Injury. 2025 Jul 15;56(10):112615. doi: 10.1016/j.injury.2025.112615. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the economic burden of hip fracture hospitalizations associated with mental health and substance use (MHSU) disorder.

METHODS: We retrospectively analyzed the National Inpatient Sample 2016-2020. Patients 65 years and older with hip fracture-related ICD-10 diagnosis and discharge codes were selected. Pre-defined by Clinical Classification Software (CCS), we identified 34 MHSU groups. We analyzed MHSU disorders in two ways: first, we looked at patients with at least one MHSU disorder to compare demographic and clinical characteristics; and second, we examined individual MHSU categories separately to assess their prevalence and compare costs. The dependent variable was the hospitalization cost adjusted for 2024 inflation. Multiple regression analysis with a log transformation of costs was used to assess hospitalization costs by individual MHSU categories, adjusting for confounding factors.

RESULTS: Of 274,784 inpatient hip fracture admissions, 35 % had at least one diagnosis related to MHSU. Among the 34 MHSU categories, only five had a prevalence greater than 1 %: depression (15 %), anxiety or fear-related disorders (14 %), alcohol use (3 %), opioid use (3 %), and tobacco use (9 %). Patients with MHSU were younger and had longer hospital length of stay (LOS) than patients with no MHSU (NoMHSU) (median age 80 vs. 84 years, p < 0.001; median LOS 5 days vs. 4 days, p < 0.001). The total estimated cost of hospitalization for the cohort was $30.5 billion during the study period. Patients with MHSU incurred higher mean hospitalization costs compared to NoMHSU ($22,634 vs. $22,000, p < 0.001). After adjusting for demographic, regional, and clinical factors, costs were 4 % (p < 0.001) and 6 % higher (p < 0.001) for patients with alcohol-related and opioid-related disorders, respectively, compared to those without these conditions.

CONCLUSIONS: The economic burden of hip fractures in older adults is significant and exacerbated by the presence of substance use disorders, particularly alcohol- and opioid-related, underscoring the need for targeted policies and clinical interventions to optimize care and resource allocation for this population.

PMID:40743636 | DOI:10.1016/j.injury.2025.112615

Injury. 2025 Jul 3:112562. doi: 10.1016/j.injury.2025.112562. Online ahead of print.

ABSTRACT

Not available.

PMID:40738828 | DOI:10.1016/j.injury.2025.112562

Injury. 2025 Jul 22:112623. doi: 10.1016/j.injury.2025.112623. Online ahead of print.

ABSTRACT

PURPOSE: Inferior vena cava (IVC) filters are considered for preventing fatal pulmonary embolism (PE) in patients unable to undergo anticoagulant therapy. Trauma patients face a heightened risk of PE due to immobility and hypercoagulability. Although effective, IVC filters have long-term risks and should be removed when no longer indicated. A dedicated follow-up clinic can improve IVC filter retrieval rates and minimize complications. This study evaluates the impact of a dedicated clinic on retrieval rates, complications, and follow-up.

METHODS AND MATERIALS: A retrospective analysis was conducted on trauma patients with IVC filters inserted between October 2011 and October 2021. A dedicated trauma clinic, established in January 2018, followed discharged patients with inserted IVC filters. Inclusion criteria included prophylactic and therapeutic indications and emergent presentations. Patients who died during hospitalization or had filters retrieved at other hospitals were excluded.

RESULTS: During the pre-clinic period, 639 IVC filters were inserted, and 380 (59.5 %) were retrieved, with an average dwell time of 200 days. In the post-clinic period, 332 filters were inserted, and 278 (83.8 %) were retrieved, with a reduced average dwell time of 150 days. Complications decreased from 37 cases (average dwell time: 303 days) pre-clinic to 10 cases (average dwell time: 187 days) post-clinic.

CONCLUSION: The establishment of a dedicated follow-up clinic significantly improved IVC filter retrieval rates and reduced dwell times at this trauma center. This study highlights the value of follow-up clinics in ensuring timely IVC filter retrieval and minimizing complications when filters are no longer clinically required.

PMID:40738827 | DOI:10.1016/j.injury.2025.112623

Injury. 2025 Jul 24;56(10):112611. doi: 10.1016/j.injury.2025.112611. Online ahead of print.

