TRAUMA-INDUCED COAGULOPATHY: PREVALENCE AND ASSOCIATION WITH MORTALITY PERSIST 20 YEARS LATER.

Introduction: A 2003 landmark study identified the prevalence of early trauma-induced coagulopathy (eTIC) at 28% with a strong association with mortality of 8.9%. Over the last 20 years, there have been significant advances in both the fundamental understanding of eTIC and therapeutic interventions.

Academic global surgical competencies: A modified Delphi consensus study.

Academic global surgery is a rapidly growing field that aims to improve access to safe surgical care worldwide. However, no universally accepted competencies exist to inform this developing field. A consensus-based approach, with input from a diverse group of experts, is needed to identify essential competencies that will lead to standardization in this field.

Qualitative Analysis of the Host-Perceived Impact of Unidirectional Global Surgery Training in Kijabe, Kenya: Benefits, Challenges, and a Desire for Bidirectional Exchange.

Background: As globalization of surgical training increases, growing evidence demonstrates a positive impact of global surgery experiences on trainees from high-income countries (HIC). However, few studies have assessed the impact of these largely unidirectional experiences from the perspectives of host surgical personnel from low- and middle-income countries (LMIC). This study aimed to assess the impact of unidirectional visitor involvement from the perspectives of host surgical personnel in Kijabe, Kenya.

Early trauma induced coagulopathy (ETIC): prevalence across the injury spectrum.

Introduction: Newer studies have hypothesised about a coagulopathy that occurs early after trauma, early trauma induced coagulopathy, ETIC, and is defined by an elevated admission prothrombin time (PT). Also, referred to by some authors as acute traumatic coagulopathy, it has been most often studied in cohorts of severely injured or hypotensive patients. However, we wanted to prospectively investigate ETIC in a large all-comers cohort to confirm its prevalence across the entire spectrum of injury, to evaluate its risk pattern and to determine a possible relationship to reduced survival.

Alcohol-related injury visits: do we know the true prevalence in U.S. trauma centres?

Introduction: Alcohol consumption is a significant risk factor for injuries. Further, level I trauma centres are mandated to screen and provide a brief intervention for identified problem drinkers. However, a valid population-based estimate of the magnitude of the problem is unknown.

Adrenocorticotropic hormone and cortisol response to corticotropin releasing hormone in the critically ill-a novel assessment of the hypothalamic-pituitary-adrenal axis.

Background: The pathophysiology of adrenal insufficiency, common in surgical intensive care units, has not been fully elucidated.

Methods: Patients at risk (age > 55 years, in the surgical intensive care unit >1 week, baseline cortisol < 20 μg/dL) were enrolled. After measuring cortisol and adrenocorticotropic hormone (ACTH), corticotropin-releasing hormone (CRH) was administered.

Evaluation of trauma and critical care training courses on the knowledge and confidence of participants in Kenya and Zambia.

Background: Trained health-care personnel are essential for improved outcomes for injured and critically ill patients. The highest injury-related mortality is seen in sub-Saharan Africa, where there is a paucity of skilled personnel. Therefore, the College of Surgeons of East, Central, and Southern Africa (COSECSA) along with Emory University provided an acute trauma care (ATC) and fundamental critical care support course (FCCS).

The epidemiology of childhood injury in Maputo, Mozambique.

Background: Injury remains a major cause of death and disability worldwide.

Aims: This study describes the characteristics of childhood injury at three hospitals in Maputo, Mozambique.

Methods: An observational, prospective convenience study was conducted in June and July 2007.

Evaluation of fundamental critical care course in Kenya: knowledge, attitude, and practice.

Background: Critical care training for medical personnel is crucial for the survival of the highest acuity patients. The Fundamental Critical Care Course (FCCS), a critical care course developed by the Society of Critical Care Medicine, permits course adaption and, thus, has potential for global dissemination. The FCCS course was provided in two Kenyan hospitals after minimal adaption.

Assessment of acute trauma care training in Kenya.

An Acute Trauma Care (ATC) course was adapted for resource-limited healthcare systems based on the American model of initial care for injured patients. The course was taught to interested medical personnel in Kenya. This study undertook a survey of the participants' healthcare facilities to maximize the applicability of ATC across healthcare settings.

Pneumomediastinum in the injured patient: inconsequential or predictive?

Free air in the peritoneum is a portent of significant pathology in the patient with abdominal trauma. The finding of a pneumomediastinum (PM) on a thoracic computed tomography scan (CT) of a trauma patient is, however, not clinically well-defined. The objectives of this study were to evaluate the incidence, pattern, and outcome of CT-diagnosed PM in a cohort of injured patients.

Evaluation of training of surgery interns to perform brief alcohol interventions for trauma patients.

Background: Because nearly half of injured patients admitted to trauma centers misuse alcohol, the American College of Surgeons has required that Level I trauma centers have a mechanism for providing brief bedside counseling interventions (BI) to patients with alcohol problems. We hypothesized that with minimal training, surgical interns could become proficient at performing BI.

Study Design: First-year surgical interns were trained in an 8-hour BI workshop.

Can secondary extremity compartment syndrome be diagnosed earlier?

Background: In 2002, our institution published a 5-year retrospective review of 10 patients who developed secondary extremity compartment syndrome (SECS) with a mortality rate of 70%. Since then, we have aggressively screened for the development of SECS in high-risk patients. We postulate that awareness of SECS and vigilant monitoring for its development would result in earlier diagnosis and treatment and improved outcome.

Prospective randomized control trial of intermittent versus continuous gastric feeds for critically ill trauma patients.

Background: This study compared an intermittent feeding regimen (one-sixth of daily needs infused every 4 hours) with a continuous (drip) feeding regimen for critically ill trauma patients. There were two outcome variables: time to reach goal volume and the days on 100% of caloric needs via an enteral route in the first 10 days of the intensive care unit stay. Adverse events were also tallied.

Trauma deaths in the first hour: are they all unsalvageable injuries?

Background: With the advent of trauma systems, time to definitive care has been decreased. We hypothesized that a subset of patients who are in extremis from the time of prehospital transport to arrival at the trauma center, and who ultimately die early after arrival, may in fact have a potentially salvageable single-organ injury.

Methods: We reviewed all deaths that occurred in the first hour after hospital admission.

Frederick G. Banting: Giving prospects for life from the past to the new millennium.

It was early and the patients bore our presence as we switched on lights, pulled back covers, and inquired about bodily functions. It was the early morning hours, and we were performing morning resident rounds in a university-teaching hospital. One lady was sitting up, ready for the residents.

Early coagulopathy predicts mortality in trauma.

Background: Coagulopathy and hemorrhage are known contributors to trauma mortality; however, the actual relationship of prothrombin time (PT) and partial thromboplastin time (PTT) to mortality is unknown. Our objective was to measure the predictive value of the initial coagulopathy profile for trauma-related mortality.

Methods: We reviewed prospectively collected data on trauma patients presenting to a Level I trauma center.