Trauma Surgery & Acute Care Open最新文献

{"title":"Optimizing trauma laparotomy outcomes: the role of Enhanced Recovery After Surgery protocols in reducing hospital length of stay.","authors":"Amit Gupta, Vijayan Purushothaman, Joses Dany James","doi":"10.1136/tsaco-2025-001772","DOIUrl":"10.1136/tsaco-2025-001772","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001772"},"PeriodicalIF":2.1,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484051","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":"Are electric scooters a lost cause?","authors":"Hee Soo Jung, Rakesh Kumar","doi":"10.1136/tsaco-2025-001776","DOIUrl":"10.1136/tsaco-2025-001776","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001776"},"PeriodicalIF":2.1,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484044","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":"Investigating the timing of catheter removal after traumatic bladder injury: a single-institution 12-year experience.","authors":"Danielle J Wilson, Isaac Melin, Nayan Shah, R Corey O'Connor, Thomas Carver","doi":"10.1136/tsaco-2024-001693","DOIUrl":"10.1136/tsaco-2024-001693","url":null,"abstract":"<p><strong>Abstract: </strong></p><p><strong>Introduction: </strong>Traumatic bladder injuries, although rare, may result in significant patient morbidity. Operative management is recommended for intraperitoneal (IP), mixed, and select extraperitoneal (EP) injuries. Current guidelines lack recommendations on catheter duration following operative repair and suggest follow-up cystography may be unnecessary for simple, repaired injuries. This has led to practice variation in postoperative management at our institution. We hypothesized that the trauma surgery service would have a shorter catheter duration and obtain fewer follow-up cystograms compared with the urology service, without increased complications.</p><p><strong>Methods: </strong>A retrospective review was conducted at a single level 1 trauma center between January 2010 and December 2022. All patients with traumatic bladder injuries during this period were included from the trauma registry. Those who were <18 years of age, lacked a full-thickness injury, died within 7 days of presentation, had a concomitant urethral injury or complex injury, did not undergo surgical repair, were lost to follow-up, underwent surgical management elsewhere, or had an iatrogenic injury were excluded. Data on patient demographics, management, and complications were recorded. Injuries were classified as complex when involving the trigone, ureters, or bladder neck, or were described as complex in the operative report.</p><p><strong>Results: </strong>Of the 178 patients identified, 86 met the inclusion criteria. IP injuries were most common (43%), followed by EP (31%), and mixed (26%). Patient outcomes following the repair of simple injuries were similar regardless of the team performing the repair, although differences in catheter duration (11 days vs 17 days, p=0.006) and use of postoperative cystography (77% vs 100%, p<0.001) were observed (trauma vs urology, respectively).</p><p><strong>Conclusion: </strong>Variations in postoperative management regarding catheter drainage and follow-up imaging for simple bladder repairs resulted in similar leak and complication rates. Our findings present an opportunity to reduce the duration of postoperative catheter drainage and cystography use in simple repairs.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001693"},"PeriodicalIF":2.1,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11840895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469360","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":"Critical considerations to facilitate multidisciplinary care for survivors of firearm injury.","authors":"Virginia McCarthy, Catherine Garrison Velopulos, Quintin W O Myers","doi":"10.1136/tsaco-2024-001723","DOIUrl":"10.1136/tsaco-2024-001723","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001723"},"PeriodicalIF":2.1,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459609","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":"Handoffs and transitions of care in the intensive care unit: an American Association for the Surgery of Trauma Critical Care Committee clinical consensus document.","authors":"Rachel D Appelbaum, Michael S Farrell, J Jason Hoth, Hee Soo Jung, Abhijit Pathak, Aussama K Nassar, Joseph Cuschieri, Deborah M Stein, John V Agapian","doi":"10.1136/tsaco-2024-001677","DOIUrl":"10.1136/tsaco-2024-001677","url":null,"abstract":"<p><strong>Abstract: </strong></p><p><strong>Objectives: </strong>The American Association for the Surgery of Trauma (AAST) Critical Care Committee chose handoffs and transitions of care in the intensive care unit (ICU) as a clinically relevant topic for review. This clinical consensus document aims to provide practical guidance to the surgical intensivist on the best practices for patient handoffs and transitions of care.</p><p><strong>Methods: </strong>A working group was formed from the committee-at-large to complete this work. The members of the working group were each assigned a subtopic to review using research to date. The research on which the recommendations are based was compiled at the discretion of the working group. Any topic with discrepant or minimal supporting literature was reviewed by the AAST Critical Care Committee through an anonymous survey.