ABSTRACT

OBJECTIVE: To characterize the mechanisms, distribution, and outcomes of traumatic limb amputations among military casualties during the Israel-Hamas War, and to evaluate the association between life-saving interventions and survival.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective observational study analyzed data from the Israel Defense Forces Trauma Registry. The cohort included 3253 urgent battlefield casualties who sustained limb injuries and were treated by IDF medical forces between October 27th, 2023 and October 31st, 2024.

MAIN OUTCOMES AND MEASURES: The primary outcomes were anatomical distribution of amputations, mechanism of injury, application of life-saving interventions (tourniquet, whole blood, freeze-dried plasma), and survival on the way to hospital admission and during hospitalization.

RESULTS: Of 3253 casualties, 135 (4.2 %) were initially recorded as having amputations. After review, 112 cases were confirmed to involve at least one amputated limb. Explosive devices were the leading cause of injury among amputees (88.9 %). Among the 112 confirmed cases, 50 (44.6 %) survived until hospital admission, and 62 (55.4 %) were pronounced dead prior to hospital arrival; 4 of the survivors died during hospitalization. Tourniquets were applied in 90 % of survivors compared to 24.2 % of deceased (p < 0.001). Whole blood and FDP were administered more frequently in survivors (60 % and 40 %, respectively) than in deceased casualties (9.7 % and 4.8 %, respectively; p < 0.001 for both). Above-knee amputations were the most common anatomical level in both groups.

CONCLUSION AND RELEVANCE: Combat-related limb amputations during the Israel-Hamas War were primarily caused by explosions and were associated with high mortality. Prompt application of life-saving interventions, particularly tourniquets and early blood resuscitation, was strongly associated with survival. These findings emphasize the critical need for rapid hemorrhage control and trauma care readiness in modern military conflict settings.

PMID:40738012 | DOI:10.1016/j.injury.2025.112611

Injury. 2025 Jul 22:112622. doi: 10.1016/j.injury.2025.112622. Online ahead of print.

NO ABSTRACT

PMID:40731241 | DOI:10.1016/j.injury.2025.112622

Injury. 2025 Jul 10;56(10):112609. doi: 10.1016/j.injury.2025.112609. Online ahead of print.

ABSTRACT

INTRODUCTION: Intraarticular scapular fractures occur mostly in high-energy injuries in contrast to glenoid fractures, which occur mostly in humeral head dislocations. In addition to open repositioning and osteosynthesis, minivascular osteosynthesis under the control of fluoroscopy and arthroscopy has been also used. Arthroscopy allows debridement of the fracture line in the intraarticular area as well as its repositioning during repositioning maneuvers under direct visualization. Furthermore, arthroscopy allows full control over the placement of osteosynthetic material in the subchondral region.

MATERIAL AND METHODS: Between 2013 and 2020, we performed osteosyntheses of 15 intraarticular fractures of the scapula using arthroscopy in addition to perioperative fluoroscopy. Patients were followed up at regular intervals at a mean of 10 days, 4 weeks, 3, 6, 12 and 24 months and 5 years after surgery including radiographic follow-up. Clinical outcomes and signs of radiological fracture healing were assessed continuously. Additionally, at 2 and 5 years after surgery, we evaluated the results according to the Constant score system. In particular, we evaluated ventral flexion of the arm, which we consider the dominant indicator of shoulder joint function.

RESULTS: There were 11 males and 4 females, mean age 37.5 (24-52) years. Perioperatively, we achieved fracture reduction with dislocation in the intraarticular region up to a maximum of 2 mm, which was measured arthroscopically and on perioperative and postoperative radiographs. We did not observe any inflammatory complications in the postoperative period. The mean duration of fracture healing was 112 days. The mean Constant score at two years after surgery was 85 points, and at five years was 87 points.

DISCUSSION: There are relatively few papers on similar topics in the world literature, but those that exist present the benefits of arthroscopy in some types of osteosyntheses of intraarticular fractures of the scapula. The most reported are osteosyntheses of the anterior glenoid in bony Bankart lesions. The numbers of patients in each paper are comparable or smaller.

CONCLUSION: Minimally invasive osteosynthesis of intraarticular fractures of the scapula under arthroscopic control allows precise reduction of fragments. Our study demonstrated favourable outcomes of this method with minimal complications.

PMID:40729990 | DOI:10.1016/j.injury.2025.112609

Injury. 2025 Jul 21;56(10):112618. doi: 10.1016/j.injury.2025.112618. Online ahead of print.

