Search Results (135)

Background: Although diagnostic reference levels (DRLs) based on anatomical regions are widely used in computed tomography (CT) imaging, a clinical-indication-based approach provides a more accurate representation of daily practice and protocol variation. This study aimed to establish typical radiation doses for common CT clinical indications among adult patients at King Abdulaziz University Hospital (KAUH) in Saudi Arabia. Methods: This retrospective cross-sectional study included 298 adult patients who underwent CT examinations between 2020 and 2025 using two dual-source scanners operating in single- and dual-source modes. Demographic data, acquisition parameters, and radiation dose metrics, including CT dose index (CTDI_vol) and the dose–length product (DLP), were extracted from scanner consoles. Six clinical indications were analyzed: brain trauma, sinusitis, chest metastases (chest Mets), interstitial lung disease (ILD), abdominopelvic metastases (AbdPel Mets), and hernia. Results: Typical median CTDI_vol values in mGy were 36.4 for brain trauma, 3.4 for sinusitis, 4.9 for chest Mets, 5.6 for ILD, 7.2 for AbdPel Mets and hernia. Corresponding DLP values in mGy·cm were 654, 50, 173, 188, 344, and 369, respectively. Brain trauma demonstrated the highest radiation exposure, whereas sinusitis CT showed the lowest. Most values were comparable to or lower than international DRLs. Conclusions: This study provides the first comprehensive clinical-indication-based DRL data in Saudi Arabia beyond anatomical benchmarks, supporting ongoing dose optimization and future national DRL development. Full article

Background: Blunt thoracic aortic injury (BTAI) is an uncommon but life-threatening consequence of blunt thoracic trauma. Left-sided hemothorax is frequently identified during initial evaluation and typically prompts early chest drainage. However, when an unrecognized BTAI is present, pleural decompression may precipitate hemodynamic instability. This study aimed to identify early predictors of BTAI requiring thoracic endovascular aortic repair (TEVAR) in patients presenting with left-sided hemothorax. Methods: We conducted a single-center retrospective cohort study including consecutive trauma patients aged ≥ 16 years with radiologically confirmed left-sided hemothorax between 2015 and 2025. Patients were stratified according to the need for TEVAR. Clinical, laboratory, and radiological variables available at emergency department admission were analyzed. Independent predictors of BTAI requiring TEVAR were identified using multivariable logistic regression. Results: Among 146 included patients, 27 (18%) underwent TEVAR for confirmed BTAI. Patients requiring TEVAR were generally younger and more frequently involved in high-energy trauma. Independent predictors of TEVAR included high-energy mechanism (p = 0.048), lower admission hemoglobin (p = 0.007), presence of extra-thoracic fractures (p < 0.001), and a higher number of right-sided rib fractures (p = 0.018). The volume of left-sided hemothorax was not independently associated with BTAI. The model demonstrated strong discriminative ability (AUC = 0.926). Conclusions: In trauma patients with left-sided hemothorax, BTAI requiring TEVAR may occur even in the presence of minimal pleural effusion. Readily available admission parameters may help identify patients who could benefit from a CT angiography-first approach rather than routine early chest drainage, except in cases of immediate life-threatening pleural compromise. Full article

Background: Rib fractures are a common cause of morbidity in trauma patients. The surgical stabilization of rib fractures (SSRF) has gained increasing attention as a therapeutic option; however, evidence from multiple meta-analyses remains heterogeneous. Methods: We performed an overview of 11 meta-analyses, including a total of 1,117,849 adult patients (narrative umbrella review), published between November 2020 and November 2025 to summarize and critically appraise high-level evidence comparing SSRF with non-operative management (NOM) in adults with traumatic rib fractures. PubMed (MEDLINE) and Embase were searched for eligible meta-analyses. Outcomes of interest included mechanical ventilation duration, pneumonia, ICU and hospital length of stay, mortality, pain, quality of life, and need for tracheostomy. Results: Eleven meta-analyses met the inclusion criteria. Across outcomes, the direction of effect generally favored SSRF in selected patients, particularly with respect to a shorter duration of mechanical ventilation (mean difference up to approximately 4–6 days), reduced pulmonary complications (risk ratio approximately 0.4–0.7), shorter ICU and hospital stay, and improved pain control. However, results varied substantially across studies. A consistent mortality benefit was not observed. Subgroup analyses suggested that the benefits of SSRF were more pronounced in patients with flail chest, severe fracture patterns, and early surgery, whereas findings were less consistent in elderly patients and in patients with less severe injuries. Conclusions: This narrative umbrella review suggests that SSRF is associated with improved short-term outcomes in selected adult patients with traumatic rib fractures but should not be considered a universal standard of care. Careful patient selection, timing of intervention, and multidisciplinary evaluation remain essential. Further high-quality prospective studies are needed to better define optimal indications and management strategies. Full article

