Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 40 appraisals
Telemedicine journal and e-health : the official journal of the American Telemedicine Association
Application of Telehealth and Artificial Intelligence in Military Health Care: A Promising Combination for the Future
BACKGROUND: Military and peace-support operations increasingly depend on medical capability delivered under difficult circumstances: distance, limited number of specialists, disrupted connectivity, and mass-casualty risk. Consequently, military health care systems operate during missions in uniquely constrained and high-risk environments, ranging from remote bases and naval platforms to active combat zones and humanitarian missions. These mission contexts demand rapid, reliable, and scalable medical solutions that can function despite limited personnel, infrastructure, and connectivity. METHOD: By reviewing existing literature and considering several different programs for military health care using telehealth and artificial intelligence (AI), the key performance indicators are explored to evaluate the synergy of telehealth and AI, following its implementation. RESULTS: Telehealth has become an increasingly important component of modern health care and holds the promise of increasing access to (special) health care without moving the patient but the information. Telehealth also enables continuity of care on missions and has already demonstrated its value in extending medical expertise across distance, while AI is evolving rapidly as a powerful enabler of decision support, automation, and predictive analytics in the medical field. As AI capabilities mature, several medical specialties may benefit, particularly in medical imaging, through faster triage, more consistent interpretation, and better prioritization of scarce specialist time. It also contributes to "decision support "while making proposals based on big data, machine learning and AI (e.g., in a Trauma registry). Telehealth provides the communication backbone that preserves these interactions and enables safe use of AI-enabled support in dispersed operations. CONCLUSIONS: The convergence of telehealth and AI in military health care will lead to a strategic capability with increased efficiency and enhance readiness, resilience, access to medical care, and quality of care for military personnel, including faster and more accurate diagnoses and better patient monitoring. Both technologies (AI and telehealth) are expected to continue to advance and play an even larger role in optimizing health care in the military.
3 Aug 2026
Read appraisal →European journal of trauma and emergency surgery : official publication of the European Trauma Society
The association between pancreatic enzyme serum concentrations and blunt pancreatic trauma: a systematic review.
PURPOSE: Blunt pancreatic trauma is uncommon. When suspected, serum amylase and lipase are measured, but their diagnostic value remains uncertain. This systematic review evaluated the diagnostic performance of serum amylase and serum lipase in detecting blunt pancreatic trauma in adults. METHODS: MEDLINE, Embase, Scopus and Cochrane Central were searched for studies evaluating serum amylase and/or lipase in adults with blunt pancreatic trauma. Observational studies reporting diagnostic accuracy or clinical outcomes were included. Two reviewers independently screened studies and assessed risk of bias using the Newcastle-Ottawa Scale. RESULTS: Four observational studies met inclusion criteria. A total of 4937 patients with blunt abdominal trauma, including 150 with pancreatic injury were investigated. Two studies evaluated serum lipase alone and two compared amylase and lipase. Pancreatic injuries were graded according to the American or Japanese Association for the Surgery of Trauma. Early serum amylase measurement (< 90 min post-injury) demonstrated low sensitivity. In contrast, testing performed more than 3 h after injury has shown improved diagnostic accuracy with one study suggesting combined serum amylase and lipase testing can achieve a sensitivity of 85% and specificity of 100%. CONCLUSION: Early serum pancreatic enzymes measurement does not appear to aid initial management decisions following blunt abdominal trauma. Delayed testing (> 3-6 h), particularly using lipase or combined lipase and amylase showed improved diagnostic performance. Prospective multicentre validation is needed to define their role in guiding further imaging after equivocal or negative initial CT.
22 July 2026
Read appraisal →Scientific reports
The influence of contact body size on superficial and deep tissue pain perception for development of a collision dummy.
The use of robots is playing an increasingly important role in industrial manufacturing. Collaborative robots operated alongside humans can pose a hazard. Pain perception as an injury risk indicator is contingent on several factors, especially contact surface, anatomical region and the difference between superficial and deep tissue pain. In this article, we have conducted an experimental load study with human subjects in which we have analyzed these factors to enable the development of a pain-sensitive dummy for testing collaborative robot against biomechanical thresholds. For the load test, we used our established algometer setup with three different contact bodies (7 × 7 mm2, 14 × 14 mm2 and 24 × 24 mm2) to evaluate six anatomical regions of the arm. Subjects were instructed to activate a switch whenever they sensed pain after starting the test procedure. The algometer increased the force in 5 N/s increments. We used topical anesthetic to distinguish between superficial and deep tissue pain. We had 11 male subjects for measurements. The greatest force had to be applied with the medium-sized contact body to induce pain perception. Local anesthetization made it necessary to increase the force of the small and large contact bodies significantly. Our finding that peak force is a reliable indicator of the perception of pain caused by the medium-sized contact body indicates that the contact body's size affects peak force magnitude significantly.
17 July 2026
Read appraisal →The Journal of the American Academy of Orthopaedic Surgeons
Clinical Outcomes and Safety Profile of Open and Arthroscopic Subtalar Joint Arthrodesis: A Systematic Review
BACKGROUND: Open and arthroscopic subtalar arthrodesis are safe and effective surgeries for patients with notable arthritis; however, not an established superiority among them has been found. This systematic review aims to present all of the available literature on studies directly comparing both surgeries. METHODS: Two independent authors completed a systematic literature search using the following databases: PubMed, Embase, and the Cochrane library. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol and the Cochrane Handbook guidelines were followed. In addition, the MINORS score was used to evaluate the quality and bias of the nonrandomized controlled trials. Our search criteria included only studies that included both open and arthroscopic subtalar arthrodesis. RESULTS: A total of four studies including 125 open and 130 arthroscopic surgeries met the inclusion criteria for the current systematic review. The mean age and body mass index of patients in the open and arthroscopic groups were 50.0 ± 2.3 and 47.9 ± 1.4 years and 29.0 ± 3.7 and 29.5 ± 2.6 kg/m 2 , respectively. Patients in the open cohort and arthroscopic cohort were followed for a mean of 16.9 ± 6.5 and 15.8 ± 4.7 months, respectively. Union rate was 95.4% ± 4.6% vs. 93.6 ± 4.0%, and the time to fusion was 14 ± 1.6 vs. 10.5 ± 1.6 weeks. The overall complication rate among patients who underwent open arthrodesis was 44.0%, whereas the complication rate was 39% among patients who underwent arthroscopic arthrodesis. Patients stayed in the hospital for 2.2 ± 0.9 days following an open procedure versus 1.1 ± 0.5 days following minimally invasive procedures. CONCLUSION: The current systematic review found a high rate of union among both group of patients. Although trends suggested higher union rates and fewer complications in the arthroscopic cohort, no notable differences were found. Although limited, we hope that this systematic review may help to guide evidence-based decisions when planning the surgical management of patients with severe subtalar arthritis.
17 July 2026
Read appraisal →Hernia : the journal of hernias and abdominal wall surgery
Fasciotens® for abdominal wall closure: current evidence and clinical perspectives.
PURPOSE: Management of open abdomen (OA) and complex ventral hernias remains associated with high morbidity, prolonged hospitalization, and substantial healthcare costs. Vertical fascial traction has emerged as a novel approach aimed at facilitating early primary fascial closure. This study provides a narrative review and multidimensional overview of the available evidence regarding the Fasciotens® device, focusing on clinical outcomes, safety, economic considerations, and organizational aspects. METHODS: A narrative systematic literature review was performed to identify studies evaluating the use of Fasciotens® in adult patients with open abdomen or complex ventral hernias. Clinical, economic, organizational, and ethical domains were assessed. RESULTS: Available evidence, primarily derived from observational studies and case series, suggests that the use of Fasciotens® is associated with high rates of primary fascial closure, shorter time to closure, and reductions in intra‑abdominal pressure. Device‑related adverse events appear to be infrequent and mainly limited to minor skin‑related complications. Preliminary economic considerations indicate that earlier closure and avoidance of complex reconstructive procedures may reduce operative time, intensive care unit stay, and overall hospital resource utilization. CONCLUSION: Current evidence supports the clinical feasibility and potential value of Fasciotens® as an adjunctive technology for the management of open abdomen and complex ventral hernias. However, the available data are limited by small sample sizes and non‑comparative study designs. Further prospective and comparative studies are needed to better define its role within standardized treatment pathways.
16 July 2026
Read appraisal →PloS one
Edge-intelligent safelink-V2X: A low-latency cooperative framework for real-time vulnerable road user protection.
The protection of Vulnerable Road Users (VRUs) remains a major challenge in modern transportation safety, as onboard line-of-sight and adverse weather conditions limit conventional onboard sensors. Existing systems that rely solely on vehicle-based sensing or on isolated communication struggle to provide timely, accurate alerts in dynamic urban environments. To address these shortcomings, this paper introduces SafeLink-V2X, a comprehensive Vehicle-to-Everything Cooperative Warning Framework designed to enhance safety for pedestrians, cyclists, and scooter riders. SafeLink-V2X employs Cellular Vehicle-to-Everything (C-V2X) and Dedicated Short-Range Communications (DSRC) protocols to enable direct data exchange of location, velocity, and heading between connected vehicles, smart infrastructure, and VRUs via smartphones or wearable tags. By applying sensor fusion and machine learning-based conflict prediction, the system identifies potential collision points and issues real-time, context-aware warnings through vehicle HMIs and VRU devices, promoting immediate evasive action. Evaluation on urban intersection simulations (detailed in Section 5) demonstrates that SafeLink-V2X reduces simulated collision probability by up to 91.4%, increases situational awareness measures by 44%, and lowers end-to-end alert latency by 30% compared to baseline onboard-only and communication-only systems under the same conditions.
