Weekly digest
Week of 24 August 2026
35 papers collected from PubMed, last swept 24 August 2026.
Top 10
Ranked by study design, journal and study size.
Hospital-based violence intervention programs in the United States and Canada: A systematic review, meta-analysis, and practice management guideline from EAST [Update 2026]
EAST conditionally recommends hospital-based violence intervention programs (HVIPs) in urban trauma centers to reduce violent-injury recidivism (meta-analysis of 10 studies OR 0.60, 95% CI 0.38–0.94), while noting low overall evidence quality and substantial heterogeneity; centers should evaluate program design locally.
Intravenous iron to treat anaemia before cardiac surgery (ITACS): international, double blind, placebo controlled randomised trial
In 955 anaemic elective cardiac surgery patients, preoperative IV iron modestly reduced red cell transfusion (61% vs 68%) and marginally improved days alive and at home at 90 days — supporting IV iron as part of patient blood management.
Early red blood cell transfusion strategy in septic shock among patients with cancer: the TRANSPORT randomized controlled trial
In 187 cancer patients with septic shock, a liberal (Hb 9 g/dL) vs restrictive (7 g/dL) transfusion strategy gave no difference in 12-h lactate clearance or 28-day mortality, but more thrombotic events with liberal — no support for routinely preferring either strategy.
Eastern vs. Western trauma guidelines for resuscitative thoracotomy: A comparative analysis of indications, outcomes, and philosophical approaches
Across 467 resuscitative thoracotomy patients, EAST (signs of life) and WTA (prehospital arrest time) guidelines identified similar survivor subsets (survival ~6–7%, neurologically intact ~5–6%); both signs of life and arrest duration matter, supporting development of a unified RT guideline.
Global practices and attitudes in acute appendicitis management: the PAMAP-W international survey and Delphi consensus study on the WSES appendicitis grading system
Survey of 467 surgeons across 64 countries plus a WSES Delphi produced grade-linked expert statements for acute appendicitis, targeting persistent variability in stump closure, drainage, antibiotic duration and follow-up in complicated disease.
Operative and non-operative management of people with hip fracture: A modified-Delphi study to develop an international consensus
An international panel reached high consensus on 14 of 15 statements to guide shared decision-making around non-operative hip-fracture care, aimed at more consistent management of frail older adults at end of life.
Physiological comparison of high-flow oxygen via endotracheal tube and T-piece strategies during spontaneous breathing trials: a randomized crossover study
High-flow oxygen via ETT during SBTs generated flow/port-dependent airway pressure and lung-volume gains with lower driving pressure and better oxygenation than T-piece, positioning tracheal HFO as a distinct weaning strategy (clinical outcomes still unproven).
Research and Knowledge Translation Priorities for the Prehospital Care of Older Adults: A Modified Delphi Study
Multidisciplinary Delphi panel prioritised EMS research/knowledge gaps for older adults; evaluation after perceived low-acuity falls, fall prevention, clinician training, and geriatric trauma triage topped the list, offering a roadmap for prehospital geriatric care.
Defining pediatric cervical spine clearance with computed tomography: A prospective observational study by the Western Pediatric Surgery Research Consortium and Western Trauma Association
In children with blunt trauma, cervical spine CT was highly sensitive for clinically significant injury (98.7% after accounting for retrospectively identifiable injuries) with a negative predictive value of ~100%, supporting definitive pediatric c-spine clearance based on a normal CT.
Respiratory mechanics modifies the impact of ventilator settings on clinical outcome in patients with acute brain injury
In ventilated acute brain injury patients, higher tidal volume helped only when respiratory system elastance was low; optimal tidal volume falls and optimal rate rises as elastance increases, with ~1 cmH2O driving pressure ≈ 3 breaths/min in prognostic weight — argues for elastance/driving-pressure-guided settings.
By category
New Research19 papers
Tranexamic acid for neurological outcomes and mortality in adults with hemorrhagic acute brain injury: an updated systematic review and meta-analysis of randomized controlled trials
Across 7 RCTs (>12,000 adults with TBI, spontaneous ICH, or SAH), TXA did not reduce short-term (RR 0.93, 0.86–1.00) or long-term mortality (RR 1.02) and did not improve neurological outcomes; its effect on rebleeding was inconclusive and thromboembolic events were not increased. Does not support routine TXA for intracranial hemorrhagic brain injury.
