Journal of Trauma and Acute Care Surgery最新文献

{"title":"Hypocaloric feeding in critically ill trauma patients: A scoping review of the literature.","authors":"Joshua D Preston, Victoria E Wagner, John R Galloway, Thomas R Ziegler, Elizabeth R Benjamin","doi":"10.1097/TA.0000000000004704","DOIUrl":"https://doi.org/10.1097/TA.0000000000004704","url":null,"abstract":"<p><strong>Abstract: </strong>Following traumatic injury, a state of hypercatabolism ensues because of the burden of critical illness, stress, tissue injury, wound healing, drug administration, and inflammation, making optimal nutritional support imperative. Hypocaloric feeding, which entails prioritizing protein delivery over caloric supply early on in critical illness, has garnered substantial attention in critical care nutrition. Hypocaloric feeding has been examined closely in medical intensive care units (ICUs) but has been understudied in surgical ICUs, much less in the traumatically injured patient. This scoping review aims to provide a landscape of the available literature on hypocaloric feeding in critically ill trauma patients and establish where major knowledge gaps and questions remain. Primary literature on the effects of caloric and protein intake in trauma patients was systematically identified using PubMed. Literature was further filtered to only include studies that included or focused entirely on trauma patients and the effects of caloric or protein manipulation and provision. Data on sample sizes, nutritional regimens, conclusions, and confounders were charted for studies that met eligibility criteria. Twenty-six total studies were eligible for inclusion. Among these, 50% were retrospective cohort studies, 35% were randomized controlled trials (RCTs), 11% were prospective cohort studies, and 4% were historically controlled trials. When viewed as a whole, the effect of hypocaloric nutrition on critically ill trauma patients appeared variable and often contradictory. However, when the available RCTs that were performed in trauma populations or included a substantial number of trauma patients were examined in isolation, hypocaloric feeding was either beneficial or neutral in its effect on ICU outcomes. Hypocaloric nutrition is safe and feasible in critically ill trauma patients. However, large RCTs dedicated specifically to trauma populations are warranted to determine if hypocaloric feeding improves overall outcomes in this unique patient population.LEVEL OF EVIDENCE:Literature Review; Level III.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postdischarge venous thromboembolism after trauma: Extending care beyond hospital walls.","authors":"Hamna Shahbaz, Faisal A Shaikh, Zoltan H Nemeth","doi":"10.1097/TA.0000000000004717","DOIUrl":"https://doi.org/10.1097/TA.0000000000004717","url":null,"abstract":"","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical management of incarcerated and strangulated inguinal hernias requiring urgent surgical intervention: A systematic review, meta-analysis, and practice management guideline from the Eastern Association for the Surgery of Trauma.","authors":"Michael S Farrell, Zugui Zhang, Jordan Kirsch, Katie Bower, Curtis Bower, Rondi Gelbard, Alistair J Kent, Konstantin Khariton, Arielle Perez, Emanuele Lo Menzo, Judy B Rabinowitz, Asanthi Ratnasekera","doi":"10.1097/TA.0000000000004740","DOIUrl":"https://doi.org/10.1097/TA.0000000000004740","url":null,"abstract":"<p><strong>Background: </strong>Patients with acutely incarcerated or strangulated inguinal hernias require urgent surgical evaluation. Most literature on inguinal hernia management focuses on elective repairs. We aimed to provide evidence-based guidelines for managing inguinal hernias requiring urgent surgical intervention.</p><p><strong>Methods: </strong>An evidence-based systematic review was performed. Clinically relevant questions regarding defined Population(s), Intervention(s), Comparison(s), and Outcome(s) were selected. These questions centered around the timing of intervention, the use of mesh, the surgical approach, and the use of antibiotics in patients who presented with incarcerated or strangulated inguinal hernias requiring urgent surgical interventions. A comprehensive literature search was completed from 1946 through March 11, 2024. The Grading of Recommendations Assessment, Development and Evaluation methodology was used in the creation of the recommendations. Consensus was achieved for all final recommendations.