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Integration of Medical Legal Services into a Hospital-Based Violence Intervention Program: A Survey and Interview-Based Provider Needs Assessment. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-03-14 Jake Sonnenberg, Ariana Metchick, Caitlin Schille, Prashati Bhatnagar, Lisa Kessler, Deborah Perry, Vicki Girard, Belinda Taylor, Erin Hall
Violent injury among trauma surgery patients is strongly associated with exposure to harmful social determinants of health and negative long-term health outcomes. Medical-legal partnerships in other settings successfully provide patients with legal services to address similar health-harming legal needs and may offer a promising model for the care of violently-injured patients.
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Acute Emergence of the Intestinal Pathobiome after Postinjury Pneumonia. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-03-14 Jennifer A Munley, Lauren S Kelly, Gwoncheol Park, Stacey K Drury, Gwendolyn S Gillies, Preston S Coldwell, Kolenkode B Kannan, Letitia E Bible, Philip A Efron, Ravinder Nagpal, Alicia M Mohr
Previous preclinical studies have demonstrated sex-specific alterations in the gut microbiome following traumatic injury or sepsis alone; however, the impact of host sex on dysbiosis in the setting of postinjury sepsis acutely is unknown. We hypothesized that multicompartmental injury with subsequent pneumonia would result in host sex-specific dysbiosis.
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A multi-dimensional approach to identifying high performing trauma centers across the United States. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-03-14 Doulia M Hamad, Haris Subacius, Arielle Thomas, Matthew P Guttman, Bourke W Tillmann, Angela Jerath, Barbara Haas, Avery B Nathens
The differentiators of centers performing at the highest level of quality and patient safety are likely both structural and cultural. We aimed to combine five indicators representing established domains of trauma quality, and to identify and describe the structural characteristics of consistently performing centers.
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Impact of Resuscitation Adjuncts on Post-Intubation Hypotension in Patients with Isolated TBI. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-03-14 Tanya Anand, Omar Hejazi, Madolyn Conant, Dylan Joule, Megan Lundy, Christina Colosimo, Audrey Spencer, Adam C Nelson, Lou Magnotti, Bellal Joseph
Post-intubation hypotension (PIH) is a risk factor of endotracheal intubation (ETI) after injury. For those with traumatic brain injury (TBI), one episode of hypotension can potentiate that injury. This study aims to identify the resuscitation adjuncts which may decrease the incidence of PIH in this patient population.
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Obesity Is Associated with Improved Early Survival but Increased Late Mortality in Surgical Patients with Sepsis: A Propensity Matched Analysis. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-03-14 Anahita Jalilvand, Megan Ireland, Courtney Collins, Whitney Kellett, Scott Strassel, Robert Tamer, Wendy Wahl, Jon Wisler
While obesity is a risk factor for post-operative complications, its impact following sepsis is unclear. The primary objective of this study was to evaluate the association between obesity and mortality following admission to the surgical ICU (SICU) with sepsis.
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Using Chest X-Ray to Predict Tube Thoracostomy in Traumatic Pneumothorax: A Single-Institution Retrospective Review. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-03-14 Shruthi Srinivas, Katelyn Henderson, Katherine C Bergus, Ayanna Jacobs, Holly Baselice, Edwin Donnelly, Carrie Valdez, Brett M Tracy, Julia R Coleman
Traumatic pneumothorax (PTX) is a common occurrence in thoracic trauma patients, with a majority requiring tube thoracostomy (TT) for management. Recently, the "35-mm" rule has advocated for observation of patients with PTX less than 35 mm on chest computed tomography (CT) scan. This rule has not been examined in chest x-ray (CXR). We hypothesize that a similar size cutoff can be determined in CXR
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Identifying Community Safety and Policy-Based Injury Prevention Opportunities to Reduce Golf Cart Injuries. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-03-08 Jana DeJesus, Carlos Chavez, Jazzalyn Zou, Kush Brahmbhatt, Elizabeth O'Daniel, August Schaeffer, Nikhil R Shah, Hoang Nguyen, Julie Matson, Ravi Radhakrishnan, Bindi Naik-Mathuria
In small US communities, golf cart utilization has become increasingly more common. In the past 3 years, the incidence and severity of pediatric golf cart-related trauma evaluated at our trauma center has noticeably increased. Thus, the aim of this study was to analyze trends, identify risk and protective factors, and provide community-level recommendations to improve golf cart safety for children
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Role of Vena Cava Filter in the Prophylaxis and Treatment of Venous Thromboembolism in Injured Adult Patients: A Systematic Review, Meta-Analysis, and Practice Management Guideline from the Eastern Association for the Surgery of Trauma. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-03-08 Bishwajit Bhattacharya, Lisa Kodadek, Igor Nichiporenko, Shawna Morrissey, Jordan Kirsch, Jeff Choi, Husayn Ladhani, George Kasotakis, Kaushik Mukherjee, Chaitan Narsule, Rahul Sharma, Lucy Ruangvoravat, Jeremy Grushka, Rishi Rattan, Nikolay Bugaev
Injured patients are at an increased risk of developing deep vein thrombosis (DVT) and pulmonary embolism (PE). Inferior vena cava (IVC) filters have been used in injured patients to prevent venous thromboembolism (VTE), but current evidence-based guidelines are lacking.
