J Trauma Acute Care Surg [JOURNAL]
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200 papers
A simplified sequential organ failure assessment score is associated with 30-day trauma mortality.
Dadhwal US
J Trauma Acute Care Surg · 2026 Apr · PMID 42023937 · Publisher ↗
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Thrombotic and thromboembolic events were not associated with tranexamic acid in three large randomized controlled trials.
Brito AMP, Kenny JE, Mitra B … +8 more , Neal MD, Gruen R, Barrett CD, Bernard S, Medcalf R, Rowell S, Sperry JL, Schreiber MA
J Trauma Acute Care Surg · 2026 Jul · PMID 42023936 · Publisher ↗
BACKGROUND: Thrombotic and thromboembolic events are a common and potentially preventable complication in multitrauma patients, and substantial quality improvement efforts are directed at prevention. The results of sever...
BACKGROUND: Thrombotic and thromboembolic events are a common and potentially preventable complication in multitrauma patients, and substantial quality improvement efforts are directed at prevention. The results of several randomized controlled trials (RCTs) related to the association between tranexamic acid (TXA) and thrombotic/thromboembolic events have demonstrated conflicting results. We aimed to address this by examining whether prehospital TXA was associated with higher rates of thrombotic/thromboembolic events in a harmonized data set from three large multicenter RCTs. METHODS: We analyzed data using a harmonized data set from three RCTs examining the effects of prehospital TXA: The Pre-Hospital Anti-fibrinolytics for Traumatic Coagulopathy and Hemorrhage Study (PATCH trial), Study of Tranexamic Acid During Air and Ground Medical Prehospital Transport Trial (STAAMP trial) and the Prehospital TXA for TBI trial, part of the Resuscitation Outcomes Consortium (ROC trial). Outcomes included deep venous thrombosis (DVT), pulmonary embolism (PE), myocardial infarction, stroke, combined venous thrombotic/thromboembolic events (VTE), and combined arterial thrombotic/thromboembolic events. Multivariable regression was used to adjust for TXA administration, sex, age, injury severity score, Glasgow Coma Scale, shock index, and 24-hour red cell transfusion. RESULTS: There were no differences in myocardial infarction, stroke, arterial thrombotic/thromboembolic events, DVT, PE, or VTE in patients who were randomized to TXA compared with those who were not. On univariate analysis, rates of PE, DVT and VTE were significantly higher in the PATCH cohort compared with STAAMP and ROC cohorts, but patients in PATCH had significantly higher injury severity scores and chest trauma when compared with those in ROC and STAAMP. CONCLUSION: This multicenter database combining three large RCTs showed that randomization to TXA was not associated with higher rates of arterial and VTE. The higher rates of thrombotic/thromboembolic events observed in the PATCH trial may be explained by higher injury severity as well as protocolized screening. ( J Trauma Acute Care Surg. 2026;101: 48-56. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). LEVEL OF EVIDENCE: Sub-analysis of randomized controlled trials; Level II.
Essential considerations in the use of improvised tourniquet: An editorial on "An American College of Surgeons Committee on trauma stop the bleed guideline on the use of improvised tourniquets for trauma patients with life-threatening extremity hemorrhage 2025".
Tatebe LC, Fischer PE, Nathens AB … +3 more , Kerby JD, Staudenmayer KL, Chicago, Illinois
J Trauma Acute Care Surg · 2026 Jun · PMID 42023933 · Publisher ↗
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Resuscitative thoracotomy in modern warfare: Experience from a Military-Civilian trauma system.
Eidelman P, Katzir O, Akler D … +10 more , Radomislensky I, Dym I, Amir T, Gershgoren H, Khanchin G, Mercer D, Lipsky AM, Shapiro A, Epstein D, Haifa, Israel
J Trauma Acute Care Surg · 2026 Apr · PMID 42023932 · Publisher ↗
BACKGROUND: Resuscitative thoracotomy (RT) is a last-resort intervention for traumatic cardiac arrest or impending cardiovascular collapse. Although outcomes after RT are well described in civilian trauma, data from mode...
