Weekly digest
Week of 31 August 2026
42 papers collected from PubMed, last swept 31 August 2026.
Top 10
Ranked by study design, journal and study size.
American Association for the Surgery of Trauma/American College of Surgeons Committee on Trauma clinical protocol for nutrition support in adult trauma
New AAST/ACS-COT protocol standardizes nutrition in adult trauma: screen all for malnutrition, use indirect calorimetry in the critically ill, start early enteral feeds once resuscitation is complete (continuous gastric, post-pyloric if high aspiration risk), reserve parenteral nutrition for enteral contraindications, and individualize enteral timing in shock/vasopressors given mesenteric ischemia risk; immunonutrition, glutamine, and pro/prebiotics are not recommended.
Evidence-based, cost-effective management of empyema and chylothorax: JTACS Emergency General Surgery Algorithms work group
New EGS work-group algorithm giving a standardized, cost-conscious diagnostic and management pathway for empyema and chylothorax — a practical decision aid for acute-care surgeons.
Early mobilization for mechanical ventilation for sepsis or acute respiratory failure (EVER): a multicenter randomized controlled trial with 12-month outcomes
In 169 ventilated patients (sepsis/acute respiratory failure) across 5 Korean ICUs, a protocolized six-step early mobilization program did not improve functional status (FSS-ICU) at ICU discharge or patient-reported outcomes at 12 months vs usual care, despite earlier/more mobilization; a signal that only patients reaching higher mobilization steps (sit-to-stand+) had better function suggests dose/achievement, not protocol assignment, may matter.
Safety recommendations on laboratory and blood count values for early mobilization in critically ill adults: an expert consensus
Delphi consensus of 24 ICU experts sets lab/blood-count thresholds for safe early mobilization (hemoglobin, platelets, lactate, INR, pH, potassium), recommends deferring mobilization during transfusion, and flags Hb drop ≥2 g/dL/24h or platelet fall ≥20%/24h as contraindications.
Prehospital Blood Transfusion Coalition: framework for EMS Blood Program Coordinator responsibilities
PHBTC (aligned with AABB) formally defines the scope and duties of EMS Blood Program Coordinators/Managers — storage and transport validation, continuous component monitoring, standardized education, regulatory compliance, and interagency coordination — to make civilian prehospital whole-blood programs safe and reproducible across diverse EMS systems.
Effectiveness of protein in critical illness: why observational studies and RCTs disagree
Older observational data linking high protein intake to lower ICU mortality likely reflect statistical artefacts (immortal-time, confounding-by-indication, collider bias, etc.); recent RCTs (EFFORT 2023, PRECISe 2024, TARGET Protein 2025) show no benefit — a useful reminder to weight the trials over the cohorts when setting ICU protein targets.
ICU-specific virtual reality for mental health after critical illness: an international three-arm randomized clinical trial
A single ICU-specific VR video (early or late) did not improve PTSD, anxiety, depression, or quality of life at 6 months versus standard care in ICU survivors, though patients rated it highly for understanding their ICU stay — negative trial that argues future VR for post-intensive-care syndrome should be multi-session, personalized, and targeted to high-risk patients.
Pattern of blast injuries — a systematic review: Part 1, improvised, multiple and unspecified explosive devices
Across 70 studies, extremity injuries (including amputations) are the leading blast-injury pattern; body-region distribution differs between military and civilians (more head injuries in military, more thorax/abdomen in civilians), likely reflecting protective-equipment availability — useful for preparedness and resource planning.
Psychosocial coping with intensive care delirium: a mixed-methods systematic review of patient and family perspectives
Synthesis of 10 studies shows ICU patients and families actively use problem-, emotion-, and meaning-focused coping during delirium; families are a primary coping resource while managing their own distress — supports family-centred, coping-informed psychosocial interventions. Notably no quantitative studies existed, flagging an evidence gap.
Chloral hydrate outperforms oral midazolam for facilitating venipuncture in children: a double-blind RCT
In an ED/trauma setting, oral chloral hydrate (50 mg/kg) beat oral midazolam (0.3 mg/kg) — fewer venipuncture attempts (1.30 vs 1.96), faster sedation and IV access, shorter total procedure time, higher satisfaction, comparable safety — supporting it as a preferred agent for procedural sedation in young children.