</p><p><strong>Results: </strong>Of 7,038 articles reviewed, 34 met the inclusion criteria. Early intervention (<6 hours from symptom onset) was associated with a lower incidence of bowel resection (odds ratio [OR], 0.1 [0.05, 0.29]; p < 0.0001). Hernia repair with mesh was associated with decreased incidence of recurrence (OR, 0.34 [0.13, 0.87]; p = 0.02) and mixed results for surgical site infections. Laparoscopic repairs decreased recurrence rates (OR, 0.75 [0.58, 0.99]; p = 0.03) and had shorter hospital length of stay (mean difference, -3.00 [-5.54, -0.47]; p < 0.01) compared with open repairs. There were not enough studies to address the routine use of postoperative antibiotics. Quality was deemed very low with much of the literature being retrospective studies.</p><p><strong>Conclusion: </strong>We conditionally recommend early surgical intervention for adult patients presenting with acutely incarcerated or strangulated inguinal hernias who are deemed to require surgery. We conditionally recommend mesh repairs over primary tissue repairs and laparoscopic approaches over open approaches for this population. No recommendations can be made regarding the routine use of antibiotics.</p><p><strong>Level of evidence: </strong>Systematic Review/Meta-analysis; Level III.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enteral protein supplementation in critically ill trauma and surgical patients: A single-center randomized clinical trial.","authors":"Grant E O'Keefe, Siobhan P Brown, Marilyn M Shelton, Qian Qiu, Erika K Bisgaard, Ida M Wilson, Jamie L Robinson, Daniel J Roubik, Alex Molloy, Susanne May","doi":"10.1097/TA.0000000000004745","DOIUrl":"https://doi.org/10.1097/TA.0000000000004745","url":null,"abstract":"<p><strong>Background: </strong>Critically ill trauma and surgical patients are highly catabolic, with expected high protein needs. However, there is uncertainty regarding the amount of protein required to optimize their outcomes. We conducted a single-center, randomized clinical trial to test the hypothesis that supplementing enteral protein intake would improve outcomes.</p><p><strong>Methods: </strong>Between November 15, 2016, and November 26, 2021, critically ill trauma and surgical patients were randomized either to a treatment arm aimed to deliver 2 g/kg/d of enteral protein or to standard nutritional care. Data were collected and subjects were followed until hospital discharge. Serum transthyretin concentration 14 to 21 days following intensive care unit admission and ventilator-free days were prespecified endpoints.</p><p><strong>Results: </strong>We randomized 500 subjects who were predominantly male (77%), suffered traumatic injuries (86%), and had a median age of 47 years. Those in the treatment arm received twice the amount of protein than those in the control arm (1.2 ± 0.65 g/kg/d vs. 0.6 ± 0.39 g/kg/d averaged over the first 7 days of hospitalization; p < 0.001). We observed no significant difference in mean transthyretin concentrations (difference of means, 0.8 mg/dL; 95% confidence interval, -1.3 to 2.8; p value = 0.46) or ventilator-free days (difference of means, -1.1; 95% confidence interval, -2.8 to 0.6; p value = 0.21). Participants receiving supplemental protein had higher blood urea nitrogen concentrations and were more likely to require reintubation.</p><p><strong>Conclusion: </strong>In this clinical trial of critically ill trauma and surgical patients, protein supplementation did not improve outcomes but was associated with increased complications.</p><p><strong>Level of evidence: </strong>Therapeutic/Care Management; Level II.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prehospital pain medication disparities among pediatric trauma patients transported to a single Level I center.","authors":"Holly Hughes Garza, DeLawnia Comer-HaGans, James M Bradford, Carlos Vr Brown, Jessica Naiditch, Karla A Lawson","doi":"10.1097/TA.0000000000004711","DOIUrl":"https://doi.org/10.1097/TA.0000000000004711","url":null,"abstract":"<p><strong>Background: </strong>This study examines the association of race and ethnicity with prehospital pain medication use among pediatric trauma patients transported to a single Level I trauma center. Results augment existing literature by highlighting intersecting social and demographic factors while adjusting for clinical need and appropriateness.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted of all patients transported directly to our hospital from the scene of injury from August 2015 through July 2022. We examined multiple outcomes including whether prehospital pain medication was administered, what medication, routes, and doses were used, and trends over time. Multivariable modified mixed effects Poisson regression with robust error variance was used to estimate relative rates of pain medication use.