Early Surgical Stabilization of Rib Fractures is Feasible in Patients With Non-Urgent Operative Pelvic Injuries.

Introduction: The feasibility of prioritizing surgical stabilization of rib fractures (SSRF) in patients with other injuries is unknown. The purpose of this study was to evaluate the timing and outcomes of SSRF between patients with and without non-urgent operative pelvic injuries.

Patients And Methods: In this retrospective observational study, all patients between 2010 and 2020 who underwent SSRF (SSRF group) and those who underwent SSRF and non-urgent operative management of pelvic fractures (SSRF + P group) were included.

Predictors for Withdrawal of Life-Sustaining Therapies in Patients With Traumatic Brain Injury: A Retrospective Trauma Quality Improvement Program Database Study.

Many patients with severe traumatic brain injuries (TBIs) undergo withdrawal of life-sustaining therapies (WLSTs) or transition to comfort measures, but noninjury factors that influence this decision have not been well characterized. We hypothesized that WLST would be associated with institutional and geographic noninjury factors. All patients with a head Abbreviated Injury Scale score ≥3 were identified from 2016 Trauma Quality Improvement Program data.

Variations in Discharge Destination Following Severe Traumatic Brain Injury across the United States.

Background: Discharge destination after traumatic brain injury (TBI) may be influenced by non-patient factors such as regional or institutional practice patterns. We hypothesized that non-patient factors would be associated with discharge destination in severe TBI patients.

Methods: All patients in the ACS Trauma Quality Improvement Program 2016 data set with severe TBI, defined as head Abbreviated Injury Scale ≥3, were categorized by discharge destination.

Factors Influencing the Entrustment of Resident Operative Autonomy: Comparing Perceptions of General Surgery Residents and Attending Surgeons.

Background: General surgery residents may be underprepared for practice, due in part to declining operative autonomy during training. The factors that influence entrustment of autonomy in the operating room are unclear.

Objective: To identify and compare the factors that residents and faculty consider influential in entrustment of operative autonomy.

Dose-dependent association between blood transfusion and nosocomial infections in trauma patients: A secondary analysis of patients from the PAMPer trial.

Background: The Prehospital Air Medical Plasma (PAMPer) trial demonstrated a survival benefit to trauma patients who received thawed plasma as part of early resuscitation. The objective of our study was to examine the association between blood transfusion and nosocomial infections among trauma patients who participated in the PAMPer trial. We hypothesized that transfusion of blood products will be associated with the development of nosocomial infections in a dose-dependent fashion.

Management of simple and retained hemothorax: A practice management guideline from the Eastern Association for the Surgery of Trauma.

Background: Traumatic hemothorax poses diagnostic and therapeutic challenges both acutely and chronically. A working group of the Eastern Association for the Surgery of Trauma convened to formulate a practice management guideline for traumatic hemothorax.

Methods: We formulated four questions: whether tube thoracostomy vs observation be performed, should pigtail catheter versus thoracostomy tube be placed to drain hemothorax, should thrombolytic therapy be attempted versus immediate thoracoscopic assisted drainage (VATS) in retained hemothorax (rHTX), and should early VATS (≤4 days) versus late VATS (>4 days) be performed? A systematic review was undertaken from articles identified in multiple databases.

Critical Care Documentation for the Dying Trauma Patient: Are We Recognizing Our Own Efforts?

Background: Missed documentation for critical care time (CCT) for dying patients may represent a missed opportunity for physicians to account for intensive care unit (ICU) services, including end-of-life care. We hypothesized that CCT would be poorly documented for dying trauma patients.

Methods: Adult trauma ICU patients who died between December 2014 and December 2017 were analyzed retrospectively.

Risk Factors for Wound Infection in Outpatients With Lower Extremity Burns.

Background: We sought to evaluate risk factors for wound infection in patients with lower extremity (LE) burn.

Methods: Adults presenting with LE burn from January 2014 to July 2015 were included. Data regarding demographics, injury characteristics, and outcomes were obtained.

Review of Sepsis in Burn Patients in 2020.

Severe burn injury results in substantial damage to the skin, inhibiting its ability to perform as the primary barrier to infection. Additionally, severe burn injury can lead to critical illness and extensive time in the intensive care unit (ICU). These two factors work to increase the risk of sepsis in the burn patient compared with other hospitalized patients.

Burn Wound Colonization, Infection, and Sepsis.

