Journal of Trauma and Acute Care Surgery最新文献

{"title":"Closer to home: Managing more than three rib fractures at level IV trauma centers.","authors":"Adam Lizak, Anthony Allsbrook, Rebecca Wilde-Onia, Lisa Robins, Rebecca Boyer, James Cipolla, Peter Thomas, Roberto Castillo, Maxwell A Braverman","doi":"10.1097/TA.0000000000004575","DOIUrl":"10.1097/TA.0000000000004575","url":null,"abstract":"<p><strong>Introduction: </strong>Rib fractures remain a significant source of trauma admissions. In 2020, the Pennsylvania Trauma System Foundation standards changed to allow patients with more than three rib fractures to be admitted to level IV centers. The primary aim of this study was to evaluate outcomes of patients with more than three uncomplicated rib fractures admitted to level IV trauma centers.</p><p><strong>Methods: </strong>Our network database was queried for patients with isolated uncomplicated rib fractures between 2018 and 2022. Patients were stratified based on evaluation before or after the change in standards. Patients evaluated at level IV centers were compared for demographics, injury characteristics, transfer rate, and outcomes. Finally, 1:1 propensity score matching was used to create a matched group of patients with more than three rib fractures to assess outcomes based on admission to level IV versus level I/II centers.</p><p><strong>Results: </strong>A total of 1,070 patients with isolated rib fractures were admitted over the study period. Level IV centers evaluated 360 patients with 132 (36.6%) and 228 (63.3%) in the pre- and poststandard change periods. There was a significant reduction in transfers for isolated rib fractures (56% vs. 21% p < 0.01). Compared with patients with three or less rib fractures, those with more than three fractures had similar hospital length of stay (median [interquartile range (IQR)], 3 [2-5] vs. 2 [1-4]; p = 0.29) and mortality (0% vs. 2.3%, p = 0.22). After propensity match, there was no difference in age (median [IQR], 71 [60-81] vs. 73 [65-85]; p = 0.24), injury characteristics, hospital length of stay (median [IQR], 2.5 [2-5] vs. 2 [1-4]; p = 0.37), and mortality (1.7% vs. 0%, p = 0.30).</p><p><strong>Conclusion: </strong>Change in state admission standards allowed for a reduction in transfer of patients with more than three isolated rib fractures. In a group of matched patients with more than three rib fractures, level IV centers had similar outcomes to level I or II centers.</p><p><strong>Level of evidence: </strong>Prognostic and Epidemiological; Level IV.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"875-879"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143492590","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":"Not all call is created equally: The impact of culture and sex on burnout related to in-house call.","authors":"Jamie J Coleman, Caitlin K Robinson, William von Hippel, Mitchell J Cohen","doi":"10.1097/TA.0000000000004538","DOIUrl":"10.1097/TA.0000000000004538","url":null,"abstract":"<p><strong>Background: </strong>In-house call (IHC) has previously been shown to result in increased burnout in acute care surgeons (ACSs). There is wide variation, however, in the implementation and culture of work surrounding IHC across trauma centers and within the demographics of practicing ACSs. We hypothesized that local work practices and culture surrounding IHC as well as sex of ACSs would impact burnout.</p><p><strong>Methods: </strong>Continuous physiologic data were collected over 6 months from 224 ACSs who wore a fitness wearable. Acute care surgeons were sent daily surveys to record work, personal activities, and feelings of burnout. The Maslach Burnout Inventory was completed by ACSs at the beginning and end of the study period.</p><p><strong>Results: </strong>Forty-eight (21.5%) of ACS reported being expected to complete the usual workday after IHC, 94 (42.2%) were expected to finish work from IHC, and 81 (36.3%) were expected to leave immediately after IHC was over. Acute care surgeons expected to complete a usual workday postcall were more likely to be burned out, and IHC resulted in a greater increase in their daily feelings of burnout than among ACSs who reported working in other work cultures. Females showed higher levels of daily burnout than males but no difference in the degree to which IHC led to burnout.</p><p><strong>Conclusion: </strong>In-house call results in increased burnout in all ACSs; however, IHC had a larger impact on daily feelings of burnout in ACSs expected to work without adjustments to their work schedule postcall. Although female ACSs reported higher levels of daily burnout than male ACSs, IHC increased daily feelings of burnout equally between the two sexes. Taken together, these findings necessitate caution about work expectations surrounding IHC and suggest a need for the deliberate creation of a postcall culture for ACS.