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BACKGROUND: The COVID-19 pandemic negatively impacted the collective American psyche. Socioeconomic hardships including social isolation led to an increase in firearm sales. Previous regional studies demonstrated increased penetrating trauma during the pandemic but it is unclear if trauma systems were prepared for this influx of penetrating injuries. This study aimed to confirm this increased penetrating trauma trend nationally and hypothesized penetrating trauma patients treated during the pandemic had a higher risk of complications and death, compared to pre-pandemic patients. METHODS: The 2017-2020 Trauma Quality Improvement Program database was divided into pre-pandemic (2017-2019) and pandemic years (2020). Bivariate analyses and a multivariable logistic regression analyses were performed controlling for age, comorbidities, injuries, and vitals on arrival. RESULTS: From 3,525,132 patients, 936,890 (26.6 %) presented during the pandemic. The pandemic patients had a higher rate of stab-wounds (4.8 % vs. 4.5 %, p > 0.001) and gunshot wounds (5.8 % vs. 4.6 %, p

This document assesses the appropriateness of various imaging studies for acute penetrating trauma to the torso. Penetrating trauma most commonly occurs from gunshots and stabbings, although any object can impale the patient. Anatomic location, type of penetrating trauma, and hemodynamic status are among the many important factors when deciding upon if, what, and when imaging is needed to further evaluate the patient. Imaging plays a critical role in the management of these patients. CT, in particular, aids in identifying and predicting internal injuries based upon trajectory of the object. Clinical variants are distinguished by ballistic versus nonballistic injuries, hemodynamic status, and compartment of the body injured. Ballistic trauma trajectory is less predictable, and imaging recommendations are adjusted for this unpredictability. Excluded from this document are penetrating traumatic injuries to pediatric patients and specific recommendations when the genitourinary system is clinically suspected to be injured, the latter of which is more specifically discussed in other Appropriateness Criteria documents. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are documented annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer documented journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer documented literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation. [ABSTRACT FROM AUTHOR]

Lumbar artery pseudoaneurysms are a rare complication of penetrating trauma that can result in devastating retroperitoneal hemorrhage or embolic complications if left untreated. Prompt recognition in the trauma setting can lead to timely definitive diagnosis via spinal angiography and treatment via endovascular embolization. We present a case of lumbar artery pseudoaneurysm secondary to a gunshot wound to the spine treated via coil embolization. [ABSTRACT FROM AUTHOR]

Background: Approximately 458,000 victims were deceased from intentional violence in 2021. A stabbing assault causes 25% of homicides. The study aims to evaluate injury patterns, trauma scores, radiological findings, types of treatment, and outcomes of stab assault patients admitted to a tertiary emergency department (ED). Methods: This is a retrospective observational study of stabbing injury patients in the ED of Hacettepe University, Turkey. The sites and patterns of injury, radiological findings, treatment methods, consultations, and complications are acquired from the patient's files. Trauma scores and frequency of outcomes, such as the need for surgery, hospitalization, or mortality, were calculated for all patients. Results: Among the 648 patients, 564 (87%) were male. The median age was 28 (interquartile range [IQR]:13). The commonly injured body parts were the extremities (75%), thorax (21.9%), and abdomen (16.9%). The median RTS was 7,84 (IQR:0), and the median ISS was 2 (IQR:3). The fluid was detected in 13 of 88 patients by FAST, solid organ injuries in 21 patients, and gastric and intestinal injuries in 11 patients by abdominal CT. One hundred sixty-one patients underwent moderate and major surgery. Complications developed in 13 patients. 74,4% of the patients (n = 482) were treated in ED and 21.8% (n = 141) of patients were hospitalized in wards, 2.3% (n = 15) in intensive care unit and 1.5% (n = 10) patients died. GCS, RTS, and probability of survival (Ps) were significantly lower, and ISS was significantly higher in deceased patients and patients who needed erythrocyte replacement. Conclusion: The majority of stab wounds were detected in extremities, but severe and lethal stabbing injuries were on the thorax and abdomen. In thoracoabdominal stabbing injuries, x-rays and FAST can be ineffective in detecting critical and fatal injuries. Therefore, thoracic and abdominal CT should be planned early to detect possible causes of death and make a timely and accurate diagnosis. Lower GCS, RTS, and Ps or higher ISS scores were related to the need for erythrocyte replacement. [ABSTRACT FROM AUTHOR]

Outcomes from trauma at the major referral hospital [Hospital Nacional de San Benito (HNSB)] in El Petén, Guatemala, have not been analyzed. Empirical evidence demonstrated a high number of motorcycle accidents (MAs). We hypothesized a large incidence of head trauma with poor outcomes in MAs compared to all other forms of blunt trauma. Our hypothesis was tested by performing a community observational study and a retrospective chart review in El Petén, Guatemala. An independent observer catalogued 100 motorcycle riders on the streets of El Petén for riding practices as well as helmet utilization. HNSB does not have electronic medical records. For this study, we performed a retrospective chart review of randomly selected nonconsecutive trauma admission at HNSB between March 2018 and June 2023. Blunt trauma was compared between MAs versus all others. Variables were examined by parametric and nonparametric tests as well as contingency table analyses. Most motorcycles riders involved multiple individuals (2.61 ± 0.79/motorcycle). Seventy riders included children (median = 1.0 [Q1-Q3 range = 1.0-3.0]/motorcycle). Overall, only three riders were wearing helmets. Forty-one were women. Of patients presenting to HNSB with trauma, 91 charts were reviewed (33.0 [20.0-37.0] y old; male 89%), 76.7% were blunt, and 23.3% were penetrating trauma. Within blunt trauma, 57.1% were MAs versus 42.9% all others; P = 0.13. MAs were younger (29.5 [20.0-37.0] versus 34.0 [21.8-45.8] y old; P < 0.05) and of similar gender (male 82.5% versus 96.6%; P = 0.1). More MAs had a computed tomography (70.0% versus 30.0%; P < 0.01) and they were more likely to present with head trauma (72.5% versus 46.7%; P = 0.04) but similar Glasgow Coma Scale (15.0 [13.5-15.0] versus 15.0 [12.5-15.0]; P = 0.7). MAs were less likely to require surgical intervention (37.5% versus 56.7%; P = 0.05) but had similar hospital length of stay (4.0 [2-6] versus 4.0 [2-10.5] d; P = 0.5). Unsafe motorcycle practices in El Petén are staggering. Most trauma at HNSB is blunt, and likely from MAs. More patients with MAs presented with head trauma. However, severe trauma might be transferred to higher level hospitals or mortality might occur on scene, which will need further investigations. Assessment of mortality from trauma admissions is ongoing. These findings should lead to enforcement of safe motorcycle practices in El Petén, Guatemala. [ABSTRACT FROM AUTHOR]

