Disparity in Risk of Readmission in Adult Burn Patients: Analysis of a Nationwide Readmission Database.

Introduction: Burn injuries remain a significant cause of disability, impacting long term quality-of-life and imposing large costs on our health systems. Readmission is a metric of quality and an important contributor to this economic burden. The association of socioeconomic and insurance status with burn readmission is not well established.

A Consequence of an Electrical-Burn Injury: Atrial Fibrillation.

Cardiac arrhythmias following electrocution injuries can accompany high-voltage or high- intensity currents. Contributing factors to electrical hazard are the type of current, voltage, resistance, and duration of contact and pathway through the body. It is important to monitor for delayed arrhythmias in patients with an electrical injury.

Maintaining a whole blood-centered transfusion improves survival in hemorrhagic resuscitation.

Background: Whole blood (WB) transfusion has been shown to improve mortality in trauma resuscitation. The optimal ratio of packed red blood cells (pRBC) to WB in emergent transfusion has not been determined. We hypothesized that a low pRBC/WB transfusion ratio is associated with improved survival in trauma patients.

To leave or not to leave: American Association for the Surgery of Trauma (AAST) panel discussion on personal, parental, and family leave.

Navigating planned and emergent leave during medical practice is very confusing to most physicians. This is especially challenging to the trauma and acute care surgeon, whose practice is unique due to overnight in-hospital call, alternating coverage of different services, and trauma center's staffing challenges. This is further compounded by a surgical culture that promotes the image of a 'tough' surgeon and forgoing one's personal needs on behalf of patients and colleagues.

Impact of Geriatric Trauma Co-Management on 1-Year Mortality in Older Adults with Multiple Rib Fractures.

Background: Rib fractures in older adults are associated with higher morbidity and mortality. Geriatric trauma co-management programs have looked at in-hospital mortality but not long-term outcomes.

Methods: A retrospective study of multiple rib fracture patients 65 years and older (n=357), admitted from September 2012 to November 2014 comparing Geriatric trauma co-management (GTC) vs Usual Care by trauma surgery (UC).

Funding the war in America: A look in the mirror.

Background: Health care political action committees (HPACs) historically contribute more to candidates opposing firearm restrictions (FRs), clashing with their affiliated medical societies. These societies have increasingly emphasized the prevention of firearm violence and it is not known if recent contributions by their HPACs have aligned with their stated goals. We hypothesized that such HPACs still contribute similar amounts toward legislators up for reelection opposing FR.

Safety and Feasibility of Ultra-Restrictive Transfusion Protocol as a Blood-Preservation Strategy During Shortage Crises.

Background: We hypothesized that implementation of new ultra-restrictive transfusion protocol in adult surgical intensive care units (SICU) was safe and feasible during pandemic-associated shortage crises.

Methods: Retrospective analysis two months pre- and post-implementation of ultra-restrictive transfusion protocol in March 2020 with hemoglobin cutoff of 6 g/dL (6.5 g/dL if ≥ 65 years old) for patients without COVID, active bleeding, or myocardial ischemia.

Lucky number 13: Association between center-specific chest wall stabilization volumes and patient outcomes.

Background: Chest wall stabilization (CWS) improves outcomes for patients with chest wall injury (CWI). We hypothesized that patients treated at centers with higher annual CWS volumes experience superior outcomes.

Methods: A retrospective study of adults with acute CWI undergoing surgical stabilization of rib or sternal fractures within the 2019 Trauma Quality Improvement Program database, excluding those with 24-hour mortality or any Abbreviated Injury Scale body region of six, was conducted.

Comparison of surgical stabilization of rib fractures vs epidural analgesia on in-hospital outcomes.

Introduction: Surgical stabilization of rib fractures (SSRF) improves functional outcomes compared to controls, partly due to reduction in pain. We investigated the impact of early SSRF on pulmonary complications, mortality, and length of stay compared to non-operative analgesia with epidural analgesia (EA).

Methods: Retrospective cohort study of the Trauma Quality Improvement Program (TQIP) 2017 dataset for adults with rib fractures, excluding those with traumatic brain injury or death within twenty-four hours.

The association between household and neighborhood characteristics and COVID-19 related ICU admissions.

Introduction: Approaches to COVID-19 mitigation can be more efficiently delivered with a more detailed understanding of where the severe cases occur. Our objective was to assess which demographic, housing and neighborhood characteristics were independently and collectively associated with differing rates of severe COVID-19.

Methods: A cohort of patients with SARS-CoV-2 in a single health system from March 1, 2020 to February 15, 2021 was reviewed to determine whether demographic, housing, or neighborhood characteristics are associated with higher rates of severe COVID-19 infections and to create a novel scoring index.

Surgical Infection Society: Chest Wall Injury Society Recommendations for Antibiotic Use during Surgical Stabilization of Traumatic Rib or Sternal Fractures to Reduce Risk of Implant Infection.

Surgical stabilization of rib fractures is recommended in patients with flail chest or multiple displaced rib fractures with physiologic compromise. Surgical stabilization of rib fractures (SSRF) and surgical stabilization of sternal fractures (SSSF) involve open reduction and internal fixation of fractures with a plate construct to restore anatomic alignment. Most plate constructs are composed of titanium and presence of this foreign, non-absorbable material presents opportunity for implant infection.

Outcomes of PEG placement by acute care surgeons compared to those placed by gastroenterology.

