Cassidy D. D., Rothrock S. G., Wandling G., Myers C. T., Arwady K., Schiffert S., Trojano M., Sawyers R., Iuteri C., & Byrne C. (2025). Accuracy of the Orlando Head CT Criteria in detecting clinically significant abnormalities in patients without head trauma: A systematic review and meta-analysis. Academic Emergency Medicine, (BACKGROUND: This systematic review and meta-analysis evaluated the accuracy of the Orlando Head CT Criteria (focal deficit, altered mental status, age≥60, headache with vomiting) in predicting clinically significant abnormalities (CSAs) in ED patients without trauma. METHODS: This study followed PRISMA-DTA guidelines. Searched databases included PubMed, EMBASE, Web of Science, CINAHL, Google Scholar, and gray literature. Studies were included if they contained ED patients without trauma and analyzed accuracy of the Orlando Head CT Criteria. Summary estimates of sensitivity, specificity, diagnostic odds ratio (DOR), and likelihood ratios (LRs) were calculated using a bivariate mixed model with a random-effects approach. Risk of bias and applicability were assessed via QUADAS-2 and certainty of evidence via the GRADE framework. Heterogeneity was assessed via forest plots, a hierarchical summary receiver operating characteristic curve and subgroup analysis. Sensitivity analysis was performed using the leave-one-out method. Threshold effects were investigated via Spearman's correlation and publication bias using Deeks' funnel plot. RESULTS: Seven studies (8914 patients) were included: four prospective and three retrospective. Orlando Head CT Criteria were 98.4% (95% confidence interval [CI] 97.1%-99.1%) sensitive, 17.9% (95% CI 12.3%-25.3%, 95% CI) specific with a DOR of 13.4 (95% CI 6-29.6) and negative LR (-LR) of 0.09 (95% CI 0.04-0.19) in predicting CSA CT scans. Implementation of these criteria would have decreased CT use by 16.2% (95% CI 9.7%-23.9%). GRADE certainty of evidence was moderate. No subgroup or single study was a source of heterogeneity. There were no threshold effects (Spearman ρ = -0.26). We found no publication bias (Deeks' funnel plot asymmetry test, p = 0.71). CONCLUSION: Orlando Head CT Criteria were sensitive in detecting CSA CT scans with a low -LR. Further studies are required to assess whether these criteria can decrease CT use or augment clinical judgment for patients undergoing nontrauma cranial CT.
https://pubmed.ncbi.nlm.nih.gov/?otool=iaufhhslib&term=40396783


Breuking E. A., de Fraiture E. J., Krijgh D. D., van Wessem K., de Bruin I. G., Hietbrink F., & Ruiterkamp J. (2025). Current applications of indocyanine green fluorescence angiography in trauma patients and its potential impact: a systematic review. BMJ Open, 15(5), pp. e099755.
OBJECTIVES: Tissue viability assessment is one of the main challenges in trauma surgery. Vitality assessment using indocyanine green fluorescence angiography (ICG-FA) may improve surgical decision-making. This systematic review gives an overview of current applications of ICG-FA in surgical treatment of traumatic injury and its effects on the incidence of postoperative complications and intraoperative decision-making. DESIGN: Systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES: PubMed, EMBASE and MEDLINE were searched through 18 December 2023. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Primary research reports regarding indocyanine green (ICG)-fluorescence in patients with traumatic injury were included. Exclusion criteria were use of ICG for treatment of burn wounds, traumatic brain injury or reconstructive surgery, absence of an English or Dutch full-text and non-primary study design. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers performed the search and screening process according to standardised methods. Risk of bias was assessed using the Methodological Index for Non-Randomised Studies. Data were presented in text and overview tables. RESULTS: Thirteen studies were included, of which six were case series/reports including three or fewer patients. Within the other seven studies, 301 patients received ICG-guided surgery. ICG was used for perfusion assessment in all studies. Injury types consisted of traumatic extremity and abdominal injury. All studies reported beneficial effects such as necrosis detection, determination of resection/debridement margins and reduction of debridement procedures. ICG could improve intraoperative decision-making and significantly decrease postoperative complications. No included studies reported ICG-related complications or adverse events. CONCLUSION: The available literature regarding the use of ICG-FA in trauma surgery is limited, and comparability is low. Still, the results are promising and show a large potential of ICG-FA for better and more efficient treatment of trauma patients. Further research with larger samples and comparable conditions is thus necessary and highly recommended.
https://pubmed.ncbi.nlm.nih.gov/?otool=iaufhhslib&term=40409973


Schaechter T., Flowers S. N., Weiss M., Becker-Haimes E. M., & Sanchez A. L. (2025). Culturally Adapted Interventions for Anxiety and Trauma-Related Disorders in Marginalized Youth: A Systematic Review. Child Psychiatry and Human Development, (Treatment inequities persist among marginalized youth who experience anxiety and trauma-related disorders. Culturally adapted interventions show potential for improving outcomes for marginalized youth. However, it is unclear the extent to which they improve engagement and can be successfully implemented in practice settings. This systematic review characterizes adaptations to anxiety treatments and their effectiveness for treatment engagement, clinical, and implementation outcomes. Twelve articles met inclusion criteria. Adaptations most frequently altered treatment procedures, language, or content, and least frequently altered treatment approach or goals based on cultural conceptualizations of mental health. Most adaptations targeted racially or ethnically minoritized youth and did not target intersectionality. Adapted treatments were overall effective in reducing anxious distress, yet rigorous study designs were lacking. Engagement outcomes for adapted treatments were inconsistent, and implementation outcomes (e.g., feasibility, acceptability, fidelity) were rarely assessed. The current literature is promising yet inconclusive about the benefits of adapted treatments over standard protocols.
https://pubmed.ncbi.nlm.nih.gov/?otool=iaufhhslib&term=40397328


