Journal of Trauma and Acute Care Surgery最新文献

{"title":"Mechanism matters: Differential benefits of cold-stored whole blood for trauma resuscitation from a prospective multicenter study.","authors":"Joshua Dilday, Shea Gallagher, Kazuhide Matsushima, Morgan Schellenberg, Kenji Inaba, Joshua P Hazelton, John Oh, Jennifer Gurney, Matthew Martin","doi":"10.1097/TA.0000000000004353","DOIUrl":"10.1097/TA.0000000000004353","url":null,"abstract":"<p><strong>Background: </strong>Resuscitation with cold-stored low-titre whole blood (LTOWB) has increased despite the paucity of robust civilian data. Most studies are in predominately blunt trauma and lack analysis of specific subgroups or mechanism of injury. We sought to compare outcomes between patients receiving LTOWB versus balanced component therapy (BCT) after blunt (BL) and penetrating (PN) trauma.</p><p><strong>Methods: </strong>Secondary analysis of a prospective multicenter study of patients receiving either LTWOB-containing or BCT resuscitation was performed. Patients were grouped by mechanism of injury (BL vs. PN). A generalized estimated equations model using inverse probability of treatment weighting was employed. Primary outcome was mortality and secondary outcomes were acute kidney injury, venous thromboembolism, pulmonary complications, and bleeding complications. Additional analyses were performed on no-traumatic brain injury (TBI), severe torso injury, and LTOWB-only resuscitation patients.</p><p><strong>Results: </strong>There were 1,617 patients (BL 47% vs PN 54%) identified; 1,175 (73%) of which received LTOWB. PN trauma patients receiving LTOWB demonstrated improved survival compared to BCT (77% vs. 56%; p < 0.01). Interval survival was higher at 6 hours (95% vs. 88%), 12 hours (93% vs. 80%), and 24 hours (88% vs. 57%) (all p < 0.05). The survival benefit following LTOWB was also seen across PN non-TBI (83% vs. 52%), and severe torso injuries (75% vs. 43%) (all p < 0.05). After controlling for age, sex, injury severity, and trauma center, LTWOB was associated with decreased odds of death (odds ratio, 0.31, p < 0.05) in PN trauma. However, no difference in overall mortality was seen across the BL groups. Both PN and BL patients receiving LTOWB had more frequent acute kidney injury compared to BCT (19% vs. 7% and 12% vs 6%, respectively; p < 0.05).</p><p><strong>Conclusion: </strong>Low-titre whole blood resuscitation was independently associated with decreased mortality following PN trauma, but not BL trauma. Further analysis in BL trauma is required to identify subgroups that may demonstrate survival benefit.</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":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141065477","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":"Quantifying the benefit of whole blood on mortality in trauma patients requiring emergent laparotomy.","authors":"Daniel Lammers, Richard Betzold, John McClellan, Matthew Eckert, Jason Bingham, Parker Hu, Stuart Hurst, Emily Baird, Zain Hashmi, Jeffrey Kerby, Jan O Jansen, John B Holcomb","doi":"10.1097/TA.0000000000004382","DOIUrl":"10.1097/TA.0000000000004382","url":null,"abstract":"<p><strong>Background: </strong>Whole blood (WB) transfusions in trauma represent an increasingly utilized resuscitation strategy in trauma patients. Previous reports suggest a probable mortality benefit with incorporating WB into massive transfusion protocols. However, questions surrounding optimal WB practices persist. We sought to assess the association between the proportion of WB transfused during the initial resuscitative period and its impact on early mortality outcomes for traumatically injured patients.</p><p><strong>Methods: </strong>We performed a retrospective analysis of severely injured patients requiring emergent laparotomy and ≥3 units of red blood cell containing products (WB or packed red blood cells) within the first hour from an ACS Level I Trauma Center (2019-2022). Patients were evaluated based on the proportion of WB they received compared with packed red blood cells during their initial resuscitation (high ratio cohort ≥50% WB vs. low ratio cohort <50% WB). Multilevel Bayesian regression analyses were performed to calculate the posterior probabilities and risk ratios (RR) associated with a WB predominant resuscitation for early mortality outcomes.</p><p><strong>Results: </strong>Two hundred sixty-six patients were analyzed (81% male; mean age, 36 years; 61% penetrating injury; mean Injury Severity Score, 30). The mortality was 11% at 4 hours and 14% at 24 hours. The high ratio cohort demonstrated a 99% (RR, 0.12; 95% credible interval, 0.02-0.53) and 99% (RR, 0.22; 95% credible interval, 0.08-0.65) probability of decreased mortality at 4 hours and 24 hours, respectively, compared the low ratio cohort. There was a 94% and 88% probability of at least a 50% mortality relative risk reduction associated with the WB predominate strategy at 4 hours and 24 hours, respectively.