Purpose: To describe early and medium-term outcomes following SSRF implementation over 7 years in a level 1 trauma centre, as management of severe blunt chest wall trauma. Methodology: A retrospective review was conducted over the previous 7 years at Royal Perth Hospital SMTU. Patients were identified using theatre coding, and a variety of variables were collected via imaging, clinical notes and DMR. Collected variables included demographics, mechanism of injury, injury severity, chest wall morphology, timing and indications for fixation, ventilatory days post‐fixation, tracheostomy, pulmonary and wound complications, mortality, and documented clinical or radiological short-term outcomes. Results: The cohort was comprised of patients with more than 10 rib fractures secondary to high-energy blunt force chest trauma following motor vehicle and motorbike crashes. Common indications for SSRF were chest wall deformity, clinical or radiological flail, or respiratory failure despite maximal conservative management. SSRF was carried out within 72 hours of arrival at RPH in most cases. Ventilatory duration post fixation varied from no requirement to prolonged courses requiring tracheostomy, commonly in the context of associated traumatic brain injury. Complications occurred in a substantial minority. Mortality reflected overall injury burden and treatment‐limitation decisions rather than chest wall injury alone. Among patients with available follow‐up, most demonstrated satisfactory healing and functional recovery. Conclusion: In this level 1 trauma centre, SSRF for severe blunt chest wall trauma was associated with acceptable complication rates, low procedure‐related mortality and favourable functional outcomes, supporting its continued use within a structured protocol and providing a foundation for future comparative effectiveness studies.

Purpose: Splenic rupture is a recognised complication of acute Plasmodium falciparum and P. vivax malaria, but the risk of splenic rupture in chronic asymptomatic infections is not known. In malaria-endemic regions, chronic parasitemia is common and associated with splenomegaly and structural changes that may reduce splenic integrity. Here, we assessed population level data to determine the association between chronic malaria and trauma-related splenic rupture requiring splenectomy. Methods: In Timika, Papua, Indonesia, we determined the proportion of individuals with asymptomatic peripheral parasitaemia by microscopy and polymerase chain reaction (PCR) in two complementary study cohorts aged ≥10 years. The first cohort, conducted between 2015-2021, comprised 33 patients undergoing trauma-related splenectomy at the local district hospital. The second cohort, conducted in 2013, comprised 1,807 participants in household survey of the general Timika population. Results: The prevalence of asymptomatic peripheral PCR-positive parasitaemia was 87.9% (29/33) in the splenectomised patients compared to 38.6% (697/1,807) in the general Timika population (adjusted Odds Ratio [aOR] = 10.0 [95%CI: 3.5-28.8], p<0.0001). The difference was greatest for chronic patent (microscopy-detectable) infections (aOR = 5.7 (95%CI: 2.8-11.7), and remained apparent when stratifying by infecting parasite species including for P. falciparum (aOR = 5.4 [95%CI: 2.5-11.9]) and P. vivax (aOR = 3.2 [95%CI: 1.2-8.6]). Conclusion: Patients undergoing trauma-related splenectomy are twice as likely to have chronic malaria than the general population, suggesting that chronic P. falciparum or P. vivax infection may predispose individuals to splenic rupture following trauma. Our findings point towards an additional consequence of chronic infection in endemic areas and adds to existing reasons to diagnose and treat chronic parasitemia, particularly in groups who are prone to trauma.

