Injury. 2025 May 14;56(8):112427. doi: 10.1016/j.injury.2025.112427. Online ahead of print.

ABSTRACT

INTRODUCTION: Trauma video review (TVR), whereby resuscitations in the trauma bay are audio-visually recorded, has not been investigated within the orthopaedic context. The purpose of this study was to evaluate the utility of TVR as a practical method to evaluate the delivery of orthopaedic care and resident competency in the trauma bay.

MATERIALS AND METHODS: This was a retrospective study of 15 trauma resuscitations performed at an academic, level I trauma center between May - June 2024. TVR was used to evaluate the quality of orthopaedic care delivered in the trauma bay and to assess resident competency using Accreditation Council for Graduate Medical Education (ACGME) milestones and American Board of Orthopaedic Surgery (ABOS) Knowledge, Skills and Behavior criteria.

RESULTS: TVR allowed for quantification of multiple orthopaedic time-based metrics. TVR identified themes to prompt institutional quality improvement initiatives in the future. Importantly, TVR provided a unique opportunity to evaluate the resident interacting as part of an impromptu multidisciplinary team in a high stress environment. TVR effectively provided a method to assess competency using ACGME and ABOS criteria.

CONCLUSIONS: TVR is a practical tool to evaluate and improve the quality of orthopaedic care provided in the trauma bay. It offers a unique opportunity to assess resident competency by ACGME and ABOS criteria.

PMID:40412348 | DOI:10.1016/j.injury.2025.112427

Injury. 2025 May 15;56(8):112441. doi: 10.1016/j.injury.2025.112441. Online ahead of print.

ABSTRACT

OBJECTIVES: To address the conflicting evidence in the literature regarding time to surgery and its impact on outcomes for distal femoral fractures.

METHODS: This is a retrospective review of the American College of Surgeon's (ACS) National Surgical Quality Improvement Project (NSQIP®) database, that collects data from 680 hospitals across the United States. The database was queried from 2010-2021. Case selection was done by use of ICD-9 & ICD-10 codes for native distal femoral fractures and periprosthetic distal femur fractures, along with CPT codes for surgical fixation of distal femur, total knee arthroplasty and revision knee arthroplasty. Pre-operative, operative and post-operative factors were compared for patients undergoing surgery on hospital day 0 or 1 (HD ≤ 1) to patients undergoing surgery after hospital day 1(HD > 1). Primary outcome measure was 30-day mortality. Chi-square and logistic regression were used for univariable and multivariable analyses, respectively.

RESULTS: A total of 6857 cases were identified (mean age of 71.5 years). 84.5 % underwent surgery on HD ≤ 1, and 15.5 % on HD > 1. Rate of mortality was 1.37 % and 3.26 %, respectively. Patients who underwent surgical fixation of distal femoral fracture on HD ≤ 1 had a 40 % decrease in odds of mortality compared to fixation on HD > 1 (OR 0.587; p = 0.031). A multi variable analysis revealed that presence of dyspnea (OR 4.338, p = 0.005), preoperative blood transfusion (HR 2.32, p = 0.001) and bleeding disorder (OR 1.727, p = 0.03) were associated with increased mortality at 30-days on multivariable analysis, while younger age (OR 0.216; p = 0.001) had a protective effect.

CONCLUSIONS: Delayed surgical fixation is associated with increased odds of 30-day mortality for patients with distal femoral fractures. Further studies will help determine if the increased mortality is caused by the delay itself or by other confounding variables not identified in this study that may be associated with the reason for the delay.

LEVEL OF EVIDENCE: Level III.

PMID:40412347 | DOI:10.1016/j.injury.2025.112441

Injury. 2025 May 16;56(8):112439. doi: 10.1016/j.injury.2025.112439. Online ahead of print.

ABSTRACT

BACKGROUND: Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in patients with acute spinal cord injury (SCI). This study aimed to evaluate VTE incidence in patients with acute SCI and explore injury and management characteristics that may identify high-risk patients.

METHODS: Retrospective review of consecutive patients with acute SCI ≥18 years admitted to the National Spinal Injuries Unit (NSIU) between January 2016 and December 2020 was conducted. Data were extracted from the NSIU database, internal picture archiving and communication system and hospital records. Primary outcome was VTE incidence. Latent Class Analysis (LCA) was used to identify subgroups of patients based on injury level, neurological impairment and operative management. Subgroups were linked to VTE outcomes using BCH-Adjusted Proportional Assignment correction and multiple logistic regression.