Background: Traumatic hemothorax is a common complication of blunt chest trauma and remains associated with significant morbidity and mortality. Although contrast-enhanced computed tomography (CT) is central to diagnosis, the optimal criteria for selecting patients who require invasive management versus conservative treatment remain unclear. This study aimed to evaluate the management strategies and clinical outcomes of traumatic hemothorax and to identify predictors of surgical intervention and postoperative complications. Methods: We conducted a retrospective, single-center cohort study including adult patients admitted to a Level II Emergency Department with hemothorax following blunt chest trauma between January 2019 and December 2024. Primary outcomes were the need for urgent chest drainage or surgery. Secondary outcomes included postoperative complications, length of hospital stay, and intensive care unit admission. Univariable and multivariable regression analyses were performed to identify factors associated with surgical intervention and complications. Results: Seventy-two patients were included (mean age 60.0 ± 20.5 years; 80.6% male). Rib fractures were the most common cause of hemothorax (61.1%). Chest tube placement was required in 70.8% of cases, and 31.9% underwent urgent surgical intervention. Active bleeding on contrast-enhanced CT was identified in 16.7% of patients and was the only independent predictor of urgent surgery (OR 3.85, 95% CI 1.07–13.88; p = 0.039). The initial volume of blood drained after chest tube insertion did not differ between surgically and non-surgically managed patients. Conservative management was successful in 19.4% of cases. Postoperative complications occurred in five patients and were associated with a higher comorbidity burden. Overall mortality was 5.6%. Conclusions: In traumatic hemothorax following blunt chest trauma, active bleeding on contrast-enhanced CT seems to be the strongest predictor of urgent surgical intervention, whereas initial pleural drainage volume alone is not. Conservative management is safe in selected patients, while comorbidities influence postoperative outcomes. Multidisciplinary management and accurate radiological assessment are essential to guide timely and appropriate treatment. Full article

The sternum protects the intrathoracic organs and contributes to chest wall mechanics, which makes reconstruction after tumor resection, trauma, or infection a demanding biomechanical problem. This study presents an in silico workflow for preselecting materials for sternal implants before physical prototyping. After a virtual resection, an anatomically conformal implant was designed and candidate biomaterials were screened in CES Selector using density, elastic modulus, fatigue strength, fracture toughness, toxicity, medical grade suitability, and MRI safety. A representative subset of the screened candidates was then compared by finite element modeling in terms of stress transfer and deformation. Seventeen candidates met the screening criteria. Ti-13Nb-13Zr showed an elastic modulus of about 80 GPa, and the titanium-based candidates showed deformation values of about 0.96 to 1.03 mm, whereas GF PEEK reached about 1.74 mm. The stress shielding index also showed that titanium-based materials remained on the implant-dominant side, while polymer-based materials shifted stress transfer toward bone. Taken together, the findings suggest that Ti-13Nb-13Zr offers the best overall balance for load-bearing sternal reconstruction, whereas PEEK-based systems may be more suitable within the present model for hybrid or adjunct designs. The proposed workflow can support early implant planning and guide future experimental and clinical studies. Full article

Background/Objectives: Pediatric thoracic trauma requires prompt stabilization and timely imaging; however, actual sequencing and escalation triggers are infrequently delineated at the pathway level. The aim of this study was to analyze imaging pathways observed in routine clinical practice at our institution and to outline a preliminary escalation framework integrating injury mechanism, clinical severity, and initial ultrasound findings. Methods: A retrospective cohort study was conducted at the “Louis Țurcanu” Clinical Emergency Hospital for Children, Timișoara, Romania, including 66 children admitted with primary thoracic trauma between January 2022 and December 2024. Clinical trajectory markers (transfer-in, ICU admission, length of stay) and imaging utilization/sequencing (FAST, CXR, CT, MRI/CTA) were extracted. We divided injuries into two groups: bony (like fractures of the clavicle or scapula) and non-bony. CT escalation was characterized as a chest CT conducted upon admission. Fisher’s exact and Mann–Whitney U tests were used for comparative analyses. Results: FAST was done on all patients but was infrequently positive. Imaging followed heterogeneous but structured patterns, most commonly FAST with CXR, with or without CT. A large group of them had CT scans without first having any X-rays. CT escalation was associated with fracture-pattern injuries and higher-acuity trajectories (transfer-in and ICU admission), as well as prolonged hospital stays. Pathway-level assessment demonstrated that CT escalation effectively captured bony injury patterns, whereas FAST proficiently sorted ICU-level trajectories. Conclusions: Pediatric thoracic trauma imaging functioned as a selective escalation system: FAST served as a universal bedside entry step, and CT operated as an injury pattern- and acuity-linked severity gate. Making this escalation logic clear may help with standardization while still protecting against radiation. Full article

