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The concept of the “Golden Hour” has been a time-honored tenet of prehospital trauma care, despite a paucity of data to substantiate its validity. Non-compressible torso hemorrhage has been demonstrated to be a significant cause of mortality in both military and civilian settings. We sought to characterize the impact of prehospital time and torso injury severity on survival. Furthermore, we hypothesized that time would be a significant determinant of mortality in patients with higher Abbreviated Injury Scale (AIS) grades of torso injury (AIS ≥ 4) and field hypotension (prehospital SBP ≤ 110 mmHg) as these injuries are commonly associated with hemorrhage. Data for this analysis was generated from a registry of 2,523,394 injured patients entered into the National Trauma Data Bank Research Data Set from 2012 to 2014. Patients with torso injury were identified utilizing Abbreviated Injury Scale (AIS) for body regions 4 (Thorax) and 5 (Abdomen). Specific inclusion criteria for this study included pre-hospital time, prehospital SBP ≤110 mmHg, torso injury qualified by AIS and mortality. Patients with non-survivable torso injury (AIS = 6), severe head injuries (AIS ≥ 3), no signs of life in the field (SBP = 0), interfacility transfers, or those with any missing data elements were excluded. This classification methodology identified a composite cohort of 42,135 adult patients for analysis. The overall mortality rate of the study population was 7.9% (3326/42,135); Torso AIS and prehospital time were noted to be strong independent predictors of patient mortality in all population strata of the analysis (P < 0.05). The data demonstrated a profound incremental increase in mortality in the early time course after injury associated with torso AIS ≥4. In patients with high-grade torso injury, AIS grades ≥4, the degree anatomic disruption is associated with significant hemorrhage. In our study, a precipitous rise in patient mortality was exhibited in this high-grade injury group at prehospital times <30 min. Our data highlight the critical nature of prehospital time in patients with non-compressible torso hemorrhage. However, realizing that evacuation times ≤30 min may not be realistic, particularly in rural or austere environments, future efforts should be directed toward the development of therapies to increase the window of survival in the prehospital environment. •Risk of death increased with longer prehospital times, most prominent within the first 30 min.•Mortality risk was more significant with higher Torso Abbreviated Injury Scale (AIS) scores.•Need to develop strategies to increase the window of survival in the prehospital environment.

Spleen injuries are among the most frequent trauma-related injuries. At present, they are classified according to the anatomy of the injury. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic derangement, and the associated injuries. The management of splenic trauma patients aims to restore the homeostasis and the normal physiopathology especially considering the modern tools for bleeding management. Thus, the management of splenic trauma should be ultimately multidisciplinary and based on the physiology of the patient, the anatomy of the injury, and the associated lesions. Lastly, as the management of adults and children must be different, children should always be treated in dedicated pediatric trauma centers. In fact, the vast majority of pediatric patients with blunt splenic trauma can be managed non-operatively. This paper presents the World Society of Emergency Surgery (WSES) classification of splenic trauma and the management guidelines.

