J Trauma Acute Care Surg [JOURNAL]
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Ordoñez CA, Serna JJ, Parra MW
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, Gempeler A, Fernández MI, Montilla D, Barbosa M, Salcedo A, Serna CA, Sánchez B, Franco MJ, Palacios H, García AF, Rodríguez-Holguín F
J Trauma Acute Care Surg
· 2026 May · PMID 41925571
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BACKGROUND: We set out to evaluate outcomes of an innovative surgical approach that combines the use of a resuscitative median sternotomy and a descending aortic occlusion open (Ordoñez Maneuver) and/or endovascular for...BACKGROUND: We set out to evaluate outcomes of an innovative surgical approach that combines the use of a resuscitative median sternotomy and a descending aortic occlusion open (Ordoñez Maneuver) and/or endovascular for hemodynamically unstable patients suffering from penetrating chest trauma. METHODS: We conducted a retrospective observational study at a Level I trauma center from 2018 to 2024. Eighty-two patients (older than 18 years) with severe penetrating chest trauma (Injury Severity Score, >15) who underwent an emergency median sternotomy with or without aortic occlusion were included. The primary outcome was mortality. RESULTS: A total of 82 patients (93% male; median age, 27 years) underwent median sternotomy. The median Injury Severity Score was 25 with estimated blood loss of 3 L. Forty-eight patients (59%) underwent aortic occlusion: 23 (28%) via open cross-clamping and 25 (30%) via resuscitative endovascular balloon occlusion of the aorta. The median aortic occlusion time was 30 minutes. Thoracic vessel injuries occurred in 66% of patients, cardiac injuries in 29%, and lung injuries in 71%. Overall mortality was 27%. The expected mortality in the resuscitative median sternotomy (RMS) cohort was 34.15% (28 expected deaths), compared with 26.8% observed mortality (22 observed deaths; p = 0.32). Among the survivors, the median intensive care unit length of stay was 4 days, and the median hospital length of stay was 8 days. CONCLUSION: A resuscitative median sternotomy in combination with an aortic occlusion (open and/or endovascular) is a feasible and versatile option for hemodynamically unstable patients with penetrating chest trauma. This approach offers access to both hemithoraces and mediastinal structures through a single incision without higher than expected mortality. Further validation from future prospective, comparative studies are necessary before broader recommendations can be made. ( J Trauma Acute Care Surg . 2026;100: 810-817. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). LEVEL OF EVIDENCE: Therapeutic/Care Management; Level V.
Yamamoto R, Eastridge BJ, Endo A
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, Yamakawa K, Sasaki J
J Trauma Acute Care Surg
· 2026 May · PMID 41925570
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Scalea TM, Baltimore, Maryland
J Trauma Acute Care Surg
· 2026 May · PMID 41925569
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Stewart C, Al Ma'ani M, Castillo-Diaz F
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, Magnotti LJ, Joseph B
J Trauma Acute Care Surg
· 2026 May · PMID 41925562
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INTRODUCTION: Traumatic brain injury is a leading cause of mortality in pediatric trauma, and intracranial pressure (ICP) monitoring is recommended in severe cases. Current guidelines do not favor one monitoring techniqu...INTRODUCTION: Traumatic brain injury is a leading cause of mortality in pediatric trauma, and intracranial pressure (ICP) monitoring is recommended in severe cases. Current guidelines do not favor one monitoring technique over another, and while combined approaches may offer benefits, individual effect of each technique on outcomes remains unclear. The study aim is to analyze differences in invasive monitors. METHODS: This is analysis of American College of Surgeons Trauma Quality Improvement Program (2017-2021). We included all pediatric (younger than 18 years) trauma patients with severe traumatic brain injury who received invasive ICP monitoring and were admitted for at least 24 hours. Patients were stratified based on type of ICP monitoring: those with an extraventricular drain (EVD) or an intraparenchymal monitor (IPM). Patients who received both monitoring devices were excluded. Primary outcomes included