Scoping it Out: The Use of Laparoscopy After Penetrating Trauma in Stable Children.

Introduction: In stable children with penetrating abdominal trauma, literature regarding the use of laparoscopy (LAP) remains limited. Given increasing evidence in favor of LAP for selective adult trauma patients, we reviewed contemporary practices and outcomes in pediatric trauma patients.

Methods: The American College of Surgeons (ACS) Trauma Quality Programs data was utilized to identify children (<18 years) from 2016 to 2021 with a penetrating abdominal injury who underwent surgery within 24 h of admission.

Two-center analysis of cannabis on venous thromboembolism risk after traumatic injury: A matched analysis.

Background: Conflicting evidence exists evaluating associations between cannabis (THC) and post-traumatic DVT.

Methods: Retrospective analysis (2014-2023) of patients ≥15yrs from two Level I trauma centers with robust VTE surveillance and prophylaxis protocols. Multivariable hierarchical regression assessed the association between THC and DVT risk.

Lessons for the next pandemic: analysis of the timing and outcomes including post-discharge decannulation rates for tracheostomy in severe COVID-19 respiratory failure.

Purpose: COVID-19 patients with respiratory failure frequently require prolonged ventilatory support that would typically warrant early tracheostomy. There has been significant debate on timing, outcomes, and safety of these procedures. The purpose of this study was to determine the epidemiological, hospital, and post-discharge outcomes of this cohort, based on early (ET) versus late (LT) tracheostomy.

To the point: Utility of laparoscopy for operative management of stabbing abdominal trauma.

Background: Algorithms for managing penetrating abdominal trauma are conflicting or vague regarding the role of laparoscopy. We hypothesized that laparoscopy is underutilized among hemodynamically stable patients with abdominal stab wounds.

Methods: Trauma Quality Improvement Program data (2016-2019) were used to identify stable (SBP ≥110 and GCS ≥13) patients ≥16yrs with stab wounds and an abdominal procedure within 24hr of admission.

A Window of Opportunity: Understanding Pediatric Falls Using Area Deprivation Index.

Introduction: The purpose of our study is to assess neighborhood socioeconomic disadvantage (NSD) as a risk factor for window falls (WF) in children.

Methods: A single institution retrospective review was performed of patients ≤18 years old with fall injuries treated at a Level I trauma center between 2018 and 2021. Demographic, injury, and NSD characteristics which were collected from a trauma registry were analyzed and compared between WF versus non-window falls.

Modified Brain Injury Guidelines for preinjury anticoagulation in traumatic brain injury: An opportunity to reduce health care resource utilization.

Introduction: The Brain Injury Guidelines (BIG) stratify patients by traumatic brain injury (TBI) severity to provide management recommendations to reduce health care resource burden but mandates that patients on anticoagulation (AC) are allocated to the most severe tertile (BIG 3). We sought to analyze TBI patients on AC therapy using a modified BIG model to determine if this population can offer further opportunity for safe reductions in health care resource utilization.

Methods: Patients 55 years or older on AC with traumatic intracranial hemorrhage (ICH) from two centers were retrospectively stratified into BIG 1 to 3 risk groups using modified BIG criteria excluding AC as a criterion.

Firearm Assaults in Communities: The Impact of COVID-19 Lockdown.

Background: Firearm violence has increased nationwide, with recent surges linked to the COVID-19 pandemic. We measured traumatic assault trends at our urban Level I trauma center and assessed rates of firearm violence over time and pre/post local COVID-19 lockdown based on levels of socioeconomic disadvantage.

Methods: We conducted a retrospective review (2016-2022) of assault patients 16 years and older.

Financial vulnerability of trauma centers: A national analysis.

Objective: Trauma centers function as an essential safeguard in the United States health care system. However, there has been minimal study of their financial health or vulnerability. We sought to perform a nationwide analysis of trauma centers using detailed financial data and a recently developed Financial Vulnerability Score (FVS) metric.

Evaluating pediatric car safety compliance in motor vehicle collisions: Identifying high-risk groups for improper restraint usage.

Purpose: To identify patient factors associated with improper restraint usage and worse trauma outcomes for pediatric patients involved in motor vehicle collisions (MVCs).

Methods: Retrospective study performed at a Level I pediatric trauma center for patients (≤18 yr) evaluated after MVC between 2008 and 2018. The Area Deprivation Index (ADI) was used to measure neighborhood socioeconomic disadvantage (NSD) levels based on the patient's home address.

Higher religiosity and spirituality are associated with ethnic group membership among middle-aged and older adults living with HIV.

HIV is a chronic illness that impacts the lives of more than 1 million people in the United States. As persons living with HIV (PWH) are living longer, it is important to understand the influence that religiosity/spirituality has among middle-aged and older PWH. Compare the degree of religiosity/spirituality among middle-aged and older PWH and HIV-negative individuals, and to identify demographic, clinical, and psychosocial factors associated with religiosity/spirituality among PWH.

Bike Helmet Usage in the Most Disadvantaged Neighborhoods: A Focused Area for Trauma Prevention.

Introduction: There is a paucity of data to describe how neighborhood socioeconomic disadvantage (NSD) correlates with childhood injuries and outcomes. This study assesses the relationship of NSD to bicycle safety and trauma outcomes among pediatric bicycle versus automobile injuries.

Methods: Between 2008 and 2018, patients ≤18 y old with bicycle versus automobile injuries from a Level I pediatric trauma center were evaluated.

Why Trauma Care is Not Expensive: Detailed Analysis of Actual Costs and Cost Differences of Patient Cohorts.

Background: Trauma patients are resource intensive, requiring a variety of medical and procedural interventions during hospitalization. These expenses often label trauma care as "high cost" based on gross hospital charges. We hypothesized that a financial metric built on actual costs and clinically relevant trauma patient cohorts would demonstrate a lower true cost of trauma care than the standardly reported gross hospital charges.

