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Current Issue Highlights

Socioeconomic and geographic variation in response to trauma medical home intervention
November 2026: 101(5):903-912
BACKGROUND:
Many injury survivors experience persistent biopsychosocial morbidity after hospital discharge. The trauma medical home (TMH), a multidisciplinary coordinated care model, demonstrated modest benefit in a multicenter randomized trial, but its effectiveness across rural and socioeconomically deprived populations remains unclear.
METHODS:
This post hoc retrospective analysis of the TMH parent randomized trial included patients aged older than or equal to 50 years with an Injury Severity Score ≥9 across four level I trauma centers. For this study, patients were categorized by rurality and Area Deprivation Index (ADI). Outcomes included the SF-36 Physical and Mental Component Scores (PCS, MCS), depression [Patient Health Questionnaire-9 (PHQ-9)], anxiety [Generalized Anxiety Disorder (GAD-7)], physical function [Short Physical Performance Battery (SPPB)], and health care utilization. Interaction effects between TMH and rural/urban status or ADI were evaluated at baseline, 6 months, and 12 months
RESULTS:
Four hundred thirty patients were included [216 TMH and 214 in usual care (UC)]. On the basis of urbanicity, the effectiveness of TMH on quality of life, psychological, physical, and health care utilization was similar at 6 and 12 months. ADI stratification showed greater differences. In high-ADI urban areas, baseline MCS scores were similar between TMH (47.5 ± 13.0) and UC (48.6 ± 12.8). By 6 months, TMH patients improved to 54.9 ± 8.8 compared with 49.0 ± 13.1 in UC, with a predicted difference of 7.7 (95% CI: 1.32, 12.83, P=0.016), demonstrating a clinically and statistically significant benefit of TMH
CONCLUSIONS:
The TMH was associated with greater mental health improvement among patients with high area deprivation, particularly in urban settings, suggesting a potential role in reducing disparities through coordinated care.
LEVEL OF EVIDENCE:
Prognostic and Epidemiological; Level III
The long road home: A WTA multicenter study of patient preferences and risk tolerance in the regionalization of acute care surgery
November 2026: 101(5):894-902
BACKGROUND:
Regionalization of acute care surgery (ACS) aims to improve outcomes by transferring complex cases from local hospitals to tertiary centers. Although improved outcomes have been demonstrated for select conditions, regionalization may impose social and financial burdens, and patient preferences in the ACS setting remain poorly characterized. We evaluated patient preferences and risk tolerance related to ACS regionalization in a multicenter cohort.
METHODS:
We prospectively surveyed 602 adults with trauma or emergency general surgery (EGS) conditions at five trauma centers. Using a modified standard gamble utility assessment, patients indicated preferences for local care versus regional transfer under scenarios of equal perioperative risk and increasing hypothetical risks at their local hospital (absolute increases of 2%, 4%, 6%). Demographics and clinical variables were collected. Univariate analyses identified factors associated with local versus regional preference, and multivariable logistic regression determined independent predictors of site preference.
RESULTS:
Among 602 patients [67% EGS, 33% trauma, median age 50 (interquartile range: 24–61); 60% males], most preferred local care when complication or mortality risks were equivalent between hospitals (93% and 92%, respectively). As local risk increased, preference for local care declined; however, nearly half of patients preferred to remain at their local hospital despite a doubling of complication or mortality risk (4% vs. 2%). Preference for regional transfer at this inflection point was associated with higher household income, younger age, willingness to travel for specialty care, intensive care unit admission, and prior transfer. Trauma versus EGS diagnosis and mechanism did not predict site preference. Substantial variation in risk tolerance was observed across centers.
CONCLUSIONS:
ACS patients strongly prefer local care when outcomes are equivalent, and many are willing to forego interhospital transfer despite substantially increased risk. These findings highlight a discordance between patient preferences, risk tolerance, and regionalization practices, underscoring the need to incorporate patient perspectives into ACS transfer decision-making. (J Trauma Acute Care Surg. 2026;101: 894–902.)
LEVEL OF EVIDENCE:
Prognostic and Epidemiological; Level III.
Filling gaps or filling wallets? The role of for-profit medicine in the US trauma system
November 2026: 101(5):886-893
BACKGROUND:
After the US trauma system contracted in the 1990s with the loss of financially vulnerable trauma centers (TCs), a subsequent re-expansion took place. Many new trauma centers are for-profit (FPTCs) and may provide redundant care for affluent populations. Little is known about their role in the national trauma system. We hypothesized that FPTC catchments would provide redundant coverage to affluent populations.
METHODS:
Data for the contiguous United States were obtained from the 2020 Decennial Census or American Community Survey. Population-weighted centroids of each census tract, as well as TC locations, were geocoded in ArcGIS Pro. FPTC status was obtained from the Centers for Medicare and Medicaid Services. Road and traffic data were obtained from Esri StreetMaps Premium. The shortest travel time from each population-weighted centroid was calculated to the nearest TC to delineate coverage areas and populations. This analysis was repeated without FPTCs to assess contributions to the trauma system. Data were exported to Stata for further analysis.