Background: Acute retinal necrosis is a rare but devastating acute posterior uveitis caused by a member of the herpes virus family. We report an extremely rare ARN case following penetrating trauma in the contralateral eye. Case presentation: A 61-year-old male was misdiagnosed as sympathetic ophthalmia due to a penetrating trauma history of the contralateral eye. The subsequent administration of high-dose IVMP therapy led to rapid progression of the retinal necrosis. ARN was strongly suspected base on the clinical examination and confirmed by the PCR aqueous testing. The patient finally got good visual outcomes by the effective and prompt antiviral treatment. Conclusion: Ophthalmologists should be alert to the possibility that penetrating injury can trigger the activation of latent viruses. If a patient experiences visual symptoms in the contralateral eye after an open-globe injury, it is recommended that a thorough peripheral retinal examination be performed to avoid missing ARN. [ABSTRACT FROM AUTHOR]

Abstract Background Approximately 458,000 victims were deceased from intentional violence in 2021. A stabbing assault causes 25% of homicides. The study aims to evaluate injury patterns, trauma scores, radiological findings, types of treatment, and outcomes of stab assault patients admitted to a tertiary emergency department (ED). Methods This is a retrospective observational study of stabbing injury patients in the ED of Hacettepe University, Turkey. The sites and patterns of injury, radiological findings, treatment methods, consultations, and complications are acquired from the patient’s files. Trauma scores and frequency of outcomes, such as the need for surgery, hospitalization, or mortality, were calculated for all patients. Results Among the 648 patients, 564 (87%) were male. The median age was 28 (interquartile range [IQR]:13). The commonly injured body parts were the extremities (75%), thorax (21.9%), and abdomen (16.9%). The median RTS was 7,84 (IQR:0), and the median ISS was 2 (IQR:3). The fluid was detected in 13 of 88 patients by FAST, solid organ injuries in 21 patients, and gastric and intestinal injuries in 11 patients by abdominal CT. One hundred sixty-one patients underwent moderate and major surgery. Complications developed in 13 patients. 74,4% of the patients (n = 482) were treated in ED and 21.8% (n = 141) of patients were hospitalized in wards, 2.3% (n = 15) in intensive care unit and 1.5% (n = 10) patients died. GCS, RTS, and probability of survival (Ps) were significantly lower, and ISS was significantly higher in deceased patients and patients who needed erythrocyte replacement. Conclusion The majority of stab wounds were detected in extremities, but severe and lethal stabbing injuries were on the thorax and abdomen. In thoracoabdominal stabbing injuries, x-rays and FAST can be ineffective in detecting critical and fatal injuries. Therefore, thoracic and abdominal CT should be planned early to detect possible causes of death and make a timely and accurate diagnosis. Lower GCS, RTS, and Ps or higher ISS scores were related to the need for erythrocyte replacement.

Background: Trauma is a leading cause of morbidity and mortality worldwide. The frequency of trauma-related deaths depends on various factors such as the severity and mechanism of the trauma.Objectives: This study aimed to determine the frequency, causes, and outcomes of trauma in patients referred to the emergency department of Ali Ibn Abitaleb Hospital, Rafsanjan, Iran, in 2021.Methods: A case-series study was conducted, examining the medical files of 4689 trauma patients referred to the emergency department of Ali Ibn Abitaleb Hospital in 2021. Data on age, gender, marital status, place of residence, mode of transportation to the hospital, reasons for admission (extremity trauma, head and neck trauma, thorax trauma, abdominal trauma, spine trauma, multiple trauma), type of trauma (blunt or penetrating), and mechanisms of trauma (traffic accidents, falls, fights, burns, electrocutions, work-related accidents) were recorded. The mortality rate and factors influencing it were also evaluated.Results: Among 4,689 trauma patients, the most common reasons for admission were organ trauma (46.4%), multiple trauma (23.5%), and cervical spine trauma (21.7%). The most common mechanisms of trauma were traffic accidents (68.3%) and fights (17.2%). Most patients (3506, 74.8%) had penetrating trauma. A total of 68 patients (1.5%) died from trauma. Significant factors related to mortality included old age (p

Background: The COVID-19 pandemic negatively impacted the collective American psyche. Socioeconomic hardships including social isolation led to an increase in firearm sales. Previous regional studies demonstrated increased penetrating trauma during the pandemic but it is unclear if trauma systems were prepared for this influx of penetrating injuries. This study aimed to confirm this increased penetrating trauma trend nationally and hypothesized penetrating trauma patients treated during the pandemic had a higher risk of complications and death, compared to pre-pandemic patients. Methods: The 2017–2020 Trauma Quality Improvement Program database was divided into pre-pandemic (2017–2019) and pandemic years (2020). Bivariate analyses and a multivariable logistic regression analyses were performed controlling for age, comorbidities, injuries, and vitals on arrival. Results: From 3,525,132 patients, 936,890 (26.6 %) presented during the pandemic. The pandemic patients had a higher rate of stab-wounds (4.8 % vs. 4.5 %, p > 0.001) and gunshot wounds (5.8 % vs. 4.6 %, p

Our previous work demonstrated that use of ShotSpotter (SS), a gunfire detection system, and use of police department (PD) transport decreased response and transport time for gunshot wound (GSW) victims versus events with non-ShotSpotter (NSS). The purpose of this study was to evaluate transport trends and how they are linked to SS in the period of 2016-2021 in Camden, NJ. This was a single-center, retrospective observational study. Demographics, response time, transport time, and clinical data were collected. Independent t -test, Mann–Whitney U test, chi-squared test, and linear regression to correct for transport time and method of transport were used to compare outcomes (P < 0.05). A total of 267 GSWs were included: 77 emergency medical technicians (EMS)-SS, 41 EMS-NSS, 116 PD-SS, and 33 PD-NSS. When comparing response from 2016 to 2021, PD improved from 4 to 2 min (P = 0.001). EMS improved from 6.4 min (EMS-NSS) and 4.5 min (EMS-SS) to 5 min (EMS- NSS) and 4 min (EMS-SS) (P = 0.281). In addition, PD transport times, 5 min (SS) and 4 min (NSS), were faster than EMS, 9 min (SS and NSS) (P < 0.001). Overall PD transport volume increased with a peak in 2020 (68.3%). There was also an increase in PD-NSS transport 4% to 37.9% (P < 0.001). EMS-SS transport decreased from 54.7% to 6.9% (P < 0.001). The presence of SS technology in a small urban setting continues to be associated with a higher rate of PD transport of GSW victims. The critical time of dispatch and transport for both PD and EMS has shown durable improvement. • Police response and transport times still faster in small US city. • Continued improvement of police transport times in small US city. • Increased police transport without ShotSpotter attributed to community policing policy. • Decreased emergency medical technicians transport attributed to emergency medical technicians shortage in light of COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Routine evaluation with CTA for patients with isolated lower extremity penetrating trauma and normal ankle-brachial-indices (ABI) remains controversial. While prior literature has found normal ABI's (≥0.9) and a normal clinical examination to be adequate for safe discharge, there remains concern for missed injuries which could lead to delayed surgical intervention and unnecessary morbidity. Our hypothesis was that routine CTA after isolated lower extremity penetrating trauma with normal ABIs and clinical examination is not cost-effective. We performed a decision-analytic model to evaluate the cost-effectiveness of obtaining a CTA routinely compared to clinical observation and ABI evaluation in hemodynamically normal patients with isolated penetrating lower extremity trauma. Our base case was a patient that sustained penetrating lower extremity trauma with normal ABIs that received a CTA in the trauma bay. Costs, probability, and Quality-Adjusted Life Years (QALYs) were generated from published literature. Clinical evaluation only (no CTA) was cost-effective with a cost of $2056.13 and 0.98 QALYs gained compared to routine CTA which had increased costs of $7449.91 and lower QALYs 0.92. Using one-way sensitivity analysis, routine CTA does not become the cost-effective strategy until the cost of a missed injury reaches $210,075.83. Patients with isolated, penetrating lower extremity trauma with normal ABIs and clinical examination do not warrant routine CTA as there is no benefit with increased costs. • Despite current guidelines, CT angiography is still performed in stable lower extremity penetrating injuries. • Operative intervention for a missed lower extremity vascular injury is rare. • Routine CTA in those with normal ABIs and examination is more costly with increased morbidity and no added health benefit. [ABSTRACT FROM AUTHOR]

