Trauma Surgery & Acute Care Open最新文献

{"title":"Re-evaluation of cutting criteria for limb amputation using the Mangled Extremity Severity Score.","authors":"Ryosuke Omoto, Yutaka Umemura, Kensei Hanaoka, Yumika Yonao, Hiroki Kai, Kazuya Oi, Takaya Nishiura, Ayumi Nitta, Sung Ho Kim, Tomoki Yamada, Mitsuhiro Noborio, Satoshi Fujimi, Yasuaki Mizushima","doi":"10.1136/tsaco-2024-001694","DOIUrl":"10.1136/tsaco-2024-001694","url":null,"abstract":"<p><strong>Background: </strong>Decision-making regarding amputation in severe open extremity fractures is challenging. Various scoring systems, such as the Mangled Extremity Severity Score (MESS), have guided critical decisions for nearly three decades, yet no consensus or clear criteria have been established. The aim of this study is to identify predictive factors for amputation in open extremity fractures using MESS.</p><p><strong>Method: </strong>We retrospectively analyzed patients with open limb fractures classified as Gustilo-Anderson type 3B or 3C, treated between April 2013 and September 2024 at two tertiary hospitals in Osaka, Japan. We compared MESS values between patients who underwent limb preservation and those who required amputation at any time during hospitalization and performed receiver operating characteristic curve analysis to identify the optimal MESS cut-off value for predicting amputation.</p><p><strong>Results: </strong>The preservation and amputation groups comprised 36 and 18 patients, respectively. The mean (±SD) total MESS was significantly lower in the preservation group than that in the amputation group (5.7±1.5 vs 8.0±1.4; p≤0.001). MESS ≥7 demonstrated a sensitivity of 83% and a specificity of 78%, whereas MESS ≥8 showed increased specificity (92%) with slightly reduced sensitivity (78%). The area under the curve for MESS was 0.86, and for MESS ≥8, it was significantly higher than that for MESS ≥7 (p=0.020).</p><p><strong>Conclusion: </strong>Although MESS remains a valuable tool for decision-making in amputation, our findings suggest that a revised cut-off score of 8 may better reflect the current trauma management capabilities. This adjustment could enhance the predictive accuracy of MESS, facilitating more informed clinical decisions in severe limb trauma.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001694"},"PeriodicalIF":2.1,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754609","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":"Penetrating neck trauma: a comprehensive review.","authors":"Lindsey Loss, Reynold Henry, Anna White, Kazuhide Matsushima, Christopher Barrett, Daniel Lammers, Martin Schreiber, Kenji Inaba","doi":"10.1136/tsaco-2024-001619","DOIUrl":"10.1136/tsaco-2024-001619","url":null,"abstract":"<p><p>Although the overall incidence is low, penetrating neck trauma can result in devastating injuries. The traditional zonal approach is being increasingly abandoned in favor of selective approaches, especially as mandatory exploration can result in non-therapeutic interventions and associated complications. Additionally, the trajectory of the missile cannot be accurately assessed based on external wounds. Decision-making using the hard and soft signs of trauma and increased resolution of imaging modalities are progressively supplanting the older zonal approaches. Here we discuss the modern diagnostic approach, operative interventions, and the appropriateness of observation.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001619"},"PeriodicalIF":2.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754522","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":"Intracranial pressure monitoring in older adults with severe traumatic brain injury: questions remain unanswered.","authors":"Daniel L Horwitz, Mira H Ghneim","doi":"10.1136/tsaco-2025-001819","DOIUrl":"10.1136/tsaco-2025-001819","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001819"},"PeriodicalIF":2.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754444","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":"Acute care, acute conversations: palliative care needs in acute care surgery.","authors":"Mackenzie Cook, David Zonies","doi":"10.1136/tsaco-2025-001806","DOIUrl":"10.1136/tsaco-2025-001806","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001806"},"PeriodicalIF":2.1,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754437","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":"Crossing the chasm: engaging Black men survivors of gun violence in mental health services.","authors":"Erin Major, Celina Thomas, Charlotte Healy, Amy VanderStoep, Joseph B Richardson, Thomas M Scalea, Melike N Harfouche","doi":"10.1136/tsaco-2024-001560","DOIUrl":"10.1136/tsaco-2024-001560","url":null,"abstract":"<p><strong>Background: </strong>Despite being high risk for post-traumatic stress disorder, Black men survivors of gun violence, and particularly young men aged 18-24, seldom participate in mental health services after injury. The aim of this study was to identify barriers to participation in mental health services for this population.