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Trauma and Acute Care Surgery Research: Innovations, Challenges, and Future Directions

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Intensive Care".

Deadline for manuscript submissions: 20 December 2025 | Viewed by 8399

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Prof. Dr. Frederick Rogers

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Guest Editor

Regions Hospital, 640 Jackson St, St Paul, MN 55101, USA
Interests: trauma; acute care surgery; injury; trauma care; critical care

Special Issue Information

Dear Colleagues,

In this Special Issue clinical and basic science advances and summaries of the current state of the art related to trauma care will be summarized from nationally known trauma care experts, and the current state of trauma system development will be provided both in the US and internationally. Trauma care is in a constant state of evolution, and it is important for trauma care practitioners to be alert to the best available evidence so as to provide optimal care for their patients. This Special Issue on trauma care will provide the most up-to-date information on best practices for taking care of the severely injured trauma patient.

Prof. Dr. Frederick Rogers
Guest Editor

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Keywords

trauma care
best practices
clinical care
trauma system development
optimal trauma care

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Research

11 pages, 210 KB

Open AccessArticle

Incidence and Risk Factors of Developing a Dysrhythmia After Blunt Thoracic Trauma

by Jessica Jowers, Kevin Van Derveer, Katherine Moore, Nathaniel Harshaw, Julie M. Reichert, Hannah Karr, Urhum Khaliq, David J. Cziperle and Lindsey L. Perea

J. Clin. Med. 2025, 14(17), 6253; https://doi.org/10.3390/jcm14176253 - 4 Sep 2025

Viewed by 444

Abstract

Background/Objectives: The incidence of dysrhythmia after blunt thoracic trauma varies in the literature from 8–75%, and the complication rate from these dysrhythmias is not well studied. The aims of this study are to (1) identify the incidence of dysrhythmia following blunt thoracic trauma, (2) identify risk factors associated with developing a dysrhythmia, and (3) identify the incidence of cardiac intervention after developing a dysrhythmia. We hypothesize that blunt thoracic trauma may result in post-injury dysrhythmias. Methods: This is a retrospective review of trauma patients ≥ 18 years with a blunt mechanism of injury at a Level 1 Trauma Center from 1/2010 to 3/2022. Patients were included if they had one of the following: rib fracture, sternal fracture, chest wall contusion, pneumothorax, hemothorax, chest pain, chest wall deformity, or chest wall crepitus. Patients were excluded if they had an Abbreviated Injury Scale Chest = 0 or if they had a pre-existing dysrhythmia. Univariate, multivariate, and multivariable statistical analyses were performed. Results: In total, 2943 patients met inclusion criteria. In total, 574 (19.5%) developed a dysrhythmia; 100 (17.4%) required a new antiarrhythmic at discharge. Patients who developed a dysrhythmia had a nearly two times greater likelihood of requiring cardiac intervention than those without a dysrhythmia (AOR: 1.79; p = 0.004). Additional risk factors for requiring cardiac intervention included Injury Severity Score (ISS) 16–25 and >25 (p < 0.001). Conclusions: The incidence of dysrhythmia after blunt thoracic injury is 19.5% at our level I trauma center. Based on our study, patients that were older, had an ISS > 25, had a history of previous cardiac disease, or required > 5 units of blood products were at an increased risk of developing a dysrhythmia following trauma. As such, future consideration should be given to extended guidelines in monitoring these vulnerable patients. Full article

(This article belongs to the Special Issue Trauma and Acute Care Surgery Research: Innovations, Challenges, and Future Directions)

9 pages, 678 KB

Open AccessArticle

Rib Healing and Heterotopic Ossification After Surgical Stabilization of Rib Fractures

by Alexander Hoey, Daniel Akyeampong, Arjun Patel, Ronald Gross and Evert A. Eriksson