Background: This systematic review investigates the diagnostic value of ultrasound in the evaluation of torso injuries following a penetrating trauma. Methods: We searched PubMed, Scopus, and WOS databases for related original articles until May 7, 2023, and extracted data related to diagnostic performance. The bivariate model and hierarchic summary receiver operating characteristic (HSROC) approach were used to calculate pooled diagnostic values. Cochrane Q test and I-squared were performed to evaluate heterogeneity. We assessed heterogeneity with meta-regression. Results: Seventeen studies were included, which involved a total number of 1866 patients. According to meta-analysis, sonography demonstrated a pooled sensitivity of 56% (45–67%) and specificity of 96% (94–97%), positive likelihood ratio (LR +) of 13.66 (8.03–23.23), and negative likelihood ratio (LR-) of 0.45 (0.35–0.59) for detecting abdominal injuries. In pericardial penetrating trauma, pooled sensitivity was 100% (45–100%), pooled specificity was 99% (96–100%), LR + was 136.7 (24.8–752.3), and LR- was 0.00 (0.00–1.22). For thoracic penetrating trauma, pooled sensitivity was 99% (93–100%) and specificity was 100% (98–100%). Conclusions: Sonography demonstrated promising diagnostic value in the initial assessment of torso penetrating trauma, particularly in the thoracic and pericardial regions. However, the sensitivity of sonography is limited in abdominal penetrating trauma and a combination with other imaging modalities should be considered in these cases. [ABSTRACT FROM AUTHOR]

Traumatic vascular injuries consist of direct or indirect damage to arteries and/or veins and account for 3% of all traumatic injuries. Typical consequences are hemorrhage and ischemia. Vascular injuries of the extremities can occur isolated or in association with major trauma and other organ injuries. They account for 1–2% of patients admitted to emergency departments and for approximately 50% of all arterial injuries. Lower extremities are more frequently injured than upper ones in the adult population. The outcome of vascular injuries is strictly correlated to the environment and the time background. Treatment can be challenging, notably in polytrauma because of the dilemma of which injury should be prioritized, and treatment delay can cause disability or even death, especially for limb vascular injury. Our purposes are to discuss the role of computed tomography angiography (CTA) in the diagnosis of vascular trauma and its optimized protocol to achieve a definitive diagnosis and to assess the radiological signs of vascular injuries and the possible pitfalls. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic created difficulties in access to care. There was also increased penetrating trauma in adults, which has been attributed to factors including increased firearm sales and social isolation. However, less is known about the relationship between the pandemic and pediatric trauma patients (PTPs). This study aimed to investigate the national incidence of penetrating trauma in PTPs, hypothesizing a higher rate with onset of the pandemic. We additionally hypothesized increased risk of complications and death in penetrating PTPs after the pandemic versus prepandemic. We included all PTPs (aged ≤17-years-old) from the 2017-2020 Trauma Quality Improvement Program database, dividing the dataset into two eras: prepandemic (2017-2019) and pandemic (2020). We performed subset analyses of the pandemic and prepandemic penetrating PTPs. Bivariate analyses and a multivariable logistic regression analysis were performed. Of the 474,524 PTPs, 123,804 (26.1%) were from the pandemic year. The pandemic era had increased stab wounds (3.3% versus 2.8%, P > 0.001) and gunshot wounds (5.5% versus 4.0%, P < 0.001) compared to the prepandemic era. Among penetrating PTPs, the rates and associated risk of in-hospital complications (2.6% versus 2.8%, P = 0.23) (odds ratio 0.90, confidence interval 0.79-1.02, P = 0.11) and mortality (4.9% versus 5.0%, P = 0.58) (odds ratio 0.90, confidence interval 0.78-1.03, P = 0.12) were similar between time periods. This national analysis confirms increased penetrating trauma, particularly gunshot wounds in pediatric patients following onset of the COVID-19 pandemic. Despite this increase, there was no elevated risk of death or complications, suggesting that trauma systems adapted to the "dual pandemic" of COVID-19 and firearm violence in the pediatric population. [ABSTRACT FROM AUTHOR]

IntroductionThere may be an association between violence and methamphetamine use. We hypothesized that trauma patients screening positive for methamphetamines are more likely to present after penetrating trauma and have increased mortality.MethodsThe 2017-2019 TQIP was used to 1:2 match methamphetamine (meth+) patients to patients testing negative for all drugs (meth-). Patients with polysubstance/alcohol use were excluded. Bivariate and logistic regression analyses were performed.ResultsThe rate of methamphetamine use was 3.1 %. After matching, there was no difference in vitals, injury severity score, sex, and comorbidities between cohorts (all p > 0.05). Compared to meth-, the meth+ group was more commonly sustained penetrating trauma (19.8 % vs. 9.2 %, p

Albert Yao,1,2 Jaiden I Busso,3 Nisha Lakhi1,4 1New York Medical College, School of Medicine, Valhalla, NY, USA; 2Maimonides Medical Center, Department of Pediatrics, Brooklyn, NY, USA; 3Boston University, Boston, MA, USA; 4Richmond University Medical Center, Department of Trauma Surgery, Staten Island, NY, USACorrespondence: Nisha Lakhi, Richmond University Medical Center Staten Island, Staten Island, NY, USA, Email nlakhi@nymc.eduBackground: Obesity is associated with increased morbidity and mortality in trauma scenarios; however, there has been conflicting evidence on outcomes of obesity and penetrating injuries, specifically gunshot wounds and stab wounds. We hypothesized that obesity may be protective due to a “cushioning effect” attributed to increased adiposity.Methods: This was a retrospective cohort study of patients presenting to a Level 1 Trauma Center with a penetrating trauma (gunshot/stab) injury during 2008– 2021. Patients with a BMI ≥ 30 were compared to those with a BMI < 30. The primary outcome was Injury Severity Score (ISS). Secondary outcomes included intensive care unit (ICU) length of stay, days on ventilation, length of hospital stay, service of admission (trauma surgery, general surgery, discharged home, general medical floor), the body region of injury(s), Abbreviated Injury Scale (AIS), OR requirement, type of surgery, and discharge status. Statistical analysis was performed using χ2-test or Fisher’s exact tests for categorical data, and Student’s t-test or Mann–Whitney U-test for continuous variables with p < 0.05 as statistically significant. Subgroup analysis was performed based on the mechanism of injury.Results: There were 721 patients that met inclusion criteria, of which 540 were classified in the non-obese group and 181 (25.1%) in the obese group. The primary outcome, mean ISS score, in obese patients (9.0, SD = 13.0) and non-obese patients (9.4, SD = 13.8) was similar between groups respectively. Secondary outcomes, which included rates of severe abdominal injury (AIS ≥ 3), rates of intra-abdominal organ injury, and rates of gastro-intestinal resection, were also similar between non-obese and obese patients.Conclusion: This study did not demonstrate the existence of a “cushioning effect” in the setting of penetrating traumatic injury. Patients with increased BMI had similar a ISS score and patterns of injury as their non-obese counterparts.Keywords: penetrating trauma, gun violence, obesity, cushioning effect

