Levetiracetam Prophylaxis for Post-traumatic Brain Injury Seizures is Ineffective: A Propensity Score Analysis.

Introduction: Early seizures after severe traumatic brain injury (TBI) have a reported incidence of up to 15 %. Prophylaxis for early seizures using 1 week of phenytoin is considered standard of care for seizure prevention. However, many centers have substituted the anticonvulsant levetiracetam without good data on the efficacy of this approach.

Early surgical intervention and its impact on patients presenting with necrotizing soft tissue infections: A single academic center experience.

Objectives: Early diagnosis and emergent surgical debridement of necrotizing soft tissue infections (NSTIs) remains the cornerstone of care. We aimed to study the effect of early surgery on patients' outcomes and, in particular, on hospital length of stay (LOS) and Intensive Care Unit (ICU) LOS.

Materials And Methods: Over a 6-year period (January 2003 through December 2008), we analyzed the records of patients with NSTIs.

Traumatic intracranial aneurysm in blunt trauma.

Introduction: Computed Tomography Angiography (CTA) is being used to identify traumatic intracranial aneurysms (TICA) in patients with findings such as skull fracture and intracranial haemorrhage on initial Computed Tomography (CT) scans after blunt traumatic brain injury (TBI). However, the incidence of TICA in patients with blunt TBI is unknown. The aim of this study is to report the incidence of TICA in patients with blunt TBI and to assess the utility of CTA in detecting these lesions.

Unveiling posttraumatic stress disorder in trauma surgeons: a national survey.

Background: The significance of posttraumatic stress disorder (PTSD) in trauma patients is well recognized. The impact trauma surgeons endure in managing critical trauma cases is unknown. The aim of our study was to assess the incidence of PTSD among trauma surgeons and identify risk factors associated with the development of PTSD.

The physiological effects of hyperosmolar resuscitation: 5% vs 3% hypertonic saline.

Background: Use of 5% normal saline (NS) is gaining renewed interest. The primary aim of our study was to compare the physiological effects after the administration of different concentrations of hypertonic saline (3% vs 5%NS) in the initial resuscitation of trauma.

Methods: We performed a retrospective analysis of a prospectively collected database of all trauma patients who received hypertonic saline during initial resuscitation.

Prothrombin complex concentrate use in coagulopathy of lethal brain injuries increases organ donation.

Coagulopathy is a defined barrier for organ donation in patients with lethal traumatic brain injuries. The purpose of this study was to document our experience with the use of prothrombin complex concentrate (PCC) to facilitate organ donation in patients with lethal traumatic brain injuries. We performed a 4-year retrospective analysis of all patients with devastating gunshot wounds to the brain.

The BIG (brain injury guidelines) project: defining the management of traumatic brain injury by acute care surgeons.

Background: It is becoming a standard practice that any "positive" identification of a radiographic intracranial injury requires transfer of the patient to a trauma center for observation and repeat head computed tomography (RHCT). The purpose of this study was to define guidelines-based on each patient's history, physical examination, and initial head CT findings-regarding which patients require a period of observation, RHCT, or neurosurgical consultation.

Methods: In our retrospective cohort analysis, we reviewed the records of 3,803 blunt traumatic brain injury patients during a 4-year period.

Clinical outcomes in traumatic brain injury patients on preinjury clopidogrel: a prospective analysis.

Background: Patients receiving antiplatelet medications are considered to be at an increased risk for traumatic intracranial hemorrhage after blunt head trauma. However, most studies have categorized all antiplatelet drugs into one category. The aim of our study was to evaluate clinical outcomes and the requirement of a repeat head computed tomography (RHCT) in patients on preinjury clopidogrel therapy.

Repeal of the concealed weapons law and its impact on gun-related injuries and deaths.

Background: Senate Bill 1108 (SB-1108) allows adult citizens to carry concealed weapons without a permit and without completion of a training course. It is unclear whether the law creates a "deterrent factor" to criminals or whether it escalates gun-related violence. We hypothesized that the enactment of SB-1108 resulted in an increase in gun-related injuries and deaths (GRIDs) in southern Arizona.

Telephotography in trauma: a 2-year clinical experience.

Introduction: Smartphones can be used to record and transmit high-quality clinical photographs. The aim of this study was to describe our experience with smartphone telephotography in the care of trauma patients. We hypothesized that smartphone telephotography can be safely and effectively implemented on a trauma service.

Repeat head computed tomography in anticoagulated traumatic brain injury patients: still warranted.

Anticoagulation agents are proven risk factors for intracranial hemorrhage (ICH) in traumatic brain injury (TBI). The aim of our study is to describe the epidemiology of prehospital coumadin, aspirin, and Plavix (CAP) patients with ICH and evaluate the use of repeat head computed tomography (CT) in this group. We performed a retrospective study from our trauma registry.

The conjoint effect of reduced crystalloid administration and decreased damage-control laparotomy use in the development of abdominal compartment syndrome.

Background: Anticipation of abdominal compartment syndrome (ACS) is a factor for performing damage-control laparotomy (DCL). Recent years have seen changes in resuscitation patterns and a decline in the use of DCL. We hypothesized that reductions in both crystalloid resuscitation and the use of DCL is associated with a reduced rate of ACS in trauma patients.

Predicting hospital discharge disposition in geriatric trauma patients: is frailty the answer?

