Prevalence and ethnic/racial disparities in the distribution of pediatric injuries in South Florida: implications for the development of community prevention programs.

Background: The state of Florida continues to report significant gender, ethnic and racial disparities in trauma incidence, access to care and outcomes in the adult population. Our objective was to assess pediatric injury profiles and ethnic/racial disparities of specific injuries in a Regional Trauma Center (TC) in South Florida.

Methods: Retrospective data from November 2011 to December 2015 were obtained from the Level 2 TC registry for children ≤21 years old.

Unsupervised procedures by surgical trainees: a windfall for private insurance at the expense of graduate medical education.

Background: Surgical faculty cannot always be present while trainees perform minor procedures. Fees are not obtained for these unsupervised services because Medicare rules do not allow residents and fellows to bill. Medicare already supplements hospitals via medical education funds and thus reimbursement for trainee services would constitute double billing.

First report on safety and efficacy of hetastarch solution for initial fluid resuscitation at a level 1 trauma center.

Background: For logistics, the US Army recommends Hextend (Hospira; 6% hetastarch in buffered electrolyte, HET) for battlefield resuscitation. To support this practice, there are laboratory data, but none in humans. To test the hypothesis that HET is safe and effective in trauma, we reviewed our first 6 months of use at a civilian level 1 trauma center.

A review of ureteral injuries after external trauma.

Introduction: Ureteral trauma is rare, accounting for less than 1% of all urologic traumas. However, a missed ureteral injury can result in significant morbidity and mortality. The purpose of this article is to review the literature since 1961 with the primary objective to present the largest medical literature review, to date, regarding ureteral trauma.

Is the FAST exam reliable in severely injured patients?

Introduction: Highly sensitive and accurate for the detection of injuries requiring intervention in haemodynamically unstable patients, FAST may underestimate intra-abdominal injuries in stable patients with blunt abdominal trauma. Diminished accuracy of ultrasound has been reported in different cohorts of multiple injured patients. We hypothesised that multiple injured patients with a high Injury Severity Score (ISS) will have a decreased accuracy of FAST for the assessment of blunt abdominal trauma.

Electronic medical records and mortality in trauma patients.

Background: The Electronic Medical Record (EMR) has been proposed as a way to reduce medical errors. It can also be used to document clinician involvement, which may affect outcomes. We sought to determine whether the EMR could be used to improve attending involvement in daily care, enhance surgical revenue, and lower mortality of patients with trauma.

Heart rate variability as a triage tool in patients with trauma during prehospital helicopter transport.

Background: Prehospital triage of patients with trauma is routinely challenging, but more so in mass casualty situations and military operations. The purpose of this study was to prospectively test whether heart rate variability (HRV) could be used as a triage tool during helicopter transport of civilian patients with trauma.

Methods: After institutional review board approval and waiver of informed consent, 75 patients with trauma requiring prehospital helicopter transport to our level I center (from December 2007 to November 2008) were prospectively instrumented with a 2-Channel SEER Light recorder (GE Healthcare, Milwaukee, WI).

Trauma surgeon mortality rates correlate with surgeon time at institution.

Background: Trauma centers have been created to bring traumatized patients together with experienced surgeons. We reviewed our outcomes to determine if mortality rates for high Injury Severity Scores (>or= 35) correlate with surgeon experience at our trauma center.

Study Design: Using our prospectively collected database, we compared our results with mean mortality for high-volume American College of Surgeon-certified trauma centers reporting to the National Trauma Data Bank.

Outcomes of Acinetobacter baumannii infection in critically ill surgical patients.

Background: Multi-drug resistant (MDR) organisms in intensive care units (ICUs) are a growing concern. The emergence of several infections with MDR Acinetobacter baumannii prompted a review of cases and evaluation of the efficacy of intervention.

Objective: To determine the rate of clinical cure, the incidence of drug resistance, and the mortality rate associated with A.

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.

Survival after prolonged length of stay in a trauma intensive care unit.

Background: Intensive care unit (ICU) patients comprise a small proportion of patients in the hospital but consume a disproportionate amount of hospital resources. In our cost-conscious environment, it becomes necessary to address the overall performance of our ICUs. This study was designed to analyze survival among trauma ICU (TICU) patients with a length of stay (LOS) >1 month.

