Trauma Surgery & Acute Care Open最新文献

{"title":"Identifying those at risk: predicting patient factors associated with worse EGS outcomes.","authors":"Komal Abdul Rahim, Namra Qadeer Shaikh, Maryam Pyar Ali Lakhdir, Asma Altaf Hussain Merchant, Noreen Afzal, Saad Bin Zafar Mahmood, Saqib Kamran Bakhshi, Mushyada Ali, Zainab Samad, Adil H Haider","doi":"10.1136/tsaco-2024-001690","DOIUrl":"10.1136/tsaco-2024-001690","url":null,"abstract":"<p><strong>Background: </strong>Comorbidity has a detrimental impact on Emergency General Surgery (EGS) outcomes. In lesser-developed countries with inconsistent documentation of comorbid conditions, undiagnosed and progressively worsening comorbidities can worsen EGS outcomes. We aimed to discern the comorbidity index as a predictor of complications and inpatient mortality in EGS using a large South Asian sample population.</p><p><strong>Materials and methods: </strong>Data of adult patients with AAST-defined EGS diagnoses at primary index admission from 2010 to 2019 were retrieved. Patients were categorized into predefined EGS groups using ICD-9 CM codes. Primary exposure was comorbidity using the Charlson Comorbidity Index (CCI). The primary outcome was inpatient mortality, and the secondary outcome was complication status. Multiple logistic and Cox regression with Weibull distribution was performed.</p><p><strong>Results: </strong>Analysis of 32 280 patients showed a mean age of 40.06±16.87 years. Overall comorbidity, inpatient mortality, and complication rates were 44.6%, 2.42% and 36.37%, respectively. Patients with moderate CCI had the highest complications (AOR 6.61, 95% CI 5.91, 7.37), and severe comorbidity had the highest hazards (AOR 3.79, 95% CI 2.89, 4.98). Male gender, increasing age, emergent admission status, and lack of insurance were associated with moderate and severe CCI, resulting in prolonged length of stay (5.72 and 5.83 days), reduced survival time (20.04 and 21.95 days), and higher mortality rates (10.52% and 9.48%).</p><p><strong>Conclusions: </strong>We identified predictive patient-level factors associated with higher CCI and worse EGS outcomes. Our findings can help stratify population subsets at risk of worse outcomes, provide valuable insight into disease progression, and aid decision-making in EGS patients.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 2","pages":"e001690"},"PeriodicalIF":2.1,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12121602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180279","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":"Is fixation of a single end of flail segment rib fractures enough?","authors":"Anthony Perugini, James Iandoli, Nicholas Pelz, Daniel DeGenova, Anthony Melaragno, Mallory Faherty, Benjamin C Taylor","doi":"10.1136/tsaco-2024-001707","DOIUrl":"10.1136/tsaco-2024-001707","url":null,"abstract":"<p><strong>Background: </strong>Segmental rib fractures in blunt thoracic trauma present with increased morbidity and mortality with an association of increased pulmonary insult and concomitant injuries. There is a paucity within the literature regarding the necessity of fixation of one or both segments of rib fractures in a flail chest. This study aimed to analyze surgical rib fixation and assess outcomes for non-fixed fractured rib ends in segmental rib fractures.</p><p><strong>Methods: </strong>This is a retrospective review of 125 patients who underwent open reduction internal fixation of flail segmental rib fractures at our urban Level 1 trauma center. Initial plain films and CT were compared with follow-up plain film imaging at 3 months to assess radiographic outcomes, fracture healing, fixation failure, or residual deformity. Clinical outcomes such as length of intensive care unit (ICU) stay, length of ventilatory support, associated pneumonia, duration until chest tube removal, and need for additional rib surgery were analyzed.</p><p><strong>Results: </strong>Fixation of a single end of segmental rib fractures and flail segments was associated with decreased incidence of fracture union at 3 months postoperatively (43/55 vs 65/70, respectively; p=0.018) but failed to show any difference in fracture collapse (50/55 vs 67/70, respectively; p=0.223). There were no differences between postoperative ICU length of stay (4.18±5.54 vs 4.62±4.48 days, respectively; p=0.690), postoperative ventilatory status (29/55 vs 38/70, respectively; p=0.840), duration of ventilatory support (3.52±4.69 vs 4.34±5.87, respectively; p=0.430), or associated pneumonia (7/55 vs 8/70, respectively; p=0.770).</p><p><strong>Conclusions: </strong>These data support that fixation of both sides of flail segment rib fractures results in improved rib fracture union at 3 months postoperatively. However, fixation of both sides of flail segments does not appear to result in any difference in fracture collapse or clinical perioperative outcomes.</p><p><strong>Level of evidence: </strong>Therapeutic Level III.