</p><p><strong>Results: </strong>Recommendations for healthcare handovers include formally recognized handoffs at dedicated times, an interactive verbal exchange including all patients with a focus on what to anticipate or what is needs to be completed, tools to record and maintain information, and training to new providers on the handoff process and technology.</p><p><strong>Conclusion: </strong>As clinicians, we strive to provide the best evidence-based care to our patients. It is essential to study these high states, ICU handoffs to enhance the safety, efficiency, and effectiveness of patient care transitions, ultimately leading to better patient outcomes and provider satisfaction.</p><p><strong>Level of evidence: </strong>V.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001677"},"PeriodicalIF":2.1,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459613","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":"Break the cycle Baltimore: proceedings from a summit to unite violence prevention stakeholders.","authors":"Emily Kemper, Matthew Price, Melissa Hirsch, Insia Zufer, Kathleen Wagner-Kosmakos, Madhu Subramanian, Joseph Sakran, Nathan Irvin, Katherine Hoops","doi":"10.1136/tsaco-2024-001518","DOIUrl":"10.1136/tsaco-2024-001518","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001518"},"PeriodicalIF":2.1,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459599","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":"Associations between baseline pain, depressive symptoms, and unpaid caregiving needs and 1-year postdischarge outcomes among seriously ill older adults admitted for trauma.","authors":"Hiba Dhanani, Yihan Wang, Evan Bollens-Lund, Amanda Reich, Jolene Wong, Claire Ankuda, Stuart Lipsitz, Tamryn Gray, Dae Hyun Kim, Christine Ritchie, Zara Cooper","doi":"10.1136/tsaco-2024-001608","DOIUrl":"10.1136/tsaco-2024-001608","url":null,"abstract":"<p><strong>Background: </strong>Many older adults with trauma have pre-existing serious illness like dementia, frailty, and organ insufficiency and are candidates for palliative care to improve outcomes and reduce downstream healthcare utilization. We hypothesize that baseline pain, depressive symptoms, and unpaid caregiving needs are associated with increased healthcare utilization in the year after trauma admission in seriously ill older adults.</p><p><strong>Methods: </strong>Using the Health and Retirement Study (2008-2018) linked to Medicare claims, we identified adults aged ≥66 years admitted for trauma. We assessed pre-admission pain (none/mild vs moderate/severe), depressive symptoms (no-Center for Epidemiologic Studies Depression Scale (CES-D) <3 vs yes-CES-D ≥3) and unpaid caregiving needs (none vs any); and hospital characteristics: trauma center designation and palliative care service. The χ² tests were used for categorical variables, and t-tests were used for continuous variables. Associations of pain, depressive symptoms, unpaid caregiving needs with healthcare utilization were tested with negative binomial and Poisson regression models.</p><p><strong>Results: </strong>Among 1693 older adults with serious illness, a third (35.7%) were older than 85 years, two-thirds were female (67.5%), and almost all were White (88.7%). Before trauma, 36.4% reported moderate/severe pain, 40.2% reported depressive symptoms (CES-D >3), and 34.9% reported any amount of hours/week of unpaid caregiving needs. Adjusted analyses demonstrated that compared with those without depressive symptoms, seriously ill older adults with depressive symptoms were less likely to be alive (incidence rate ratio (IRR) 0.61, 95% CI 0.41 to 0.91), had more emergency room visits (IRR 1.62, 95% CI 1.15 to 2.27), and more hospital visits (IRR 1.48, 95% CI 1.08 to 2.03) in the year after admission. Adjusted analyses of association of pain and caregiving with healthcare utilization were not significant.</p><p><strong>Conclusions: </strong>Seriously ill older trauma patients with depressive symptoms have increased healthcare utilization in the year after discharge. Palliative care interventions may improve patient outcomes and reduce postdischarge healthcare utilization.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001608"},"PeriodicalIF":2.1,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459579","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":"Association of hyponatremia with outcomes after geriatric trauma: a systematic review and meta-analysis.","authors":"Ariana Naaseh, Steven Tohmasi, Carrie Stoll, Chongliang Luo, Lauren H Yaeger, Mark H Hoofnagle, Graham A Colditz, Marguerite W Spruce","doi":"10.1136/tsaco-2024-001562","DOIUrl":"10.1136/tsaco-2024-001562","url":null,"abstract":"<p><strong>Background: </strong>Trauma is a major cause of mortality in the elderly population. Hyponatremia is the most common electrolyte imbalance in geriatric patients and has been demonstrated to be a risk factor for altered cognition, low bone density, falls, and death. We systematically and critically reviewed the literature to ascertain the association between hyponatremia and geriatric trauma outcomes.