Our purpose was to assess the prevalence of liver injuries as well as concomitant injuries to the liver and spleen in patients with blunt or penetrating abdominal trauma, and to determine the prevalence, management and outcome of active bleeding and contained vascular injuries (CVI; pseudoaneurysm/AV-fistula) seen on admission CT. A retrospective, single-center, longitudinal cohort study with nine-year data (2013–2021) of all ≥ 15-year-old patients with severe blunt or penetrating abdominal trauma and an ICD code for liver and/or splenic trauma. CT examinations were identified. Radiology, medical reports and images were reviewed and only patients with an adequate admission CT were included in the final study group. Of 2805 patients with abdominal trauma (71% males), 409 patients (14.6%) had a liver injury, and 329 had a CT on admission (329/409; 80.4%). 313 patients (11.2%) had a splenic injury and 262 had a CT (262/313; 83.7%). Of these, 65 patients or 2.3% (65/2805) had injury to both organs, with 49 patients with CT (49/65; 75.4%), combined group (CG) (79% males). The median (range) ISS was 21 (4–75) for single organ injury patients and 34 (9–75) for patients with both organs injured ( p  < 0.0001). Active liver or splenic bleeding was seen in 5.8% and 17.9%, respectively. In CG, 11 (11/49; 22.4%) patients had active bleeding. Of these, two patients had active bleeing in both organs (4.1%). Liver patients with active bleeding had significantly higher ISS ( p  = 0.025) than those without. In CG, ISS did not differ significantly between patients with and without active bleeding ( p  = 0.073), however, it tended to be higher in those with active bleeding. Most liver injuries with active bleeding were treated non-operatively (12/19; 63.2%). An active bleeding was more common in spleen than in liver patients; odds ratio (OR) (95% CI) 3.57 (2.04–6.25), p  < 0.0001. A CVI was more common in splenic compared with liver injuries, OR 6.71 (95% CI; 2.27–19.9, p  < 0.0001). Active bleeding was more common in CG than in single organ injury patients; OR 3.67 (1.73–7.79), p  < 0.0016. 30-day survival rate did not differ between patients with or without active bleeding, but was slightly lower in CG compared with only liver injury (89.8% vs. 93.7%, p  = 0.36). In conclusion the prevalence of liver injury in abdominal trauma seen on admission CT was 11.7% of all patients with blunt or penetrating abdominal trauma, and concomitant splenic and liver injury was seen in 1.7%. Non-operative management was applied in almost two thirds of patients with liver injuries. Active bleeding was seen in 5.8% of liver, 17.9% of splenic and 22.4% of CG patients. ISS was doubled in CG compared with single organ injury patients. Active bleeding was more common in CG, and CG had slightly increased mortality rate compared with single organ injury patients.

We aimed to evaluate the diagnostic value of soluble interleukin-2 receptor (sIL-2R), tumor necrosis factor-α (TNF-α), procalcitonin (PCT), and combined detection for sepsis infection in patients with closed abdominal injury complicated with severe multiple abdominal injuries. One hundred forty patients with closed abdominal injury complicated with severe multiple abdominal injuries who were diagnosed and treated from 2015 to 2020 were divided into a sepsis group ( = 70) and an infection group ( = 70). The levels of sIL-2R, TNF-α, and PCT in the sepsis group were higher than those in the infection group ( < 0.05). The receiver operating characteristic (ROC) curve showed that the areas under the ROC curve (AUCs) of sIL-2R, TNF-α, PCT and sIL-2R+TNF-a+PCT were 0.827, 0.781, 0.821, and 0.846, respectively, which were higher than those of white blood cells (WBC, 0.712), C-reactive protein (CRP, 0.766), serum amyloid A (SAA, 0.666), and IL-6 (0.735). The AUC of the three combined tests was higher than that of TNF-α, and the difference was statistically significant ( < 0.05). There was no significant difference in the AUCs of sIL-2R and TNF-α, sIL-2R and PCT, TNF-α and PCT, the three combined tests and sIL-2R, and the three combined tests and PCT ( > 0.05). When the median was used as the cut point, the corrected sIL-2R, TNF-α, and PCT of the high-level group were not better than those of the low-level group ( > 0.05). When the four groups were classified by using quantile as the cut point, the OR risk values of high levels of TNF-α and PCT (Q4) and the low level of PCT (Q1) after correction were 7.991 and 21.76, respectively, with statistical significance ( < 0.05). The detection of sIL-2R, TNF-α, and PCT has good value in the diagnosis of sepsis infection in patients with closed abdominal injury complicated with severe multiple abdominal injuries. The high concentrations of PCT and TNF-α can be used as predictors of the risk of septic infection.

Few studies have investigated risk factors for recurrence of blunt traumatic abdominal wall hernias (TAWH). Twenty trauma centers identified repaired TAWH from January 2012 to December 2018. Logistic regression was used to investigate risk factors for recurrence. TAWH were repaired in 175 patients with 21 (12.0%) known recurrences. No difference was found in location, defect size, or median time to repair between the recurrence and non-recurrence groups. Mesh use was not protective of recurrence. Female sex, injury severity score (ISS), emergency laparotomy (EL), and bowel resection were associated with hernia recurrence. Bowel resection remained significant in a multivariable model. Female sex, ISS, EL, and bowel resection were identified as risk factors for hernia recurrence. Mesh use and time to repair were not associated with recurrence. Surgeons should be mindful of these risk factors but could attempt acute repair in the setting of appropriate physiologic parameters. [Display omitted] •Bowel resection is a recurrence risk factor in blunt traumatic abdominal wall hernias.•Time to repair and mesh use are not associated with recurrence.•Early repair of these injuries is feasible.