ABSTRACT

BACKGROUND: Fragility fractures of the pelvis (FFPs) in older adults are increasingly recognized as serious injuries with substantial morbidity. However, mortality after FFP has not been comprehensively quantified across timepoints or patient subgroups, limiting the ability to inform prognosis and guide clinical strategies. This systematic review and meta-analysis aimed to assess the 1-year mortality following FFP in patients aged ≥60 years. We also assessed the mortality at 30 days, 3 months, 6 months, 2 years, and 5 years after FFP, and the differences in mortality by geographic region, sex, fracture classification, or treatment modality.

METHODS: We conducted a systematic review and meta-analysis of studies published from inception to May 2024 in MEDLINE, Embase, and CENTRAL databases. Eligible studies reported mortality outcomes in patients aged ≥60 years with FFP. A random-effects model was used to estimate pooled mortality at prespecified time points. We assessed the risk of bias using the Joanna Briggs Institute (JBI) Prevalence Critical Appraisal Tool. Subgroup analyses were conducted to assess differences by region, sex, fracture classification, and treatment modality. We conducted a sensitivity analysis including only the high-quality studies according to the JBI assessment. The certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach.

RESULTS: The pooled 1-year mortality was 17 % (95 % confidence interval, 14 %-19 %). The certainty of this evidence was rated as low because of publication bias and heterogeneity. The mortality at 30 days, 3 months, 6 months, 2 years, and 5 years were 5 %, 10 %, 14 %, 26 %, and 46 %, respectively. Mortality was lower in studies from Asia than in those from Europe or North America. Male sex, lower-grade FFPs, and nonoperative management showed numerically higher mortality, though not statistically significant.

CONCLUSION: FFPs are associated with substantial short- and long-term mortality, warranting their recognition as high-risk injuries in older adults. Regional and treatment-related variation highlights the need for individualized management. Future research should clarify causal mechanisms and assess targeted interventions to reduce mortality risk.

PMID:40714375 | DOI:10.1016/j.injury.2025.112618

Injury. 2025 Jul 19:112619. doi: 10.1016/j.injury.2025.112619. Online ahead of print.

ABSTRACT

INTRODUCTION: Despite evidence of frequent adverse psychological reactions including PTSD in major trauma survivors, psychological support represents a frequent gap in UK major trauma care pathways. North Bristol Trust Major Trauma and Plastics Psychology Service has been newly developed in response at an NHS Major Trauma Centre (MTC). The service aims to address patients' psychological needs early on and throughout recovery from major trauma, alongside physical and functional recovery. Thus, a qualitative service evaluation was conducted. It aimed to explore major trauma clinicians' perspectives and experiences of the psychology service and to identify areas of strength and opportunity for development.

METHOD: Semi-structured interviews were conducted with a purposive sample of seven major trauma clinicians working at the MTC who make referrals to, and interact with, the psychology service. Data were thematically analysed using a codebook approach.

RESULTS: Thematic analysis of qualitative data revealed five themes: (1) Necessity of specialist psychology for major trauma patients; (2) Psychological involvement facilitates patients' recovery; (3) Psychologists have an important role in supporting clinicians; (4) Requirement for service expansion; (5) Importance of psychologists' integration within a multidisciplinary team. Overall, the importance of the psychology service in facilitating patients' holistic recovery was emphasised, as well as its role in emotionally and professionally supporting major trauma clinicians. Service expansion was suggested to better meet patients' needs by permitting increased provision of training and formalised support sessions for clinicians, greater involvement of psychologists in rehabilitation, and psychological support for patients' families.

CONCLUSIONS: Findings highlighted a perceived positive impact of integrated, specialist psychological support on the recovery of major trauma patients and the psychological wellbeing of major trauma clinicians. A need for future service expansion to overcome current capacity pressures and permit suggested developments was also emphasised. Replication of the psychology service in additional NHS MTCs to reach patients in other regions offers a potential solution to current inequities in post-major trauma psychological care in the UK.

PMID:40713353 | DOI:10.1016/j.injury.2025.112619

Injury. 2025 Jul 16:112612. doi: 10.1016/j.injury.2025.112612. Online ahead of print.

ABSTRACT

BACKGROUND: Shock index (SI) has been used to identify patients at risk for severe injury and predict those who require an emergent intervention. In adults, SI > 0.9 is considered elevated. Shock index pediatric age-adjusted (SIPA) modifies this threshold based on patients' age. This analysis leverages a large dataset to empirically identify threshold values of SI using a composite outcome capturing patients' need for emergent intervention.