By category
Consensus/Guideline3 papers
Chinese expert consensus on tetanus prophylaxis in major trauma (2026 Edition)
Trauma-specific consensus filling a gap left by general open-wound guidance — covers damage-control debridement, immune-status assessment, active/passive immunization, immunocompromised and mass-casualty scenarios, and resource-limited settings for tetanus prophylaxis in major trauma.
Early management of crush injury and crush syndrome: a Faculty of Pre-Hospital Care consensus statement
UK Faculty of Pre-Hospital Care consensus de-emphasizes aggressive fluid loading and reframes hyperkalaemia concerns in prehospital crush injury/crush syndrome, giving practicable recommendations for developed-system EMS.
Resuscitative thoracotomy for traumatic cardiac arrest in settings where penetrating injury is uncommon: insights from the Austrian multi-society consensus
Austrian multi-society consensus offers guidance on when resuscitative thoracotomy for traumatic cardiac arrest is justified in predominantly blunt-trauma systems, where the evidence and expected benefit differ from penetrating-trauma-heavy settings.
New Research21 papers
Effect of Body Position on Chest Compression Quality During CPR in an Obesity Simulation Model: A Randomized Crossover Trial
In an obesity CPR manikin model, compression depth collapsed (median adequate-depth compressions fell from 98% to 0%) despite greater rescuer effort, and elevating the paramedic on a 10 cm platform did NOT help. Signals that simple ergonomic fixes are insufficient for CPR in patients with obesity — a simulation study, so treat as hypothesis-generating.
Risk factors for hypothermia on trauma center arrival in injured children
In pediatric trauma, hypothermia on arrival tracked with air-EMS transport (OR 1.74), firearm injury (OR 1.97), and TBI severity (up to OR 2.40); 8.2% had missing/invalid temperatures, more often in severely injured and Black/Hispanic children — pointing to concrete targets for prehospital warming and documentation QI.
Outcome-informed emergency medical services response planning: a systematic review
Only three quasi-experimental studies (2.9M+ EMS responses) have aligned EMS dispatch/response plans with linked patient outcomes; all pointed the same way — fewer high-priority (lights-and-sirens) responses and improved system efficiency without clear evidence of harm. Evidence base is thin, so treat as feasibility signal, not proof.
Principles of safe day-case appendicectomy and patient satisfaction: a systematic review
In carefully selected uncomplicated appendicitis (age <65, ASA 1-2, non-insulin-dependent, well-controlled pain, home support), same-day discharge showed no significant increase in reintervention/reoperation and high satisfaction (59-91%) — evidence for standardized day-case EGS pathways.
Significant other reported outcome measures within European cohorts of severely injured patients: a systematic review
Relatives of severely injured patients (mostly TBI cohorts) show high early rates of depression, anxiety and stress (28-56%) and reduced quality of life that persists long-term; ~50% report unmet information/emotional needs. Argues for standardizing significant-other outcome measures alongside patient PROMs in trauma care.
Blood pressure reduction time windows in stroke: a systematic review and network meta-analysis
Prehospital BP lowering was associated with higher mortality in ischemic stroke versus reference and versus the 48-h window, while timing made no significant mortality difference in ICH or unspecified stroke — supporting caution with prehospital BP reduction until stroke subtype is confirmed (evidence confidence limited).
High-dose four-factor prothrombin complex concentrate for vitamin K antagonist reversal before urgent surgery: subanalysis of the LEX-209 randomized, active-controlled trial
In the subset with supratherapeutic INR >6 (n=23) needing urgent surgery, high-dose 4F-PCC (50 IU/kg) achieved effective hemostasis in 100% with no thromboembolic events, supporting the maximum-dose strategy for severe VKA-associated coagulopathy.
Transformation into chronic subdural hematoma following acute SDH: incidence, outcomes, predictors (PERSIST score)
2.8% of acute SDH patients were readmitted with chronic SDH within 180 days, carrying substantial morbidity (26% functional decline, 34% needing evacuation). The validated PERSIST score stratifies risk (highest decile 7.1% vs lowest 0.7%) to flag patients who may warrant closer surveillance.
