Search Results (47)

In recent years, the rapid development of lightweight Unmanned Aerial Vehicle (UAV) technology under 250 g has begun to challenge the validity of existing mass-based safety classifications. The commonly used 250 g threshold for defining “harmless” UAVs has become a subject requiring more detailed evaluations, especially as new models with increased speed and performance enter the market. This study aims to reassess the adequacy of the current 250 g mass limit by conducting a comprehensive analysis using human-centered injury metrics, including kinetic energy, Blunt Criterion (BC), Viscous Criterion (VC), and the Abbreviated Injury Scale (AIS). Within this scope, an extensive dataset of commercial UAV models under 500 g was compiled, with a particular focus on the sub-250 g segment. For each model, KE, BC, VC, and AIS values were calculated using publicly available technical data and validated physical models. The results were compared against established injury thresholds, such as 14.9 J (AIS-3 serious injury), 25 J (“harmless” threshold), and 33.9 J (AIS-4 severe injury). Furthermore, new recommendations were developed for regulatory authorities, including energy-based classification systems and mission-specific dynamic threshold mechanisms. According to the findings of this study, most UAVs under 250 g continue to remain below the current “harmless” threshold values. However, some next-generation high-speed UAV models are approaching or exceeding critical KE levels, indicating a need to reassess existing regulatory approaches. Additionally, the strong correlation between both BC and VC metrics with AIS outcomes demonstrates that these indicators are complementary and valuable tools for assessing injury risk. In this context, the adoption of an energy-based supplementary classification and dynamic, mission-based regulatory frameworks is recommended. Full article

Background: Severe traumatic brain injury (TBI) remains a leading cause of mortality and long-term morbidity, particularly in high-acuity trauma settings. We aim to evaluate the clinical, physiologic, and socioeconomic factors associated with outcomes in patients with severe traumatic brain injury (TBI) at a single urban Level 1 trauma center. Method: This is a single-center, retrospective study of patients presenting with severe TBI between 1 January 2020 and 31 December 2023 at Elmhurst Hospital Center in Queens, New York. Patients were identified using ICD trauma codes and an Abbreviated Injury Severity (AIS) Head score of ≥3. Demographic data, injury characteristics, vital signs, airway interventions, alcohol level, and insurance status were analyzed. Result: A total of 1130 patients met the inclusion criteria. The cohort was predominantly male (76.1%) with a mean age of 52.7 years. Blunt trauma accounted for 97.8% of cases, with a mortality rate of 13.8%, while penetrating trauma comprised 2.2%, with a markedly higher mortality rate of 48%. Patients who died as full code had lower mean systolic blood pressure (82.5 mmHg), oxygen saturation (63%), and shorter emergency department stays (~3.7 h). The mean Glasgow Coma Scale (GCS) score was 12.6, dropping to 6.0 in patients who died. Moreover, higher AIS Head and Injury Severity Score (ISS) values were correlated with worse outcomes. Severely intoxicated patients had higher TBI incidence, with no clear difference observed when compared to normal BAC levels. Self-pay patients exhibited the highest mortality (40%). All associations were statistically significant (p < 0.0001). Conclusions: Severe TBI outcomes are significantly influenced by injury mechanisms, physiologic parameters, and socioeconomic status. These findings emphasize the need for targeted prognostic tools and improved trauma system preparedness for TBI patients at risk of poor outcomes. Full article

