Search Results (150)

Background: Traumatic adrenal injury (TAI) is a rare but significant condition that affects 2.5% of patients with thoracoabdominal trauma. The impact of adrenal hematoma volume on clinical outcomes remains underexplored. This study aimed to evaluate factors associated with morbidity and mortality in patients with TAI, with a particular focus on adrenal hematoma volume as a predictive marker. Methods: Retrospective data from patients with radiologically confirmed TAI between 2013 and 2023 was analyzed. Clinical, demographic, and radiological variables were reviewed. Hematoma volume was calculated from computed tomography (CT) imaging and analyzed using univariate and multivariate models. Receiver operating characteristic (ROC) analysis was employed to evaluate its predictive accuracy. Results: Sixty patients were included in the study. The median hematoma volume was 16.0 cm³, with a predominance of injuries on the right side. The morbidity and mortality rates were 18.3% and 8.3%, respectively. Univariate analysis identified a lower Glasgow Coma Scale (GCS) score, higher Injury Severity Score (ISS), and increased hematoma volume as significant factors. In multivariate analysis, hematoma volume and GCS score remained independent predictors of adverse outcomes. A volume threshold of >23 cm³ was associated with significantly higher morbidity and mortality (AUC = 0.80, 95% CI: 0.68–0.92). Conclusions: This study is the first to demonstrate that the volume of adrenal hematoma is an independent predictor of adverse outcomes in patients with traumatic adrenal injury. Integrating volume into clinical assessment may help identify high-risk patients requiring improved observation and management. Full article

Objective: Potassium levels (KLs) influence clinical outcomes in severe traumatic brain injury (TBI). This study investigates the relationship between KLs and clinical outcomes to improve prognosis and guide management. Method: A retrospective study was conducted at a level 1 trauma center in Queens, New York, from January 2020 to December 2023. Patients with an AIS score of 3 or higher were included. KLs were measured at the time of hospital admission, ICU admission, ICU discharge, hospital discharge, and death, if applicable. Clinical outcomes such as age, race, length of hospital stay (H LOS), ICU length of stay (ICU LOS), ventilation days (VDs), Glasgow Coma Scale (GCS), and mortality were assessed. Results: KLs were categorized into five groups: extreme hypokalemia (<2.5 mEq/L), hypokalemia (2.6–3.5 mEq/L), normokalemia (3.5–5.2 mEq/L), hyperkalemia (5.2–7.0 mEq/L), and extreme hyperkalemia (>7.0 mEq/L). Significant correlations were observed between KLs at hospital admission and age (p = 0.0113), race (p = 0.003), and H LOS (p = 0.079). ICU KLs showed positive correlations with AIS head score (p = 0.038), ISS (p = 7.84 × 10⁻⁶), and GCS (p = 2.6 × 10⁻⁶). ICU KLs were also associated with LOS in the Emergency Department (ED) (p = 6.875 × 10⁻⁶) and ICU (p = 1.34 × 10⁻²¹), as well as VDs (p = 7.19 × 10⁻⁷). ICU discharge KLs correlated with ISS (p = 2.316 × 10⁻³), GCS (p = 2.201 × 10⁻³), ED LOS (p = 3.163 × 10⁻⁴), and VDs (p = 7.44 × 10⁻⁴). KLs at discharge were linked with mortality (p < 0.0001) and H LOS (p = 0.0091). Additionally, KLs at the time of death were correlated with ISS (p = 0.01965), GCS (p = 0.01219), ED LOS (p = 0.00594), ICU LOS (p = 0.049), VDs (p = 0.00005), and mortality (p < 0.0001). Conclusions: Potassium imbalances, especially hypokalemia, significantly affect outcomes in severe TBI patients. Monitoring and managing KLs may improve prognosis. Full article