BACKGROUND: Resuscitative thoracotomy (RT) is a last-resort intervention for traumatic cardiac arrest or impending cardiovascular collapse. Although outcomes after RT are well described in civilian trauma, data from modern warfare-characterized by high-energy penetrating mechanisms, advanced prehospital care, and rapid evacuation-remain limited. This study evaluated the characteristics and outcomes of RT performed during recent combat operations within a combined military-civilian trauma system. METHODS: We conducted a retrospective cohort study of all combat casualties who underwent emergency department (ED) RT during the Israel-Hamas conflict (October 27, 2023, to October 27, 2025). Data were extracted from prehospital and ED medical records and postmortem computed tomography reports. RT was defined as a thoracotomy performed in the ED in a pulseless patient with the intent to restore spontaneous circulation. The primary outcome was 30-day survival. Secondary outcomes included return of spontaneous circulation (ROSC) and 24-hour survival. RESULTS: Among 2,335 combat trauma admissions, 27 patients (1.2%) underwent RT. All were young male casualties with penetrating injuries, predominantly from explosive mechanisms (74.1%). Severe trauma was common (ISS ≥25 in 92.6%). Prehospital blood products were administered in 77.8% of patients, and 66.7% arrived at the ED within 60 minutes of injury. ROSC was achieved in 40.7%, of whom 90.9% were transferred to the operating room. Two patients (7.4%) survived to 24 hours and 30 days, both with good neurologic outcomes. No patient who lost pulse before hospital arrival survived. CONCLUSIONS: Among modern warfare casualties treated at civilian trauma centers, survival after RT is comparable to that reported in civilian series, despite severe and complex injury patterns. RT should not be considered futile for penetrating abdominal, pelvic, or extremity hemorrhage, even in the presence of associated head injury. In contrast, prehospital circulatory arrest is associated with an extremely poor prognosis.(J Trauma Acute Care Surg. 2026;000:000-000. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.).
Quantifying costs during trauma bay resuscitation: A time-driven activity-based costing (TDABC) study.
Balde M, Jayakumar P, Siu V … +8 more , Dubose J, Teixeira P, Cardenas T, Brown LH, Robert M, Ali S, Brown CVR, Austin, Texas
J Trauma Acute Care Surg · 2026 Apr · PMID 42018724 · Publisher ↗
BACKGROUND: As the health care system embraces value-based care, an accurate definition of the cost component of the value equation is essential. Time-driven activity-based costing (TDABC) is a bottom-up cost management...
BACKGROUND: As the health care system embraces value-based care, an accurate definition of the cost component of the value equation is essential. Time-driven activity-based costing (TDABC) is a bottom-up cost management method that calculates the cost of a service by tracking the time it takes to complete each step in a process. This study aims to use TDABC to calculate the costs associated with the initial resuscitation of trauma patients. METHODS: TDABC was used to measure the direct and indirect costs associated with the initial resuscitation of adult trauma patients who arrived at our Level 1 trauma center under the highest level of activation. We defined the initial resuscitation phase as the time from arrival in the trauma bay to departure for either a CT scan or the operating room. Time-stamped 360-degree video footage of each trauma resuscitation was used to calculate per-minute costs of both personnel and supplies. Indirect costs were determined using the total annual operating expenses of our institution, as reported to the Centers for Medicare and Medicaid Services. RESULTS: A total of 134 consecutive patients (mean age 36 y, 68% male) were included. The average duration of initial trauma resuscitation was 17 minutes, with an average total cost of $3,628 per resuscitation-comprising $506 in direct costs and $3,122 in indirect costs. CONCLUSIONS: TDABC is a valuable tool for measuring the costs associated with the trauma bay resuscitation of injured patients. This approach enables trauma centers to more accurately assess the financial aspects of patient care and identify opportunities for optimizing resource allocation during the resuscitation phase. (J Trauma Acute Care Surg. 2026;00: 00-00. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). LEVEL OF EVIDENCE: Economic and Value-based Evaluations; Level III.
Refining normoxemia targets in acute burn care: Reply.
Douin DJ, Rice JD, Ginde AA
J Trauma Acute Care Surg · 2026 Apr · PMID 42018719 · Publisher ↗
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Disparities in trauma care: A Western Trauma Association panel discussion on sex, financial, and geographic disparities in trauma care.
Murphy PB, Cronn S, Tatbe L … +3 more , West MA, Davis KA, New Haven, Connecticut
J Trauma Acute Care Surg · 2026 Apr · PMID 42018713 · Publisher ↗
Reducing disparities and achieving health equity are critical goals for the trauma community. Although significant advances have been made in short-term trauma outcomes, disparities persist across various dimensions incl...
Reducing disparities and achieving health equity are critical goals for the trauma community. Although significant advances have been made in short-term trauma outcomes, disparities persist across various dimensions including race, sex, gender, socioeconomic status, and geographic location. This manuscript represents a distillation of a panel discussion from the 2024 Western Trauma Association meeting that examined three under-recognized categories of trauma disparities beyond traditional demographic factors. First, sex-related disparities in motor vehicle crashes stem from crash test dummies designed primarily for male physiology. Second, financial toxicity and exploring the relationship between acute trauma, financial hardship, and long-term mental and physical quality of life. Third, geographic disparities create "trauma deserts" where disadvantaged populations experience prolonged transport times and reduced access to life-saving care. The panel explored opportunities within each to improve patient outcomes at the local, regional, and national levels. (J Trauma Acute Care Surg. 2026;00:000-000. Copyright© 2026 Wolters Kluwer Health, Inc. All rights reserved.).
Association of plasma transfusion timing with mortality among patients with traumatic intracranial hemorrhage across US adult civilian trauma centers.
