Trauma Surgery & Acute Care Open最新文献

{"title":"To fix or let them flail: the who, what and when of rib fixation.","authors":"John T Simpson, Adrian Camarena, Patrick Georgoff, Joseph Fernandez-Moure","doi":"10.1136/tsaco-2025-001801","DOIUrl":"10.1136/tsaco-2025-001801","url":null,"abstract":"<p><p>Rib fractures occur in 10% of traumatic injuries and are a common source of morbidity and mortality. Mortality rates for rib fractures remain alarmingly high. Despite increasing literature in support of surgical stabilization of rib fracture (SSRF), acceptance and incorporation of SSRF as the standard of care has not occurred across trauma centers. This expert review highlights the 'who, what and when' of SSRF and argues for SSRF as the gold standard for the restoration of form and function following chest wall injury.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 Suppl 1","pages":"e001801"},"PeriodicalIF":2.1,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12094122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120945","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":"Reclaim the duct! Laparoscopic common bile duct exploration for the acute care surgeon.","authors":"Katherine Cironi, Matthew J Martin","doi":"10.1136/tsaco-2025-001821","DOIUrl":"https://doi.org/10.1136/tsaco-2025-001821","url":null,"abstract":"<p><p>Laparoscopic common bile duct exploration (LCBDE) has emerged as a viable and effective alternative to the traditional multistage management of choledocholithiasis involving preoperative or postoperative endoscopic retrograde cholangiopancreatography (ERCP). Despite its advantages, LCBDE remains underused, particularly among trauma and acute care surgeons, due to its technical challenges and limited training opportunities. This practical review examines advancements in LCBDE technology, exploring its clinical applications, outlining key steps for its successful implementation, and evaluating selected current literature. Multiple studies have demonstrated that LCBDE achieves comparable success rates to ERCP and reduces hospital length of stay, overall costs, and the need for additional procedures. However, barriers to widespread adoption persist, primarily related to the technical learning curve, limited exposure during surgical training, and institutional workflow constraints favoring ERCP. With recent advancements in surgical technology and enhanced training models, LCBDE is becoming increasingly adoptable. Given their frequent management of biliary abnormality, trauma and acute care surgeons should develop proficiency in this technique to optimize patient outcomes and minimizing procedural burden.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 Suppl 1","pages":"e001821"},"PeriodicalIF":2.1,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12004475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033513","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":"x-ABC versus ABC: shifting paradigms in early trauma resuscitation.","authors":"Alexandra Mp Brito, Martin Schreiber","doi":"10.1136/tsaco-2025-001773","DOIUrl":"10.1136/tsaco-2025-001773","url":null,"abstract":"<p><p>Exsanguinating hemorrhage is the most common cause of preventable death after trauma. Since the development of cardiopulmonary resuscitation, the airway, breathing and circulation (ABCs) have been applied to early resuscitation in different contexts including trauma. The ABCs have been a pivotal paradigm in the Advanced Trauma Life Support course since its development, but recent data have indicated that prioritizing the management of eXsanguinating hemorrhage (x-ABC) improves outcomes. In this review, we examine the history and evolution of the ABCs in the context of resuscitation research to the recent adoption of x-ABC in trauma.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 Suppl 1","pages":"e001773"},"PeriodicalIF":2.1,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12094115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120946","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":"One for the ages: optimizing geriatric care in the intensive care unit.","authors":"Tanya Egodage, Purvi Pravinchandra Patel","doi":"10.1136/tsaco-2025-001785","DOIUrl":"10.1136/tsaco-2025-001785","url":null,"abstract":"<p><p>Increasing proportions of patients admitted to intensive care units (ICUs) are >65 years of age. Geriatric critical care requires a nuanced approach that optimizes outcomes and is mindful of patient desires. This occurs by identifying at-risk patients and implementing protocols and multidisciplinary care which targets patients' clinical status, prevents neurologic and physical deterioration, and addresses comorbidities in the setting of altered physiology. In this article, we will review evidence-based practices to enhance the care of older adult patients in the ICU.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 Suppl 1","pages":"e001785"},"PeriodicalIF":2.1,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12164298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302934","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":"Managing severe (and open) pelvic disruption.","authors":"Alexander L Eastman, April Miller","doi":"10.1136/tsaco-2025-001820","DOIUrl":"https://doi.org/10.1136/tsaco-2025-001820","url":null,"abstract":"<p><p>Open pelvic fractures are a rare yet catastrophic injury pattern, often resulting from high-energy trauma such as motor vehicle collisions, motorcycle accidents, and pedestrian impacts. They account for only 2%-4% of all pelvic fractures, but their severity lies in the complex anatomy of the pelvis and its associated structures, including the vasculature, bowel, bladder, and genital organs. Mortality rates range from 15% to 50%, with some studies reporting rates as high as 70% in cases involving severe perineal or rectal injuries. These injuries pose two main risks to survival: hemorrhagic shock in the acute phase and pelvic sepsis during the later phases of recovery. Acute hemorrhage can occur from arterial injury (eg, internal iliac arteries), venous plexuses, or bony sources. Delayed deaths are often caused by sepsis due to fecal contamination of wounds or infected hematomas. Additionally, these fractures are often associated with other life-threatening injuries, including intra-abdominal trauma, genitourinary disruptions, and neurovascular compromise, further complicating their management. Management of these injuries has evolved significantly with advancements in hemorrhage control techniques such as preperitoneal pelvic packing and resuscitative endovascular balloon occlusion of the aorta. A multidisciplinary approach is essential to address the multifaceted challenges posed by these injuries.