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Trauma is a leading cause of mortality. Holistic views of trauma systems consider injury as a public health problem that requires efforts in primary, secondary and tertiary prevention. However, the performance of trauma systems is commonly judged on the in-hospital mortality rate. Such a focus misses opportunities to consider all deaths within a population, to understand differences in in-hospital and out-of-hospital trauma deaths and to inform population-level injury prevention efforts. The aim of this study was to provide an epidemiological overview of out-of-hospital and in-hospital trauma deaths in a geographically-defined area over a 10-year period. We performed a population-based review of out-of-hospital and in-hospital trauma deaths over the period of 01 July 2006 to 30 June 2016 in Victoria, Australia, using data from the National Coronial Information System and the Victorian State Trauma Registry. Temporal trends in population-based incidence rates were evaluated. Over the study period, there were 11,246 trauma deaths, of which 71% were out-of-hospital deaths. Out-of-hospital trauma deaths commonly resulted from intentional self-harm events (50%) and transport events (35%), while in-hospital trauma deaths commonly resulted from low falls (≤1 metre) (50%). The incidence of overall trauma deaths did not change over the study period (incidence rate ratio 0.998; 95%CI: 0.991, 1.004; P = 0.56). Out-of-hospital deaths accounted for most trauma deaths. Given the notable differences between out-of-hospital and in-hospital trauma deaths, monitoring of all trauma deaths is necessary to inform injury prevention activities and to reduce trauma mortality. The absence of a change in the incidence of both out-of-hospital and in-hospital trauma deaths demonstrates the need for enhanced activities across all aspects of injury prevention.

Objective To describe the application of data linkage for analysing coagulation abnormalities and blood transfusion practices in patients with chronic liver disease (CLD) presenting to emergency departments (EDs). Methods Patients with CLD presenting to 104 Queensland Health EDs (January 2016–August 2023) were identified using International Classification of Diseases codes. Phase 1 deterministically linked ED, admission, pathology, transfusion and death records using unique identifiers. Phase 2 used Structured Query Language (SQL) to capture transfusion timing. The model incorporated data from both digital and non‐digitalised hospitals. Results Phase 1 linkage identified 36,643 ED presentations, 443,367 admissions, 47,357 deaths, 3,004,236 pathology results and 140,687 blood transfusion events. Phase 2 identified 23,578 ED presentations by 11,961 patients, linked to 20,312 admissions, 921 deaths, 22,284 full blood counts (FBC), 19,408 coagulation profiles, 3068 blood gases, 457 rotational thromboelastometry (ROTEM) and 53 thromboelastography tests. Transfusion data were linked to 1616 presentations, including of 1358 red blood cell (RBC) transfusion episodes, 330 fresh frozen plasma, 324 cryoprecipitate, 418 platelets, 51 fibrinogen concentrate and 280 Prothrombinex‐VF administration episodes. High linkage rates were achieved for FBC (99.4%), coagulation profile (97.6%) and biochemistry (92.3%), while linkages for blood gas (34.6%), ROTEM (13.8%) and thromboelastography (2.5%) were less frequent. Massive transfusions occurred in 27 presentations (≥ 4 RBC units in 4 h) and in 22 presentations (≥ 10 RBC units in 24 h), with 100% linkage for FBC and coagulation profiles in both groups. Conclusion The feasibility of data linkage to investigate coagulation abnormalities and transfusion in CLD patients was demonstrated. This model provides a scalable method for haemovigilance and transfusion research. Trial registration The authors have confirmed clinical trial registration is not needed for this submission. This study demonstrates the feasibility of applying a data linkage framework to evaluate coagulation abnormalities and transfusion practices in patients with chronic liver disease (CLD) presenting to emergency departments (EDs). Coagulation and transfusion data are typically fragmented across hospitals and information systems, limiting comprehensive analysis at a statewide or national level. This study addresses that gap by integrating multiple datasets and outlining the linkage challenges encountered in applied haematology. Using statewide data, we showed that conventional coagulation profiles and viscoelastic haemostatic assays (ROTEM and TEG) can be linked to transfusion events, including at defined intervals from ED arrival—within 4 h, within 24 h, and in relation to massive transfusion thresholds. This approach enables temporal alignment of laboratory results with transfusion timing, supporting real‐world evaluation of clinical decision‐making during early haemostatic resuscitation. It includes mapping test timing, ED presentation and blood component use across all hospitals, addressing the longstanding fragmentation of transfusion and coagulation records. The resulting dataset provides a foundation for further analyses examining associations between coagulation parameters and transfusion decisions. The methodology offers a scalable informatics model for haemovigilance, with broader applicability to statewide or national transfusion‐focused initiatives, including audit, research and surveillance programs.

