Stop The Falls! A framework for injury prevention outreach for older adults presented by the American Association for the Surgery of Trauma Geriatric Trauma and Injury Prevention Committees.

With the increasing age of the population in the USA, fall prevention events to target older patients are imperative. The American Association for the Surgery of Trauma hosted a fall prevention event at the host city of the 2023 Annual Meeting. We review the planning and implementation of this "Stop the Falls" event, in hopes that other institutions may benefit and sustainably effectuate fall prevention events for an increasingly geriatric population.

Increased Morbidity and One-Year Post-Discharge Mortality in Patients with Bacteremia Undergoing Emergent Cholecystectomy: An Exploratory Retrospective Observational Study.

Gallbladder disease, one of the most common diseases in the United States, ranges from symptomatic gallstones to severe systemic infections from cholangitis. Little research is available on how often patients undergoing emergent cholecystectomy also have bacteremia. We hypothesized that blood cultures would be performed rarely in patients undergoing emergent cholecystectomy, and that positive cultures would be associated with worse outcomes.

Geography of the Underserved: The Contribution of Rural Non-Trauma Hospitals to Trauma Care.

Objective: To determine the proportion and characteristics of injured rural residents treated at urban trauma centers (TCs), urban non-trauma centers (NTCs), rural TCs, and rural NTCs.

Summary Background Data: Timely treatment at a designated trauma center improves outcomes for patients with serious injuries, but rural residents have limited access to designated trauma centers. Rural non-trauma centers may constitute an underrecognized source of trauma care.

Scanning the aged to minimize missed injury: An Eastern Association for the Surgery of Trauma multicenter study.

Background: Despite the high incidence of blunt trauma in older adults, there is a lack of evidence-based guidance for computed tomography (CT) imaging in this population. We aimed to identify an algorithm to guide use of a pan-scan (head/cervical spine [C-spine]/torso) or a selective scan (head/C-spine ± torso). We hypothesized that a patient's initial history and examination could be used to guide imaging.

Alcohol use disorder in the intensive care unit a highly morbid condition, but chemical dependency discussion improves outcomes.

Background: Alcohol use disorders (AUD) are common in patients admitted to intensive care units (ICU) and increase the risk for worse outcomes. In this study, we describe factors associated with patient mortality after ICU admission and the effect of chemical dependency (CD) counseling on outcomes in the year following ICU admission.

Methods: We retrospectively reviewed patient demographics, hospital data, and documentation of CD counseling by medical providers for all ICU patients with AUD admitted to our institution between January 2017 and March 2019.

Outcomes after rib fractures: more complex than a single number.

Purpose: Rib fractures are common injuries that can lead to morbidity and mortality.

Methods: Data on all patients with rib fractures admitted to a single trauma center between January 1, 2008 and December 31, 2018 were reviewed.

Results: A total of 1,671 admissions for rib fracture were examined.

Prospective validation and application of the Trauma-Specific Frailty Index: Results of an American Association for the Surgery of Trauma multi-institutional observational trial.

Background: The frailty index is a known predictor of adverse outcomes in geriatric patients. Trauma-Specific Frailty Index (TSFI) was created and validated at a single center to accurately identify frailty and reliably predict worse outcomes among geriatric trauma patients. This study aims to prospectively validate the TSFI in a multi-institutional cohort of geriatric trauma patients.

ED to ED transfer does not prolong emergency department stays in a rural trauma system.

Background: In many rural trauma systems injured patients are initially evaluated at a local hospital, and once stabilized transferred to a trauma center for definitive care. In the U.S.

Surgical Infection Society Guidelines for Antibiotic Use in Patients Undergoing Cholecystectomy for Gallbladder Disease.

Manifestations of gallbladder disease range from intermittent abdominal pain (symptomatic cholelithiasis) to potentially life-threatening illness (gangrenous cholecystitis). Although surgical intervention to treat acute cholecystitis is well defined, the role of antibiotic administration before or after cholecystectomy to decrease morbidity or mortality is less clear. The Surgical Infection Society's Therapeutics and Guidelines Committee convened to develop guidelines for antibiotic use in patients undergoing cholecystectomy for gallbladder disease to prevent surgical site infection, other infection, hospital length of stay, or mortality.

Surgical Infection Society Guidelines for Total Abdominal Colectomy versus Diverting Loop Ileostomy with Antegrade Intra-Colonic Lavage for the Surgical Management of Severe or Fulminant, Non-Perforated Colitis.

infection (CDI) can result in life-threatening illness requiring surgery. Surgical options for managing severe or fulminant, non-perforated colitis include total abdominal colectomy with end ileostomy or creation of a diverting loop ileostomy with antegrade vancomycin lavage. The Surgical Infection Society's Therapeutics and Guidelines Committee convened to develop guidelines for summarizing the current SIS recommendations for total abdominal colectomy versus diverting loop ileostomy with antegrade lavage for severe or fulminant, non-perforated colitis.

Is it a matter of time? The effect of transfer time on femur fracture outcomes.