Background/Objectives: Older trauma patients experience increased in-hospital mortality due to the physiological challenges associated with aging and injury severity. However, limited data exist on long-term mortality rates beyond hospital discharge, particularly among severely injured elderly trauma patients. Understanding these outcomes is essential for improving clinical management and rehabilitation strategies. The objective of this study was to evaluate cumulative mortality rates (in-hospital, 28-day, 1-year, 2-year, and 3-year) in older trauma patients with an Injury Severity Score (ISS) ≥ 16. Independent risk factors for 1-year mortality were also identified. Methods: This retrospective cohort study included all trauma patients aged ≥ 65 years with ISS ≥ 16 admitted to the Emergency Department of our level 1 trauma center between January 2017 and December 2022. Demographic characteristics, injury patterns (Abbreviated Injury Scale (AIS) scores, ISS), and mortality rates were collected from electronic health records. Patients were stratified into two age groups: 65–80 years and >80 years. Mortality rates were compared with those in the corresponding age groups in the general Swiss population. Statistical analysis included Kaplan–Meier survival curves and logistic regression for identifying risk factors associated with 1-year mortality. Results: A total of 1189 older trauma patients with a mean ISS of 24.3 ± 7.9 were included. The most common injury was severe head trauma (AIS head ≥ 3: 70.6%), followed by chest trauma (AIS chest ≥ 3: 28.2%) and extremity injuries (AIS extremity ≥ 3: 17.4%). The overall in-hospital mortality rate was 10.3%. Mortality rates at 28 days, 1 year, 2 years, and 3 years were 15.8%, 26.5%, 31.5%, and 36.3%, respectively. Age-stratified analysis showed significantly higher mortality rates in patients aged > 80 years compared to the 65- to 80-year group at all post-discharge time points (28-day: 22.6% vs. 11.9%, p < 0.001; 1-year: 39.9% vs. 18.8%, p < 0.001; 2-year: 46.5% vs. 22.8%, p < 0.001; 3-year: 56.4% vs. 24.9%, p < 0.001). Compared to the general Swiss population, we observed significantly higher mortality rates at all measured time points in elderly trauma patients, particularly in those aged over 80 years, with 1-year mortality rates of 39.9% vs. 10% in the general population and 3-year mortality rates of 56.4% vs. 30% in the general population. Independent risk factors for 1-year mortality included advanced age and severe head injury (AIS head ≥ 3, p < 0.001). Conclusions: Severely injured elderly trauma patients face high long-term mortality risks, with 1-year mortality rates reaching 26.5% overall and nearly 40% in patients aged > 80 years. These findings highlight the need for research on tailored, holistic management strategies, including comprehensive in-hospital care, specialized neurorehabilitation, and post-discharge follow-up programs to improve survival and functional recovery in this vulnerable population. Full article

Background/Objectives: The Geriatric Trauma Outcome Score (GTOS) is used to predict in-hospital mortality in geriatric patients with trauma. However, its applicability to elderly patients with multiple traumas and severe traumatic brain injury (TBI) remains poorly understood. This study aimed to evaluate the predictive accuracy of the GTOS in elderly patients with multiple traumas and TBI and assess its performance in patients with mild and severe TBI. Methods: We retrospectively analyzed 1283 geriatric multiple trauma patients (aged ≥ 65 years) treated at a regional trauma center from 2019 to 2023. Patients were stratified into mild (head Abbreviated Injury Scale [AIS] ≤ 3) and severe (head AIS ≥ 4) TBI groups. GTOS values were calculated for each patient, and predicted mortality was compared with in-hospital mortality. GTOS predictive accuracy was assessed by analyzing the receiver operating characteristic curve. Results: Patients had a median Injury Severity Score of 18 (interquartile range: 10–25); 33.3% of patients received red blood cell transfusions within 24 h. The overall in-hospital mortality rate was 17.9%; GTOS predicted a mortality rate of 17.6% ± 0.17. The GTOS accurately predicted the in-hospital mortality in the entire cohort, achieving an Area Under the Curve (AUC) of 0.798. Predictive accuracy diminished for patients with severe TBI (AUC = 0.657), underestimating actual mortality (39.5% vs. 28.8% predicted). Conclusions: While the GTOS remains a useful tool for predicting in-hospital mortality in elderly patients with multiple traumas, it consistently underestimates mortality risk in those with severe TBI. Therefore, applying the GTOS in this patient subgroup warrants careful consideration. Full article