RESULTS: 1369 patients were included in the analysis. Mean age was 54 years (SD-20) with a male predominance (831/1369; 61 %). VTE incidence was 2.34 %(CI: 1.60 - 3.28)(32/1369). LCA identified three distinct subgroups: undifferentiated injury, multilevel injury, and thoracic-spine predominant injury. Significant differences in VTE rates were observed across the subgroups, with thoracic spine injury associated with the highest VTE risk. After adjustment, individuals with thoracic-spine injuries and severe neurological impairment had an almost 4-fold increase in the odds of developing VTE compared to those with other injury/management profiles.

CONCLUSION: This study highlights the importance of tailored VTE prevention strategies for patients with acute SCI based on injury and management characteristics. An individualized approached to VTE risk stratification and prevention is required in this group.

PMID:40398331 | DOI:10.1016/j.injury.2025.112439

Injury. 2025 Apr 12;56(7):112288. doi: 10.1016/j.injury.2025.112288. Online ahead of print.

ABSTRACT

Spinal cord injury (SCI) is one of the most devastating neurological disorders associated with severe locomotor disability and a high rate of morbidity. Over the last 20-30 years, animal SCI models have proven to be extremely useful in better understanding the underlying molecular mechanism(s) involved in human traumatic SCI and in assessing the efficacy of available therapeutic agents. Thus, the current review article aims to provide readers with an overview of the methods used to induce traumatic SCI and highlight the recent advances in assessment of the functional recovery in rodent models. SCI models are classified into contusion, compression, transection, and Hypoxia-ischemia based on the mechanism of injury caused. Transection injury models are useful for studying the anatomic regeneration and neural circuitries in locomotion, whereas, compression/contusion injury models are used for studying complex biomechanism and neuropathology of human SCI. The ultimate goal of pre-clinical experimental work on traumatic SCI model is to develop effective repair/regenerative strategies for the clinical purpose. Here, we have summarized recent functional recovery assessment tool including quantification of myelin loss and motor neuron counts, axonal regeneration through behavioural and molecular studies.

PMID:40398195 | DOI:10.1016/j.injury.2025.112288

Injury. 2025 May 12;56(7):112428. doi: 10.1016/j.injury.2025.112428. Online ahead of print.

ABSTRACT

INTRODUCTION: Fractures of the distal humerus are common in older patients with osteoporotic bone, often presenting as complex, multi-fragmentary injuries involving the articular surface. This complexity complicates the decision between open reduction and internal fixation (ORIF) and total elbow arthroplasty (TEA), as both procedures carry specific risks. Hemiarthroplasty (HA) may be a viable alternative, yet few studies have compared its outcomes with those of ORIF. In this retrospective matched-pair study, we aimed to compare primary HA versus ORIF for complex distal humerus fractures. Our hypothesis was that HA could achieve functional outcomes equivalent to ORIF when joint reconstruction is not feasible.

MATERIALS AND METHODS: We matched 10 pairs of patients who underwent HA or ORIF between 2018 and 2022. Matching criteria included age, gender, and fracture classification (Orthopaedic Trauma Association (OTA) or Dubberley classification for coronal shear fractures). Functional outcomes were assessed using the Quick Disabilities of the Arm, Shoulder, and Hand (qDASH) score and the Mayo Elbow Performance Score (MEPS). The mean follow-up was 29 months for the HA group and 33 months for the ORIF group.

RESULTS: Both treatment groups exhibited satisfactory functional outcomes. In the HA group, the median MEPS was 89.5 and a qDASH score of 21.6. Mean range of motion in extension/flexion was 105.9°. The ORIF group had a median MEPS of 81.5, a qDASH of 17 and a mean range of motion of 116.5°. No significant differences in functional outcomes were observed between the two groups CONCLUSIONS: HA can yield functional results comparable to ORIF in managing complex distal humerus fractures. When ORIF is not feasible, HA is an effective alternative, particularly for physically active patients over 60 years, as it avoids the limitations associated with linked total elbow arthroplasty, such as weight restrictions and the risk of ulnar component loosening.

LEVEL OF EVIDENCE: Level III.

PMID:40393340 | DOI:10.1016/j.injury.2025.112428

Injury. 2025 May 9:112418. doi: 10.1016/j.injury.2025.112418. Online ahead of print.