mortality and need for surgical intervention. Multivariable regression analysis was performed. RESULTS: A total of 4,250 met our inclusion criteria. The median age was 13 years, with 67% being male. The median Injury Severity Score was 27. Majority of patients (64.6%) underwent IPM placement. Distribution of pediatric trauma center verification differed between groups (IPM had a higher proportion at pediatric Level II centers, 15.9% vs. 10.6%, while EVD had a higher proportion at pediatric Level III/below, 50.9% vs. 45.2%; p < 0.001). Overall rate of mortality was 20% with no significant differences between the two groups ( p = 0.432). However, patients in EVD group had a lower rate of surgical intervention (EVD: 46% vs. IPM: 56.9%, p < 0.001). On multivariable regression analysis, EVD was independently associated with decreased mortality (adjusted odds ratio, 0.750; p = 0.019) and need for surgical intervention (adjusted odds ratio, 0.702; p < 0.001). CONCLUSION: Despite lack of guidelines on choice of ICP monitoring for pediatric patients, EVD placement alone was associated with 30% reduction in need for surgical intervention and 25% lower mortality. These findings highlight the need to further evaluate relative benefits of EVD versus IPM in reducing surgical interventions in this population. ( J Trauma Acute Care Surg . 2026;100: 754-759. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). LEVEL OF EVIDENCE: Therapeutic/Care Management; Level IV.
Chaudhari PP, Durham S, Pineda J
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, Bachur R, Durazo-Arvizu R, Frazier SB, Corwin D, Brumberg EH, Henkel EB, Andriescu EC, McGarghan F, Michelson KA, Root JM, Rojas CR, Summerford K, Yeung C, Esrock L, Steimle M, Ryan S, A Gardiner M, Abe N, Titze N, Saidinejad M, Khemani R
J Trauma Acute Care Surg
· 2026 May · PMID 41925534
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BACKGROUND: Substantial practice variation exists in the management of children with complicated mild traumatic brain injury (mTBI), defined as a Glasgow Coma Scale score of 13 to 15 with intracranial injury on neuroimag...BACKGROUND: Substantial practice variation exists in the management of children with complicated mild traumatic brain injury (mTBI), defined as a Glasgow Coma Scale score of 13 to 15 with intracranial injury on neuroimaging. Accurate risk stratification can aid clinicians with decisions after intracranial injuries are identified on initial neuroimaging. Our objective was to derive and validate a clinical risk score to predict critical interventions and clinically significant neurologic deterioration in children with complicated mTBI. METHODS: We conducted a 12-center, retrospective, cohort study of children younger than 18 years with complicated mTBI evaluated in participating emergency departments between May 2014 and March 2021. Our primary outcome was a composite of traumatic brain injury-related critical medical or neurosurgical intervention, mortality, and/or clinically important neurologic deterioration within 96 hours of emergency department arrival. We split the sample into 70% derivation and 30% validation cohorts and used multivariable logistic regression β coefficients to weight each clinical and neuroradiographic predictor and generate a clinical risk score. RESULTS: Among 870 children included, 16.4% experienced the primary outcome. Variables included in the final, reduced multivariable model were age 2 years or older, Glasgow Coma Scale (13 or 14 vs. 15), multiple hemorrhages, hemorrhage size ≥5 mm, depressed skull fracture, holohemispheric or chronic-appearing hemorrhage, epidural hemorrhage, mass effect, and high-risk imaging findings (midline shift, herniation, diffuse axonal injury, or diffuse cerebral edema). The area under the curve of the final model was 0.894 (95% confidence interval, 0.849-0.939) in the validation cohort. A clinical risk score of ≤3 was found in 49.6% of the validation cohort, which had a negative predictive value of 96.9 (92.3-99.2). CONCLUSION: We developed and internally validated a clinical risk score that accurately stratifies children with complicated mTBI by risk of critical interventions and deterioration. This tool can aid postneuroimaging decisions in pediatric trauma patients. ( J Trauma Acute Care Surg . 2026;100: 795-803. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). LEVEL OF EVIDENCE: Diagnositc Tests or Criteria; Level III.