METHODS: Pediatric patient data was abstracted from the Trauma Quality Improvement Program Participant Use Files from 2013 - 2020. 484,586 patients were included in the analysis. Area under the receiver-operator characteristic curve (AUROC) was used to empirically derive optimal cutoffs by age group. Need for emergent intervention included craniotomy, thoracotomy, laparotomy, chest tube, angioembolization, endotracheal intubation, and blood transfusion within 24 h of arrival or use of mechanical ventilation or admission to an intensive care unit.

RESULTS: Empirically derived SIPA-E cutoffs (1.23, 1.05, 0.95, and 0.85 for ages 1-3, 4-6, 7-12, and 13-17 years, respectively) were similar to established SIPA-L cutoffs (1.22, 1.22, 1.00, and 0.90). Overall accuracy was consistent between the two cutoffs with nearly equal trades of sensitivity for specificity but remain low overall (empirical cutoff sensitivity = 33.8 %, specificity = 79.5 %; established cutoff sensitivity = 26.5 %, specificity = 86.8 %).

CONCLUSIONS: Empirically derived cutoffs agreed with established cutoffs for SIPA, but overall accuracy is low. Rather than predicting broad outcomes, SIPA seems better suited to narrow cases where it has shown greater accuracy, such as the need for urgent blood transfusion.

LEVEL OF EVIDENCE: Prognostic/epidemiological; Level III.

PMID:40713352 | DOI:10.1016/j.injury.2025.112612

Injury. 2025 Jul 8;56(8):112578. doi: 10.1016/j.injury.2025.112578. Online ahead of print.

ABSTRACT

PURPOSE: Acetabular fractures remain one of the most complex injuries in orthopedic trauma surgery. Although the Judet-Letournel classification is widely accepted, it is predominantly descriptive and may offer limited intraoperative guidance. This study aims to present a simplified framework based on functional fracture orientation, distinguishing between column and transverse fracture families. Through this lens, surgical planning, reduction strategy, and fixation method selection can be facilitated.

METHODS: A five-step interpretation model was developed to classify and manage acetabular fractures. The model includes: (1) identification of primary and secondary fracture lines, (2) radiographic analysis from AP and Judet views, (3) axial CT orientation to determine fracture trajectory, (4) identification of the constant fragment, and (5) evaluation of endo-pelvic and exo-pelvic accessibility. Each fracture family was analyzed to correlate fracture morphology with specific reduction maneuvers, clamp positioning, and definitive implant placement.

RESULTS: Column fractures follow a coronal orientation when viewed on an axial CT, while transverse and T-type fractures propagate in a sagittal plane and often involve both columns. T-type fractures present an additional vertical component requiring dual-column reduction. For each fracture pattern, tailored reduction tools and implant configurations are proposed according to anatomical accessibility and biomechanical demands.

CONCLUSION: This structured approach offers a reproducible analytical tool for preoperative planning and intraoperative execution. By simplifying fracture type interpretation and aligning morphology with fixation strategy, it supports accurate surgical decision-making, enhances training for orthopedic trauma surgeons and improves fixation outcomes.

PMID:40706357 | DOI:10.1016/j.injury.2025.112578

Injury. 2025 Jul 8:112601. doi: 10.1016/j.injury.2025.112601. Online ahead of print.

ABSTRACT

BACKGROUND: Controversies remain about the decision to proceed to aortic occlusion (AO) using either REBOA or resuscitative thoracotomy (RT) in severely injured patients worldwide. Present study aims to identify and evaluate the differences in AO technique use related to patients' conditions.

MATERIAL AND METHODS: This was a comparative study using a multicenter registry of postinjury AO (October 2013-February 2022). AO via REBOA was compared with RT performed in the emergency department of facilities experienced in both procedures and documented in Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) registry. Participants were adult trauma patients 16 years or older who experienced AO via REBOA zone 1 vs RT. The primary outcome was to identify the differences between patients treated with RT or REBOA. Ethical committee study approval number (Maryland IRB #HCR-HP-00,055,545-11).