Abu Halimah J., Zalah A. A., Alammari A. H., Basowed S. B., Mobarki A. T., Khawaji E. A., Arishi R. A., Almohammed R. S., Almubarak A. A., & Buhulaigah B. A. (2025). Regional Nerve Blocks for Trauma Pain in the Emergency Department: A Systematic Review of Efficacy and Safety. Cureus, 17(4), pp. e82073.
Effective acute pain management in the emergency department is essential, especially for patients with fractures, dislocations, and other musculoskeletal injuries. Conventional approaches like systemic opioids and procedural sedation, while commonly used, can lead to side effects such as respiratory issues, nausea, extended emergency department stays, and potential opioid dependence. In recent years, ultrasound-guided nerve blocks have gained attention as a safer and more targeted method of pain control that can reduce reliance on opioids. This review explored how ultrasound-guided nerve blocks compare to traditional pain management strategies in terms of effectiveness, safety, and clinical outcomes. A detailed search was conducted across several major medical databases, including PubMed, Scopus, Web of Science, the Cochrane Central Register of Controlled Trials, and the Virtual Health Library. Search terms focused on ultrasound, anesthesia, nerve blocks, and emergency care. The review included only randomized controlled trials published in English that involved adult patients receiving ultrasound-guided nerve blocks for acute pain in emergency settings. The main outcomes assessed were pain relief (measured using validated scales), opioid use, time spent in the emergency department, patient satisfaction, and adverse events. Out of 3,299 studies initially identified, 2,430 remained after removing duplicates. After reviewing 60 full-text articles, nine met the inclusion criteria for analysis. The results showed that ultrasound-guided nerve blocks provided more rapid and sustained pain relief than standard treatments, with a noticeable reduction in opioid use. They were also linked to shorter emergency department stays, higher levels of patient satisfaction, and a low rate of complications when carried out by trained providers. These findings suggest that ultrasound-guided nerve blocks can be a highly effective first-line option for managing acute pain in trauma patients. Still, further studies are recommended to optimize their use and encourage broader implementation in emergency care settings.
https://pubmed.ncbi.nlm.nih.gov/?otool=iaufhhslib&term=40351990


Velu M. E., Kuiper R. M., Schok M., Sleijpen M., de Roos C., & Mooren T. (2025). Effectiveness of trauma-focused treatments for refugee children: a systematic review and meta-analyses. Eur J Psychotraumatol, 16(1), pp. 2494362.
ABSTRACTBackground: Prevalence of posttraumatic stress disorder (PTSD) in refugees is higher compared to the general population, and barriers in accessing mental health care are often experienced. With staggering numbers of people seeking refuge around the world, and 40% being 18 years or younger, effective trauma-focused therapies for refugee children with PTSD are highly needed.Objective: A systematic review and meta-analyses were conducted to provide an overview of, and to analyse, intervention studies using PTSD measures in young refugees, assessing treatment effectiveness and addressing efforts to mitigate barriers to mental health care.Method: Eleven databases were searched for studies evaluating trauma-focused treatments (TFT) for refugee children (0-18). Meta-analyses were conducted for all included studies grouped together; and second, per intervention type, using posttreatment measures and follow-up measures. Pooled between-group effect sizes (ESs) and pre-post ESs, using a random-effects model were calculated.Results: A total of 47 studies was retrieved, with 32 included in the meta-analyses. The narrative review highlighted positive outcomes in reducing posttraumatic stress symptoms for CBT-based interventions, EMDR therapy, KIDNET, and other treatments such as art therapy. Meta-analyses revealed medium pooled pre-post ESs for CBT-based interventions (ES = -.55) and large for EMDR therapy (ES = -1.63). RCT and CT studies using follow-up measures showed promising outcomes for KIDNET (ES = -.49). High heterogeneity of the included studies limited interpretation of several other combined effects. Results should be interpreted with caution due to the generally low quality of the included studies. All studies addressed efforts to minimize treatment barriers.Conclusion: More high-quality studies are urgently needed to inform treatment recommendations. Evidence-based therapies, such as CBT-based interventions, EMDR therapy, and KIDNET, demonstrate promising findings but need further replication. Strategies to overcome barriers to treatment may be necessary to reach this population.
A systematic review and meta-analysis evaluated intervention studies targeting PTSD in young refugees, analysing treatment effectiveness and barriers to mental health care.Meta-analyses revealed medium to large pre–post effect sizes for CBT-based interventions and EMDR therapy. Medium between-group effect sizes where shown for KIDNET when using follow-up measures, suggesting effectiveness over time. All studies addressed efforts to minimize treatment barriers.Due to high heterogeneity and generally low study quality, additional high-quality research is needed to inform treatment recommendations. Implementing strategies to overcome treatment barriers may be essential for effectively reaching this population.
eng
https://pubmed.ncbi.nlm.nih.gov/?otool=iaufhhslib&term=40387621