Londoño Barrientos M, Amarillo Gutierrez D, López Zapata CA
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, Morales-Uribe CH, Mejía Toro DA, Delgado López CA
J Trauma Acute Care Surg
· 2026 Jul · PMID 41885281
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BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as a minimally invasive alternative to resuscitative thoracotomy (RT) for noncompressible torso hemorrhage. Comparative effectiven...BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as a minimally invasive alternative to resuscitative thoracotomy (RT) for noncompressible torso hemorrhage. Comparative effectiveness remains uncertain. This is a systematic review and meta-analysis evaluating the effectiveness and safety of REBOA versus RT in adult trauma patients with exsanguinating hemorrhagic shock or traumatic cardiac arrest. METHODS: A systematic search of MEDLINE, PubMed, Embase, Scopus, and ClinicalTrials.gov was performed through August 2025 for comparative observational studies assessing REBOA versus RT with supraceliac aortic cross-clamping in adults (≥18 y). The primary outcome was in-hospital mortality, with stratified analyses by physiological state (shock vs. cardiac arrest) and early versus late mortality. Secondary outcomes included overall complications, neurological status, and aortic occlusion metrics. RESULTS: Fourteen studies comprising 9,028 patients (2,477 REBOA; 6,551 RT) were included; six studies (2,912 patients) contributed to the primary pooled analysis. REBOA was associated with significantly lower in-hospital mortality (OR: 0.17, 95% CI: 0.10-0.28; I2 =53.2%; moderate-certainty evidence). The benefit was greater in hemorrhagic shock (OR: 0.18, 95% CI: 0.12-0.28) than in cardiac arrest (OR: 0.32, 95% CI: 0.15-0.69). Early mortality showed the most substantial effect (OR: 0.12, 95% CI: 0.07-0.23). REBOA improved neurological outcomes but increased complication rates (OR: 7.81, 95% CI: 3.88-15.72) and prolonged aortic occlusion duration. CONCLUSIONS: REBOA demonstrates superior survival compared with RT in carefully selected patients with trauma, particularly those in hemorrhagic shock. Despite increased complications, current evidence supports REBOA as the preferred aortic occlusion strategy when performed by experienced teams within structured trauma systems. Further research should refine selection criteria and methods to mitigate complication risk. ( J Trauma Acute Care Surg. 2026;101: 162-172. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). LEVEL OF EVIDENCE: Systematic Review and Meta-Analysis, Level III.
Huang JG, Wang CC, Huang RW
J Trauma Acute Care Surg
· 2026 Jul · PMID 41885273
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Navarro ME, Olson MT, Lee YB
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, Flinn Patterson A, Rall J, Saul-McBeth J, Hart TG, Causey MW, Houston, TX
J Trauma Acute Care Surg
· 2026 Mar · PMID 41879864
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BACKGROUND: Noncompressible torso hemorrhage (NCTH) is the leading cause of potentially preventable death in modern combat. Intravascular ultrasound (IVUS) offers real-time, intraluminal visualization that could enable t...BACKGROUND: Noncompressible torso hemorrhage (NCTH) is the leading cause of potentially preventable death in modern combat. Intravascular ultrasound (IVUS) offers real-time, intraluminal visualization that could enable targeted endovascular hemorrhage control, but its effectiveness depends on the operator's ability to correctly interpret IVUS images during active bleeding. Surgeon diagnostic performance in this context is unknown. METHODS: We conducted a