JAMA surgeryPub Date : 2024-09-18DOI: 10.1001/jamasurg.2024.3771
Juan Duchesne
{"title":"Opening New Frontiers in Prehospital Teletrauma.","authors":"Juan Duchesne","doi":"10.1001/jamasurg.2024.3771","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.3771","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":16.9,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142245393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JAMA surgeryPub Date : 2024-09-18DOI: 10.1001/jamasurg.2024.3758
Zain G Hashmi,Omar Rokayak,Krislyn M Boggs,Kori S Zachrison,Janice A Espinola,Molly P Jarman,Jan O Jansen,Jayme E Locke,Jeffrey D Kerby,Carlos A Camargo
{"title":"Teletrauma Use in US Emergency Departments.","authors":"Zain G Hashmi,Omar Rokayak,Krislyn M Boggs,Kori S Zachrison,Janice A Espinola,Molly P Jarman,Jan O Jansen,Jayme E Locke,Jeffrey D Kerby,Carlos A Camargo","doi":"10.1001/jamasurg.2024.3758","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.3758","url":null,"abstract":"ImportanceNearly 30 million predominantly rural US residents lack timely access to trauma care expertise available at level I or II trauma centers. Telehealth is an established approach to improve access to health care expertise using remote consultation; however, the prevalence of use of telehealth in trauma (teletrauma) across the US is not known.ObjectiveTo examine the prevalence of, trends in, and factors associated with teletrauma use and adoption among US emergency departments (EDs).Design, Setting, and ParticipantsThis survey study included data from the National Emergency Department Inventory (NEDI)-USA survey from January 1, 2016, to December 31, 2020. Each year, a 1-page survey was sent to the directors of nonfederal, nonspecialty EDs by mail and email up to 3 times; nonresponders were further contacted via telephone to complete the survey. Data were analyzed from January to March 2023.Main Outcomes and MeasuresThe primary outcome was self-reported ED use of teletrauma for each year studied. Additional measures included data regarding self-reported use of any other telehealth service and ED characteristics. Multivariable logistic regression analyses were performed to assess ED characteristics associated with teletrauma use in 2020 and teletrauma adoption between 2017 and 2020.ResultsOf 5586 EDs in the US in 2020, 4512 had available teletrauma survey data (80.8% response rate); 379 (8.4%) of these EDs reported teletrauma use. In contrast, 2726 (60.4%) reported use of any other telehealth service. Teletrauma use (among EDs with any telehealth use) ranged between 0% in Alabama; Connecticut; Washington, DC; Indiana; New Jersey; Nevada; Oklahoma; Oregon; Rhode Island; and South Carolina to more than 60% in Arkansas (39 of 64 [60.9%]), South Dakota (31 of 41 [75.6%]), and North Dakota (30 of 35 [85.7%]). Factors associated with teletrauma use included rural location (odds ratio [OR], 2.44; 95% CI, 1.77-3.36), critical access hospital (OR, 2.67; 95% CI, 1.83-3.88), and basic stroke hospital vs nonstroke hospital (OR, 1.74; 95% CI, 1.32-2.30) designations. Factors associated with adoption of teletrauma by 2020 included critical access hospital (OR, 1.98; 95% CI, 1.35-2.90) and basic stroke hospital vs nonstroke hospital (OR, 1.42; 95% CI, 1.04-1.94) designation.Conclusion and RelevanceThis survey study found that teletrauma use lagged significantly behind use of other telehealth services in US EDs in 2020. While most EDs using teletrauma were located in rural areas, there was significant state-level variation in teletrauma use. Future research is needed on how teletrauma is being used and to identify barriers to its wider implementation.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":16.9,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142245396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"An Update on the Survival of the First 50 Face Transplants Worldwide.","authors":"Pauliina Homsy,Lioba Huelsboemer,Juan P Barret,Phillip Blondeel,Daniel E Borsuk,Daniel Bula,Bruce Gelb,Pedro Infante-Cossio,Laurent Lantieri,Samir Mardini,Emmanuel Morelon,Serdar Nasir,Francis Papay,Palmina Petruzzo,Eduardo Rodriguez,Özlenen Özkan,Selahattin Özmen,Bohdan Pomahac,Patrik Lassus","doi":"10.1001/jamasurg.2024.3748","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.3748","url":null,"abstract":"ImportanceSince 2005, a total of 50 face transplants have been reported from 18 centers in 11 countries. The overall survival of the grafts has not yet been established.ObjectiveTo assess the survival of the face transplant grafts and evaluate factors potentially influencing it.Design, Setting, and ParticipantsData on all the transplants