Trauma Surgery & Acute Care Open最新文献

{"title":"From Peril to Protection: an evaluation of regulations impacting eScooter injuries.","authors":"Kendra M Black, Jarrett E Santorelli, Todd W Costantini, Leslie M Kobayashi, Jay J Doucet, Laura N Haines","doi":"10.1136/tsaco-2024-001440","DOIUrl":"10.1136/tsaco-2024-001440","url":null,"abstract":"<p><strong>Background: </strong>The use of standing electric motorized scooters (eScooters) has skyrocketed since its first release in 2016. This quickly popularized form of transportation has been associated with significant injury and even death. These eScooter-related traumatic injuries led to local advocacy efforts, resulting in safety restrictions including speed limit geofencing, sidewalk restrictions, and limiting the number of eScooter providers in high-density population areas. We hypothesized that these local safety restrictions decreased the number of eScooter-related injuries presenting to our trauma center. .</p><p><strong>Methods: </strong>This is a retrospective cohort study of eScooter-crash patients presenting to our Level 1 trauma center from July 2018 to June 2023. Variables included patient demographics, injury severity score (ISS), and mortality. The primary outcome was the rate of eScooter patients presenting over time in relation to the implementation of local-regional safety regulations.</p><p><strong>Results: </strong>A total of 381 patients presented after eScooter crashes. Males were 73.8% of patients. The average age was 38.6 years; 45+ years was the most common age group at 33%, followed by ages 25-34 (31%). The mean ISS was 9±6, with ISS 0-9 (65.1%), 10-15 (24.4%), 16-24 (8.4%), and >25 (20.1%). There were three (0.8%) deaths. The median number of eScooter patients per month with prespeed limits was nine and post five (p=0.005), showing a 44.4% decrease in injured patients. After February 2022 restrictions, the rate precipitously declined with a median of two (p=0.033), reflecting an additional 60% decrease in injured patients.</p><p><strong>Conclusion: </strong>Local advocacy resulting in increased safety regulations was associated with a significant reduction in injured patients secondary to eScooter use. This demonstrates the importance of advocacy efforts in response to changes in injury patterns and mechanisms of injury. We believe that our work can serve as a model for other urban centers seeking to reduce eScooter-related injuries and implement effective safety measures.</p><p><strong>Level of evidence: </strong>IV, prognostic/epidemiologic.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001440"},"PeriodicalIF":2.1,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11815460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143410949","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":"Empowering recovery: a remote spirometry system and mobile app for monitoring and promoting pulmonary rehabilitation in patients with rib fracture.","authors":"Chien-An Liao, Tai-Horng Young, Ling-Wei Kuo, Chih-Yuan Fu, Szu-An Chen, Yu-San Tee, Shih-Ching Kang, Chi-Tung Cheng, Chien-Hung Liao","doi":"10.1136/tsaco-2023-001309","DOIUrl":"10.1136/tsaco-2023-001309","url":null,"abstract":"<p><strong>Background: </strong>Multiple rib fractures commonly result from blunt chest trauma. These fractures can lead to prolonged impairment in pulmonary function and often require long-term rehabilitation. This pilot study aimed to evaluate the feasibility of a remote spirometry device for continuous monitoring of lung function in patients with multiple rib fractures.</p><p><strong>Methods: </strong>Between January 2021 and April 2021, we implemented a remote spirometry system for adult patients with multiple rib fractures and collected their clinical data. We used a Restart system to monitor the respiratory parameters of patients. This system included a wireless spirometer and a Healthy Lung mobile application. A portable spirometer was used to measure forced vital capacity (FVC), peak expiratory flow (PEF), and forced expiratory volume in 1 second.</p><p><strong>Result: </strong>In total, 21 patients were included in this study. We categorized the participants into two age groups: those older and those younger than 65 years. No significant differences were observed between the two groups regarding demographic characteristics or device adoption rates. However, we observed that patients under 65 years demonstrated more remarkable improvement in pulmonary function than their older counterparts, with significant differences in FVC (110% vs 10%, p=0.032) and PEF (64.2% vs 11.9%, p=0.003).</p><p><strong>Conclusion: </strong>The adoption of the remote spirometry device is similar between older and younger patients with rib fractures. However, the device improves pulmonary function more in patients in a younger age group. This tool may be effective as a real-time, continuous pulmonary function monitoring system for patients with multiple rib fractures.