Injury最新文献

{"title":"Trends in medical healthcare complaints at two Danish orthopedic departments - A descriptive study.","authors":"Oliver Lyndrup, Johanne Louise Christiansen, Charlotte Juhl Lorentsen, Ane Simony","doi":"10.1016/j.injury.2026.113519","DOIUrl":"10.1016/j.injury.2026.113519","url":null,"abstract":"<p><strong>Introduction: </strong>Medical healthcare complaints are commonly encountered in orthopedic surgery departments. Consequently, the heads of departments spend considerable amount of time addressing these complaints. Younger doctors report that their concern for receiving medial complaints may create a stressful work environment. This study investigated trends in formal complaints regarding medical treatment at orthopedic departments at Lillebaelt Hospital METHODS: This descriptive study included all formal complaints regarding medical treatment, submitted through the Danish Healthcare Authorities, and received at at two orthopedic departments at Lillebaelt Hospital, Region of Southern Denmark, during 2023. Outcomes were the number of complaints for each medical staff group, elective or acute setting, the reason for the complaint and the distribution of complaints between the two hospitals.</p><p><strong>Results: </strong>58 formal complaints were registered during the study period, 16 of these involved more than one staff group. 39 (67%) complaints included a consultant and 16 (28%) a resident in training. 42 (72%) patients complained about treatment, five (9%) of behavior, and one (2%) of the examination performed. The complaints were distributed between 22 (38%) from the elective department and 36 (62%) from the traumatology department.</p><p><strong>Conclusion: </strong>Few complaints involved residents and most of these were aimed at more than one staff group, indicating that fear of complaints among younger doctors should be low. The elective department had fewer complaints than the department of traumatology. However, no difference was observed when adjusted for number of patient visits.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"113519"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148537580","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 outcomes of interventional radiology versus operative management in hemodynamically stable and unstable moderate-to-severe high-grade blunt renal trauma.","authors":"Ariel Hus, Yumna Indorewala, Hazem Nasef, Sukriti Prashar, Logan Rogers, Youssef Nasef, Adel Elkbuli","doi":"10.1016/j.injury.2026.113634","DOIUrl":"10.1016/j.injury.2026.113634","url":null,"abstract":"<p><strong>Background: </strong>Blunt renal trauma remains a major source of morbidity and mortality despite advances in non-operative management. This study evaluates clinical outcomes in adults with moderate-to-severe high-grade blunt renal trauma, comparing interventional radiology (IR) and operative management.</p><p><strong>Methods: </strong>This retrospective cohort study utilized the ACS-TQIP-PUF dataset (2017-2023) to evaluate outcomes in adult (≥18 years) trauma patients with moderate-to-severe (AIS abdomen ≥ 2, ISS ≥ 9) high-grade (AAST grade ≥4) blunt renal trauma who underwent operative management or IR approach. Patients were stratified by hemodynamic stability, initial hypertension, and trauma center level. Primary outcomes included mortality and nephrectomy rates. Secondary outcomes included transfusion requirements, nonoperative management failure, and complications.</p><p><strong>Results: </strong>In hemodynamically stable adult trauma patients with moderate-to-severe blunt renal injuries, IR was associated with lower 24-hour (aOR 0.477, 95% CI 0.274-0.83, p = 0.009) and in-hospital mortality (aOR 0.210, 95% CI 0.116-0.378, p < 0.001). Among unstable patients, IR was associated with reduced in-hospital mortality (aOR 0.076, CI: 0.007-0.847, p = 0.036). IR was also associated with reduced in-hospital mortality when stratifying by presence of initial hypertension (aOR 0.317, 95% CI:0.103-0.973, p = 0.045) and trauma center level, specifically at level I centers (24-hour mortality: aOR 0.047, CI:0.006-0.370, p = 0.004; in-hospital mortality: aOR 0.135, CI: 0.042-0.435, p < 0.001). Overall, no significant difference in odds of complications were observed.</p><p><strong>Conclusion: </strong>IR intervention was determined to be a safe and effective management approach for adult trauma patients with moderate-to-severe high-grade blunt renal injuries regardless of hemodynamic stability, initial hypertension, or trauma center level.