Trauma Care

Background/Objectives: In the past few decades, there have been advancements in surgical techniques, improved understanding of spinal biomechanics, and awareness of complications associated with halo vest (HV) use with resultant surgical treatment of various pathologies that cause acute or chronic atlantoaxial instability. The purpose of this study was to see how HV usage has changed over time. Methods: A retrospective analysis of the North American Clinical Trials Network database. Patients with cervical spinal cord injury from 2006 through 2019 were identified and the trend of HV use was analyzed. Results: The mean age of patients who received HV was 37.4 years and 50 for those treated with other options, p < 0.0001. Its use consistently declined after 2009. After 2015 this decline reached nil in the database (p < 0.0001). Patients between 45 and 59 years (3.4%) and Above 60 years (2.8%) group had the least treatment using HV. Fall accident (4.7%, p = 0.0295) and central cord syndrome (4.6%, p = 0.0004) were associated with low HV use. Pulmonary complications were higher (89.4%) with HV use (vs. 65.9% with no HV), p = 0.0008. Pulmonary complications with HV decreased after 2012. Conclusions: HV as treatment option for conditions involving the cervical spine has decreased. This declining trend is attributable to decreased use in older individuals due to higher rates of complications and unfavorable outcomes with its use. The decreasing trend appears to coincide with published data showing better outcomes with surgical treatment and unfavorable outcomes with HV use.

Background/Objectives: Traumatic brain injury in elderly patients is a significant public health concern, particularly for those on antithrombotic therapy. A clearer understanding of how different antithrombotic agents affect the likelihood of intracranial hemorrhage in elderly patients with TBI is needed to guide clinical management. Therefore, the objective of this study was to assess the effect of preinjury antithrombotic agents on the incidence of intracranial hemorrhage in elderly patients with traumatic brain injury. Methods: The design was a retrospective cohort study set in a regional Australian hospital emergency department. The study evaluated elderly patients (≥65 years) with head injury cases identified from the integrated electronic medical record using SNOMED codes. Data on patient demographics, antithrombotic use, computed tomography imaging, and outcomes were collected. Results: A total of 152 elderly TBI patients were included in the study. Of these patients, 90.1% had falls leading to TBI. Among the patients, 30.3% were on antiplatelet agents, 23% were on direct oral anticoagulants, 7.2% were on vitamin K antagonists, and 39.5% were not on any antithrombotic agents. Intracranial hemorrhage was found in 26.5% of patients, with both direct oral anticoagulants (aOR 4.87, 95% CI 1.42–16.67, p < 0.01) and vitamin K antagonists (aOR 4.95, 95% CI 1.04–23.55, p < 0.04) demonstrating statistically significant associations with increased odds of ICH. Conclusions: Both vitamin K antagonists and direct oral anticoagulants were associated with a higher odds of intracranial hemorrhage in elderly patients with TBI, while antiplatelet therapy did not show this effect.

Goring during bullfights represents a penetrating trauma with a high risk of muscular, vascular, and vital injuries. Despite its frequency and severity, limited information is available on the immediate physiological response of the bullfighter at the moment of trauma. This case report describes the heart rate of a professional bullfighter who was gored during a bullfight, underwent surgery, and returned to fight the next bull. During the first fight, the bullfighter suffered a penetrating goring wound to the inner side of the lower third of his right thigh and a fracture of the ninth rib with intercostal rupture. Upon standing, he experienced a marked drop in heart rate and a feeling of loss of consciousness, possibly associated with vasovagal presyncope. He was transferred to the infirmary in hemodynamically stable condition. He was given local anesthesia, followed by surgical exploration, cleaning, and layered closure of the wound. After surgery, the bullfighter experienced a gradual increase in heart rate upon standing, possibly due to postural changes and postoperative sympathetic activation. He then returned to the bullring to resume activity. This case report highlights a possible vasovagal response to penetrating trauma, which may be relevant for trauma care, as a vasovagal or parasympathetic-predominant autonomic response could influence early clinical assessment.