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 2","pages":"e001707"},"PeriodicalIF":2.1,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12121575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182866","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":"Bridging the gap: whole blood and plasma in prehospital hemorrhagic shock resuscitation.","authors":"Matthew J Levy, Donald H Jenkins, Frances X Guyette, John B Holcomb","doi":"10.1136/tsaco-2025-001828","DOIUrl":"10.1136/tsaco-2025-001828","url":null,"abstract":"<p><p>Life-threatening hemorrhage remains a leading cause of preventable trauma-related mortality. Prehospital blood product administration has shown promise in improving outcomes; however, widespread implementation of whole blood programs faces significant logistical and operational challenges. Plasma represents a practical alternative that warrants thorough examination. Contemporary evidence, specifically the landmark PAMPer trial and secondary analysis of the COMBAT trial, demonstrates that prehospital plasma administration reduces 30-day mortality by 9.8% in trauma patients at risk of hemorrhagic shock, particularly when transport times exceed 20 minute. Plasma's efficacy stems from a reduction in trauma-induced coagulopathy and endothelial glycocalyx damage. While liquid plasma has a limited shelf life, dried plasma offers extended storage capability at room temperature for up to 2 years, presenting a logistically favorable option for emergency medical service (EMS) systems. Costs vary significantly between formulations, ranging from US$40 to US$100 for liquid plasma to US$700 to US$1500 for dried plasma. However, consideration must be given to the short shelf-life of liquid plasma. Prehospital plasma, particularly dried plasma, represents an important advancement in trauma management and represents a viable alternative to crystalloid-only resuscitation where whole blood may not be available or feasible. Implementation success depends on regional deployment strategies, blood bank partnerships, funding, training, and community engagement. Future research should focus on optimizing plasma utilization and improving patient outcomes through clinical and implementation-science approaches for EMS systems for which whole blood may not be an option.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 2","pages":"e001828"},"PeriodicalIF":2.1,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12104949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151786","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":"Incidence of opportunities for improvement in trauma patient care: a retrospective registry-based study.","authors":"Kelvin Szolnoky, Elias Joneborg, Jonatan Attergrim, Hussein Albaaj, Lovisa Strömmer, Olof Brattström, Martin Jacobsson, Martin Gerdin Wärnberg","doi":"10.1136/tsaco-2024-001676","DOIUrl":"10.1136/tsaco-2024-001676","url":null,"abstract":"<p><strong>Introduction: </strong>Trauma is a leading cause of death in individuals aged 45 and younger, contributing significantly to the global disease burden. Local trauma quality improvement programs have been implemented to improve clinical practice and patient outcomes. Multidisciplinary peer reviews, included in quality improvement programs, aim to identify opportunities for improvement in trauma patient care and implement corrective measures. This study assesses the incidence and trends of these opportunities across clinically important trauma cohorts.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using data from the trauma registry at Karolinska University Hospital in Solna, Sweden, between 2017 and 2022. Patients screened for opportunities for improvement were categorized into common trauma cohorts. Logistic regression was used to analyze trends in the occurrence of opportunities for improvement over the years in each cohort. The relationship between opportunities for improvement and trauma cohorts was also assessed.</p><p><strong>Results: </strong>Out of 7192 patients included, 404 (6%) had at least one opportunity for improvement. A statistically significant decrease in opportunities for improvement per year was observed overall (OR 0.90; 95% CI 0.84 to 0.95). Significant decreases were identified in patients with blunt multisystem trauma without traumatic brain injury (TBI) (OR 0.82; 95% CI 0.72 to 0.93), isolated severe TBI (OR 0.61; 95% CI 0.41 to 0.91), and severe penetrating injuries (OR 0.68; 95% CI 0.50 to 0.92). The blunt multisystem with TBI cohort showed a non-significant increase. After adjusting for Injury Severity Score, only the blunt multisystem without TBI cohort remained significantly associated with opportunities for improvement (OR 1.69; 95% CI 1.24 to 2.31).</p><p><strong>Conclusion: </strong>The incidence of opportunities for improvement in trauma care showed a significant decrease, indicating that the current trauma quality improvement program at Karolinska University Hospital may be effective in reducing opportunities for improvement. Patients with blunt multisystem trauma without TBI were at higher risk for opportunities for improvement compared with other trauma cohorts.</p><p><strong>Level of evidence: </strong>Level IV: retrospective study with up to three negative criteria.