Purpose:Early mortality in major trauma has decreased,but MODS remains a leading cause of poor outcomes,driven by trauma-induced cytokine storms that exacerbate injuries and organ damage.Methods:This prospective cohor...Purpose:Early mortality in major trauma has decreased,but MODS remains a leading cause of poor outcomes,driven by trauma-induced cytokine storms that exacerbate injuries and organ damage.Methods:This prospective cohort study included 79 major trauma patients(ISS>15)treated in the National Center for Trauma Medicine,Peking University People''s Hospital,from September 1,2021,to July 31,2023.Patients(1)with ISS>15(according to AIS 2015),(2)aged 15-80 years,(3)admitted within 6 h of injury,(4)having no prior treatment before admission,were included.Exclusion criteria were(1)GCS score<9 or AIS score≥3 for TBI,(2)confirmed infection,infectious disease,or high infection risk,(3)pregnancy,(4)severe primary diseases affecting survival,(5)recent use of immunosuppressive or cytotoxic drugs within the past 6 months,(6)psychiatric patients,(7)participation in other clinical trials within the past 30 days,(8)patients with incomplete data or missing blood samples.Admission serum inflammatory cytokines and pathophysiological data were analyzed to develop machine learning models predicting MODS within 7 days.LR,DR,RF,SVM,NB,and XGBoost were evaluated based on the area under the AUROC.The SHAP method was used to interpret results.Results:This study enrolled 79 patients with major trauma,and the median(Q1,Q3)age was 51(35,59)years(52 males,65.8%).The inflammatory cytokine data were collected for all participants.Among these patients,35(44.3%)developed MODS,and 44(55.7%)did not.Additionally,2 patients(2.5%)from the MODS group succumbed.The logistic regression model showed strong performance in predicting MODS.Ten key cytokines,IL-18,Eotaxin,MCP-4,IP-10,CXCL12,MIP-3α,MCP-1,IL-1RA,Cystatin C,and MRP8/14 were identified as critical to the trauma-induced cytokine storm and MODS development.Early elevation of these cytokines achieved high predictive accuracy,with an AUROC of 0.887(95%CI 0.813-0.976).Conclusion:Trauma-induced cytokine storms are strongly associated with MODS.Early identification of inflammatory cytokine changes enables better prediction and timely interventions to improve outcomes.展开更多
The United Kingdom has a population of 67 million people and is divided into 4 nations:England,Wales,Scotland,and the North of Ireland.Healthcare is provided free to all within each nation via the National Health Serv...The United Kingdom has a population of 67 million people and is divided into 4 nations:England,Wales,Scotland,and the North of Ireland.Healthcare is provided free to all within each nation via the National Health Service(NHS),which is funded by taxes and national insurance payments.Each year,there are approximately 22,000 casesof“major trauma”in the UK across the four nations.Prior to 2010,trauma patients in the UK were managed at any acute hospital with an Emergency Department,irrespective of resource availability or clinical experience and expertise.In the late 2000s,national reports identified significant variation or serious failings in the organization of UK trauma care.These reports,together with political drivers for centralized services,led to the formation of the national major trauma system made up of regional trauma networks.England was the first nation to implement the systemin 2012 and this re-organization of major trauma care was asso ciated with a 19% increase in the odds of survivalfor patients who reached hospital alive.This paper will provide an overview of the positive attributes and challenges within 6 key components of the national trauma system:pre-hospital care,facility-based care,trauma networks,the trauma registries,rehabilitation and governance,financing,and quality assurance.展开更多
Purpose:Alcohol has been associated with 10%—35%trauma admissions and 40%trauma-related deaths globally.In response to the COVID-19 pandemic,the United Kingdom entered a state of"lockdown"on March 23,2020.R...Purpose:Alcohol has been associated with 10%—35%trauma admissions and 40%trauma-related deaths globally.In response to the COVID-19 pandemic,the United Kingdom entered a state of"lockdown"on March 23,2020.Restrictions were most significantly eased on June 1,2020,when shops and schools re-opened.The purpose of this study was to quantify the effect of lockdown on alcohol-related trauma admissions.Methods:All adult patients admitted as"trauma calls"to a London major trauma centre during April 2018 and April 2019(pre-lockdown,n=316),and 1st April—31st May 2020(lockdown,n=191)had electronic patient records analysed retrospectively.Patients’blood alcohol level and records of intoxication were used to identify alcohol-related trauma.Trauma admissions from pre-lockdown and lockdown cohorts were compared using multiple regression analyses.Results:Alcohol-related trauma was present in a significantly higher proportion of adult trauma calls during lockdown(lockdown 60/191(31.4%),vs.pre-lockdown 62/316(19.6%);(odds ratio(OR):0.83,95%CI:0.38—1.28,p<0.001).Lockdown was also associated with increased weekend admissions of trauma(lockdown 125/191 weekend(65.5%)vs.pre-lockdown 179/316(56.7%);OR:0.40,95%CI:0.79 to-0.02,p=0.041).No significant difference existed in the age,gender,or mechanism between pre-lockdown and lockdown cohorts(p>0.05).Conclusions:The United Kingdom lockdown was independently associated with an increased proportion of alcohol-related trauma.Trauma admissions were increased during the weekend when staffing levels are reduced.With the possibility of further global"waves"of COVID-19,the long-term repercussions of dangerous alcohol-related behaviour to public health must be addressed.展开更多