J. Clin. Med. 2025, 14(15), 5581; https://doi.org/10.3390/jcm14155581 - 7 Aug 2025

Viewed by 444

Abstract

Background: Little is known about the rate of rib fracture healing after Surgical Stabilization of Rib Fractures (SSRFs). We sought to evaluate the radiographic evidence of rib healing and hypertrophic ossification (HO) in patients after SSRFs. Methods: A single-center retrospective cohort study was conducted on all patients who had undergone SSRFs from 1 January 2010 to 31 March 2023 and had a computed tomography (CT) of the chest performed greater than 6 months after SSRFs. The rib fracture locations were mapped on the initial trauma CT scan and evaluated on the follow-up CT scan for healing and HO formation. Results: A total of 254 SSRF cases were evaluated, 21 patients met the inclusion criteria; out of 208 fractures, 109 underwent SSRFs. The median time to follow-up CT scan was 17(7–88) months. Overall, 95% of the fractures healed completely. Seventy percent of the non-union fractures were in posterior or paraspinal locations on ribs 8–10. HO was noted in nine patients and seen as early as 8 months post-operatively. A significant association was identified between the fixation method used to perform SSRFs (89% vs. 11%, p = 0.024) and operative day (6(0–9) vs. 2(2–5), p = 0.023). Conclusions: Non-union of rib fractures is uncommon after SSRFs. Many of these fractures involve the posterior or paraspinal lower rib cage. HO between fractures is common after SSRFs. Full article

(This article belongs to the Special Issue Trauma and Acute Care Surgery Research: Innovations, Challenges, and Future Directions)

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20 pages, 1026 KB

Open AccessArticle

Occupational Injuries Among Hospital Workers: A Retrospective Study in Turkey

by Volkan Medeni, Sultan Pınar Çetintepe, İrem Medeni, Hilal Özdemir Öztel, Fatma Bozdağ and Asiye Uğraş Dikmen

J. Clin. Med. 2025, 14(4), 1050; https://doi.org/10.3390/jcm14041050 - 7 Feb 2025

Cited by 1 | Viewed by 2552

Abstract

Introduction: Occupational injuries among healthcare workers adversely affect the quality of healthcare services by undermining their physical and mental well-being. This study evaluates the frequency, characteristics, and influencing factors of occupational injuries among non-physician healthcare workers in a university hospital. Methods: This cross-sectional study examines occupational injuries reported between 2020 and 2023 at a university hospital in Turkey. Variables included sociodemographic characteristics, occupation, department, working hours, cause and type of injury, time of injury, affected body part, use of personal protective equipment (PPE), medical intervention, and incapacity for work. Results: A total of 694 occupational injuries were reported at Gazi University Hospital between 2020 and 2023, with the fewest cases occurring in 2021. Among the injured workers, 58.8% were female, 89.2% were aged between 20 and 49 years, 30.1% did not use PPE, 76.4% received medical intervention, and 11.1% experienced incapacity for work. Cleaning workers (33.6%) and nurses (32.1%) accounted for the highest proportion of injuries. Sharps injuries were the most common type (48.8%), while injuries to the hands, fingers, and wrists comprised 53.3% of cases. The highest frequency of injuries occurred between 11:00 and 11:59 am. Sharps injuries were significantly associated with gender, age, educational background, occupation, working hours, and injury time. In contrast, cases of workplace violence were significantly associated with gender, occupation, and working hours. Conclusions: Sharps injuries and violence represent critical occupational hazards. Preventive strategies should be tailored to healthcare workers’ occupational roles and educational levels. Effective surveillance systems and reporting mechanisms should be implemented to promote workplace safety and reduce the risk of injuries. Full article

(This article belongs to the Special Issue Trauma and Acute Care Surgery Research: Innovations, Challenges, and Future Directions)

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18 pages, 2478 KB

Open AccessArticle

Comparative Study of Exchange Nailing and Augmentative Plating for Treating Aseptic Nonunion of Femoral Shafts Post Intramedullary Nailing: A Single-Blind, Multicentric Randomized Clinical Trial

by Mehdi Motififard, Hamid Mousavi, Nasrollah Iranpanah, Hossein Akbari Aghdam, Mehdi Teimouri, Mohsen Aliakbari, Mohammad Parhamfar, Somaye Shirazi Nejad, Mahdi Shahsavan, Amin Daemi, Ashkan Salehi and Mohammad Shahsavan