</p><p><strong>Methods: </strong>We searched seven databases for articles published from inception to October 2023. Studies included reported on geriatric trauma, hyponatremia, and clinical outcomes. Two investigators independently reviewed 6535 abstracts, 235 full-text articles, and critically appraised each study. Study details, patient characteristics, and outcomes were independently extracted by two reviewers. Data quality assessment was performed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Publication bias was assessed using funnel plot-based methods. A meta-analysis of risk ratios (RR) was performed using the random effects method.</p><p><strong>Results: </strong>Four retrospective cohort studies involving 11 894 geriatric patients were included. Among these, 492 (21.4%) were classified as trauma patients due to a fall and 1806 (78.6%) were classified as a trauma patient due to the presence of a fracture. In total, 2298 (19.3%) patients were classified as hyponatremic (125-135 mmol/L) while 9596 (80.7%) were classified as normonatremic. The pooled RR for in-hospital mortality for hyponatremic patients was 2.23 (95% CI 1.51 to 3.74) with high heterogeneity across the studies (I²=82.17%).</p><p><strong>Conclusions: </strong>Geriatric trauma patients presenting with hyponatremia appear to have an increased risk of in-hospital mortality. Given this association, national trauma registries should consider collecting serum sodium values for geriatric patients and providers should work to address hyponatremia as a possible contribution to falls. Given the paucity of published literature on this topic, there is a need for prospective studies evaluating the association between hyponatremia and geriatric trauma outcomes.</p><p><strong>Level of evidence: </strong>Level III, systematic review with meta-analysis.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001562"},"PeriodicalIF":2.1,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11831274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442119","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":"'Health equity and trauma-informed care: a humanistic approach'.","authors":"Stephanie Bonne, Rochelle Dicker","doi":"10.1136/tsaco-2024-001719","DOIUrl":"10.1136/tsaco-2024-001719","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001719"},"PeriodicalIF":2.1,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11831284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442134","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 injected into the peritoneal space improves survival in a model of complex pelvic fracture and retroperitoneal exsanguination.","authors":"Quynh P Pham, John O Hwabejire, Ahmed E Elsharkawy, Ahmed I Eid, Michael J Duggan, Shawn Gelsinger, Michael Fornaciari, Upma Sharma, David R King","doi":"10.1136/tsaco-2024-001701","DOIUrl":"10.1136/tsaco-2024-001701","url":null,"abstract":"<p><strong>Background: </strong>Mortality for patients with pelvic fracture with hemorrhagic shock ranges from 21% to 57%. ResQFoam administered intra-abdominally has previously been shown to provide a survival benefit in large-animal models of abdominal exsanguination. It also significantly decreased mortality in models of retroperitoneal hemorrhage with complex pelvic fracture when deployed in the preperitoneal space. We hypothesized that percutaneously administered ResQFoam into the abdominal cavity could decrease mortality in exsanguinating pelvic hemorrhage.</p><p><strong>Methods: </strong>Using non-coagulopathic Yorkshire swine, the injury model consisted of a unilateral, closed-cavity retroperitoneal vascular hemorrhage (with intraperitoneal communication) combined with a complex pelvic fracture. After the injury, animals received fluid resuscitation alone (control, n=14), fluid resuscitation with ResQFoam deployed in the preperitoneal pelvic space (n=10), or fluid resuscitation with ResQFoam deployed intra-abdominally (n=10). Hemodynamic monitoring was continued for 3 hours or until death.</p><p><strong>Results: </strong>Intra-abdominal and preperitoneal use of ResQFoam provided a similar significant survival benefit compared with controls. The median survival times for the intra-abdominal and preperitoneal ResQFoam groups were 87 and 124 min, respectively, compared with 17 min for the control group (p=0.008 and 0.002, respectively). The survival rate at 3 hours was 40% for both ResQFoam groups compared with 0% in controls (p=0.020). There was no significant difference in the median survival time or overall survival curves between the two ResQFoam groups (p=0.734 and p=0.975, respectively). Both ResQFoam groups stabilized mean arterial pressure and significantly reduced hemorrhage rate. The average hemorrhage rate in control animals was 4.9±4.6 g/kg/min compared with 0.6±0.6 g/kg/min and 0.5±0.5 g/kg/min in the intra-abdominal (p=0.008) and preperitoneal (p=0.002) ResQFoam groups, respectively.</p><p><strong>Conclusions: </strong>Similar survival benefit and hemorrhage control were achieved with ResQFoam in the treatment of exsanguinating pelvic hemorrhage with complex pelvic fracture whether it was administered preperitoneally or intra-abdominally. Thus, ResQFoam can be administered intra-abdominally to treat either abdominal or pelvic hemorrhage.</p><p><strong>Level of evidence: </strong>Not applicable (animal study).</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001701"},"PeriodicalIF":2.1,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11831287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442138","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}