Trauma Surgery & Acute Care Open最新文献

{"title":"20 units and beyond: where is the line between utility and futility?","authors":"Eugenia Ester Lee, Kazuhide Matsushima","doi":"10.1136/tsaco-2026-002552","DOIUrl":"10.1136/tsaco-2026-002552","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e002552"},"PeriodicalIF":2.5,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991544","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":"Same-day appendectomy: applying the literature to optimize patient throughput and satisfaction.","authors":"Erin C Howell, Navpreet K Dhillon","doi":"10.1136/tsaco-2026-002488","DOIUrl":"10.1136/tsaco-2026-002488","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e002488"},"PeriodicalIF":2.5,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881847","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":"Improved venous thromboembolism (VTE) prophylaxis in traumatic brain injury (TBI) is 'In-EViTBI-abl'.","authors":"Felix Yong, Sarah Yager, Eric J Ley","doi":"10.1136/tsaco-2026-002546","DOIUrl":"10.1136/tsaco-2026-002546","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e002546"},"PeriodicalIF":2.5,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881818","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":"Prognostication, neurologic injury, and the limits of registry data in trauma end-of-life care.","authors":"Katie L Bower","doi":"10.1136/tsaco-2026-002501","DOIUrl":"10.1136/tsaco-2026-002501","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e002501"},"PeriodicalIF":2.5,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881854","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":"Challenging convention: a secondary data analysis of circulation-first versus airway-first triage in trauma patients receiving blood transfusions.","authors":"Jacob Metheny, Gena V Topper, Bedda L Rosario-Rivera, Eva Zadorozny, Jared Plumb, Aara Sheth, Patrick Morris, Stephen R Wisniewski, Jason L Sperry, Francis X Guyette, Tanya Egodage","doi":"10.1136/tsaco-2026-002358","DOIUrl":"10.1136/tsaco-2026-002358","url":null,"abstract":"<p><strong>Background: </strong>Trauma guidelines have historically recommended intubation prior to transfusion, yet intubation and mechanical ventilation can exacerbate hemodynamic instability. We hypothesized that injured patients resuscitated with a circulation-first approach would require fewer blood transfusions and would have lower mortality than those managed with an airway-first approach.</p><p><strong>Methods: </strong>This secondary data analysis of the Linking Investigations in Trauma and Emergency Services (LITES) database compared trauma patients in hemorrhagic shock who received blood products and intubation within 30 minutes of each other. 'ABC' patients were intubated first, whereas 'CAB' patients received blood first. A subgroup analysis compared patients with penetrating injuries only. Outcomes included transfusion volume, whole blood (WB) utilization, mortality, and hospital length of stay (HLOS).</p><p><strong>Results: </strong>35 CAB and 49 ABC patients were included. The ABC group suffered more blunt injuries (73.5% vs 42.9%, p=0.02) and were more likely to receive WB in the prehospital setting (75.5% vs 48.6%, p=0.02). Transfusion requirements were significantly higher in the CAB group (7195 mL vs 6090 mL, p=0.01), although this was not the case after removal of outliers. In the penetrating cohort (17 CAB, 11 ABC), CAB patients were less likely to be transferred directly from the scene (70.6% vs 72.7%), yet were more likely to receive WB in the prehospital setting (64.7% vs 27.3%). There were no differences with respect to mortality or HLOS.</p><p><strong>Conclusion: </strong>When comparing a circulation-first to an airway-first approach to triage in a unique, severely injured cohort of trauma patients, there was no difference detected in transfusion requirements or mortality. Centers participating in LITES more frequently used CAB over ABC for patients with penetrating trauma. The sample size and characteristics of this cohort limit its generalizability and highlight the need for prospective multicenter trials to guide the triage and management of hemorrhagic shock.</p><p><strong>Level of evidence: </strong>III, prognostic/epidemiological.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e002358"},"PeriodicalIF":2.5,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881812","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":"Rescued, not spared: complications and survival after thoracic damage control.","authors":"Lee M Fuentes, Bonnie Du Cruz, Carlos V R Brown","doi":"10.1136/tsaco-2026-002536","DOIUrl":"10.1136/tsaco-2026-002536","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e002536"},"PeriodicalIF":2.5,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881870","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":"Prehospital Blood Transfusion Coalition: framework for EMS Blood Program Coordinator responsibilities.","authors":"Holly O'Byrne, Jon Krohmer, Randall Schaefer, Eric A Bank, John B Holcomb, William J Bullock, Ronnie L Hill, Matthew Levy","doi":"10.1136/tsaco-2025-002134","DOIUrl":"10.1136/tsaco-2025-002134","url":null,"abstract":"<p><strong>Background: </strong>The success of prehospital blood transfusion programs depends not only on clinical guidelines and provider competencies but also on robust program coordination.</p><p><strong>Methods: </strong>This guidance defines the scope and responsibilities of Emergency Medical Services (EMS) Blood Program Coordinators and Program Managers, in alignment with the AABB (American Association of Blood and Biotherapies) <i>Standards for Emergency Prehospital and Scheduled Out-of-Hospital Transfusions</i>, as well as the Prehospital Blood Transfusion Coalition (PHBTC) clinical practice guideline for civilian EMS. Coordinators oversee program implementation, regulatory compliance, operational logistics, and quality management under the supervision of the Transfusion Administration Service medical director.