{"title":"FEATURED ARTICLES FOR CME CREDIT OCTOBER 2022.","authors":"","doi":"10.1097/01.ta.0000874308.69711.39","DOIUrl":"https://doi.org/10.1097/01.ta.0000874308.69711.39","url":null,"abstract":"","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":" ","pages":"e153-e154"},"PeriodicalIF":3.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40371278","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}
Nathan Georgette, Robert Keskey, David Hampton, Emily Alberto, Nikunj Chokshi, Tanya L Zakrison, Kenneth Wilson, Alisa McQueen, Randall S Burd, Mark B Slidell
{"title":"Derivation and validation of an improved pediatric shock index for predicting need for early intervention and outcomes in pediatric trauma.","authors":"Nathan Georgette, Robert Keskey, David Hampton, Emily Alberto, Nikunj Chokshi, Tanya L Zakrison, Kenneth Wilson, Alisa McQueen, Randall S Burd, Mark B Slidell","doi":"10.1097/TA.0000000000003727","DOIUrl":"https://doi.org/10.1097/TA.0000000000003727","url":null,"abstract":"<p><strong>Background: </strong>Shock index, pediatric age adjusted (SIPA), has been widely applied in pediatric trauma but has limited precision because of the reference ranges used in its derivation. We hypothesized that a pediatric shock index (PSI) equation based on age-based vital signs would outperform SIPA.</p><p><strong>Methods: </strong>A retrospective cohort of trauma patients aged 1 to 18 years from Trauma Quality Programs - Participant Use File 2010 to 2018 was performed. A random 70% training subset was used to derive Youden index-optimizing shock index (SI) cutoffs by age for blood transfusion within 4 hours. We used linear regression to derive equations representing the PSI cutoff for children 12 years or younger and 13 years or older. For children 13 years or older, the well-established SI of 0.9 remained optimal, consistent with SIPA and other indices. For children 12 years or younger in the 30% validation subset, we compared our age-based PSI to SIPA as predictors of early transfusion, mortality, pediatric intensive care unit admission, and injury severity score of ≥25. For bedside use, a simplified \"rapid\" pediatric shock index (rPSI) equation was also derived and compared with SIPA.</p><p><strong>Results: </strong>A total of 439,699 patients aged 1 to 12 years met the inclusion criteria with 2,718 (1.3% of those with available outcome data) requiring transfusion within 4 hours of presentation. In the validation set, positive predictive values for early transfusion were higher for PSI (8.3%; 95% confidence interval [CI], 7.5-9.1%) and rPSI (6.3%; 95% CI, 5.7-6.9%) than SIPA (4.3%; 95% CI, 3.9-4.7%). For early transfusion, negative predictive values for both PSI (99.3%; 95% CI, 99.2-99.3%) and rPSI (99.3%; 95% CI, 99.2-99.4%) were similar to SIPA (99.4%; 95% CI, 99.3-99.4%).</p><p><strong>Conclusion: </strong>We derived the PSI and rPSI for use in pediatric trauma using empiric, age-based SI cutoffs. The PSI and rPSI achieved higher positive predictive values and similar negative predictive values to SIPA in predicting the need for early blood transfusion and 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":"474-481"},"PeriodicalIF":3.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40397045","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}
Omar Obaid, Tanya Anand, Adam Nelson, Raul Reina, Michael Ditillo, Collin Stewart, Molly Douglas, Randall Friese, Lynn Gries, Bellal Joseph
{"title":"Fibrinogen supplementation for the trauma patient: Should you choose fibrinogen concentrate over cryoprecipitate?","authors":"Omar Obaid, Tanya Anand, Adam Nelson, Raul Reina, Michael Ditillo, Collin Stewart, Molly Douglas, Randall Friese, Lynn Gries, Bellal Joseph","doi":"10.1097/TA.0000000000003728","DOIUrl":"https://doi.org/10.1097/TA.0000000000003728","url":null,"abstract":"<p><strong>Background: </strong>Trauma-induced coagulopathy is frequently associated with hypofibrinogenemia. Cryoprecipitate (Cryo), and fibrinogen concentrate (FC) are both potential means of fibrinogen supplementation. The aim of this study was to compare the outcomes of traumatic hemorrhagic patients who received fibrinogen supplementation using FC versus Cryo.</p><p><strong>Methods: </strong>We performed a 2-year (2016-2017) retrospective cohort analysis of the American College of Surgeons Trauma Quality Improvement Program database. All adult trauma patients (≥18 years) who received FC or Cryo as an adjunct to resuscitation were included. Patients with bleeding disorders, chronic liver disease, and those on preinjury anticoagulants were excluded. Patients were stratified into those who received FC, and those who received Cryo. Propensity score matching (1:2) was performed. Outcome measures were transfusion requirements, major complications, hospital, and intensive care unit lengths of stay, and mortality.