Patient-reported outcome measures (PROMs) are widely used in trauma and injury research to assess health-related quality of life (HRQoL), mental health and functional recovery. However, PROMs are rarely adapted to reflect the lived experiences, cultural values and determinants of health for priority populations, particularly Aboriginal and Torres Strait Islander peoples, who experience a disproportionate burden of injury in Australia. This systematic review addressed the inclusion of health equity indicators and Indigenous knowledges for PROMs used in observational Australian trauma and injury studies for adults (≥ 18 years). A systematic search of Medline (OVID), CINAHL (EBSCO) and Scopus was performed including prospective cohort or longitudinal designs, focused on trauma-related injuries conducted in Australia. Data were extracted and appraised using the CREATE and PROGRESS-PLUS tools to assess Indigenous engagement and equity-sensitive reporting. Across the 11 included studies, 17 different PROMs were used with SF-36 and PCL-C being the most common. Physical and mental health outcomes were consistently impaired post-injury, with long-term impacts. Equity considerations were largely absent; none of the studies met all PROGRESS-PLUS criteria and Indigenous knowledges were not incorporated. Priority populations, including Aboriginal and Torres Strait Islander peoples, culturally and linguistically diverse (CALD) communities, people with disabilities and women, were frequently underrepresented or excluded. These findings highlight significant gaps in equity-sensitive PROM use and the urgent need for culturally safe and inclusive PROM development that reflects diverse recovery experiences thereby supporting equitable trauma care and follow-up. This study looked at how injury research in Australia uses patient-reported outcome measures (PROMs) to understand recovery after injury. PROMs are tools that ask patients about their health and wellbeing, but they often don’t reflect the experiences or cultural values of Aboriginal and Torres Strait Islander peoples, who are more likely to be injured and face worse outcomes. We reviewed 11 studies and found that while 17 different PROMs were used, none were designed with or for Aboriginal and Torres Strait Islander communities. Most studies didn’t include key equity factors like race, language, disability, or gender in their analysis, and Indigenous perspectives were missing entirely. This means current trauma research may not correctly capture the recovery journeys of priority populations. Our findings show an urgent need to develop culturally safe and inclusive PROMs that reflect diverse experiences and support fairer trauma care. This work can help improve health outcomes and ensure that Aboriginal and Torres Strait Islander peoples are meaningfully included in future research and healthcare planning.
Blunt cerebrovascular injury (BCVI) is a rare but potentially devastating complication of pediatric blunt trauma. Delayed or missed diagnosis may result in ischemic stroke, permanent neurological deficits, or death. To avoid missed injuries, many trauma centers apply liberal computed tomography angiography (CTA) screening strategies, although this may expose children to substantial and potentially unnecessary radiation. Several adult- and pediatric-derived screening tools have been proposed, but their applicability in pediatric trauma populations remains controversial. This study aimed to evaluate the incidence of BCVI, imaging utilization, and the diagnostic performance of pediatric BCVI screening approaches in a German Level I trauma center cohort. This retrospective observational cohort study included pediatric trauma patients aged 0-15 years who underwent CT imaging following blunt trauma between January 2005 and December 2020 at a Level I trauma center in Germany. Patients were identified through systematic review of electronic medical records and radiological databases. BCVI was defined as traumatic injury to the carotid or vertebral arteries detected by CTA or magnetic resonance imaging (MRI). Demographic, clinical, imaging, and outcome data were collected retrospectively. The McGovern score was calculated for patients with sufficient available data and evaluated using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operating characteristic (ROC) analysis. Additionally, the theoretical applicability of PECARN and Scandinavian pediatric head trauma guidelines was explored to assess potential reductions in CT utilization. A total of 956 pediatric trauma patients underwent CT imaging, of whom 668 (70%) additionally received CTA. BCVI was diagnosed in 6 patients, corresponding to an incidence of 0.6%. Five injuries were identified by CTA and one by MRI. All BCVI patients presented with focal neurological deficits at initial evaluation. The McGovern score could be calculated in 896 patients. Using a cutoff value of ≥ 3 points, all BCVI cases were correctly identified, resulting in a sensitivity of 100%, specificity of 83.8%, PPV of 4.0%, and NPV of 100%. ROC analysis demonstrated excellent discriminative ability with an area under the curve of 0.960 (95% CI 0.923-0.989). However, the small number of BCVI cases limited statistical power. Theoretical application of PECARN and Scandinavian guidelines suggested that a substantial proportion of CT examinations may have been avoidable. BCVI is an uncommon but clinically significant injury in pediatric blunt trauma. Despite its low incidence, CTA utilization was high in our cohort, raising concerns regarding potential overuse of imaging and radiation exposure. Pediatric-specific screening tools such as the McGovern score may help identify low-risk patients while maintaining high sensitivity. However, larger prospective multicenter studies are required to validate pediatric BCVI screening strategies and optimize the balance between early diagnosis and radiation avoidance.
