Journal of Trauma and Acute Care Surgery最新文献

{"title":"Western Trauma Association critical decisions in trauma: Damage-control resuscitation.","authors":"Chasen A Croft, Manuel Lorenzo, Raul Coimbra, Juan C Duchesne, Charles Fox, Jennifer Hartwell, John B Holcomb, Natasha Keric, Matthew J Martin, Gregory A Magee, Laura J Moore, Alicia R Privette, Morgan Schellenberg, Kevin M Schuster, Ronald Tesoriero, Jordan A Weinberg, Deborah M Stein","doi":"10.1097/TA.0000000000004466","DOIUrl":"https://doi.org/10.1097/TA.0000000000004466","url":null,"abstract":"","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":"98 2","pages":"271-276"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047192","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":"Penalizing underage alcohol use is associated with lower mortality for young drivers: Use/lose laws and their association with motor vehicle collision mortality.","authors":"Gi Jung Shin, Cheryl K Zogg, William Rice, Ruidi Xu, Manuel Castillo-Angeles, Sonal Swain, Suresh K Agarwal, Krista L Haines","doi":"10.1097/TA.0000000000004511","DOIUrl":"10.1097/TA.0000000000004511","url":null,"abstract":"<p><strong>Background: </strong>Motor vehicle collisions (MVC) continue to be a leading cause of mortality for youth in the United States. Since 2010, seven states have revoked mandatory laws that suspended licenses for underage alcohol use, also known as use/lose laws. This study analyzed whether each state's policy change was associated with increased youth MVC mortality.</p><p><strong>Methods: </strong>State mortality data for youth ages 15 years to 20 years in MVCs involving a young driver (i.e., ages 15-20 years) were obtained from the Fatality Analysis Reporting System. Population data was retrieved from the Centers for Disease Control and Prevention's Wide-ranging ONline Data for Epidemiologic Research. Motor vehicle collisions mortality rates were calculated for each state with a law change per 1,000,000 persons. For difference-in-difference analysis, each state's youth MVC mortality rates from 3 years prior to the law change were compared with rates from 3 years post-law changes, relative to a national average compiled of states with no law changes.</p><p><strong>Results: </strong>From 2010 to 2020, seven states revoked one or more of their mandatory use/lose laws. For all states, young driver MVC mortality rates significantly increased after removal of use/lose legislation (South Dakota: 5.4 excess deaths per million (EDPM), Indiana: 5.6 EDPM, Georgia 28.0 EDPM, Oregon: +41.9 EDPM, Pennsylvania: +10.4 EDPM, Delaware: +45.4 EDPM, Illinois +29.2 EDPM, all p < 0.001).</p><p><strong>Conclusion: </strong>Examining mortality rates at the state reveals a significant negative association between penalizing underage alcohol use and young driver MVC deaths. Future legislation and health outcomes analysis should consider state-level differences to retain and develop effective policies that reduce injury-related mortality.</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":"212-218"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895603","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":"Awaiting insurance coverage: Medicaid enrollment and post-acute care use after traumatic injury.","authors":"Diane N Haddad, Justin S Hatchimonji, Ella C Eisinger, Angela T Chen, Kristen M Chreiman, Omar I Ramadan, Anna U Morgan, M Kit Delgado, Niels D Martin, Mark J Seamon, Lisa M Knowlton, Elinore J Kaufman","doi":"10.1097/TA.0000000000004550","DOIUrl":"https://doi.org/10.1097/TA.0000000000004550","url":null,"abstract":"<p><strong>Background: </strong>Lack of insurance after traumatic injury is associated with decreased use of postacute care and poor outcomes. Insurance linkage programs enroll eligible patients in Medicaid at the time of an unplanned admission. We hypothesized that Medicaid enrollment would be associated with increased use of postacute care, but also with prolonged hospital length of stay (LOS) while awaiting insurance authorization.</p><p><strong>Methods: </strong>We linked trauma registry and EMR data to identify patients ages 18 years to 64 years admitted from 2017 to 2021 to a Level I trauma center. Patients admitted without insurance and retroactively insured (RI) during hospitalization were compared with patients with established Medicaid (MI) and those remaining uninsured (UI). We measured postacute care use including home health care, rehabilitation, and skilled nursing facilities. We tested the association between insurance status and discharge disposition and LOS (primary outcome) using multivariable negative binomial regression. Direct costs were compared between groups.</p><p><strong>Results: </strong>We compared 494 RI patients to 1706 MI and 148 UI patients. Retroactively insured patients had longer hospitalization (median LOS [interquartile range], 4 days [2-9 days]) than other groups (MI, 4 [2-8] and UI 2 [1-3]), p < 0.001). Retroactively insured patients were more likely to be discharged with home health care and to inpatient rehabilitation than UI patients (p < 0.001). After adjusting for injury and management characteristics, RI was associated with longer LOS compared with MI for patients discharged to inpatient facilities (p < 0.001). Median costs for RI patients discharged to a facility were $10,284 higher than MI patients, ranging from $8,582 for Injury Severity Score <9 to $51,883 for Injury Severity Score ≥25.