ABSTRACT

BACKGROUND: For firearm-related injuries (FRI), understanding spatial injury patterns may inform intervention strategies. This study evaluates geographic FRI patterns, emphasizing (1) proximity of home address to injury location and (2) locational social determinants of health (SDOH).

METHODS: We performed a retrospective analysis of FRI patients at a Level 1 trauma center between 01/2016-10/2022. Patient home and injury ZCTAs (ZCTA tabulation areas) were collected. SDOH indicators were calculated by ZIP codes using the Distressed Communities Index (DCI, ranges from 0-100 [most distressed]) and Social Deprivation Index (SDI, ranges from 1-100 [highest deprivation]). SDOH index variations and distances between ZCTAs were calculated.

RESULTS: Of 37,537 trauma activations, 6326 were due to FRI. ZCTAs were available in 3864 (63.12 %) patients. The cohort was 86.5 % male and 85.2 % Black. Median (IQR) age was 30 (23-39) years. Home and injury locations were the same in 37.8 % of patients, within 5 miles of each other in 57.1 %, and within 20 miles in 87.2 %. DCI and SDI were significantly higher in injury vs home addresses (average DCI: home 59.5, injury 65.7; average SDI: home 71.8, injury 79.6; p < 0.001). Twenty ZCTAs (among 182) made up 68.4 % of injury locations. On linear regression, SDI and DCI were significantly associated with FRI number within ZCTAs.

CONCLUSIONS: FRI often happens close to home, and when ZCTAs differ, injury location SDOH tend to be worse. "Hotspots" with higher-than-average distress/deprivation present opportunity to maximize the impact of violence reduction; efforts should target these regions to mitigate factors perpetuating violence.

PMID:40383685 | DOI:10.1016/j.injury.2025.112418

Injury. 2025 May 8:112419. doi: 10.1016/j.injury.2025.112419. Online ahead of print.

ABSTRACT

INTRODUCTION: Hemorrhagic shock is a life-threatening condition that requires rapid identification for timely intervention. Although shock is easily discernible in the hypotensive patient, compensated shock in the "normotensive" patient is not. This study aimed to evaluate the utility of shock index (SI) in trauma patients with compensated shock.

METHODS: Patients with SBP > 90 mmHg on arrival were identified from our trauma center registry. SI was calculated by arrival heart rate divided by arrival SBP. Patients were stratified by SI using the following thresholds: ≤ 0.7, > 0.7 to 0.9, > 0.9 to 1.1, > 1.1 to 1.3, and > 1.3. Cross tabulations were used to estimate the odds of transfusion within 1 hour of arrival for each SI category with ≤ 0.7 as the referent.

RESULTS: 5958 trauma patients were included. Blood products were transfused within 1 hour of arrival in 211 (3.5 %) patients. A main effect was observed for shock index with increased risk for required transfusion for patients with admission shock index >0.7 (P < 0.001). In comparison to shock index of ≤ 0.7, odds ratios were 2.5(1.7 - 3.8), 8.2(5.4 - 12.2), 24.9(15.1 - 41.1), 59.0(32.0 - 108.6) for each categorical increase in SI.

DISCUSSION: Among trauma patients presenting without hypotension, elevated SI was associated with an increase in odds of receiving transfusion within one hour. SI may be useful in determining the presence of compensated shock in non-hypotensive patients.

PMID:40379507 | DOI:10.1016/j.injury.2025.112419

Injury. 2025 May 10;56(7):112366. doi: 10.1016/j.injury.2025.112366. Online ahead of print.

ABSTRACT

National Mine Action Strategies (NMAS) and National Surgical, Obstetric, and Anesthesia Plans (NSOAPs) have emerged as two frameworks with potential to improve the health and safety of millions living in vulnerable communities through coordinated and systematic planning. NMAS describe strategies for eliminating explosive ordnance (EO) and providing services and support to EO victims. NSOAPs outline a strategy to enhance surgical systems through surgical, anesthesia, and obstetric capacity building, taking broad approaches spanning from individual health providers and facilities to country-level Ministry of Health governance and financing. Though NMAS and NSOAPs originate in different sectors, they both adopt a systemic approach to complex problems with population-wide effects in low-resource settings. While seemingly disparate plans, NMAS and NSOAPs share overlapping objectives and methods to achieve them, each centered around promoting population health at national levels through complex infrastructure, human capacity, and resources development. NMAS and NSOAPs both encounter similar objectives, challenges, and implementation considerations which could benefit from improved communication and coordination between these communities. Analyzing the strengths and criticisms of current NMAS and NSOAPs in light of one another can help to mutually strengthen and support these critically important strategic plans.

