Volume 1, Issue 1

Objective: To evaluate the clinical efficacy and safety of minimally invasive surgery (MIS) compared with open surgery in the treatment of severe abdominal surgical trauma. Methods: A retrospective cohort study was conducted involving 216 patients with grade III–V abdominal trauma admitted to our institution between January 2018 and December 2022. Patients were divided into the MIS group (n=102) and the open surgery group (n=114) based on the surgical approach adopted. Perioperative indicators, including operation time, intraoperative blood loss, length of hospital stay, and postoperative complication rates, were compared between the two groups. In addition, the 30-day mortality rate was analyzed as the primary outcome measure. Results: The MIS group exhibited significantly shorter operation time (125.6 ± 32.4 min vs. 168.3 ± 41.2 min, P<0.001), less intraoperative blood loss (350.2 ± 120.5 mL vs. 820.6 ± 210.8 mL, P<0.001), and shorter hospital stay (10.2 ± 3.1 days vs. 15.6 ± 4.3 days, P<0.001) than the open surgery group. The overall postoperative complication rate was lower in the MIS group (18.6% vs. 35.1%, P<0.01), with significant differences in the incidence of wound infection and abdominal adhesion. There was no statistically significant difference in the 30-day mortality rate between the two groups (6.9% vs. 8.8%, P>0.05). Conclusion: Minimally invasive surgery is a safe and effective approach for selected patients with severe abdominal surgical trauma, offering advantages such as reduced intraoperative trauma, faster postoperative recovery, and lower complication rates without increasing mortality risk.

Objective: To investigate the clinical efficacy of damage control resuscitation (DCR) combined with pelvic binder fixation in the treatment of severe pelvic fracture related hemorrhagic shock. Methods: A prospective randomized controlled trial was conducted on 182 patients with unstable pelvic fractures and hemorrhagic shock admitted to our hospital from March 2019 to April 2023. Patients were randomly assigned to the DCR group (n=91) and the conventional resuscitation (CR) group (n=91). The DCR group received balanced blood product transfusion (plasma:red blood cells:platelets = 1:1:1), permissive hypotension, and early pelvic binder fixation. The CR group received traditional crystalloid fluid resuscitation and delayed pelvic fixation. Primary outcome measures included 24 hour hemostasis success rate, 30 day mortality, and multiple organ dysfunction syndrome (MODS) incidence. Secondary outcomes included length of ICU stay, total blood transfusion volume, and complication rates. Results: The 24 hour hemostasis success rate in the DCR group was significantly higher than that in the CR group (86.8% vs. 65.9%, P<0.001). The 30 day mortality rate (12.1% vs. 27.5%, P<0.01) and MODS incidence (16.5% vs. 34.1%, P<0.01) in the DCR group were significantly lower than those in the CR group. The DCR group also had shorter ICU stay (5.2 ± 1.8 days vs. 8.7 ± 2.5 days, P<0.001) and less total blood transfusion volume (12.4 ± 3.6 units vs. 18.9 ± 4.2 units, P<0.001). The incidence of coagulopathy and acute respiratory distress syndrome (ARDS) in the DCR group was significantly lower than that in the CR group (P<0.05). Conclusion: Damage control resuscitation combined with early pelvic binder fixation can effectively control hemorrhage, reduce mortality and MODS incidence, and improve the prognosis of severe pelvic fracture related hemorrhagic shock patients.

Objective: To assess the clinical impact of point of care ultrasound (POCUS) on the triage speed, diagnostic accuracy, and patient outcomes in blunt chest trauma (BCT). Methods: A retrospective observational study was conducted on 328 BCT patients admitted to our level 1 trauma center between January 2020 and December 2022. Patients were divided into the POCUS group (n=168) and the conventional assessment group (n=160) based on whether POCUS was performed during initial triage. The primary outcomes included time to definitive diagnosis, rate of unnecessary computed tomography (CT) scans, and 30 day mortality. Secondary outcomes covered length of hospital stay, ICU admission rate, and incidence of missed injuries. Results: The POCUS group had a significantly shorter time to definitive diagnosis (22.5 ± 8.6 min vs. 58.3 ± 14.2 min, P<0.001) and a lower rate of unnecessary chest CT scans (12.5% vs. 38.8%, P<0.001) compared with the conventional group. The 30 day mortality rate was 5.4% in the POCUS group and 10.6% in the conventional group (P<0.05). The incidence of missed injuries was 2.4% in the POCUS group, which was significantly lower than 8.8% in the conventional group (P<0.01). No statistically significant difference was observed in ICU admission rate between the two groups (P>0.05). Conclusion: The application of POCUS during initial triage of BCT patients can shorten diagnostic time, reduce unnecessary radiation exposure from CT scans, decrease missed injury rates, and improve short term survival outcomes.

