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The use of radiopaque markers (ROM) in penetrating trauma is based on expert opinion and historical clinical practice; however, there is no high-quality evidence to support their routine use in clinical practice.

Source
The use of radiopaque markers is medical dogma. Acad Emerg Med. 2024 Feb;31(2):193-194. doi: 10.1111/acem.14858. Epub 2024 Feb 6.

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This study demonstrated that patients 65 years and older with blunt head trauma are at high risk of significant traumatic brain injuries and poor outcomes even with low-risk mechanisms of injury such as ground level falls and no other high-risk criteria besides advanced age. These findings suggest routine head CT imaging may be helpful for elderly patients with head trauma as clinical assessment may not identify patients with significant pathology.

Source
Blunt Head Injury in the Elderly: Analysis of the NEXUS II Injury Cohort. Ann Emerg Med. 2024 Feb 9:S0196-0644(24)00003-9. doi: 10.1016/j.annemergmed.2024.01.003. Online ahead of print.

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In this systematic review, authors identified clinical practice guideline (CPG) recommendations with moderate to high quality evidence that can be used by the ED practitioner to help in the care of pediatric patients with mild traumatic brain injury (mTBI).

Source
Clinical Practice Guideline Recommendations in Pediatric Mild Traumatic Brain Injury: A Systematic Review. Ann Emerg Med. 2023 Dec 22:S0196-0644(23)01381-1. doi: 10.1016/j.annemergmed.2023.11.012. Epub ahead of print.

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In trauma patients, 24-hour mortality rate increased with increasing ratio of packed red blood cells (pRBC) to whole blood (WB) transfusion, even when pRBC transfusion was balanced with platelets and fresh frozen plasma (FFP). Mortality rate was lowest in patients transfused with whole blood alone.

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Trauma patients who were resuscitated with whole blood compared to component therapy had improved 24-hour mortality and a decrease in the total amount of blood products needed for resuscitation.

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Doing more with less: low-titer group O whole blood resulted in less total transfusions and an independent association with survival in adults with severe traumatic hemorrhage. J Thromb Haemost. 2024 Jan;22(1):140-151. doi: 10.1016/j.jtha.2023.09.025. Epub 2023 Oct 4.

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Patients with TBI who were intubated in the prehospital setting had no difference in 30-day mortality when comparing induction with ketamine versus etomidate.

Source
Etomidate versus Ketamine as prehospital induction agent in patients with suspected severe traumatic brain injury. Anesthesiology. 2024. Jan 8. Doi: 10.1097/ALN.0000000000004894. Online ahead of print.

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Overall rates of intracranial hemorrhage (ICH) in patients >65 years of age with either definite or uncertain head trauma were found to be 11.4% and 1.7%, respectively, leading these authors to recommend head CT imaging on all geriatric patients presenting with possible head trauma.

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Traumatic cardiac arrest patients receiving either resuscitative endovascular balloon occlusion of the aorta (REBOA) or resuscitative thoracotomy (RT) experienced similar outcomes, though time to successful occlusion of the aorta took significantly longer with REBOA. The limiter? Common femoral artery (CFA) access.

Source
Resuscitative endovascular balloon occlusion of the aorta and resuscitative thoracotomy are associated with similar outcomes in traumatic cardiac arrest. J Trauma Acute Care Surg. 2023 Dec 1;95(6):912-917. doi: 10.1097/TA.0000000000004094. Epub 2023 Jun 29.

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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.