Trauma Care, Volume 6, Issue 1 (March 2026) – 6 articles

Background/Objectives: Traumatic brain injury (TBI) affects more than 50 million people annually worldwide. Challenges in managing moderate-to-severe TBI include high rates of hospital-acquired infections and substantial variability in discharge disposition, and these combined challenges contribute significantly to the cost and trajectory of health recovery. Although current strategies such as antibiotic-impregnated external ventricular drains (EVDs) offer some benefit in controlling infections, they remain limited by high cost and inconsistent implementation. A clearer understanding of clinical and demographic factors associated with infection risk and discharge disposition are essential for improving care pathways. This study aims to identify and quantify key determinants of infection and discharge outcomes in patients with TBI. Methods: The National Trauma Database (NTDB) was queried using structured query language (SQL) based on predefined inclusion criteria (adult patients with ICD-coded TBI), input variables (basic demographics, injury location and severity, and vital signs), and specified outcome variables (emergency department discharge disposition, infection, and sepsis) to identify and filter the eligible patient cohort. A set of machine learning models were trained for each outcome (e.g., Emergency Department (ED) discharge, types of infections, and sepsis). Results: Data from 310,494 patients were extracted. The prediction model we developed, the Predictive TBI-Disposition Model (PTDM), was able to predict the outcome of a patient’s discharge with 96% accuracy. The accuracy of the models for infection and sepsis was 93% and 94%, respectively. Conclusions: Demographic and clinical factors significantly influence the discharge disposition and infection risk among TBI patients. Machine learning models demonstrated strong predictive performance, suggesting their utility in early risk stratification and targeted clinical decision-making. Full article

Introduction: Severe traumatic brain injury (sTBI) frequently coexists with polytrauma and often necessitates damage control neurosurgery (DCNS), where rapid decompression and temporary stabilization take precedence over definitive reconstruction. Within this context, anesthetic management must balance cerebral protection with ongoing resuscitation, yet high-quality DCNS-specific evidence remains limited. Materials and Methods: A comprehensive search of PubMed, Scopus, and Google Scholar (2015–2025) was conducted using MeSH terms and keywords related to neurotrauma, anesthesia, intracranial pressure, and perioperative management. Studies were included if they examined anesthetic or hemodynamic strategies in severe TBI or DCNS and reported relevant clinical or physiologic outcomes. Results: Nineteen articles addressing perioperative strategies for optimizing DCNS outcomes were analyzed. Discussion: Preoperative care emphasizes hemodynamic stabilization and permissive hypertension, damage control resuscitation including massive transfusion protocols, optimization of cerebral perfusion pressure (CPP) and neuromonitoring, and the use of hyperosmolar therapy. Transexamic acid can be used in sTBI safely but with unclear improvement in outcomes. Intraoperatively, propofol-based total intravenous anesthesia is generally preferred over volatile agents due to favorable effects on intracranial pressure (ICP), cerebral blood flow (CBF), autoregulation, and emergence. While historically contraindicated, ketamine and etomidate are now increasingly used as hemodynamically protective induction agents. Analgesic and sedative strategies prioritize dexmedetomidine and carefully titrated opioids to minimize respiratory depression and reduce postoperative complications. CPP and ICP-directed management relies on individualized blood pressure targets, vasopressor selection, lung-protective ventilation, and strict temperature control. Conclusions: Emerging evidence has suggested the benefit of DCNS for patient survival. Overall, perioperative care is guided largely by physiology and extrapolation, highlighting the need for standardized protocols. Full article

Background/Objectives: In the past few decades, there have been advancements in surgical techniques, improved understanding of spinal biomechanics, and awareness of complications associated with halo vest (HV) use with resultant surgical treatment of various pathologies that cause acute or chronic atlantoaxial instability. The purpose of this study was to see how HV usage has changed over time. Methods: A retrospective analysis of the North American Clinical Trials Network database. Patients with cervical spinal cord injury from 2006 through 2019 were identified and the trend of HV use was analyzed. Results: The mean age of patients who received HV was 37.4 years and 50 for those treated with other options, p < 0.0001. Its use consistently declined after 2009. After 2015 this decline reached nil in the database (p < 0.0001). Patients between 45 and 59 years (3.4%) and Above 60 years (2.8%) group had the least treatment using HV. Fall accident (4.7%, p = 0.0295) and central cord syndrome (4.6%, p = 0.0004) were associated with low HV use. Pulmonary complications were higher (89.4%) with HV use (vs. 65.9% with no HV), p = 0.0008. Pulmonary complications with HV decreased after 2012. Conclusions: HV as treatment option for conditions involving the cervical spine has decreased. This declining trend is attributable to decreased use in older individuals due to higher rates of complications and unfavorable outcomes with its use. The decreasing trend appears to coincide with published data showing better outcomes with surgical treatment and unfavorable outcomes with HV use. Full article

