Evaluation of critical care burden following traumatic injury from two randomized controlled trials.

Trauma resuscitation practices have continued to improve with new advances targeting prehospital interventions. The critical care burden associated with severely injured patients at risk of hemorrhage has been poorly characterized. We aim to describe the individual and additive effects of multiorgan failure (MOF) and nosocomial infection (NI) on delayed mortality and resource utilization.

High Dimensional Multiomics Reveals Unique Characteristics of Early Plasma Administration in Polytrauma Patients With TBI.

Objectives: The authors sought to identify causal factors that explain the selective benefit of prehospital administration of thawed plasma (TP) in traumatic brain injury (TBI) patients using mediation analysis of a multiomic database.

Background: The Prehospital Air Medical Plasma (PAMPer) Trial showed that patients with TBI and a pronounced systemic response to injury [defined as endotype 2 (E2)], have a survival benefit from prehospital administration of TP. An interrogation of high dimensional proteomics, lipidomics and metabolomics previously demonstrated unique patterns in circulating biomarkers in patients receiving prehospital TP, suggesting that a deeper analysis could reveal causal features specific to TBI patients.

Multi-omic analysis in injured humans: Patterns align with outcomes and treatment responses.

Trauma is a leading cause of death and morbidity worldwide. Here, we present the analysis of a longitudinal multi-omic dataset comprising clinical, cytokine, endotheliopathy biomarker, lipidome, metabolome, and proteome data from severely injured humans. A "systemic storm" pattern with release of 1,061 markers, together with a pattern suggestive of the "massive consumption" of 892 constitutive circulating markers, is identified in the acute phase post-trauma.

Best case/worst case for the trauma ICU: Development and pilot testing of a communication tool for older adults with traumatic injury.

Background: "Best Case/Worst Case" (BC/WC) is a communication tool to support shared decision making in older adults with surgical illness. We aimed to adapt and test BC/WC for use with critically ill older adult trauma patients.

Methods: We conducted focus groups with 48 trauma clinicians in Wisconsin, Texas, and Oregon.

Association of the Risk of a Venous Thromboembolic Event in Emergency vs Elective General Surgery.

Importance: Trauma patients have an increased risk of venous thromboembolism (VTE), partly because of greater inflammation. However, it is unknown if this association is present in patients who undergo emergency general surgery (EGS).

Objectives: To investigate whether emergency case status is independently associated with VTE compared with elective case status and to test the hypothesis that emergency cases would have a higher risk of VTE.

One-year mortality in geriatric trauma patients: Improving upon the geriatric trauma outcomes score utilizing the social security death index.

Background: Geriatric Trauma Outcomes Score (GTOS) predicts in-patient mortality in geriatric trauma patients and has been validated in a prospective multicenter trial and expanded to predict adverse discharge (GTOS II). We hypothesized that these formulations actually underestimate the downstream sequelae of injury and sought to predict longer-term mortality in geriatric trauma patients.

Methods: The Parkland Memorial Hospital Trauma registry was queried for patients 65 years or older from 2001 to 2013.

Uncertain Patency of Covered Stents Placed for Traumatic Axillosubclavian Artery Injury.

Background: Traumatic axillosubclavian artery injuries (ASAIs) are uncommon but devastating. There is increasing acceptance of covered stent use for ASAIs. However, epidemiologic and long-term outcomes data are limited.

The year in burns 2013.

Approximately 3415 research articles were published with burns in the title, abstract, and/or keyword in 2013. We have continued to see an increase in this number; the following reviews articles selected from these by the Editor of one of the major journals (Burns) and colleagues that in their opinion are most likely to have effects on burn care treatment and understanding. As we have done before, articles were found and divided into the following topic areas: epidemiology of injury and burn prevention, wound and scar characterization, acute care and critical care, inhalation injury, infection, psychological considerations, pain and itching management, rehabilitation and long-term outcomes, and burn reconstruction.

Application of the Berlin definition in PROMMTT patients: the impact of resuscitation on the incidence of hypoxemia.

Background: Acute lung injury following trauma resuscitation remains a concern despite recent advances. With the use of the PROMMTT study population, the risk of hypoxemia and potential modifiable risk factors are studied.

Methods: Patients with survival for 24 hours or greater with at least one intensive care unit day were included in the analysis.

Increasing time to operation is associated with decreased survival in patients with a positive FAST examination requiring emergent laparotomy.

Introduction: Focused assessment with sonography for trauma (FAST) is commonly used to facilitate the timely diagnosis of life-threatening hemorrhage in injured patients. Most patients with positive findings on FAST require laparotomy. Although it is assumed that an increasing time to operation (T-OR) leads to higher mortality, this relationship has not been quantified.

Clinical examination in complement with computed tomography scan: an effective method for identification of cervical spine injury.

Objective: The purpose of this study was to prospectively evaluate a protocol that assesses the efficacy and sensitivity of clinical examination in complement with computed tomographic (CT) scan in screening for cervical spine (c-spine) injury.

Methods: During the 26-month period from March 2005 to May 2007, blunt trauma patients older than 13 years were prospectively entered into a study protocol. If patients were awake and alert with Glasgow Coma Score (GCS) >or=14, clinical examination of the neck was performed.

Anatomic location of penetrating lower-extremity trauma predicts compartment syndrome development.

Background: Compartment syndrome of the lower extremity can be a difficult diagnosis to make with serious consequences if diagnosis and intervention is delayed. Identifying patients who are more likely to develop this syndrome can help prevent the associated complications. The purpose of this study was to evaluate whether the anatomic location of the penetrating lower-extremity injuries can predict development of compartment syndrome.

On-scene intravenous line insertion adversely impacts prehospital time in rural vehicular trauma.

Fatality rates from rural vehicular trauma are almost double those found in urban settings. Increased emergency medical services (EMS) prehospital time has been implicated as one of the causative factors for higher rural fatality rates. Advanced Trauma Life Support guidelines suggest scene time should not be extended to insert an intravenous catheter (IV).

Does increased emergency medical services prehospital time affect patient mortality in rural motor vehicle crashes? A statewide analysis.

Background: Fatality rates from rural vehicular trauma are almost double those found in urban settings. It has been suggested that increased prehospital time is a factor that adversely affects fatality rates in rural vehicular trauma. By linking and analyzing Alabama's statewide prehospital data, emergency medical services (EMS) prehospital time was assessed for rural and urban vehicular crashes.

Increased rural vehicular mortality rates: roadways with higher speed limits or excessive vehicular speed?

Objective: The purpose of this study was to assess whether higher roadway speed limits and excessive vehicular speed were contributing factors to increased rural vehicular mortality rates in the State of Alabama.

Methods: During a 2-year period from January 2001 through December 2002, data were collected from Alabama police crash reports and EMS patient care reports. Police crash reports and EMS patient care reports were linked utilizing an imputational methodology.