Injury最新文献

{"title":"Clinicians' attitudes towards supplemental oxygen for trauma patients - A survey.","authors":"Tobias Arleth, Josefine Baekgaard, Oscar Rosenkrantz, Stine T Zwisler, Mikkel Andersen, Iscander M Maissan, Wolf E Hautz, Philip Verdonck, Lars S Rasmussen, Jacob Steinmetz","doi":"10.1016/j.injury.2024.111929","DOIUrl":"https://doi.org/10.1016/j.injury.2024.111929","url":null,"abstract":"<p><strong>Introduction: </strong>The Advanced Trauma Life Support guidelines (ATLS; 2018, 10th ed.) recommend an early and liberal supplemental oxygen for all severely injured trauma patients to prevent hypoxaemia. As of 2024, these guidelines remain the most current. This may lead to hyperoxaemia, which has been associated with increased mortality and respiratory complications. We aimed to investigate the attitudes among clinicians, defined as physicians and prehospital personnel, towards the use of supplemental oxygen in trauma cases.</p><p><strong>Materials and methods: </strong>A European, web-based, cross-sectional survey was conducted consisting of 23 questions. The primary outcome was the question: \"In your opinion, should all severely injured trauma patients always be given supplemental oxygen, regardless of arterial oxygen saturation measured by pulse oximetry?\".</p><p><strong>Results: </strong>The survey was answered by 707 respondents, which corresponded to a response rate of 52 %. The respondents were predominantly male (76 %), with the largest representation from Denmark (82 %), and primarily educated as physicians (62 %). A majority of respondents (73 % [95 % CI: 70 to 76 %]) did not support that supplemental oxygen should always be provided to all severely injured trauma patients without consideration of their arterial oxygen saturation as measured by pulse oximetry (SpO₂), with no significant difference between physicians and non-physicians (p = 0.08). Based on the respondents' preferred dosages, the median initial administered dosage of supplemental oxygen for spontaneously breathing trauma patients with a normal SpO₂ in the first few hours after trauma was 0 (interquartile range [IQR] 0-3) litres per minute, with 58 % of respondents opting not to provide any supplemental oxygen. The lowest acceptable SpO₂ goal in the first few hours after trauma was 94 % (IQR 92-95). In clinical scenarios with TBI, higher dosage of supplemental oxygen and fraction of inspired oxygen (FiO₂) were preferred, as well as targeting partial pressure of oxygen in arterial blood as opposed to adjusting the FiO₂ directly, compared to no TBI.</p><p><strong>Conclusion: </strong>Almost three out of four clinicians did not support the administration of supplemental oxygen to all severely injured trauma patients, regardless of SpO₂. This corresponds to a more restrictive approach than recommended in the current ATLS (2018, 10th ed.) guidelines.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142396314","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 slow negative pleural suction in thoracic trauma patients undergoing tube thoracostomy-A randomised clinical trial.","authors":"Deepak Arora, Indra Singh Choudhary, Akshat Dutt, Niladri Banerjee, Anupam Singh Chauhan, Mahaveer Singh Rodha, Naveen Sharma, Ashok Kumar Puranik, Nishant Kumar Chauhan, Manoj Kumar Gupta, Ramkaran Chaudhary","doi":"10.1016/j.injury.2024.111928","DOIUrl":"https://doi.org/10.1016/j.injury.2024.111928","url":null,"abstract":"<p><strong>Introduction: </strong>Thoracic injuries are prevalent in polytrauma patients, with road traffic accidents being a major cause. In India alone, over 400,000 people were injured in such accidents in 2022. Rib fractures, haemothorax, and pneumothorax are common chest injuries, often managed with tube thoracostomy. While standard procedures for chest tube placement are established, consensus on post-insertion management, particularly regarding negative pleural suction, is lacking. Research on this topic mostly pertains to planned thoracotomies rather than trauma cases. This study seeks to compare outcomes of slow negative suction versus conventional drainage in blunt or penetrating thoracic trauma.</p><p><strong>Methods: </strong>This single-centre, open-label, randomized controlled trial in a western Indian hospital from Jan 2021 to June 2022 included adult patients with thoracic trauma requiring intercostal drainage tubes. Patients needing emergency thoracotomy, mechanical ventilation, or bilateral chest tubes were excluded. Sample size (n = 64) was calculated based on prior studies. Patients were randomly assigned to experimental (slow negative pleural suction) or control (conventional water seal drainage) groups. Both groups received standard care. Primary outcome was time to chest tube removal; secondary outcomes included hospital stay length, complications, and need for further intervention. Data were analysed using SPSS. Significance was set at p < 0.05.