</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":"880-884"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433336","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":"Geri-screen: A multicenter trial of a novel screening tool for depression and suicide risk among US trauma patients.","authors":"Shelbie D Waddle, Lavanya Sambaraju, Xane D Peters, Kevin Borrup, Alfred Croteau, Thomas H Jacome, Lisa Allee, Brian Daley, Thomas J Schroeppel, Dorian A Lamis, Meghan Fish, Greggory Davis, Hannah Bard, Cat Nordstrom, Deborah Tuggle, Eileen M Bulger, Avery B Nathens, Brendan T Campbell","doi":"10.1097/TA.0000000000004536","DOIUrl":"10.1097/TA.0000000000004536","url":null,"abstract":"<p><strong>Background: </strong>Depression and suicidal ideation rates among geriatric trauma patients admitted to the hospital are currently unknown. This study aimed to determine the prevalence of depressive symptoms, suicidal ideation and prior attempts, and lethal means access among older patients admitted to trauma centers in the United States. We hypothesized that a significant number of these patients may have unrecognized symptoms of depression and/or suicidal ideation not identified prior to hospital discharge.</p><p><strong>Methods: </strong>These data are from a multicenter survey study of injured older (≥55 years) patients admitted to non-ICU inpatient trauma services at five US trauma centers. Patients were approached to complete a tablet-based survey with two components: (1) validated depression and suicidal ideation screening tool (PHQ-9) and (2) household firearm ownership.</p><p><strong>Results: </strong>From November 2022 through May 2024, five level 1 trauma centers in five states administered surveys to 408 patients, who were mostly male, White, and older than 70 years. Overall, more than one-third (34.8%) screened positive for depressive symptoms and nearly 40% kept a firearm at home. Twenty percent of those patients experiencing suicidal ideation kept a firearm in the home.</p><p><strong>Conclusions: </strong>We identified high rates of depressive symptoms among older patients admitted to trauma centers, with one-third of patients having access to firearms in their home. Identifying depressive symptoms and suicidal ideation among patients admitted to trauma centers may allow for mental health intervention and lethal means safety counseling prior to hospital discharge.</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":"885-889"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710397","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":"Screening for mental health symptoms following pediatric traumatic injury: A practice management guideline (from the Pediatric Trauma Society, Society of Trauma Nurses, and Center for Pediatric Traumatic Stress).","authors":"Julia Price, Meghan L Marsac, Leigh E Ridings, Caitlin H Axtmayer, Richard James, Melanie Stroud, Maria Bautista Durand, Shannon W Longshore, Jennifer J Freeman, Todd Nickoles, Ian Mitchell, Chia-Lun Yang, Nancy Kassam-Adams","doi":"10.1097/TA.0000000000004578","DOIUrl":"10.1097/TA.0000000000004578","url":null,"abstract":"","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"973-983"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692675","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":"On arrival continuous brachial plexus block provides superior analgesia with reduced persistent postsurgical pain in complex hand injuries: A randomized controlled trial.","authors":"Kajal Kashyap, Nidhi Bhatia, Kajal Jain, Karan Singla, Mandeep Kumar, Revathi Nair, Sunil Gaba, Tarush Gupta","doi":"10.1097/TA.0000000000004577","DOIUrl":"10.1097/TA.0000000000004577","url":null,"abstract":"<p><strong>Background: </strong>Patients with complex hand injuries experience extreme pain and frequently witness prolonged preoperative waiting period, which intensifies their agony, especially during wound dressing and debridement, further intensifying pain of acute trauma. Hence, there is a need to study utility of continuous peripheral nerve block in settings of acute trauma emergencies. We hypothesized that, as compared with intravenous systemic analgesics, continuous brachial plexus block would provide superior analgesia in these patients.</p><p><strong>Methods: </strong>Eighty adults of either sex, with complex unilateral hand injuries (significant soft-tissue loss, crushed hand injury, and metacarpal bone fractures), having moderate-to-severe pain were randomized into two groups of 40 patients each. We excluded patients with sensory deficits, coagulopathy, or vascular injuries of the forearm. In the intervention group (group brachial plexus block [BPB]), patients received continuous infraclavicular brachial plexus block with 20 mL of 0.2% ropivacaine. In control group (group C) patients were administered intravenous analgesics (injection paracetamol [500 mg] 6 hourly with injection diclofenac [50 mg] 8 hourly). We recorded pain scores (Numeric Rating Scale) at regular intervals and total rescue analgesic used. Patients were followed-up on days 15 and 30 following surgery to note persistent postsurgical pain (PPSP). Groups were compared using Student's t test/χ 2 test as applicable. Mann-Whitney U test was used for statistical analysis of skewed continuous variables or ordered categorical data.