文摘Purpose:Early mortality in major trauma has decreased,but MODS remains a leading cause of poor outcomes,driven by trauma-induced cytokine storms that exacerbate injuries and organ damage.Methods:This prospective cohort study included 79 major trauma patients(ISS>15)treated in the National Center for Trauma Medicine,Peking University People''s Hospital,from September 1,2021,to July 31,2023.Patients(1)with ISS>15(according to AIS 2015),(2)aged 15-80 years,(3)admitted within 6 h of injury,(4)having no prior treatment before admission,were included.Exclusion criteria were(1)GCS score<9 or AIS score≥3 for TBI,(2)confirmed infection,infectious disease,or high infection risk,(3)pregnancy,(4)severe primary diseases affecting survival,(5)recent use of immunosuppressive or cytotoxic drugs within the past 6 months,(6)psychiatric patients,(7)participation in other clinical trials within the past 30 days,(8)patients with incomplete data or missing blood samples.Admission serum inflammatory cytokines and pathophysiological data were analyzed to develop machine learning models predicting MODS within 7 days.LR,DR,RF,SVM,NB,and XGBoost were evaluated based on the area under the AUROC.The SHAP method was used to interpret results.Results:This study enrolled 79 patients with major trauma,and the median(Q1,Q3)age was 51(35,59)years(52 males,65.8%).The inflammatory cytokine data were collected for all participants.Among these patients,35(44.3%)developed MODS,and 44(55.7%)did not.Additionally,2 patients(2.5%)from the MODS group succumbed.The logistic regression model showed strong performance in predicting MODS.Ten key cytokines,IL-18,Eotaxin,MCP-4,IP-10,CXCL12,MIP-3α,MCP-1,IL-1RA,Cystatin C,and MRP8/14 were identified as critical to the trauma-induced cytokine storm and MODS development.Early elevation of these cytokines achieved high predictive accuracy,with an AUROC of 0.887(95%CI 0.813-0.976).Conclusion:Trauma-induced cytokine storms are strongly associated with MODS.Early identification of inflammatory cytokine changes enables better prediction and timely interventions to improve outcomes.
文摘The United Kingdom has a population of 67 million people and is divided into 4 nations:England,Wales,Scotland,and the North of Ireland.Healthcare is provided free to all within each nation via the National Health Service(NHS),which is funded by taxes and national insurance payments.Each year,there are approximately 22,000 casesof“major trauma”in the UK across the four nations.Prior to 2010,trauma patients in the UK were managed at any acute hospital with an Emergency Department,irrespective of resource availability or clinical experience and expertise.In the late 2000s,national reports identified significant variation or serious failings in the organization of UK trauma care.These reports,together with political drivers for centralized services,led to the formation of the national major trauma system made up of regional trauma networks.England was the first nation to implement the systemin 2012 and this re-organization of major trauma care was asso ciated with a 19% increase in the odds of survivalfor patients who reached hospital alive.This paper will provide an overview of the positive attributes and challenges within 6 key components of the national trauma system:pre-hospital care,facility-based care,trauma networks,the trauma registries,rehabilitation and governance,financing,and quality assurance.
文摘Purpose:Alcohol has been associated with 10%—35%trauma admissions and 40%trauma-related deaths globally.In response to the COVID-19 pandemic,the United Kingdom entered a state of"lockdown"on March 23,2020.Restrictions were most significantly eased on June 1,2020,when shops and schools re-opened.The purpose of this study was to quantify the effect of lockdown on alcohol-related trauma admissions.Methods:All adult patients admitted as"trauma calls"to a London major trauma centre during April 2018 and April 2019(pre-lockdown,n=316),and 1st April—31st May 2020(lockdown,n=191)had electronic patient records analysed retrospectively.Patients’blood alcohol level and records of intoxication were used to identify alcohol-related trauma.Trauma admissions from pre-lockdown and lockdown cohorts were compared using multiple regression analyses.Results:Alcohol-related trauma was present in a significantly higher proportion of adult trauma calls during lockdown(lockdown 60/191(31.4%),vs.pre-lockdown 62/316(19.6%);(odds ratio(OR):0.83,95%CI:0.38—1.28,p<0.001).Lockdown was also associated with increased weekend admissions of trauma(lockdown 125/191 weekend(65.5%)vs.pre-lockdown 179/316(56.7%);OR:0.40,95%CI:0.79 to-0.02,p=0.041).No significant difference existed in the age,gender,or mechanism between pre-lockdown and lockdown cohorts(p>0.05).Conclusions:The United Kingdom lockdown was independently associated with an increased proportion of alcohol-related trauma.Trauma admissions were increased during the weekend when staffing levels are reduced.With the possibility of further global"waves"of COVID-19,the long-term repercussions of dangerous alcohol-related behaviour to public health must be addressed.
