Article 1
Accuracy, reliability, and utility of the extended focused assessment with sonography in trauma examination in the setting of thoracic gunshot wounds. Arase M, Nekooei N, Sozzi M, Schellenberg M, Matsushima K, Inaba K, Martin MJ. J Trauma Acute Care Surg. 2025 Jun 1;98(6):867-874.
Arase et al. performed a retrospective cohort study at an ACS Level I trauma center from 1/2017-12/2021, evaluating the performance of eFAST in patients with thoracic GSWs and their impact on clinical interventions. Patients that were dead on arrival were excluded from the study. eFAST results were considered true positive for pleural fluid/pneumothorax if confirmed by surgical exploration, CT, x-ray or chest tube findings. eFAST examinations were performed by emergency medicine residents/fellows, supervised by a senior resident or attending. There were 288 patients in the study, and patients were split into two groups, deceased vs. survivors. There was high specificity for the eFAST across the different components, but low sensitivity especially for detecting pneumothorax. Sensitivity was higher in deceased compared to survivors. Chest tube placement rates were significantly different between true positive and false negative groups in survivors, with the true positive group undergoing chest tube placement more frequently. Based off these results, the authors recommend that negative eFAST results should be confirmed by further imaging or interventions.
Much of the author’s findings reflect previous research in penetrating trauma to the torso; FAST is highly specific but not as sensitive in detecting injury. A novel finding in this article was the decreased frequency of chest tube insertion in the false negative group. This suggests that relying on a negative eFAST result for a thoracic GSW can lead to a delay in care. However, the major limitation of this paper is the variability in who was performing and supervising the eFAST. Ultrasound is highly dependent on the skills of the individual performing the exam. Furthermore, eFAST image results were not retrospectively reviewed for accuracy.
Article 2
Outcomes of open cardiopulmonary resuscitation in pulseless blunt chest trauma: A nationwide cohort study. Chang YR, Wang HC, Lin HF, Hsu TA, Fu CY, Bokhari F. Injury. 2025 May 17:112447.
Chang et al. performed a retrospective study using the National Trauma Database from 2014-2015, analyzing the effectiveness of open CPR in pulseless blunt chest trauma patients. Patients < 18, without initial signs of life, with burns, severe head injury, penetrating trauma, unknown injury mechanism and transport time > 60min were excluded from the study. The primary outcome of this study was ED survival rate. There was a total of 455 patients in the study, and 15.5% (n=65) of them underwent open CPR. The ED survival rate in the open CPR group was 81.5% compared to a survival rate of 46.8% in those that did not undergo open CPR (p<.001). However, there was no statistical significance in overall survival rate between the groups. Subgroup analysis demonstrated that patients with blunt cardiac injuries who underwent open CPR had higher ED survival and overall survival rates compared to those that did not.
The findings in this study reflect previous research that overall survival rate for blunt pulseless trauma patients who undergo open CPR is low. However, the ED survival rate was higher for open CPR, indicating that post-ED care is an area for improvement and future research. Additionally, open CPR may be beneficial for patients who sustain a blunt cardiac injury. There are many limitations to this study as mentioned by the authors. Firstly, there was no neurological function data recorded for patients, making it difficult to determine neurological status after open CPR in survivors. The authors also did not have access to EKG, FAST, or autopsy data. There was also a higher ISS in the open CPR group, which could have impacted the observed outcomes.
Article 3
Prehospital Tranexamic Acid for Severe Trauma. PATCH-Trauma Investigators and the ANZICS Clinical Trials Group; Gruen RL, Mitra B, et al. N Engl J Med. 2023 Jul 13;389(2):127-136.
The PATCH-Trauma trial was a multicenter, double-blind, randomized, placebo-controlled trial that evaluated the efficacy and safety of tranexamic acid therapy in patients with severe trauma who were at risk for trauma-induced coagulopathy. The researchers hypothesized that administering tranexamic acid before hospital admission would result in a greater percentage of patients surviving with a functional outcome at 6 months compared to the placebo. A total of 1310 patients across Australia, New Zealand, and Germany were assigned to receive tranexamic acid or placebo. Eligible patients were over 18 years old with suspected severe traumatic injuries treated at the scene by paramedics or physicians and transported to participating centers. Using the Coagulopathy of Severe Trauma (COAST) score, patients were assessed as being at high risk for trauma-induced coagulopathy and were eligible if the first dose of tranexamic acid or placebo could be administered within three hours after injury or before hospital admission. The primary endpoint was survival with a favorable outcome at six months, defined as a Glasgow Outcome Scale-Extended (GOS-E) score of 5 or higher. The study found no significant difference between the Tranexamic acid (53.7%) and placebo group (53.5%) 6 months after injury. However, there was a significant difference in early mortality 24 hours and 28 days after injury.
The trial had robust randomization, blinding, and statistical methods. It addressed a clinically relevant question in trauma care, as trauma is a leading cause of death in young people, with hemorrhage being a major contributor. A strength of the study was its use of the COAST score to identify high-risk patients in the pre-hospital setting for inclusion. It assessed long-term functional outcomes, which were not evaluated in previous trials. Although there was a significant reduction in early mortality in the tranexamic acid group, this did not translate into improved long-term functional outcomes. One limitation was that 13% of patients were lost to follow-up. There were protocol deviations, such as the use of open-label tranexamic acid. The findings may not apply to lower-resource trauma systems, as the study was conducted within advanced trauma networks. Nonetheless, the study provides valuable insight by showing that tranexamic acid may reduce early deaths.
Article 4
Five- year outcomes for patients sustaining severe fractures of the lower limb from the Wound Healing in Surgery for Trauma (WHIST) trial. Costa ML, Achten J, Knight R, Campolier M, Massa MS. Bone Joint J. 2024 Aug 1;106-B(8):858-864.
This five-year follow-up study looked at the outcomes of patients from the WHIST trial, which compared negative pressure wound therapy (NPWT) dressings with standard wound dressings in patients undergoing internal fixation of a complex fracture of the lower limb. Patients were over 16 years old and presented with complex fractures, including periarticular and open fractures where the wound could be primarily closed at the end of the first debridement. Of the 1,548 patients who consented, 1,520 were eligible for five-year follow-up, and only 1,015 provided at least one set of follow-up data. Patients were excluded if they presented more than 72 hours after injury, if their wound could not be closed primarily, or if they were unable to adhere to the study procedures. The primary outcome was disability and was measured by the Disability Rating Index (DRI). Secondary outcomes were health-related quality of life (EQ-5D), pain scores (VAS), neuropathic pain (DN4), and complication rates. Patients were followed annually for five years, but the study found no statistically significant differences in DRI scores or any secondary outcomes between the NPWT and standard dressing groups. Both groups reported high levels of disability and reduced quality of life in the early stages of recovery, which persisted with little improvement between two and five years. Additionally, chronic pain and neuropathic symptoms remained five years after injury.
This study stands out for its large sample size, extended follow-up duration, and use of validated patient-reported outcome measures. However, the study showed no clinical benefit of NPWT over standard wound dressings in terms of disability, pain, or complications. One limitation was the attrition rate, as only 66% of the original patients provided at least one set of outcome data during the five-year follow-up, which reduces the statistical power to detect subtle differences in outcome. The reliance on self-reported outcomes could also introduce recall or reporting bias. Outcomes, such as complications, would be best assessed through objective data as opposed to depending on patient recall. Despite these limitations, this study shows the long-term burden of complex lower limb fractures and reinforces the importance of being aware of long-term outcomes when discussing the rehabilitation and prognosis after treatment of these injuries with patients.
