Injury最新文献

{"title":"Timeliness of injury care and housing status.","authors":"Hannah Decker, Jennifer Evans, Dave Graham Squire, Sara Colom, Kenneth Perez, Maria Raven, Rebecca Plevin, Hemal K Kanzaria, Anne Stey","doi":"10.1016/j.injury.2025.112531","DOIUrl":"https://doi.org/10.1016/j.injury.2025.112531","url":null,"abstract":"<p><strong>Background: </strong>Unhoused people have longer hospital lengths of stays than housed. This study examined if unhoused people have less timely injury care than housed.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of adult injury encounters from January 2015 - December 2022 at the only level 1 trauma center in an urban county. We merged the trauma registry with a county-wide integrated dataset to reliably identify our primary exposure: housing status in the fiscal year of injury. The primary outcome was time to the operating room in hours. Secondary outcomes were emergency department (ED) length of stay in minutes and additional timeliness measures. Multivariable linear regression models with clustered standard errors estimated the association of housing status with each log-transformed outcome, adjusting for clinical and demographic covariates.</p><p><strong>Results: </strong>Among 21,264 trauma encounters, 18.8 % (N = 4003) were in unhoused people. Unhoused and housed people had similar adjusted times to operating room (9.2 versus 9.9 h; adjusted geometric mean ratio 1.07 (95 %CI 0.97-1.19; p = 0.19). ED length of stay was 17 % longer for unhoused people compared to housed (381 versus 326 min); adjusted geometric mean ratio 1.17, 95 %CI 1.13-1.21; p < 0.001). There were no clinically significant differences in Emergency Medical Services (EMS) transport time, EMS scene time, time to venous thromboembolism prophylaxis, nor time to angiography by housing status.</p><p><strong>Conclusions: </strong>Timeliness of injury care is similar between unhoused and housed people.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"112531"},"PeriodicalIF":0.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546656","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":"Computed tomography-detected hemothorax after blunt chest trauma: Does everyone need an intervention? A retrospective analysis.","authors":"Ismail Mahmood, Ali Alomar, Syed Nabir, Mohammad Asim, Zahoor Ahmed, Mohamed Nadeem Ahmed, Ayman El-Menyar, Monira Mollazehi, Ruben Peralta, Khalid Ahmed, Sandro Rizoli, Hassan Al-Thani","doi":"10.1016/j.injury.2025.112532","DOIUrl":"https://doi.org/10.1016/j.injury.2025.112532","url":null,"abstract":"<p><strong>Background: </strong>The frequent use of computed tomography (CT) scan in the evaluation of trauma patients has led to an increase in the diagnosis of hemothorax. This study aimed to assess whether a hemothorax volume of <300 ml, as determined by CT imaging, can be managed without tube thoracostomy and to identify the factors that recommend its use.</p><p><strong>Methods: </strong>A retrospective observational study was conducted at XXX Trauma Center, including all patients with traumatic hemothorax from June 2014 to January 2020. Patient demographics, injury mechanism, severity, associated chest injuries, indications for tube thoracostomy, mechanical ventilation, hospital length of stay, complications, and outcomes were reviewed. The study compared patients with hemothorax volumes < 300 ml and ≥300 ml and assessed the outcomes of conservative management without tube thoracostomy (conservative management) vs therapeutic management with tube thoracostomy placement (failed observation).</p><p><strong>Results: </strong>A total of 254 patients with hemothorax were included. Most patients (79 %) were successfully managed without tube thoracostomy insertion, while 53 patients (21 %) required tube thoracostomy after failure of conservative management. Patients with larger hemothorax volumes were significantly more likely to require tube thoracostomy (p = 0.001) and had significantly longer hospital stays (p = 0.021). Those with failed observation had higher injury severity scores (p = 0.001), more associated lung contusions (p = 0.015), pneumothorax (p = 0.024), and rib fractures (p = 0.001). They also had larger hemothorax volumes (p = 0.001), a greater need for mechanical ventilation (p = 0.001), and prolonged hospitalization (p = 0.001). Predictors of failed observation included high hemothorax volume (≥300 ml), ISS, and greater number of fractured ribs.</p><p><strong>Conclusion: </strong>Conservative management (without tube thoracostomy) was adequate for most patients with <300 ml of hemothorax volumes. Quantitative assessment of hemothorax volume should be considered part of the clinical decision-making algorithm. Further research is needed to refine management strategies and improve outcomes for traumatic hemothorax.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"112532"},"PeriodicalIF":0.