Main versus segmental hepatic artery angioembolization in patients with traumatic liver injuries: A Western Trauma Association multicenter study.

Introduction: Hepatic angioembolization is highly effective for hemorrhage control in hemodynamically stable patients with traumatic liver injuries and contrast extravasation. However, there is a paucity of data regarding the specific location of angioembolization within the hepatic arterial vasculature and its implications on patient outcomes.

Methods: A post-hoc analysis of a multicenter prospective observational study across 23 centers was performed.

Observation-first versus angioembolization-first approach in stable patients with blunt liver trauma: A WTA multicenter study.

Background: Prior studies evaluating observation versus angioembolization (AE) for blunt liver injuries (BLT) with contrast extravasation (CE) on computed tomography imaging have yielded inconsistent conclusions, primarily due to limitations in single-center and/or retrospective study design. Therefore, this multicenter study aims to compare an observation versus AE-first approach for BLT, hypothesizing decreased liver-related complications (LRCs) with observation.

Methods: We conducted a post hoc analysis of a multicenter, prospective observational study (2019-2021) across 23 centers.

Less is more: Streamlining management of isolated traumatic subarachnoid hemorrhage in the modified brain injury guidelines.

Background: Patients with isolated traumatic subarachnoid hemorrhage (iTSAH) are managed according to the modified Brain Injury Guidelines (mBIG) class. The current study aimed to describe patients with iTSAH and analyze their clinical outcomes.

Methods: A retrospective analysis was performed on trauma patients with iTSAH.

Managing career transitions in the profession of acute care surgery.

Career shifts are a naturally occurring part of the trauma and acute care surgeon's profession. These transitions may occur at various timepoints throughout a surgeon's career and each has their own specific challenges. Finding a good fit for your first job is critical for ensuring success as an early career surgeon.

A novel preoperative score to predict severe acute cholecystitis.

Background: In a large multicenter trial, The Parkland Grading Scale (PGS) for acute cholecystitis outperformed other grading scales and has a positive correlation with complications but is limited in its inability to preoperatively predict high-grade cholecystitis. We sought to identify preoperative variables predictive of high-grade cholecystitis (PGS 4 or 5).

Methods: In a six-month period, patients undergoing cholecystectomy at a single institution with prospectively graded PGS were analyzed.

Burn and Trauma Burden and Screening for Interpersonal Violence During the COVID-19 Pandemic.

Introduction: Nationwide shelter-in-place (SIP) orders during the pandemic have had long-lasting effects, including increased rates of domestic violence and interpersonal violence. Screening for violence varies by institution, which tool is used, and when. Given increases in burn and trauma admissions over the course of the pandemic, we sought to examine trends at our institution during this time period to better guide care and anticipate system-level effects.

A Real-Time Automated Machine Learning Algorithm for Predicting Mortality in Trauma Patients: Survey Says it's Ready for Prime-Time.

Background: Though artificial intelligence ("AI") has been increasingly applied to patient care, many of these predictive models are retrospective and not readily available for real-time decision-making. This survey-based study aims to evaluate implementation of a new, validated mortality risk calculator (Parkland Trauma Index of Mortality, "PTIM") embedded in our electronic healthrecord ("EHR") that calculates hourly predictions of mortality with high sensitivity and specificity.

Methods: This is a prospective, survey-based study performed at a level 1 trauma center.

Futility in acute care surgery: first do no harm.

The consequences of the delivery of futile or potentially ineffective medical care and interventions are devastating on the healthcare system, our patients and their families, and healthcare providers. In emergency situations in particular, determining if escalating invasive interventions will benefit a frail and/or severely critically ill patient can be exceedingly difficult. In this review, our objective is to define the problem of potentially ineffective care within the specialty of acute care surgery and describe strategies for improving the care of our patients in these difficult situations.

Plant phylogeny determines host selection and acceptance of the oligophagous leaf beetle Cassida rubiginosa.

Background: Predicting the host range of biocontrol agents is important for the safe and effective implementation of biocontrol of weeds. In this study, we examined the phylogenetic pattern of host selection and acceptance by the biocontrol beetle, Cassida rubiginosa. The beetle was released in New Zealand for control of Cirsium arvense, its primary host plant, but has potential to attack many Cardueae (thistles and knapweeds) species.