Time-To-OR is a critical process measure for trauma performance. However, this measure has not consistently demonstrated improvement in outcome. Using TQIP, we identified facilities by 75th percentile time-to-OR to categorize slow, average, and fast hospitals. Using a GEE model, we calculated odds of mortality for all penetrating abdominal trauma patients, firearm injuries only, and patients with major complication by facility speed. We additionally estimated odds of mortality at the patient level. Odds of mortality for patients at slow facilities was 1.095; 95% CI: 0.746, 1.608; p = 0.64 compared to average. Fast facility OR = 0.941; 95% CI: 0.780, 1.133; p = 0.52. At the patient-level each additional minute of time-to-OR was associated with 1.5% decreased odds of in-hospital mortality (OR 0.985; 95% CI:0.981, 0.989; p < 0.001). For firearm-only patients, facility speed was not associated with odds of in-hospital mortality (p -value = 0.61). Person-level time-to-OR was associated with 1.8% decreased odds of in-hospital mortality (OR 0.982; 95% CI: 0.977, 0.987; p < 0.001) with each additional minute of time-to-OR. Similarly, failure-to-rescue analysis showed no difference in in-hospital mortality at the patient level (p = 0.62) and 0.4% decreased odds of in-hospital mortality with each additional minute of time-to-OR at the patient level (OR 0.996; 95% CI: 0.993, 0.999; p = 0.004). Despite the use of time-to-OR as a metric of trauma performance, there is little evidence for improvement in mortality or complication rate with improved time-to-OR at the facility or patient level. Performance metrics for trauma should be developed that more appropriately approximate patient outcome. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Trauma care systems are life-saving significant implementations of a country's healthcare systems. Trauma care requires well-established trauma settings and organizations with experienced trauma teams including experienced emergency medicine, surgery and anesthesiology staff. This study aimed to investigate the outcomes of penetrating abdominal injuries treated by solo surgeons in a suburban area. METHODS: Medical records of the patients who were admitted to the emergency department with penetrating abdominal injuries between January 2012 and December 2021 were retrospectively analyzed. Patients were evaluated based on their injury sites and treatment approaches. RESULTS: In total, 110 patients with anterior abdominal penetrating injuries were enrolled in the study; 83 (75.4%) were stabbed and 27 (24.6%) had gunshot wounds. According to the injury site, there were 90 (81.8%) anterior; 11 (11%) right thoracoabdominal and 9 (7.2%) left thoracoabdominal injuries. Fifty-one (61.4%) stab wounds were treated with immediate laparotomy and 21 (41.1%) of these operations resulted in negative or nontherapeutic laparotomy. Also, 32 (38.6%) stab wounds were managed nonoperatively; three (9.3%) failed conservative management and received delayed laparotomy. All gunshot wounds were treated with immediate laparotomy and 14.8% resulted in either negative or nontherapeutic laparotomy. On-call surgeons were found to be more prone to perform immediate laparotomy on weekends when they were on call for 48 or 72 hours. CONCLUSION: Being a solo surgeon may increase negative laparotomy rates of penetrating abdominal injuries. This high percentage (41.1%) of negative laparotomy rates can be reduced by establishing well-organized trauma teams. [ABSTRACT FROM AUTHOR]

Background: Hemorrhaging trauma patients may be disproportionately affected by choice of induction agent during rapid sequence intubation (RSI). Etomidate, ketamine, and propofol are safe in the trauma population-at-large but have not been assessed in patients with ongoing hemorrhage. We hypothesize that in hemorrhaging patients with penetrating injury, propofol deleteriously affects peri-induction hypotension compared to etomidate and ketamine. Methods: Retrospective cohort study. Primary outcome was the effect of induction agent on peri-induction systolic blood pressure. Secondary outcomes were the incidence of peri-induction vasopressor use and quantity of peri-induction blood transfusion requirements. Linear multivariate regression modeling assessed the effect of induction agent on the variables of interest. Results: 169 patients were included, 146 received propofol and 23 received etomidate or ketamine. Univariate analysis revealed no difference in peri-induction systolic blood pressure (P =.53), peri-induction vasopressor administration (P =.62), or transfusion requirements within the first hour after induction (PRBC P =.24, FFP P =.19, PLT P =.29). Choice of RSI agent did not independently predict peri-induction systolic blood pressure or blood product administration. Rather, only presenting shock index independently predicted peri-induction hypotension. Conclusions: This is the first study to directly assess the peri-induction effects of anesthetic induction agent choice in penetrating trauma patients undergoing emergent hemorrhage control surgery. Propofol does not appear to worsen peri-induction hypotension regardless of dose. Patient physiology is most predictive of peri-induction hypotension. [ABSTRACT FROM AUTHOR]

Emergency Resuscitative Thoracotomy (ERT) is a lifesaving procedure in selected patients. Outcome mostly in blunt trauma is believed to be poor. The primary aim of this study was to determine the predictors of postoperative mortality following ERT. We retrospectively reviewed 34 patients ≥ 18 years who underwent ERT at San Camillo—Forlanini Hospital (Rome, Italy) between January 2009 and December 2022 with traumatic arrest for blunt or penetrating injuries. Of 34 ERT, 28 (82.4%) were for blunt trauma and 6 (17.6%) were for penetrating trauma. Injury Severity Score (p-value 0.014), positive E-FAST (p-value 0.023), Systolic Blood Pressure (p-value 0.001), lactate arterial blood (p-value 0.012), pH arterial blood (p-value 0.007), and bicarbonate arterial blood (p-value < 0.001) were significantly associated with postoperative mortality in a univariate model. After adjustment, the only independent predictor of postoperative mortality was Injury Severity Score (p-value 0.048). Our experience suggests that ERT is a technique that should be utilized for patients with critical penetrating injuries and blunt trauma in patients in extremis. Our study highlights as negative prognostic factors high values of ISS and lactate arterial blood, a positive E-FAST, and low values of Systolic Blood Pressure, pH arterial blood and bicarbonate arterial blood. [ABSTRACT FROM AUTHOR]

