Older trauma patients are known to be undertriaged in the prehospital setting. However, it remains unclear whether these disparities translate into differences in the delivery of critical prehospital interventions. This study aimed to evaluate age-related differences in prehospital triage, allocation, and treatment within a physician-staffed emergency medical service system. A retrospective multicenter analysis of the TraumaRegister DGU® was conducted, including trauma patients aged ≥ 20 years between 2020 and 2023 with trauma team activation and subsequent intensive care unit admission. Patients were stratified into two age groups, 20-59 vs. ≥60 years, with additional subgroups up to 90-99 years. Prehospital interventions, transport modality, and trauma center allocation were analyzed. Furthermore, predefined high-risk scenarios (severe motor vehicle trauma, traumatic brain injury with GCS ≤ 8, and pneumothorax) were evaluated. A total of 67,069 patients were included, with comparable injury severity across age groups (mean ISS 20.2). Older patients were less frequently transported by air and less often allocated to supra-regional trauma centers. While overall intervention rates were similar, differences emerged in high-risk scenarios. Older patients received endotracheal intubation and tranexamic acid less frequently despite comparable injury severity. Prehospital chest tube placement rates were low and similar across age groups. Age-related differences in prehospital triage and allocation are associated with selective differences in treatment, particularly in high-risk situations. These findings suggest that prehospital care in older trauma patients is individualized rather than uniformly reduced, but highlight the need to refine triage algorithms and guideline implementation in an aging trauma population.
 Acetabular fractures in non-osteoporotic adults result from high-energy trauma, yet not all patients with comparable pelvic impact sustain these injuries. Patient-specific acetabular morphology may influence fracture susceptibility by altering load transmission.  We conducted a CT-based case-control study in adults aged 18-65 years after high-energy trauma. Cases were polytrauma patients with acetabular fractures; controls were polytrauma patients with clear pelvic trauma but without acetabular, pelvic-ring, or sacral fractures. Measured CT parameters included anterior/posterior/superior acetabular sector angles (AASA, PASA, SASA), acetabular anteversion, acetabular width/depth, and medial acetabular wall thickness. Derived ratios (e.g., AASA/SASA) were analyzed. Group comparisons used Mann-Whitney tests; logistic regression estimated odds ratios (ORs).  Among 84 patients (47 cases, 37 controls), cases demonstrated higher AASA (66.86° ± 9.40 vs 60.46° ± 7.25; p = 0.0007), lower acetabular anteversion (15.26° ± 4.30 vs 19.35° ± 5.94; p = 0.0009), and thinner medial acetabular wall (5.55 ± 1.13 mm vs 6.27 ± 1.22 mm; p = 0.0068). Key ratios including AASA/SASA (0.538 ± 0.075 vs 0.486 ± 0.056; p = 0.0004) and wall/depth (0.160 ± 0.033 vs 0.180 ± 0.029; p = 0.0018) also differed significantly. In multivariable analysis, each 1° increase in anteversion was associated with lower fracture odds (OR 0.854; 95% CI 0.753-0.968; p = 0.0135), and each 1 mm increase in wall thickness was associated with ~ 47% lower odds (OR 0.534; 95% CI 0.342-0.834; p = 0.0058). A ratio-based model yielded similar findings.  In non-osteoporotic polytrauma patients, lower acetabular anteversion and reduced medial acetabular wall thickness are independently associated with acetabular fracture, while increased relative anterior coverage (AASA/SASA) further stratifies risk. These CT-measurable morphologic factors may help explain individual fracture susceptibility after comparable trauma exposure.