Kang H, Ong C, Kenzik K … +5 more , Boyle T, Scantling D, Saillant NN, Feldman J, Torres CM
J Trauma Acute Care Surg · 2026 Jul · PMID 42018712 · Publisher ↗
BACKGROUND: Traumatic intracranial hemorrhage (ICH) is a major driver of traumatic brain injury-related mortality. Although plasma transfusion has been associated with improved survival in these patients, the timing of t...
BACKGROUND: Traumatic intracranial hemorrhage (ICH) is a major driver of traumatic brain injury-related mortality. Although plasma transfusion has been associated with improved survival in these patients, the timing of transfusion influences outcomes is unclear. We sought to determine how plasma transfusion timing affects survival in patients with tICH, hypothesizing that earlier transfusion improves outcomes and that there is a threshold after which survival benefits diminish. METHODS: We conducted a retrospective analysis of adult trauma patients (≥18 y) with tICH who received plasma-based resuscitation within 4 hours of ED arrival between 2020 and 2021 from the ACS-TQIP database. Patients with prehospital cardiac arrest, anticoagulant therapy, nonsurvivable head injuries, and interfacility transfers were excluded. The multivariable Royston-Parmar flexible parametric regression model assessed the primary outcome of 30-day mortality. RESULTS: A total of 6,183 patients were included. Median age was 41 years, 73% were male. Median injury severity score was 34, the median head AIS score was 4, and 88% were blunt mechanisms. The overall in-hospital 30-day mortality was 45%. Survival analysis showed that patients who received plasma transfusion compared with those who had not yet received plasma at similar time points had a 45% lower hazard of death at 30 days (aHR, 0.55; 95% CI: 0.33-0.92; p =0.02). Predicted survival declined sharply in the first 30 minutes, with a 5% absolute decrease per 10-minute delay. Beyond 30 minutes, survival benefit plateaued, and the risk of neurosurgical interventions increased. CONCLUSIONS: Early plasma transfusion within the first 4 hours of ED arrival is associated with improved survival in patients with tICH, with the most pronounced benefit seen when plasma is given within the first 30 minutes. These findings highlight urgent plasma administration as a key element of early resuscitation in TBI and support prospective validation to inform trauma protocols. ( J Trauma Acute Care Surg . 2026;101: 89-96. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). LEVEL OF EVIDENCE: Therapeutic/Care Management; Level III.
Filling gaps or filling wallets? The role of for-profit medicine in the US trauma system.
Kang D, Smith S, Torres CM … +8 more , Hynes A, Janeway MG, Allee L, Buck AK, Theodore S, Seamon M, Scantling DR, Boston, Massachusetts
J Trauma Acute Care Surg · 2026 Apr · PMID 42018709 · Publisher ↗
BACKGROUND: After the US trauma system contracted in the 1990s with the loss of financially vulnerable trauma centers (TCs), a subsequent re-expansion took place. Many new trauma centers are for-profit (FPTCs) and may pr...
BACKGROUND: After the US trauma system contracted in the 1990s with the loss of financially vulnerable trauma centers (TCs), a subsequent re-expansion took place. Many new trauma centers are for-profit (FPTCs) and may provide redundant care for affluent populations. Little is known about their role in the national trauma system. We hypothesized that FPTC catchments would provide redundant coverage to affluent populations. METHODS: Data for the contiguous United States were obtained from the 2020 Decennial Census or American Community Survey. Population-weighted centroids of each census tract, as well as TC locations, were geocoded in ArcGIS Pro. FPTC status was obtained from the Centers for Medicare and Medicaid Services. Road and traffic data were obtained from Esri StreetMaps Premium. The shortest travel time from each population-weighted centroid was calculated to the nearest TC to delineate coverage areas and populations. This analysis was repeated without FPTCs to assess contributions to the trauma system. Data were exported to Stata for further analysis. RESULTS: In total, 83,713 population-weighted centroids and 2,044 TCs were captured. About 11% of tracts were primarily served by 223 FPTCs, representing the closest TC for 43M people. While overall transport times were similar between FPTCs and NPTCs (14.0 vs. 14.2 min, p=ns), the removal of FPTCs did not change national transport times (median 0 min; IQR, 0, 0; range, 0-98). FPTC catchment populations were associated with more urban [odds ratio (OR), 1.02, 95% CI, 1.01-1.02, p<0.001], Hispanic (OR, 1.14, 95% CI, 1.14-1.15, p<0.001), uninsured (OR, 1.65, 95% CI, 1.57-1.73, p<0.001) or Medicare covered (OR, 1.04, 95% CI, 1.02-1.07, p<0.001) populations. CONCLUSIONS: Most FPTCs provide redundant care to populations that are often less insured, of similar poverty levels and of different demographics as compared with nonprofit centers. However, a small subset of FPTCs provides access to care for populations who would face long transport times without them.(J Trauma Acute Care Surg. 2026;00:000-000. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). LEVEL OF EVIDENCE: Epidemiological; Level III.
