Trauma Surgery & Acute Care Open最新文献

{"title":"Bringing imaging to the bedside: unlocking the potential of handheld ultrasound for traumatic pneumothorax.","authors":"Patrick Sheahan, Paula Ferrada","doi":"10.1136/tsaco-2024-001717","DOIUrl":"10.1136/tsaco-2024-001717","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001717"},"PeriodicalIF":2.1,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024735","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":"Changes in multidisciplinary perceptions of trauma video review following implementation of a novel program: let us go to the tape.","authors":"Matthew Murray, Eli Rogers, Kate Dellonte, Ryan Peter Dumas, Michael A Vella","doi":"10.1136/tsaco-2024-001621","DOIUrl":"10.1136/tsaco-2024-001621","url":null,"abstract":"<p><strong>Abstract: </strong></p><p><strong>Background: </strong>Trauma video review (TVR) is an evolving technology that can be used to measure technical and non-technical aspects of trauma care leading to meaningful improvements. Only 30% of centers currently use TVR, with non-users citing medicolegal concerns, staff discomfort with recording, and resource constraints as barriers to implementation. Multiple studies have shown established TVR programs are well-perceived by staff. Little is known about perceptions prior to, and after implementation of a new program.</p><p><strong>Objective: </strong>This study evaluated changes in TVR perceptions following implementation of a new program.</p><p><strong>Methods: </strong>A 15-question survey was distributed to emergency department and trauma surgery providers at a level I trauma center prior to, and 1 year after, implementation of TVR. A 5-point Likert scale was used to evaluate perceptions of the value of TVR, measures of team dynamics, and staff discomfort with recording.</p><p><strong>Results: </strong>A total of 106 pre-implementation and 82 post-implementation responses were recorded. Perceptions in several domains improved post-implementation including team leader effectiveness (3 (3-4) to 4 (3-4); p=0.002), communication (3 (3-4) to 4 (3-4); p<0.001), and self confidence in role (4 (3-4) to 4 (4-5); p=0.001). Staff discomfort with recording decreased post-implementation (3 (2-4) to 2 (2-3); p=0.002).</p><p><strong>Conclusion: </strong>Our study shows that perceptions of TVR changed favorably after implementation, particularly perceptions of team dynamics and provider discomfort with recording. These results can be used to mitigate staff concerns about TVR and encourage the development of new programs.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001621"},"PeriodicalIF":2.1,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024737","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":"SAFE-GOALS: a protocol for goals of care discussions in the intensive care unit.","authors":"David Ray Velez, Thomas Dresser Irons, Anthony Brando Opimo, Emily Brown, Doug Foley, Jamie Lynn Velez, Allison G McNickle","doi":"10.1136/tsaco-2024-001663","DOIUrl":"10.1136/tsaco-2024-001663","url":null,"abstract":"<p><strong>Summary: </strong></p><p><strong>Introduction: </strong>In critical care, there is often a lack of understanding regarding patient preferences toward end-of-life care. Goals of care discussions are poorly defined and inhibited by clinician apprehension, prognostic uncertainty, and discomfort from both sides. In the delivery of bad news, protocol-based discussions have proven beneficial, yet no such protocol exists for goals of care discussions in the intensive care unit (ICU). We therefore assembled a multidisciplinary team to define a specific protocol dedicated to leading goals of care discussions in the ICU setting.</p><p><strong>Safe-goals protocol: </strong>S: set upA: acknowledgmentF: family understandingE: events of hospital courseG: get to know the patientO: optionsAL: active listening and discussionS: steps going forward.</p><p><strong>Conclusion: </strong>This protocol provides a framework for leading goals of care conversations in the ICU. Specific training should be incorporated and better emphasized in the modern medical education.