RESULTS: 1937 patients were included. Median age: 34 (25-49), 1599 (82.5 %) were men. Penetrating trauma: 52.4 %. REBOA was adopted in 501 (25.9 %) patients, RT in 1436 (74.1 %). Patients treated with REBOA were older (40vs32 years, p < 0.001), suffered more frequently blunt trauma (76.3 %vs37.7 %, p < 0.001) and had higher ISS (33vs26, p = 0.003). Fewer of them underwent prehospital cardio-pulmonary-resuscitation (23.2 %vs49.8 % p < 0.001); had higher median SBP and HR (83vs0, p < 0.001 and 106vs0, p < 0.001 respectively), serum lactate levels were lower (7.5vs10.3 p < 0.001). SBP≥ 60 mmHg pre-hospital and at-admission (OR 2.27) and GCS>8 at admission (OR 2.24), trauma cases admitted/year (>4000/year, OR 4.41), transfer from another trauma center (OR 1.94) were related to the use of REBOA. Higher Injury severity score (ISS >55, OR 0.66), lower number of trauma treated (<4000/year, OR 0.66) and penetrating trauma (OR 0.24) were related to the use of RT.

CONCLUSION: REBOA was more frequently used for older patients with blunt trauma, higher prehospital systolic blood pressure, and Glasgow Coma Scale scores above 8. RT was more commonly performed in penetrating trauma, lower injury severity scores, and facilities with fewer annual trauma admissions. These findings suggest that patient characteristics and institutional factors significantly differed between patients treated with REBOA or RT, underscoring the need for further research.

PMID:40701854 | DOI:10.1016/j.injury.2025.112601

Injury. 2025 Jul 8;56(8):112602. doi: 10.1016/j.injury.2025.112602. Online ahead of print.

ABSTRACT

BACKGROUND: Cork University Hospital (CUH) is a model 4 tertiary referral centre in the south of Ireland. A robust Orthopaedic - Orthogeriatric co-management service manages close to 500 hip fractures per year. At CUH all adults aged 60 years or older admitted with hip fracture receive comprehensive geriatric assessment (CGA) and documentation of their frailty status.

OBJECTIVE: This study aims to review the clinical epidemiology of hip fractures in a specialist orthopaedic unit in Ireland, while examining the association between CFS and prespecified patient outcomes.

DESIGN & METHODS: Utilising the Irish hip fracture database (IHFD), we collected data between 1st July 2019 to September 30th 2021. Eligible cases were all adults aged 60 years and older admitted to CUH with hip fracture as defined by IHFD. Prespecified outcomes included Length of Stay (LOS), inpatient mortality and new admission to nursing home care and these were analysed in relation to a patients CFS.

RESULTS: 1132 adults met fracture criteria and were included in the study. Increasing frailty, specifically moderate to severe frailty was associated with increased LOS, inpatient mortality and increased likelihood of discharge to nursing home care when compared to those were not frail or who had very mild to moderate frailty.

CONCLUSIONS: People living with very mild to moderate frailty and severe frailty are at significant risk of hip fracture following low volume trauma. With approximately two years of hip fracture data, we found visible, generalizable data demonstrating the association between frailty and clinical outcomes.

PMID:40700919 | DOI:10.1016/j.injury.2025.112602

Injury. 2025 Jul 11;56(8):112599. doi: 10.1016/j.injury.2025.112599. Online ahead of print.

ABSTRACT

INTRODUCTION: The optimal postoperative weight-bearing regimen for tibial plateau fractures (TPF) remains a topic of debate. It ranges from non- or touch down- weight bearing between 2-12 weeks. More recent studies suggest that early weight-bearing may not result in any loss of reduction or hardware failure.

OBJECTIVES: To describe orthopedic surgeons' preferences for postoperative regimens and factors that influence their decision making in relation to weight-bearing status after treating TPF.

METHODS: A web-based survey was developed by the authors regarding tibial plateau fractures. Participants were asked different questions about timing of weight bearing after osteosynthesis and factors that influenced the surgeon's decision-making process for 3 unicondylar and 3bicondylar tibial plateau fractures.

RESULTS: A web-based survey was developed and 151 surgeons answered our survey. 82 % were men and 62 % of respondents treated > seven tibial plateau fractures per year. In unicondylar fractures 19 % recommended full weight bearing and 81 % recommended restricted weight-bearing. In bicondylar fractures 89 % recommended restricted weight-bearing and 11 % full weight bearing. Restricted weight bearing was recommended for 2, 4, 6, 8, 10 or 12 weeks depending on the surgeon's preference. 73 % of the surgeons stated that the sense of stability in their own construction affects their postoperative weight-bearing plan and in 45 % the regimen was based on "gut feeling". Responders believed they get a stable osteosyntehsis in only 57 % of their own fixations and 48 % responded that they do not believe patients are following the postoperative weight bearing plan.