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487535","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":"Resuscitation at a cost: Excessive perioperative crystalloid administration is associated with increased fascial complications following damage control laparotomy for trauma.","authors":"Peter B DePhillips, Saskya Byerly, Peter E Fischer, Andrew J Kerwin, Thomas S Easterday, Nabajit Choudhury, Sara Soule, Sam Fasbinder, Dina M Filiberto, Isaac W Howley","doi":"10.1016/j.injury.2025.112521","DOIUrl":"https://doi.org/10.1016/j.injury.2025.112521","url":null,"abstract":"<p><strong>Introduction: </strong>Over the past two decades, damage control laparotomy and resuscitation (DCL and DCR, respectively) have become the dominant paradigms for the management of exsanguinating trauma. Fascial complications are common after DCL. Minimizing crystalloid administration is a key component of DCR, but there is little direct evidence that it reduces fascial complications. This study was designed to test the hypothesis that lower crystalloid administration volume during the perioperative period for DCL is associated with an increase in fascial closure rates and a decreased rate of fascial dehiscence.</p><p><strong>Methods: </strong>This was a retrospective observational study at a single urban trauma center. Adult trauma patients who underwent emergent DCL between March 2019 - December 2022 were included. Patients who died within 7 days of definitive closure or underwent additional intracavitary operations (e.g., thoracotomy) before or concurrent with laparotomy were excluded. Risk factors for fascial dehiscence and planned ventral hernia (PVH) were evaluated using univariate and multiple logistic regression analysis.</p><p><strong>Results: </strong>Among 287 included patients, median age was 32 (IQR 23-44), median injury severity score (ISS) 25 (17-34), median base deficit 6 (2-9), and 56.1 % had penetrating mechanism. The median crystalloid intravenous fluid (IVF) received from prehospital period to 48 h after index operation was 16.3 L (13.0-20.1 L). ISS, base deficit, and vital signs (systolic blood pressure, heart rate, and respiratory rate) did not differ between patients discharged with PVH or primary fascial closure, nor between patients who experienced a documented dehiscence event versus those who did not. Crystalloid volume was statistically different across both comparisons (primary fascial closure vs PVH at discharge: 15.6 vs 20.5 L, p < 0.001; no dehiscence vs any dehiscence 15.0 vs 18.1 L, p < 0.001). By multiple logistic regression, early IVF administration was associated with both PVH at discharge (odds ratio (OR) 1.14, 95 %CI 1.07-1.23) and fascial dehiscence (OR 1.17, 95 %CI 1.04-1.20).</p><p><strong>Conclusion: </strong>Increased volume of perioperative crystalloid is associated with higher risk of fascial complications among patients requiring DCL for trauma. The DCR paradigm may reduce surgical complications as well as mortality among patients with severe trauma requiring laparotomy.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"112521"},"PeriodicalIF":0.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144510083","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":"Early versus late venous thromboembolism prophylaxis in patients with severe blunt solid organ injury.","authors":"Aryan Rafieezadeh, Kartik Prabhakaran, Anna Jose, Jordan Kirsch, Bardiya Zangbar","doi":"10.1016/j.injury.2025.112524","DOIUrl":"10.1016/j.injury.2025.112524","url":null,"abstract":"<p><strong>Background: </strong>Patients with blunt solid organ injury (BSOI) face heightened thromboembolic risks, prompting scrutiny of early versus late venous thromboembolic (VTE) prophylaxis effects.</p><p><strong>Methods: </strong>Analyzing TQIP data (2017-2019) for adults (≥18 years) with severe BSOI under non-operative management and VTE prophylaxis, we classified patients into early (≤48 h) and late (>48 h) prophylaxis groups. We conducted a propensity score matching (PSM) to balance the population based on demographics, organ injury severity, vital signs and need for blood transfusion. Data were compared post-PSM.</p><p><strong>Results: </strong>Among 23,668 patients, mortality was 3.1 %, with 42.2 % receiving early and 57.8 % late VTE prophylaxis. Early prophylaxis correlated with lower mortality (2.1 % vs. 3.9 %), lower rates of failure of non-operative management (12.4 % vs. 16.6 %), stroke (0.7 % vs. 1.2 %), DVT (2.1 % vs. 4.9 %) and PE (1.4 % vs. 2.3 %) (p < 0.001 for all). Late prophylaxis associated with longer hospitalization and ICU stays (p < 0.001 for both). Post-match data showed that compared to early VTE prophylaxis, patients that received late VTE prophylaxis had higher mortality rates (2.5 % vs. 1.9 %), failure of non-operative management (14.6 % vs. 11.8 %), longer hospital (15.8 (8.7) vs. 12.4 (6.7) days) and ICU (8.9 (4.7) vs. 6.8 (3.4) days) LOS, and higher rates of developing thrombotic complications during hospital stay (p < 0.05, for all).</p><p><strong>Conclusion: </strong>Early VTE prophylaxis not only proves safe for isolated solid organ injury patients but also is associated with lower mortality, mitigating thromboembolic risks and shortening hospital and ICU stays.</p><p><strong>Level of evidence: </strong>Level III retrospective study.