diagnostic performance-based study using IVUS clips derived from a validated swine model of uncontrolled supraceliac aortic hemorrhage. Board-certified vascular surgeons independently reviewed 31 randomized IVUS clips (14 no-injury; 17 true injury) and identified (1) whether an injury was present, (2) the correct circumferential (clock-face) position, and (3) the correct timestamp in the pullback video sequence. "Presence accuracy" reflected the correct identification of injury presence; "composite accuracy" required all three domains. We examined performance across surgeon characteristics, IVUS wire platforms, perceived image quality, and IVUS use frequency. Mixed-effects logistic regression identified predictors of presence accuracy. RESULTS: Seven vascular surgeons provided 217 evaluations. Surgeons achieved a sensitivity of 71.4% and specificity of 43.9%. Presence and composite accuracies were 59.0% and 52.5%, respectively. False positive counts exceeded false negatives (55 vs. 34; p<0.001), but 28.6% of true injuries were missed. Diagnostic accuracy improved with perceived image quality (ρ=0.19-0.42, all p<0.01) and with the 0.018-inch versus 0.035-inch wire platform. In adjusted analysis, true injury presence (aOR=2.41, p=0.004) and surgeon confidence (aOR=1.78, p=0.039) independently predicted accuracy; perceived image quality and wire type did not. CONCLUSIONS: Vascular surgeons demonstrated limited accuracy in detecting and localizing aortic injuries using IVUS alone. These findings highlight important limitations of unaided IVUS interpretation during active hemorrhage and underscore the need for researching additional strategies to improve real-time injury localization in endovascular trauma care (J Trauma Acute Care Surg. 2026;00:00-00. 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: Omitted (animal model). STUDY TYPE: Diagnostic performance study.
Teuben MPJ, Veenstra A, Pape HC
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, Zurich, Switzerland
J Trauma Acute Care Surg
· 2026 Jun · PMID 41879862
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Spinal injuries occur frequently and influence the diagnosis and treatment of concurrent traumatic conditions. Understanding of spinal trauma patterns, clinical assessment and documentation, imaging options, and classifi...
Spinal injuries occur frequently and influence the diagnosis and treatment of concurrent traumatic conditions. Understanding of spinal trauma patterns, clinical assessment and documentation, imaging options, and classification systems is essential for making multidisciplinary treatment decisions. The initial evaluation focuses on identifying neurological deficits, assessing mechanical stability, and recognizing red-flag symptoms requiring urgent intervention. Furthermore, essential concurrent nonspinal injuries, as well as multiple spinal fractures, should be ruled out. Whole-body or whole-spine CT is the cornerstone of imaging, while magnetic resonance imaging is reserved for evaluating ligamentous injury, disc pathology, and spinal cord involvement. Internationally recognized classification systems form the basis for treatment decisions. In isolated spinal trauma, early stabilization facilitates mobilization and may improve neurological outcomes, particularly when early decompression is performed in patients with spinal cord injury. In polytrauma, however, spinal surgery must be balanced against life-threatening conditions and physiological instability. Early mobilization, respiratory support, hemodynamic optimization, and thromboprophylaxis remain critical components of postoperative care. ( J Trauma Acute Care Surg . 2026;100:850-862.