Background The traumatic abdominal wall hernia (TAWH) is strongly associated with blunt abdominal trauma. The importance of the CT scan cannot be underestimated—the diagnosis of TAWH is easy to miss clinically, but simple to spot radiologically. We report a case series of patients managed in a French-level one trauma centre, to contribute our experience in the detection and management of associated injuries, and of the hernia itself. Methods All patients (n = 4238) presenting to a single-level one trauma centre for trauma resuscitation (including systematic full-body computerised tomography) from November 2014 to February 2020 were screened for the presence of TAWH and prospectively added to our database. Particular attention was paid to the late detection of associated intra-abdominal injuries. Finally, the choice of management of the hernia itself was noted. A literature review of all case series and individual case reports until the time of writing was performed and summarised. Results We report 12 cases of TAWH amongst 4238 patients presenting to the trauma resuscitation bay between November 2014 and February 2020. All patients underwent a contrast-enhanced CT immediately after stabilisation. No patients had clinically detected TAWH prior to CT. Intra-abdominal injuries were found in 9 patients (75%), and urgent surgery was required in 7 patients (58.3%). Two (28.5%) of these seven patients had a missed diagnosis of intra-abdominal injury at the time of the index CT scan, although the TAWH had been detected. Based on our literature review, 271 patients across 12 case series were identified. In total, 183 (67;5%) of these patients were reported to have ≥ 1 associated intra-abdominal injuries. In total, 127 (46,8%) patients required an urgent laparotomy for management of these injuries. Five (3.9%) of the patients requiring urgent laparotomy had a missed CT diagnosis of intra-abdominal injury but not of TAWH at the time of the baseline CT. Conclusions TAWH is a rare clinical entity that may alert to more significant, associated trauma lesions. The CT scan is the imaging modality of choice, to both diagnose and classify the hernia and to screen for other injuries. The presence of TAWH must lower the threshold to operatively explore or at least closely monitor these patients, in view of the high rate of false-negative findings at index imaging.

Most injured children are initially seen at non-pediatric hospitals, then transferred to a pediatric trauma center for definitive care. Published outcomes of transferred children with blunt abdominal trauma (BAT) are sparse. Our objective is to describe this population and their disposition at a pediatric trauma center. The study was performed at a level-1 pediatric trauma center (PTC) using data collected from electronic medical records and trauma registry. Patients 0-18 years with BAT transferred from outside facilities (OSF) between 2009 and 2019. Penetrating injuries were excluded. 923 patients were analyzed and grouped by whether computed tomography abdominal/pelvis (CTa/p) was obtained at each facility. Those with positive CTa/p at OSF were also compared to those with positive CTa/p results at our PTC. Descriptive statistics evaluated demographics, injury mechanism, Glasgow Coma Scale (GCS), Injury Severity Scale (ISS), disposition, and length of stay (LOS). Males had higher predominance of positive CTa/p at both OSF and PTC (p = 0.0012), with motor vehicle crash (MVC) being the most common injury mechanism (p = 0.0002). Patients with positive CTa/p at PTC (n = 156) were associated with statistically higher ISS, lower GCS, more dispositions to OR and ICU, and longer LOS (all p < 0.005). Of patients with negative CTa/p at OSF (n = 41), none received subsequent CTa/p upon arrival to PTC and only 2 were admitted in the setting of head trauma. Of the patients without CTa/p performed at either facility or negative CTa/p at PTC (n = 23), most were admitted for non-abdominal trauma. Compared to those with positive CTa/p at OSF, children who had positive CTa/p at PTC were younger, had higher ISS scores, and longer LOS, suggesting they were more seriously injured. Children with BAT and negative CTa/p in absence of other injuries, may not require transfer to a PTC. Enhanced understanding of these patients may reduce unnecessary transfers, improving resource utilization. •A significant number of children sustaining blunt abdominal trauma undergo transfer.•Emerging literature on their management differs from widely accepted guidelines.•This retrospective study describes transferred children with blunt abdominal trauma.•Patients who were transferred without CT at transferring facility were younger.•Patients found to have positive CT after transfer were younger and more injured.

