Journal of Trauma and Acute Care Surgery最新文献

{"title":"Trauma Quality Programs Mortality Reporting System Case Reports: Unanticipated Mortality Due to Prolonged Operative Course.","authors":"Shailvi Gupta, Richard P Dutton, Aaron R Jensen, Samuel P Mandell, Shannon L Castle","doi":"10.1097/TA.0000000000005216","DOIUrl":"https://doi.org/10.1097/TA.0000000000005216","url":null,"abstract":"<p><strong>Abstract: </strong>The American College of Surgeons Trauma Quality Programs Mortality Reporting System is an online anonymous case reporting system designed to share experiences from rare events that may have contributed to unanticipated mortality at contributing trauma centers. This report analyzes cases, summarizes opportunities for truncated operating room time, and offers a defined framework to assess the need for a damage control strategy.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224417","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":"Weathering the storm: Predictors and resource burden of paroxysmal sympathetic hyperactivity after severe traumatic brain injury.","authors":"Tamriage Martin, Madeline Phillips, Jade Nunez, Joshua Gazzetta","doi":"10.1097/TA.0000000000005205","DOIUrl":"https://doi.org/10.1097/TA.0000000000005205","url":null,"abstract":"<p><strong>Background: </strong>Reported incidence of paroxysmal sympathetic hyperactivity (PSH) after severe traumatic brain injury (TBI) approaches one-third, largely from cohorts that excluded early deaths. Predictors and resource consequences remain unclear. We identified predictors of PSH development and associations between diagnosis, PSH Assessment Measure (PSH-AM) subscores [clinical features scale (CFS) and diagnosis likelihood tool (DLT)], and resource utilization.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of adults with severe TBI admitted to a tertiary care center intensive care unit (ICU) (October 2020-September 2025), stratified by PSH diagnosis. Two reviewers assigned PSH-AM scores. PSH cannot be diagnosed until the syndrome declares itself over days, so exposure is conditioned on survival; mortality is reported descriptively. Multivariable logistic regression identified predictors of PSH diagnosis. Log-transformed linear regressions estimated associations of PSH diagnosis and subscores with hospital length of stay (LOS), ICU LOS, and ventilator days. Thirty-day composite outcomes, inverse probability of treatment weighting (IPTW), and landmark analysis evaluated robustness.</p><p><strong>Results: </strong>Of 509 patients with severe TBI, 86 (17%) developed PSH. Younger age [odds ratio (OR): 0.97 (95% CI: 0.96-0.98); P<0.001) and higher ISS [1.05 (1.02-1.07); P<0.001] independently predicted PSH. PSH was associated with longer hospital LOS (372.9%), ICU LOS (278.3%), and more ventilator days (266.4%; all P<0.001). Mortality was 11.6% (PSH) versus 35.9% (non-PSH). IPTW demonstrated PSH had fewer days alive and out of hospital (-46.8%; P<0.001) and landmark analysis highlighted fewer ventilator-free days (-40.2%; P=0.0097) and ICU-free days (-46.9%; P<0.001). Higher DLT subscores were associated with longer hospital (36.3%; P=0.001) and ICU (23.3%; P=0.005) stays, whereas the CFS subscore showed no associations.</p><p><strong>Conclusions: </strong>The PSH diagnosis is contingent on survival. Younger patients with severe TBI who survive their initial injuries are more likely to develop PSH and occupy hospital beds meaningfully longer. The diagnosis likelihood tool, not the clinical features scale, tracks with that burden.</p><p><strong>Level of evidence: </strong>Level III, prognostic/epidemiological.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224497","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":"Defining the TBI spectrum for rib fixation.","authors":"Yu Chang","doi":"10.1097/TA.0000000000005223","DOIUrl":"https://doi.org/10.1097/TA.0000000000005223","url":null,"abstract":"","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224381","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":"Wrong hospital, wrong outcome: Impact of care fragmentation following trauma laparotomy.","authors":"Kendall R McEachron, Bethel Ozed-Williams, Sean H Nguyen, Todd W Costantini","doi":"10.1097/TA.0000000000005218","DOIUrl":"https://doi.org/10.1097/TA.0000000000005218","url":null,"abstract":"<p><strong>Background: </strong>Care fragmentation (CF), defined as readmission to a nonindex hospital, has been identified as a potential predictor of poor outcomes after traumatic injury. Trauma laparotomy (TL) is a common procedure with perioperative risk of complications and readmission. Incidence of CF following TL, its risk factors, and its effects on outcomes are unknown. We hypothesized that CF after TL is associated with increased mortality during hospital readmission compared with continuity of care (CC).