</p><p><strong>Conclusion: </strong>Preferential transfusion of WB during the initial resuscitation demonstrated a 99% probability of being superior to component predominant resuscitations with regards to 4-hour and 24-hour mortality suggesting that WB predominant resuscitations may be superior for improving early mortality. Prospective, randomized trials should be sought.</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":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140851135","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":"Platelet releasates mitigate the endotheliopathy of trauma.","authors":"Lauren T Gallagher, Ian LaCroix, Alexander T Fields, Sanchayita Mitra, Amy Argabright, Angelo D'Alessandro, Christopher Erickson, Brenda Nunez-Garcia, Kimberly Herrera-Rodriguez, Yu Celine Chou, Benjamin W Stocker, Benjamin J Ramser, Otto Thielen, William Hallas, Christopher C Silliman, Lucy Z Kornblith, Mitchell J Cohen","doi":"10.1097/TA.0000000000004342","DOIUrl":"10.1097/TA.0000000000004342","url":null,"abstract":"<p><strong>Background: </strong>Platelets are well known for their roles in hemostasis, but they also play a key role in thromboinflammatory pathways by regulating endothelial health, stimulating angiogenesis, and mediating host defense through both contact dependent and independent signaling. When activated, platelets degranulate releasing multiple active substances. We hypothesized that the soluble environment formed by trauma platelet releasates (TPR) attenuates thromboinflammation via mitigation of trauma induced endothelial permeability and metabolomic reprogramming.</p><p><strong>Methods: </strong>Blood was collected from injured and healthy patients to generate platelet releasates and plasma in parallel. Permeability of endothelial cells when exposed to TPR and plasma (TP) was assessed via resistance measurement by electric cell-substrate impedance sensing (ECIS). Endothelial cells treated with TPR and TP were subjected to mass spectrometry-based metabolomics.</p><p><strong>Results: </strong>TP increased endothelial permeability, whereas TPR decreased endothelial permeability when compared with untreated cells. When TP and TPR were mixed ex vivo, TPR mitigated TP-induced permeability, with significant increase in AUC compared with TP alone. Metabolomics of TPR and TP demonstrated disrupted redox reactions and anti-inflammatory mechanisms.</p><p><strong>Conclusion: </strong>Trauma platelet releasates provide endothelial barrier protection against TP-induced endothelial permeability. Our findings highlight a potential beneficial action of activated platelets on the endothelium in injured patients through disrupted redox reactions and increased antioxidants. Our findings support that soluble signaling from platelet degranulation may mitigate the endotheliopathy of trauma. The clinical implications of this are that activated platelets may prove a promising therapeutic target in the complex integration of thrombosis, endotheliopathy, and inflammation in trauma.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11502277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141065481","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":"Current diagnosis and management of necrotizing soft tissue infections: What you need to know.","authors":"Erika K Bisgaard, Eileen M Bulger","doi":"10.1097/TA.0000000000004351","DOIUrl":"10.1097/TA.0000000000004351","url":null,"abstract":"<p><strong>Abstract: </strong>Necrotizing soft tissue infections are rare bacterial infections of the skin and soft tissues with a high morbidity and mortality rate, requiring prompt diagnosis and surgical intervention. These represent a spectrum of disease resulting in tissue necrosis that is rapidly progressive; however, they remain a diagnostic challenge because the average surgeon or emergency medicine provider may only see one or two over the course of their career. Diagnosis is largely clinical and based on subtle physical examination findings, physiologic instability, and laboratory derangements. Aids to diagnosis such as scoring systems and cross-sectional imaging may be used; however, the findings are not specific, so management should not be based on these alone. The most common cause of necrotizing soft tissue infection is polymicrobial infection; however, specific bacteria such as clostridial species, group A streptococcal, methicillin resistant Staphylococcus aureus , and aquatic bacteria may also be causative. Initial management includes broad spectrum antibiotics, fluid resuscitation for severe sepsis, and early aggressive surgical debridement. Often, these patients require multiple operative debridement to achieve source control, and a low threshold for repeat debridement should be maintained because these infections can progress rapidly. Once source control is achieved, patients may be left with extensive wounds requiring multidisciplinary care and wound management. Necrotizing infections have long been viewed based on mortality outcomes alone because of their rarity and severity. Over recent years, more reports have shown a decrease in the mortality rates from those previously reported, allowing for a focus on methods to improve morbidity of these infections.