</p><p><strong>Results: </strong>A matched cohort of 255 patients who received fibrinogen supplementation (85 in FC, 170 in Cryo) was analyzed. Overall, the mean age was 41 ± 19 years, 74% were male, 74% were white and median Injury Severity Score was 26 (22-30). Compared with the Cryo group, the FC group required less units of packed red blood cells, fresh frozen plasma, and platelets, and had shorter in-hospital and intensive care unit length of stay. There were no significant differences between the two groups in terms of major in-hospital complications and mortality.</p><p><strong>Conclusion: </strong>Fibrinogen supplementation in the form of FC for the traumatic hemorrhagic patient is associated with improved outcomes and reduced transfusion requirements as compared with Cryo. Further studies are required to evaluate the optimal method of fibrinogen supplementation in the resuscitation of trauma patients.</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":"453-460"},"PeriodicalIF":3.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40605971","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}
Ryan P Dumas, Brittany K Bankhead, Julia R Coleman, Navpreet K Dhillon, Jonathan P Meizoso, Kovi Bessoff, William J Butler, Matt Strickland, Linda A Dultz, Kimberly Davis, Eileen M Bulger, Patrick M Reilly, Martin A Croce, David A Spain, David H Livingston, Karen J Brasel, Raul Coimbra, Lisa M Knowlton
{"title":"Developing and leading a sustainable organization for early career acute care surgeons: Lessons from the inaugural American Association for the Surgery of Trauma Associate Member Council.","authors":"Ryan P Dumas, Brittany K Bankhead, Julia R Coleman, Navpreet K Dhillon, Jonathan P Meizoso, Kovi Bessoff, William J Butler, Matt Strickland, Linda A Dultz, Kimberly Davis, Eileen M Bulger, Patrick M Reilly, Martin A Croce, David A Spain, David H Livingston, Karen J Brasel, Raul Coimbra, Lisa M Knowlton","doi":"10.1097/TA.0000000000003734","DOIUrl":"https://doi.org/10.1097/TA.0000000000003734","url":null,"abstract":"<p><strong>Abstract: </strong>The associate membership of the American Association for the Surgery of Trauma (AAST) was established in 2019 to create a defined but incorporated entity within the larger AAST for the next generation of acute care surgeons. The Associate Member Council (AMC) was subsequently established in 2020 to provide the new AM with an elected group of leaders who would represent them within the AAST. In its inaugural year, this cohort of junior faculty and surgical trainees had developed for the AM a set of bylaws, a mission statement, a strategic vision, and a succession plan. The experience of the AAST AMC is exemplary of what can be accomplished with collaboration, mentorship, innovation, and tenacity. It has the potential to serve as a template for the creation and vitalization of future professional groups. In this piece, the AMC proposes a blueprint for the successful conception of a new organization.</p>","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":" ","pages":"e143-e146"},"PeriodicalIF":3.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40464453","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}
Anne Rizzo, Matthew Martin, Kenji Inaba, Martin Schreiber, Karen Brasel, Jack Sava, David Ciesla, Jason Sperry, Rosemary Kozar, Carlos Brown, Ernest Moore
{"title":"Pregnancy in trauma-A Western Trauma Association algorithm.","authors":"Anne Rizzo, Matthew Martin, Kenji Inaba, Martin Schreiber, Karen Brasel, Jack Sava, David Ciesla, Jason Sperry, Rosemary Kozar, Carlos Brown, Ernest Moore","doi":"10.1097/TA.0000000000003740","DOIUrl":"https://doi.org/10.1097/TA.0000000000003740","url":null,"abstract":"<p><strong>Background: </strong>The Western Trauma Association has undertaken publication of best practice clinical practice guidelines on multiple trauma topics. These guidelines are based on scientific evidence, case reports, and best practices per expert opinion. Some of the topics covered by this consensus group do not have the ability to have randomized controlled studies completed because of complexity, ethical issues, financial considerations or scarcity of experience. Care of the pregnant trauma patient is one of these clinically complex situations that is based on physiologic data, standard trauma care, trauma care experience, and outcomes.</p><p><strong>Methods: </strong>Review of multiple evidence- based guidelines, case reports, and expert opinion were compiled and reviewed.</p><p><strong>Results: </strong>The algorithm is attached with detailed explanation of each step, supported by data if available.</p><p><strong>Conclusion: </strong>Resuscitative and trauma care of the mother is the utmost priority.</p><p><strong>Study type: </strong>Algorithm, expert opinion, consensus.</p><p><strong>Level of evidence: </strong>Diagnostic Tests/Criteria; Level III.</p>","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":" ","pages":"e139-e142"},"PeriodicalIF":3.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40481661","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}