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Dimethyl Sulfoxide as a Novel Therapy in a Murine Model of Acute Lung Injury. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-03-06 Sharven Taghavi, David Engelhardt, Alexandra Campbell, Inna Goldvarg-Abud, Juan Duchesne, Farhana Shaheen, Derek Pociask, Jay Kolls, Olan Jackson-Weaver
The endothelial glycocalyx (EGX) on the luminal surface of endothelial cells contributes to the permeability barrier of the pulmonary vasculature. Dimethyl sulfoxide (DMSO) has a disordering effect on plasma membranes, which prevents the formation of ordered membrane domains important in the shedding of the EGX. We hypothesized that DMSO would protect against protein leak by preserving the EGX in a
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Financial Toxicity Part II: A Practical Guide to Measuring and Tracking Long-Term Financial Outcomes Among Acute Care Surgery. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-03-05 Lisa M Knowlton, John W Scott, Phillip Dowzicky, Patrick Murphy, Kimberly A Davis, Kristan Staudenmayer, R Shayn Martin
Acute care surgery (ACS) patients are frequently faced with significant long-term recovery and financial implications that extend far beyond their hospitalization. While major injury and emergency general surgery (EGS) emergencies are often viewed solely as acute moments of crisis, the impact on patients can be lifelong. Financial outcomes after major injury or emergency surgery have only begun to
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Eastern Association for the Surgery of Trauma (EAST) System Wellness White Paper: An Evaluation of Wellness from a Systems Perspective. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-03-05 Rachel D Appelbaum, Dale Butler, Joseph J Stirparo, Jamie Coleman, Jennifer L Hartwell, Kyle Cunningham
Providers are charged with responsibility to maintain their own health and wellness [1,2]. Wellness or wellbeing is multifactorial and complex, but the construct lacks clarity [3]. Wellness can impact patient safety and it has significant financial implications. Both financial and healthcare industries have recognized this multifactorial issue, and have applied research and resources to the issue of
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Recovery after moderate to severe TBI and factors influencing functional outcome: What you need to know. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-03-05 Katherine Golden, Lydia Borsi, Ally Sterling, Joseph T Giacino
Regular Review, Level V.
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A Collaborative Multidisciplinary Trauma Program Improvement Team Improves VTE Chemoprophylaxis Guideline Compliance In Non-Operative Stable TBI. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-03-04 Abdul Hafiz Al Tannir, Simin Golestani, Morgan Tentis, Morgan Maring, Elise A Biesboer, Christopher Dodgion, Patrick B Murphy, Daniel N Holena, Colleen M Trevino, Jacob R Peschman, Thomas W Carver, David J Milia, Morgan Schellenberg, Marc A de Moya, Rachel S Morris
Delays in initiating venous thromboembolism (VTE) prophylaxis in patients suffering from traumatic brain injury (TBI) persist despite guidelines recommending early initiation. We hypothesized that the expansion of a Trauma Program Performance Improvement (PI) team will improve compliance of early (24-48 hour) initiation of VTE prophylaxis and will decrease VTE events in TBI patients.
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Social determinants of health, the microbiome, and surgical injury. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-03-04 John C Alverdy, Ann Polcari, Andrew Benjamin
Post-injury infection continues to plague trauma and emergency surgery patients fortunate enough to survive the initial injury. Rapid response systems, massive transfusion protocols, the development of level 1 trauma centers, etc., have improved the outcome for millions of patients worldwide. Yet despite this excellent initial care, patients still remain vulnerable to post-injury infections that can
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Nutritional support for the trauma and emergency general surgery patient: What You Need to Know. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-02-27 Jennifer L Hartwell, David C Evans, Matthew J Martin
Level V, literature synthesis and expert opinion.