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 2","pages":"e001676"},"PeriodicalIF":2.1,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128897","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":"Association between whole blood versus balanced component therapy and survival in isolated severe traumatic brain injury.","authors":"Shahin Mohseni, Maximilian Peter Forssten, Dhanisha Jayesh Trivedi, Andras Buki, Yang Cao, Ahmad Mohammad Ismail, Marcelo A F Ribeiro, Babak Sarani","doi":"10.1136/tsaco-2023-001312","DOIUrl":"10.1136/tsaco-2023-001312","url":null,"abstract":"<p><strong>Background: </strong>Whole blood transfusion (WBT) is associated with improved hemostasis and possibly mortality in patients with hemorrhagic shock after injury but there are no studies in patients with isolated severe traumatic brain injury (TBI). The objective of this investigation was to compare outcomes of balanced component therapy (BCT) versus WBT in patients with an isolated severe TBI.</p><p><strong>Methods: </strong>Adult patients (≥18 years) registered in the Trauma Quality Improvement Program (2016-2019) who suffered a blunt isolated severe TBI (head Abbreviated Injury Score ≥3 in the head and ≤1 in the remaining body regions) and who received a BCT (1-2:1 packed red blood cell (PRBC):fresh frozen plasma and 1-2:1 PRBC:platelets) or WBT were eligible for inclusion. Patients were matched, based on the transfusion received, using propensity score matching. The primary outcome of interest was in-hospital mortality.</p><p><strong>Results: </strong>A total of 217 patients received either WBT (n=82) or BCT (n=135). After propensity score matching, 50 matched pairs were analyzed. The rate of in-hospital mortality was significantly lower in the WBT compared with BCT group (43.1% vs 66.7%, p=0.025) corresponding to a relative risk (RR) reduction of 35% in in-hospital mortality (RR (CI 95%): 0.65 (0.43 to 0.97)). However, in subgroup analyses comparing those who were managed surgically and conservatively, this association only remained significant among patients who underwent neurosurgical intervention.</p><p><strong>Conclusions: </strong>WBT in patients with severe isolated TBI is associated with better survival compared with BCT in patients who require neurosurgical intervention. Further investigation into this finding using an appropriately powered, prospective study design is warranted.</p><p><strong>Level of evidence: </strong>Level III, therapeutic.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 2","pages":"e001312"},"PeriodicalIF":2.1,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12096991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128890","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":"Data-driven identification of urgent surgical procedures for use in trauma outcomes measurement.","authors":"Matthew Miller, Louisa Jorm, Blanca Gallego","doi":"10.1136/tsaco-2025-001783","DOIUrl":"10.1136/tsaco-2025-001783","url":null,"abstract":"<p><strong>Background: </strong>No standardized list of urgent-trauma-surgery exists for analysis in injury studies. If coded by a standard classification system, such a list could facilitate the standard evaluation and comparison of trauma systems. Solving this problem using Delphi methods or expert opinion incorporating all surgical specialties would be resource-intensive. Instead, we describe a flexible data-driven method for generating a list of urgent surgical procedures from routine administrative data.</p><p><strong>Methods: </strong>We linked perioperative and inpatient data for trauma patients with procedures booked within 24 hours of admission from a single Australian hospital (July 2018-July 2023). Surgical procedure codes were extracted where booked free-text and coded procedures matched. Procedures were labeled urgent-by-agreement if over 75% were needed within 4 hours, or urgent-by-consensus if 50-75% met this time frame with consensus below 0.7. Our method also allows adjustment for urgency time frame.</p><p><strong>Results: </strong>Of 567 unique procedures from 6,750 total in 4,737 trauma admissions, 161 were classified as urgent-by-agreement and 6 as urgent-by-consensus. 15 surgical specialties were represented on this list.</p><p><strong>Discussion and conclusions: </strong>Using routinely collected data, we outline a method for generating and updating urgent surgical procedure lists for trauma patients that could be applied at the institution level or across trauma networks. In addition, different urgency periods can be accommodated. Future work could look at further automating these processes by incorporating deep learning.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 2","pages":"e001783"},"PeriodicalIF":2.1,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12097093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128882","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 are we going to harm the next trauma patient?' Trauma care providers' perspective on potential harm to trauma patients.","authors":"Galinos Barmparas, Bryce Rh Robinson, Babak Sarani, Aaron R Jensen, Todd W Costantini, Avery B Nathens","doi":"10.1136/tsaco-2024-001628","DOIUrl":"10.1136/tsaco-2024-001628","url":null,"abstract":"<p><strong>Background: </strong>The question, \"How will the next patient be harmed?