</p><p><strong>Methods: </strong>The Nationwide Readmissions Database (2016-2022) was queried for hospitalized adult (≥18) patients with traumatic injury and open surgery of gastrointestinal or genitourinary systems during index admission, and unplanned readmission within 90 days. Demographics, comorbidities, injury severity, procedures, and disposition data were collected for patients with CF and compared with patients with CC. The primary outcome was in-hospital death during readmission. Univariate comparisons and multivariable logistic regression were performed.</p><p><strong>Results: </strong>A total of 14,773 TL patients were included in the analysis. From these, 2,059 (13.9%) were readmitted within 90 days. The average age of readmitted patients was 43 years, and the majority (68.6%) were male. Of the readmissions, 441 (21.4%) experienced CF. Discharge home from the index admission was associated with lower odds of CF (OR 0.52, 95% CI: 0.32-0.84, p=0.008). On multivariable regression analysis, CF was significantly associated with in-hospital death during readmission (OR 5.09, 95% CI: 1.22-21.16, p=0.03).</p><p><strong>Conclusions: </strong>CF is common following TL and is associated with an increased risk of death on readmission, even after adjustment for baseline comorbidities and other hospital characteristics. Patients who are discharged home are less likely to experience CF. TL survivors may represent a patient population that would benefit from targeted efforts to reduce CF.</p><p><strong>Level of evidence: </strong>Therapeutic; Level III.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224467","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":"Rigorous study design dictates sound analytical outcome: A letter to editor.","authors":"Shubham Kumar Gupta, Amit Gupta","doi":"10.1097/TA.0000000000005213","DOIUrl":"10.1097/TA.0000000000005213","url":null,"abstract":"","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207300","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":"Opioid prescribing and hospital outcomes after trauma in patients with substance use disorder: An analysis of the michigan trauma quality improvement project.","authors":"James Stathakios, Rebecca N Tsai, Yenling Lai, Vidhya Gunaseelan, Chad Brummett, Alistair J Chapman, Jennifer Waljee, Mark R Hemmila, Mark C Bicket","doi":"10.1097/TA.0000000000005202","DOIUrl":"https://doi.org/10.1097/TA.0000000000005202","url":null,"abstract":"<p><strong>Background: </strong>Trauma patients frequently have comorbid substance use disorders (SUD), which may complicate pain management and increase the risk of opioid-related adverse outcomes after discharge. We hypothesized that trauma patients with SUD would be prescribed more opioids at discharge than those without SUD.</p><p><strong>Methods: </strong>We retrospectively analyzed a cohort of adult trauma patients across the state from 2022 to 2025 using a statewide collaborative database. Primary outcomes were opioid prescription at discharge (yes/no) and amount prescribed standardized to oxycodone 5 mg pills. A multivariable approach assessed risk-adjusted differences in outcomes among patients with SUD versus without SUD.</p><p><strong>Results: </strong>Among 29,805 total patients, 8,672 (29.1%) had a diagnosis of SUD. 71.2% of patients with SUD received a discharge opioid prescription, compared with 59.6% of patients without SUD (p<0.001). After adjustment, the predicted probability of receiving an opioid prescription at discharge was 64.2% (95% CI, 63.1%-65.2%) for patients with SUD and 62.5% (95% CI, 62.0%-63.1%) for those without. Among patients that received a prescription, those with SUD were prescribed 21.2 pills of 5 mg oxycodone, corresponding to an adjusted difference of 1.6 additional pills (95% CI, 0.89-2.31; p<0.001) compared with those without. Prescribing patterns also differed by race and ethnicity: Hispanic or Latino patients were 5.4-percentage points more likely to receive an opioid prescription than non-Hispanic or Latino patients, while, among prescription recipients, Black patients received 3.56 fewer pills than White patients.