Objective: To determine the optimal timing of antibiotic administration and its impact on surgical site infection (SSI) rates in patients with open fractures. Methods: A retrospective cohort study was conducted involving 426 patients with grade I–III open fractures admitted to a Level 1 trauma center between January 2019 and December 2023. Patients were stratified into two groups based on the time from injury to first antibiotic dose: the early group (≤1 hour, n=218) and the delayed group (>1 hour, n=208). The primary outcome was the incidence of SSI within 30 days postoperatively. Secondary outcomes included the need for revision surgery, length of hospital stay, and 90 day mortality. Results: The early antibiotic group exhibited a significantly lower SSI rate (8.3% vs. 22.1%, P<0.001) compared to the delayed group. Patients in the early group also had a lower rate of revision surgery (5.5% vs. 14.4%, P<0.01), shorter hospital stay (12.4 ± 3.1 days vs. 18.7 ± 4.2 days, P<0.001), and comparable 90 day mortality (2.3% vs. 3.4%, P>0.05). Multivariate regression analysis identified delayed antibiotic administration (>1 hour) as an independent risk factor for SSI (OR=2.89, 95% CI=1.67–5.01, P<0.001). Conclusion: Administration of antibiotics within 1 hour of injury significantly reduces SSI rates and improves clinical outcomes in open fracture trauma patients, supporting current clinical guidelines advocating for prompt antibiotic prophylaxis in this population.

Objective: To explore the efficacy and safety of hypertonic saline (HS) resuscitation compared with normal saline (NS) in patients with traumatic brain injury (TBI) complicated by hemorrhagic shock. Methods: A prospective randomized controlled trial was conducted on 296 patients with moderate to severe TBI (Glasgow Coma Scale [GCS] 3–12) and hemorrhagic shock admitted to a Level 1 trauma center from June 2020 to August 2024. Patients were randomly assigned to the HS group (n=148, 7.5% hypertonic saline) and the NS group (n=148, 0.9% normal saline). The primary outcome measures included intracranial pressure (ICP) within 72 hours after resuscitation, cerebral perfusion pressure (CPP), and 28 day mortality. Secondary outcomes covered the incidence of acute lung injury (ALI), length of intensive care unit (ICU) stay, and 6 month Glasgow Outcome Scale (GOS) score. Results: The HS group exhibited significantly lower ICP levels (18.2 ± 3.5 mmHg vs. 23.5 ± 4.1 mmHg, P<0.001) and higher CPP values (72.3 ± 5.8 mmHg vs. 65.7 ± 6.2 mmHg, P<0.001) within 72 hours compared with the NS group. The 28 day mortality rate in the HS group was 16.2% (24/148), which was significantly lower than 27.0% (40/148) in the NS group (P<0.01). The incidence of ALI was comparable between the two groups (10.8% vs. 12.8%, P>0.05). The HS group had a shorter ICU stay (11.5 ± 2.7 days vs. 15.3 ± 3.2 days, P<0.001) and a higher proportion of favorable outcomes (GOS score 4–5) at 6 months (58.1% vs. 45.3%, P<0.05). Conclusion: Hypertonic saline resuscitation can effectively reduce ICP, improve CPP, decrease short term mortality, and enhance long term neurological outcomes in patients with TBI combined with hemorrhagic shock, without increasing the risk of ALI.

Objective: To investigate the predictive value of lactate clearance rate (LCR) within 24 hours after surgery for postoperative outcomes in patients with severe abdominal blunt trauma. Methods: A retrospective cohort study was conducted on 312 patients with severe abdominal blunt trauma (American Association for the Surgery of Trauma [AAST] organ injury grade ≥ III) who underwent emergency laparotomy between January 2020 and December 2023. Venous blood lactate levels were measured on admission, at 6, 12, and 24 hours postoperatively. LCR was calculated using the formula: [(admission lactate   24 hour postoperative lactate)/admission lactate] × 100%. Patients were stratified into two groups based on an optimal LCR cutoff value (≥30% vs. <30%) identified by receiver operating characteristic (ROC) curve analysis. The primary outcome measures were 30 day postoperative mortality, incidence of multiple organ dysfunction syndrome (MODS), and length of intensive care unit (ICU) stay. Secondary outcomes included postoperative complication rate, total hospital stay, and rate of reoperation. Results: The optimal LCR cutoff value for predicting 30 day mortality was 30%, with a sensitivity of 82.3% and specificity of 76.5%. Patients with LCR ≥ 30% had significantly lower 30 day mortality (7.2% vs. 31.8%, P<0.001) and MODS incidence (10.5% vs. 42.7%, P<0.001) compared to those with LCR < 30%. Multivariate logistic regression analysis confirmed that LCR < 30% was an independent risk factor for 30 day mortality (OR=5.21, 95% CI=2.87–9.45, P<0.001) and MODS (OR=6.12, 95% CI=3.38–11.11, P<0.001). Additionally, the LCR ≥ 30% group had shorter ICU stay (5.2 ± 1.8 days vs. 12.6 ± 3.5 days, P<0.001) and total hospital stay (14.5 ± 3.2 days vs. 26.8 ± 5.7 days, P<0.001), as well as lower postoperative complication rate (18.3% vs. 53.6%, P<0.001) and reoperation rate (4.8% vs. 17.5%, P<0.001). Conclusion: Lactate clearance rate within 24 hours after surgery is a reliable and easy to obtain predictor of postoperative outcomes in patients with severe abdominal blunt trauma. An LCR < 30% indicates a high risk of adverse outcomes, and close monitoring and aggressive intervention should be implemented for these patients.