Social determinants of health (SDOH) as defined by the WHO and CDC - socioeconomic status, one's physical environment, racism, discrimination, gender identity, etc. - influence the health of individuals and populations, and are understudied in trauma, injury, and surgical science. This paper quantifies the lack of awareness around excluding SDOH in retrospective injury research studies using large national databases. We reviewed 315 papers in total that use one of three national databases (ACS TQIP, NEISS, and H-CUP NEDS). For each database, we reviewed the four journals that most commonly publish papers using these databases. We conducted a scoping review. We asked two research questions of each article we reviewed: We found that 14.4% of TQIP authors in the examined journals include SDOH; 4.3% of NEISS authors include SDOH; and 83.3% of NEDS authors include SDOH. We also found that 13.6% of TQIP authors mention a lack of measuring SDOH relative to 25.5% of NEISS authors and 27.8% of NEDS authors. This scoping review of SDOH in large national injury databases finds varying levels of inclusion and acknowledgement of SDOH in trauma, emergency medicine, injury, and surgical publications. Health disparities and SDOH affect patients' baseline health status, recovery from illness and injury, and, potential injury recidivism.
Trauma is a leading global cause of preventable morbidity and mortality, with South Asia bearing a disproportionate burden due to fragmented trauma systems and resource limitations. Effective trauma care depends on coordinated personnel, infrastructure, clinical processes, and interprofessional collaboration (IPC). To map existing evidence on barriers to adult trauma care delivery in South Asia and to examine how IPC is implemented through educational, practice-based, and organisational interventions. A scoping review was conducted following the Arksey and O'Malley framework and reported in accordance with PRISMA-ScR guidelines. Four electronic databases (PubMed, Scopus, Embase, and Web of Science) and Google Scholar were searched for English-language studies published between 2005 and 2025. Eligible studies examined IPC, teamwork, or system-level challenges in adult trauma care across civilian healthcare settings. Data were charted and reported descriptively with multiple categories across system, provider, and patient levels. Twenty-one studies were included from South Asia, with most evidence originating from India, highlighting important regional research disparities. Most were conducted in tertiary emergency departments or trauma centres and employed observational or quasi-experimental designs. Interventions were classified as IP education (n = 10), IP practice (n = 8), and IP organisation (n = 1); two studies provided contextual system analyses without direct interventions. Educational and practice-based interventions consistently improved provider knowledge, confidence, communication, and process reliability. However, organisational-level interventions were scarce, and patient-level outcomes such as mortality and functional recovery were infrequently reported limiting assessment of the true clinical effectiveness of IPC interventions. Recurrent barriers included underdeveloped prehospital systems, inconsistent trauma team activation, protocol variability, workforce turnover, and limited trauma registry coverage. The evidence base on IPC in South Asia trauma care is dominated by education and practice-level interventions, with limited evaluation of system-level redesign. While IPC interventions improve teamwork and care processes, their impact on patient outcomes remains inadequately measured. Sustainable progress will require trauma registries, standardized protocols, governance reform, and multicountry patient-outcome-driven research. Policymakers should prioritize integrated trauma governance, registry systems, and regional quality assurance to translate IPC gains into measurable improvements in trauma mortality, morbidity, and recovery.
This systematic review and meta-analysis examined the association between intracranial pressure monitoring (ICPm) and mortality in patients with severe traumatic brain injury (sTBI), with additional focus on functional neurological outcomes and intensive care unit (ICU) and hospital length of stay (LOS). This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered with PROSPERO (CRD42025643607). MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched through August 1, 2025, for studies comparing ICP-monitored and non-ICP-monitored patients with traumatic brain injury. Eligible study designs included randomized controlled trials, prospective observational cohort studies, retrospective observational cohort studies, registry-based cohort studies, and case-control studies. Study quality was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology checklist, Risk of Bias 2.0 for randomized trials, and the Oxford Centre for Evidence-Based Medicine Levels of Evidence framework. Thirty-one studies met inclusion criteria. The mortality meta-analysis included 121,799 patients. Pooled crude analysis showed lower mortality in ICP-monitored patients than in non-monitored patients (OR 0.79, 95% CI 0.68-0.91, p = 0.002), with high heterogeneity (I²=92%). Across studies with extractable group-level mortality percentages, median mortality was 28.6% in ICP-monitored patients and 33.2% in non-monitored patients. Functional neurological outcomes were inconsistently reported and did not show a consistent benefit with ICPm. ICU and hospital LOS were generally longer in ICP-monitored patients. Ten studies reported complication data, most commonly infection, hemorrhagic events, and mechanical or device-related complications; reporting was heterogeneous and precluded pooled analysis. ICPm was associated with lower crude mortality in sTBI; however, substantial heterogeneity and residual confounding limit causal interpretation. Functional outcomes did not show consistent benefit. Complication reporting was inconsistent, but reported events included infection, hemorrhage, and device-related complications. Future studies should standardize functional outcome reporting and adjust for key confounders. Systematic review and meta-analysis; Level III.
