Trauma Surgery

TXA benefit concentrates in high-mortality trauma phenotypes

This analysis combined five RCTs and a large registry phenotype cohort to examine where TXA has the greatest impact. Baseline mortality ranged widely across trials and phenotypes, and TXA number needed to treat decreased as baseline mortality increased. NNT ranged from 22 to 68 in RCTs and 10 to 98 across four machine-learning–derived trauma phenotypes. These data suggest greatest TXA benefit in patients with higher predicted mortality, arguing against indiscriminate use in lower-risk trauma. Phenotype-driven stratification using early clinical variables could guide more selective, data-informed TXA administration pending prospective validation. 1

Higher EMS clinician trauma volume associates with lower early trauma mortality

This LITES cohort subset analyzed 3649 severely injured patients cared for by 359 EMS clinicians over four years. For every additional five adult trauma patients annually per crew, adjusted 6-hour mortality decreased by about 10%. In-hospital mortality also decreased modestly with higher clinician trauma volume, including in subgroups with TBI and prehospital shock. Higher trauma volume correlated with shorter scene times, but total nontrauma volume and years of experience were not linked to mortality. Findings support trauma-focused volume and skills maintenance as key metrics for EMS staffing, credentialing, and training within trauma systems. 2

Driving pressure, more than tidal volume, predicts ARDS mortality

This pooled individual-patient analysis of 7934 ARDS cases examined modifiable ventilator factors separately in pulmonary and extrapulmonary ARDS. Higher driving pressure and respiratory rate were independently associated with increased 60-day mortality across ARDS etiologies. The association between driving pressure and mortality was stronger in pulmonary ARDS than in extrapulmonary ARDS. After excluding COVID-19 patients, driving pressure remained predictive, whereas respiratory rate lost its association with mortality. Tidal volume alone was not associated with 60-day mortality, suggesting driving pressure–guided ventilation as a more relevant bedside target. 3