Journal of Trauma and Acute Care Surgery最新文献

{"title":"Inappropriate antithrombotic use in geriatric patients with complicated traumatic brain injury.","authors":"Diwas Gautam, David Botros, Jackson Aubrey, Michael T Bounajem, Sarah Lombardo, Janet Cortez, Marta McCrum, Toby Enniss, Megan Puckett, Christian A Bowers, Sarah T Menacho, Ramesh Grandhi","doi":"10.1097/TA.0000000000004552","DOIUrl":"10.1097/TA.0000000000004552","url":null,"abstract":"<p><strong>Background: </strong>Preinjury antithrombotic (AT) use is associated with worse outcomes for geriatric (65 years or older) patients with traumatic brain injury (TBI). Previous studies have found that use of AT outside established guidelines is widespread in TBI patients.</p><p><strong>Methods: </strong>In this single-center retrospective cross-sectional study, we examined inappropriate AT use among geriatric patients presenting with traumatic intracranial hemorrhage. We reviewed records of patients 65 years or older with preinjury AT use who presented to a Level 1 trauma center with traumatic intracranial hemorrhage between 2016 and 2023. Patient demographics and AT indications/types were extracted. Appropriateness of AT use was determined using established guidelines.</p><p><strong>Results: </strong>The cohort comprised 207 patients (56.5% male; median age, 77 years). Fall was the most common mechanism of injury (87.9%). At initial presentation, 87.0% of patients had mild TBI (Glasgow Coma Scale scores 13-15). The two most common indications for AT use were atrial fibrillation (41.5%) and venous thromboembolism (14.5%). Anticoagulation therapy was used by 51.7% of patients, antiplatelet therapy by 40.1%, and both by 8.2%. Prescribed AT agents included warfarin (23.2%), direct oral anticoagulants (36.2%), aspirin (32.4%), and clopidogrel (15.0%). Per clinical guidelines, 31 patients (15.0%) were determined to be inappropriately on AT therapy. On multivariable analysis, venous thromboembolism (odds ratio [OR], 5.32; 95% confidence interval [CI], 1.80-15.71; p = 0.002) and arterial stent (OR, 4.69; 95% CI, 1.53-14.37; p = 0.007) were associated with inappropriate AT use; aspirin was the most common inappropriately prescribed AT (OR, 3.59; 95% CI, 1.45-8.91; p = 0.006).</p><p><strong>Conclusion: </strong>Overall, 15% of geriatric TBI patients with preinjury AT use were prescribed this therapy outside of current guidelines. Trauma providers should remain vigilant in identifying such patients and collaborate across multidisciplinary teams to implement interventions that minimize inappropriate AT use.</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":"776-784"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932229","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":"\"Pager trauma\" as a new and destructive type of blast injuries: Retraction.","authors":"Hamid Reza Rasouli, Hadi Khoshmohabat, Fathollah Ahmadpour","doi":"10.1097/TA.0000000000004595","DOIUrl":"10.1097/TA.0000000000004595","url":null,"abstract":"","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"e18"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382731","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":"MEETINGS/COURSES.","authors":"","doi":"10.1097/01.ta.0001111788.57696.b7","DOIUrl":"10.1097/01.ta.0001111788.57696.b7","url":null,"abstract":"","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":"98 5","pages":"830"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027452","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":"Teasing out factors differentiating pathologic from benign pneumatosis intestinalis.","authors":"Julia Song, Biqi Zhang, David Mahvi, Mahsa Shariat, Manuel Castillo-Angeles, Tanujit Dey, Reza Askari","doi":"10.1097/TA.0000000000004548","DOIUrl":"10.1097/TA.0000000000004548","url":null,"abstract":"<p><strong>Background: </strong>Pneumatosis intestinalis (PI) is a rare radiographic finding that can range from being a benign process to needing emergency surgery. Sufficiently powered studies are lacking, and recommendations for management remain unclear. The purpose of this study was to identify key predictors of pathologic PI using physical examination, laboratory, and radiographic findings.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted at two quaternary academic centers (2010-2020). A total of 334 consecutive patients 18 years or older with radiographic evidence of PI were identified. Patients were excluded if they pursued comfort care or if there was concurrent radiographic evidence of vaso-occlusive process. Pathologic PI was defined as presence of ischemic and/or perforated bowel on exploratory laparotomy or death prior to planned surgery.