</p><p><strong>Results: </strong>During the study 64 patients were randomised into experimental (n = 32) or conventional (n = 32) groups. Most of the patients were males (88 %, n = 56). Both groups had similar baseline characteristics. Experimental group patients had shorter median chest tube duration (3 [IQR 2-3.75] vs. 5 [3-8.75] days, p < 0.001) and hospital stay (5 [4-8.75] vs. 10 [6-16.75] days, p = 0.004). No discomfort was reported with slow continuous negative pleural suction. Mortality was 1 (3 %) in the experimental group vs. 2 (6 %) in the conventional group. Four patients suffered retained haemothorax, with only one occurrence in the experimental group (3 %).</p><p><strong>Conclusion: </strong>Application of slow continuous negative pleural suction to chest tubes in patients of thoracic trauma can decrease the chest tube duration and the hospital stay. This study ought to be followed up with multicentric randomised clinical trials with larger sample sizes to better characterise the effects of slow continuous negative pleural suction.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407394","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":"Enhancing maternal survival in traumatic cardiovascular collapse during pregnancy: A case series on resuscitative hysterotomy (RH) from a level 1 trauma center.","authors":"Neha Aftab, Dia R Halalmeh, Antonia Vrana, Chase Smitterberg, James A Cranford, Gul R Sachwani-Daswani","doi":"10.1016/j.injury.2024.111923","DOIUrl":"https://doi.org/10.1016/j.injury.2024.111923","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Trauma during pregnancy presents multifaceted risks to both the developing fetus and the expectant mother due to pregnancy-induced physiological adaptations that affect the response to traumatic injuries. The infrequent occurrence of cardiac arrest during pregnancy necessitates interventions such as perimortem cesarean section (PMCS), now termed resuscitative hysterotomy. While early resuscitative hysterotomy focused primarily on fetal survival, more recent literature reports substantial maternal benefits. Resuscitative hysterotomy can lead to the restoration of maternal pulse and blood pressure within minutes and has shown potential to improve maternal outcomes. RH has been demonstrated to aid in fetal and maternal survival in hemodynamic unstable pregnant patients before cardiovascular collapse. The linguistic change from PMCS to resuscitative hysterotomy is a shift towards maternal-centric approaches and survival.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;In this series, we evaluate the outcomes of resuscitative hysterotomy performed before or after cardiovascular collapse to maximize maternal survival while concurrently optimizing fetal outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We performed a retrospective case series review of 4 consecutive pregnant trauma patients who underwent RH due to hemodynamic instability. In addition, we conducted a descriptive analysis of all pregnant patients from 2013 to May 2024 who presented due to a traumatic injury but did not require a RH.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The average age of patients undergoing RH was 26.5 ± 6.8 years. All patients were in the third trimester with a mean gestational age of 32.3 ± 0.5 weeks. Fifty percent (50 %) of patients were involved in motor vehicle accidents, one (25 %) pedestrian was hit by a vehicle, and one (25 %) had GSW to the head. The median time to RH was 14.5 min. The mean estimated blood loss (EBL) was 625 mL ±108.9 mL. The maternal survival rate was 50 %, with a fetal survival rate of 100 %. Three patients achieved hemodynamic stability; however, one of the patients progressed to death by neurological criteria. Therefore, we achieved 50 % of maternal survival. A resuscitative hysterotomy was performed due to early signs of maternal hemorrhagic shock and suggestive features of ongoing bleeding (persistent maternal tachycardia despite adequate analgesia and resuscitation, persistent maternal bradycardia, gradual decline of BP, and FHR abnormalities) in three patients. The remaining patient was found to have cardiac arrest at the scene with a brief return of spontaneous circulation and received resuscitative hysterotomy in the ED to restore cardiovascular function.