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AimMajor trauma (MT) has traditionally been viewed as a disease of young men caused by high-energy transfer mechanisms of injury, which has been reflected in the configuration of MT services. With ageing populations in Western societies, it is anticipated that the elderly will comprise an increasing proportion of the MT workload. The aim of this study was to describe changes in the demographics of MT in a developed Western health system over the last 20 years.MethodsThe Trauma Audit Research Network (TARN) database was interrogated to identify all cases of MT (injury severity score >15) between 1990 and the end of 2013. Age at presentation, gender, mechanism of injury and use of CT were recorded. For convenience, cases were categorised by age groups of 25 years and by common mechanisms of injury. Longitudinal changes each year were recorded.ResultsProfound changes in the demographics of recorded MT were observed. In 1990, the mean age of MT patients within the TARN database was 36.1, the largest age group suffering MT was 0–24 years (39.3%), the most common causative mechanism was road traffic collision (59.1%), 72.7% were male and 33.6% underwent CT. By 2013, mean age had increased to 53.8 years, the single largest age group was 25–50 years (27.1%), closely followed by those >75 years (26.9%), the most common mechanism was low falls (39.1%), 68.3% were male and 86.8% underwent CT.ConclusionsThis study suggests that the MT population identified in the UK is becoming more elderly, and the predominant mechanism that precipitates MT is a fall from <2 m. Significant improvements in outcomes from MT may be expected if services targeting the specific needs of the elderly are developed within MT centres.

Pediatric trauma patients often require interfacility transfer for subspecialty management of presumed isolated injuries. Understanding the frequency of additional injury in these low-acuity patients may improve resource utilization. Pediatric trauma patients transferred to a level 1 trauma center in 2019 were compared by type of presenting injury in a retrospective review. Primary outcome was additional traumatic injuries identified. 530 pediatric trauma patients were transferred, most commonly for an isolated orthopedic injury (56.5 ​%). The overall rate of additional injuries identified was 2.8 ​%, with the highest rate in patients transferred with neurosurgical injuries (6.7 ​%). When compared to other transfer patients, patients with isolated orthopedic injuries were least likely to have any additional injuries (1.0 ​% vs. 4.8 ​%, p ​= ​0.01). Pediatric trauma patients transferred with isolated injuries rarely had additional injuries identified after transfer. Streamlining care for this population while maintaining vigilance for missed injuries is a target for future interventions. •There was a low rate of additional injuries identified in pediatric trauma patients transferred for subspecialty evaluation.•Isolated orthopedic transfer patients had a significantly lower rate of additional injuries identified on trauma workup.•The lower rate of additional injuries in isolated orthopedic injury patients persisted on multivariate analysis.•Alternative means of patient assessment for this specific group may help with resource optimization.

Traumatic brain injury (TBI) is a leading cause of death and disability. Epidemiology seems to be changing. TBIs are increasingly caused by falls amongst elderly, whilst we see less polytrauma due to road traffic accidents (RTA). Data on epidemiology is essential to target prevention strategies. A nationwide retrospective cohort study was conducted. The Dutch National Trauma Database was used to identify all patients over 17 years old who were admitted to a hospital with moderate and severe TBI (AIS ≥ 3) in the Netherlands from January 2015 until December 2017. Subgroup analyses were done for the elderly and polytrauma patients. 12,295 patients were included in this study. The incidence of moderate and severe TBI was 30/100.000 person-years, 13% of whom died. Median age was 65 years and falls were the most common trauma mechanism, followed by RTAs. Amongst elderly, RTAs consisted mostly of bicycle accidents. Mortality rates were higher for elderly (18%) and polytrauma patients (24%). In this national database more elderly patients who most often sustained the injury due to a fall or an RTA were seen. Bicycle accidents were very frequent, suggesting prevention could be an important aspect in order to decrease morbidity and mortality.