12 July 2026
Read appraisal →European journal of trauma and emergency surgery : official publication of the European Trauma Society
Initial surgical management of injuries to the upper extremities for patients with multiple and/or severe injuries - a systematic review and clinical practice guideline update.
PURPOSE: Our objective was to update the evidence-based and consensus-based recommendations for the initial surgical management of upper extremity injuries in patients with suspected multiple and/or severe injuries based on current evidence. This guideline topic is part of the 2025 update of the German Guideline on the Treatment of Patients with Multiple and/or Severe Injuries. METHODS: MEDLINE and Embase were systematically searched to September 2024. Further literature reports were obtained from clinical experts. Randomised controlled trials (RCTs) or observational studies reporting risk-adjusted outcomes were included if they compared early versus delayed surgical treatment for fractures, vascular injuries, or nerve injuries affecting the upper extremities in patients with multiple and/or severe injuries. Studies comparing limb salvage versus amputation or comparing amputation criteria for the upper extremities were also included. We considered patient-relevant outcomes such as mortality and limb salvage, as well as the sensitivity and specificity of scores for predicting upper extremity amputation. Risk of bias was assessed at the outcome level using ROBINS-I for observational studies and AMSTAR-2 for systematic reviews. We used available meta-analyses if possible; alternatively, we synthesised the evidence narratively. We used GRADE to rate the certainty of evidence. Expert consensus was used to develop recommendations and determine their strength. RESULTS: Among 2498 records screened for eligibility, four studies were included. Observational studies addressed the timing of humeral fixation, the timing of revascularisation, or compared limb salvage with amputation. A systematic review evaluated scoring systems for mangled upper limb salvage. Four recommendations were modified, and one consensus-based recommendation was added. All five recommendations achieved strong consensus. CONCLUSION: The timing of surgical intervention for upper extremity injuries in polytrauma patients should be individualized, based on the patient's physiological status, injury pattern, and the risks and benefits of early versus delayed surgery. Although early surgery may improve functional outcomes and reduce complications, adequate patient stabilization is essential before proceeding. Limb salvage should be attempted for patients with a MESS score of less than seven, provided the patient is sufficiently stable and depending on the condition of the amputated limb.Although the guideline addresses patients with multiple and/or severe injuries, the scarce evidence, heterogeneity of the included studies and the limited representation of true polytrauma cohorts may restrict the applicability of the findings to the broader critically injured trauma population.
10 July 2026
Read appraisal →Medicine
Artificial intelligence-guided clavicle fracture detection on plain radiographs: A retrospective diagnostic accuracy study.
Extensive research exists on artificial intelligence (AI)-assisted fracture detection in various anatomical regions, but clavicle fractures remain comparatively understudied. This study aimed to compare the diagnostic performance of AI-guided clavicle fracture detection on plain radiographs with that of an experienced orthopedic surgeon. We retrospectively analyzed all clavicle radiographs obtained at our institution between September 11,2023 and October 31,2024 following the clinical implementation of AI-guided fracture detection. Radiological findings confirmed by a senior radiologist served as the reference standard. AI performance was additionally compared with the assessments of an experienced, blinded orthopedic surgeon. Diagnostic performance metrics included accuracy, sensitivity, specificity, Cohen kappa, F1 score, and Youden index. A total of 367 clavicle radiographs were included, comprising 186 anteroposterior (AP) and 181 second-plane views. The mean patient age was 44.6 ± 26.2 years, and 59.4% were male. According to the reference standard, clavicle fractures were present in 96 AP radiographs (51.6%) and 95 second-plane radiographs (52.5%). On AP radiographs, the AI system achieved an accuracy of 97.31%, sensitivity of 95.83%, specificity of 98.89%, Cohen kappa of 0.95, and F1 score of 0.97. Diagnostic performance on second-plane radiographs was similarly high and overall comparable to that of the experienced orthopedic surgeon. This retrospective diagnostic accuracy study shows that AI-guided clavicle fracture detection is highly accurate and reliable, with performance approaching that of an experienced orthopedic surgeon. These findings support the potential role of AI as a diagnostic support tool in clavicle fracture detection, while prospective and multicenter validation remains warranted.
28 June 2026
Read appraisal →Archives of orthopaedic and trauma surgery
Association between timing of surgery and postoperative outcomes in older adults with distal femur fractures: a systematic review and meta-analysis
INTRODUCTION: The association between surgical timing and clinical outcomes in older adults with distal femur fractures remains unclear. We conducted a systematic review and meta-analysis to evaluate whether earlier surgery is associated with improved outcomes in this population. MATERIALS AND METHODS: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, two independent reviewers searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform from inception to October 8, 2024. The primary outcome was 30-day mortality, and secondary outcomes included longer-term mortality and postoperative complications. Risk of bias was assessed using the Quality in Prognosis Studies tool, and the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: Of 6,101 records screened, 16 retrospective cohort studies comprising 31,213 patients met the inclusion criteria. Early surgery was not associated with reduced 30-day mortality (adjusted odds ratio [OR]: 0.77, 95% confidence interval [CI]: 0.56-1.05; low-certainty evidence) or with longer-term mortality at 90 days (crude OR: 0.91, 95% CI: 0.51-1.60), 180 days (crude OR: 0.46, 95% CI: 0.12-1.77), or 1 year (crude OR: 0.61, 95% CI: 0.34-1.09). Similar findings were observed for postoperative complications: cardiac complications (OR: 0.71, 95% CI: 0.48-1.07), pulmonary complications (OR: 1.07, 95% CI: 0.77-1.47), and pulmonary embolism (OR: 1.14, 95% CI: 0.62-2.16). Heterogeneity across outcomes was low to moderate, and definitions of early surgery varied among studies. Overall, this meta-analysis did not demonstrate a clinically meaningful association between surgical timing and short-term clinical outcomes in older adults with distal femur fractures. Sensitivity analyses consistently suggested lower mortality with earlier surgery, likely reflecting stricter definitions of early surgery and improved control of time-related bias. CONCLUSIONS: This meta-analysis did not demonstrate a clinically meaningful association between surgical timing and short-term clinical outcomes in older adults with distal femur fractures. Given the heterogeneity in definitions and study designs, high-quality prospective studies with standardized timing are warranted.
20 June 2026
Read appraisal →European journal of trauma and emergency surgery : official publication of the European Trauma Society
Pattern of blast injuries. A systematic review: Part 2 - Landmines, unexploded ordnance and terrorism.
PURPOSE: This systematic review analyzes the patterns and distribution of blast injuries from landmine explosions, UXOs and terror attacks including suicide bombing, in civilians and military personnel. METHODS: A search was conducted in two databases on 26. March 2025 for observational studies reporting blast injuries in civilian and military populations of all ages. Studies were clustered by explosion typ. A narrative data synthesis was performed. The JBI tool for case series was used. PROSPERO: CRD42023391736. RESULTS: 126 studies were included in the overall systematic review. 45 studies on terror & suicide bombings and 12 studies on landmines & UXOs are analyzed in the present paper. Studies on landmines from 1980 to 2006 included 13,270 individuals (age: 24.0 years (Range 8.2 years - 32.2 years); mainly male (88.9%)) in post-conflict low- and middle-income countries. Lower extremity injuries including amputations were most frequent, followed by eye injuries. Studies on terrorist attacks with a total of 12,518 mainly civilian victims (average age: 33,1 years; 61.6% males) reported on incidents in post-conflict regions and high-income cities mainly from the early 2000s. The injury pattern was multidimensional, with extremity injuries most frequent (28%-30%), including fractures, lacerations, and traumatic amputations (18%-20%). CONCLUSION: This Systematic Review Part 2 on landmines and terror attacks found that extremity injuries, including traumatic amputations, are the most frequent and dominate injury. However, the injury pattern varies depending on the explosion mechanism. Landmines primarily cause lower extremity injuries, as well as eye injuries. Terror and suicide explosions exhibit multidimensional injury pattern depending on the distance and location of the explosion.
19 June 2026
Read appraisal →British journal of sports medicine
Randomised three-armed trial investigation of the Copenhagen Achilles tendon Rupture Treatment Algorithm (CARTA) for individualised treatment of acute Achilles tendon rupture
OBJECTIVE: To evaluate whether individualised treatment using the Copenhagen Achilles Rupture Treatment Algorithm (CARTA) is superior to default operative or non-operative strategies. METHODS: We conducted a multicentre, three-arm, randomised controlled trial. Adults with acute Achilles tendon rupture were randomised (1:1:1) to individualised CARTA, non-operative or operative treatment. In the CARTA arm, surgery was indicated if ultrasound showed<25% tendon overlap or ≥7% elongation. The primary outcome was the Heel-Rise Work Test (HRWT) at 12 months. Secondary outcomes included HRWT at 6 months, and at both 6 and 12 months, the Heel-Rise Height, Achilles tendon Total Rupture Score (ATRS), Tegner activity scale, Copenhagen Achilles tendon Length Measure, Achilles Tendon Resting Angle (ATRA) and complication recordings. RESULTS: Between May 2018 and June 2023, 970 patients were screened; 300 were randomised (male/female 76%/24%, mean age 41 (SD 1)). At 12 months, data were available for 98 CARTA (64% operated), 100 non-operative and 97 operative patients. There were no significant between-group differences in HRWT at 12 months. However, CARTA significantly reduced rerupture rates by 73% compared with non-operative treatment (3% (95% CI) (1 to 8) vs 11% (6 to 19), p=0.03), improved ATRS by 8 points (1 to 15, p=0.02) and improved ATRA by -2° (-4 to -1), p=0.01). No difference between CARTA and operative treatment was found except 36% less underwent surgery. CONCLUSION: Individualised CARTA did not improve functional outcomes based on the HRWT at 12 months, but among secondary outcomes, it reduced rerupture rates and improved patient-reported outcomes compared with non-operative treatment and with fewer surgeries than routine operative care. TRIAL REGISTRATION NUMBER: NCT03525964.
