Trauma Surgery & Acute Care Open最新文献

{"title":"Intracranial pressure monitoring in patients with geriatric trauma may not improve outcome but is associated with increases in resource utilization.","authors":"Bardiya Zangbar, Aryan Rafieezadeh, Kartik Prabhakaran, Joshua Klein, Matthew Bronstein, Ilya Shnaydman, Chirag Gandhi, Peter Rhee","doi":"10.1136/tsaco-2024-001644","DOIUrl":"10.1136/tsaco-2024-001644","url":null,"abstract":"<p><strong>Background: </strong>Intracranial pressure (ICP) monitoring (ICPM) is currently recommended for severe traumatic brain injury (TBI). The hypothesis was that ICPM does not change mortality in the geriatric patient population.</p><p><strong>Methods: </strong>The Trauma Quality Improvement Program (TQIP) database (2017-2021) was queried to identify intubated geriatric patients (≥65 years of age) with isolated blunt TBI (non-Head Abbreviated Injury Scale (AIS) score <3), with admission Glasgow Coma Scale (GCS) scores of 3-8. Patients with death on arrival or with hospital length of stay <24 hours and patients who underwent craniotomy before ICPM placement were excluded. Favorable discharge disposition was defined as home with or without assistance, and rehabilitation. Propensity score matching (PSM) was performed between ICPM and non-ICPM patients and outcomes were compared. The primary outcome was defined as in-hospital mortality. Secondary outcomes were defined as discharge disposition, hospital length of stay, intensive care unit (ICU) length of stay and ventilator days.</p><p><strong>Results: </strong>A total of 19 416 patients met criteria for analysis. ICPM was placed in only 12.1% (n=2363) patients. The Injury Severity Score, GCS and head AIS were similar between the patients with and without monitors. After PSM, we were able to match 2148 patients and there was no difference in mortality between the two groups (52.4% vs 52.1%, p=0.874); however, patients treated with ICPM had significantly longer hospital length of stay (10 (5-17) vs 7 (3-15) days, p<0.001), ICU length of stay (8 (4-14) vs 6 (3-10), p<0.001) and ventilator days (6 (3-11) vs 4 (2-7), p<0.001). Discharge disposition was trending towards unfavorable with increasing age but was similar between the ICPM and No-ICPM groups (p=0.115).</p><p><strong>Conclusion: </strong>The usefulness of ICPM in geriatric patients has not yet been shown and would benefit from prospective clinical studies. Minimizing ICPM in geriatric patients may reduce resource burdening without affecting outcome.</p><p><strong>Level of evidence: </strong>Level III retrospective study.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001644"},"PeriodicalIF":2.1,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693418","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":"Palliative care in acute care surgery: research challenges and opportunities.","authors":"Amelia W Maiga, Vanessa Ho, Rachel S Morris, Lisa M Kodadek, Thaddeus J Puzio, Gail T Tominaga, Masami Tabata-Kelly, Zara Cooper","doi":"10.1136/tsaco-2024-001615","DOIUrl":"10.1136/tsaco-2024-001615","url":null,"abstract":"<p><p>Palliative care includes effective communication, relief of suffering and symptom management with an underlying goal of improving the quality of life for patients with serious illness and their families. Best practice palliative care is delivered in parallel with life-sustaining or life-prolonging care. Palliative care affirms life and regards death as a normal process, intends neither to hasten death nor to postpone death and includes but is not limited to end-of-life care. Palliative care encompasses both primary palliative care (which can and should be incorporated into the practice of acute care surgery) and specialty palliative care (consultation with a fellowship-trained palliative care provider). Acute care surgeons routinely care for individuals who may benefit from palliative care. Patients exposed to traumatic injury, emergency surgical conditions, major burns and/or critical surgical illness are more likely to be experiencing a serious illness than other hospitalized patients. Palliative care research is urgently needed in acute care surgery. At present, minimal high-quality research is available to guide selection of palliative care interventions. This narrative review summarizes the current state of research challenges and opportunities to address palliative care in acute care surgery. Palliative care research in acute care surgery can rely on either primary data collection or secondary and administrative data. Each approach has its advantages and limitations, which we will review in this article.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001615"},"PeriodicalIF":2.1,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693420","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":"Pancreaticoduodenectomy in grade V injuries.","authors":"Jake Krige, Eduard Jonas","doi":"10.1136/tsaco-2025-001822","DOIUrl":"10.1136/tsaco-2025-001822","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001822"},"PeriodicalIF":2.1,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693421","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":"CT pan-scanning versus targeted imaging among older adults after ground level falls.","authors":"Gavin Touponse, Jeff Choi, Christian Calderon, Sofia E Luna, Lakshika Tennakoon, Ara Ko","doi":"10.1136/tsaco-2024-001534","DOIUrl":"10.1136/tsaco-2024-001534","url":null,"abstract":"<p><strong>Background: </strong>Ground level falls (GLFs) among older adults are responsible for millions of injuries. Routine pan-scanning (CT imaging of the head, chest, abdomen and pelvis) is commonly employed; however, we lack robust evidence of its benefit. We investigated whether pan-scanning identifies a larger proportion of patients with significant injury or injury requiring procedural intervention and hypothesized resuscitation area findings-including radiographs, ultrasound, and external signs of injury-would detect these injuries.</p><p><strong>Methods: </strong>We queried our institutional trauma registry data for patients ≥65 years presenting to our level 1 trauma center after GLFs. Our primary outcome was injury requiring procedural intervention. LASSO (least absolute shrinkage and selection operator) regression models were fit using cross-validation to identify predictors of significant injury to the head, chest, and pelvis/lower extremity from patient characteristics and resuscitation area findings.</p><p><strong>Results: </strong>598 patients were included, among whom 17% underwent pan-scan. External signs of injury were associated with increased odds of significant injury in the head (OR 1.12; 95% CI 1.08 to 1.16), chest (OR 1.50; 95% CI 1.45 to 1.46), and extremity/pelvis (OR 1.07; 95% CI 1.04 to 1.10). Chest (OR 1.18; 95% CI 1.14 to 1.23) and pelvic X-ray (OR 1.36; 95% CI 1.33 to 1.40) were also associated with increased odds of significant injury. 17 patients required procedural interventions for head injuries and 2 for the chest. No patients had a significant injury requiring any procedures for the abdomen.</p><p><strong>Conclusions: </strong>Our study suggests resuscitation area findings may direct targeted imaging in the chest and abdomen/pelvis, but whether individual risk and institutional burden associated with pan-scanning is outweighed by its ease requires further study.</p><p><strong>Level of evidence study type: </strong>Prognostic and Epidemiological, Level IV.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001534"},"PeriodicalIF":2.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143650973","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":"Self-expanding foam for pelvic retroperitoneal hemorrhage: friend or foe?","authors":"Melike N Harfouche","doi":"10.1136/tsaco-2025-001791","DOIUrl":"10.1136/tsaco-2025-001791","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001791"},"PeriodicalIF":2.1,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11891531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597940","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 hyponatremia after geriatric trauma the new frailty?","authors":"Amandine Godier-Furnemont, Tasce Bongiovanni","doi":"10.1136/tsaco-2025-001792","DOIUrl":"10.1136/tsaco-2025-001792","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001792"},"PeriodicalIF":2.1,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11891520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597857","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":"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}