The utility of procalcitonin in critically ill trauma patients.

Background: Procalcitonin (PCT), the prohormone of calcitonin, has an early and highly specific increase in response to systemic bacterial infection. The objectives of this study were to determine the natural history of PCT for patients with critical illness and trauma, the utility of PCT as a marker of sepsis versus systemic inflammatory response syndrome (SIRS), and the association of PCT level with mortality.

Methods: PCT assays were done on eligible patients with trauma admitted to the trauma intensive care unit (ICU) of a Level I trauma center from June 2009 to June 2010, at hours 0, 6, 12, 24, and daily until discharge from ICU or death.

Ventilator-associated pneumonia rates at major trauma centers compared with a national benchmark: a multi-institutional study of the AAST.

Background: Ventilator-associated pneumonia (VAP) rates reported by the National Healthcare Safety Network (NHSN) are used as a benchmark and quality measure, yet different rates are reported from many trauma centers. This multi-institutional study was undertaken to elucidate VAP rates at major trauma centers.

Methods: VAP rate/1,000 ventilator days, diagnostic methods, institutional, and aggregate patient data were collected retrospectively from a convenience sample of trauma centers for 2008 and 2009 and analyzed with descriptive statistics.

Single-drug sedation with fentanyl for prehospital postintubation sedation in trauma patients.

Background: A fentanyl-only (FO) regimen for prehospital postintubation sedation in trauma patients was compared with the standard protocol (SP) of fentanyl + benzodiazepine.

Methods: Intubated patients transported to a Level I trauma center from December 1, 2005, to April 30, 2009, were retrospectively reviewed. Before 2007, only SP was used; afterward both regimens were used.

Age: is it all in the head? Factors influencing mortality in elderly patients with head injuries.

Background: Elderly patients, an increasing segment of the population, who sustain traumatic brain injury (TBI) are known to have worse outcomes, including higher mortality. This objective of this study was to examine the Crash Injury Research Engineering Network and to determine at what age motor vehicle crash fatalities from head injuries increased.

Methods: The Crash Injury Research Engineering Network database was queried from 1996 to 2009.

Splenic injury due to colonoscopy: analysis of the world literature, a new case report, and recommendations for management.

Splenic injury is a rare complication of colonoscopy. Most literature on the topic is case-report based. Our objective was to perform a comprehensive analysis of characteristics of splenic injury due to colonoscopy from available published reports in the world literature, to compare and contrast this entity with that of traumatic splenic injury, and provide recommendations for management based on the analysis.

Physical examination is a poor screening test for abdominal-pelvic injury in adult blunt trauma patients.

Background: To determine if physical examination can reliably detect or exclude abdominal or pelvic injury in adult trauma activation patients.

Methods: Trauma registry and medical record data were retrospectively reviewed for all adult blunt trauma patients with Glasgow coma scale score>8, from 6/30/05 to 12/31/06. Attending surgeons' dictated admission history and physical examination reports were individually reviewed.

Right atrial rupture from blunt thoracic trauma in a 4-year-old child.

Blunt cardiac injury in the pediatric population has been less frequently reported than in the adult population. Cardiac chamber rupture is a rare but highly lethal injury in both populations. The lethality of this condition is further enhanced by the multiplicity of injuries that are frequently present.

Pregnancy is not a sufficient indicator for trauma team activation.

Background: Trauma complicates 6% to 7% of all pregnancies. Adverse outcomes are rare when monitoring is normal and early warning signs absent. Trauma systems often use pregnancy as the sole criterion (PSC) for partial trauma team activation.

Contemporary analysis of thoracic aortic injury: importance of screening based on crash characteristics.

Background: To use motor vehicle crash (MVC) characteristics to determine risk of thoracic aortic injury (TAI) and provide updated mortality data.

Methods: Vehicle crash variables and patient medical data from 64,245 MVC occupants (1988-2002) were obtained from the National Automotive Sampling System. Descriptive and logistic regression analyses were used to determine the relationship of crash and occupant characteristics to TAI.

Optimizing physician staffing and resource allocation: sine-wave variation in hourly trauma admission volume.

Background: Trauma centers are faced with the challenge of managing an increasing volume of patients in an era of fewer trauma care providers and fewer hospitals providing trauma care. The purpose of this study was to determine the relationship between hourly admission volume, injury severity, resource utilization, and outcomes.

Methods: All patients in the National Trauma Data Bank admitted between 1999 and 2002 were selected.

Paramedic rapid sequence intubation for severe traumatic brain injury: perspectives from an expert panel.

Although early intubation has become standard practice in the prehospital management of severe traumatic brain injury (TBI), many patients cannot be intubated without neuromuscular blockade. Several emergency medical services (EMS) systems have implemented paramedic rapid sequence intubation (RSI) protocols, with published reports documenting apparently conflicting outcomes effects. In response, the Brain Trauma Foundation assembled a panel of experts to interpret the existing literature regarding paramedic RSI for severe TBI and offer guidance for EMS systems considering adding this skill to the paramedic scope of practice.

