Trauma Surgery & Acute Care Open最新文献

{"title":"Optimizing CT resource use in geriatric trauma: is less sometimes more?","authors":"Arnav Mahajan, Pooja Podugu, Vanessa P Ho","doi":"10.1136/tsaco-2025-001817","DOIUrl":"10.1136/tsaco-2025-001817","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 2","pages":"e001817"},"PeriodicalIF":2.1,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11967110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796464","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":"Leveraging existing infrastructure to answer clinically important questions in trauma: registry-based randomized clinical trials.","authors":"Mira Ghneim, Ben L Zarzaur, Patrick B Murphy","doi":"10.1136/tsaco-2025-001769","DOIUrl":"10.1136/tsaco-2025-001769","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001769"},"PeriodicalIF":2.1,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143773369","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":"How do I focus on mental health in a war zone? A challenge for young black men surviving gun violence.","authors":"Ashley Y Williams, Maryann I Mbaka, Antwan J Hogue","doi":"10.1136/tsaco-2025-001830","DOIUrl":"10.1136/tsaco-2025-001830","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001830"},"PeriodicalIF":2.1,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143773365","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":"Resuscitative Endovascular Balloon Occlusion of the Aorta in surgical and trauma patients: a systematic review, meta-analysis and practice management guideline from the Eastern Association for the Surgery of Trauma.","authors":"Melike N Harfouche, Nikolay Bugaev, John J Como, Douglas R Fraser, Allison G McNickle, Guy Golani, Benjamin P Johnson, Horacio Hojman, Hiba Abdel-Aziz, Jaswin S Sawhney, Daniel C Cullinane, Steven Lorch, Elliott R Haut, Nicole Fox, Laurence S Magder, George Kasotakis","doi":"10.1136/tsaco-2024-001730","DOIUrl":"10.1136/tsaco-2024-001730","url":null,"abstract":"<p><strong>Background: </strong>The role of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in the management of patients with subdiaphragmatic bleeding, as well as its utility in traumatic cardiac arrest (TCA), is unknown.</p><p><strong>Methods: </strong>A working group from the Eastern Association for the Surgery of Trauma (EAST) applied the Grading of Recommendations Assessment, Development and Evaluation methodology (GRADE) to perform a systematic review and meta-analysis, assess the level of evidence, and create recommendations pertaining to the use of REBOA in the management of trauma or non-trauma patients, as well as those in TCA (1946 to 2024).</p><p><strong>Results: </strong>Thirty-one studies were included in the meta-analysis. In unstable trauma patients with subdiaphragmatic bleeding, there was no significant difference in mortality among patients who were treated with REBOA vs no REBOA [OR 0.86, 95% CI 0.37, 2.04]. Subgroup analysis for individuals with pelvic fractures demonstrated higher mortality for REBOA vs no REBOA [OR=2.15, CI 1.35, 3.42]. In patients with TCA, pooled analysis demonstrated decreased mortality with REBOA vs resuscitative thoracotomy (OR 0.32, 95% CI 0.15, 0.69). Compared with no REBOA, prophylactic placement of REBOA prior to cesarean section in placenta accreta syndrome (PAS) had lower intra-operative blood loss [-1.06 L, CI -1.57 to -0.56] and red blood cell transfusion [-2.44 units, CI -4.27 to -0.62]. Overall, the level of evidence was assessed by the working group as very low.</p><p><strong>Conclusion: </strong>Considering the risks associated with its use and lack of discernible benefit, the committee conditionally recommends against the use of REBOA in trauma patients who are hemodynamically unstable due to suspected subdiaphragmatic hemorrhage. Further research is needed to identify specific subpopulations who may benefit. For individuals with TCA due to suspected subdiaphragmatic bleeding and for prophylactic placement in PAS, the committee conditionally recommends for the use of REBOA.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001730"},"PeriodicalIF":2.1,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754612","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":"Repairing a remote complication of abdominal penetrating trauma: diagnosis and management of a debilitating gastrocolic fistula.","authors":"Joy Obayemi, Peter Sienko, Aasma Hossain, Ryan Eton, Gary Vercruysse","doi":"10.1136/tsaco-2024-001620","DOIUrl":"10.1136/tsaco-2024-001620","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001620"},"PeriodicalIF":2.1,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754611","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":"Re-evaluation of cutting criteria for limb amputation using the Mangled Extremity Severity Score.","authors":"Ryosuke Omoto, Yutaka Umemura, Kensei Hanaoka, Yumika Yonao, Hiroki Kai, Kazuya Oi, Takaya Nishiura, Ayumi Nitta, Sung Ho Kim, Tomoki Yamada, Mitsuhiro Noborio, Satoshi Fujimi, Yasuaki Mizushima","doi":"10.1136/tsaco-2024-001694","DOIUrl":"10.1136/tsaco-2024-001694","url":null,"abstract":"<p><strong>Background: </strong>Decision-making regarding amputation in severe open extremity fractures is challenging. Various scoring systems, such as the Mangled Extremity Severity Score (MESS), have guided critical decisions for nearly three decades, yet no consensus or clear criteria have been established. The aim of this study is to identify predictive factors for amputation in open extremity fractures using MESS.