RESULTS:
In total, 83,713 population-weighted centroids and 2,044 TCs were captured. About 11% of tracts were primarily served by 223 FPTCs, representing the closest TC for 43M people. While overall transport times were similar between FPTCs and NPTCs (14.0 vs. 14.2 min, p=ns), the removal of FPTCs did not change national transport times (median 0 min; IQR, 0, 0; range, 0–98). FPTC catchment populations were associated with more urban [odds ratio (OR), 1.02, 95% CI, 1.01–1.02, p<0.001], Hispanic (OR, 1.14, 95% CI, 1.14–1.15, p<0.001), uninsured (OR, 1.65, 95% CI, 1.57–1.73, p<0.001) or Medicare covered (OR, 1.04, 95% CI, 1.02–1.07, p<0.001) populations.
CONCLUSIONS:
Most FPTCs provide redundant care to populations that are often less insured, of similar poverty levels and of different demographics as compared with nonprofit centers. However, a small subset of FPTCs provides access to care for populations who would face long transport times without them. (J Trauma Acute Care Surg. 2026;101: 886–893.)
LEVEL OF EVIDENCE:
Prognostic/Epidemiological; Level III.
E-bikes and E-scooters are not bicycles or motorcycles: The case for a dedicated trauma registry mechanism
November 2026: 101(5):876-885
BACKGROUND:
Powered micromobility devices (PMDs), including electric scooters (e-scooters) and electric bicycles (e-bikes), can operate at speeds approaching those of low-speed motorcycles. Yet PMDs are treated as low-energy mechanisms in trauma surveillance systems and are not classified as distinct mechanisms of injury. Although prior studies report higher head injury rates in PMD crashes than bicycle crashes, injury severity and health care utilization relative to motorcycle crashes are not known. We hypothesized that e-scooter and e-bike crashes demonstrate distinct injury and resource utilization patterns compared with motorcycles and bicycles.
METHODS:
We performed a retrospective cohort study using the 2023 Florida Agency for Health Care Administration emergency department and inpatient databases. Encounters for motorcycle, bicycle, e-scooter, or e-bike crashes were identified. Patients meeting National Trauma Data Standard criteria were classified as trauma registry-eligible. Multivariable regression evaluated associations between mechanism and severe head and facial injury.
RESULTS:
Of 50,889 encounters, 10,522 (20.7%) were trauma registry-eligible. Median ISS was highest for motorcyclists [10 (interquartile range: 4–22)], followed by bicyclists [9 (1–14)], e-bike [8 (2–17)], and e-scooter riders [6 (1–15)] (p<0.001). On adjusted analyses, e-scooter and e-bike crashes had no significant differences in adjusted odds ratios (aORs) of severe head injury relative to motorcycle crashes, while e-bike crashes were associated with a higher aOR of severe facial injury (aOR: 1.78, 95% confidence interval: 1.15–2.74). E-bike injuries demonstrated the second-highest intensive care unit utilization and per-encounter hospital charges after motorcycles (both p<0.001).
CONCLUSIONS:
E-scooter and e-bike crashes demonstrated injury and resource utilization patterns distinct from both traditional bicycles and motorcycles. Head injury risk among PMD riders was similar to that of motorcyclists, while facial injury risk among e-bike riders exceeded that of motorcyclists. Findings highlight the need for improved injury surveillance and evidence-based helmet standards for PMD users, including evaluation of whether full-face protection may be warranted.
LEVEL OF EVIDENCE:
Prognostic/Epidemiological; Level III.
Reductions in PTSD symptom clusters among perinatal and postnatal survivors of intimate partner violence participating in the Heartbeats program
November 2026: 101(5):868-875
BACKGROUND:
Intimate partner violence (IPV) remains a leading cause of injury among women, especially during pregnancy and the postpartum period. Experiencing IPV increases the risk of mental health disorders, including post-traumatic stress disorder (PTSD). PTSD during the perinatal period is associated with poorer maternal mental health and adverse early child outcomes. Heartbeats (HB) is a hospital-based, community-linked violence intervention program designed to reduce morbidity and mortality among perinatal and postnatal survivors of IPV. HB provides crisis intervention, intensive case management, and counseling to pregnant patients up to 2 years postpartum who have experienced IPV. Given the high burden of mental health concerns in this population, a primary goal of HB is to reduce PTSD symptoms.
METHODS:
This study was conducted at a Level 1 trauma center. Participants were identified through IPV-related injury presentations, routine hospital screening, or referrals. Seventy-four participants completed the PTSD Checklist for DSM-5 (PCL-5) at intake (baseline) and 4 months postbaseline (follow-up). Total PTSD and subscale scores were calculated for intrusion (re-experiencing), avoidance, negative alterations in cognition and mood, and alterations in arousal and reactivity (hyperarousal). Paired-samples t tests assessed changes from baseline to follow-up.