Kraus M., Gueorguiev B., Pastor T., Zderic I., Lenz M., Knobe M., Beeres F. J. P., Richards R. G., Pape H. C., & Pastor T. (2025). Evolving fracture management: the role of helical plating in orthopaedic trauma surgery - a narrative review. European Journal of Trauma and Emergency Surgery, 51(1), pp. 203.
PURPOSE: This narrative review systematically compiles and analyzes existing literature on the use of helical plates in orthopaedic trauma surgery. By synthesizing data across various study types, it provides a comprehensive overview of the biomechanical characteristics, clinical outcomes, and anatomical advantages of helical plating. METHODS: A systematic search was performed using PubMed and Web of Science databases, employing defined search terms to identify relevant studies. Single case reports were excluded, while structured case series were included. Retrieved studies were categorized into five groups: simulation studies, biomechanical studies, case series, clinical comparative studies, and anatomical studies. RESULTS: The review identified studies from 1992 to 2023, with most of the research focusing on the femur (7 studies) and humerus (6 studies). Biomechanical studies (7) were the most common, followed by clinical case series (7), comparative studies (4), and finite element analyses (3). European institutions contributed to the majority of research, with additional studies from Asia and South America. No randomized controlled trials were found. Helical plates demonstrated comparable stability to straight plates, with distinct biomechanical advantages: superior torsional resistance in femoral fractures and improved neurovascular safety in humeral fractures. CONCLUSION: Helical plates offer a viable alternative to straight plates in long bone fractures, particularly for protecting neurovascular structures. Optimal designs vary by location, with 45° helical plates recommended for humeral minimally invasive plate osteosynthesis, 180° helical plates for young patients with femoral fractures, and 90° helical plates in geriatric double plating constructs. Further high-quality research is needed to establish definitive clinical guidelines.
https://pubmed.ncbi.nlm.nih.gov/?otool=iaufhhslib&term=40353854


Yong J. H., Tan J. H., Chen J., & Hey H. W. D. (2025). Computed tomography versus magnetic resonance imaging of the cervical spine in the spinal clearance of trauma patients: a systematic review and meta-analyses. European Spine Journal, (PURPOSE: (1) Assess the proportion of trauma patients with missed cervical spine injuries that magnetic resonance imaging (MRI) identifies after a negative computed tomography (CT); (2) Perform subgroup analyses based on age and Glasgow Coma Scale (GCS) on presentation; (3) Evaluate treatment changes due to MRI findings. METHODS: This systematic review and meta-analyses was conducted with reference to the PRISMA guidelines. We included studies investigating cervical spine clearance in trauma patients using CT and MRI. Outcomes of interest included the number of injuries each modality identified, and the number of treatment changes prompted by MRI findings. Outcomes were expressed as proportions and their 95% confidence intervals (95% CI). This study is registered with PROSPERO at CRD42023490354. RESULTS: Thirty-six studies involving 6784 patients were analysed. MRI identified missed injuries in 17% of patients following a negative CT (Proportions 0.17, 95% CI 0.12-0.23). Subgroup analyses showed that paediatrics (Proportions 0.32, 95% CI 0.13-0.58) were at higher risk of missed injuries than adults (Proportions 0.13, 95% CI 0.05-0.27), and that alert patients (Proportions 0.28, 95% CI 0.13-0.48) were at higher risk of missed injuries than obtunded patients (Proportions 0.14, 95% CI 0.08-0.23). Clinically significant injuries identified on MRI prompted treatment changes in 4% of patients (Proportions 0.04, 95% CI 0.02-0.07). CONCLUSION: Trauma patients with a negative CT cervical spine had a 17% chance of missed injuries if MRI cervical spine was not performed, with paediatric and alert patients having a higher risk. These missed injuries can lead to potential morbidity and mortality if left untreated.
https://pubmed.ncbi.nlm.nih.gov/?otool=iaufhhslib&term=40407903


Mao X., Feng X., Li C., Xu X., Zhao L., Xu J., Bi L., & Yue Z. (2025). Septic shock caused by Elizabethkingia miricola in an elderly trauma patient: a case report and systematic literature review. Front Med (Lausanne), 12, pp. 1561379.
OBJECTIVE: Elizabethkingia miricola is a rarely encountered pathogen in clinical settings, predominantly causing infections in immunocompromised individuals. To advance the understanding of E. miricola infection, we present a case of E. miricola infection and conduct a literature review. METHODS: We report a case of pulmonary infection caused by E. miricola in a 90-year-old trauma patient, marking the first documented instance of treatment with eravacycline. We also conducted a systematic review of the relevant literature. A comprehensive search was performed using the PubMed and Web of Science databases up to November 2024. A qualitative synthesis was conducted on all available case reports and case series related to E. miricola infections. RESULTS: A total of 63 cases from 21 studies were included in this systematic review. According to these case reports, infections caused by E. miricola most commonly occur in the lungs (34/63), bloodstream (6/63), and urinary tract (4/63). Risk factors for E. miricola infection include immunodeficiency, prolonged hospitalization in the intensive care unit (ICU), prolonged mechanical ventilation, and the use of broad-spectrum antibiotics. Notably, a considerable proportion of cases (17/63) are hospital-acquired. CONCLUSION: Elizabethkingia miricola represents a rare but highly lethal opportunistic pathogen. Early identification and treatment with sensitive antibiotics are required to improve the prognosis of patients. The present case and literature review provide options for the diagnosis and treatment of similar cases in the future and serve as a reference for preventing and controlling the occurrence and spread of nosocomial infections. SYSTEMATIC REVIEW REGISTRATION: https://pubmed.ncbi.nlm.nih.gov/, https://www.webofscience.com/wos/.
https://pubmed.ncbi.nlm.nih.gov/?otool=iaufhhslib&term=40400627