14 June 2026
Read appraisal →Journal of the American College of Surgeons
Improving Trauma Triage Accuracy with Large Language Models: A Comparison to Human Expert Decisions
BACKGROUND: Accurate prehospital trauma triage and communication determine morbidity, mortality, and system efficiency. Advancements in large language models (LLMs) offer an opportunity to improve triage and yet to be implemented in prehospital trauma triage. STUDY DESIGN: This retrospective cohort study evaluates LLM performance in trauma triage and accuracy of prehospital tele-communication. Of 410 pediatric activations at a Level I center (January 2023 to May 2025, IRB no. 00009569), 133 activations with emergency medical service recordings, human-generated trauma pages, and injury severity scores were analyzed. Audio was transcribed with OpenAI Whisper. Structured "Essential Transcripts" were generated with named entity recognition. Entity ablation tested redaction of triage parameters on accuracy. In a prospective arm, trauma surgeons reviewed emergency medical service transcripts and triaged activations pre- and post-LLM exposure. Cribari criteria defined over and undertriage. McNemar's test and 95% CIs assessed paired differences in accuracy. RESULTS: The primary endpoint: LLM undertriage demonstrated modest improvement; 4.8% (3 to 8.2) vs 5.1% (3.1 to 9.3, p = 0.73, Bonferroni p = 1). For secondary endpoints, LLM triage outperformed human clinicians: 83.5% accuracy (80.6 to 90.6) vs 78.9% (73.9 to 82.6, p < 0.01, Bonferroni p < 0.01), with overtriage 58.6% (51.4 to 73.7) vs 71.8% (p < 0.05, Bonferroni p < 0.09). "Essential Transcripts" reduced transcript length by 80.8% (p < 0.001) while preserving accuracy (81.9%, 76.6 to 87.5, p < 0.001, Bonferroni p < 0.05). Entity ablation had marginal effect on triage. In prospective evaluation, human triage accuracy improved after LLM exposure (73.7% [69.8 to 77.2]) to 75.8% ([71.9 to 79.2], p = 0.04, Bonferroni p = 0.12), significantly improving the odds of a correct triage decision (odds ratio 2.57, 95% CI 1.39 to 6.83, p < 0.01). CONCLUSIONS: LLMs achieve triage accuracy comparable to trauma staff in retrospective review of pediatric trauma. Further validation is needed to assess clinical outcomes, generalizability, and user acceptance before widespread deployment.
14 June 2026
Read appraisal →Neurosurgical review
Bilateral decompressive craniectomy in pediatric patients: A systematic review.
Traumatic brain injury (TBI) and other acute neurological insults remain leading causes of pediatric morbidity and mortality. In cases where elevated intracranial pressure (ICP) is refractory to maximal medical therapy, decompressive craniectomy (DC) may be considered as a salvage intervention. Although bilateral, bifrontal, bitemporal, and cruciate decompressive approaches are used in selected patients with diffuse cerebral edema or bihemispheric swelling, their role, timing, complications, and outcomes remain poorly defined in pediatric populations. Following PRISMA guidelines, PubMed, Scopus, Embase, and PubMed Central were searched for English-language studies reporting bifrontal, bitemporal, bilateral, or cruciate decompressive craniectomy in pediatric or young adult patients, defined a priori as age ≤ 21 years, with refractory intracranial hypertension from traumatic or non-traumatic etiologies. Studies were included only if the cohort met this age criterion or if pediatric/young adult outcomes could be separately extracted. Mixed-age studies without extractable pediatric/young adult data were excluded from the primary synthesis. Data regarding demographics, operative technique, timing, mortality, complications, ICP response, and functional outcomes were extracted and synthesized qualitatively because of clinical and methodological heterogeneity. Five studies met eligibility criteria for the primary pediatric/young adult synthesis, including one small randomized pilot trial and four observational cohorts. The available evidence was heterogeneous with respect to indication, ICP threshold, timing of surgery, operative technique, and outcome measurement. Bitemporal, bifrontal, bilateral, and cruciate decompressive strategies were reported primarily in selected patients with severe traumatic brain injury or diffuse cerebral swelling. Several larger pediatric decompressive craniectomy cohorts included only small bilateral or bifrontal subgroups, and outcomes were not always stratified by technique. Reported mortality, functional recovery, hydrocephalus, subgaleal collections, and need for reoperation varied across studies. Early decompression was associated with ICP reduction and favorable outcomes in limited reports, including one small randomized trial, but the evidence remains insufficient to determine comparative efficacy, optimal timing, or superiority of one bilateral decompressive approach. Bilateral, bifrontal, bitemporal, and cruciate decompressive craniectomy have been reported as feasible salvage strategies for carefully selected pediatric and young adult patients with refractory intracranial hypertension. However, current evidence is sparse, heterogeneous, and often not technique-specific. Therefore, definitive conclusions regarding efficacy, optimal timing, or superiority of one bilateral approach cannot be made. Prospective multicenter studies with standardized age definitions, ICP thresholds, operative taxonomy, complication reporting, and long-term neurocognitive outcomes are needed.
1 June 2026
Read appraisal →Journal of robotic surgery
Robot-assisted percutaneous pelvic channel screw placement for unstable pelvic ring injuries: a systematic review and meta-analysis with narrative technical comparison of multi-platform differences
Percutaneous pelvic channel screw fixation is a key technique for the minimally invasive treatment of pelvic ring injuries. Robotic-assisted systems aim to improve accuracy and reduce radiation, but direct comparative studies across platforms are lacking. This systematic review and meta-analysis primarily compares robot-assisted versus conventional fluoroscopy-guided pelvic channel screw placement, with a secondary narrative comparison of technical differences across TiRobot, Mazor X, and ROSA platforms. We systematically searched PubMed, Web of Science, Embase, Cochrane Library, CNKI, Wanfang, and CBM databases up to April 2026. Comparative studies of robot-assisted versus conventional fluoroscopy-guided pelvic channel screw placement in adult pelvic ring injury patients were included. Primary outcomes were screw accuracy (Gras classification) and radiation exposure. Secondary outcomes included operative time, functional recovery (Majeed score), complications, and cost. No direct head-to-head studies comparing different robotic platforms for pelvic screw placement were identified; therefore, platform comparisons are primarily narrative and indirect, with spine surgery data presented as hypothesis-generating only. Risk of bias was assessed using ROBINS-I and RoB-2, and evidence was graded using the GRADE system. Fifteen studies (1,247 patients, 2,893 screws) were included. Primary meta-analysis showed that robot-assisted placement significantly improved screw accuracy (excellent/good rate: 98.2% vs. 86.4%; OR = 5.32, 95%CI: 3.18-8.89, p < 0.001; GRADE: Low certainty due to risk of bias) and reduced radiation exposure (SMD=-1.84, 95%CI: -2.43 to -1.25; GRADE: Low certainty due to serious inconsistency). Operative time showed no significant difference in studies by experienced surgeons (MD=-5.2 min, 95%CI: -11.0 to 0.6). Functional outcomes (Majeed score) were comparable between groups (MD = 0.8, 95%CI: -0.7 to 2.3). Overall complications were significantly reduced with robotic assistance (OR = 0.46, 95%CI: 0.30-0.71; GRADE: Low certainty due to risk of bias). For platform comparisons, TiRobot has the strongest pelvic trauma-specific evidence from 11 studies (847 patients). Evidence for Mazor X and ROSA in pelvic trauma is limited to technical descriptions and indirect spine surgery data; no direct pelvic trauma validation is available. Robot-assisted pelvic channel screw placement is superior to conventional methods in accuracy and radiation reduction, with comparable functional outcomes and fewer complications. TiRobot demonstrates the strongest pelvic trauma-specific evidence based on available comparative studies. Mazor X and ROSA require direct pelvic trauma validation before their performance can be reliably compared. TiRobot may have lower acquisition costs in Chinese healthcare settings, but formal cost-effectiveness analyses are lacking for all platforms. Significant evidence gaps remain, including lack of high-quality RCTs, absence of direct platform comparisons in pelvic trauma, and insufficient cost-effectiveness analyses.
28 May 2026
Read appraisal →Archives of orthopaedic and trauma surgery
Comparative analysis of the improvement in shoulder rotation in complex shoulder fractures treated by reverse shoulder arthroplasty compared to open reduction and internal fixation: a systematic review and meta-analysis
PURPOSE: To compare the clinical and functional outcomes of open reduction and internal fixation (ORIF) and reverse shoulder arthroplasty (RSA) in patients aged ≥ 65 years with complex proximal humeral fractures (PHFs). METHODS: A systematic review and meta-analysis was conducted according to the PRISMA guidelines. PubMed, Web of Science, ScienceDirect, EBSCO, and the Cochrane Library were searched for randomized controlled trials (RCTs) and cohort studies published in English without date restrictions. Eligible studies compared RSA and ORIF in elderly patients with PHFs and reported functional, radiographic, or complication outcomes. Pooled data were analyzed using a random-effects model. RESULTS: Twenty-two studies involving > 34,000 patients were included. RSA was associated with greater forward flexion and a trend toward improved abduction, whereas internal rotation favored ORIF without reaching significance. No significant differences were observed in external rotation. The functional scores (Constant-Murley, Oxford Shoulder Score) were similar, and the complication and reoperation rates did not differ significantly between the groups. CONCLUSION: RSA offers modest advantages in forward flexion compared with ORIF but does not consistently improve overall functional scores or reduce complications. RSA may be preferred in elderly patients with poor bone stock or rotator cuff pathology, whereas ORIF remains appropriate for patients in whom joint preservation is feasible. High-quality RCTs with standardized outcome reporting are needed to clarify the optimal surgical management.
