Presenting predictions and performance of probabilistic models for clinical decision support in trauma care.

Introduction: Both predictions and performance of clinical predictive models can be presented with various verbal and visual representations. This study aims to investigate how different risk and performance presentations for probabilistic predictions affect clinical users' judgement and preferences.

Methods: We use a clinical Bayesian Network (BN) model that has been developed for predicting the risk of Trauma Induced Coagulopathy (TIC).

Counterfactual reasoning using causal Bayesian networks as a healthcare governance tool.

Background: Healthcare governance (HG) is a quality assurance processes that aims to maintain and improve clinical practice. Clinical decisions are routinely reviewed after the outcome is known to learn lessons for the future. When the outcome is positive, then practice is praised, but when practice is suboptimal, the area for improvement is highlighted.

A scoping review, novel taxonomy and catalogue of implementation frameworks for clinical decision support systems.

Background: The primary aim of this scoping review was to synthesise key domains and sub-domains described in existing clinical decision support systems (CDSS) implementation frameworks into a novel taxonomy and demonstrate most-studied and least-studied areas. Secondary objectives were to evaluate the frequency and manner of use of each framework, and catalogue frameworks by implementation stage.

Methods: A scoping review of Pubmed, Scopus, Web of Science, PsychInfo and Embase was conducted on 12/01/2022, limited to English language, including 2000-2021.

Identification of major hemorrhage in trauma patients in the prehospital setting: diagnostic accuracy and impact on outcome.

Background: Hemorrhage is the most common cause of potentially preventable death after injury. Early identification of patients with major hemorrhage (MH) is important as treatments are time-critical. However, diagnosis can be difficult, even for expert clinicians.

Updating and recalibrating causal probabilistic models on a new target population.

Objective: Very often the performance of a Bayesian Network (BN) is affected when applied to a new target population. This is mainly because of differences in population characteristics. External validation of the model performance on different populations is a standard approach to test model's generalisability.

Methods used to evaluate usability of mobile clinical decision support systems for healthcare emergencies: a systematic review and qualitative synthesis.

Objective: The aim of this study was to determine the methods and metrics used to evaluate the usability of mobile application Clinical Decision Support Systems (CDSSs) used in healthcare emergencies. Secondary aims were to describe the characteristics and usability of evaluated CDSSs.

Materials And Methods: A systematic literature review was conducted using Pubmed/Medline, Embase, Scopus, and IEEE Xplore databases.

Diagnostic accuracy of clinical examination to identify life- and limb-threatening injuries in trauma patients.

Background: Timely and accurate identification of life- and limb-threatening injuries (LLTIs) is a fundamental objective of trauma care that directly informs triage and treatment decisions. However, the diagnostic accuracy of clinical examination to detect LLTIs is largely unknown, due to the risk of contamination from in-hospital diagnostics in existing studies. Our aim was to assess the diagnostic accuracy of initial clinical examination for detecting life- and limb-threatening injuries (LLTIs).

Impact of Ischemia Duration on Lower Limb Salvage in Combat Casualties.

Introduction: The 6-hour threshold to revascularization of an ischemic limb is ubiquitous in the trauma literature, however, contemporary evidence suggests that this threshold should be less. This study aims to characterize the relationship between the duration of limb ischemia and successful limb salvage following lower extremity arterial trauma.

Methods: This is a cohort study of the United States and UK military service members injured while serving in Iraq or Afghanistan between 2003 and 2013.

Predicting the Outcome of Limb Revascularization in Patients With Lower-extremity Arterial Trauma: Development and External Validation of a Supervised Machine-learning Algorithm to Support Surgical Decisions.

Objectives: Estimating the likely success of limb revascularization in patients with lower-extremity arterial trauma is central to decisions between attempting limb salvage and amputation. However, the projected outcome is often unclear at the time these decisions need to be made, making them difficult and threatening sound judgement. The objective of this study was to develop and validate a prediction model that can quantify an individual patient's risk of failed revascularization.

Early Identification of Trauma-induced Coagulopathy: Development and Validation of a Multivariable Risk Prediction Model.

Objective: The aim of this study was to develop and validate a risk prediction tool for trauma-induced coagulopathy (TIC), to support early therapeutic decision-making.

Background: TIC exacerbates hemorrhage and is associated with higher morbidity and mortality. Early and aggressive treatment of TIC improves outcome.

Prehospital tranexamic acid shortens the interval to administration by half in Major Trauma Networks: a service evaluation.

Introduction: Tranexamic acid (TXA) reduces bleeding and mortality. Recent trials have demonstrated improved survival with shorter intervals to TXA administration. The aims of this service evaluation were to assess the interval from injury to TXA administration and describe the characteristics of patients who received TXA pre-hospital and in-hospital.

Outcomes following trauma laparotomy for hypotensive trauma patients: A UK military and civilian perspective.

Background: The management of trauma patients has changed radically in the last decade, and studies have shown overall improvements in survival. However, reduction in mortality for the many may obscure a lack of progress in some high-risk patients. We sought to examine the outcomes for hypotensive patients requiring laparotomy in UK military and civilian cohorts.

Long-term, patient-centered outcomes of lower-extremity vascular trauma.

Objective: To describe the long-term outcomes of military lower-extremity vascular injuries, and the decision making of surgeons treating these injuries.

Background: Lower-extremity vascular trauma is an important cause of preventable death and severe disability, and decisions on amputation or limb salvage can be difficult. Additionally, the complexity of the condition is not amenable to controlled study, and there is limited data to guide clinical decision making and establish sensible treatment expectations during rehabilitation.

Combining data and meta-analysis to build Bayesian networks for clinical decision support.

Complex clinical decisions require the decision maker to evaluate multiple factors that may interact with each other. Many clinical studies, however, report 'univariate' relations between a single factor and outcome. Such univariate statistics are often insufficient to provide useful support for complex clinical decisions even when they are pooled using meta-analysis.

Injury pattern and mortality of noncompressible torso hemorrhage in UK combat casualties.

Background: Hemorrhage following traumatic injury is a leading cause of military and civilian mortality. Noncompressible torso hemorrhage (NCTH) has been identified as particularly lethal, especially in the prehospital setting.

Methods: All patients sustaining NCTH between August 2002 and July 2012 were identified from the UK Joint Theatre Trauma Registry.

Frequency and relevance of acute peritraumatic pulmonary thrombus diagnosed by computed tomographic imaging in combat casualties.

Background: Posttraumatic pulmonary embolism is historically diagnosed after clinical deterioration within the first week after injury. An increasing prevalence of immediate and asymptomatic pulmonary embolism have been reported in civilian and military trauma, termed hereafter as acute peritraumatic pulmonary thrombus (APPT). The objective of this study was to define the frequency of APPT diagnosed by computed tomographic (CT) imaging in wartime casualties.

Major trauma and urban cyclists: physiological status and injury profile.

Introduction: Pedal cycling in cities has the potential to deliver significant health and economic benefits for individuals and society. Safety is the main concern for potential cyclists although the statistical risk of death is low. Little is known about the severity of injuries sustained by city cyclists and their outcome.

Single-center experience of endovascular abdominal aortic aneurysm repair (EVAR) in patients not participating in the U.K. EVAR trials.

The objective was to evaluate outcomes of a high-risk patient cohort following endovascular abdominal aortic aneurysm repair (EVAR) treatment not entered into the U.K. endovascular stent-graft aortic aneurysm repair trials (EVAR-1 or -2) because of equipoise absence but where EVAR was judged to be the most appropriate intervention option on compassionate grounds.