The Journal of Trauma and Acute Care Surgery最新文献

{"title":"In-hospital outcomes of intercostal nerve cryoablation and surgical stabilization of rib fractures.","authors":"Carlos A Fernandez,&nbsp;Joel R Narveson,&nbsp;Fang Niu,&nbsp;Elizabeth Norton,&nbsp;Emily C Brown,&nbsp;Viren Punja,&nbsp;Jessica M Veatch,&nbsp;Thomas Capasso,&nbsp;Neil D Patel,&nbsp;Kaily Ewing,&nbsp;Eric Kuncir","doi":"10.1097/TA.0000000000003623","DOIUrl":"https://doi.org/10.1097/TA.0000000000003623","url":null,"abstract":"<p><strong>Background: </strong>Severe pain and pulmonary complications commonly follow rib fractures, both of which may be improved by surgical stabilization of rib fractures (SSRFs). However, significant postoperative pain still persists which may negatively impact in-hospital outcomes. Combining intercostal nerve cryoablation (INCA) with SSRF may improve those outcomes by further decreasing postoperative pain, opioid consumption, and pulmonary complications. The hypothesis is that INCA plus SSRF reduces opioids consumption compared with SSRF alone.</p><p><strong>Methods: </strong>The retrospective analysis included trauma patients 18 years or older who underwent SSRF, with or without INCA, in a Level I trauma center between 2015 and 2021. Patients received INCA at the surgeons' discretion based on familiarity with the procedure and absence of contraindications. Patients without INCA were the historical control group. Reported data include demographics, mechanism and severity of injury, number of ribs stabilized, cryoablated nerves, intubation rates and duration of mechanical ventilation. The primary outcome was total morphine milligrams equivalent consumption. Secondary outcomes were intensive care unit length of stay, hospital length of stay, incidence of pneumonia, and tracheostomy rates, and discharge disposition. Long-term outcomes were examined up to 6 months for adverse events.</p><p><strong>Results: </strong>Sixty-eight patients were included, with 44 receiving INCA. There were no differences in rates of pneumonia ( p = 0.106) or duration of mechanical ventilation ( p = 0.687), and hospital length of stay was similar between groups ( p = 0.059). However, the INCA group demonstrated lower total morphine milligrams equivalent ( p = 0.002), shorter intensive care unit length of stay ( p = 0.021), higher likelihood of home discharge ( p = 0.044), and lower rate of intubation ( p = 0.002) and tracheostomy ( p = 0.032).</p><p><strong>Conclusion: </strong>Combining INCA with SSRF may further improve in-hospital outcomes for patients with traumatic rib fractures.</p><p><strong>Level of evidence: </strong>Therapeutic/Care Management; Level III.</p>","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":" ","pages":"695-701"},"PeriodicalIF":3.4,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40316480","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":"Trauma transfers discharged from the emergency department: Is there a role for telemedicine?","authors":"Lindsay J Lindsey,&nbsp;Lindsey S Rasmussen,&nbsp;Landon S Hendrickson,&nbsp;Emily S Frech,&nbsp;Steven P Bozell,&nbsp;Kenneth E Stewart,&nbsp;Ryan O Kennedy,&nbsp;Alisa Cross,&nbsp;Roxie M Albrecht,&nbsp;Amanda M Celii","doi":"10.1097/TA.0000000000003749","DOIUrl":"https://doi.org/10.1097/TA.0000000000003749","url":null,"abstract":"","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":" ","pages":"e177-e178"},"PeriodicalIF":3.4,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40577544","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":"Trauma transfers discharged from the emergency department: Is there a role for telemedicine?","authors":"Christina Riojas","doi":"10.1097/TA.0000000000003721","DOIUrl":"https://doi.org/10.1097/TA.0000000000003721","url":null,"abstract":"","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":" ","pages":"e176-e177"},"PeriodicalIF":3.4,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40575019","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":"Coming in hot: Police transport and prehospital time after firearm injury.","authors":"Eric Winter,&nbsp;James P Byrne,&nbsp;Allyson M Hynes,&nbsp;Zhi Geng,&nbsp;Mark J Seamon,&nbsp;Daniel N Holena,&nbsp;Neil R Malhotra,&nbsp;Jeremy W Cannon","doi":"10.1097/TA.0000000000003689","DOIUrl":"https://doi.org/10.1097/TA.0000000000003689","url":null,"abstract":"<p><strong>Background: </strong>In Philadelphia, PA, police and emergency medical services (EMS) transport patients with firearm injuries. Prior studies evaluating this system have lacked reliable prehospital times. By linking police and hospital data sets, we established a complete timeline from firearm injury to outcome. We hypothesized that police-transported patients have shorter prehospital times that, in turn, are associated with improved survival and increased unexpected survivorship at 6 and 24 hours.