Because trauma patients in class II shock (blood loss of 15%-30% of total blood volume) arrive normotensive, this makes the identification of shock and subsequent prognostication of outcomes challenging. Our aim was to identify early predictive factors associated with worse outcomes in normotensive patients following penetrating trauma. We hypothesize that abnormalities in initial vital signs portend worse outcomes in normotensive patients following penetrating trauma. A retrospective review was performed from 2006 to 2021 using our trauma database and included trauma patients presenting with penetrating trauma with initial normotensive blood pressures (systolic blood pressure ≥90 mmHg). We compared those with a narrow pulse pressure (NPP ≤25% of systolic blood pressure), tachycardia (heart rate ≥100 beats per minute), and elevated shock index (SI ≥ 0.8) to those without. Outcomes included mortality, intensive care unit admission, and ventilator use. Chi-squared, Mann–Whitney tests, and regression analyses were performed as appropriate. We identified 7618 patients with penetrating injuries and normotension on initial trauma bay assessment. On univariate analysis, NPP, tachycardia, and elevated SI were associated with increases in mortality compared to those without. On multivariable logistic regression, only NPP and tachycardia were independently associated with mortality. Tachycardia and an elevated SI were both independently associated with intensive care unit admission. Only an elevated SI had an independent association with ventilator requirements, while an NPP and tachycardia did not. Immediate trauma bay NPP and tachycardia are independently associated with mortality and adverse outcomes and may provide an opportunity for improved prognostication in normotensive patients following penetrating trauma. [ABSTRACT FROM AUTHOR]

Introduction: The incidence of penetrating neck injuries is experiencing an upward trend. Given that hemorrhaging stands as one of the most preventable causes of fatality in traumatic situations, the prospect of employing a foley catheter (FC) to manage bleeding following penetrating neck injuries has led to contemplation on its integration into standardized protocols for bleeding control (BC), both in prehospital and in-hospital settings. Furthermore, inquiries into establishing standardized schedules for its application have arisen. Material and Methods: A meticulous search strategy was conducted utilizing the NCBI Medical Subject Heading (MeSH) term "foley*" and various combinations such as "foley" AND "trauma"; "foley" AND "neck"; "foley" AND "penetrating"; "catheter" AND "balloon" AND "trauma"; "gunshot" AND "neck"; "hemorrhage*" AND "neck" across multiple databases. These databases include MEDLINE, PubMed, PubMed Central, Scopus, Ovid, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL). Additionally, comprehensive searches using these terms were performed on Google, Google Scholar, and ResearchGate. The references cited in documents retrieved from these searches, covering 1833 to 2023, were thoroughly scrutinized. Results: 15 relevant articles were identified, and pertinent data were extracted from these studies. Historically, the use of FC was confined to immediate bleeding control; however, it has now extended its application into prehospital, emergency room (ER), and intraoperative settings. The primary success rate of FC stands at n=229 out of 274 cases (84%). FC serves as a valuable tool to bridge the gap in time before reaching the ER or operating room (OR), facilitating necessary radiological studies or interventions, especially when more severe injuries necessitate prioritization. Typically, FC was retained for 24-48 hours, but instances of prolonged applications up to 240 hours have been documented. Notably, it includes the definitive management of venous neck bleeding injuries, contingent upon excluding significant arterial defects through CTA. Late rebleeding stands at a low rate of 6% (14 out of 229 cases). Conclusion: Using FC is a pertinent strategy in managing neck injuries resulting from bleeding from penetrating wounds. Its substantial primary success rate in prehospital and ER phases surpasses the success rates achieved solely through pressure or chitosan dressing. Post-primary bleeding control, the presence of FC facilitates examinations and radiological interventions. Determining the optimal duration for FC placement remains a subject for consideration, leaning toward 2-3 days, if not longer. FC is progressively solidifying its role in Selective Non-Operative Management (SNOM) for hemorrhagic penetrating neck injuries. Consequently, a Foley catheter should be an essential tool in the possession of every prehospital and ER physician. Further delineation of criteria establishing the suitability of FC placement as definitive SNOM therapy for hemorrhagic penetrating neck injuries warrants consolidation.

Introduction: Emergency Department Thoracotomy (EDT) warrants further investigation in the pediatric population due to concerns about its futility. Our study evaluates how patient demographics, injury characteristics, and physiologic status influence pediatric EDT outcomes in blunt and penetrating trauma. Methods: This retrospective study analyzed patients ≤19 years who received EDT within 1 hour of arrival to the ED from the National Trauma Data Bank. Cases were stratified by blunt and penetrating trauma. Descriptive statistics and univariate analysis were used to identify predictors of survival post-EDT. Results: Of the 1,075 pediatric patients who underwent Emergency Department Thoracotomy (EDT), 79.6 % experienced penetrating trauma and 20.4 % blunt trauma, with survival rates at 25.9 % and 9.1 %, respectively. Survivors of penetrating trauma typically presented with more stable vital signs, such as pulse rate, oximetry, and Glasgow Coma Scale (GCS) scores, and lower Injury Severity Scores (ISS), all correlating with survival (p < 0.05). Survivors of blunt trauma were distinguished by higher respiratory rates and temperatures (p < 0.05). Risk factor analysis indicated that age-adjusted bradycardia, age-adjusted hypotension, and pre-hospital cardiac arrest were significant predictors of mortality across trauma types (penetrating trauma: OR = 18.7, 6.2, and 20.7; blunt trauma: OR = 12, 2.69, and 6.4, all p < 0.05). Notably, pre-hospital respiratory support was associated with a reduced risk of mortality for both types of trauma (OR = 0.32 for penetrating, and OR = 0.23 for blunt, p < 0.05). Conclusions: The study affirms the significance of pre-hospital care, showing that stable vitals and respiratory support enhance pediatric thoracotomy outcomes. Ongoing research into pediatric-specific trauma protocols are needed. Type of Study: Retrospective cohort Level of Evidence: III

To solve complex forensic cases, medico-legal issues such as cause of death, manner of death, weapon used, postmortem interval, and volitional activity must be resolved. An otherwise healthy 43-year-old male was found dead in a pool of blood 500 m from his home. On inspection, six penetrating lacerations were found on the left side of the chest. Police began an inquiry because they suspected firearm injuries. A dual-pointed weapon inflicted these paired penetrating injuries. The same weapon stabbed the victim three times. The injuries resembled rifle entry wounds, yet there were no exit wounds or bullets inside the corpse. In the field of forensic pathology, there exist numerous cases when antemortem penetrating wounds and post-mortem defects exhibit similarities to firearm injuries, leading to potential confusion among the parties involved in the investigation. In order to effectively manage complex cases, a thorough comprehension of various injury types and the weapons responsible for causing them is essential. Therefore, appropriate training and close supervision are required to enhance the quality and credibility of these investigations as a whole.

