Injury最新文献

{"title":"An epidemiological analysis of extracorporeal membrane oxygenation use in trauma.","authors":"Marianne C Wallis, Julie A Rizzo, Erika R O'Neil, Valerie G Sams, Steven G Schauer","doi":"10.1016/j.injury.2026.113271","DOIUrl":"https://doi.org/10.1016/j.injury.2026.113271","url":null,"abstract":"<p><strong>Background: </strong>Trauma is the leading cause of death in younger adults and children. Severe polytrauma predisposes patients to the failure of multiple organ systems, including the cardiovascular and respiratory systems, at times necessitating extracorporeal membrane oxygenation (ECMO). ECMO use in the setting of trauma is increasing, yet little data exists describing current practice patterns. We performed an epidemiological analysis of ECMO use and outcomes in trauma patients.</p><p><strong>Study design and methods: </strong>We analyzed data from the Trauma Quality Improvement Program Registry from 2017 to 2023. Procedure codes were used to identify the application of ECMO. Pediatric patients were those < 18 years of age. We analyzed two groups from this data set: one including all patients who required ECMO and a separate group including only pediatric cases. We used descriptive and inferential statistical methods.</p><p><strong>Results: </strong>There were 8,014,737 encounters of which 1919 had documented ECMO use. Within that group, 224 were < 18 years of age. The median time from hospital arrival to the first initiation of ECMO was 44 h (interquartile range [IQR] 5-147). The incidence per year ranged from 1.9 to 2.9 events per 10,000 encounters. Survival ranged from 59% to 68% per year. The number of facilities with documented ECMO use annually ranged from 103 to 158 and overall increased during the time of the study. Interfacility transfer was common but was not related to survival.</p><p><strong>Discussion: </strong>ECMO use demonstrated steady growth in the number of performing facilities throughout the study period. Survival was similar to previous reports. Our findings will help inform targeted clinical guidelines for the use of ECMO in adult and pediatric trauma populations.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"113271"},"PeriodicalIF":2.0,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719297","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 \"Multiple iliosacral screws in a single osseous fixation pathway: Utility and safety\".","authors":"Mustafa Mert Terzi, Kadir Bahadır Alemdaroğlu","doi":"10.1016/j.injury.2026.113256","DOIUrl":"https://doi.org/10.1016/j.injury.2026.113256","url":null,"abstract":"","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"113256"},"PeriodicalIF":2.0,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679587","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":"Letter to the Authors of 'Lessons learned: The thematic analysis of eight countries with mature trauma systems'.","authors":"Rafael Consunji, Ayman El-Menyar, Ruben Peralta, Husham Abdelrahman, Sandro Rizoli, Hassan Al-Thani","doi":"10.1016/j.injury.2026.113248","DOIUrl":"https://doi.org/10.1016/j.injury.2026.113248","url":null,"abstract":"","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"113248"},"PeriodicalIF":2.0,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679629","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 \"Suture button versus syndesmotic screw fixation in acute ankle fractures with syndesmotic injury: An umbrella review of functional outcomes and clinical relevance based on the minimal clinically important difference\".","authors":"Manish Juneja, Harshawardhan Ramteke, Rakhshanda Khan","doi":"10.1016/j.injury.2026.113251","DOIUrl":"https://doi.org/10.1016/j.injury.2026.113251","url":null,"abstract":"","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"113251"},"PeriodicalIF":2.0,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694253","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":"Shock and Trauma Risk Index Nomogram (STRIN): A bedside physiology-based tool for early-high-acuity care triage in major trauma.","authors":"S Saronni, G Mecca, C Rampin, A Agarossi, A Ripoll-Gallardo, G Colzani, S Cimbanassi, O Chiara","doi":"10.1016/j.injury.2026.113214","DOIUrl":"https://doi.org/10.1016/j.injury.2026.113214","url":null,"abstract":"<p><strong>Background: </strong>Major trauma is a leading cause of mortality and permanent disability, especially in younger adults. Early identification of high-risk patients is critical for appropriate care. Tools like the Shock Index (SI) or New Trauma Score (NTS) enable rapid bedside assessment but show variable performance across populations.</p><p><strong>Objective: </strong>To develop and internally test the Shock Trauma Risk Index Nomogram (STRIN), integrating Shock Index (SI), Glasgow Coma Scale (GCS), oxygen saturation (SpO₂), and mean arterial pressure (MAP) for early risk stratification of time-critical resource use in major trauma.