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140866433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prehospital tranexamic acid is associated with a survival benefit without an increase in complications: Results of two harmonized randomized clinical trials.","authors":"Michael Mazzei, Jack K Donohue, Martin Schreiber, Susan Rowell, Francis X Guyette, Bryan Cotton, Brian J Eastridge, Raminder Nirula, Gary A Vercruysse, Terence O'Keeffe, Bellal Joseph, Joshua B Brown, Matthew D Neal, Jason L Sperry","doi":"10.1097/TA.0000000000004315","DOIUrl":"10.1097/TA.0000000000004315","url":null,"abstract":"<p><strong>Introduction: </strong>Recent randomized clinical trials have demonstrated that prehospital tranexamic acid (TXA) administration following injury is safe and improves survival. However, the effect of prehospital TXA on adverse events, transfusion requirements, and any dose-response relationships require further elucidation.</p><p><strong>Methods: </strong>A secondary analysis was performed using harmonized data from two large, double-blinded, randomized prehospital TXA trials. Outcomes, including 28-day mortality, pertinent adverse events, and 24-hour red cell transfusion requirements, were compared between TXA and placebo groups. Regression analyses were used to determine the independent associations of TXA after adjusting for study enrollment, injury characteristics, and shock severity across a broad spectrum of injured patients. Dose-response relationships were similarly characterized based upon grams of prehospital TXA administered.</p><p><strong>Results: </strong>A total of 1,744 patients had data available for secondary analysis and were included in the current harmonized secondary analysis. The study cohort had an overall mortality of 11.2% and a median Injury Severity Score of 16 (interquartile range, 5-26). Tranexamic acid was independently associated with a lower risk of 28-day mortality (hazard ratio, 0.72; 95% confidence interval [CI], 0.54-0.96; p = 0.03). Prehospital TXA also demonstrated an independent 22% lower risk of mortality for every gram of prehospital TXA administered (hazard ratio, 0.78; 95% CI, 0.63-0.96; p = 0.02). Multivariable linear regression verified that patients who received TXA were independently associated with lower 24-hour red cell transfusion requirements ( β= - 0.31; 95% CI, -0.61 to -0.01; p = 0.04) with a dose-response relationship ( β= - 0.24; 95% CI, -0.45 to -0.02; p = 0.03). There was no independent association of prehospital TXA administration on thromboembolism, seizure, or stroke.</p><p><strong>Conclusion: </strong>In this secondary analysis of harmonized data from two large randomized interventional trials, prehospital TXA administration across a broad spectrum of injured patients is safe. Prehospital TXA is associated with a significant 28-day survival benefit and lower red cell transfusion requirements at 24 hours and demonstrates a dose-response relationship.</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":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11422517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140207161","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":"Does preperitoneal packing increase venous thromboembolim risk among trauma patients? A prospective multicenter analysis across 17 level I trauma centers.","authors":"Lisa Marie Knowlton, Angela Sauaia, Ernest E Moore, M Margaret Knudson","doi":"10.1097/TA.0000000000004416","DOIUrl":"10.1097/TA.0000000000004416","url":null,"abstract":"<p><strong>Introduction: </strong>Pelvic fractures are associated with a high risk of venous thromboembolism (VTE). Among treatment options, including pelvic angioembolization (PA), preperitoneal pelvic packing (PPP), and pelvic open reduction internal fixation (ORIF), PPP has been postulated as a VTE risk factor. We aimed to characterize the risk of VTE among pelvic fracture patients receiving PPP, PA or ORIF.</p><p><strong>Methods: </strong>We used observational data from a 17-site Consortium of Leaders in the Study of Traumatic Thromboembolism (CLOTT) study group, a US level I trauma center collaborative working to identify factors associated with posttraumatic VTE, deep venous thrombosis, pulmonary embolism, or pulmonary thrombosis. The CLOTT criteria included age 18 to 40 years with at least one independent VTE risk factor. We compared outcomes of PPP, PA, and pelvic ORIF to reference of no pelvic intervention. Our primary outcome was VTE. A competing risk analysis was performed.