Background and Objectives: Rib fractures cause intense pain, leading to respiratory complications. Standard care relies on systemic opioids, which carry significant adverse effects. The serratus anterior plane block (SAPB) has emerged as a promising regional anesthetic technique, but its efficacy remains unclear. This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the efficacy and safety of SAPB versus standard care in patients with rib fractures. Materials and Methods: A comprehensive search of PubMed, Scopus, CENTRAL, and Web of Science was conducted for RCTs comparing SAPB to standard care in adults with rib fractures. The primary outcome was the pain score. Secondary outcomes included 24 h opioid consumption, need for rescue analgesia, and complications. Standardized mean differences (SMD) and risk ratios (RR) were pooled, using STATA SE 19.5. Results: Three RCTs involving 310 patients were included. SAPB significantly decreased pain scores at 2 h (SMD: −1.30, 95% CI [−2.39, −0.20]; p = 0.02), 6 h (SMD: −0.75, 95% CI [−1.41, −0.09]; p = 0.03), 12 h (SMD: −0.37, 95% CI [−0.68, −0.07]; p = 0.02), and 24 h (SMD: −5.67, 95% CI [−9.90, −1.43]; p = 0.01). This was associated with a significant reduction in 24 h opioid consumption (SMD: −0.45, 95% CI [−0.69, −0.21]; p < 0.001). However, no significant differences were found in the need for rescue analgesia (RR: 1.06, 95% CI [0.97, 1.16]; p = 0.18). Conclusions: SAPB provides significant short-term analgesic benefits and reduces opioid consumption in patients with acute rib fractures. While it appears safe, the current evidence is limited by a small number of trials and is insufficient to recommend SAPB as a first-line management option over standard care. Full article

Introduction: Chest drainage is central to thoracic surgery, pleural medicine, and emergency care, yet practice remains heterogeneous in tube caliber, access, suction, device selection, and removal thresholds. This narrative review aims to synthesize evidence and translate it into guidance. Materials and Methods: We performed a narrative review with PRISMA-modeled transparency. Using backward citation from recent comprehensive overviews, we included randomized trials, meta-analyses, guidelines/consensus statements, and high-quality observational studies. We extracted data on indications, technique, tube size, analog versus digital drainage, suction versus water-seal drainage, removal criteria, and key pleural conditions. Due to heterogeneity in device generations, suction targets, and outcomes, we synthesized the findings qualitatively according to converged evidence. Results: After lung resection, single-drain strategies, early use of water-seal, and standardized removal at ≤300–500 mL/day reduce pain and length of stay without increasing the need for reintervention; digital systems support objective removal using sustained low-flow thresholds (approximately 20–40 mL/min). Small-bore (≤14 Fr) Seldinger catheters perform comparably to larger tubes for secondary and primary pneumothorax and enable ambulatory pathways. In trauma, small-bore approaches can match large-bore drainage in stable patients when paired with surveillance and early escalation of care. For pleural infection, image-guided drainage, combined with fibrinolytics or surgery, is key. Indwelling pleural catheters provide relief comparable to talc in dyspnea associated with malignant effusions in patients with non-expandable lungs. Complications are mitigated by ultrasound guidance and avoiding abrupt high suction after chronic collapse; however, these strategies must be balanced against risks of malposition, occlusion or retained collections, prolonged air leaks, and device complexity, which demand protocolized escalation and team training. Conclusions: Practice coalesces around three pillars—right tube, right system, proper criteria. Adopt standardized pathways, device-agnostic thresholds, and volume or airflow criteria. Trials should harmonize “seal” definitions and validate telemetry-informed removal strategies. Full article