Purpose Polytrauma is increasingly recognized as a disease beyond anatomical injuries. Due to population growth, centralization, and slow uptake of preventive measures, major trauma presentations in most trauma systems show a slow but steady increase. The proportional contribution of polytrauma patients to this increase is unknown. Methods A 13-year retrospective analysis ending 31/12/2021 of all major trauma admissions (ISS > 15) to a level-1 trauma center were included. Polytrauma was classified using the Newcastle definition. Linear regression analysis was used to compare the rates of patient presentation over time. Logistic regression was used to measure for change in proportion of polytrauma. Data are presented as median (IQR), with odds ratios and 95% confidence intervals as appropriate. Results 5897 (age: 49 ± 43 years, sex: 71.3% male, ISS: 20 ± 9, mortality: 10.7%) major trauma presentations were included, 1,616 (27%) were polytrauma (age: 45 ± 37 years, 72.0% male, ISS: 29 ± 14, mortality: 12.7%). Major trauma presentations increased significantly over the study period (+ 8 patients per year (3–14), p  < 0.01), aged significantly (0.42 years/year (0.25–0.59, p  < 0.001). The number of polytrauma presentations per year did not change significantly (+ 1 patients/year (– 1 to 4, p  > 0.2). Overall unadjusted mortality did not change (OR 0.99 (0.97–1.02). Polytrauma mortality fell significantly (OR 0.96 (0.92–0.99)) over the study period. Conclusions Polytrauma patients represent about 25% of the major trauma admissions, with higher injury severity, static incidence and higher but improving mortality in comparison to all major trauma patients. Separate reporting and focused research on this group are warranted as monitoring the entire major trauma cohort does not identify these specifics of this high acuity subgroup.

Background Large multi-centre studies of clavicle fractures have so far been missing. The aim of this observational study was to describe the epidemiology, classification and treatment of clavicle fractures in the The Swedish Fracture Register (SFR) that collects national prospective data from large fracture populations. Methods Data were retrieved from the SFR on all clavicle fractures sustained by patients ≥ 15 years of age in 2013–2014 ( n  = 2 422) with regards to date of injury, cause of injury, fracture classification and treatment. Results Sixty-eight per cent of the clavicle fractures occurred in males. The largest subgroup was males aged 15–24 years, representing 21% of clavicle fractures. At the ages of 65 years and above, females sustained more clavicle fractures than males. Same-level falls and bicycle accidents were the most common injury mechanisms. Displaced midshaft fractures constituted 43% of all fractures and were the most frequently operated fractures. Seventeen per cent of the patients underwent operative treatment within 30 days of the injury, where plate fixation was the choice of treatment in 94% of fractures. Conclusion The largest patient group was young males. Displaced midshaft fractures were the most common type of clavicle fracture as well as the most frequently operated type of fracture.

The treatment of severely injured patients requires complex pre-hospital and in-hospital emergency interventions. The German Guideline on the Treatment of Multiple and/or Severe Injuries (‘German Polytrauma Guideline’) was developed to provide a standardized, evidence-based treatment approach for this purpose. High guideline adherence is supposed to positively affect quality of care and patient outcomes. The aim of this study is to quantify the adherence to the strong recommendations of the German Polytrauma Guideline in a sample of patients treated at all German trauma centres using data from the TraumaRegister DGU (TR-DGU, Trauma Registry) from over a decade (2011–2022). All strong recommendations from the 2016 version of the German Polytrauma Guideline that could be operationalised in the TR-DGU were selected. Adherence to these recommendations was examined for a population of adults (≥ 16 years) with severe injuries (injury severity score ≥ 16) who were directly admitted to a German trauma centre in the period of 2011–2022 and for whom TR-DGU data were available ( N  = 141,073). Adherence rates were calculated at the recommendation level. We found acceptable adherence rates for most of the investigated recommendations in the pre-hospital and in-hospital trauma data combined. Poor adherence rates were observed for pre-hospital decompression of tension pneumothoraxes, pre-hospital administration of tranexamic acid (TXA), exploratory thoracotomy in hemodynamically unstable patients with penetrating injuries, and decompression of space-occupying intracranial injuries. Our results indicate that many of the strong recommendations of the German Polytrauma Guideline are adhered to in the pre-hospital and in-hospital care of severely injured patients in Germany. We have also identified recommendations where measures should be taken to improve adherence. These results need to be interpreted in the context of the limitations of registry-based studies. The present study is registered as TRDGU project ID 2,023,008 and follows the publication guidelines of the TraumaRegister DGU.

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.