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 Suppl 1","pages":"e001820"},"PeriodicalIF":2.1,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12010346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053043","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":"Optimizing CT resource use in geriatric trauma: is less sometimes more?","authors":"Arnav Mahajan, Pooja Podugu, Vanessa P Ho","doi":"10.1136/tsaco-2025-001817","DOIUrl":"10.1136/tsaco-2025-001817","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 2","pages":"e001817"},"PeriodicalIF":2.1,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11967110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796464","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":"Leveraging existing infrastructure to answer clinically important questions in trauma: registry-based randomized clinical trials.","authors":"Mira Ghneim, Ben L Zarzaur, Patrick B Murphy","doi":"10.1136/tsaco-2025-001769","DOIUrl":"10.1136/tsaco-2025-001769","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001769"},"PeriodicalIF":2.1,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143773369","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":"How do I focus on mental health in a war zone? A challenge for young black men surviving gun violence.","authors":"Ashley Y Williams, Maryann I Mbaka, Antwan J Hogue","doi":"10.1136/tsaco-2025-001830","DOIUrl":"10.1136/tsaco-2025-001830","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001830"},"PeriodicalIF":2.1,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11962794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143773365","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":"Resuscitative Endovascular Balloon Occlusion of the Aorta in surgical and trauma patients: a systematic review, meta-analysis and practice management guideline from the Eastern Association for the Surgery of Trauma.","authors":"Melike N Harfouche, Nikolay Bugaev, John J Como, Douglas R Fraser, Allison G McNickle, Guy Golani, Benjamin P Johnson, Horacio Hojman, Hiba Abdel-Aziz, Jaswin S Sawhney, Daniel C Cullinane, Steven Lorch, Elliott R Haut, Nicole Fox, Laurence S Magder, George Kasotakis","doi":"10.1136/tsaco-2024-001730","DOIUrl":"10.1136/tsaco-2024-001730","url":null,"abstract":"<p><strong>Background: </strong>The role of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in the management of patients with subdiaphragmatic bleeding, as well as its utility in traumatic cardiac arrest (TCA), is unknown.</p><p><strong>Methods: </strong>A working group from the Eastern Association for the Surgery of Trauma (EAST) applied the Grading of Recommendations Assessment, Development and Evaluation methodology (GRADE) to perform a systematic review and meta-analysis, assess the level of evidence, and create recommendations pertaining to the use of REBOA in the management of trauma or non-trauma patients, as well as those in TCA (1946 to 2024).</p><p><strong>Results: </strong>Thirty-one studies were included in the meta-analysis. In unstable trauma patients with subdiaphragmatic bleeding, there was no significant difference in mortality among patients who were treated with REBOA vs no REBOA [OR 0.86, 95% CI 0.37, 2.04]. Subgroup analysis for individuals with pelvic fractures demonstrated higher mortality for REBOA vs no REBOA [OR=2.15, CI 1.35, 3.42]. In patients with TCA, pooled analysis demonstrated decreased mortality with REBOA vs resuscitative thoracotomy (OR 0.32, 95% CI 0.15, 0.69). Compared with no REBOA, prophylactic placement of REBOA prior to cesarean section in placenta accreta syndrome (PAS) had lower intra-operative blood loss [-1.06 L, CI -1.57 to -0.56] and red blood cell transfusion [-2.44 units, CI -4.27 to -0.62]. Overall, the level of evidence was assessed by the working group as very low.</p><p><strong>Conclusion: </strong>Considering the risks associated with its use and lack of discernible benefit, the committee conditionally recommends against the use of REBOA in trauma patients who are hemodynamically unstable due to suspected subdiaphragmatic hemorrhage. Further research is needed to identify specific subpopulations who may benefit. For individuals with TCA due to suspected subdiaphragmatic bleeding and for prophylactic placement in PAS, the committee conditionally recommends for the use of REBOA.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001730"},"PeriodicalIF":2.1,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754612","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":"Repairing a remote complication of abdominal penetrating trauma: diagnosis and management of a debilitating gastrocolic fistula.","authors":"Joy Obayemi, Peter Sienko, Aasma Hossain, Ryan Eton, Gary Vercruysse","doi":"10.1136/tsaco-2024-001620","DOIUrl":"10.1136/tsaco-2024-001620","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001620"},"PeriodicalIF":2.1,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754611","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}