28 May 2026
Read appraisal →JMIR formative research
Testing a Smartphone-Based Intervention Targeting Anxiety Sensitivity Among Women Presenting for Emergency Care After Sexual Assault: Pilot Randomized Controlled Trial
BACKGROUND: Anxiety sensitivity (AS), defined as the fear of anxious arousal, is a promising therapeutic target for reducing posttraumatic stress disorder (PTSD) symptom development after trauma exposure. Initial research suggests that smartphone-based AS interventions may be acceptable to sexual assault survivors at risk for PTSD symptoms and effective for symptom reduction, but only small one-arm proof-of-concept studies have been conducted. OBJECTIVE: The goal of this study was to extend prior proof-of-concept work by conducting a pilot randomized controlled trial. The aims were to evaluate intervention efficacy, AS and PTSD symptom change, the acceptability and credibility of a control intervention, and the feasibility of a larger randomized controlled trial. METHODS: A total of 60 women with high AS presenting for emergency care after sexual assault were recruited and randomized to either the AS intervention or a control condition, and they were followed up with for over 6 months via remote self-report questionnaires. RESULTS: The findings indicated that the study population is at risk and in need of intervention: 88.8% (40/45) and 80.6% (29/36) of women sexual assault survivors in the sample met the criteria for probable PTSD at 7 weeks and 6 months post assault, respectively. Most (16/27, 59.3%) individuals receiving the AS intervention who completed it rated it as acceptable (eg, 18/21, 85.7% reported that the treatment was helpful). Early within-group reductions were not statistically significant, but by month 6, statistically significant reductions in AS and PTSD symptoms were observed in both conditions. Recruitment and retention data supported the feasibility of the study design, although some suggestions were noted for future research (eg, improving intervention and ecological momentary assessment compliance). CONCLUSIONS: This pilot study replicated the proof of concept and acceptability of a novel smartphone-based intervention targeting AS delivered to women sexual assault survivors presenting to emergency care. Intervention completion was in line with or better than traditional therapy but remained a challenge. Our selected control condition demonstrated a larger effect than expected, and we were unable to track its initiation or completion, causing difficulty in drawing conclusions. Overall, the results highlight the need for additional research.
27 May 2026
Read appraisal →Scientific reports
Impact of a structured case report on self-reported responses to simulated emergency scenarios: a randomized survey-based study
Case reports are a long-standing component of medical research, but their association with self-reported responses to simulated clinical scenarios remains underexplored. This study investigated whether exposure to a structured case report influences simulated emergency medical decisions. This randomized survey-based study was conducted among licensed physicians between March and May 2025. Participants were randomly assigned to an intervention group, which received a structured case report on blunt neck trauma, or a control group, which did not. Both groups subsequently provided self-reported Likert-scale responses to identical simulated emergency scenarios, covering five domains: local trauma consequences, accompanying injuries, diagnostic methods, airway management strategies, and hospital selection. Responses were collected on Likert scales. Group differences were assessed using Mann-Whitney U tests, t-tests, and chi-squared tests; prespecified exploratory subgroup analyses examined the moderating role of clinical experience. Sixty-three participants completed the study. Baseline demographics and qualifications did not differ significantly between groups. Exposure to the case report was associated with statistically significant differences in self-reported responses to simulated scenarios, with the most pronounced associations in airway management strategies (all five items statistically significant, median effect size r = 0.44). Intervention participants assigned higher ratings to maintaining spontaneous breathing and supraglottic airway use, while assigning lower appropriateness to endotracheal intubation and cricothyrotomy. Moderate associations were observed in diagnostic choices (e.g., pathological breath sounds, ultrasound use) and hospital selection (e.g., ECMO availability). No consistent effects were found for local or accompanying injuries. Exploratory stratified analyses revealed that junior physicians (≤ 5 years of practice) appeared more responsive, with significant differences across multiple domains and larger effect sizes (median r > 0.6). In contrast, no statistically significant between-group differences were detected in the senior (> 15 years) subgroup, although this exploratory analysis was limited by small subgroup size. Structured case reports may influence self-reported responses to simulated emergency scenarios, particularly among less experienced clinicians. These findings suggest that the educational impact of case-based learning formats may vary depending on the level of clinical experience, but do not allow conclusions about real-world clinical behavior or patient outcomes. Future work should further investigate adaptive case report formats and their potential integration into emergency medicine training.Trial registration: German Clinical Trials Register (DRKS00038961), registered von 13 January 2026.
27 May 2026
Read appraisal →Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology
Vascularized versus nonvascularized free fibular grafts in reconstruction of post-traumatic critical long bone defects, a comparative study
BACKGROUND: Reconstruction of critical-sized long bone defects is a complex orthopedic challenge. Free fibular grafts, vascularized (FVFG) and nonvascularized (NVFG), are established reconstructive options, but comparative clinical outcomes remain uncertain. PURPOSE: To compare clinical and radiological outcomes of FVFG and NVFG in patients with post-traumatic critical bone defects more than 10 cm. METHODS: A randomized controlled trial was conducted with 50 patients assigned equally to FVFG or NVFG groups. The primary outcome was time to union, while secondary outcomes included graft hypertrophy, functional scores (DASH and LEFS), complication rates, and donor site morbidity. RESULTS: The mean time to union was 5.78 months in the FVFG group and 6.17 months in the NVFG group, showing no statistically significant difference (p = 0.447). Rates of graft hypertrophy, functional recovery, and complications were comparable between the groups. CONCLUSIONS: Both FVFG and NVFG provide effective reconstruction for critical bone defects, with nearly similar healing times and functional outcomes. NVFG may represent a less complex alternative in selected cases.
26 May 2026
Read appraisal →Archives of orthopaedic and trauma surgery
Extracorporeal shockwave therapy in bone fractures: a systematic review
INTRODUCTION: The increasing incidence of fractures and cases of delayed union or nonunion has encouraged the search for non-invasive therapies. Extracorporeal shockwave therapy (ESWT) has been proposed as a strategy to stimulate bone regeneration and improve fracture healing. MATERIALS AND METHODS: A systematic review was conducted following PRISMA guidelines, with searches performed in PubMed, Scopus, Web of Science, and Embase (2005-2025). Clinical studies evaluating ESWT for fracture treatment with radiographic assessment of bone healing and the presence of a control group were included. RESULTS: A total of 834 studies were initially identified, of which 7 were included in the final analysis. Most studies demonstrated positive effects of ESWT, including improved bone healing, pain reduction, and functional recovery. However, there was considerable heterogeneity in treatment protocols and relatively small sample sizes. CONCLUSION: ESWT shows potential as a non-invasive therapy to stimulate fracture healing, particularly in cases of delayed union or nonunion. However, further controlled clinical trials and standardized protocols are needed to confirm its clinical effectiveness.
25 May 2026
Read appraisal →European journal of pediatrics
Pediatric Trauma Score (PTS) combined with blood lactate measurement provides clinical treatment guidance and prognosis prediction for children with compound injuries: a prospective study
UNLABELLED: Compound injuries in children are the leading cause of death and disability, and early and accurate assessment is crucial to optimize treatment. This study aimed to explore the clinical value of Pediatric Trauma Score (PTS) combined with blood lactate measurement in the triage, treatment guidance and prognosis prediction of pediatric compound injuries. From January 2023 to December 2024, a randomized, single-blind controlled trial was conducted in the emergency department of Hebei Provincial Children's Hospital (the only tertiary pediatric medical center in Hebei Province), China. A total of 546 children with compound injuries who presented to the hospital were included and randomly divided into the intervention group (n = 273, managed by PTS combined with dynamic monitoring of blood lactate) and the control group (n = 273, managed by PTS only). The main outcomes were the timeliness of rescue (time to critical intervention) and the accuracy of prognosis prediction (predictive effectiveness of mortality and major complications). Secondary outcomes included emergency department length of stay, unplanned Intensive Care Unit (ICU) admission, and 30-day complication rate. The median time from admission to initiation of key interventions was significantly shorter in the intervention group compared with the control group (45 [interquartile range (IQR): 30-65] min vs. 68 [IQR: 45-95] min, P < 0.001). The area under the receiver operating characteristic (ROC) curve (AUC) of the combined indicator (PTS + initial lactate) to predict 30-day mortality was 0.936 (95% CI: 0.902-0.970), which was significantly higher than PTS alone (AUC: 0.812, P < 0.001) or initial lactate (AUC: 0.855, P = 0.002). The emergency department length of stay, unplanned ICU admission rate and 30-day complication rate of the intervention group were significantly lower than those of the control group (all P < 0.05). Dynamic monitoring showed that 6-h lactate clearance < 30% was a strong independent predictor of the occurrence of multiple organ dysfunction syndrome (MODS) (odds ratio (OR) = 5.42, 95% CI: 2.88-10.21,P < 0.001. CONCLUSION: The combined application of PTS and blood lactate integrates physiological status and metabolic information, which can significantly improve the accuracy of early triage of pediatric compound injuries, guide the implementation of rescue measures, and effectively predict prognosis through dynamic monitoring, providing a reliable basis for precise personalized management. WHAT IS KNOWN: • Compound injuries in children are the leading cause of death and disability, and early and accurate assessment is crucial to optimize treatment. WHAT IS NEW: • The combined application of the Pediatric Trauma Score (PTS) and blood lactate signifi cantly improves the accuracy of early triage and 30-day mortality prediction, shortens the time to critical intervention, and reduces unplanned ICU admission and 30-day complication rates in pediatric compound injuries. • Dynamic monitoring shows that 6-hour lactate clearance 30% is a strong independent predictor of multiple organ dysfunction syndrome (MODS).
25 May 2026
Read appraisal →The journal of trauma and acute care surgery
Chilling the nerve, easing the pain?: A randomized clinical trial evaluating surgeon-administered bedside percutaneous cryoneurolysis for rib fracture pain.
