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Background Hemorrhage from intra-abdominal injuries (IAI) is a leading cause of traumatic deaths in children. Concern over misdiagnosing IAIs has resulted in excessive use of abdominal computed tomography (CT). Despite its many benefits, CT presents risks to children most notably radiation-induced malignancies. Thus, we must safely limit abdominal CT evaluation to those at non-negligible risk. The focused assessment with sonography for trauma (FAST) examination uses abdominal ultrasonography to detect the presence of intraperitoneal fluid in injured patients and may decrease abdominal CT use in some children. Limited and conflicting data exists on the utility of the FAST examination in children. A large multicenter study is thus necessary to determine if the FAST examination should routinely be included in the diagnostic evaluation of injured children. Methods This is a multicenter, randomized controlled clinical trial to assess the impact of the FAST examination on the initial evaluation of children with blunt abdominal trauma. Enrolled participants will be randomized 1:1 to the FAST examination plus routine care or routine care alone during their initial emergency department (ED) evaluation. The study will enroll 3194 (initial sample size) to 4346 (second sample size) children at six diverse sites. The primary outcomes are as follows: (1) The proportion of abdominal CT in the initial 24 h of care and (2) the proportion of missed or delayed diagnoses of IAIs. Secondary outcomes include (1) ED length of stay, (2) hospitalization proportion and length of hospital stay, (3) physician suspicion of IAI, (4) the proportion of abdominal CT use in the subgroup of children 0 to 3 years old, and (5) laparotomy proportion. Hospitalized participants will be followed through their stay, and guardians of those discharged from the ED will be contacted after 1 week to assess their status. Discussion The study will determine if the FAST examination results in a safe reduction of CT use in injured children and will provide definitive evidence if the FAST examination should be routinely implemented in the initial evaluation of children with blunt abdominal trauma. Trial registration ClinicalTrials.gov NCT05910567. Registered on May 9, 2023

To compare the effect of high-dose intravenous corticosteroid therapy with placebo in the treatment of recent traumatic optic neuropathy (TON). In a double-masked placebo-controlled clinical trial, 31 eyes of 31 patients were randomly assigned to two groups. Patients with history of trauma < or =7 days were included. Unconscious patients, eyes with penetrating trauma and candidates for decompression surgery were excluded. The treatment group (16 eyes) received 250 mg methylprednisolone intravenously every 6 h for 3 days, then 1 mg/kg prednisolone orally for 14 days; the placebo group (15 eyes) received 50 ml normal saline intravenously every 6 h for 3 days, then placebo for 14 days. Visual improvement was considered as a decrease of at least 0.4 logMAR in final visual acuity. Mean final BCVA (best corrected visual acuity) in the treatment group was 1.11+/- 1.14 and the placebo group was 1.78 +/- 1.23. This difference was not significant (P = 0.13). Visual acuity was improved in 68.8% of the treatment group and 53.3% of the placebo group, but the difference was not statistically significant (P = 0.38). The difference between initial and final BCVA in both groups was determined to be statistically significant (P < 0.001 and 0.010 respectively). Our study confirms earlier findings that there is no difference in visual acuity improvement between intravenous high-dose corticosteroids and placebo in treatment of recent TNO.