Background: Liver trauma is prevalent following blunt and penetrating injuries. This study examined liver trauma in a South African urban trauma centre, focusing on the unique prevalence of penetrating injuries and surgical interventions. Methods: A retrospective analysis was conducted of 512 priority-one patients with liver trauma from January 2017 to December 2023 at Charlotte Maxeke Johannesburg Academic Hospital. The data collected included demographics, injury mechanisms, liver injury grades, associated injuries, injury severity scores (ISS and NISS), surgical interventions, and mortality rates. Statistical analyses were performed using Stata (V.18) and R software (version 4.3.2). Results: The median age of the patients was 31 years, with a predominance of male patients (91%) and patients of African ethnicity (95%). Penetrating trauma accounted for 73% of the cases. Most liver injuries were minor (grades I–III). There was a 5% overall mortality rate, with a higher rate observed in patients requiring emergency surgery (10% vs. 1% for non-operative management, p < 0.001). Just over half of the patients required emergency laparotomy, and the majority of these patients sustained penetrating liver trauma. Complications occurred in 6.6% of the patients, predominantly biliary in nature. Conclusions: This study highlights the high incidence of penetrating liver trauma in South Africa, which reflects the context of interpersonal violence. The mortality rate aligns with international standards and demonstrates the need for effective management strategies. These findings emphasise the need for tailored approaches to liver trauma based on injury patterns and demographics, and further research is needed to explore the associated mortality and complications. 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: The clinical significance of serum potassium levels at admission in patients with blunt hepatic trauma remains insufficiently defined. This study aimed to evaluate the prevalence and prognostic value of admission hypokalemia in this patient population. Methods: We conducted a retrospective analysis of 164 patients with radiologically confirmed blunt liver trauma admitted between 2016 and 2023. Preoperative, intraoperative, and postoperative data were collected to assess the association between serum potassium levels and trauma severity (AAST grade—American Association for the Surgery of Trauma, ISS—Injury Severity Score), in-hospital morbidity, mortality, and length of stay. Univariate and multivariate analyses were performed, including checks for normality and multicollinearity. Results: Serum potassium levels showed a significant positive correlation with age (p = 0.0064), and an inverse correlation with liver injury severity (AAST grade; p = 0.01). Lower potassium levels were associated with longer hospital stays (p = 0.0459) and higher morbidity (p = 0.022). In multivariate analysis, only age (p = 0.036) and AAST grade (p = 0.014) were independent predictors of serum potassium concentration. Potassium levels were not independently associated with mortality. Conclusions: Admission hypokalemia is a common finding in blunt liver trauma and correlates with injury severity and adverse clinical outcomes. Potassium concentration may serve as a readily available, low-cost biomarker for early risk stratification in these patients. Further prospective studies are warranted to confirm its prognostic utility. Full article

Background: Flail chest (FC) injuries are multiple adjacent segmental rib fractures, commonly associated with a high complication and mortality risk. Recent evidence suggests that the early surgical stabilization of FC injuries is beneficial for restoring breathing mechanics. However, little is known about the effects on lung volumes when invasive ventilation is performed after surgery. Methods: This retrospective study included multiple trauma (MT) patients operatively treated for an FC injury between 2011 and 2024. The indication for surgery was based on a computed tomography (CT) proof of an FC, objectifiable paradoxical breathing, and prolonged weaning. All patients treated used a single osteosynthesis system. Lung volumes were manually measured in preoperative and postoperative CT scans of the thorax in the thinnest CT reconstructions available. The primary outcomes of interest were the changes in the lung volumes following surgical stabilization of the FC. Results: During this study, 21 patients (90.48% male) were operatively treated for their FC injury. All patients had been affected by high-energy trauma. The corresponding median Injury Severity Score (ISS) was 26 (IQR 17.5, 33). Patients suffered 7 (IQR 6, 10) and 6 (IQR 2, 9) fractured ribs of the left and right hemithorax, respectively. Three (IQR 0, 3) and two (IQR 0, 3) ribs of the left and right hemithorax, respectively, were stabilized at 7 (IQR 2, 18) days post admission. There were no significant changes in the lung volumes comparing preoperative and postoperative CT scans. Conclusions: As this study did not detect CT volume changes comparing preoperative and postoperative scans, CT scans following surgery may not qualify for an objective measurement of the surgical effectiveness regarding lung volume restoration in the short-term follow-up. Long-term changes in CT-measured lung volume changes need to be evaluated to prove an objective surrogate parameter for surgical effectiveness regarding the restoration of the thorax integrity. Full article

