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Advances in Trauma Care and Emergency Medicine

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

Deadline for manuscript submissions: 20 June 2026 | Viewed by 21680

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Special Issue Editors

Dr. Lothar Andreas Schwarte

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Guest Editor

1. Department of Anesthesiology, Amsterdam University Medical Center, 1081 HV Amsterdam, The Netherlands
2. Helicopter Emergency Medical Service‚ Lifeliner 1, 1044 AN Amsterdam, The Netherlands
Interests: emergency medicine; trauma care; resuscitation; anesthesia; monitoring of circulation; diving medicine; hyper-baric medicine; HEMS
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Patrick Schober

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Guest Editor

1. Department of Anesthesiology, Amsterdam University Medical Center, 1081 HV Amsterdam, The Netherlands
2. Helicopter Emergency Medical Service‚ Lifeliner 1, 1044 AN Amsterdam, The Netherlands
Interests: emergency medicine; trauma; cadiopulmonary resuscitation; anesthesia; medical statistics
Special Issues, Collections and Topics in MDPI journals

Dr. Georgios F. Giannakopoulos

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Guest Editor

1. Helicopter Emergency Medical Service‚ Lifeliner 1, 1044 AN Amsterdam, The Netherlands
2. Department of Surgery, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
Interests: pre- and in-hospital trauma care; trauma surgery; spine surgery; treatment of open fractures and fracture-related infections; emergency medicine
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The management of trauma and emergency medicine share a broad overlap in their management priorities and respective challenges. Importantly, in both fields, time is of the essence to prevent and limit morbidity and mortality. The initial treatment in both fields focuses on the restoration and stabilization of vital functions, rather than a definitive therapy of the underlying disease. Furthermore, a broad overlap also exists in the organizational approach to both fields: Severe trauma and emergency medical cases are regularly treated before arrival in the hospital already, e.g., by paramedics or prehospital emergency physicians. Also, within the hospital, the initial organizational approach overlaps, with severe trauma cases and emergency medicine cases being presented in the emergency department and usually treated initially by a multidisciplinary team according to international guidelines. After stating those shared aspects to underline why both topics fit and complement each other within one Special Issue, it is also obvious that both fields are highly diverse, and many facets hereof may be presented in this upcoming Special Issue. Thus, it is the aim of this Special Issue to highlight recent advances in trauma care and emergency medicine, including pre-hospital care, the emergency department, the operating room, and the intensive care unit.

The scope of this Special Issue includes, but is not limited to:

Organizational aspects of trauma care and emergency medicine;
Approaches to life-threatening conditions;
Diagnostics, including ultrasonography and monitoring vital functions;
Fluid resuscitation and emergency (surgical) procedures;
Cardiopulmonary resuscitation;
Emergency anesthesia and critical care;
Application of novel technologies, e.g., drones or artificial intelligence;
Trauma care and emergency care in the austere environment.

We welcome high-quality original studies (clinical and experimental), well-designed meta-analyses, and informative reviews. We look forward to your contribution.

Dr. Lothar Andreas Schwarte
Prof. Dr. Patrick Schober
Dr. Georgios F. Giannakopoulos
Guest Editors

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Keywords

trauma
trauma care
emergency medicine
pre-hospital
emergency room
intensive care unit

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Published Papers (6 papers)

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Research

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14 pages, 2926 KB

Open AccessArticle

Early Immune Alterations in Adult Patients with Trauma According to Injury Severity: Cell-Death Patterns and Inflammatory Mediator Profiles

by Sung-Joon Park, Jung-Youn Kim, Sora Yun, Si-Hwa Kim, Kap Su Han, Jong-Hak Park and Young-Hoon Yoon