Rodriguez KA, Tran QK, Ali M
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, Sarani B, Asad Z, Redmond J, Pourmand A, Washington, District of Columbia
J Trauma Acute Care Surg
· 2026 Mar · PMID 41879772
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BACKGROUND: End-tidal carbon dioxide (ETCO₂) is a noninvasive marker reflecting the interplay of ventilation, perfusion, and metabolism. Its prognostic value as a predictor for mortality in trauma patients remains variab...BACKGROUND: End-tidal carbon dioxide (ETCO₂) is a noninvasive marker reflecting the interplay of ventilation, perfusion, and metabolism. Its prognostic value as a predictor for mortality in trauma patients remains variably defined across prehospital and emergency department (ED) settings. METHODS: We conducted a systematic review and meta-analysis. PubMed, SCOPUS, Cochrane Library, Web of Science, and EMBASE were searched from inception to February 2025, with an update in July 2025. Eligible studies enrolled trauma patients with reported ETCO₂ and stratified outcomes by low versus normal/high ETCO₂ (as defined by the original authors). The primary outcome was all-cause mortality; the secondary outcome was receipt of any blood transfusion. Random-effects models generated pooled odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity, sensitivity, publication bias, and moderator/meta-regression analyses were performed. RESULTS: Eight observational studies (n= 2,407) met the inclusion criteria: three prospective Emergency Department-based and 5 retrospective prehospital cohorts. All studies were based in the United States. Overall, 732 (30%) patients had low ETCO₂. Low ETCO₂ was associated with significantly higher mortality (21.8% vs. 12.0%); pooled OR 9.59 (95% CI: 3.35-27.49; P<0.001). Findings were robust to one-study-removed sensitivity analyses (OR range 5.88-15.23). Prospective ED studies demonstrated lower heterogeneity (I²≈28%) than retrospective studies (I²≈83%). Thresholds defining "low" ETCO₂ varied (≤30-≤33 mm Hg). Meta-regression showed higher initial systolic blood pressure correlated with lower mortality odds (corr. coeff. -0.101; 95% CI: -0.17 to -0.029; P=0.0054). Four studies reporting transfusion showed higher odds with low ETCO₂ (7.4% vs. 1.3%); pooled OR: 3.32 (95% CI: 2.12-6.15; P<0.001). CONCLUSIONS: Low ETCO2 is strongly associated with increased mortality and transfusion in the trauma population. Given its low cost and noninvasive nature, prehospital and Emergency department ETCO2 measurement and use for risk stratification should be considered. Standardized thresholds for low, normal, and high ETCO2 and prospective studies are needed to optimize clinical implementation. (J Trauma Acute Care Surg. 2026;00:00-00. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). LEVEL OF EVIDENCE: Systematic Review/Meta-analysis; Level III.
Sucher J, Emery R, Lim H
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, McNeal M, Hussein Q, Castro A, Holden R, Springs H, Moeser P, Khwaja A, Khalpey Z, Dzandu J, Barletta J, Mangram A
J Trauma Acute Care Surg
· 2026 Jul · PMID 41879770
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BACKGROUND: Traumatic posterior mediastinal hematoma (TPMH) is a potentially life-threatening entity that, in rare instances, can lead to obstructive shock and sudden death secondary to left atrial compression (LAC). We...BACKGROUND: Traumatic posterior mediastinal hematoma (TPMH) is a potentially life-threatening entity that, in rare instances, can lead to obstructive shock and sudden death secondary to left atrial compression (LAC). We describe the clinical course and outcomes of seven adult patients with TPMH and LAC. A brief literature review is presented. METHODS: Seven patients (ages spanning from the 20s to 80s) with TPMH and LAC were identified at a Level 1 trauma center from 2016 to 2023. The first 2 patients were identified following standard quality improvement case reviews for unexplained death. The subsequent five patients were prospectively identified during initial trauma evaluation. A retrospective evaluation of all patients was performed using the chart and computed tomography review. RESULTS: All seven patients sustained polytrauma. The mechanisms of injury were motor vehicle crash (4), motorcycle crash (1), golf cart crash (1), and bicycle crash (1). The first two patients with TPMH and LAC died shortly after admission (167 and 339 min) of suspected obstructive shock without evidence of significant hemorrhage. The subsequent five patients were identified during initial trauma evaluation, and each underwent aggressive fluid resuscitative management with 100% survival. CONCLUSIONS: TPMH may lead to significant LAC, which can result in sudden death. Our experience suggests that TPMH with LAC is associated with mid-thoracic spine fractures, rib fractures, and polytrauma secondary to high-energy mechanisms. Emphasis on its early recognition is paramount, with a focus on aggressive fluid and blood resuscitation, vasopressor support when needed, and immediate correction of any coagulopathy. In reviewing the literature, nonoperative management is often successful. Selective cases requiring angiography with embolization or hematoma evacuation via thoracotomy have been documented. Our goal is to raise awareness of this entity and its potential lethality. ( J Trauma Acute Care Surg . 2026;101: 173-177. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). LEVEL OF EVIDENCE: V.