Abstract Purpose During hostilities, gunshot wounds are the most common cause of penetrating injuries. In 8–10% of abdominal injuries kidneys are involved. The treatment method include surgical or conservative treatment (fluids + blood components). Methods Of 1266 combat trauma cases treated during 6 to 14 rotation of the Polish Military Contingent in Afghanistan, we extracted a subgroup of 44 kidney injuries. Corelation of trauma mechanism, PATI score, treatment methods, and outcomes was evaluated. Results Out of the 41 renal injuries, 20 considered left, 18 right, and 3 both kidneys. There were no statistical significancy in injury lateralization (p = 0.669), and no differences regarding side of a trauma and quantity of blood component used for the treatment (p = 0.246). Nephrectomy was performed on 17 patients (13 left vs. 4 right). A significant correlation between PATI score and the need for a nephrectomy (p = 0.027) was confirmed. Penetrating trauma recquired higher number of blood components comparing to blunt trauma (p

Nonobstetric vaginal or vulva trauma is an extremely rare occurrence, with an incidence of < 0.2% of traumas. CT represents the gold standard in the diagnosis of gunshot lesions due to its ability to detect and stage injuries with very high sensitivity and specificity. A standardized protocol for penetrating trauma is still under debate for the use of intravenous contrast only or also rectal and oral contrast. Herein, we report a case of gunshot vaginal trauma in a 43-year-old patient presenting with vaginal bleeding. In our case, the protocol was “patient's tailored,” the intravaginal selective use of air was administered due to symptoms (vaginal bleeding) and CT findings, this 2-step protocol increased diagnostic confidence and allow a correct and challenging diagnosis.

Penetrating trauma to the head and neck has increased during the past decade in Sweden. The aim of this study was to characterize these injuries and evaluate the outcomes for patients treated at a tertiary trauma center. Swedish trauma registry data were extracted on patients with head and neck injuries admitted to Karolinska University Hospital (Stockholm, Sweden) between 2011 and 2019. Outcome information was extracted from hospital records, with the primary endpoints focusing on the physiological outcome measures and the secondary endpoints on the surgical and radiological outcomes. Of 1436 patients with penetrating trauma, 329 with penetrating head and neck injuries were identified. Of the 329 patients, 66 (20%) had suffered a gunshot wound (GSW), 240 (73%) a stab wound (SW), and 23 (7%) an injury from other trauma mechanisms (OTMs). The median age for the corresponding 3 groups of patients was 25, 33, and 21 years, respectively. Assault was the primary intent, with 54 patients experiencing GSWs (81.8%) and 158 SWs (65.8%). Patients with GSWs had more severe injuries, worse admission Glasgow coma scale, motor, scores, and a higher intubation rate at the injury site. Most GSW patients underwent major surgery (59.1%) as the initial procedure and were more likely to have intracranial hemorrhage (21.2%). The 30-day mortality was 45.5% (n = 30) for GSWs, 5.4% (n = 13) for SWs, and 0% (n = 0) for OTMs. There was an annual increase in the incidence and mortality for GSWs and SWs. Between 2011 and 2019, an increasing annual trend was found in the incidence and mortality from penetrating head and neck trauma in Stockholm, Sweden. GSW patients experienced more severe injuries and intracranial hemorrhage and underwent more surgical interventions compared with patients with SWs and OTMs. [ABSTRACT FROM AUTHOR]

Ballistic injuries cause both a temporary and permanent cavitation event, making them far more destructive and complex than other penetrating trauma. We hypothesized that global injury scoring and physiologic parameters would fail to capture the lethality of gunshot wounds (GSW) compared to other penetrating mechanisms. The 2019 American College of Surgeons Trauma Quality Programs participant use file was queried for the mortality rate for GSW and other penetrating mechanisms. A binomial logistic regression model ascertained the effects of sex, age, hypotension, tachycardia, mechanism, Glasgow Coma Scale, ISS, and volume of blood transfusion on the likelihood of mortality. Subgroup analyses examined isolated injuries by body regions. Among 95,458 cases (82% male), GSW comprised 46.4% of penetrating traumas. GSW was associated with longer hospital length of stay (4 [2-9] versus 3 [2-5] days), longer intensive care unit length of stay (3 [2-6] versus 2 [2-4] days), and more ventilator days (2 [1-4] versus 2 [1-3]) compared to stab wounds, all P < 0.001. The model determined that GSW was linked to increased odds of mortality compared to stab wounds (odds ratio 4.19, 95% confidence interval 3.55-4.93). GSW was an independent risk factor for acute kidney injury, acute respiratory distress syndrome, venous thromboembolism, sepsis, and surgical site infection. Injury scoring systems based on anatomical or physiological derangements fail to capture the lethality of GSW compared to other mechanisms of penetrating injury. Adjustments in risk stratification and reporting are necessary to reflect the proportion of GSW seen at each trauma center. Improved classification may help providers develop quality processes of care. This information may also help shape public discourse on this highly lethal mechanism. [ABSTRACT FROM AUTHOR]

Purpose: During hostilities, gunshot wounds are the most common cause of penetrating injuries. In 8–10% of abdominal injuries kidneys are involved. The treatment method include surgical or conservative treatment (fluids + blood components). Methods: Of 1266 combat trauma cases treated during 6 to 14 rotation of the Polish Military Contingent in Afghanistan, we extracted a subgroup of 44 kidney injuries. Corelation of trauma mechanism, PATI score, treatment methods, and outcomes was evaluated. Results: Out of the 41 renal injuries, 20 considered left, 18 right, and 3 both kidneys. There were no statistical significancy in injury lateralization (p = 0.669), and no differences regarding side of a trauma and quantity of blood component used for the treatment (p = 0.246). Nephrectomy was performed on 17 patients (13 left vs. 4 right). A significant correlation between PATI score and the need for a nephrectomy (p = 0.027) was confirmed. Penetrating trauma recquired higher number of blood components comparing to blunt trauma (p < 0.001). The renal salvage rate was in study group was 61.36%. The overall survival (OS) rate was 90.25% − 4 patients died due to trauma. Conclusions: The damage side does not result in a statistically significant increase in the need for blood transfusions or differences in the PATI score. The mechanism of trauma does, however, affect the number of blood components required for treatment, particularly in cases of penetrating trauma. With the introduction of proper treatment, the overall survival rate exceeds 90%, even when opting for conservative treatment. [ABSTRACT FROM AUTHOR]