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;RH in pregnant patients with traumatic injury and impending hemorrhagic shock or cardiovascular collapse may provide maternal survival benefits by supporting circulatory function and promoting resuscitation with no additional risks to fetal outco","PeriodicalId":94042,"journal":{"name":"Injury","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142335200","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":"Effects of post rib plating tube thoracostomy output on the need for thoracic re-intervention: Does the volume matter?","authors":"Negaar Aryan, Jeffry Nahmias, Areg Grigorian, Zoe Hsiao, Avneet Bhullar, Matthew Dolich, Mallory Jebbia, Falak Patel, Jacquelyn Hemingway, Elliot Silver, Sebastian Schubl","doi":"10.1016/j.injury.2024.111910","DOIUrl":"https://doi.org/10.1016/j.injury.2024.111910","url":null,"abstract":"<p><strong>Background: </strong>Surgical stabilization of rib fractures (SSRF) has been demonstrated to improve early clinical outcomes. Tube thoracostomy (TT) is commonly performed with SSRF, however there is a paucity of data regarding when removal of TT following SSRF should occur. This study aimed to compare patients undergoing thoracic reinterventions (reintubation, reinsertion of TT/pigtail, or video-assisted thoracic surgery) to those not following SSRF+TT, hypothesizing increased TT output prior to removal would be associated with thoracic reintervention.</p><p><strong>Methods: </strong>We performed a single center retrospective (2018-2023) analysis of blunt trauma patients ≥ 18 years-old undergoing SSRF+TT. The primary outcome was thoracic reinterventions. Patients undergoing thoracic reintervention ((+)thoracic reinterventions) after TT removal were compared to those who did not ((-)thoracic reintervention). Secondary outcomes included TT duration and outputs prior to removal.</p><p><strong>Results: </strong>From 133 blunt trauma patients undergoing SSRF+TT, 23 (17.3 %) required thoracic reinterventions. Both groups were of comparable age. The (+)thoracic reintervention group had an increased injury severity score (median: 29 vs. 17, p = 0.035) and TT duration (median: 4 vs. 3 days, p < 0.001) following SSRF. However, there were no differences in median TT outputs between both cohorts post-SSRF day 1 (165 mL vs. 160 mL, p = 0.88) as well as within 24 h (60 mL vs. 70 mL, p = 0.93) prior to TT removal.</p><p><strong>Conclusion: </strong>This study demonstrated over 17 % of SSRF+TT patients required a thoracic reintervention. There was no association between thoracic reintervention and the TT output prior to removal. Future studies are needed to confirm these findings, which suggest no absolute threshold for TT output should be utilized regarding when to pull TT following SSRF.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142396315","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":"Resuscitative endovascular balloon occlusion of the aorta provides better survival outcomes for noncompressible blunt torso bleeding below the diaphragm compared to resuscitative thoracotomy.","authors":"Chien-An Liao, Shu-Yi Huang, Chih-Po Hsu, Ya-Chiao Lin, Chi-Tung Cheng, Jen-Fu Huang, Hsi-Hsin Li, Wen-Ya Tung, Yi-Jung Chen, Ken-Hsiung Chen, Shih-Tien Wang","doi":"10.1016/j.injury.2024.111916","DOIUrl":"https://doi.org/10.1016/j.injury.2024.111916","url":null,"abstract":"<p><strong>Background: </strong>Resuscitative endovascular balloon occlusion of the aorta (REBOA) serves as a bridging intervention for subsequent definitive haemorrhagic control. This study compared the clinical outcomes of REBOA and resuscitative thoracotomy (RT) in patients with bleeding below the diaphragm.</p><p><strong>Materials and methods: </strong>This retrospective cohort study included adult trauma patients who presented to the Trauma Quality Improvement Program between 2020 and 2021 and who underwent either REBOA or RT in the emergency department (ED). Patients with severe head and chest injuries, characterised by an Abbreviated Injury Scale (AIS) score greater than 3, were excluded. The clinical data of patients treated with REBOA and those treated with RT were compared, and multivariable logistic regression (MLR) was employed to identify prognostic factors associated with mortality.</p><p><strong>Results: </strong>A total of 346 patients were enrolled: 138 (39.9 %) received REBOA, and 208 (60.1 %) received RT at the ED. Patients in the RT group underwent ED cardiopulmonary resuscitation (CPR) more frequently (58.2 % vs. 23.2 %; p < 0.001) and had a higher mortality rate (87.0 % vs. 45.7 %; p < 0.001). Patients who died had lower Glasgow Coma Scale scores (6 [4.5] vs. 11 [4.9]; p < 0.001), underwent more ED CPR (58.6 % vs. 9.8 %; p < 0.001), and received RT more frequently (74.2 % vs. 26.5 %, p < 0.001). The MLR revealed that the major prognostic factors for mortality were systolic blood pressure (odds ratio [OR] 0.988, 95 % confidence interval [CI] 0.978-0.998; p = 0.014), ED CPR (OR 11.111, 95 % CI 4.667-26.452; p < 0.001), abdominal injuries with an AIS score ≥ 4 (OR 4.694, 95 % CI 1.921-11.467; p = 0.001) and RT (OR 5.693, 95 % CI 2.690-12.050; p < 0.001).