Background: Major trauma is a leading cause of severe disability and mortality. The influence of patient sex on outcome after severe trauma is a topic of ongoing discussion. We present a prospective multicenter study on the effects of trauma severity on health-related quality of life (HRQoL) of female patients. We hypothesized that the impairment of HRQoL after major trauma between the sexes depends not only on sex itself but also on age. Methods: This multicenter prospective registry-based observational study compared sex-based differences in HRQoL of patients who sustained major trauma Injury Severity Score (ISS ≥ 16). The HRQoL was assessed using the EQ-5D-3L (European Quality of Life 5-Dimension 3-Level Version) score over 2 years post-trauma. Results: We included 416 patients (116 female/300 male) with an ISS > 16 (median ISS 22 IQR 18/30). All patients had a lower HRQoL after trauma than the population norm. Increased AIS (Abbreviated Injury Scale) face and extremity scores and ASA (American Society of Anesthesiologists) scores showed a significant decrease in HRQoL. Even though the groups of female and male patients were comparable in injury severity, female patients reported significantly more problems on the anxiety and depression scales than male patients 6 months (p = 0.003) and 24 months (p = 0.044) after trauma (6 months: female 46% vs. male 30%; 24 months: female 44% vs. male 32%). We observed the greatest improvement in the EQ Index over time in patients between 16 and 39 years of age, especially female patients (0.78 to 0.87 in females under 39 years of age, compared to males in the same age group 0.76 to 0.81). Females over 65 years of age initially presented the lowest EQ Index of 0.62. It remained significantly lower over time and was lower compared to male patients of the same age group (female EQ Index after 24 months was 0.68 compared to men over the age of 65 who presented an EQ Index of 0.75). Conclusions: All patients included in this study presented a lower HRQoL after trauma than the population norm. Female patients under 39 years of age reported the most improvement. Females over 65 years of age showed a limited HRQoL, which remained significantly lower over time. Female patients reported significantly more anxiety and depression after major trauma than male patients. Thus, further development and methodologically rigorous testing of ortho-geriatric initiatives, psychosocial support, and prevention measures are required to improve the care after major trauma, particularly for the female elderly. Full article

Objective: Fluctuations in sodium levels (SLs) may increase mortality, severity, and prolonged length of stay (LOS) in critically ill patients. We aim to study the effect of SL on various clinical outcomes in patients with severe traumatic brain injury (TBI). Methods: This is a single-center, retrospective study of patients with severe TBI from 1 January 2020 to 31 December 2023, inclusive. Patients were identified using Abbreviated Injury Severity (AIS) scores and International Classification of Diseases (ICD) injury descriptions. Result: Variations in hospital (H) admission SLs were statistically significant across four age ranges (pediatric, young adult, older adults, and elderly). Intensive care unit (ICU) admission, H discharge, and death also showed significance. A statistical difference was noted in ICU discharge levels while comparing blunt versus penetrating injury. We found statistically significant differences in SLs at H admission, ICU admission, and ICU discharge when compared to the Injury Severity Score (ISS) and the Glasgow Coma Scale (GCS) at admission. A linear regression analysis revealed a statistically significant positive correlation between ICU admission SLs and ISS. We discovered statistically significant differences when comparing ICU admission levels to H LOS, ventilator days, and mortality. Conclusions: SL upon ICU admission is correlated with ISS, GCS, and mortality rates. The elevated admission SL was linked to adverse hospital outcomes, including prolonged LOS at the H, ICU, and mechanical ventilation. Moreover, variability in serum SLs is independently associated with mortality throughout the hospital stay, irrespective of the absolute serum sodium concentration. Full article