Hospital Medicaid payer mix associated with inpatient mortality following traumatic brain injury.
Vattipally VN, Kramer P, Ran KR … +9 more , Jo J, Suarez JI, Sakran JV, Haut ER, Huang J, Bettegowda C, DiGiorgio AM, Azad TD, Baltimore, MD
J Trauma Acute Care Surg · 2026 Apr · PMID 42018704 · Publisher ↗
BACKGROUND: Disparities in traumatic brain injury (TBI) outcomes are well-documented at the patient level, but less is known about how hospital-level Medicaid burden influences outcomes after TBI. We investigated whether...
BACKGROUND: Disparities in traumatic brain injury (TBI) outcomes are well-documented at the patient level, but less is known about how hospital-level Medicaid burden influences outcomes after TBI. We investigated whether hospitals with a higher Medicaid payer mix were associated with poorer outcomes for patients with TBI. METHODS: Using the ACS TQIP data set, we performed a retrospective cohort study of adult patients with TBI. We calculated the proportion of Medicaid-insured patients at each hospital and classified hospitals into quartiles of advancing Medicaid payer mix. Risk-adjusted multivariable logistic regression models investigated the relationships between hospital quartile and inpatient mortality and favorable discharge (ie, to home or inpatient rehabilitation). Effect modification was tested between hospital quartile, patient age, and race. We repeated these models after propensity score matching between quartile 1 (Q1, least Medicaid) and quartile 4 (Q4, most Medicaid) hospitals, and again among a subgroup of patients younger than 65 years. RESULTS: Among 384,394 patients treated across 737 hospitals, 13% (N=50,493) were Medicaid-insured. Hospitals had a median Medicaid payer mix of 9.9% (IQR, 5.9%-16%). Treatment at Q4 hospitals was associated with higher risk-adjusted odds of inpatient mortality (OR, 1.30; 95% CI, 1.24-1.36). This effect was amplified with increasing age (p<0.001; Q4: OR, ≥65 vs. <65 y, 1.34 [1.26-1.42] vs. 1.17 [1.08-1.26]) but was diminished for black patients (p=0.02; Q4: OR, black vs. white, 1.13 [0.98-1.31] vs. 1.32 [1.25-1.39]). After matching, patients treated at Q4 hospitals had higher odds of inpatient mortality (OR, 1.31; 95% CI, 1.25-1.38) and lower odds of favorable discharge (OR, 0.85; 95% CI, 0.83-0.87), and these associations persisted in the subgroup of patients younger than 65 years. CONCLUSIONS: Hospitals serving a higher proportion of Medicaid-insured patients were associated with poorer outcomes after TBI. These findings highlight the importance of addressing hospital-level disparities in trauma care delivery. (J Trauma Acute Care Surg. 2026;00: 00-00. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). LEVEL OF EVIDENCE: Retrospective Cohort Study; Level III.
Noninvasive fascial traction improves primary fascial closure and reduces the incidence of incisional hernia in open abdomens.
Fellows TK, Ng D, Rotstein O … +2 more , Rezende-Neto JB, Toronto, Canada
J Trauma Acute Care Surg · 2026 Apr · PMID 42017782 · Publisher ↗
BACKGROUND: Open abdomens (OA) remain a major source of morbidity and mortality in trauma and emergency general surgery (EGS). Fascial traction has been shown to improve primary closure of the OA. However, reports on the...
BACKGROUND: Open abdomens (OA) remain a major source of morbidity and mortality in trauma and emergency general surgery (EGS). Fascial traction has been shown to improve primary closure of the OA. However, reports on the incidence of incisional hernias (IH) after OA closure are scarce. The purpose of this study was to evaluate factors associated with primary fascial closure and the development of IH in OA managed with two different methods. METHODS: A retrospective cohort study of all OA patients with midline laparotomies for trauma and EGS (January 2019 to October 2024) in a level 1 trauma center. Patients were divided into two groups, those treated with a noninvasive fascial traction device in conjunction with negative pressure wound therapy (NPWT) system (AbClo + AbThera) and those treated only with NPWT system. Outcomes included fascial width at closure attempt, primary closure (fascia-to-fascia), and incidence of IH. Univariate regression models were performed to identify factors associated with IH. RESULTS: A total of 143 patients met inclusion criteria, 85 (59.4%) used AbClo + AbThera and 58 (40.6%) AbThera only. Primary closures were 94.1% (AbClo + AbThera) versus 72.4% (AbThera only); absolute risk difference 21.7% (95% CI: 9.5-34.8) and relative risk 1.30. Fascial widths were narrower in successful closures 6.0 versus 11.9 cm and in AbClo + AbThera (4.0 cm) versus AbThera alone (10.2 cm); 61.3% reduction in gap size; (all P<0.001). IH cumulative incidences were 28.8% (12-mo), 36.4% (24-mo). The 12-month incidence was lower with AbClo + AbThera (14.1%) versus AbThera alone (63.1%), P<0.0001. Fascia width ≥10 cm increased hernia risk (hazard ratio=3.71). The relative risk reduction in hernia risk was 60.7% with AbClo + AbThera; absolute risk reduction 24.8. CONCLUSIONS: Management of OA with AbClo + AbThera improved fascial closure and reduced incisional hernias compared AbThera alone. (J Trauma Acute Care Surg. 2026;00: 000-000. Copyright © 2026 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Surgery of Trauma.). LEVEL OF EVIDENCE: Retrospective Comparative Study; Level IV.