Kim MS, Mun AH, Arkowitz DW
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, Sharf T, Borgman M, Chaudhari PP, Chiusolo F, Cotton BA, Delaney M, Ditillo M, Finkelstein RA, Gaines BA, Hewes HA, Holmes JF, Jenkins DH, Karam O, Kornblith A, Leeper CM, Muszynski JA, Nahmias J, Nishijima DK, Notrica DM, Russell RT, Spinella PC, Steiner ME, Streck CJ, Stricker PA, Vavilala MS, Vogel AM, Yazer MH, Kuppermann N, Leonard JC, Jensen AR, Burd RS, Washington, DC
J Trauma Acute Care Surg
· 2026 Mar · PMID 41879753
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BACKGROUND: Blood transfusion and hemorrhage control procedures can be unreliable surrogates for bleeding requiring intervention in children. Some receive unnecessary blood transfusions or lack intraoperative findings fo...BACKGROUND: Blood transfusion and hemorrhage control procedures can be unreliable surrogates for bleeding requiring intervention in children. Some receive unnecessary blood transfusions or lack intraoperative findings for hemorrhage, while others die before an intervention occurs. Standardized criteria for adjudicating the presence of actionable hemorrhage are needed. We aimed to define expert consensus criteria for retrospectively identifying actionable hemorrhage within 6 hours of emergency department (ED) arrival. METHODS: Experts from six specialties involved in pediatric trauma care participated in a modified Delphi study. Panelists were prompted to consider "actionable hemorrhage" as "severe bleeding or injuries at risk of progression to class III or IV shock without prompt intervention." In Round 1, panelists answered five free-response questions identifying criteria for actionable hemorrhage, including indicators for transfusion and hemorrhage control procedures, postmortem findings, and other relevant factors. Responses were consolidated and rated on a five-point strength-of-indication scale in subsequent rounds. Consensus was defined a priori as ≥70% agreement among panelists. Stability of consensus (p>0.05) between rounds was assessed using the Wilcoxon Signed-Rank Test. RESULTS: Three Delphi rounds were required to achieve a stable consensus. Twenty-nine of 32 participating panelists participated in all three rounds. Thirteen statements achieved stable consensus as strong indicators of actionable hemorrhage. Criteria with the highest agreement included partial/total resection of intrathoracic/abdominal bleeding solid organs (96.4%), hemoglobin<6 g/dL (93.1%), and resuscitative thoracotomy/sternotomy with hilar or thoracic/abdominal aortic cross-clamp, cardiac massage, or cardiorrhaphy (92.9%). No statements reached a stable consensus as weak indicators of actionable hemorrhage. CONCLUSIONS: We established expert consensus criteria for adjudication of actionable hemorrhage in injured children within 6 hours of ED arrival. These criteria reflect strong indicators that an intervention or death was due to an actionable hemorrhage. Prospective validation of these criteria is needed. (J Trauma Acute Care Surg. 2026;00:00-00. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). LEVEL OF EVIDENCE: Diagnostic Test/Criteria; Level III.