PMID:40378730 | DOI:10.1016/j.injury.2025.112366

Injury. 2025 May 6:112414. doi: 10.1016/j.injury.2025.112414. Online ahead of print.

ABSTRACT

PURPOSE: The Rural Trauma Team Development Course (RTTDC) was introduced in 1998 in response to a growing number of deaths in rural areas due to trauma. Current literature provides evidence of the effectiveness of the RTTDC in reducing delays in the trauma transfer process in the United States. London Health Sciences Centre (LHSC) implemented the RTTDC in August of 2017. The objective of this study was to evaluate its impact in the Canadian setting.

METHODS: A retrospective cohort study of referred trauma patients before and after delivery of the RTTDC was conducted. The primary outcome was the proportion of patients transferred within 3 h of arrival at referring hospital. Statistical analyses compared pre and post RTTDC groups. Following multiple imputation, multivariable logistic regression analysis was used to control for confounding between groups. A planned subgroup analysis included only patients who met trauma team activation criteria and/or had an ISS ≥16. Course attendee satisfaction was measured using the American College of Surgeons RTTDC 4th Edition Course Evaluation and the Southwest Regional Trauma Network RTTDC Evaluation.

RESULTS: In total 180 patients were included in the study. Patients had a mean age of 52.0 (20.4) years, were most often male (73.3 %), sustained a blunt injury (92.8 %) with a mean ISS of 15.8 (10.5). The proportion of patients who were transferred within 3 h of arrival at primary hospital was 48.9 % pre-RTTDC and 56.7 % post-RTTDC (p = 0.370). Hosting an RTTDC did not have a significant impact on the proportion of patients transferred within 3 h of primary hospital arrival (OR = 1.18 (0.63, 2.20)). Median time (hours) spent at a primary hospital was similar (3.1 (1.4, 4.2) vs 2.7 (1.7, 3.8), p = 0.702), as was median decision to transfer time (hours) (1.5 (0.6, 2.5) vs 1.6 (0.6, 2.5), p = 0.837). Results of the subgroup analyses were similar (N = 98). Attendee satisfaction with the RTTDC was exceedingly positive.

CONCLUSION: In this study, participation in a one-day RTTDC did not result in a 20 % improvement in the proportion of patients being transferred from a referring hospital within 3 h. More accessible and sustainable educational outreach strategies are required to make further improvements.

PMID:40374421 | DOI:10.1016/j.injury.2025.112414

Injury. 2025 May 14;56(7):112409. doi: 10.1016/j.injury.2025.112409. Online ahead of print.

ABSTRACT

BACKGROUND: Following multiple trauma, individuals experience significant disability and poor functioning across several health domains. Rehabilitation is a component of trauma care management, however, there is limited evidence on patient outcomes after multiple trauma and the effectiveness of rehabilitation. This study was based on a Value-Based HealthCare (VBHC) framework and aimed to evaluate the impact of multiple trauma on patients' function and quality of life, and the relationship between these outcomes and the cost of inpatient rehabilitation. It also aimed to obtain the patient perspective regarding health areas to address for future trauma research.

METHODS: This prospective, cohort study recruited 62 adult participants from a specialist inpatient rehabilitation unit following multiple trauma orthopaedic injuries. Patients health-related quality of life was measured using the 12-Item Short Form Health Survey (Version 2) (SF-12v2). The SF-12v2 was completed during inpatient rehabilitation (to capture patient recalled pre-injury quality of life) and via a telephone interview at two weeks after rehabilitation discharge. Patients also self-reported their satisfaction with the SF-12v2 and identified important health areas to address after multiple trauma. Routine inpatient rehabilitation data was collected including: the Functional Independence Measure (FIM) (assesses patients' functional independence on rehabilitation admission and discharge) and demographics.