When demography challenges policy: the rising burden of proximal femur fractures as a role model and driver for geriatric trauma care in Germany
German proximal femur fracture cases rose 54% (2000-2023) and are projected to climb ~75% more to ~318,000/year by 2050, with 74% in patients aged 80+; direct costs roughly double to €6.4B. Modeled workforce gap of ~700 trauma surgeons and ~7,500 geriatricians — a system-planning wake-up call for geriatric trauma capacity.
Early (<24 h) VTE prophylaxis in traumatic brain injury: the EViTBI algorithm (national cohort)
A derived/internally-validated risk score classified ~45% of isolated-TBI patients as low risk, in whom early (<24 h) pharmacologic prophylaxis was associated with lower mortality, DVT, and PE. Associative and hypothesis-generating — prospective validation with serial imaging needed before use, but it reframes the "wait 72 h" default.
Physician-staffed prehospital units for severely injured patients in the Stockholm trauma system — is there a survival benefit?
In 11,063 registry patients, prehospital physician exposure was not associated with lower 30-day mortality (and had lower discharge GOS), whereas HEMS transport was independently associated with improved survival — questioning blanket physician staffing and pointing to patient selection and mode of transport as the real levers.
ARDS management in trauma patients
State-of-the-art review frames trauma-related ARDS as a "multi-hit" process (initial injury + dysregulated inflammation + secondary insults like transfusion, infection, fat embolism); management stays largely supportive with lung-protective ventilation, multimodal imaging (CXR, lung ultrasound, CT) for risk stratification, pain control, hemodynamic optimization and timely surgery, with individualized approaches for TBI and hypothermia.
An epidemiological evaluation of fatal and nonfatal assault related firearm injuries among youth aged 0-17 years
Using linked NEDS and NVDRS data from 41 states (2019-2020), an estimated ~6,820 US children had nonfatal firearm assaults and >2,300 died over two years, with non-Hispanic Black, male, and older youth bearing disproportionate morbidity and mortality — reinforcing the case for community violence-reduction programs and firearm-policy reform.
Left ventricular unloading during VA-ECMO for refractory cardiogenic shock: a target trial emulation multicenter analysis
Across 264 VA-ECMO patients at two high-volume centers, LV unloading (Impella or IABP) was not associated with lower 60-day mortality and carried more device-related complications, arguing for phenotype-driven rather than routine unloading.
State-of-the-art review: ß-blockade in critical illness
Beta-blockade in the ICU remains context-dependent: established benefit in acute MI, tachyarrhythmias, hypertensive emergencies, thyroid storm and variceal-bleed prevention, but evidence is limited/conflicting in septic shock, TBI, acute heart failure and burns. Safety depends on agent/dose, patient phenotype, timing, and whether it is continuation vs de novo initiation — argues for a phenotype-driven, physiology-guided approach.
Trends, disparities, and outcomes of pediatric firearm-related injuries in the United States: A national analysis from 2016 to 2021
Pediatric firearm hospitalizations rose 52% (2016–2021) with in-hospital mortality up from 6.7% to 9.8%; unintentional injuries overtook assault by 2021, and burden fell disproportionately on minority and lower-income children—pointing to prevention, storage, and access policy.
Surgical stabilization of rib fractures is associated with lower adjusted odds of adverse pulmonary outcomes across RibScore-defined injury severity
In 3,066 blunt rib-fracture patients, SSRF was associated with ~43% lower adjusted odds of a composite pulmonary complication (pneumonia, prolonged ventilation, or tracheostomy) and of respiratory failure versus nonoperative management, despite SSRF patients having worse chest-wall injury (higher RibScore).
The impact of pre- versus postoperative geriatric consultation in elderly patients with hip fractures
In 1776 hip-fracture patients ≥70, timing of geriatric consultation (pre- vs postoperative) was not independently associated with delirium (~19.7% vs 19.5%) or other short-term outcomes—access to geriatric co-management may matter more than its exact timing.
Injury patterns, management and outcomes of hemodynamically unstable pelvic fractures at an Australian level 1 trauma centre: a 10-year registry analysis
Among 152 hemodynamically unstable major pelvic-ring injuries, in-hospital mortality was 7.2% and haemorrhage-related mortality just 2% (MTP activated in 45%, angioembolisation in only 5.9%) — reinforcing that mature trauma systems can achieve very low pelvic-haemorrhage mortality.