</p><p><strong>Conclusions: </strong>In cases of blunt trauma, prompt identification of the bleeding source is crucial. For patients with bleeding below the diaphragm, REBOA led to higher survival rates than did RT. However, it is important to consider the limitations of the database and the necessary exclusions from our analysis.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142396316","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":"Identifying opportunities for community EMS fall prevention.","authors":"Tynan H Friend, Alexander J Ordoobadi, Zara Cooper, Ali Salim, Molly P Jarman","doi":"10.1016/j.injury.2024.111915","DOIUrl":"https://doi.org/10.1016/j.injury.2024.111915","url":null,"abstract":"<p><strong>Background: </strong>Falls are a leading cause of morbidity and mortality among older adults in the United States. Current fall prevention interventions rely on provider referral or enrollment during inpatient admissions and require engagement and independence of the patient. Community emergency medical services (CEMS) are a unique opportunity to rapidly identify older adults at risk for falls and provide proactive fall prevention interventions in the home. We describe the demographics and treatment characteristics of the older adult population most likely to benefit from these interventions.</p><p><strong>Materials and methods: </strong>We linked 2019 Healthcare Cost and Utilization Project Massachusetts State Emergency Department (ED) and State Inpatient Databases with American Hospital Association survey data to query ED encounters and inpatient admissions for adults age ≥55 with ED encounters for fall-related injury between July 1, 2019 and December 31, 2019. Univariable descriptive statistics assessed participant characteristics and bivariable tests of significance compared diagnoses, disposition, and hospital characteristics between older adults with and without an EMS encounter in the six months prior to the presenting fall.</p><p><strong>Results: </strong>Of 66,027 older adults who presented with a fall to a Massachusetts ED in July-December 2019, 7,942 (11%) had a prior encounter with EMS in the preceding six months, most of which included an injury diagnosis (99%). Compared to older adults without previous EMS encounters, those with previous EMS encounters were more often in poorer health (17% vs. 10% with multiple or complex comorbidities, p < 0.001) and of lower socioeconomic status (12% vs. 8% in lowest neighborhood income quartile, p < 0.001; 10% vs. 6% enrolled in Medicaid, p < 0.001) compared to those without a prior EMS encounter.</p><p><strong>Conclusions: </strong>A significant proportion of older adults presenting to the ED with fall related injury have encounters with EMS in the preceding months. These participants are predisposed to poorer health and economic outcomes worsened by their fall and thus demonstrate a population that would benefit from CEMS fall prevention programs.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142335201","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":"Clinical patterns and outcomes of hospitalized patients with grinder-related neurovascular injuries: A decade of experience from a Level I Trauma center.","authors":"Hassan Al-Thani, Ayman El-Menyar, Mohammad Asim, Ibrahim Afifi","doi":"10.1016/j.injury.2024.111914","DOIUrl":"10.1016/j.injury.2024.111914","url":null,"abstract":"<p><strong>Background: </strong>Occupational injuries impose a substantial global burden, affecting millions of workers annually, which demands urgent attention to enhance workplace safety and health standards. We aimed to outline the frequency, patterns of injury, and clinical characteristics of patients injured by high-rotation cutting tools (grinders) and to pinpoint the neurovascular (nerves and blood vessels) injuries.</p><p><strong>Methods: </strong>A retrospective study was conducted and included all adult patients hospitalized because of grinder-related injuries at the only level I Trauma Center in the country. The characteristics of patients, mechanism of injury, management and outcomes were analyzed based on the anatomical location of injuries.