Background: The growth of the geriatric population, resulting in an exponential increase in the number of injured older people, determines the necessity of ensuring adequate access to specialized units such as trauma centers (TCs). The specificity of pathophysiological processes that progress with age, worsening the body's response to trauma, makes it difficult to develop an optimal triage protocol for geriatric patients, reducing high undertriage, i.e., underestimation of injuries and referral to lower-reference units. Aim: To verify the TC qualification criteria for 65+ patients and analyze the weights of individual triage factors for these patients. Methods: This was a retrospective analysis of the medical records of ED patients from the Clinical Hospital with TC in Poland admitted from 1.01.2017 to 31.12.2020. Among 155,320 ED patients, 6541 who formed Trauma group 65+ were selected, in which the TRISS score was estimated. The TC 65+ group meeting the currently applicable TC qualification criteria was selected. The TRISS cutoff value, TRISS 65+ group and TC-omitted 65+ group were determined. The significance of TC qualification factors was estimated. Receiver operating characteristic (ROC curve) analysis and multiple linear regression analysis were used for statistical classification. Results: The value of ≤ 88.84% determined the threshold for TC qualification, and the leakage of criteria was 58.51%. Six significant factors with different typing weights were identified: GCS ≤ 8 (− 42.90%), extensive crush injury of the extremities (− 33.74%), and RR < 10/min (− 16.16%), blunt injury to thoracic internal organs (− 13.75%), pelvic fracture (− 11.35%) and SBP ≤ 80 mmHg (− 10.41%) were performed. The weight + SD of each factor reduced the potential TRISSe value to ≤ 88.84% (threshold). Modifications of the cutoff values of significant physiological parameters were determined, i.e., GCS ≤ 14 (sensitivity = 79.79%, specificity = 98.25%, AUC = 0.896, Youden index = 0.780) and SBP ≤ 129 mmHg with questionable efficacy of the result. Conclusions: The current TC qualification criteria require modification for geriatric patients, which would complete the leakage estimated at 58.51% according to the TRISS scale. The leakage results from underestimation of the weight of the 6 triage factors to the TC, and the modification of the criteria should include a reduction in the current requirement of 4 factors to 1 and allow admission to the TC of a 65+ trauma patient with one of the following anatomical injuries: extensive crush injury of extremities, blunt injuries with symptoms of damage to internal thoracic organs, pelvic fracture, or one of the disorders of physiological parameters: GCS ≤ 8, RR < 10/min, or SBP ≤ 80 mmHg. In the other cases, the modification should also take into account the change in the GCS limit value to ≤ 14 (instead of ≤ 8) and the change in the SBP cutoff value from ≤ 80 mmHg to a higher one (but ≤ 129 mmHg) or the use of another factor. To complete the formula (undertriage according to ISS = 73.47%), additional factors, such as the mechanism of injury, must be included. It is necessary to develop research on the criteria for the qualification of geriatric patients to the TC, and the use of weight analysis of individual factors may contribute to the identification of properly balanced triage criteria.

Background: Standardized trauma assessment is essential for early clinical decision-making; however, it remains challenging in older adults because age-related physiological changes may obscure injury severity. Accurate triage is critical to ensure timely access to trauma centers (TCs). While triage decisions must rely on immediately available clinical findings, advanced trauma scoring systems are typically based on diagnostic data obtained later in the course of care. Although these tools are not suitable for real-time triage, they are established predictors of mortality and may provide an objective basis for evaluating TC qualification criteria. Because current national TC qualification criteria do not adequately account for age-specific factors, they may contribute to undertriage in older patients. This study aimed to retrospectively identify the trauma scoring system most suitable for evaluating TC qualification criteria in geriatric trauma patients. Methods: We conducted a retrospective cohort study of patients admitted to the emergency department of a single clinical hospital with a TC between 2017 and 2020. Among 155,320 ED admissions, 6,541 trauma patients aged ≥ 65 years were identified. Injury severity and physiological status were assessed using the coded Revised Trauma Score (RTSc), Injury Severity Score (ISS), and Trauma and Injury Severity Score (TRISS). A predefined subgroup of patients meeting national TC qualification criteria (TC group 65+) was analyzed separately. Predictive performance for in-hospital mortality was evaluated using receiver operating characteristic (ROC) curve analysis. Results: TRISS showed the highest discrimination for in-hospital mortality (AUC 0.888), followed by ISS (0.867) and RTSc (0.687). In the TC group 65+ , the mean TRISS-predicted survival probability was 34.58%, whereas observed in-hospital survival was 48.72%. The estimated undertriage rate was 73.47%, suggesting that current national TC qualification criteria may perform inadequately in older trauma patients. Conclusion: Current national TC qualification criteria may contribute to undertriage among older patients, potentially delaying access to advanced trauma care. Among the evaluated scoring systems, TRISS demonstrated the highest discriminatory performance for in-hospital mortality and appears to be the most suitable retrospective reference standard for assessing TC qualification criteria in geriatric trauma patients.