</p><p><strong>Methods: </strong>Data of a retrospective cohort (March 2022-December 2024) from a single level-1 centre retrieved from Lombardy registry was considered. Adult patients (≥16 years) with major trauma and complete vital signs were included. Composite outcome was emergency surgery (ES) within 6 h, massive transfusion (MT) (≥10 units of packed red blood cells within 24 h or ≥4 units within first hour), Intensive Care Unit (ICU) admission and interventional radiology procedures (IR). The model was developed using multivariable logistic regression with Restricted Cubic Splines. Performance was assessed through discrimination (AUROC), calibration (Hosmer-Lemeshow test, Brier score), and internal testing via bootstrap resampling. Comparative performance against SI and NTS included AUROC, Net Reclassification Improvement (NRI), Integrated Discrimination Improvement (IDI), and Decision Curve Analysis (DCA).</p><p><strong>Results: </strong>Among 611 patients, STRIN demonstrated superior discrimination (AUROC = 0.8441 [95% CI 0.813-0.875]) compared to SI (0.6979 [0.6566-0.7392]) and NTS (0.7582 [0.7212-0.7953]; p < 0.001 for both comparisons). STRIN showed satisfactory calibration (Hosmer-Lemeshow p = 0.096), lower Brier score (0.157), and minimal bias-corrected error (0.017). DCA revealed higher net benefit across clinically relevant thresholds. Compared to SI and NTS, STRIN achieved significant NRI (0.519 and 0.484, respectively) and IDI (0.179 and 0.107). Bootstrap testing confirmed model stability (optimism-corrected AUROC = 0.782; calibration slope = 0.98).</p><p><strong>Conclusions: </strong>STRIN is a pragmatic, high-performing model for early risk stratification of time-critical interventions in major trauma. Leveraging four readily available physiological parameters, it offers a clinically actionable alternative to existing scores. External validation is ongoing across Lombardy; STRIN holds promise for integration into prehospital and emergency workflows to support timely, physiology-based decision-making in trauma care.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"113214"},"PeriodicalIF":2.0,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147629636","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 \"Orthopedic trauma in pregnancy: A literature review\" (Fang et al., Injury).","authors":"Jaroslaw Pecold, Lukasz Szarpak, Mahdi Al-Jeabory, Robert Weglowski","doi":"10.1016/j.injury.2026.113213","DOIUrl":"https://doi.org/10.1016/j.injury.2026.113213","url":null,"abstract":"","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"113213"},"PeriodicalIF":2.0,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679569","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":"The role of palliative care in older persons trauma.","authors":"Mark Baxter","doi":"10.1016/j.injury.2026.113212","DOIUrl":"https://doi.org/10.1016/j.injury.2026.113212","url":null,"abstract":"","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"113212"},"PeriodicalIF":2.0,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679670","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":"Delivering psychosocial care and support in traumatic injury follow-up: A qualitative study of clinician's experiences.","authors":"Elizabeth Wake, Jamie Ranse, Andrea P Marshall","doi":"10.1016/j.injury.2026.113198","DOIUrl":"https://doi.org/10.1016/j.injury.2026.113198","url":null,"abstract":"<p><strong>Introduction: </strong>The purpose of trauma follow-up care after hospital discharge is to support patients with serious injuries recover to their fullest extent. Whilst the physical health of patients is a central focus of follow-up care, psychosocial support is described as challenging and inadequate, with few trauma follow-up services able to provide integrated psychosocial support inclusive of routine access to psychosocial experts. As trauma follow-up care within Australia and New Zealand (Australia and New Zealand) is predominantly provided by nursing and medical trauma clinicians, exploring how psychosocial care and support is provided by these clinicians is warranted. The broad aim of this qualitative study was to explore trauma clinicians' experiences in providing trauma follow-up care with this paper focusing on the provision of psychosocial care and support.</p><p><strong>Methods: </strong>Semi-structured interviews were used to explore the experiences of trauma clinicians in providing follow-up care after hospital discharge to patients who have experienced serious injury. Twenty participants were purposively selected from public hospitals throughout Australia and New Zealand who provided trauma follow-up care after hospital discharge. Qualitative data were transcribed verbatim and analysed using inductive content analysis.</p><p><strong>Results: </strong>Psychosocial care and support provided by trauma service clinicians during follow-up appointments to patients who have experienced serious injuries can be separated into three categories: (i) recognising the importance of psychosocial health after injury; (ii) components of psychosocial care which has three sub-categories of (a) comprehensive psychosocial care and support; (b) variability in assessment; (c) health care practitioner preparedness to provide psychosocial support; and (iii) access to psychological services.</p><p><strong>Conclusion: </strong>Trauma clinicians recognise the importance of providing psychosocial care and support to patients who experience serious injury. In the absence of routine access to expert psychosocial/psychological practitioners, trauma clinicians provided psychosocial support using a variety of approaches which results in disparities in how psychosocial care is provided to patients in Australia and New Zealand. Implementation of a standardised assessment to psychosocial health, in conjunction with an anticipatory framework to assist trauma clinicians in providing psychosocial care and support, may provide a partial solution, and reduce the incidence of psychosocial issues and improve an individual's quality of life following serious injury.