</p><p><strong>Results: </strong>Of the 334 patients included in our study, 91 (27%) underwent exploratory laparotomy, of which 59 (65%) had ischemic and/or perforated bowel. These latter patients and 10 other patients who died before exploratory laparotomy defined the pathologic PI cohort. A stepwise model was created for predicting pathologic disease. Significant predictors were the presence of portal venous gas, multisegment PI, vasopressor use, peritonitis, increasing leukocyte count, and end organ injury, which were used to construct a nomogram for clinical use.</p><p><strong>Conclusion: </strong>A nomogram score based on presence of portal venous gas, multisegment PI, vasopressor use, peritonitis, leukocytosis, and end organ injury may help predict the probability of pathologic PI and therefore can inform surgical decision making.</p><p><strong>Level of evidence: </strong>Therapeutic/Care Management; Level III.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"806-815"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143408882","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 trauma awareness in health care: Insights from the AAST and Trauma Prevention Coalition Survey.","authors":"June Yao, Jeffry Nahmias, Glen Tinkoff, Deborah A Kuhls, Graal Diaz, Stephanie Bonne, Leah Tatebe, Alexis Moren, Kristen Carter, Christine Castater, Carlos Palacio-Lascano, Sue Prentiss, Thomas K Duncan","doi":"10.1097/TA.0000000000004546","DOIUrl":"10.1097/TA.0000000000004546","url":null,"abstract":"<p><strong>Background: </strong>Trauma-informed care (TIC) is a framework designed to understand and address the impacts of trauma, ensuring physical, psychological, and emotional safety for all involved. It seeks to prevent retraumatization and promote a sense of control and empowerment across diverse populations.</p><p><strong>Method: </strong>This Trauma Prevention Coalition survey study assessed TIC implementation among members from 13 of the 16 participating organizations, focusing on prevalence, awareness, and training gaps.</p><p><strong>Results: </strong>Out of 948 participants, 91% (n = 861) were affiliated with trauma centers. In adult trauma centers: 19.3% were from Level I, 9.4% from Level II, 5.4% from Level III, 3.1% from Level IV, and 1.2% from Level V. In addition, 1.2% were from nonadult trauma centers, and 2.5% worked in centers serving both adult and pediatric patients. In pediatric centers: 18.6% were from Level I, 13.0% from Level II, 1% from Level III, and 67.0% from nonpediatric centers. Trauma-informed care principles were integrated into the core values of 35.5% of trauma centers, while 64.5% had not adopted them. Only 17.0% had TIC training plans, with 57.7% lacking or unaware of such plans. Bivariate regression analysis indicated that TIC integration decreased for Level II, Level IV, and nontrauma centers compared with Level I adult trauma centers, but increased for Level III. In pediatric centers, TIC integration decreased for Level II, Level III, Level IV, and nontrauma centers compared with Level I. Pediatric trauma centers showed a higher TIC integration rate (71.6%) compared with adult centers (39.4%, p < 0.01).</p><p><strong>Conclusion: </strong>TIC adoption varies significantly across trauma center levels, with higher prevalence in pediatric and Level I centers. The study underscores the need for comprehensive TIC training within trauma care systems.</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":"729-733"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143408935","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":"PAD2 disturbs cardiomyocyte calcium homeostasis by citrullinating SERCA2a protein in hemorrhagic shock induced arrhythmia.","authors":"Lebin Gan, Rui Li, Qiang Wang, Jing Zhou, Mengwei Zhang, Minghong Leng, Junhui Zhao, Fenghe Yang, Shi Jia, Wei Huang, Jingjing Ye, Ming Zheng, Tianbing Wang","doi":"10.1097/TA.0000000000004644","DOIUrl":"https://doi.org/10.1097/TA.0000000000004644","url":null,"abstract":"<p><strong>Background: </strong>Malignant arrhythmia induced by traumatic hemorrhage is a leading cause of early mortality in hemorrhagic shock. Understanding the mechanisms driving these arrhythmias and identifying therapeutic targets are critical for improving early survival in patients with traumatic hemorrhagic shock.