Paediatric supraventricular tachycardia (SVT) is a common arrhythmia of great clinical significance. If not treated promptly, it can cause heart failure and cardiogenic shock. Depending on the patient’s condition, SVT treatment involves vagal manoeuvres, pharmacological, or direct current cardioversion. The goal of acute SVT management is to immediately convert SVT to a normal sinus rhythm (NSR) and prevent its recurrence. Adenosine is recommended as the first-line treatment for stable SVT by the European Resuscitation Council (ERC) and American Heart Association (AHA) guidelines, when vagal manoeuvres have proven ineffective. The ERC and AHA guidelines recommend the intravenous route of administration. The intraosseous (IO) administration technique is also possible, but still relatively unknown. The aim of this paper is to describe a 3.5-year-old child with SVT that was converted to NSR following IO administration of adenosine. Successful conversion was achieved after the second attempt with the adenosine dose. In the described case, there was no recurrence of SVT.

Background and Objectives: Massive extremity haemorrhage remains the leading cause of preventable death on the battlefield and among trauma victims in civilian settings. Tourniquets are an effective, low-cost tool used to rapidly control bleeding. However, the availability of certified tourniquet models during a full-scale armed conflict can be significantly limited. This favours the emergence of locally manufactured devices. The aim of this study was to compare the effectiveness of the DNIPRO Gen 2 and SICH tourniquets with the CAT Gen 7 and SOFTT W Gen 4 tourniquets recommended by the Committee on Tactical Combat Casualty Care. Materials and Methods: The study included 51 Ukrainian medics experienced in prehospital care. Application speed was measured with a stopwatch, and occlusion success was confirmed by Doppler ultrasound. Pain was measured using the NRS, and participants were also able to provide subjective comments regarding the ergonomics and design of the tourniquets. Results: The four tourniquets tested demonstrated different occlusion success rates in arm and leg application. In upper extremity application, the SICH had the highest success rate (98.0%) and was associated with higher odds of successful application compared with the SOFTT-W Gen 4 (OR 25.14). In lower extremity application, the CAT Gen 7 had the highest rate of success (94.1%) and was 7.5 times more likely to achieve occlusion than the SOFTT-W Gen 4 (OR 7.54). The DNIPRO Gen 2 was rated most painful (Median 6), with significantly lower pain levels reported for the SICH (Median 4), the CAT Gen 7 (Median 5), and the SOFTT-W Gen 4 (Median 4). Conclusions: The DNIPRO Gen 2 and SICH tourniquets demonstrated high occlusion success rates, comparable to the CAT Gen 7 and superior to the SOFTT-W Gen 4. These findings suggest that Ukrainian-manufactured tourniquets may demonstrate comparable performance to CoTCCC-recommended tourniquets in a simulated prehospital setting.

Paediatric supraventricular tachycardia (SVT) is a common arrhythmia of great clinical significance. If not treated promptly, it can cause heart failure and cardiogenic shock. Depending on the patient’s condition SVT treatment involves vagal manoeuvres, pharmacological or direct current cardioversion. The goal of acute SVT management is to immediately convert SVT to normal sinus rhythm (NSR) and prevent its recurrence. Adenosine is recommended as first-line treatment for stable SVT by the European Resuscitation Council (ERC) and American Heart Association (AHA) guidelines when vagal manoeuvres have proven ineffective. ERC and AHA guidelines recommend the intravenous route of administration. Intraosseous (IO) administration technique is also possible, but still relatively unknown. The aim of this paper is to describe a 3.5-year old child with SVT which was converted to NSR following IO administration of adenosine. Successful conversion was achieved in the second attempt with the adenosine dose. In the described case, there was no recurrence of SVT.