Goldszmidt R., Chen S. P., Gewurtz R., Hand C., Ward B., & Marshall C. A. (2025). Experiences of Trauma for Older Adults With Lived and Living Experiences of Homelessness in Middle to High Income Countries: A Systematic Review and Meta-Aggregation. Gerontologist, 65(6.
BACKGROUND AND OBJECTIVES: Research has identified that the number of older adults experiencing homelessness in middle to high income countries is growing. Coincidingly, in recognition that individuals with housing precarity often have experiences of trauma, there have been increasing calls for trauma-and-violence-informed care (TVIC) in practice and research. We conducted this review to consolidate existing literature that explores experiences of trauma among older adults who have experienced homelessness. RESEARCH DESIGN AND METHODS: We conducted a systematic review of qualitative evidence and meta-aggregation following the Joanna Briggs Institute methodology, in adherence with PRISMA guidelines. RESULTS: Our search yielded 24 studies. Through a process of meta-aggregation, we generated 5 synthesized findings: (a) Being let down by society and systems; (b) the world is not a safe place; (c) survivor not victim; (d) living in the long shadow of trauma; and (e) homelessness as a deeply personal trauma. DISCUSSION AND IMPLICATIONS: Our findings underscore the reality that older adults without housing face multiple experiences of trauma, including the trauma of homelessness itself. Considering these findings, research, practice, and policies need to focus on ways to better support older adults, both in preventing trauma and assisting those who have already experienced trauma. Our findings indicate the necessity of: (a) implementing TVIC across all sectors who work with older adults; (b) supporting older adults to age in place in safe, deeply affordable, accessible housing; and (c) creating shelter environments more suitable for older adults, and especially those who have experienced trauma.
https://pubmed.ncbi.nlm.nih.gov/?otool=iaufhhslib&term=40057817


Baldini V., Gnazzo M., Varallo G., De Ronchi D., & Fiorillo A. (2025). Exploring the impact of childhood trauma on obsessive-compulsive disorder: A systematic review focused on adult populations. International Journal of Social Psychiatry, pp. 207640251339510.
BACKGROUND: Childhood trauma has been linked to various psychiatric disorders, including obsessive-compulsive disorder (OCD). However, the relationship between specific types of childhood trauma and their impact on the subtypes and severity of obsessive-compulsive symptoms remains poorly understood. This systematic review aims to consolidate current evidence on the potential associations between childhood trauma and obsessive-compulsive symptoms. METHODS: We conducted a systematic search across four electronic databases, including PubMed, Web of Science, EMBASE, and PsycINFO, to identify studies examining the relationship between childhood trauma and obsessive-compulsive symptoms. Eligible studies were screened, data extracted, and methodological quality assessed. RESULTS: The final selection consisted of 22 studies corresponding to 5603 individuals with a diagnosis of OCD (mean age: 29.8 ± 9.9 years; 52% females). The findings suggest that individuals with OCD frequently have childhood trauma. Emotional abuse and neglect were significantly associated with higher Yale-Brown Obsessive-Compulsive Scale scores and increased prevalence of religious, sexual, and aggressive obsessions. Two studies identified potential mechanisms linking trauma to OCD, including cerebellar remodeling and dysregulation of stress-response systems. CONCLUSIONS: Childhood trauma, particularly emotional abuse and neglect, appears to contribute to OCD severity and symptom specificity, with trauma histories being more pronounced in treatment-resistant cases. These findings highlight the importance of trauma-informed care in OCD assessment and treatment. Future research should address methodological heterogeneity, explore longitudinal pathways, and investigate neurobiological mechanisms to elucidate the trauma-OCD relationship further.
https://pubmed.ncbi.nlm.nih.gov/?otool=iaufhhslib&term=40365724


Liu K., Patey C., Norman P., Moellekaer A. B., Lim R., Alvarez A., & Heymann E. P. (2025). Interventions to reduce burnout in emergency medicine: a national inventory of the Canadian experience to support global implementation of wellness initiatives. Internal and Emergency Medicine, 20(4), pp. 1245-1264.
Burnout in healthcare workers is a global issue, with Emergency Medicine (EM) particularly impacted. Many countries have tried implementing wellness initiatives to reduce burnout and improve wellness. This paper summarizes interventions implemented in Canada to-date with the aim of supporting the design of wellness interventions in EDs globally. A systematic review and a grey literature search were completed in November 2023. Original studies in both English and French that included the implementation and evaluation of a wellness intervention in EDs in Canada were included. The study design, content of the intervention, target population, and outcomes were extracted and narratively analyzed. 13 studies were included. Each implemented a unique wellness intervention for EDs. All three studies (3/3, 100%) that included a structured wellness curriculum demonstrated significant improvement in burnout as measured by the Maslach Burnout Inventory, physical health (PCS-8), and Brief Resident Wellness Profile (BRWP). Other interventions included Ice Cream Rounds, therapy dogs, changing the duration of night shifts, and sessions on resilience and self-care. Our Canada-wide analysis of wellness interventions identified initiatives geared towards trainees, staff, or entire ED workface groups. Examples include educational programs, dedicated sessions for compassion literacy and resilience, critical events debriefing, and optimizing shift schedules. Structured wellness curriculums seem to be effective, and this area warrants further study. Moreover, we identify a need for global collaboration to build wellness programs and for more easily translatable standardized outcome measures for assessing the efficacy of wellness programs in EM.
https://pubmed.ncbi.nlm.nih.gov/?otool=iaufhhslib&term=39652281