included in this multicenter cohort study were collected at participating transplant centers for updated nonpublished data, supplemented with literature review for nonparticipating centers. Data from 2005 until September 2023, were included. Data were analyzed from November 11, 2005, through September 18, 2023. Patients included the first 50 patients in the world to have received a face transplant.ExposureFace transplant graft.Main Outcomes and MeasuresThe primary outcome was the overall survival of the face transplant graft, defined as either transplant loss or patient death. The secondary outcome was the number of acute rejection episodes per year.ResultsThe 50 transplants were performed on 39 men (81%) and 9 women (19%) with a median age of 35 (range, 19-68) years at the time of the transplant. The median follow-up time was 8.9 (range, 0.2-16.7) years. During the follow-up, 6 transplants were lost with 2 patients retransplanted. There were 10 patients who died, 2 of whom had lost a transplant. The 5- and 10-year survival of the transplants was 85% (SD, 5%) and 74% (SD, 7%), respectively. The sequential number of the transplant in the world was a significant predictor of survival (hazard ratio, 95; 95% CI, 90-100; P < 05). The median number of acute rejection episodes per year was 1.2 (range, 0-5.3) for the transplants that were lost and 0.7 (range, 0-4.6) for the transplants that survived. No correlation with patient and transplant variables was detected for either the transplant survival or the number of rejection episodes.Conclusions and RelevanceIn this study, the overall survival of the face transplants is encouraging. These data suggest that the acceptable long-term survival of face transplants makes them a reconstructive option for extensive facial defects.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":16.9,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142245395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JAMA surgeryPub Date : 2024-09-11DOI: 10.1001/jamasurg.2024.3372
Kathryn M. Stadeli, Farah B. Mohamed, Lauren L. Agoubi, Abdifatah Dahiye, Elina Serrano, Maymuna Haji-Eda, Monica S. Vavilala
{"title":"Teaching Bleeding Control and Building Trust With a Community Affected by Firearm Injuries","authors":"Kathryn M. Stadeli, Farah B. Mohamed, Lauren L. Agoubi, Abdifatah Dahiye, Elina Serrano, Maymuna Haji-Eda, Monica S. Vavilala","doi":"10.1001/jamasurg.2024.3372","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.3372","url":null,"abstract":"This survey study evaluates a program for increasing bystander bleeding control skills, improving self-efficacy for bleeding control, and building trust between community participants and first responders in a Somali community in the US affected by firearm-related deaths.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":16.9,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142170819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JAMA surgeryPub Date : 2024-09-11DOI: 10.1001/jamasurg.2024.3365
James McDermott, Lillian S. Kao, Jessica A. Keeley, Areg Grigorian, Angela Neville, Christian de Virgilio
{"title":"Necrotizing Soft Tissue Infections","authors":"James McDermott, Lillian S. Kao, Jessica A. Keeley, Areg Grigorian, Angela Neville, Christian de Virgilio","doi":"10.1001/jamasurg.2024.3365","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.3365","url":null,"abstract":"ImportanceNecrotizing soft tissue infections (NSTIs) are severe life- and limb-threatening infections with high rates of morbidity and mortality. Unfortunately, there has been minimal improvement in outcomes over time.ObservationsNSTIs are characterized by their heterogeneity in microbiology, risk factors, and anatomical involvement. They often present with nonspecific symptoms, leading to a high rate of delayed diagnosis. Laboratory values and imaging help increase suspicion for NSTI, though ultimately, the diagnosis is clinical. Surgical exploration is warranted when there is high suspicion for NSTI, even if the diagnosis is uncertain. Thus, it is acceptable to have a certain rate of negative exploration. Immediate empirical broad-spectrum antibiotics, further tailored based on tissue culture results, are essential and should be continued at least until surgical debridement is complete and the patient shows signs of clinical improvement. Additional research is needed to determine optimal antibiotic duration. Early surgical debridement is crucial for improved outcomes and should be performed as soon as possible, ideally within 6 hours of presentation. Subsequent debridements should be performed every 12 to 24 hours until the patient is showing signs of clinical improvement and there is no additional necrotic tissue within the wound. There are insufficient data to support the routine use of adjunct treatments such as hyperbaric oxygen therapy and intravenous immunoglobulin. However, clinicians should be aware of multiple ongoing efforts to develop more robust diagnostic and treatment strategies.Conclusions and RelevanceGiven the poor outcomes associated with NSTIs, a review of clinically relevant evidence and guidelines is warranted. This review discusses diagnostic and treatment approaches to NSTI while highlighting future directions and promising developments in NSTI management.