Management of traumatic vascular injuries to the neck: a 7-year experience at a Level I trauma center.

Injury to the carotid artery results in significant mortality and morbidity. The general consensus is to repair all injuries to the common and internal carotid arteries. Ligation is usually reserved for neurologic or hemodynamic instability.

Popliteal artery injuries in an urban trauma center with a rural catchment area: do delays in definitive treatment affect amputation?

Extended length of time from injury to definitive vascular repair is considered to be a predictor of amputation in patients with popliteal artery injuries. In an urban trauma center with a rural catchment area, logistical issues frequently result in treatment delays, which may affect limb salvage after vascular trauma. We examined how known risk factors for amputation after popliteal trauma are affected in a more rural environment, where patients often experience delays in definitive surgical treatment.

Blunt renal trauma and the predictors of failure of non-operative management.

Objectives: While non-operative management of renal trauma in selected patients is now an accepted management option, predictors of failure of this treatment strategy are still unclear.

Methods: Five-year retrospective study of all patients with blunt renal injuries managed non-operatively at a Level I Trauma Center. Abstracted data included patient demographics, initial vital signs, base deficit, associated injuries, use of blood transfusion, management, and outcomes.

The weight of obesity in patients with lower extremity vascular injuries.

Objective: Clinical obesity is an epidemic problem in the United States. The impact of this disease upon traumatic lower extremity vascular injuries (LEVI) is as yet undefined. We hypothesized that clinical obesity adversely affects outcome in patients with traumatic LEVI.

Open-book pelvic fractures with perineal open wounds: a significant morbid combination.

Open-book pelvic fractures (OBPF) with concomitant intra-abdominal injuries carry a high morbidity and mortality; the significance of associated perineal open wound (OBPF-POW) has not been defined. We hypothesize that the presence of perineal open wounds increases morbidity, mortality, and concomitant use of hospital resources. Patients diagnosed with OBPF over a 5-year period at a Level I trauma center were identified by trauma registry review, and were retrospectively reviewed under an Institutional Review Board-approved protocol.

Impact of obesity in damage control laparotomy patients.

Background: Obesity is an independent predictor of increased morbidity and mortality in critically injured trauma patients. We hypothesized that obese patients in need of damage control laparotomy (DCL) will encounter an increase incidence of postsurgical complications with a concomitant increase mortality when compared with a cohort of nonobese patients.

Methods: All adult trauma patients who underwent DCL during a 4-year period at a Level I Trauma Center were retrospectively reviewed.

Proximal splenic angioembolization does not improve outcomes in treating blunt splenic injuries compared with splenectomy: a cohort analysis.

Background: Although splenic angioembolization (SAE) has been introduced and adopted in many trauma centers, the appropriate selection for and utility of SAE in trauma patients remains under debate. This study examined the outcomes of proximal SAE as part of a management algorithm for adult traumatic splenic injury compared with splenectomy.

Methods: A retrospective cohort analysis was performed on all hemodynamically stable (HDS) blunt trauma patients with isolated splenic injury and computed tomographic (CT) evidence of active contrast extravasation that presented to a level 1 Trauma Center over a period of 5 years.

Brachial artery injuries in a rural catchment trauma center: are the upper and lower extremity the same?

Background: The predictors of amputation for patients with lower extremity vascular trauma are well described in the literature, but the predictors of amputation in the upper extremity are not so well defined. We hypothesize that the predictors of amputation in the lower extremity are much different when compared with the upper extremity.

Methods: Retrospective chart review of all brachial artery traumatic injuries presenting to a rural-state university trauma center.

Is there a role for secondary thoracic ultrasound in patients with penetrating injuries to the anterior mediastinum?

Pericardial tamponade (PT) after penetrating thoracic injury can be lethal if not diagnosed and treated promptly. Most patients present with PT shortly after their injuries occur, but delayed presentation of PT (delayed pericardial tamponade [DPT]) has occurred as late as 73 days after initial injury. Initial evaluation of patients with an anterior mediastinal penetrating injury includes physical examination, chest x-ray, and echocardiography.

Impact of telemedicine upon rural trauma care.

Objectives: Only preliminary reports have evaluated the impact of telemedicine in trauma care. This study will analyze outcomes before (pre-TM) and after (post-TM) implementation of telemedicine in the management of rural trauma patients initially treated at local community hospitals (LCH) before trauma center (TC) transfer.

Methods: Seven rural hospital emergency departments in Mississippi were equipped with dual video cameras with remote control capability.

Refractory gastroparesis after Roux-en-Y gastric bypass: surgical treatment with implantable pacemaker.

Background: Gastroparesis is a rare complication of Roux-en-Y gastric bypass. We evaluate the role of gastric electrical stimulation in medically refractory gastroparesis.

Methods: Patients with refractory gastroparesis after gastric bypass for morbid obesity were studied.