Trauma Surgery & Acute Care Open最新文献

{"title":"Defining the acute care surgeon: American Association for the Surgery of Trauma (AAST) panel discussion on full-time employment, compensation and career trajectory.","authors":"Patrick B Murphy, Jeffry Nahmias, Stephanie Bonne, Jamie Coleman, Marc de Moya","doi":"10.1136/tsaco-2024-001500","DOIUrl":"10.1136/tsaco-2024-001500","url":null,"abstract":"<p><p>Since its inception, the specialty of acute care surgery has evolved and now represents a field with a broad clinical scope and large variations in implementation and practice. These variations produce unique challenges and there is no consistent definition of the scope, intensity or value of the work performed by acute care surgeons. This lack of clarity regarding expectations extends to surgeons and non-surgeons outside of our specialty, compounding difficulties in advocacy at the local, regional and national levels. Coupled with a lack of clarity surrounding the definition of full-time employment, these challenges have prompted surgeons to develop initiatives within acute care surgery in collaboration with the American Association for the Surgery of Trauma (AAST). A panel session at the AAST 2023 annual meeting was held to discuss the need to define a full-time equivalent for an acute care surgeon and how to consider and incorporate non-clinical responsibilities. Experiences, perspectives and propositions for change were discussed and are presented here.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"9 1","pages":"e001500"},"PeriodicalIF":2.1,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11448165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372960","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":"Implementation of a novel daily performance improvement checklist (PIC) improves alcohol screening and intervention compliance in trauma.","authors":"Michelle Jeffery, Ashley Toussaint, Rachel L Choron, Zachary P Englert, Charoo Piplani, Timothy Murphy, Lisa A Falcon, Mayur Narayan, Amanda L Teichman","doi":"10.1136/tsaco-2024-001517","DOIUrl":"10.1136/tsaco-2024-001517","url":null,"abstract":"<p><strong>Introduction: </strong>Screening, brief intervention, and referral to treatment (SBIRT) has demonstrated up to 50% reduction in alcohol-related traumatic injury and is mandated by the American College of Surgeons for trauma center accreditation. While SBIRT effectiveness has been previously investigated, optimal implementation in the trauma setting has not. We sought to improve SBIRT compliance through integration of screening into a performance improvement checklist (PIC) deployed during morning report. We hypothesized that PIC would establish a self-sustaining model for improved alcohol screening/intervention.</p><p><strong>Methods: </strong>This was a retrospective study comparing trauma patients pre-PIC (January-May 2022) to post-PIC (January-May 2023) after PIC implementation in January 2023. The primary outcome was SBIRT performance. The PIC prompted alcohol intervention specialist consultation if blood alcohol content >80 mg/dL, <21 years old, or Alcohol Use Disorders Identification Test ≥8. Significance was determined if p<0.05.</p><p><strong>Results: </strong>There were 705 pre-PIC and 840 post-PIC patients. Pre-PIC unscreened patients were more often uninsured (13% vs. 25%, p<0.01) and black (8% vs. 14%, p=0.02) compared with screened pre-PIC patients. There were no significant differences among screened versus unscreened patients after PIC with respect to age, sex, race, or ethnicity (p>0.05). Overall, screening improved pre-PIC to post-PIC (52% vs. 88%, p<0.01) and the percentage of patients who screened positively also increased after PIC (8% vs. 23%, p<0.01). Brief intervention was unchanged (83% vs. 81%, p=1).</p><p><strong>Conclusion: </strong>The PIC is a novel tool that demonstrated improved alcohol screening and referral. It improved compliance with SBIRT and reduced implicit bias in the population screened. Utilization of a PIC is easily translatable to other centers and could become a national standard to advance performance improvement.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"9 1","pages":"e001517"},"PeriodicalIF":2.1,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11440234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142354558","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 (REBOA) for non-trauma patients in an urban hospital: a series of two cases.","authors":"Jan C van de Voort, Suzanne M Vrancken, Eric R Manusama, Boudewijn L S Borger van der Burg, Pieter Klinkert, Rigo Hoencamp","doi":"10.1136/tsaco-2024-001515","DOIUrl":"10.1136/tsaco-2024-001515","url":null,"abstract":"<p><strong>Background: </strong>Resuscitative endovascular balloon occlusion of the aorta (REBOA) is increasingly being used for temporary bleeding control in patients with trauma with non-compressible truncal hemorrhage (NCTH). In recent years, the technique is gaining popularity in postpartum hemorrhage and non-traumatic cardiac arrest, although still underutilized. In other surgical fields, however, there is not yet much awareness for the possible advantages of this technique. Consequently, for non-trauma indications, limited data are available.</p><p><strong>Methods: </strong>Description of the use of REBOA in two patients with hemorrhagic shock due to exsanguinating non-traumatic NCTH.</p><p><strong>Results: </strong>In the first case, REBOA was deployed at the emergency department in a patient in their 80s presenting with hemorrhagic shock due to a ruptured abdominal aortic aneurysm. Hemodynamic stability was obtained and a CT scan was subsequently performed for planning of endovascular aneurysm repair. After successful placement of the endograft, the REBOA catheter was deflated and removed. In the second case, REBOA was performed in a patient with shock due to iatrogenic epigastric artery bleeding after an umbilical hernia repair to prevent hemodynamic collapse and facilitate induction of anesthesia for definitive surgery. During laparotomy, blood pressure-guided intermittent aortic balloon occlusion was used to preserve perfusion of the abdominal organs. Patient made a full recovery.