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In the first ever randomized clinical trial (RCT) of resuscitative endovascular balloon occlusion of the aorta (REBOA), exsanguinating patients receiving REBOA and standard care suffered greater mortality than those receiving standard care alone. But don’t throw those balloons away just yet, this study had significant limitations.
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Emergency department thoracotomy (EDT) is recommended in pulseless pediatric patients with signs of life* who have penetrating thoracic/abdominopelvic trauma; if pulseless with signs of life* and blunt trauma, a conditional recommendation is made.
Source
Emergency department thoracotomy in children: A Pediatric Trauma Society, Western Trauma Association, and Eastern Association for the Surgery of Trauma systematic review and practice management guideline. J Trauma Acute Care Surg. 2023 Sep 1;95(3):432-441. doi: 10.1097/TA.0000000000003879. Epub 2023 Mar 11.
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Blast injuries combine common polytrauma mechanisms – blunt, penetrating, burns – with the unique pathophysiology of blast wave injuries, and mass casualty scenarios. While rare, these patients are resource-intensive, prone to delayed yet rapid clinical deterioration, and carry high morbidity and mortality.
Source
High risk and low prevalence diseases: Blast injuries. Am J Emerg Med. 2023 Aug;70:46-56. doi: 10.1016/j.ajem.2023.05.003. Epub 2023 May 5.
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ACEP has issued an updated Clinical Policy to provide evidence-based guidelines for management of adult patients presenting to the ED with mild traumatic brain injury based on systematic review of available literature.
Source
Clinical Policy: Critical Issues in Management of Adult Patients Presenting to the Emergency Department with Mild Traumatic Brain Injury. Ann Emerg Med. 2023 May; 81(5): e63-e105. doi: 10.1016/j.annemergmed.2023.01.014.
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This article was a multi-institutional prospective validation of the American Association for Surgery of Trauma (AAST) Brain Injury Guidelines (BIG), which were developed to guide effective resource utilization for traumatic brain injury. The validation study demonstrated that this system was accurate and safe and that its implementation can reduce CT scan utilization and neurosurgical consultation.
Source
Validating the Brain Injury Guidelines: Results of an American Association for the Surgery of Trauma prospective multi-institutional trial. J Trauma Acute Care Surg. 2022 Aug 1;93(2):157-165. doi: 10.1097/TA.0000000000003554. Epub 2022 Mar 28.
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At least in the initial period, there appears to be no clinically meaningful difference in IQ scores in pediatric patients after a concussion.
Source
IQ After Pediatric Concussion. Pediatrics. 2023. 152(2);e2022060515. https://doi.org/10.1542/peds.2022-060515.
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A reduction in both 24-hour and in-hospital mortality was seen among children who received a transfusion after traumatic injury in the prehospital setting compared to those who were transfused in the emergency department.
Source
Association of Prehospital Transfusion With Mortality in Pediatric Trauma. JAMA Pediatr. 2023 Jul 1;177(7):693-699. doi: 10.1001/jamapediatrics.2023.1291.
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In this prospective observational study of patients undergoing CT imaging of the abdomen/pelvis for blunt trauma, gestalt among Emergency Medicine residents/attendings and General Surgery residents was moderately accurate but not sufficiently sensitive to rule out clinically significant injuries when the acceptable miss rate was set at 2%.
Source
Accuracy of physician gestalt in prediction of significant abdominal and pelvic injury in adult blunt trauma patients [published online ahead of print, 2023 Jun 26]. Acad Emerg Med. 2023;10.1111/acem.14768. doi:10.1111/acem.14768.
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Prehospital administration of tranexamic acid (TXA) did not result in greater functional survival in patients with major trauma and suspected trauma-induced coagulopathy.
Source
Prehospital Tranexamic Acid for Severe Trauma. N Engl J Med. 2023 Jun 14. doi: 10.1056/NEJMoa2215457. Epub ahead of print.
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This large multi-center retrospective cohort study found no difference in overall risk-adjusted mortality for severely injured trauma patients treated by a surgeon versus non-surgeon trauma team leader (TTL).
Source
Do patient outcomes differ when the trauma team leader is a surgeon or non-surgeon? A multicentre cohort study. CJEM. 2023 Jun;25(6):489-497. doi: 10.1007/s43678-023-00516-z. Epub 2023 May 15.