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"112524"},"PeriodicalIF":0.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340784","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":"Impact of anticoagulant therapy on delayed intracranial haemorrhage after traumatic brain injury: A study on the role of repeat CT scans and extended observation.","authors":"Jacopo Davide Giamello, Gianpiero Martini, Chiara Fulcheri, Gian Luca Visconti, Sara Curtetti, Jessica Lakehal, Luca Panuele, Salvatore D'Agnano, Alessia Poggi, Francesco Tosello, Giuseppe Romano, Remo Melchio, Andrea Sciolla, Luigi Fenoglio, Enrico Lupia, Giuseppe Lauria","doi":"10.1016/j.injury.2025.112523","DOIUrl":"10.1016/j.injury.2025.112523","url":null,"abstract":"<p><strong>Introduction: </strong>Traumatic brain injury (TBI) is a major contributor to emergency department (ED) visits worldwide, with older adults being particularly susceptible due to fall-related injuries. The widespread use of anticoagulants, including direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs), raises concerns about the risk of delayed intracranial haemorrhage (dICH), even in cases where the initial head computed tomography (CT) scan shows no abnormalities. The optimal strategies for managing and monitoring these patients remain a subject of ongoing debate.</p><p><strong>Materials and methods: </strong>We conducted a monocentric retrospective observational study at Santa Croce e Carle Hospital, Cuneo, Italy, from January 2019 to August 2024. We included patients aged ≥18 years, on chronic anticoagulant therapy, presenting with mild TBI (GCS ≥13) and a negative initial CT scan. All patients underwent a second CT after 24 h of observation, regardless of clinical changes. The primary outcome was the incidence of dICH. Secondary outcomes included neurosurgical interventions and 30-day mortality.</p><p><strong>Results: </strong>The study included 596 patients (median age 83 years; 46.5 % male). Most patients were on DOACs (74.5 %), and falls were the most common trauma mechanism (90.4 %). dICH was diagnosed in 2 % of patients (n = 12), with subarachnoid haemorrhage and subdural hematoma being the most frequent findings (5 patients each). None of the dICH cases required neurosurgical intervention or resulted in mortality at 30 days. Patients with dICH were more likely to have a GCS <15 upon arrival (16.7 % vs. 3.9 %; p = 0.17) and experienced high-energy trauma mechanism, (16.7 % vs. 1.7 %; p = 0.044); among patients with dICH, 41.7 % were on VKA therapy, compared to 25.2 % of patients without dICH (p = 0,33). Complications during hospitalization, primarily nosocomial infections and delirium, occurred in 66 % of patients hospitalized for dICH.</p><p><strong>Conclusion: </strong>Our findings confirm that dICH after TBI in anticoagulated patients with a negative initial CT is rare and typically benign. Routine prolonged observation and repeat CTs may not be necessary for all patients, particularly those without high-risk factors; individualized management based on clinical risk factors could minimize unnecessary hospitalizations, reduce complications, and optimize healthcare resources.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"112523"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334652","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":"Intraoperative assessment of syndesmotic instability: What technique minimizes surgeon error?","authors":"James Amis","doi":"10.1016/j.injury.2025.112472","DOIUrl":"https://doi.org/10.1016/j.injury.2025.112472","url":null,"abstract":"","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"112472"},"PeriodicalIF":0.0,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304103","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":"A prospective multi-site cohort study on the prevalence of frailty in patients aged over 70 years presenting after serious injury and implications for outcomes.","authors":"Anthony P Joseph, Bonnie M Liu, Martie Botha, Elizabeth Wake, James E Hardy, Bhavik Patel, Sarah N Hilmer","doi":"10.1016/j.injury.2025.112514","DOIUrl":"https://doi.org/10.1016/j.injury.2025.112514","url":null,"abstract":"<p><strong>Introduction: </strong>Major Trauma Hospitals are receiving increasing numbers of older patients after serious injury. Outcomes in these patients vary with the nature of the injury and other factors such as frailty. We aimed to determine the prevalence of frailty and adverse events in older patients managed by acute trauma services during the index hospital admission, and the frequency of adverse outcomes at three, six and twelve months after discharge in an Australian setting.</p><p><strong>Methodology: </strong>This study assessed the prevalence of frailty in a prospective multicentre cohort study of seriously injured patients aged ≥ 70 years admitted to three Major Trauma Services in Australia. Patients were followed for twelve months after injury to assess for adverse outcomes associated with the presence of frailty or other factors. During the index admission patients were assessed for frailty, co-morbidities, Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). Patients were monitored for adverse events and whether a Geriatrician review occurred. Outcomes assessed at three, six and twelve months included increased dependency, falls, confusion, readmission to hospital, transfer to a Residential Aged Care Facility and death.