Background: Trauma systems in rural areas often require longdistance transfers for definitive care. Delays in care, such as delayed femurfracture repair have been reported to be associated with poorer outcomes, butlittle is known about how transfer time affects time to repair or outcomesafter femur fractures.

Methods: We conducted a retrospective review of all trauma patients transferred to our level 1 rural trauma center between May 1, 2016-April 30, 2019.

Evaluating our progress with trauma transfer imaging: repeat CT scans, incomplete imaging, and delayed definitive care.

Purpose: Many trauma patients present at non-trauma centers and require transfer. CT imaging obtained at the initial hospital (IH) may lead to delays in definitive trauma care, and previous studies have shown imaging is often repeated at the trauma center (TC).

Methods: A retrospective review was performed of all tier 1 trauma patients transferred to our TC between May 2018 and April 2019.

Surgical Infection Society Guidelines for Antibiotic Use in Patients with Traumatic Facial Fractures.

Facial fractures are common in traumatic injury. Antibiotic administration practices for traumatic facial fractures differ widely. The Surgical Infection Society's (SIS's) Therapeutics and Guidelines Committee convened to develop guidelines for antibiotic administration in the management of traumatic facial fractures.

Vasopressors in Sepsis.

Background: Sepsis accounts for 10% of intensive care unit admissions and significant healthcare costs. Although the mortality rate from sepsis has been decreasing with better critical care, early identification of septic patients, and prompt interventions, the mortality rate remains 20%-30%.

Method: Review of the English-language literature.

Total Pancreatectomy With Intraportal Islet Autotransplantation as a Treatment of Chronic Pancreatitis in Patients With CFTR Mutations.

Objectives: Chronic pancreatitis (CP) is an infrequent but debilitating complication associated with CFTR mutations. Total pancreatectomy with islet autotransplantation (TPIAT) is a treatment option for CP that provides pain relief and preserves β-cell mass, thereby minimizing the complication of diabetes mellitus. We compared outcomes after TPIAT for CP associated with CFTR mutations to CP without CTFR mutations.

Obstructive Sleep Apnea: A Risk Factor for Surgical Site Infection following Colectomy.

Background: Obstructive sleep apnea (OSA) is associated with increased systemic oxidative stress, endothelial dysfunction, and activation of pro-inflammatory cascades, which increase host susceptibility to infection. OSA has not been evaluated as a risk factor for surgical site infection (SSI) following colectomy. We hypothesized that OSA increases the risk for SSI after colectomy.

Abdominal Hysterectomy: Reduced Risk of Surgical Site Infection Associated with Robotic and Laparoscopic Technique.

Background: Hysterectomy is one of the most common procedures performed in the United States. New techniques utilizing laparoscopic and robotic technology are becoming increasingly common. It is unknown if these minimally invasive surgical techniques alter the risk of surgical site infections (SSI).

Positive sterility cultures of transplant solutions during pancreatic islet autotransplantation are associated infrequently with clinical infection.

Background: Chronic pancreatitis is a painful and often debilitating disease. Total pancreatectomy with intra-portal islet autotransplantation (TP-IAT) is a treatment option that allows for pain relief and preservation of beta-cell mass, thereby minimizing the complication of diabetes mellitus. Cultures of harvested islets are often positive for bacteria, possibly due to frequent procedures prior to TP-IAT, such as endoscopic retrograde cholangiopancreatography (ERCP), stenting, or other operative drainage procedures.

Preinjury Fed State Alters the Physiologic Response in a Porcine Model of Hemorrhagic Shock and Polytrauma.

Introduction: Hemorrhagic shock and injury lead to dramatic changes in metabolic demands and continue to be a leading cause of death. We hypothesized that altering the preinjury metabolic state with a carbohydrate load prior to injury would affect subsequent metabolic responses to injury and lead to improved survival.

Methods: Sixty-four pigs were randomized to fasted (F) or carbohydrate prefeeding (CPF) groups and fasted 12 h prior to experiment.

Pre-operative antiseptic shower and bath policy decreases the rate of S. aureus and methicillin-resistant S. aureus surgical site infections in patients undergoing joint arthroplasty.

Background: Surgical site infection (SSI) following joint arthroplasty increases length of stay, hospital cost, and leads to patient and healthcare provider dissatisfaction. Due to the presence of non-biologic implants (the prosthetic joint) in these procedures, infection is often devastating and treatment of the infection is more difficult. For this reason, prevention of SSI is of crucial importance in this population.

Computed tomography scans with intravenous contrast: low incidence of contrast-induced nephropathy in blunt trauma patients.

Background: Computed tomography (CT) with intravenous (IV) contrast is an important step in the evaluation of the blunt trauma patient; however, the risk for contrast-induced nephropathy (CIN) in these patients still remains unclear. The goal of this study was to describe the rate of CIN in blunt trauma patients at a Level 1 trauma center and identify the risk factors of developing CIN.

Methods: After internal review board approval, we reviewed our Level 1 trauma registry to identify blunt trauma patients admitted during a 1-year period.