</p><p><strong>Results: </strong>127 patients were hospitalized with grinder-related injuries over ten years. The incidence of GRIs showed an increasing trend over the years. All patients were males with a mean (SD) age of 34.9 (9.8) years. The majority were general laborers (66.1 %), injured by portable grinders (86.6 %), and direct blade contact (64.6 %). The median Injury Severity Score (ISS) was 5.0(IQR 4.0-9.0), and the median Glasgow Coma Scale (GCS) at ED was 15 (3-15). The most frequently injured part was the upper extremity (36.2 %), followed by the lower extremity (33.9 %) and the face (27.6 %). One-third of cases had vascular injuries, and 23.6 % had nerve injuries. Suturing was done for all patients; repairs and debridements were performed in 62 % and 58 % of cases, respectively, and 21 % required vascular surgery. Amputations were required in 9.4 % of cases. Thirty patients had nerve injuries involving the median (11 %) and radial (9.4 %) nerves. Among patients who had neurovascular injuries, 30 % (12/40) experienced complications during the hospital stay, while 60 % (24/40) ended up with physical disabilities.</p><p><strong>Conclusion: </strong>Individuals affected by power-tool accidents were predominantly young males, mainly general laborers, with a significant proportion being expatriates. The trend of grinder-related injuries increases over time, with portable grinders being a primary source of injuries due to direct contact with the blade. The anatomical injuries mainly include fractures of the upper and lower extremities. Further studies are warranted to understand the cultural aspects and training requirements of workers handling power tools, aiming to achieve sustainable injury prevention effectively.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376401","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":"Incidence, severity and changes of abnormal vital signs in trauma patients: A national population-based analysis.","authors":"Ingrid Aalberg, Trond Nordseth, Pål Klepstad, Leiv Arne Rosseland, Oddvar Uleberg","doi":"10.1016/j.injury.2024.111884","DOIUrl":"https://doi.org/10.1016/j.injury.2024.111884","url":null,"abstract":"<p><strong>Background: </strong>Physiological criteria are used to assess the potential severity of injury in the early phase of a trauma patient's care trajectory. Few studies have described the extent of abnormality in vital signs and different combinations of these at a national level. Aim of the study was to identify physiologic abnormalities in trauma patients and describe different combinations of abnormalities and changes between the pre-hospital and emergency department (ED) settings.</p><p><strong>Method: </strong>Norwegian Trauma Registry (NTR) data between 01.01.15 - 31.12.18, where evaluated on the prevalence and characteristics of abnormal physiologic variables. Primary outcome were rates of hypoventilation (respiratory rate [RR] < 10 breaths per min), hyperventilation (RR > 29 breaths per min), hypotension (systolic blood pressure [SBP] < 90 mmHg), and reduced level of consciousness (Glasgow Coma Scale [GCS] < 13).</p><p><strong>Results: </strong>A total of 24,482 patients were included. Documented values for RR, SBP and GCS were 77.6%, 78.5% and 81.9% in the pre-hospital phase, and the corresponding percentages in the ED were 95.5%, 99.2% and 98.6%, respectively. In the pre-hospital phase, 3,615 (14.8%) patients had at least one abnormal vital sign, whereas the corresponding numbers in the ED, were 3,616 (14.8%) patients. The most frequent combination was low GCS and hyperventilation. A worsened RTS-score from pre-hospital phase to the ED was observed for RR, SBP and GCS in 3.9%, 1.2% and 1.9% of incidents, respectively. Overall 30-day mortality was 3.1% (n=752). Of these, 60.8% had abnormal vital signs, with decreased GCS as the most prevalent (61.3%).</p><p><strong>Conclusion: </strong>Most trauma patients had normal vital signs. According to the RTS-score, there were few deteriorations in RR, SBP and GCS between pre-hospital phase and the ED. The most frequent abnormality was low GCS, with a higher proportion in those who died within 30 days.