</p><p><strong>Results: </strong>217 patients were recruited between 2018 and 2023 across the three hospitals. At index admission, 32 (14.7%) patients were frail and another 28 (12.9%) were near frail. Geriatrician review was more likely for frail patients and there were similar rates of inpatient complications for both frail and non-frail patients. Frailty at index admission was associated with increased dependency, falls, readmission and confusion at three, six and twelve months and with an increased risk of death at three and six months.</p><p><strong>Conclusions: </strong>Frailty was associated with delayed adverse outcomes up to 12 months following admission for serious trauma in older people at three major Australian trauma services. Assessment of frailty on admission may be useful in stratifying outcome risk for older patients. Further research into frailty interventions and pathways is recommended.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"112514"},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287654","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 Artificial intelligence versus orthopedic surgeons as an orthopedic consultant in the emergency department.","authors":"Shuang Gao, Daquan Yan, Long He","doi":"10.1016/j.injury.2025.112467","DOIUrl":"https://doi.org/10.1016/j.injury.2025.112467","url":null,"abstract":"","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"112467"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144562428","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":"Outcomes of intramedullary versus plate fixation in distal fibula fractures: Comment on the study by Auger et al.","authors":"Dr Sitanshu Barik, Dr Vikash Raj, Dr Vishal Kumar","doi":"10.1016/j.injury.2025.112438","DOIUrl":"https://doi.org/10.1016/j.injury.2025.112438","url":null,"abstract":"","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"112438"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144201245","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":"Subdural effusion secondary to unilateral decompressive craniectomy in patients with traumatic brain injury: Incidence, clinical characteristics, predictors and outcomes.","authors":"Jun Shen, Qian An, Guanjie Hu, Xiaochun Jiang, Shaolin Zhang","doi":"10.1016/j.injury.2025.112446","DOIUrl":"https://doi.org/10.1016/j.injury.2025.112446","url":null,"abstract":"<p><strong>Background: </strong>Currently, there is a lack of literature reporting on the risk factors associated with various types of subdural effusion (SDE). The purpose of this study is to investigate the incidence, risk factors, and prognosis of different types of SDE that occur secondary to unilateral decompressive craniectomy (DC) in patients with traumatic brain injury (TBI).</p><p><strong>Methods: </strong>A total of 417 patients who met the inclusion criteria were analyzed. The incidence, treatment, and prognosis of various types of SDE were examined. Risk factors associated with different types of SDE were identified through univariate analysis followed by multivariable logistic regression analysis.</p><p><strong>Results: </strong>The overall incidence of SDE was 50.6 %. There was no statistically significant difference in GOS scores among the various types of SDE (P = 0.511). Age (per 10-year increase) (OR, 1.471; 95 % CI, 1.201-1.802; P < 0.001), alcoholism (OR, 2.027; 95 % CI, 1.021-4.022; P = 0.043), combined with contralateral subdural hematoma (OR, 4.874; 95 % CI, 2.676-8.878; P < 0.001), and contralateral pneumocephalus after surgery (OR, 4.051; 95 % CI, 1.837-8.934; P = 0.001) were identified as independent risk factors for the occurrence of contralateral SDE. The type of injury (acute subdural hematoma, ASDH) (OR, 1.918; 95 % CI, 1.367-2.690; P <0.001), was an independent risk factor for the occurrence of ipsilateral SDE. Combined with contralateral subdural hematoma (OR, 2.669; 95 % CI, 1.161-6.139; P = 0.021) and contralateral pneumocephalus after surgery (OR, 2.271; 95 % CI, 1.177-4.381; P = 0.014) were independent risk factors for the occurrence of interhemispheric SDE.</p><p><strong>Conclusions: </strong>Various types of SDE do not significantly affect the prognosis of patients with traumatic brain injury (TBI). Independent risk factors for the occurrence of contralateral SDE include age, alcoholism, and the presence of contralateral subdural hematoma and contralateral pneumocephalus following surgery. The type of injury being ASDH is the only risk factor for ipsilateral SDE. Combined with contralateral subdural hematoma and contralateral pneumocephalus after surgery were independent risk factors for the occurrence of interhemispheric SDE.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"112446"},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176294","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}