The excruciating pain of patients with renal colic on presentation to the emergency department requires effective analgesia to be administered in the shortest possible time. Trials comparing intramuscular non-steroidal anti-inflammatory drugs with intravenous opioids or paracetamol have been inconclusive because of the challenges associated with concealment of randomisation, small sample size, differences in outcome measures, and inadequate masking of participants and assessors. We did this trial to develop definitive evidence regarding the choice of initial analgesia and route of administration in participants presenting with renal colic to the emergency department. In this three-treatment group, double-blind, randomised controlled trial, adult participants (aged 18–65 years) presenting to the emergency department of an academic, tertiary care hospital in Qatar, with moderate to severe renal colic (Numerical pain Rating Scale ≥4) were recruited. With the use of computer-generated block randomisation (block sizes of six and nine), participants were assigned (1:1:1) to receive diclofenac (75 mg/3 mL intramuscular), morphine (0·1 mg/kg intravenous), or paracetamol (1 g/100 mL intravenous). Participants, clinicians, and trial personnel were masked to treatment assignment. The primary outcome was the proportion of participants achieving at least a 50% reduction in initial pain score at 30 min after analgesia, assessed by intention-to-treat analysis and per-protocol analysis, which included patients where a calculus in the urinary tract was detected with imaging. This trial is registered with ClinicalTrials.gov, number NCT02187614. Between Aug 5, 2014, and March 15, 2015, we randomly assigned 1645 participants, of whom 1644 were included in the intention-to-treat analysis (547 in the diclofenac group, 548 in the paracetemol group, and 549 in the morphine group). Ureteric calculi were detected in 1316 patients, who were analysed as the per-protocol population (438 in the diclofenac group, 435 in the paracetemol group, and 443 in the morphine group). The primary outcome was achieved in 371 (68%) patients in the diclofenac group, 364 (66%) in the paracetamol group, and 335 (61%) in the morphine group in the intention-to-treat population. Compared to morphine, diclofenac was significantly more effective in achieving the primary outcome (odds ratio [OR] 1·35, 95% CI 1·05–1·73, p=0·0187), whereas no difference was detected in the effectiveness of morphine compared with intravenous paracetamol (1·26, 0·99–1·62, p=0·0629). In the per-protocol population, diclofenac (OR 1·49, 95% CI 1·13–1·97, p=0·0046) and paracetamol (1·40, 1·06–1·85, p=0·0166) were more effective than morphine in achieving the primary outcome. Acute adverse events in the morphine group occurred in 19 (3%) participants. Significantly lower numbers of adverse events were recorded in the diclofenac group (7 [1%] participants, OR 0·31, 95% CI 0·12–0·78, p=0·0088) and paracetamol group (7 [1%] participants, 0·36, 0·15–0·87, p=0·0175) than in the morphine group. During the 2 week follow-up, no additional adverse events were noted in any group. Intramuscular non-steroidal anti-inflammatory drugs offer the most effective sustained analgesia for renal colic in the emergency department and seem to have fewer side-effects. Hamad Medical Corporation Medical Research Center, Doha, Qatar.

Blunt vertebral artery injury (VAI) is associated with severe cervicocephalic trauma and may have devastating consequences. This study aimed to determine the incidence and nature of VAI in polytrauma patients. The secondary objective was to assess the association of VAI with previously suggested risk factors. It was a retrospective observational study of all polytrauma patients admitted to the trauma unit between April 2018 and July 2019, who had CT neck angiography to diagnose blunt VAI according to modified Denver criteria. Out of 1084 admitted polytrauma patients, 1025 (94.6%) sustained blunt trauma. Of these, 120 (11.7%) underwent screening CT neck angiography. VAI was detected in 10 (8.3%; 95% CI 4.1–14.8) patients. There were three patients with Grade I injury, two with Grade II, and five with Grade IV injury. Among all trauma admissions, the incidence of diagnosed VAI was 0.9% (95% CI 0.5–1.8). Among patients suspected of VAI, there was no univariable association of VAI with C-Spine fracture: OR 4.2 (95% CI 0.51–34.4; p  = 0.18). There were two (20%) deaths related to VAI. Traumatic VAI was uncommonly detected in this major trauma service in Saudi Arabia. High suspicion and liberal screening by CT angiography in cases where VAI is possible should be considered to avoid missed injuries.

Background In the intense setting of reception and resuscitation of critically bleeding patients, wastage of up to 10% of blood components occur, commonly due to prolonged breaks in the cold chain. Additionally, some transfusions may be avoidable. The aim of this study was to assess the impact of dedicated transfusion teams (staff focused solely on blood handling during resuscitation) on blood component wastage and transfusion volumes. Methods This was a retrospective pre- and post-intervention study. We introduced a transfusion team for all episodes of blood transfusion in a level 1 trauma centre. The core elements of the intervention were: (1) dedicated ‘blood checkers’ without other competing duties during the resuscitation, (2) a 17-minute timer activated on receipt of blood components, (3) telephone for communication with the blood bank, and (4) a pre-determined process of blood component request, usage and return discussed at the initial team huddle. Results Patient demographics, indications for transfusion and massive transfusion rates were similar between the pre- and post-intervention periods. During 01 Jan 2019 to 30 Jun 2021 (pre-intervention), 109 (1.7%) of 6619 blood component units dispensed were wasted. Following the intervention, until 30 Jun 2023, 73 (1.1%) of 6575 units were wasted ( p  = 0.008). In the post intervention period, median patient transfusion volumes were significantly lower at 2 (inter-quartile range; IQR 2–6) compared to 3 (IQR 2–6) units ( p  = 0.002). Discussion Dedicated transfusion teams during emergency use of blood were associated with lower wastage and lower transfusion volumes. Transfusion teams may lead to more precise management of critical bleeding, while enabling cognitive capacity for the team leader to focus on identifying and controlling haemorrhage.

