Article 1
Rib fractures in frail geriatric patients: Does surgical stabilization improve outcomes? Zangbar B, Mehta R, Prabhakaran K, Jose A, Vetri R, Froula G, Shnaydman I, Kirsch J. J Trauma Acute Care Surg. 2026 Jan 1;100(1):40-46.
This retrospective TQIP analysis (2017-2022) evaluated frail patients (mFI ≥0.25) ≥65 years of age with ≥2 rib fractures, comparing surgical stabilization of rib fractures (SSRF) to non-operative management (NOPM). After propensity matching (1,063 per group), SSRF was associated with lower mortality (5.4% vs 10.2%, p<0.001) without differences in VAP, ARDS or tracheostomy. SSRF patients had higher ICU readmission and longer ICU and hospital LOS. Timing subgroup analysis showed worse outcomes when fixation occurred >72 hours, including higher unplanned intubation, tracheostomy, ventilator days and longer LOS. Regression modeling demonstrated ~50% reduction in odds of mortality with SSRF compared to NOPM, and each day of delay increased LOS and ventilator duration; this mortality association persisted even after excluding patients with flail chest.
These findings suggest frailty alone should not preclude SSRF, as the study demonstrates an association with improved survival, albeit without a measurable reduction in pulmonary complications. The importance of timing is notable, with delayed fixation associated with worse outcomes. However, the retrospective registry design cannot determine causality, patient selection rationale, or whether complications preceded or followed surgery. Moreover, with the frailty scoring system used in the study, frailty is defined by comorbidities rather than functional status. Prospective studies with clearer indications and timing strategies are needed. For now, the study supports considering early SSRF in selected frail elderly patients when otherwise appropriate.
Article 2
Clinical characteristics, management, and outcomes of traumatic cerebral venous sinus thrombosis. Kapitanski L, Thiyagarajah K, Makedonov I, Berger F, Abdulrehman J, Chapman M, da Costa L, Geerts W, Hawkes C, Pirouzmand F, Reiter S, Bosson JL, Fowler R, Galanaud JP. J Trauma Acute Care Surg. 2026 Jan 1;100(1):90-96.
This single-center retrospective cohort study evaluated traumatic cerebral venous sinus thrombosis (CVST) among trauma patients admitted to a single Level 1 trauma center between 2014-2023. Among 18,569 trauma patients, 7,921 (42.7%) had TBI and 170 (2.1% of TBI patients) had CVST, with prevalence increasing with injury severity (0.9% overall, 2.1% in TBI, 4.8% in severe TBI). All patients had intracranial hemorrhage and nearly all had skull fracture. Most patients (67.6%) received standard VTE prophylaxis rather than therapeutic anticoagulation, initiated a median of 3 days post-injury. Therapeutic anticoagulation was infrequently used (10%) and typically initiated for indications other than the CVST, reflecting a predominantly non-aggressive treatment approach. During hospitalization and available follow-up, no patients treated with prophylactic dosing developed symptomatic CVST-related stroke, hemorrhage, or death, and only rare asymptomatic thrombus extension occurred. Overall mortality was 16.5% and appeared related to underlying injury rather than CVST.
These findings suggest routine escalation to therapeutic anticoagulation may not be required in the acute phase. In a population largely managed with prophylactic dosing, clinically significant CVST progression and anticoagulation complications were uncommon, supporting a conservative initial approach while hemorrhage risk remains high. This is particularly relevant in settings where practice patterns favor full-dose anticoagulation once intracranial bleeding stabilizes. However, the retrospective design, lack of comparator treatment groups, and limited long-term follow-up prevent defining an optimal anticoagulation strategy. The study, therefore, supports that early standard VTE prophylaxis is well-tolerated, with reassuring outcomes despite infrequent use of therapeutic anticoagulation.
Article 3
Air Medical Prehospital Triage Score and Racial and Ethnic Disparities in Air Transport After Injury. Byrd T, Boland S, Lu L, Silver D, Brown JB. JAMA Surg. 2026 Jan 1;161(1):31-37.