</p><p><strong>Results: </strong>Among 2,308 pediatric trauma patients, 82% had any prehospital record of pain and 67% had a pain score of at least 4 out of 10, yet 35% received pain medication. Black or Hispanic patients were 20% to 23% less likely to receive prehospital pain medication than White patients (adjusted relative rate, 0.77; 95% confidence interval, 0.71-0.84 and adjusted relative rate, 0.80; 95% confidence interval, 0.74-0.87, respectively) after controlling for clinical need, appropriateness, and patient or family preference. Factors associated with both race/ethnicity and not receiving pain medication included younger age, lower socioeconomic status, language barrier, lack of prehospital vascular access, and involvement in a motor vehicle collision. Improvement was seen over the study period: the proportion of trauma patients given prehospital pain medication increased and disparities by race and ethnicity decreased in magnitude.</p><p><strong>Conclusion: </strong>Prehospital treatment of pain was suboptimal among pediatric trauma patients and unequal by race and ethnicity. Understanding of local factors that may drive these disparities provide avenues to drive change from multiple angles. Potential prehospital care interventions could target implicit biases, diversity in hiring, training in treatment of pain in young children, and possibly expansion of intranasal and oral medication use.</p><p><strong>Level of evidence: </strong>Observational (Retrospective Cohort); Level III.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomy of the intercostal nerves of ribs in the lower rib cage: A pilot study.","authors":"Arjun N Patel, Greg T Squires, Matthew C Sherrier, Dane N Daley, Steven W Kubalak, Evert A Eriksson","doi":"10.1097/TA.0000000000004749","DOIUrl":"https://doi.org/10.1097/TA.0000000000004749","url":null,"abstract":"<p><strong>Background: </strong>Traditional intercostal nerve anatomy teaching describes nerves crossing directly across the costal margin. Significant variability in costal margin bony anatomy has been described. Our cadaveric study evaluated variability, branching, and coursing patterns of intercostal nerves at the costal margin.</p><p><strong>Methods: </strong>Cadaveric dissections were performed evaluating the branching anatomy and course of intercostal nerves, specifically of ribs 7 to 9, at the costal margin because of the highly variable rib anatomy and neural innervation of abdominal wall musculature in this region. Experienced chest wall surgeons evaluated this anatomy using a standardized dissection and assessment to quantify the location and branches of the nerves.</p><p><strong>Results: </strong>The intercostal nerves and costal margins of 12 hemithoraces were dissected (n = 12). All seventh, eighth, and ninth nerve gave rise to a diaphragmatic branch. The seventh nerve arborized at the costochondral junction in 25% of hemithoraces. The eighth nerve arborized at the costochondral junction in 42% of hemithoraces and continued arborizing at the ninth rib tip in 33%. The ninth nerve arborized at the costochondral junction in 60% of hemithoraces and continued arborizing at the ninth rib tip in 90%. When the eighth rib directly attached to the sternum (42%), the seventh nerve entered the 7/8 interchondral groove, and the eighth nerve directly crossed then ascended along the costal margin giving off abdominal wall musculature branches. When the seventh rib directly attached to the sternum with the eighth rib joining to form the costal margin (58%), the seventh nerve directly crossed then ascended along the costal margin with similar branching.</p><p><strong>Conclusion: </strong>The seventh, eighth, and ninth intercostal nerves arborize at the costal margin (costochondral junction) to provide branches into the diaphragm and abdominal wall musculature with additional arborization at the lower rib tips. The seventh and eighth intercostal nerve location is variable based on their associated bony anatomy at the costal margin.</p><p><strong>Level of evidence: </strong>Diagnostic Test; Level II.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chest wall injury surgeon, know thyself.","authors":"Fredric M Pieracci, Andrew Doben, Evert Eriksson, Susan Kartiko, Babak Sarani, Thomas White, SarahAnn Whitbeck","doi":"10.1097/TA.0000000000004723","DOIUrl":"https://doi.org/10.1097/TA.0000000000004723","url":null,"abstract":"<p><strong>Abstract: </strong>The use of surgical stabilization of rib fractures (SSRF) for non-flail fracture patterns continues to rise. However, multiple, recent randomized controlled trials in this patient population have failed to show a clear benefit to surgery. Rather than widening the gap between research and practice, we must embrace these trials, learn from them, and continue to refine the indications for surgery. Approaching SSRF with an awareness of our own cognitive biases, as well as scientific rigor, will advance the discipline of chest wall injury surgery.