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":"57 10","pages":"113634"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889801","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":"Mechanism-specific structural patterns in hospitalized severe mechanical open-globe injury: Implications for triage and operative preparedness in a 13-year tertiary referral cohort.","authors":"Chen Qin, Xin Hua, Jie Zhu, Tian Yang","doi":"10.1016/j.injury.2026.113750","DOIUrl":"https://doi.org/10.1016/j.injury.2026.113750","url":null,"abstract":"<p><strong>Background: </strong>Severe mechanical open-globe injury (OGI) is a vision-threatening emergency. Injury mechanism is often available at first contact, whereas definitive structural classification may emerge only after clinical and operative assessment. We examined whether hospitalized severe mechanical OGI shows mechanism-specific structural patterns and whether final structural phenotype is associated with short-term inpatient course.</p><p><strong>Methods: </strong>We conducted a single-center retrospective cohort of 1096 index hospitalizations for severe mechanical OGI during 2013-2025 at a tertiary referral center in eastern China. Injury mechanisms were adjudicated from free-text cause fields using a prespecified coding framework. The primary outcome was final Birmingham Eye Trauma Terminology (BETT) phenotype. Mechanism-phenotype associations were assessed using an L2-penalized multinomial logistic model adjusted for age, sex, and calendar year; exponentiated contrasts were reported as adjusted odds ratios. Secondary classification-to-course analyses evaluated early visual status, visual-category improvement, length of stay, procedural burden, and treatment non-completion, with presenting visual acuity added to secondary models.</p><p><strong>Results: </strong>Industrial metal injury was the dominant mechanism (45.5%), followed by plastic/other foreign-body injury (9.7%) and falls (7.2%). Mechanism was strongly associated with final BETT phenotype (Pearson χ² = 425.62, p < 0.001). Industrial metal injury clustered toward intraocular foreign body (IOFB)-related injury and laceration without IOFB (37.3% and 36.3%), whereas falls and fireworks were rupture-dominant (96.2% and 96.0%). In the adjusted multinomial model, falls were strongly associated with globe rupture rather than laceration without IOFB compared with industrial metal injury (adjusted OR 27.40, 95% CI 12.71-77.54). Globe rupture showed the most severe inpatient course: 79.6% presented with light perception/no light perception, 94.0% had poor discharge visual acuity, and 34.3% had documented treatment non-completion. After additional adjustment for presenting visual acuity, rupture remained associated with poor discharge visual acuity (adjusted OR 5.25, 95% CI 2.84-9.71) and treatment non-completion (adjusted OR 3.78, 95% CI 2.19-6.52).</p><p><strong>Conclusions: </strong>Hospitalized severe mechanical OGI exhibited mechanism-specific structural patterns that extended beyond anatomical classification by mapping onto short-term inpatient course. Mechanism may support early structural suspicion, operative preparedness, expectation management, and treatment-pathway counseling, complementing rather than replacing examination, imaging, and operative assessment.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"113750"},"PeriodicalIF":2.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120806","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":"Plastic and reconstructive surgery management of civilians and military injuries during the 2023-2024 Middle East conflict.","authors":"Dana Adelson, Ravit Yanko, Atalia Soriano, Arik Zaretski, Daniel Kedar, Roei Singolda, Moshe Lachiani, Ehud Arad, David Leshem, Yoav Barnea","doi":"10.1016/j.injury.2026.113720","DOIUrl":"https://doi.org/10.1016/j.injury.2026.113720","url":null,"abstract":"<p><strong>Background: </strong>On October 7, 2023, a large-scale regional attack amid an armed conflict in the Middle East, resulting in an unprecedented number of wounded civilians and soldiers. Medical centers faced the challenge of managing a large influx of trauma patients on the day of the attack and throughout the ensuing conflict. This study presents our plastic surgery team's experience in immediate and reconstructive care highlighting key lessons learned.