Al-Kayed J., Okoli C. C., Williams L. B., Ickes M. J., & Rayens M. K. (2025). The Association Between Work- and Trauma-Related Factors and Risky Alcohol Use Among Health Care Providers: A Systematic Review. Journal of Addictions Nursing, 36(2), pp. 121-143.
BACKGROUND: About 65 million health care providers worldwide are exposed to trauma. Work-related trauma exposure is associated with risky alcohol use, which is correlated with health burdens and productivity impairments among health care providers. Hence, it is important to highlight the association between work-related trauma exposure factors and risky alcohol use among health care providers. OBJECTIVE: In this systematic review, we examined the relationship between work-related factors, trauma exposure, and risky alcohol use among health care providers. METHODS: We conducted a systematic search of PubMed, PsychINFO, and Google Scholar databases including studies published in English up to February 2024. RESULTS: Of 15 retrieved studies, researchers examined the association between work-related factors and risky alcohol use among health care providers in 10 studies. Increased burnout (work stress) was significantly associated with increased risky alcohol use among health care providers. However, there were differences between nurses/midwives and physicians in the relationship of risky alcohol use with work schedules (e.g., night shifts and hours worked). In the remaining five studies, trauma exposure increased risky alcohol use among health care providers. CONCLUSIONS: Evidence suggests that work-related factors and trauma exposure are significantly associated with risky alcohol use among health care providers. However, the extent of the association varies among health care provider specialties. Thus, it is necessary in the future to evaluate the association between work- and trauma-related factors and risky alcohol use among each specialty of health care providers, especially nursing, which represents the largest number of employees in the health sector.
https://pubmed.ncbi.nlm.nih.gov/?otool=iaufhhslib&term=40455634


Xiao K., Sayed H., Xing J., Zhang X. Y., Ai J., Teopiz K. M., Ho R., Rhee T. G., Lo H. K. Y., Guillen-Burgos H. F., Vinberg M., & McIntyre R. S. (2025). The prevalence, clinical impact, and therapeutic considerations of trauma in adults with bipolar disorder: A systematic review. Journal of Affective Disorders, pp. 119507.
BACKGROUND: Exposure to severe stressful life events (e.g., physical, sexual, emotional abuse and/or physical or emotional neglect) is common among adults with bipolar disorder (BD) and is associated with poor prognosis and clinical outcomes. This systematic review aims to evaluate the prevalence, clinical impact, and therapeutic considerations of trauma in adults with BD. METHODS: A systematic review of primary research was conducted using Embase, PsycInfo, MEDLINE, and PubMed databases from inception to January 2025, following PRISMA criteria. Sixteen human studies evaluating the prevalence, clinical impact, and therapeutic considerations of trauma in adults with BD were included. RESULTS: Prevalence rates of trauma range from approximately 40-60 % of adults with BD. Childhood physical maltreatment is highly associated with comorbidities and symptom severity in adults with BD. Childhood emotional maltreatment is associated with an earlier age of onset, greater illness severity, comorbidity and suicidality in BD. The moderating effects of trauma in BD treatment response across disparate modalities of treatment are not adequately characterized. CONCLUSIONS: Trauma, particularly childhood trauma, is prevalent and has a severe negative clinical impact on the presentation, progression, treatment, and outcomes of adults with BD. The research strategic priority is to characterize the biosignature of trauma in BD, the impact of trauma on treatment outcomes, and to empirically evaluate integrated models of care in persons with BD with a history of trauma.
https://pubmed.ncbi.nlm.nih.gov/?otool=iaufhhslib&term=40449746


Shafi S. Q., Audei W., Shaw A. V., Fullilove S., Rodrigues J. N., & Wormald J. C. R. (2025). The risk of surgical site infection for hand trauma surgery performed outside main theatres: a systematic review and meta-analysis. Journal of Hand Surgery, European Volume, pp. 17531934251345358.
Increasing pressure on healthcare systems and limited emergency operating capacity has reduced the availability of main theatres for hand trauma surgery. This has led to an increase in hand trauma surgery performed outside the main theatre (OMT). Data on the risk of surgical site infection (SSI) in the OMT setting for hand trauma are limited. This systematic review and meta-analysis summarize the risk of SSI for hand trauma surgery in this setting. We included seven studies involving 1635 patients. The meta-analysis suggests an SSI risk of 2.8%, which is a lower estimate than the overall risk of SSI in hand trauma surgery. Hand trauma surgery performed OMT is not associated with an increased risk of SSI compared with existing summary estimates. This supports recent guidelines from the British Society for Surgery of the Hand, and Getting It Right First Time programme.
https://pubmed.ncbi.nlm.nih.gov/?otool=iaufhhslib&term=40439078