Zachary T Sheff, Brett W Engbrecht, Richard Rodgers, Lewis E Jacobson, Jodi L Smith
{"title":"Mortality of adolescents with isolated traumatic brain injury does not vary with type of level I trauma center.","authors":"Zachary T Sheff, Brett W Engbrecht, Richard Rodgers, Lewis E Jacobson, Jodi L Smith","doi":"10.1097/TA.0000000000003611","DOIUrl":"https://doi.org/10.1097/TA.0000000000003611","url":null,"abstract":"<p><strong>Background: </strong>Pediatric patients with isolated severe traumatic brain injury (TBI) treated at pediatric trauma centers (PTCs) have lower mortality than those treated at adult trauma centers (ATCs) or mixed trauma centers (MTCs). The primary objective of this study was to determine if adolescent patients (15-17 years) with isolated severe TBI also benefited from treatment at PTCs.</p><p><strong>Methods: </strong>This was a cross-sectional analysis using a national sample of adolescent trauma patients obtained from the American College of Surgeons' Trauma Quality Program Participant Use Files for 2013 to 2017 (n = 3,524). Mortality, the primary outcome variable, was compared between Level I PTCs, ATCs, and MTCs using multiple logistic regression controlling for patient characteristics and injury severity. Secondary outcomes included discharge disposition, utilization of craniotomy, intensive care unit (ICU) utilization, ICU length of stay (LOS), and hospital LOS.</p><p><strong>Results: </strong>Prior to adjustment, patients treated at ATCs (odds ratio [OR], 2.76; p = 0.032) and MTCs (OR, 2.36; p = 0.070) appeared to be at greater risk of mortality than those treated at PTCs. However, after adjustment, this difference disappeared (ATC OR, 1.21; p = 0.733; MTC OR, 0.95; p = 0.919). Patients treated at ATCs and MTCs were more severely injured than those treated at PTCs and more likely to be admitted to an ICU (ATC OR, 2.12; p < 0.001; MTC OR, 1.91; p < 0.001). No other secondary outcome differed between center types.</p><p><strong>Conclusion: </strong>Adolescent patients with isolated severe TBI treated at ATCs and MTCs had similar mortality risk as those treated at PTCs. The difference in injury severity across center types warrants additional research.</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":"538-544"},"PeriodicalIF":3.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40371277","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":"Another milestone reached: Emergency general surgery verification program.","authors":"Raul Coimbra","doi":"10.1097/TA.0000000000003756","DOIUrl":"https://doi.org/10.1097/TA.0000000000003756","url":null,"abstract":"","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":" ","pages":"425-426"},"PeriodicalIF":3.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40577470","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}
Matthieu Vasse, Yaniss Belaroussi, Jean-Philippe Avaro, Nazim Biri, Antoine Lerner, Pascal-Alexandre Thomas, Henri de Lesquen
{"title":"Surgical exploration for stable patients with penetrating cardiac box injuries: When and how? A cohort of 155 patients from Marseille area.","authors":"Matthieu Vasse, Yaniss Belaroussi, Jean-Philippe Avaro, Nazim Biri, Antoine Lerner, Pascal-Alexandre Thomas, Henri de Lesquen","doi":"10.1097/TA.0000000000003561","DOIUrl":"https://doi.org/10.1097/TA.0000000000003561","url":null,"abstract":"<p><strong>Background: </strong>The management of penetrating thoracic injuries in moribund or unstable patients is clearly described in contrast to that of stable patients, particularly for those with a cardiac box injury. This anatomic location suggests a potentially lethal cardiac injury and requires urgent therapeutic decision making. The present study aims at determining when surgical exploration is beneficial for stable patients presenting with penetrating cardiac box injuries (PCBIs).</p><p><strong>Methods: </strong>This was a retrospective study of stable civilian patients with PCBI referred to level I trauma centers in the Marseille area between January 2009 and December 2019. Using post hoc analysis of the management outcomes, patients whose surgery was considered therapeutic (group A) were compared with those whose surgery was considered nontherapeutic and with nonoperated patients (group B).