Pancreaticoduodenectomy in trauma patients with grade IV-V duodenal or pancreatic injuries: a post hoc analysis of an EAST multicenter trial.

Introduction: The utility of pancreaticoduodenectomy (PD) for high-grade traumatic injuries remains unclear and data surrounding its use are limited. We hypothesized that PD does not result in improved outcomes when compared with non-PD surgical management of grade IV-V pancreaticoduodenal injuries.

Methods: This is a retrospective, multicenter analysis from 35 level 1 trauma centers from January 2010 to December 2020.

Pelvic fractures in blunt trauma patients: A comparative study.

Background: Pelvic fractures (PF) with concomitant injuries are on the rise due to an increase of high-energy trauma. Increase of the elderly population with age related comorbidities further complicates the management. Abdominal organ injuries are kindred with PF due to the proximity to pelvic bones.

Are geriatric transfer patients with traumatic brain injury at risk for worse outcomes compared to non-geriatric? Propensity-matched study.

Objective: To compare outcomes between geriatric and non-geriatric patients with traumatic brain injury (TBI) transferred to trauma center and effects of anticoagulants/antiplatelets (AC/AP) and reversal therapy.

Methods: A retrospective review of 1,118 patients with TBI transferred from acute care facilities to level 1 trauma center compared in groups: geriatric versus non-geriatric, geriatric with AC/AP therapy versus without, and geriatric AC/AP with AC/AP reversal therapy versus without.

Results: Patients with TBI constituted 54.

Stop exsanguination by inflation: management of aorta-esophageal fistula bleeding.

Aortoesophageal fistula is rare and typically presents itself to the emergency department as Chiari's Triad of mid-thoracic pain, sentinel arterial hemorrhage, and exsanguination after a symptom-free interval. However, fatal bleeding may be the first and last presentation of an aortoesophageal fistula. When a patient experiences massive hematemesis without witnesses, EMS may assume that bleed is of a traumatic mechanism.

Two surgical pathways for isolated hip fractures: A comparative study.

Background: Hip fractures (HF) are common among the aging population, and surgery within 48 h is recommended. Patients can be hospitalized for surgery through different pathways, either trauma or medicine admitting services.

Aim: To compare management and outcomes among patients admitted through the trauma pathway (TP) medical pathway (MP).

Outcomes among trauma patients with duodenal leak following primary versus complex repair of duodenal injuries: An Eastern Association for the Surgery of Trauma multicenter trial.

Background: Duodenal leak is a feared complication of repair, and innovative complex repairs with adjunctive measures (CRAM) were developed to decrease both leak occurrence and severity when leaks occur. Data on the association of CRAM and duodenal leak are sparse, and its impact on duodenal leak outcomes is nonexistent. We hypothesized that primary repair alone (PRA) would be associated with decreased duodenal leak rates; however, CRAM would be associated with improved recovery and outcomes when leaks do occur.

The timing and value of early postoperative computed tomography after head surgery in traumatic brain injury patients.

Objective: To analyze the timing of the early postoperative computed tomography (CT) in traumatic brain injury (TBI) patients, and compare CT and neurological examination (NE) findings.

Methods: Retrospective analysis included 353 TBI patients admitted to two level 1 trauma centers (2016-2020) who underwent head surgery and postoperative CT within 24 h. Analyzed variables: age, Injury Severity Score (ISS), Glasgow Coma Score (GCS), Abbreviated Injury Scale head (AISh), comorbidities, CT and NE findings and timing, head surgery type, and mortality.

Acute cardiac tamponade secondary to nonpenetrating injury from gunshot with beanbag round: A case report and literature review.

Over the past twenty years, "less-lethal" munitions have caused a variety of significant, life-threatening injuries. However, evidence of blunt cardiac injury due to these weapons is sparse. A healthy 44-year old man presented with hemodynamic instability due to cardiac tamponade after he was shot with a beanbag, ultimately requiring operative intervention.

Injury Characteristics, Outcomes, and Health Care Services Use Associated With Nonfatal Injuries Sustained in Mass Shootings in the US, 2012-2019.

Importance: Civilian public mass shootings (CPMSs) in the US result in substantial injuries. However, the types and consequences of these injuries have not been systematically described.

Objective: To describe the injury characteristics, outcomes, and health care burden associated with nonfatal injuries sustained during CPMSs and to better understand the consequences to patients, hospitals, and society at large.

Impact of time to surgery on mortality in hypotensive patients with noncompressible torso hemorrhage: An AAST multicenter, prospective study.

Background: Death from noncompressible torso hemorrhage (NCTH) may be preventable with improved prehospital care and shorter in-hospital times to hemorrhage control. We hypothesized that shorter times to surgical intervention for hemorrhage control would decrease mortality in hypotensive patients with NCTH.

Methods: This was an AAST-sponsored multicenter, prospective analysis of hypotensive patients aged 15+ years who presented with NCTH from May 2018 to December 2020.

Blunt Cardiac Injury in Patients With Sternal Fractures.

Background Blunt cardiac injury (BCI) is a possible consequence of sternal fractures (SF). There is a scarcity of studies addressing BCI in patients with different types of SF and with pre-existing cardiac conditions. The goal of this study was to delineate diagnostic patterns of BCI in different cohorts of SF patients.