\" is a component of strategies used to identify latent safety risks in healthcare. We sought to survey a broad audience attending the 2023 annual conference of the American College of Surgeons-Trauma Quality Improvement Program to record their perception of the risks that might lead to patient harm at their own trauma centers.</p><p><strong>Methods: </strong>Attendees were surveyed with a single free-text question \"How are we going to harm the next patient?\" using a quick response code. All responses were categorized into clustered themes. To report the results using a standardized reporting taxonomy, the responses were also classified according to the Joint Commission (JC) patient safety event taxonomy for near misses and adverse events. Results were reported as counts and as proportions of responders.</p><p><strong>Results: </strong>During the 3-day duration of the conference, 64 participants provided 80 responses. Provider-related risk (n=16, 25.0%) was the most commonly reported category, followed closely by practice management guideline related (n=14, 21.9%) and communication gaps or failures (n=12, 18.8%). \"Clinical performance\" was the most commonly reported subclassification in the main category \"type\" of the JC patient safety event taxonomy (n=34, 53.1%), followed by patient management (n=30, 46.9%). \"Human error\" was the most common subclassification in the main category \"cause\" (n=48, 75.0%).</p><p><strong>Conclusions: </strong>Human failures, rather than systems issues, were perceived to be responsible for the majority of potential harm in trauma patients by a broad audience of trauma care providers. These results require amplified focus on strategies that decrease the impact of the human element while enhancing process standardization and addressing barriers to the implementation of processes and guidelines. It might also suggest an opportunity to bring forward alternative conceptual frameworks to advance safety in trauma care.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 2","pages":"e001628"},"PeriodicalIF":2.1,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12086880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102763","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 penetrating neck injury to zone III in an initially unstable patient.","authors":"Benjamin William W Stocker, Christopher D Raeburn, William Aaron Marshall, Michael W Cripps, Kristy Lynn Hawley","doi":"10.1136/tsaco-2024-001724","DOIUrl":"10.1136/tsaco-2024-001724","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 2","pages":"e001724"},"PeriodicalIF":2.1,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12086891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102764","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":"Ending nuclear weapons, before they end us.","authors":"Chris Zielinski","doi":"10.1136/tsaco-2025-001909","DOIUrl":"10.1136/tsaco-2025-001909","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 2","pages":"e001909"},"PeriodicalIF":2.1,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095046","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":"Growing injury threats to longevity in the older population: American Association for the Surgery of Trauma Prevention Committee topical update.","authors":"Carlos H Palacio, D'Andrea Joseph, Christine Castater, Deborah A Kuhls, Shelbie Kirkendoll, Paul Albini, Thomas K Duncan","doi":"10.1136/tsaco-2024-001526","DOIUrl":"10.1136/tsaco-2024-001526","url":null,"abstract":"<p><p>As the exponential growth in the elderly population occurs, it is essential that we identify age-specific risk factors that impact the outcome of injury in the elderly. In this review article, we describe the different mechanisms of injury that threaten the elderly. There will be a description of ground-level falls-the most common form of trauma-related injury in that group (and how community-based programs can help prevent the complications associated with them). Other injury mechanisms such as motor vehicle collisions and pedestrian-related trauma will be discussed. In addition, abuse of the older patients and the specific screening tools that clinicians can use to recognize victims are described. A review of threats to any population is not complete without examining the impact of firearms. The article concludes with a topic less explored in the medical community-the use of firearms by elderly patients and the impact of dementia on gun ownership. It is essential that the acute care surgeons and other clinicians understand these injury risk factors to better serve their community with injury prevention efforts such as advocacy and education.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 2","pages":"e001526"},"PeriodicalIF":2.1,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095047","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}