</p><p><strong>Methods: </strong>This retrospective study linked patient-level data from OpenDataPhilly Shooting Victims and the Pennsylvania Trauma Systems Foundation. All adults transported to a Level I or II trauma center after firearm injury in Philadelphia from 2015 to 2018 were included. Patient-level characteristics were compared between cohorts; unexpected survivors were identified using Trauma Score-Injury Severity Score. Multiple regression estimated risk-adjusted associations between transport method, prehospital time, and outcomes.</p><p><strong>Results: </strong>Police-transported patients (n = 977) had significantly shorter prehospital times than EMS-transported patients (n = 320) (median, 9 minutes [interquartile range, 7-12 minutes] vs. 21 minutes [interquartile range, 16-29 minutes], respectively; p < 0.001). Police-transported patients were more often severely injured than those transported by EMS (60% vs. 50%, p = 0.002). After adjusting for confounders, police-transported patients had improved survival relative to EMS on hospital arrival (87% vs. 84%, respectively, p = 0.035), but not at 6 hours (79% vs. 78%, respectively, p = 0.126) or 24 hours after arrival (76% vs. 76%, respectively, p = 0.224). Compared with EMS, police-transported patients were significantly more likely to be unexpected survivors at 6 hours (6% vs. 2%, respectively, p < 0.001) and 24 hours (3% vs. 1%, respectively, p = 0.021).</p><p><strong>Conclusion: </strong>Police-transported patients had more severe injuries, shorter prehospital times, and increased likelihood of unexpected survival compared with EMS-transported patients. After controlling for confounders, patient physiology and injury severity represent meaningful determinants of mortality in our mature trauma system, indicating an ongoing opportunity to optimize in-hospital care. Future studies should investigate causes of death among unexpected early survivors to mitigate preventable mortality.</p><p><strong>Level of evidence: </strong>Prognostic/Epidemiological, Level III.</p>","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":" ","pages":"656-663"},"PeriodicalIF":3.4,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40571272","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":"Common bile duct stones management: A network meta-analysis.","authors":"Shahin Mohseni, Gary Alan Bass, Maximilian Peter Forssten, Isidro Martínez Casas, Matthew Martin, Kimberly A Davis, Elliott R Haut, Michael Sugrue, Hayato Kurihara, Babak Sarani, Yang Cao, Raul Coimbra","doi":"10.1097/TA.0000000000003755","DOIUrl":"10.1097/TA.0000000000003755","url":null,"abstract":"<p><strong>Background: </strong>Timely management is critical for treating symptomatic common bile duct (CBD) stones; however, a single optimal management strategy has yet to be defined in the acute care setting. Consequently, this systematic review and network meta-analysis, comparing one-stage (CBD exploration or intraoperative endoscopic retrograde cholangiopancreatography [ERCP] with simultaneous cholecystectomy) and two-stage (precholecystectomy or postcholecystectomy ERCP) procedures, was undertaken with the main outcomes of interest being postprocedural complications and hospital length of stay (LOS).</p><p><strong>Methods: </strong>PubMed, SCOPUS, MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were methodically queried for articles from 2010 to 2021. The search terms were a combination of medical subject headings terms and the subsequent terms: gallstone; common bile duct (stone); choledocholithiasis; cholecystitis; endoscopic retrograde cholangiography/ERCP; common bile duct exploration; intraoperative, preoperative, perioperative, and postoperative endoscopic retrograde cholangiography; stone extraction; and one-stage and two-stage procedure. Studies that compared two procedures or more were included, whereas studies not recording complications (bile leak, hemorrhage, pancreatitis, perforation, intra-abdominal infections, and other infections) or LOS were excluded. A network meta-analysis was conducted to compare the four different approaches for managing CBD stones.