Tang F, Han C, Liu S
J Trauma Acute Care Surg
· 2026 Mar · PMID 41879740
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Newman-Plotnick H, Byrne JP, Haut ER
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, Hultman CS
J Trauma Acute Care Surg
· 2026 Apr · PMID 41874291
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Shaikh FA, Charles EJ, Nemeth ZH
J Trauma Acute Care Surg
· 2026 Apr · PMID 41874290
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Khizar H, Yang J
J Trauma Acute Care Surg
· 2026 Apr · PMID 41874289
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McLauchlan N, Chernysh IN, Weisel JW
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, Cannon JW
J Trauma Acute Care Surg
· 2026 Apr · PMID 41874288
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Jensen K, Horns JJ, Lombardo S
… +1 more
, McCrum ML
J Trauma Acute Care Surg
· 2026 Apr · PMID 41874287
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INTRODUCTION: Equity is the "sixth domain" of health care quality but is not explicitly assessed by the American College of Surgeons Trauma Quality Improvement Program (TQIP). We sought to assess equitable outcomes withi...INTRODUCTION: Equity is the "sixth domain" of health care quality but is not explicitly assessed by the American College of Surgeons Trauma Quality Improvement Program (TQIP). We sought to assess equitable outcomes within hospitals for populations that experience health disparities. METHODS: Retrospective analysis of 2018-2020 TQIP data from Level 1/2 trauma centers (TCs). Following TQIP methodology, we applied multivariable logistic regression to calculate hospital-level risk-adjusted mortality and observed versus expected (O/E) in-hospital mortality ratios to identify low- (O/E, 95% confidence interval <1), average-, and high-mortality (O/E, 95% confidence interval >1) TCs. Using stratified analyses, we evaluated within-hospital equity by race (Black vs. Non-Hispanic White), ethnicity (Hispanic vs. Non-Hispanic White), and insurance (uninsured, Medicaid vs. commercial) by assessing concordance with advantaged reference group and presence of low-mortality gap (<5% difference). RESULTS: We analyzed 892,583 patients at 384 TCs. A total of 192 hospitals (50%) were classified as "low-mortality" (median O/E, 0.85 [0.76-0.93]), 22 (5.7%) as average, and 170 (44.3%) as "high-mortality" (median O/E, 1.13 [1.06-1.22]). Low-mortality TCs treated a higher proportion of White patients (75% vs. 68%) and blunt injuries (95% vs. 93%), with higher Medicaid population (43% vs. 35%) relative to high-mortality hospitals. In stratified analyses among low-mortality TCs, only 4 (2.1%) of hospitals satisfied both equity criteria for their Black patients, 10 (5.2%) for Hispanic patients, 14 (7.3%) for Medicaid patients, and 6 (3.1%) for uninsured patients. CONCLUSION: A minority of low-mortality TCs achieve equitable outcomes, with both minoritized and socioeconomically vulnerable populations affected. Such inequities are masked in quality improvement reports of total populations. Equity measures including stratified analyses should be incorporated into standard quality improvement reports to inform hospital-level initiatives and purposefully improve care for populations that experience health disparities. LEVEL OF EVIDENCE: Prognostic and Epidemiologic; Level III.
Michelle H, Grigorian A, Nahmias J
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, Lekawa M, Swentek L, Guner Y, Goodman L, Jebbia M, Orange, CA
J Trauma Acute Care Surg
· 2026 Mar · PMID 41873860
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BACKGROUND: Trauma is the leading cause of death among adolescent patients, but the characteristics and outcomes of adolescent pregnant trauma patients (aPTPs) are not well defined. This study aimed to compare aPTPs to a...BACKGROUND: Trauma is the leading cause of death among adolescent patients, but the characteristics and outcomes of adolescent pregnant trauma patients (aPTPs) are not well defined. This study aimed to compare aPTPs to adolescent nonpregnant trauma patients (non-PTPs), evaluating demographics, injury profiles and outcomes, with the primary outcome being any complication. We hypothesized that aPTPs would have higher complication rates compared with non-PTPs. METHODS: The 2020-2022 Trauma Quality Improvement Program database was queried for female trauma patients between the ages 12 and 17 years. No patients were excluded. aPTPs were compared non-PTPs with bivariate analyses. RESULTS: Of 45,908 adolescent female trauma patients, 273 (0.6%) were pregnant, with the youngest 13 years old. The median age of aPTPs was 17 compared with 15 for non-PTPs ( p <0.001). aPTPs had higher representation of Black (35.5% vs. 17.8%, p <0.001) and Hispanic patients (25.2% vs. 17.6%, p =0.002). aPTPs had higher rates of smoking (5.9% vs. 2.2%, p <0.001) and substance use (5.5% vs. 1.9%, p <0.001) compared with non-PTPs, with 40.7% aPTPs screening positive for illicit drugs on admission. aPTPs also had increased rates of gunshot wounds (16.8% vs. 5.3%, p <0.001). aPTPs more often sustained complications (4.4% vs. 1.9%, p =0.004) compared with non-PTPs. However, the cohorts had similar lengths of hospital stay, and rates of operative intervention and mortality (all p >0.05). CONCLUSIONS: This national analysis highlights that aPTPs are disproportionately minorities and have higher rates of penetrating trauma, substance use and complications compared with adolescent non-PTPs. These findings emphasize the need for targeted primary prevention and intervention programs in this high-risk population. ( J Trauma Acute Care Surg . 2026;00:00-00. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). LEVEL OF EVIDENCE: Retrospective Case Control Study; Level III.