Early administration of high dose enoxaparin after traumatic brain injury.

Background: Early enoxaparin 30 mg BID administration at 24 h post-injury has been demonstrated in patients with traumatic brain injury (TBI). However this dose can also yield subtherapeutic anti-Xa levels in 30-50% of trauma patients, suggesting that larger doses may be required for adequate prophylaxis against venous thromboembolism (VTE). The safety of enoxaparin 40 mg BID in trauma patients has previously been shown - however, these studies have largely excluded TBI patients.

Imaging acute cholecystitis, one test is enough.

Background: Patients with right upper quadrant pain are often imaged using multiple modalities with no established gold standard. A single imaging study should provide adequate information for diagnosis.

Methods: A multicenter study of patients with acute cholecystitis was queried for patients who underwent multiple imaging studies on admission.

Establishing a core outcomes set for massive transfusion: An Eastern Association for the Surgery of Trauma modified Delphi method consensus study.

Background: The management of severe hemorrhage has changed significantly over recent decades, resulting in a heterogeneous description of diagnosis, treatment, and outcomes in the literature, which is not suitable for data pooling. Therefore, we sought to develop a core outcome set (COS) to help guide future massive transfusion (MT) research and overcome the challenge of heterogeneous outcomes reporting.

Methods: Massive transfusion content experts were invited to participate in a modified Delphi study.

How Do Hospital-Specific Data Dictionaries Impact Competency Level With Data Collection: A National Survey.

Background: Trauma registry staff are tasked with high-quality data collection to support program requirements. Hospital-specific data dictionaries are increasingly used to ensure accurate data collection, yet it is unknown how such a resource impacts a trauma registry team's competency with data collection.

Objective: This study sought to explore whether having a hospital-specific data dictionary affected trauma service team members' self-reported competency level with abstracting required and nonrequired data elements.

Trauma Registry Data Collection Practices and the Impact of Hospital Data Dictionaries: A National Survey.

Background: Trauma programs are required to collect a uniform set of trauma variables and submit data to regional, state, and or national registries. Programs may also collect unique data elements to support hospital-specific initiatives.

Objective: This study explored what additional data elements are being collected by U.

Provider Perception of Time During Trauma Resuscitation: A Prospective Quantitative Trauma Video Review Analysis.

Introduction: Delays in transition to the next phase of care result in increased mortality. Prehospital literature suggests emergency medical service technicians underestimate transport times by as much as 20%. What remains unknown is clinician perception of time during the trauma resuscitation.

A core outcome set for damage control laparotomy via modified Delphi method.

Objectives: Damage control laparotomy (DCL) remains an important tool in the trauma surgeon's armamentarium. Inconsistency in reporting standards have hindered careful scrutiny of DCL outcomes. We sought to develop a core outcome set (COS) for DCL clinical studies to facilitate future pooling of data via meta-analysis and Bayesian statistics while minimizing reporting bias.

Monthly Trauma Training and Simulation Are Associated With Improved Resident Skill and Leadership.

Background: Training for trauma procedures has been limited to infrequent courses with little data on longitudinal performance, and few address procedural and leadership skills with granular assessment. We implemented a novel training program that emphasized an assessment of trauma resuscitation and procedural skills.

Objective: This study aimed to determine whether this program could demonstrate improvement in both skill sets in surgical trainees over time.

Revision of the AAST grading scale for acute cholecystitis with comparison to physiologic measures of severity.

Background: Grading systems for acute cholecystitis are essential to compare outcomes, improve quality, and advance research. The American Association for the Surgery of Trauma (AAST) grading system for acute cholecystitis was only moderately discriminant when predicting multiple outcomes and underperformed the Tokyo guidelines and Parkland grade. We hypothesized that through additional expert consensus, the predictive capacity of the AAST anatomic grading system could be improved.

Defining adverse events during trauma resuscitation: a modified RAND Delphi study.

Background: The majority of preventable adverse event (AEs) in trauma care occur during the initial phase of resuscitation, often within the trauma bay. However, there is significant heterogeneity in reporting these AEs that limits performance comparisons between hospitals and trauma systems. The objective of this study was to create a taxonomy of AEs that occur during trauma resuscitation and a corresponding classification system to assign a degree of harm.