CONCLUSION: Our survey study demonstrated variability among orthopedic surgeons regarding postoperative weight-bearing in tibial plateau fractures. Further research is required to understand the stability of tibial plateau fractures and quantify whether we can allow patients to weight bear earlier safely.

PMID:40694897 | DOI:10.1016/j.injury.2025.112599

Injury. 2025 Jul 10;56(8):112600. doi: 10.1016/j.injury.2025.112600. Online ahead of print.

ABSTRACT

BACKGROUND: Missed injuries (MIs) remain a significant and potentially preventable complication in trauma care, often associated with increased morbidity, mortality, prolonged hospitalization, and legal consequences. Despite decades of recognition, MIs continue to challenge trauma teams, particularly in complex, multi-injury scenarios.

OBJECTIVE: This study aims to review the literature and identify the most relevant factors contributing to missed injuries in trauma patients, highlighting opportunities for prevention and clinical improvement.

METHODS: A systematic review was conducted according to PRISMA guidelines using PubMed. Inclusion criteria encompassed studies reporting on trauma patients with MIs, their risk factors, prevalence, and clinical outcomes. Exclusion criteria included non-trauma-focused studies, non-peer-reviewed articles, and case reports. Five key domains were assessed: trauma characteristics, injury-specific factors, diagnostic limitations, patient-related challenges, and human (physician) factors.

RESULTS: High Injury Severity Score (ISS), altered mental status (e.g., low Glasgow Coma Scale), polytrauma, and cognitive biases such as anchoring were consistently associated with higher rates of MIs. Non-spinal orthopedic injuries, abdominal and thoracic lesions, and retroperitoneal or diaphragmatic injuries were among the most frequently missed. Diagnostic limitations included false-negative imaging, misinterpretation of radiological exams, and inadequate protocols in unstable patients. Patient factors-such as obesity, advanced age, alcohol or drug intoxication, and pregnancy-also contributed to delayed diagnosis. Inexperience, fatigue, and poor communication were recurrent human factors linked to diagnostic failures. The implementation of Trauma Tertiary Surveys (TTS) significantly reduced MI incidence and improved detection of occult injuries.

CONCLUSION: Missed injuries are multifactorial events influenced by the complexity of trauma, diagnostic limitations, patient characteristics, and human error. Proactive strategies, including TTS, heightened awareness of injury-specific challenges, improved imaging protocols, and fostering a collaborative trauma culture, are critical to minimizing missed diagnoses and enhancing trauma care quality.

PMID:40690819 | DOI:10.1016/j.injury.2025.112600

Injury. 2025 Jul 8:112591. doi: 10.1016/j.injury.2025.112591. Online ahead of print.

ABSTRACT

PURPOSE: Post-traumatic stress disorder (PTSD) is a known potential sequel to physical trauma. PTSD in trauma patients has seldom been studied in New Zealand. This study aimed to measure the prevalence and predictors of PTSD among hospitalized trauma patients in Christchurch, New Zealand.

METHODOLOGY: Participants who presented to Christchurch Hospital and were included in the NZ Major Trauma Registry (Injury Severity Score ≥ 12) were recruited. Eligible participants were mailed a questionnaire containing a series of self-reported 5-point rating scales that assess DSM-5 symptoms of PTSD. Baseline characteristics and demographic data were obtained from the NZ Major Trauma Registry. PTSD caseness was determined at a cutoff score >30 and analyses were performed accordingly.

RESULTS: Among 203 patients with major trauma (24 % response rate), 37 (18 %) were classed as having PTSD. Questionnaires were completed at mean 2.75 (standard deviation = 0.67) years since the injury. In univariable analysis, crossing PTSD threshold was positively associated with younger age (p < 0.001); the presence of anxiety (p < 0.001) and depression (p < 0.001); higher Injury Severity Score (p = 0.004); vehicle related injury (p = 0.009); GCS <15 (p < 0.001); having an alcohol related injury (p = 0.025); and all subscales of perceived social support (p < 0.05). In a backwards stepwise multivariable model controlling for age and sex unconditionally, the variables predictive of PTSD were younger age; Glasgow Coma Scale <15; and vehicle-related trauma.

CONCLUSION: High rates of PTSD exist in patients following major trauma in NZ. Patients who are young; and those with initial Glasgow Coma Scale <15; and vehicle-related trauma are at a higher risk of developing PTSD following major trauma.

PMID:40683803 | DOI:10.1016/j.injury.2025.112591

Injury. 2025 Jul 15:112614. doi: 10.1016/j.injury.2025.112614. Online ahead of print.

