Category: Trauma
Keywords: Male. Female, outcome, trauma (PubMed Search)
Posted: 3/6/2025 by Robert Flint, MD
(Updated: 7/18/2025)
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The Pan-Asia Trauma Outcomes Study database was reviewed for differences in in-hospital mortality and functional capacity at discharge between male and female trauma patients. There were 76,000 trauma patients from 12 Asian countries in this study. The authors concluded: “This study indicates no difference in the general trauma outcomes in the Asia Pacific between females and males. Although younger females with less severe injuries had better functional outcomes, this advantage disappeared in severe injuries and those over 50 years.” There were several differences in mechanism of injury and age of presentation. “With females more frequently represented in the ??50 age group (60.13%) compared to males (44.87%) (p?<?0.001). Trauma type also varied between sexes; 95.51% of females experienced blunt trauma compared to 93.65% of males (p?<?0.001). Anatomically, males predominantly sustained injuries to the head, face, thorax, abdomen, and upper extremities, whereas females more frequently suffered injuries to the lower extremities and spine (p?<?0.001).” This is similar toEuropean and North American data
Bin Kunji Mohamad, M., Jamaluddin, S.F., Ahmad, N. et al. Trauma outcomes differences in females: a prospective analysis of 76 000 trauma patients in the Asia-Pacific region and the contributing factors. Scand J Trauma Resusc Emerg Med 33, 34 (2025). https://doi.org/10.1186/s13049-025-01342-1
Category: Trauma
Keywords: EMS, AlS, trauma, Bls, outcome (PubMed Search)
Posted: 3/5/2025 by Robert Flint, MD
(Updated: 7/18/2025)
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Large retrospective propensity matching study looking at mortality in trauma patients based on ALS vs. BLS transport crew found lower mortality in those attended by ALS crews. The matching was “based on patient age, sex, year, ICD-10-CM based injury severity score, mechanism of injury, AIS based body region of injury, EMS characteristics including time with patient and prehospital interventions performed, prehospital vital signs, and trauma center designation.”
This is different than other studies which showed limited difference. other studies have shown improved survival with police “scooping and running” with penetrating trauma patients.
Harrison, Julia MD; Bhardwaj, Akshay MS; Houck, Olivia MPH; Sather, Kristiana MD; Sekiya, Ayako MPH; Knack, Sarah MD; Saarunya Clarke, Geetha PhD; Puskarich, Michael A. MD, MSCR; Tignanelli, Chris MD, MSc; Rogers, Lisa MPH; Marmor, Schelomo PhD; Beilman, Greg MD. Emergency medical services level of training is associated with mortality in trauma patients: A combined prehospital and in hospital database analysis. Journal of Trauma and Acute Care Surgery 98(3):p 402-409, March 2025. | DOI: 10.1097/TA.0000000000004540
Category: Trauma
Keywords: Trauma, geriatric, fall, pain management, fracture, rib, pelvis (PubMed Search)
Posted: 3/1/2025 by Robert Flint, MD
(Updated: 3/2/2025)
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Rib and pelvic fractures are common findings in geriatric trauma patients, even in low impact trauma such as falls from standing. Pain management is vital for improving morbidity and mortality. The IFEM White Paper suggests:
“Use multimodal pain management strategies, including regional anesthesia and non-opioid analgesics, to control pain without compromising recovery.
Monitor closely for complications such as pneumonia or hemodynamic instability, intervening promptly to mitigate risks.
Collaborate with physiotherapists to implement early mobility programs, reducing the risk of deconditioning and promoting recovery.”
A multidisciplinary team proficient in geriatric trauma care leads to better outcomes. This may require transfer to a trauma center.
Trauma in Older Adults: Evidence-Based Guidelines for Optimized Care White Paper
Trauma Special Interest Group and Geriatric Emergency Medicine Special Interest Group
https://assets.nationbuilder.com/ifem/pages/1768/attachments/original/1740084007/IFEM_Trauma_in_Older_Adults_Evidence-Based_Guidelines_for_Optimized_Care_White_Paper_December_2024.pdf?1740084007
Published: December 2024
Category: Trauma
Keywords: Trauma, geriatrics, frailty (PubMed Search)
Posted: 3/1/2025 by Robert Flint, MD
(Updated: 7/18/2025)
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This white paper reminds us that age is just a number; frailty is a better predictor of morbidity and mortality after trauma.