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":16.9,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142170817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JAMA surgeryPub Date : 2024-09-11DOI: 10.1001/jamasurg.2024.3581
Karen Trang, Hannah C. Decker, Andrew Gonzalez, Logan Pierce, Amy M. Shui, Genevieve B. Melton-Meaux, Elizabeth C. Wick
{"title":"Electronic Surgical Consent Delivery Via Patient Portal to Improve Perioperative Efficiency","authors":"Karen Trang, Hannah C. Decker, Andrew Gonzalez, Logan Pierce, Amy M. Shui, Genevieve B. Melton-Meaux, Elizabeth C. Wick","doi":"10.1001/jamasurg.2024.3581","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.3581","url":null,"abstract":"ImportanceMany health systems use electronic consent (eConsent) for surgery, but few have used surgical consent functionality in the patient portal (PP). Incorporating the PP into the consent process could potentially improve efficiency by letting patients independently review and sign their eConsent before the day of surgery.ObjectiveTo evaluate the association of eConsent delivery via the PP with operational efficiency and patient engagement.Design, Setting, and ParticipantsThis mixed-methods study consisted of a retrospective quantitative analysis (February 8 to August 8, 2023) and a qualitative analysis of semistructured patient interviews (December 1, 2023, to January 31, 2024) of adult surgical patients in a health system that implemented surgical eConsent. Statistical analysis was performed between September 1, 2023, and June 6, 2024.Main Outcomes and MeasuresPatient demographics, efficiency metrics (first-start case delays), and PP access logs were analyzed from electronic health records. Qualitative outcomes included thematic analysis from semistructured patient interviews.ResultsIn the PP-eligible cohort of 7672 unique patients, 8478 surgical eConsents were generated (median [IQR] age, 58 [43-70] years; 4611 [54.4%] women), of which 5318 (62.7%) were signed on hospital iPads and 3160 (37.3%) through the PP. For all adult patients who signed an eConsent using the PP, patients waited a median (IQR) of 105 (17-528) minutes to view their eConsent after it was electronically pushed to their PP. eConsents signed on the same day of surgery were associated with more first-start delays (odds ratio, 1.59; 95% CI, 1.37-1.83; <jats:italic>P</jats:italic> &amp;lt; .001). Themes that emerged from patient interviews included having a favorable experience with the PP, openness to eConsent, skimming the consent form, and the importance of the discussion with the surgeon.Conclusions and RelevanceThese findings suggest that eConsent incorporating PP functionality may reduce surgical delays and staff burden by allowing patients to review and sign before the day of surgery. Most patients spent minimal time engaging with their consent form, emphasizing the importance of surgeon-patient trust and an informed consent discussion. Additional studies are needed to understand patient perceptions of eConsent, PP, and barriers to increased uptake.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":16.9,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142170856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JAMA surgeryPub Date : 2024-09-11DOI: 10.1001/jamasurg.2024.2753
Lois K. Lee, Danielle Laraque-Arena, Eric W. Fleegler
{"title":"The Updated Haddon Matrix for Pediatric Firearm Injuries","authors":"Lois K. Lee, Danielle Laraque-Arena, Eric W. Fleegler","doi":"10.1001/jamasurg.2024.2753","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.2753","url":null,"abstract":"This Viewpoint presents an updated scientific approach applied to the foundational framework of the Haddon Matrix for injury prevention to reduce firearm injuries and deaths to children and youth.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":16.9,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142170848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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