Pelvic fractures in blunt trauma patients:A comparative study

BACKGROUND Pelvic fractures(PF)with concomitant injuries are on the rise due to an increase of high-energy trauma.Increase of the elderly population with age related comorbidities further complicates the management.Abdominal organ injuries are kindred with PF due to the proximity to pelvic bones.Presence of contrast blush(CB)on computed tomography in patients with PF is considered a sign of active bleeding,however,its clinical significance and association with outcomes is debatable.AIM To analyze polytrauma patients with PF with a focus on the geriatric population,co-injuries and the value of contrast blush.METHODS This retrospective cohort study included 558 patients with PF admitted to level 1 trauma center(01/2017-01/2023).Analyzed variables included:Age,sex,mechanism of injury(MOI),injury severity score(ISS),Glasgow coma scale(GCS),abbreviated injury scale(AIS),co-injuries,transfusion requirements,pelvic angiography,embolization,laparotomy,orthopedic pelvic surgery,intensive care unit and hospital lengths of stay,discharge disposition and mortality.The study compared geriatric and non-geriatric patients,patients with and without CB and abdominal co-injuries.Propensity score matching was implemented in comparison groups.RESULTS PF comprised 4%of all trauma admissions.89 patients had CB.286(52%)patients had concomitant injuries including 93(17%)patients with abdominal co-injuries.Geriatric patients compared to non-geriatric had more falls as MOI,lower ISS and AIS pelvis,higher GCS,less abdominal co-injuries,similar CB and angio-embolization rates,less orthopedic pelvic surgeries,shorter lengths of stay and higher mortality.After propensity matching,orthopedic pelvic surgery rates remained lower(8%vs 19%,P<0.001),hospital length of stay shorter,and mortality higher(13%vs 4%,P<0.001)in geriatric patients.Out of 89 patients with CB,45(51%)were embolized.After propensity matching,patients with CB compared to without CB had more pelvic angiography(71%vs 12%,P<0.001),higher embolization rates(64%vs 22%,P=0.02)and comparable mortality.CONCLUSION Half of the patients with PF had concomitant co-injuries,including abdominal co-injuries in 17%.Similarly injured geriatric patients had higher mortality.Half of the patients with CB required an embolization.

Prognostic Factors to Reduce ICU Overtriage in Elderly Patients with Isolated Mild Traumatic Brain Injury

Introduction: Elderly patients with mild traumatic brain injury (mTBI) are frequently admitted to an intensive care unit (ICU), which is potentially both harmful and unnecessary. It is not known which patients may be safely observed in a non-ICU setting, potentially improving ICU utilization. The purpose of this study was to identify factors that predict which geriatric patients with traumatic brain injury may be admitted to a level of care other than the ICU. Methods: Adults ≥65+ years admitted with positive radiologic study demonstrating isolated mTBI (defined as Glasgow Coma Scale (GCS) 13 - 15) that was initially managed nonoperatively between January 2011-December 2016 were identified. Primary outcomes evaluated included over triage and Glasgow Outcome Scale (GOS). Results: 207 were identified. Most patients presented with GCS 15 (77.8%) and were admitted to ICU (85.5%). 27% (n = 55) met overtriage criteria. The most common TBI was subdural hemorrhage (SDH) (48.8%) followed by subarachnoid hemorrhage (SAH) (22.2%). Hemorrhage progression developed in 8.7% of subjects, but there was no difference across TBI type. 21.7% of patients developed a ≥2 point decrease in GCS during their hospital stay. Upon discharge, 89.9% had a GOS ≥ 4 - 5. Presence/type of a single intracranial hemorrhage (ICH) was not significantly associated with outcome, but presence of bilateral or multiple lesions was significantly associated with poor outcome (p = 0.04). Conclusions: Overtriage of patients to an ICU is costly, resource intensive, and avoidable. Here, we suggest a conservative framework to assist the determination of which patients can be safely observed in non-ICU setting. Future studies should determine if this framework is generalizable to the entire geriatric population who present with mTBI.

What’s new in trauma 2020

Throughout the past 2020,the pandemic COVID-19 has caused a big global shock,meanwhile it brought a great impact on the public health network.Trauma emergency system faced a giant challenge and how to manage trauma under the pandemic of COVID-19 was widely discussed.However,the trauma treatment of special population(geriatric patients and patients taking anticoagulant drugs)has received inadequate attention.Due to the high mortality following severe traumatic hemorrhage,hemostasis and traumainduced coagulopathy are the important concerns in trauma treatment.Sepsis is another topic should not be ignored when we talking about trauma.COVID-19 itself is a special kind of sepsis,and it may even be called as serious systemic infection syndrome.Sepsis has been become a serious problem waiting to be solved urgently no matter in the fields of trauma,or in intensive care and infection,etc.This article reviewed the research progress in areas including trauma emergency care,trauma bleeding and coagulation,geriatric trauma and basic research of trauma within 2020.