Trauma Surgery & Acute Care Open最新文献

{"title":"Does mean arterial pressure augmentation improve neurological recovery of blunt spinal cord injuries: an EAST multicenter trial.","authors":"Aimee LaRiccia, Stephanie Doris, Bhairav Shah, Tanisha Kashikar, Erik Teicher, Lindsey Perea, Jennifer Huber, Malia Eischen, H Akin Erol, Michael Steven Farrell, Lauren Colom, Stephanie Scott, Brian Daley, James Bardes, Gregory Schaefer, Melissa Moncrief, William DeVoe, Ryan Peter Dumas, Caitlin Anne Fitzgerald, William Brigode, John D Berne, Dalier R Mederos, Scott Armen, Melissa Linskey Dougherty, Asanthi Ratnasekera, Emily Alberto, Alison Smith, Bradley M Dennis, Stephen Gadomski, Jeffry Nahmias, Claudia Alvarez, Salina Wydo, Jennifer Schweinsburg, Carlos H Palacio, M Chance Spalding, Joshua Hill","doi":"10.1136/tsaco-2025-001768","DOIUrl":"10.1136/tsaco-2025-001768","url":null,"abstract":"<p><strong>Background: </strong>Treatment of blunt traumatic spinal cord injuries (SCIs) often includes maintaining elevated mean arterial blood pressures (MAP) to enhance perfusion to the spinal cord. Optimal hyperperfusion protocols and treatment algorithms have yet to be delineated due to a paucity of large volume prospective studies. This study aims to identify predictors of neurological improvement in American Spinal Injury Association (ASIA) impairment score following blunt SCI.</p><p><strong>Study design: </strong>Prospective (January 10, 2021 to June 1, 2023) multicenter study included blunt SCI patients age >18 with complete neurological examination documented on hospital arrival. Patients were divided into two groups: neurological improvement and no improvement, based on their change in ASIA score from arrival to hospital discharge.</p><p><strong>Results: </strong>A total of 19 centers contributed 222 patients of those, 164 had pre-ASIA and post-ASIA scores. The ASIA improvement group had 36 patients (22%). There was no statistical difference in the median percentage of time patients spent at a MAP >85 mm Hg during treatment 80.7% (IQR 63.6, 93.4) no improvement vs 83.6% (IQR 70.1, 93.0) in the improvement, (p=0.87). There was no difference in the median duration of MAP treatment in hours between the groups (95.6 hours (IQR 62.55, 113.48) in the no improvement group versus 96 (IQR 72, 113.5) (p=0.40) in the improvement group).</p><p><strong>Conclusions: </strong>Overall, 22% of all blunt SCI patients saw an improvement in their ASIA score. Adherence to and length of MAP augmentation was not a statistically significantly different between groups.</p><p><strong>Level of evidence: </strong>Level IV Therapeutic/Care Management.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 3","pages":"e001768"},"PeriodicalIF":2.2,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12359463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144883839","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":"Beyond the break: development and validation of a new classification system for acute traumatic rib fractures.","authors":"Joseph Frank Sucher, Hoang Lim, Ramy El Mankabady, Bradley Faliks, Scott Sholem, Christopher Mellon, Adam Mina, Mytia McNeal, Chuck Balcome, Kallen Beall, Asim Khwaja, James Dzandu, Alicia Mangram","doi":"10.1136/tsaco-2025-001812","DOIUrl":"10.1136/tsaco-2025-001812","url":null,"abstract":"<p><strong>Background: </strong>Despite the high incidence and significant injury burden of rib fractures, a universally agreed-upon taxonomy for acute traumatic rib fractures (TARF) has not been established. We propose a novel TARF with three components: (1) the rib that is fractured, (2) the anatomic sector of the fracture, and (3) the fracture severity. We hypothesized that each of these components can be interpreted on chest CT by radiologists and trauma surgeons with acceptable interobserver agreement (IOA), providing a consistent method for describing traumatic rib fractures.</p><p><strong>Methods: </strong>Between August and November 2020, 100 patients with reported rib fractures from our Level 1 trauma database were randomly selected for study inclusion. Two lead surgeons created a key map on specific fracture variable data on chest CT. Four surgeons, one chief surgical resident, and one radiologist completed the interpretation of 50 CT images (Set 1). Each physician was provided feedback and asked to verify and interpret a second set of 50 CT chest scans (Set 2) to determine the final IOA.</p><p><strong>Results: </strong>The baseline IOA between the lead surgeons on Set 2 was 86.3%. The radiologist scored 83.9% agreement on Set 1 and was excluded from further review. Four surgeons and one chief resident had a mean IOA of 41.9% for Set 1. Subsequently, they had a mean IOA of 72% on Set 2.