How long are mechanically ventilated patients fasted prior to surgery? An exploratory study examining preoperative fasting practices across trauma centres.

For mechanically ventilated patients undergoing surgery, interrupting enteral feeding to prevent pulmonary aspiration is common; however, there are no published preoperative fasting guidelines for these patients, resulting in fasting practices that often vary greatly between hospitals. This retrospective study described fasting practices and surgical outcomes of mechanically ventilated patients across five trauma centres. The primary exposure was hours nil per os before surgery and was stratified into short (<6h) and moderate (≥6h) fasting duration.

Delayed splenic hemorrhage: Myth or mystery? A Western Trauma Association multicenter study.

Background: Multi-detector computed tomography imaging is now the reference standard for identifying solid organ injuries, with a high sensitivity and specificity. However, delayed splenic hemorrhage (DSH), defined as no identified injury to the spleen on the index scan but delayed bleeding from a splenic injury, has been reported. We hypothesized that the occurrence of DSH would be minimized by utilization of modern imaging techniques.

Contemporary management of subclavian and axillary artery injuries-A Western Trauma Association multicenter review.

Background: Subclavian and axillary artery injuries are uncommon. In addition to many open vascular repairs, endovascular techniques are used for definitive repair or vascular control of these anatomically challenging injuries. The aim of this study was to determine the relative roles of endovascular and open techniques in the management of subclavian and axillary artery injuries comparing hospital outcomes, and long-term limb viability.

Association of Injury Factors, Not Body Mass Index, With Hospital Resource Usage in Trauma Patients.

Background: Allocating resources appropriately requires knowing whether obese patients use more resources during a hospital stay than nonobese patients.

Objectives: To determine if trauma patients with different body mass indexes differed in use of resources measured as a multifaceted outcome variable.

Methods: A trauma registry was used for a retrospective study of adult patients admitted to a midwestern level I trauma center.

Pediatric trauma system models: do systems using adult trauma surgeons exclusively compare favorably with those using pediatric surgeons after initial resuscitation with an adult trauma surgeon?

Background: A shortage of pediatric surgeons exists. The purpose of this study was to evaluate pediatric outcomes using pediatric surgeons vs adult trauma surgeons.

Methods: A review was conducted at 2 level II pediatric trauma centers.

The effect of methodology in determining disparities in in-hospital mortality of trauma patients based on payer source.

A retrospective registry review of adult patients admitted to a Level I trauma center sought to determine whether results regarding in-hospital mortality associated with payer source vary on the basis of methodology. Patients were categorized into 4 literature-derived definitions (Definition 1: insured and uninsured; Definition 2: commercially insured, publicly insured, and uninsured; Definition 3: commercially insured, Medicaid, Medicare, and uninsured; and Definition 4: commercially insured, Medicaid, and uninsured). In-hospital mortality differences were found in Definitions 2 and 3, and when reclassifying dual-eligible Medicare/Medicaid into socioeconomic and age indicators.

Nonsurgical management of blunt splenic injury: is it cost effective?

Background: This study analyzed outcomes and cost of splenic embolization compared with surgery for the management of blunt splenic injury.

Methods: We performed a retrospective chart review of all patients admitted with isolated, blunt splenic injury. An intent-to-treat analysis was initially conducted.

Sew it up! A Western Trauma Association multi-institutional study of enteric injury management in the postinjury open abdomen.

Background: Use of damage control surgery techniques has reduced mortality in critically injured patients but at the cost of the open abdomen. With the option of delayed definitive management of enteric injuries, the question of intestinal repair/anastomosis or definitive stoma creation has been posed with no clear consensus. The purpose of this study was to determine outcomes on the basis of management of enteric injuries in patients relegated to the postinjury open abdomen.

Management of maxillofacial injuries with severe oronasal hemorrhage: a multicenter perspective.

Background: Airway establishment and hemorrhage control may be difficult to achieve in patients with massive oronasal bleeding from maxillofacial injuries. This study was formulated to develop effective algorithms for managing these challenging injuries.

Methods: Trauma registries from nine trauma centers were queried over a 7-year period for injuries with abbreviated injury scale face >/= 3 and transfusion of >/=3 units of blood within 24 hours.

Impact of fluconazole administration on outcomes in critically ill patients.

Background: Serious infections caused by Candida spp. are an increasingly important cause of morbidity and mortality in critically ill patients. It is unclear which patients will benefit from therapy and at what point to institute treatment.

Senior surgical residents can accurately interpret trauma radiographs.

Surgical residents routinely interpret radiographic studies during the evaluation of trauma patients, which directs further evaluation and invasive procedures. Official interpretations--"post-reading"--of radiographs by radiologists may be delayed by hours or even days. Trauma surgeons frequently act on their impressions before "official" readings are available.