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001663"},"PeriodicalIF":2.1,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024789","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":"Trauma Survivors Network: history and evolution of a program empowering survivors and families impacted by traumatic injury.","authors":"Eileen M Flores, Christopher P Michetti, Samir M Fakhry, Katherine Joseph, Elizabeth Wysocki, Anna Newcomb","doi":"10.1136/tsaco-2024-001576","DOIUrl":"10.1136/tsaco-2024-001576","url":null,"abstract":"<p><p>The Trauma Survivors Network (TSN), a program of the American Trauma Society (ATS), has a unique history spanning decades with a vision to continue expanding and strengthening services to support survivors and families impacted by traumatic injury. Since the COVID-19 pandemic, the ATS has adapted TSN services to provide both virtual and in-person services for trauma survivors, increasing equity and inclusion for many survivors to access TSN services for the first time. The recent policy changes in the American College of Surgeons Committee on Trauma <i>New Standards for Care of the Injured Patient</i> provide an impetus for the TSN to grow and expand services in support of a diverse group of trauma survivors and their loved ones. This paper highlights the collateral impact of traumatic injury, the history and ongoing growth of the TSN and its services to date, the challenges encountered in establishing and maintaining the TSN program, and the equity and inclusion that the TSN offers internationally to support a diverse range of survivors with various forms of trauma and polytrauma.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001576"},"PeriodicalIF":2.1,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024809","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 robotic utilization: the role of preoperative grading scales in prioritizing robotic surgery for minimally invasive cholecystectomy.","authors":"Kristy Lynn Hawley, Madhuri Nagaraj, William Aaron Marshall","doi":"10.1136/tsaco-2024-001713","DOIUrl":"10.1136/tsaco-2024-001713","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001713"},"PeriodicalIF":2.1,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024779","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 between prophylactic intermittent non-invasive positive pressure ventilation and incidence of pneumonia in patients with cervical spinal cord injury: a retrospective single-center cohort study.","authors":"Yuita Fukuyama, Kazuhiro Okada, Takashi Tagami, Yoshiaki Hara, Shoji Yokobori","doi":"10.1136/tsaco-2024-001631","DOIUrl":"10.1136/tsaco-2024-001631","url":null,"abstract":"<p><strong>Background: </strong>Patients with cervical spinal cord injuries (CSCIs) have a high incidence of respiratory complications. The effectiveness of non-invasive positive pressure ventilation (NPPV) in preventing respiratory complications such as pneumonia in acute CSCIs remains unclear. We evaluated whether intermittent NPPV (iNPPV) could prevent pneumonia in patients with acute CSCIs.</p><p><strong>Methods: </strong>This single-center, retrospective study evaluated patients diagnosed with CSCIs with American Spinal Injury Association Impairment Scale scores of A-C between January 2012 and December 2022. Patients were categorized based on receipt of iNPPV into the iNPPV and usual care groups. Prophylactic iNPPV was defined as the initiation of iNPPV within 72 hours of admission. The primary outcome was the development of pneumonia. The secondary outcomes were other respiratory complications (tracheal intubation and tracheostomy) and adverse events (delirium and vomiting). The groups were compared with regard to outcomes after adjustment for patient backgrounds using inverse probability of treatment weighting (IPTW) with propensity scores.</p><p><strong>Results: </strong>Of the 213 patients during the study period, 94 were included. Of these, 61 (64.9%) received prophylactic iNPPV. The incidence of pneumonia was 27.9% in the iNPPV group and 48.5% in the usual care group in the unadjusted cohort. In the propensity score analysis using IPTW, the iNPPV group showed a lower incidence of pneumonia than the usual care group (29.0% vs 56.5%, p<0.001). Tracheal intubation and tracheostomy were less common in the iNPPV group than those in the usual care group (10.6% vs 29%; p=0.001 and 10.6% vs 27.1%; p=0.003, respectively). The incidences of delirium and vomiting did not increase in the iNPPV group.</p><p><strong>Conclusions: </strong>Prophylactic iNPPV was associated with a lower incidence of pneumonia in patients with acute CSCIs.</p><p><strong>Level of evidence: </strong>Ⅳ.