</p><p><strong>Conclusions: </strong>Our experience suggests that this taxonomy can be used among surgical and radiology experts to better describe the true rib fracture burden, allowing for highly detailed information in a concise clinically relevant format. Furthermore, this TARF may allow for optimal comparison of patients with rib fractures and potentially provide improved insight into fracture patterns and patient outcomes with or without surgical rib fixation. Further investigations utilizing this TARF are needed.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 3","pages":"e001812"},"PeriodicalIF":2.2,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12352215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875320","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":"My father never told me the whole story.","authors":"David A Hampton","doi":"10.1136/tsaco-2025-002010","DOIUrl":"https://doi.org/10.1136/tsaco-2025-002010","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 3","pages":"e002010"},"PeriodicalIF":2.2,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12336606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144822722","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":"Pediatric cervical spine clearance: a 10-year evaluation of X-ray in evaluable patients at a level 1 pediatric trauma center.","authors":"William Starr, Stephanie Iantorno, Jing Wang, Richard Eldredge, Rajiv Iyer, Karch Smith, Natalya McNamara, Kezlyn Larsen, Stephen Fenton, Robert Swendiman, Katie Russell","doi":"10.1136/tsaco-2024-001539","DOIUrl":"10.1136/tsaco-2024-001539","url":null,"abstract":"<p><strong>Objectives: </strong>Cervical spine (c-spine) X-ray (XR) remains an important tool for pediatric trauma patients. XR is a low radiation alternative to multidetector CT (MDCT). Our primary aims were to analyze the sensitivity of a negative c-spine XR and to analyze what factors lead to additional imaging after a negative c-spine XR.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted at a level 1 pediatric trauma center from 2012 to 2021. We compared the group with negative c-spine XR and no additional imaging to the group with negative c-spine XR followed by additional c-spine MDCT and/or MRI.</p><p><strong>Results: </strong>There were 2,081 negative XRs and 1,974 (95%) had their c-spines cleared without additional imaging. No patient required an operation for a clinically significant c-spine injury in this group, and we consider this no missed injuries. The remaining 108 patients had additional c-spine imaging after negative c-spine XR for c-spine clearance (24 MDCT, 76 MRI, 8 MDCT and MRI). Indications for additional c-spine imaging were pain (48.1%), Glasgow Coma Scale (GCS) score ≤14 (43.5%), and paresthesia (8.3%). Patients who received additional imaging were more likely to have a GCS score ≤12 (25.4% vs 4.1%), Injury Severity Score >15 (21.9% vs 8.1%), Level 1 Trauma activation (21% vs 5%), Abbreviated Injury Scale head score of 4 or 5 (29% vs 5%), be intubated (30% vs 2%), and have non-accidental trauma as their mechanism of injury (20% vs 1%) (p value<0.0001, for all). Five patients who received additional imaging were treated with a cervical collar, but no operative intervention.</p><p><strong>Conclusions: </strong>In this cohort, screening XR had a sensitivity of 100% for clinically significant c-spine injuries. GCS was the most significant predictor of obtaining additional imaging. A negative XR combined with a normal physical examination in an evaluable pediatric patient is a safe way of clearing the c-spine.</p><p><strong>Level of evidence: </strong>Study contains level III evidence.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 3","pages":"e001539"},"PeriodicalIF":2.2,"publicationDate":"2025-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144785409","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":"Low radiation, high yield: reclaiming the first-line role of radiographs.","authors":"Gena V Topper, Tanya Egodage, Nicole Fox","doi":"10.1136/tsaco-2025-002003","DOIUrl":"10.1136/tsaco-2025-002003","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 3","pages":"e002003"},"PeriodicalIF":2.2,"publicationDate":"2025-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144785408","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":"Language of prevention: advancing firearm safety through health literacy.","authors":"Natasha Houshmand, Joseph Sakran","doi":"10.1136/tsaco-2025-001949","DOIUrl":"10.1136/tsaco-2025-001949","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 3","pages":"e001949"},"PeriodicalIF":2.2,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12315016/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776260","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":"Prolonged atriocaval shunt utilization as a damage control tool for the management of juxtarenal IVC injury with a multitude of complex abdominal