Objectives: Subway-related accidents have risen with advancements in the system. We aim to study the injury patterns from these incidents. Methods: This is a retrospective study from a single center, covering patients from 1 January 2016 to 31 December 2023. Patients were identified using International Classification of Diseases (ICD) injury descriptions and Abbreviated Injury Scale (AIS) body regions. Results: Out of 360 patients (total), 23.5% presented with head injuries with an AIS score ≥ 3. Patients with blunt trauma (93.99%) were in higher numbers than penetrating (5.74%) and burn trauma (0.3%). Overall, the mean Injury Severity Score (ISS) was 10.69, suggesting a broad range of traumatic injuries. ISSs for severe injuries (17–24) comprised 9.2%, moderate injuries (10–16) comprised 17.5%, and minor injuries (1–9) comprised 60.8%. Falls had the highest percentage of traumatic brain injuries (TBI) (65.60%) and fractures (67.50%). Assaults showed a significant occurrence of traumatic thoracic injuries (28.90%). Suicide attempts demonstrated a high percentage of traumatic amputations (30.80%). In the emergency department (ED), most patients (69.4%) were admitted for further care, such as trauma, neurosurgery, or other care. Of these patients, 0.5% died in the ED, 0.5% died on arrival, and 1.04% died within 15 min of arrival. The mortality rate among serious fall patients was 17.20% compared to the suicide and train-struck groups at 37.90% each. Conclusions: There were high occurrences of TBIs, and fractures, thoracic injuries, and amputations. Numbers of patients with blunt trauma were a lot higher than those with penetrating and burn trauma. The mortality rates observed in the suicide and train-struck groups were higher than those in patients with severe falls. Full article

Patients with severe traumatic brain injury (STBI) often experience an abnormal hemostasis that contributes to mortality and unfavorable neurological outcomes. Objectives: We aimed to analyze epidemiologic, clinical, and laboratory factors associated with mortality in patients with STBI during the first 48 h after in-hospital admission. Methods: We performed an observational retrospective study of STBI patients with associated extracranial trauma [defined as Injury Severity Score (ISS) ≥ 16 with an Abbreviated Injury Scale (AIS) head and neck ≥ 3 and Glasgow Coma Scale (GCS) ≤ 8] admitted to a Level II trauma center over seven years (2015–2021). Patients were divided into two groups: survivors and dead. We assessed differences regarding demographics, trauma severity, hemodynamics, disability, need for surgery, length of stay, transfusions, need for massive transfusion protocol, and hemostatic laboratory parameters at different time points. Results: A total of 134 STBI patients were included. Patients who died were older, mostly men, and showed higher trauma severity and disability. Hemoglobin, platelets, and clotting parameters deteriorated after admission to the emergency department (ED) with significant differences between groups within the first 24 h after admission. Platelet count < 150 × 10³/μL at ED arrival, GCS, and age were independent risk factors for mortality. Conclusions: Older age, GCS, and platelet count at ED arrival were independent risk factors for mortality in STBI patients with associated extracranial trauma. Early thrombocytopenia < 150 × 10³/μL at ED arrival may be used as a simple prognostic tool to early predict mortality between non-isolated STBI. Full article

