Trauma Surgery & Acute Care Open最新文献

{"title":"Precision hemostasis: how viscoelastic testing guides real-time decision-making in trauma.","authors":"Alexandra M P Brito, Martin A Schreiber","doi":"10.1136/tsaco-2026-002241","DOIUrl":"https://doi.org/10.1136/tsaco-2026-002241","url":null,"abstract":"<p><p>Viscoelastic testing is an old but evolving technology that is commonly used in the management of trauma patients. Unlike conventional coagulation studies that provide information on specific parts of the clotting process, viscoelastic testing gives a more global view of clotting. The two currently used forms of viscoelastic testing are rotational thromboelastometry (ROTEM) and thromboelastography (TEG). This review will outline the history, technical aspects, and clinical data for ROTEM and TEG in the context of managing traumatic injury.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 Suppl 1","pages":"e002241"},"PeriodicalIF":2.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843334","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":"Ghost in the Machine: Leveraging artificial intelligence in the trauma bay.","authors":"Emma Gilman Burke, Chloe Nobuhara, Alex H Lee, Joshua Aaron Villarreal, Caitlin Anne Fitzgerald, Ryan Peter Dumas","doi":"10.1136/tsaco-2026-002259","DOIUrl":"https://doi.org/10.1136/tsaco-2026-002259","url":null,"abstract":"<p><p>The first hour after injury, often termed the 'golden hour,' relies on rapid and accurate decision making to ensure timely delivery of trauma care. Coordination of prehospital resources, triage, resuscitation, and imaging is critical to patient outcomes. Unlike static algorithms or prediction scores, artificial intelligence (AI) models can integrate large volumes of data to provide actionable decision support. This narrative review explores current and emerging applications of AI in trauma care, specifically focusing on its role within the trauma bay.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 Suppl 1","pages":"e002259"},"PeriodicalIF":2.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13140952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843278","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":"Antimicrobial resistance emergence during war: looking for answers beyond antibiotics.","authors":"Sinead Kilgarriff, Clare Rock","doi":"10.1136/tsaco-2026-002329","DOIUrl":"https://doi.org/10.1136/tsaco-2026-002329","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 2","pages":"e002329"},"PeriodicalIF":2.2,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13110671/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147782201","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":"War against superbugs, stopping them before they stop us: a biological warfare approach to safeguard European biosecurity.","authors":"Hailie Uren, B Hudson Berrey, Kostiantyn Gumeniuk, Volodymyr Kovalchuk, Olena Moshynets, Jennifer M Gurney, Douglas Davis, Uliana Pidvalna, Dmytro Beshley, Yvette Godwin, Shehan Hettiaratchy, Roseanne A Ressner, Mykola L Ankin, Solomiia Voitsekhovska, Frank Butler, John B Holcomb","doi":"10.1136/tsaco-2025-002169","DOIUrl":"10.1136/tsaco-2025-002169","url":null,"abstract":"<p><p>Russia's full-scale invasion of Ukraine has transformed both the modern battlefield and the microbial environment surrounding the war-wounded. Explosive injuries, prolonged evacuation, and limited opportunities for early decontamination have contributed to an unprecedented rise in multidrug-resistant organism (MDRO) infections. This paper describes how routine infection prevention and control (IPC) and antimicrobial stewardship (AMS) systems have become inadequate under conflict conditions and how contamination evolves into colonization and then systemic infection as casualties move through the evacuation pathway. Building on the national IPC and AMS strengthening, we outline a complementary crisis intervention: the application of chemical, biological, radiological, and nuclear-inspired decontamination principles to routine trauma care. These measures incorporate structured early irrigation and debridement, antiseptic cleansing, removal of contaminated materials, and the use of dedicated decontamination spaces at hospital entry. They are designed to reinforce existing programs by reducing microbial burden at the earliest point of contact. Implementing this approach aims to disrupt MDRO acquisition and transmission, protect fragile healthcare infrastructure, and mitigate escalating biosecurity risks. Ukraine's conflict experience has informed the development of this proposed concept, with formal implementation and impact evaluation planned as the next phase of work. LEVEL OF EVIDENCE: Level V (Current Opinion).