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001309"},"PeriodicalIF":2.1,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11808876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392022","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":"Redefining conversations at the crossroads of care using the SAFE-GOALS framework.","authors":"Yasmin Arda, Matthew A Bartek","doi":"10.1136/tsaco-2025-001789","DOIUrl":"10.1136/tsaco-2025-001789","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001789"},"PeriodicalIF":2.1,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11808901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392025","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":"Advancing care in high-grade liver injuries: the transformative impact of multidisciplinary collaboration.","authors":"Ara J Feinstein, Natasha Keric","doi":"10.1136/tsaco-2024-001744","DOIUrl":"10.1136/tsaco-2024-001744","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001744"},"PeriodicalIF":2.1,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11804191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383419","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":"Hepatic angioembolization after trauma: what do we need to tell our patients afterwards?","authors":"James Bardes","doi":"10.1136/tsaco-2025-001753","DOIUrl":"10.1136/tsaco-2025-001753","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001753"},"PeriodicalIF":2.1,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256847","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":"Understanding hospital length of stay in trauma laparotomy patients: a National Trauma Database Study.","authors":"Hayaki Uchino, Evan G Wong, Kosar Khwaja, Jeremy Grushka","doi":"10.1136/tsaco-2024-001641","DOIUrl":"10.1136/tsaco-2024-001641","url":null,"abstract":"<p><strong>Introduction: </strong>The diverse procedures and varying patient conditions in trauma laparotomy cases lead to significant variability in hospital length of stay (HLOS), posing challenges for effective patient care. Strategies to reduce HLOS are varied, with multiple factors potentially modifiable through targeted interventions. These interventions are most effective when target populations and their associated factors are clearly defined. This study aimed to stratify trauma laparotomy patients by their HLOS and identify factors associated with HLOS to enhance patient care.</p><p><strong>Methods: </strong>A retrospective analysis was conducted using the National Trauma Data Bank from January 2017 to December 2019. Adult trauma patients who underwent trauma laparotomy following blunt or penetrating abdominal injuries were identified using International Classification of Diseases, 10th Revision codes and Abbreviated Injury Scales. HLOS was stratified into three groups based on the IQR of the study population: short (< 5 days), medium (5-11 days) and long (> 11 days).</p><p><strong>Results: </strong>A total of 27 434 trauma laparotomy patients were identified. The overall median HLOS was 7.0 (5.0, 11.0) days. Penetrating mechanisms, particularly stab wounds, were strongly associated with a short HLOS. Additionally, isolated abdominal trauma, splenic injuries or spleen-related procedure were more likely to result in a short HLOS. Patients with a long HLOS experienced higher rates of in-hospital complications and were more frequently discharged to home with home health services or to extended care facilities. Most comorbidities were associated with a long HLOS, and patients with Medicaid or Medicare had a higher likelihood of a long HLOS.</p><p><strong>Conclusion: </strong>Despite the relatively homogenous trauma population, HLOS distribution varied significantly. Stratification based on HLOS revealed distinct factors associated with short and long HLOS categories, indicating that targeted interventions for each category could potentially reduce HLOS and enhance patient outcomes in the current era of constrained healthcare resources.</p><p><strong>Level of evidence study type: </strong>Level IV, therapeutic/care management.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001641"},"PeriodicalIF":2.1,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256851","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":"Geriatric nutrition in the surgical patient: an American Association for the Surgery of Trauma Critical Care and Geriatric Trauma Committees clinical consensus document.","authors":"Michael Steven Farrell, Tasce Bongiovanni, Joseph Cuschieri, Tanya Egodage, Adel Elkbuli, Rondi Gelbard, Randeep Jawa, Samrah Mitha, Aussama Khalaf Nassar, Abhijit Pathak, Ruben Peralta, Tyler Putnam, Deborah M Stein","doi":"10.1136/tsaco-2024-001602","DOIUrl":"10.1136/tsaco-2024-001602","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001602"},"PeriodicalIF":2.1,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190628","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":"Effectiveness of syndecan-1 as an adjunct diagnostic marker in small bowel injury: a report of two cases.","authors":"Fuminori Yamaji, Tetsuya Fukuta, Masahiro Ichihashi, Yosuke Mizuno, Keiko Suzuki, Takahito Miyake, Norihide Kanda, Hideshi Okada","doi":"10.1136/tsaco-2024-001727","DOIUrl":"10.1136/tsaco-2024-001727","url":null,"abstract":"<p><strong>Background: </strong>Small bowel injuries are rare in trauma. Diagnosing these injuries is difficult owing to the lack of clear signs, and delays in diagnosis might increase complications and mortality. Trauma can damage the vascular endothelial glycocalyx, with syndecan-1 emerging as a marker of injury. Here, we describe two cases of small bowel injury due to traffic motor vehicle crash trauma.