RESULTS: The sample's mean age was 51.6 years (standard deviation: 17.8) and the majority were male (69.4 %). Between rehabilitation admission to discharge, patients' demonstrated a statistically significant increase in function (FIM scores). However, quality of life (SF-12v2 scores) significantly decreased between pre-injury to after hospital discharge. At both timepoints, an increased proportion of patients had quality of life scores that were below the population norms. Increased rehabilitation costs (i.e., longer inpatient stays) were positively and significantly associated with increased functional independence, albeit, not quality of life scores. Patients identified important health areas that related to individual outcomes (e.g., mental health, limitations, goals) and familial impacts.

CONCLUSIONS: This study reported that an individually tailored rehabilitation program was cost effective and led to significant improvements in patient function. Patients experienced significant impacts to quality of life after multiple trauma, which suggests the need for a long-term and integrated care plan including psychological medical input.

PMID:40373364 | DOI:10.1016/j.injury.2025.112409

Injury. 2025 May 7;56(7):112412. doi: 10.1016/j.injury.2025.112412. Online ahead of print.

ABSTRACT

BACKGROUND: Ferrous metal foreign bodies (FMFBs) are often the most common metallic foreign bodies for the widespread application and low price of ferrous metal, but these bodies are very tiny and with the uncertainty of the position, it is very difficult to find them and get them out without a hitch. Our aim was to evaluate the reliability of retrieval of FMFBs from limbs soft tissue aided by a permanent magnet. In addition, we sought to analyze the outcomes of retrieval of FMFBs from limbs soft tissue aided by a permanent magnet.

METHODS: twenty-two patients with FMFBs in limbs soft tissue who underwent surgical intervention were included between September 2022 and April 2024. Preoperative X-ray localization and intraoperative magnet assistance were performed on all patients. Clinical evaluations included operation time and postoperative complications. The mean follow-up period was 10 ± 2.4 months.

RESULTS: these FMFBs have been got out successfully in all the cases without complications. The average distance between the foreign body and the body surface measured before surgery was 2.35 cm.The operation time ranged from 30 s to 45 min, with an average operation time of 13.7 min.

CONCLUSIONS: Retrieval of FMFBs from limbs soft tissue aided by a permanent magnet is an effective and reliable treatment without postoperative complications.

PMID:40373363 | DOI:10.1016/j.injury.2025.112412

Injury. 2025 May 8;56(7):112410. doi: 10.1016/j.injury.2025.112410. Online ahead of print.

ABSTRACT

BACKGROUND: Cephalomedullary nails (CMN) are widely used for fixation of unstable pertrochanteric fractures. In 2018, the Depuy Synthes Trochanteric Fixation Nail - Advanced (TFNA) implant was introduced at a level I academic trauma center. Subsequently, clinical concerns were raised about the use of the TFNA due to reports of nail breakage. The purpose of this study was to investigate the risk of nail breakage between TFNA and other nail models. Long term outcomes following nail failure were evaluated.

METHODS: A retrospective cohort study was conducted using data of 1665 patients who had undergone a CMN procedure between 2014 and 2020. Data were handpicked from patient records. The nail breakage and breakage time of the TFNA were compared to the TFN, PFNA, Gamma3, and Intertan using cox regression analysis and logistic regression analysis. Long term outcomes were evaluated by assessing Oxford Hip Scores (OHS).

RESULTS: The number of cephalomedullary nails were as follows: TFNA 754 (45.3 %), Gamma3 462 (27.7 %), PFNA 234 (14.1 %), TFN 211 (12.7 %), and Intertan 4 (0.2 %). A total of 21 (1.3 %) nails broke during the follow-up period. The TFNA broke the most often with 15 cases (2.0 %), followed by the Gamma3 with five cases (1.1 %) and the PFNA with one case (0.4 %). Overall, the mean (SD) nail breakage time was 222 (148) days. However, for the TFNA, Gamma3 and PFNA, the mean breakage times were 177 days (110), 292 (153) and 545, respectively. In logistic regression analysis we observed significant difference between TFNA and non-TFNA group. The odds ratio (OR) for nail breakage in TFNA group was 2.66 [95 % Ci, 1.01-6.99, p = 0.047]. The mean (SD) one year OHS for Total Hip Arthroplasty after nail breakage and overall OHS for re-osteosynthesis was 38.6 (9.8) and 36.3 (7.8), respectively.

CONCLUSIONS: Our study provides evidence suggesting that the TFNA may be associated with an increased risk of nail breakage compared to other nail models. It should be noted that implant breakage is a relatively infrequent complication. Long-term outcomes following secondary procedures were comparable between THA and re-osteosynthesis.