Background: Percutaneous endoscopic gastrostomy (PEG) tubes are placed by gastroenterologists (GI) and surgeons throughout the country. At Rhode Island Hospital, before July of 2017, all PEGs were placed by GI. In July of 2017, in response to a growing need for PEGs, acute care surgeons (ACS) also began performing PEGs at the bedside in ICUs.

Impact of Direct Transport vs. Transfer on Out-of-Hospital Traumatic Cardiac Arrest.

Background: Injured patients benefit from direct transport to a trauma center; however, it is unknown whether patients with traumatic out-of-hospital cardiac arrest (OHCA) benefit from initial resuscitation at the nearest emergency department (ED) if a trauma center is farther away. We hypothesized that patients with traumatic OHCA transported directly to a trauma center have less in-hospital mortality after initial resuscitation compared to those transferred from non-trauma centers.

Methods: We examined patients presenting with traumatic OHCA within our institutional trauma registry and the National Trauma Data Bank (NTDB) and excluded patients with ED mortality.

Application of pie-crusting technique to facilitate closure of open abdomen after decompressive laparotomy.

We present the case of a 23-year-old man who developed abdominal compartment syndrome secondary to severe pancreatitis and required decompressive laparotomy and pancreatic necrosectomy. Despite application of a temporary abdominal closure system (ABThera Open Abdomen Negative Pressure Therapy), extensive retroperitoneal oedema and inflammation continued to contribute to loss of domain and prevented primary closure of the skin and fascia. The usual course of action would have involved reapplication of ABThera system until primary closure could be achieved or sufficient granulation tissue permitted split-thickness skin grafting.

Time to Head Computed Tomography Protocol in Traumatic Brain Injury: A Quality Improvement Metric.

Background: Early identification of traumatic brain injury (TBI) with head CT HCT should expedite operative decision-making and improve outcome. We aimed to determine whether an early HCT protocol in TBI patients would improve outcome.

Methods: A multidisciplinary protocol to obtain an HCT within 30 minutes from arrival for patients with GCS ≤ 13 was instituted on 1/1/2015.

Adding Infectious Insult to Traumatic Injury: The Impact of Infectious Complications in End-of-Life Decision Making.

Trauma increases the risk for infection, but it is unknown how infection affects goals-of-care (GOC) decision making. We sought to determine how infections impact transition to comfort measures only (CMO), hypothesizing that infectious complications would expedite withdrawal of life-sustaining treatment (WOLST). We performed a retrospective review at a level-one trauma center over two years for adult patients without pre-existing advance directives who were made CMO with length of stay longer than one day.

Optimizing surgical stabilization of rib fractures using intraoperative ultrasound localization.

Background: Surgical stabilization of rib fractures (SSRF) significantly improve the outcomes of patients with rib fractures. Ultrasound is a specific modality for localizing rib fractures. We hypothesized that use of perioperative ultrasound localization of fracture sites optimizes surgical approach and clinical outcomes.

Decision Making Regarding Trauma Patients in Rhode Island who Present on Anticoagulants and Antiplatelet Agents: A Multidisciplinary and Collaborative Approach.

Objectives: Use of anticoagulant and antiplatelet medications (AAMs) is increasing significantly with our growing population of older adults. AAMs worsen outcomes in trauma patients. Our goal was to improve collaboration between trauma and outpatient providers and to improve safety in making decisions on anticoagulant and antiplatelet medications(AAMs) after injuries.

Prehospital shock index outperforms hypotension alone in predicting significant injury in trauma patients.

Background: The American College of Surgeons Resources for Optimal Care of the Injured Patient recommends using hypotension, defined as systolic blood pressure ≤90 mm Hg, as an indicator of a full team trauma activation. We hypothesized that an elevated shock index (SI) predicts significant traumatic injuries better than hypotension alone.

Methods: This is a retrospective cohort study analyzing full team trauma activations between February 2018 and January 2020, excluding transfers and those who had missing values for prehospital blood pressure or heart rate.

Emergency medical services protocols for traumatic brain injury in the United States: A call for standardization.

Background: Traumatic brain injury (TBI) with acute elevation in intracranial pressure (ICP) is a neurologic emergency associated with significant morbidity and mortality. In addition to indicated trauma resuscitation, emergency department (ED) management includes empiric administration of hyperosmolar agents, rapid diagnostic imaging, anticoagulation reversal, and early neurosurgical consultation. Despite optimization of in-hospital care, patient outcomes may be worsened by variation in prehospital management.

Unjustified Administration in Liberal Use of Tranexamic Acid in Trauma Resuscitation.

Background: Early administration of tranexamic acid (TXA) has been widely implemented for the treatment of presumed hyperfibrinolysis in hemorrhagic shock. We aimed to characterize the liberal use of TXA and whether unjustified administration was associated with increased venous thrombotic events (VTEs).

Methods: We identified injured patients who received TXA between January 2016 and January 2018 by querying our Level 1 trauma center's registry.

Clinical management of rib fractures and methods for prevention of pulmonary complications: A review.

Rib fractures are common injuries associated with significant morbidity and mortality, largely due to pulmonary complications. Despite equivocal effectiveness data, incentive spirometers are widely utilized to reduce pulmonary complications in the postoperative setting. Few studies have evaluated the effectiveness of incentive spirometry after rib fracture.