Reading the signs in penetrating cervical vascular injuries: Analysis of hard/soft signs and initial management from a nationwide vascular trauma database.

Background: Algorithms for management of penetrating cervical vascular injuries (PCVIs) commonly call for immediate surgery with "hard signs" and imaging before intervention with "soft signs." We sought to analyze the association between initial examination and subsequent evaluation and management approaches.

Methods: Analysis of PCVIs from the American Association for the Surgery of Trauma Prospective Observational Vascular Injury Treatment vascular injury registry from 25 US trauma centers was performed.

Integrating traffic safety data with area deprivation index: A method to better understand the causes of pediatric pedestrian versus automobile collisions.

Background: The purpose of this study was to identify clinical and traffic factors that influence pediatric pedestrian versus automobile collisions (P-ACs) with an emphasis on health care disparities.

Methods: A retrospective review was performed of pediatric (18 years or younger) P-ACs treated at a Level I pediatric trauma center from 2008 to 2018. Demographic, clinical, and traffic scene data were analyzed.

Pediatric trauma in the California-Mexico border region: Injury disparities by Area Deprivation Index.

Background: The California-Mexico border region is a high-volume trauma area with populations of widely disparate socioeconomic status. This work analyzed differences in demographics and mechanism of injury in children using the Area Deprivation Index (ADI), a composite measure of 17 markers of neighborhood socioeconomic disadvantage.

Methods: A retrospective review was performed of pediatric patients evaluated at the regional Level I Pediatric Trauma Center between 2008 and 2018.

The where, when, and why of surgical rib fixation: Utilization patterns, outcomes, and readmissions.

Introduction: There has been increasing use of surgical stabilization of rib fractures (SSRF), but most literature demonstrate outcomes of single centers during the index hospitalization. We sought to analyze statewide patterns and longer-term outcomes after SSRF.

Methods: Adult patients with >1 rib fracture in the 2016-2018 California Office of Statewide Health Planning Database were identified.

Isolated Intracranial Hemorrhage in Elderly Patients With Pre-Injury Anticoagulation: Is Full Trauma Team Activation Necessary?

Background: Traumatic intracranial hemorrhage (ICH) is a highly morbid injury, particularly among elderly patients on preinjury anticoagulants (AC). Many trauma centers initiate full trauma team activation (FTTA) for these high-risk patients. We sought to determine if FTTA was superior compared with those who were evaluated as a trauma consultation (CON).

Multi-center validation of the Bowel Injury Predictive Score (BIPS) for the early identification of need to operate in blunt bowel and mesenteric injuries.

Introduction: The Bowel Injury Prediction Score (BIPS) is a tool for identifying patients at risk for blunt bowel and mesenteric injury (BBMI) requiring surgery. BIPS is calculated by assigning one point for each of the following: (1) WBC ≥ 17,000, (2) abdominal tenderness, and (3) injury grade ≥ 4 (mesenteric contusion or hematoma with bowel wall thickening or adjacent interloop fluid collection) on CT scan. A total score ≥ 2 is associated with BBMI requiring surgery.

An assessment of dexmedetomidine as an opioid-sparing agent after neonatal open thoracic and abdominal operations.

Objective: To evaluate the efficacy of dexmedetomidine as an opioid-sparing agent in infants following open thoracic or abdominal operations.

Methods: Retrospective review of postoperative neonates who received IV acetaminophen with or without dexmedetomidine. The primary outcome was opioid dosage within the first ten postoperative days.

Impact of a Workflow-Integrated Web Tool on Resource Utilization and Information-Seeking Behavior in an Academic Anesthesiology Department: Longitudinal Cohort Survey Study.

Background: Medical resident reading and information-seeking behavior is limited by time constraints as well as comfort in accessing and assessing evidence-based resources. Educational technology interventions, as the preferred method for millennial leaners, can reduce these barriers. We implemented an educational web tool, consisting of peer-reviewed articles as well as local and national protocols and policies, built into the daily workflow of a university-based anesthesiology department.

A tale of two centers: Is low-molecular-weight heparin really superior for prevention of posttraumatic venous thromboembolism?

Background: Low-molecular-weight heparin (LMWH) is widely used for venous thromboembolism chemoprophylaxis following injury. However, unfractionated heparin (UFH) is a less expensive option. We compared LMWH and UFH for prevention of posttraumatic deep venous thrombosis (DVT) and pulmonary embolism (PE).

The rising tide of methamphetamine use in elderly trauma patients.

Background: Methamphetamine (METH) is associated with an elevated risk of injury and the outcomes in the elderly remain unclear. We analyzed METH's impact in elderly trauma patients.

Methods: Retrospective analysis (2009-2018) of trauma patients at a Level I trauma center.

Nationwide analysis of resuscitative thoracotomy in pediatric trauma: Time to differentiate from adult guidelines?

Background: Emergency department thoracotomy (EDT) for pediatric patients is uncommon, and practice patterns have not been evaluated. We examined the indications and outcomes for EDT by trauma center designation using a nationwide database.

Methods: Patients 16 years or younger who underwent EDT within 30 minutes of arrival from 2013 to 2016 were identified in the American College of Surgeons National Trauma Data Bank.

Association of Trauma Center Level and Patient Volume with Outcomes for Penetrating Thoracic Trauma.

Background: We investigated the potential link between trauma center American College of Surgeons verification level and institutional volume of penetrating thoracic trauma with outcomes for patients with penetrating thoracic trauma.

Methods: Penetrating thoracic injuries were identified in the National Trauma Data Bank from 2013 to 2016. Primary exposures were trauma center American College of Surgeons verification level and annual penetrating trauma caseload by center.