Ten‐year trends of adult trauma patients in Central Denmark Region from 2010 to 2019: A retrospective cohort study

Penetrating trauma on the rise- nine-year trends of severe trauma in Sweden

PURPOSE

Sweden has an established trauma system involving national trauma criteria and the Swedish trauma registry (SweTrau), since over a decade. Meanwhile, the injury panorama has evolved, with an increase in gang-related violence in the Swedish community. In this study, we aimed to investigate long-term trends in mortality, management and trauma type in two major Swedish trauma centers over a nine-year period.

METHODS

All trauma patients with a New Injury Score (NISS) > 15 or a Trauma Alert (TA) call during 2013-2021 were identified in the participating centers' SweTrau registries. Data were analysed regarding mortality, proportion of emergency interventions, intensive care unit (ICU) admissions, mechanism of injury and type of trauma (penetrating or blunt). To assess trends, Chi-Squared test for trend and JoinPoint regression method were used.

RESULTS

A total of 10,587 patients were included in the study. Mortality remained unchanged over time in patients with NISS > 15 (10.0-10.9%, p = 0.963) but increased in patients with a TA and NISS < 15 (1.3-2.7%, p = 0.005). For NISS > 15, the proportion undergoing emergency interventions was stable (53.9%-48.8%, p = 0.297) while ICU admissions declined (62.1%-45.7%, p < 0.001). Penetrating trauma increased (12.4-19.6%, p < 0.001), including knife (10.0-15.7%, p < 0.001) and gunshot wounds (2.3-3.8%, p < 0.001), whereas accidents involving motorcycles (8.8%-7.0%, p = 0.004) and pedestrians (5.3%-2.2%, p < 0.001) decreased. Assaults (both penetrating and blunt) increased from 14.7 to 21.4% (p < 0.001).

CONCLUSIONS

In this trend analysis at two major Swedish trauma centers during 2013-2021, penetrating trauma increased with over 50% while traffic injuries decreased. The rise in mortality in patients with a TA and NISS < 15 is concerning and requires further evaluation, as do the reduction in ICU admissions.

European military surgical teams in combat theater: A survey study on deployment preparation and experience

INTRODUCTION

Adequate (predeployment) training of the nowadays highly specialized Western military surgical teams is vital to ensure a broad range of surgical skills to treat combat casualties. This survey study aimed to assess the self-perceived preparedness, training needs, deployment experience, and post-deployment impact of surgical teams deployed with the Danish, Dutch, or Finnish Armed Forces. Study findings may facilitate a customized predeployment training.

METHODS

A questionnaire was distributed among Danish, Dutch, and Finnish military surgical teams deployed between January 2013 and December 2020 (N = 142). The primary endpoint of self-perceived preparedness ratings, and data on the training needs, deployment experiences, and post-deployment impacts were compared between professions and nations.

RESULTS

The respondents comprised 35 surgeons, 25 anesthesiologists, and 39 supporting staff members, with a response rate of 69.7 % (99/142). Self-perceived deployment preparedness was rated with a median of 4.0 (IQR 4.0-4.0; scale: 1 [very unprepared]-5 [more than sufficient]). No differences were found among professions and nations. Skills that surgeons rated below average (median <6.0; scale: 1 [low]-10 [high]) included tropical disease management and maxillofacial, neurological, gynecological, ophthalmic, and nerve repair surgery. The deployment caseload was most often reported as <1 case per week (41/99, 41.4 %). The need for professional psychological help was rated at a median of 1.0 (IQR 1.0-1.0; scale: 1 [not at all]-5 [very much]).

CONCLUSIONS

Military surgical teams report overall adequate preparedness for deployment. Challenges remain for establishing broadly skilled teams because of a low deployment caseload and ongoing primary specializations. Additional training and exposure were indicated for several specialism-specific skill areas. The need for specific training should be addressed through customized predeployment programs.

Spanish vs USA cohort comparison of prehospital trauma scores to predict short-term mortality

BACKGROUND

This study aimed to evaluate three prehospital early warning scores (EWSs): RTS, MGAP and MREMS, to predict short-term mortality in acute life-threatening trauma and injury/illness by comparing United States (US) and Spanish cohorts.