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A Core Outcome Set for Acute Necrotizing Pancreatitis: an Eastern Association for the Surgery of Trauma Modified Delphi Method Consensus Study. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-02-26 Michael Farrell, Adanan Alseidi, Saskya Byerly, Paul Fockens, Frederick A Giberson, Jeffrey Glaser, Karen Horvath, David Jones, Casey Luckhurst, Nathan Mowery, Bryce R H Robinson, Allie Rodriguez, Vikesh K Singh, Ajith K Siriwardena, Santhi Swaroop Vege, Guru Trikudanathan, Brendan C Visser, Rogier P Voermans, Daniel Dante Yeh, Rondi B Gelbard
The management of acute necrotizing pancreatitis (ANP) has changed dramatically over the past 20 years including the use of less invasive techniques, the timing of interventions, nutritional management, and anti-microbial management. This study sought to create a core outcome set (COS) to help shape future research by establishing a minimal set of essential outcomes that will facilitate future comparisons
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Handoffs and Transitions of Care: A Systematic Review, Meta-Analysis, and Practice Management Guideline from the Eastern Association for the Surgery of Trauma. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-02-26 Rachel D Appelbaum, Thaddeus J Puzio, Zachary Bauman, Sofya Asfaw, Audrey Spencer, Ryan P Dumas, Kavneet Kaur, Kyle W Cunningham, Dale Butler, Jaswin S Sawhney, Stephen Gadomski, Chelsea R Horwood, Mary Stuever, Alyssa Sapp, Rajesh Gandhi, Jennifer Freeman
The Joint Commission reports at least half of communication breakdowns occur during handovers or transitions of care. There is no consensus on how best to approach the transfer of care within Acute Care Surgery (ACS). We conduct a systematic review and meta-analysis of the current data on handoffs and transitions of care in ACS patients and evaluate the impact of standardization and formalized communication
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The Role of Emergency Department Thoracotomy in Patients with Cranial Gunshot Wounds. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-02-20 Justin S Hatchimonji, Nicole A Meredyth, Sriharsha Gummadi, Elinore J Kaufman, Jay A Yelon, Jeremy W Cannon, Niels D Martin, Mark J Seamon
Although several society guidelines exist regarding emergency department thoracotomy (EDT), there is a lack of data upon which to base guidance for multiple gunshot wound (GSW) patients whose injuries include a cranial GSW. We hypothesized that survival in these patients would be exceedingly low.
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Contemporary management of open extremity fractures: What You Need to Know. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-02-20 Philip F Stahel, Adam M Kaufman
Open extremity fractures are high-risk injuries prone to significant complications, including soft tissue loss, bone defects, infection, infected nonunion, and the necessity for limb amputation. Large-scale multicenter prospective studies from the "Lower Extremity Assessment Project" (LEAP) and the "Major Extremity Trauma Consortium" (METRC) have provided novel scientific insights pertinent to the
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Outcomes of Patients Enrolled in a Prospective and Randomized Trial on Basis of Gestalt Assessment or ABC Score. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-02-12 Emily W Baird, Daniel T Lammers, Peter Abraham, Zain G Hashmi, Russell L Griffin, Shannon W Stephens, Jan O Jansen, John B Holcomb
The Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial rapidly enrolled patients based on an ABC ≥ 2 score, or Physician Gestalt (PG) when ABC score was <2. The objective of this study was to describe what patients were enrolled by the two methods and whether patient outcomes differed based these enrollments. We hypothesized that there would be no differences in outcomes based on
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Identifying Injuries Suggestive of Child Physical Abuse: An Innovative Application of the Trauma Quality Improvement Program. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-02-12 Leighton Reed, Lisa Odendal, Danielle Mercurio, Christopher W Snyder
Child physical abuse (CPA) carries high risk of morbidity and mortality. Screening for CPA may be limited by subjective risk criteria and racial and socioeconomic biases. This study derived, validated, and compared age-stratified International Classification of Diseases, 10th revision (ICD-10) diagnosis codes indicating high risk of CPA.
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PROSTAGLANDIN E-MAJOR URINARY METABOLITES AS A NEW BIOMARKER FOR ACUTE MESENTERIC ISCHEMIA. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-02-05 Keisuke Suzuki, Koji Morishita, Tomohiro Adachi, Akira Suekane, Keita Nakatsutsumi, Panu Teeratakulpisarn, Mitsuaki Kojima, Raul Coimbra, Yasuhiro Otomo
Acute mesenteric ischemia (AMI) is an emergent vascular disease caused by cessation of the blood supply to the small intestine. Despite advances in the diagnosis, intervention, and surgical procedures, AMI remains a life-threatening condition. Prostaglandin E2 Major Urinary Metabolite (PGE-MUM), the urinary metabolite of Prostaglandin E2, is known to be stable in urine and has been suggested to be
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Management of Pediatric Lower Extremity Vascular Trauma: Adult vs Pediatric Level I Trauma Centers. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-02-05 Goeto Dantes, Zachary J Grady, Ahna Weeks, Nathaniel Forrester, Jose B Trinidad, Alexis Stokes, Valerie L Dutreuil, Annie Cheng, Phillip Kim, Randi N Smith, Christopher R Ramos, Samual R Todd, Alexis Smith, Jason D Sciarretta
Pediatric lower extremity vascular injury (PLEVI) is uncommon. Though epidemiologic studies exist, the availability of granular data is sparse. Additionally, few studies compare the management between adult (ATC) and pediatric (PTC) trauma centers. The objective of this study was to analyze the surgical management of PLEVIs between a Level I ATC and a Level 1 PTCs in our metropolitan area.