Background Sensor devices have enabled estimations of head impact kinematics across contact sports. Objectives To quantitatively report the magnitude (linear and rotational acceleration) and frequency of game-related head impacts recorded in male contact sports athletes. Methods A systematic review was conducted in June 2017. Inclusion criteria were English-language in vivo studies published after 1990 with a study population of male athletes aged ≥ 16 years, in any sport, where athletes were instrumented with an accelerometer device for measuring head impacts. Study populations were not limited to players with a clinical diagnosis of concussion. Results Twenty-one studies met the inclusion criteria with 12 conducted on American Football athletes. Six of these studies were included for meta-analysis. At a threshold of 10 g , amateur rugby players sustained the most impacts per player per game (mean = 77, SD = 42), followed by amateur Australian Football (mean = 29, SD = 37) and collegiate lacrosse athletes (mean = 11.5, SD = 3.6). At thresholds of greater than 14.4 g , high school American Football athletes sustained between 19 (SD = 19.1) and 24.4 (SD = 22.4) impacts per player per game. Statistically significant heterogeneity was observed among the included studies, and meta-analysis of impact magnitude was limited. Conclusions The frequency of “head acceleration events” was quantified and demonstrated substantial variation in methodology and reporting of results. Future research with standardised reporting of head impacts and inclusion of non-helmeted sports is warranted to enable more robust comparisons across sports. Prospero ID CRD42017070065.

Background and objectives: Prompt identification of patients with acute traumatic coagulopathy (ATC) is necessary to expedite appropriate treatment. An early clinical prediction tool that does not require laboratory testing is a convenient way to estimate risk. Prediction models have been developed, but none are in widespread use. This systematic review aimed to identify and assess accuracy of prediction tools for ATC. Materials and Methods: A search of OVID Medline and Embase was performed for articles published between January 1998 and February 2018. We searched for prognostic and predictive studies of coagulopathy in adult trauma patients. Studies that described stand-alone predictive or associated factors were excluded. Studies describing prediction of laboratory-diagnosed ATC were extracted. Performance of these tools was described. Results: Six studies were identified describing four different ATC prediction tools. The COAST score uses five prehospital variables (blood pressure, temperature, chest decompression, vehicular entrapment and abdominal injury) and performed with 60% sensitivity and 96% specificity to identify an International Normalised Ratio (INR) of >1.5 on an Australian single centre cohort. TICCS predicted an INR of >1.3 in a small Belgian cohort with 100% sensitivity and 96% specificity based on admissions to resuscitation rooms, blood pressure and injury distribution but performed with an Area under the Receiver Operating Characteristic (AUROC) curve of 0.700 on a German trauma registry validation. Prediction of Acute Coagulopathy of Trauma (PACT) was developed in USA using six weighted variables (shock index, age, mechanism of injury, Glasgow Coma Scale, cardiopulmonary resuscitation, intubation) and predicted an INR of >1.5 with 73.1% sensitivity and 73.8% specificity. The Bayesian network model is an artificial intelligence system that predicted a prothrombin time ratio of >1.2 based on 14 clinical variables with 90% sensitivity and 92% specificity. Conclusions: The search for ATC prediction models yielded four scoring systems. While there is some potential to be implemented effectively in clinical practice, none have been sufficiently externally validated to demonstrate associations with patient outcomes. These tools remain useful for research purposes to identify populations at risk of ATC.

Background Concussion is common in the sporting arena and is often challenging to diagnose. The development of wearable head impact measurement systems has enabled measurement of head kinematics in contact sports. Objectives The objective of this systematic review was to determine the characteristics of head kinematics measured by an accelerometer system among male athletes diagnosed with concussion. Methods A systematic search was conducted in July 2015. Inclusion criteria were English-language studies published after 1990 with a study population of male athletes, in any sport, where objectively measured biomechanical forces were reported in the setting of a concussive event. The random effects meta-analysis model was used to combine estimates of biomechanical force measurements in concussed athletes. Results Thirteen studies met the inclusion criteria, the majority of which were conducted with high school and college football teams in the US. Included studies measured a combination of linear and rotational acceleration. The meta-analysed mean peak linear head acceleration associated with a concussive episode was 98.68 g (95 % CI 82.36–115.00) and mean peak rotational head acceleration was 5776.60 rads/s 2 (95 % CI 4583.53–6969.67). The estimates of the biomechanical forces were consistent across studies, with I 2 values of 0 % for both meta-analyses. Conclusions Head impact monitoring through accelerometery has been shown to be useful with regard to characterising the kinematic load to the head associated with concussion. Future research with improved clinical outcome measures and head kinematic data may improve accuracy when evaluating concussion, and may assist with both interpretation of biomechanical data and the development and utilisation of implementation strategies for the technology.