Abstract Rationale Acute lung injury is a common complication after severe trauma, which predisposes patients to multiple organ failure. This syndrome largely accounts for the late mortality that arises and despite many theories, the pathological mechanism is not fully understood. Discovery of histone-induced toxicity in mice presents a new dimension for elucidating the underlying pathophysiology. Objectives To investigate the pathological roles of circulating histones in trauma-induced lung injury. Methods Circulating histone levels in patients with severe trauma were determined and correlated with respiratory failure and Sequential Organ Failure Assessment (SOFA) scores. Their cause–effect relationship was studied using cells and mouse models. Measurements and Main Results In a cohort of 52 patients with severe nonthoracic blunt trauma, circulating histones surged immediately after trauma to levels that were toxic to cultured endothelial cells. The high levels were significantly associated with the incidence of acute lung injury and SOFA scores, as well as markers of endothelial damage and coagulation activation. In in vitro systems, histones damaged endothelial cells, stimulated cytokine release, and induced neutrophil extracellular trap formation and myeloperoxidase release. Cellular toxicity resulted from their direct membrane interaction and resultant calcium influx. In mouse models, cytokines and markers for endothelial damage and coagulation activation significantly increased immediately after trauma or histone infusion. Pathological examinations showed that lungs were the predominantly affected organ with edema, hemorrhage, microvascular thrombosis, and neutrophil congestion. An anti-histone antibody could reduce these changes and protect mice from histone-induced lethality. Conclusions This study elucidates a new mechanism for acute lung injury after severe trauma and proposes that circulating histones are viable therapeutic targets for improving survival outcomes in patients.

Pulmonary contusion is a common finding after blunt chest trauma. The physiologic consequences of alveolar hemorrhage and pulmonary parenchymal destruction typically manifest themselves within hours of injury and usually resolve within approximately 7 days. Clinical symptoms, including respiratory distress with hypoxemia and hypercarbia, peak at about 72 h after injury. The timely diagnosis of pulmonary contusion requires a high degree of clinical suspicion when a patient presents with trauma caused by an appropriate mechanism of injury. The clinical diagnosis of acute parenchymal lung injury is usually confirmed by thoracic computed tomography, which is both highly sensitive in identifying pulmonary contusion and highly predictive of the need for subsequent mechanical ventilation. Management of pulmonary contusion is primarily supportive. Associated complications such as pneumonia, acute respiratory distress syndrome, and long-term pulmonary disability, however, are frequent sequelae of these injuries.

Blunt traumatic aortic injury (BTAI) is severe, often fatal in younger populations due to high‐energy deceleration mechanisms. Thoracic endovascular aortic repair (TEVAR) has revolutionised BTAI treatment, surpassing the previously standard open surgical repair in mortality and complication rates. Despite its success, concerns arise regarding TEVAR's long‐term effects, especially in younger BTAI patients. Key physiological changes following TEVAR include alterations in aortic size, shape, compliance and flow dynamics, leading to loss of the Windkessel effect and a consequent increased pulse wave velocity and decreased radial strain, which can contribute to the development of hypertension. These alterations also predispose patients to changes in cardiovascular flow (increased reverse systolic flow, reduced maximum velocity and altered helical flow), potentially increasing the risk of left ventricular dysfunction and coronary artery disease. Physiological changes also increase the likelihood of complications such as graft migration. Clinical outcomes of TEVAR for BTAI have generally been favourable, with significant reductions in mortality and cerebrovascular accident rates compared to open surgical repair. However, long‐term complications, including the need for re‐interventions, remain a concern, though studies suggest these are infrequent. The durability of TEVAR in younger patients, who may experience decades of device use, poses unique challenges, particularly due to the natural progression of aortic morphology over time. Therefore, adapting TEVAR to the physiological needs of younger BTAI patients is essential. Developing more compliant endografts and using shorter stents with improved materials can help minimise structural and haemodynamic changes and enhance cardiovascular outcomes, supporting the long‐term health of this vulnerable population. What is the topic of this review? How thoracic endovascular aortic repair (TEVAR) influences aortic morphology, haemodynamics and cardiovascular outcomes in younger blunt traumatic aortic injury (BTAI) patients, and the associated long‐term complications and mitigation strategies. What advances does it highlight? TEVAR alters aortic compliance and flow dynamics, increasing risks of hypertension, cardiac remodelling, and complications like endograft migration and endoleaks. However, TEVAR offers low mortality and complication rates versus open surgical repair. Strategies such as reducing stented aortic length, improving endograft materials, and precise device sizing are critical for mitigating risks, enhancing outcomes and addressing the unique physiological demands of younger BTAI patients.

