Trauma Surgery & Acute Care Open最新文献

{"title":"Risk factors for progression of intracranial hemorrhage after initiation of VTE chemoprophylaxis: an evaluation of 1390 TBI patients.","authors":"Keith Walter Burczak, Jan-Michael Van Gent, Devi Bavishi, Joel James, Thomas W Clements, Thaddeus J Puzio, Bryan A Cotton","doi":"10.1136/tsaco-2024-001606","DOIUrl":"10.1136/tsaco-2024-001606","url":null,"abstract":"<p><strong>Objectives: </strong>Patients with traumatic intracranial hemorrhage (ICH) often undergo early stability CT scans to evaluate for progression of bleeding. The factors associated with progression after initiating venous thromboembolism (VTE) chemoprophylaxis (CP) remain poorly described. This study aimed to determine the rate of and factors associated with ICH progression following CP initiation.</p><p><strong>Methods: </strong>This retrospective observational study included adult (≥16 years) polytrauma patients with blunt or penetrating traumatic brain injury (TBI) admitted between September 2016 and December 2021. Progression was defined as a radiographic increase in ICH following VTE CP initiation, determined by neurosurgery or radiology faculty. Postprophylaxis CT scans were obtained based on clinical deterioration. Associated factors, neurosurgical intervention rates, and outcomes were evaluated.</p><p><strong>Results: </strong>Among 1390 included patients, ICH progression occurred in 3% (43) following CP initiation. Patients with progression were older (55 vs 45 years) and had higher injury severity scores (33 vs 27; p<0.05). Rates of pneumonia (49% vs 21%) and sepsis (19% vs 9%) were higher in the progression group (p<0.05). There was no difference between groups in time to prophylaxis initiation (40 vs 38 hours), survival (88% vs 92%), or VTE incidence (0% vs 4%; all p=NS). Factors associated with progression included midline shift (21% vs 6%), subdural hematoma (47% vs 26%), and prior progression on 6-hour stability CT (64% vs 34%; p<0.05). Multivariate analysis confirmed these findings. Among progression patients, 9% required intervention after CP, with only two requiring craniotomy.</p><p><strong>Conclusions: </strong>ICH progression is rare (3%) after VTE CP initiation. Associated factors align with spontaneous progression, suggesting that ICH progression is independent of early VTE prophylaxis (<48 hours). These findings support the safety of early VTE CP as the standard of care for mitigating VTE risk in TBI patients with TBI.</p><p><strong>Level of evidence: </strong>Level III, retrospective study with up to two negative criteria.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 3","pages":"e001606"},"PeriodicalIF":2.2,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207699","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":"Fatal neurological deterioration after minor head trauma in a patient with prior neurosurgical intervention: a gap in the brain injury guidelines?","authors":"Tamir E Bresler, Ryan Meyer, Tyler Wilson, Amanda Brooks, Timothy Deaconson","doi":"10.1136/tsaco-2025-001867","DOIUrl":"10.1136/tsaco-2025-001867","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 3","pages":"e001867"},"PeriodicalIF":2.2,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207674","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":"CO2, infections, and critical illnesses.","authors":"Lewis Stanton Coleman","doi":"10.1136/tsaco-2025-002069","DOIUrl":"10.1136/tsaco-2025-002069","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 3","pages":"e002069"},"PeriodicalIF":2.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150758","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":"Complex management of a patient with impalement injury to the neck.","authors":"Kevin T Petersen, Brent Blackwell, Harris Kashtan, Deborah A Kuhls, Allison G McNickle","doi":"10.1136/tsaco-2025-001879","DOIUrl":"10.1136/tsaco-2025-001879","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 3","pages":"e001879"},"PeriodicalIF":2.2,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041381","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":"From guideline to bedside, improving evidenced-base care.","authors":"Melinda L Staub, Bryan W Carr, Brian K Yorkgitis","doi":"10.1136/tsaco-2025-001835","DOIUrl":"10.1136/tsaco-2025-001835","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 3","pages":"e001835"},"PeriodicalIF":2.2,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12414152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024268","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":"Understanding the rural injury providers' experiences with trauma clinical guidance: a qualitative case series.","authors":"Andrew Steiner, Michael A Person, Darren D Bowe, Alyssa Johnson, Gabriela Zavala Wong, Kirsten Senturia, Ashley N Moreno, Lacey N LaGrone","doi":"10.1136/tsaco-2024-001598","DOIUrl":"10.1136/tsaco-2024-001598","url":null,"abstract":"<p><strong>Introduction: </strong>Trauma is the leading cause of death among individuals aged 1-44 years, and it is estimated that many of these deaths could be prevented. Clinical guidance is an essential step toward the optimization of trauma care, especially within rural environments. This qualitative case series seeks to better understand how trauma clinical guidance (TCG) plays a role in rural trauma providers' patient management.</p><p><strong>Methods: </strong>An initial exploratory qualitative case series consisting of five semi-structured interviews with rural providers recruited using snowball sampling from existing professional networks were conducted between February and April 2024. Providers were asked to provide details on how they approach clinical uncertainty and if clinical guidance plays a role in their decision making. Then, providers performed real-time reviews of clinical guidance documents, identifying areas for clinical guidance improvement. Interviews were recorded, transcribed, and data analyzed using narrative and thematic approaches, with key themes identified through peer debriefing with relevant quotes selected.