“Frailty, characterized by reduced physiological reserve and increased vulnerability to stressors, is a significant factor influencing recovery from trauma. Individuals with frailty may experience slower healing, higher rates of complications, and longer hospital stays. Tools such as the Clinical Frailty Scale (CFS) and the Trauma-Specific Frailty Index (TSFI) have been developed to assess frailty systematically, enabling clinicians to predict outcomes and guide treatment decisions.”
Trauma in Older Adults: Evidence-Based Guidelines for Optimized Care White Paper
Trauma Special Interest Group and Geriatric Emergency Medicine Special Interest Group
https://assets.nationbuilder.com/ifem/pages/1768/attachments/original/1740084007/IFEM_Trauma_in_Older_Adults_Evidence-Based_Guidelines_for_Optimized_Care_White_Paper_December_2024.pdf?1740084007
Published: December 2024
Category: Trauma
Keywords: Ems, trauma, arrest, resuscitation (PubMed Search)
Posted: 2/23/2025 by Robert Flint, MD
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This position paper from American College of Surgeons, NAEMSP, and ACEP outlines a literature based approach to prehospital care of traumatic circulatory arrest. It logically could be applied to care in the hospital as well. Care of a traumatic arrest is different than a medical etiology arrest.
“Emphasize the identification of reversible causes of traumatic circulatory arrest and timely use of clinically indicated life-saving interventions (LSIs) within the EMS clinician’s scope of practice. These include:
Epinephrine should not be routinely used, and if used should not be administered before other LSIs.
External chest compressions may be considered but only secondary to other LSIs.
Chest decompression if there is clinical concern for a tension pneumothorax. Empiric bilateral decompression, however, is not indicated in the absence of suspected chest trauma.
Airway management using the least-invasive approach necessary to achieve and maintain airway patency, oxygenation, and adequate ventilation.
External hemorrhage control with direct pressure, wound packing, and tourniquets.”
Amelia M. Breyre, Nicholas George, Alexander R. Nelson, Charles J. Ingram, Thomas Lardaro, Wayne Vanderkolk, John W. Lyng,
Prehospital Management of Adults With Traumatic Out-of-Hospital Circulatory Arrest—A Joint Position Statement,
Annals of Emergency Medicine,
Volume 85, Issue 3,
2025,
Pages e25-e39,
ISSN 0196-0644,
https://doi.org/10.1016/j.annemergmed.2024.12.015.
Category: Trauma
Keywords: Peds, trauma, centers, adolescents (PubMed Search)
Posted: 2/16/2025 by Robert Flint, MD
(Updated: 7/18/2025)
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Looking at 416 patients aged 12-16, 48% at a Peds trauma center vs 20% at adult Level 1 center vs 34% at an adult level 2 center, there was no difference in in hospital mortality between adult and pediatric centers.
The authors conclude “These findings suggest that severely injured adolescents aged 12 to 16 years may be safely treated at either adult or pediatric trauma centers.”
Muttalib F, Tillmann B, Ernst G, Murthy S, Bhutta Z, Hansen B, Adhikari NKJ. Mortality Among Severely Injured Adolescents Admitted to Pediatric vs Adult Trauma Centers. JAMA Netw Open. 2024 Dec 2;7(12):e2450647. doi: 10.1001/jamanetworkopen.2024.50647.
Category: Trauma
Keywords: Cervical sound, age, geriatric, trauma, clearance (PubMed Search)
Posted: 2/1/2025 by Robert Flint, MD
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Not based on currently available literature.
This editorial reminds us that the only evidenced based screening criteria we have for C-spine clearance in those over age 65 after trauma is the Canadian C-Spine Rule (2002). This rule recommends imaging for all patients over age 65. No large, well done study indicates physical exam or other means can be used to clear C-Spines in those over age 65.
Rodriguez R, Greenberg S. Is older age an appropriate criterion alone for ordering cervical spine CT after trauma. Acad Emerg Med. 2024; 00: 1-2. doi:10.1111/acem.15001
Category: Trauma
Keywords: Chest trauma, ketorolac, ketamine (PubMed Search)
Posted: 1/26/2025 by Robert Flint, MD
(Updated: 7/18/2025)
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This small study randomized patients with 2 or greater rib fractures or requiring chest tube insertion into a kerorolac (30 mg) or ketamine (0.25 mg/kg) group and evaluated pain levels pre, 30 and 60 minutes post medication administration. They also looked at need for morphine rescue medication. The ketamine group had superior pain control and required less rescue medication.