Purpose: Blunt cerebrovascular injury (BCVI) is a potentially devastating complication of trauma that is detected by CT angiography (CTA), guided by the Denver criteria. Acute assessment and management are well defined. Longer-term follow-up practices remain inconsistent. This study examines decade-long trends in BCVI screening, incidence, management, and follow-up at a State Trauma Unit. Methods: A retrospective cohort study was performed using the Royal Perth Hospital State Trauma Unit registry. All adults ≥18 years admitted with major trauma between 1 January 2015 and 31 December 2024 were included. Patients who had CTA for suspected BCVI were identified. Demographics, CTA indication, BCVI grade, acute management, and follow-up were extracted. Incidence was reported per major trauma admission and per CTA performed. Outcomes included hospital mortality, length of stay, and discharge destination. Analyses were descriptive and univariate, with odds ratios and confidence intervals reported. Ethics approval was obtained. Results: There were 9,724 major trauma admissions, increasing from 920 in 2015 to 1,123 in 2024. The median age was 49 years (IQR=35) with male predominance (74.7%). Use of CTA increased from 18% of admissions in 2015 to 37% in 2024. CTA was commonly indicated by radiologic findings (75.5%), with 5.0% indicated by clinical findings, and 19.5% by a combination. BCVI per CTA decreased from 20% in 2015 to 10% in 2024; BCVI per admission was static at 4.2%. BCVI associated with higher mortality (OR=2.1, 95%CI=1.6-2.8), longer length of stay by 7.5 days (95%CI=5.1-9.9), and greater need for rehabilitation (OR=2.6, 95%CI=2.1-3.3). Conclusion: BCVI incidence was consistent over a decade, despite a two-fold increase in CTA use. BCVI associated with higher mortality and morbidity, likely reflecting overall injury severity, not independent causation. Follow-up was variable, providing opportunity to standardise longer-term management pathways for BCVI patients.

Background: Vascular trauma is frequently immediately life-threatening and occurs in the setting of complex multisystem injury, where delays to definitive haemorrhage control or revascularisation markedly worsen outcomes, and therefore inter-hospital transfer is not feasible, underscoring the importance of an embedded vascular surgery service within a major trauma centre. This study examines the volume, acuity, and procedural scope of vascular trauma managed at Alfred Health, Victoria’s highest-level trauma centre. Methods: All vascular surgical procedures performed at Alfred Health between 2010 and 2025 were retrospectively analysed. Trauma-related operations were identified and classified as non-iatrogenic or iatrogenic. Demographics, physiological status, anatomical distribution, and operative technique were examined. Results: Over the 15-year study period, 698 vascular operations were performed for trauma indications with non-iatrogenic trauma accounting for 358. Patients were predominantly male (78.8%) and physiologically high-risk (64.5% ASA III–V). Vascular injury involved a broad anatomical distribution, including lower limb vasculature (12.0%), thoracic and thoracoabdominal aorta (11.3%), popliteal and femoral vessels (10.6%), subclavian and axillary vessels (8.7%), brachial and upper limb arteries (7.6%), and cervical vessels (6.5%). Operative management was heterogeneous, encompassing open repair (local repair 17.6%, ligation 8.7%, interposition grafting 7.0%, bypass 12.7%), endovascular intervention (stents and stent grafts 22.1%), hybrid procedures, fasciotomy (2.2%), and major amputation (3.1%). Conclusions: This 15-year experience demonstrates that vascular trauma represents a sustained, high-acuity workload requiring immediate access to comprehensive open, endovascular, and hybrid surgical capability. We demonstrate that an embedded vascular surgery service is indispensable for definitive trauma care and cannot be replaced by transfer-dependent models.

Background: Abdominal and pelvic vascular injuries are among the most lethal forms of trauma, associated with high morbidity and mortality. Despite advances in trauma care, data describing their epidemiology, management strategies, and outcomes remain limited, particularly within the Australian context. This study aims to characterise the epidemiological patterns of abdominal and pelvic vascular trauma presenting to Gold Coast University Hospital (GCUH) and compare these findings with national and international data. Methods: All patients presenting to GCUH between January 2014 and December 2019 with abdominal or pelvic vascular injuries were identified.A descriptive analysis of patient demographics, injury mechanisms, interventions, and outcomes was performed. Results: During the study period, 5,452 trauma admissions were recorded, of which 68 patients sustained abdominal or pelvic vascular injuries. Blunt trauma accounted for 53 cases (77.9%), while penetrating trauma accounted for 15 cases (22.1%). Most patients were male (n = 51, 75%). Interventions were required in 57 patients (83.8%), including open surgery in 28 cases (41.2%), endovascular intervention in 27 cases (39.7%), and combined approaches in 2 cases (2.9%). The most frequently injured vessels were the visceral arteries (51.9%) and iliac arteries (22.7%). Overall mortality was 8.8%, with all deaths occurring following blunt trauma. Conclusions: Abdominal and pelvic vascular injuries represent a small but highly severe subset of trauma, with mortality rates exceeding those of general trauma populations. Blunt mechanisms, particularly those related to road traffic accidents, predominate and account for all observed fatalities. These findings highlight the critical role of rapid diagnosis and access to both open and endovascular expertise in major trauma centres. Importantly, they also underscore the potential impact of motor vehicle safety initiatives and targeted injury prevention programmes in reducing their incidence in Australia.

