Trauma Surgery

Multiomic trajectories identify trauma thromboinflammation endotypes and predict organ failure

Serial plasma proteomic and metabolomic profiling defined distinct thromboinflammation states after trauma in a clinical-trial cohort. Patients with similar injury patterns clustered into biologic endotypes with markedly different risks of organ failure, ICU stay, and mortality. Omic markers predicted organ failure and ICU time more accurately than conventional injury covariates. Profiles of proteasome activation, catabolism, and superoxide formation were linked to heart failure, lung failure, and acute lung injury vulnerability. Endotypes assigned from a single early plasma sample reproduced injury and outcome patterns in a separate validation cohort. 1

Trauma center volume shapes real-world management of blunt traumatic aortic injury

This Aortic Trauma Foundation registry analyzed 1,061 blunt traumatic aortic injuries from 48 centers between 2014 and 2024. High-volume centers treated patients with higher Injury Severity Scores and more Grade I lesions but similar hemodynamics compared with low-volume centers. Thoracic endovascular aortic repair use differed significantly by center volume, especially for minimal aortic injuries, despite comparable injury grades. Primary outcomes included treatment modality and mortality, with detailed tracking of aortic-related deaths and perioperative complications. Findings reveal substantial practice variation in choosing medical therapy, TEVAR, or open repair across centers with similar case-mix. 2

Delayed diagnosis of colon anastomotic leak increases failure-to-rescue

In this VA cohort of 39,175 colon resections, 3.1% developed organ space surgical site infection as a leak surrogate. About one-third of these infections were diagnosed only after sepsis and classified as delayed. Delayed leaks had more discrete complications, higher reoperation rates, and longer hospital stays than early-identified leaks. Failure-to-rescue after leak was markedly higher when diagnosis followed sepsis compared with early diagnosis. These data support structured early leak detection pathways rather than waiting for overt septic deterioration. 3

Conservative versus liberal oxygen targets show similar outcomes in ventilated ICU adults

This meta-analysis pooled nine randomized trials including 20,447 mechanically ventilated critically ill adults. Conservative oxygenation targets produced similar 90-day mortality to liberal targets, with a risk ratio of 1.01 (95% CI 0.94–1.09). ICU length of stay, organ support–free days, and most adverse events were comparable between groups. In septic patients, conservative targets yielded more vasopressor-free days, and post–cardiac arrest patients showed a possible survival advantage. Evidence certainty was generally moderate for mortality and key ICU outcomes, despite open-label designs. 4