Family caregivers (FCs) play a vital role in supporting the care of older adults with trauma admitted to the emergency departments (EDs). However, their needs are often unmet and overlooked by healthcare providers. This study aimed to assess the needs of FCs of older adults with trauma admitted to the EDs in Iran. A cross-sectional study was conducted in 2024 at Shahid-Beheshti Hospital in Kashan, Iran, involving 402 FCs of older adult trauma patients. Participants were recruited through consecutive sampling. Data were collected using the Questionnaire for the Assessment of the Needs of Caregivers of Patients with Trauma in the Emergency Department (QANCPT). Descriptive statistics and regression analysis were performed using. The mean (SD) age of FCs was 44.80 (12.90) years, and 52.98% were female. Among patients, 45.02% were female, and falls were the most common cause of their injury (50.25%). The mean (SD) overall needs score was 2.47 (0.32) out of 4. In regression analysis, caregiver needs were associated with their own education level and gender, as well as patient-related factors, including age, number of children, length of ED stay, and cause and location of injury. FCs of older trauma patients reported substantial unmet needs in the ED. Acknowledging and addressing these needs is essential for healthcare providers in the ED. Doing so can significantly improve both the patient care process and recovery outcomes.
Racial-based traumatic stress (RBTS) is a well-established, transdiagnostic risk factor associated with mental and physical health concerns among people of color. RBTS may arise immediately following a discriminatory encounter or develop as a psychological response to repeated racial stress. Racial microaggressions, subtle, ambiguous discriminatory events, are particularly harmful, as their cumulative impact can contribute to significant psychological distress. Although prior research has documented strong, bidirectional links between racial microaggressions and posttraumatic stress, no study has examined the extent to which microaggressions predict RBTS or how individual risk and resilience factors shape this relationship. A racially diverse people of color sample (N = 880, Mage = 23.4, SD = 3.24) was recruited using an online cross-sectional survey assessing racial microaggressions, RBTS, psychological distress, coping, and ethnic identity. Structural equation modeling was used to examine parallel and moderated mediation models. Racial microaggressions predicted psychological distress indirectly through both immediate and current RBTS, with the direct effect nonsignificant, indicating full mediation. Negative coping strengthened, whereas positive coping weakened, the links between microaggressions and RBTS. Affirmed ethnic identity showed mixed effects, offering protection when adaptive coping was high and maladaptive coping was low. Conditional indirect effects indicated that trauma pathways were strongest under high negative coping and low positive coping. These findings suggest that racial microaggressions contribute to distress chiefly through trauma-related mechanisms, including immediate reactions. Coping strategies and ethnic identity shaped these pathways, underscoring the clinical value of fostering adaptive coping and identity-affirming practices. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Right-sided traumatic diaphragmatic hernias are rare and easily missed due to liver shielding. Persistent or delayed respiratory or abdominal symptoms after blunt trauma warrant CT evaluation. Early laparoscopic repair enables safe reduction, tension-free closure, and rapid recovery, preventing life-threatening complications like strangulation or bowel ischemia.
Non-operative management (NOM) is the preferred approach for hemodynamically stable patients with blunt abdominal trauma (BAT) involving solid organ injuries. It is associated with shorter hospital stays (LOS) and favorable outcomes, particularly in pediatric patients, who have high rates of such injuries. This review assesses the efficacy of NOM in both pediatric and adult populations and compares outcomes between these groups. A meta-analysis and systematic literature review was performed using databases such as PubMed, MEDLINE, Google Scholar, Springer, and ScienceDirect to identify English-language studies published from 1980 to 2025 on NOM of abdominal solid organ injuries (ASOI) from blunt trauma (BT) in pediatric and adult patients, adhering to PRISMA guidelines. The systematic review analyzed outcomes from 21 clinical studies that met the inclusion criteria, in contrast, nine studies only met the inclusion criteria for the meta-analysis assessment. This meta-analysis and systematic review validates that NOM of blunt ASOI is effective and safe in both children and adults. Although NOM in adults is generally limited to lower-grade injury, children are frequently managed non-operatively for higher-grade injury, reflecting perhaps differences in injury pattern and clinical management considerations, despite overall very similar protocols being applied. The data of this study displayed also no statistically significant differences between children and adults regarding the other clinical parameters LOS, blood transfusion requirement, hemodynamic instability and mortality.