</p><p><strong>Results: </strong>Of the five providers interviewed, three provide care at a critical access hospital, one provides care at a level II trauma center, and one at a level III trauma center. Two interviewees mentioned that they do not use clinical guidance often in direct patient care, and three highlighted the use of advanced trauma life support as the foundation of their practice on which they expand their tools and training. Common requests of TCG from rural providers included: (1) visual components to guide workflow, (2) easy discoverability in a central place, (3) relevant across various resource settings, (4) a centralized 'stamp of approval,' for guidelines that have been mutually agreed on via extensive collaboration, and (5) transfer guidance.</p><p><strong>Conclusion: </strong>The needs of rural trauma providers should be a focal point when working to improve the creation and dissemination of TCG. Collaboration when creating new TCG is essential. By intentionally designing for the rural population, we will increase the reach and impact of the guidance developed, as well as improve its accessibility and usability for all providers, regardless of resource setting. Through these efforts, we will decrease the disparate burden of trauma and unintentional injury on rural patients and their healthcare providers.</p><p><strong>Level of evidence: </strong>Level V.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 Suppl 5","pages":"e001598"},"PeriodicalIF":2.2,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12414208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024250","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":"Conference Proceedings for the <i>2024 Design for Implementation: The Future of Trauma Research and Clinical Guidance</i> Conference Series.","authors":"Danielle J Wilson, Jaclyn A Gellings, Gabriela Zavala, Andrew Steiner, Bethany M Kwan, Pamela J Bixby, Michelle A Price, Cynthia Lizette Villarreal, Ashley N Moreno, Lacey N LaGrone","doi":"10.1136/tsaco-2024-001583","DOIUrl":"10.1136/tsaco-2024-001583","url":null,"abstract":"<p><p>Traumatic injury is the leading cause of death for individuals aged 1-45 in the USA. Variations in patient management based on geographic locations, community resources, and provider characteristics contribute to disparities in patient outcomes. It is estimated that 20,000 Americans lives could be saved yearly if all trauma centers performed as well as the highest-performing center, which is achievable, in part, through the reduction of inappropriate practice variation. Trauma clinical guidance currently lacks standardization, is redundant, and remains difficult to access and implement at the bedside. To explore and address these issues, the <i>Design for Implementation: The Future of Trauma Research and Clinical Guidance</i> (DFI) Conference Series was developed. This conference series and complementary research aims to redesign the development, dissemination, and implementation of trauma clinical guidance with a focus on more effective and equitable systems. To do so, key community partners were convened to present clinical guidance best practices, including digital integration, resource stratification, and patient-centeredness. Conference attendees, which included partners from various provider groups, patients, dissemination and implementation scientists, public health experts, government agencies, and software developers, worked together to create a \"minimum viable product\" which specified key objectives for an ideal future state of trauma clinical guidance, as well as the \"risk\", \"audience\", and \"key performance indicators\". The next conference in the series will take place in February 2025, with a focus on translating the conceptualized priorities into tangible solutions. This paper serves to share the events from the 2024 conference proceedings.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 Suppl 5","pages":"e001583"},"PeriodicalIF":2.2,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12414216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024266","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":"Precision medicine in acute spinal cord injury: moving beyond static hemodynamic targets.","authors":"Tej D Azad, Gary Schwartzbauer, Nicholas Theodore","doi":"10.1136/tsaco-2025-001961","DOIUrl":"10.1136/tsaco-2025-001961","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 3","pages":"e001961"},"PeriodicalIF":2.2,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12414179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024293","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":"Dissecting inequity: global systematic review of trauma clinical guidance.","authors":"Gabriela Zavala Wong, Maclean S Panshin, Tina Samsamshariat, Mohamed Albirair, Jakob E Gamboa, Colby G Simmons, Ashley D Farley, Lacey N LaGrone","doi":"10.1136/tsaco-2024-001624","DOIUrl":"10.1136/tsaco-2024-001624","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Efforts to strengthen healthcare systems have led to the development of clinical practice guidance, defined as clinical decision-making aids built on scientific evidence, experiential knowledge, and ideally, patient values. This review evaluates the accessibility, relevance, and quality of existing trauma guidance globally.