Background/Objectives: Traumatic brain injury in elderly patients is a significant public health concern, particularly for those on antithrombotic therapy. A clearer understanding of how different antithrombotic agents affect the likelihood of intracranial hemorrhage in elderly patients with TBI is needed to guide clinical management. Therefore, the objective of this study was to assess the effect of preinjury antithrombotic agents on the incidence of intracranial hemorrhage in elderly patients with traumatic brain injury. Methods: The design was a retrospective cohort study set in a regional Australian hospital emergency department. The study evaluated elderly patients (≥65 years) with head injury cases identified from the integrated electronic medical record using SNOMED codes. Data on patient demographics, antithrombotic use, computed tomography imaging, and outcomes were collected. Results: A total of 152 elderly TBI patients were included in the study. Of these patients, 90.1% had falls leading to TBI. Among the patients, 30.3% were on antiplatelet agents, 23% were on direct oral anticoagulants, 7.2% were on vitamin K antagonists, and 39.5% were not on any antithrombotic agents. Intracranial hemorrhage was found in 26.5% of patients, with both direct oral anticoagulants (aOR 4.87, 95% CI 1.42–16.67, p < 0.01) and vitamin K antagonists (aOR 4.95, 95% CI 1.04–23.55, p < 0.04) demonstrating statistically significant associations with increased odds of ICH. Conclusions: Both vitamin K antagonists and direct oral anticoagulants were associated with a higher odds of intracranial hemorrhage in elderly patients with TBI, while antiplatelet therapy did not show this effect. Full article

Goring during bullfights represents a penetrating trauma with a high risk of muscular, vascular, and vital injuries. Despite its frequency and severity, limited information is available on the immediate physiological response of the bullfighter at the moment of trauma. This case report describes the heart rate of a professional bullfighter who was gored during a bullfight, underwent surgery, and returned to fight the next bull. During the first fight, the bullfighter suffered a penetrating goring wound to the inner side of the lower third of his right thigh and a fracture of the ninth rib with intercostal rupture. Upon standing, he experienced a marked drop in heart rate and a feeling of loss of consciousness, possibly associated with vasovagal presyncope. He was transferred to the infirmary in hemodynamically stable condition. He was given local anesthesia, followed by surgical exploration, cleaning, and layered closure of the wound. After surgery, the bullfighter experienced a gradual increase in heart rate upon standing, possibly due to postural changes and postoperative sympathetic activation. He then returned to the bullring to resume activity. This case report highlights a possible vasovagal response to penetrating trauma, which may be relevant for trauma care, as a vasovagal or parasympathetic-predominant autonomic response could influence early clinical assessment. Full article

Background: To compare the biomechanical strength of three fixation techniques for the elbow anterior capsule and coronoid process using a synthetic ulna model. We hypothesize that a cortical suture button would be equivalent to the bone tunnel model but inferior to a screw-post construct. Methods: A biomechanical study was conducted using a composite ulna bone model to simulate coronoid process fixation with three techniques: traditional trans-osseous bone tunnel repair, suspensory fixation using a cortical button, and a screw-post construct using a 3.5 mm cortical screw. All constructs were assembled using high-strength suture. Each specimen underwent axial loading on an Instron machine until failure, defined as loss of fixation through the dorsal cortex. Peak ultimate strength was recorded. Statistical analysis was performed using one-way ANOVA and Tukey’s HSD test. Results: The suture button construct demonstrated the highest mean ultimate strength at 490.3 ± 125.2 N, significantly greater than both the bone tunnel (328.8 ± 86.4 N, p < 0.01) and screw-post constructs (273.4 ± 54.5 N, p < 0.001). While the bone tunnel construct exhibited a 20.3% higher strength than the screw-post construct, this difference was not statistically significant (p = 0.13). The screw-post construct showed the least variability in strength to failure but the lowest overall strength. The suture button demonstrated the greatest mechanical strength but also the most variability. Conclusions: Suspensory fixation using a titanium cortical suture button provides significantly greater mechanical strength compared to traditional bone tunnel and screw-post techniques in a synthetic ulna model. While variability was greatest with the suture button construct, its superior load-bearing capacity suggests potential advantages in stabilizing the elbow through anterior capsule and coronoid fracture repair. These findings support further clinical investigation of suture button fixation as a viable technique in complex elbow injuries. Full article