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PROPOSED REVISION OF THE AMERICAN ASSOCIATION FOR SURGERY OF TRAUMA RENAL TRAUMA ORGAN INJURY SCALE: SECONDARY ANALYSIS OF THE MULTI-INSTITUTIONAL GENITOURINARY TRAUMA STUDY. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-01-29 Rano Matta, Sorena Keihani, Kevin Hebert, Joshua J Horns, Raminder Nirula, Marta McCrum, Benjamin J McCormick, Joel A Gross, Ryan P Joyce, Douglas M Rogers, Sherry S Wang, Judith C Hagedorn, J Patrick Selph, Rachel L Sensenig, Rachel A Moses, Christopher M Dodgion, Shubham Gupta, Kaushik Mukherjee, Sarah Majercik, Joshua A Broghammer, Ian Schwartz, Sean P Elliott, Benjamin N Breyer, Nima Baradaran
This study updates the American Association for Surgery of Trauma (AAST) Organ Injury Scale (OIS) for renal trauma using evidence-based criteria for bleeding control intervention.
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Contemporary Management and Outcomes of Blunt Traumatic AAST-OIS Grade III and IV Pancreatic Injuries in Children: A TQIP analysis. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-01-29 Jessica L Rauh, Lucas P Neff, Maximilian Peter Forssten, Marcelo A F Ribeiro, Babak Sarani, Shahin Mohseni
The Trauma Quality Improvement Program (TQIP) database has delineated management strategies and outcomes for adults with AAST-OIS grade III-IV pancreatic injuries and suggests that non-operative management (NOM) is a viable option for these injuries. However, management strategies vary for children following significant pancreatic injuries and outcomes for these intermediate/high grade injuries have
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Socioeconomic disparities based on shooting intent in pediatric firearm injury. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-01-29 Cary M Cain, Abiodun O Oluyomi, Ned Levine, Lisa Pompeii, Omar Rosales, Bindi Naik-Mathuria
Pediatric firearm injury is often associated with socioeconomically disadvantaged neighborhoods. Most studies only include fatal injuries and do not differentiate by shooting intent. We hypothesized that differences in neighborhood socioeconomic disadvantage would be observed among shooting intents of fatal and nonfatal cases.
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A Protocol Driven Approach to Reduce Lengths of Stay for Pediatric Blunt Liver and Spleen Injury Patients. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-01-26 Chen Chia Wang, Ashwin Gupta, Michelle Stone, Monica Milovancev, Kelsie Townsend, Shilin Zhao, Amber Greeno
Our institution updated blunt liver and spleen injury (BLSI) protocols in 2019 in adherence to updated American Pediatric Surgery Association (APSA) recommendations. This retrospective study compares resource utilization for pediatric BLSI patients treated under old and updated guidelines.
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Reverse shock index multiplied by the motor component of the Glasgow Coma Scale predicts mortality and need for intervention in pediatric trauma patients. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-01-26 Tanner Smida, Patrick Bonasso, James Bardes, Bradley S Price, Federico Seifarth, Lori Gurien, Robert Maxson, Robert Letton
Timely identification of high-risk pediatric trauma patients and appropriate resource mobilization may lead to improved outcomes. We hypothesized that reverse shock index times the motor component of the Glasgow Coma Scale (rSIM) would perform equivalently to reverse shock index times the total Glasgow Coma Scale (rSIG) in the prediction of mortality and the need for intervention following pediatric
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Pediatric thoracic cage fractures - mind the sternum: A retrospective analysis of the ACS-TQIP database. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-01-26 Anthony di Natale, Allison L Mak, Rosa Hwang, Myron Allukian, Gary W Nace, Michael L Nance
The thoracic cage is an anatomical entity formed by the thoracic spine, ribs, and sternum. As part of this osteoligamentous complex, the sternum contributes substantially to the stability of the thoracic spine. This study investigates the influence of a concomitant sternal fracture (SF) on the treatment and hospital course of pediatric patients with a thoracic vertebral fracture (TVF).