Background: Minimally invasive off-pump coronary artery bypass grafting (MICS-OPCAB) offers potential advantages over conventional sternotomy, including reduced trauma and faster recovery. This study evaluates the safety and feasibility of MICS-OPCAB at our centre. Methods: We retrospectively analysed 50 consecutive MICS-OPCAB procedures performed via left anterior thoracotomy at our institution between January 2023 and June 2025. Data collected included patient demographics, operative details, and postoperative outcomes. Endpoints were 30-day mortality, conversion to sternotomy, and postoperative complications. Results: The cohort included 41 males (82%) with a mean age of 63.1 ± 8.7 years (range 40–80) and mean BMI 27.8 ± 4.3 kg/m². Comorbidities included diabetes mellitus in 26%, COPD in 12%, and chronic kidney disease in 8%. Canadian Cardiovascular Society angina classes III–IV were present in 46%. The majority of patients (64%) had single-vessel CAD while 34% had two-vessel and 2% had three-vessel involvement. The mean Logistic EuroSCORE I was 2.19 ± 1.53. Left internal mammary artery (LIMA) grafting was performed in 96% of cases. Additional conduits included left radial artery in 32% and saphenous vein in 8%, with T-grafts in 26% and sequential grafting in 4%. The average number of grafts per patient was 1.35 ± 0.53 (range 1–3). The procedure was performed off-pump in 96% of cases, with two patients (4%) requiring CPB support during conversion from mini-thoracotomy. The overall conversion rate to sternotomy was 16% (eight patients), predominantly due to difficult or injurious IMA harvest or anatomical limitations. The mean operative time was 197.8 ± 76.8 min and decreased significantly after the first 25 cases (220 min vs. 175 min). Atrial fibrillation occurred in 18%, pleural effusion in 28% (10% requiring drainage), and chest infection in 8%. Wound complications arose in 4%. There was no 30-day mortality. ICU stay averaged 2 ± 2.2 days (range 1–14), and total hospital stay was 5.7 ± 2.7 days where institutional coronary bypass stay is normally 7.9 +/− 7.0 days. Conclusion: These results demonstrate that MICS-OPCAB is a safe and feasible approach for selected patients requiring multivessel coronary artery bypass grafting. There are some technical challenges during the learning curve for which conversion to open surgery can confer good outcomes. Traversing the early learning curve can confer additional benefits to later patients. Full article

Background/Objectives: Thoracic trauma remains a leading cause of trauma-related illness and death. Despite advances in imaging, ventilation strategies, and surgical fixation, its management remains a topic of debate, with varying practices across hospitals. Current Gaps: Although surgical stabilization of rib fractures (SSRF) has shown a mortality benefit in cases of flail chest and in elderly patients, its indications for non-flail cases remain uncertain. Analgesia strategies are evolving, and epidural remains the gold standard; however, it is limited by contraindications. In contrast, regional blocks, such as the erector spinae plane block (ESPB) and serratus anterior plane block (SAPB), are emerging as safer alternatives to opioid and thoracic epidural analgesia (TEA). Artificial intelligence (AI) is transforming imaging interpretation and risk stratification; however, its integration into daily trauma care is still in its early stages of development. Perspective: This article examines the integration of surgical innovation, regional anesthesia, and AI-powered diagnostics as integral components of future thoracic trauma care. We emphasize the importance of standardized surgical criteria, multimodal pain management approaches, and AI-assisted decision-making tools. Conclusions: Thoracic trauma care is shifting toward a personalized, multidisciplinary, and technology-enhanced approach. Incorporating evidence-based SSRF, advanced pain management techniques, and AI-supported imaging can help reduce mortality, enhance recovery, and optimize resource utilization. Full article

Background: Tracheal stenosis in children is a rare but potentially life-threatening condition. We report a case of multilevel tracheal stenosis in a child who sustained blunt chest trauma in a car accident. Case Presentation: The patient is an 11-year-old previously healthy boy who presented to the pediatric emergency room unconscious after being rolled over while seated unstrained inside a vehicle. A chest CT scan showed bilateral pulmonary contusions. He required intubation and mechanical ventilation initially but was noted to have biphasic stridor after extubation. He presented to the pediatric pulmonary clinic 2 weeks after discharge from the hospital with persistent stridor and shortness of breath on exertion. Spirometry revealed flattening of the inspiratory and expiratory limbs of the flow-volume loop, suggestive of fixed large airway obstruction. Direct laryngoscopy and bronchoscopy were performed and revealed multilevel tracheal stenosis. He was successfully treated with repeated bronchoscopic balloon dilatation with sustained improvement in symptoms and spirometry findings 8 months post final procedure. Conclusion: Tracheal stenosis should be suspected in children who sustain blunt chest trauma. Early recognition and treatment with bronchoscopic balloon dilatation can prevent long-term complications. Full article