BACKGROUND: A cornerstone of rib fracture management is multimodal pain control, which includes scheduled nonopioid analgesics, as-needed opioids, regional or neuraxial blockade, and surgical stabilization of rib fractures. However, adverse effect profiles and individual factors limit their use in all patients. Surgeon-administered, ultrasound-guided percutaneous cryoneurolysis performed at the patient bedside is a promising analgesic adjunct. METHODS: We performed a prospective, randomized clinical trial assessing benefit and safety of surgeon-administered percutaneous cryoneurolysis to our existing multimodal rib fracture pain control bundle (standard of care [SoC]) for injured adults aged 18 to 64 years. Patients with fractured ribs 3 to 9 were randomized within 72 hours of admission to receive either surgeon-administered, ultrasound-guided percutaneous cryoneurolysis at the bedside and our multimodal pain control bundle, or SoC alone. Patients undergoing surgical stabilization of rib fractures were excluded. The primary outcome was pain score at discharge. Secondary outcomes included hospital length of stay, intervention-associated adverse events, morphine milligram equivalent (MME) use, Short Form (SF)-12, and McGill Pain Score (Patient Reported Outcomes), which were assessed at discharge and 1-, 3-, and 12-month intervals after discharge. RESULTS: Forty-three patients were randomized: 24 in the intervention arm and 19 in the SoC arm, with 3 screen failures. The median age was 53 years (interquartile range [IQR], 45-60 years), 9 patients (23%) were female, the median Injury Severity Score was 13 (IQR, 10-17), and the median number of rib fractures was 6 (IQR, 4-8). Patients were well matched with no differences between groups. No intervention-associated adverse events were identified. Pain scores, MME use, and Patient Reported Outcomes were not different between groups at discharge, 1 month, 3 months, or 12 months. CONCLUSION: Application of surgeon-administered, ultrasound-guided percutaneous cryoneurolysis at the bedside is safe but was not associated with reduced pain or MME use when compared with SoC. ( J Trauma Acute Care Surg . 2026;100: 863-870. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level II.
23 May 2026
Read appraisal →The journal of trauma and acute care surgery
Cognitive dysfunction after polytrauma in the absence of traumatic brain injury: A systematic review of incidence.
BACKGROUND: Polytrauma patients frequently experience long-term health impacts, including cognitive impairments. While traumatic brain injury (TBI) is a recognized nonmodifiable cause, polytrauma patients are likely to face cognitive challenges potentially linked to systemic inflammation and multiple surgical interventions even in the absence of TBI. This review aims to describe the incidence and identify factors associated with cognitive dysfunction in adult multiple injury patients without Frank TBI. METHODS: A systematic search was conducted across MEDLINE, CINAHL, EMBASE, and Scopus databases on August 17, 2023, to identify studies reporting on cognitive dysfunction in adults with polytrauma, excluding brain injuries. The Critical Appraisal Skills Programme checklists guided study appraisal, and findings were narratively synthesized. RESULTS: From 2719 articles identified (including one through citation searching), 47 were fully screened, yielding 10 cohort studies for inclusion. The reported incidence of cognitive dysfunction among multiple injury patients without TBI varied widely, from 0% to 60%, with a majority (eight out of ten studies) noting incidences of 30% or higher. No consensus was found for a relationship of other studied factors with cognitive dysfunction. Injury Severity Score was found to not be associated with cognitive dysfunction in selected studies which analyzed this factor. CONCLUSION: This review suggests a high prevalence of cognitive dysfunction in multiple injury patients without TBI. The evidence base is limited by heterogeneity of the inclusion criteria, and the cognitive outcome measures. IMPLICATIONS OF KEY FINDINGS: Multiple injury is associated with long term cognitive dysfunction even without primary brain injury. This aspect of the disease of multiple injury needs further characterization to identify predictors and potential preventive and therapeutic interventions. Standardized reporting is also required to be able to monitor incidence and prevalence. ( J Trauma Acute Care Surg . 2026;100: 973-981. Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.). LEVEL OF EVIDENCE: Systematic Review; Level II.
23 May 2026
Read appraisal →Surgical and radiologic anatomy : SRA
Proximal femoral morphometry and its association with hip fracture patterns: a systematic review with meta-analysis
PURPOSES: Proximal femoral fractures (PFFs) represent a major cause of morbidity and mortality in the elderly population. Beyond bone mineral density, proximal femoral (PF) and hip joint (HJ) morphometry have been implicated in fracture susceptibility and fracture pattern. However, the relative contribution of individual geometric parameters remains incompletely defined. The purpose of this study was to systematically evaluate the association between PF and HJ morphometry and hip fracture (HF) patterns, and to assess the predictive value of radiographic morphometric parameters derived from standard anteroposterior radiographs. MATERIALS AND METHODS: A systematic review with meta-analysis was conducted in accordance with PRISMA guidelines. PubMed and MEDLINE databases were searched up to September 2025 for observational studies reporting radiographic morphometric parameters in patients with unilateral PFFs. Statistical meta-analysis was performed with random-effect models to compare intracapsular-ICF/subcapital-SCF fractures with intertrochanteric (ITF) and extracapsular (ECF) fracture patterns. RESULTS: Twenty-two studies comprising 4184 patients (77.8% female; pooled mean age 77.4 years) were included. Meta-analysis using a random-effects model revealed that ITF were significantly associated with a smaller femoral head diameter (p < 0.001) and increased medial neck cortex thickness (p = 0.021) compared with ICF. ECF demonstrated significantly longer femoral neck axis length (p = 0.012), increased horizontal offset (p = 0.048), smaller absolute offset (p = 0.026) and shorter hip axis length (p = 0.026) than ICFs. Angular parameters provided the most robust stratification. ITFs and ECFs exhibited significantly lower (more varus) neck-shaft angles (p < 0.001) and significantly higher Wiberg angles (p < 0.001) compared with the ICF group. CONCLUSIONS: PF and HJ morphometry are associated with distinct HF patterns, independently of bone mineral density. Simple linear and angular measurements obtained from standard anteroposterior radiographs may assist fracture pattern stratification, risk assessment, and preoperative planning in elderly patients.
22 May 2026
Read appraisal →JBJS reviews
Medial Parapatellar vs. Transpatellar Approach in Tibial Intramedullary Nailing: A Systematic Review and Meta-Analysis of Pain and Function
BACKGROUND: Tibial intramedullary nailing (IMN) is the standard treatment for tibial shaft fractures, yet anterior knee pain (AKP) remains common, affecting nearly 47% of patients. Despite the reported advantages of suprapatellar techniques, infrapatellar approaches-medial parapatellar (MPP) and transpatellar (TP)-remain the most commonly used methods for tibial IMN. This systematic review and meta-analysis compares MPP and TP approaches regarding pain, AKP incidence, range of motion (ROM), knee function, and fracture healing. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed, Embase, Scopus, and Web of Science were searched up to November 2024. Randomized clinical trials (RCTs) and comparative observational studies in adults undergoing tibial IMN via MPP or TP approaches were included. Outcomes were AKP incidence, pain intensity, knee function, ROM, and union-related variables. Pooled mean differences (MDs) and risk ratios (RRs) were calculated using random-effects and common-effects models. RESULTS: Twelve cohort studies (782 patients) and 9 RCTs (462 patients) were included. Across cohort studies, MPP was associated with a significantly lower AKP risk at latest follow-up (RR = 0.76 [0.63; 0.90]) and at 6 months. Visual analog scale pain at 3-month postoperative also favored MPP (MD = -1.27 [-1.94; -0.60]) but did not reach the minimal clinically important difference. RCTs demonstrated similar trends toward lower pain and AKP with MPP, but without statistical significance. Functional outcomes and ROM generally favored MPP across both study designs, though findings were inconsistent and unsuitable for pooling. Fracture healing and union rates were comparable between approaches. CONCLUSION: The MPP approach for tibial IMN was linked to a lower incidence of AKP compared with the TP approach, while offering comparable or better functional outcomes, ROM, and pain intensity. These findings suggest MPP as the preferred infrapatellar approach in appropriate clinical settings. Nonetheless, high-quality studies with standardized outcome measures are essential to validate these findings. LEVEL OF EVIDENCE: Level III (systematic review of RCTs and retrospective comparative studies). See Instructions for Authors for a complete description of levels of evidence.
21 May 2026
Read appraisal →JAMA
Using Serious Games to Increase the Implementation of Trauma Triage Guidelines: A Randomized Clinical Trial
IMPORTANCE: Low-cost methods that improve physician adherence to clinical guidelines are lacking. Trauma triage exemplifies time-sensitive conditions where guideline adherence remains at 50% or less despite stakeholder efforts, particularly when treating older adults. OBJECTIVE: To determine whether a theory-based serious game (a purpose-driven video game) improves emergency physician adherence to trauma triage guidelines for older adults. DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial recruited 800 emergency physicians responsible for the triage of Medicare fee-for-service injured patients (≥65 years of age) at emergency departments within nontrauma centers in the US. Physician enrollment began November 27, 2023, and concluded February 7, 2024. Data collection began January 1, 2024 (or the date of enrollment), and ended February 6, 2025. The patients were treated during the 1 year after physician enrollment. INTERVENTIONS: Game-based training on a tablet for an initial session of 2 hours and then a 20-minute session each quarter (4 doses; n = 400 physicians) vs usual education (n = 400 physicians). MAIN OUTCOMES AND MEASURES: The primary outcome was undertriage (defined as the proportion of severely injured patients not transferred to trauma centers) during the year after randomization. The secondary outcomes were overtriage (defined as the proportion of transferred patients with minor injuries) and a composite clinical outcome of 30-day mortality or hospital readmission. Medicare fee-for-service claims were analyzed using mixed-effects regression models. RESULTS: Of the 800 physicians, the length of experience was a median of 10 (IQR, 6-17) years in practice, 71% were male (563/789), and 750 (94%) had completed Advanced Trauma Life Support. The physicians worked at 1147 hospitals and treated 41 073 injured Medicare patients, of whom 1738 (4.2%) had severe injuries. Of the physicians in the game-based training (intervention) group, 99% (397/399) received 1 dose and 67% (268/399) received 4 doses. Physicians in the game-based training group had a lower proportion of severely injured older adults who were undertriaged (49%; 402/819) compared with the usual education (control) group (57%; 527/919) (model-adjusted difference, -7% [95% CI, -13% to -0.8%]; P = .02). The model-adjusted difference did not differ for the outcomes of overtriage (-3% [95% CI, -6% to 1%]; P = .14) and the composite outcome (-0.4% [95% CI, -5% to 4%]; P = .87). CONCLUSIONS AND RELEVANCE: Among physicians responsible for the triage of patients in emergency departments of nontrauma centers, use of a theory-based serious game decreased the proportion of severely injured patients who were undertriaged. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06063434.
