February 2026 - Special Edition: Papers that Should Change Your Practice

This issue was prepared by EAST Manuscript and Literature Review Committee Members Justin Hatchimonji, MD and Elizabeth Krebs, MD, MSc.


Thank you to Haemonetics for supporting the EAST Monthly Literature Review.


Special Edition: Papers that Should Change Your Practice - Featuring papers discussed during the "Scientific Papers that Should Change Your Practice" Session at the 39th EAST Annual Scientific Assembly.

Article 1
PECARN prediction rule for cervical spine imaging of children presenting to the emergency department with blunt trauma: a multicentre prospective observational study. Leonard JC, Harding M, Cook LJ, et al. Lancet Child Adolesc Health. 2024 Jul;8(7):482-490.

In this long-awaited study, the Pediatric Emergency Care Applied Research Network (PECARN) screened children aged 0-17 presenting to one of 9 emergency departments with blunt trauma in the United States, using data to develop an imaging rule for this population and adding to their prior guidelines for head imaging. Children presenting directly to the emergency department who underwent imaging were included; clinicians documented physical exam findings prior to knowing the outcome of that imaging. Patients were followed up 21-28 days later. Using this data and a classification and regression tree (CART) analysis, the authors analyzed 11,857 children in a derivation cohort and 10,573 in a validation cohort. Having discerned several risk factors, the authors suggest a tiered system in which some factors prompt CT imaging (GCS 3-8 or unresponsive on AVPU, abnormal ABCs, or focal neuro deficits) and some factors prompt plain film X-ray (GCS 9-14 or verbal or pain on AVPU, midline neck tenderness, “substantial” head or torso injury). As was the goal, using this rule resulted in only 60.4% specificity but a 99.9% negative predictive value.

This study adds to the already widely-adopted PECARN head imaging rule and provides a guidelines for clinicians treating bluntly injured pediatric trauma patients. The design is robust. The authors note that if this rule had been applied to the entire cohort used in the study, the use of neck CT would have decreased from 17.2% to 6.9%; a substantial decrease without appreciable rate of missed injury. This rule should be adopted in this patient population.

Article 2
Scanning the aged to minimize missed injury: An Eastern Association for the Surgery of Trauma multicenter study. Ho V, Kishawi S, Hill H, et al. J Trauma Acute Care Surg. 2025 Jan 1;98(1):101-110.

In this EAST multicenter trial, data were prospectively collected on geriatric (>=65 years) blunt trauma patients at 18 trauma centers. Regression and machine learning algorithms were applied to identify populations that warrant a pan-scan, versus more selective imaging. Over 5,000 patients were enrolled, 47.1% of whom had an injury. They conclude that all geriatric blunt trauma patients should undergo head and C-spine CTs, and that torso scans should be reserved for patients with an abnormal exam or one of the following: GCS<15, Rapid deceleration, Antiplatelet/anticoagulation, iNtoxication, Distracting injury, Emergency procedure (central line, chest tube, etc) (acronym: GRANDE). This would have resulted in a 1.6% rate of missed injuries if applied to this cohort.

This study fills a knowledge gap in the literature. Recognizing that this population is likely over-scanned in an attempt to not miss injuries, a rule that both maximizes negative predictive value and provides a more nuanced framework that may help reduce the number of scans ordered in these patients was much-needed. This cohort was approximately 2/3 ground-level falls. Future directions may focus on this population; given that this algorithm suggests scanning patients on anticoagulation and a significant proportion of our geriatric trauma population includes AC patients falling from ground level, one may wonder if all of these patients truly should undergo CT of the torso. Additionally, as we continue to debate BCVI screening in the broader trauma population, the question of whether (or for whom) CTA neck should be applied among this population will be important.

Article 3
Negative Pressure Dressings to Prevent Surgical Site Infection After Emergency Laparotomy: The SUNRRISE Randomized Clinical Trial. SUNRRISE Trial Study Group; Atherton K, Brown J, Clouston H, Coe P, Duarte R, et al. JAMA. 2025 Mar 11;333(10):853-863.