Traumatic defects of the helical rim caused by human bites present significant reconstructive challenges because of tissue loss, infection risk, and the need to preserve auricular contour and symmetry. We report a 27-year-old man who presented with a middle-third defect of the left helical rim following necrosis of an initially sutured avulsed flap caused by a human bite injury. After discussion of reconstructive options, including chondrocutaneous advancement and staged flap procedures, a single-stage modified postauricular flap without skin grafting was selected to preserve ear size and minimize donor-site morbidity. The flap was successfully inset with restoration of the helical contour, and postoperative follow-up demonstrated stable healing, preserved auricular shape, and high patient satisfaction without complications. This case highlights that a single-stage modified postauricular flap is a reliable and patient-centered option for reconstruction of traumatic helical rim defects following human bite injuries.
This study aims to develop and externally evaluate a machine learning (ML)-based predictive model for incident delirium in patients with traumatic brain injury (TBI). Patients diagnosed with TBI from the MIMIC-IV and eICU-CRD databases were included. Predictors were selected using Boruta and LASSO regression. Five ML algorithms were developed and compared, with logistic recalibration applied to the external cohort. Model performance was assessed using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA). Shapley Additive Explanations (SHAP) was utilized to decode individual risk contributions. Subgroup and sensitivity analyses were conducted to define clinical boundaries and evaluate model robustness. A total of 915 TBI patients from the MIMIC-IV database and 317 from the eICU-CRD database were included. Random Forest (RF) model achieved balanced performance with an internal AUC of 0.819 and an external AUC of 0.706. The model exhibited favorable internal calibration, adequate external recalibration, and positive clinical net benefits (internal: 0.155, external: 0.080). Overall SHAP analysis identified invasive ventilation, Glasgow Coma Scale (GCS), extracranial injury, Acute Physiology Score III (APSIII), hemoglobin and mixed intra-/extra-axial injury as primary predictors. Crucially, stratified SHAP analysis identified invasive ventilation as the primary driver across all strata, with baseline GCS scores attaining their maximum predictive weight in the medium-risk tier. Subgroup analyses of the external cohort indicated robust generalization in younger patients (AUC = 0.780) and those with extracranial injuries (AUC = 0.762), with expected attenuation in subgroups with higher clinical severity (AUC: 0.578-0.589). Sensitivity analyses confirmed the model's stable performance against competing mortality and missing data (all DeLong test p > 0.05). The RF model demonstrated acceptable discriminative capacity and clinical utility for early delirium prediction in patients with TBI. Supported by SHAP, it translated complex predictions into an actionable three-tiered framework, serving as a valuable adjunct for guiding early monitoring and neuroprotective strategies.
暂无摘要（点击查看详情）
To evaluate the prevalence and cultural attitudes surrounding laryngopharyngeal injuries in Brazilian Jiu-Jitsu (BJJ) and Mixed Martial Arts (MMA) athletes. Cross-sectional, mixed-methods study. Community-based survey and interviews of BJJ/MMA practitioners. BJJ/MMA practitioners were recruited over a 6-week period via social media and targeted email distribution. The 44-item survey collected data on the awareness and prevalence of laryngopharyngeal symptoms and injuries, care-seeking behaviors, and clinical outcomes related to chokeholds. 13 respondents participated in semi-structured interviews to further explore these themes. Of 160 survey respondents, 88% reported laryngopharyngeal symptoms following chokeholds, most commonly sore throat (79%) and odynophagia (66%). Most symptoms resolved within 1 week (68%), though 15% reported permanent voice change. 87% of practitioners continued training while symptomatic, and 78% indicated that permanent voice changes would not deter them from training. 50% of respondents indicated they would not seek care if symptoms lasted fewer than 2 weeks. Only 11% sought medical care (n = 18), of whom nearly half (n = 8) were diagnosed with a hyolaryngeal fracture. Interviews highlighted limited awareness of laryngopharyngeal injury risks and a prevailing "push through the pain" cultural ethos. Despite chokeholds being a foundational technique in BJJ/MMA, there is a paucity of data on laryngopharyngeal injury in these sports. Laryngopharyngeal symptoms are common among athletes yet often disregarded, with athletes frequently continuing to train despite symptoms and seldom seeking care. These findings underscore a gap in awareness and highlight the need for further research and education regarding laryngeal safety in combat sports.