Background: Electric motorized rental scooters (ES) were introduced in Italy in 2019 as an alternative form of urban transportation, aiming to reduce traffic congestion and air pollution. As their popularity has grown, a parallel increase in ES-related injuries has been observed. This study aims to investigate the types and patterns of ES-related injuries and to identify potentially modifiable risk factors. Methods: We conducted a retrospective analysis of all consecutive patients admitted to the Emergency Department of Policlinico Umberto I in Rome between January 2020 and December 2022 following ES-related trauma. Collected data included demographics, injury mechanisms and types, helmet use, Injury Severity Score (ISS), blood alcohol levels, and patient outcomes. Results: A total of 411 individuals presented to the Emergency Department due to ES-related injuries, either as riders or pedestrians. The mean age was 31 years (range: 2–93); 38 patients (9%) were under 18 years of age. Fifty-six accidents (14%) occurred during work-related commutes. Only three riders (0.7%) wore helmets, and nine patients (2%) had blood alcohol levels > 0.50 g/L. Cranial injuries (134 cases, 32%) and upper limb fractures (93 cases, 23%) were the most frequently reported serious injuries. The mean ISS was 4.5; 17 patients (4%) had an ISS ≥ 16. A total of 270 orthopedic injuries and 118 (29%) maxillofacial injuries were documented. Head trauma was reported in 115 patients (28%), with 19 cases classified as severe traumatic brain injuries. Twenty-three patients (5.5%) were hospitalized, three (0.7%) required intensive care, and one patient (0.2%) died. Conclusions: ES-related injuries are becoming increasingly common and present a significant public health concern. A nationwide effort is warranted to improve rider safety through mandatory helmet use, protective equipment, alcohol consumption control, and stricter enforcement of speed regulations. Full article

Background: The increasing incidence of pelvic ring and acetabular fractures represents a major challenge in the field of trauma surgery. Hemorrhage and thrombosis are among the most severe complications associated with these injuries. The common instability of those fractures, together with an anatomic proximity to blood vessels, increases the risk of perioperative bleeding. Vascular wall irritation during surgery additionally adds to a substantial risk for thrombotic events. Therefore, evaluating the risk for hemorrhage and thrombosis in pelvic ring and acetabular fractures is vital to identify an adequate anticoagulation management. Methods: The incidence of hemorrhagic and thrombotic events, as well as the association of patient characteristics with the investigated outcomes of 16,359 cases, were analyzed retrospectively using data from the German Pelvic Trauma Registry. Moreover, a risk assessment survey was conducted among traumatologists experienced in pelvic ring and acetabular surgery. The results were compared to those of the registry study. Results: A high rate of thrombotic events was found in the middle-age decade (41–50 years). In patients with an age ≤ 40 and >50 years, hemorrhage complications predominated. The logistic regression identified pelvic ring fractures in geriatric patients, acetabular fractures, and Injury Severity Score (ISS) ≥ 16 to be associated with bleeding complications. Factors associated with thrombosis included pelvic ring fractures in non-geriatric patients, acetabular fractures in geriatric and non-geriatric patients, ISS, and male gender. The survey demonstrated that preoperatively, the risk for hemorrhage was considered more significant. Perioperatively, however, thrombosis was regarded as more important. Conclusions: Separate guidelines for prophylactic anticoagulation in pelvic ring and acetabular fractures that also consider individual patient characteristics, such as age, gender, and ISS, are necessary to improve perioperative management and reduce the morbidity and mortality associated with these injuries. Full article

Background: Road traffic injuries (RTIs) significantly contribute to disability and death in Qatar. This observational study aimed to explore RTI mortality and injury severity trends from 2011 to 2022. Methods: Data from the national trauma database were analyzed retrospectively for mortality rates, injury severity, and characteristics of the injured populations over the years (2011–2022). Results: RTIs represented around 61.3% (n = 12,644) of 20,642 trauma hospitalizations over 12 years. The aggregate RTI mortality rate decreased from 12 to 8 per 100,000 persons, with a mean patient age of 31.8 years. The sum of deaths was 2464, comprising 1022 (41%) in-hospital and 1442 (59%) out-of-hospital fatalities. Among in-hospital deaths, bike-related mortalities totaled 35 (3%), motorcycle-related mortalities 53 (5%), motor vehicle mortalities 561 (55%), and pedestrian mortalities 373 (36%). Based on the injury severity score (ISS), RTIs were divided into four categories, namely, mild (ISS: 1–9), moderate (ISS: 10–15), severe (ISS: 16–24), and fatal (ISS: 25–75). The ISS ranged from 12 to 14, while the median ranged from 10 to 12. The injury frequency showed that mild injuries comprised 40.6% (4545), moderate injuries 26.2% (2934 subjects), and severe 16.7% (1873 subjects). Profound injuries accounted for 13.3% (1490 subjects). Severe and fatal injuries combined dropped from 30% in 2011 to 25% by 2022. Inversely, moderate injuries increased from 24% to 30%, representing a downward trend of the injury severity. Motorcycle-related injuries rose from around 3% to 28% between 2011 and 2022. Motor vehicle and pedestrian injuries declined from about 67% to 54% and 27% to 15%, respectively. Winter, Autumn, Spring, and Summer accounted for 27%, 26%, 24%, and 23% of the total injuries (11,153), respectively. Conclusions: RTI in-hospital mortality and injury severity decreased over the study period. Injury prevention programs should target frequent injury seasons and high-risk populations, such as motorcyclists. Full article

