The Journal of Trauma and Acute Care Surgery最新文献

{"title":"Comparison of thoracic epidural catheter and continuous peripheral infusion for management of traumatic rib fracture pain.","authors":"Robel T Beyene,Marshall W Wallace,Nicholas Statzer,Susan E Hamblin,Edward Woo,Scott D Nelson,Brian F S Allen,Matthew D McEvoy,Derek A Riffert,Amber N Wesoloski,Fei Ye,Rebecca Irlmeier,Michele Fiorentino,Bradley M Dennis","doi":"10.1097/ta.0000000000004445","DOIUrl":"https://doi.org/10.1097/ta.0000000000004445","url":null,"abstract":"BACKGROUNDThoracic epidural catheters (TECs) are useful adjuncts to multimodal pain regimens in traumatic rib fractures. However, TEC placement is limited by contraindications, patient risk profile, and provider availability. Continuous peripheral infusion of ketamine and/or lidocaine is an alternative that has a modest risk profile and few contraindications. We hypothesized that patients with multiple traumatic rib fractures receiving TECs would have better pain control, in terms of daily morphine milligram equivalents (MMEs) and mean pain scores (MPSs) when compared with continuous peripheral infusions of ketamine and/or lidocaine.METHODSWe retrospectively analyzed traumatic rib fracture admissions to a level 1 trauma center between January 2018 and December 2020. We evaluated two treatment groups: TEC only and continuous infusion only (drip only). A linear mixed-effects model evaluated the association of MME with treatment group. An interaction term of treatment group by time (days 1-7) was included to allow estimating potential time-dependent treatment effect on MME. A zero-inflated Poisson mixed-effects model evaluated the association of treatment with MPS. Both models adjusted for confounders.RESULTSA total of 1,647 patients were included. After multivariable analysis, a significant, time-varying dose-response relationship between treatment group and MME was found, indicating an opioid-sparing effect favoring the TEC-only group. The opioid-sparing benefit for TEC-only therapy was most prominent at day 3 (27.4 vs 36.5 MME) and day 4 (27.3 vs 36.2 MME) (p < 0.01). The drip-only group had 1.21 times greater MPS than patients with TEC only (p < 0.001).CONCLUSIONDrip-only analgesia is associated with higher daily MME use and MPS, compared with TEC only. The maximal benefit of TEC therapy appears to be on days 3 and 4. Prospective, randomized comparison between groups is necessary to evaluate the magnitude of the treatment effect.LEVEL OF EVIDENCETherapeutic/Care Management; Level III.","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142260515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-time attending trauma surgeon assessment of direct-to-operating room trauma resuscitations: Results from a prospective observational study.","authors":"Heewon Lee,Joshua Dilday,Amelia Johnson,Andrea Kuchler,Michael Rott,Frederick Cole,Ronald Barbosa,William Long,Matthew J Martin","doi":"10.1097/ta.0000000000004447","DOIUrl":"https://doi.org/10.1097/ta.0000000000004447","url":null,"abstract":"BACKGROUNDDirect-to-operating room (DOR) resuscitation expedites interventions for trauma patients. Perceived benefit from the surgeon's perspective is not well known. This study assesses the integration of a real-time surgeon assessment tool into a DOR protocol.METHODSSurgeon assessment tool results from a prospective study of DOR cases were analyzed. Analysis assessed patient factors and surgeon perception for appropriateness and benefit of DOR. Multivariate analysis identified independent factors associated with perceived DOR benefit.RESULTSA total of 104 trauma patients underwent DOR resuscitation; 84% were perceived as appropriate triage, and 48% as beneficial. Patients with Injury Severity Score of >15 (50% vs. 28%), systolic blood pressure of <90 mm Hg (24% vs. 9%), and severe abdominal injury (28% vs. 9%) had higher perceived DOR benefits (all p < 0.05). Patients deemed to benefit from DOR underwent more emergent interventions or truncal surgery (44% vs. 92%, p < 0.01). No difference in benefit was seen based on age, sex, Glasgow Coma Scale score of <9, or injury mechanism. Forty-four percent had perceived benefit from DOR resuscitation despite requiring imaging after initial