Trauma Surgery & Acute Care Open最新文献

{"title":"Unpacking the sepsis controversy.","authors":"John Alverdy","doi":"10.1136/tsaco-2024-001733","DOIUrl":"10.1136/tsaco-2024-001733","url":null,"abstract":"<p><p>Despite its many definitions and revisions, consensus statements and clinical guidelines, the term 'sepsis' continues to be referred to as a discrete clinical entity that is often claimed to be a direct cause of mortality. The assertion that sepsis can be defined as a 'life-threatening organ dysfunction caused by a dysregulated host response to infection,' has led to a field dominated by failed clinical trials informed by host-centered, pathogen-agnostic, animal experiments in which animal models do not recapitulate the clinical condition. The observations from the National Health Service from England that claim that 77.5% of sepsis deaths occur in those aged 75 years or older and those from the USA indicating that most patients dying <i>of</i> sepsis have also been diagnosed with 'hospice qualifying conditions,' seem to refute the assertion that sepsis is caused by, rather than associated with, a 'dysregulated host response.' This piece challenges the current conceptual framework that forms the basis of the sepsis definition. Here we posit that as a result of both its definition and the use of inappropriate animal models, ineffective clinical treatments continue to be pursued in this field.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001733"},"PeriodicalIF":2.1,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11881180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Looking toward a career in acute care surgery with a heart centered on service.","authors":"Michael S Rallo","doi":"10.1136/tsaco-2025-001766","DOIUrl":"https://doi.org/10.1136/tsaco-2025-001766","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001766"},"PeriodicalIF":2.1,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of a traumatic splenic injury in the setting of polysubstance use and challenging social factors.","authors":"Carlie J Arbaugh, Annika Brakebill, David A Spain, Lisa Marie Knowlton","doi":"10.1136/tsaco-2024-001680","DOIUrl":"10.1136/tsaco-2024-001680","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001680"},"PeriodicalIF":2.1,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trauma video review: how long do we curb our enthusiasm?","authors":"Madhu Subramanian, Jeff Jopling","doi":"10.1136/tsaco-2024-001741","DOIUrl":"10.1136/tsaco-2024-001741","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001741"},"PeriodicalIF":2.1,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11848654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing trauma laparotomy outcomes: the role of Enhanced Recovery After Surgery protocols in reducing hospital length of stay.","authors":"Amit Gupta, Vijayan Purushothaman, Joses Dany James","doi":"10.1136/tsaco-2025-001772","DOIUrl":"10.1136/tsaco-2025-001772","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001772"},"PeriodicalIF":2.1,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are electric scooters a lost cause?","authors":"Hee Soo Jung, Rakesh Kumar","doi":"10.1136/tsaco-2025-001776","DOIUrl":"10.1136/tsaco-2025-001776","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001776"},"PeriodicalIF":2.1,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigating the timing of catheter removal after traumatic bladder injury: a single-institution 12-year experience.","authors":"Danielle J Wilson, Isaac Melin, Nayan Shah, R Corey O'Connor, Thomas Carver","doi":"10.1136/tsaco-2024-001693","DOIUrl":"10.1136/tsaco-2024-001693","url":null,"abstract":"<p><strong>Abstract: </strong></p><p><strong>Introduction: </strong>Traumatic bladder injuries, although rare, may result in significant patient morbidity. Operative management is recommended for intraperitoneal (IP), mixed, and select extraperitoneal (EP) injuries. Current guidelines lack recommendations on catheter duration following operative repair and suggest follow-up cystography may be unnecessary for simple, repaired injuries. This has led to practice variation in postoperative management at our institution. We hypothesized that the trauma surgery service would have a shorter catheter duration and obtain fewer follow-up cystograms compared with the urology service, without increased complications.</p><p><strong>Methods: </strong>A retrospective review was conducted at a single level 1 trauma center between January 2010 and December 2022. All patients with traumatic bladder injuries during this period were included from the trauma registry. Those who were <18 years of age, lacked a full-thickness injury, died within 7 days of presentation, had a concomitant urethral injury or complex injury, did not undergo surgical repair, were lost to follow-up, underwent surgical management elsewhere, or had an iatrogenic injury were excluded. Data on patient demographics, management, and complications were recorded. Injuries were classified as complex when involving the trigone, ureters, or bladder neck, or were described as complex in the operative report.</p><p><strong>Results: </strong>Of the 178 patients identified, 86 met the inclusion criteria. IP injuries were most common (43%), followed by EP (31%), and mixed (26%). Patient outcomes following the repair of simple injuries were similar regardless of the team performing the repair, although differences in catheter duration (11 days vs 17 days, p=0.006) and use of postoperative cystography (77% vs 100%, p<0.001) were observed (trauma vs urology, respectively).</p><p><strong>Conclusion: </strong>Variations in postoperative management regarding catheter drainage and follow-up imaging for simple bladder repairs resulted in similar leak and complication rates. Our findings present an opportunity to reduce the duration of postoperative catheter drainage and cystography use in simple repairs.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001693"},"PeriodicalIF":2.1,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11840895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Critical considerations to facilitate multidisciplinary care for survivors of firearm injury.","authors":"Virginia McCarthy, Catherine Garrison Velopulos, Quintin W O Myers","doi":"10.1136/tsaco-2024-001723","DOIUrl":"10.1136/tsaco-2024-001723","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001723"},"PeriodicalIF":2.1,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Handoffs and transitions of care in the intensive care unit: an American Association for the Surgery of Trauma Critical Care Committee clinical consensus document.","authors":"Rachel D Appelbaum, Michael S Farrell, J Jason Hoth, Hee Soo Jung, Abhijit Pathak, Aussama K Nassar, Joseph Cuschieri, Deborah M Stein, John V Agapian","doi":"10.1136/tsaco-2024-001677","DOIUrl":"10.1136/tsaco-2024-001677","url":null,"abstract":"<p><strong>Abstract: </strong></p><p><strong>Objectives: </strong>The American Association for the Surgery of Trauma (AAST) Critical Care Committee chose handoffs and transitions of care in the intensive care unit (ICU) as a clinically relevant topic for review. This clinical consensus document aims to provide practical guidance to the surgical intensivist on the best practices for patient handoffs and transitions of care.</p><p><strong>Methods: </strong>A working group was formed from the committee-at-large to complete this work. The members of the working group were each assigned a subtopic to review using research to date. The research on which the recommendations are based was compiled at the discretion of the working group. Any topic with discrepant or minimal supporting literature was reviewed by the AAST Critical Care Committee through an anonymous survey.</p><p><strong>Results: </strong>Recommendations for healthcare handovers include formally recognized handoffs at dedicated times, an interactive verbal exchange including all patients with a focus on what to anticipate or what is needs to be completed, tools to record and maintain information, and training to new providers on the handoff process and technology.</p><p><strong>Conclusion: </strong>As clinicians, we strive to provide the best evidence-based care to our patients. It is essential to study these high states, ICU handoffs to enhance the safety, efficiency, and effectiveness of patient care transitions, ultimately leading to better patient outcomes and provider satisfaction.</p><p><strong>Level of evidence: </strong>V.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001677"},"PeriodicalIF":2.1,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Break the cycle Baltimore: proceedings from a summit to unite violence prevention stakeholders.","authors":"Emily Kemper, Matthew Price, Melissa Hirsch, Insia Zufer, Kathleen Wagner-Kosmakos, Madhu Subramanian, Joseph Sakran, Nathan Irvin, Katherine Hoops","doi":"10.1136/tsaco-2024-001518","DOIUrl":"10.1136/tsaco-2024-001518","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001518"},"PeriodicalIF":2.1,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}