An Abdominal Seat Belt Sign is Associated With Similar Incidence of Hollow Viscus Injury but Increased In-Hospital Mortality in Older Adult Trauma Patients: A PCSA Multicenter Study.

Background: The abdominal seat belt sign (SBS) is associated with an increased risk of hollow viscus injury (HVI). Older age is associated with worse outcomes in trauma patients. Thus, older trauma patients ≥65 years of age (OTPs) may be at an increased risk of HVI with abdominal SBS.

Occult major venous injury in penetrating thigh trauma: An underdiagnosed cause of morbidity and mortality.

Background: There are no current consensus guidelines that address screening patients who may have occult major venous injury in the setting of penetrating thigh trauma. Yet, such injuries confer significant morbidity and mortality to trauma patients if left untreated.

Methods: This paper examines the cases of three patients who presented to our single level I trauma center after sustaining penetrating thigh trauma with negative CT arteriography, all of whom were eventually diagnosed with occult major venous injury.

Development and Validation of a Novel Hollow Viscus Injury Prediction Score for Abdominal Seatbelt Sign: A Pacific Coast Surgical Association Multicenter Study.

Background: High-quality CT can exclude hollow viscus injury (HVI) in patients with abdominal seatbelt sign (SBS) but performs poorly at identifying HVI. Delay in diagnosis of HVI has significant consequences necessitating timely identification.

Study Design: This multicenter, prospective observational study conducted at 9 trauma centers between August 2020 and October 2021 included adult trauma patients with abdominal SBS who underwent abdominal CT before surgery.

Predictors of poor outcomes after cholecystectomy in gallstone pancreatitis: NSQIP analysis of 30-day morbidity and mortality.

Background: Contemporary nationwide outcomes of gallstone pancreatitis (GSP) managed by cholecystectomy at the index hospitalization are limited. This study aims to define the rate of 30-day morbidity and mortality and identify associated perioperative risk factors in patients undergoing cholecystectomy for GSP.

Methods: Patients from the ACS-NSQIP database with GSP without pancreatic necrosis, who underwent cholecystectomy during the index hospitalization from 2017 to 2019 were selected.

Excluding Hollow Viscus Injury for Abdominal Seat Belt Sign Using Computed Tomography.

Importance: Abdominal seat belt sign (SBS) has historically entailed admission and observation because of the diagnostic limitations of computed tomography (CT) imaging and high rates of hollow viscus injury (HVI). Recent single-institution, observational studies have questioned the utility of this practice.

Objective: To evaluate whether a negative CT scan can safely predict the absence of HVI in the setting of an abdominal SBS.

Early Cholecystectomy in Gallstone Pancreatitis Patients With and Without End Organ Dysfunction: A NQSIP Analysis.

Introduction: While literature widely supports early cholecystectomy for mild gallstone pancreatitis (GSP), this has not been reflected in clinical practice. Early cholecystectomy for GSP with end organ dysfunction remains controversial.

Objective: This study aims to evaluate the rate and outcomes of early cholecystectomy (<3 days from admission) in mild GSP patients with end organ dysfunction (+EOD) and without (-EOD).

AAST multicenter prospective analysis of prehospital tourniquet use for extremity trauma.

Background: Tourniquet use for extremity hemorrhage control has seen a recent increase in civilian usage. Previous retrospective studies demonstrated that tourniquets improve outcomes for major extremity trauma (MET). No prospective study has been conducted to date.

Short Courses of Antibiotics Are Safe in Necrotizing Soft Tissue Infections.

Introduction: Necrotizing soft tissue infections (NSTIs) carry high morbidity and mortality. While early aggressive surgical debridement is well-accepted treatment for NSTIs, the optimum duration of adjunct antibiotic therapy is unclear. An increasing focus on safety and evidence-based antimicrobial stewardship suggests a value in addressing this knowledge gap.

Prognostic factors for development of acute respiratory distress syndrome following traumatic injury: a systematic review and meta-analysis.

Background: Our purpose was to summarise the prognostic associations between various clinical risk factors and development of acute respiratory distress syndrome (ARDS) following traumatic injury.

Methods: We conducted this review in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and CHARMS (Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies) guidelines. We searched six databases from inception through December 2020.

Systematic Review of Serum Biomarkers in Traumatic Brain Injury.

Traumatic brain injury (TBI) is responsible for the majority of trauma-related deaths and is a leading cause of disability. It is characterized by an inflammatory process involved in the progression of secondary brain injury. TBI is measured by the Glasgow Coma Scale (GCS) with scores ranging from 15-3, demonstrating mild to severe brain injury.

Short-Term Outcomes Following Removal of Infected Hernia Mesh.

There are limited studies regarding outcomes of replacing an infected mesh with another mesh. We reviewed short-term outcomes following infected mesh removal and whether placement of new mesh is associated with worse outcomes. Patients who underwent hernia repair with infected mesh removal were identified from 2005 to 2018 American College of Surgeons-National Surgical Quality Improvement Program database.

Recovery of Pediatric Patients After Firearm Injury: Can Health Systems Do More?

Background: Firearm injuries are the second leading cause of death among youth in the United States. Nonfatal firearm injuries far outnumber fatalities, yet data detailing the recovery and post-injury needs of pediatric patients after hospital discharge are limited. This study evaluated health system support of pediatric patients after firearm injury, from acute hospitalization to outpatient follow-up.

Traumatized attendings - When the doctor has the disease.

Background: This study aims to compare PTSD prevalence between seven medical specialties and to identify potential risk factors for PTSD.