Kartiko S., Atahar J., Rattan R., Zebley J. A., Tatebe L. C., Perea L., Ruggiero K. J., Levett P., Wassertzug D., Koenig S., Mashbari H., Smith R. N., Hink A. B., Allee L., Ortiz D., Hai S. A., Butler C., Prince H., Murphy P., & Teichman A. L. (2025). Posttraumatic stress disorder mitigation in trauma patients: An evidence-based systematic review from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg, (BACKGROUND: Because of advances in trauma care, there has been increased survival among trauma patients. However, less progress has been made to address posttraumatic psychological disorders. Many trauma patients (19-42%) report emotional or psychological distress after injury, and over one in five will develop posttraumatic stress disorder (PTSD) and/or depression within the first postinjury year. We aim to establish a practice management guideline using a systematic review to provide guidance on early identification of individuals at risk for PTSD and evidence-based treatment options to assist our patients to mitigate the development of PTSD. METHODS: Clinically relevant questions regarding screening of and intervention for PTSD in adult trauma patients with clearly defined patient Population(s), Intervention(s), Comparison(s), and appropriately selected Outcomes were determined. A systematic literature review was conducted for the period of January 1, 1996, to September 9, 2023. The quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation methodology. The working group reached consensus on the final evidence-based recommendations. RESULTS: The literature search yielded 9,387 studies, of which 25 met the criteria for inclusion. Screening and interventions were mostly successful in the identification and management of acute stress disorder/PTSD. The use of cognitive behavioral therapy was the most successful therapy, especially when used with high-risk individuals. CONCLUSION: We conditionally recommend screening to identify patients at risk for PTSD during their initial hospitalization. We strongly recommend the use of cognitive behavioral therapy for mitigation of PTSD. LEVEL OF EVIDENCE: Systematic Review/Meta-analysis; Level II.
https://pubmed.ncbi.nlm.nih.gov/?otool=iaufhhslib&term=40358601


Solarczyk J., Ciminero M., Sprague S., Vallier H. A., & Morshed S. (2025). Nonpharmacological interventions to reduce posttraumatic stress disorder, depression, or anxiety symptoms after trauma: A systematic review and meta-analysis. J Trauma Acute Care Surg, (BACKGROUND: Recent novel digital interventions may be transformative in overcoming persistent barriers to access in-person psychological therapies. OBJECTIVE: This study aimed to synthesize evidence from randomized controlled trials (RCTs) of nonpharmacological interventions that prevents or treats anxiety, depression, or posttraumatic stress disorder (PTSD) among civilians recovering from physical traumatic injury. METHODS: We searched PubMed, Embase, Web of Science, PsychINFO, Cochrane Central Register of Controlled Trials, and Google Scholar for articles since inception to December 28, 2023. We performed English-language RCTs of patients 18 years or older who sustained a physical injury and were assessed for symptoms of PTSD, depression, or anxiety within 1 year of injury. Dual reviewers performed screening for advancement to full-text review, data extraction, and final eligibility for systematic review and meta-analysis, and conflicts were resolved by the senior author. Meta-analysis used random effects. The primary outcome was standardized mean difference (SMD) between intervention and comparator groups. RESULTS: We identified 3,001 articles for title and abstract review. Overall, nonpharmacological interventions significantly prevented or treated PTSD (pooled SMD, -0.71; 95% confidence interval [CI], -1.06 to -0.36), depression (pooled SMD, -0.42; 95% CI, -0.68 to -0.17), and anxiety (pooled SMD, -0.69; 95% CI, -1.01 to -0.37). Cognitive behavioral therapy (CBT) was associated with decreased symptoms of PTSD (pooled SMD, -1.10; 95% CI, -1.54 to -0.66), depression (pooled SMD, -0.87; 95% CI, -1.22 to -0.52), and anxiety. Non-CBT significantly reduced anxiety (pooled SMD, -0.40; 95% CI, -0.74 to -0.07). Collaborative care, non-CBT, and digital treatments failed to reach significance for PTSD and depression. CONCLUSION: Our systematic review and meta-analysis of RCTs suggest efficacy of CBT for PTSD, depression, and anxiety and non-CBT for anxiety, after physical trauma. LEVEL OF EVIDENCE: Systematic Review and Meta-analysis; Level III.
https://pubmed.ncbi.nlm.nih.gov/?otool=iaufhhslib&term=40434848