</p><p><strong>Results: </strong>A total of 155 patients with PCBI were included, with 88% (n = 137) of stab wound injuries. Overall, surgical exploration was performed in 54% (n = 83), considered therapeutic in 71% (n = 59), and performed by video-assisted thoracoscopy surgery in 42% (n = 35) with a conversion rates of 14% (n = 5). Initial extended fast assessment with sonography for trauma revealed the presence of hemopericardium in 29% (n = 29) in group A versus 9.5% (n = 7) in group B, p = 0.010, and was associated with a negative predictive value of 93% regarding the presence of a cardiac injury. Chest tube flow was significantly higher in patients who required surgery, with a median (interquartile range) of 600.00 (350.00-1200.00) mL versus 300.0 (150.00-400.00) mL ( p = 0.001).</p><p><strong>Conclusion: </strong>Extended fast assessment with sonography for trauma and chest tube flow are the cornerstones of the management of stable PCBI. Video-assisted thoracoscopy represents an interesting approach to check intrathoracic wounds while minimizing surgical morbidity.</p><p><strong>Level of evidence: </strong>Therapeutic/Care Management; Level IV.</p>","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":" ","pages":"394-401"},"PeriodicalIF":3.4,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39893253","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}
Maria Baimas-George, Samuel W Ross, Timothy Hetherington, Marc Kowalkowski, Huaping Wang, Kyle Thompson, Kyle Cunningham, Brent D Matthews, Addison K May, Caroline E Reinke
{"title":"The physiology of failure: Identifying risk factors for mortality in emergency general surgery patients using a regional health system integrated electronic medical record.","authors":"Maria Baimas-George, Samuel W Ross, Timothy Hetherington, Marc Kowalkowski, Huaping Wang, Kyle Thompson, Kyle Cunningham, Brent D Matthews, Addison K May, Caroline E Reinke","doi":"10.1097/TA.0000000000003618","DOIUrl":"https://doi.org/10.1097/TA.0000000000003618","url":null,"abstract":"<p><strong>Background: </strong>Emergency general surgery (EGS) patients have increased mortality risk compared with elective counterparts. Recent studies on risk factors have largely used national data sets limited to administrative data. Our aim was to examine risk factors in an integrated regional health system EGS database, including clinical and administrative data, hypothesizing that this novel process would identify clinical variables as important risk factors for mortality.</p><p><strong>Methods: </strong>Our nine-hospital health system's billing data were queried for EGS International Classification of Disease codes between 2013 and 2018. Codes were grouped by diagnosis, and urgent or emergent encounters were included and merged with electronic medical record clinical data. Outcomes assessed were inpatient and 1-year mortality. Standard and multivariable statistics evaluated factors associated with mortality.</p><p><strong>Results: </strong>There were 253,331 EGS admissions with 3.6% inpatient mortality rate. Patients who suffered inpatient and 1-year mortality were older, more likely to be underweight, and have neutropenia or elevated lactate. On multivariable analysis for inpatient mortality: age (odds ratio [OR], 1.7-6.7), underweight body mass index (OR, 1.6), transfer admission (OR, 1.8), leukopenia (OR, 2.0), elevated lactate (OR, 1.8), and ventilator requirement (OR, 7.1) remained associated with increased risk. Adjusted analysis for 1-year mortality demonstrated similar findings, with highest risk associated with older age (OR, 2.8-14.6), underweight body mass index (OR, 2.3), neutropenia (OR, 2.0), and tachycardia (OR, 1.7).</p><p><strong>Conclusion: </strong>After controlling for patient and disease characteristics available in administrative databases, clinical variables remained significantly associated with mortality. This novel yet simple process allows for easy identification of clinical data points imperative to the study of EGS diagnoses that are critical in understanding factors that impact mortality.</p><p><strong>Level of evidence: </strong>Prognostic and Epidemiologic; Level III.</p>","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":" ","pages":"409-417"},"PeriodicalIF":3.4,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40413486","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":"FEATURED ARTICLES FOR CME CREDIT SEPTEMEBR 2022.","authors":"","doi":"10.1097/01.ta.0000874012.13706.3f","DOIUrl":"https://doi.org/10.1097/01.ta.0000874012.13706.3f","url":null,"abstract":"","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":" ","pages":"e128-e129"},"PeriodicalIF":3.4,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40413487","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}