OBJECTIVE: Acute respiratory distress syndrome (ARDS) is associated with high mortality and morbidity. Extracorporeal membrane oxygenation (ECMO) is one of the interventions that have been in practice for ARDS for decades.
OBJECTIVE: The purpose of the study was to investigate the outcomes of ECMO in pediatric trauma patients who suffered from ARDS.
METHODS: Observational cohort study.
METHODS: The Trauma Quality Improvement Program database for years 2017 to 2019 and 2021 through 2022 was accessed for the study. All children younger than 18 years old who were admitted to the hospital after trauma and suffered from ARDS were included in the study. Other variables included in the study were patients\' demographics, clinical characteristics, Injury Severity Score (ISS), Glasgow Coma Scale (GCS) score, comorbidities, and outcomes.
METHODS: ECMO is the exposure, and the outcomes are in-hospital mortality and hospital complications (acute kidney injury [AKI], pneumonia and deep vein thrombosis [DVT]).
RESULTS: Of 453 patients who qualified for the study, propensity score matching found 50 pairs of patients. There were no significant differences identified between the groups, ECMO+ vs. ECMO- on patients\' age in years (16 yr; interquartile range [IQR], 13.25-17 yr vs. 16 yr [14.25-17 yr]), race (White; 62.0% vs. 66.0%), sex (male; 78% vs. 76%), ISS (23 [IQR, 9.25-34] vs. 22 [9.25-32]), and GCS (15 [IQR, 3-15] vs. 13.5 [3-15]), mechanism of injury; and comorbidities. There was no difference between the groups, ECMO+ vs. ECMO-, in-hospital mortality (10.0% vs. 20.0%; p = 0.302), hospital complications (AKI 12.0% vs. 2.0%; p = 0.131), pneumonia (10.0% vs. 20.0%; p = 0.182 > ), and DVT (16% vs. 6%; p = 0.228).
CONCLUSIONS: No difference in mortality was observed in injured children who suffered from the ARDS and were placed on ECMO when compared with patients who were not placed on ECMO. Patients with trauma and ARDS who require ECMO have comparable outcomes to those who do not receive ECMO. A larger sample size study is needed to find the exact benefit of ECMO in this patients\' cohort.

BACKGROUND: In the recent years, National Early Warning Score2 (NEWS2) is utilized to predict early on, the worsening of clinical status in patients. To this date the predictive accuracy of National Early Warning Score (NEWS2), Revised Trauma Score (RTS), and Trauma and injury severity score (TRISS) regarding the trauma patients\' mortality rate have not been compared. Therefore, the objective of this study is comparing NEWS2, TRISS, and RTS in predicting mortality rate in trauma patients based on prehospital data set.
METHODS: This cross-sectional retrospective diagnostic study performed on 6905 trauma patients, of which 4191 were found eligible, referred to the largest trauma center in southern Iran, Shiraz, during 2022-2023 based on their prehospital data set in order to compare the prognostic power of NEWS2, RTS, and TRISS in predicting in-hospital mortality rate. Patients are divided into deceased and survived groups. Demographic data, vital signs, and GCS were obtained from the patients and scoring systems were calculated and compared between the two groups. TRISS and ISS are calculated with in-hospital data set; others are based on prehospital data set.
RESULTS: A total of 129 patients have deceased. Age, cause of injury, length of hospital stay, SBP, RR, HR, temperature, SpO2, and GCS were associated with mortality (p-value < 0.001). TRISS and RTS had the highest sensitivity and specificity respectively (77.52, CI 95% [69.3-84.4] and 93.99, CI 95% [93.2-94.7]). TRISS had the highest area under the ROC curve (0.934) followed by NEWS2 (0.879), GCS (0.815), RTS (0.812), and ISS (0.774). TRISS and NEWS were superior to RTS, GCS, and ISS (p-value < 0.0001).
CONCLUSIONS: This novel study compares the accuracy of NEWS2, TRISS, and RTS scoring systems in predicting mortality rate based on prehospital data. The findings suggest that all the scoring systems can predict mortality, with TRISS being the most accurate of them, followed by NEWS2. Considering the time consumption and ease of use, NEWS2 seems to be accurate and quick in predicting mortality based on prehospital data set.