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142335202","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":"Timing of ultra-portable ultrasound (UPUS) Examinations in detecting clinically concerning recurrent pneumothorax.","authors":"Abdul Hafiz Al Tannir, Courtney J Pokrzywa, Thomas W Carver, Elise A Biesboer, Juan F Figueroa, Basil Karam, Marc A de Moya, Patrick B Murphy","doi":"10.1016/j.injury.2024.111872","DOIUrl":"https://doi.org/10.1016/j.injury.2024.111872","url":null,"abstract":"<p><strong>Background: </strong>Recurrent pneumothorax (rPTX) is a common complication following thoracostomy tube (TT) removal in chest trauma patients. While chest X-ray (CXR) is most commonly used to detect a rPTX, bedside ultraportable ultrasound (UPUS) is a feasible, low cost, and radiation free alternative. No consensus exists with regards to the optimal timing of diagnostic imaging to assess for rPTX post-TT removal. Accordingly, we sought to identify an ideal UPUS timing to detect a rPTX METHODS: We conducted a single center prospective study of adult (≥18years) patients admitted with a chest trauma. UPUS examinations were performed using the Butterfly iQ⁺™ ultrasound. Three intercostal spaces (ICS) were evaluated (2nd through 4th). Post-TT UPUS examinations were performed at different timepoints following tube removal (1-6 h). A rPTX on UPUS was defined as the absence of lung-sliding in one or more intercostal spaces, and was considered a clinically concerning rPTX if lung-sliding was absent in ≥2 ICS. UPUS findings were compared to CXR.</p><p><strong>Results: </strong>Ninety-two patients (97 hemi-thoraces) were included in the analysis. A total of 58 patients had a post-TT removal rPTX of which 11 were either clinically concerning or expanding. Comparing UPUS findings to CXR, the 3-hour post-TT removal ultrasound examinations were associated with the highest sensitivity. By hour 4, no rPTX showed expansion in size. Three patients required an intervention for a clinically concerning rPTX, all of whom were detected on UPUS 3-hour post-TT removal.</p><p><strong>Conclusion: </strong>Bedside UPUS performed at 3-hour post-TT removal has the highest sensitivity in detecting clinically concerning rPTX. Size of rPTX appears to stabilize by hour 4. In the absence of clinical symptoms, repeat imaging or observation of non-significant rPTX beyond 4 h may not provide added clinical benefit.</p><p><strong>Level of evidence: </strong>Level II, Diagnostic Tests or Criteria.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142335203","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":"Does PIC score pick correctly? Evaluation of a modified-PIC based admission a single institution retrospective cohort study.","authors":"Courtney H Meyer, Mari Freedberg, Janelle Tanghal, Christine Castater, Crystal T Nguyen, Randi N Smith, Jason D Sciarretta, Jonathan Nguyen","doi":"10.1016/j.injury.2024.111860","DOIUrl":"https://doi.org/10.1016/j.injury.2024.111860","url":null,"abstract":"<p><strong>Introduction: </strong>The Pain, Inspiratory effort, Cough score (PIC) has been developed and widely adopted to guide clinical prognostication for patients with chest wall injury. To date, the efficacy, accuracy, and safety of a PIC based triage system has not been validated. Therefore, this study sought to evaluate the use of a modified-PIC score to triage and down-grade trauma patients with chest wall injury at a single institution.</p><p><strong>Methods: </strong>A retrospective study was conducted at a large, Level I Trauma Center on patients with chest wall injuries admitted between 1/1/2018-10/31/20,222. On 12/1/2020, our institution implemented a modified-PIC triage tool including the PIC score, age, and severity of chest wall injury. The Pre-PIC (1/1/2018-11/20/2020) and Post-PIC (1/1/2021-10/31/2022) groups were composed based on admission date and outcomes between the two were compared.</p><p><strong>Results: </strong>2,627 patients comprised the Pre-PIC group and 2,212 patients comprised Post-PIC. The groups didn't differ significantly in demographics or mechanisms of injury except for COVID status. Post-intervention, a greater proportion of patients were triaged to the intermediate care unit instead of the ICU or floor. There were no significant differences in hospital length of stay (LOS), ventilator days, unplanned ICU admission, or mortality in Pre-PIC vs Post-PIC. ICU LOS, rates of ARDS, and cardiac arrest with return of spontaneous circulation (ROSC) were significantly lower in Post-PIC. Multivariable models demonstrated significantly lower ARDS rates and ICU free days. ICU LOS trended towards significance as well.</p><p><strong>Conclusions: </strong>This is the largest study, to date, evaluating the impact of a modified-PIC triage system on clinical outcomes. The results suggest a modified-PIC triage system may lead to decreased ICU days, ARDS rates, and rates of cardiac arrest w/ ROSC, potentially improving hospital resource allocation. Further prospective and multi-center studies are needed to validate our understanding on the impact of a chest wall scoring system on triage and outcomes.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142304839","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}