Objective: To investigate the impact of trauma team activation (TTA) time on short term and long term mortality, as well as morbidity outcomes, in patients with polytrauma. Methods: A retrospective single center cohort study was conducted on 1,246 polytrauma patients (Injury Severity Score [ISS] ≥ 16) admitted to a Level 1 trauma center between January 2018 and December 2022. TTA time was defined as the interval from patient arrival at the emergency department (ED) to the time the full trauma team was assembled and ready for patient care. Patients were stratified into three groups based on TTA time: Group A (≤ 5 minutes, n=412), Group B (6–10 minutes, n=528), and Group C (> 10 minutes, n=306). The primary outcome measures were 24 hour, 30 day, and 1 year mortality rates. Secondary outcomes included the incidence of multiple organ dysfunction syndrome (MODS), length of intensive care unit (ICU) stay, total hospital length of stay, and rate of unplanned reoperations within 30 days. Results: The 24 hour mortality rate was significantly lower in Group A (3.2%) compared to Group B (7.0%) and Group C (14.4%) (P<0.001). Similarly, 30 day mortality was 8.0% in Group A, 15.2% in Group B, and 28.1% in Group C (P<0.001), while 1 year mortality showed the same trend (12.4% vs. 21.6% vs. 36.3%, P<0.001). Multivariate logistic regression analysis confirmed that TTA time > 10 minutes was an independent risk factor for 30 day mortality (OR=3.12, 95% CI=2.01–4.85, P<0.001) and MODS (OR=2.76, 95% CI=1.89–4.02, P<0.001). Group A also had shorter ICU stay (7.2 ± 2.8 days vs. 10.5 ± 3.5 days vs. 15.8 ± 4.2 days, P<0.001) and lower unplanned reoperation rate (5.6% vs. 9.8% vs. 17.3%, P<0.001) compared to Groups B and C. Conclusion: Prolonged trauma team activation time is independently associated with increased mortality and morbidity in polytrauma patients. Reducing TTA time to ≤ 5 minutes can significantly improve clinical outcomes, highlighting the need for optimized ED workflow and trauma team response protocols.

Objective: To compare the clinical efficacy of vacuum assisted closure (VAC) therapy and traditional wet to dry dressing in the management of moderate to severe open soft tissue trauma of the lower extremity. Methods: A prospective randomized controlled trial was conducted on 196 patients with Gustilo Anderson grade II–III open soft tissue injuries of the lower extremity admitted to a Level 1 trauma center between March 2021 and April 2024. Patients were randomly assigned to the VAC group (n=98) and the traditional dressing group (n=98). The VAC group received negative pressure wound therapy (NPWT) at  125 mmHg continuous suction, while the traditional group received daily wet to dry dressing changes with normal saline soaked gauze. Primary outcome measures included wound healing time, complete wound closure rate at 8 weeks, and incidence of surgical site infection (SSI). Secondary outcomes covered frequency of dressing changes, patient reported pain score (Visual Analogue Scale, VAS), length of hospital stay, and rate of skin graft or flap surgery. Results: The VAC group exhibited significantly shorter mean wound healing time (28.5 ± 6.2 days vs. 42.3 ± 8.7 days, P<0.001) and higher 8 week complete closure rate (89.8% vs. 65.3%, P<0.001) compared with the traditional dressing group. The incidence of SSI was significantly lower in the VAC group (8.2% vs. 24.5%, P<0.001). Patients in the VAC group reported lower mean VAS pain scores (3.1 ± 1.2 vs. 5.8 ± 1.5, P<0.001) and required fewer dressing changes per week (1.2 ± 0.3 vs. 7.0 ± 0.5, P<0.001). The rate of skin graft or flap surgery was 12.2% in the VAC group, significantly lower than 30.6% in the traditional group (P<0.01). Multivariate logistic regression analysis confirmed that VAC therapy was an independent protective factor for delayed wound healing (OR=0.21, 95% CI=0.10–0.44, P<0.001) and SSI (OR=0.28, 95% CI=0.12–0.65, P<0.01). Conclusion: Vacuum assisted closure therapy significantly improves wound healing outcomes, reduces infection risk, alleviates patient pain, and decreases the need for reconstructive surgery in patients with open soft tissue trauma of the lower extremity, making it a superior alternative to traditional wet to dry dressing.