injuries.","authors":"Edgar B Rodas, Stefan Leichtle, Mike Mallah, Kyle J Alexander, Sierra L Patterson, William B French, Levi Procter, Jessica Potter, Brian J Strife, Leopoldo Fernandez, Michel B Aboutanos","doi":"10.1136/tsaco-2025-001882","DOIUrl":"10.1136/tsaco-2025-001882","url":null,"abstract":"<p><p>We describe the surgical dilemma of an adult male who arrived with a penetrating injury to the suprarenal inferior vena cava (IVC), where conventional intraoperative hemorrhage control failed. Our team innovated by using an atriocaval shunt for temporization of the injury during resuscitation, enabling us to return to the operating room and perform primary repair. Notably, the prolonged use of the atriocaval shunt as a damage control strategy represents a novel application, as it remained in place for several hours-a first in reported cases. We detail this technique, the multidisciplinary approach to managing concomitant severe injuries, and the resulting complications and outcomes. This case highlights the challenges of managing suprarenal IVC injuries and demonstrates the potential role of prolonged atriocaval shunting as a damage control strategy.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 3","pages":"e001882"},"PeriodicalIF":2.1,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683203","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":"Reinforcing the value of statewide trauma systems.","authors":"James Edward Gannon, Bonnylin Covey Van Winkle, Elwood Conaway","doi":"10.1136/tsaco-2025-001972","DOIUrl":"10.1136/tsaco-2025-001972","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 3","pages":"e001972"},"PeriodicalIF":2.1,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683204","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 clinical practice guideline for civilian emergency medical services.","authors":"Matthew J Levy, Randall M Schaefer, Holly Obyrne, Jon R Krohmer, Eric A Bank, John B Holcomb","doi":"10.1136/tsaco-2025-001931","DOIUrl":"10.1136/tsaco-2025-001931","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 3","pages":"e001931"},"PeriodicalIF":2.1,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683202","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":"Economic impact of reduced state trauma mortality on lifetime personal income and state tax revenue.","authors":"Harold Edward Groce, Dennis Wayne Ashley, Joe Sam Robinson","doi":"10.1136/tsaco-2024-001698","DOIUrl":"10.1136/tsaco-2024-001698","url":null,"abstract":"<p><strong>Background: </strong>In 2003, Georgia's trauma mortality rate was 16% above the national average. By 2020, mortality had decreased to 6% below the national average, translating to 1,803 fewer lives lost than might have been expected if 2003 trends had continued. The purpose of this study is to assess the state-wide economic impact of reduced mortality and disability measured in the amount of lifetime personal income and state tax revenue preserved.</p><p><strong>Methods: </strong>Using the Centers for Disease Control and Prevention's Web-Based Injury Statistics Query and Reporting System database, state/national trauma mortality rates for 2020 were compared with 2003. Years of potential life lost (YPLL) for trauma victims up to 65 were calculated for the same time period. Rates of severe disability were calculated based on the average results of four studies (1992-2022) and used to estimate additional YPLL. The per-capita personal income for Georgia and the average percent of personal income paid in state taxes were calculated using federal and state data. These numbers were then multiplied by state YPLL rates to calculate lifetime personal income and state tax revenue lost due to trauma.</p><p><strong>Results: </strong>$4.3 billion in lifetime personal income preserved (averted death $1.3 billion and averted disability $2.9 billion). $508 million in lifetime tax revenue preserved (averted death $158 million and averted disability $349 million).</p><p><strong>Conclusions: </strong>Reduced state trauma mortality and disability substantially benefitted lifetime potential personal income and lifetime potential state and local tax revenue. This study provides states with a template to evaluate the economic impact of reducing trauma mortality. While the causes of reduced mortality are manifold, anything that can be done to reduce trauma mortality is a worthwhile investment. Accordingly, state trauma system funding should be considered an <i>investment</i>, not a cost.</p><p><strong>Level of evidence: </strong>Economic and value-based evaluations, Level III.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 3","pages":"e001698"},"PeriodicalIF":2.1,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12265832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650611","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}