In-Hospital Drug Use Affects a Broad Patient Population and the Health Care System.

Introduction: Patients who suffer from addiction sometimes take illicit substances while in the hospital (in-hospital drug use [IHDU]), which can lead to unnecessary work-up and preventable treatments when symptoms develop. The purpose of this study was to define the frequency and scope of this problem, who it affects, and its impact on the medical system.

Methods: We reviewed all incident reports from our large, urban level 1 trauma center that involved a patient being found with illicit substances in the hospital between January 2020 and January 2023.

Real-time performance improvement optimizes damage control resuscitation best practice adherence: Results of a pilot prospective observational study.

Background: Maintaining balanced blood product ratios during damage control resuscitation (DCR) is independently associated with improved survival. We hypothesized that real-time performance improvement (RT-PI) would increase adherence to DCR best practice.

Study Design And Methods: From December 2020-August 2021, we prospectively used a bedside RT-PI tool to guide DCR in severely injured patients surviving at least 30 min.

Effectiveness of the Introduction to Critical Care in Emergency Medicine Curriculum's Implementation Among Trainees Interested in Intensive Care.

Background: Emergency physicians and trainees provide the initial care for critically ill patients. In times of emergency department boarding, this care may extend beyond the first few hours. To meet the needs of this population, a standardized novel critical care curriculum targeting third- and fourth-year medical students was developed.

Maintaining a whole blood-centered transfusion improves survival in hemorrhagic resuscitation.

Background: 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.

Frailty Is Associated With Decreased Survival in Adult Patients With Nonoperative and Operative Traumatic Subdural Hemorrhage: A Retrospective Cohort Study of 381,754 Patients.

Objective: We investigated frailty's impact on traumatic subdural hematoma (tSDH), examining its relationship with major complications, length of hospital stay (LOS), mortality, high level of care discharges, and survival probabilities following nonoperative and operative management.

Background: Despite its frequency as a neurosurgical emergency, frailty's impact on tSDH remains underexplored. Frailty characterized by multisystem impairments significantly predicts poor outcomes, necessitating further investigation.

A tale of two cities: Policing and firearm homicides in Boston and Philadelphia.

Background: Recent political movements have raised questions about the effectiveness of police funding, but the impact of law enforcement budgets on firearm violence is unknown. We hypothesized that department funding and measures of police activity would be associated with decreased shootings and firearm homicides (FHs) in two major cities with different police funding patterns.

Methods: We collected data from the following sources: district attorney's offices, police departments, Federal Bureau of Investigation Uniform Crime Reporting program, the Centers for Disease Control, the Annual Survey of Public Employment and Payroll, and the American Community Survey.

Funding the war in America: A look in the mirror.

Background: Health care political action committees (HPACs) historically contribute more to candidates opposing firearm restrictions (FRs), clashing with their affiliated medical societies. These societies have increasingly emphasized the prevention of firearm violence and it is not known if recent contributions by their HPACs have aligned with their stated goals. We hypothesized that such HPACs still contribute similar amounts toward legislators up for reelection opposing FR.

Open versus percutaneous tube thoracostomy with and without thoracic lavage for traumatic hemothorax: a novel randomized controlled simulation trial.

Objective: To quantify and assess the relative performance parameters of thoracic lavage and percutaneous thoracostomy (PT) using a novel, basic science 2×2 randomized controlled simulation trial.

Summary Background Data: Treatment of traumatic hemothorax (HTX) with open tube thoracostomy (TT) is painful and retained HTX is common. PT is potentially less painful whereas thoracic lavage may reduce retained HTX.

Coming in hot: Police transport and prehospital time after firearm injury.

Background: In Philadelphia, PA, police and emergency medical services (EMS) transport patients with firearm injuries. Prior studies evaluating this system have lacked reliable prehospital times. By linking police and hospital data sets, we established a complete timeline from firearm injury to outcome.

Modifiable Factors Related to Firearm Homicides: A Broader View of Our Lane.

Objective: This study aims to identify modifiable factors related to firearm homicide (FH).

Summary Background Data: Many socioeconomic, legislative and behavioral risk factors impact FH. Most studies have evaluated these risk factors in isolation, but they coexist in a complex and ever-changing American society.

What happens after they survive? The role of anticoagulants and antiplatelets in IVC injuries.

Background: Venous thromboembolism (VTE) after an inferior vena cava (IVC) injury is a devastating complication. Current practice involves variable use of anticoagulation and antiplatelet (AC/AP) agents. We hypothesized that AC/AP can reduce the incidence of VTE and that delayed institution of AC/AP is associated with increased VTE events.

Traumatic proximal brachial artery injury selectively managed non-operatively: A case report and review of the literature.

A right hand dominant 18-year-old female with a body mass index greater than forty presented to the trauma bay after sustaining two gunshot wounds to her right upper extremity. On physical exam, she had doppler signals and she reported neuropathy in the right median nerve distribution. She had no active signs of bleeding and she was subsequently taken to computed tomography which revealed an abrupt proximal brachial artery opacification with distal reconstitution in addition to having air tracking into the axillary and subclavian arteries.

Finding the missing bullet: A case report of an unusual trajectory from the left scapula into the left orbit.

Evaluating a traumatically injured patient requires a systematic evaluation that can rapidly detect life threatening injuries. When there is a discrepancy in the number of expected retained bullets, one must re-evaluate the initial work-up. This case consists of an extremely unusual trajectory course of a scapular wound where the ballistic then traversed off the scapula through the neck entering the para-pharyngeal space, travelling through the facial bones, and coming to rest within the left eye, itself.

A surgical needs assessment for airway rapid responses: A retrospective observational study.

Background: Airway rapid response (ARR) teams can be compiled of anesthesiologists, intensivists, otolaryngologists, general and thoracic surgeons, respiratory therapists, and nurses. The optimal composition of an ARR team is unknown but considered to be resource intensive. We sought to determine the type of technical procedures performed during an ARR activation to inform team composition.

Staying on target: Maintaining a balanced resuscitation during damage-control resuscitation improves survival.

Background: Damage-control resuscitation (DCR) improves survival in severely bleeding patients. However, deviating from balanced transfusion ratios during a resuscitation may limit this benefit. We hypothesized that maintaining a balanced resuscitation during DCR is independently associated with improved survival.