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic review evaluated trauma-related clinical guidance sources published from 2016 to 2023, searching in English across eight databases and 28 professional society websites. Using a combination of Medical Subject Headings terms, a series of protocols, guidelines, position articles, reviews and consensus documents were assessed using the National Guideline Clearinghouse Extent Adherence to Trustworthy Standards (NEATS).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Out of 986 records, 108 met review criteria, excluding unretrievable (13), outdated (25), non-trauma (110), and not fitting a guidance resource definition (730). Almost 90% of trauma guidance resources featured a first author from a high-income country (HIC). When categorizing trauma guidance resources by the first author's region, 44% came from North America, 8% from South America, 34% from Europe, 13% from Asia and Pacific and 1% from Africa. 82% of clinical guidance was public access with no registration required, and the remaining 18% had an average cost of US$45.7 (13.38 SD) the majority of which was generated by US trauma professional organizations. Regarding quality standard adherence, the mean quality score of all sources was 3.81 (scale 1-5), 77% disclosed the source of funding, 91% involved a multidisciplinary group and 54% explicitly mentioned the inclusion of a methodological expert. On logistic regression, the only factor predictive of a high (≥4) NEATS quality score was the presence of a methodological expert. There was no observed association between quality and language, author origin, multidisciplinary group, and professional society endorsement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;Retrieved articles were mostly published in English and predominantly produced by HIC authors. Low- and middle-income country (LMIC) researchers relied on collaboration for most publications. Most resources were open access, however, the average cost for those which require paid access (US$45.7) may be cost-prohibitive to LMIC providers. Generally, clinical practice guidance resources have a fair quality score when evaluated with the NEATS scorecard. Nonetheless, methodological expert involvement is often overlooked, despite its impact on guidance resources quality. Limitations of this review include the exclusive use of English for search terms, which may have led to the under-representation of sources in other languages and those from LMIC regions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The reviewed trauma clinical guidance published between 2016 and 2023 predominantly featured authors from HICs, with limited represe","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 Suppl 5","pages":"e001624"},"PeriodicalIF":2.2,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12414201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024234","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 community clinical guidance needs: a mixed-methods iterative consensus-building study.","authors":"Jenny M Guido, Morgan Krause, Andrew Steiner, Amanda Nicol, Katheryn T Grider, Gabriela Zavala Wong, Ashley N Moreno, Lacey N LaGrone","doi":"10.1136/tsaco-2024-001592","DOIUrl":"10.1136/tsaco-2024-001592","url":null,"abstract":"<p><strong>Introduction: </strong>Developing and implementing trauma clinical guidance is integral to providing quality care to all trauma patients while maintaining a minimum standard of treatment. A mixed-methods novel consensus-building approach was used to identify the current barriers to developing and implementing trauma clinical guidance and highlight the priority areas for change to better support end users.</p><p><strong>Methods: </strong>As part of year 1 of the Design for Implementation: The Future of Trauma Clinical Guidance and Research Conference Series, preconference participant surveys and hybrid, professionally facilitated, structured dialogue were used to define the ideal future state of trauma clinical guidance development and dissemination. Novel to this context, in-person and virtual \"user stories\", a form of structured focus group, were generated, and a \"minimum viable product\" (MVP), a form of brokered dialogue, was developed. Descriptive statistics and thematic analysis were used to evaluate preconference survey and \"user story\" results.</p><p><strong>Results: </strong>72 in-person and up to 35 virtual attendees participated. The majority (92%) of in-person attendees and nearly half (48%) of virtual attendees completed the preconference survey. Participants identified barriers along the continuum of clinical guidance development, dissemination, and adoption. Areas for improvement centered around the creation, storage, and use of guidance. Across the survey and user stories, participants expressed the need for clinical guidance that is comprehensive, evidence-based, coordinated, and easily accessible by all clinicians both domestically and abroad. The MVP targeted the risks and objectives to improved guidance. A prominent theme throughout this consensus-building assessment was the imperative for collaboration between professional societies for clinical guidance development and dissemination.</p><p><strong>Discussion: </strong>Trauma clinical guidance must be current, consolidated, and coordinated with patient-centered outcomes prioritized. Next steps include turning the MVP produced into a prototype and refining it to inform a national redesign of trauma clinical guidance.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 Suppl 5","pages":"e001592"},"PeriodicalIF":2.2,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12414228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024289","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}