J. Clin. Med. 2026, 15(11), 4371; https://doi.org/10.3390/jcm15114371 - 5 Jun 2026

Viewed by 183

Abstract

Background/Objectives: Trauma triggers complex early immune responses. However, the relationship among trauma severity, changes in immune cell survival, and circulating inflammatory mediators remains unclear. This study compared early cell viability and death patterns in CD66b⁺ granulocytes, total T lymphocytes, and CD4⁺ and CD8⁺ T-cell subsets as well as inflammatory mediator levels between patients with non-severe and severe trauma. Methods: This single-center prospective observational study included 67 adult patients with trauma who were classified into non-severe and severe trauma groups according to the Injury Severity Score (ISS < 15 vs. ISS ≥ 15). Blood samples were obtained within 1 h of arrival at the emergency department. Flow cytometry was used to assess the viability, early apoptosis, late apoptosis, and necrosis in the leukocyte subsets. Serum concentrations of intercellular adhesion molecule-1 (ICAM-1), macrophage migration inhibitory factor (MIF), CD40 ligand (CD40L), and interleukin-1 receptor antagonist (IL-1ra) were measured using enzyme-linked immunosorbent assays. Results: The severe trauma group had a significantly lower proportion of early apoptotic CD66b⁺ granulocytes than the non-severe trauma group (2.9% [1.4–6.7] vs. 6.3% [3.7–10.9], p = 0.001), whereas the live, late apoptotic, and necrotic CD66b⁺ granulocyte fractions did not differ significantly between the two groups. Most T-cell death parameters were similar between the groups, although an exploratory increase in necrotic CD4⁺ T lymphocyte abundance was observed in the severe trauma group. IL-1ra levels were significantly higher in the severe trauma group than in the non-severe trauma group and were associated with ISS in both mediator-only and adjusted sensitivity regression analyses. Conclusions: Severe trauma was associated with reduced early apoptosis in the CD66b⁺ granulocyte compartment and elevated IL-1ra levels shortly after injury compared with non-severe trauma. These findings suggest that early immune alterations after severe trauma may involve compartment-specific granulocyte death patterns and counter-regulatory inflammatory responses rather than generalized changes across leukocyte populations. Full article

(This article belongs to the Special Issue Advances in Trauma Care and Emergency Medicine)

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11 pages, 707 KB

Open AccessArticle

Femoral Nerve Block Versus Pericapsular Nerve Group Block for Pain Management in Emergency Department Patients with Extracapsular Hip Fractures

by Kar Mun Cheong, Hua Li, Su Weng Chau, Cheng-Han Chiang, Yi-Kung Lee and Tou-Yuan Tsai

J. Clin. Med. 2026, 15(4), 1454; https://doi.org/10.3390/jcm15041454 - 12 Feb 2026

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Abstract

Background and Objectives: Regional anesthesia is one of the critical alternatives for managing severe pain in patients with hip fractures. Femoral nerve block (FNB) is a common technique, and pericapsular nerve group block (PENG) has emerged as a promising alternative. However, the comparative efficacy of these techniques in extracapsular hip fractures, which have a distinct innervation pattern from intracapsular fractures, is not well established. Thus, we compared the analgesic efficacy of ultrasound-guided FNB and PENG blocks in emergency department (ED) patients with extracapsular hip fractures. Methods: This single-center, retrospective observational study was conducted from 1 January 2020 to 31 July 2021. We included adult patients presenting to the ED with an acute, isolated extracapsular hip fracture who received FNB or PENG. The primary outcome was pain reduction, analyzed by pain trajectory analysis according to the pain intensity difference (PID) at multiple time points (0, 15, 30, 60, and 120 min) and a time-to-event analysis for meaningful pain relief (PID ≥ 4). Secondary outcomes included rescue morphine consumption, ED length of stay (LOS), and hospital LOS. Results: Thirty-nine patients were included (21 FNB; 18 PENG). The FNB group demonstrated a significantly greater reduction in pain scores over time than the PENG group (likelihood ratio test p < 0.001). In the time-to-event analysis, median time to meaningful pain relief was 1 min in the FNB group versus 114 min in the PENG group. Cox proportional hazards modeling demonstrated that the FNB group achieved meaningful pain relief 2.40 times faster than the PENG group (HR = 2.40, 95% CI = 1.06–5.44, p = 0.03). There were no significant differences between the groups in rescue morphine use, ED LOS, or hospital LOS after multivariable adjustment. Conclusions: In this retrospective observational study of patients with extracapsular hip fractures, FNB was associated with more rapid and effective pain relief than PENG. These findings suggest that FNB may be considered a favorable regional analgesic technique for these patients, though prospective randomized trials are needed to establish definitive treatment recommendations. Full article

(This article belongs to the Special Issue Advances in Trauma Care and Emergency Medicine)