Accurate prehospital trauma triage remains challenging despite structured activation criteria, particularly in patients without overt physiologic instability. Prehospital point-of-care lactate has been proposed as a physiologic adjunct to support early identification of severely injured patients. This prospective multicenter cohort study evaluated the association between prehospital lactate and injury severity in trauma team-activated patients within a structured guideline-based trauma system. This prospective observational multicenter cohort study included adult trauma patients transported by emergency medical services to three Level I trauma centers and managed in the trauma room following trauma team activation (TTA). Prehospital lactate was measured by capillary earlobe sampling before or during transport and was not used for clinical decision-making. The primary outcome was severe injury, defined as Injury Severity Score (ISS) ≥16. Secondary outcomes were Abbreviated Injury Scale (AIS) ≥4 in at least one body region and intensive care unit (ICU) admission > 24 hours. Diagnostic performance was assessed using receiver operating characteristic (ROC) analysis and predefined lactate thresholds of ≥2 mmol/L and ≥4 mmol/L. A total of 108 patients were included, of whom 26 (24.1%) had ISS ≥ 16. Prehospital lactate levels were higher in severely injured than in non-severely injured patients. For prediction of ISS ≥ 16, prehospital lactate yielded an area under the curve (AUC) of 0.636 (95% CI 0.509-0.763). At a threshold of ≥2 mmol/L, sensitivity was 80.7%, whereas specificity was limited. Higher thresholds increased specificity at the expense of sensitivity. Similarly limited discriminatory performance was observed for AIS ≥ 4 and ICU admission > 24 hours. In trauma team-activated patients within a structured guideline-based trauma system, prehospital lactate was associated with severe injury but showed limited discriminatory performance for ISS-defined severe injury. Based on these findings, prehospital lactate does not appear suitable as a stand-alone trauma triage parameter in this setting but may provide complementary physiologic information when integrated into multimodal prehospital assessment strategies alongside established trauma team activation criteria. Future adequately powered prospective studies should evaluate its incremental value in combination with established physiologic parameters and focus on clinically proximal outcomes such as trauma team activation, hemorrhage control procedures, transfusion requirements, or other early life-saving interventions.
The reverse shock index multiplied by the simplified motor score (rSI-sMS) can rapidly reflect hemorrhagic shock and neurological status for rapid injury severity assessment in trauma patients during the emergency department triage, even when patient information is incomplete. However, its predictive and discriminatory performance for short- and long-term trauma outcomes remains to be validated as superior to conventional physiological indicators. This study was a 13-year multicenter validation cohort study conducted across three geographically distinct campuses of Tzu Chi Hospital within the same healthcare system network. We retrospectively analyzed data from a prospectively maintained multicenter trauma registry to compare the discriminatory performance of the rSI-sMS, shock index (SI), modified shock index (mSI), reverse shock index multiplied by the Glasgow Coma Scale motor subscale, and reverse shock index multiplied by the Glasgow Coma Scale (rSI-GCS) in predicting 3- and 7-day mortality, in-hospital mortality, ≥14-day intensive care unit (ICU) stay, and ≥30-day total hospital stay among trauma patients. This study included 26,606 trauma patients. The rSI-sMS's discriminatory performance for in-hospital mortality, 3-day mortality, 7-day mortality, ≥14-day ICU stay, and ≥30-day total hospital stay (areas under the receiver operating characteristic curves [AUROCs]: 0.722, 0.793, 0.774, 0.605, and 0.639, respectively) was superior to those of SI (AUROCs: 0.540, 0.580, 0.557, 0.513, and 0.576, respectively), mSI (AUROCs: 0.551, 0.584, 0.567, 0.522, and 0.577, respectively), and rSI-GCS (AUROCs: 0.707, 0.773, 0.758, 0.601, and 0.637 respectively; all P < 0.001). rSI-sMS was also superior at discriminating clinical outcomes in patients with injury severity scores ≥16, chronic diseases, cardiovascular diseases, and traumatic brain injuries, as well as geriatric and nongeriatric patients. The optimal rSI-sMS cutoff of four demonstrated 79.5%, 79.4%, 79.5%, 66.6%, and 78.7% overall accuracy for 3-day mortality, 7-day mortality, in-hospital mortality, ≥14-day ICU stay, and ≥30-day total hospital stay, respectively. Compared with SI, mSI, and reverse shock index multiplied by the Glasgow Coma Scale motor subscale, rSI-sMS demonstrated modestly improved discriminatory performance across several clinical outcomes, including mortality, ICU admission, and prolonged hospitalization, with discriminatory ability comparable to that of rSI-GCS. However, its performance for long-term hospitalization outcomes remained limited, and its clinical impact and practical utility require further confirmation through prospective studies and validation.