LEVEL OF EVIDENCE: Level IV.

PMID:40367833 | DOI:10.1016/j.injury.2025.112410

Injury. 2025 May 8;56(7):112365. doi: 10.1016/j.injury.2025.112365. Online ahead of print.

ABSTRACT

PURPOSE: Fractures in infants younger than 1 year without an obvious accidental cause raise suspicion of child abuse, warranting a skeletal survey. However, adherence to child abuse screening guidelines remains suboptimal. This study aimed to identify factors associated with skeletal survey completion in infants with fractures in the absence of a clear accidental context.

METHODS: A retrospective chart review was conducted on children younger than 1 year with at least one fracture, identified over a 6-year period (2017-2023) at a French tertiary children's hospital. Infants with fractures due to obstetric trauma or road traffic accidents were excluded. Multivariate logistic regression was used to determine factors associated with skeletal survey completion.

RESULTS: A total of 312 children were included, of whom 97 (33%) underwent a skeletal survey. Among those children, additional fractures were detected in 16 (16.5%). Skeletal surveys were more frequently performed in boys (odds ratio [OR]: 3.82, 95% confidence interval [CI]: 1.66-8.84), younger infants, and those with an inconsistent or evolving trauma explanation (OR: 17.18, 95% CI: 1.86-158.26) or no reported explanation (OR: 16.56, 95% CI: 6.30-43.54).

CONCLUSIONS: Only one-third of infants were screened for occult fractures, but the factors associated with skeletal survey completion aligned with established clinical guidelines. Long-term follow-up is necessary to assess whether the two-thirds of children who were unscreened were later identified as victims of child abuse.

PMID:40354771 | DOI:10.1016/j.injury.2025.112365

Injury. 2025 May 6;56(7):112413. doi: 10.1016/j.injury.2025.112413. Online ahead of print.

ABSTRACT

INTRODUCTION: The impact of social determinants on clinical outcomes following surgeries for orthopaedic injuries are well-documented. In this study, we sought to quantify the representation of women, racial, and ethnic minorities in US-based clinical trials for hip fracture surgery.

METHODS: This was a cross-sectional analysis of patients enrolled in US-based, interventional clinical trials for hip fractures registered on ClinicalTrials.gov (2000-2022). Participation-to-prevalence ratios (PPRs) were calculated for demographic groups in clinical trials relative to their prevalence among patients receiving hip fracture surgery in the National Inpatient Sample (2006-2015). PPRs between 0.8-1.2 were considered equitable representation. PPRs<0.8 were considered underrepresentation and PPRs>1.2 were considered overrepresentation. Temporal trends were analyzed between previous (2000-2010) and contemporary (2011-2022) periods.

RESULTS: There were thirty-eight hip fracture clinical trials involving 6937 participants included in this study. All clinical trials reported sex, but only sixteen trials (42 %) reported race and ten trials (26 %) reported ethnicity. In total, trial participants were predominately White (89.3 %) and female (68.0 %). Few patients were non-White including Asian (7.2 %), Black (2.1 %), and Hispanic (0.8 %). Female (PPR=0.97) and male (PPR=1.07) patients had equitable representation. However, Hispanic (PPR=0.22), and African American (PPR=0.51) patients were underrepresented. White patients (PPR=1.00) had equitable representation while Asian patients were overrepresented (PPR=4.50). The rate of race (P < 0.001) and ethnicity (P = 0.010) reporting increased between previous and contemporary periods.

CONCLUSION: Recruitment of racial and ethnic minorities into hip fracture clinical trials remains limited. The impact of social determinants on outcomes after trauma surgery requires equitable representation of all groups in clinical trials to ensure translatability of results. Stakeholders across healthcare, industry, and government must work to address these disparities.

PMID:40354770 | DOI:10.1016/j.injury.2025.112413

Injury. 2025 May 5:112351. doi: 10.1016/j.injury.2025.112351. Online ahead of print.

ABSTRACT

BACKGROUND: Chest wall injury is common among trauma patients. Generally, patients with more medical problems tend to have worse outcomes with rib fractures. Our aim was to determine if surgical stabilization of rib fractures (SSRF) increases the likelihood of discharge to home.