Background Falls remain a significant cause of morbidity in the Australian trauma population. Data exists correlating injury severity with fall height, but our anecdotal observations have been that even with a fall from standing height (FFSH) the patterns and severity of injury have been surprising. We present a narrative study describing how injury patterns differ across major trauma patients suffering from different fall heights. Methods A retrospective study of 1587 major trauma patients admitted to the Royal Melbourne Hospital having sustained a fall from 01/03/20 to 31/12/23. These patients were categorised into FFSH, low ladder, roof height and greater heights to compare mortality and injury patterns. Results Overall males were more likely to be admitted with major injuries from a fall than females (71%, n = 1126), although 42% of FFSH were female. Head and neck injuries (AIS > 3) were most common in all heights but more so in FFSH. Thoracic injuries increased with height of fall. FFSH had the highest mortality rates with age > =65 having a larger impact on odds of mortality than fragility (age OR = 5.45, 95% CI: 2.74-10.83 vs CFS > =5 OR = 2.10, 95% CI: 1.48 – 2.98). Traumatic brain injury (TBI) was the most common cause of death in all falls (83%), but this was only a slight majority in FFSH with other causes approaching 48%. Conclusion Having an awareness of expected injury patterns in different groups of fall heights aids clinical assessment. Identifying at risk patient groups may assist with fall injury prevention initiatives.

Purpose: Obesity is associated with worse trauma outcomes and has been proposed as a modifier in trauma triage. Early identification, however, commonly relies on visual assessment. This study evaluates the accuracy of visual obesity classification and height and weight estimation by trauma care providers at first patient contact. Methods: This prospective observational study was conducted at a Level I trauma centre. Paramedics, emergency department (ED) nurses, and ED physicians independently estimated patient height, weight, and obesity status on arrival. Measured anthropometric values served as the reference standard. Diagnostic performance metrics for obesity classification and estimation error metrics for height and weight were calculated. Results: One hundred and forty-three trauma patients were included (68.5% male; median age 44 years), with an obesity prevalence of 28.7%. Overall sensitivity for visual obesity classification was 80.2% and specificity was 89.8%, with no significant differences between professional groups. Height estimation was more accurate than weight estimation, but substantial inter-individual variability was observed for both parameters. Internal consistency between visual obesity classification and BMI derived from estimated height and weight was high (87.6%). Conclusion: Visual assessment of obesity in trauma patients demonstrates high specificity but only moderate sensitivity, resulting in a clinically relevant proportion of patients with obesity being missed. Given the variability of anthropometric estimation and the importance of early risk stratification, visual assessment alone appears insufficient for use as an independent trauma triage criterion, supporting the need for more objective methods of early obesity identification.

