Journal of Trauma and Acute Care Surgery最新文献

{"title":"Design and implementation of an international multiarm, multistage master protocol for trials of complex traumatic wound care during active war in Ukraine.","authors":"Corey B Bills, Camille J Hochheimer, Samantha C Roberts, Roman Fishchuk, Jennifer Peers, Samantha Simon, Olena V Omelianenko, Hnat L Herych, Oleksii V Altanets, Nazariy A Beley, Col Vikhyat S Bebarta, Col Ret Sean Keenan, Laurel Beaty, Stacy A Trent, Nichole E Carlson, Adit A Ginde","doi":"10.1097/TA.0000000000005017","DOIUrl":"https://doi.org/10.1097/TA.0000000000005017","url":null,"abstract":"<p><strong>Background: </strong>Traumatic wound infections are a significant contributor to morbidity and mortality during war. Given challenges of performing clinical trials during war and the urgent need for interventions to prevent and treat infected traumatic wounds exacerbated by global increases in antimicrobial resistance, we developed the Prevention and Treatment Clinical Trials for Antimicrobial Resistance Research to Improve Outcomes of Traumatic Wounds in Ukraine (PACT-ARROW). We provide an overview of the protocol and implementation strategy.</p><p><strong>Methods: </strong>PACT-ARROW is a multiarm multistage (MAMS) platform designed to evaluate the safety, efficacy, and effectiveness of device and therapeutic interventions to optimize outcomes of patients hospitalized in Ukraine with acute traumatic wounds. The aim is to improve standard or available care with the possibility to study multiple interventions simultaneously. A platform steering committee will review potential interventions, determine alignment with the mission of the protocol, and promote those with sufficient evidence to warrant testing in a trial.</p><p><strong>Results: </strong>PACT-ARROW has undergone local and national ethics approval in the United States and Ukraine. We began with a prospective observational cohort (ARROW), with over 350 patients enrolled. A corresponding interventional trial, with a targeted enrollment of 150, just began enrollment. Expansion of interventions and target populations is planned.</p><p><strong>Conclusions: </strong>The intended benefits of the platform include standardized patient enrollment criteria, outcomes tailored to feasible data collection during active war, and improvements in patient care for the treatment of complex and infected traumatic wounds. The design is intended to apply to a broad set of interventions with relevant patient-centered outcomes, all while addressing challenges of performing clinical trials in a war environment. Future studies utilizing the PACT-ARROW master protocol are planned. (J Trauma Acute Care Surg. 2026;000: 000-000. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.).</p><p><strong>Study type: </strong>Protocol.</p><p><strong>Level of evidence: </strong>Level I.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147839511","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":"Why research articles in acute care surgery get rejected: 10 critical mistakes to avoid.","authors":"Philip F Stahel, Navid Ziran, Nathan Butler, Raul Coimbra","doi":"10.1097/TA.0000000000004940","DOIUrl":"10.1097/TA.0000000000004940","url":null,"abstract":"<p><strong>Abstract: </strong>This manuscript synthesizes the authors' anecdotal experience as editors and peer reviewers by summarizing 10 commonly encountered flaws in the presentation of submitted research manuscripts in the field of trauma and acute care surgery that may contribute to editorial decisions to reject. Notably, most of the listed mistakes are preventable through strict adherence to scientific reporting, coherent formatting, and proofreading before submission. ( J Trauma Acute Care Surg . 2026;100:831-835. Copyright © 2026 The Author(s). Published byWolters Kluwer Health, Inc. on behalf of the American Association for the Surgery of Trauma.).</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"831-835"},"PeriodicalIF":3.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13117527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147628229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TBI-associated acute lung injury is associated with downregulation of miRNA-362.","authors":"William Johnston, Julissa Arzave, Connor Yuengert, Dong Jun Park, Todd W Costantini, Brian P Eliceiri, Jessica L Weaver","doi":"10.1097/TA.0000000000004937","DOIUrl":"10.1097/TA.0000000000004937","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injuries (TBIs) are a common cause of morbidity and mortality after major trauma. In addition to local injury effects, TBI is associated with a systemic inflammatory response and acute lung injury (ALI), which increases mortality and worsens neurological outcomes. The exact mechanism of this ALI is not known. Extracellular vesicles (EVs) are small cell-derived particles involved in cell-cell communication that carry a wide variety of payloads, including proteins and microRNAs (miRNAs), which can mediate inflammation. We sought to characterize EV-derived miRNAs associated with TBI-induced ALI.