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001631"},"PeriodicalIF":2.1,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024718","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":"Safety or speed? Assessing alternative vascular access for angiography after resuscitative endovascular balloon occlusion of the aorta (REBOA) in severe pelvic trauma patients.","authors":"Yau-Ren Chang, Yu-Tung Wu, Szu An Chen, Chih-Yuan Fu, Chi-Tung Cheng, Ling-Wei Kuo, Jen Fu Huang, Chien-Hung Liao, Chi-Hsun Hsieh","doi":"10.1136/tsaco-2024-001530","DOIUrl":"10.1136/tsaco-2024-001530","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Pelvic fractures often result in life-threatening bleeding and hemodynamic instability. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as a promising strategy for patients with severe pelvic fractures, facilitating subsequent hemostatic interventions. Transcatheter arterial embolization (TAE) is a well-established procedure for managing pelvic fractures accompanied by hemorrhage.Ideally, an angiographic access point distinct from the initial REBOA placement is sought to maintain REBOA deflation without complete removal, thereby preventing hemodynamic instability during the procedure. However, in cases of extreme and severe pelvic trauma, gaining access for REBOA is already challenging, not to mention the additional difficulty posed by subsequent angiographic access.This study aims to assess the challenges associated with gaining access in cases where successful TAE was ultimately performed, particularly in the context of severe pelvic trauma. We investigate the complexities surrounding access management and its implications for patient outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a retrospective analysis of patients who presented with pelvic fractures and underwent sequential REBOA and TAE procedures at our institution between 2017 and 2023. We excluded patients with Abbreviated Injury Scores (AIS) ≥3 in systems other than the pelvis, those who underwent TAE prior to REBOA, and cases of suboptimal REBOA insertion.We collected demographic data, injury characteristics, details of the REBOA and TAE procedures, information on complications, and data on patient survival. The primary endpoints of our analysis included overall survival and the success of TAE (defined as post TAE mean arterial pressure (MAP) ≥65 mm Hg). Secondary endpoints encompassed the duration details of two interventions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Between 2017 and 2023, a total of 17 patients were included in this study. Among this cohort, 12 (70.6%) were male, with a median age of 51 years. Overall survival was 23.5%. Patients were grouped into angiography after REBOA deflation (AAD) or angiography after REBOA removal (AAR). AAR group was younger (39.0 vs 63.0, p=0.030) and had higher Shock Index at triage (2.30 vs 1.10, p=0.015). More patient whose post TAE MAP &gt;=65 mm Hg was found in the AAR group, although no significant difference on overall survival (25.0% vs 22.2%, p=1.000). Angiographic cannulation times, pre-angiographic MAP, and amount of pre-angiographic transfusion of packed red blood cell were similar across groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Our findings provide empirical insights into vascular access selection and suggest that AAR in the management of severe pelvic fractures can be beneficial, particularly when pre-angiographic resuscitation is sufficient. Larger studies are required to validate these observations and assess long-term outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Level of evidence: &lt;/s","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001530"},"PeriodicalIF":2.1,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024791","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":"Feasibility of ultraportable US in detecting clinically concerning recurrent pneumothorax in patients with chest trauma.","authors":"Abdul Hafiz Al Tannir, Courtney Pokrzywa, Patrick B Murphy, Elise A Biesboer, Juan Figueroa, Basil S Karam, Marc DeMoya, Thomas Carver","doi":"10.1136/tsaco-2024-001464","DOIUrl":"10.1136/tsaco-2024-001464","url":null,"abstract":"<p><strong>Background: </strong>Bedside thoracic ultrasound (US) offers numerous advantages over chest X-ray (CXR) for identification of recurrent pneumothoraces (PTX) after tube thoracostomy (TT) removal. Technologic advancements have led to the development of hand-held devices capable of producing high-quality images termed ultra-portable US (UPUS). We hypothesized that UPUS would be as successful as CXR in detecting post-TT removal PTX and would be preferred by patients.