Evidence map›Paper›PMID 38302619›Full record

ArticleScientific reports2024

Mechanism matters: mortality and endothelial cell damage marker differences between blunt and penetrating traumatic injuries across three prehospital clinical trials.

Jack K Donohue, Danielle S Gruen, Nidhi Iyanna, John M Lorence, Joshua B Brown, Francis X Guyette, Brian J Daley, Brian J Eastridge, Richard S Miller, Raminder Nirula and 9 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Scientific reports, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Blood transfusion strategies for major bleeding in trauma.The Cochrane database of systematic reviews · 2025
    Pooled it
  2. Article
  3. Article
  4. Review
  5. Is Mechanism a Biological Variable?: A Secondary Analysis of the PROPPR Trial.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2025
    Article
  6. Review
  7. Article
  8. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

19 authors.

Jack K DonohueDivision of Trauma and General Surgery, Department of Surgery, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA, USA.
Danielle S GruenDivision of Trauma and General Surgery, Department of Surgery, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA, USA.
Nidhi IyannaDivision of Trauma and General Surgery, Department of Surgery, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA, USA.
John M LorenceDivision of Trauma and General Surgery, Department of Surgery, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA, USA.
Joshua B BrownDivision of Trauma and General Surgery, Department of Surgery, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA, USA.
Francis X GuyetteDepartment of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Brian J DaleyDepartment of Surgery, University of Tennessee Health Science Center, Knoxville, TN, USA.
Brian J EastridgeDepartment of Surgery, University of Texas Health San Antonio, San Antonio, TX, USA.
Richard S MillerDepartment of Surgery, JPS Health Network, Fort Worth, TX, USA.
Raminder NirulaDepartment of Surgery, University of Utah, Salt Lake City, UT, USA.
Brian G HarbrechtDepartment of Surgery, University of Louisville, Louisville, KY, USA.
Jeffrey A ClaridgeDepartment of Surgery, Metro Health Medical Center, Case Western Reserve University, Cleveland, OH, USA.
Herb A PhelanDepartment of Surgery, University of Texas Southwestern, Dallas, TX, USA.
Gary A VercruysseDepartment of Surgery, University of Arizona, Tucson, AZ, USA.
Terence O'KeeffeDepartment of Surgery, University of Arizona, Tucson, AZ, USA.
Bellal JosephDepartment of Surgery, University of Arizona, Tucson, AZ, USA.
Matthew D NealDivision of Trauma and General Surgery, Department of Surgery, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA, USA.
Timothy R BilliarDivision of Trauma and General Surgery, Department of Surgery, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA, USA.
Jason L SperryDivision of Trauma and General Surgery, Department of Surgery, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA, USA. sperryjl@upmc.edu.

Funding

University of Pittsburgh Clinical and Translational Science InstituteUL1TR001857 · NCATS · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI REIS, STEVEN E · 2016 to 2025
$129.3M
Institutional Career Development CoreKL2TR001856 · NCATS · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI RAY, KRISTIN N, RUBIO, DORIS M · 2016 to 2025
$13.8M
NRSA Training CoreTL1TR001858 · NCATS · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI RADOMSKI, THOMAS, RUBIO, DORIS M · 2016 to 2025
$11.1M
Pragmatic, Prehospital Group O Whole Blood Early Resuscitation Pilot TrialR34HL135224 · NHLBI · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI SPERRY, JASON LEE, TRIULZI, DARRELL J · 2017 to 2019
$594k
NCATS NIH HHS KL2 TR001856NCATS NIH HHS TL1 TR001858NCATS NIH HHS UL1 TR001857NHLBI NIH HHS R34 HL135224
6 · The paper itself

Abstract

Injury mechanism is an important consideration when conducting clinical trials in trauma. Mechanisms of injury may be associated with differences in mortality risk and immune response to injury, impacting the potential success of the trial. We sought to characterize clinical and endothelial cell damage marker differences across blunt and penetrating injured patients enrolled in three large, prehospital randomized trials which focused on hemorrhagic shock. In this secondary analysis, patients with systolic blood pressure < 70 or systolic blood pressure < 90 and heart rate > 108 were included. In addition, patients with both blunt and penetrating injuries were excluded. The primary outcome was 30-day mortality. Mortality was characterized using Kaplan-Meier and Cox proportional-hazards models. Generalized linear models were used to compare biomarkers. Chi squared tests and Wilcoxon rank-sum were used to compare secondary outcomes. We characterized data of 696 enrolled patients that met all secondary analysis inclusion criteria. Blunt injured patients had significantly greater 24-h (18.6% vs. 10.7%, log rank p = 0.048) and 30-day mortality rates (29.7% vs. 14.0%, log rank p = 0.001) relative to penetrating injured patients with a different time course. After adjusting for confounders, blunt mechanism of injury was independently predictive of mortality at 30-days (HR 1.84, 95% CI 1.06-3.20, p = 0.029), but not 24-h (HR 1.65, 95% CI 0.86-3.18, p = 0.133). Elevated admission levels of endothelial cell damage markers, VEGF, syndecan-1, TM, S100A10, suPAR and HcDNA were associated with blunt mechanism of injury. Although there was no difference in multiple organ failure (MOF) rates across injury mechanism (48.4% vs. 42.98%, p = 0.275), blunt injured patients had higher Denver MOF score (p < 0.01). The significant increase in 30-day mortality and endothelial cell damage markers in blunt injury relative to penetrating injured patients highlights the importance of considering mechanism of injury within the inclusion and exclusion criteria of future clinical trials.

Indexed as

Emergency Medical ServicesWounds, NonpenetratingWounds, PenetratingEndothelial CellsHumansProportional Hazards ModelsRetrospective Studies

Identifiers

PMID38302619
PMCPMC10834504

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.