</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 2","pages":"e002169"},"PeriodicalIF":2.2,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13084856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147722596","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":"Emergency preservation and resuscitation in exsanguination cardiac arrest: science fiction to future reality?","authors":"Mason H Remondelli, Kennedy Nye, Jonathan Wang, Joseph Rhee, Kyle Patterson, Meredith Lackie, Amy Wang, Benjamin L Scott, Keith Amberman, Rex Atwood, John Travis Green, Joseph Bozzay, Woo Do, Elizabeth K Powell, Jonathan J Morrison, David Burmeister, Eric Elster, Matthew Bradley, Patrick Walker","doi":"10.1136/tsaco-2025-002165","DOIUrl":"10.1136/tsaco-2025-002165","url":null,"abstract":"<p><p>Non-compressible torso hemorrhage (NCTH), leading to exsanguination cardiac arrest, remains the primary cause of preventable death in combat trauma. As the future operational environment shifts toward large-scale combat operations (LSCO) with delayed evacuations and increased casualty volumes, existing damage control strategies may prove inadequate due to limited resources and delayed evacuation. In 1984, US Army Colonel Ronald Bellamy challenged military medicine to develop new interventions for hemorrhagic shock, emphasizing the need for technologies that could 'buy time' for evacuation and surgical intervention. Decades later, Emergency Preservation and Resuscitation (EPR), which induces a hypometabolic state through profound hypothermia, offers a potential solution to this problem. This review summarizes the historical evolution of the EPR concept, from early military observations to modern preclinical and clinical advancements in EPR. We explore emerging technologies, such as portable extracorporeal life support systems (eg, MobyBox and CARL), organ perfusion platforms (BrainEx and OrganEx) and adjunctive pharmacologic agents (eg, Frunexian, PEG-20K, TAT-PHLPP9c and mitochondrial transplantation), that can enhance the efficacy of EPR, leading to optimized organ recovery. These innovations provide a foundation for developing resource-expedient EPR capabilities tailored for future battlefields. By synthesizing current evidence and examining the military context of prolonged casualty care, this paper outlines how EPR could meet Bellamy's challenge and serve as a next-generation tool for combat casualty care. As military medicine prepares for future conflicts, EPR may provide a critical capability to reduce mortality from NCTH and revolutionize combat trauma management in LSCO scenarios.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 2","pages":"e002165"},"PeriodicalIF":2.2,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13084794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147723759","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":"Perforated ulcer: patient education series understanding trauma and emergency surgery conditions.","authors":"Katherine Marie Kelley, Shannon Marie Foster","doi":"10.1136/tsaco-2025-002011","DOIUrl":"https://doi.org/10.1136/tsaco-2025-002011","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 2","pages":"e002011"},"PeriodicalIF":2.2,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13064173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147676698","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":"Rapid prediction of cerebral edema on CT scan after traumatic brain injury.","authors":"Ryan B Felix, Jamie Podell, Kathalyn Urquizo, Yasmin Alamdeen, Devon Beagan, Minahil Cheema, Gunjan Y Parikh, William Teeter, Hegang Chen, Lujie Karen Chen, Roumen Vesselinov, John P Fisher, Shiming Yang, Peter Hu, Neeraj Badjatia","doi":"10.1136/tsaco-2025-002021","DOIUrl":"https://doi.org/10.1136/tsaco-2025-002021","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) affects 1.7 million individuals annually in the USA, with cerebral edema (CE) as a critical determinant of outcomes and neurosurgical interventions. Delays in TBI diagnosis and triage in prehospital or resource-limited settings contribute to suboptimal care. This study evaluated the predictive potential of machine learning models using clinical and physiological data to detect CE on initial head CT scans, addressing this gap.</p><p><strong>Methods: </strong>We conducted a mixed retrospective and prospective study of 1222 suspected TBI patients. Data included clinical characteristics, radiographic scores (Marshall and Rotterdam), and physiological features derived from ECG and photoplethysmography signals collected within 1 hour of admission. Statistical models employed logistic regression and gradient boosting, using Shapley additive explanations for feature importance. Model performance was assessed using the area under the receiver operating characteristic curve (AUROC).</p><p><strong>Results: </strong>The models demonstrated high predictive accuracy for CE-related radiographic features, including midline shift and cisternal abnormalities (AUROC: 0.79-0.85). Clinical features such as Glasgow Coma Scale components and intubation status, combined with physiological variables like heart rate variability, contributed significantly to predictions. In contrast, predictions for other findings (eg, epidural hematoma) showed lower discriminatory power. Prehospital applicability was highlighted by the reliance on readily available physiological data.</p><p><strong>Conclusions: </strong>Machine learning models effectively predict CE prior to CT scans, offering a rapid decision support tool for triage and neurosurgical prioritization in austere and resource-limited settings. Early identification of CE could improve patient outcomes by optimizing transport and treatment strategies. Future research should focus on multicenter validation and streamlined data collection to enhance generalizability and clinical utility.