</p><p><strong>Methods: </strong>Over a 2-year period, 1 hour-long focus group was conducted with three counselors of the local hospital-based violence intervention program and 21 individual, semistructured in-depth interviews were held with Black men who were hospitalized for a firearm-related injury. All interviews were recorded and transcribed. Transcripts were coded using open coding and grounded theory methodology and ultimately grouped into themes using MAXQDA V.2022 software.</p><p><strong>Results: </strong>Median age of participants was 34 years (IQR=11). Barriers to participation revolved around competing priorities/stressors, expense, difficulty with trust and openness and the demands of street life. Motivating factors included cultural competence, persistence, availability, reliability and genuineness of the therapy staff. Most participants denied negative social stigma of therapy as a barrier but emphasized that the individual must value therapy to participate. Young, Black men were perceived as struggling with self and peer-imposed views of masculinity that conflicted with therapy participation.</p><p><strong>Conclusion: </strong>Black men who have experienced violent firearm injury face strong social pressures that conflict with participation in mental health services. Programs must be integrated with other social services and be responsive to community conditions to be successful.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001560"},"PeriodicalIF":2.1,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754441","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":"Intracranial pressure monitoring in patients with geriatric trauma may not improve outcome but is associated with increases in resource utilization.","authors":"Bardiya Zangbar, Aryan Rafieezadeh, Kartik Prabhakaran, Joshua Klein, Matthew Bronstein, Ilya Shnaydman, Chirag Gandhi, Peter Rhee","doi":"10.1136/tsaco-2024-001644","DOIUrl":"10.1136/tsaco-2024-001644","url":null,"abstract":"<p><strong>Background: </strong>Intracranial pressure (ICP) monitoring (ICPM) is currently recommended for severe traumatic brain injury (TBI). The hypothesis was that ICPM does not change mortality in the geriatric patient population.</p><p><strong>Methods: </strong>The Trauma Quality Improvement Program (TQIP) database (2017-2021) was queried to identify intubated geriatric patients (≥65 years of age) with isolated blunt TBI (non-Head Abbreviated Injury Scale (AIS) score <3), with admission Glasgow Coma Scale (GCS) scores of 3-8. Patients with death on arrival or with hospital length of stay <24 hours and patients who underwent craniotomy before ICPM placement were excluded. Favorable discharge disposition was defined as home with or without assistance, and rehabilitation. Propensity score matching (PSM) was performed between ICPM and non-ICPM patients and outcomes were compared. The primary outcome was defined as in-hospital mortality. Secondary outcomes were defined as discharge disposition, hospital length of stay, intensive care unit (ICU) length of stay and ventilator days.</p><p><strong>Results: </strong>A total of 19 416 patients met criteria for analysis. ICPM was placed in only 12.1% (n=2363) patients. The Injury Severity Score, GCS and head AIS were similar between the patients with and without monitors. After PSM, we were able to match 2148 patients and there was no difference in mortality between the two groups (52.4% vs 52.1%, p=0.874); however, patients treated with ICPM had significantly longer hospital length of stay (10 (5-17) vs 7 (3-15) days, p<0.001), ICU length of stay (8 (4-14) vs 6 (3-10), p<0.001) and ventilator days (6 (3-11) vs 4 (2-7), p<0.001). Discharge disposition was trending towards unfavorable with increasing age but was similar between the ICPM and No-ICPM groups (p=0.115).</p><p><strong>Conclusion: </strong>The usefulness of ICPM in geriatric patients has not yet been shown and would benefit from prospective clinical studies. Minimizing ICPM in geriatric patients may reduce resource burdening without affecting outcome.</p><p><strong>Level of evidence: </strong>Level III retrospective study.