METHODS: We performed a retrospective cohort study of patients with ≥1 comorbidity, aged 18-99 with rib fractures from five Chest Wall Injury Society (CWIS) Collaborative Centers. Discharge disposition of patients who underwent SSRF was compared to those who did not undergo surgery. Discharge to home was considered the ideal state to which other discharge dispositions were compared. For the model to estimate discharge to a rehabilitation hospital or skilled nursing facility, a multivariable logistic regression analysis was performed.

RESULTS: 790 patients with ≥1 comorbidities and rib fractures were identified, and 545 (61.8 %) patients were discharged to home. Logistic regression analysis demonstrated SSRF (0.33 (0.15 - 0.75)) and tobacco use (0.62 (0.39 - 0.96)) were independently associated with discharge to home.

CONCLUSION: In patients with rib fractures and at least one comorbid condition, SSRF is associated with discharge to home. Counterintuitively, tobacco use was also associated with discharge to home.

LEVEL OF EVIDENCE: Level II STUDY TYPE: Therapeutic/Care Management.

PMID:40350351 | DOI:10.1016/j.injury.2025.112351

Injury. 2025 Apr 29;56(7):112359. doi: 10.1016/j.injury.2025.112359. Online ahead of print.

ABSTRACT

BACKGROUND: Emergency interhospital transfer can be conducted using either ground-based emergency medical services (GEMS) or helicopter emergency medical services (HEMS). The choice between these modes of transportation relies mostly on urgency and transfer distances, however they are further influenced by road traffic, weather and resource availability. While some studies suggest that HEMS may improve survival rates for severely injured patients, the time efficiency of HEMS versus GEMS across varying distances remains underexplored.

METHODS: This retrospective clinical cohort study analyzed 1784 emergency interhospital transfers from 11 hospitals to Innsbruck University Hospital in Austria, over a 10-year period (2013-2023), comparing efficiency of GEMS and HEMS across distances from 11 hospitals within a 115 km radius. Outcome assessment included time duration of distinct phases of transfer, including dispatch time, isolated transport duration, overall transfer duration, total resource occupancy time, and cost efficiency.

RESULTS: HEMS was primarily used for longer distances, while GEMS were almost exclusively used for transports <30 km. For hospitals >50 km away, the mean overall transfer duration was 58.1 (± 16.5) minutes for HEMS and 77.1 (± 20.3) minutes for GEMS (p < 0.001). For hospitals within 50 km, the mean overall transfer duration was 46.4 (± 13.9) minutes for HEMS and 44.0 (± 12.9) minutes for GEMS (p = 0.175). Cost analysis revealed that HEMS was significantly more expensive than GEMS, with a cost disparity of up to 17 times the cost per route.

CONCLUSION: GEMS is more efficient and should be considered for all transfers under 30 km, while HEMS offers a time advantage for distances exceeding 50 km, providing potentially crucial time savings in time-critical cases. For intermediate distances, HEMS may be justified when reducing treatment delays is essential. Decisions regarding transport modality should consider not only the distance but also urgency and the potential clinical benefits of faster treatment. Future studies should examine the clinical outcomes of different transfer modes to better guide transport decisions.

PMID:40349570 | DOI:10.1016/j.injury.2025.112359

Injury. 2025 Apr 30;56(7):112375. doi: 10.1016/j.injury.2025.112375. Online ahead of print.

NO ABSTRACT

PMID:40347809 | DOI:10.1016/j.injury.2025.112375

Injury. 2025 Apr 30;56(7):112373. doi: 10.1016/j.injury.2025.112373. Online ahead of print.

ABSTRACT

BACKGROUND: Furniture and television-associated injuries are prevalent in homes and schools, especially among young children. Collisions, tip-overs, and falls off these structures are common mechanisms of injury that often involve the head and face, resulting in emergency room visits. This study aims to estimate the number of craniofacial injuries resulting from furniture accidents in the pediatric population and offer guidance to parents and/or guardians on child safety and prevention strategies to mitigate these risks.

METHODS: The National Electronic Injury Surveillance System (NEISS) assessed furniture or television-related craniofacial injuries in children who presented to the emergency department (ED) from 2013 to 2022. Patients were included in this study if they were younger than 18 and evaluated for an isolated face, head, mouth, or neck injury. National estimates, demographics, diagnoses, location of the accident, and other clinical characteristics were analyzed. Linear regression was used to assess the incidence of injury over the 10-year period.