Blunt aortic injury occurs after sudden deceleration, and it is second only to head injury as the leading cause of death after automobile crashes. Helical computed tomography of the thorax is more sensitive than angiography for detection. Although immediate operative repair was once the rule, endovascular repair is now an alternative for many patients, including those with multiple major injuries. The endovascular approach can improve survival as well as reduce the risk of paraplegia. Blunt aortic injury occurs after sudden deceleration, and it is second only to head injury as the leading cause of death after automobile crashes. Helical CT of the thorax is more sensitive than angiography for detection. Although immediate operative repair was once the rule, endovascular repair is now an alternative for many patients. Blunt aortic injury occurs in less than 1% of motor vehicle crashes but is responsible for 16% of the deaths. 1 This injury is second only to head injury as the leading cause of death after vehicular crashes. 2 Up to 80% of patients die before their arrival at a hospital. Of those who survive the initial injury, a majority will die without definitive treatment. 3 Mechanism of Injury Blunt aortic injury most often occurs after sudden deceleration, usually in automobile crashes. Other causes include crashes of motorcycles and aircraft, auto–pedestrian collisions, falls, and crush injury. 3 In a prospective study of hospital admissions . . .

Chest trauma has a significant relevance on outcome after severe trauma. Clinically, impaired lung function typically occurs within 72 hours after trauma. However, the underlying pathophysiological mechanisms are still not fully elucidated. Therefore, we aimed to establish an experimental long-term model to investigate physiological, morphologic and inflammatory changes, after severe trauma. Male pigs ( sus scrofa ) sustained severe trauma (including unilateral chest trauma, femur fracture, liver laceration and hemorrhagic shock). Additionally, non-injured animals served as sham controls. Chest trauma resulted in severe lung damage on both CT and histological analyses. Furthermore, severe inflammation with a systemic increase of IL-6 (p = 0.0305) and a local increase of IL-8 in BAL (p = 0.0009) was observed. The pO 2 /FiO 2 ratio in trauma animals decreased over the observation period (p < 0.0001) but not in the sham group (p = 0.2967). Electrical Impedance Tomography (EIT) revealed differences between the traumatized and healthy lung (p < 0.0001). In conclusion, a clinically relevant, long-term model of blunt chest trauma with concomitant injuries has been developed. This reproducible model allows to examine local and systemic consequences of trauma and is valid for investigation of potential diagnostic or therapeutic options. In this context, EIT might represent a radiation-free method for bedside diagnostics.

Background Brain Trauma Foundation (BTF) guidelines recommend intracranial pressure (ICP) monitoring in patients who sustained severe traumatic brain injury (TBI). Compliance to BTF guidelines is variable, and the effect of ICP monitoring on outcomes remains a controversial issue. The purpose of this study was to assess guidelines compliance in patients who sustain a severe TBI and to analyze the effect of ICP monitoring on outcomes. Methods Trauma Quality Improvement Program database study, which included patients with isolated severe blunt head trauma (head Abbreviated Injury Scale ≥3 with Glasgow Coma Scale <9). Patients with severe extracranial injuries excluded. Analyzed variables were demographics, comorbidities, mechanism of injuries, head injury specifics, AIS for each body area, Injury Severity Score, admission vital signs, placement of ICP catheter and craniectomy. Multivariate analysis was used to identify independent predictors for outcomes, overall and in the groups of patients with head AIS 3, 4 or 5. Results During the study period 13,188 patients with isolated severe TBI met the BTF guidelines for ICP monitoring. An ICP catheter was placed in 1519 (11.5%) patients. Stepwise logistic regression analysis identified age ≥65 years, hypotension on admission, AIS 4 and AIS 5 as independent predictors for mortality. ICP monitoring was not an independent protective variable in terms of mortality (OR 1.12; 95% CI, 0.983–1.275; p  = 0.088). Overall, ICP monitor placement was independently associated with increased overall complications (OR 2.089; 95% CI, 1.85–2.358; p  < 0.001), infectious complications (OR 2.282; 95% CI, 2.015–2.584; p  < 0.001) and poor functional independence (OR 1.889; 95% CI, 1.575–2.264; p  < 0.001). Sub analysis of the groups of patients with head AIS 3, 4, and 5 failed to show any protective effect of ICP monitors against mortality. In the group of patients with head AIS 4, ICP placement was an independent predictor of mortality (OR 2206; 95% CI, 1652–2948; p  < 0.001). Conclusions Compliance with the BTF guidelines for ICP monitoring is poor. ICP monitoring does not have any survival benefit in patients with isolated severe blunt TBI and is associated with more complications and increased utilization of hospital resources.