Hossein Zabihi Mahmoodabadi MD, Zeynab Seyed Javadein MD, Fatemeh Moosaie MD, MPH, Ali Faegh, Maryam Bahreini MD
First published: 31 December 2024
Category: Trauma
Keywords: occipital, condyles, fracture, cervical spine (PubMed Search)
Posted: 1/19/2025 by Robert Flint, MD
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Fractures of the occipital condyles are a relatively rare injury that occur in high energy blunt mechanisms (IE roll over MVC) most commonly. Physical exam will show signs of basilar skull fracture and significant pain at the base of the skull/upper C-spine. CT scan is the gold standard to make the diagnosis. Look for signs of upper extremity weakness on physical exam or cranial nerve injuries. Those type of findings should also prompt emergent MRI evaluation. Treatment generally is long term immobilization in a collar however Type 3 and those with neurologic findings may require surgical intervention.
Anderson and Montesano Classification
Type I 3% of occipital condyle fracturesImpaction-type fracture with comminution of the occipital condyle
Due to compression between the atlantooccipital joint
Stable injury due to minimal fragment displacement into the foramen magnum
Type II 22% of occipital condyle fracturesBasilar skull fracture that extends into one or both occipital condyles
Due to a direct blow to skull and a sheer force to the atlantooccipital joint
Stable injury as the alar ligament and tectorial membrane are usually preserved
Type III 75% of occipital condyle fractures Avulsion fracture of condyle in region of the alar ligament attachment (suspect underlying occipitocervical dissociation)
Due to forced rotation with combined lateral bending
Has the potential to be unstable due to craniocervical disruption
Category: Trauma
Keywords: Frail, trauma, mortality, outcome (PubMed Search)
Posted: 1/12/2025 by Robert Flint, MD
(Updated: 7/18/2025)
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The Trauma Frailty Index has been validated to predict inpatient mortality, major complications and discharge to rehab facility. “In addition, frailty was significantly associated with higher adjusted odds of mortality, major complications, readmissions, and fall recurrence at 3 months postdischarge ( p < 0.05).”
It is a simple 15 variable index.
Joseph B, Saljuqi AT, Amos JD, Teichman A, Whitmill ML, Anand T, Hosseinpour H, Burruss SK, Dunn JA, Najafi K, Godat LN, Enniss TM, Shoultz TH, Egodage T, Bongiovanni T, Hazelton JP, Colling KP, Costantini TW, Stein DM, Schroeppel TJ, Nahmias J; AAST Frailty MIT Study Group. Prospective validation and application of the Trauma-Specific Frailty Index: Results of an American Association for the Surgery of Trauma multi-institutional observational trial. J Trauma Acute Care Surg. 2023 Jan 1;94(1):36-44. doi: 10.1097/TA.0000000000003817. Epub 2022 Oct 17. PMID: 36279368.
Category: Trauma
Keywords: chest injury, exercise, chronic pain, (PubMed Search)
Posted: 12/30/2024 by Robert Flint, MD
(Updated: 7/18/2025)
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This study suggests no. The control arm was given standard physical therapy and the intervention arm was instructed in four basic exercises to do on their own daily for a week. Patents were then surveyed to assess for long term pain. There was no difference in pain between the two groups. Meaning, at least in this study reliant on patient journaling and follow up, that these four simple exercises did not impact long term pain in chest wall injured patients. More work needs to be done in this important area.
Cheri Battle, Timothy Driscoll, Deborah Fitzsimmons, Shaun Harris, Fiona Lecky, Claire O'Neill, Alan Watkins, Jane Barnett, Susan Davies, Hayley Anne Hutchings, Kate Jones, Andrew Eglington, Sophie Place, Hannah Toghill, Katie Foster, Bethan Uzzell, Elizabeth Ford, Mark Baker, Sophie Lewis, Sara Davies, Sarah Nicholls, Amy Charnock, Claire Watkins, Sarah-Jane Garside, Jeannie Bishop, Thomas Dawson, Jessica Pendlebury, Reece Doonan,
EarLy Exercise in blunt Chest wall Trauma: A multi-centre, parallel randomised controlled trial (ELECT2 Trial),
Injury,
2024,
112075,
ISSN 0020-1383,
https://doi.org/10.1016/j.injury.2024.112075.C
Category: Trauma
Keywords: Trauma, oxygen, mortality (PubMed Search)
Posted: 12/14/2024 by Robert Flint, MD
(Updated: 12/15/2024)
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In this randomized trial of restrictive oxygen (arterial oxygen sat of 94% ) vs. liberal oxygen (12-15 L of O2 per minute) for 8 hours after traumatic injury there was no difference in mortality or major respiratory complications at 30 days between the two groups.