ABSTRACT

INTRODUCTION: Minimizing crystalloid administration to hemorrhaging trauma patients has been shown to decrease morbidity and mortality. Iatrogenic harm from 'over-resuscitation' may be a concern for trauma patients undergoing prolonged EMS transport. Our primary objective was to quantify the volume of prehospital crystalloid administered to hypotensive trauma patients with at least 30 min of exposure to prehospital care for whom fluid administration was not indicated in the intervention arm of prior randomized trials of fluid restriction. In addition, we aimed to identify factors associated with crystalloid administration and determine if trends in administration were present across the study period.

STUDY DESIGN: The ESO Data Collaborative 2018-2022 annual datasets were used for this study. Trauma patients who received prehospital vascular access, had a minimum systolic blood pressure between 75 and 90 mmHg, a GCS ≥ 14, and were exposed to EMS care for >30 min (on-scene to destination arrival interval) were evaluated for inclusion. The primary outcome for this analysis was the documented volume of crystalloid administration. Logistic regression modeling was used to investigate factors associated with the administration of >500 mL of crystalloid.

RESULTS: After application of exclusion criteria, 26,447 patients treated by 1150 EMS agencies were evaluated. Patients received a median of 200 [10,500] mL of fluid in the prehospital setting, and 95 % of patients received <1010 mL. Overall, 5745 (21.7 %) patients received >500 mL of fluid. Factors associated with administration of >500 mL of fluid included increased 'EMS exposure' time (OR 1.01 [1.01, 1.01] per minute), IV cannula size (22 G OR: 0.5 [0.4, 0.6], 20 G OR: [reference], 18 G OR: 2.1 [2.0, 2.3], 16 G OR: 4.6 [4.1, 5.2]), age (0.996 [0.994, 0.997]) per year, female sex (0.72 [0.68, 0.77]), minimum SBP (0.95 [0.94, 0.96] per mmHg), and penetrating injury, (1.9 [1.7, 2.1]).

CONCLUSION: Overall, crystalloid volumes administered in the prehospital setting were low in this cohort of hypotensive trauma patients exposed to at least 30 min of prehospital care. This may suggest that the practice of fluid restriction for patients who are hypotensive following trauma has permeated into EMS practice nationwide.

PMID:40683802 | DOI:10.1016/j.injury.2025.112614

Injury. 2025 Jul 8;56(8):112594. doi: 10.1016/j.injury.2025.112594. Online ahead of print.

ABSTRACT

BACKGROUND: Fragility fractures of the pelvis (FFP) pose significant challenges in geriatric care, with conservative management strategies remaining inconsistent. This scoping review aimed to map current trends in conservative treatment strategies for FFP and summarize associated clinical outcomes and complications.

METHODS: We examined (1) the types of conservative treatments used, (2) their temporal changes, and (3) their associated clinical outcomes. To visualize temporal trends, Pearson's correlation analysis was used to assess the frequency of reported interventions and outcomes over time.

RESULTS: A total of 75 studies were included. The most frequently reported conservative treatments were pain control (66 studies, 88.0 %), rehabilitation (52 studies, 69.3 %), and full-weight-bearing (22 studies, 29.3 %), all demonstrating significant increasing trends (p < 0.05). Outcomes were categorized into objective measures (e.g., mobility, hospitalization, mortality), subjective measures (e.g., Visual Analog Scale [VAS], functional scores), and complications (e.g., thromboembolic events, general infections). However, no statistically significant associations were found between specific conservative treatments and clinical outcomes.

CONCLUSION: Pain control, rehabilitation, and full-weight-bearing strategies have become increasingly central to conservative FFP management, particularly in osteoporotic populations. Evaluated outcomes included mobility, hospitalization, mortality, patient status, pain control, and complications such as infections and thromboembolic events. These findings underscore the variability in current practices and highlight the need for further research to develop a more structured evidence base for conservative FFP management.

PMID:40683060 | DOI:10.1016/j.injury.2025.112594

Injury. 2025 Jul 9;56(8):112592. doi: 10.1016/j.injury.2025.112592. Online ahead of print.

ABSTRACT

BACKGROUND: Abdominal solid organ (ASO) trauma of the spleen, kidney, and liver is common in children and often accompanies other traumatic injuries, posing significant clinical challenges. Non-operative management (NOM) is preferred according to current guidelines for both low- and high-grade lesions when hemodynamic stability is achievable. Aggressive surgical treatment can lead to chronic organ dysfunction, surgical related complications and long-term sequelae, while NOM failure may result in critical bleeding and multiorgan failure. This systematic review aimed to describe the prevalence of NOM failure in pediatric patients with traumatic ASO injuries and its predictors.

