing individual and collective strengths. The findings may have implications for designing or redesigning similar trauma services in the future by ensuring external and internal risks to service provision are mitigated.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"112651"},"PeriodicalIF":2.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812814","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":"Psychosocial needs in fracture-related infection patients: A call for action.","authors":"Nike Walter, Volker Alt","doi":"10.1016/j.injury.2025.112652","DOIUrl":"https://doi.org/10.1016/j.injury.2025.112652","url":null,"abstract":"","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"112652"},"PeriodicalIF":2.0,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144839456","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":"Nonoperative management of blunt splenic injury: Need for routine serial imaging? A ten-year retrospective series.","authors":"Stephanie Jensen, Camille Simmons, Chiung K Wu, Ansley Ricker, Samuel Ross, Ronald F Sing, Rafael Torres Fajardo","doi":"10.1016/j.injury.2025.112627","DOIUrl":"https://doi.org/10.1016/j.injury.2025.112627","url":null,"abstract":"<p><strong>Background: </strong>The role for routine follow-up imaging in nonoperative management (NOM) of blunt splenic injury (BSI) remains controversial. Delayed complications, specifically vascular abnormalities such as pseudoaneurysms are associated with failure of NOM (FNOM). This study examined a ten-year experience with NOM of BSI and the influence of repeat imaging. Our centers have no guidelines for follow-up imaging.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted including all trauma patients with BSI admitted within a regional trauma system (two Level III and one Level I ACS-verified trauma centers) between 2013 and 2022. Patient demographics, injury features, imaging and outcomes were obtained from trauma registry data and chart review. Patients undergoing splenectomy 6 hours or more after presentation were categorized as FNOM.</p><p><strong>Results: </strong>A total of 1815 patients presented with BSI during the study period. Urgent splenectomy was performed in 15.6 % (N=283). The rate of FNOM was 3.4 % (N=62). Among the 1532 patients initially managed nonoperatively, 139 (9.1 %) underwent a follow-up CT scan. Most scans were obtained in response to clinical changes, while 13.7 % (N= 19) were obtained for splenic surveillance. Follow-up scans were followed by 8 splenectomies and 9 embolizations. Among the 19 scans performed for surveillance, two revealed a pseudoaneurysm; one of which underwent embolization. Results are limited by a low rate of screening imaging and a lack of long-term outcome information.</p><p><strong>Conclusion: </strong>A low rate of FNOM was achieved despite less than 2 % (19/1532) of patients undergoing screening follow-up imaging. These findings suggest that there is limited opportunity for routine surveillance imaging to improve outcomes in BSI. Reimaging in response to clinical changes is a cost-effective alternative.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"112627"},"PeriodicalIF":2.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144850180","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":"Should we be scoring pain differently for rib fractures? A comparison of two scoring systems.","authors":"Kate V Lauer, Ann P O'Rourke, Katie E Austin-Nash, Ben L Zarzaur, Nicole L Werner","doi":"10.1016/j.injury.2025.112625","DOIUrl":"https://doi.org/10.1016/j.injury.2025.112625","url":null,"abstract":"<p><strong>Introduction: </strong>Uncontrolled rib fracture pain can lead to hypoventilation, impaired airway clearance, and progression to respiratory failure and death. Pain control is a mainstay of treatment, but pain assessments are most commonly obtained while a patient is at rest. A novel approach is to assess movement-evoked pain in order to better capture pain that limits physical function. We hypothesized that movement-evoked pain scores (MPS) for patients with rib fractures would be higher than resting pain scores (RPS) and would better correlate with opioid administration.</p><p><strong>Methods: </strong>A retrospective observational study was performed at a single Level 1 trauma center. Adult trauma patients (≥18 years old) admitted between January and March of 2022 with at least one rib fracture were included. Patients with other significant injuries (non-chest AIS >2) or those unable to self-report pain scores were excluded. Pain was scored on a 0-10 scale, with 10 indicating the most severe pain. RPS and MPS obtained at the same time during the first ten hospital days were averaged, and the means were compared using paired t-tests. Additionally, mean daily morphine milligram equivalents (MME) were analyzed.</p><p><strong>Results: </strong>The cohort consisted of 80 patients (median age 69 [IQR 48-79]; 65 % male; 88 % white). The majority were involved in blunt trauma (95 %) with a median length of admission of 4 days (IQR 2-8). The median number of rib fractures was 4 (IQR 2-6), and the median injury severity score was 10 (IQR 9-14). A total of 1692 paired pain scores from 416 patient hospital days were analyzed with higher mean daily MPS across all hospital days (p < 0.001). MPS and RPS differed for 79 % of patient hospital days, with a mean difference of 2.3 (SD 1.4, p < 0.001). Higher mean daily MPS were correlated with higher mean daily opioid use (R²=0.54), and days with differing scores had higher mean MME [42.5 (SD 49.6) vs 23.6 (56.1)].</p><p><strong>Conclusions: </strong>Resting and movement-evoked pain scores for patients with rib fractures varied significantly, and movement-evoked pain scores were consistently higher. Opioid use was positively correlated with movement-evoked pain scores. Utilization of movement-evoked pain scores may improve patient pain control and outcomes.