Methods: A cross-sectional national survey of attending physicians (n = 2216) was conducted and screened for PTSD using the Primary Care PTSD Screen. Stepwise multivariable regression analysis with backward elimination identified potential risk factors.

Temporary intravascular shunts after civilian arterial injury: A prospective multicenter Eastern Association for the Surgery of Trauma study.

Introduction: We sought to determine the impact of the indication for shunt placement on shunt-related outcomes after major arterial injuries. We hypothesized that a shunt placed for damage control indications would be associated with an increase in shunt-related complications including shunt dislodgement, thrombosis, or distal ischemia.

Patients & Methods: A prospective, multicenter study (eleven level one US trauma centers) of all adult trauma patients undergoing temporary intravascular shunts (TIVS) after arterial injury was undertaken (January 2017-May 2019).

Predictors of mortality and cost among surgical patients requiring rapid response team activation.

Background: Prior studies of rapid response team (RRT) implementation for surgical patients have demonstrated mixed results with respect to reductions in poor outcomes. The aim of this study was to identify predictors of in-hospital mortality and hospital costs among surgical inpatients requiring RRT activation.

Methods: We analyzed data prospectively collected from May 2012 to May 2016 at The Ottawa Hospital.

Trauma patients returning to the emergency department after discharge.

Background: While readmission rates of trauma patients are well described, little has been reported on rates of re-presentation to the emergency department (ED) after discharge. This study aimed to determine rates and contributing factors of re-presentation of trauma patients to the ED.

Methods: One-year retrospective analysis of discharged adult trauma patients at a county-funded safety-net level one trauma center.

Helicopter Transport Has Decreased Over Time and Transport From Scene or Hospital Matters.

Objective: Several reports have found helicopter emergency medical services (HEMS) to be associated with a lower risk of mortality compared with ground emergency medical services (GEMS); however, most studies did not control for transport time or stratify interfacility versus scene. We hypothesize that the HEMS transport rate has decreased nationally and that the risk of mortality for HEMS is similar to GEMS when adjusting for transport time and stratifying by scene or interfacility.

Methods: The Trauma Quality Improvement Program (2010-2016) was queried for adult patients transported by HEMS or GEMS.

Current Management of Extraperitoneal Bladder Injuries: Results from the Multi-Institutional Genito-Urinary Trauma Study (MiGUTS).

Purpose: We studied the current management trends for extraperitoneal bladder injuries and evaluated the use of operative repair versus catheter drainage, and the associated complications with each approach.

Materials And Methods: We prospectively collected data on bladder trauma from 20 level 1 trauma centers across the United States from 2013 to 2018. We excluded patients with intraperitoneal bladder injury and those who died within 24 hours of hospital arrival.

Electric Scooter Injury in Southern California Trauma Centers.

Background: Electric scooters are popular in Southern California due to their ease of use, affordability, and availability. The objective of this study was to characterize how hospital admissions and outcomes varied due to electric scooter injury among Southern California trauma centers.

Study Design: Trauma registry data from 9 urban trauma centers were queried for patients sustaining injury while operating an electric scooter from January to December 2018.

Evaluation and management of blunt cerebrovascular injury: A practice management guideline from the Eastern Association for the Surgery of Trauma.

Background: Blunt cerebrovascular injuries (BCVIs) are associated with significant morbidity and mortality. This guideline evaluates several aspects of BCVI diagnosis and management including the role of screening protocols, criteria for screening cervical spine injuries, and the use of antithrombotic therapy (ATT) and endovascular stents.

Methods: Using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, a taskforce of the Practice Management Guidelines Committee of the Eastern Association for the Surgery of Trauma performed a systematic review and meta-analysis of currently available evidence.

Implementation of a multidisciplinary perinatal emergency response team improves time to definitive obstetrical evaluation and fetal assessment.

Background: Trauma is the leading cause of nonobstetric death during pregnancy and is associated with an increased risk of maternal and fetal mortality. In an effort to improve the delivery of care to pregnant trauma patients, we developed an institutional multidisciplinary quality initiative designed to improve response times of nontrauma specialists and ensure immediate availability of resources. We hypothesized that implementation of a perinatal emergency response team (PERT) would improve time to patient and fetal evaluation and monitoring by the obstetrics (OB) team and improve both maternal and fetal outcomes.

Defining the surgical critical care research agenda: Results of a gaps analysis from the Critical Care Committee of the American Association for the Surgery of Trauma.

Background: There has been an unprecedented increase in critical care research recently, and there is a need for an organized and systematic approach to surgical critical care research planning. The purpose of this article was to establish a surgical critical care research agenda via a systematic review of the literature and needs assessment.

Methods: A systematic review of the literature was performed to identify high-impact critical care articles since 1999 on the basis of citation data.

Predictors of Morbidity and Mortality in Complex Paraesophageal Hernia Repair: A NSQIP Analysis.

Paraesophageal hernia (PEH) repair is typically performed electively. Complex PEHs (obstructed or gangrenous) require more urgent repair and can have significant complications. Although elective repair is primarily laparoscopic, limited data are available on the use of laparoscopy for complex cases.

Wound Culture Utility in Negative Surgical Exploration for Necrotizing Soft Tissue Infection.

Early surgical intervention decreases mortality in necrotizing soft tissue infections (NSTIs). Yet, a subset of patients will not have NSTIs (non-NSTIs) at the time of exploration. We hypothesized that NSTI and non-NSTI patients had similar causative organisms and that intraoperative wound cultures could help guide management.