</p><p><strong>Results: </strong>A total of 16 studies (8,644 participants) addressing the LOS and 41 studies (19,756 participants) addressing postprocedural complications were included in the analysis. The one-stage approaches were associated with a decrease in LOS compared with the two-stage approaches. Common bile duct exploration demonstrated a lower overall risk of complications compared with preoperative ERCP, but there were no differences in the overall risk of complications in the remaining comparisons. However, differences in specific postprocedural complications were detected between the four different approaches managing CBD stones.</p><p><strong>Conclusion: </strong>This network meta-analysis suggests that both laparoscopic CBD exploration and intraoperative ERCP have equally good outcomes and provide a preferable single-anesthesia patient pathway with a shorter overall length of hospital stay compared with the two-stage approaches.</p><p><strong>Level of evidence: </strong>Systematic Review/Meta Analysis; Level III.</p>","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":" ","pages":"e155-e165"},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40679175","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":"Response to letter to the editor, re: A multicenter validation of the modified brain injury guidelines: Are they safe and effective?","authors":"Abid D Khan,&nbsp;Robert C McIntyre,&nbsp;Richard P Gonzalez,&nbsp;Thomas J Schroeppel","doi":"10.1097/TA.0000000000003739","DOIUrl":"https://doi.org/10.1097/TA.0000000000003739","url":null,"abstract":"","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":" ","pages":"e174-e175"},"PeriodicalIF":3.4,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40480714","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":"Prospective evaluation of the selective nonoperative management of abdominal stab wounds: When is it safe to discharge?","authors":"Natthida Owattanapanich,&nbsp;Camilla Cremonini,&nbsp;Morgan A Schellenberg,&nbsp;Kazuhide Matsushima,&nbsp;Meghan R Lewis,&nbsp;Lydia Lam,&nbsp;Matthew J Martin,&nbsp;Kenji Inaba","doi":"10.1097/TA.0000000000003733","DOIUrl":"https://doi.org/10.1097/TA.0000000000003733","url":null,"abstract":"<p><strong>Background: </strong>The optimal observation time required to exclude hollow viscus injury in patients undergoing selective nonoperative management (SNOM) for abdominal stab wounds (SWs) remains unclear. The aim of this study was to determine the safe period of observation required before discharge.</p><p><strong>Methods: </strong>In this prospective observational study, all patients who sustained an abdominal SW were screened for study inclusion (July 2018 to May 2021). The primary study outcome was time to SNOM failure, defined as the need for surgical intervention after an initial period of observation.</p><p><strong>Results: </strong>During the study period, 256 consecutive patients with an abdominal SW met the study criteria. The mean age was 33 (26-46) years, and 89% were male. Of all patients, 77% had single SW, and 154 (60%) had an anterior abdominal SW (most common site right upper quadrant, 31%). Forty-six (18%) underwent immediate laparotomy because of evisceration (59%), hemodynamic instability (33%), or peritonitis (24%). The remaining 210 patients (82%) were taken for computed tomography scan (n = 208 [99%]) or underwent clinical observation only (n = 2 [<1%]). Of the patients undergoing computed tomography scan, 27 (13%) triggered operative intervention, and 9 (4%) triggered angioembolization. The remaining 174 patients (83%) underwent SNOM. Of these, three patients (2%) failed SNOM and underwent laparotomy: two developed peritonitis at 10 and 20 hours after arrival, respectively, and at laparotomy had small bowel and gastric injuries. The third patient developed increasing leukocytosis but had nontherapeutic laparotomy.