20 May 2026
Read appraisal →Oral and maxillofacial surgery
Early versus delayed management of maxillofacial fractures: a systematic review and meta-analysis with context-based subgroup analysis
PURPOSE: Maxillofacial fractures are common injuries caused by traffic accidents, interpersonal violence, and falls. In resource-limited or remote settings, definitive management is often delayed due to limited diagnostic facilities, lack of surgical expertise, and referral constraints, raising concerns about increased complication rates. The current literature reports conflicting results. Some studies suggest that delayed management does not significantly affect outcomes, whereas others show higher complication rates and functional impairment. Therefore, this review aims to identify the associations between delayed management and complications. METHODS: This review followed PRISMA guidelines and was registered in PROSPERO. Observational studies published between 2005 and 2025 were systematically retrieved from PubMed, Europe PMC, ScienceDirect, and OpenAlex. Thirteen studies met the inclusion criteria, with nine included in the meta-analysis. RESULTS: Pooled analysis demonstrated no statistically significant difference in overall complication rates between delayed and early management (RR 1.07; 95% CI 0.72-1.60; p = 0.72), with no evidence of substantial publication bias. CONCLUSION: Although no significant difference in the occurrence of complications was found between delayed and early management of maxillofacial fractures, there was a tendency for complications such as infection, malunion, or nonunion to occur more frequently in the delayed management group.
19 May 2026
Read appraisal →BMJ open
Cluster-randomised-controlled trial evaluating the impact of implementing the Canadian C-Spine Rule in prehospital cervical spine trauma care by the French Emergency Medical Call Center: IPSTRAUC study - a protocol
INTRODUCTION: In France, cervical spine trauma frequently results in systematic prehospital immobilisation with a cervical collar, despite a low incidence of clinically significant injuries. This practice may lead to unnecessary discomfort, delayed care and emergency department (ED) overcrowding. The Canadian C-Spine Rule (CCR) is a validated tool for identifying patients at low risk of cervical injury but its use is currently limited to ED settings. An adapted version (CCRa) has been validated in Canada for prehospital use, demonstrating safe reduction in immobilisation rates. This study aims to evaluate the feasibility, safety and clinical impact of CCRa implementation in the French prehospital emergency setting. The objectives are to assess whether the implementation of the CCRa by French prehospital emergency teams can safely reduce unnecessary cervical spine immobilisation in stable trauma patient, optimise imaging use and decrease ED overcrowding while maintaining patient safety. METHODS AND ANALYSIS: This is multicentre, cluster-randomised-controlled trial involving 16 Emergency Medical Call Center and their affiliated prehospital emergency services in France. Each centre will be randomised to either implement the CCRa or usual care with standard immobilisation practices. Alert adult patients (18-65 years) with suspected closed cervical spine trauma and Glasgow Coma Scale score of 15 will be included. The primary outcome is the proportion of patients with suspected cervical spine trauma who are transported to the ED. Secondary outcomes include the appropriateness of cervical spine immobilisation, use of cervical imaging, ED visits for neck pain, immobilisation-related complications, healthcare costs at 30 days, and feasibility and acceptability of CCRa implementation among prehospital professionals (effectiveness-implementation hybrid type 1 design). Quantitative data will be collected during prehospital care, ED admission and follow-up at days 14 and 30, while implementation outcomes will be assessed at the end of the intervention period using questionnaires and qualitative interviews. ETHICS AND DISSEMINATION: The study has been approved by a national ethics committee (CPP), the French competent authority and registered to the French National Authorities (ID-RCB 2024-A00636-41). It is funded by the French Ministry of Health via the 2023 PREPS programme (DGOS). Results will be published in a peer-reviewed journal and presented at relevant scientific meeting. The sponsor of the study is Rennes University Hospital. The findings may support broader CCRa implementation in European EMS systems. TRIAL REGISTRATION NUMBER: NCT06983873.
14 May 2026
Read appraisal →JAMA
Intrawound Tobramycin Plus Vancomycin to Prevent Surgical Site Infection in Tibial Fractures: The TOBRA Randomized Clinical Trial
IMPORTANCE: Previous research has suggested that intrawound vancomycin powder reduces deep surgical site infections among patients with periarticular tibial fractures at high risk of infection. It is unknown whether the addition of tobramycin powder further decreases infection rates. OBJECTIVE: To compare whether the combination of tobramycin plus vancomycin vs vancomycin alone delivered as intrawound powder at the time of definitive fixation reduces deep surgical site infections. DESIGN, SETTING, AND PARTICIPANTS: Open-label, assessor-masked, randomized clinical trial conducted at 39 US trauma centers. Eligible patients were adults with an operatively treated periarticular tibial fracture (either tibial plateau or pilon) who met 1 of 3 criteria for elevated infection risk. Enrollment occurred between June 18, 2021, and December 12, 2024 (final follow-up, July 15, 2025). INTERVENTIONS: Intrawound tobramycin (1.2 g) plus vancomycin (1.0 g) powder vs intrawound vancomycin (1.0 g) powder delivered at the time of definitive fixation. MAIN OUTCOMES AND MEASURES: The primary outcome was a deep surgical site infection requiring surgical management within 182 days of definitive fracture fixation. Secondary outcomes included deep surgical site infections with pathogens that were gram-negative only, deep surgical site infections with at least 1 pathogen that was gram-positive, deep surgical site infections with polymicrobial cultures, deep surgical site infections with negative culture results, and cellulitis or skin infections treated only with antibiotics. RESULTS: Among the 1660 participants randomized, 1528 (mean age, 47.0 [SD, 14.3] years; 603 female [39.5%]; 925 male [60.5%]) were included in the primary analysis. Deep surgical site infections occurred in 51 of 753 participants (182-day probability, 7.4%) in the tobramycin plus vancomycin group and 47 of 775 participants (182-day probability, 6.6%) in the vancomycin alone group (hazard ratio, 1.11; 95% bayesian credible interval, 0.75-1.66; posterior probability of superiority, 29.7%). The threshold required for superiority was not reached for any secondary outcome. CONCLUSIONS AND RELEVANCE: Among patients with operatively treated periarticular tibial fractures at high risk of infection, adding intrawound tobramycin powder to vancomycin powder at the time of definitive fixation did not reduce deep surgical site infections compared with vancomycin powder alone. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02227446.
14 May 2026
Read appraisal →Archives of orthopaedic and trauma surgery
Defining orthoplastic limb salvage centers: a systematic review
INTRODUCTION: Limb salvage centers have increased in number over time, but lack standardized defining criteria. This systematic review aimed to assess organizational features of limb salvage centers and determine whether orthoplastic centers, in comparison to vascular limb salvage centers, represent a distinct care model that may benefit from standardization. METHODS: We conducted a systematic review of publications related to limb salvage centers by searching MEDLINE, Embase, Web of Science, and Cochrane databases from their inception through 2024. We quantified binary data extraction as a reporting score of 26 organizational features across six structural care domains for limb salvage centers, based on a validated quality measurement framework. Organizational features differentiating distinct center types were identified to establish a quality framework for orthoplastic centers. Statistical comparisons between center types were performed using appropriate tests (p < 0.05). RESULTS: Of 118 included studies, orthoplastic (n = 43) and vascular (n = 48) centers represented 77% of all studies. Recent increases in orthoplastic publications show substantial variability in organizational features. Orthoplastic center literature more frequently reported plastic surgery consultation criteria (p < 0.001), surgical outcomes (p < 0.001), and centralized network integration (p ≤ 0.006), highlighting acute reconstructive approaches. Vascular center studies documented significantly more organizational team features (p < 0.001) and quality systems (p = 0.033), reflecting established care frameworks for chronic disease management. Six organizational features characterized orthoplastic centers with > 70% prevalence, providing a benchmark framework with standardization priorities. CONCLUSION: Orthoplastic limb salvage centers demonstrate distinct care paradigms that benefit from standardization. Our findings suggest structural benchmarks to support the need for standardized development of orthoplastic limb salvage centers.