</p><p><strong>Methods: </strong>This retrospective study includes data on war-related injuries treated by our Plastic Surgery team from October 7, 2023, to June 1, 2024. Treatment varied by injury type and severity, with patients receiving care solely by plastic surgeons or within a multidisciplinary team. Data included demographics, injury types, wound management, complications, and microbiology.</p><p><strong>Results: </strong>Seventy-two patients with 132 wounds were included, predominantly involving the extremities, with lower limbs most frequently affected (53%). Blast-related shrapnel injuries were the leading mechanism (68%). One-third of wounds demonstrated bacterial growth, predominantly Gram-negative organisms. While a subset of wounds healed by secondary intention, most required surgical intervention, often following a staged approach. Notably, immediate closure performed by non-plastic surgery teams was associated with a complication rate of 72%, compared to 18% and 17% for immediate and delayed closure performed by the plastic surgery team, respectively (p < 0.001). Overall, early primary closure was associated with significantly higher complication rates compared to delayed closure or reconstructive techniques (p = 0.025), further supporting the importance of specialist involvement in closure decision-making.</p><p><strong>Conclusion: </strong>Plastic surgery plays a pivotal role in the management of traumatic wounds, addressing both acute injuries and delayed reconstruction. Early involvement of plastic surgeons in the management of war-related injuries is essential for optimizing decision-making through careful wound assessment and appropriate timing of closure, ultimately improving outcomes.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"113720"},"PeriodicalIF":2.0,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An evaluation of the variability in the number of high-level trauma centers per million people across the United States.","authors":"William Y York, Russell B Wohl, Ernest E Moore, Jaimo Ahn, Mara L Schenker, Joshua A Parry","doi":"10.1016/j.injury.2026.113723","DOIUrl":"https://doi.org/10.1016/j.injury.2026.113723","url":null,"abstract":"<p><strong>Introduction: </strong>The number of High-Level Trauma Centers (HLTCs) (Level I or II) per million people across the United States (US) is variable. The purpose of this study was to describe that variability and to determine if it was correlated with state characteristics.</p><p><strong>Methods: </strong>A cross-sectional study of the US was performed utilizing census data. The number of HLTCs per million people in each state was calculated. The correlation between the number of HLTCs per million and the following variables was evaluated for: population density, black and white race, land area, median household income, employment rate, uninsured rate, poverty rate, and public health insurance coverage rate.</p><p><strong>Results: </strong>All fifty states were included. The median number of HLTCs per million was 1.58 (IQR 1.14-2.45) and ranged from 0.47 in New Mexico to 6.28 in North Dakota. The median ratio of level 1 to level 2 trauma centers located in each area was 0.51 (IQR 0.25-1.0) and ranged from 0.0 to 4.0. HLTCs per million was positively correlated with white race (R=0.41, p = 0.002) and employment rate (R=0.32, p = 0.02) and negatively correlated with population density (R=-0.31, p = 0.02) and black race (R=-0.37, p = 0.008). No statistically significant correlations were observed between HLTCs per million and land area, median household income, uninsured rate, poverty rate, disability rate, or public health insurance coverage rate (p > 0.05).</p><p><strong>Conclusions: </strong>The number of HLTCs per million across the United States varied widely and was positively correlated with white race and employment rate and negatively correlated with black race and population density.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"113723"},"PeriodicalIF":2.0,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149032332","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":"Comorbidities in major trauma patients in New Zealand: A retrospective cohort study of prevalence and associations with healthcare utilisation, mortality and cost.","authors":"Helen Harcombe, Gabrielle Davie, Dave Barson, Brett Maclennan, Trudy Sullivan","doi":"10.1016/j.injury.2026.113721","DOIUrl":"https://doi.org/10.1016/j.injury.2026.113721","url":null,"abstract":"<p><strong>Introduction: </strong>The prevalence of chronic health conditions is increasing in New Zealand (NZ) and internationally. This means that more people entering the health system for an acute event, such as major trauma, are likely to have other health conditions (i.e. comorbidities) that may impact their healthcare needs, outcomes and/or cost. This study examines comorbidities among major trauma patients injured in NZ between 2018 and 2022.