This retrospective cohort study investigated disparities in prehospital air medical transport evaluating patients from the Pennsylvania Trauma Outcomes Study database between 2000 and 2020. Patients were included if they were 16 years or older and underwent ground or helicopter emergency medical service transport. The study evaluated air vs ground transport and Air Medical Prehospital Triage (AMPT) score use as they related to socio-environmental context and patient mortality. The AMPT score is a validated prehospital tool that uses patient criteria to triage patients for air transport. Socio-environmental context was evaluated with the Area Deprivation, Social Deprivation, and Distressed Communities Indices (ADI, SDI, DCI). Multivariable logistic regression analyses were used to evaluate the association between race and ethnicity and transport mode, as well as the potential impact of AMPT score and the impact of transport on mortality. A total of 307,831 patients were evaluated, with 21% of patients transported by air and most of those patients being young, male, white, and with higher injury severity and mortality. Air Medical Transport was significantly associated with increased survival, and as ADI, SDI, and DCI increased, race and ethnicity had increasing impact on prehospital transport mode, with ADI accounting for approximately 38% of disparity. The most prominent finding was that when AMPT criteria were used in triage, there was no significant association between race and ethnicity and transport mode.
This study is limited by its retrospective nature and narrow scope of a single state’s database. Conditions limiting AMT availability and patients transported to non-trauma centers were not controlled for, further limiting the generalizability of this study’s findings. Despite these limitations, this study supports the use of the AMPT score in pre-hospital transportation triage, calling for a more rigorous prospective evaluation of this tool. Additionally, many studies evaluating healthcare disparities primarily consider race and ethnicity, and this study’s use of ADI, SDI, and DCI allows for a more complete understanding of the social determinants of health impacting pre-hospital trauma care. Overall, this study supports the use of standardized, evidence based triage criteria such as AMPT score in determining prehospital transport mode, demonstrating its potential for reducing both mortality and healthcare disparity.
Article 4
Disparity in time to hemorrhage control surgery for injured older adults. Ordoobadi AJ, Wu C, Castillo-Angeles M, Salim A, Jarman MP, Nitzschke S.J Trauma Acute Care Surg. 2026 Jan 1;100(1):105-112.
This retrospective cohort study investigated time to hemorrhage control surgery in older adults with traumatic injury, evaluating patients from the Trauma Quality Improvement Program database from 2017-2019. Patients were included if they were taken directly from the emergency department to the operating room, and patients who were functionally dependent or with advanced directives were excluded. The primary outcome was time to surgery for hemorrhage control, defined as duration between arrival and time of surgery. A multivariable Poisson regression was used to evaluate difference in time to surgery between patients aged 18-64 compared to patients 65 years and older, controlling for patient demographics, mechanism, ISS, trauma center level, and operation. A total of 29,406 patients were evaluated, with adjusted time to surgery 9.4 minutes longer for older adults. The adjusted difference in time to surgery was not as prominent in a subanalysis of patients with shock index ≥1, demonstrating that the lack of traditional vital sign abnormalities in older patients may contribute to this disparity. Increasing age by 10 year increments demonstrated trend toward longer time to OR with increasing age.
This study describes a delay in hemorrhage control surgery in older adults, identifying a potential opportunity for improvement in trauma care. This disparity is potentially attributable to delayed recognition of shock in older adults, with home medications such as beta blockers and time required to consider goals of care also contributing. This study is limited by its retrospective nature, inability to control for home medications, and lack of quantification of frailty in the older adults studied. Because patients with advanced directives or functional dependence were excluded, the impact of goals of care discussions on time to surgery may be inadequately captured. While the disparity in time to surgery in the older adults cohort was statistically significant at 9.4 minutes, it is unclear whether that delay has clinical significance. Overall, this large cohort study sheds light on a disparity in trauma care, and draws awareness to the physiological and cognitive complexity of managing trauma patients in the context of an aging population.
