30-Second Takeaway
- Geriatric consult services in trauma centers correlate with markedly lower risk-adjusted mortality in injured adults ≥65.
- Early rib fixation (<72 hours) in older adults shortens ICU stay, ventilation duration, and complications without increasing mortality.
- In patients ≥150 kg, ~0.34 mg/kg enoxaparin BID appears appropriate for VTE prophylaxis anti-Xa targets.
- Novel topical and systemic hemostats show promise for non-compressible and thrombocytopenic bleeding in preclinical models.
- ICU transfusion and antithrombotic-bleeding monitoring should move beyond simple hemoglobin and ICD code triggers.
Week ending January 31, 2026
Organizing trauma systems for aging, complex, and coagulopathic patients
Geriatric consult services in trauma centers link to substantially lower O:E mortality
In this national survey of 145 US trauma centers, only 34% had a dedicated geriatric consult service for injured adults ≥65 years. Centers with geriatric consults more often had Level I verification, frailty assessment protocols, and geriatric pharmacists than those without services. Hospitals with geriatric consult services had fewer high-mortality outliers on unadjusted analysis (17% vs 44%). On multivariable modeling, geriatric consult availability was associated with markedly lower odds of higher-than-expected mortality (OR 0.20, 95% CI 0.05–0.73). These data support formal geriatric consultation and structured geriatric processes as organizational priorities in trauma systems caring for older adults.
Early SSRF in geriatric rib fractures shortens stay, ventilation, and complications
This NTDB cohort included 5,129 trauma patients ≥65 years undergoing surgical stabilization of rib fractures between 2018 and 2022. Early SSRF (<72 hours) was used in about 60% of patients and was associated with shorter hospital and ICU length of stay. Early fixation also reduced duration of mechanical ventilation and complications such as unplanned intubation, tracheostomy, ARDS, and pneumonia. Mortality rates were similar between early and late SSRF, suggesting no survival penalty with earlier operation. These findings support prioritizing early SSRF in appropriate geriatric patients to decrease resource use and pulmonary morbidity.
Self-expanding procoagulant powder outperforms XStat and gauze in porcine non-compressible hemorrhage
Researchers developed a self-gelling, self-expanding polyacrylic acid–polyethyleneimine hemostatic powder with foaming and high tissue adhesion. The optimized formulation (PP/PT5-TXA30) activated red cells, platelets, and fibrin, and rapidly plugged bleeding defects in multiple animal models. In a lethal porcine subclavian artery and vein transection model, this powder achieved superior hemorrhage control versus gauze and XStat. The material also accelerated full-thickness skin wound healing in preclinical testing. These results highlight a potential future adjunct for battlefield and civilian non-compressible torso hemorrhage, pending human safety and efficacy data.
Weight-based enoxaparin 0.34 mg/kg BID targets prophylactic anti-Xa in patients ≥150 kg
This multicenter retrospective study evaluated twice-daily prophylactic enoxaparin dosing in 311 hospital encounters for adults weighing ≥150 kg. Peak anti-Xa levels were drawn after at least three consecutive doses, targeting 0.2–0.4 IU/mL. Linear regression showed a significant correlation between weight-based dose and peak anti-Xa, albeit with modest explained variance. A dose of 0.34 mg/kg BID was predicted to achieve a peak anti-Xa of 0.3 IU/mL in this population. Observed VTE and major bleeding events were rare, suggesting this regimen is a reasonable empiric starting point for morbidly obese inpatients.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.