Acetabular fractures are complex injuries with substantial potential impact on function, quality of life, and return to work. This study evaluated demographic, radiologic, and surgical determinants of mid-term patient-reported outcomes, hospitalization, and vocational recovery after open reduction and internal fixation (ORIF). In this retrospective cohort, patients undergoing acetabular ORIF with ≥ 2-year follow-up and complete radiographic/clinical records were included. Outcomes included the modified Harris Hip Score (mHHS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), SF-12 (PCS-12/MCS-12), length of stay (LOS), time to return to work (RTW), and RTW status. Analyses were adjusted for baseline comorbidity using the Charlson Comorbidity Index (CCI), using ANCOVA. Forty-two patients were analyzed (mean age 35.60 ± 13.12 years; 73.8% male), with a mean follow-up of 35.86 ± 6.89 months. Mean mHHS and WOMAC were 77.79 ± 19.17 and 24.52 ± 9.54, respectively. Mean length of stay and return-to-work (RTW) were 6.52 ± 3.11 days and 6.54 ± 4.67 months, respectively (66.7% returned to a similar activity level). After adjustment, anatomic reduction quality was significantly associated with the mHHS function subscale (P = 0.005) and shorter hospitalization (P < 0.001). Femoral head injury (FHI) was associated with worse WOMAC total (P = 0.019). Comminution was associated with PCS-12 (P = 0.028) and longer LOS (P = 0.007). Associated fracture patterns were linked to prolonged LOS (P = 0.006). No variable significantly predicted RTW time/status. Mid-term outcomes after acetabular ORIF were generally acceptable. Reduction quality showed consistent associations with functional outcome and hospitalization burden, while FHI was associated with worse patient-reported disability. Several radiologic predictors influenced hospitalization burden more than late patient-reported outcomes.
Social identities shape recovery after trauma, yet little is known about how different identity types foster resilience or perpetuate distress in survivors of domestic violence (DV). We investigated whether the number and centrality (i.e., subjective importance) of family and community identities predicted psychological and physiological health among women accessing DV support services in Ireland, an understudied population in trauma research. Sixty-four women (Mage = 43.87 years) reported their meaningful social group memberships, coded as family, community, and total identities. Psychological outcomes were complex posttraumatic stress symptoms and posttraumatic growth. The physiological outcome was salivary secretory immunoglobulin A, a biomarker of mucosal immune function. Multiple regression models with bootstrapped estimates (5,000 resamples) tested associations between identity variables and health outcomes. The total number of identities did not predict outcomes. However, greater number and centrality of family identities were robustly associated with higher complex posttraumatic stress symptoms. In contrast, greater number of community identities predicted lower complex posttraumatic stress symptoms, higher posttraumatic growth, and higher secretory immunoglobulin A levels. Centrality of community identities also predicted higher posttraumatic growth. Effect sizes were large, with confidence intervals excluding zero. Findings highlight the critical role of identity type and centrality in DV recovery. Whereas family identities may exacerbate trauma-related distress, community identities were protective, predicting psychological resilience and enhanced immune function. By focusing on women in Irish DV services, this study broadens trauma recovery research beyond predominantly North American samples. Interventions should prioritize fostering safe, valued community roles to support recovery among DV survivors. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Trauma Registries with a focus on severely injured patients use survival as their primary outcome. In order to compare hospitals, interventions, and changes over time, a precise risk of death prediction is mandatory. The German TraumaRegister DGU® uses the RISC II model (Revised Injury Severity Classification, version II) since 2013. The aging trauma population and an improved handling of missing data required the present revision. A total of 53,738 seriously injured trauma patients documented in 2022-2023 served as basis for development and validation (3:1 ratio). Missing values should now be considered to be within normal physiological range except in patients with specific findings indicative for an altered physiology. These findings were suggested by clinical experts and validated by registry data. The increasing age of trauma patients was addressed by additional categories and higher point weights. A logistic regression analysis provided new point weights for all predictors. Precision (observed versus predicted mortality) and discrimination (area under the receiver operating characteristic curve, AUROC) were calculated in the development and validation dataset. Patients in both datasets were well comparable, with a mean age of 55 years, 69% males, and an average Injury Severity Score (ISS) of 18 points. The rate of missing values ranged from 0% (compulsory data) to 17.5% (initial base excess). Missing pre-injury health status was imputed by age, missing pupil size, light reaction, and motor function were imputed by severity of head injury. In case of specific findings, blood pressure and initial laboratory values were imputed by injury severity (ISS), or blood transfusion, or catecholamines, or intake of anticoagulation drugs. The AUROC was 0.946 (95% confidence interval 0.944-0.949) for the new RISC III score which was confirmed in the validation data (0.949; CI 0.945-0.954). Observed and predicted mortality were 13.1% / 13.0% in the development dataset, and 13.2% / 13.0% in the validation dataset. Risk of death estimates require repeated validations. The increasing number of elderly trauma patients, some of them with restrictions regarding the intensity of treatment, required this update of the RISC II model. New point weights for age were established now, especially for the elderly, in order to enhance the precision of prediction in this patient group. Patients with missing values showed on average a low injury severity, thus replacing a missing value with the normal category as a general rule (RISC III) seems to be superior than replacing it with an average value (RISC II). The new prediction model shows high discrimination and precision in both datasets, development and validation, and will replace the previous version in quality reports and scientific analyses.