</p><p><strong>Results: </strong>Significantly more patients in group BPB reported Numeric Rating Scale score of <4, 1 hour following intervention (100% in group BPB vs. 57.5% in group C; p = 0.00). No patients in group BPB reported pain/discomfort during any interventions, like wound assessment/dressings. On the contrary, 55% (n = 22/40) of patients in group C experienced moderate-to-severe pain ( p = 0.00) and required rescue analgesic. The median preoperative waiting time was significantly less in group BPB (18 [16-18] vs. 48 [24-48] hours; p = 0.00). Significantly more patients in group C reported PPSP on days 15 and 30 (19/40 in group C vs. 6/40 in group BPB; p = 0.03).</p><p><strong>Conclusion: </strong>On-arrival blocks with catheter technique provide consistent pain relief, with lower PPSP, and hence should be integrated in pain management protocols.</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":"934-941"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143615876","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":"Exploratory cluster analysis of IL2Ra and associated biomarkers and complications after blunt chest trauma.","authors":"Krista L Haines, Renhua Li, Scott Grey, Ha Eun Kim, Eric Gann, Chandra Almond, Michael Rouse, MaryBeth Joshi, Seth Schobel, Suresh Agarwal, Allan Kirk, Eric Elster, Joseph S Fernandez-Moure","doi":"10.1097/TA.0000000000004568","DOIUrl":"10.1097/TA.0000000000004568","url":null,"abstract":"<p><strong>Background: </strong>Rib fractures compromise approximately 40% of all fractures in the United States. Despite their prevalence, the relationship between rib fractures, solid organ injuries, and immune responses remains poorly understood. This exploratory study investigates the immunological profile associated with pulmonary and renal complications in rib fracture patients using data from our Surgical Critical Care Initiative Clinical Data Repository. The aim is to correlate distinct cytokine/chemokine profiles with high-energy rib fracture patterns, such as first rib fracture, and associated complications, potentially providing predictive biomarkers for patient outcomes.</p><p><strong>Methods: </strong>Clinical and demographic data on patients with rib fractures were extracted from Surgical Critical Care Initiative Clinical Data Repository. Patients were categorized based on the presence or absence of complications. A comprehensive panel of 46 inflammation and tissue repair biomarkers was measured using the Meso Scale Discovery platforms. Principal component analysis was used to reduce the dimensionality of the cytokine data. Statistical and machine learning models assessed the association between biomarker patterns, rib fracture localization, and complications. Logistic regression models with high discriminative performance were developed for first rib fractures (high energy transfer), lung injury, and pneumonia.</p><p><strong>Results: </strong>Among 150 rib fracture patients, 73 had complications. Cytokine analysis revealed two distinct clusters: Cluster 1, associated with pro-inflammatory responses and tissue repair, and Cluster 2, linked with anti-inflammatory responses, angiogenesis, and immunometabolism. Predictive models demonstrated strong validity (area under the curve, >0.90) and identified key variables such as the cytokine IL2Ra, significantly associated with acute kidney injury, acute lung injury, and pulmonary complications post-rib fractures, particularly first rib fractures.</p><p><strong>Conclusion: </strong>IL2Ra release is significantly correlated with high-energy transfer injuries like first rib fractures, indicating a bidirectional relationship between these fractures and the immune response. Furthermore, a hierarchical relationship exists among clinical complications, with kidney and lung injuries frequently preceding pneumonia. These findings underscore the potential utility of integrating immunological markers into clinical decision-support frameworks for personalized therapeutic interventions.</p><p><strong>Level of evidence: </strong>Prognostic and Epidemiological; Level IV.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"899-906"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999401","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":"Management of adhesive small bowel obstruction during pregnancy in the United States.","authors":"Matthew J Ashbrook, Vincent Cheng, Emma Longo, Nathan Kohrman, Koji Matsuo, Matthew J Martin, Kenji Inaba, Kazuhide Matsushima","doi":"10.1097/TA.0000000000004518","DOIUrl":"10.1097/TA.0000000000004518","url":null,"abstract":"<p><strong>Background: </strong>Adhesive small bowel obstruction (ASBO) is a rare, nonobstetrical abdominal emergency. Optimal management of ASBO during pregnancy remains unknown. This study analyzes management trends and outcomes of pregnant patients with ASBO in the United States.