</p><p><strong>Methods: </strong>In this retrospective cohort study, records were linked between Te Rēhita Whētuki o Aotearoa, the New Zealand Trauma Registry and the National Minimum Dataset of hospital discharges for those who experienced a major trauma event (Injury Severity Score (ISS) > 12 or had died in hospital following trauma) in NZ during 2018-2022. Comorbidities were determined using the Multimorbidity Index (M3) using a five-year lookback from the date of discharge.</p><p><strong>Results: </strong>Over 5 years, 11,768 patients were hospitalised for major trauma in NZ. Over half of these (54%) had at least one comorbidity as assessed by the M3. Of those hospitalised with major trauma in 2018, 53% had at least one comorbidity, rising to 56% in 2022. Comorbidities typically resulted in longer length of stay, longer length of ICU stay, longer hours on a ventilator and higher in-hospital and 12-month post-discharge mortality. For example, for the 5143 with serious injury (ISS 16-24), median length of stay was 6 days for those with no comorbidities (M3 =0) and 18 days for those with an M3 > 2; median length of ICU stay was 39 h for those with no comorbidities (M3 =0), and 116 h for those with an M3 > 2. Publicly-funded healthcare costs tended to be higher for those with more comorbidities.</p><p><strong>Discussion: </strong>The increasing presence of comorbidities has implications for patient care, complexity and healthcare needs of those hospitalised following major trauma. As well as having implications for health service delivery, the findings of this study suggest that it is important to consider prevention, not only with regard to trauma, but also in relation to comorbidities, to reduce the burden on individuals and the healthcare system.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"113721"},"PeriodicalIF":2.0,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149027252","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":"Cooler by cooler - Forecasting transfusion demand and volumes in trauma.","authors":"Allan E Stolarski, Kevin J Brady, Jonathan D Stallings, Dane Scantling, Crisanto Torres, Charlene Ong, Emanuele Lagazzi, Mark Seamon, Niels Martin, Brian A Telfer, Noelle Saillant","doi":"10.1016/j.injury.2026.113719","DOIUrl":"https://doi.org/10.1016/j.injury.2026.113719","url":null,"abstract":"<p><strong>Introduction: </strong>Predictive algorithms may optimize the delivery of care by facilitating early identification of resource requirements. We hypothesize that injury patterns and vitals obtained early after trauma can predict blood volume requirements for blunt and penetrating trauma across a wide array of environments.</p><p><strong>Methods: </strong>Patients 18-60 years with blunt, penetrating and burn were included from the 2020 American College of Surgeons-Trauma Quality Improvement Program (TQIP) registry. Emergency Medical Services (EMS) and emergency department (ED) vital signs were analyzed. External injuries that could be easily noted in the field were curated from ICD codes. Blood volumes were treated as a continuous variable with probabilistic distributions predicted. Blood products characterized include packed red blood cells, plasma, platelets, cryoprecipitate and whole blood. The Field Artificial Intelligence Triage (FAIT) tool utilizes 10-fold cross validation using logistic regression and class-based weighting for predictions.</p><p><strong>Results: </strong>The population was 401,337 patients; (314,790 blunt, 71,760 penetrating, and 5726 burn) patients. The median age was 37 (interquartile range (IQR), 27-50). Median injury severity score (ISS) of 6 (IQR, 4-12) with ISS of 26 (IQR, 17-35) for those receiving massive transfusion (>4 units/4 h). FAIT accurately predicted when patients did not require blood; 0.91 ± 0.00 (AUC). Overall predictive capabilities for transfusion volume across ranges corresponding to transfusion (>0 units/4 h), massive transfusion (>4 units/4 h), and ultra-massive transfusion (>10 units/4 h and >20 units/4 h) had an AUC of 0.91-0.95 for the EMS + ED and 0.87-0.91 for the EMS vitals alone. Overall survival for different transfusion thresholds was 71% for > 5 units, 62% for > 10 units and 35% for > 50 units (AUC 0.94-0.95 ± 0.01).