Investigating patterns of long-term opioid usage in 11,771 trauma survivors with up to 6 years follow-up in Denmark.
Millarch AS, Schøning J, Hjulmand VG … +6 more , Lind AB, Winther S, Possfelt-Møller E, Preisler L, Aasvang EK, Sillesen M
J Trauma Acute Care Surg · 2026 Jul · PMID 42017764 · Publisher ↗
BACKGROUND: Opioids have a well-known capacity to induce long-term dependency with related increased morbidity and mortality. Usage patterns following traumatic injury are, however, not well studied. We investigated long...
BACKGROUND: Opioids have a well-known capacity to induce long-term dependency with related increased morbidity and mortality. Usage patterns following traumatic injury are, however, not well studied. We investigated long-term opioid usage patterns for trauma survivors, hypothesizing that postdischarge sustained opioid use was prevalent for both preinjury opioid naïve and opioid users. We furthermore hypothesized that postdischarge opioid use would be associated with overall survival (OS) and hospital contacts. METHODS: Electronic health records from 11,771 trauma patients surviving to discharge from the Capital and Zealand regions in Denmark from January 1, 2017, to July 30, 2023, were merged with prescription medication registry data to uncover preadmission and postadmission opioid use. Prescription medication data were available from January 1, 1994, to September 30, 2023, allowing for between 2 months and 6 years follow-up. Data were analyzed using descriptive statistics and OS analyses using regression corrected for age, sex, Injury Severity Score, Elixhauser comorbidity score, and pretrauma opioid use. RESULTS: Of all trauma survivors, 25.8% had prescription opioid use following discharge. This pattern was more frequent in patients with pretrauma opioid use (74.3%) versus pretrauma opioid naïve patients (21.9%). Of preinjury opioid naïve patients using prescription opioids postdischarge, 33.4% still maintained usage at 1-year follow-up, dropping to 13.8% at 3 years follow-up. Cox regression corrected for confounders could not identify an association between postdischarge opioid use and OS (hazard ratio, 1.08, p = 0.44). Postdischarge opioid use was associated with risk of 30-day readmission (hazard ratio, 1.59), as well as overall hospital admissions and outpatient contacts. CONCLUSION: For trauma survivors, postdischarge long-term opioid use is prevalent in trauma survivors, highlighting the potential for close follow-up and opioid tapering plans to optimize long-term outcomes. Postdischarge opioid use could not be associated with OS but was associated with increased healthcare resource utilization. ( J Trauma Acute Care Surg. 2026;101: 104-110. Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.). LEVEL OF EVIDENCE: Retrospective; Level III.
Venovenous ECMO and damage-control laparotomy: Important questions remain.
Lu CW, Chang YY
J Trauma Acute Care Surg · 2026 Apr · PMID 41995203 · Publisher ↗
Abstract loading — click title to view on PubMed.
Sex differences in outcomes following whole blood transfusion for patients with severe hemorrhage.
Yu E, Katsura M, Braschi C … +2 more , Matsushima K, Los Angeles, California
J Trauma Acute Care Surg · 2026 Apr · PMID 41995184 · Publisher ↗
BACKGROUND: Whole blood (WB) transfusion is increasingly used for trauma patients with hemorrhagic shock; however, sex-based differences in utilization and outcomes remain incompletely understood. The purpose of this stu...