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Brain Death/Death by Neurologic Criteria: What You Need to Know. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-01-26 Nicholas J Larson, David J Dries, Benoit Blondeau, Frederick B Rogers
Since the beginning of time, man has been intrigued with the question of when a person is considered dead. Traditionally, death has been considered the cessation of all cardiorespiratory function. At the end of the last century a new definition was introduced into the lexicon surrounding death in addition to cessation of cardiac and respiratory function: Brain Death/Death by Neurologic Criteria (BD/DNC)
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USE OF A STATEWIDE SOLID ORGAN INJURY PROCOTCOL TO OPTIMIZE TRIAGE, TREATMENT, AND TRANSFER FOR PEDIATRIC ABDOMINAL TRAUMA. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-01-26 Robert A Swendiman, Katie W Russell, Kezlyn Larsen, Matthew Eyre, Stephen J Fenton
The Utah Pediatric Trauma Network (UPTN) is a non-competitive collaboration of all 51 hospitals in the state of Utah with the purpose of improving pediatric trauma care. Created in 2019, UPTN has implemented evidence-based guidelines based on hospital resources and capabilities with quarterly review of data collected in a network-specific database. A blunt solid organ injury (SOI) protocol was developed
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Consensus on resuscitative endovascular balloon occlusion of the aorta (REBOA) in civilian (pre-hospital) trauma care: a Delphi study. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-01-16 Jan C van de Voort, Boris Kessel, Boudewijn L S Borger van der Burg, Joseph J DuBose, Tal M Hörer, Rigo Hoencamp
REBOA could prevent lethal exsanguination and support cardiopulmonary resuscitation. In pre-hospital trauma and medical emergency settings, a small population with high mortality rates could potentially benefit from early REBOA deployment. However, its use in these situations remains highly disputed. Since publication of the first Delphi study on REBOA, in which consensus was not reached on all addressed
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Trends and Variation in Cervical Spine Imaging Utilization Across Children's Hospitals for Pediatric Trauma. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-01-10 Erin E Ross, Shadassa Ourshalimian, Ryan G Spurrier, Pradip P Chaudhari
Cervical spine evaluation is a critical component in trauma evaluation, and though several pediatric cervical spine evaluation algorithms have been developed, none has been widely implemented. Here, we assess rates of cervical spine imaging use across children's hospitals, specifically temporal trends in imaging use, variation across hospitals in imaging used, and timing of magnetic resonance imaging
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Decompressive Craniectomy versus Craniotomy for Acute Subdural Hematoma: Updated meta-analysis of real-world clinical outcome after RESCUE-ASDH trial. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-01-10 Yu Chang, Chia-En Wong, Pang-Shuo Perng, Hany Atwan, Kuan-Yu Chi, Jung-Shun Lee, Liang-Chao Wang, Chih-Yuan Huang
The RESCUE-ASDH trial found that disability and quality-of-life outcomes were similar between craniotomy and decompressive craniectomy for traumatic acute subdural hematoma, contrasting previous literature. This meta-analysis aims to validate the applicability of RESCUE-ASDH results using real-world data in acute subdural hematoma patients.
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Does destination make a difference? Outcomes after a policy change affecting cutoff times for pre-hospital transport. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-01-10 Elizabeth Renaud, Olivia Cummings, Melissa Vanover, Joshua Ray Tanzer, Andrew McCarthy
Facilitating primary triage and care at Pediatric Trauma Centers (PTCs) can improve outcomes for children after trauma. However, scene location and regional EMS regulations may result in initial evaluation occurring at non-pediatric facilities with later transportation to PTCs for definitive care. In this study, we assessed the results of a change in transport time cutoff from 30 to 45 minutes on pediatric
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Trauma Surgeons Experience Compassion Fatigue - A Major Metropolitan Area Survey. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-01-10 Lea Hoefer, Leah C Tatebe, Purvi Patel, Anna Tyson, Samuel Kingsley, Grace Chang, Matt Kaminsky, James Doherty, David Hampton
Compassion Fatigue (CF), the physical, emotional, and psychological impact of helping others, is composed of three domains: Compassion Satisfaction (CS), Secondary Traumatic Stress (STS), and Burnout (BO). Trauma surgeons (TS) experience work-related stress resulting in high rates of CF which can manifest as physical and psychological disorders. We hypothesized that TS experience CF and there are potentially
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Modern Mechanical Ventilation Strategies for the Acute Care Surgeon: What You Need to Know. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-01-10 Pauline K Park, Lena M Napolitano
Acute respiratory failure (ARF) is associated with significant morbidity and mortality in trauma and emergency surgery patients. Pulmonary complications following surgery among the most frequent and costly postoperative events. ARF support with mechanical ventilation is life-saving but may lead to ventilator-induced lung injury (VILI), worsening secondary injury. Decades of randomized clinical trials
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DOES FRAILTY IMPACT FAILURE-TO-RESCUE IN GERIATRIC TRAUMA PATIENTS? J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-01-10 Mitsuaki Kojima, Koji Morishita, Tomohisa Shoko, Bishoy Zakhary, Todd Costantini, Laura Haines, Raul Coimbra
Failure-to-rescue (FTR), defined as death following a major complication, is a metric of trauma quality. The impact of patient frailty on FTR has not been fully investigated, especially in geriatric trauma patients. This study hypothesized that frailty increased the risk of FTR in geriatric patients with severe injury.