</p><p><strong>Conclusion: </strong>The FAIT tool capably distinguishes patients who require transfusion from those who do not across a wide array of injury patterns, severity, and environments. With only limited pre-hospital inputs, the model predicts transfusion volumes within clinically relevant margins.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"113719"},"PeriodicalIF":2.0,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149003217","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 and patient-reported outcomes for bicycle and micro-mobility accidents: A prospective study with 12-month injury follow-up.","authors":"Odd Mjåland, Ingeborg Storesund Hesjevoll, Torkel Bjørnskau, Olav Røise, Andrew M Garratt","doi":"10.1016/j.injury.2026.113705","DOIUrl":"https://doi.org/10.1016/j.injury.2026.113705","url":null,"abstract":"<p><strong>Introduction: </strong>There has been a huge increase in bicycle and micromobility device use in Europe but the systematic collection of accident and injury data including patient-reported outcome measures is lacking.</p><p><strong>Materials and methods: </strong>Prospective registration of accidents from bicycle-and micro-mobility usage within Agder County, Norway from 1st June 2022-30 th September 2023. Study sites had posters, folders and business cards with project QR codes linked to accident questionnaires covering helmet use, type of bicycle, type of accident and retrospective pre-injury EQ-5D-5L. Within 5 days, the injured were telephoned and asked for consent to the collection of clinical data covering injury and treatment, and EQ-5D-5L follow-up at 3, 6, and 12 months. The Abbreviated Injury Scale (AIS) and New Injury Severity Score (NISS) were used for injury severity/site and overall severity, respectively. Multi-trauma followed the Newcastle definition. Multiple injury was defined as > 1 affected AIS body chapter.</p><p><strong>Results: </strong>Of 460 eligible patients, 317 (68%) completed the baseline EQ-5D-5L. The mean age was 37 yrs and 39% were female. Median (IQR) NISS was 4 (1-5), 38% had multiple (2-5) injuries, 1% were multi-trauma according to the Newcastle definition, AIS upper extremity injuries affected over 60%. 78% had worn a helmet, 25% rode an electric bicycle, and 75% of accidents did not involve other road users. Median (IQR) recovery was 37 (14-61) days; 11 (3%) had not fully recovered at 12 months. At 12 months both EQ-5D-5L index (p = 0.001) and EQ VAS (p = 0.001) scores exceeded those at pre-injury, and the only significant difference across demographic and clinical strata was observed for injury type: those with multiple injuries had lower improvements in EQ-5D-5L index scores compared to those with single injuries (p = 0.034).</p><p><strong>Conclusion: </strong>Within this sample of bicycle and micromobility accidents that is broadly representative for Norway, the great majority of injuries were to the head and extremities, with fast recovery to pre-accident self-reported health-related quality of life. Given the high number of bicycle accidents and continued increase in bicycle and e-scooter use, further accident and injury monitoring is recommended.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"113705"},"PeriodicalIF":2.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956939","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":"Digital Stop The Bleed® training compared with in-person Stop The Bleed® training: Human instructors needed to demonstrate psychomotor skills.","authors":"Isaac Salisbury, Silvia Manzanero, Chiara Santomauro, Sarah Pearce, Jourdaine Young, Rebekah Young, Matthew Jennings, Frances Williamson, Michael Muller","doi":"10.1016/j.injury.2026.113666","DOIUrl":"https://doi.org/10.1016/j.injury.2026.113666","url":null,"abstract":"<p><strong>Background: </strong>Stop the Bleed® (STB) training can effectively prepare first responders to intervene and prevent the injured from dying from uncontrolled bleeding, but traditional in-person instruction limits the number of people who can access training. The aim of this study was to evaluate the effectiveness of a digital STB training package consisting of an animated video and a short interactive quiz, compared with conventional instructor-led training.</p><p><strong>Study design: </strong>Pseudo-randomised non-inferiority simulation study with N = 93 layperson participants recruited at a single health service precinct. Groups were randomised to either in-person training with an instructor or digital training on a laptop. Participants' knowledge and ability to perform STB bleeding control techniques was assessed with a manikin arm. Participant self-rating and self-efficacy were compared with performance.