BACKGROUND: Whole blood (WB) transfusion is increasingly used for trauma patients with hemorrhagic shock; however, sex-based differences in utilization and outcomes remain incompletely understood. The purpose of this study was to examine sex-based differences in WB utilization and survival using a large national trauma dataset. METHODS: We performed a retrospective cohort study using the 2021 to 2022 American College of Surgeons Trauma Quality Improvement Program database. Trauma patients (16 y) with blunt or penetrating trauma, shock index >1, and receipt of 4 units of blood within 4 hours were included. Patients were then stratified by sex and WB receipt within 4 hours. Multivariable logistic regression assessed associations between WB transfusion and 4-hour, 24-hour, and 30-day mortality. Cox proportional hazards models evaluated in-hospital mortality. Models were adjusted for patient demographics, injury characteristics, and institutional factors. Sensitivity analyses using facility-clustered generalized estimating equations (GEE) were performed. Dose-response was evaluated using WB proportion of total transfusion volume within 4 hours. RESULTS: Among 8,631 patients (6,743 males and 1,888 females), WB was administered more frequently to males (33.8% vs. 22.3%, p<0.001). In adjusted analysis, WB was associated with lower 24-hour mortality among males (odds ratio [OR]: 0.76, 95% confidence interval [CI]: 0.63-0.92, p=0.004) and reduced in-hospital mortality risk (hazard ratio [HR]: 0.88, 95% CI: 0.79-0.99, p=0.028). Facility-clustered models confirmed reduced 24-hour mortality in males (OR 0.77, 95% CI: 0.61-0.96, p=0.022). Increasing WB exposure demonstrated a dose-response association with lower early and in-hospital mortality among males (p<0.022), with no significant associations observed in females. WB was not associated with increased rates of major complications for either sex. CONCLUSION: In this nationwide study, WB was used less frequently in females and was associated with improved survival only among males. These findings underscore the need for prospective studies to clarify biological and systemic contributors to these disparities. (J Trauma Acute Care Surg. 2026;00: 00-00. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). LEVEL OF EVIDENCE: Prognostic/epidemiological; Level IV.
Aggressive calcium chloride dosing reduces early mortality in trauma patients receiving whole blood resuscitation.
Rajesh A, Barry L, Limon D … +8 more , Patel P, Epley S, Hargrove K, Giddings D, Tobin J, Eastridge B, Nicholson S, Jenkins D
J Trauma Acute Care Surg · 2026 Jul · PMID 41995161 · Publisher ↗
BACKGROUND: Hypocalcemia has been recognized as a contributor to trauma-related mortality, yet optimal dosing of calcium during massive transfusion remains undefined. The literature suggests that ≥1 g of calcium per 2 to...
BACKGROUND: Hypocalcemia has been recognized as a contributor to trauma-related mortality, yet optimal dosing of calcium during massive transfusion remains undefined. The literature suggests that ≥1 g of calcium per 2 to 4 units of blood may correct hypocalcemia, but its effect on survival is unclear. This study evaluated the association between varying calcium:low-titer O whole blood (LTOWB) ratios and 24-hour mortality to define clinically meaningful supplementation targets. METHODS: We performed a retrospective single-center cohort study of all trauma patients receiving LTOWB and calcium, prehospital, or within 4 hours of arrival (2020-2023). Demographics, mechanism of injury, Injury Severity Score (ISS), transfusion volume, and calcium administration were collected. Calcium supplementation was defined as a continuous variable (grams/unit), mutually exclusive ranges, and threshold doses of ≥1 g per 2, 3, or 4 units of LTOWB. The primary outcome was 24-hour mortality. Multivariable logistic regression adjusted for confounders and calcium supplementation strategy. RESULTS: Of 542 LTOWB recipients, 99 undergoing CPR were excluded; 164 received no calcium, and 273 had complete datasets for analysis. Median age was 36 (25-50) years, 72% were male, median ISS was 19 [10-28], and 55% sustained blunt trauma. Median arrival ionized calcium was 1.02 (0.79-1.14) mEq/L. Twenty-four-hour mortality was 13.6% (n=37). On multivariable analysis, ≥1 g calcium chloride per 2 units of LTOWB independently reduced the odds of 24-hour mortality by 84% [odds ratio, 0.164 (0.034-0.796), p =0.025]. Calcium chloride at this threshold neared significance for reduction in mortality ( p =0.06, adjusted OR=0.221 (0.045-1.077)] when restricting the analysis to patients receiving ≥2 units of LTOWB, while gluconate had no significant associations in this cohort with greater need for LTOWB resuscitation. CONCLUSIONS: In trauma patients receiving LTOWB, calcium chloride administered at ≥1 g per 2 units showed a consistent association with improved early survival. A ≥1:2 calcium chloride-to-LTOWB dosing protocol may be an effective and clinically relevant target for trauma resuscitation. Prospective validation is warranted. ( J Trauma Acute Care Surg. 2026;101: 57-64. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). LEVEL OF EVIDENCE: Retrospective cohort study; Level III.
Noninvasive respiratory support strategies in chest trauma: A systematic review and network meta-analysis.
Taniguchi H, Utsumi S, Kajiyama T … +2 more , Aoki M, Hokkaido, Japan
J Trauma Acute Care Surg · 2026 Apr · PMID 41989256 · Publisher ↗
BACKGROUND: Chest trauma often causes respiratory impairment and carries substantial mortality, particularly among intubated patients. Although guidelines recommend noninvasive ventilation (NIV) for hypoxemic respiratory...