Background: Extremity fractures are common injuries in polytraumatized patients. Concomitant injuries to the soft tissue, vessels and nerves in these fractures are defined as mangled extremities. The decision for or against limb salvage is dependent on the patient’s physiology and the limb status. In severely injured patients with critical physiological status, limb salvage may be contraindicated. International data on the epidemiology and management of mangled limbs in severely injured patients are lacking. Thus, the aim of this study was to assess the incidence of polytraumatized patients with severe injuries to either upper (UL) or lower limb (LL) as well as their management. Methods: A retrospective cohort analysis was conducted of patients aged 16 years and above with an Injury Severity Score (ISS) ≥ 16 who sustained fractures to the limbs and were admitted to a certified trauma center of the TraumaRegister DGU^® (TR-DGU) between 2009 and 2019. Results: In total, we assessed 32,572 patients (UL: 14,567, mean age 48.3 years, 70% male and LL: 18,005, mean age 47.0 years, 70.5% male) The mean ISS in UL was 28.8 (LL 29.3). Fractures to the humerus (n = 4969) and radius (n = 7008) were predominantly assessed in UL, and fractures to the femur (n = 9502) and tibia (n = 8076) were most common in LL. In both groups, the most frequent injury mechanism was motor vehicle accidents, and more than half (UL: 9416 and LL: 11,689) of the patients had additional severe Abbreviated Injury Scale (AIS) ≥ 3 chest trauma. 915 patients in UL and 1481 in LL died within 24 h of the index admission. Surgical amputation occurred in 242 (UL) and 422 (LL) cases with a peak ratio in patients with an ISS above 50 in both groups. In both groups, patients with severe concomitant chest trauma were more often surgically amputated. In both groups, fewer patients with surgical amputations died within 24 h of admission (3.3% vs. 6.3% UL; 6.4% vs. 8.3% LL) compared to patients without amputation, but more patients with surgical amputations died within the overall hospital admissions (15.7% vs. 11.9% UL; 19.2% vs. 14.2%). In both groups, hemodynamical shock as well as the administration of Packed Red Blood Cells (PRBCs) were associated with a higher amputation rate. Conclusions: Surgical amputations after major trauma seem to be rare. Hemodynamical instability seems to play a key role in the management of mangled limbs. Patients with life-saving surgical amputation still have an increased overall in-hospital mortality. Full article

Background: Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in trauma patients, necessitating reliable prognostic tools. The segmented neutrophil-to-monocyte (SeMo) ratio, indicative of the inflammatory response, has emerged as a valuable biomarker. This study evaluates the prognostic value of dynamic changes in the SeMo ratio in predicting outcomes for patients with moderate to severe TBI. Methods: A retrospective analysis was conducted on data from 1118 TBI patients admitted to the surgical intensive care unit at a level I trauma center between January 2009 and December 2020. Patients were selected based on an Abbreviated Injury Scale (AIS) score ≥ 3 in the head region. Initial and follow-up SeMo ratios were calculated upon admission and 48–72 h later, respectively. The dynamic SeMo ratio was defined as the difference between the second and initial SeMo ratios. Statistical analyses included receiver operating characteristic (ROC) curve analysis to determine the optimal threshold for mortality prediction, and comparative analysis of clinical outcomes. Results: The study cohort included 121 deceased and 997 surviving patients. Deceased patients had significantly higher second SeMo ratios (20.9 ± 16.1 vs. 15.8 ± 17.2, p = 0.001) and dynamic SeMo ratios (2.4 ± 19.8 vs. −2.1 ± 19.5, p = 0.019) than those survival patients. In the multivariate analysis, the dynamic SeMo is a significant independent risk factor for in-hospital mortality (OR 1.01, 95%CI: 1.01–1.03, p = 0.031). The optimal cut-off for the dynamic SeMo ratio was 5.96, above which patients exhibited higher mortality (21.4% vs. 8.5%, p < 0.001), higher adjusted mortality (adjusted odds ratio: 2.98; 95% confidence interval: 1.95–4.56; p = 0.005), and longer hospital stays (23.6 days vs. 19.7 days, p = 0.005). Discussion: Dynamic SeMo ratio changes serve as a prognostic marker for in-hospital mortality and hospital stay duration in moderate to severe TBI patients. A higher dynamic SeMo ratio indicates increased risk, highlighting the importance of early monitoring and intervention. Future prospective studies should validate these findings and explore integration with other biomarkers for enhanced prognostication. Full article