Aim: Penetrating traumas (PT) in children, caused by firearms or cut/pierce instruments, are relatively rare, accounting for 10-20% of pediatric traumas. These traumas are serious and can lead to significant consequences, hence the need for prompt and multidisciplinary management. Materials and Methods: The study is a retrospective analysis of pediatric patients treated for PT in the pediatric intensive care unit (PICU). Patients were divided into two groups based on the cause of injury: cut/pierce instrument wounds and firearm wounds. Data collected included age, gender, diagnosis at PICU admission, type of trauma, cause of trauma (assault, suicide), vital signs, nature of trauma (thoracic, abdominal, cranial, extremity), associated organ failures, surgical needs, performed surgeries or procedures, need for respiratory and cardiovascular support, transfusion requirements, lab parameters (blood gases and organ functions), Pediatric trauma score (PTS), Pediatric Risk of Mortality (PRISM) score, PICU stay duration, and outcomes. Results: Between April 2022 and November 2023, a total of 425 pediatric cases were treated for trauma in the PICU, with a 6% frequency of PT. The majorities of PT cases were in the adolescent age group and were male (76%). The cause of PT was violence in 88% (22/25) cases and attempted suicide in 12% (3/25) cases. 72% were caused by cut/pierce objects and 28% were caused by firearm wounds. The location of trauma was thoracic in 48% (12/25), abdominal in 44% (11/25), thoraco-abdominal in 4% (1/25), and lower extremity in 4% (1/25). There was no cranial penetrating trauma. However, there was no vascular injury in any of the cases, despite damage to extremities near major arteries. In most cases (19/25, 76%), thoracic and/or abdominal surgery, including tube thoracostomy, was required to treat hemopneumothorax. Blood transfusion was performed in 52% of the cases (13/25). Five cases required non-invasive mechanical ventilation, and one case required mechanical ventilation. The cases were hospitalized in the PICU for a mean period of 3.7 days. The mean PTS score was 6.2±1.4 (range: 2-8), and the mean PRISM score was 10.9±3.7 (range: 7-37). All cases were discharged. There were no deaths. Conclusion: Penetrating traumas are rare in children but can lead to serious consequences. Therefore, a rapid and multidisciplinary approach is vital in the management of PT cases in children. [ABSTRACT FROM AUTHOR]

Penetrating trauma occurs less frequently in females than in males. Studies on penetrating injuries are conducted in predominantly male populations. We aim to elucidate the demographics and outcomes of penetrating trauma specifically in females to mitigate disparities of care in females. A retrospective review of hospitalized adult trauma patients suffering penetrating trauma from 2015 to 2021 was performed in an urban American College of Surgeon-verified level 1 trauma center. Patients were stratified by sex (females or males) and mechanism of injury (gun-related versus nongun-related). The primary outcome was mortality, and secondary outcomes included incidence of blood transfusion, incidence of surgical/interventional radiology (IR) interventions, hospital length of stay (LOS), and complications. Descriptive statistics were employed with a significance defined as P value <0.05. A multivariate logistic regression was used to determine the impact of sex on mortality, surgical/IR interventions, and hospital LOS. Females with penetrating injury had lower Injury Severity Score (1 versus 4, P < 0.05) than males, but had similar mortality rates (4% versus 6%, P = 0.06). In multivariable logistic analysis adjusting for age and Injury Severity Score, while females experience 33% fewer OR/IR intervention, there was no statistically significant difference in mortality rates, hospital LOS, and complication rates between males and females. Despite receiving fewer surgical/IR intervention, females with penetrating injuries have similar outcomes to their male counterparts. Further study is needed to study this discrepancy. [ABSTRACT FROM AUTHOR]

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Background: Patients discharged against medical advice do not receive adequate treatment and have a greater risk of readmission. This study assessed the rate of discharges against medical advice following assault-related penetrating trauma, with secondary aims to evaluate long term pre/post-injury hospitalizations and mortality. Methods: Adult assault-related penetrating injuries admitted to a Level 1 Trauma Center were identified in the prospectively maintained database. Chart review was conducted for hospitalizations ± 5 years from index injury and statewide mortality data was used to identify deaths outside of hospital care. Results: Out of a total of 1,744 assault-related penetrated injuries, 3.2% (52/1630) of survivors discharged against medical advice. Reasons for discharge against medical advice included: unknown (38%), home/child/family/pets (25%), unhappy with care/restrictions (23%), and work/money/other (13%). Post-discharge mortality did not differ between routine (6.5%) and against medical advice discharge (3.9%). Against medical advice and routine discharge had similar rates of any hospitalization (38.5 v 28.2%) and trauma hospitalization in prior 5-years (35 v 36%). However, significantly more against medical advice discharges had prior hospitalizations involving drug or alcohol abuse (65 v 38%), but not mental health diagnosis (55 v 55%). Significantly more against medical advice discharges have post-injury hospitalizations compared to routine discharges (48 vs 26.5%); however, include similar rates of repeat traumatic injury (36 v 32%). Conclusions: Those with against medical advice discharges were significantly more likely to have prior hospitalizations involving drug or alcohol abuse and significantly higher rates of post-injury hospitalizations. However, we did not see an increase in repeat traumatic injury or post-discharge mortality in those with against medical advice discharges when compared to those with routine discharges. [ABSTRACT FROM AUTHOR]

Background: On March 14, 2020, schools across North Carolina (NC) closed in response to Covid-19, forcing completion of the school year at home. Most pediatric trauma occurs at home with a higher prevalence when children are out of school. We queried the state trauma database to assess if the 2020 "shelter in place" was associated with an increase in pediatric trauma statewide. Methods: The NC trauma database was queried for injuries in children (age < 18 yrs) from 13 March-1 August 2020, and the corresponding months of 2018 and 2019. The number and type of injuries were compared. We also queried the NC death certificate and child welfare databases. Data were analyzed by standard statistical methods using chi-squared or Kruskal-Wallis test. Results: Total pediatric trauma cases were lower during 2020 (71.6 per 100,000) compared to 2018 (92.4 per 100,000) and 2019 (80 per 100,000) (P < .001); however, average injury severity score (ISS) was higher (P = .001). A significant increase in firearm injuries were seen in 2020 (P = .016), with an increase in mortality (P = .08) and ISS (P = .013). The rate of child abuse trauma decreased in 2020 (P = .005) as did the number of child abuse and neglect reports (P < .001). There were also significant decreases in trauma due to sports, burns, falls, and motor vehicle accidents. Conclusion: While overall pediatric trauma decreased during the Covid-19 pandemic, there was an alarming increase in penetrating injuries in children. Child abuse trauma and reports decreased, which is concerning for lower identification of abuse. [ABSTRACT FROM AUTHOR]