</p><p><strong>Methods: </strong>The National Inpatient Sample was queried for pregnant women diagnosed with ASBO from January 2003 to September 2015. Patients were grouped into three management strategies: nonoperative management (NOM), immediate operation (from admission to hospital day 1), or delayed operation (after hospital day 1). Multivariable regression analysis was used to evaluate the association between management strategies and maternal or perinatal complications. The impact of delayed operation on patient outcomes was also assessed.</p><p><strong>Results: </strong>A total of 4,266 pregnant patients with ASBO were identified: 1,974 (46.3%) were managed nonoperatively, 1,177 (27.6%) underwent immediate operation, and 1,115 (26.1%) underwent delayed operation. The rate of NOM did not significantly change over the study period. Compared with NOM, immediate operation was not associated with increased complication rates, whereas delayed operation was associated with higher rates of maternal septic shock (odds ratio [OR], 5.63; 95% confidence interval [CI], 1.09-29.21; p = 0.04) and preterm labor, delivery, or abortion (OR, 2.41; 95% CI, 1.56-3.72; p < 0.001). In analysis of patients who underwent surgery, each day of delay in operation was associated with a 14% higher chance of preterm labor, delivery, or abortion (OR, 1.14; 95% CI, 1.08-1.21; p < 0.001).</p><p><strong>Conclusion: </strong>Pregnant patients presenting with ASBO were often managed operatively. Delay to operation was associated with increased odd of maternal and perinatal complications. Surgeons should be involved early in determining the optimal management for ASBO.</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":"915-920"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066434","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":"Accuracy, reliability, and utility of the extended focused assessment with sonography in trauma examination in the setting of thoracic gunshot wounds.","authors":"Miharu Arase, Negar Nekooei, Marco Sozzi, Morgan Schellenberg, Kazuhide Matsushima, Kenji Inaba, Matthew J Martin","doi":"10.1097/TA.0000000000004583","DOIUrl":"10.1097/TA.0000000000004583","url":null,"abstract":"<p><strong>Background: </strong>The extended focused assessment with sonography in trauma (eFAST) examination includes additional thoracic views beyond the standard focused assessment with sonography in trauma examination. Its validation has predominantly been conducted in blunt trauma cases. Our aim was to evaluate the eFAST examination in a targeted population with penetrating thoracic trauma.</p><p><strong>Methods: </strong>Patients with thoracic gunshot wounds who underwent eFAST between 2017 and 2021 were included from a local trauma registry. Performance metrics for each component of eFAST in each window and pathological condition were analyzed across the entire population, as well as within two cohorts: survived and deceased patients. Chest tube placement rates were compared within true-positive and false-negative (FN) eFAST results for subgroups with pneumothorax or hemothorax.</p><p><strong>Results: </strong>A total of 288 patients were included (male, 91% male; Injury Severity Score ≥15, 48%; and died, 17%). Thirty-nine percent required chest tube, and 18% required urgent thoracic surgical intervention. Although specificity was high (91-100%) for all components, the sensitivity was less than 50% for all thoracic views, except for \"no cardiac motion\" (100% sensitivity). Sensitivity for pericardial fluid was 47%; for pneumothorax, 22%; for hemothorax, 36%; and for peritoneal fluid, 51% in the total population. Comparing survived versus deceased cohort, the eFAST sensitivity was higher among deaths for all components. The majority of patients (>70%) with a FN eFAST for pneumothorax or hemothorax received chest tube.</p><p><strong>Conclusion: </strong>The eFAST examination showed highly variable performance metrics among patients with penetrating thoracic trauma, with all thoracic components demonstrating high specificity but low overall sensitivity. Urgent interventions were frequently received in patients with FN studies.</p><p><strong>Level of evidence: </strong>Diagnostic Test/Criteria; Level III.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"867-874"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605553","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":"Damage control does not offer a survival advantage and increases the risk of serious complications compared with early total care in severely injured patients with femoral shaft fractures.","authors":"Bruno C Coimbra, Junsik Kwon, Bishoy Zakhary, Babak Sarani, Matthew Firek, Timothy Allison-Aipa, Raul Coimbra","doi":"10.1097/TA.0000000000004594","DOIUrl":"10.1097/TA.0000000000004594","url":null,"abstract":"<p><strong>Background: </strong>Damage control orthopedics (DCO) was proposed to minimize the second hit of extensive surgical procedures in severely injured patients when treated with early fracture fixation (early total care [ETC]). The impact of DCO and ETC on the outcomes of severely injured patients sustaining femoral shaft fractures (FSFs) is unclear. We hypothesized that DCO is associated with lower mortality and decreased incidence of complications compared with ETC.