Further evidence that managing hypoxia is important but over oxygenation at best offers no benefit and may add harm.
Arleth T, Baekgaard J, Siersma V, et al. Early Restrictive vs Liberal Oxygen for Trauma Patients: The TRAUMOX2 Randomized Clinical Trial. JAMA. Published online December 10, 2024. doi:10.1001/jama.2024.25786
Category: Trauma
Posted: 12/8/2024 by Robert Flint, MD
(Updated: 12/9/2024)
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What is the diagnosis? Treatment? Other imaging indicated?
Acetabulum fracture.
Usually seen in high mechanism situations such as MVCs. Can be seen in elderly fall patients.
Treatment is usually surgical (ORIF) unless non-displaced or if it involves less than 20% of posterior column. These can be managed with 6 weeks of minimal weight bearing. CT scan is almost universally used for better visualization and operative management.
“Some landmarks of the hip are compared on the right and left sides of the pelvis:
https://radiopaedia.org/cases/acetabular-fracture-anterior-and-posterior-columns
https://www.orthobullets.com/trauma/1034/acetabular-fractures
Category: Trauma
Keywords: Liver laceration, embolization, observation. (PubMed Search)
Posted: 12/7/2024 by Robert Flint, MD
(Updated: 12/8/2024)
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This prospective observational study looked at patients with liver lacerations and active contrast extravasation who either had immediate embolization vs. observation. After matching for age, injury score etc. the observation first approach did as well as those who had immediate embolization.
Journal of Trauma and Acute Care Surgery 97(5):p 764-769, November 2024. | DOI: 10.1097/TA.0000000000004372
Category: Trauma
Keywords: vetebral fracture, trauma, fall, spinal injury (PubMed Search)
Posted: 12/1/2024 by Robert Flint, MD
(Updated: 7/18/2025)
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Fall from a height of 6 feet with back pain. Plain film shown. What is the diagnosis? Any further imaging indicated? Treatment? Disposition?
The question that must be answered is, is this a compression fracture or a burst fracture. A compression fracture without any retropulsion into the canal and any other associated injuries is a stable fracture that can be managed with pain control, out patient follow up and possible kyphosplasty for significant loss of vertebral height. A burst fracture is inherently unstable and is a risk for spinal cord injury. CT imaging answers are questions most efficiently.
To help distinguish burst from compression: “Burst fractures are a type of compression fracture related to high-energy axial loading spinal trauma that results in disruption of a vertebral body endplate and the posterior vertebral body cortex. Retropulsion of posterior cortex fragments into the spinal canal is frequently included in the definition. However, some authors, including the popular AO spine classification system, define a burst fracture as any axial compression fracture involving an endplate and the posterior cortex regardless of retropulsion." 2
1. https://radiopaedia.org/cases/acute-l1-burst-compression-fracture
Category: Trauma
Keywords: collision, extrication, trauma, motor vehicle, extraction, rapid, spinal immobilization (PubMed Search)
Posted: 11/24/2024 by Robert Flint, MD
(Updated: 7/18/2025)
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It is important for trauma and emergency care providers to understand what our patients experience prior to arrival in our clean, safe, and structured emergency department. It is also vitally important that we are involved in training and education in the pre-hospital environment. A group in the United Kingdom is challenging the age old “wisdom” that post-motor vehicle crash extrication should be slow, methodical, and work to have absolutely no movement in the spinal canal. Spinal immobilization and slow extrication instead of rapid resuscitation appears to be bad for patients. Based on several of their ground breaking papers they have published a 14 point recommendation of patient extrication post motor vehicle collision. Here are two important tenets they propose. For an in-depth discussion check out November 14, 2024 / CPD, Podcasts, Roadside to Resus.