RESULTS: From 2013 to 2022, 1696 entries accounted for an estimated 41,914 injuries presenting to a NEISS-participating ED nationwide for pediatric craniofacial-related furniture injuries. A significant decrease in annual cases was seen over the 10-year period (R2 = 0.88, p < 0.001). The mean age of injury was 3.9 years, and most injuries were made up of toddlers aged 1-3 years old (53.3 %). Males were more frequently affected (55.8 %). The most common diagnoses were concussion/closed head injuries (48.5 %) and soft tissue injuries (24.6 %). Most children were treated and released (93.8 %), though some were hospitalized (3.03 %), and fatalities were rare (0.13 %). An estimated 21.0 % of craniofacial injuries were due to television tip-overs, and 43 % were accidents involving consumer storage units, such as furniture with drawers or hinged doors. Injuries were primarily at home (76.5 %) or at school (2.83 %).

CONCLUSION: Pediatric craniofacial injuries from furniture and television tip-overs remain a concern despite recent declines, particularly affecting infants and toddlers under four years old. Continued efforts are needed to address safety risks associated with tip-overs in the home and school settings.

PMID:40347808 | DOI:10.1016/j.injury.2025.112373

Injury. 2025 Apr 30;56(7):112370. doi: 10.1016/j.injury.2025.112370. Online ahead of print.

ABSTRACT

OBJECTIVES: Whilst the availability of clinical psychology is one of the key requirements for Major Trauma Centres (MTCs) outlined by NHS England, a previous study identified significant gaps in psychology provision across MTCs [1,2]. The present study aimed to understand whether MTC psychology services in England and Wales are fulfilling the section of the NHS standard contract for MTCs relating to psychology provision. It also sought to benchmark services against the relevant guidelines and standards published by the National Institute of Health and Care Excellence (NICE) and the Association of Clinical Psychologists UK (ACP-UK).

METHODS: All MTCs in England and Wales were contacted. Four told us that they have no specialist MTC psychology service. The remaining centres completed a questionnaire about their psychology service and rated whether it met, partially met, or did not meet the NHS standard contract and each of the NICE guidelines and ACP-UK standards. 25 MTC psychology services completed the questionnaire.

RESULTS: Variation was found across MTCs in the dedicated whole time equivalent (WTE) of psychology staffing, the banding of the most senior psychologist in each service, and the total percentage of MTC patients that are seen by psychology. Over half of services did not meet or only partially met the NHS standard contract. Many of the ACP-UK standards were either not met or only partially met by a majority of services.

CONCLUSIONS: The study indicates that significant variation in resource exists across MTC psychology services in England and Wales, leading to differences in the ability of services to meet standards and guidelines. Further work is indicated to address this variation and develop a minimum workforce model for MTC psychology services, to ensure equity of access to psychological support in MTCs across England and Wales.

PMID:40347807 | DOI:10.1016/j.injury.2025.112370

Injury. 2025 May 3;56(7):112402. doi: 10.1016/j.injury.2025.112402. Online ahead of print.

ABSTRACT

BACKGROUND: The trauma tertiary survey (TTS) is a critical step in identifying missed injuries following primary and secondary trauma assessment. The TTS is traditionally performed by junior medical professionals on a trauma unit. Despite this, increasing trauma caseloads have led to challenges with TTS adherence, missed injuries and overwork. This has prompted interest into delegating some of the TTS tasks to non-medical professionals, however the efficacy and safety of this approach is poorly characterised.

METHODS: A scoping review was conducted following Joanna Briggs Institute methodology following a comprehensive search in Medline, Embase, Emcare and CINAHL databases. The search encompassed terms related to TTS and non-medical professionals. Outcomes were related to safety and efficacy of TTS performed by non-medical professionals.

RESULTS: Four observational studies involving trauma nurses (n = 3) and midlevel providers (n = 1) as non-medical providers of the TTS were included. Overall, there was evidence to suggest TTS performed by non-medical providers had similar missed injury detection rates and saved up to 1802 h of time for trauma residents. However, non-medical professionals demonstrated variable knowledge of TTS protocols, with gaps identified in training and experience.

CONCLUSION: TTS performed by non-medical professionals appears feasible and yields comparable clinical outcomes to medical staff, with potential to alleviate medical workforce pressures. These findings are based on studies of high clinical heterogeneity and poor control for confounders.

PMID:40344858 | DOI:10.1016/j.injury.2025.112402