Sex and mechanism-specific differences in outcomes following massive transfusion in trauma: A meta-analysis
Meta-analysis examining how patient sex and injury mechanism modify outcomes after massive transfusion in trauma — relevant to risk stratification and interpreting MT/whole-blood resuscitation trials.
The unmet need and demand of blood products in low- and middle-income countries: A systematic review and meta-analysis
SR-MA quantifying the gap between blood supply and demand across low- and middle-income countries — directly relevant to trauma/hemorrhage resuscitation capacity and transfusion access in resource-limited settings. (PubMed abstract not yet available; based on title/metadata.)
Patient-level reclassification and discordance between SOFA and SOFA-2: a multicenter ICU study
The revised SOFA-2 systematically reclassifies organ-dysfunction severity vs original SOFA; patients scored equal by one system remain heterogeneous in mortality by the other — the two provide complementary, not interchangeable, information.
Incidence rate and risk factors of ventilator-associated pneumonia in neurocritical patients with acute cerebrovascular diseases: A systematic review and meta-analysis
Meta-analysis (16 studies, 16,702 patients) found a pooled VAP incidence of 31.6% in ventilated patients with acute cerebrovascular disease; older age (≥65) and COPD were the most consistent risk factors — flagging targets for prevention in this understudied neurocritical population.
Early Surgery and Outcomes in Severe Burns: A Prospective Multicenter Observational Study
In adults with >20% TBSA burns, first excision within 48h was associated with lower adjusted 90-day mortality (aOR 2.3 for delayed excision) despite more early sepsis — supports early excision in modern burn care.
Epidemiology, associated injuries, and surgical intervention of 255,081 clavicle fractures in the United States from 2015 to 2024
Across 255,081 US clavicle fractures, incidence rose 68% over the decade with a bimodal age distribution (peaks <19 and >80) and male predominance; rib fracture was the most common associated injury (14%) and ORIF rates climbed to ~8.5%, highest in 20–29-year-olds — useful for screening associated thoracic injury and understanding shifting operative practice.
Tranexamic acid after aneurysmal subarachnoid hemorrhage is associated with worse outcome in males: post hoc analysis of the ULTRA trial
Post hoc analysis of the ULTRA trial (812 aneurysmal SAH patients) found ultra-early, short-term TXA was associated with worse 6-month functional outcome in males (aOR 1.94, 95% CI 1.20–3.14) but not in females; reinforces that routine TXA cannot be recommended in aneurysmal SAH.
Preoperative stay under 48 h after admission for proximal femur fractures is linked to fewer complications and better outcomes
Surgery within 48h of admission for proximal femur fractures was associated with lower in-hospital mortality, fewer complications and better discharge mobility (though delayed patients were higher-risk — possible confounding by indication).
A pragmatic clinical definition of traumatic shock using systolic blood pressure and shock index: A national registry study
In 47,730 Australian/NZ major-trauma patients, defining traumatic shock as SBP ≤90 mmHg or shock index >1 flagged a subgroup with ~4x higher in-hospital mortality (30.9% vs 7.4%), giving a simple, reproducible bedside definition for a condition that still lacks consensus.
Epidemiological characteristics and temporal trends of adult acute compartment syndrome from 2015 to 2025
Across a decade of US data, fasciotomy-treated ACS stayed rare and stable (~33/million), mostly lower-extremity and tied to open injuries and tibial shaft fractures, with 6% 30-day mortality — useful denominators for a limb-threatening emergency.
Intercontinental aeromedical transfers after decompressive craniectomy for severe traumatic brain injury: Systematic review and evidence-informed fitness-to-fly pathway
Evidence on flying after decompressive craniectomy for severe TBI is heterogeneous; secondary physiological insults in transit — not elapsed postop time or a fixed intracranial-air threshold — drive risk, supporting a structured defer/conditional/ready fitness-to-fly pathway.
Tele-Robotic Surgery for Combat Casualty Care: Proof of Feasibility
In cadaver experiments with surgeons 1,096 km apart, experienced robotic surgeons rapidly adapted to added telecommunication latency (up to ~378 ms) while maintaining performance — indicating satellite-based tele-robotic surgery for shipboard/combat casualty care is feasible.
Surgical stabilization of rib fractures in adult trauma patients with flail chest with or without severe traumatic brain injury: A national analysis
SSRF showed no mortality benefit over non-operative management in isolated flail chest, but in flail-chest patients with severe TBI it was linked to lower in-hospital mortality (OR 0.28) — though at the cost of longer ICU stay and more VAP/tracheostomy across both groups.