Damage to the eye from blast exposure can occur as a result of the overpressure air-wave (primary injury), flying debris (secondary injury), blunt force trauma (tertiary injury), and/or chemical/thermal burns (quaternary injury). In this study, we investigated damage in the contralateral eye after a blast directed at the ipsilateral eye in the C57Bl/6J and DBA/2J mouse. Assessments of ocular health (gross pathology, electroretinogram recordings, optokinetic tracking, optical coherence tomography and histology) were performed at 3, 7, 14 and 28 days post-trauma. Olfactory epithelium and optic nerves were also examined. Anterior pathologies were more common in the DBA/2J than in the C57Bl/6 and could be prevented with non-medicated viscous eye drops. Visual acuity decreased over time in both strains, but was more rapid and severe in the DBA/2J. Retinal cell death was present in approximately 10% of the retina at 7 and 28 days post-blast in both strains. Approximately 60% of the cell death occurred in photoreceptors. Increased oxidative stress and microglial reactivity was detected in both strains, beginning at 3 days post-injury. However, there was no sign of injury to the olfactory epithelium or optic nerve in either strain. Although our model directs an overpressure air-wave at the left eye in a restrained and otherwise protected mouse, retinal damage was detected in the contralateral eye. The lack of damage to the olfactory epithelium and optic nerve, as well as the different timing of cell death as compared to the blast-exposed eye, suggests that the injuries were due to physical contact between the contralateral eye and the housing chamber of the blast device and not propagation of the blast wave through the head. Thus we describe a model of mild blunt eye trauma.

Blunt chest trauma (BCT) is common and frequently associated with adverse complications. Beyond merely impeding regular respiration, adverse events (AEs) such as hemothorax or pneumothorax can hinder the patient's recovery. Herein, we aim to validate potential predictive factors for AEs among adults with BCT who were admitted concurrently through the dataset focusing on the limited information available upon their arrival at the emergency department (ED). Seventeen variables—including patients' demographics, comorbidities, and vital signs/hemogram data upon arrival at the ED—were investigated. A penalized logistic regression model was applied to the derivation cohort and validated in a subgroup using the same dataset (80%:20%). In addition, we employed the least absolute shrinkage and selection operator (LASSO) logistic regression to develop a nomogram, which enhances the accuracy of estimating individual probabilities for AEs after admission for BCT. Our retrospective review encompassed 3,668 adult patients between 2017 and 2021, and the incidence of AEs was 15.6% (572 out of 3,668). Penalized logistic regression was conducted both without and with the hemogram data (Model 1 and Model 2), yielding relatively satisfactory results (R 2: 0.271 vs. 0.291; area under the curve: 0.784 vs. 0.797, respectively). Despite the model's relatively high predictive value in the derivation cohort, the validation data still maintained an acceptable accuracy of 0.7456 and 0.7049, respectively. Employing our penalized logistic regression analysis, the recently formulated nomogram exhibited proficiency in predicting AEs following BCT. This effectiveness was achieved by integrating vital signs, hemogram data, and comorbidities recorded upon their arrival at the ED.