Prehospital rapid sequence intubation for head trauma: conditions for a successful program.

Background: Recent reports have questioned the safety and efficacy of prehospital rapid sequence intubation (RSI) for patients with head trauma. The purpose of this study is to determine the rate of successful prehospital RSI, associated complications, and delays in transport of critically injured trauma patients treated by a select, well-trained group of paramedics with frequent exposure to this procedure and a rigorous quality control system.

Methods: A helicopter paramedic group's database of patient flight records (1999 to 2003) was merged with registry data of a suburban Level I trauma center.

Management of brain-injured patients by an evidence-based medicine protocol improves outcomes and decreases hospital charges.

Objective: Traumatic brain injury (TBI) is the leading cause of death from blunt trauma, with an estimated cost to society of over dollar 40 billion annually. Evidence-based guidelines for TBI care have been widely discussed, but in-hospital treatment of these patients has been highly variable. The purpose of this study was to determine whether management of TBI patients according to a protocol based on the Brain Trauma Foundation (BTF) guidelines would reduce mortality, length of stay, charges, and disability.

Current diagnostic approaches lack sensitivity in the diagnosis of perforated blunt small bowel injury: analysis from 275,557 trauma admissions from the EAST multi-institutional HVI trial.

Objectives: Blunt SBI is infrequent and its diagnosis may be difficult, especially in the face of confounding variables. The purpose of this study was to evaluate methods for making the diagnosis of blunt SBI.

Methods: Patients with blunt small bowel injury (SBI) were identified from the registries of 95 trauma centers for a 2-year period (1998-1999).

Incidence of hollow viscus injury in blunt trauma: an analysis from 275,557 trauma admissions from the East multi-institutional trial.

Background: Blunt hollow viscus injury (HVI) is uncommon. No sufficiently large series has studied the prevalence of these injuries in blunt trauma patients. This study defines the prevalence of blunt HVI, in addition to the associated morbidity and mortality rates for this diagnosis on the basis of a series of over 275,000 trauma admissions.

The resident experience on trauma: declining surgical opportunities and career incentives? Analysis of data from a large multi-institutional study.

Purpose: The surgical resident experience with trauma has changed. Many residents are exposed to predominantly nonoperative patient care experiences while on trauma rotations. Data from a large multicenter study were analyzed to estimate surgical resident exposure to trauma laparotomy, diagnostic peritoneal lavage (DPL), and focused abdominal sonography for trauma (U/S).

Life in recovery: rebuilding from trauma.

Trauma can cause visible, often profound physical injuries for patients. The emotional and social drain that families and health care providers experience can also be life-altering. REBUILD is a program designed by a level 1 trauma center that incorporates former patients and their families in a support group to aid previous and new patients, their families, and care providers by sharing mutual experiences and learning from each other.

Aggressive driving: a preliminary analysis of a serious threat to motorists in a large metropolitan area.

Objective: Aggressive driving is consistently rated as the leading concern of motorists in our metropolitan area, ahead of even "drunken driving." Few objective data exist on the incidence of aggressive driving. The purpose of this study was to determine the incidence of selected aggressive driving behaviors and to establish a baseline for future interventions and research.

Percutaneous endoscopic gastrostomy: the preferred method of elective feeding tube placement in trauma patients.

Purpose: The purpose of this study was to determine whether gastric feeding tubes placed by the percutaneous endoscopic route resulted in fewer and less severe complications than open surgical gastrostomy (SG).

Methods: Charts for all trauma patients admitted 1/94 to 12/98, which had an electively placed feeding tube, were individually reviewed. All tube-related complications were recorded.

What's a trauma surgeon worth? A salary survey of the Eastern Association for the Surgery of Trauma.

Background: Professional compensation is an important consideration for all physicians. Few objective data specific to trauma surgery are available to those seeking employment or contract renegotiation in the United States. National benchmark salary data should assist trauma surgeons in securing fair and equitable compensation.

Windows 99: a source of suburban pediatric trauma.

Background: Falls from windows in urban areas cause a significant number of pediatric injuries. Window falls have not been well described in the nonurban setting. We describe the epidemiology of window falls from residential homes among pediatric patients at a suburban Level I trauma center.

Relatively short diagnostic delays (<8 hours) produce morbidity and mortality in blunt small bowel injury: an analysis of time to operative intervention in 198 patients from a multicenter experience.

Objective: Blunt small bowel injury (SBI) is uncommon, and its timely diagnosis may be difficult. The impact of operative delays on morbidity and mortality has been unclear. The purpose of this study was to determine the relationship of diagnostic delays to morbidity and mortality in blunt SBI.