The SUNRRISE trial is a randomized clinical trial comparing incisional negative pressure wound therapy (iNPWT) to standard dressing for patients with emergency laparotomy with skin closure. A total of 840 patients were randomized from 22 hospitals in the UK and 12 hospitals in Australia. Patients received either iNPWT, remaining for 7 days or until discharge, or a surgeon’s choice of standard simple dressing. The primary outcome was surgical site infection (SSI) up to 30 days post-procedure, as evaluated by blinded reviewers. The patient groups were similarly distributed, with procedures classified as 24% clean, 43% clean-contaminated, 19% contaminated, and 14% dirty/infected. The overall 30-day SSI rate was 28.4% in the iNPWT group, and 27.4% in the surgeon’s preference dressing group (p=.78). There was also no observed difference in secondary outcomes between the groups, including length of stay or serious adverse events. Prespecified subgroup analyses, stratifying by bowel procedure, wound class, or weight classification, also did not demonstrate a difference in SSI rate with iNPWT.

Overall, this study showed no observed difference in surgical site infection rates between patients receiving iNPWT versus standard surgical dressing. However, it is notable that overall wound classification included a high proportion of clean and clean-contaminated wounds, and did have a reasonably high overall SSI rate around 28%. The population was potentially limited by the consent process in an emergency situation, with a number of patients excluded due to unavailable staff for consenting, lack of preoperative patient identification, and inability of patient or surrogate to provide consent. Nonetheless, the trial is strengthened by its large size, robust randomization, and blinded assessments for SSI. Given the increased cost of iNPWT, this trial provides a strong argument against routine use of iNPWT in patients undergoing emergency laparotomy.

Article 4
Timing to First Whole Blood Transfusion and Survival Following Severe Hemorrhage in Trauma Patients. Torres CMc, Kenzik KM, Saillant NN, Scantling DR, Sanchez SE, Brahmbhatt TS, Dechert TA, Sakran JV. JAM Surg. 2024 Apr 1;159(4):374-381.

This retrospective cohort study investigated the impact of timing of first whole blood transfusion on mortality, evaluating patients from the American College of Surgeons Trauma Quality Improvement Program (TQIP) database. Patients were included if they presented to a level 1 or level 2 trauma center between January 1, 2029 and December 31, 2020, presented with systolic blood pressure less than 90 mm Hg, had a shock index greater than 1, underwent massive transfusion protocol (MTP), and received a whole blood transfusion as an adjunct to MTP within 24 hours of emergency department (ED) arrival. The primary outcomes were survival at 24 hours and 30 days. A multivariable Royston-Parmar flexible parametric survival hazards regression model was used to evaluate 24-hour and 30-day mortality. A total of 1394 patients were evaluated, with median time to whole blood of 30 minutes and median time to first MTP product of 36 minutes. Survival curves demonstrated improved survival at 24 hours (adjusted hazard ratio, 0.40; 95% CI, 0.22-0.73; P = .003), and improved survival at 30 days (adjusted hazard ratio, 0.32; 95% CI, 0.22-0.45; P < .001) with earlier whole blood administration. The most prominent inflection point for reduced survival was when whole blood was given after 14 minutes from ED arrival.

The study is limited by its retrospective, large database nature. The results may also be confounded by increased resources available in settings with earlier whole blood administration and by increased required procedures delaying whole blood administration. The study also does not account for prehospital whole blood transfusion, as that is not in the TQIP data set. However, the study is strengthened by its statistical methods, carefully chosen study population, and large sample size. Overall, the investigation adds to the growing body of literature demonstrating improved outcomes with whole blood incorporated as part of a MTP strategy, as well as literature describing the benefits of earlier blood transfusion. The noted inflection point for improved outcomes with whole blood given less than 14 minutes from ED arrival provides an interesting potential goal for trauma bay transfusion.

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This Literature Review is being brought to you by the EAST Manuscript and Literature Review Committee. Have a suggestion for a review or an additional comment on articles reviewed? Please email [email protected].
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