Weekly digest
Week of 28 September 2026
24 papers collected from PubMed, last swept 28 September 2026.
Top 10
Ranked by study design, journal and study size.
Management of Colon and Rectal Injuries From Blunt and Penetrating Trauma: Evidence-Based Recommendations From the World Society of Emergency Surgery
A WSES GRADE-based guideline (17 PICO questions) endorsing a selective, physiology-driven approach to colorectal trauma: primary repair or resection-with-anastomosis over routine diversion for most stable patients, proximal diversion as default for extraperitoneal rectal injury, no routine presacral drainage/distal washout, antibiotics ≤24h, and early enteral nutrition in selected patients.
American Association for the Surgery of Trauma/American College of Surgeons-Committee on Trauma clinical protocol for blunt splenic injury
A joint AAST/ACS-COT clinical protocol standardizing management of blunt splenic injury across adult and pediatric patients — algorithmic guidance on non-operative management, angioembolization, and thresholds for operative intervention to reduce practice variation.
Geriatric trauma triage: A Western Trauma Association critical decisions algorithm
A Western Trauma Association critical-decisions algorithm for the injured older adult, giving structured guidance on field triage, frailty assessment, trauma-team activation, and ICU admission — aimed at reducing the well-documented undertriage of geriatric trauma patients.
A multicenter randomized, double-blinded placebo-controlled phase 2 trial to evaluate safety and efficacy of ilofotase alfa in patients at risk for kidney injury following open heart surgery
In 204 high-risk on-pump cardiac-surgery patients, two perioperative doses of ilofotase alfa did not reduce postoperative kidney function loss (sCr ratio 1.21 vs 1.27, p=0.31) or major adverse kidney events at day 60 versus placebo, with no safety concerns — a negative result for this AKI-prevention strategy.
Intraosseous versus intravenous access in adult out-of-hospital cardiac arrest: a Bayesian secondary analysis of the PARAMEDIC-3 randomised controlled trial
In 6,082 adults with OHCA, an intraosseous-first vascular-access strategy was more likely harmful than beneficial versus intravenous-first (81.6% posterior probability of inferiority for 30-day survival; 98% for ROSC), though any effect is likely modest — reinforcing IV-first access as the default in adult OHCA.
Increased ureagenesis revealing metabolic intolerance to enhanced nutrition in the PICU: a secondary analysis of the PEPaNIC RCT
Secondary analysis of PEPaNIC links the harm from early parenteral nutrition in critically ill children to a surge in ureagenesis (rising urea/creatinine) — a marker of metabolic intolerance to high amino-acid loads — reinforcing caution about aggressive early feeding in the PICU.
Indirect calorimetry-guided nutrition during weaning from prolonged mechanical ventilation: a double-blind randomized controlled trial
In 211 adults ventilated ≥21 days, indirect calorimetry-guided feeding produced numerically higher weaning success (58% vs 50%) and lower 1-year mortality (48% vs 56%) than predictive-equation feeding but without statistical significance; a smaller gap between measured and delivered energy was independently linked to successful weaning, supporting larger trials of measured-energy-guided nutrition.
Impact of systemic comorbidities and interaction patterns on mortality following major emergency abdominal surgery: A nationwide register-based cohort study
Across 61,400 Danish patients undergoing major emergency abdominal surgery, comorbidity combinations (notably cardiac, renal, liver, and cerebrovascular disease) interacted to drive mortality beyond their isolated effects — risk tools that treat comorbidities as independent underestimate risk in multimorbid patients.
Is ultra-early endoscopy always beneficial? A systematic review and meta-analysis of timing-dependent outcomes in nonvariceal upper gastrointestinal bleeding
Across 9 studies (10,785 adults with nonvariceal upper GI bleeding), ultra-early endoscopy (≤6 h) did not reduce mortality (OR 0.88) or rebleeding versus early endoscopy (>6 h), and did not change transfusion, surgery, or length of stay — but was associated with more ICU admissions (OR 1.41). Supports adequate resuscitation and timely endoscopy within the standard 24-h window rather than rushing to ≤6 h.
Emergency medical services agency-level variation in non-initiation of resuscitation and termination of resuscitation in out-of-hospital cardiac arrest
Across 560,240 non-traumatic OHCA encounters in the ESO Data Collaborative (2018–2024), EMS agencies varied widely in non-initiation of resuscitation (MOR 2.30) and in applying termination-of-resuscitation for TOR-eligible patients (MOR 4.13) even after case-mix adjustment — flagging substantial unwarranted variation in prehospital resuscitation decision-making.
By category
New Research11 papers
Prognostic impact of bystander-patient relationship and age in patients with out-of-hospital cardiac arrest
In the All-Japan Utstein Registry (554,923 witnessed OHCA, 2005–2023), family-member-witnessed arrests had the lowest 1-month neurologically favorable survival (4.2% vs 10.1% for passersby vs 15.3% for friends/colleagues); the association reversed in the young (family-witnessed better at ages 20–40) but held for worse outcomes in the elderly — pointing to targeted CPR training for family members of high-risk older adults.
Rescue-Breathing Versus Chest Compression-Only Bystander Cardiopulmonary Resuscitation in Non-Cardiac Out-of-Hospital Cardiac Arrest: A Nationwide Retrospective Cohort Study
Across 154,137 Japanese non-cardiac OHCA cases, bystander rescue-breathing CPR was associated with modestly lower 30-day mortality and unfavorable neurological outcomes versus compression-only CPR — the benefit concentrated in children and in drowning/asphyxial arrests, supporting rescue breaths when the arrest is non-cardiac.