RESULTS:
Significant reductions were observed in total PTSD symptoms (M=9.16, SD=23.64, p=0.003) and across all subscales: intrusion (re-experiencing; M=2.76, SD=6.19, p<0.001), avoidance (M=1.18, SD=2.90, p<0.001), negative alterations in cognition and mood (M=3.82, SD=8.83, p<0.001), and alterations in arousal and reactivity (hyperarousal; M=2.33, SD=7.25, p=0.008).
CONCLUSIONS:
HB program participation was associated with significant reductions in overall PTSD severity and each DSM-5 symptom cluster. These findings support the potential of integrated hospital-based, community-linked programs to improve trauma recovery outcomes among perinatal survivors of IPV.
LEVEL OF EVIDENCE:
Prognostic/Epidemiological; Level III.

Latest Articles

Calculating trauma undertriage rates: Are we using the wrong formula—and the wrong definition?
Journal of Trauma and Acute Care Surgery. November 6, 2026
BACKGROUND:
Undertriage (UT) is central to trauma center quality improvement, yet UT definitions vary, and no data-driven consensus target exists for interfacility benchmarking. We compared facility-level UT rates across four methods and assessed the impact on facility benchmarking.
METHODS:
This retrospective study included patients aged 18 to 89 from Level I & II trauma centers in the ACS TQP Files (2021–2023). Facility-level UT was calculated using the Cribari Matrix Method (CMM), modified Cribari Matrix Method (mCMM), Standardized Triage Assessment Tool (STAT), and High-Intensity Time-Sensitive (HITS) intervention-based definition representing trauma team actions. Paired facility-level UT rates were compared across methods. To estimate benchmarking impact, we calculated within-facility rank change (higher rank = higher UT) relative to CMM.
RESULTS:
2,643,881 patients and 515 facilities were included. Median facility-level UT significantly differed by method: CMM 11% [interquartile range: 9–14], mCMM 60% [50–67], STAT 6% [5–8], and HITS 30% [22–40] (all P<0.001). At individual hospitals, the median range of maximum UT values between methods was 53% [44–60]. The median absolute facility rank change between the CMM method and other tools was 129 [54.5–236.5] for mCMM, 48 [17–90] for STAT, and 142 [62.5–252.5] for HITS.
CONCLUSIONS:
These UT data highlight a concerning level of variation and uncertainty in the calculation and interpretation of a key trauma center performance metric. Until a UT definition is standardized and data-driven UT target goals established, cross-center benchmarking using UT should be interpreted cautiously and may be better suited for within-center trending.
LEVEL OF EVIDENCE:
Level III, therapeutic/care management.
Calcium in trauma resuscitation: Transfusion volume or measurement-guided replacement?
Journal of Trauma and Acute Care Surgery. November 5, 2026
Persistent gaps in health-related quality of life measures for older adult trauma patients: A systematic review
Journal of Trauma and Acute Care Surgery. November 5, 2026
BACKGROUND:
Older adults experience persistent functional and psychosocial consequences after trauma, but it remains unclear whether commonly used health-related quality of life (HRQoL) instruments adequately measure recovery in this population. This systematic review appraised psychometric evidence and risk of bias for HRQoL instruments used in United States trauma cohorts that included adults aged 65 years or older.
METHODS:
MEDLINE, EMBASE, and CINAHL were searched from inception through January 28, 2026. Two reviewers independently screened studies and extracted data. Risk of bias was evaluated using an adapted Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) assessment. Studies evaluating an HRQoL instrument as the target measure underwent Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) Risk of Bias assessment for each reported measurement property. Results were rated as sufficient, insufficient, or indeterminate and synthesized by instrument.
RESULTS:
Of 17,195 records, 19 studies were included. Studies most often examined isolated orthopedic trauma (n=7, 36.8%), spinal cord injury (n=6, 31.6%), other injury populations (n=3, 15.8%), polytrauma or systemic injury (n=2, 10.5%), and burns (n=1, 5.3%). Frequently evaluated domains included physical functioning (n=16), emotional or mental health (n=13), overall life satisfaction (n=13), social functioning (n=11), and physical symptoms (n=10). Although all studies used at least one previously developed patient-reported measure, none explicitly adapted or comprehensively validated an eligible HRQoL instrument for older adult trauma patients. Ten studies evaluated a target HRQoL instrument, contributing 33 COSMIN measurement property assessments: 19 sufficient, 10 indeterminate, and 4 insufficient. Overall risk of bias was low in six studies, moderate in eight, serious in three, and unclear in two.
CONCLUSIONS:
Existing studies show that HRQoL instruments have been used in trauma cohorts including older adults, but they do not establish validity for older adult trauma patients specifically. Future studies should evaluate promising instruments in cohorts designed around older adults’ recovery priorities and clinical characteristics after trauma.
LEVEL OF EVIDENCE:
Systematic Review; Level III.