Traumatic brain injury (TBI) is a major cause of disability and socioeconomic burden worldwide. Using updated Global Burden of Disease Study 2021 estimates, this study assessed global TBI burden from 1990 to 2021 and projected future patterns to 2050. Global Burden of Disease Study 2021 estimates were used to evaluate TBI incidence, prevalence, and years lived with disability (YLDs) in 204 countries and territories. Age-standardized rates were stratified by age, sex, region, and sociodemographic index (SDI). Age-period-cohort (APC) modeling, frontier analysis, and inequality metrics were applied to characterize temporal patterns and disparities. Bayesian APC models projected population-level burden to 2050, and eXtreme Gradient Boosting-SHapley Additive exPlanation models were used as supplementary tools for prediction and interpretation. Model performance was assessed using cross-validation. From 1990 to 2021, incident, prevalent, and YLD cases increased by 22.35%, 53.27%, and 52.65%, respectively, whereas the corresponding age-standardized rates declined by 20.16%, 16.52%, and 16.19%. Men consistently had a higher burden than women. The APC model suggested a transition around 52.5 years, indicating a shift toward older populations. In low-SDI regions, the age-standardized YLD rate changed by 1.14% (95% uncertainty interval: -2.32 to 5.03), indicating no statistically significant change. SDI showed an inverted U-shaped association with YLD rates. Age-standardized incidence rate increased in the Caribbean and Oceania. Cross-validation showed close agreement between observed and predicted values (cross-validated R2 = 0.997-0.998; mean absolute error = 2.27-16.64). Projections suggested declining age-standardized rates through 2050. Global TBI burden increased in absolute numbers but declined in age-standardized rates. Persistent age, sex, socioeconomic, and regional disparities support targeted prevention, trauma-care strengthening, and rehabilitation planning.
The management of blunt pancreatic trauma in pediatric patients has evolved with the establishment of designated pediatric trauma centers. Given that pancreatic injuries frequently occur alongside other major injuries, studies specifically assessing outcomes remain limited. We compared outcomes for children with blunt pancreatic injury treated at pediatric versus nonpediatric trauma centers. Using the National Trauma Data Bank (2017-2023), we identified trauma patients aged ≤18 y with blunt pancreatic injury. Patients transferred out and those with severe nonabdominal injuries (AIS ≥3) were excluded. Outcomes included pancreas repair or resection, pancreatic duct procedures, hemorrhage control laparotomy, blood product transfusion, computed tomography (CT) utilization, in-hospital complications, discharge home, and hospital length of stay. Data were analyzed using multivariable regression and severity-adjusted models to evaluate clinical outcomes in children with blunt pancreatic injury. Among 1387 children, 802 (58%) were treated at pediatric trauma centers. After adjustment, treatment at pediatric trauma centers was associated with lower odds of pancreas repair/resection (adjusted odds ratio [aOR] 0.60), lower CT abdomen/pelvis utilization (aOR 0.68), fewer in-hospital complications (aOR 0.59), and a higher likelihood of discharge home (aOR 3.97). Hospital length of stay was also shorter among children treated at pediatric trauma centers. Pancreatic duct procedures did not differ by center type. In severity-stratified analyses, these associations were most apparent in lower-grade injuries, where pediatric trauma centers were associated with lower odds of operative intervention, complications, transfusion, hemorrhage control laparotomy, and CT utilization. In the restricted cohort excluding hollow viscus or mesenteric injury, the main findings were preserved. In pediatric blunt pancreatic injury, treatment at pediatric trauma centers was associated with a more favorable pattern of short-term outcomes and resource utilization. The observed associations may support early pediatric trauma center involvement for selected children with suspected blunt pancreatic injury.
Since the onset of the 2023 Israel-Gaza war, the healthcare system in the Gaza Strip has nearly collapsed. More than 70,937 casualties and 171,192 injuries have been reported, yet limited data exist on injury types and outcomes. Critical care services are essential during conflicts. This study aimed to determine causes of intensive care unit (ICU) admissions, associated injuries, complications, and outcomes in the Gaza Strip. We conducted a prospective cohort study of all adult and pediatric patients admitted to the ICUs at European Gaza Hospital and Shuhada Al-Aqsa Hospital between May 29 and June 30, 2024. Outcomes of interest were causes of admission, survival, types of complications, and length of stay. A total of 115 patients were admitted. Median age was 27 years (interquartile range 18-38), including 30 pediatric patients (26%). Thirty-five patients were female (30%). Trauma with or without burns accounted for 75 admissions (65%), while 27 (23.5%) had medical causes. Among trauma patients, 56 (75%) were from explosive injuries; traumatic brain injury was most common (30/75, 40%), including 10 of 21 pediatric trauma patients (47.6%). During ICU stay, 12 patients developed sepsis (10.6%), 10 developed septic shock (8.8%), and 12 developed multiorgan dysfunction (10.6%). Of 112 patients with known disposition, 64 were discharged and 48 died (43%). Median ICU survival was 6 days (95% confidence interval 5-17), and 17 days for pediatric patients (95% confidence interval 5-not calculable). Severe traumatic brain injury (33%) was the leading cause of death, followed by septic shock (22%). The high burden of trauma, complications, and mortality reflects the critical collapse of Gaza's healthcare system. Women and children represented a substantial proportion of ICU patients, highlighting civilian vulnerability. Urgent international medical intervention, humanitarian support, and a permanent ceasefire are essential to prevent continued loss of life.