</p><p><strong>Methods: </strong>C57BL/6J mice underwent controlled cortical impact as a TBI injury model or sham procedure (anesthesia only). Bronchoalveolar lavage fluid (BALF) was then collected 4 hours postinjury. ALI after injury was determined via BALF protein concentration and H&E lung histology grading. BALF EVs were isolated using size exclusion chromatography, and EV concentration was confirmed via vesicle flow cytometry. EV miRNA sequencing was performed, comparing sham and injured mice. The effect of miR-362-3' on lung epithelium was evaluated using proteome profiler and western blot analysis.</p><p><strong>Results: </strong>ALI after TBI injury was demonstrated by increased total protein concentration in BALF (p=0.006) and increased lung histologic injury score (p<0.0001). EVs were isolated using size exclusion chromatography and verified with vesicle flow cytometry. miRNA sequencing of BALF EVs demonstrated downregulation of 17 different miRNAs, most notably miRNA-362-3'. Treatment of MLE-12 with miRNA-362-3' loaded EVs resulted in the downregulation of the proinflammatory cytokine TIMP-1.</p><p><strong>Conclusions: </strong>We successfully identified multiple downregulated miRNAs from BALF in an in vivo model of TBI-induced ALI. Treatment with one of these downregulated miRNAs, miRNA-362-3', resulted in the downregulation of TIMP-1 in lung epithelial cells. This suggests that the downregulation of miR-362-3' contributes to TBI-induced ALI. (J Trauma Acute Care Surg. 2026;100:779-786. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.).</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":"100 5","pages":"779-786"},"PeriodicalIF":3.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775438","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":"Discharge functional status and predictors of all-cause geriatric trauma readmission across a mature trauma network.","authors":"Annette Palladino, Emily Wheeler, Megan Welborn, Luke Bauerle, Adam Lizak, Jill Stoltzfus, Rebecca Boyer, Lisa Robins, Rebecca Wilde-Onia, James Cipolla, Peter Thomas, Roberto Castillo, Maxwell A Braverman","doi":"10.1097/TA.0000000000004908","DOIUrl":"10.1097/TA.0000000000004908","url":null,"abstract":"<p><strong>Introduction: </strong>Readmission after trauma remains a significant challenge in the geriatric population. Few studies have looked at geriatric trauma readmission (GTR) across a mature trauma network including at level IV centers. Our objective was to determine if discharge functional status predicts GTR across all levels of trauma centers. Secondary objective was to determine incidence and reason for GTR.</p><p><strong>Methods: </strong>Institutional trauma registries were queried for all geriatric trauma admissions across our network (2018-2023). These data were merged with all-cause network readmission data. Demographics, injury characteristics, trauma center level, frailty, discharge functional status (functional independence measure [FIM]), disposition, and payor status were compared between non-GTR and GTR patients. Univariate, followed by multivariate, logistic regression was used to identify predictors of readmission. Reason for GTR and time to GTR were examined.</p><p><strong>Results: </strong>A total of 11,270 patients were admitted across the network with a median age of 81 years (interquartile range, 74-88 years) and a median Injury Severity Score of 5 (4-9), while 6.6% (n = 741) had an Injury Severity Score of >16. All-cause GTR rate was 6.2% (n = 700). On multivariate analysis, FIM score (odds ratio [OR], 0.99 [0.95-1.02]; p  = 0.60), treatment at a level IV center, and disposition were not predictors of GTR. The results were similar after adjusting for frailty, with three or more comorbidities (OR, 1.708 [1.16-2.51]; p  < 0.01) and hospital length of stay (OR, 1.05 [1.01-1.09]; p  < 0.01) representing the highest predictors of GTR. Fourteen percent (n = 101/700) of GTR patients were readmitted for a trauma complication, 11% (n = 75) for new injury, 63% (n = 439) for a medical condition, and 12% (n = 84) because of prior refusal for rehab. The median time to GTR was 14 days (interquartile range, 6-21 days). Fifty-seven percent (n = 396) had incomplete follow-up.