Bahader GA, Fimbres JC, Blum SD
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, Hall MW, Sribnick EA, Columbus, Ohio
J Trauma Acute Care Surg
· 2026 Mar · PMID 41870894
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BACKGROUND: Trauma is a leading cause of pediatric morbidity and mortality. Children with traumatic brain injury (TBI), especially with extracranial injuries, can develop immune suppression and subsequent infection. Immu...BACKGROUND: Trauma is a leading cause of pediatric morbidity and mortality. Children with traumatic brain injury (TBI), especially with extracranial injuries, can develop immune suppression and subsequent infection. Immune checkpoint pathways, for example, programmed death-ligand 1 (PD-L1), may contribute. We hypothesized that an anti-PD-L1 antibody would safely prevent immune suppression in a juvenile rat model of polytraumatic TBI. METHODS: Juvenile rats underwent TBI plus systemic hemorrhage (TBI/H) or sham injury. Rats received daily injections of saline or anti-PD-L1 (10 μg or 100 μg) for 7 days. Systemic immune function was assessed by measuring TNFα production in whole blood and splenocytes after ex vivo stimulation with lipopolysaccharide. Cytokines were measured by ELISA or proteome array. Immunofluorescence was used to quantify microglia, astrocytes, and neurons in postinjury day (PID) 7 brain tissue. Cognitive function was assessed by behavioral testing on PID 1. RESULTS: TBI/H resulted in lower TNFα response in whole blood and spleen ( p =0.02) versus sham-injured rats. TBI/H rats treated with 100 μg anti-PD-L1 had higher TNFα response in whole blood ( p =0.04) and spleen ( p =0.02) versus TBI/H rats treated with saline. Lower dose anti-PD-L1 had no effect on immune function. Unstimulated plasma was examined using a proteome array, and higher levels of inflammatory mediators were noted on PID 7 in injured animals treated with 100 µg anti-PD-L1 versus saline. The 100 μg anti-PD-L1 group had higher perilesional microglia ( p =0.004) and astrocyte ( p =0.03) counts, as compared with TBI/H+saline. Barnes maze results were not different between injured rats treated with 10 μg anti-PD-L1 versus sham injury, but the 100 μg dose resulted in worse performance ( p =0.007). CONCLUSIONS: Anti-PD-L1 treatment prevented posttraumatic immune suppression but only at a dose that resulted in higher numbers of perilesional microglia and no improvement in spatial memory. As such, PD-L1 blockade may not be a good candidate for safely reversing immune suppression after pediatric TBI. ( J Trauma Acute Care Surg. 2026;00:00-00. Copyright © 2026 The Author(s). Published byWolters Kluwer Health, Inc. on behalf of the American Association for the Surgery of Trauma.). LEVEL OF EVIDENCE: Not applicable (basic science/animal research).