</p><p><strong>Results: </strong>Among 1,387 pelvic fracture patients, VTE incidence was 5.6%. The ORIF patients were most likely to develop VTE (24.7%), while VTE incidence for PPP was 9.0% and 2.6% for PA. After multivariate, risk-competing analysis, none of the three treatment interventions for pelvic fractures were significantly associated with VTE. Initiation of VTE prophylaxis in the first 24 hours of admission independently halved VTE incidence (hazard ratio, 0.55; confidence interval, 0.33-0.91).</p><p><strong>Conclusion: </strong>Pelvic fracture interventions do not appear to be independent risk factors for VTE in our study. Initiation of VTE pharmacoprophylaxis within the first 24 hours of admission remains critical to significantly decreasing VTE formation in this high-risk population.</p><p><strong>Level of evidence: </strong>Therapeutic Study; Level III.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141759522","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":"Does early transfusion of cold-stored whole blood reduce the need for component therapy in civilian trauma patients? A systematic review.","authors":"Mohamad Risha, Abdullah Alotaibi, Shane Smith, Fran Priestap, Alla Iansavitchene, Colin Laverty, Rich Hilsden, Andrew Beckett, David Spurrell, Kelly Vogt, Ian Ball","doi":"10.1097/TA.0000000000004429","DOIUrl":"10.1097/TA.0000000000004429","url":null,"abstract":"<p><strong>Background: </strong>Civilian acute trauma care has advanced in recent decades; however, traumatic injury remains the leading cause of death in individuals aged 15 to 29 years in the United States and worldwide. Uncontrolled hemorrhage is the leading preventable cause of death in trauma patients, with up to half of these deaths occurring before reaching a medical facility. The timely application of hemorrhage control measures is critical to enhance the survivability of trauma patients and is one of the major challenges faced by medical providers in austere environments. The purpose of this review is to explore if early resuscitation with cold-stored whole blood therapy reduces the need for component therapy in the first 24 hours postinjury in the civilian population.</p><p><strong>Methods: </strong>Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we performed a systematic literature search in Medline, EMBASE, and Transfusion Evidence Library for studies reporting data on 24-hour blood product usage in trauma patients in hemorrhagic shock receiving initial therapy with whole blood. Two reviewers independently performed the selection of eligible studies.</p><p><strong>Results: </strong>Of a total of 2,150 identified studies, 11 studies (n = 4,792) met the inclusion criteria. There was heterogeneity in the study design, interventions, and outcomes. Seven studies reported a statistically significant decrease in 24-hour transfusion requirements in the whole blood intervention group in comparison with the control component therapy group. Three studies reported no significant difference between the two groups. One of the studies reported an increase in 24-hour transfusion requirements in the whole blood group.</p><p><strong>Conclusion: </strong>Overall, there appears to be a decrease in component therapy use following initial resuscitation with whole blood in trauma patients with hemorrhagic shock. However, further research is needed to address this important practical question (PROSPERO registration no. CRD42023422173).</p><p><strong>Level of evidence: </strong>Systematic Review; Level IV.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349166","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":"No benefit from the addition of low-dose ketamine infusion to standard evidence-based care of patients with multiple rib fractures.","authors":"Chad Macheel, Joseph Farhat, Jonathan Gipson, Peter Lindbloom, Michaela A West","doi":"10.1097/TA.0000000000004398","DOIUrl":"https://doi.org/10.1097/TA.0000000000004398","url":null,"abstract":"<p><strong>Background: </strong>Multiple rib fractures from blunt thoracic trauma cause significant morbidity. Optimal current management includes multimodal analgesia, pulmonary hygiene, and early mobilization. Low-dose ketamine infusion (LDKI) has been proposed as an adjunctive analgesic in this setting. A prior study reported decreased pain scores with LDKI in patients with multiple rib fractures. We hypothesized that LDKI would decrease morphine milligram equivalents (MMEs) in patients with multiple rib fractures.