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Does the injury pattern drive the surgical treatment strategy in multiply injured patients with major fractures? J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-01-10 Sascha Halvachizadeh, Roman Pfeifer, James Duncan, Felix Karl Ludwig Klingebiel, Yannik Kalbas, Till Berk, Valentin Neuhaus, Hans-Christoph Pape
The timing of definitive surgery in multiple injured patients remains a topic of debate, and multiple concepts have been described. Although these included injury severity as a criterion to decide on the indications for surgery, none of them considered the influence of injury distributions. We analyzed whether injury distribution is associated with certain surgical strategies and related outcomes in
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Surgical Stabilization of Rib Fractures for Flail Chest: Analysis of Center-Based Variability in Practice and Outcomes. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-01-10 Mathieu Hylands, David Gomez, Bourke Tillmann, Barbara Haas, Avery Nathens
Given the lack of high-quality data on patient selection for surgical stabilization of rib fractures (SSRF), significant variability in practice likely exists across trauma centers. We aimed to determine whether centers with a more liberal approach to SSRF had improved outcomes.
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Use of MRI in patients with severe diffuse traumatic brain injury: a matched National Trauma Data Bank analysis. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-01-10 Sai Chilakapati, Anthony J Dragun, Ryan G Chiu, Keith M George, Alex B Valadka
MRI is increasingly used to evaluate patients with diffuse traumatic brain injury (dTBI). However, the utility of early MRI is understudied. We hypothesize that early MRI patients will have increased length of stay but no changes in ICP management or disposition.
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ROBOtic Care Outcomes Project (ROBOCOP) for Acute Gallbladder Pathology. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-01-09 Shannon Greenberg, Marc Abou Assali, Yanli Li, Hannah Bossie, Chris Neighorn, Esther Wu, Kaushik Mukherjee
Robotic cholecystectomy is being increasingly used for patients with acute gallbladder disease who present to emergency department, but clinical evidence is limited. We aimed to compare the outcomes of emergent laparoscopic and robotic cholecystectomies in a large real-world database.
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The use and timing of angio-embolization in pediatric blunt liver and spleen injury. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-01-09 Jessica A Naiditch, David M Notrica, Lois W Sayrs, Maria Linnaus, Rachael Stottlemyre, Nilda M Garcia, Karla A Lawson, Aaron S Cohen, Robert W Letton, Jeremy Johnson, R Todd Maxson, James W Eubanks, Mark Ryan, Adam Alder, Todd A Ponsky, Shawn D St Peter, Amina M Bhatia, Charles M Leys
Nonoperative management (NOM) is the standard of care for the management of blunt liver and spleen injuries (BLSI) in the stable pediatric patient. Angiography with embolization (AE) is utilized as an adjunctive therapy in the management of adult BLSI patients, but it is rarely utilized in the pediatric population. In this planned secondary analysis, we describe the current utilization patterns of
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Next Generation Tourniquet: Recommendations for Future Capabilities and Design Requirements. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-01-08 Sena R Veazey, Jared F Mike, Darke R Hull, Kathy L Ryan, Jose Salinas, John F Kragh
Advances in tourniquet development must meet new military needs for future large scale combat operations or civilian mass casualty scenarios. This includes the potential use of engineering and automation technologies to provide advanced tourniquet features. A comprehensive set of design capabilities and requirements for an intelligent or smart tourniquet needed to meet the challenges currently does
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Ccr2 Dependent Monocytes Exacerbate Intestinal Inflammation and Modulate Gut Serotonergic Signaling Following Traumatic Brain Injury. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-01-08 Mahmoud G El Baassiri, Zachariah Raouf, Hee-Seong Jang, Daniel Scheese, Johannes W Duess, William B Fulton, Chhinder P Sodhi, David J Hackam, Isam W Nasr
Traumatic brain injury (TBI) leads to acute gastrointestinal dysfunction and mucosal damage, resulting in feeding intolerance. Ccr2+ monocytes are crucial immune cells that regulate the gut's inflammatory response via the brain-gut axis. Using CCR2KO mice, we investigated the intricate interplay between these cells to better elucidate the role of systemic inflammation after TBI.
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Factors associated with trauma recidivism in young children. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-01-08 Caroline Q Stephens, Caroline G Melhado, Amy M Shui, Ava Yap, Willieford Moses, Aaron R Jensen, Christopher Newton
Trauma recidivism is associated with future trauma-associated morbidity and mortality. Previous evidence suggests that socioeconomic factors predict trauma recidivism in older children (10-18 years); however, risk factors in US children ≤10 have not been studied. We sought to determine the factors associated with trauma recidivism in young children ≤10.