</p><p><strong>Conclusion: </strong>REBOA deployment was successful in achieving temporary hemorrhage control and hemodynamic stability in patients with non-traumatic NCTH. REBOA facilitated diagnostic work-up, transportation to the operating room and prevented hemodynamic collapse during definitive surgical repair. In the right patient and skilled hands, this relatively simple endovascular procedure could buy precious time and prove lifesaving in a variety of non-compressible hemorrhage.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"9 1","pages":"e001515"},"PeriodicalIF":2.1,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11440202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142354560","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":"Use of an Integrated Pulmonary Index pathway decreased unplanned ICU admissions in elderly patients with rib fractures.","authors":"Nicholas Davis, Peter Lindbloom, Kathleen Hromatka, Jonathan Gipson, Michaela A West","doi":"10.1136/tsaco-2024-001523","DOIUrl":"10.1136/tsaco-2024-001523","url":null,"abstract":"<p><p>Unplanned intensive care unit (ICU) admission (UIA) is a Trauma Quality Improvement Program benchmark that is associated with increased morbidity, mortality, and length of stay (LOS). Elderly patients with multiple rib fractures are at increased risk of respiratory failure. The Integrated Pulmonary Index (IPI) assesses respiratory compromise by incorporating SpO₂, respiratory rate, pulse, and end-tidal CO₂ to yield an integer between 1 and 10 (worst and best). We hypothesized that IPI monitoring would decrease UIA for respiratory failure in elderly trauma patients with rib fractures.</p><p><strong>Methods: </strong>Elderly (≥65 years old) trauma inpatients admitted to a level 1 trauma center from February 2020 to February 2023 were retrospectively studied during the introduction of IPI monitoring on the trauma floor. Patients with ≥4 rib fractures (or ≥2 with history of chronic obstructive pulmonary disease) were eligible for IPI monitoring and were compared with a group of chest Abbreviated Injury Scale score of 3 (≥3 rib fractures) patients who received usual care. Nurses contacted the surgeon for IPI ≤7. Patient intervention was left to the discretion of the provider. The primary endpoint was UIA for respiratory failure. Secondary endpoints were overall UIA, mortality, and LOS. Statistical analysis was performed using χ² test and Student's t-test, with p<0.05 considered significant.</p><p><strong>Results: </strong>A total of 110 patients received IPI monitoring and were compared with 207 patients who did not. The IPI cohort was comparable to the non-IPI cohort in terms of gender, Injury Severity Score, Abbreviated Injury Scale, mortality, and LOS. There were 16 UIAs in the non-IPI cohort and two in the IPI cohort (p=0.039). There were no UIAs for respiratory failure in the IPI group compared with nine in the non-IPI group (p=0.03).</p><p><strong>Conclusion: </strong>IPI monitoring is an easy-to-set up tool with minimal risk and was associated with a significant decrease in UIA in elderly patients with rib fracture.</p><p><strong>Level of evidence: </strong>Level III, therapeutic/care management.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"9 1","pages":"e001523"},"PeriodicalIF":2.1,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11440210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142354561","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 aspirin enough for venous thromboembolism prophylaxis?","authors":"Erin Grace Dawson, Niels D Martin","doi":"10.1136/tsaco-2024-001605","DOIUrl":"https://doi.org/10.1136/tsaco-2024-001605","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"9 1","pages":"e001605"},"PeriodicalIF":2.1,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11423751/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142354559","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":"Identifying blunt duodenal injury by bicycle handlebar with methylene blue.","authors":"Rachna Vemireddy, Hima Bindu Thota, Mitchell Chaar, Bruno Molino","doi":"10.1136/tsaco-2024-001527","DOIUrl":"https://doi.org/10.1136/tsaco-2024-001527","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"9 1","pages":"e001527"},"PeriodicalIF":2.1,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11409396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296399","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":"Appendicitis- Patient education series: understanding trauma and emergency surgery conditions.","authors":"Raafat John Kuk, Kimberly Hendershot","doi":"10.1136/tsaco-2024-001623","DOIUrl":"https://doi.org/10.1136/tsaco-2024-001623","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"9 1","pages":"e001623"},"PeriodicalIF":2.1,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11409370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296305","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":"Rib fractures - Patient education series: understanding trauma and emergency surgery conditions.","authors":"Joshua Dilday, Elliott R Haut","doi":"10.1136/tsaco-2024-001622","DOIUrl":"https://doi.org/10.1136/tsaco-2024-001622","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"9 1","pages":"e001622"},"PeriodicalIF":2.1,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11409406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296406","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":"Patient education series: understanding trauma and emergency general surgery conditions.","authors":"Joshua Dilday, Patrick M Reilly, Elliott R Haut, Matthew J Martin, Kimberly Hendershot","doi":"10.1136/tsaco-2024-001589","DOIUrl":"https://doi.org/10.1136/tsaco-2024-001589","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"9 1","pages":"e001589"},"PeriodicalIF":2.1,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11409326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296402","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":"Percutaneous cryoneurolysis: new kid on the rib fracture pain 'Block'.","authors":"Simeng Wang, Alexandra A Myers, Joseph D Forrester","doi":"10.1136/tsaco-2024-001575","DOIUrl":"https://doi.org/10.1136/tsaco-2024-001575","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"9 1","pages":"e001575"},"PeriodicalIF":2.1,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11409356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296403","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}