Vocational rehabilitation plays a key role in the overall improvement of the quality of life for patients with chronic illness or after injury. Physicians have an important role in identifying suitable patients and recommending vocational rehabilitation as part of a comprehensive rehabilitation treatment. This article provides an overview of the use of vocational rehabilitation in the treatment of various patients with different types of illnesses and suggests criteria for selecting appropriate patients for involvement in vocational rehabilitation. The review presents the current state of vocational rehabilitation, its possibilities, limitations, and challenges for further development. One of the main challenges is the potential use of vocational rehabilitation for patients on temporary disability leave. Although employment law has allowed this possibility for 20 years, in practice, the tool of vocational rehabilitation has not yet been used for this group of individuals. The article also brings new findings revealed by research conducted within an experimental project that pilot tested the concept of so-called \"vocational rehabilitation centers.\" The research showed, among other things, that the early involvement of individuals with disabilities in vocational rehabilitation, combined with a multidisciplinary approach, more than triples their chances of obtaining or retaining employment.

BACKGROUND: Vehicles play an important role in pedestrian injury risk in crashes. This study examined the association between vehicle front-end geometry and the risk of fatal pedestrian injuries in motor vehicle crashes.
METHODS: A total of 17,897 police-reported crashes involving a single passenger vehicle and a single pedestrian in seven states were used in the analysis. Front-end profile parameters of vehicles (2,958 vehicle makes, series, and model years) involved in these crashes were measured from vehicle profile photos, including hood leading edge height, bumper lead angle, hood length, hood angle, and windshield angle. We defined a front-end-shape indicator based on the hood leading edge height and bumper lead angle. Logistic regression analysis evaluated the effects of these parameters on the risk that a pedestrian was fatally injured in a single-vehicle crash.
RESULTS: Vehicles with tall and blunt, tall and sloped, and medium-height and blunt front ends were associated with significant increases of 43.6%, 45.4%, and 25.6% in pedestrian fatality risk, respectively, when compared with low and sloped front ends. There was a significant 25.1% increase in the risk if a hood was relatively flat as defined in this study. A relatively long hood and a relatively large windshield angle were associated with 5.9% and 10.7% increases in the risk, respectively, but the increases were not significant.
CONCLUSIONS: Vehicle front-end profiles that were significantly associated with increased pedestrian fatal injury risk were identified.
CONCLUSIONS: Automakers can make vehicles more pedestrian friendly by designing vehicle front ends that are lower and more sloped. The National Highway Traffic Safety Administration (NHTSA) can consider evaluations that account for the growing hood heights and blunt front ends of the vehicle fleet in the New Car Assessment Program or regulation.

BACKGROUND: Children experiencing trauma are at risk of developing acute and chronic stress disorders. In 2022, the American College of Surgeons Committee on Trauma required verified pediatric trauma centers to screen at-risk patients and provide mental health provider referrals as needed.
OBJECTIVE: The study objective is to assess the current readiness of pediatric trauma centers to meet the new American College of Surgeons requirements.
METHODS: This study used an exploratory, electronic, cross-sectional survey design. The Pediatric Trauma Society distributed a survey on mental health screening practices to its members in February 2023. Results were summarized with descriptive statistics. Chi-square test was used to compare responses of Levels I and II pediatric trauma centers.
RESULTS: There were 91 survey responses from the PTS membership of 1247 (response rate of 7.3%). Fifty-nine participants were from Level I and 27 from Level II pediatric trauma centers. 63.8% of Level I and 51.9% of Level II center respondents currently screened for acute stress (χ2(1) = 1.09, p = .30). Of these, 75.7% of Level I and 57.1% of Level II center respondents routinely screened all admitted trauma patients (χ2(1) = 1.68, p = .19). However, only 32.4% of Level I and 21.4% of Level II respondents reported having outpatient acute stress referral protocols. For pediatric trauma centers currently without screening, 65% of Level I and 46.2% of Level II pediatric trauma center respondents felt they needed more than six months to establish a program (χ2(1) = 1.15, p = .28). Most respondents (68.9%) reported staff shortages as a barrier to the delivery of acute stress services.
CONCLUSIONS: Pediatric trauma center compliance with acute stress screening requirements for verification is variable. Pediatric trauma centers may benefit from technical assistance with acute stress screening.