Background: Fractured ribs remain a significant cause of morbidity and are associated with severe injuries requiring several healthcare resources and may be associated with prolonged hospital stays that may require an ICU facility. In our facility, we have a high burden of patients sustaining rib fractures, and we aim to compare management options, outcomes, and factors associated with mortality from a single center. Methods: A retrospective review was performed on patients who presented with rib fractures at a Level 1 Trauma facility in Johannesburg, undergoing medical or surgical management. The study included data from 1 July 2011 until 31 December 2020. All patients were identified using the Medibank database. STATA Version 18 software was used for all data analysis. A p-value of <0.05 was considered statistically significant. Injuries were subdivided according to the Abbreviated Injury Severity score as follows, Mild = AIS Grade I–II, Moderate = AIS Grade III, Severe AIS Grade IV–V. Results: There was a total of 940 patients. The median age was 45 (IQR: 34–55) years, with 22% female patients in a cohort of 940. The mechanism of injury was blunt in 96%. Most patients (93%) fractured 3/> ribs. Only 4.6% sustained a flail chest. The median SBP was 126 mmHg (IQR:109–144), and the pulse rate was 91 (IQR: 79–108) beats per minute. The mean Injury Severity Score (ISS) and New Injury Severity Score (NISS) were 17 (IQR: 10–29) and 22 (IQR: 14–34), respectively. The most common associated injuries were chest trauma in 42%, combined abdominal and pelvic trauma in 35%, and severe extremity trauma in 37%. The mortality rate was 17% (159/940). Most patients required medical and supportive management, with only 8% undergoing rib plating (76/940). The mean length of stay was 14 days (IQR: 6–25). Statistically significant factors associated with mortality were rib fractures 3≥, flail chest, higher ISS, severe head, neck, chest, abdomen and pelvis injuries (p-value 0.001) and severe extremity injury (p-value 0.006). Conclusions: Rib fractures remain a common pathology in the trauma population, and these patients can have significant associated injuries. With an appropriate multidisciplinary approach, our study found an 83% survival rate, and only 8% of patients requiring surgical intervention. Poor outcomes in patients are directly linked to the number of ribs involved, the injury severity score, associated injuries, and advanced age. Full article

Background/Objectives: Accurate and prompt tube thoracostomy (TT) placement within the safety zone while avoiding diaphragmatic injury remains challenging, particularly in trauma patients with distorted thoracic anatomy. This study evaluated the accuracy and safety of landmark-based TT techniques, including a novel mid-sternum method. Methods: In this retrospective study, chest computed tomography scans of 245 adult trauma patients who presented to a Level I trauma center in Korea between February and June 2022 were analyzed. TT insertion routes using the mid-sternum, nipple, and mid-arm point methods were compared against the conventional fifth intercostal space (ICS) method. Results: Of the 245 enrolled patients, the median age was 55.0 years (interquartile range, 42.0–64.0), and 186 (75.9%) were male. On the right side, routes avoiding the diaphragm were observed in 82.0% (fifth ICS), 92.7% (mid-sternum), 55.5% (nipple), and 90.2% (mid-arm point) of patients. The mid-sternum method showed a significantly higher avoidance rate than the fifth ICS method (p < 0.001), with 91.1% sensitivity and 77.4% specificity for identifying TT routes within the safety zone. On the left side, routes avoiding the diaphragm were observed in 97.6% (fifth ICS), 98.8% (mid-sternum), 86.9% (nipple), and 95.1% (mid-arm point) of patients, with no significant difference between the fifth ICS and mid-sternum methods (p = 0.375). The mid-sternum method showed 90.4% sensitivity and 85.2% specificity for routes within the safety zone. Conclusions: The mid-sternum method demonstrated high anatomical safety and performance comparable to or superior to the conventional fifth ICS method, particularly in minimizing the risk of diaphragmatic injury. It may offer a practical and safe alternative for TT placement in trauma care. Full article