Patterns of negative trauma laparotomy worldwide: a sub-analysis of a global dataset
7.2% (1 in 14) of trauma laparotomies were negative; penetrating mechanism (OR 2.37) and lower surgeon grade (registrar vs consultant, OR 2.91) independently predicted a negative laparotomy, whereas country development index and hospital resource level did not — the authors propose negative-laparotomy rate as a trauma-system performance benchmark.
The use of Capnometry in Prehospital Intubation and Association with 30-Day Mortality: A Nationwide Registry Study
Danish registry data show prehospital capnometry was used in only ~80% of intubations but was independently associated with lower 30-day mortality (aOR 0.52); abnormal EtCO2, especially hypocapnia, tracked worse outcomes — reinforcing routine waveform capnography.
Risk stratification in older adults with rib fractures: Performance of the STUMBL score
In geriatric rib-fracture patients, higher STUMBL scores independently predicted 3-month mortality, delirium, and failure to return home; a cut-point >15 was sensitive but non-specific, so it best complements frailty/cognition assessment rather than replacing it.
Association of cerebral tissue oxygen saturation with the development of delirium in circulatory shock — a prospective observational cohort study (ASSESS-SHOCK)
In 256 circulatory shock patients, 48-hour mean cerebral tissue oxygen saturation (NIRS) did not predict delirium, but lower values were associated with higher 90-day mortality — suggesting cerebral NIRS may flag mortality risk rather than delirium.
Sex-Associated Proteomic Signatures Persist Independent of Injury Severity and Shock Physiology in Acute Trauma
In 292 highest-tier trauma activations sampled within 1 h of injury (pre-transfusion), male and female patients showed distinct early plasma proteomic signatures (e.g., FCN3, SHBG, CERU, PZP, APOD) that persisted after adjustment for age, ISS, base deficit and lactate — suggesting sex-informed "endotyping" could refine precision trauma resuscitation.
Clinical Pearl6 papers
ARDS management beyond the guidelines: a practical physiology-based approach to individualized care
Practical bedside framework for individualizing ARDS ventilation beyond guideline targets — starting settings, meeting driving-pressure goals, assessing recruitability/PEEP, and managing respiratory drive during the shift from controlled to assisted ventilation.
Ocular Complications During Prone Positioning Ventilation in Critically Ill Adults: A Systematic Review
Proned ICU patients are at risk of chemosis, exposure keratopathy and raised intraocular pressure, with lagophthalmos, deep sedation, high PEEP and prolonged proning as associated factors; heterogeneity prevents incidence estimates, but the review supports structured eye protection and repeated ocular assessment before/during/after proning.
A double-hit analysis: Evaluating the nephrotoxicity of dual intravenous and vancomycin impregnated cement exposure
In 589 fracture-related infection patients, adding postoperative IV vancomycin to vancomycin-impregnated cement did not raise AKI incidence (18.1% vs 14.5%) but did cause larger creatinine rises; AKI risk was driven mainly by pre-existing CKD. Supports cautious dual antibiotic therapy with close renal monitoring, especially in CKD.
Comparative efficacy of the femoral neck system, cannulated cancellous screws combined with medial buttress plate, and cannulated cancellous screws in femoral neck fractures in young and middle-aged adults
In 355 adults (18–65) with femoral neck fractures, adding a medial buttress plate to cannulated screws sped early functional recovery but gave no long-term advantage over FNS or CCS while adding surgical trauma; implant removal, medial cortex comminution, Pauwels III and poor reduction were the key drivers of complications — argues for individualized implant choice, not universal MBP.
Early treatment goal uncertainty as a barrier to regional analgesia and respiratory deterioration in traumatic rib fractures: a propensity-weighted analysis
In 236 ICU patients with ≥3 rib fractures, regional analgesia was associated with less respiratory deterioration than systemic-dominant analgesia (aOR 0.44); early "treatment goal uncertainty" (present in 40%) tracked with lower regional-analgesia use and worse respiratory outcomes.
Leveling the playing field: A pressure-sensing trocar improves speed and accuracy in tube thoracostomy
A pressure-sensing "ThoraSET" trocar that signals tissue layers cut chest-tube placement time and improved accuracy (79% vs 54%) mostly for less-experienced operators — an early-stage device idea to standardize an error-prone emergency procedure, pending clinical validation.