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001644"},"PeriodicalIF":2.1,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693418","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":"Palliative care in acute care surgery: research challenges and opportunities.","authors":"Amelia W Maiga, Vanessa Ho, Rachel S Morris, Lisa M Kodadek, Thaddeus J Puzio, Gail T Tominaga, Masami Tabata-Kelly, Zara Cooper","doi":"10.1136/tsaco-2024-001615","DOIUrl":"10.1136/tsaco-2024-001615","url":null,"abstract":"<p><p>Palliative care includes effective communication, relief of suffering and symptom management with an underlying goal of improving the quality of life for patients with serious illness and their families. Best practice palliative care is delivered in parallel with life-sustaining or life-prolonging care. Palliative care affirms life and regards death as a normal process, intends neither to hasten death nor to postpone death and includes but is not limited to end-of-life care. Palliative care encompasses both primary palliative care (which can and should be incorporated into the practice of acute care surgery) and specialty palliative care (consultation with a fellowship-trained palliative care provider). Acute care surgeons routinely care for individuals who may benefit from palliative care. Patients exposed to traumatic injury, emergency surgical conditions, major burns and/or critical surgical illness are more likely to be experiencing a serious illness than other hospitalized patients. Palliative care research is urgently needed in acute care surgery. At present, minimal high-quality research is available to guide selection of palliative care interventions. This narrative review summarizes the current state of research challenges and opportunities to address palliative care in acute care surgery. Palliative care research in acute care surgery can rely on either primary data collection or secondary and administrative data. Each approach has its advantages and limitations, which we will review in this article.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001615"},"PeriodicalIF":2.1,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693420","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":"Pancreaticoduodenectomy in grade V injuries.","authors":"Jake Krige, Eduard Jonas","doi":"10.1136/tsaco-2025-001822","DOIUrl":"10.1136/tsaco-2025-001822","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001822"},"PeriodicalIF":2.1,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693421","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":"CT pan-scanning versus targeted imaging among older adults after ground level falls.","authors":"Gavin Touponse, Jeff Choi, Christian Calderon, Sofia E Luna, Lakshika Tennakoon, Ara Ko","doi":"10.1136/tsaco-2024-001534","DOIUrl":"10.1136/tsaco-2024-001534","url":null,"abstract":"<p><strong>Background: </strong>Ground level falls (GLFs) among older adults are responsible for millions of injuries. Routine pan-scanning (CT imaging of the head, chest, abdomen and pelvis) is commonly employed; however, we lack robust evidence of its benefit. We investigated whether pan-scanning identifies a larger proportion of patients with significant injury or injury requiring procedural intervention and hypothesized resuscitation area findings-including radiographs, ultrasound, and external signs of injury-would detect these injuries.</p><p><strong>Methods: </strong>We queried our institutional trauma registry data for patients ≥65 years presenting to our level 1 trauma center after GLFs. Our primary outcome was injury requiring procedural intervention. LASSO (least absolute shrinkage and selection operator) regression models were fit using cross-validation to identify predictors of significant injury to the head, chest, and pelvis/lower extremity from patient characteristics and resuscitation area findings.</p><p><strong>Results: </strong>598 patients were included, among whom 17% underwent pan-scan. External signs of injury were associated with increased odds of significant injury in the head (OR 1.12; 95% CI 1.08 to 1.16), chest (OR 1.50; 95% CI 1.45 to 1.46), and extremity/pelvis (OR 1.07; 95% CI 1.04 to 1.10). Chest (OR 1.18; 95% CI 1.14 to 1.23) and pelvic X-ray (OR 1.36; 95% CI 1.33 to 1.40) were also associated with increased odds of significant injury. 17 patients required procedural interventions for head injuries and 2 for the chest. No patients had a significant injury requiring any procedures for the abdomen.</p><p><strong>Conclusions: </strong>Our study suggests resuscitation area findings may direct targeted imaging in the chest and abdomen/pelvis, but whether individual risk and institutional burden associated with pan-scanning is outweighed by its ease requires further study.</p><p><strong>Level of evidence study type: </strong>Prognostic and Epidemiological, Level IV.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001534"},"PeriodicalIF":2.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143650973","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 for pelvic retroperitoneal hemorrhage: friend or foe?","authors":"Melike N Harfouche","doi":"10.1136/tsaco-2025-001791","DOIUrl":"10.1136/tsaco-2025-001791","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001791"},"PeriodicalIF":2.1,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11891531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597940","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}