</p><p><strong>Methods: </strong>The Trauma Quality Improvement Project database was queried from 2007 to 2021. Adult patients 14 years or older with FSF and Injury Severity Score of >15 were included. Patients were divided into ETC and DCO groups and stratified according to fracture type: open or closed. The primary outcomes included acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), severe sepsis, deep venous thrombosis (DVT), and mortality. Inverse probability treatment of weighting was used to balance the two cohorts of interest. A binomial logistic regression analysis was performed after inverse probability treatment of weighting to identify potential associations between the type of fixation procedure and the outcomes of interest.</p><p><strong>Results: </strong>A total of 44,577 FSF patients were included. Mortality was 2.1%. No survival advantage was observed in the DCO group (odds ratio [OR], 0.92). However, significant associations between DCO and the risk of ARDS (OR, 1.64), AKI (OR, 1.57), severe sepsis (OR, 1.64), and DVT (OR, 1.64) were identified. Damage control orthopedics was not associated with decreased mortality after stratifying patients according to the fracture type and the type of operation.</p><p><strong>Conclusion: </strong>Damage control orthopedics is not associated with improved survival of severely injured patients with FSF. Damage control orthopedics is associated with an increased risk of ARDS, AKI, severe sepsis, and DVT compared with ETC. These findings persisted after analyzing the type of fracture. These results are significant for clinical practice, as more patients could be treated by ETC when compensated physiologically, independent of the fracture type.</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":"907-914"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663713","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":"Platelet flux in trauma-associated venous thromboembolism: A secondary analysis of the Consortium of Leaders in the Study of Traumatic Thromboembolism (CLOTT) studies.","authors":"Elizabeth Andraska, Alexander Fields, Brenda Nunez-Garcia, Ernest Moore, Charles E Wade, M Margaret Knudson, Matthew D Neal, Lucy Kornblith","doi":"10.1097/TA.0000000000004592","DOIUrl":"10.1097/TA.0000000000004592","url":null,"abstract":"<p><strong>Background: </strong>Venous thromboembolism (VTE) after traumatic injury is morbid. Evaluating changes in platelets in injured patients who develop VTE could identify platelet-based strategies for management of thrombotic complications after injury.</p><p><strong>Methods: </strong>In a prospectively designed secondary analysis of a multicenter cohort study conducted by the Consortium of Leaders in the Study of Traumatic Thromboembolism (CLOTT1) study group, injured patients aged 18 to 40 years admitted for a minimum of 48 hours with at least one risk factor for VTE were evaluated. A subset of CLOTT1 patients had platelet aggregometry and thromboelastography performed to examine platelet function (CLOTT2). Patients who developed VTE were compared with those who did not.</p><p><strong>Results: </strong>Of 7,805 patients from CLOTT1 (mean [SD] age, 29.1 [6.4] years; 1,987 [25.5%] female), 425 (5.4%) developed VTE. Platelet count was lower at each time point for patients with VTE (admission: 242 [234-251] vs. 254 [252-256], p < 0.01; hospital day 1: 157 [150-164] vs. 197 [195-198], p < 0.01; all counts ×10 9 /L). An initial 10-point reduction in platelet count was associated with development of VTE (odds ratio, 1.32 [1.13-1.53]; p < 0.01) controlling for shock, injury severity, coagulopathy, sex, and product transfusion. When evaluating 129 CLOTT2 patients, velocity of platelet aggregation was higher on admission in the VTE group (18.5 vs. 12.8 aggregation units/min; p < 0.01) in response to adenosine diphosphate stimulation. In response to thrombin stimulation, velocity of platelet aggregation was higher at 48 hours (34.4 vs. 12.3 aggregation units/min; p < 0.01), and overall aggregation was higher in the VTE group at 72 hours (area under the curve, 173.2 vs. 129.6; p < 0.01). Thromboelastography results were not different between groups.</p><p><strong>Conclusion: </strong>This study identified an association of early reduction in platelet count with the development of VTE in injured patients at risk for VTE. P2Y 1/2 and protease-activated receptor 1 receptor stimulation changes in platelet aggregation responses are altered in VTE patients. Interrogating platelet count and functional responses may be beneficial in evaluating thrombotic complications after injury.</p><p><strong>Level of evidence: </strong>Diagnostic Test/Criteria; Level III.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"957-965"},"PeriodicalIF":2.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663726","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}