BACKGROUND: Chest trauma often causes respiratory impairment and carries substantial mortality, particularly among intubated patients. Although guidelines recommend noninvasive ventilation (NIV) for hypoxemic respiratory failure, high flow nasal cannula (HFNC) is increasingly used despite limited comparative evidence. The objective was to compare the effects of conventional oxygen therapy (COT), HFNC, and NIV on escalation of respiratory support and in-hospital outcomes in adults with hypoxemic respiratory failure after chest trauma. METHODS: We conducted a systematic review and network meta-analysis registered in UMIN (UMIN000059126) and reported according to PRISMA-NMA. MEDLINE, Cochrane Central, Cumulative Index to Nursing and Allied Health Literature, WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov were searched from January 2000 to July 2025. Randomized controlled trials and high-quality observational studies were eligible if they compared at least two of COT, HFNC, and NIV in adults with hypoxemia due to chest trauma. The primary outcome was escalation of respiratory support; secondary outcomes were in-hospital mortality and length of hospital stay. A random-effects frequentist network meta-analysis was performed. RESULTS: Four studies met eligibility criteria (three randomized trials and one observational study), including 3,270 patients: 1,465 received NIV, 1,613 HFNC, and 192 COT. Compared with COT, NIV was associated with a lower risk of escalation of respiratory support [odds ratio (OR), 0.42; 95% CI, 0.20-0.85] and a lower escalation risk than HFNC (OR, 0.72; 95% CI, 0.58-0.89). HFNC showed uncertain benefit relative to COT (OR, 0.58; 95% CI, 0.29-1.16). NIV was also associated with lower in-hospital mortality and shorter hospital stay than both COT and HFNC. Reported device-related and clinical complications were uncommon. CONCLUSIONS: In adults with hypoxemic respiratory failure after chest trauma, NIV appears more effective than HFNC and COT in preventing escalation of respiratory support and improving in-hospital outcomes.(J Trauma Acute Care Surg. 2026;00:000-000. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). LEVEL OF EVIDENCE: Systematic review/meta-analyses; Level II.
Appendiceal stump length as a predictor of operative outcomes in complicated appendicitis.
Gerard J, Knapp C, Nemykina Y … +4 more , Bornt W, Whetten E, Woodward A, Tierney JF
J Trauma Acute Care Surg · 2026 Jul · PMID 41989245 · Publisher ↗
BACKGROUND: Optimal management of patients with acute complicated appendicitis remains debated. Traditional management often emphasized nonoperative treatment using antibiotics and, when necessary, percutaneous drainage....
BACKGROUND: Optimal management of patients with acute complicated appendicitis remains debated. Traditional management often emphasized nonoperative treatment using antibiotics and, when necessary, percutaneous drainage. Growing evidence indicates that operative management may be safe in select patients. This study aimed to evaluate whether appendiceal stump size ≥2 cm on preoperative CT scan is predictive of intraoperative complexity and postoperative outcomes. METHODS: A multicenter retrospective review evaluated operative outcomes in patients with acute complicated appendicitis identified on preoperative imaging that were managed operatively from January 2018 to May 2024. Appendiceal stump length was measured on computed tomography (CT) by an attending acute care surgeon. The primary outcome was the need for extended resection. Secondary outcomes included conversion to open, readmission, length of stay (LOS), postoperative abscess, and mortality. RESULTS: One hundred fifty-two patients met the inclusion criteria: 98 had stump size ≥2 cm, and 54 had stump length <2 cm. Patients with stump size ≥2 cm were more likely to have chronic kidney disease (0.0% vs. 9.9%, p =0.002). There were no other differences in baseline characteristics. Patients with stump size <2 cm had a significantly increased risk of need for extended resection (OR=20.2, 95% CI: 4.43-92.15, p <0.001). They also had a significantly increased odds of conversion to open surgery (OR=5.9, 95% CI: 1.97-17.63, p <0.001). LOS was longer in patients with appendiceal stumps <2 cm (mean 4.6±3.7 d) compared with those with appendiceal stumps ≥2 cm (3.0±2.3 d, p =0.01). There was no difference in readmissions, postoperative abscess, or mortality. CONCLUSIONS: Appendiceal stump length ≥2 cm was associated with significantly reduced risk of conversion to open and extended resection. These patients also had shorter LOS. Stump length on preoperative imaging may serve as a useful adjunct in operative planning for patients with acute complicated appendicitis. ( J Trauma Acute Care Surg . 2026;101: 97-103. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). LEVEL OF EVIDENCE: Original Research-Therapeutic/Care Management; Level III.
Timely diagnosis and surgical source control remain the fundamental determinants of outcome in necrotizing soft tissue infections.
Sartelli M, Vallicelli C, Podda M … +2 more , Coccolini F, Catena F
J Trauma Acute Care Surg · 2026 Jul · PMID 41983739 · Publisher ↗
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Hospital-based psychological consultation relates to post-discharge treatment engagement following violent injury.