Category: Trauma
Keywords: Immobilization cervical spine, intubation (PubMed Search)
Posted: 11/21/2024 by Robert Flint, MD
(Updated: 7/18/2025)
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The authors looked at 51 patients intubated with both anterior and posterior cervical collar in place and measured the degree of movement within the spine during intubation. They repeated this process in 51 additional patients with just the posterior portion of the collar in place. They found there was one degree of difference in movement between the two groups. This adds evidence that removing the anterior portion of the collar is safe when intubating trauma patients.
Jo, WY., Choi, JH., Kim, J. et al. Cervical spine motion during videolaryngoscopic intubation using a Macintosh-style blade with and without the anterior piece of a cervical collar: a randomized controlled trial. Can J Anesth/J Can Anesth (2024). https://doi.org/10.1007/s12630-024-02849-4
Category: Trauma
Keywords: Trauma, CT scan, gunshot wound (PubMed Search)
Posted: 11/10/2024 by Robert Flint, MD
(Updated: 11/17/2024)
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This retrospective study illustrates that the use of CT scanning to identify injury in gun shot wounds to the abdomen is not sensitive or specific enough to obviate the need for laparotomy. “Admission hypotension, abdominal pain and/or peritonitis, evisceration, and a transabdominal trajectory were considered clear indications for laparotomy.” If there is clear indication to go to the OR, stopping in CT does not add any benefit.
Vasquez, Matthew MD; Dhillon, Navpreet K. MD; Feliciano, David V. MD, FACS, MAMSE†; Scalea, Thomas M. MD, FACS, MCCM
Journal of Trauma and Acute Care Surgery 97(5):p 785-790, November 2024. | DOI: 10.1097/TA.0000000000004404
Category: Trauma
Keywords: ketamine, trauma (PubMed Search)
Posted: 11/14/2024 by Ashley Martinelli
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An out-of-hospital, randomized, placebo-controlled, blinded, parallel group study was conducted in adult patients under the care of the city fire-based emergency medical services and the local level one trauma center. Adult male patients experiencing moderate to severe pain due to traumatic injuries received either 50mg of intranasal ketamine or placebo in addition to fentanyl after randomization in the field by the paramedic (a novel approach). The primary outcome was reduction of pain by 2 points 30 minutes after study drug administration.
199 patients were randomized with 107 receiving ketamine and 92 with placebo. Patients were young (30-40), and had a median weight of 83 kg. Pretreatment pain scores were 10/10 and patients presented to the ED 14 minutes after receiving study medication. The most common injuries were falls, MVC, and GSW. Half of the patients received IV fentanyl but others had IM or IN routes.
Ketamine receipt did not lead to a 2 point reduction in pain scores (36% vs 44.7% p = 0.22). There was no difference in pain at 3 hours, additional medications received, or total amount of analgesia received. Notably, there were no differences in adverse events.
McMullan JT, Droege CA, Chard KM, Otten EJ, Hart KW, Lindsell CJ, Strilka RJ. Out-of-Hospital Intranasal Ketamine as an Adjunct to Fentanyl for the Treatment of Acute Traumatic Pain: A Randomized Clinical Trial. Ann Emerg Med. 2024 Oct;84(4):363-373. doi: 10.1016/j.annemergmed.2024.04.018. Epub 2024 Jun 12. PMID: 38864781.
Category: Trauma
Keywords: Trauma,blood, TXA, prehospital (PubMed Search)
Posted: 11/10/2024 by Robert Flint, MD
(Updated: 11/11/2024)
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Administration of prehospital TXA was found to improve 28 day mortality and decrease the amount of blood required to be transfused without any increased risk of thromboembolism or seizure. Two grams of TXA was superior to one gram and no TXA.
Mazzei, Michael MD, MPH?; Donohue, Jack K. BA?; Schreiber, Martin MD; Rowell, Susan MD, MBA; Guyette, Francis X. MD; Cotton, Bryan MD; Eastridge, Brian J. MD; Nirula, Raminder MD; Vercruysse, Gary A. MD; O'Keeffe, Terence MD; Joseph, Bellal MD; Brown, Joshua B. MD, MSc; Neal, Matthew D. MD; Sperry, Jason L. MD, MPH
Journal of Trauma and Acute Care Surgery 97(5):p 697-702, November 2024. | DOI: 10.1097/TA.0000000000004315