Blunt cerebrovascular injury (BCVI) is a serious complication of trauma that can lead to stroke if not detected early. Current selective screening criteria may miss a significant number of cases, prompting interest in universal computed tomography angiography (CTA) screening. We aim to evaluate whether universal CTA screening improves detection of BCVI compared with selective risk-factor-based screening in adult trauma patients, and to assess its impact on injury grade detection, clinical outcomes (stroke, mortality), cost-effectiveness, and imaging-related risks. A systematic review was conducted using PubMed, Embase, Cochrane, ProQuest, and Google Scholar through March 2026. Studies comparing universal versus selective CTA screening for BCVI in adult trauma patients were included. Data on detection, outcomes, and cost-effectiveness were extracted. A total of 1,362 records were identified, with 8 studies included after screening. Selective screening criteria missed 16%-37% of BCVI cases compared with universal CTA. Universal screening improved detection of both low- and high-grade injuries. Stroke incidence ranged from 8%-10%, with some cases occurring in patients without traditional risk factors. Imaging-related complications were low (AKI ~1.4%). Cost-effectiveness analyses showed universal CTA remained below willingness-to-pay thresholds (~$71,949/QALY) and improved quality-adjusted life years. Universal CTA screening for BCVI can be suggested as a diagnostic modality as it appears to improve detection of both low and high-grade injuries that may be missed with selective approaches. Additionally, CTA-based screening was deemed to be cost effective. Although limited, current evidence suggests that imaging-related harms are low, supporting the consideration of broader CTA screening strategies in appropriately selected trauma populations.
Respiratory dysfunction is a leading cause of morbidity and mortality after cervical spinal cord injury (C-SCI). Respiratory impairment is exacerbated by mechanical ventilation, which is associated with higher infection rates and diaphragm atrophy. Intramuscular stimulation of the diaphragm, that is, diaphragm pacing (DP), is a potential strategy to facilitate ventilator weaning, enhance respiratory function, and reduce complications. However, its impact on respiratory recovery and neuromuscular activation remains understudied. This prospective observational case series evaluated changes in respiratory function and diaphragm activation over two months in 11 patients with acute traumatic C-SCI who underwent DP. Outcomes included tidal volume, respiratory rate, minute ventilation, maximal inspiratory/expiratory pressure generation (MIP/MEP), forced vital capacity (FVC), and diaphragm electromyography (EMG) recorded from the implanted electrodes. Participants demonstrated severe respiratory impairment at baseline, with tidal volumes averaging 2.8±1.3 mL/kg and FVC at 19±14% of predicted. Despite this, 89% weaned from mechanical ventilation within 41±19.8 days post-injury. Significant weekly improvements were evident in tidal volume (+0.26 mL/kg), respiratory rate (-0.66 breaths/min), and minute ventilation (+0.35 L/min). MIP and MEP increased by 3% predicted function per week, and FVC increased by 2% of predicted function per week. Diaphragm EMG amplitudes during quiet breathing decreased over time, particularly in patients with high baseline activation (>80% of maximum) possibly reflecting improved neuromuscular efficiency. These findings suggest that DP may support early respiratory recovery after C-SCI improving respiratory function and diaphragm activation. Future research is needed to elucidate the underlying mechanisms and optimize clinical use of DP for respiratory recovery after C-SCI. (J Trauma Acute Care Surg 2026;00:000-000. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). Therapeutic Study; Level IV.
