An overview of the first week of the PLOS Medicine Trauma Special Issue
This month, PLOS Medicine is proud to present our Special Issue on Traumatic Injury. Guest Editors Professor Karim Brohi (Queen Mary University of London) and Dr. Martin Schreiber (Oregon Health & Science University), have advised us on the selection of the research papers and commissioning of discussion pieces that appear in the Special Issue. The articles cover a range of topics, including research on the causes of and risk factors for traumatic injury, diagnosis and treatment of patients critical conditions following traumatic injury, management of severe blood loss and coagulotherapy, the short- and long-term impact of neurotrauma, and the early inflammatory and immune responses to trauma that can lead to severe complications.
We have some exciting articles publishing in the first week:
Do head injuries increase risk of neurodegenerative disease later in life? In a large retrospective cohort study, Rahul Raj and colleagues investigated the association between traumatic brain injury (TBI) and developing neurodegenerative disease. They focused on the working-age population (18-65 years old), and using data from the Finnish national health registries, they were able to look at disease risk many years later (median follow-up 10 years). They found that a history of moderate-to-severe TBI was associated with a 90% increased risk of developing dementia, but not Parkinson’s disease or amyotrophic lateral sclerosis, when compared to patients with a history of mild TBI, and that risk may increase with TBI severity.
With improvements in trauma care, more patients are surviving from serious injury, raising questions about the long-term impact of traumatic injury on health, and the quality of care for survivors. In a population-based longitudinal study in Victoria, Australia, Belinda Gabbe and colleagues studied the long-term outcomes of seriously injured patients. Three years after injury, 20% of patients had died. Among survivors, there was a high prevalence of continued problems post discharge, with patients reporting issues with mobility (37%), self-care (21%), usual activities (47%), pain/discomfort (50%), and anxiety/depression (41%). The authors note that the prevalence of these ongoing health problems suggest the need for interventions that reduce the longer-term impact of injuries, such as rehabilitation programs, as well as interventions to prevent major trauma overall.
Femoral shaft fractures are common in major trauma, and while early definitive stabilization is associated with improved outcomes and recommended in practice guidelines, early fixation does not always occur. James Byrne and colleagues studied data from patients who underwent definitive femur fixation at 216 United States trauma centers and found significant hospital-level variation in delayed fixation that was not explained by patient case mix. Patients treated at hospitals performing more delayed fixations were more likely to experience pulmonary embolism and require greater length of stays compared to hospitals performing delayed fixation more rarely. These outcome findings highlight the importance of minimizing delays in fixation.
Early restoration of blood flow to ischemic organs following trauma is key to improving outcomes, but can lead to reperfusion injury, often as severe as the initial ischemic event. There is no currently approved treatment. In a translational study using preclinical preclinical rat injury models, Alex Dyson and colleagues investigated the potential of ammonium tetrathiomolybdate (ATTM), a molecule belonging to a new class of inorganic sulfide-releasing molecules, to protect organs from injury after restoration of blood flow following ischemia. They found that ATTM decreased oxygen metabolism and protected against reperfusion injury and organ damage following heart attack, stroke, and hemorrhage, with significant improvements in outcome and a good safety profile. While effectiveness and safety still need to be explored in humans, ATTM could potentially be used in patients as a short-term protective therapy while blocked blood vessels feeding major organs such as the brain and heart are being opened up, or during resuscitation from severe bleeding.
Lastly, in a Perspective, John B Holcomb discusses lessons learned from treating military injuries, which he terms “war’s only silver lining”. Holcomb summarizes recent conceptual and practical advances in trauma care, discusses examples that have been successfully translated between military and civilian settings and some that have not, and presents directions for future research.
New Trauma Special Issue papers will appear throughout July 2017 in PLOS Medicine, alongside our regular content. To view new papers as they publish, go to the Special Issue collection. In week 4, join some of our authors on a Reddit AMA.
Featured Image credit: U.S. Navy Journalist 2nd Class Shane Tuck, Wikimedia Commons