And Miles to Go Before We Sleep: EAST Diversity and Inclusivity Progress and Remaining Challenges.

Objective: The aim of this study was to examine the diversity, equity, and inclusion landscape in academic trauma surgery and the EAST organization.

Summary Background Data: In 2019, the Eastern Association for the Surgery of Trauma (EAST) surveyed its members on equity and inclusion in the #EAST4ALL survey and assessed leadership representation. We hypothesized that women and surgeons of color (SOC) are underrepresented as EAST members and leaders.

Risk factors associated with venous thromboembolism in isolated blunt chest trauma.

Isolated chest trauma is not historically considered to be a major risk factor for venous thromboembolism (VTE). After blunt chest trauma, VTE may be underappreciated because pain, immobility, and inadequate prophylaxis as a result of hemorrhage risk may all increase the risk of VTE. This investigation determines the predictors and rate of VTE after isolated blunt chest trauma.

Screening for blunt cardiac injury: an Eastern Association for the Surgery of Trauma practice management guideline.

Background: Diagnosing blunt cardiac injury (BCI) can be difficult. Many patients with mechanism for BCI are admitted to the critical care setting based on associated injuries; however, debate surrounds those patients who are hemodynamically stable and do not otherwise require a higher level of care. To allow safe discharge home or admission to a nonmonitored setting, BCI should be definitively ruled out in those at risk.

Selective nonoperative management of blunt splenic injury: an Eastern Association for the Surgery of Trauma practice management guideline.

Background: During the last century, the management of blunt force trauma to the spleen has changed from observation and expectant management in the early part of the 1900s to mainly operative intervention, to the current practice of selective operative and nonoperative management. These issues were first addressed by the Eastern Association for the Surgery of Trauma (EAST) in the Practice Management Guidelines for Non-operative Management of Blunt Injury to the Liver and Spleen published online in 2003. Since that time, a large volume of literature on these topics has been published requiring a reevaluation of the current EAST guideline.

Nonoperative management of blunt hepatic injury: an Eastern Association for the Surgery of Trauma practice management guideline.

Background: During the last century, the management of blunt force trauma to the liver has changed from observation and expectant management in the early part of the 1900s to mainly operative intervention, to the current practice of selective operative and nonoperative management. These issues were first addressed by the Eastern Association for the Surgery of Trauma in the Practice Management Guidelines for Nonoperative Management of Blunt Injury to the Liver and Spleen published online in 2003. Since that time, a large volume of literature on these topics has been published requiring a reevaluation of the previous Eastern Association for the Surgery of Trauma guideline.

Impact of a graduated driver's license law on crashes involving young drivers in New York State.

Background: Motor vehicle crashes constitute the greatest risk of injury for young adults. Graduated driver licensing (GDL) laws have been used to reduce the number of injuries and deaths in the young driver population. The New York State GDL law increased supervision of young driver and limited both time-of-day driven and number of passengers.

Helicopters improve survival in seriously injured patients requiring interfacility transfer for definitive care.

Background: Helicopter transport (HT) is frequently used for interfacility transfer of injured patients to a trauma center. The benefits of HT over ground transport (GT) in this setting are unclear. By using a national sample, the objective of this study was to assess whether HT impacted outcomes following interfacility transfer of trauma patients.

Mechanism of injury and special consideration criteria still matter: an evaluation of the National Trauma Triage Protocol.

Background: The Centers for Disease Control recently updated the National Trauma Triage Protocol. This field triage algorithm guides emergency medical service providers through four decision steps (physiologic [PHY], anatomic [ANA], mechanism, and special considerations) to identify patients who would benefit from trauma center care. The study objective was to analyze whether trauma center need (TCN) was accurately predicted solely by the PHY and ANA criteria using national data.

Helicopters and the civilian trauma system: national utilization patterns demonstrate improved outcomes after traumatic injury.

Background: The role of helicopter transport (HT) in civilian trauma care remains controversial. The objective of this study was to compare patient outcomes after transport from the scene of injury by HT and ground transport using a national patient sample.

Methods: Patients transported from the scene of injury by HT or ground transport in 2007 were identified using the National Trauma Databank version 8.

Ground level falls are associated with significant mortality in elderly patients.

Background: Falls from height are considered to be high risk for multisystem injury. Ground-level falls (GLF) are often deemed a low-energy mechanism of injury (MOI) and not a recommended triage criterion for trauma team activation. We hypothesize that in elderly patients, a GLF may represent a high-risk group for injury and concurrent comorbidities that warrant trauma service evaluation and should be triaged appropriately.

Trauma center designation correlates with functional independence after severe but not moderate traumatic brain injury.

Background: The mortality of traumatic brain injury (TBI) continues to decline, emphasizing functional outcomes. Trauma center designation has been linked to survival after TBI, but the impact on functional outcomes is unclear. The objective was to determine whether trauma center designation influenced functional outcomes after moderate and severe TBI.

Prehospital spinal immobilization does not appear to be beneficial and may complicate care following gunshot injury to the torso.

Background: Prehospital spinal immobilization (PHSI) is routinely applied to patients sustaining torso gunshot wounds (GSW). Our objective was to evaluate the potential benefit of PHSI after torso GSW versus the potential to interfere with other critical aspects of care.

Methods: A retrospective analysis of all patients with torso GSW in the Strong Memorial Hospital (SMH) trauma registry during a 41-month period and all patients with GSW in the National Trauma Data Bank (NTDB) during a 60-month period was conducted.

Perforated appendicitis: is early laparoscopic appendectomy appropriate?

Background: Laparoscopic appendectomy for nonperforated appendicitis is associated with improved outcomes; however, laparoscopy has been challenged for perforated appendicitis owing to higher morbidity compared with open or staged procedures. The purpose of this study was to determine whether the laparoscopic approach for perforated appendicitis results in improved outcomes compared with open appendectomy.

Methods: Postoperative patient records for confirmed perforated appendicitis from 2005 to 2008 were reviewed retrospectively.

Does the need for noncardiac surgery during ventricular assist device therapy impact clinical outcome?

Background: The role of the ventricular assist device (VAD) in the management of heart failure is expanding. Despite its success, the clinical course for patients requiring noncardiac surgery (NCS) during VAD support is not well described. The objective of this study was to identify VAD patients requiring NCS (+NCS) and compare outcomes with those not requiring NCS (-NCS).

Abdominal compartment syndrome: clinical aspects and monitoring.

Markedly elevated intra-abdominal pressures will result in predictable hemodynamic consequences related to compromised venous return. When the hemodynamic abnormalities are associated with organ dysfunction of failure, patients suffer from the abdominal compartment syndrome. At-risk patients should be routinely monitored for intra-abdominal hypertension, and a multidisciplinary care paradigm should be established.