Background Ocular trauma is a significant cause of blindness and is often missed in polytrauma. No contemporary studies report eye injuries in the setting of severe trauma in the UK. We investigated ocular injury epidemiology and trends among patients suffering major trauma in England and Wales from 2004 to 2021. Methods We conducted a retrospective study utilising the Trauma Audit and Research Network (TARN) registry. Major trauma cases with concomitant eye injuries were included. Major trauma was defined as Injury Severity Score >15. Ocular injuries included globe, cranial nerve II, III, IV, and VI, and tear duct injuries. Orbital fractures and adnexal and lid injuries were not included. Demographics, injury profiles, and outcomes were extracted. We report descriptive statistics and 3-yearly trends. Results Of 287 267 major trauma cases, 2368 (0.82%) had ocular injuries: prevalence decreased from 1.87% to 0.66% over the 2004–2021 period ( P  < 0.0001). Males comprised 72.2% of ocular injury cases, median age was 34.5 years. The proportion of ocular injuries from road traffic collisions fell from 43.1% to 25.3% while fall-related injuries increased and predominated (37.6% in 2019/21). Concomitant head injury occurred in 86.6%. The most common site of ocular injury was the conjunctiva (29.3%). Compared to previous TARN data (1989–2004), retinal injuries were threefold more prevalent (5.9% vs 18.5%), while corneal injuries were less (31.0% vs 6.6%). Conclusions Whilst identifying eye injuries in major trauma is challenging, it appears ocular injury epidemiology in this setting has shifted, though overall prevalence is low. These findings may inform prevention strategies, guideline development and resource allocation.

We investigated the impact of blunt pulmonary contusion (BPC) in patients with rib fractures. Adult patients with rib fractures caused by blunt mechanisms were enrolled over 3 years at a Level 1 trauma center. BPC was defined according to percentage of lung affected as: moderate (1–19% contusion) or severe (≥20% contusion). In total, 1448 of the 7238 admitted patients had rib fractures. Of these, 321 (22.2%) had BPC: 236 moderate and 85 severe. Patients with BPC were more likely to be admitted to the ICU (moderate: OR 1.55, 95% CI 1.10–2.19; severe: OR 2.74, 95% CI 1.41–5.32). Significantly increased rates of pneumonia (OR 2.52, 95% CI 1.43–4.90) and empyema (OR 4.80, 95% CI 1.07–21.54) were found for moderate and severe BPC, respectively. ICU admission and infectious pulmonary complications were more likely with BPC. The presence of BPC on admission CT is also prognostic of increased resource utilization. •Pulmonary contusion occurs in 22% of patients with rib fractures from blunt trauma.•Patients with contusions are more likely to require intensive care and ventilation.•Patients with ≥20% total lung contusion have a trend towards increased mortality. Blunt pulmonary contusion (BPC) significantly impacts morbidity and mortality. We investigated the effect of BPC in polytrauma patients with rib fractures.

Background Peripheral nerve injury (PNI) as an adjunct lesion in patients with upper extremity trauma has not been investigated in a Central European setting so far, despite of its devastating long-term consequences. This study evaluates a large multinational trauma registry for prevalence, mechanisms, injury severity and outcome characteristics of upper limb nerve lesions. Methods After formal approval the TraumaRegister DGU® (TR-DGU) was searched for severely injured cases with upper extremity involvement between 2002 and 2015. Patients were separated into two cohorts with regard to presence of an accompanying nerve injury. For all cases demographic data, trauma mechanism, concomitant lesions, severity of injury and outcome characteristics were obtained and group comparisons performed. Results About 3,3% of all trauma patients with upper limb affection (n = 49,382) revealed additional nerve injuries. PNI cases were more likely of male gender (78,6% vs.73,2%) and tended to be significantly younger than their counterparts without nerve lesions (mean age 40,6 y vs. 47,2 y). Motorcycle accidents were the most frequently encountered single cause of injury in PNI patients (32,5%), whereas control cases primarily sustained their trauma from high or low falls (32,2%). Typical lesions recognized in PNI patients were fractures of the humerus (37,2%) or ulna (20,3%), vascular lacerations (arterial 10,9%; venous 2,4%) and extensive soft tissue damage (21,3%). Despite of similar average trauma severity in both groups patients with nerve affection had a longer primary hospital stay (30,6 d vs. 24,2 d) and required more subsequent inpatient rehabilitation (36,0% vs. 29,2%). Conclusion PNI complicating upper extremity trauma might be more commonly encountered in Central Europe than suggested by previous foreign studies. PNI typically affect males of young age who show significantly increased length of hospitalization and subsequent need for inpatient rehabilitation. Hence these lesions induce extraordinary high financial expenses besides their impact on health related quality of life for the individual patient. Further research is necessary to develop specific prevention strategies for this kind of trauma.