Background: Traumatic brain injury (TBI) is a major cause of mortality and disability worldwide, with severe cases significantly increasing the risk of complications and long-term mortality. The Geriatric Trauma Outcome Score (GTOS), based on age, injury severity, and transfusion need, has been validated for predicting mortality in older trauma patients, but its utility in predicting mortality for TBI patients remains unexplored. Methods: This retrospective study included 5543 adult trauma patients with isolated moderate to severe TBI, defined by head Abbreviated Injury Scale (AIS) scores of ≥ 3, from 1998 to 2021. GTOS was calculated with the following formula: age + (Injury Severity Score × 2.5) + 22 (if transfused within 24 h). The area under the receiver operating characteristic curve (AUROC) assessed GTOS’s ability to predict mortality. The optimal GTOS cutoff value was determined using Youden’s index. Mortality rates were compared between high- and low-GTOS groups, separated by the optimal GTOS cutoff value, including a propensity score-matched analysis adjusting for baseline characteristics. Results: Among 5543 patients, mortality was 8.3% (462 deaths). Higher mortality is correlated with male sex, older age, higher GTOS, and comorbidities like hypertension, coronary artery disease, and end-stage renal disease. The optimal GTOS cut-off for mortality prediction was 121.5 (AUC = 0.813). Even when the study population was matched by propensity score, patients with GTOS ≥121.5 had much higher odds of death (odds ratio 2.64, 95% confidence interval 1.93–3.61, p < 0.001) and longer hospital stays (mean 16.7 vs. 12.2 days, p < 0.001) than those with GTOS < 121.5. Conclusions: These findings support the idea that GTOS is a useful tool for risk stratification of in-hospital mortality in isolated moderate to severe TBI patients. However, we encourage further research to refine GTOS for better applicability in TBI patients. Full article

Background: Scientific studies on severely injured patients commonly utilize the Abbreviated Injury Scale (AIS) and the Injury Severity Score (ISS) for injury assessment and to characterize trauma cohorts. However, due to potential deterioration (e.g., in the case of an increasing hemorrhage) during the clinical course, the assessment of injury severity in traumatic brain injury (TBI) can be challenging. Therefore, the aim of this study was to investigate whether and to what extent the worsening of TBI affects the AIS and ISS. Methods: We retrospectively evaluated 80 polytrauma patients admitted to the trauma room of our level I trauma center with computed-tomography-confirmed TBI. The initial AIS, ISS, and Trauma and Injury Severity Score (TRISS) values were reevaluated after follow-up imaging. Results: A total of 37.5% of the patients showed a significant increase in AIS_head (3.7 vs. 4.1; p = 0.002) and the ISS (22.9 vs. 26.7, p = 0.0497). These changes resulted in an eight percent reduction in their TRISS-predicted survival probability (74.82% vs. 66.25%, p = 0.1835). Conclusions: The dynamic nature of intracranial hemorrhage complicates accurate injury severity assessment using the AIS and ISS, necessitating consideration in clinical studies and registries to prevent systematic bias in patient selection and subsequent data analysis. Full article

Background: Major thoracic trauma represents a life-threatening condition, requiring a prompt multidisciplinary approach and appropriate pathways for effective recovery. While acute morbidity and mortality are well-known outcomes in thoracic-traumatized patients, long-term quality of life in patients surviving surgical treatment has not been widely investigated before. Methods: Between November 2016 and November 2023, thirty-two consecutive patients were operated on because of thoracic trauma. Age, sex, comorbidities, location and extent of thoracic trauma, Injury Severity Score (ISS), Abbreviated Injury Scale (AIS), Organ Injury Scale (OIS), intra and extrathoracic organ involvement, mechanism of injury, type of surgical procedure, postoperative complications, ICU and total length of stay, immediate clinical outcomes and long-term quality of life—by using the EQ-5D-3L scale and Numeric Rate Pain Score (NPRS)—were collected for each patient Results: Results indicated no significant difference in EQOL.5D3L among patients with thoracic trauma based on AIS (p = 0.55), but a significant difference was observed in relation to ISS (p = 0.000011). Conclusions: ISS is correlated with the EQOL.5D3L questionnaire on long-term quality of life, representing the best prognostic factor—in terms of long-term quality of life—in patients surviving major thoracic trauma surgical treatment. Full article