Blunt traumatic aortic rupture (BTAR) is a life-threatening injury that can occur in high-impact events such as motor vehicle collisions, falls, and sports-related trauma involving the thorax. Despite improvements in vehicle safety features and regulations by using anthropometric test devices, BTAR remains associated with substantial clinical severity and high mortality, and its underlying rupture mechanisms are still poorly understood. We developed a novel proof of concept for a human-thorax surrogate for in-vitro crash testing comprising a pulsatile heart pump, anatomically shaped silicone aorta, 3D-printed rib cage, and ballistic gel damping layer to investigate the fluid mechanics response to thoracic impact. The cardiovascular mock circulatory loop system of this surrogate was validated by obtaining physiological pressure waveforms with 120/80 mmHg of pressure and an average flow rate of 5.18 L/min. Subsequently, impacts were delivered to the sternum using a standardized pendulum system commonly employed in crash test dummy calibration. Impact severity was modulated by varying the pendulum's release height, corresponding to different kinetic energy levels. Instantaneous aortic pressure waveforms were recorded before, during, and after impact. The results demonstrate that thoracic impacts induce sharp, transient alterations in aortic pressure magnitude, with greater severity observed at higher energy levels, reaching a peak of aortic pressure of 287.01 mmHg. This experimental approach provides reproducible and physiologically relevant conditions for studying BTAR and offers valuable insights into the mechanisms underlying aortic rupture, which may guide the design of improved prevention and protection strategies.
Armed conflict forces parents to balance truth-telling with emotional protection to maintain children's sense of security. This study evaluates the "Children's Dictionary for War Situations", a tool developed during the 2023 Israel-Hamas war to assist parents in mediating complex reality. Utilizing a mixed-methods approach, 81 parents of children aged 4-16 were surveyed regarding the tool's efficacy, missing concepts, and age-appropriateness. Findings indicate significant gaps in addressing highly charged traumatic concepts, specifically "kidnapped" and "hostage". Parents reported difficulty navigating "modulated disclosure", the tension between accurate information and emotional shielding. Results underscore the critical role of parental mediation in buffering trauma and highlight the need for clinically informed, developmentally appropriate communication tools. These findings offer implications for fostering child resilience and supporting parental guidance strategies during ongoing military crises.
Brain injuries often have lifelong consequences that include long-term impairments and disability. Policy-, community-, and society-level interventions are a critical path to survivor impact. A recent qualitative study highlighted the potential of a new tool, Brain Injury Identification Cards, for enhancing survivor safety, self-advocacy, and well-being. The primary purpose of our study was to conduct a quantitative assessment of perceived benefits and self-reported credibility, expectancy, and acceptability to inform future trials. In this cross-sectional study, we assessed the impressions of current owners (N = 99) of Brain Injury Identification Cards. We administered online self-report questionnaires and characterized perceived experiences, acceptability, and utility using descriptive statistics. Most (>67%) had favorable impressions about their own use of the Brain Injury Identification Cards, although approximately 19% perceived the cards as stigmatizing or embarrassing, and 22% said the cards were not helpful for their stress and anxiety surrounding traumatic brain injury symptoms. Overall, participants rated treatment credibility and expectancy as high, and all respondents who completed survey items (n = 96) indicated that they would recommend cards to others with traumatic brain injury and other medical conditions. Our findings highlight the perceived benefits of using a Brain Injury Identification Card among established Card owners. Future studies in representative samples of survivors assessing user experiences before and after the receipt of Brain Injury Identification Cards are needed to assess potential intervention effects. (PsycInfo Database Record (c) 2026 APA, all rights reserved).