Sternal fractures in blunt trauma patients.

Purpose: Sternal fractures (SF) are commonly associated with other injuries and their incidence is on the rise. The aim was to evaluate injury characteristics and outcomes in patients with all types of SF after blunt trauma.

Methods: Retrospective analysis of 380 SF patients from two Level 1 trauma centers was performed.

Comparison of Geriatric Versus Non-geriatric Trauma Patients With Palliative Care Consultations.

Background: Palliative care in trauma patients is still evolving. The goal was to compare characteristics, outcomes, triggers and timing for palliative care consultations (PCC) in geriatric (≥65 y.o.

Reduction in Potentially Inappropriate Interventions in Trauma Patients following a Palliative Care Consultation.

Palliative care is expanding as part of treatment, but remains underutilized in trauma settings. Palliative care consultations (PCC) have shown to reduce nonbeneficial, potentially inappropriate interventions (PII), as decision for their use should always be made in the context of both the patient's prognosis and the patient's goals of care. To characterize trauma patients who received PCC and to analyze the effect of PCC and do-not-resuscitate (DNR) orders on PII in severely injured patients.

Surgical Stabilization of Rib Fractures: Indications, Techniques, and Pitfalls.

Unlabelled: Rib fractures are a common thoracic injury that is encountered in 20% to 39% of patients with blunt chest trauma and is associated with substantial morbidity and mortality. Traditionally, the majority of patient with rib fractures have been managed nonoperatively. Recently, the utilization of surgical stabilization of rib fractures has increased considerably because the procedure has shown improved outcomes.

Wound patterns in survivors of modern firearm related civilian Mass Casualty Incidents.

Background: Civilian mass shooting events (CMSE) are occurring with increased frequency. Unfortunately, our knowledge of how to respond to these events is largely based on military experience and medical examiner data. While this translational knowledge has improved our basic response to such events, it is critical that we have a better under-standing of the wound patterns observed and the resources utilized in civilian mass shootings.

Palliative Care Consultations in Trauma Patients and Role of Do-Not-Resuscitate Orders: Propensity-Matched Study.

Objective: To delineate characteristics of trauma patients associated with a palliative care consultation (PCC) and to analyze the role of do-not-resuscitate (DNR) orders and related outcomes.

Methods: Retrospective study included 864 patients from 2 level one trauma centers admitted between 2012 and 2019.  Level 1 trauma centers are designated for admission of the most severe injured patients.

Intravenous Ibuprofen Reduces Opioid Consumption During the Initial 48 Hours After Injury in Orthopedic Trauma Patients.

Objectives: To evaluate the efficacy of intravenous (IV) ibuprofen (Caldolor) administration in the management of acute pain in orthopedic trauma patients and to minimize opioid use.

Design: Randomized controlled trial, double-blind, parallel, placebo-controlled.

Setting: Level 1 Trauma Center.

Early Versus Late Tracheostomy in Trauma Patients With Rib Fractures.

Background: Patients with blunt chest trauma with multiple rib fractures (RF) may require tracheostomy. The goal was to compare early (≤7 d) versus late (>7 d) tracheostomy patients and to analyze clinical outcomes, to determine which timing is more beneficial.

Methods: This retrospective review included 124 patients with RF admitted to trauma ICU at two level 1 trauma centers who underwent tracheostomy.

Tracheostomy in trauma patients with rib fractures.

Purpose: Patients with rib fractures (RF) may require prolonged mechanical ventilation and tracheostomy. Indications for tracheostomy in trauma patients with RF remain debatable. The goal was to delineate characteristics of patients who underwent tracheostomy due to thoracic versus extra-thoracic causes, such as maxillofacial-mandibular injury (MFM), traumatic brain injury (TBI), and cervical vertebrae trauma (CVT), and to analyze clinical outcomes.

Outcome Analysis of Surgical Stabilization of Rib Fractures in Trauma Patients.

Objectives: To compare outcomes in patients with rib fractures (RFX) who underwent surgical stabilization of rib fractures (SSRF) to those treated nonoperatively.

Design: Retrospective cohort study.

Setting: Two Level 1 Trauma Centers.

Evaluation of patients with surgically stabilized rib fractures by different scoring systems.

Purpose: Surgical Stabilization (SSRF) is gaining popularity as an alternative to non-operative management (NOM) of patients with rib fractures, however, there are no established guidelines for patients' quantifiable evaluation and for SSRF recommendation. Known rib scoring systems include: Rib Fracture Score (RFS), Chest Wall Trauma Score (CWTS), Chest Trauma Score (CTS) and RibScore (RS), but are underutilized. The purpose was to provide values of scoring systems in SSRF and NOM patients and correlate them with treatment assignment.

Quantification of rib fractures by different scoring systems.

Background: The three known systems for evaluation of patients with rib fractures are rib fracture score (RFS), chest trauma score (CTS), and RibScore (RS). The aim was to establish critical values for these systems in different patient populations.

Methods: Retrospective cohort study included 1089 patients with rib fractures, from level-1 trauma center; divided into two groups: first group included 620 nongeriatric patients, and second group included 469 geriatric patients (≥65 y.