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16 pages, 417 KB

Open AccessArticle

Prehospital Cardiopulmonary Resuscitation in Patients with Suspected Severe Traumatic Brain Injury: A BRAIN PROTECT Sub-Analysis

by Floor J. Mansvelder, Elise Beijer, Anthony R. Absalom, Frank W. Bloemers, Dennis Den Hartog, Nico Hoogerwerf, Esther M. M. Van Lieshout, Stephan A. Loer, Joukje van der Naalt, Lothar A. Schwarte, Sebastiaan M. Bossers and Patrick Schober

J. Clin. Med. 2026, 15(3), 934; https://doi.org/10.3390/jcm15030934 - 23 Jan 2026

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Abstract

Background/Objectives: Severe traumatic brain injury (TBI) carries high mortality, and outcomes are particularly poor when prehospital cardiopulmonary resuscitation (CPR) is required. Because these patients are often excluded from research, epidemiological data and prognostic insights are limited. This study aimed to describe characteristics and outcomes of patients with suspected severe TBI who received prehospital CPR. Methods: We performed a sub-analysis of the prospectively collected multicenter BRAIN-PROTECT registry, including all patients with suspected severe TBI who underwent prehospital CPR and were transported to a participating trauma center. Results: A total of 256 patients with suspected severe TBI who received prehospital CPR were included. Early mortality was high, with 22.6% declared dead in the emergency department and an additional 28.9% within 24 h, resulting in 48.5% 24 h survival. Thirty-day mortality was 79.9%. Among survivors, 45.7% achieved moderate disability or good recovery at discharge. Outcomes, 30-day mortality, and neurological status at discharge did not differ between isolated and non-isolated TBI. Characteristics often seen in survivors included shockable initial rhythm, reactive pupils, and lack of anisocoria. All patients without prehospital return of spontaneous circulation died. Conclusions: Although overall 30-day mortality was high, survival among patients for whom resuscitation was attempted and who reached hospital care was not negligible, and a substantial proportion of the survivors achieved moderate to good neurological recovery. Prehospital ROSC and shockable rhythms were associated with better outcomes, suggesting that resuscitation may be valuable and warranted in selected patients with potentially reversible conditions. Further studies are needed to better define prognostic factors and guide management in this highly vulnerable population. Full article

(This article belongs to the Special Issue Advances in Trauma Care and Emergency Medicine)

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13 pages, 962 KB

Open AccessArticle

Ultrasound-Guided Nerve Blocks for Patients with Clavicle Fracture in the Emergency Department

by Cheng-Chien Chen, En-Hsien Su, Hua Li, Kar Mun Cheong, Yung-Yi Cheng, Su Weng Chau, Yi-Kung Lee and Tou-Yuan Tsai

J. Clin. Med. 2026, 15(2), 523; https://doi.org/10.3390/jcm15020523 - 8 Jan 2026

Viewed by 1103

Abstract

Background: Opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) for clavicle fracture pain management carry significant adverse effect and allergic reaction risks. This study assessed ultrasound-guided nerve block (USNB) efficacy for acute clavicle fracture pain in emergency department (ED) patients, providing an alternative to NSAIDs and opioids with fewer adverse effects. Methods: This retrospective, single-center observational study was conducted in accordance with Methods of Medical Record Review Studies in Emergency Medicine Research guidelines. Adult patients (≥20 years) who presented to the ED with traumatic clavicle fractures between 1 January 2015 and 30 November 2023 were included. Of the 343 eligible patients, 12 received ultrasound-guided nerve blocks (USNB) and 331 received standard care. To improve exchangeability, 1:10 matching with replacement was performed according to patients’ characteristics, such as age, sex, initial pain score, and comorbidities. The primary outcome was pain relief, assessed via the pain intensity difference (PID) on the Numerical Rating Scale within 360 min post-intervention. Meaningful pain relief was defined as a PID ≥ 4. Secondary outcomes included rescue opioid use, ED length of stay, hospital length of stay, and USNB-associated complications, such as vascular puncture, nerve injury, or local anesthetic systemic toxicity. Data were analyzed using time-course, time-to-event (time to meaningful pain relief), and linear regression analyses. Results: A total of 12 patients in the USNB group and 85 matched patients in the standard care group were analyzed after baseline characteristics matching with replacement. Compared to standard care, USNB was associated with significantly greater pain relief (p < 0.001). In the time-to-event analysis, USNB led to a 3.41-fold faster achievement of meaningful pain relief compared with that achieved with standard care (HR = 3.41; 95% CI, 1.47–7.90; p = 0.004). No significant differences were observed between groups in rescue opioid use, ED length of stay, or hospital length of stay. No USNB-associated complication developed in the USNB group. Conclusions: In patients with traumatic clavicle fractures, USNB provides more rapid and sustained pain relief than standard analgesic care in the ED, without increasing the ED length of stay. Large prospective studies are needed to confirm these findings. Full article