ObjectiveTo evaluate the association between a prehospital-to-in-hospital integrated transfusion workflow and transfusion timeliness, coagulation-related indices, and short-term clinical outcomes in patients with severe trauma requiring emergency transfusion.MethodsThis single-center observational before-and-after study included 120 consecutive patients with severe trauma requiring emergency transfusion (60 per group). The conventional workflow group included patients treated between January 2022 and August 2023, and the integrated workflow group included patients treated between January 2024 and March 2025. The integrated workflow comprised prehospital assessment, real-time pre-arrival communication, early activation of emergency and transfusion resources, electronic transfusion ordering, and dedicated blood product delivery. The primary outcome was time to first transfusion, interpreted as a process-efficiency measure. Secondary outcomes included coagulation-related indices before transfusion and at 24 h, 24-h blood product utilization, intensive care unit length of stay, and in-hospital mortality. Univariable and multivariable analyses were performed to evaluate the association between workflow group and key outcomes.ResultsBaseline demographic, clinical, and pretransfusion laboratory characteristics were generally comparable between groups. The integrated workflow group had a shorter time to first transfusion than the conventional workflow group (25.1 ± 6.4 vs. 56.3 ± 8.2 min, p < 0.001). Fresh frozen plasma transfused within 24 h was higher in the integrated workflow group (1776 ± 348 vs. 1395 ± 317 mL, p < 0.001), whereas 24-h packed red blood cell use was similar (14.2 ± 5.4 vs. 14.7 ± 5.7 U, p = 0.645). At 24 h after transfusion, international normalized ratio and activated partial thromboplastin time were lower in the integrated workflow group (1.24 ± 0.29 vs. 1.37 ± 0.33, p = 0.022; 35.1 ± 6.6 vs. 42.1 ± 8.1 s, p < 0.001). Intensive care unit length of stay was shorter (7.3 ± 2.3 vs. 8.7 ± 3.8 days, p = 0.013). In-hospital mortality was numerically lower but did not differ significantly between groups (13.3% vs. 21.7%, p = 0.337).ConclusionsIn this single-center observational before-and-after study, a prehospital-to-in-hospital integrated transfusion workflow was associated with shorter time to first transfusion, greater early plasma administration, more favorable coagulation-related indices at 24 h, and shorter intensive care unit length of stay in patients with severe trauma requiring emergency transfusion. These findings should be interpreted primarily as evidence of improved workflow efficiency and hypothesis-generating associations with intermediate physiologic and short-term clinical outcomes. Further multicenter studies using standardized workflow timestamps, protocol-adherence assessment, and more rigorous adjustment for confounding are needed to determine whether this approach improves patient-centered outcomes across different trauma systems.
The optimal timing for post traumatic Chest Wall Reconstruction (CWR) in severely injured / polytraumatized patients with severe chest wall instability remains a subject of debate. While early surgery within 72 h is associated with improved outcomes, the efficacy and safety of an even earlier "rapid sequence" approach on the day of admission are unclear. This study aims to compare outcomes of severely injured patients undergoing rapid sequence surgery (Day 0) versus early surgery (Days 1-3). A retrospective analysis was conducted using data from the TraumaRegister DGU® (2015-2023). Patients with serious chest wall injuries (AISThorax ≥3), an Injury Severity Score (ISS) ≥ 9, who survived the first 48 h and underwent CWR were included. Patients were stratified into a "Rapid Sequence" group (surgery on Day 0) and an "Early" group (surgery on Days 1-3). Propensity score matching (PSM) was performed to balance baseline characteristics, including injury patterns, demographics, and initial physiological status. Primary outcome was in-hospital mortality. Secondary outcomes included sepsis, multi-organ failure (MOF), and length of stay. From an initial cohort of 34,659 patients with severe chest wall injuries, 2,498 operatively treated patients with a known date of surgery were analyzed. 1,168 (46.8%) underwent rapid sequence surgery (Day 0) and 567 (22.7%) underwent early surgery (Days 1-3). Before matching, the Rapid Sequence group had a higher ISS (27.7 vs. 26.0), a higher incidence of severe head trauma (14.4% vs. 9.2%), and significantly higher mortality (8.4% vs. 4.1%). PSM yielded 500 matched pairs. Despite matching, the Rapid Sequence group retained a higher baseline injury burden (mean ISS: 28.1 vs. 26.2; mortality prognosis (Revised Injury Severity Classification, Version III (RISC III) Score): 16.2% vs. 10.7%). The primary outcome showed a nearly threefold higher mortality rate in the Rapid Sequence group (10.6% vs. 3.6%; p < .001). Rates of sepsis (14.6% vs. 12.0%) and MOF (33.6% vs. 28.3%) were also higher in the rapid group, though not statistically significant. In this large registry analysis, rapid sequence CWR on the day of admission identified a distinct subgroup of patients with more severe concomitant injuries and higher baseline risk. The higher mortality in this group likely reflects residual confounding by indication and survivorship bias, rather than a detrimental effect of rapid surgery per se. This suggests that the decision for immediate surgery is likely driven by life-threatening concomitant injuries not fully captured in the matching model, identifying a patient population with an intrinsically higher risk of death. Our findings therefore do not justify a blanket Day-0-for-all strategy, but are consistent with the broader literature suggesting that CWR performed within 72 h is beneficial when timing is individualized to overall injury severity and physiological stability.