</p><p><strong>Results: </strong>Participants' mean (standard deviation) knowledge scores were significantly non-inferior in the digital group (9.74 (0.26)) compared with in-person (9.62 (0.35), p = 0.003) at a non-inferiority margin of 0.2 SDs. However, digital training participants succeeded less frequently at wound packing (80%) and tourniquet application (52%) compared to in-person training participants (100% packing and 86% tourniquet). Participants' self-efficacy ratings of performance correlated poorly with actual performance.</p><p><strong>Conclusions: </strong>Digital Stop the Bleed® training was as effective as instructor-led training for teaching laypersons the recognition and theory of immediate management of life-threatening bleeding. Psychomotor skills (packing, tourniquet) were inferior, highlighting the utility of observing physical demonstration for skill acquisition. These findings inform future improvements to digital STB training and suggest that the place of digital training in the widespread rollout of STB is to supplement rather than replace instructor-led training.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"113666"},"PeriodicalIF":2.0,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956955","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 Birmingham Eye Trauma Terminology - Extension from Lebanon (BETT-XL) classification: A multi-center validation in modern warfare.","authors":"Riwa Ibrahim, Oulyana Arafat, Romy Mansour, Ama Sadaka, Faten Al Ghadban, Ahmad Nemer, Souha Allam, Georges El Mollayess, Roland Seif, Hibah Osman, Ghassan Abu-Sittah, Jamal Bleik, Karim Sleiman","doi":"10.1016/j.injury.2026.113687","DOIUrl":"https://doi.org/10.1016/j.injury.2026.113687","url":null,"abstract":"<p><strong>Background: </strong>In modern warfare, ocular injuries frequently result in severe injuries that challenge existing classification systems. The standardized Birmingham Eye Trauma Terminology (BETT) does not adequately capture the extensive globe or periocular damage encountered in conflict settings. We aimed to develop an extension to BETT capable of classifying the full spectrum of injuries. We further sought to validate the extended framework using a real-world cohort from the 2024 pagers explosions in Lebanon.</p><p><strong>Methods: </strong>Phase I included a targeted literature review of severe ocular trauma cases unclassifiable on BETT, based on which experts practicing in conflict zones identified the gaps in and developed the BETT Extension from Lebanon (BETT-XL). In Phase II, we validated BETT-XL by applying it to a retrospective multicenter cohort of ocular injuries from the pager explosions. Data on examination on presentation, imaging, primary management, and intraoperative findings were collected. From available data, we classified the injuries using the BETT and BETT-XL systems.</p><p><strong>Results: </strong>The literature review identified the following injuries as unclassifiable in BETT: Traumatic Evisceration, Luxation, Avulsion, and Traumatic Exenteration. We addressed the first three gaps by incorporating three novel subcategories in BETT-XL, and by adding Traumatic Exenteration to a previous modification of BETT that incorporated periocular injuries. The validation cohort included ninety-three patients with pager-related ophthalmic trauma. Closed Globe injuries were present in 36.6% and 22.6% of right and left eyes respectively. Per BETT, Open Globe injuries were present in 19.4% and 25.8% of eyes. An additional 24.7% and 34.4% of severely injured eyes were unclassifiable in BETT, and were presented under the BETT-XL category of Traumatic Evisceration.</p><p><strong>Conclusion: </strong>BETT-XL provides an evidence-based extension that incorporates previously unclassifiable, severe ocular injuries. This enables a more comprehensive characterization of modern conflict-related ocular injuries. Further prospective studies can be done to validate it across diverse conflict-affected settings and to document inter-rater reliability and prognostic utility. These results also highlight the devastating impact of blasts on vision, and the necessity of conflict medicine preparedness in care systems, starting with updated classification systems.</p>","PeriodicalId":94042,"journal":{"name":"Injury","volume":" ","pages":"113687"},"PeriodicalIF":2.0,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148922402","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}