10 May 2026
Read appraisal →Journal of the American College of Surgeons
In-Hospital Mortality Prediction of Patients Requiring Extracorporeal Membrane Oxygenation Using Composite Lactate Metrics and Weight-of-Evidence Modeling
BACKGROUND: Mortality prognostication in adult patients requiring extracorporeal membrane oxygenation (ECMO) is not accurate or established. We hypothesized that composite lactate-based metrics and machine-learning models would improve in-hospital mortality prognostication compared with lactate alone in this population. STUDY DESIGN: We conducted a retrospective study of adult patients supported with ECMO at a Level I trauma center from 2022 to 2024 (N = 104). Composite metrics were generated by multiplying lactate by acid-base markers and comparing performance to lactate after Benjamini-Hochberg correction to control the false discovery rate. For machine-learning models, 3 multilayer perceptron architectures were developed using laboratory markers from a patient's hospital admission. Feature attribution through local interpretable model-agnostic explanations guided the development of a weight-of-evidence (WoE) model using only initial laboratory values. RESULTS: The composite metric of average arterial lactate × average arterial bicarbonate was the most significantly elevated marker in nonsurvivors and more significant than lactate alone (false discovery rate-adjusted p = 4.49 × 10 -4 vs 2.14 × 10 -3 ). The 100 × 50 multilayer perceptron architecture achieved 85% accuracy (95% CI 80 to 89%), 87% precision (95% CI 82% to 92%), F1 score of 0.81 (95% CI 0.74 to 0.86), and area under the curve of 0.879 (95% CI 0.84 to 0.92). Local interpretable model-agnostic explanations identified kidney replacement therapy, surrogate respiratory quotient, lactate gradient, and arterial bicarbonate as metrics incorporated in the WoE model achieving 80% accuracy (95% CI 76% to 84%), 70% precision (95% CI 63% to 77%), F1 score of 0.72 (95% CI 0.66 to 0.78), and area under the curve of 0.886 (95% CI 0.853 to 0.920). CONCLUSIONS: Composite lactate metrics and the WoE model improved in-hospital mortality prediction in patients requiring ECMO. Prospective studies and external validation are warranted to confirm these findings.
4 May 2026
Read appraisal →BMJ open
Prevalence of incidental findings requiring interventions in CT for trauma patients in the emergency department: a systematic review and meta-analysis
OBJECTIVE: To systematically review and meta-analyse the prevalence of incidental findings (IFs) requiring interventions identified in CT performed for patients with traumatic injuries in the emergency department, including pathologically confirmed cancers and emergent non-traumatic vascular pathologies. DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed, EMBASE and Cochrane CENTRAL databases from database inception to 22 November 2024. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Prospective or retrospective studies involving traumatic injury patients presented at the emergency department reporting IFs of clinical significance detected through CT with any interventions proposed were included. Studies that exclusively included paediatric populations were excluded. The systematic review methods included double-screening, dual assessment of eligibility and study validity, dual data extraction, Bayesian multivariate random-effects meta-analysis of prevalence and employing the Grading of Recommendations, Assessment, Development and Evaluations' rating for the certainty of evidence. The primary outcomes were IFs requiring any interventions, and subset IFs requiring urgent interventions. Secondary outcomes were histologically confirmed cancers and emergent non-traumatic vascular pathologies. RESULTS: 22 studies (1 with a prospective and 21 with a retrospective design) mainly from high-income countries using limited-quality data based on clinical practice involving 18 538 patients were included. 9 studies evaluated the whole body, while 13 evaluated selective body regions. The grading criteria for IFs were non-uniform, and the image interpreters involved had diverse experience and expertise. The summary prevalence estimates for IFs requiring any interventions, urgent interventions, pathologically confirmed cancers and emergent non-traumatic vascular pathologies detected in the whole body were 29.8% (95% credible interval (CrI) 20.4% to 42.9%; very low certainty), 7.6% (95% CrI 4.5% to 14.8%; low certainty), 0.6% (95% CrI 0.3% to 1.6%; moderate certainty) and 0.3% (95% CrI 0.1% to 0.9%; moderate certainty), respectively. These findings were largely identified in the chest or abdomen and pelvis, with the overall detection frequency reduced with the scanned body regions narrowed (very low to moderate certainty). Sparse data on the head, neck and spine resulted in limited results. CONCLUSIONS: IFs identified in trauma whole-body CT requiring intervention are prevalent and can lead to substantial medical costs. The widely reported prevalence range suggests variations in radiologist recommendations and reporting in clinical practice and calls for standardisations. IFs requiring urgent intervention are not rare, which leads to a diagnosis of significant diseases including cancers and urgent vascular pathologies. Future studies should report long-term, patient-relevant results based on standardised classification and reporting systems. PROSPERO REGISTRATION NUMBER: CRD42020187852.
18 Apr 2026
Read appraisal →European journal of trauma and emergency surgery : official publication of the European Trauma Society
Comparison of CATCH, PECARN and CHALICE rules in children with minor head trauma
PURPOSE: The aim of this study is to prospectively compare the diagnostic performance of the PECARN, CATCH, and CHALICE clinical decision rules in pediatric patients presenting with minor head trauma, within a rural secondary-level emergency department characterized by limited resources, high patient volume, and restricted access to specialist physicians. METHODS: The study was designed as a prospective observational study. The PECARN, CATCH, and CHALICE clinical decision rules were applied to the patients included in the study, and the data were recorded. The data included in the study were statistically analyzed using the SPSS (Statistical Package for Social Sciences; SPSS Inc., Chicago, IL) 27 program. A value of p < 0.05 was considered statistically significant. RESULTS: A total of 1,032 patients were included in the study. The PECARN did not miss any of the 15 patients with pathological brain CT and had 100% sensitivity and 52.1% specificity. CATCH failed to detect pathological brain CT in 1 patient and had 93.3% sensitivity and 53.3% specificity. CHALICE failed to detect pathological brain CT in 2 patients, with 86.7% sensitivity and 87.8% specificity. Overall, PECARN was more successful in detecting pathological brain CT, but it also had a high false-positive brain CT rate. CONCLUSION: PECARN criteria are more sensitive than other criteria in predicting brain CT pathology, but they lead to a large number of brain CT scans. While the CHALICE criteria are beneficial in reducing unnecessary brain CT scans, they may miss positive cases.
16 Apr 2026
Read appraisal →Journal of affective disorders
Development and validation of machine learning models to predict PTSD at multiple time points in hospitalized trauma patients
BACKGROUND: Posttraumatic stress disorder (PTSD) is a severe trauma-related mental disorder with high global burden. Early identification remains challenging, particularly in developing regions. Leveraging routinely collected clinical biomarkers may offer a scalable solution for timely risk detection. METHOD: This multicenter study utilized two independent prospective trauma cohorts to develop and externally validate machine learning models for predicting PTSD at 1, 3, and 6 months post-trauma. The development cohort consecutively enrolled 382 hospitalized trauma patients (Nov 2023-Dec 2024), while the external validation cohort included 204 patients (Oct 2021-Nov 2022). Predictors comprised psychosocial variables and routine clinical biochemical markers, including inflammatory indicators, liver and renal function markers, and hematological parameters. Five models were constructed (Logistic Regression, Random Forest, SVM, XGBoost, and Neural Network), with performance evaluated by AUC and feature importance interpreted via SHAP. RESULTS: Support Vector Machine achieved the best performance at 1 month (AUC = 0.84), while Random Forest models performed best at 3 and 6 months (AUC = 0.78 and 0.87). SHAP analysis indicated that ASDS were the most important predictors at all time points, with feature importance shifting over time. Acute stress and psychological state were dominant at 1 month, fearful experiences with physiological responses at 3 months, and chronic psychological burden and emotional state at 6 months. CONCLUSIONS: PTSD can be reliably predicted using psychosocial data and routine clinical biochemical markers. These findings support the integration of clinically accessible biological data into early PTSD risk screening, particularly in resource-limited settings.
15 Apr 2026
Read appraisal →Disaster medicine and public health preparedness
The Beirut Pager Explosions of 2024: A Systematic Review of an Unprecedented Mass Casualty Event
OBJECTIVE: In September 2024, Lebanon experienced an unprecedented mass casualty incident involving the simultaneous detonation of thousands of weaponized pager devices. This systematic review characterizes the resulting injury patterns, surgical burden, and disaster-response lessons to help inform future preparedness and response strategies. METHODS: PubMed, Embase, Scopus, and Web of Science were searched for studies on casualties from the pager explosions. A random-effects meta-analysis estimated pooled prevalence of injuries by body region. RESULTS: Sixteen articles met inclusion criteria overall, comprising seven studies in the clinical synthesis and nine articles in the qualitative disaster-response synthesis. A consistent injury pattern predominantly affected the hands, face, and eyes. Specialty-specific cohorts demonstrated severe ocular destruction, frequent hand amputation, and a substantial operative burden. In the two comparable hospital-based cohorts eligible for meta-analysis, upper extremity injuries were most common (pooled prevalence 84%; 95% CI: 73-91%; I2 = 0%). The incident exposed critical weaknesses in triage, communication, and specialty surge capacity. CONCLUSION: The 2024 pager explosions produced a novel injury signature distinct from conventional blast trauma. These findings, while based on limited case series, underscore the urgent need for health care systems to develop flexible, adaptive disaster plans that can respond to the unique threats of unconventional warfare.
14 Apr 2026
Read appraisal →European journal of trauma and emergency surgery : official publication of the European Trauma Society
A machine-learning-based tool for stroke risk prediction in blunt cerebrovascular injury: development and preliminary evaluation
PURPOSE: Stroke risk correlates with the Biffl grading system in blunt cerebrovascular injury (BCVI). Although anti-thrombotic therapy is the mainstay of stroke prevention, no point-of-care clinical decision-support tool exists to guide timing for therapy. We sought to develop an interactive online calculator that incorporates patient-specific demographic and injury characteristics to estimate stroke risk and risk reduction with anti-thrombotic (AT) administration. METHODS: Data from BCVI patients (n = 1,197) at a Level I Trauma Center were retrospectively collected. Six machine learning methods were employed to predict stroke risk with and without AT therapy. Class imbalance was addressed using downsampling and/or class weighting. Model performance was assessed using 10-fold cross-validation. The model was implemented as an R-based Shiny online application. RESULTS: Stroke rate among the population was 4%, and the strongest predictors for stroke were the greatest Biffl grade of carotid (aOR [95%CI] = 2.02 [1.62-2.53]) and vertebral injuries (1.44 [1.18-1.77]). The least absolute shrinkage and selection operator (LASSO) model outperformed all others, achieving 66% [33%-100%] sensitivity and 74% [62%-82%] specificity for stroke prediction, with an area under the receiver operating characteristic curve of 0.79 [0.57-0.95]. This model was integrated into an interactive online tool ( https://grady-bcvi-calc.shinyapps.io/calculator/ ), where patient demographic and injury characteristics can be used to compute baseline stroke risk and estimate stroke risk with AT. CONCLUSION: We developed and evaluated a preliminary predictive model for personalized stroke risk assessment in patients with BCVI using key risk factors. The integration of patient-specific risk-benefit assessments into clinical decision-making could optimize and reduce variability in AT therapy. External validation is warranted to prepare this tool for broad clinical applicability.