</p><p><strong>Conclusions: </strong>Our findings demonstrate that patients with SUD received opioids more frequently and in greater amounts at discharge, yet absolute differences were small in magnitude and may not represent clinically meaningful differences. Differences in prescribing by race and ethnicity were larger in magnitude and warrant further investigation.</p><p><strong>Level of evidence: </strong>Prognostic and epidemiological; Level III.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207143","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":"Trends in mortality rates in hypotensive pediatric trauma patients undergoing emergent trauma laparotomy.","authors":"Emilie Barnes, Rindi Uhlich, Bridget Budny, Hannah Dice, Jessica Brady, Parker Hu","doi":"10.1097/TA.0000000000005217","DOIUrl":"https://doi.org/10.1097/TA.0000000000005217","url":null,"abstract":"<p><strong>Background: </strong>Massive hemorrhage remains the leading cause of preventable death after pediatric trauma. Emergent trauma laparotomy (ETL) is a common operation to obtain hemorrhage control. Mortality rates for adult patients in hemorrhagic shock requiring ETL remain high and unchanged. Information on mortality rates after ETL in pediatric patients is limited. We sought to evaluate trends in mortality rates for pediatric ETL patients.</p><p><strong>Methods: </strong>The National Trauma Data Bank (NTDB) was queried from 2007 to 2023. Patients aged 0 to 18 years old were included if they underwent ETL. ETL was defined as laparotomy within 1 hour of arrival. Hypotension was defined as a systolic blood pressure <90 mm Hg on arrival. The primary outcome was annual hospital mortality rates for hypotensive patients requiring ETL. Secondary outcomes included annual 24-hour mortality rates for both hypotensive and all patients requiring ETL. Mortality rates were compared in 5-year cohorts to reduce annual variability.</p><p><strong>Results: </strong>A total of 11,374 patients underwent ETL. The majority of patients were male (79%; n=78,963/11,374). Most patients were between the ages of 12 and 17 (84%; n=9,565/11,374), followed by ages 5 to 11 (11%; n=1,227/11,374), then ages 0 to 4 (5%; n=582/11,374). Penetrating injuries predominated (69%; n=7,866/11,374). The hospital mortality rate for all patients was 18.3% (n=2,079/11,374). Of patients who died, 74% were within 24 hours of arrival (n=1,533/2,079). Overall, 19% (n=2,125/11,374) were hypotensive on arrival. For hypotensive patients, the 24-hour and hospital mortality rates were 30% (n=641/2,125) and 45.9% (n=976/2,125). There was year-to-year variability in rates of hospital mortality of hypotensive patients through the study period (p<0.001). However, the average mortality rates from 2007 to 2011 (45%; n=293/645) and 2019 to 2023 (42%; n=266/638) were unchanged (p=0.95).</p><p><strong>Conclusions: </strong>Pediatric trauma patients with exsanguinating hemorrhage requiring ETL continue to suffer high rates of mortality. These findings underscore the urgent need for targeted research and performance improvement.</p><p><strong>Level of evidence: </strong>Prognostic and Epidemiological; Level III.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207310","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":"In older adults, \"mild\" by GCS does not mean low risk: Multicenter study of 1,157 patients with mild TBI and acute subdural hematoma.","authors":"Alessandro Orlando, Harun Mazumder, Lori F Harbour, Samir M Fakhry","doi":"10.1097/TA.0000000000005206","DOIUrl":"https://doi.org/10.1097/TA.0000000000005206","url":null,"abstract":"<p><strong>Background: </strong>Acute traumatic subdural hematoma (SDH) is the most common intracranial injury in mild TBI (mTBI), particularly in older adults. However, the relationship of patient and brain computed tomography (CT) characteristics with outcomes remains poorly described in a contemporary cohort. This study aims to characterize outcomes in younger and older adults with mTBI and isolated acute SDH.</p><p><strong>Methods: </strong>This was a 10-center, retrospective cohort study of adult traumas with emergency department Glasgow Coma Scale (GCS) 13 to 15 and acute traumatic SDH on initial brain CT ('22-'23). Trauma registry, EHR, and Picture Archiving and Communication System (PACS) data were collected through automated and manual methods. The primary outcome was total mortality (TM=death+hospice discharge); the sample was stratified by 18 to 64 versus older than or equal to 65 years. Multivariable backward selection logistic regression examined 21 demographic, injury, and brain CT covariates.