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Improving Outcomes in EGS: Construct of a Collaborative Quality Initiative. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-01-08 Mark R Hemmila, Pooja U Neiman, Beckie L Hoppe, Laura Gerhardinger, Kim A Kramer, Jill L Jakubus, Judy N Mikhail, Amanda Y Yang, Hugh J Lindsey, Roy J Golden, Eric J Mitchell, John W Scott, Lena M Napolitano
Emergency general surgery conditions are common, costly, and highly morbid. The proportion of excess morbidity due to variation in health systems and processes of care is poorly understood. We constructed a collaborative quality initiative for emergency general surgery to investigate the emergency general surgery care provided and guide process improvements.
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Faster Refill in an Urban EMS System Saves Lives: A Prospective Preliminary Evaluation of a Prehospital Advanced Resuscitative Care Bundle. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2024-01-08 Jacob M Broome, Kristen D Nordham, Mark Piehl, Danielle Tatum, Sydney Caputo, Cameron Belding, Valerie J De Maio, Sharven Taghavi, Olan Jackson-Weaver, Charlie Harris, Patrick McGrew, Alison Smith, Emily Nichols, Thomas Dransfield, David Rayburn, Megan Marino, Jennifer Avegno, Juan Duchesne
Military experience has demonstrated mortality improvement when advanced resuscitative care (ARC) is provided for trauma patients with severe hemorrhage. The benefits of ARC for trauma in civilian EMS systems with short transport intervals are still unknown. We hypothesized that ARC implementation in an urban EMS system would reduce in-hospital mortality.
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Exosomal miRNA Following Severe Trauma: Role in Bone Marrow Dysfunction. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2023-12-28 Jennifer A Munley, Micah L Willis, Gwendolyn S Gillies, Kolenkode B Kannan, Valerie E Polcz, Jeremy A Balch, Evan L Barrios, Shannon M Wallet, Letitia E Bible, Philip A Efron, Robert Maile, Alicia M Mohr
Severe trauma disrupts bone marrow function and is associated with persistent anemia and altered hematopoiesis. Previously, plasma-derived exosomes isolated after trauma have been shown to suppress in vitro bone marrow function. However, the cargo contained in these vesicles has not been examined. We hypothesized that trauma plasma-derived exosomes exhibit microRNA (miR) changes that impact bone marrow
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What Medical-Legal Partnerships can do for Trauma Patients and Trauma Care. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2023-12-27 Rucha Alur, Erin Hall, M J Smith, Tanya Zakrison, Carly Loughran, Franklin Cosey-Gay, Elinore Kaufman
Trauma patients are particularly vulnerable to the impact of pre-existing social and legal determinants of health post-injury. Trauma patients have a wide range of legal needs, including housing, employment, debt, insurance coverage, and access to federal and state benefits. Legal support could provide vital assistance to address the social determinants of health for injured patients. Medical Legal
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Maintaining a Whole Blood-Centered Transfusion Improves Survival in Hemorrhagic Resuscitation. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2023-12-21 Griffin J Feinberg, Anastasia C Tillman, Marcelo L Paiva, Brent Emigh, Stephanie N Lueckel, Allyson M Hynes, Tareq Kheirbek
Whole blood (WB) transfusion has been shown to improve mortality in trauma resuscitation. The optimal ratio of packed red blood cells (pRBC) to WB in emergent transfusion has not been determined. We hypothesized that a low pRBC:WB transfusion ratio is associated with improved survival in trauma patients.