11 Apr 2026
Read appraisal →Medical science monitor : international medical journal of experimental and clinical research
Ultrasound-Guided Modified Clavipectoral Fascial Plane Block With Superficial Cervical Plexus Block for Midshaft Clavicular Surgery: A Prospective Randomized Controlled Trial
BACKGROUND This study evaluated the efficacy and safety of modified clavipectoral fascial plane block (mCPB) plus superficial cervical plexus block (SCPB) compared with interscalene brachial plexus block (ISBP) in midshaft clavicular fracture surgery. MATERIAL AND METHODS Fifty-six patients scheduled for midshaft clavicular surgery under regional anesthesia were randomly allocated to a control (ultrasound-guided ISBP plus SCPB) or experimental (mCPB plus SCPB) group at a 1: 1 ratio. The primary outcome was the Numerical Rating Scale (NRS) score at 12 hours postoperatively. Secondary outcomes were NRS scores at 4, 8, and 24 hours; rescue analgesic administration frequency; block success rate; procedural and onset times; and hemidiaphragmatic paralysis incidence. RESULTS Block success was 100% in both groups, without differences in performance time or onset time. A significant group × time interaction was observed (P<0.001). Compared with the control group, the experimental group had significantly lower NRS scores at 12 hours (estimated mean difference -1.29; P<0.001) and 24 hours (estimated mean difference -2.36; P<0.001). No significant differences occurred at 4 or 8 hours. Rescue analgesic requirements within 24 hours were significantly reduced in the experimental group (P=0.002). Hemidiaphragmatic paralysis incidences were 71.4% in the control group and 0% in the experimental group (P<0.001). CONCLUSIONS In midshaft clavicular fracture surgery, mCPB plus SCPB provided effective anesthesia with procedural characteristics comparable to ISBP, while avoiding hemidiaphragmatic paralysis and demonstrating superior analgesia at 12 and 24 hours. These findings require validation in larger multicenter trials.
8 Apr 2026
Read appraisal →Journal of special operations medicine : a peer reviewed journal for SOF medical professionals
AI-Assisted Lung Sliding Detection in Point-of-Care Ultrasound by Marine Corps Corpsmen: A Multi-Reader Study
BACKGROUND: Artificial intelligence (AI) has the potential to address training limitations and inter-operator variability that constrain the use of lung ultrasound (LUS) in austere and prehospital settings. This pilot study evaluated whether AI-based decision support could improve the diagnostic accuracy and confidence of United States Marine Corps Corpsmen in identifying absent lung sliding, a key indicator of pneumothorax, during LUS interpretation. METHODS: This pilot-prospective multi-reader, multi-case study involved five military medics, all novices in point-of-care ultrasound, each interpreting 50 de-identified LUS video clips twice, once without AI assistance (control) and once with AI assistance (ATLAS, Deep Breathe Inc., London, Canada), in randomized order with at least a 2-hour washout between sessions. Expert consensus served as a reference standard. Diagnostic performance was assessed using area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, and accuracy. Differences were analyzed using the Random-Reader Random-Case method. Per-clip reader confidence ratings were compared using the Stuart-Maxwell test. RESULTS: AI assistance significantly improved diagnostic performance across all measured outcomes. The mean AUROC increased from 0.72 (SD 0.16) without AI to 0.93 (SD 0.04) with AI (P=.03). Sensitivity rose from 0.63 (SD 0.14) to 0.90 (SD 0.09), specificity from 0.70 (SD 0.15) to 0.86 (SD 0.10), and overall accuracy from 0.67 (SD 0.10) to 0.88 (0.06) (McNemar's test, P<.001). Reader confidence also improved, with high-confidence ratings nearly doubling from 20% to 37%, and low-confidence ratings decreasing from 38% to 33%. These distributional changes were statistically significant (Stuart-Maxwell χ², P<.001). CONCLUSION: AI support markedly improved the diagnostic accuracy and confidence of novice LUS interpretation for detecting absent lung sliding. These findings suggest that real-time AI-based decision support may help improve access to high-quality LUS in military and other resource-limited care settings.
5 Apr 2026
Read appraisal →Journal of special operations medicine : a peer reviewed journal for SOF medical professionals
Combat-Related Orthopedic Trauma in the Russo-Ukrainian War: A Systematic Review
INTRODUCTION: The Russo-Ukrainian conflict has produced large numbers of military and civilian casualties, with orthopedic and musculoskeletal trauma representing a major proportion of combat injuries. Explosions, gunshots, and blast mechanisms frequently generate complex wounds that demand specialized surgical and rehabilitative management. This review summarizes injury types, mechanisms, severity, clinical responses, and gaps in current knowledge. METHODS: Following PRISMA guidelines, a comprehensive search of PubMed, Scopus, Web of Science, and MEDLINE via WoS was conducted in February 2025. Eligible studies published from 2014 to 2024 included case reports, case series, cohort studies, and observational research describing orthopedic injuries in military or civilian populations affected by the conflict. Two reviewers independently screened studies, performed quality assessments using Joanna Briggs Institute tools and STROBE criteria, and synthesized data qualitatively with descriptive statistics when available. RESULTS: Thirty-one studies were included, primarily case reports and retrospective analyses from Ukrainian military hospitals and frontline facilities. Explosive and ballistic trauma produced high-energy fractures, traumatic amputations, severe soft-tissue loss, and neurovascular damage. Management strategies included external and internal fixation, bone grafting, microsurgical reconstruction, distraction osteogenesis, and the progressive use of 3D-printed implants to support limb salvage. Rehabilitation, including pain control, physiotherapy, and prosthetic training, was essential for functional recovery. Long-term complications included neuromas, phantom pain, stump morbidity, and psychological trauma. Telemedicine enabled remote consultation and continuity of care under resource-limited conditions. CONCLUSIONS: Combat-related orthopedic injuries in this conflict require advanced surgical techniques, coordinated multidisciplinary support, and prolonged rehabilitation. Expanded data collection, standardized reporting, and long-term follow-up are essential to improve functional outcomes and reintegration.
4 Apr 2026
Read appraisal →Current opinion in anaesthesiology
Real-time, artificial intelligence-guided intraoperative resuscitation and fluid management in trauma anesthesia
PURPOSE OF REVIEW: To synthesize recent advances in intraoperative resuscitation for trauma surgery, including fluid composition, transfusion thresholds, and coagulopathy management, and to identify emerging directions that address persistent gaps in precision. Particular attention is given to prospective evidence, as forward-looking evaluations better capture real-world performance, workflow integration, and clinical impact, culminating in the integration of artificial intelligence and machine learning as the next stage of innovation. RECENT FINDINGS: Major trials over the past 5 years have refined evidence for balanced transfusion ratios, restrictive transfusion thresholds, and the transition from crystalloid to hemostatic and physiology-guided strategies. However, outcome variability underscores the need for individualized, data-driven resuscitation. Early prospective machine learning evaluations - along with the US Food and Drug Administration-cleared point-of-care systems such as APPRAISE-HRI - demonstrate that multimodal physiologic modeling can predict hemorrhage and fluid responsiveness as accurately as expert clinicians, while offering real-time monitoring and guidance. SUMMARY: The field is shifting from protocol-based to precision-guided trauma resuscitation. Future progress will rely on randomized-controlled-trial-validated, adaptive, human-in-the-loop artificial intelligence workflows that integrate continuous physiologic data with clinical judgment to enhance the timing, composition, and safety of intraoperative fluid and transfusion therapy.
4 Apr 2026
Read appraisal →Current opinion in anaesthesiology
Artificial intelligence-driven predictive analytics for postoperative management and recovery in trauma patients
PURPOSE OF REVIEW: Post-traumatic care is evolving from a reactive, protocol-driven paradigm to a predictive, personalized approach. This review examines how artificial intelligence and machine learning are redefining postoperative management by predicting complications before they manifest. RECENT FINDINGS: Recent literature (2023-2025) highlights three major advances: (a) the validation of gradient boosting algorithms (e.g. Extreme Gradient Boosting) that significantly outperform traditional scoring systems for predicting trauma-induced coagulopathy; (b) the development of interpretable, phenotype-specific models for venous thromboembolism risk stratification, particularly in traumatic brain injury; and (c) the emergence of real-time sepsis prediction tools that account for the sterile inflammation inherent to trauma. However, a recurring limitation in current research is the reliance on retrospective datasets and single-center validations, underscoring the critical need for rigorous external validation across diverse patient populations before widespread clinical adoption. SUMMARY: Artificial intelligence is not merely a monitoring tool but a driver of precision medicine in trauma. By leveraging diverse modalities, from computer vision in radiology to natural language processing in electronic health records, clinicians can now anticipate adverse events. To bridge the gap between algorithm and bedside, future efforts must focus on overcoming significant implementation barriers, such as data interoperability, and ensuring model generalizability.
4 Apr 2026
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