METHODS: A systematic literature search was conducted in PubMed, Scopus, and Cochrane Library from inception to August 2024. Studies were extracted for the prevalence of NOM failure and prespecified predictors. Study quality was assessed using the Joanna Briggs Institute's critical appraisal tool for prevalence reporting. A proportion meta-analysis provided a pooled estimate of NOM failure. Subgroup analysis for specific organs and meta-regressions for candidate predictors was performed. Multimodel inference estimated predictor importance in multivariable modeling.

RESULTS: The search yielded 67 studies evaluating the NOM course of 37,340 children. The pooled prevalence of NOM failure was 0.04 (95 % CI: 0.03-0.06). Multimodel inference showed that NOM failure prevalence increased with higher injury severity score (ISS), AAST grade, and age. The confidence in these results was rated moderate. Complications had a pooled prevalence of 0.09 and missed injuries 0.03.

CONCLUSIONS: NOM failure in pediatric post-traumatic ASO injuries is relatively infrequent, with high organ salvage rates achievable even in high-grade and multisystem trauma. Younger children achieve higher NOM success, suggesting potential for more conservative strategies. Complications requiring non-surgical interventions and missed injuries are not negligible, indicating the need for strict monitoring, in particular if aggressive preservation is the objective.

PMID:40683059 | DOI:10.1016/j.injury.2025.112592

Injury. 2025 Jul 16;56(8):112613. doi: 10.1016/j.injury.2025.112613. Online ahead of print.

ABSTRACT

CASE: Femoral shaft fractures with concomitant vascular injury requiring limb revascularization, although rare, are a limb-threatening condition. Historically, emergent external fixation of the femur fracture followed by vascular repair has been considered the standard of care. We discuss four cases of femoral fracture with an associated vascular injury amenable to nail fixation stabilized by expeditious intramedullary nailing (IMN), followed by limb revascularization. We discuss the timeline and duration of the procedure for this technique.

CONCLUSION: Expeditious femoral IMN prior to limb revascularization has multiple clinical advantages and has become our standard protocol for these injuries.

PMID:40683058 | DOI:10.1016/j.injury.2025.112613

Injury. 2025 Jul 11;56(8):112596. doi: 10.1016/j.injury.2025.112596. Online ahead of print.

ABSTRACT

INTRODUCTION: Trauma team activation criteria (TTAC) are used within Trauma Activation Systems (TAS) to facilitate the rapid identification of patients with major traumatic injuries requiring a hospital trauma system response, including the attendance of a multidisciplinary trauma team. The value of individual activation criteria available at the time a decision to activate the system response is made is uncertain. We conducted a systematic review to identify TTAC associated with the presence of major traumatic injuries in adult trauma patients.

METHODS: We searched MEDLINE, EMBASE, and CINAHL (01-01-2000 to 5-07-2024) for studies using multivariable methods to evaluate associations between physiological, anatomical and mechanism of injury variables available or obtained at emergency department triage and the presence of major traumatic injuries. Risk of bias was assessed using the QUIPs tool, meta-analysis was conducted using a random effects approach, and certainty of evidence assessed using GRADE.

RESULTS: We included 7 studies from major trauma centres in North America (n = 3), Australia (n = 2), Israel (n = 1) and Italy (n = 1). Studies were predominantly retrospective, evaluated a wide range of activation criteria, and used varying definitions of major trauma. We demonstrated with moderate certainty that low Glasgow Coma Score (OR 9.4 95 %CI 4.6-19.3), systolic hypotension (OR 4.4 95 %CI 2.2-8.8), abnormal vital signs (OR 3.7 95 %CI 2.6-5.3) and multi-region trauma (OR 4.7 95 %CI 3.5-6.5) were associated with the presence of major trauma. The certainty of evidence for the association between mechanism of injury and other physiological criteria and major trauma was low or very low.

CONCLUSION: Low GCS, systolic hypotension, abnormal vital signs at emergency department triage and the presence of multi-region trauma predict the presence of major trauma in adult trauma patients. These criteria could form the foundation of evidence-based TTAC. Remaining TTAC should reflect the trauma population and local major trauma response capabilities, with audit and revision necessary for optimal TTAC.

PMID:40683057 | DOI:10.1016/j.injury.2025.112596