</p><p><strong>Conclusion: </strong>Selective nonoperative management of stab wounds to the abdomen commonly avoids nontherapeutic operative intervention and its resultant complications. A small percentage of patients will fail SNOM, and therefore, close clinical observation of these patients in hospital is critical. All patients in this series who failed SNOM did so within 24 hours of presentation. Therefore, we recommend a period of 24 hours of close clinical monitoring to exclude a hollow viscus injury before discharge of patients with abdominal stab wounds who do not meet the criteria for immediate operative intervention.</p><p><strong>Level of evidence: </strong>Prognostic/Epidemiological; Level III.</p>","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":" ","pages":"639-643"},"PeriodicalIF":3.4,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40471161","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":"Ventilator-associated pneumonia and intubation location in adults with traumatic injuries: Systematic review and meta-analysis.","authors":"Laura Baumann,&nbsp;Kelsey Harper,&nbsp;Natalie Riblet,&nbsp;Colman Hatton,&nbsp;Patricia Ruth Atchinson,&nbsp;Matthew Roginski","doi":"10.1097/TA.0000000000003737","DOIUrl":"https://doi.org/10.1097/TA.0000000000003737","url":null,"abstract":"<p><strong>Background: </strong>Ventilator-associated pneumonia (VAP) is an important cause of morbidity and mortality among critically ill patients, particularly those who present with traumatic injuries. This review aims to determine whether patients with traumatic injuries who are intubated in the prehospital setting are at higher risk of developing VAP compared with those intubated in the hospital.</p><p><strong>Methods: </strong>A systematic review of Medline, Scopus, and Cochrane electronic databases was conducted from inception to January 2021. Inclusion criteria were patients with traumatic injuries who were intubated in the prehospital or hospital settings with VAP as an outcome. Using a random-effects model, the risk of VAP across study arms was compared by calculating a summary relative risk with 95% confidence intervals. The results of individual studies were also summarized qualitatively.</p><p><strong>Results: </strong>The search identified 754 articles of which 6 studies (N = 2,990) met the inclusion criteria. All studies were good quality based on assessment with the Newcastle Ottawa scale. Prehospital intubation demonstrated an increased risk of VAP development in two of the six studies. Among the six studies, the overall quality weighted risk ratio was 1.09 (95% confidence interval, 0.90-1.31).</p><p><strong>Conclusion: </strong>Traumatically injured patients who are intubated in the prehospital setting have a similar risk of developing VAP compared with those that are intubated in the hospital setting.</p><p><strong>Level of evidence: </strong>Systematic review and meta-analysis; Level IV.</p>","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":" ","pages":"e130-e138"},"PeriodicalIF":3.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40584731","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":"Burnout reduction in acute care surgeons: Impact of faculty schedule change at a level 1 trauma and tertiary care center.","authors":"Caitlin Elizabeth Jones,&nbsp;Elizabeth Dora Fox,&nbsp;Steven B Holsten,&nbsp;Cassandra Q White,&nbsp;Rashid K Sayyid,&nbsp;Terence O'Keeffe,&nbsp;Andrew G Lawson","doi":"10.1097/TA.0000000000003736","DOIUrl":"https://doi.org/10.1097/TA.0000000000003736","url":null,"abstract":"<p><strong>Background: </strong>Acute care surgeons are prone to burnout because of heavy workload, concurrent clinical responsibilities, and busy in-house call. Modifiable burnout factors have been identified, but few studies have looked for longitudinal effects after change is implemented. We hypothesized that optimizing faculty workflow could decrease burnout without compromising productivity.</p><p><strong>Methods: </strong>We streamlined the faculty schedule at our institution to eliminate 24-hour call by creating weekly blocks of 12-hour day and night call, free from other clinical obligations. Protected academic time was added. The Maslach Burnout Inventory and Areas of Worklife Survey for health care providers were given to faculty, as well as close friends or family, at baseline, 6 months, and 12 months. Maslach Burnout Inventory and Areas of Worklife Survey proprietary formulas were used to assess change in factors contributing to burnout. Our primary outcome measure was the presence of factors contributing to burnout. Chart delinquency, relative value units, and academic projects were secondary outcome measures assessing clinical productivity change.