</p><p><strong>Methods: </strong>A prospective randomized placebo-controlled trial was performed in adult (18 years or older) patients with three or more rib fractures. A prestudy power analysis calculated an 80% chance of identifying a 15% decrease in MMEs with 50 subjects. The study was approved by the institutional review board and informed consent obtained in all subjects. Demographic (age, sex) and injury specific information (Injury Severity Score, number of rib fractures) were obtained. Subjects were randomized 1:1 to receive continuous LDKI (0.1 mg/kg/h) or placebo infusion (0.9% NaCl) for ≤48 hours. All patients received a standard evidence-based multidisciplinary protocol for rib fractures management. Primary outcome measure was MME use or pulmonary complications. Statistical comparison of LDKI versus placebo was performed using the Mann-Whitney U test.</p><p><strong>Results: </strong>All 50 enrolled subjects (placebo, 25; LDKI, 25) received study drug infusion. The two groups were well matched for age, Injury Severity Score, and number of rib fractures. We observed no differences in the Day 1 (p = 0.961), Day 2 (p = 0.373), or total MMEs (p = 0.946) between groups. Similar total MME use was observed when subjects who received ≥40 hours of study drug and were compared (p = 0.924). Use of LDKI did not alter subsequent need for opiate analgesics postinfusion, hospital length of stay, pulmonary complications, or need for readmission.</p><p><strong>Conclusion: </strong>The addition of LDKI to an established multimodal, evidence-based protocol for management of multiple rib fractures did not decrease opiate usage or impact pulmonary complications.</p><p><strong>Level of evidence: </strong>Therapeutic/Care Managaement; Level I.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502921","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":"The difficult airway in trauma: What you need to know.","authors":"Vadine Eugene, Jason Hutzler, James Kempema, James Bradford, Carlos V R Brown","doi":"10.1097/TA.0000000000004402","DOIUrl":"10.1097/TA.0000000000004402","url":null,"abstract":"<p><strong>Abstract: </strong>Airway evaluation and management are generally the first priority for treatment of trauma patients from the prehospital setting throughout their hospital stay. Delay in recognition of an airway problem, or inability to oxygenate or ventilate because of an inadequate airway, will lead to rapid death. Therefore, all clinicians involved in the care of trauma patients should have adequate knowledge of current best practices for airway evaluation and management. In addition, trauma providers should develop and maintain the skills needed to perform various airway maneuvers to establish and maintain an adequate airway. While elective airway management has the luxury of time for thorough airway evaluation, the airway management in the trauma setting does not allow this same opportunity. For this reason, all trauma airways should be presumed to be a difficult airway, and teams should prepare accordingly. This review will summarize the best practices for airway evaluation and management for trauma patients from the prehospital setting through the emergency department.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141076157","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 care and its financing around the world.","authors":"Tiffany E Chao, Kathryn Chu, Timothy C Hardcastle, Elmin Steyn, Christine Gaarder, Li Hsee, Yasuhiro Otomo, Felipe Vega-Rivera, Raul Coimbra, Kristan Staudenmayer","doi":"10.1097/TA.0000000000004448","DOIUrl":"10.1097/TA.0000000000004448","url":null,"abstract":"<p><strong>Abstract: </strong>Worldwide, one billion people sustain trauma, and 5 million people will die every year from their injuries. Countries must build trauma systems to effectively address this high-burden disease, but efforts are often challenged by financial constraints. Understanding mechanisms for trauma funding internationally can help to identify opportunities to address the burden of injuries. Trauma leaders from around the world contributed summaries around how trauma is managed across their respective continents. These were aggregated to create a comparison of worldwide trauma systems of care. The burden of injuries is high across the world's inhabited continents, but trauma systems remain underfunded worldwide and, as a result, are overall underdeveloped and do not rise to the levels required given the burden of disease. Some countries in Africa and Asia have invested in financing mechanisms such as road accident funds or trauma-specific funding. In Latin America, active surgeon involvement in accident prevention advocacy has made meaningful impact. All continents show progress in trauma system maturation. This article describes how different regions of the world organize and commit to trauma care financially. Overall, while trauma tends to be underfunded, there is evidence of change in many regions and good examples of what can happen when a country invests in building trauma systems.</p><p><strong>Level of evidence: </strong>Expert Opinions; Level VII.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349171","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}