</p><p><strong>Method: </strong>We retrospectively analyzed patients with open limb fractures classified as Gustilo-Anderson type 3B or 3C, treated between April 2013 and September 2024 at two tertiary hospitals in Osaka, Japan. We compared MESS values between patients who underwent limb preservation and those who required amputation at any time during hospitalization and performed receiver operating characteristic curve analysis to identify the optimal MESS cut-off value for predicting amputation.</p><p><strong>Results: </strong>The preservation and amputation groups comprised 36 and 18 patients, respectively. The mean (±SD) total MESS was significantly lower in the preservation group than that in the amputation group (5.7±1.5 vs 8.0±1.4; p≤0.001). MESS ≥7 demonstrated a sensitivity of 83% and a specificity of 78%, whereas MESS ≥8 showed increased specificity (92%) with slightly reduced sensitivity (78%). The area under the curve for MESS was 0.86, and for MESS ≥8, it was significantly higher than that for MESS ≥7 (p=0.020).</p><p><strong>Conclusion: </strong>Although MESS remains a valuable tool for decision-making in amputation, our findings suggest that a revised cut-off score of 8 may better reflect the current trauma management capabilities. This adjustment could enhance the predictive accuracy of MESS, facilitating more informed clinical decisions in severe limb trauma.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001694"},"PeriodicalIF":2.1,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754609","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":"Penetrating neck trauma: a comprehensive review.","authors":"Lindsey Loss, Reynold Henry, Anna White, Kazuhide Matsushima, Christopher Barrett, Daniel Lammers, Martin Schreiber, Kenji Inaba","doi":"10.1136/tsaco-2024-001619","DOIUrl":"10.1136/tsaco-2024-001619","url":null,"abstract":"<p><p>Although the overall incidence is low, penetrating neck trauma can result in devastating injuries. The traditional zonal approach is being increasingly abandoned in favor of selective approaches, especially as mandatory exploration can result in non-therapeutic interventions and associated complications. Additionally, the trajectory of the missile cannot be accurately assessed based on external wounds. Decision-making using the hard and soft signs of trauma and increased resolution of imaging modalities are progressively supplanting the older zonal approaches. Here we discuss the modern diagnostic approach, operative interventions, and the appropriateness of observation.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001619"},"PeriodicalIF":2.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754522","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":"Intracranial pressure monitoring in older adults with severe traumatic brain injury: questions remain unanswered.","authors":"Daniel L Horwitz, Mira H Ghneim","doi":"10.1136/tsaco-2025-001819","DOIUrl":"10.1136/tsaco-2025-001819","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001819"},"PeriodicalIF":2.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754444","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":"Acute care, acute conversations: palliative care needs in acute care surgery.","authors":"Mackenzie Cook, David Zonies","doi":"10.1136/tsaco-2025-001806","DOIUrl":"10.1136/tsaco-2025-001806","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001806"},"PeriodicalIF":2.1,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754437","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":"Crossing the chasm: engaging Black men survivors of gun violence in mental health services.","authors":"Erin Major, Celina Thomas, Charlotte Healy, Amy VanderStoep, Joseph B Richardson, Thomas M Scalea, Melike N Harfouche","doi":"10.1136/tsaco-2024-001560","DOIUrl":"10.1136/tsaco-2024-001560","url":null,"abstract":"<p><strong>Background: </strong>Despite being high risk for post-traumatic stress disorder, Black men survivors of gun violence, and particularly young men aged 18-24, seldom participate in mental health services after injury. The aim of this study was to identify barriers to participation in mental health services for this population.</p><p><strong>Methods: </strong>Over a 2-year period, 1 hour-long focus group was conducted with three counselors of the local hospital-based violence intervention program and 21 individual, semistructured in-depth interviews were held with Black men who were hospitalized for a firearm-related injury. All interviews were recorded and transcribed. Transcripts were coded using open coding and grounded theory methodology and ultimately grouped into themes using MAXQDA V.2022 software.</p><p><strong>Results: </strong>Median age of participants was 34 years (IQR=11). Barriers to participation revolved around competing priorities/stressors, expense, difficulty with trust and openness and the demands of street life. Motivating factors included cultural competence, persistence, availability, reliability and genuineness of the therapy staff. Most participants denied negative social stigma of therapy as a barrier but emphasized that the individual must value therapy to participate. Young, Black men were perceived as struggling with self and peer-imposed views of masculinity that conflicted with therapy participation.</p><p><strong>Conclusion: </strong>Black men who have experienced violent firearm injury face strong social pressures that conflict with participation in mental health services. Programs must be integrated with other social services and be responsive to community conditions to be successful.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001560"},"PeriodicalIF":2.1,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754441","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}