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"112625"},"PeriodicalIF":2.0,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765896","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":"Inter-hospital variation in transfusion practices for severe trauma.","authors":"Troy N Coaston, Amulya Vadlakonda, Saad Mallick, Esteban Aguayo, Nam Yong Cho, Galinos Barmparas, Peyman Benharash","doi":"10.1016/j.injury.2025.112630","DOIUrl":"https://doi.org/10.1016/j.injury.2025.112630","url":null,"abstract":"<p><strong>Background: </strong>Ideal blood transfusion practices have evolved over the last decade, with updated recommendations for the plasma:red blood cell (RBC) ratio. A ≥ 1:1 ratio of plasma:RBC has been associated with improved survival. The objective of the current study was to evaluate interhospital variation in plasma:RBC ratio and the associated inpatient mortality.</p><p><strong>Methods: </strong>All adult patients (≥18 years) with severe injuries undergoing transfusion within 4 hours of admission were identified in the 2020-2021 Trauma Quality Improvement Program database. Transfusion was considered balanced when whole blood or a ≥ 1:1 ratio of plasma:RBC units was administered. Multilevel mixed-effects models were utilized to generate empirical Bayesian estimates of random intercepts for risk-adjusted plasma:RBC ratio at each center, with centers in the highest quartile labeled High-Ratio Centers (HRC). Multivariable logistic regression was constructed to identify factors independently associated with mortality.</p><p><strong>Results: </strong>Of 35,215 patients receiving care across 424 facilities, 38.0% were admitted to HRC. An estimated 17% of plasma:RBC variation was attributable to hospital effects (intraclass correlation coefficient = 0.17). Following risk-adjustment, HRC (Adjusted Odds Ratio [AOR] 0.81, 95% Confidence Interval [CI] 0.76-0.86) and balanced transfusion (AOR 0.92, 95%CI 0.86-0.98) were associated with reduced odds of mortality. The association of HRC with lower odds of mortality persisted when examining only unbalanced transfusions (n = 28,280, AOR 0.84, 0.78-0.90 95%CI).</p><p><strong>Discussion: </strong>Care at centers with high plasma:RBC ratios was linked to reduced mortality, even among unbalanced transfusion. Our findings demonstrate the utility of this value as a hospital quality metric.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"112630"},"PeriodicalIF":2.0,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762786","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":"Efficacy of venous supercharged reverse sural artery flap for reconstruction of severe limb trauma: comparative study including high-risk patients.","authors":"Takashi Kageyama, Hokuto Morii, Tsubasa Takahashi, Yasuhisa Ueda, Koichi Inokuchi","doi":"10.1016/j.injury.2025.112631","DOIUrl":"https://doi.org/10.1016/j.injury.2025.112631","url":null,"abstract":"<p><strong>Background: </strong>The reverse sural artery flap (RSAF) was reported to be a less technically demanding method for the coverage of defects in the distal lower leg, which can be elevated with short operative times. However, several studies pointed out the high frequency of partial necrosis in patients with comorbidities, which was primarily attributed to inadequate venous drainage. To overcome this challenge, we hypothesized that venous supercharging could effectively alleviate congestion of RSAF, potentially minimizing partial necrosis and related complications not only in healthy patients but also in comorbid patients.</p><p><strong>Methods: </strong>A single-center retrospective observational study was conducted. We reviewed patients with severe limb trauma who underwent RSAF for soft tissue defects on the distal lower legs, ankles, and feet from 2009 to 2022. All flaps were performed within 2 months of the injuries. Patients were divided into the Supercharge group and the Control group based on the presence of supercharge. The flap necrosis, major and minor complications, and nonunion were compared between the two groups. Additionally, these outcomes were also evaluated among high-risk patients with at least one comorbidity, including diabetes mellitus, peripheral arterial disease, venous insufficiency, advanced age over 50 years, or history of smoking.</p><p><strong>Results: </strong>A total of 30 patients including 16 males met the criteria, with 9 cases in the Supercharge group and 21 cases in the Control group. The Supercharge group decreased the frequencies of overall necrosis (11 % vs 71 %) as well as wound dehiscence (22 % vs 67 %). The Supercharge group also exhibited a relatively lower frequency of major complications (0 % vs 29 %) and minor complications (0 % vs 33 %) compared to the Control group. Among 21 high-risk patients with 7 supercharged cases and 14 control cases, supercharging decreased overall necrosis (14 % vs 71 %) and relatively suppressed major and minor complications (both of them: 0 % vs 36 %).</p><p><strong>Conclusion: </strong>Venous supercharging of RSAF decreased the overall necrosis, potentially enhancing its clinical utility even in high-risk patients. Supercharged RSAF can be a valuable option as initial flap reconstruction for traumatic distal limb defects.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"112631"},"PeriodicalIF":2.0,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812813","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":"Comment on \"Ultrasound-guided erector spinae plane block for analgesia of traumatic rib fractures\".","authors":"Chitta Ranjan Mohanty, Anju Gupta, Amiya Kumar Barik, Rakesh Vadakkethil Radhakrishnan, Shivani Pandey","doi":"10.1016/j.injury.2025.112632","DOIUrl":"https://doi.org/10.1016/j.injury.2025.112632","url":null,"abstract":"","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"112632"},"PeriodicalIF":2.0,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812812","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}