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"113198"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147617274","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":"Predictors of traumatic brain injury amongst secondary school students in England: A retrospective cohort study using electronic health records.","authors":"M T Benavente, R Wilson, J Jackson, K Birnie, J Mytton, S Ijaz, M Booker, A Burrell, A Hall, G Haythornthwaite, J Hong, M D Lyttle, L Pocock, L J Scott, C Williams, I Wright, J Savović, M T Redaniel","doi":"10.1016/j.injury.2026.113168","DOIUrl":"https://doi.org/10.1016/j.injury.2026.113168","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) in children and adolescents is a leading cause of disability and mortality, with long-term health-related consequences. There is little evidence describing the children and adolescents most at risk of TBI.</p><p><strong>Objective: </strong>To identify the demographic and clinical predictors of TBI in secondary school-aged children in England.</p><p><strong>Participants and setting: </strong>Linked Clinical Practice Research Datalink and Hospital Episode Statistics Admitted Patient Care data were used to identify patients aged 11-18 years registered with a GP surgery in England between 2013 and 2021.</p><p><strong>Methods: </strong>Multivariable Cox regression was used to assess the association between demographic and clinical risk factors and time to medically attended TBI.</p><p><strong>Results: </strong>The analytical sample included 402,249 children, 2.3% of which had a TBI presenting to primary or hospital care when aged 11-18 years. In the fully adjusted model, increased risk of TBI was associated with being male; less socioeconomically deprived; having a history of fracture, abuse, depression, or previous TBI; having two or more previous GP visits, having more previous Emergency Department visits; and having fewer hospital admissions.</p><p><strong>Conclusion: </strong>Using a nationally representative dataset we were able to identify which children were most at risk of TBI in their secondary school years. TBI is often preventable and targeted interventions could be aimed at these children and their families.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"113168"},"PeriodicalIF":2.0,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147625273","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":"Video review analysis of early common femoral arterial access in trauma: Can we identify occult shock?","authors":"Shyam Murali, Jeremy Cannon, Sarah Joergensen, Alea Iris Zone, Liam Forsythe, Martha Brinson, Kristen Chreiman, Benjamin S Abella, Frances Shofer, Zaffer Qasim","doi":"10.1016/j.injury.2026.113169","DOIUrl":"https://doi.org/10.1016/j.injury.2026.113169","url":null,"abstract":"<p><strong>Background: </strong>Early common femoral artery (CFA) access in trauma resuscitation has the potential to improve hemodynamic monitoring and facilitate interventions. However, data on its utilization and impact are limited. This study aimed to collect objective data on early CFA access.</p><p><strong>Methods: </strong>We conducted a prospective observational study using trauma video review at a Level 1 trauma center. Critically injured trauma patients were included based on predefined criteria. Video and chart review were used to collect data on patient demographics, injury characteristics, procedural details of CFA access (including time of procedural milestones), and hemodynamic measurements. Trauma team leaders were also surveyed to determine their impressions on early arterial access.</p><p><strong>Results: </strong>Among 72 patients, 34.7% underwent early CFA access. Early CFA access was associated with blunt mechanism (p < 0.001), lower presenting GCS (p = 0.006), and worse functional status at discharge (p = 0.028). The median time from arrival to visualizing an arterial waveform was 16.5 min (IQR 13.2, 26.2). Ultrasound improved first-pass success rates (median attempt number: 1 vs 2, p = 0.030). Noninvasive systolic blood pressure measurements were, on average, 13.5 mmHg higher than invasive measurements; the discrepancy was more pronounced in patients with arterial SBP < 90 mmHg, and 9 paired measurements revealed occult shock diagnosed only by CFA access. Early CFA access was associated with a longer time to incision (49 min [IQR 42-69] vs 34 min [IQR 26-37]; p = 0.002), but not with a delay in time to hemostasis (162 [IQR 127-220] vs 160 [IQR 92-271]; p > 0.999).</p><p><strong>Conclusions: </strong>Early CFA access in trauma resuscitation is feasible and can be performed rapidly, particularly with the use of ultrasound. While early CFA access may increase time to incision, it does not delay hemostasis. Further research should evaluate the direct impact of early CFA access on patient outcomes and resource utilization.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"113169"},"PeriodicalIF":2.0,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147535266","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}