Background: The frailty index (FI) has been shown to predict outcomes in geriatric patients. However, FI has never been applied as a prognostic measure after trauma. The aim of our study was to identify hospital admission factors predicting discharge disposition in geriatric trauma patients.

Acquired coagulopathy of traumatic brain injury defined by routine laboratory tests: which laboratory values matter?

Background: Coagulopathy is a major determinant of disability and death in patients with traumatic intracranial hemorrhage. However, the correlation between coagulopathy defined by routine coagulation tests and clinical outcomes in traumatic brain injury (TBI) is not well defined. The aim of our study was to determine the effect of coagulopathy diagnosed by routine laboratory tests on outcomes in TBI patients.

Modified Veress needle decompression of tension pneumothorax: a randomized crossover animal study.

Background: The current prehospital standard of care using a large bore intravenous catheter for tension pneumothorax (tPTX) decompression is associated with a high failure rate. We developed a modified Veress needle (mVN) for this condition. The purpose of this study was to evaluate the effectiveness and safety of the mVN as compared with a 14-gauge needle thoracostomy (NT) in a swine tPTX model.

Contemporary acute care surgery percutaneous endoscopic gastrostomy tube placement: an extreme bumper height and complications.

Background: As the role of acute care surgery (ACS) becomes more prevalent, clinicians in this specialty will be placing more percutaneous endoscopic gastrostomy (PEG) tubes. In this contemporary series of ACS PEG procedures, we hypothesized that technical aspects of PEG tube placement may play an important role.

Methods: For our retrospective study, we queried our tertiary Level I trauma center's prospectively maintained ACS database for PEG tube placement.

Fatal gunshot wound to the head: the impact of aggressive management.

Background: Patients with fatal gunshot wounds (GSWs) to the head often have poor outcomes but are ideal candidates for organ donation. The purpose of this study was to evaluate the effects of aggressive management on organ donation in patient with fatal GSWs to the head.

Methods: A 5-year review of all patients at a trauma center with GSWs to the head was performed.

Mild and moderate pediatric traumatic brain injury: replace routine repeat head computed tomography with neurologic examination.

Background: Opinion is divided on the role of routine repeat head computed tomography (RHCT) for guiding clinical management in pediatric patients with blunt head trauma. We hypothesize that routine RHCT does not lead to change in management in mild and moderate traumatic brain injury (TBI).

Methods: This is a 3-year retrospective study of all patients of age 2 years to 18 years with blunt TBI admitted to our Level 1 trauma center with an abnormal head CT.

Improving survival rates after civilian gunshot wounds to the brain.

Background: Gunshot wounds to the brain are the most lethal of all firearm injuries, with reported survival rates of 10% to 15%. The aim of this study was to determine outcomes in patients with gunshot wounds to the brain, presenting to our institution over time. We hypothesized that aggressive management can increase survival and the rate of organ donation in patients with gunshot wounds to the brain.

Low-dose aspirin therapy is not a reason for repeating head computed tomographic scans in traumatic brain injury: a prospective study.

Background: Most studies have categorized all antiplatelet drugs into one category. The aim of our study was to evaluate the utility of repeat head computed tomography (RHCT) and outcomes in patients on low-dose aspirin (acetylsalicylic acid; ASA) therapy.

Methods: Patients with traumatic brain injury with intracranial hemorrhage on initial head computed tomography (CT) were prospectively enrolled.

The acute care surgery model: managing traumatic brain injury without an inpatient neurosurgical consultation.

Background: Neurosurgical services are a limited resource and effective use of them would improve the health care system. Acute care surgeons (ACS) are accustomed to treating mild traumatic brain injury (TBI) including those with minor radiographic intracranial injuries. We hypothesized that ACS safely manage mild TBI with intracranial hemorrhage (ICH) on head computed tomographic (CT) scan without neurosurgical consultation (NC).

Rehabilitation after trauma; does age matter?

Background: Variability exits in the ability to predict overall recovery after trauma and inpatient rehabilitation. The aim of this study was to identify factors predicting functional improvement in trauma patients undergoing inpatient rehabilitation.

Methods: We performed a 3-y retrospective cohort analysis on a prospectively collected database of all trauma patients discharged from a level I trauma center to a single inpatient rehabilitation center.

Improving communication in level 1 trauma centers: replacing pagers with smartphones.

Introduction: Communication among healthcare providers continues to change, and 90% of healthcare providers are now carrying cellular phones. Compared with pagers, the rate and amount of information immediately available via cellular phones are far superior. Wireless devices such as smartphones are ideal in acute trauma settings as they can transfer patient information quickly in a coordinate manner to all the team members responsible for patient care.

Prothrombin complex concentrate: an effective therapy in reversing the coagulopathy of traumatic brain injury.

Background: Coagulopathy in patients with traumatic brain injury (TBI) is a well-studied concept. Prothrombin complex concentrate (PCC) has been shown to be an effective treatment modality for correction of TBI coagulopathy. However, its use and effectiveness compared with recombinant factor VII (rFVIIa) in TBI has not been established.

Continuous noninvasive hemoglobin monitor from pulse ox: ready for prime time?

Background: Advances in technology have allowed for continuous noninvasive hemoglobin monitoring (SpHb), which may enable earlier detection of hemorrhage and more efficient surgical and/or blood transfusion management. The use of SpHb has not been described in the trauma population. The purpose of the present study was to evaluate the accuracy of a SpHb measurement device in severely injured trauma patients.