Decreased mortality after prehospital interventions in severely injured trauma patients.

Background: We test the hypothesis that prehospital interventions (PHIs) performed by skilled emergency medical service providers during ground or air transport adversely affect outcome in severely injured trauma patients.

Methods: Consecutive trauma activations (March 2012 to June 2013) transported from the scene by air or ground emergency medical service providers were reviewed. PHI was defined as intubation, needle decompression, tourniquet, cricothyroidotomy, or advanced cardiac life support.

Differences between blunt and penetrating trauma after resuscitation with hydroxyethyl starch.

Background: The purpose of this study was to test the hypothesis that a single bolus of 6% hydroxyethyl starch (HES 450/0.7 in lactated electrolyte injection) during initial resuscitation has a differential effect in blunt and penetrating trauma patients.

Methods: Consecutive admissions to the trauma service were reviewed.

Does traumatic brain injury increase the risk for venous thromboembolism in polytrauma patients?

Background: Trauma is a major risk factor for venous thromboembolism (VTE). Traumatic brain injury (TBI) is generally considered to further increase the VTE risk, which should prompt routine thromboprophylaxis. However, the associated risk for intracranial hemorrhage often delays anticoagulants.

Vasopressor use during emergency trauma surgery.

Most evidence suggests early vasopressor use is associated with death after trauma, but no previous study has focused on patients requiring emergency operative intervention (OR). We test the hypothesis that vasopressors are harmful in this population. Records from 746 patients requiring OR from July 2009 to March 2013 were retrospectively reviewed and stratified based on vasopressor use (epinephrine [EPI], phenylephrine, ephedrine, norepinephrine, dobutamine, vasopressin) or no vasopressor use.

Do all trauma patients benefit from tranexamic acid?

Background: This study tested the hypothesis that early routine use of tranexamic acid (TXA) reduces mortality in a subset of the most critically injured trauma intensive care unit patients.

Methods: Consecutive trauma patients (n = 1,217) who required emergency surgery (OR) and/or transfusions from August 2009 to January 2013 were reviewed. At surgeon discretion, TXA was administered at a median of 97 minutes (1-g bolus then 1-g over 8 hours) to 150 patients deemed high risk for hemorrhagic death.

Long-term coagulation changes after resection of thoracoabdominal malignancies.

Background: The purpose of this study was to evaluate the long-term coagulation status of patients undergoing malignancy resection.

Study Design: A prospective observational trial was conducted with informed consent in 52 patients (age 66 ± 10 years and 60% male) with thoracoabdominal tumors (pancreas [n = 18, 35%], esophagus [n = 13, 25%], liver [n = 7, 14%], stomach [n = 6, 12%], bile duct [n = 3, 6%], retroperitoneal [n = 3, 6%], and duodenum [n = 2, 4%]) with 6- to 12-month follow-up. Coagulation was evaluated with rotational thromboelastography (ROTEM) on whole blood and with a panel of hemostatic markers on stored plasma.

Novel prehospital monitor with injury acuity alarm to identify trauma patients who require lifesaving intervention.

Background: A miniature wireless vital signs monitor (MWVSM, www.athena.gtx.

Hypercoagulability and other risk factors in trauma intensive care unit patients with venous thromboembolism.

Background: Thromboelastography (TEG) on hospital admission can identify hypercoagulable trauma patients at risk for venous thromboembolism (VTE), but the value of TEGs obtained after multiple interventions, including tranexamic acid (TXA), has not been defined. We test the following hypotheses. (1) TEG on intensive care unit (ICU) admission can help stratify patients screened with Greenfield's risk assessment profile (RAP) for VTE.

Vasopressin for cerebral perfusion pressure management in patients with severe traumatic brain injury: preliminary results of a randomized controlled trial.

Background: After traumatic brain injury (TBI), catecholamines (CAs) may be needed to maintain adequate cerebral perfusion pressure (CPP), but there are no recommended alternative vasopressor therapies. This is an interim report of the first study to test the hypothesis that arginine vasopressin (AVP) is a safe and effective alternative to CAs for the management of CPP in patients with severe TBI.

Methods: Since 2008, all TBI patients requiring intracranial pressure monitoring at this Level 1 trauma center have been eligible for a randomized trial to receive either CA or AVP if vasopressors were required to maintain CPP greater than 60 mm Hg.

Identifying pitfalls in chest tube insertion: improving teaching and performance.

Objective: Chest tube thoracostomies are common surgical procedures, but little is known about how practitioners learn the skill. This study evaluates the frequency with which correctly performed tasks are executed by subjects during chest tube thoracostomies.

Design: In this prospective study, we developed a mobile-learning module, containing stepwise multimedia guidance on chest tube insertion.

Exploring trauma recidivism in an elderly cohort.

Purpose: As the population ages, trauma in the elderly is an increasingly recognized source of elderly morbidity. However, previous reviews on the topic provide only broad recommendations. The purpose of this study was to examine the elderly recidivist cohort at an urban trauma center for mechanisms of repeat injury.