Older adults account for a rising proportion of trauma admissions, yet most prognostic tools for this group predict mortality alone. A validated multi-outcome model could support early risk stratification and optimize trauma care planning. This study developed and validated the Older Trauma Outcome Prediction (OTOP) model, the first tool designed to estimate multiple inpatient outcomes in older trauma patients. This study used Western Australia Trauma Registry linked data on patients aged ≥ 50 years admitted after external injury (2000-2020). Predictor variables, identified from a systematic review, included demographic factors, co-morbidities, injury characteristics, physiological measurements, and resuscitation indicators. The cohort was randomly divided into training (80%) and validation (20%) sets. Ridge logistic regression was used for binary outcomes (in-hospital mortality, surgery, intensive care unit (ICU) admission, medical complications), multinomial logistic regression was used for discharge destination, and quasi-Poisson regression was used for hospital length of stay. Model performance was assessed using the area under the curve (AUC), calibration, and error metrics. This study analysed 105 972 trauma admissions aged ≥ 50 years between 2000 and 2020 (84 778 patients in the training cohort, 21 194 in the validation cohort). The mean age of all patients was 74.0 years, and 45.3% were men. Mortality prediction showed excellent discrimination (AUC 0.95), outperforming the Geriatric Trauma Outcome Score (AUC 0.83). The surgery and ICU admission models performed well (AUC 0.97 and 0.96, respectively). Length-of-hospital-stay prediction demonstrated moderate accuracy (mean absolute error 4.9 days), whereas prediction of medical complications was limited (AUC 0.60). Discharge destination was accurately classified into home, rehabilitation, residential care, or death. OTOP is the first validated multi-outcome prognostic model for older trauma patients, providing accurate and clinically relevant predictions to support early decision-making and optimize trauma system resource use.
Background: Traumatic brain injury (TBI) is a major cause of morbidity and mortality in older adults. While age and severity are known predictors of outcomes, limited research exists on how specific TBI types and sizes affect prognosis in older age groups.Methods: A retrospective cohort study analyzed data from the American College of Surgeons Trauma Quality Programs Participant Use File (ACS-TQIP-PUF) (2017-2022) including 182,661 adults ≥40 years with isolated blunt TBI (subdural hematoma >8mm, epidural hematoma >8mm, contusion >2cm, subarachnoid hemorrhage, or diffuse axonal injury [DAI]) and no skull fractures. Polytrauma cases were excluded. Outcomes included in-hospital mortality, intensive care unit (ICU) length of stay (LOS), and ventilator days. Multivariable logistic and linear regression models were used, adjusting for demographic, clinical, and injury characteristics.Results: Elderly patients (≥65 years) showed significantly higher mortality across all TBI types, most notably with contusions >2cm (OR 4.85, 95% CI 3.46-6.80, P<.01). DAI in elderly patients was associated with the longest ICU LOS (+2.63 days, 95% CI 1.76-3.49, P<.01) and ventilator duration (+4.29 days, 95% CI 1.90-6.67, P<.01). Factors such as anticoagulation use, low Glasgow Coma Scores, and specific comorbidities further increased risk.Conclusions: Older adults with larger, isolated TBIs, especially contusions and DAI, experience worse clinical outcomes. These findings underscore the critical need for age-tailored trauma management protocols and early intervention strategies to reduce mortality and improve recovery in this vulnerable population.