Background: Mood disorders, especially depression, and emotional difficulties such as anxiety are very common problems among patients with spinal cord injuries (SCIs). The lack of physical training may deteriorate their mental state, which, in turn, has a significant impact on their improvement in functioning. The aim of the present study was to examine the influence of innovative rehabilitation approaches involving robotic-assisted gait therapy (RAGT) on the depression and anxiety symptoms in patients with SCI. Methods: A total of 110 participants with subacute SCIs were enrolled in this single-center, single-blinded, single-arm, prospective study; patients were divided into experimental (robotic-assisted gait therapy (RAGT)) and control (conventional gait therapy with dynamic parapodium (DPT)) groups. They received five training sessions per week over 7 weeks. At the beginning and end of therapy, the severity of depression was assessed via the Depression Assessment Questionnaire (KPD), and that of anxiety symptoms was assessed via the State–Trait Anxiety Inventory (STAI X-1). Results: SCI patients in both groups experienced significantly lower levels of anxiety- and depression-related symptoms after completing the seven-week rehabilitation program (KPD: Z = 6.35, p < 0.001, r = 0.43; STAI X-1: Z = −6.20, p < 0.001, r = 0.42). In the RAGT group, post-rehabilitation measurements also indicated an improvement in psychological functioning (i.e., decreases in depression and anxiety and an increase in self-regulation (SR)). Significant results were noted for each variable (STAI X-1: Z = −4.93; KPD: Z = −5.26; SR: Z = −3.21). In the control group, there were also decreases in the effects on depression and state anxiety and an increase in self-regulation ability (STAI X-1: Z = −4.01; KPD: Z = −3.65; SR: Z = −2.83). The rehabilitation modality did not appear to have a statistically significant relationship with the magnitude of improvement in the Depression Assessment Questionnaire (KPD) (including self-regulation) and State–Trait Anxiety Inventory (STAI) scores. However, there were some significant differences when comparing the groups by the extent and depth of the injury and type of paralysis. Moreover, the study did not find any significant relationships between improvements in physical aspects and changes in psychological factors. Conclusions: Subjects in the robotic-assisted gait therapy (RAGD) and dynamic parapodium training (DPT) groups experienced decreases in anxiety and depression after a 7-week rehabilitation program. However, the rehabilitation modality (DPT vs. RAGT) did not differentiate between the patients with spinal cord injuries in terms of the magnitude of this change. Our results suggest that individuals with severe neurological conditions and complete spinal cord injuries (AIS A, according to the Abbreviated Injury Scale classification) may experience greater benefits in terms of changes in the psychological parameters after rehabilitation with RAGT. Full article

The objective of this study was to determine whether there is an association between sex and outcome in trauma patients presented with severe traumatic brain injury (TBI). A retrospective multicenter study was performed in trauma patients aged ≥ 16 years who presented with severe TBI (Head Abbreviated Injury Scale (AIS) ≥ 4) over a 4-year-period. Subgroup analyses were performed for ages 16–44 and ≥45 years. Also, patients with isolated severe TBI (other AIS ≤ 2) were assessed, likewise, with subgroup analysis for age. Sex differences in mortality, Glasgow Outcome Score (GOS), ICU admission/length of stay (LOS), hospital LOS, and mechanical ventilation (MV) were examined. A total of 1566 severe TBI patients were included (831 patients with isolated TBI). Crude analysis shows an association between female sex and lower ICU admission rates, shorter ICU/hospital LOS, and less frequent and shorter MV in severe TBI patients ≥ 45 years. After adjusting, female sex appears to be associated with shorter ICU/hospital LOS. Sex differences in mortality and GOS were not found. In conclusion, this study found sex differences in patient outcomes following severe TBI, potentially favoring (older) females, which appear to indicate shorter ICU/hospital LOS (adjusted analysis). Large prospective studies are warranted to help unravel sex differences in outcomes after severe TBI. Full article