</p><p><strong>Conclusion: </strong>Hospital length of stay and more than three comorbidities but not FIM score predict GTR with most GTR for a new or preexisting medical condition. These variables represent suitable targets for GTR reduction. ( J Trauma Acute Care Surg . 2026;100: 730-738. Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.).</p><p><strong>Level of evidence: </strong>Prognositc and Epidemiologic; Level IV.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"730-738"},"PeriodicalIF":3.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145900647","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":"Evaluating the first response to resuscitation prior to resuscitative endovascular balloon occlusion of the aorta catheter placement.","authors":"Johan Schmitt, Quentin Mathais, Rachel Russo","doi":"10.1097/TA.0000000000004878","DOIUrl":"10.1097/TA.0000000000004878","url":null,"abstract":"","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"e50-e51"},"PeriodicalIF":3.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145793793","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":"Trauma and emergency surgical care at rural emergency hospital-eligible facilities: Interstate variation and policy implications for rural health systems.","authors":"Nina M Clark, Alexandra H Hernandez, Cody L Mullens, Gordon Riha, John W Scott, Barclay T Stewart","doi":"10.1097/TA.0000000000004904","DOIUrl":"10.1097/TA.0000000000004904","url":null,"abstract":"<p><strong>Introduction: </strong>Timely access to emergency surgical care is a key metric for health system development and performance. To mitigate the risks of rural hospital closures in the United States, the 2021 Consolidated Appropriations Act introduced the rural emergency hospital (REH) designation, which promotes closure of inpatient units in small hospitals in favor of emergency and outpatient services via supplemental funding and reimbursement. We investigated trauma and emergency general surgery volumes at REH-eligible hospitals to evaluate the potential impact of REH designation on trauma and emergency general surgery care.</p><p><strong>Methods: </strong>We used the 2021 Healthcare Cost and Utilization Project from five geographically diverse states (California, Florida, Iowa, Maryland, and Wisconsin) to select encounters where adult patients were treated for acute injuries or emergency general surgery conditions. We then identified REH-eligible hospitals (critical access hospitals or rural hospitals with <50 inpatient beds), comparing case volumes and patient populations at REH-eligible and -ineligible hospitals.</p><p><strong>Results: </strong>We analyzed 2.1 million encounters. Trauma and emergency general surgery encounters at REH-eligible hospitals demonstrated substantial interstate variation, comprising 2% to 37% of statewide hospitalizations and up to 17% of statewide inpatient days, with rural states showing the highest proportions. Compared with ineligible hospitals, REH-eligible hospitals treated a higher proportion of patients who were White (85% vs. 55%), were living in rural areas (79% vs. 8%), and had lower incomes; treated fewer patients operatively (2% vs. 11%); and transferred more patients (5% vs. 3%) (all p  < 0.001).</p><p><strong>Conclusion: </strong>Hospitals eligible for REH designation contribute substantially to the care of injured and emergency general surgery patients, although this is variable across states. While this policy may preserve emergency services in rural areas, the substantial variation in REH-eligible hospital utilization and the vulnerable populations served necessitate systematic evaluation of impacts on surgical access, transfer protocols, and regional care capacity given the irreversible structural changes inherent in this designation. ( J Trauma Acute Care Surg . 2026;100: 768-776. Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.).</p><p><strong>Level of evidence: </strong>Prognositc and Epidemiologic; Level III.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"768-776"},"PeriodicalIF":3.