Infection is a major cause of morbidity and mortality among burn patients, and it is important to understand the progression of wound colonization to wound infection to systemic sepsis. After a review of the literature we describe the clinical characteristics of burn wound colonization, infection, and sepsis, and conclude with best practices to decrease these complications. Burn wounds are initially sterile after the thermal insult but become colonized by gram-positive organisms and subsequently by gram-negative organisms.

Pre-Operative Antibiotic Agents for Facial Fractures: Is More than One Day Necessary?

Despite a paucity of evidence, patients with facial fractures often receive long courses of pre-operative antibiotic agents. This study compared the effect of a short versus long pre-operative antibiotic course on the development of post-operative head/neck infections in this population. All adult patients admitted between January 2010 and May 2015 to a level 1 trauma center with isolated head/neck injuries who underwent surgery for facial fracture(s) were included.

Grade of injury, not initial management, is associated with unplanned interventions in liver injury.

Introduction: Risk factors for complications after liver injury do not distinguish between patients undergoing selective non-operative management (sNOM) vs operative management (OM) as the initial treatment strategy. Our objective was to identify risk factors for complications requiring an unplanned intervention following sNOM or OM. We hypothesized that patient undergoing sNOM will have fewer unplanned interventions.

Catheter-Associated Urinary Tract Infections among Trauma Patients: Poor Quality of Care or Marker of Effective Rescue?

Catheter-associated urinary tract infection (CAUTI) is associated generally with worse outcomes among hospitalized patients, but the impact of CAUTI on clinical outcomes is poorly described in trauma patients. We hypothesized that trauma patients with CAUTI would have worse outcomes such as longer length of stay (LOS), fewer discharges to home, and higher outcome of death. Patients with LOS >2 d in the 2016 Trauma Quality Improvement Program (TQIP) database were included.

Outcomes in patients with gunshot wounds to the brain.

Introduction: Gunshot wounds to the brain (GSWB) confer high lethality and uncertain recovery. It is unclear which patients benefit from aggressive resuscitation, and furthermore whether patients with GSWB undergoing cardiopulmonary resuscitation (CPR) have potential for survival or organ donation. Therefore, we sought to determine the rates of survival and organ donation, as well as identify factors associated with both outcomes in patients with GSWB undergoing CPR.

Goals of Care Discussions for the Imminently Dying Trauma Patient.

Background: A structured family meeting (FM) is recommended within 72 h of admission for trauma patients with high risk of mortality or disability. Multidisciplinary FMs (MDFMs) may further facilitate decision-making. We hypothesized that FM within three hospital days (HDs) or MDFM would be associated with increased use of comfort measures.

Current Evaluation of Antibiotic Usage in Complicated Intra-Abdominal Infection after the STOP IT Trial: Did We STOP IT?

Background: After publication of the Study to Optimize Peritoneal Infection Therapy (STOP IT) trial, we sought to determine if we were implementing study findings into practice appropriately. We had three objectives: evaluate antibiotic usage; evaluate patient outcomes; and delineate differences in antibiotic usage between general surgeons (GS) and trauma/acute care surgery trained surgeons (TACS).

Patients And Methods: This was an analysis of patients with complicated intra-abdominal infection admitted via the emergency department from February 2014 through May 2017.

Efficiency of care and cost for common emergency general surgery conditions: Comparison by surgeon training and practice.

Background: Our institutional emergency general surgery service is staffed by both trauma and critical care-trained surgeons and other boarded general surgeons and subspecialists. We compared efficiency of care for common emergency general surgery conditions between trauma and critical care-trained surgeons and boarded general surgeons and subspecialists.

Methods: Adults admitted between February 2014 and May 2017 with acute appendicitis, acute cholecystitis, intestinal obstruction, incarcerated hernia, or other acute abdominal diagnoses seen by emergency general surgery service were included.

Utility of Sequential Organ Failure Assessment score in predicting bacteremia in critically ill burn patients.

Background: We evaluated whether qSOFA ≥2 and an increase in SOFA (ΔSOFA) ≥2 can help predict bacteremia in a critically ill burn population.

Methods: Patients age ≥15 and TBSA ≥15% admitted between 2009 and 2015 were included. All blood cultures were recorded, and positive and negative blood culture days were defined based on the culture results.

Managing complications in endoscopic procedures: bleeding from a biopsy site.

Bleeding related to endoscopic biopsies is relatively uncommon and tends to be a self-limiting process. This article aims to identify those groups of patients that are at a higher risk at the time of the pre procedural evaluation, and to review the current guidelines regarding high risk patients (with special consideration for those who are anticoagulated). It also reviews current strategies for diagnosis, initial evaluation and management of a post procedural bleed.