</p><p><strong>Methods: </strong>We conducted a single-center prospective, feasibility, study at a level I trauma center investigating the use of UPUS in patients with trauma with TT placement. UPUS images were obtained daily while the TT was in place and post-TT removal (ranging from 1 through 6 hours). A clinically concerning PTX on UPUS was defined as the absence of lung sliding on two or more intercostal spaces. Poststudy Likert surveys were administered to assess patient preferences.</p><p><strong>Results: </strong>Ninety-two patients were included in the analysis. The majority were men (87%), and the median age was 47 years. Thirty-five patients (36%) had discordant imaging findings. There were 11 clinically concerning PTX, of which 10 (91%) were detected on UPUS and 8 (73%) on CXR. Three patients required an intervention for post-pull PTX, all of whom were identified on UPUS. Eighty-four percent (N=70) of surveyed patients preferred UPUS over CXR with 92% reporting no discomfort with UPUS compared with 49% with CXR.</p><p><strong>Conclusion: </strong>Bedside UPUS is preferred by patients and can successfully identify clinically concerning post-TT removal PTX. Implementation of UPUS as a post-TT removal diagnostic tool is a safe and effective alternative to CXR.</p><p><strong>Level of evidence: </strong>Level II, diagnostic tests or criteria.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"9 1","pages":"e001464"},"PeriodicalIF":2.1,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012455","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":"Clinical utility of routine postoperative labs in emergency general surgery patients.","authors":"Rebecca Empey, Hyunkyu Ko, Ram Nirula","doi":"10.1136/tsaco-2024-001568","DOIUrl":"10.1136/tsaco-2024-001568","url":null,"abstract":"<p><strong>Background: </strong>Morning postoperative labs are often obtained for emergency general surgery (EGS) patients. Studies in other surgical fields indicate that routine postoperative day 1 (POD1) labs are sometimes being performed excessively and do not require intervention. The purpose of this study is to identify predictors indicating the need for POD1 labs in EGS patients based on likelihood of intervention.</p><p><strong>Methods: </strong>This is a retrospective review of non-critically ill EGS patients from 2022 to 2023 who received POD1 morning labs. The odds of having an abnormal result and likelihood of intervention were measured through multivariate logistic regression accounting for patient characteristics and procedure. Least absolute shrinkage and selection operator (LASSO) regression analysis was performed to determine significant predictors of an abnormal result and intervention.</p><p><strong>Results: </strong>502 EGS patients were included. LASSO revealed that procedure duration, fever, lysis of adhesions, preoperative systolic blood pressure <90 mm Hg, older age, heart failure, operative blood loss, chronic kidney disease, and anticoagulation use were independent predictors for any abnormal result (area under the receiver operation curve (AUC)=0.785). Independent predictors of intervention were procedure duration, older age, higher estimated blood loss (EBL), anticoagulant use, and lysis of adhesions (AUC=0.704). Procedures >400 min carried an 84.3% chance of an abnormal lab requiring intervention. EBL >200 mL carried a 75.5% chance of an abnormal lab requiring intervention.</p><p><strong>Conclusion: </strong>POD1 labs for non-critically ill EGS patient rarely require intervention and can be safely omitted. Labs should be considered for longer procedures, higher EBLs, older patients, those on anticoagulation, or after lysis of adhesions.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"9 1","pages":"e001568"},"PeriodicalIF":2.1,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012454","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":"Patient education series: exploratory laparotomy.","authors":"Aimee LaRiccia, Caitlin Anne Fitzgerald","doi":"10.1136/tsaco-2024-001685","DOIUrl":"https://doi.org/10.1136/tsaco-2024-001685","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"9 1","pages":"e001685"},"PeriodicalIF":2.1,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012456","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}