</p><p><strong>Methods: </strong>Peripheral blood samples from patients with hemorrhagic shock were collected and analyzed for peptidylarginine deiminase 2 (PAD2) protein levels using ELISA. Pad2 knockout mice (Pad2-/-, Pad2 KO) were generated, and the hemorrhagic shock model was constructed via femoral artery cannulation and bloodletting. Cardiomyocytes were isolated and contractility and calcium content were measured by confocal microscopy. PAD2 subcellular localization was assessed through immunofluorescence and Western blotting. Proteins interacting with PAD2 in cardiomyocytes were identified using co-immunoprecipitation followed by mass spectrometry (CoIP-MS). The effect of PAD2 on sarcoplasmic reticulum calcium-ATPase 2a (SERCA2a) activity and citrullination was evaluated through enzyme activity assays and protein citrullination detection. AAV9-PAD2 was injected into mice via tail vein to induce in vivo overexpression of PAD2 in the myocardium. The effects of PAD2 enzymatic activity mutations and a PAD2-specific inhibitor on survival rate and arrhythmia following hemorrhagic shock were assessed through intraperitoneal injection.</p><p><strong>Results: </strong>PAD2 protein levels were significantly elevated in the peripheral blood of patients with hemorrhagic shock. Pad2 knockout improved calcium homeostasis in the sarcoplasmic reticulum of cardiomyocytes and alleviated post-shock arrhythmia in mice. Following hypoxia, PAD2 exhibited increased colocalization with the sarcoplasmic reticulum. During hypoxia, PAD2 inhibited SERCA2a activity through citrullination. AAV9-mediated overexpression of PAD2 in cardiomyocytes worsened both survival rates and the incidence of ventricular arrhythmia following hemorrhagic shock in mice. Conversely, PAD2 enzymatic activity mutations and a PAD2-specific inhibitor improved survival rates and reduced arrhythmia after hemorrhagic shock.</p><p><strong>Conclusion: </strong>During myocardial hypoxia occurs in hemorrhagic shock, PAD2 reduces SERCA2a enzyme activity by citrullination, disrupting myocardial calcium homeostasis. Peptidylarginine deiminase 2 gene deficiency or inhibition improves ventricular arrhythmias and increases survival following hemorrhagic shock.</p><p><strong>Level of evidence: </strong>Original Research-basic sciences research; not applicable.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989571","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":"Efficient evacuation - enhanced survival: Insights from Gaza conflict trauma care.","authors":"Itay Fogel, Snir Balziano, Michal Tunik, Dan Prat, Ran Barzilay, Nehemia Greenstein","doi":"10.1097/TA.0000000000004531","DOIUrl":"10.1097/TA.0000000000004531","url":null,"abstract":"<p><strong>Background: </strong>Combat-related injuries have evolved in urban warfare because of close-contact engagements and high-energy blast injuries, with rapid medical evacuation improving survival rates. This study analyzes injury patterns and outcomes in the Gaza conflict, emphasizing the need to optimize trauma care protocols in modern combat environments, particularly because of the unique proximity of conflict zones to tertiary trauma centers.</p><p><strong>Methods: </strong>A retrospective study was conducted at a single center involving 189 patients evacuated by helicopter to a Level I tertiary trauma center. Subgroup analysis based on Injury Severity Scores was performed.</p><p><strong>Results: </strong>Shrapnel impacts were the leading cause of injuries (58.7%), followed by blast injuries (48.1%) and gunshot wounds (30.7%). Extremity injuries were most common (61.4%), with 46.3% of patients needing surgery within 24 hours, mainly orthopedic procedures (75.3%). The average hospital stay was 21.9 days. In-hospital mortality rate was 4.2% (two patients). Infections occurred in 17.9% of cases, with fungal infections at 8.9% and bacterial infections at 15.3%.</p><p><strong>Conclusion: </strong>In modern urban warfare, effective medical interventions play a crucial role in mitigating challenges. This study emphasizes the importance of rapid evacuation and advanced trauma management, reflected in low in-hospital mortality rates, highlighting the significance of timely interventions, personal protective equipment, specialized orthopedic trauma care, and robust infection control measures.