Introduction: Peritoneal violation as an indication for surgery in anterior abdominal stab wounds (SW) is known to be associated with significant non-therapeutic exploration, but remains a common practice. This study reviews our experience in a high resource but low penetrating injury volume centre in New Zealand. Materials and Methods: A retrospective study was conducted over a 20-year period from 2004-2024 and included all patients with anterior abdominal SWs treated at Auckland City Hospital. Results: A total of 182 patients were included. 98 (54%) proceeded directly to surgery due to haemodynamic instability, peritonitis, evisceration and / or high suspicion of intra-abdominal injury. The remaining 84 patients all underwent CT. 33 did not show evidence of peritoneal breach and the other 51 demonstrated peritoneal violation. Of the 51 patients who demonstrated peritoneal violation on CT, 28 (55%) had associated organ injury, and the remaining 23 (45%) demonstrated peritoneal violation alone. 49 of the 51 patients underwent surgery. 38 proceed to laparotomy, all of which were positive (28 therapeutic, 10 non-therapeutic). 5 underwent laparoscopy which required conversion to laparotomy, all 5 of which were positive (4 therapeutic and 1 non-therapeutic). 6 underwent laparoscopy that did not require conversion. 4 were positive (3 therapeutic and 1 non-therapeutic) and 2 were negative. Overall, 47 (96%) were positive for injury and the remaining 2 (4%) was negative. Of the 47 positive cases, 35 (74%) were considered therapeutic and the remaining 12 (26%) were non-therapeutic. The overall morbidity was 16% and the mortality was 0%. Conclusions: Peritoneal violation remains an indication for surgery, which not changed over the past decade and was associated with high rates of positive exploration. It would appear that this approach remains appropriate in our environment over the past two decades and is associated with significant non-therapeutic rate at surgery.

Purpose Tracheostomies are used in trauma patients in the Intensive Care Unit (ICU) if intubation is likely to be prolonged to facilitate ventilator weaning and neurological or airway assessment. This paper investigates the impact of tracheostomies on ventilation duration and considers factors associated with prolonged ventilation or delayed decannulation. Methodology Patients who had a tracheostomy between July 2020 and July 2025 were identified from the Royal Melbourne Hospital Trauma Registry which captures all injury-related admissions. Data collected included demographics, injury severity, mechanical ventilation hours, length of stay, general and tracheostomy-specific complications. Analysis used χ 2 and Fisher's test for categorical variables and the Mann Whitney U test for continuous ones. Results A total of 102 patients were included. Length of ICU stay was shorter in the early tracheostomy group (defined as tracheostomy 10 days or earlier from intubation) compared with the late group (U = 524, Z = −4.92, p < .001, r = .49). There was no difference when analysing total length of stay or complication rates. Obese patients required longer ventilation post tracheostomy compared with non-obese patients (U=406, Z = -3.02, p = .003, r = .3). Patients who developed pneumonia post tracheostomy took longer to decannulate (U= 697, Z = -2.35, p = .02, r =.24), as did those with major injures (ISS >15) compared with minor injuries (U= 144, Z = -2.68, p =.01, r= .28). Conclusion Earlier tracheostomies were associated with shorter stays in ICU but did not affect complication rates or total hospital stay. Obese patients required longer mechanical ventilation following tracheostomy, suggesting increased difficulty with ventilator weaning and highlighting a potential for early tracheostomy. Patients who developed pneumonia and those with more severe injuries took longer to decannulate and may also benefit from early tracheostomy.

Purpose: Tourniquets are life-saving in severe extremity haemorrhage, but prolonged application raises concerns regarding limb ischaemia. Western Australia’s vast geography and single Level 1 trauma centre may result in extended prehospital tourniquet times. The purpose of this study was to examine patterns of prehospital tourniquet use, duration, and outcomes in major trauma patients. Methodology: A retrospective registry and chart review was performed of major trauma patients (ISS >12) with prehospital tourniquet application admitted to Royal Perth Hospital between 2013 and 2022. Demographics, injury characteristics, tourniquet duration (where documented), interventions, amputation, and mortality were analysed, including comparison between metropolitan and rural presentations. Results: Seventy-two patients (79 limbs) were included (85% male; mean age 37.4 years; mean ISS 25.8). Injuries occurred in metropolitan areas in 71% and rural areas in 29%; 35% were transported by air. Blunt trauma predominated (78%). Tourniquet duration was documented in 40 limbs, with a mean time of 3 h 25 min. Rural patients had significantly longer tourniquet times than metropolitan patients (4 h 28 min vs 2 h 40 min; p=0.044). Open fractures occurred in 77% of limbs. Amputation occurred in 43%, likely reflecting injury severity. Overall mortality was 20.8%, with haemorrhage contributing to over half of deaths. Conclusion: In this civilian cohort, prehospital tourniquet durations, particularly in rural Western Australia, were substantially longer than reported elsewhere. Despite prolonged application and high injury severity, outcomes are comparable with international experience, supporting tourniquet use in geographically dispersed trauma systems.