Rate of future hemolytic disease of the fetus and newborn following the prehospital transfusion of RhD-positive blood products to females of childbearing potential in the USA
Modeling the real-world cohort of 957 females of childbearing potential given prehospital RhD-positive products puts the future HDFN risk at only ~0.2-0.3% per year (one case per ~2.4-80.7 years by region), largely because most were of advanced maternal age and likely RhD-positive. Supports using RhD-positive blood in prehospital hemorrhagic shock when RhD-negative units are scarce.
2025 Practice-changing articles in trauma, EGS, pediatric trauma, and surgical critical care: an EAST narrative review
EAST's annual roundup distills 13 practice-shaping 2025 studies (RCTs + large multicenter cohorts) spanning early resuscitation, timing of lifesaving interventions, analgesia/sedation, ventilator management, infection prevention, transfusion timing, perioperative antibiotics, imaging in older adults, and pediatric trauma pathways — a ready-made map of what changed this year.
Clinical Pearl8 papers
Balancing lung and brain: physiological strategies for ARDS management in acute brain injury
ARDS complicates up to a third of acute brain injury patients and forces a real trade-off — lung-protective low-tidal-volume/higher-PEEP ventilation raises PaCO2 and can worsen intracranial pressure, while tight CO2 control deviates from ARDS strategy. Argues for physiology-driven, patient-specific ventilation guided by multimodal neuromonitoring (ICP, brain tissue oxygenation) rather than protocolised care.
Limited clinical utility of risk stratification for CT decision-making in patients ≥ 75 years with mild traumatic brain injury
In a 3,088-patient cohort of mild TBI, patients ≥75 years (55% of the cohort) were scanned 98% of the time; a multivariable risk model had only moderate discrimination (AUC 0.69) and could safely cut CT use by just 1.5% at 100% sensitivity — rule-out strategies offer little practical benefit for reducing head CT in the very elderly.
Prospective analysis of 1619 alpine skiing and snowboarding injuries: spatial clustering and prevention implications
A third of ski/snowboard injuries clustered on just 3% of slope length (steep, narrow, high-traffic runs), and injury type tracked with sport, sex, age and terrain rather than day-to-day weather. Points prevention at redesigning slope hotspots, sex-adjusted binding settings, routine wrist protectors for snowboarding children, and better pole-release systems.
Prehospital emergency cricothyroidotomy in Denmark: a nationwide cohort study, 2016-2023
Across all of Denmark, prehospital surgical cricothyroidotomy is exceedingly rare (71 cases in 8 years) but had high procedural success (87%) in a physician-staffed EMS system; survival was low, reflecting the extremis of patients needing it. Benchmarks the "can't intubate, can't oxygenate" rescue airway.
Time to surgery and its impact on length of stay and mortality for neck of femur fractures at a major trauma centre
In 4,415 hip-fracture patients, surgical delay beyond 36 h was associated with significantly higher in-hospital mortality for both intracapsular and extracapsular fractures, and longer stay for intracapsular fractures — supporting prioritized early surgery, especially in patients ≥70.
Volume-dependent detection of free intraperitoneal fluid by FAST: a prospective in-vivo study with sequential fluid instillation
FAST sensitivity is strongly volume-dependent — only 14% at 250 mL, 37% at 500 mL, but 74% at 1000 mL and 91% at 1500 mL — so a negative FAST does not exclude significant intra-abdominal bleeding in an unstable patient. Longitudinal (vs transverse) views of the Douglas pouch boosted sensitivity by >20%; Morison's pouch had the highest yield.
Thoracic damage control: association of complications and mortality
Among severely injured patients undergoing thoracic damage control, complications were near-universal (74%) but did NOT predict death; only blunt mechanism (OR 3.82) and admission pH <7.1 (OR 3.13) independently predicted mortality — i.e., the physiology present at arrival, not downstream ICU complications, drives outcome.
AKI as a systemic syndrome and its impact on other organ systems
AKI, which hits ~half of ICU patients, is reframed as a systemic syndrome driving remote dysfunction in lung, brain, heart, liver, and immune system via inflammation and metabolite accumulation — argues clinicians should watch for multi-organ crosstalk and flags limitations of MAKE as a trial endpoint.