(This article belongs to the Special Issue Advances in Trauma Care and Emergency Medicine)

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13 pages, 1382 KB

Open AccessArticle

Early Evaluation of Myeloperoxidase and Delta Neutrophil Indices Is Similar to 48 h Sequential Organ Failure Assessment Score for Predicting Multiple Organ Failure After Trauma

by Woo Jin Jung, Hye Sim Kim, Kyoung Chul Cha, Young-Il Roh, Gyo Jin An, Yong Sung Cha, Hyun Kim, Kang Hyun Lee, Sung Oh Hwang and Oh Hyun Kim

J. Clin. Med. 2025, 14(10), 3447; https://doi.org/10.3390/jcm14103447 - 15 May 2025

Cited by 1 | Viewed by 1016

Abstract

Background/Objectives: Multiple organ failure is the main cause of mortality in severely injured patients who survive the early post-trauma phase. Myeloperoxidase and delta neutrophil indices may serve useful markers for the early diagnosis of an inflammatory condition. We aimed to ascertain the use of these indices for predicting multiple organ failure after a major trauma. Methods: A retrospective study was performed based on a level I trauma center database that included trauma patients with an injury severity score of >15 points. Organ function was evaluated according to the sequential organ failure assessment score within at least 48 h of admission and the myeloperoxidase and delta neutrophil indices, which were measured every morning. Results: A total of 96 patients were included in this study. Compared with the non-multiple-organ-failure group, the multiple organ failure group had similar myeloperoxidase indices but a significantly higher delta neutrophil index. Multivariate logistic regression analysis revealed no significant difference in the predictive power among the post-trauma multiple organ failure models that included various factors, although model 7, which combined the sequential organ failure assessment score and the myeloperoxidase and delta neutrophil indices, tended to have the maximum predictive power. Conclusions: Early delta neutrophil index (DNI) values and the composite model incorporating SOFA, absolute MPXI, and DNI each demonstrated moderate ability to predict multiple organ failure after major trauma. Prospective multicenter studies that include granular treatment variables are warranted to validate these biomarkers and to explore whether their incorporation into real-time decision tools can improve outcomes. Full article

(This article belongs to the Special Issue Advances in Trauma Care and Emergency Medicine)

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Review

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18 pages, 622 KB

Open AccessReview

Extended Focused Assessment with Sonography for Trauma in the Emergency Department: A Comprehensive Review

by Federico M. Bella, Alessandra Bonfichi, Ciro Esposito, Christian Zanza, Abdelouahab Bellou, Domenico Sfondrini, Antonio Voza, Andrea Piccioni, Antonio Di Sabatino and Gabriele Savioli

J. Clin. Med. 2025, 14(10), 3457; https://doi.org/10.3390/jcm14103457 - 15 May 2025

Cited by 13 | Viewed by 17238

Abstract

The Extended Focused Assessment with Sonography for Trauma (eFAST) plays a crucial role in the emergency department (ED) by providing rapid and non-invasive diagnostic information in trauma patients. It is a diagnostic-free fluid detection technique that uses sonography to assess trauma in different anatomical windows of the chest and abdomen and has been accepted in multiple studies as the initial diagnostic tool for torso injuries in blunt abdominal trauma. By promptly identifying potentially life-threatening injuries, such as haemoperitoneum, haemothorax, and cardiac tamponade, eFAST facilitates timely intervention and improves patient outcomes in the ED. The eFAST exam is reliable, with high sensitivity and specificity, even when performed by non-radiological personnel, saving time and resources in the chaotic emergency environment. This review aims to assess the diagnostic reliability and limitations of eFAST in different trauma conditions and to outline its goals in trauma critical care and in “ABCDE” resuscitation. Full article

(This article belongs to the Special Issue Advances in Trauma Care and Emergency Medicine)

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