</p><p><strong>Conclusion: </strong>Enrollment in Medicaid after traumatic injury is associated with postacute care use, but the current enrollment process may delay discharge. Streamlining insurance enrollment and permitting discharge with pending application status could reduce unnecessary hospital days, saving costs and improving improve patient experience.</p><p><strong>Level of evidence: </strong>Prognostic/Epidemiological; Level IV.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066429","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":"https://doi.org/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":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-30","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":"The Journal of Trauma and Acute Care Surgery Biostatistical Reviews.","authors":"Raul Coimbra","doi":"10.1097/TA.0000000000004573","DOIUrl":"https://doi.org/10.1097/TA.0000000000004573","url":null,"abstract":"","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059500","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":"Utility of Computed Tomography Angiography of the Head in the Management of the Blunt Trauma Patient with Intracranial Hemorrhage.","authors":"Emily Winifred Rady, Bhairav Shah, Katrina Wierzbicki, Nathaniel Kenworthy, Michael Lieber, Michal Radomksi","doi":"10.1097/TA.0000000000004563","DOIUrl":"https://doi.org/10.1097/TA.0000000000004563","url":null,"abstract":"<p><strong>Background: </strong>Computed tomography angiography of the head (CTAH) is not routinely obtained during the initial evaluation of patients with traumatic intracranial hemorrhage (ICH); however, it is useful for diagnosing vascular pathologies that may have led to the bleed. The aims of this study were to identify traumatic ICH patient characteristics on presentation that are associated with positive CTAH findings to elucidate which ones should prompt a CTAH and compare outcomes of patients with positive and negative CTAH findings.</p><p><strong>Methods: </strong>This is a retrospective cohort study of 522 patients who had blunt traumatic ICH and subsequently received CTAH between January 1, 2017, and January 1, 2022. Patients were then sorted into two cohorts: positive and negative CTAH findings. The CTAH findings were our primary outcomes and included a spectrum of traumatic vascular injuries as well as nontraumatic vascular pathologies. Secondary outcomes included mortality, intensive care unit admission, intensive care unit length of stay, and neurological intervention rates.</p><p><strong>Results: </strong>A total of 108 patients (20.7%) had positive CTAH findings. Patients with positive CTAH findings were more likely to be older, have lower heart rate, have more neurological deficits at admission, have fewer signs of external injury, and have increased need for cerebral angiogram and neuro-embolization. Patients with no pathologic CTAH findings were 3.9 times more likely to be alive at discharge. Initial heart rate and presence of neurological deficits on arrival were found to be independent predictors of positive CTAH findings.</p><p><strong>Conclusion: </strong>Empiric CTAH is not necessary in all traumatic ICH patients. However, given the increased rates of neurologic procedures and mortality in patients with positive findings on CTAH, we recommend obtaining CTAH in blunt traumatic ICH patients who present with neurological deficits. The presence of external injuries alone should not influence the clinician's decision to obtain a CTAH.</p><p><strong>Level of evidence: </strong>Prognostic and Epidemiological; Level III.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059502","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 diagnosis and management of acute traumatic diaphragmatic injury: A Western Trauma Association clinical decisions algorithm.","authors":"Morgan Schellenberg, Raul Coimbra, Chasen A Croft, Charles Fox, Jennifer Hartwell, Natasha Keric, Manuel Lorenzo, Matthew J Martin, Gregory A Magee, Laura J Moore, Alica R Privette, Kevin M Schuster, Ronald Tesoriero, Jordan A Weinberg, Deborah M Stein","doi":"10.1097/TA.0000000000004554","DOIUrl":"https://doi.org/10.1097/TA.0000000000004554","url":null,"abstract":"","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059563","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 achievement of hemostasis defined by transfusion velocity: A possible mechanism for whole blood survival benefit.","authors":"Amanda M Chipman, James F Luther, Francis X Guyette, Bryan A Cotton, Jeremy W Cannon, Martin A Schreiber, Ernest E Moore, Nicholas Namias, Joseph P Minei, Mark H Yazer, Laura Vincent, Abigail L Cotton, Vikas Agarwal, Joshua B Brown, Christine M Leeper, Matthew D Neal, Raquel M Forsythe, Stephen R Wisniewski, Jason L Sperry","doi":"10.1097/TA.0000000000004507","DOIUrl":"https://doi.org/10.1097/TA.0000000000004507","url":null,"abstract":"<p><strong>Introduction: </strong>Whole blood resuscitation is associated with survival benefits in observational cohort studies. The mechanisms responsible for outcome benefits have not been adequately determined. We sought to characterize the achievement of hemostasis across patients receiving early whole blood versus component resuscitation. We hypothesized that achieving hemostasis would be associated with outcome benefits and patients receiving whole blood would be more likely to achieve hemostasis.