Aim: Older adult pedestrians are at greater risk of severe injuries than younger pedestrians due to gradual physical changes and coexisting medical conditions. This leads to longer hospital stays, increased mortality risk, and higher inpatient costs. Focusing on the aging population, this study explores the characteristics and injury profiles of pedestrian crossing accidents in the capital city of Bern, Switzerland. Methods: Our retrospective cohort study comprised adult patients admitted to our ED between 1 January 2013 and 31 December 2023, as crossing (or zebra crossing)-related pedestrian victims. Two cohorts were formed on the basis of age < 65 and ≥65 years and compared according to the setting of the accident, type, pattern of the injury, and clinical outcomes (short-term mortality, ICU/hospital length of stay). Results: Of a total of 124 patients, 31.5% (n = 39) of patients were elderly (65+ group). In contrast to the younger patients, the aging population was predominantly admitted as inpatients (64.1% vs. 35.3%, p = 0.001) and was hospitalised in the intensive care unit (20.5% vs. 6%, p = 0.020). Older patients were more likely to be polytraumatised (41% vs. 11.8%, p = 0.001) and to have been tossed or hurled than patients under 65 years (75% vs. 47.3%, p = 0.016). Fractures of the upper extremities (17.9% vs. 4.7%, p = 0.016), pelvis (30.8% vs. 9.4%, p = 0.003), and thoracic spine (12.8% vs. 2.4%, p = 0.019) were significantly more common in the elderly population. Intracranial haemorrhage (35.9% vs. 17.6%, p = 0.026), abdominal trauma (17.9% vs. 5.9%, p = 0.035), and relevant vessel damage (30.8% vs. 3.5%, p < 0.001) were also significantly higher in geriatric patients. Trauma indices were slightly more increased in the older population than in the younger group (ISS; p = 0.004 and AIS > 2 of chest and thoracic spine; abdomen, pelvic contents, and lumbar spine; extremities & bony pelvis p < 0.05). The 65+ group had a longer length of hospital stay (p = 0.001) and ICU stay (p = 0.002). A hospital stay longer than 7 days was also significantly more common in elderly individuals (p = 0.007). In-hospital (15.4% vs. 1.2%, p = 0.001) and 30-day mortality (17.9% vs. 1.2%, p < 0.001) were significantly higher in patients over 65 years of age. Conclusion: In our study, the impact of pedestrian crossing accidents was more severe in the elderly, as indicated by the severity of injuries, hospitalisation rate, longer length of hospital and ICU stays, and higher mortality rates. These findings underline the importance of developing tailored strategies to reduce crosswalk accidents and to optimise management approaches for these vulnerable patients. Full article

Background: Polytrauma remains a leading cause of mortality and disability worldwide. Although trauma-related deaths have declined in recent decades, the drivers of this trend remain incompletely understood. Traumatic brain injury (TBI) is the principal cause of death and long-term disability in polytrauma, making it a critical determinant of outcomes. This study aimed to examine long-term trends in clinical characteristics, management strategies, and outcomes of polytraumatized patients with TBI (PTBI), with a particular focus on factors influencing overall and cause-specific mortality. Methods: We conducted a retrospective observational study of a prospectively maintained trauma registry over a 25-year period (1993–2018) at the Gregorio Marañón University General Hospital (Madrid, Spain). Adult patients with PTBI were included. Epidemiological, clinical, and outcome data were analyzed globally and across four time periods. Results: Among 768 patients with PTBI, mean age was 43 years (±20), and 29% were female. Most sustained closed TBIs (96%) with concomitant severe injuries to the head, chest, and extremities (median Injury Severity Score [ISS] 27; median New Injury Severity Score [NISS] 34). Emergency surgery was required in 51%, and 84% were admitted to intensive care. Over time, the incidence of polytrauma decreased, mainly reflecting fewer traffic-related injuries following advances in prevention and legislation. Despite an increasingly older and comorbid population, ISS/NISS and early mortality declined, largely due to improvements in prehospital care and hemorrhage control. Although crude TBI-related mortality appeared unchanged (28%), this pattern likely reflects offsetting influences, including an older and more comorbid patient population, a higher relative burden of severe cases, and the limitations of mortality alone to capture gains in functional outcomes. Conclusions: Advances in trauma systems and preventive policies have substantially reduced the burden of polytrauma and improved survival. However, severe TBI remains the principal unresolved challenge, highlighting the urgent need for innovative neuroprotective strategies and greater emphasis on functional recovery. Full article