evaluation. Patients with perceived benefit had a higher rate of unplanned return to the operating room (16% vs. 2%, p < 0.05), but no differences in complication rates, Glasgow Outcome Score, or mortality. Injury Severity Score of >15 was the only independently associated variable with a perceived benefit on surgeon assessment tool (odds ratio, 3.5; p < 0.05).CONCLUSIONThe majority of DOR resuscitations were deemed as appropriately triaged, and approximately half had a perceived benefit. Benefit was associated with higher injury severity and the need for urgent interventions but was not predicted by injury mechanism or other triage variables.LEVEL OF EVIDENCEPrognostic and Epidemiological; Level IV.","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142260550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bleeding control methods for kids: A pediatric approach to the national education campaign-a pilot program.","authors":"Melissa Anderson,Renaldo Williams","doi":"10.1097/ta.0000000000004454","DOIUrl":"https://doi.org/10.1097/ta.0000000000004454","url":null,"abstract":"BACKGROUNDThe project purpose was to design and test an age-appropriate curriculum to train children aged 5 through 13 years on bleeding control methods based on the national Stop the Bleed initiative. Studies have shown that children as young as 5 years are able to perform first aid and cardiopulmonary resuscitation. The project aimed to demonstrate that children as young as 5 years can be taught bleeding control methods. Our hypothesis was that there would be a 60% retention rate on retesting of the children within 1 year across all age groups.METHODSThe study design was an observational cohort study from February 2018 to January 2020. Participants (aged 5 through 13 years) were trained on bleeding control methods but using an age-based curriculum. The initial training included 500 children. The participants were taught tourniquet applications, wound packing, and direct pressure skills. The curriculum consisted of a 30-minute didactic portion with participant involvement and engagement followed by 30 minutes of hands-on skill training and demonstration. In addition, participants were required to be able to recite the \"5 Rules\" to helping hurt people. Descriptive statistics were performed.RESULTSParticipants were retested approximately 1 year after the initial training. The retest group only consisted of 227 participants because of a multitude of reasons for the decrease in children. Children were tested in comprehension and application of each skill. Results indicated a greater than 70% retention for all skills across all participants for the retesting after 1 year.CONCLUSIONThe findings indicated that children as young as 5 years can be taught to perform bleeding control methods of tourniquet application, wound packing, and direct pressure. While the results indicate that the older the child, the better the retention, if children were provided multiple trainings over a 1-year period, the retention could be higher.LEVEL OF EVIDENCEObservational Cohort Study; Level VIII.","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142260549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Whole blood to total transfusion volume ratio in injured children: A national database analysis.","authors":"Insiyah Campwala,Ander Dorken-Gallastegi,Philip C Spinella,Joshua B Brown,Christine M Leeper","doi":"10.1097/ta.0000000000004443","DOIUrl":"https://doi.org/10.1097/ta.0000000000004443","url":null,"abstract":"BACKGROUNDWhole blood (WB) resuscitation is increasingly common in adult trauma centers and some pediatric trauma centers, as studies have noted its safety and potential superiority to component therapy (CT). Previous analyses have evaluated WB as a binary variable (any versus none), and little is known regarding the \"dose response\" of WB in relation to total transfusion volume (TTV) (WB/TTV ratio).METHODSInjured children younger than 18 years who received any blood transfusion within 4 hours of hospital arrival across 456 US trauma centers were included from the American College of Surgeons Trauma Quality Improvement Program database. The primary outcome was 24-hour mortality, and the secondary outcome was 4-hour