Appelbaum R. D., Yorkgitis B., Rosen J., Butts C. A., To J., Knight A. W., Zhang J., Kirsch J. M., Levin J. H., Riera K. M., Kelley K. M., Carter K. T., Sawhney J. S., Mukherjee K., Metz T. D., Fiorentino M. N., Cantrell S., Sapp A., Potgieter C. J., Kasotakis G., Como J. J., & Freeman J. (2025). Trauma in pregnancy: A systematic review, meta-analysis, and practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg, (BACKGROUND: The care of the injured pregnant patient presents unique challenges. There is no consensus on how best to approach certain aspects of injury during pregnancy. In this review, we aim to clarify the current care of the injured pregnant patient by reviewing the existing literature guided by clinical experience. METHODS: Clinically relevant questions regarding the management of pregnant trauma patients with defined Population, Intervention, Comparison, and Outcomes (PICOs) were determined specific to resuscitative hysterotomy (RH), fetal monitoring, pregnancy-specific laboratory tests, imaging, and timing of fetal evaluation. A systematic literature review and meta-analysis were conducted using Grading of Recommendations Assessment, Development, and Evaluation methodology. Appropriate studies that met the inclusion criteria did not exist for PICO1 on RH and PICO5 on timing of fetal evaluation. We therefore relied on a literature review and expert consensus to address these PICOs. RESULTS: Sixteen studies were identified for systematic review, and a subset was deemed appropriate for meta-analysis. In trauma patients with pregnancies (estimated gestational age, ≥20 weeks) undergoing resuscitative thoracotomy for traumatic arrest, we conditionally recommend RH as soon as possible. In trauma patients with viable pregnancies, we conditionally recommend a formal observation period of at least 4 to 6 hours. In trauma patients with viable pregnancies, we cannot recommend for or against pregnancy-specific laboratory tests and nonionizing radiation imaging being performed. The workgroup suggests that possible effects of ionizing radiation exposure should not prevent medically indicated diagnostic imaging. Kleihauer-Betke testing should be performed in patients who are Rh negative to determine an appropriate dose of Rh D immunoglobulin. In trauma patients with viable pregnancies, we conditionally recommend that fetal assessment should be performed at the end of the primary survey after a rapid maternal evaluation. CONCLUSION: This work summarizes the best available evidence pertaining to the management of trauma in pregnancy, as the best early treatment of the fetus is the optimal resuscitation of the mother. LEVEL OF EVIDENCE: Systematic Review/Meta-analysis; Level III.
https://pubmed.ncbi.nlm.nih.gov/?otool=iaufhhslib&term=40454982


Yates Z., Lee P., Zagales R., Tweedie C., Dourvetakis K., Hus A., Amin Q., Rogers L., & Elkbuli A. (2025). Assessment of Volume and Fluid Resuscitation Strategies for Critically Ill Geriatric Trauma Patients: A Systematic Review. Journal of Trauma Nursing, (OBJECTIVE: This study aims to evaluate fluid resuscitation strategies including volume assessment measures, conservative versus aggressive fluid resuscitation, and multifocal fluid resuscitation protocols in critically ill geriatric trauma patients. DATA SOURCES: A comprehensive search was conducted across five databases including PubMed, Google Scholar, ProQuest, Embase, and Cochrane. STUDY SELECTION: Studies were included based on their relevance to volume assessment measures, conservative versus aggressive fluid resuscitation, and multifocal fluid resuscitation protocols in critically ill geriatric trauma patients. DATA EXTRACTION: A total of 14 studies met the inclusion criteria. Outcomes of interest included mortality, intensive care unit length of stay, ventilator days, and in-hospital complications. DATA SYNTHESIS: The initial query identified 1,257 studies, and after inclusion/exclusion criteria, a total of 14 studies were evaluated. On average, serum lactate levels above 2.5 mmol/L were found to be significantly associated with mortality. Conservative approaches to fluid resuscitation that were on average <1,500 cc were also found to decrease mortality and incur no increase in in-hospital complications. Additionally, goal-oriented geriatric fluid resuscitation protocols utilizing multiple measures for hemodynamic stability were found to reduce mortality in patients following the implementation of the protocol. CONCLUSION: Serum lactate level kept on average below 2.5 mmol/L has shown to be an effective volume assessment measure and associated with decreased mortality. Additionally, conservative fluid resuscitation with volume maintained on average <15,000 cc was also associated with decreased mortality compared to aggressive fluid resuscitation measures. Lastly, goal-oriented geriatric fluid resuscitation protocols that aimed to maintain multiple volume assessment measures were associated with decreased mortality and complication rates. Implementation of these protocols has the potential to significantly improve outcomes in this vulnerable population.
https://pubmed.ncbi.nlm.nih.gov/?otool=iaufhhslib&term=40424396


Armstrong H., Whitehurst J., Morris R. K., Hodgetts Morton V., & Man R. (2025). Antibiotic prophylaxis for childbirth-related perineal trauma: A systematic review and meta-analysis. PloS One, 20(5), pp. e0323267.
INTRODUCTION: Childbirth-related perineal trauma affects the vast majority of women who give birth vaginally and subsequent complications such as wound infection occur frequently. Antibiotic prophylaxis is not currently recommended following first or second degree tears, or episiotomies. We aimed to evaluate the effectiveness of prophylactic antibiotics for preventing complications from perineal trauma across all types of childbirth-related perineal trauma. MATERIALS AND METHODS: Databases were searched from inception to February 2024. Randomised controlled trials, non-randomised interventional studies and observational studies were eligible for inclusion where women experienced childbirth-related perineal trauma and received antibiotic prophylaxis or placebo, including any type of tear or episiotomy. The primary outcome was perineal wound infection. Results were combined into meta-analysis using a random effects model. RESULTS: 14 studies were eligible for inclusion (eight randomised controlled trials, six observational) involving 8,878 women. Ten studies were deemed to have a high overall risk of bias. Overall the GRADE certainty of findings were low. Twelve studies were included in the analysis for perineal wound infection, involving 8,438 women. There was a reduced rate of perineal wound infection when prophylactic antibiotics were received (relative risk 0.57, 95% confidence interval 0.48 to 0.67). The subgroup analysis by type of tear demonstrated association with reduced risk of infection when prophylactic antibiotics were received, in the non-obstetric anal sphincter injuries combined subgroup (relative risk 0.50, 95% confidence interval 0.41-0.63) and the episiotomy only subgroup (relative risk 0.57, 95% confidence interval 0.36-0.91). CONCLUSIONS: Prophylactic antibiotics are associated with a reduced risk of perineal wound infection. Despite these findings, there are not sufficient high-quality randomised controlled trials to adequately inform guideline change amongst women with first/second degree tears or episiotomies. We recommend that an adequately powered, robust, randomised controlled trial is needed amongst women with first/second degree tears or episiotomies after spontaneous birth.
https://pubmed.ncbi.nlm.nih.gov/?otool=iaufhhslib&term=40344566