Randomized controlled clinical trial of point-of-care, limited ultrasonography for trauma in the emergency department: the first sonography outcomes assessment program trial.

Study Objective: Annually, 38 million people are evaluated for trauma, the leading cause of death in persons younger than 45 years. The primary objective is to assess whether using a protocol inclusive of point-of-care, limited ultrasonography (PLUS), compared to usual care (control), among patients presenting to the emergency department (ED) with suspected torso trauma decreased time to operative care.

Methods: The study was a randomized controlled clinical trial conducted during a 6-month period at 2 Level I trauma centers.

What does ultrasonography miss in blunt trauma patients with a low Glasgow Coma Score (GCS)?

Background: The role of ultrasound (US) as a screening tool for the evaluation of blunt abdominal trauma is still controversial. Determining the types of missed injuries and the accuracy of US in patients with a low GCS will improve the evaluation of these blunt trauma patients.

Methods: Prospectively collected data from the trauma registry of a Level I trauma center was reviewed.

The nonoperative management of penetrating internal jugular vein injury.

Objective: The objective of this study was to review the outcome of nonoperative treatment for penetrating internal jugular vein (IJ) injuries in a continuous series of prospectively identified, hemodynamically stable patients.

Methods: All penetrating neck injuries assessed from February 1, 2004, to August 31, 2004, were prospectively identified. Patients without an indication for urgent neck exploration underwent diagnostic assessment with multislice helical computed tomographic angiography with or without vascular ultrasonography.

Predictors of mortality in trauma patients.

The purpose of this study was to ascertain risk factors for death from trauma. The large cohort allows for simultaneous evaluation of known mortality risk factors along with controlling for factors to assess the influence of each independently. Individually, base deficit, temperature, hypotension, age, and injury severity have been shown to be associated with an increased risk of death.

Surgeon-performed ultrasound in the ICU setting.

Evaluation of critically ill patients is often challenging due to altered sensorium, underlying disease, and the presence of multiple drains or monitoring devices. In such circumstances, the ability of physicians to perform ultrasound examinations in the intensive care unit provides a useful diagnostic and therapeutic adjunct. In this article,we review the application of surgeon-performed ultrasonography in the evaluation and management of critically ill patients.

A prospective evaluation of ultrasonography for the diagnosis of penetrating torso injury.

Background: Ultrasound (US) is commonly used for the diagnosis of hemoperitoneum after blunt abdominal trauma, but the value of US as an aid for identification of operative lesions after penetrating trauma is not well documented. The purpose of this investigation was to determine the accuracy of US for the evaluation of penetrating torso trauma and to assess the impact of this information on patient management.

Methods: We conducted a prospective cohort observational study of consecutive penetrating torso patients at a Level I trauma center.

Diagnostic peritoneal lavage through an abdominal stab wound.

Diagnostic peritoneal lavage (DPL) is one of the most useful tools in the diagnosis of intraperitoneal injuries secondary to stab wounds. The lavage catheter is inserted into the peritoneal cavity through a surgical incision or a blind puncture. Complications related to the catheter insertion were previously reported in both techniques.

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.

Predicting the need for laparotomy in pediatric trauma patients on the basis of the ultrasound score.

Background: It is possible to quantify the amount of hemoperitoneum seen on focused assessment with sonography for trauma (FAST) using a simple scoring system that had previously been shown to correlate with the need for subsequent laparotomy in adults. A score of 3 or greater was shown to be highly accurate in predicting the need for laparotomy. We hypothesized that this scoring system might also predict the need for laparotomy in pediatric trauma patients.

Unexpected findings in trauma patients dying in the intensive care unit: results of 153 consecutive autopsies.

Background: The true incidence of missed injuries in trauma-related deaths is unknown, because in only about 60% of injury-related deaths nationwide is an autopsy performed. Few studies have documented the frequency of missed diagnoses leading to deaths specifically in the trauma ICU population. We attempted to evaluate the incidence and nature of missed injuries and complications in trauma- and burn-related deaths in our ICU given an autopsy rate of close to 100%.