Background: We aimed to evaluate the clinical significance of abnormal rotational thromboelastometry (ROTEM) findings in trauma patients and investigate the relationships between FIBTEM-maximum clot firmness (MCF), fibrinogen concentration and patient outcomes. Methods: A retrospective cohort analysis was conducted on adult trauma patients who underwent on-admission ROTEM testing between January 2020 and January 2021. Univariate analyses compared data based on injury severity, ROTEM findings (normal vs. abnormal), and initial fibrinogen concentration (normal vs. hypofibrinogenemia). ROC curve analysis was performed to determine the diagnostic performance of FIBTEM A10/MCF for its association with hypofibrinogenemia. Results: A total of 1488 patients were included in this study; the mean age was 36.4 ± 14.2 years and 92% were male. In total, 376 (25.3%) patients had ROTEM abnormalities. Severe injuries (ISS ≥ 16) were associated with a higher shock index, positive troponin T levels, standard coagulation abnormalities, hypofibrinogenemia, and abnormal ROTEM parameters (p < 0.05). These patients also had higher rates of massive transfusions and in-hospital mortality (p = 0.001). Coagulation alterations were significantly associated with higher injury severity score (ISS), shock index, head abbreviated injury score (AIS), hypofibrinogenemia, transfusion need, and mortality (p < 0.05). Hypofibrinogenemic patients were younger, sustained severe injuries, had higher shock indices and coagulation marker levels, required more intensive treatments, had longer hospital stays, and had higher mortality (p < 0.05). A significant positive correlation was found between plasma fibrinogen concentration and FIBTEM-MCF (r = 0.294; p = 0.001). Conclusions: Approximately one-fourth of the patients had early traumatic coagulopathy, as assessed by ROTEM. The FIBTEM A10/MCF may serves as a surrogate marker for plasma fibrinogen concentration. While prior studies have established the link between ROTEM and injury severity, our findings reinforce its relevance across varying trauma severity levels. However, prospective studies are warranted to validate its role within diverse trauma systems and evolving resuscitation protocols. Full article

Background/Objectives: Trauma remains a leading cause of morbidity and mortality worldwide, significantly affecting younger and aging populations. The regional trauma center establishment in South Korea in 2014 marked a pivotal advancement in the national trauma care system. This study reviews data from the Incheon Regional Trauma Center, analyzing patient demographics, injury mechanisms, and outcome trends. Methods: This retrospective analysis included 32,025 patients with trauma treated at the Incheon Regional Trauma Center from 2014 to 2023. Data from the Korean Trauma Database included demographics, injury mechanisms, Injury Severity Scores (ISSs), and outcomes. We considered the initial treatment setting in our analysis to evaluate its potential impact on patient outcomes. Patients were stratified into four ISS categories and five age groups (0–12, 13–19, 20–64, 65–79, and ≥80 years). Statistical comparisons used chi-square tests and analysis of variance. Results: The proportion of older patients (≥65 years) increased significantly from 23.3% in 2014 to 45.2% in 2023, with patients aged ≥ 80 years showing the highest rise and mortality (6.7%). Traffic accidents decreased from 30.7% to 28.2%, while slip injuries increased from 26.9% to 34.0%. Patients with ISSs > 15 increased, peaking in 2022 (mortality, 15.6%). Despite improved trauma care infrastructure, the overall mortality rate reached 5.9% in 2022, possibly due to more complex cases and an aging population. Conclusions: This study highlights evolving challenges in trauma care due to demographic shifts and rising injury severity. These findings underscore the need for tailored geriatric trauma care, improved infrastructure, and targeted interventions for high-risk groups. Further research is needed to optimize trauma systems and address the growing burden of geriatric trauma. 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