</p><p><strong>Methods: </strong>We performed a post hoc retrospective secondary analysis of data from a recent prospective observational cohort study comparing early whole blood and component resuscitation in patients at risk of hemorrhagic shock. Achievement of hemostasis was defined by receiving a single unit of blood or less, including whole blood or red cells, in any 60-minute period, over the first 4 hours from the time of arrival. Time-to-event analysis with log-rank comparison and regression modeling were used to determine the independent benefits of achieving hemostasis and whether achieving hemostasis was associated with whole blood resuscitation.</p><p><strong>Results: </strong>For the current analysis, 1,047 patients met the inclusion criteria for the study. When we compared patients who achieved hemostasis versus those who did not, achievement of hemostasis had significantly more hemostatic coagulation parameters, had lower transfusion requirements, and was independently associated with 4-hour, 24-hour and 28-day survival. Whole blood patients were significantly more likely to achieve hemostasis (88.9% vs. 81.1%, p < 0.001). Whole blood patients achieved hemostasis earlier (log-rank χ2 = 8.2, p < 0.01) and were independently associated with over twofold greater odds of achieving hemostasis (odds ratio, 2.4; 95% confidence interval, 1.6-3.7; p < 0.001).</p><p><strong>Conclusion: </strong>Achievement of hemostasis is associated with significant outcome benefits. Early whole blood resuscitation is associated with a greater independent odds of achieving hemostasis and at an earlier time point. Reaching a nadir transfusion rate early following injury represents a possible mechanism of whole blood resuscitation and its attributable outcome benefits.</p><p><strong>Level of evidence: </strong>Secondary Analysis; Level III.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047186","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":"Wealth is health: High economic status in Cameroon correlates with protective gear use in traffic injuries and improved clinical outcomes.","authors":"Fanny N Dissak Delon, Mark T Yost, Arole Darwin Touko, Roland Mfondoum, Rasheedat Oke, S Ariane Christie, Alain Chichom-Mefire, Alan Hubbard, Catherine Juillard","doi":"10.1097/TA.0000000000004515","DOIUrl":"https://doi.org/10.1097/TA.0000000000004515","url":null,"abstract":"<p><strong>Introduction: </strong>Africa is the least motorized populated continent, yet it experiences the highest traffic fatality rate. Despite laws mandating helmet and seatbelt use, data on protective gear use among Cameroonian road traffic injury (RTI) patients remains sparse.</p><p><strong>Methods: </strong>We extracted Cameroon Trauma Registry data prospectively collected from 10 hospitals during July 2022 to December 2023. Protective gear users wore helmets in motorcycle and seatbelts/car seats in vehicle crashes. We categorized patients into five economic clusters based on ownership of durable goods using parallel distance matrix computation. We analyzed associations between continuous variables with Wilcoxon rank-sum and categorical variables with χ2 and multivariate logistic regression. Our primary outcome was in-hospital death or major disability at discharge.</p><p><strong>Results: </strong>Among 3,554 RTI patients, 303 (9%) used protective gear. A larger proportion of patients who did not use protective gear were designated as majorly disabled or dead (20% vs. 16%, p < 0.001). The greatest percentage of protective gear users belonged to the richest cluster, while the poorest cluster patients comprised the smallest proportion of protective gear users (13% vs. 3%, p < 0.001). The richest cluster demonstrated the smallest percentage of major disability or death (13%), while the poorest cluster had the greatest percentage (28%, p < 0.001). When controlling for age, protective gear use, and injury severity, the three poorest clusters showed the greatest odds of major disability or death (cluster 3: adjusted odds ratio [AOR], 2.34; 95% confidence interval [CI], 1.58-3.46; cluster 4: AOR, 2.09; 95% CI, 1.59-2.74; cluster 5: AOR, 2.38; 95% CI, 1.24-4.58).</p><p><strong>Conclusion: </strong>Greater economic status is associated with increased protective gear use during RTIs in Cameroon. Despite suffering the most severe outcomes, the poorest patients remain less likely to use protective gear. Enforcement of protective gear laws and economic incentives such as price subsidies for helmets and seatbelts would particularly benefit the most vulnerable population.</p><p><strong>Level of evidence: </strong>Retrospective Comparative Study; Level IV.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023874","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":"Kidney organ injury scaling: 2025 update.","authors":"Sorena Keihani, Gail T Tominaga, Rano Matta, Joel A Gross, Chris Cribari, Krista L Kaups, Marie Crandall, Rosemary A Kozar, Nicole L Werner, Ben L Zarzaur, Michael Coburn, Jeremy B Myers","doi":"10.1097/TA.0000000000004509","DOIUrl":"https://doi.org/10.1097/TA.0000000000004509","url":null,"abstract":"<p><strong>Abstract: </strong>The American Association for the Surgery of Trauma initially published the organ injury scaling for the kidney in 1989, which was subsequently updated in 2018. This current American Association for the Surgery of Trauma kidney organ injury scaling update incorporates the latest evidence in diagnosis and management of renal trauma and is based upon a multidisciplinary consensus. These changes reflect the near universal use of computed tomography for renal trauma evaluation and the widespread adoption of conservative management across all grades of renal trauma.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007399","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}