mortality. Multivariate analysis was used to evaluate associations between WB administration and mortality and WB/TTV ratio and mortality.RESULTSOf 4,323 pediatric patients included in final analysis, 88% (3,786) received CT only, and 12% (537) received WB with or without CT. Compared with the CT group, WB recipients were more likely to be in shock, according to pediatric age-adjusted shock index (71% vs. 60%) and had higher median (interquartile range) Injury Severity Score (26 [17-35] vs. 25 [16-24], p = 0.007). Any WB transfusion was associated with 42% decreased odds of mortality at 4 hours (adjusted odds ratio [aOR], 0.58 [95% confidence interval, 0.35-0.97]; p = 0.038) and 54% decreased odds of mortality at 24 hours (aOR, 0.46 [0.33-0.66]; p < 0.001). Each 10% increase in WB/TTV ratio was associated with a 9% decrease in 24-hour mortality (aOR, 0.91 [0.85-0.97]; p = 0.006). Subgroup analyses for age younger than 14 years and receipt of massive transfusion (>40 mL/kg) also showed statistically significant survival benefit for 24-hour mortality.CONCLUSIONIn this retrospective American College of Surgeons Trauma Quality Improvement Program analysis, use of WB was independently associated with reduced 24-hour mortality in children; further, higher proportions of WB used over the total resuscitation (WB/TTV ratio) were associated with a stepwise increase in survival.LEVEL OF EVIDENCEPrognostic and Epidemiological; Level III.","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142260551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary Diagnosis and Management of Mild TBI (Concussions): What You Need to Know.","authors":"Joseph C Panzera, Olivia E Podolak, Christina L Master","doi":"10.1097/ta.0000000000004297","DOIUrl":"https://doi.org/10.1097/ta.0000000000004297","url":null,"abstract":"Concussion is a common injury in children and adolescents and is a form of mild traumatic brain injury that surgeons will see in their acute care practice. With a rapidly changing evidence base for diagnosis and management, we will focus on the importance of timely identification and diagnosis, as well as the early initiation of active management of pediatric concussion immediately after injury through recovery. This approach involves the application of targeted therapies for specific deficits identified after concussion, addressing the individual pattern of symptoms experienced by patients following concussion. We will review what is known about the underlying pathophysiology that drives the clinical manifestations of concussion, the targeted clinical assessments that can both aid in the diagnosis of concussion, as well as drive the active rehabilitation of deficits seen after concussion. The standardized approach to the return to activities will also be described, including return to learning and sports.","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140834817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Harnessing eCIRP by PS-OMe miR130: A promising shield against hemorrhage-induced lung injury.","authors":"Zhijian Hu, Jingsong Li, Asha Jacob, Ping Wang","doi":"10.1097/ta.0000000000004361","DOIUrl":"https://doi.org/10.1097/ta.0000000000004361","url":null,"abstract":"Hemorrhagic shock (HS) poses a life-threatening condition with the lungs being one of the most susceptible organs to its deleterious effects. Extracellular cold-inducible RNA binding protein (eCIRP) has emerged as a pivotal mediator of inflammation, and its release has been observed as a case of HS-induced tissue injury. Previous studies unveiled a promising engineered microRNA, designated PS-OMe miR130, which inhibits eCIRP, thereby safeguarding vital organs. In this study, we hypothesized that PS-OMe miR130 serves as a protective shield against HS-induced lung injury by curtailing the overzealous inflammatory immune response.","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140834635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Whole blood versus balanced resuscitation in massive hemorrhage: six of one or half dozen of the other?","authors":"Cassie A Barton, Heath J Oetken, Nicolas L Hall, Michael Kolesnikov, Elizabeth S Levins, Thomas Sutton, Martin Schreiber","doi":"10.1097/ta.0000000000004366","DOIUrl":"https://doi.org/10.1097/ta.0000000000004366","url":null,"abstract":"Whole