Background: Trauma laparotomy (TL) remains a cornerstone of trauma care. We aimed to investigate prehospital measures associated with in-hospital mortality among casualties subsequently undergoing TLs in civilian hospitals. Methods: This retrospective cohort study cross-referenced the prehospital and hospitalization data of casualties treated by Israel Defense Forces-Medical Corps teams who later underwent TLs in civilian hospitals between 1997 and 2020. Results: Overall, we identified 217 casualties treated by IDF-MC teams that subsequently underwent a TL, with a mortality rate of 15.2% (33/217). The main mechanism of injury was documented as penetrating for 121/217 (55.8%). The median heart rate and blood pressure were within the normal limit for the entire cohort, with a low blood pressure predicting mortality (65 vs. 127, p < 0.001). In a multivariate analysis, prehospital endotracheal intubation (ETI), emergency department Glasgow coma scores of 3–8, and the need for a thoracotomy or bowel-related procedures were significantly associated with mortality (OR 6.8, p < 0.001, OR = 48.5, p < 0.001, and OR = 4.61, p = 0.002, respectively). Conclusions: Prehospital interventions introduced throughout the study period did not lead to an improvement in survival. Survival was negatively influenced by prehospital ETI, reinforcing previous observations of the potential deleterious effects of definitive airways on hemorrhaging trauma casualties. While a low blood pressure was a predictor of mortality, the median systolic blood pressure for even the sickest patients (ISS > 16) was within normal limits, highlighting the challenges in triage and risk stratification for trauma casualties.

BACKGROUND: Lifesaving interventions (LSIs) are the hallmark of medical care in trauma casualties, reducing mortality and morbidity. Analgesia is another essential treatment, which has been shown to improve outcomes and decrease long-term complications. However, oligoanalgesia is common, and information regarding its relation to the performance of LSIs is scarce. The purpose of this study was to assess the relation between the performance of LSIs and analgesia administration in the prehospital environment. METHODS: A retrospective database-based study was performed, including all trauma casualties treated by Israeli Defense Forces physicians and paramedics during 2006 to 2017 and admitted to hospitals participating in the Israeli National Trauma Registry. Included LSIs were tourniquet application, administration of tranexamic acid and freeze-dried plasma, and administration of chest decompression. Casualties treated with endotracheal intubation or cricothyroidotomy were excluded. RESULTS: In the multivariable logistic regression analysis, LSIs were associated with prehospital analgesia administration (odds ratio [OR], 3.59; confidence interval [CI], 2.56–5.08; p < 0.001). When assessing for the different LSIs, tourniquet application (OR, 2.83; CI, 1.89–4.27; p < 0.001) and tranexamic acid administration (OR, 4.307; CI, 2.42–8.04; p < 0.001) were associated with prehospital analgesia administration. CONCLUSION: A positive association exists between performance of LSIs and administration of analgesia in the prehospital environment. Possible explanations may include cognitive and emotional biases affecting casualty care providers. LEVEL OF EVIDENCE: Retrospective study, level IV.

Background: Cervical spine (C-spine) trauma usually results from blunt injuries and is traditionally managed by prehospital spinal immobilization using a cervical collar. We sought to examine if prehospital C-spine immobilization is associated with actual C-spine injuries and what factors are associated with the decision to immobilize the C-spine. Methods: We retrospectively analyzed blunt trauma patients treated by Israeli Defense Force (IDF) medical teams from 2015 to 2020. Children, penetrating injuries, and non-threatening injuries were excluded. Demographic data, injury characteristics, and prehospital information were collected from the IDF Trauma Registry’s electronic medical records and merged with corresponding hospital data from the Israeli National Trauma Registry. Results: Overall, 220 patients were included, with a mean age of 32 and a predominance of male patients (78%). Most injuries were due to motor vehicle collisions (77%). In total, 40% of the patients received a cervical collar. C-spine injuries were present in 8%, of which 50% were immobilized with a cervical collar. There were no significant differences in the incidences of C-spine injuries or disability outcomes with or without collar immobilization. The use of a collar was significantly associated with backboard immobilization (OR = 14.5, p < 0.001) and oxygen use (OR = 2.5, p = 0.032). Conclusions: Prehospital C-spine immobilization was not associated with C-spine injury or neurological disability incidences. C-spine immobilization by medical providers may be influenced by factors other than the suspected presence of a C-spine injury, such as the use of a backboard. Clear clinical guidelines for inexperienced medical providers are called for.

Background: Women with congenital long‐QT syndrome (LQTS) experience increased risk of cardiac events (CE) after the onset of adolescence, possibly due to the effect of sex hormones on the cardiac ion channels. We hypothesized that late menarche may affect the risk of CE in women with LQTS. Methods: Beginning in 2010, information on age at menses onset was obtained from all women enrolled in the Rochester LQTS Registry. Multivariable modeling was employed to evaluate the association of age at menarche with the burden of CE (total number of syncope, aborted cardiac arrest, and LQTS‐related sudden cardiac death) during the subsequent 20 years of follow‐up. Menarche groups were defined as early (16 years). Results: We report data on 435 genetically confirmed LQTS women, of whom 68, 346, and 21 were in the early, normal, and late‐onset groups, respectively. The mean cumulative rate of CE at 20 years of follow‐up in women with late menarche was 28% and 64% higher than in women with normal or early menarche, respectively; P <0.001 for the overall difference during follow‐up. Consistently, multivariable analysis showed that late menarche was associated with a pronounced 52% increased risk of CE compared with normal menarche ( P =0.02). Conclusions: Late menarche is associated with increased risk of CE in women with congenital LQTS. Further research is warranted to validate these findings and ascertain the explanatory pathophysiological pathways.

Background: Cardiac implantable electronic devices (CIEDs) frequently detect brief, often subclinical atrial fibrillation (AF), but their value for predicting progression to persistent AF remains uncertain. Statistical and machine learning (ML) approaches may enable dynamic risk stratification using this longitudinal device data. Objective: To develop a risk stratification model using clinical and CIED‐derived AF burden measured over a rolling 6‐month window to predict progression to persistent AF. Methods: We analyzed continuous CIED data from 1985 patients without prior persistent AF implanted between 2016 and 2024 at a tertiary medical center. AF burden and clinical variables were summarized using overlapping 6‐month rolling windows to estimate 1‐year risk of persistent AF. Associations were evaluated using Kaplan–Meier and Cox proportional hazards models. A gradient‐boosted decision tree model (XGBoost) was used to predict progression. Results: During a mean follow‐up of 1192 days, 874 patients (44%) developed paroxysmal AF, of whom 257 (29%) progressed to persistent AF after a mean of 813 days. Patients with no AF or < 1 h/day of AF in the prior 6 months had > 97% 1‐year freedom from persistent AF, whereas those with > 8 h/day had a 63% progression rate. Higher AF burden was strongly associated with progression (maximum HR 8.66, p < 0.001). The ML model demonstrated high predictive performance (sensitivity 99.4%, specificity 95.7%). Conclusion: CIED‐detected AF burden is strongly associated with progression to persistent AF. ML‐based analysis of 6‐month device data enables accurate, point‐in‐time risk stratification to support earlier and more targeted clinical management.