</p><p><strong>Results: </strong>Responsibilities include validating storage and transport systems, ensuring continuous monitoring of blood components, standardizing education, and facilitating interagency collaboration. By formalizing this role, the guideline supports safe and consistent program operations across diverse EMS systems.</p><p><strong>Conclusion: </strong>Collectively, the PHBTC series provides a structured framework to advance prehospital transfusion as a reliable, evidence-based intervention that improves outcomes for patients with life-threatening hemorrhage.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e002134"},"PeriodicalIF":2.5,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819533","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":"EMS blood coordinators: core to the mission of saving lives with prehospital blood transfusion.","authors":"Timothy Chizmar","doi":"10.1136/tsaco-2026-002517","DOIUrl":"10.1136/tsaco-2026-002517","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e002517"},"PeriodicalIF":2.5,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819511","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":"Early (<24 hours) venous thromboembolism prophylaxis in traumatic brain injury: development of the EViTBI algorithm using a national cohort.","authors":"Heather X Rhodes-Lyons, Lucy Martinek, Christopher Ruiz, Antonio Pepe","doi":"10.1136/tsaco-2026-002316","DOIUrl":"10.1136/tsaco-2026-002316","url":null,"abstract":"<p><strong>Abstract: </strong></p><p><strong>Background: </strong>Optimal timing of venous thromboembolism (VTE) prophylaxis after traumatic brain injury (TBI) remains uncertain because of competing concerns regarding thromboembolism prevention and hemorrhagic progression. National recommendations remain inconsistent, and prophylaxis is frequently delayed beyond 72 hours.</p><p><strong>Objective: </strong>To develop and internally validate the early VTE prophylaxis in TBI (EViTBI) algorithm for identifying a reproducible low-risk cohort potentially eligible for early (<24 hours) pharmacologic prophylaxis.</p><p><strong>Methods: </strong>A retrospective cohort study was performed using the American College of Surgeons Trauma Quality Improvement Program Participant Use File (2017 to 2021). Adults with isolated TBI and complete prophylaxis-timing data were included. Multivariable logistic regression generated adjusted ORs for mortality, deep vein thrombosis (DVT), and pulmonary embolism (PE). Adjusted ORs were converted to weighted log-odds (mortality×2; VTE outcomes×1 negative) and summed to create the EViTBI score. Expert-derived thresholds were compared with receiver operating characteristic (ROC) and Youden Index analyses. Discrimination was assessed using the c-statistic.</p><p><strong>Results: </strong>Among 58 418 patients, 7590 (12.9%) received early prophylaxis. EViTBI classified 44.5% as low risk, 29.9% as moderate risk, and 25.5% as high risk. Compared with high-risk patients, low-risk patients had lower mortality (OR 0.15; 95% CI 0.13 to 0.17), DVT (OR 0.19; 95% CI 0.16 to 0.23), and PE (OR 0.23; 95% CI 0.17 to 0.31). Multivariable model discrimination was strong (c=0.740.75). The composite EViTBI score demonstrated acceptable discrimination for mortality (AUC=0.68). ROC and Youden analyses supported the expert-derived thresholds.</p><p><strong>Conclusion: </strong>EViTBI identified nearly half of isolated TBI patients as a reproducible low-risk cohort in whom early prophylaxis was associated with lower mortality and VTE rates. Findings are associative and hypothesis-generating; prospective validation incorporating serial imaging and prophylaxis fidelity is required before clinical implementation.</p><p><strong>Level of evidence: </strong>Prognostic study, level III.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e002316"},"PeriodicalIF":2.5,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819571","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":"Modified, bicarbonate-augmented direct peritoneal resuscitation for refractory acidosis after damage control laparotomy: a single-center case series.","authors":"Grayson Mast, Ryan Carver, William M Rice, Jessica Burgess","doi":"10.1136/tsaco-2026-002430","DOIUrl":"10.1136/tsaco-2026-002430","url":null,"abstract":"<p><strong>Introduction: </strong>Despite the utilization of damage control laparotomy (DCL) in acute care surgery, refractory acidosis remains a formidable challenge. This retrospective case series describes our experience with modified direct peritoneal resuscitation (DPR) with sodium bicarbonate in conjunction with DCL as an adjunct for refractory acidosis.</p><p><strong>Methods: </strong>We present a retrospective case series of nine adult patients from one tertiary care center following DCL with refractory acidosis treated with DPR using 1.5% peritoneal dialysate with 300 mEq of sodium bicarbonate per 2 L bag.</p><p><strong>Results: </strong>The change in patients' pre-intervention vs 24-hour post-intervention pH was significant, 0.25 (95% CI 0.011 to 0.392; p=0.031). The change in lactic acid at 24 hours was also significant at -10.2 (mmol/L) (95% CI -16.9 to -3.6; p=0.016). Changes in norepinephrine doses trended down, but did not reach statistical significance.</p><p><strong>Conclusion: </strong>Further investigation of DPR with sodium bicarbonate for managing refractory acidosis in patients who undergo DCL is warranted.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 3","pages":"e002430"},"PeriodicalIF":2.5,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819576","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}