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966596","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":"Evidence-based, cost-effective management of perforated peptic ulcer disease: An algorithm of the Journal of Trauma and Acute Care Surgery Emergency General Surgery Algorithms Working Group.","authors":"Raul Coimbra, Walter L Biffl, Todd W Costantini, Jose J Diaz, Kenji Inaba, David H Livingston, Lena Napolitano, Ali Salim, Robert J Winchell","doi":"10.1097/TA.0000000000004948","DOIUrl":"10.1097/TA.0000000000004948","url":null,"abstract":"","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"700-706"},"PeriodicalIF":3.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13117578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147480970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invited commentary: One incision, complete access-Median sternotomy and aortic occlusion in penetrating chest trauma.","authors":"Matthew J Wall","doi":"10.1097/TA.0000000000004961","DOIUrl":"10.1097/TA.0000000000004961","url":null,"abstract":"","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"820-821"},"PeriodicalIF":3.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147628270","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":"Early versus delayed appendectomy for acute uncomplicated appendicitis in adult and pediatric patients: A systematic review and meta-analysis.","authors":"Hasnaien Ahmed, Faith Trinh, Sukhdeep Jatana, Kaden Fujita, Janice Y Kung, Uzair Jogiat, Shahzeer Karmali, Noah Switzer, Valentin Mocanu","doi":"10.1097/TA.0000000000004906","DOIUrl":"10.1097/TA.0000000000004906","url":null,"abstract":"<p><strong>Background: </strong>Appendicitis has traditionally been managed with urgent surgery. Because of operative room and logistic constraints, surgery may be delayed. Evidence on the impact of this delay remains equivocal. The aim of this systematic review and meta-analysis is to assess postoperative outcomes of delayed appendectomy amongst both pediatric and adult populations.</p><p><strong>Methods: </strong>A systematic review with meta-analysis was performed including studies comparing cohorts of urgent versus delayed appendectomy, excluding those with interval appendectomy. Studies were included as long as one relevant postoperative complication was mentioned; for adults, only prospective studies were included. A comprehensive search of six databases was performed including studies from January 1, 2000, to January 15, 2024. A meta-analysis with a random effects model and restricted maximum likelihood was used.</p><p><strong>Results: </strong>Of 11,227 citations, 20 pediatric and 5 adult studies were included, with 827,019 and 4250 patients, respectively. Definitions of early surgery cohorts were usually surgery within 4 to 12 hours or overnight, and delayed surgery >4 to 12 hours or next day. The pediatric meta-analysis revealed no increased risk of intraoperative perforation in delayed versus emergent cohorts (odds ratio [OR], 1.16; 95% confidence interval [CI], 0.78-1.72), length of stay (mean difference, 1.2 days; 95% CI, -0.3 to -2.8), abscess (OR, 0.80; 95% CI, 0.29-2.25), surgical site infection (OR, 1.11; 95% CI, 0.93-1.30), or readmission (OR, 0.82; 95% CI, 0.55-1.21). The adult meta-analysis results revealed no difference between the delayed and emergent appendectomy groups for intraoperative perforation (OR, 1.29; 95% CI, 1.00-1.67), abscess (OR, 1.54; 95% CI, 0.58-4.10), surgical site infection (OR, 1.35; 95% CI, 0.71-2.56), or conversion to open (OR, 0.81; 95% CI, 0.64-1.03). Subgroup analyses showed increased length of stay in pediatric population (mean difference, 0.42 days; 95% CI, 0.10-0.74).</p><p><strong>Conclusion: </strong>These findings suggest that a modest delay in appendectomy may be permissible in pediatric and adult settings and adult patients presenting with acute appendicitis. While this does not replace surgeon clinical acumen, it may help guide decision making in resource-constrained settings. ( J Trauma Acute Care Surg . 2026;100: 822-830. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.).</p><p><strong>Level of evidence: </strong>Systematic Review and Meta-analysis; Level III.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"822-830"},"PeriodicalIF":3.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146119163","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":"More than an algorithm: CAB as a shared responsibility.","authors":"Paula Ferrada","doi":"10.1097/TA.0000000000004963","DOIUrl":"10.1097/TA.0000000000004963","url":null,"abstract":"","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"e53-e54"},"PeriodicalIF":3.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147480888","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}