Trauma Surgery

Trauma center care improves 1-year survival in injured adults ≥65 without isolated severe TBI

This population-based cohort included 55,799 adults ≥65 years in Ontario with moderate or severe injury, excluding isolated hip fractures. Only 28.4% received trauma center care, yet overall 1-year mortality was high at 27.4%. Instrumental-variable analysis showed trauma center care reduced 1-year mortality by 3.5% absolute (95% CI 1.2–5.8). Benefit was consistent across age and injury severity strata, but absent in isolated brain injuries (mortality difference -1.3%; 95% CI -4.1–1.5). 1

Earlier nonsurgical resuscitation improves early mortality in isolated moderate–severe TBI

This cohort of 507 adults with isolated moderate-to-severe TBI in South Africa evaluated timing of grouped nonsurgical critical resuscitative interventions (nsCRIs). Receiving nsCRIs within 1 hour was associated with a 26% reduction in 7-day mortality versus >3 hours or missed nsCRIs (HR 0.74; 95% CI 0.56–0.98). In severe TBI, ≤1-hour nsCRIs yielded a 29% relative 7-day mortality reduction (HR 0.71; 95% CI 0.50–1.00). For blunt or mixed-mechanism TBI, timely nsCRIs improved 7-day mortality (HR 0.79; 95% CI 0.71–0.88) and discharge GCS (OR 1.79; 95% CI 1.01–3.19). 2

Post-intensive care syndrome after in-hospital cardiac arrest is frequent and predominantly physical

Using South Korea’s national insurance database, investigators studied 43,331 in-hospital cardiac arrest survivors for new-onset post-intensive care syndrome (PICS). The 12-month cumulative incidence of coded PICS was 6.7%, rising to 15.9% among stable one-year survivors. Physical impairment predominated (15.0%), whereas coded cognitive (0.5%) and psychiatric (0.8%) impairments were far less frequent. Extracorporeal membrane oxygenation support and longer hospitalization independently predicted PICS diagnoses. 3