Trauma: Overview

Abstract
Purpose: Pediatric craniomaxillofacial trauma presents unique diagnostic and management challenges due to the anatomical and developmental characteristics of children.

Methods: This retrospective study analyzed 795,431 pediatric trauma cases (ages 0-18 years) from the National Trauma Data Bank (2017-2022) to characterize injury patterns and risk factors.

Results: Among 119,324 cases (15.0%) involving craniomaxillofacial fractures, incidence increased significantly with age, from 0.93% in infants to 5.59% in adolescents. Motor vehicle collisions were the leading mechanism, doubling fracture risk (odds ratio 2.39, 95% confidence interval 2.19-2.59), while proper restraint use reduced risk by 43% (odds ratio 0.572, 95% confidence interval 0.52-0.62). Falls were the predominant mechanism in younger children, whereas motor vehicle collisions, assault, and firearm-related injuries increased with age. Fracture patterns shifted developmentally: cranial vault fractures dominated in younger children, while cranial base, midface, mandibular, and dental fractures became prevalent in older populations.

Conclusion: These findings emphasize the need for age-specific prevention strategies, including improved restraint compliance and targeted injury mitigation programs, to reduce the burden of pediatric facial trauma.

Abstract
Background: Traumatic brain injury (TBI) is a Major contributor to morbidity and mortality in the United States. Although prior research has suggested potential gender differences in TBI outcomes, limited data exist on surgical cohorts. This study aimed to evaluate gender-based disparities in postoperative complications and 30-day outcomes following surgical management of TBI using a large national surgical registry.

Methods: A retrospective cohort study was performed using the 2023 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Adults (≥ 18 years) who underwent surgical intervention for TBI were identified using Current Procedural Terminology codes. Patients were stratified by gender, and comparisons were made using Wilcoxon rank-sum and χ2 tests. Multivariate logistic regression was conducted to assess independent predictors of 30-day morbidity and mortality.

Results: Of the 2,519 patients, 64.8% were Male and 35.2% were female. Female patients were significantly older (70.9 ± 14.6 vs. 67.2 ± 16.0 years, p < 0.001) and had higher rates of hypertension (65.1% vs. 58.1%, p < 0.001), bleeding disorders (25.5% vs. 19.4%, p < 0.001), and frailty (modified frailty index ≥ 2 in 31.0% vs. 28.6%, p < 0.001). Additionally, postoperative urinary tract infections (odds ratio [OR] 2.35, 95% confidence interval [CI] 1.56-3.55, p < 0.001), transfusion requirement (OR 1.67, 95% CI 1.34-2.08, p < 0.001), and 30-day morbidity (OR 1.29, 95% CI 1.10-1.52, p = 0.002) were significantly higher in female patients. Multivariate analysis confirmed female gender as an independent predictor of 30-day morbidity (OR 1.31, 95% CI 1.02-1.68, p = 0.034). No significant difference in 30-day mortality between male and female patients was observed (OR 1.08, 95% CI 0.87-1.33, p = 0.493).

Conclusions: Female patients undergoing surgical treatment for TBI experience significantly higher postoperative morbidity despite comparable mortality. Increased age, comorbidity burden, and complication rates in female patients underscore the need for gender-specific perioperative strategies. Limitations include the 30-day follow-up window and retrospective design. These findings support further investigation into tailored interventions to mitigate gender disparities in neurosurgical care.

Abstract
Objective: This study aimed to investigate the impact of the type and number of prehospital interventions, in addition to prehospital time intervals, on inhospital mortality among trauma patients.

Methods: According to a 13-year prospective trauma registry, three prehospital time intervals of response time, on-scene time, and transport time were assessed. Prehospital interventions were classified into four categories: stop bleeding strategies, immobilization, basic airway management, and advanced resuscitation.

Results: A total of 13,533 patients were included. Relative to patients not receiving prehospital interventions, there was longer on-scene time for those who received immobilization (10.4 vs. 8.68 min), basic airway management (11.4 vs. 9.40 min), and advanced resuscitation (12.6 vs. 9.53 min). Furthermore, relative to patients who survived in hospital, those who died significantly had longer on-scene time (11.4 vs. 9.64 min) and sustained immobilization (74.7% vs. 52.5%), basic airway management (30.7% vs. 7.6%), advanced resuscitation (32.0% vs. 0.1%), and ≥ 4 prehospital interventions (30.4% vs. 4.6%). Results of the multivariable logistic regression analysis shows that without adjustment for type and number of prehospital interventions, longer on-scene time (odds ratio [OR] = 1.03; 95% confidence interval [CI], 1.01-1.04) were significantly associated with increased mortality; however, after additional adjustment for type and number of prehospital interventions, no significant association between each of the three prehospital time intervals and mortality was detected. Furthermore, compared to patients who did not receive prehospital interventions, those who received wound packing/compression had a significantly lower risk of mortality (OR = 0.54; 95% CI, 0.36-0.80), whereas those who received basic airway management (OR = 1.73; 95% CI, 1.15-2.60), advanced resuscitation (OR = 33.4; 95% CI, 14.9-75.0), and three (OR = 2.60; 95% CI, 1.01-6.93) and ≥ 4 (OR = 2.97; 95% CI, 1.01-9.63) prehospital interventions had a significantly higher risk of mortality.

Conclusions: There exists a tradeoff between prehospital trauma interventions and shortening on-scene time for mortality risk; however, implementing some interventions for hemorrhage control and hemostatic resuscitation can benefit the survival of trauma patients the most.