blood (WB) resuscitation is increasingly used at trauma centers. Prior studies investigating outcomes in WB versus component-only (CO) resuscitation have been limited by small cohorts, low volumes of WB resuscitation, and unbalanced CO resuscitation. This study aimed to address these limitations using data from a high-volume Level I trauma center, which adopted a WB-first resuscitation paradigm in 2018. We hypothesized that the resuscitation method, WB or balanced CO, would have no impact on patient mortality.","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140829038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using implementation science to decrease variation and high opioid administration in a surgical ICU.","authors":"Kyle J Kalkwarf, Brett J Bailey, Allison Wells, Allison K Jenkins, Rebecca R Smith, Jordan W Greer, Richard Yeager, Nolan Bruce, Joseph Margolick, Melissa R Kost, Mary K Kimbrough, Matthew L Roberts, Benjamin L Davis, Anna Privratsky, Geoffrey M Curran","doi":"10.1097/ta.0000000000004365","DOIUrl":"https://doi.org/10.1097/ta.0000000000004365","url":null,"abstract":"High doses and prolonged duration of opioids are associated with tolerance, dependence, and increased mortality. Unfortunately, despite recent efforts to curb outpatient opioid prescribing because of the ongoing epidemic, utilization remains high in the intensive care setting, with intubated patients commonly receiving infusions with a potency much higher than doses required to achieve pain control. We attempted to use implementation science techniques to monitor and reduce excessive opioid prescribing in ventilated patients in our Surgical ICU.","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140829037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"4-factor prothrombin complex concentrate is not inferior to andexanet alfa for the reversal or oral factor Xa inhibitors: An Eastern Association for the Surgery of Trauma multicenter study.","authors":"Jordan M Estroff, Joseph Devlin, Lara Hoteit, Adnan Hassoune, Matthew D Neal, Joshua B Brown, Liling Lu, Shannon Kotch, Joshua P Hazelton, Ashton B Christian, Eric O Yeates, Jeffry Nahmias, Lewis E Jacobson, Jamie Williams, Kevin M Schuster, Rick O'Connor, Gregory R Semon, Angela D Straughn, Daniel Cullinane, Tanya Egodage, Michelle Kincaid, Allison Rollins, Richard Amdur, Babak Sarani","doi":"10.1097/ta.0000000000004345","DOIUrl":"https://doi.org/10.1097/ta.0000000000004345","url":null,"abstract":"Andexanet Alfa (AA) is the only FDA approved reversal agent for apixaban and rivaroxaban (DOAC). There are no studies comparing its efficacy with 4-Factor Prothrombin Complex Concentrate (PCC). This study aimed to compare PCC to AA for DOAC reversal, hypothesizing non-inferiority of PCC.","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140834788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effects of prehospital TXA on mortality and neurologic outcomes in patients with traumatic intracranial hemorrhage: a subgroup analysis from the prehospital TXA for TBI trial.","authors":"Susan Rowell, Eric N Meier, Tatiana Hoyos Gomez, Michael Fleming, Jon Jui, Laurie Morrison, Eileen Bulger, George Sopko, Myron Weisfeldt, Jim Christenson, Pat Klotz, Jason McMullan, Jeannie Callum, Kellie Sheehan, Brian Tibbs, Tom Aufderheide, Bryan Cotton, Rajesh Gandhi, Ahamed Idris, Ralph J Frascone, Michael Ferrara, Neil Richmond, Delores Kannas, Rob Schlamp, Bryce Robinson, David Dries, John Tallon, Audrey Hendrickson, Mark Gamber, John Garrett, Robert Simonson, W Ian McKinley, Martin Schreiber","doi":"10.1097/ta.0000000000004354","DOIUrl":"https://doi.org/10.1097/ta.0000000000004354","url":null,"abstract":"In the Prehospital Tranexamic Acid (TXA) for TBI Trial, TXA administered within two hours of injury in the out-of-hospital setting did not reduce mortality in all patients with moderate/severe traumatic brain injury (TBI). We examined the association between TXA dosing arms, neurologic outcome, and mortality in patients with intracranial hemorrhage (ICH) on computed tomography (CT).","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140834782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}