Purpose Whilst the pathophysiology of Pulmonary Embolus (PE) in major trauma patients is well described, less is understood about those presenting with a Pulmonary Thrombus (PT) on initial trauma CT scan, though direct thoracic trauma has been implicated. This study aims to compare the proportions of accepted risk factors for venous thromboembolic disease in patients with PT events versus both later PE events and a control group. Methodology This is a retrospective review of prospectively-collated trauma database of a major trauma centre, including all patients who had a PE during their admission from 2014-2023. events were categorised into ‘PE’ diagnosed <24 hours from admission (PT group), 24-72hrs (intermediate PE) and those diagnosed >72 hours for admission (late PE). Variables included patient demographics, anticoagulation and VTE history, shock, Injury Severity Score (ISS) and the Abbreviated Injury Score (AIS) for thoracic and head injury, and mortality. Analysis was two-fold, firstly a comparison the frequencies of co-variates between PT and late PE groups (Fischer’s exact & rank sum) and secondly, a case-control study where the PT group matched for age, gender, mechanism of injury and ISS with 3:1 with controls. Results 35 patients were included in the PT group and 129 patients in the late PE group. PT group patients were more likely to be female (37.3% vs 19.4%, p=0.02), however no other difference in age, mortality, ISS, thoracic or head AIS or admission details reached statistical significance. When compared to matched controls, the PT group were more likely to be smokers (OR 6.91 [1.63-33.65], p<0.05) and had a longer hospital length of stay (9.93 days vs 4.93, p<0.05) but no other differences reached statistical significance. Conclusion Trauma patients suffering a PT event are more likely to be female than later PE events, and smokers compared with controls. There was no evidence of an association with chest trauma in this series.

Purpose: While resuscitative thoracotomy in trauma is well-studied, data on non-emergent thoracotomy—particularly in older adults—remain limited. This study evaluated whether age predicts outcomes following non-emergent thoracotomy in older trauma patients. Methodology: We conducted a 5-year retrospective analysis of the American College of Surgeons-Trauma Quality Improvement Program (2017-2021), including trauma patients aged ≥ 60 undergoing thoracotomy (excluding those performed in the ED or on direct OR transfer). Patients were grouped by age (60-69, 70-79, and 80-89). Primary outcomes were mortality, major complications, and prolonged ventilation (>7 days); secondary outcomes included hospital and ICU length of stay. Multivariable regression assessed age's independent effect on outcomes. Results: Among 3,673 older adult patients who underwent thoracotomy, 641 were non-emergent. Mean (SD) age was 70 (7) years, and 72% were male. Median [IQR] ISS and chest AIS were 12 [9-17] and 3 [2-4]. Median [IQR] time to thoracotomy was 51 [21-114] hours. Age distribution was 54% (60-69 years), 33% (70-79 years), and 13% (80-89 years), with no significant difference in ISS, chest AIS, or thoracotomy timing between groups. However, frailty was higher in the 80-89 group (p=0.002). Univariate analysis showed no differences in mortality (p=0.128), major complications (p=0.651), prolonged ventilation (p=0.358), hospital LOS (p=0.436), or ICU LOS (p=0.975). Multivariable analysis revealed no age-related association with mortality (aOR: 1.414, p=0.102), major complications (aOR: 0.850, p=0.284), or prolonged ventilation (aOR: 0.780, p=0.155). Conclusion: Nine in ten older adult trauma patients who underwent non-emergent thoracotomy survived to discharge. Increasing age did not predict adverse outcomes, indicating that non-emergent thoracotomy may remain appropriate in this population.