Retrospective Evaluation of Splenic Artery Embolization Outcomes in the Management of Blunt Splenic Trauma: A Single Centre Experience at a Large Level 1 Trauma Centre.

Purpose: Retrospective review of splenic artery embolization (SAE) outcomes performed for blunt abdominal trauma.

Materials And Methods: 11-year retrospective review at a large level-1 Canadian trauma centre. All patients who underwent SAE after blunt trauma were included.

Interdisciplinary strategies to prevent long-term and detrimental opioid use following trauma: a stakeholder consensus study.

Objective: Prolonged opioid use is common following traumatic injuries. Although preventive strategies have been recommended, the evidence supporting their use is low. The objectives of this study were to select interdisciplinary strategies to prevent long-term, detrimental opioid use in trauma patients for further evaluation and to identify implementation considerations.

Strategies to prevent long-term opioid use following trauma: a Canadian practice survey.

Purpose: To evaluate how Canadian clinicians involved in trauma patient care and prescribing opioids perceive the use and effectiveness of strategies to prevent long-term opioid therapy following trauma. Barriers and facilitators to the implementation of these strategies were also assessed.

Methods: We conducted a web-based cross-sectional survey.

Strategies aimed at preventing chronic opioid use in trauma and acute care surgery: a scoping review protocol.

Introduction: Globally every year, millions of patients sustain traumatic injuries and require acute care surgeries. A high incidence of chronic opioid use (up to 58%) has been documented in these populations with significant negative individual and societal impacts. Despite the importance of this public health issue, optimal strategies to limit the chronic use of opioids after trauma and acute care surgery are not clear.

Prevalence of risky driving behaviours on popular television series.

Motor vehicle crashes are a leading cause of death among young adults. Social media and television have been shown to affect the likelihood that young adults will engage in risk-taking behaviour. We watched 216 episodes of five popular television series on Netflix and identified 333 separate driving scenes, of which 271 (81.

Safety and efficacy of noninvasive ventilation in patients with blunt chest trauma: a systematic review.

Introduction: This systematic review looks at the use of noninvasive ventilation (NIV), inclusive of noninvasive positive pressure ventilation (NPPV) and continuous positive pressure ventilation (CPAP), in patients with chest trauma to determine its safety and clinical efficacy in patients with blunt chest trauma who are at high risk of acute lung injury (ALI) and respiratory failure.

Methods: We searched the MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) databases. Pairs of reviewers abstracted relevant clinical data and assessed the methodological quality of randomized controlled trials (RCTs) using the Cochrane domain and observational studies using the Newcastle-Ottawa Scale.

The Advanced Trauma Operative Management course--a two student to one faculty model.

Background: The internationally recognized Advanced Trauma Operative Management (ATOM) course uses a 1:1 student-to-faculty teaching model. This study examines a two student to one faculty ATOM teaching model.

Materials And Methods: We randomly assigned 16 residents to four experienced ATOM faculty members.

Ultrasound-guided tracheostomy--not for the many, but perhaps the few... or the one.

Percutaneous tracheostomy has become a routine procedure in most intensive care units, and point of care ultrasound is becoming used with greater frequency to augment diagnosis and therapy for critically ill patients. The case series from Rajajee and colleagues incorporates 'real-time' ultrasound in an effort to improve the safety of percutaneous tracheostomy. While their report does not prove that ultrasound should be used prior to or during all percutaneous tracheostomies, it does reinforce several important safety considerations concerning the anatomy of the neck, and in particular the potential to encounter bleeding complications during these procedures.

Access to trauma systems in Canada.

Background: Trauma is a leading cause of morbidity, potential years of life lost and health care expenditure in Canada and around the world. Trauma systems have been established across North America to provide comprehensive injury care and to lead injury control efforts. We sought to describe the current status of trauma systems in Canada and Canadians' access to acute, multidisciplinary trauma care.

Surgisis® in the management of the complex abdominal wall in trauma: a case series and review of the literature.

Managing complex abdominal wall injuries acutely or at the time of reconstruction is challenging. Contaminated surgical fields, devitalized tissue, intestinal fistula and tissues under tension contribute to clinical scenarios where closure is not possible or morbidity is unacceptable. The introduction of an absorbable extracellular matrix derived from porcine small intestinal submucosa (Surgisis) adds a potentially useful tool to the surgeon's armamentarium.

Assessing response to changing plasma/red cell ratios in a bleeding trauma patient.

Recent military experience suggests that transfusing fresh frozen plasma and packed red cells in a 1:1 ratio may improve survival in exsanguinating trauma patients. We report the case of a single patient who required massive transfusion after suffering a single gunshot wound. Initially, the patient received FFP:PRBC in 1:2 ratio, but this did not correct laboratory parameters except for INR and clotting factor VII level, which were likely normalized by treatment with recombinant activated factor VII.

Abnormal coagulation tests are associated with progression of traumatic intracranial hemorrhage.