Sleep-Wake Disturbances in Pediatric Traumatic Brain Injury: A Systematic Review and Meta-Analysis of Interventions
Across 19 studies (N=1113) in children with mild-to-severe TBI, cognitive behavioral therapy for insomnia was the most consistently effective treatment for post-injury sleep-wake disturbances and persistent post-concussion symptoms, while melatonin showed mixed, non-significant pooled effects.
Sex differences in epidemiology, care, and outcomes in patients with out-of-hospital cardiac arrest in China
In the prospective multicenter BASIC-OHCA cohort (33,650 EMS-treated OHCA in China), women had higher adjusted odds of prehospital ROSC (OR 1.21) and survival to admission (OR 1.33) but no advantage by discharge or 30 days, and fared worse than men in key subgroups (age ≥50, shockable rhythm, no prehospital epinephrine) — an early female advantage lost during hospital care, flagging a disparity to target.
Comorbidities in major trauma patients in New Zealand: A retrospective cohort study of prevalence and associations with healthcare utilisation, mortality and cost
In 11,768 NZ major trauma patients (2018–2022), over half had at least one comorbidity (rising 53%→56% over the period); comorbidity was linked to longer hospital and ICU stays, more ventilator hours, higher in-hospital and 12-month mortality, and higher cost.
Effect of prehospital cervical spine immobilization on mortality and neurological outcome in trauma patients: TraumaRegister DGU
In a multicenter registry analysis (31,055 patients; 16,922 propensity-matched), prehospital cervical spine immobilization was not associated with lower hospital mortality or better neurological outcome (GOS) — even in the subgroup with confirmed cervical spine injury — arguing against routine, undifferentiated immobilization.
Mortality Associated with Intensive Care Unit Admission and Mechanical Ventilation in Adults with Acute Chest Syndrome: A Systematic Review
In a PRISMA systematic review (8 studies) of adults with sickle cell acute chest syndrome requiring ICU or mechanical ventilation, mechanical ventilation was the strongest mortality marker (OR up to 67.5 for MV <96 h in the largest cohort), alongside pulmonary hypertension/cor pulmonale and comorbidity burden; documented bacterial infection was uncommon and procalcitonin-guided antibiotic discontinuation was safe — favoring early recognition, severity-based respiratory support, and antimicrobial stewardship.
A Robust Educational Initiative for EMS Clinicians Focusing on Pit-Crew CPR Improves Neurologically Intact Survival
Across 27 EMS agencies in Connecticut (1,917 non-traumatic OHCA), a structured pit-crew CPR training program was associated with an immediate rise in ROSC (aOR 1.41) and a gradual increase in neurologically intact survival (aOR 1.20 per 4-month interval) after implementation, though overall survival to discharge did not change — supporting team-based resuscitation training within existing EMS systems.
Association of early hyperosmolar therapy and operative interventions in severe traumatic brain injury
In a propensity-matched TQIP analysis (174 pairs), starting hyperosmolar therapy (hypertonic saline or mannitol) within 3 h of admission in severe TBI did not change operative interventions or mortality versus a later start, but was associated with fewer ICU days and ventilator days.
Noninvasive fascial traction improves primary fascial closure and reduces the incidence of incisional hernia in open abdomens
In open-abdomen management, a noninvasive fascial-traction technique increased primary fascial closure rates and reduced the incidence of incisional hernia — a low-morbidity adjunct to closing the open abdomen. (Full abstract not yet posted; bottom line taken from the published title/conclusion.)
Prehospital Minithoracostomy versus Chest Drainage for Emergency Pleural Decompression in Major Trauma
In a physician-led HEMS cohort (n=94; 66 minithoracostomy vs 28 chest drainage), prehospital minithoracostomy did not lengthen scene time and had far fewer recorded complications than chest drainage; because allocation was non-randomized with differential complication ascertainment, the finding is hypothesis-generating rather than proof of superiority.
Clinical Pearl3 papers
Geriatric trauma care: What you need to know
Older trauma patients fare worse because of reduced physiologic reserve, preinjury comorbidities, and geriatric-specific syndromes; a proactive, multidisciplinary approach — early team activation, prompt resuscitation, comorbidity and syndrome management, and a focus on functional recovery — improves outcomes.
Combined NRB and Nasal Cannula Oxygen Delivery Is Inferior to Flush Rate NRB for Emergency Preoxygenation
In a healthy-volunteer crossover study (n=30), combining a non-rebreather mask with a nasal cannula (each at 15 or 25 L/min) gave inferior end-expiratory oxygen than a non-rebreather alone at flush rate — flush-rate NRB should remain the preferred preoxygenation strategy for spontaneously breathing prehospital patients.
Enhancing Far-Forward Resuscitation: A Quantitative Laboratory Analysis of Blood Warmer Devices Used in Austere Environments
In a bench comparison of six portable blood warmers using cold-stored whole blood, the MWarmer gave the most consistent warming (outlet 40–41°C across pressures) while the LifeWarmer Quantum was fastest but warmed poorly under pressure — supporting the MWarmer for far-forward/austere trauma resuscitation.