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A more targeted embolization strategy in blunt splenic trauma reduces procedural volume without increasing splenectomy rates.","authors":"Amanda M Marsh, Navpreet K Dhillon, Rosemary A Kozar, Joseph J DuBose, C Yvonne Chung, Rishi Kundi, Thomas M Scalea, Melike N Harfouche","doi":"10.1097/TA.0000000000004710","DOIUrl":"https://doi.org/10.1097/TA.0000000000004710","url":null,"abstract":"<p><strong>Background: </strong>The role of splenic angioembolization (SAE) in blunt splenic injury (BSI) has evolved. Revision of the American Association for the Surgery of Trauma (AAST) Splenic Organ Injury Scale BSI classification scheme and increased quality of computed tomography (CT) scans may now identify injuries that no longer benefit from SAE. Our current BSI algorithm recommends mandatory SAE only for high-risk features (pseudoaneurysms ≥10 mm, moderate to large hemoperitoneum, significant parenchymal injury). We hypothesized that this strategy reduced the use of SAE without increasing overall splenectomy or delayed splenectomy rates.</p><p><strong>Methods: </strong>We reviewed hemodynamically stable patients with AAST Grades II to V BSI on initial contrast CT scan. Patients who underwent splenectomy prior to CT were excluded. An interrupted time-series analysis was performed with a cutoff of January 2019, when the algorithm was introduced, spanning 3 years before and 5.5 years after (PRE vs. POST). The primary outcomes of interest were changes in rates of SAE, overall splenectomy, and delayed splenectomy >24 hours after admission across the two time periods.</p><p><strong>Results: </strong>A total of 840 patients met the inclusion criteria, 369 individuals in the PRE group versus 471 in the POST group. The overall rate of SAE decreased from 29% to 17% (p < 0.001) after algorithm implementation without a significant change in rates of overall splenectomy (PRE 30% vs. POST 34%, p = 0.14) or delayed splenectomy (PRE 1.9% vs. POST 3.6%, p = 0.014). In the absence of any significant changes in AAST grade or rates of pseudoaneurysm in the PRE and POST periods, fitted time trends for monthly rates of SAE demonstrate a sharp decline after introduction of the algorithm (p = 0.04).</p><p><strong>Conclusion: </strong>A more selective approach to the use of angioembolization for BSI leads to a reduction in procedural volumes without increasing overall or delayed splenectomy rates. Future research should evaluate conservative approaches of SAE while better defining which high-risk features are mitigated by SAE.</p><p><strong>Level of evidence: </strong>Therapeutic/Care Management; Level IV.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment and training of Ukrainian trauma and combat casualty care via international symposia.","authors":"John B Holcomb, Terry M Rauch, Shannon Dittlinger, Warren C Dorlac, Tiffany E Hamm, Terry M Rauch, Therese A West, Travis M Polk","doi":"10.1097/TA.0000000000004722","DOIUrl":"https://doi.org/10.1097/TA.0000000000004722","url":null,"abstract":"<p><strong>Abstract: </strong>The Russian Federation (RF) full invasion of Ukraine (UA) in 2022 presents a unique opportunity to understand how large-scale combat operations (LSCOs) strain and destabilize healthcare and trauma system infrastructure. To share clinical knowledge gained in combat casualty care and learn from the UA LSCO experience, nine symposia were held from June 2023 to June 2024, gathering international experts with key leaders and medical personnel from UA. This effort was supported by the United States Department of Defense Combat Casualty Research Program (DoD CCCRP) in accordance with the US Congressional direction to establish military medical partnerships with the UA specified the National Defense Authorization Acts of 2023 and 2024. The DoD CCCRP seeks to develop requirements driven knowledge and material solutions for the care of combat-related traumatic injury during current and future conflicts. The symposia summarized herein consisted of 40- to 60-person discussions focused on key topics of interest, including trauma system and registries, hemostatic resuscitation, evacuation, telemedicine, brain health, tourniquet use, rehabilitation, and research and logistical needs. Personal relationships were formed and feedback from the symposia have enabled evidence-based changes to United States and North Atlantic Treaty Organization trauma care guidelines and similarly have benefited our UA colleagues.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceptions of ambulance use in South Asia a perplexing phenomenon.","authors":"Omama Asim, Adina Jabeen, Rameen Zafar","doi":"10.1097/TA.0000000000004676","DOIUrl":"https://doi.org/10.1097/TA.0000000000004676","url":null,"abstract":"","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}