</p><p><strong>Case presentation: </strong>The patients, one in their 40s and one teenaged, were transported to our hospital after a traffic motor vehicle crash. Both patients were wearing seat belts at the time of the motor vehicle crash, and the car's airbags deployed properly. Their vital signs were stable at admission, and non-operative treatment was selected. However, their abdominal pain did not improve, and based on posthospitalization CT reconstructive imaging, intra-abdominal hemorrhage was suspected. Surgery was performed, revealing small intestinal injuries. In both patients, a high serum syndecan-1 level in the blood test at admission was a common characteristic.</p><p><strong>Conclusion: </strong>Increased serum syndecan-1 level was observed in blood tests during the initial treatment of small intestinal injuries in these patients, suggesting its potential utility in early diagnosis. However, further accumulation of cases and detailed studies are required to substantiate these results.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001727"},"PeriodicalIF":2.1,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11784201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081164","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":"Tranexamic acid as an adjunct to resuscitative endovascular balloon occlusion of the aorta does not worsen outcomes in a porcine model of hemorrhage.","authors":"Leslie E Neidert, Clifford G Morgan, Dominic Lonowski, Cecilia Castro, Peter J Hemond, Valeria R Lozano, Michael M Tiller, Sylvain Cardin, Jacob J Glaser","doi":"10.1136/tsaco-2024-001559","DOIUrl":"10.1136/tsaco-2024-001559","url":null,"abstract":"<p><strong>Background: </strong>Non-compressible torso hemorrhage (NCTH) represents a leading cause of preventable mortality in trauma. Resuscitative endovascular balloon occlusion of the aorta (REBOA) stabilizes NCTH but may predispose patients to thrombus generation. REBOA must therefore be prospectively evaluated for coagulation risks with concomitant usage of anti-fibrinolytic tranexamic acid (TXA). Using a porcine model of hemorrhage, it was hypothesized that TXA with REBOA would worsen coagulation outcomes and organ damage.</p><p><strong>Materials and methods: </strong>Thirty-two male Yorkshire swine underwent 30% blood volume hemorrhage with randomization to vehicle control (VC; normal saline), VC+REBOA, TXA, or TXA+REBOA. At T0, animals received 10 mL/minute of group-specific infusion (GSI) followed at T10 by 500 mL of whole blood (WB), second GSI at 13 mL/hour, and Zone 1 REBOA inflation in REBOA groups. At T40, REBOA was deflated, with additional 500 mL WB, and continuation of GSI for 3 hours. Physiological, coagulation, and inflammatory parameters were measured throughout the protocol, with postmortem histopathology.</p><p><strong>Results: </strong>After REBOA deflation at T40, lactate was significantly higher for the REBOA groups versus the non-REBOA groups, and pH, bicarbonate, and base excess were all significantly lower than the non-REBOA groups. There were no significant differences observed between groups in coagulation, inflammatory, metabolic, or histopathologic parameters.</p><p><strong>Conclusions: </strong>Administration of TXA with REBOA did not cause more deleterious coagulation outcomes. All significant changes were expected results of REBOA ischemia, and not attributable to TXA treatment. This suggests NCTH can safely be treated with both hemorrhage control methods without exacerbating clotting outcomes.</p><p><strong>Level of evidence: </strong>Not applicable-basic animal research.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001559"},"PeriodicalIF":2.1,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11781125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068225","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":"Multidisciplinary management of transorbital transverse penetrating brain injury by retained knife.","authors":"Vsevolod Shurkhay, Brandon L King, Eric Schinnerer, Changxing Liu, Michael Charles, Yashar S Kalani","doi":"10.1136/tsaco-2024-001682","DOIUrl":"10.1136/tsaco-2024-001682","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001682"},"PeriodicalIF":2.1,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047982","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}