</p><p><strong>Level of evidence: </strong>Level III, Prognostic.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 2","pages":"e002021"},"PeriodicalIF":2.2,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13064127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147676804","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":"Strategies for improving rural trauma health systems.","authors":"Chavi Rehani, Joseph V Sakran, Michael Person, Andrew Bernard, Zain G Hashmi, Jeffrey Kerby, Morgan Krause, Nakul Raykar, Katie W Russell, Lacey N LaGrone","doi":"10.1136/tsaco-2025-002170","DOIUrl":"https://doi.org/10.1136/tsaco-2025-002170","url":null,"abstract":"<p><p>Rural Americans face persistent and widening disparities in trauma and emergency care driven by geographic isolation, limited workforce capacity, longer transport times, and fragile hospital finances. These challenges are poised to intensify under the 2025 tax and spending reconciliation law, which substantially reduces federal Medicaid and Children's Health Insurance Program funding and is projected to increase uninsurance, placing already vulnerable rural hospitals at heightened risk of service reduction or closure. This article examines the structural pressures confronting rural trauma systems and proposes strategic, scalable solutions to strengthen resilience. Key recommendations include the development of Regional Medical Operations Coordinating Centers to enhance regional and interstate collaboration, optimize patient flow, and support disaster preparedness; targeted investments in workforce recruitment, retention, and teletrauma infrastructure; and hospital stabilization through right-sizing, repurposing underused capacity, and expanding telehealth and mobile care models. While new Rural Health Transformation Program grants may offer limited relief, sustained leadership and coordinated policy action will be required to ensure equitable access to high-quality trauma and emergency care in rural communities and to prevent geography from determining survival.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 2","pages":"e002170"},"PeriodicalIF":2.2,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13064167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147676819","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":"Artificial Intelligence in Surgical Care: A Point-Counterpoint Analysis.","authors":"Saman Qadri, Divya Kewalramani, Michel B Aboutanos, Mayur Narayan, Megan T Quintana","doi":"10.1136/tsaco-2025-002093","DOIUrl":"https://doi.org/10.1136/tsaco-2025-002093","url":null,"abstract":"<p><p>Artificial intelligence (AI) integration in surgical care represents a paradigm shift with significant potential benefits and risks. This point-counterpoint debate examined the proposition that AI improves surgical patient care. A structured debate format featuring Dr Divya Kewalramani (pro-AI) and Dr Michael Aboutanos (con-AI) explored the current state, opportunities, and challenges of AI implementation in surgical practice. The pro-AI argument emphasized addressing surgical care gaps through predictive analytics, supply chain optimization, and enhanced postoperative monitoring. The con-AI position highlighted concerns about data biases, validation deficits, hallucinations, and implementation risks. While AI demonstrates potential to improve surgical care, substantial challenges remain regarding validation, inclusivity, and oversight. Responsible adoption requires robust evaluation frameworks, diverse datasets, and continuous postimplementation monitoring.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 2","pages":"e002093"},"PeriodicalIF":2.2,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13064163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147676621","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":"Maintaining longevity and fulfillment in academic surgery.","authors":"Leah Aakjar, Mayur Narayan, Grace Rozycki, Adrian Park, Jamie Coleman","doi":"10.1136/tsaco-2025-001983","DOIUrl":"https://doi.org/10.1136/tsaco-2025-001983","url":null,"abstract":"<p><p>Academic surgery is a demanding and multifaceted career that places sustained pressure on clinical performance, scholarly productivity, administrative service, and personal resilience. While the risk of burnout is high, some surgeons achieve long-term fulfillment and professional longevity through intentional strategies. This was a panel discussion with trauma surgeon participants from all career stages that was held at the 2025 annual American College of Surgeons Point Counterpoint conference to discuss how to lead a long and fulfilling career in academic surgery. This manuscript reflects and expands on key themes from that discussion, and while there are no universal guidelines, it will highlight several strategies to foster longevity and fulfillment in an academic career.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 2","pages":"e001983"},"PeriodicalIF":2.2,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13064187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147676735","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}