J. Clin. Med. 2024, 13(22), 6928; https://doi.org/10.3390/jcm13226928 - 18 Nov 2024

Cited by 1 | Viewed by 2463

Abstract

Background: Aseptic nonunion of femoral shafts after intramedullary nailing (IMN) can be a challenging condition that may lead to long-term disability and the need for multiple surgical procedures. This study compared the clinical and radiological outcomes between exchange nailing and augmentative plating with bone grafting. Methods: In this multicenter, prospective, single-blind, randomized controlled trial, patients with aseptic nonunion of the femoral shaft after IMN were randomly assigned to receive exchange nailing or augmentative plating. The primary outcomes measured were the time to bone union and union rate 12 months after revision surgery. The secondary outcomes included operative time, blood loss, hospitalization duration, pain level using the visual analog scale (VAS), knee range of motion (ROM), and complication rates. Results: The augmentative plating group had a significantly shorter mean time to union (5.39 ± 1.29 months) compared with the exchange nailing group (7.38 ± 1.97 months; p < 0.001). The union rates at 12 months were 100% in the augmentative plating group and 89.65% in the exchange nail group. Augmentative plating resulted in a shorter operation time (99.46 ± 11.08 min vs. 106.45 ± 12.22 min; p = 0.025) and reduced blood loss (514.79 ± 45.87 mL vs. 547.72 ± 54.35 mL; p = 0.016). Significant pain reduction was observed in the augmentative plating group, with preoperative VAS scores decreasing from 6.04 ± 2.28 to 2.64 ± 1.50, compared with a decrease from 5.66 ± 2.21 to 3.66 ± 2.19 in the exchange nailing group (p = 0.047). Knee ROM improved significantly in the augmentative plating group (p = 0.0176). The complication rate was lower in the augmentative plating group (3.57%) than in the exchange nail group (17.24%). Conclusions: Augmentative plating with autologous bone grafting is superior to exchange nailing for treating aseptic nonunion of femoral shafts. It is associated with faster healing, higher union rates, better clinical and functional outcomes, and fewer complications. We recommend this technique as the preferred treatment option for such complex cases. Full article

(This article belongs to the Special Issue Trauma and Acute Care Surgery Research: Innovations, Challenges, and Future Directions)

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10 pages, 530 KB

Open AccessArticle

Does Trauma Center Volume Matter? An Analysis of Trauma Center Volume on Outcome Using the TQIP/NTDB Database

by Alan Cook, Nicholas J. Larson, Heidi M. Altamirano, Brittany Ray, Brandi Pero, Musharaf Mohiuddin, Rebecca Swindall, Carly Wadle, David J. Dries, Benoit Blondeau and Frederick Rogers

J. Clin. Med. 2024, 13(22), 6655; https://doi.org/10.3390/jcm13226655 - 6 Nov 2024

Viewed by 1623

Abstract

Background: Increasing trauma center admission volume is said to decrease mortality. Evidence supporting this position is dependent upon patient groups and the time period studied, and gaps remain. We evaluated the effect of annual volume of critically injured patients on hospital mortality, comparing two time periods. The effect of critically injured patient volume on risk-adjusted mortality was hypothesized to decrease over time. Methods: This was a retrospective cohort study comparing data from an early group (2007–2011) and late group (2017–2021) of the National Trauma Data Bank. Critically injured adults (ISS > 15) admitted to the intensive care unit (ICU) or operating room from the emergency department at Level I and II trauma centers were included. The outcome of interest was risk-adjusted mortality across quintiles of patient admission volume, modeled using mixed-effects generalized linear models. Results: In total, 802,824 patients were included, 321,209 and 481,615 in the early and late groups, respectively. In the early group, increased patient volume was associated with a decreased risk-adjusted odds of mortality. This association was not seen in the late group. The overall odds of mortality in the late group demonstrated decreased mortality over time (OR 0.84, p < 0.001). Conclusions: The annual volume of critically injured patients was associated with decreased odds of hospital mortality during 2007–2011, though this effect was no longer present in the 2017–2021 sample. The continued dissemination of the best practices is warranted to decrease mortality, regardless of the admission volume of critically injured patients. Full article

(This article belongs to the Special Issue Trauma and Acute Care Surgery Research: Innovations, Challenges, and Future Directions)

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