</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":"798-805"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932222","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 initiation of rehabilitation therapies in children with severe traumatic brain injury: An algorithm based on expert panel recommendations.","authors":"Christian M Niedzwecki, Michelle L Seymour, Emily Hermes, Betsy Lewis, Kathryn DeMarco, Shari L Wade, Stacy Suskauer, Bindi Naik-Mathuria, Mary E Fallat","doi":"10.1097/TA.0000000000004490","DOIUrl":"10.1097/TA.0000000000004490","url":null,"abstract":"","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"824-829"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12036771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255855","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":"Early Venous Thromboembolism Prophylaxis in Brain Injury Guidelines 1 and Brain Injury Guidelines 2 Traumatic Brain Injury Patients: A 5-Year Analysis.","authors":"Sigfredo Villarin Ayala, Omar Hejazi, Mohammad Al Ma'ani, Adam Nelson, Muhammad Haris Khurshid, Collin Stewart, Francisco Castillo Diaz, Audrey L Spencer, Louis J Magnotti, Bellal Joseph","doi":"10.1097/TA.0000000000004647","DOIUrl":"https://doi.org/10.1097/TA.0000000000004647","url":null,"abstract":"<p><strong>Objectives: </strong>Brain Injury Guidelines (BIG) was developed to reduce hospitalization of patients with mild traumatic brain injury (TBI). Limited data on venous thromboembolism (VTE) prophylaxis for patients were categorized as BIG 1 and BIG 2 hospitalized for non-TBI-related trauma. The aim of this study is to assess safety of early VTE prophylaxis among BIG 1 and BIG 2 patients. We hypothesize that early VTE prophylaxis is safe.</p><p><strong>Methods: </strong>We performed retrospective analysis of 2017-2021 TBI database at our level 1 trauma center and included all adult trauma patients with TBI categorized as BIG 1 or BIG 2 who received thromboprophylaxis. Patients were stratified into EARLY (≤24 hours) and LATE (>24 hours) initiation of VTE prophylaxis. Outcomes were rates of repeat head computed tomography (RHCT) scan for neurological deterioration, mortality, deep vein thrombosis (DVT), and pulmonary embolism. Multivariable logistic regression was performed to identify independent effect of timing of VTE prophylaxis on outcomes.</p><p><strong>Results: </strong>A total of 634 met the inclusion criteria. The mean age was 42, 62% were males, the mean systolic blood pressure was 129 mm Hg, and the median ISS was 13. There were 393 patients in EARLY group. Only 20 patients underwent RHCT with no difference between the groups (p = 0.398), with no worsening from index head CT. EARLY group had lower incidence of DVT (EARLY: 1% vs. LATE: 5%, p = 0.020) but no difference in pulmonary embolism (p = 0.620) or mortality (p = 0.265). On multivariable regression analysis, early VTE prophylaxis was associated with reducing risk of DVT (adjusted odds ratio, 0.341; 95% confidence interval, 0.121-0.783; p = 0.043). However, it was not associated with RHCT (p = 0.219) or mortality (p = 0.653).</p><p><strong>Conclusion: </strong>Early thromboprophylaxis for BIG 1 or BIG 2 trauma patients is safe and associated with reducing DVT risk without increasing risk of ICH progression or mortality. Future studies are needed to validate thromboprophylaxis risk-benefit ratio among BIG 1 and BIG 2 patients.</p><p><strong>Level of evidence: </strong>Therapeutic/Care Management; Level III.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017375","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":"Selective nonoperative management of abdominal gunshot wounds: What you need to know.","authors":"Kazuhide Matsushima, Kenji Inaba","doi":"10.1097/TA.0000000000004535","DOIUrl":"10.1097/TA.0000000000004535","url":null,"abstract":"<p><strong>Abstract: </strong>Since the 1990s, there has been a slow but steady adoption of selective nonoperative management (SNOM) for abdominal gunshot wounds (GSW). Multiple studies have shown that SNOM is feasible and can be performed safely, even at trauma centers with low penetrating trauma volumes. The principles of SNOM for abdominal GSW consists of (1) careful patient selection, (2) diagnostic workup with CT, and (3) clinical observation. By implementing SNOM, the number of patients undergoing a nontherapeutic laparotomy can significantly be improved to less than 10%. Overall, approximately one third of patients with abdominal GSW can be managed nonoperatively. This review article provides a practical approach to the management of patients with an abdominal GSW.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":"675-680"},"PeriodicalIF":2.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801269","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}