Background: Intracranial hemorrhage (ICH) is common in traumatic brain injury (TBI) and a major determinant of death and disability. ICH commonly increases in size and coagulopathy has been implicated in such progression. We investigated the association between coagulopathy diagnosed by routine laboratory tests and ICH progression.

Extravasation of intravenous computed tomography scan contrast in blunt abdominal and pelvic trauma.

Background: Intravenous contrast extravasation (CE) on computed tomography (CT) scan in blunt abdominal trauma is generally regarded as an indication for the need for invasive intervention (either angiography or laparotomy). More recently, improvements in CT scan technology have increased the sensitivity in detecting CE, and, thus, we postulate that not all patients with this finding require intervention.

Methods: This study is a retrospective review of all patients who underwent a CT scan for blunt abdominal trauma between January 1999 and September 2003.

Retrograde urethrocystography impairs computed tomography diagnosis of pelvic arterial hemorrhage in the presence of a lower urologic tract injury.

Background: There is controversy about the appropriate sequence of urologic investigation in patients with pelvic fracture. Use of retrograde urethrography or cystography may interfere with regular pelvic CT scanning for arterial extravasation.

Study Design: We performed a retrospective study at a regional trauma center in Toronto, Canada.

Perioperative vasopressors are associated with an increased risk of gastrointestinal anastomotic leakage.

Background: The purpose of this study was to investigate the effect of vasopressors on gastrointestinal (GI) anastomotic leaks. Vasopressors are commonly used in surgical patients admitted to the intensive care unit (ICU) and their effects on GI anastomotic integrity are unknown.

Patients And Methods: Surgical patients admitted to the ICU in our tertiary university hospital following the creation of a GI anastomosis were studied by a retrospective chart analysis for anastomotic leaks and complications

Results: A total of 223 patients with 259 GI anastomoses, mostly for cancer, were admitted to the ICU immediately after surgery.

Radiation exposure from diagnostic imaging in severely injured trauma patients.

Background: Trauma patients often require multiple imaging tests, including computed tomography (CT) scans. CT scanning, however, is associated with high-radiation doses. The purpose of this study was to measure the radiation doses trauma patients receive from diagnostic imaging.

Preventable deaths from hemorrhage at a level I Canadian trauma center.

Background: Studies of trauma deaths have had a tremendous impact on the quality of contemporary trauma care. We studied causes of trauma death at a Level I Canadian trauma center, and tabulated preventable deaths from hemorrhage using explicit criteria.

Methods: Trauma registry data were used to identify all trauma deaths at our institution from January 1, 1999 to December 31, 2003.

Association between alcohol and mortality in patients with severe traumatic head injury.

Hypothesis: Admission blood alcohol concentration (BAC) is associated with in-hospital death in patients with severe brain injury from blunt head trauma.

Design: Retrospective cohort study.

Setting: Academic level I trauma center in Toronto, Ontario.

Recombinant activated coagulation factor VII and bleeding trauma patients.

Background: Recombinant activated coagulation factor VII (rFVIIa) is increasingly being administered to massively bleeding trauma patients. rFVIIa has been shown to correct coagulopathy and to decrease transfusion requirements. However, there is no conclusive evidence to suggest that rFVIIa improves the survival of these patients.

Traumatic abdominal wall hernia: epidemiology and clinical implications.

Background: Traumatic abdominal wall hernias (TAWHs) are uncommon, and it remains controversial whether such patients require urgent laparotomy. As such, this study was undertaken to assess the clinical sequelae of operative versus nonoperative management of TAWH, and whether certain patient or injury characteristics are predictive of the need for early surgery.

Methods: Retrospective review of all patients presenting acutely with a TAWH at a Regional Trauma Center from January 2000 to December 2004.

Diagnosis and outcome of blunt caval injuries in the modern trauma center.

Background: Blunt vena caval injury (BCI) is uncommon with only a few published reports in the literature. Recently, with high resolution computed tomography (CT) scan imaging signs of caval injury are sometimes found in hemodynamically stable patients. The purpose of this study was to assess the current course of patients with BCI.

Do trauma patients with a Glasgow Coma Scale score of 3 and bilateral fixed and dilated pupils have any chance of survival?

Background: Low Glasgow Coma Scale score (GCS) and pupillary status predict poor outcomes in head injury (HI) patients. We compared the mortality of GCS 3 patients having bilateral fixed and dilated pupils (BFDP) with GCS 3 patients having reactive pupils (RP). We then determined if trauma system or patient factors were responsible for the difference in mortality.

Risk and benefit of intravenous contrast in trauma patients with an elevated serum creatinine.

Objective: Assess if the benefits outweigh the risks of intravenous (iv) contrast in trauma patients who present with an elevated serum creatinine (Cr).

Background: Radiologic investigations with iv contrast are often used in trauma patients to rapidly assess for life threatening injuries. However, contrast nephropathy (CNP) is associated with increased morbidity and mortality.