Traumatic pneumothorax (TP) is considered a prevalent pathology involved in chest trauma. Higher the number of accompanying pathologies, higher the rates of prolonged length of hospital stays and mortality. This study aimed to investigate the effect of accompanying pathologies on mortality in patients with TP. This study followed a single-center retrospective design. Patients with trauma who were diagnosed with pneumothorax in a tertiary emergency department in Turkey between January 1, 2022 and December 31, 2023, were included in the study. Logistic regression analysis was used to investigate the factors affecting mortality. During the study period, 252 patients were diagnosed with TP. The median age of these patients was 56 years, and the median length of hospital stay was 4 days. The most prevalent accompanying pathologies in patients with TP included rib fracture, hemothorax, and fracture of any of the extremities. The most prevalent pathologies associated with mortality were hemothorax, lung contusion, lower extremity fracture, traumatic brain injury and abdominal injury (P = .007, P = .036, P = .027, P = .005, and P = .002, respectively). Accompanying pathologies associated with an increased risk of mortality included bilateral pneumothorax, traumatic brain injury and abdominal injury (P < .001, P = .035, and P = .001, respectively). TP is considered one of the most prevalent chest traumas that can cause mortality. While accompanying pathologies such as hemothorax, lung contusion, and lower extremity fractures are associated with higher mortality in univariate analyses, they do not independently predict death. The independent predictors that substantially increase the risk of mortality in patients with TP are bilateral pneumothorax, traumatic brain injury, and abdominal injury.
Orthopaedic trauma is frequently accompanied by psychological distress, including depression, anxiety, and post-traumatic stress, particularly in low- and middle-income countries. Beyond injury severity and surgical factors, psychological outlook-encompassing negative cognitions (e.g., catastrophising) and positive constructs (e.g., optimism, resilience, social support)-may substantially influence pain, disability, and functional recovery [3,4,6,17,18]. To narratively review evidence on the impact of psychological outlook on clinical, functional, and psychosocial outcomes after orthopaedic trauma, with emphasis on India, Central India, and comparable low-resource settings [4,10,17]. A structured narrative review of English-language studies (January 2000-October 2025) was conducted using PubMed, Scopus, and Google Scholar. Observational and interventional studies examining associations between psychological factors and pain, disability, function, quality of life, or rehabilitation outcomes in adult orthopaedic trauma populations were included [4,6,15]. Across diverse settings, approximately one-quarter to one-half of orthopaedic trauma patients experience clinically significant psychological distress, which consistently predicts higher pain, greater disability, and poorer quality of life independent of injury characteristics [2-4,14,15,17,18]. Catastrophising and fear-avoidance beliefs are associated with delayed functional recovery, whereas optimism, self-efficacy, and social support correlate with better rehabilitation adherence and outcomes [5,7,14-16,18]. Indian context literature highlights high distress burden and important modifiers including stigma, family dynamics, and socioeconomic stress [9,10]. Psychological outlook is a modifiable determinant of recovery after orthopaedic trauma. Integrating brief psychological screening and low-cost, culturally sensitive support strategies into routine trauma care represents a pragmatic opportunity to improve outcomes in Central India and similar low-resource settings [6,10,17-19].
Nurses are central to trauma care in both peacetime and conflict, where training and expertise directly affect patient outcomes. Cooperative training between healthcare professionals from opposing communities is rare in regions of ongoing violence, yet may be a powerful mechanism for strengthening regional trauma systems and advancing health diplomacy. Operating Together is a binational initiative that brings Palestinian and Israeli trauma providers together for joint training. This study describes the establishment of a regional Advanced Trauma Care for Nurses (ATCN) program serving both Israeli and Palestinian communities, evaluates course effectiveness, and health‑diplomacy attitudes. Between January 1 and December 31, 2025, six ATCN providers and two ATCN instructor courses were conducted. Participants completed anonymous questionnaires assessing satisfaction, perceived clinical relevance, and attitudes toward Palestinian-Israeli health cooperation. Descriptive statistics summarized responses, and comparisons used independent‑samples t tests and Fisher's exact tests (significance p < 0.05). Of 52 participants, 36 completed the study (50% Israeli, 50% Palestinian). Participants reported high course satisfaction (M = 8.44/10) and perceived educational impact (M = 4.39/5). Most (94.4%) expressed interest in maintaining professional contact. The belief that cooperation improves patient care is strongly correlated with positive health‑diplomacy attitudes (rs =.74, p < .001). Palestinian nurses reported significantly higher scores regarding the role of health cooperation in conflict resolution and mutual understanding (both p = .006). Male participants had higher health‑diplomacy index scores than female participants (p = .004). In the context of ongoing conflict, joint ATCN courses for Palestinian and Israeli nurses were associated with high educational satisfaction and strong support for continued professional cooperation. Participants perceived binational training as beneficial for trauma care and contributing to a more positive climate. Joint trauma nursing education may provide a promising platform for strengthening trauma systems and advancing health diplomacy in conflict‑affected settings. Prognostic and epidemiological; Level II-III (educational intervention).