The management of penetrating abdominal wounds has greatly benefited from the development of computed tomography (CT), particularly in stable patients. In this setting, the scanner is the reference examination. Our study aims to evaluate the performance of preoperative CT in the assessment of penetrating abdominal lesions. Between January 1, 2015 and January 1, 2022, 81 patients were hospitalized following penetrating abdominal trauma at the Army Training Hospitals of Sainte-Anne and Laveran. Fifty-one stable patients who had an abdominopelvic CT scan and thereafter underwent abdominal surgery (laparotomy or laparoscopy) were included. Radiological and surgical data were collected from the electronic record and compared by a descriptive analysis (calculation of the sensitivity, specificity, positive and negative predictive value of the CT for the detection of lesions of the various organs) and by a correlation of the CT findings with surgical findings using Kripendorff's alpha coefficient. The cohort was largely male (n = 45; 88%), with injuries by knife wound in 62.7% of cases (n = 32) and gunshot in 35.3% (n = 18) of cases. The median age was 36 years (25–47). The median index of severity score (ISS) was 17 (10–26). Excellent agreement between predicted and actual findings was obtained for solid organs (α = 0.801) with high sensitivity and specificity (81.8% and 96.6%, respectively). The largest discrepancies were observed for the hollow organs (α = 26.2%, sensitivity of 53.3% and specificity of 76.2%) and the diaphragm (α = 67.3%, sensitivity 75%, specificity 92.3%). Surgical exploration was non-therapeutic for five patients (9.8%). The failure rate for non-operative treatment was 10% (n = 1). CT detection of solid organ lesions in patients with penetrating abdominal wounds is excellent. However, the detection of hollow organ and diaphragmatic wounds remains a challenge with a risk of over- and underdiagnosis. Laparoscopic exploration should be able to fill in the gaps in the CT findings. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to evaluate utility and reliability of chest CT as a standalone screening modality for stable patients with thoracic GSWs and potential transmediastinal trajectories. Methods: All patients with thoracic GSWs over a 5-year period were identified. Unstable patients requiring immediate surgery were excluded and the remaining underwent chest CT with intravenous contrast. Sensitivity and specificity for clinically significant injuries were tested against an aggregate gold standard of discharge diagnosis including imaging, operative and clinical findings. Results: A total of 216 patients met inclusion criteria and underwent chest CT. After imaging, 65 (30.1%) had indication for immediate surgery, of which 10 (4.6%) underwent a thoracic procedure for chest injuries while 151 (69.9%) were selected for nonoperative management (NOM). 11 (5.1%) required a delayed thoracic operation, none due to injuries missed on CT. The remaining 140 (64.8%) underwent successful NOM. Up to 195 (90.3%) patients had successful NOM of thoracic injuries. Only 9.2% required additional imaging, all negative. CT identified a cardiac injury in one case and a vascular injury in two cases, all confirmed by surgery, while one thoracic IVC injury missed on CT was found intraoperatively. 2 patients had CT suspicious for esophageal injury, ruled out by following investigations. There was one death in the total cohort, none in the NOM group. Conclusions: Modern high-quality CT provides highly accurate and reliable screening modality for penetrating chest and mediastinal injuries and can be used as a standalone study in most patients or to guide further tests. Chest CT facilitated successful NOM. [ABSTRACT FROM AUTHOR]

Abstract Background Prehospital tracheal intubation (TI) is associated with increased mortality in patients with penetrating trauma, and the utility of prehospital advanced airway management is debated. The increased incidence of deadly violence in Sweden warrants a comprehensive evaluation of current airway management for patients with penetrating trauma in the Swedish prehospital environment and on arrival in the emergency department (ED). Methods This was an observational, multicenter study of all patients with penetrating trauma and injury severity scores (ISSs) ≥ 15 included in the Swedish national trauma register (SweTrau) between 2011 and 2019. We investigated the frequency and characteristics of prehospital and ED TI, including 30-day mortality and patient characteristics associated with TI. Result Of 816 included patients, 118 (14.5%) were intubated prehospitally, and 248 (30.4%) were intubated in the ED. Patients who were intubated prehospitally had a higher ISS, 33 (interquartile range [IQR] 25, 75), than those intubated in the ED, 25 (IQR 18, 34). Prehospital TI was associated with a higher associated mortality, OR 4.26 (CI 2.57, 7.27, p

Abstract Purpose To assess the effectiveness of trans-arterial vascular interventions in treatment of civilian gunshot wounds (GSW). Materials and methods A retrospective review was performed at a level-1 trauma center to include 46 consecutive adults admitted due to GSW related hemorrhage and treated with endovascular interventions from July 2018 to July 2022. Patient demographics and procedural metrics were retrieved. Primary outcomes of interest include technical success and in-hospital mortality. Factors of mortality were assessed using a logistic regression model. Results Twenty-one patients were brought to the endovascular suite directly (endovascular group) from the trauma bay and 25 patients after treatment in the operating room (OR group). The OR group had higher hemodynamic instability (48.0% vs 19.0%, p = 0.040), lower hemoglobin (12.9 vs 10.1, p = 0.001) and platelet counts (235.2 vs 155.1, p = 0.003), and worse Acute Physiology and Chronic Health Evaluation (APACHE) score (4.1 vs 10.2, p

Abstract Introduction Sweden is facing a surge of gun violence that mandates optimized prehospital transport approaches, and a survey of current practice is fundamental for such optimization. Management of severe, penetrating trauma is time sensitive, and there may be a survival benefit in limiting prehospital interventions. An important aspect is unregulated transportation by police or private vehicles to the hospital, which may decrease time but may also be associated with adverse outcomes. It is not known whether transport of patients with penetrating trauma occurs outside the emergency medical services (EMS) in Sweden and whether it affects outcome. Method This was a retrospective, descriptive nationwide study of all patients with penetrating trauma and injury severity scores (ISSs) ≥ 15 registered in the Swedish national trauma registry (SweTrau) between June 13, 2011, and December 31, 2019. We hypothesized that transport by police and private vehicles occurred and that it affected mortality. Result A total of 657 patients were included. EMS transported 612 patients (93.2%), police 10 patients (1.5%), and private vehicles 27 patients (4.1%). Gunshot wounds (GSWs) were more common in police transport, 80% (n = 8), compared with private vehicles, 59% (n = 16), and EMS, 32% (n = 198). The Glasgow coma scale score (GCS) in the emergency department (ED) was lower for patients transported by police, 11.5 (interquartile range [IQR] 3, 15), in relation to EMS, 15 (IQR 14, 15) and private vehicles 15 (IQR 12.5, 15). The 30-day mortality for EMS was 30% (n = 184), 50% (n = 5) for police transport, and 22% (n = 6) for private vehicles. Transport by private vehicle, odds ratio (OR) 0.65, (confidence interval [CI] 0.24, 1.55, p = 0.4) and police OR 2.28 (CI 0.63, 8.3, p = 0.2) were not associated with increased mortality in relation to EMS. Conclusion Non-EMS transports did occur, however with a low incidence and did not affect mortality. GSWs were more common in police transport, and victims had lower GCS scorescores when arriving at the ED, which warrants further investigations of the operational management of shooting victims in Sweden.

Traumatic vascular injuries consist of direct or indirect damage to arteries and/or veins and account for 3% of all traumatic injuries. Typical consequences are hemorrhage and ischemia. Vascular injuries of the extremities can occur isolated or in association with major trauma and other organ injuries. They account for 1–2% of patients admitted to emergency departments and for approximately 50% of all arterial injuries. Lower extremities are more frequently injured than upper ones in the adult population. The outcome of vascular injuries is strictly correlated to the environment and the time background. Treatment can be challenging, notably in polytrauma because of the dilemma of which injury should be prioritized, and treatment delay can cause disability or even death, especially for limb vascular injury. Our purposes are to discuss the role of computed tomography angiography (CTA) in the diagnosis of vascular trauma and its optimized protocol to achieve a definitive diagnosis and to assess the radiological signs of vascular injuries and the possible pitfalls.