Introduction: Traumatic brain injuries (TBIs) are conditions affecting brain function caused by blunt or penetrating forces to the head. Symptoms may include confusion, impaired consciousness, coma, seizures, and focal or sensory neurological motor injuries. Objective: This study evaluated sex hormone profiles and their predictive role in returning consciousness after severe traumatic brain injury. Materials and Methods: We included 120 patients with TBIs and collected comprehensive information about each patient, including the cause of the trauma, age, gender, Glasgow Coma Scale (GCS) score, Injury Severity Score (ISS), and neuroradiological imaging data. The ISS was used to assess the severity of the trauma. At the same time, the lowest GCS score was recorded either before sedation and intubation in the emergency room or by emergency medical services personnel. For female participants, samples were collected during the luteal phase of the menstrual cycle (days 18 to 23). Results: The mean age of male patients was 33.40 years, ranging from 23 to 45 years, while female patients had an average age of 34.25 years, ranging from 25 to 48 years. The primary cause of injury for both genders was motor vehicle accidents. In male patients, testosterone levels were significantly higher in those classified as responsive (RC) compared to those non-responsive (NRC), with levels of 2.56 ± 0.47 ng/mL versus 0.81 ± 0.41 ng/mL (p = 0.003). A cut-off point of 1.885 ng/mL for testosterone levels in males was established, achieving a sensitivity and specificity of 86.7% and 86.7%, respectively. In female patients, progesterone levels were elevated in those who regained consciousness, measuring 1.80 ± 0.31 ng/mL compared to 0.62 ± 0.31 ng/mL (p = 0.012). A cut-off point of 1.335 ng/mL for progesterone levels in females was determined, with a sensitivity and specificity of 93.3% and 86.7%, respectively. Conclusions: We can conclude that sex hormone levels in the acute phase of TBIs can vary between males and females. Notably, serum testosterone levels in males and progesterone levels in females with TBIs are significant prognostic factors for assessing the likelihood of regaining consciousness after such injuries. These findings underscore the importance of considering sex hormone profiles in TBI recovery prognosis. Full article

Background/Objectives: The preventable trauma death rate (PTDR) reflects the quality of trauma management systems. In the Republic of Korea, the PTDR in Seoul, the capital city, decreased from 30.8% in 2015 to 20.4% in 2019. However, it remains the highest in the country. In contrast, Gyeonggi-Incheon, which includes Gyeonggi Province and Incheon Metropolitan City surrounding Seoul, had the lowest nationwide PTDR (27.4% in 2015 to 13.1% in 2019). This study aimed to investigate the characteristics and in-hospital mortality risk factors for patients with trauma in Seoul and Gyeonggi-Incheon. Methods: This retrospective cohort study used data from a 2016 to 2020 Community-Based Severe Trauma Survey. Among 237,616 patients, 24,448 were included in the study after applying the inclusion and exclusion criteria. Results: The proportions of the population with motor vehicle and workers’ compensation insurance increased with increasing injury severity in both regions. The injury severity score (ISS) was significantly higher in Gyeonggi-Incheon in the ISS < 9 and ISS 9–15 groups. Across all hospital levels, the proportion of patients who visited regional trauma centers in Seoul was low across all three ISS groups (0.2%[n = 26], 0.6%[n = 23], and 1.9%[n = 56] for ISS < 9, ISS 9–15, and ISS > 15, respectively). Conversely, in Gyeonggi-Incheon, the proportion of patients who visited regional trauma centers increased as injury severity increased across all three ISS groups (37.3%[n = 1404], 50.6%[n = 732], and 64.4%[n = 856] for ISS < 9, ISS 9–15, and ISS > 15, respectively). In Seoul, the identified in-hospital mortality risk factors included age, National Health Insurance (NHI) loss, other insurance, ISS, regional and local emergency centers or institutes, and the number of angioembolizations. In Gyeonggi-Incheon, the in-hospital mortality risk factors included age, ISS, falls and slippage, and the number of angioembolizations. Conclusions: The unique in-hospital mortality risk factors in Seoul compared with those in Gyeonggi-Incheon include transfers to regional emergency centers (ISS > 15), local emergency centers or institutes (ISS > 15), NHI loss (ISS 9–15 and ISS > 15), and the use of other insurance (ISS > 15). 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