ObjectivePediatric head trauma is common, but computed tomography exposes children to ionizing radiation. This systematic review and meta-analysis evaluated the diagnostic accuracy of point-of-care ultrasound for pediatric skull fractures and clarified its role as an adjunct to clinical assessment rather than a replacement for computed tomography when intracranial injury is suspected.MethodsWe conducted a systematic review and bivariate random-effects diagnostic test meta-analysis guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement and registered in the International Prospective Register of Systematic Reviews (Registration Number: CRD420251139217). PubMed, Embase, the Cochrane Library, and Web of Science were searched from inception through 3 September 2025. Two reviewers independently screened studies, extracted 2 × 2 diagnostic data, and assessed risk of bias using the Quality Assessment of Diagnostic Accuracy Studies-2 tool.ResultsNine studies conducted in emergency department settings met the inclusion criteria. Point-of-care ultrasound demonstrated a pooled sensitivity of 0.90 (95% confidence interval: 0.84-0.94), specificity of 0.98 (95% confidence interval: 0.94-0.99), and an area under the summary receiver operating characteristic curve of 0.96 (95% confidence interval: 0.94-0.97). The summary positive likelihood ratio was 41.73 (95% confidence interval: 15.85-109.87), and the negative likelihood ratio was 0.10 (95% confidence interval: 0.07-0.17). Deeks' funnel plot showed no evidence of small-study effects (P = 0.80).ConclusionsPoint-of-care ultrasound shows high diagnostic accuracy for detecting pediatric skull fractures and may support bedside risk stratification in selected children with low- or intermediate-risk mild head trauma. However, most isolated linear skull fractures are managed conservatively, and point-of-care ultrasound does not evaluate intracranial injury. Computed tomography decisions should therefore remain anchored in neurological status, injury mechanism, validated pediatric head injury decision rules, and clinician judgment.
To describe the proportion, demographic profile, mechanisms, temporal distribution, injury patterns and in-hospital outcomes of adults with major work-related trauma admitted to hospitals in Abu Dhabi. Retrospective cohort study using prospectively collected trauma registry data. Seven trauma-receiving hospitals in the Emirate of Abu Dhabi, United Arab Emirates, from 2014 to 2023. Adults aged 18 years or older with injuries coded as work-related in the Abu Dhabi Trauma Registry and an Injury Severity Score (ISS) of 12 or greater. Proportion of adult trauma admissions with ISS≥12 that were work-related; mechanisms of injury; anatomical injury pattern; intensive care unit (ICU) use; hospital and ICU length of stay; discharge disposition; and in-hospital mortality. Among 7019 adults with ISS≥12, 1318 (18.8%) had work-related injuries. Patients were predominantly young, with a median age of 33 years (IQR 27-42), male (98.6%) and non-local (98.8%). Falls from more than 1 meter were the leading mechanism (52.7%), followed by struck-by-object injuries (17.9%) and road traffic collisions (8.8%). Head and neck (53.1%), extremity (49.4%) and chest (48.3%) injuries were common, with a median of 2 injured body regions (IQR 2-3). Median ISS was 22 (IQR 17-29). ICU admission was required in 43.0%; median ICU length of stay was 5 days (IQR 3-12), median hospital length of stay was 8 days (IQR 3-16) and in-hospital mortality was 8.9%. Burns had the highest mortality (31.0%). 76% of all trauma patients were discharged home; however around 14% required transfer, long-term care or rehabilitation. Major work-related trauma in Abu Dhabi occurs predominantly among young non-local men, is caused mainly by falls from height and struck-by events and places a substantial burden on trauma and critical care services. Prevention should prioritise control of high-energy workplace hazards, especially falls from height, while service planning should account for rehabilitation and longer-term recovery needs.
To evaluate the predictive performance of combining serum D-Dimer levels with Injury Severity Score (ISS) for forecasting in-hospital mortality and unfavourable outcomes among trauma patients. An analytical study. Place and Duration of the Study: Department of Emergency, Foshan Hospital of Traditional Chinese Medicine, Foshan, China, from January 2021 to April 2025. Trauma patients were divided into a survival group (n = 250) and a death group (n = 35) based on in-hospital survival status. Whole-body CT examinations were performed upon admission, and general clinical data, serum D-Dimer levels, and ISS scores were compared between the two groups. ROC curves were generated to evaluate predictive performance. Logistic regression identified independent prognostic factors, which were then used to build a nomogram model using R software. A total of 285 trauma patients were included, with a mortality rate of 12.3%. Logistic regression analysis revealed that D-Dimer (p <0.001), ISS score (p = 0.02), GCS (p = 0.06), and days of hospitalisation (p <0.001) were independent risk factors for in-hospital mortality. The AUC was 0.766 for D-dimer, 0.740 for the ISS score, and 0.811 for the combined model. The combined model demonstrated significantly better predictive performance than either individual predictor (p <0.05). The nomogram was constructed based on the results of the multivariate regression analysis and demonstrated good predictive performance. D-Dimer levels and ISS scores were higher in trauma patients who died during hospitalisation. Trauma, D-Dimer, Injury severity score.