Objective: To assess the predictive value of 24 hour lactate clearance rate (LCR) for postoperative mortality, multiple organ dysfunction syndrome (MODS), and other clinical outcomes in patients with severe abdominal blunt trauma undergoing emergency laparotomy. Methods: A retrospective cohort study was conducted on 348 patients with severe abdominal blunt trauma (American Association for the Surgery of Trauma [AAST] organ injury grade ≥ III) admitted to a Level 1 trauma center from January 2021 to December 2024. Venous lactate levels were measured on admission, and at 6, 12, and 24 hours postoperatively. LCR was calculated as [(admission lactate − 24 hour lactate)/admission lactate] × 100%. Patients were stratified by the optimal LCR cutoff value (≥25% vs. <25%) determined via receiver operating characteristic (ROC) curve analysis. Primary outcomes included 30 day postoperative mortality and MODS incidence within 7 days. Secondary outcomes encompassed intensive care unit (ICU) length of stay, total hospital stay, and unplanned reoperation rate. Results: The optimal LCR cutoff for predicting 30 day mortality was 25%, with an area under the curve (AUC) of 0.83, sensitivity of 85.1%, and specificity of 78.2%. Patients with LCR ≥25% had significantly lower 30 day mortality (6.7% vs. 35.2%, P<0.001) and MODS incidence (9.2% vs. 48.1%, P<0.001) compared to those with LCR <25%. Multivariate logistic regression confirmed LCR <25% as an independent risk factor for 30 day mortality (OR=5.89, 95% CI=3.21–10.83, P<0.001) and MODS (OR=6.72, 95% CI=3.68–12.26, P<0.001). Additionally, the LCR ≥25% group had shorter ICU stay (4.8 ± 1.5 days vs. 13.2 ± 3.8 days, P<0.001), shorter total hospital stay (13.6 ± 2.9 days vs. 28.1 ± 6.2 days, P<0.001), and lower unplanned reoperation rate (4.1% vs. 18.7%, P<0.001). Conclusion: The 24 hour lactate clearance rate is a reliable, cost effective predictor of postoperative outcomes in patients with severe abdominal blunt trauma. An LCR <25% identifies patients at high risk of adverse outcomes, warranting intensified monitoring and targeted intervention.

Objective: To evaluate the efficacy and safety of prophylactic antifungal therapy in reducing invasive fungal infections (IFIs) and improving clinical outcomes in critically ill patients with severe burn and trauma. Methods: A multicenter randomized controlled trial was conducted on 426 patients with severe burn (total body surface area [TBSA] ≥ 30%) or polytrauma (Injury Severity Score [ISS] ≥ 25) admitted to 12 Level 1 trauma and burn centers across the United States from January 2022 to March 2025. Patients were randomly assigned to the prophylactic antifungal group (n=213, fluconazole 400 mg/day intravenously for 14 days) and the control group (n=213, placebo). The primary outcome measure was the incidence of proven or probable IFIs within 28 days of admission, diagnosed according to the European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) criteria. Secondary outcomes included 28 day and 90 day all cause mortality, length of intensive care unit (ICU) stay, total hospital stay, and incidence of adverse drug reactions. Results: The incidence of IFIs was significantly lower in the prophylactic antifungal group than in the control group (8.9% vs. 22.1%, P<0.001). The most common IFIs in the control group were candidemia (12.2%) and invasive pulmonary aspergillosis (5.6%). The 28 day mortality rate was 15.5% in the prophylactic antifungal group and 26.3% in the control group (P=0.002), while the 90 day mortality rate was 21.1% and 32.4% respectively (P=0.003). Multivariate logistic regression analysis confirmed that prophylactic antifungal therapy was an independent protective factor for IFIs (OR=0.32, 95% CI=0.17–0.60, P<0.001) and 28 day mortality (OR=0.46, 95% CI=0.27–0.79, P=0.005). The prophylactic antifungal group also had shorter mean ICU stay (22.5 ± 6.8 days vs. 28.7 ± 8.2 days, P<0.001) and total hospital stay (38.2 ± 9.5 days vs. 46.5 ± 11.3 days, P<0.001). The incidence of adverse drug reactions (including hepatotoxicity and electrolyte disturbances) was comparable between the two groups (7.5% vs. 6.1%, P=0.486). Conclusion: Prophylactic antifungal therapy with fluconazole significantly reduces the incidence of IFIs and improves survival in critically ill patients with severe burn and trauma, with a favorable safety profile. This intervention should be considered as a standard component of care for this high risk population.