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BACKGROUND: The balanced transfusion of blood components plays a leading role in traumatic hemostatic resuscitation. Yet, previous whole blood studies have only focused on urban trauma center settings.
OBJECTIVE: To compare component vs whole blood therapy on wastage rates and mortality in the rural setting.
METHODS: This study was a nonrandomized, retrospective, observational, single-center study on a cold-stored whole blood program implementation for adult massive transfusions from 2020 to 2022 at a Level II trauma center. Trauma registry data determined the facility\'s whole blood needs and facilitated sustainable blood supplies. Whole blood use protocols were established, and utilization and laboratory compliance for incompatible ABO antibody hemolysis was monitored and reviewed monthly at stakeholder and trauma services meetings.
RESULTS: From 2018 to 2019, the facility initiated component therapy massive transfusions every 9 days (n = 41). Therefore, four units of low-titer, O-positive whole blood delivered fortnightly was determined to provide patient coverage and minimize wastage. Across the study time frame (2020-2022), there were n = 68 hemodynamically unstable patients, consisting of those receiving whole blood, n = 37, and patients receiving component therapy, n = 31. Mortality rates were significantly lower (p = .030) in the whole blood population (n = 3, 8%) compared to those solely receiving component therapy (n = 9, 29%). Wastage rates were constantly evaluated; in 2021, 43.4% was not utilized, and in 2022, this was reduced to 38.7%. Anecdotally, nurses appreciated the ease of administration and documentation of transfusing whole blood, as it negated ratio compliance.
CONCLUSIONS: This evidence-based whole blood program provides vital care to severely injured trauma patients in a vast, rural region.

BACKGROUND: There is a need for activation criteria that reflect the different factors affecting rural trauma patients.
OBJECTIVE: To develop effective activation criteria for a rural trauma center among adults, incorporating variables specific to the geography, mechanisms of injury, and population served.
METHODS: This is a single-center, retrospective cohort study conducted from (23 years) January 1, 2000, to July 31, 2023. The data collected patient demographics, injury details, morbidity, and preexisting comorbidity. This research included all adult (≥15 years) true Level I trauma activations defined as an injury severity score > 25 and met the need for trauma intervention criteria. The patients were grouped into adult and elderly categories. The analysis utilized a logistic regression model with the outcome of a true Level I trauma activation.
RESULTS: A total of 19,480 patients were included in the sample; 2,858 (14.6%) met the Level I activation criteria. Elderly Level I activation included assault, pedestrian struck, multiple pelvic fractures, traumatic pneumo/hemothorax, mediastinal fracture, sternum fracture, and flail rib fracture.
CONCLUSIONS: Using the findings of the logistic regression model, this center has made more robust activation guidelines adapted to its rural population.

BACKGROUND: The lifestyle differences of Anabaptists and their views on health care may yield different injury patterns than standard populations and require a customized approach to injury prevention and health care delivery.
OBJECTIVE: To identify differences in injury patterns and delays in care-seeking behaviors among the Anabaptists in Wisconsin.
METHODS: This single-center retrospective cohort study was conducted from (23 years) January 1, 2000, to December 31, 2023. Local Trauma Registry data collected patient demographics, injury details, morbidity outcomes, in-hospital mortality, and preexisting comorbidity. Anabaptist trauma patients were isolated by confirmed identification in the Trauma Registry. The analysis utilized both descriptive statistics and a logistic regression model with the outcome of Anabaptist.
RESULTS: A total of 14,431 patients were included in the analysis; 81 (0.4%) were confirmed as Anabaptist. The Anabaptist population showed a higher likelihood of helicopter transportation (odds ratio [OR] 4.64, p < .01) and an activation of Pediatric Level I (OR 4.07, p < .01). As the emergency department shock index increased by one unit, the odds of being Anabaptist increased by 9.87 (p < .01). The injury mechanisms that were associated with the Anabaptist population included buggy collisions (OR 312.58, p < .01), caught or crushed (OR 5.21, p = .01), machinery (OR 5.38, p < .01), near drowning (OR 14.09, p < .01), scooter (OR 13.93, p = .04), and woodworking (OR 12.81, p = .01).
CONCLUSIONS: This study identified differences in injury patterns and delays in care-seeking behaviors in the Anabaptist population.

Events such as the COVID-19 pandemic and the war in Ukraine have increased people\'s awareness of mental health issues. Psychological trauma impacts patients in the acute care setting through physical and mental health presentations. Trauma is a public health issue crossing all socioeconomic groups and is related to social determinants of health. Trauma-informed care (TIC) is an evidence-based approach to providing care. TIC is within the scope of nursing practice and improves outcomes for patients. However, there is a lack of standard terms or practices within healthcare. Additionally, there is superficial acknowledgment of the need for TIC at the local or national level regarding policy. Nurses need to adopt TIC into practice and advocate for policy change to improve the health and lives of those seeking care.