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Implementation Evaluation of Tiered Tele-Triage Pathways for Burn Center Consultations and Transfers. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2023-12-21 Lauren L Agoubi, Nina M Clark, Sarah Gibbs, Barclay T Stewart, Xinyao G DeGrauw, Monica S Vavilala, Frederick P Rivara, Saman Arbabi, Tam N Pham
Early transfer to specialized centers improves trauma and burn outcomes, however, overtriage can result in unnecessary burdens to patients, providers, and health systems. Our institution developed novel burn triage pathways in 2016 to improve resource allocation. We evaluated the implementation of these pathways, analyzing trends in adoption, resource optimization, and pathway reliability after implementation
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Performance of three predictive scores to avoid delayed diagnosis of significant blunt bowel and mesenteric injury. A 12-year retrospective cohort study. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2023-12-19 Fabio Agri, Basile Pache, Mylène Bourgeat, Vincent Darioli, Nicolas Demartines, Sabine Schmidt, Tobias Zingg
Avoiding missed diagnosis and therapeutic delay for significant blunt bowel and mesenteric injuries (sBBMI) after trauma is still challenging despite the widespread use of computed tomography. Several scoring tools aiming at reducing this risk have been published. The purpose of the present work was to assess the incidence of delayed (>24 h) diagnosis for sBBMI patients and to compare the predictive
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Antibiotic prophylaxis in trauma: GAIS, SIS-E, WSIS, AAST, WSES guidelines. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2023-12-18 Federico Coccolini, Massimo Sartelli, Robert Sawyer, Kemal Rasa, Marco Ceresoli, Bruno Viaggi, Fausto Catena, Dimitrios Damaskos, Enrico Cicuttin, Camilla Cremonini, Ernest E Moore, Walter L Biffl, Raul Coimbra
Trauma is a complex disease, and the use of antibiotic prophylaxis (AP) in trauma patients is common practice. However, considering the increasing rates of antibiotic resistance, AP use should be questioned and limited only to specific cases. Antibiotic stewardship is of paramount importance in fighting resistance spread. Definitive rules or precise indications about antibiotic prophylaxis in trauma
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Older females have increased mortality after trauma as compared to younger females and males, associated with increased fibrinolysis. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2023-12-08 R W G Dujardin, D J B Kleinveld, C E van den Brom, L M G Geeraedts, E Beijer, C Gaarder, K Brohi, S Stanworth, P I Johansson, J Stensballe, M Maegele, N P Juffermans
Female sex may provide a survival benefit after trauma, possibly attributable to protective effects of estrogen. This study aims to compare markers of coagulation between male and female trauma patients across different ages.
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Analysis of lipid metabolites derived from gut microbiota in ischemia-reperfusion model. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2023-12-08 Keita Nakatsutsumi, Koji Morishita, Todd W Costantini, Tomohiro Adachi, Akira Suekane, Keisuke Suzuki, Mitsuaki Kojima, Makoto Arita, Yasuhiro Otomo
Disruption of intestinal barrier caused by intestinal ischemia due to hemorrhagic shock, is associated with the pathogenesis of multiple organ dysfunction (MOD) after severe trauma. Mesenteric lymph (ML) plays an important role as a route for transporting inflammatory mediators, including lipids. Post-biotics, such as 10-hydroxy-cis-12-octadecenoic acid (HYA), have received much attention as a treatment
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Long wavelength light exposure reduces systemic inflammation coagulopathy, and acute organ injury following polytrauma in mice. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2023-12-08 Mohammadreza Zarisfi, Reem Younes, Nijmeh Alsaadi, Zeyu Liu, Patricia Loughran, Kelly Williamson, Philip C Spinella, Susan Shea, Matthew R Rosengart, Elizabeth A Andraska, Matthew D Neal
Evidence suggests that variation in light exposure strongly influences the dynamic of inflammation, coagulation, and the immune system. Polytrauma induces systemic inflammation that can lead to end-organ injury. Here, we hypothesize that alterations in light exposure influence post-trauma inflammation, coagulopathy, and end-organ injury.
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Risk-stratified thromboprophylaxis effects of aspirin versus low-molecular-weight heparin in orthopaedic trauma patients: a secondary analysis of the PREVENT CLOT trial. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2023-12-08 Nathan N O'Hara, Robert V O'Toole, Katherine P Frey, Renan C Castillo, Joseph Cuschieri, Elliott R Haut, Gerard P Slobogean, Reza Firoozabadi, Ashley Christmas, William T Obremskey, Anthony R Carlini, Greg Gaski, Matthew E Kutcher, Debra Marvel, Deborah M Stein
The PREVENT CLOT trial concluded that thromboprophylaxis with aspirin was noninferior to low-molecular-weight heparin (LMWH) in preventing death after orthopaedic trauma. However, it was unclear if these results applied to patients at highest risk of thrombosis. Therefore, we assessed if the effect of aspirin versus LMWH differed based on patients' baseline risk of venous thromboembolism (VTE).
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Endotheliopathy of Trauma in Children: The Association of Syndecan-1 with Injury and Poor Outcomes. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2023-12-08 Katrina M Morgan, Elissa Abou-Khalil, Barbara A Gaines, Christine M Leeper
The contribution of the endothelium to trauma-induced coagulopathy has not been thoroughly investigated in injured children.
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Tranexamic acid is not associated with a higher rate of thrombotic-related reintervention after major vascular injury repair. J. Trauma Acute Care Surg. (IF 3.4) Pub Date : 2023-12-08 Sina Asaadi, Kaushik Mukherjee, Ahmed M Abou-Zamzam, Liang Ji, Xian Luo-Owen, Maryam B Tabrizi, Richard D Catalano, Joseph J Dubose, Martin G Rosenthal
Tranexamic acid (TXA) is associated with lower mortality and transfusion requirements in trauma patients, but its role in thrombotic complications associated with vascular repairs remains unclear. We investigated whether TXA increases the risk of thrombosis-related technical failure (TRTF) in major vascular injuries (MVI).