Timmer-Murillo SC, Bird CM, Schramm AT … +6 more , McBain S, Jayan D, Schumann NR, Marks MR, Geier TJ, Milwaukee, WI
J Trauma Acute Care Surg · 2026 Apr · PMID 41983720 · Publisher ↗
BACKGROUND: The field of trauma surgery has recognized the significant psychological distress and psychiatric comorbidity of trauma patients, and, increasingly, the critical role that psychological factors play in patien...
BACKGROUND: The field of trauma surgery has recognized the significant psychological distress and psychiatric comorbidity of trauma patients, and, increasingly, the critical role that psychological factors play in patients' long-term adjustment to injury. Patients experiencing violence-related injuries are at added risk of poor mental health outcomes. The current study sought to better understand the association between contact with a psychology consultation service during hospitalization for violently injured patients and post-discharge health care utilization. METHODS: A retrospective cohort study from 2016 to 2022 of adults older than or equal to 18 years with traumatic injuries was conducted at a level I trauma center in the US Midwest from 2017 to 2022. Trauma Registry and Electronic Medical Record (EMR) data were pulled for injury characteristics (injury severity score, length of hospital stay), receipt of inpatient psychological consultation, the total time spent with psychology services during the hospitalization, hospital readmission, emergency department visits, and outpatient injury-related and mental health visits. Four analyses of covariance (ANCOVA) examined differences in health care utilization outcomes between patients who received psychology consultations and those who did not. Further, linear regressions examined if total amount of psychology service time was associated with outcomes. RESULTS: A total of 3,322 patients (M age =34.55, SD=13.23) were admitted for a violence-related injury between 2016 and 2022. The results demonstrated that those with psychological consultations had more post-discharge injury-related appointments, mental health appointments, and ED visits, but not readmissions. Further, total time with inpatient mental health service predicted post-discharge injury-related and mental health service utilization. CONCLUSIONS: Results indicate that involvement with inpatient psychology services post-injury was associated with follow-up care attendance. With prior research showing patient engagement improving recovery outcomes, embedded psychological care may aid in reducing barriers to treatment both inpatient and post-discharge. ( J Trauma Acute Care Surg . 2026;00: 00-00. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved). LEVEL OF EVIDENCE: Level III.
Hypothermia on trauma center arrival has a much greater impact on outcomes at the extremes of age.
Crosier CJ, Rempson CM, Green A … +3 more , Pracht EE, Snyder CW, St Petersburg, FL
J Trauma Acute Care Surg · 2026 Apr · PMID 41972955 · Publisher ↗
BACKGROUND: Hypothermia is a potentially modifiable risk factor for poor outcomes in trauma; differences in impact of hypothermia on different age groups are not well-defined. This study characterized the effects of vary...
BACKGROUND: Hypothermia is a potentially modifiable risk factor for poor outcomes in trauma; differences in impact of hypothermia on different age groups are not well-defined. This study characterized the effects of varying levels of hypothermia on injured patients by age. We hypothesized that pediatric and geriatric trauma patients would be disproportionately impacted by hypothermia. METHODS: This retrospective cohort study included all patients with a valid arrival temperature from the 2020 to 2023 Trauma Quality Improvement Program database. Patients were categorized by arrival temperature: normothermia (36 to 38°C), mild hypothermia (35 to 35.9°C), severe hypothermia (<35°C), or hyperthermia (>38°C), and by age group (≤5, 6 to 11, 12 to 15, 16 to 17, 18 to 39, 40 to 64, 65 to 79, or >80 y). Outcomes were in-hospital mortality and early (<4 h) blood transfusion. Multivariable logistic regression evaluated the combined effects of arrival temperature and age group on outcomes, adjusting for confounding variables. RESULTS: Of 4,135,371 patients, 244,203 (5.9%) had mild and 37,839 (0.9%) severe hypothermia. Mortality was 28.1% in severe hypothermia versus 8.8% mild hypothermia versus 1.9% normothermia (P<0.0001); early transfusion occurred for 30.0% in severe hypothermia versus 13.5% mild hypothermia versus 3.2% normothermia (P<0.0001). Multivariable logistic regression demonstrated that hypothermia had different effects on different age groups. Odds of mortality showed a U-shaped distribution across the age spectrum, with children and elderly patients experiencing the highest impact of hypothermia (odds ratios 17.3 for age <5, 12.1 for 6 to 11, 9.7 for 12 to 15, 6.1 for 16 to 17, 4.8 for 18 to 39, 4.6 for 40 to 64, 5.4 for 65 to 79, and 7.1 for >80 years with severe hypothermia). Early blood transfusion showed similar patterns. CONCLUSIONS: Hypothermia disproportionately affects pediatric and elderly patients, exacerbating their risk of mortality and early blood transfusion. The findings highlight the importance of recognizing and responding to hypothermia at the extremes of age. Strategies to mitigate traumatic hypothermia should be further investigated and optimized based on age group. (J Trauma Acute Care Surg. 2026;00: 00-00. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). LEVEL OF EVIDENCE: Prognostic/Epidemiologic; Level III.
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