</p><p><strong>Results: </strong>Survey completion rates were 92% for faculty and 80% for family. All burnout risk factors improved at 6 and 12 months. In surgeon and family groups, the following improvements were noted in the mean scores of risk factors at 1 year: workload (74%, 68%), control (38%, 16%), reward (14%, 24%), fairness (69%, 22%), emotional exhaustion (27.5%, 24%), depersonalization (37.5%, 14%), personal accomplishment (12.5%, 2%), community (3%, 5%), values (10%, 15%), and over-all burnout (12.5%, 23.3%). There was a reduction in charts reaching delinquent status. Relative value unit production did not decrease.</p><p><strong>Conclusion: </strong>This study demonstrates that implementing a weekly, 12-hour call schedule can improve factors leading to burnout. Improvements were noted in surgeon and family groups alike, signifying both subjective improvements and observed change in the surgeons' behavior, without compromising clinical productivity.</p><p><strong>Level of evidence: </strong>Therapeutic/Care Management; Level III.</p>","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":" ","pages":"439-445"},"PeriodicalIF":3.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40471162","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":"Scalable deep learning algorithm to compute percent pulmonary contusion among patients with rib fractures.","authors":"Jeff Choi,&nbsp;Katherine Mavrommati,&nbsp;Nancy Yanzhe Li,&nbsp;Advait Patil,&nbsp;Karen Chen,&nbsp;David I Hindin,&nbsp;Joseph D Forrester","doi":"10.1097/TA.0000000000003619","DOIUrl":"https://doi.org/10.1097/TA.0000000000003619","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary contusion exists along a spectrum of severity, yet is commonly binarily classified as present or absent. We aimed to develop a deep learning algorithm to automate percent pulmonary contusion computation and exemplify how transfer learning could facilitate large-scale validation. We hypothesized that our deep learning algorithm could automate percent pulmonary contusion computation and that greater percent contusion would be associated with higher odds of adverse inpatient outcomes among patients with rib fractures.</p><p><strong>Methods: </strong>We evaluated admission-day chest computed tomography scans of adults 18 years or older admitted to our institution with multiple rib fractures and pulmonary contusions (2010-2020). We adapted a pretrained convolutional neural network that segments three-dimensional lung volumes and segmented contused lung parenchyma, pulmonary blood vessels, and computed percent pulmonary contusion. Exploratory analysis evaluated associations between percent pulmonary contusion (quartiles) and odds of mechanical ventilation, mortality, and prolonged hospital length of stay using multivariable logistic regression. Sensitivity analysis included pulmonary blood vessel volumes during percent contusion computation.</p><p><strong>Results: </strong>A total of 332 patients met inclusion criteria (median, 5 rib fractures), among whom 28% underwent mechanical ventilation and 6% died. The study population's median (interquartile range) percent pulmonary contusion was 4% (2%-8%). Compared to the lowest quartile of percent pulmonary contusion, each increasing quartile was associated with higher adjusted odds of undergoing mechanical ventilation (odds ratio [OR], 1.5; 95% confidence interval [95% CI], 1.1-2.1) and prolonged hospitalization (OR, 1.6; 95% CI, 1.1-2.2), but not with mortality (OR, 1.1; 95% CI, 0.6-2.0). Findings were similar on sensitivity analysis.</p><p><strong>Conclusion: </strong>We developed a scalable deep learning algorithm to automate percent pulmonary contusion calculating using chest computed tomography scans of adults admitted with rib fractures. Open code sharing and collaborative research are needed to validate our algorithm and exploratory analysis at a large scale. Transfer learning can help harness the full potential of big data and high-performing algorithms to bring precision medicine to the bedside.</p><p><strong>Level of evidence: </strong>Prognostic and epidemiological, Level III.</p>","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":" ","pages":"461-466"},"PeriodicalIF":3.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40315050","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}