METHODS

A total of 8,854 patients, 8,598/256 survivors/nonsurvivors, comprised the unified cohort. Datasets were randomly divided into training and test sets. Training sets were used to analyse the discriminative power of the scores in terms of the area under the curve (AUC), and the score performance was assessed in the test set in terms of sensitivity (SE), specificity (SP), accuracy (ACC) and balanced accuracy (BAC).

RESULTS

The three scores showed great discriminative power with AUCs>0.90, and no significant differences between cohorts were found. In the test set, RTS/MREMS/MGAP showed SE/SP/ACC/BAC values of 86.0/89.9/89.6/87.1%, 91.0/86.9/87.5/88.5%, and 87.7/82.9/83.4/85.2%, respectively.

CONCLUSIONS

All EWSs showed excellent ability to predict the risk of short-term mortality, independent of the country.

Admission of Upper Extremity Injuries Presenting to the Emergency Department: An NEISS Study

BACKGROUND

Upper extremity injuries account for 36.5% of presentations to the emergency department in the United States. This study seeks to determine current rates of upper extremity injuries that present to the emergency department and the injury characteristics of patients requiring admission.

METHODS

National Electronic Injury Surveillance System was queried for a 10-year period for upper extremity injuries. Further analysis was done to evaluate specific patient demographics, injury characteristics, and mechanisms of injury of those patients who were admitted to the hospital.

RESULTS

Between 2012 and 2021, 39 160 365 persons are estimated to have presented to 100 United States emergency departments for managing upper extremity injuries, accounting for 28.8% of total presentations. A total of 12 662 041 upper extremity patients were pediatric (32.3%). Admissions occurred in 4.6% of presentations. The most common presenting diagnosis was laceration (24.9%), while the most common admission diagnosis was fracture (49.7%). The majority had injuries involving their forearms (19.9%). The most common injury-associated consumer product group was stairs, ramps, landings, and floors at 28.5%. Of the 445 644 patients, those estimated to have been injured by stairs, ramps, landings, and floors adults were 429 435 or 96.4%. The most common injury-associated product in pediatric populations was playground equipment (23.6%), of which 53.7% was from monkey bars and other climbing apparatuses.

CONCLUSION

This study demonstrates an overall increase in admissions for upper extremity injuries in the setting of similar rates of overall upper extremity injuries with fractures and forearm being the most common diagnosis and body part involved, respectively.

LEVEL OF EVIDENCE

IV; Database.

Defining Characteristics of Middle-Aged and Geriatric Orthopedic Trauma in New York City over a 7-Year Period

OBJECTIVES

Examine the patterns and defining characteristics of middle-aged and geriatric patients who sustain orthopedic trauma in New York City.

STUDY DESIGN

Retrospective cohort study.

METHODS

11,677 patients >55 years old treated for traumatic orthopedic injuries were grouped into cohorts based on their age group (cohorts of 55-64, 65-74, 75-84, 85-94, ≥95 years) and year of presentation (2014-2021). Each patient was reviewed for demographics/comorbidities, injury mechanism/type, mortality data. Comparative analyses were conducted.

RESULTS

The average age of our cohort was 74 years old. The majority of patients were female (69%) and sustained their injuries via a ground level fall. The most common injuries sustained by patients occurred at the upper extremity (40%), hip (26%), and lower extremity (25%) with 820 (7%) patients sustaining polytrauma. The incidence of hip fractures and pelvic injuries increased with older age. Older patients had a higher rate of mortality through 1-year in addition to a longer length of stay. In contrast, the incidence of injury to the upper and lower extremity decreased with older age.

CONCLUSIONS

The rate of mortality out through 1-year following orthopedic trauma increased as patients got older. Significantly more women experienced a traumatic injury during 2014-2021. As age increased, ground level falls were the most common mechanism of injury with injuries more likely to occur in the axial skeleton, notably the hip and pelvis. Younger patients experienced higher rates of upper and lower extremity trauma. Providers should keep these patterns in mind to optimize care for middle-aged and geriatric trauma patients.