The advancement of seat belts have been essential to reducing morbidity and mortality related to motor vehicle collisions (MVCs). The “seat belt sign” (SBS) is an important physical exam finding that has guided management for decades. This study, comprising a systematic review and random-effects meta-analysis, asses the current literature for the likelihood of the SBS relating to intra-abdominal injury and surgical intervention. PubMed and Scopus databases were searched from their beginnings through August 4, 2023 for eligible studies. Outcomes included the prevalence of intra-abdominal injury and need for surgical intervention. Cochrane's Risk of Bias (RoB) tool and the Newcastle-Ottawa Scale (NOS) were applied to assess risk of bias and study quality; Q-statistics and I2 values were used to assess for heterogeneity. The search yielded nine observational studies involving 3050 patients, 1937 (63.5%) of which had a positive SBS. The pooled prevalence of any intra-abdominal injury was 0.42, (95% CI 0.28–0.58, I2 = 96%) The presence of a SBS was significantly associated with increased odds of intra-abdominal injury (OR 3.62, 95% CI 1.12–11.6, P = 0.03; I2 = 89%), and an increased likelihood of surgical intervention (OR 7.34, 95% CI 2.03–26.54, P < 0.001; I2 = 29%). The measurement for any intra-abdominal injury was associated with high heterogeneity, I2 = 89%. This meta-analysis suggests that the presence of a SBS was associated with a statistically significant higher likelihood of intra-abdominal injury and need for surgical intervention. The study had high heterogeneity, likely due to the technological advancements over the course of this study, including seat belt design and diagnostic imaging sensitivity. Further studies with more recent data are needed to confirm these results.

Purpose To establish the incidence of pancreatic trauma in North Queensland to the region’s only tertiary paediatric referral centre, and to determine the patient’s outcomes based on their management. Methods A single centre, retrospective cohort study of patients < 18 years with pancreatic trauma from 2009 to 2020 was performed. There were no exclusion criteria. Results Between 2009 and 2020 there were 145 intra-abdominal trauma cases, 37% from motor vehicle accidents (MVA), 18.6% motorbike or quadbike, and 12.4% bicycle or scooter accidents. There were 19 cases of pancreatic trauma (13%), all from blunt trauma and with associated injuries. There were 5 AAST grade I, 3 grade II, 3 grade III, 3 grade IV injuries, and 4 with traumatic pancreatitis. Twelve patients were managed conservatively, 2 were managed operatively for another reason, and 5 were managed operatively for the pancreatic injury. Only 1 patient with a high grade AAST injury was successfully managed non-operatively. Complications included pancreatic pseudocyst ( n  = 4/19; 3 post-op), pancreatitis ( n  = 2/19; 1 post op), and post-operative pancreatic fistula (POPF) ( n  = 1/19). Conclusion Due to North Queensland’s geography, diagnosis and management of traumatic pancreatic injury is often delayed. Pancreatic injuries requiring surgery are at high risk for complications, prolonged length of stay, and further interventions.

The incidence of blunt abdominal injury (BAI) in the adult population has been estimated to be between 0.03% and 4.95%. However, the impact of BAI on the pediatric population remains unknown. We conducted a retrospective review of National Trauma Data Bank datasets for the years 2017–2019. We included patients under the age of 18 who experienced blunt trauma and had suffered a blunt abdominal injury with an Abbreviated Injury Scale (AIS) severity score of 2 or higher. Out of the 8064 pediatric patients with isolated abdominal trauma, 134 patients also suffered from BAI. We found no difference in the outcomes of patients with blunt adrenal injury in terms of mortality, length of stay in the intensive care unit (ICU) and hospital, and the number of ventilator days. Within poly-trauma patients BAI was associated with worst patient outcomes. This study demonstrates that BAI has minimal clinical impact on patient outcomes in isolation. However it is associated with worst outcomes in poly trauma patients suggesting correlation with increased trauma burden. III. •Patients with adrenal injury similar ICU and Hospital length of stays to patients without.•Mortality is the same in pediatric patients with blunt adrenal injury compared to those without.•Adrenal Injury occurs in 5% of pediatric trauma patients.