</p><p><strong>Results: </strong>In total, 1,157 patients were included (18-64 y: 28%; ≥65 y: 72%; 58% transferred in). Median [IQR] non-head ISS was 1 [1-5] in 18 to 64 years, and 1 [1-2] in older than or equal to 65 years. Ten percent had neurosurgical intervention (18-64 y: 8%; ≥65 y: 11%). TM was higher in older than or equal to 65 years than 18 to 64 years (10% vs. 3%). Compared with older than or equal to 65 years, 18 to 64 years were discharged home more frequently (78% vs. 51%) and to hospice less frequently (2% vs. 7%). In 18 to 64 years, factors associated with TM were race, advance directive, functional dependence, ISS, more midline shift, and thicker SDH (too few TMs for adjusted models). In older than or equal to 65 years, factors independently associated with TM were advance directive (aOR [95% CI]: 11.8 [2.9-49.0]), male sex (3.0 [1.3-7.0]), midline shift (1.8 [1.3-2.6]), shock index (1.5 [1.1-2.1]), and worsening SDH on follow-up CT (2.9 [1.3-6.6]).</p><p><strong>Conclusions: </strong>Despite presenting as \"mild\", these data highlight that older adults with SDH have high TM and should continue to receive the highest-level care with timely goals-of-care discussions. The association between advance directives and TM should be interpreted within the context of baseline vulnerability and preinjury treatment preferences, not as a biological mortality predictor.</p><p><strong>Level of evidence: </strong>Level III, prognostic/epidemiological.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207219","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 clinically relevant porcine model of flail chest: Development and multimodal validation.","authors":"Shu Li, Yiguo Zhao, Qingmei Liang, Yulu He, Fengxue Zhu","doi":"10.1097/TA.0000000000005198","DOIUrl":"https://doi.org/10.1097/TA.0000000000005198","url":null,"abstract":"<p><strong>Background: </strong>Flail chest has high mortality, but large-animal models with thoracic anatomy comparable to humans are lacking. The objective of this study was to develop a clinically relevant porcine flail chest model that preserves pleural, pulmonary, and neurovascular integrity, and to validate it using multimodal assessment including computed tomography (CT) imaging and physiologic parameters.</p><p><strong>Methods: </strong>Twelve male Landrace pigs were randomly assigned to a flail chest (FC) group and a multiple single rib fracture (MRF) group (n=6 per group). Under general anesthesia, controlled osteotomies were performed on the fifth to eighth ribs. The intercostal neurovascular bundle was protected, and the parietal pleura was bluntly separated before each osteotomy to preserve pleural integrity. In the FC group, each rib was transected at two sites to create a four-rib flail segment; in the MRF group, a single transection was made per rib. Paradoxical chest wall motion was visually confirmed in the FC group before layered closure. Invasive arterial pressure, heart rate, pulse oxygen saturation (SpO₂), and end‑tidal carbon dioxide tension (ETCO₂) were monitored throughout. Chest CT was performed on Day 7.</p><p><strong>Results: </strong>All surgeries were successful, with no mortality. Paradoxical chest wall motion was confirmed in all FC animals after emergence. The SpO₂/FiO₂ ratio declined postoperatively in both groups, with a significantly greater decrease in the FC group than in the MRF group (221.0±1.4 vs. 260.2±1.9, P<0.001). Heart rate and mean arterial pressure increased in both groups and were significantly higher in the FC group (P<0.001). CT confirmed the intended fracture patterns and flail-segment displacement, with no evidence of pleural breach, pulmonary injury, pneumothorax, or hemothorax.</p><p><strong>Conclusions: </strong>A standardized porcine flail chest model was established that preserves pleural, pulmonary, and neurovascular integrity, allowing the isolated study of rib fracture pathophysiology. This model will facilitate future research on fixation materials and surgical techniques.</p><p><strong>Study type: </strong>Basic Science/ Animal Study.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194941","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":"Authors' reply: Comment on \"trauma-specific revision of the Japanese Association for Acute Medicine disseminated intravascular coagulation criteria improves outcome prediction in severely injured patients\".","authors":"Momoko Sugimoto, Wataru Takayama, Takeshi Wada, Takayuki Ogura, Koji Morishita","doi":"10.1097/TA.0000000000005189","DOIUrl":"https://doi.org/10.1097/TA.0000000000005189","url":null,"abstract":"","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194967","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}