Dawood R., Vosper J., Gibson S., & Irons C. (2025). How do people with a history of sexual abuse experience talking therapies for sexual trauma? A systematic review of qualitative findings. Psychology and Psychotherapy, 98(2), pp. 211-231.
OBJECTIVES: This systematic review investigated the qualitative experiences of sexual abuse survivors in talking therapy treatments with respect to the helpful and hindering aspects of therapy. METHODS: Searches were conducted on five databases; PubMed, Web of Science, PyscInfo, PsycArticles and PsycExtra and through searching reference lists. Papers were included where they provided qualitative primary data of client experiences of therapy, did not involve specialist clinical populations and were written in English. Papers were included irrespective of whether study participants had experienced sexual abuse in childhood, adulthood or both. Studies were appraised using the Critical Appraisal Skills Programme (CASP) qualitative checklist. Meta-study was used to analyse the results. RESULTS: Four themes were generated: (1) helpful therapy relies on choice, autonomy, and the freedom to choose when to speak and what to speak on, (2) engagement relies on considerations of the complexity of recovery from sexual abuse, (3) feeling cared for and connected with the therapist is important and (4) a sensitive and thoughtful end of therapy can bring positive holistic emotional and lifestyle changes. CONCLUSIONS: This study provides clinical insights into the helpful aspects of therapy, facilitating a safe therapeutic engagement, and managing an effective and sensitive transition into recovery. These themes are considered in relation to understanding supportive factors in therapy.
https://pubmed.ncbi.nlm.nih.gov/?otool=iaufhhslib&term=39887817


Ferrada P., Shafique S., Brenner M., Burlew C., Catena F., Coleman J., Coleman J., Demetriades D., Demoya M., Di Saverio S., Dissanaike S., Dransfield T., DuBose J., Duchesne J., Elkbuli A., Foianini E., Gambardella J., Garcia A., Goldberg A., Goralnick E., Holcomb J., Jonathan M., Joseph B., Jacobs L., Kerby J., Lawerance R., Leichtle S., Lucas C., Machain G., Macleod J., Maher Z., Martin M., Mendez N., Menegozzo C., Merlini I., Namias N., Narayan M., Ordonez C., Ottolino P., Patel M., Qasim Z. A., Quiodettis M., Young L. S., Ratnasekera A., Rayburn D., Salamea J., Sarani B., Scalea T., Seamon M., Spain D., Steele P., Taghavi S., Tatebe L., Vega F., Velmahos G., Zakrison T., Biffl W. L., Damaskos D., Coccolini F., Vallicelli C., Moore E. E., Ansaloni L., & Kluger Y. (2025). Prioritizing circulation over airway to improve survival in trauma patients with exsanguinating injuries: a world society of emergency surgery-panamerican trauma consensus statement. World Journal of Emergency Surgery, 20(1), pp. 47.
INTRODUCTION: Hemorrhage is one of the leading causes of preventable death in trauma patients. For decades, the Airway-Breathing-Circulation (ABC) approach has been the cornerstone of trauma care. However, emerging evidence suggests that prioritizing airway management in exsanguinating patients may worsen hypotension and increase mortality. This systematic review and meta-analysis aim to evaluate the effectiveness of the Circulation-Airway-Breathing (CAB) approach compared to the traditional ABC sequence in improving survival in trauma patients with severe hemorrhage. METHODS: A systematic review was conducted in accordance with the PRISMA guidelines. Databases including PubMed and Ovid MEDLINE, SCOPUS, web of science and EMBASE were searched for studies published up to September 2024. Eligible studies included observational and comparative studies reporting outcomes of trauma patients with exsanguinating hemorrhage. The Newcastle-Ottawa Scale was used for risk of bias assessment. A meta-analysis was performed using a random-effects model to calculate pooled odds ratios (OR) for mortality, with 95% confidence intervals (CI). Subgroup analysis was conducted to compare the ABC and CAB approaches in prospective and retrospective studies. RESULTS: Six studies (N = 11,855 patients) met the inclusion criteria. The meta-analysis revealed a significant increase in mortality associated with the ABC approach (pooled OR: 3.65, 95% CI: 1.74-7.65). Subgroup analysis of prospective cohort studies found an even higher mortality risk (POR: 9.99, 95% CI: 5.59-17.85) when compared with POR of retrospective studies (POR: 2.42, 95%CI: 1.08-5.36). High heterogeneity (I2 = 92%) was observed across the studies, likely due to variations in patient populations and resuscitation protocols. CONCLUSION: Prioritizing circulation over airway management in trauma patients with exsanguinating injuries significantly reduces mortality compared to the traditional ABC approach. The present consensus paper, conducted according to the WSES methodology(3), aims to provide a review of the literature comparing the CAB approach to the traditional ABC sequence in trauma patients with exsanguinating hemorrhage, to develop a shared consensus statement based on the currently available evidence.
https://pubmed.ncbi.nlm.nih.gov/?otool=iaufhhslib&term=40457450