The Journal of Trauma and Acute Care Surgery最新文献

{"title":"\"The armor phenomenon\" in obese patients with penetrating thoracoabdominal injuries: A systematic review and meta-analysis.","authors":"Andy Ze Lin Chen,&nbsp;Tae Hwan Lee,&nbsp;Jeremy Hsu,&nbsp;Tony Pang","doi":"10.1097/TA.0000000000003566","DOIUrl":"https://doi.org/10.1097/TA.0000000000003566","url":null,"abstract":"<p><strong>Background: </strong>Obesity represents a growing global health threat, which generally portends increased morbidity and mortality in the context of traumatic injuries. We hypothesized that there may exist a protective effect related to increased weight and truncal girth provided for obese patients in penetrating torso injuries, although this may not exert a significant positive impact overall upon clinical outcomes.</p><p><strong>Methods: </strong>A comprehensive review of the literature was conducted across five databases up to March 2021 (Medline, Pubmed, Embase, Web of Science and the Cochrane library) to examine the effect of obesity on penetrating thoracoabdominal injuries. The primary outcome was to determine the rate of nonsignificant injury and injury patterns. Secondary outcomes examined were lengths of stay, complications, and mortality. Comparisons were drawn by meta-analysis. The study protocol was registered with PROSPERO under CRD42020216277.</p><p><strong>Results: </strong>There were 2,952 publications assessed with 12 meeting the inclusion criteria for review. Nine studies were included for quantitative analysis, including 5,013 patients sustaining penetrating thoracoabdominal injuries, of which 29.6% were obese. Obese patients that sustained stab injuries underwent more nontherapeutic operations. Obese patients that sustained gunshot injuries had longer intensive care and total hospital length of stay. Obese patients suffered more respiratory complications and were at an increased risk of death during their admission.</p><p><strong>Conclusion: </strong>The \"armor phenomenon\" does not truly protect obese patients, a population that experiences increased morbidity and mortality following penetrating thoracoabdominal injuries.</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":"e101-e109"},"PeriodicalIF":3.4,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39946684","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":"Urine leaks in children sustaining blunt renal trauma.","authors":"Muhammad Owais Abdul Ghani,&nbsp;Elizabeth Snyder,&nbsp;Mark C Xu,&nbsp;Katlyn G McKay,&nbsp;Jarrett Foster,&nbsp;Carmen Tong,&nbsp;Douglas B Clayton,&nbsp;Amber Greeno,&nbsp;Bassil Azam,&nbsp;Shilin Zhao,&nbsp;Marta Hernanz-Schulman,&nbsp;Harold N Lovvorn","doi":"10.1097/TA.0000000000003532","DOIUrl":"https://doi.org/10.1097/TA.0000000000003532","url":null,"abstract":"<p><strong>Background: </strong>Few consensus statements exist to guide the timely diagnosis and management of urine leaks in children sustaining blunt renal trauma (BRT). The aims of this study were to characterize kidney injuries among children who sustain BRT, evaluate risk factors for urine leaks, and describe the negative impact of urinoma on patient outcomes and resource consumption.</p><p><strong>Methods: </strong>A retrospective review was performed of 347 patients, younger than 19 years, who presented with BRT to a single American College of Surgeons-verified Level I Pediatric Trauma Center between 2005 and 2020. Frequency of and risk factors for urine leak after BRT were evaluated, and impact on patient outcomes and resource utilization were analyzed.</p><p><strong>Results: </strong>In total, 44 (12.7%) patients developed urine leaks, which exclusively presented among injury Grade 3 (n = 5; 11.4%), Grade 4 (n = 27; 61.4%), and Grade 5 (n = 12; 27.3%). A minority of urine leaks (n = 20; 45.5%) were discovered on presenting CT scan but all within 3 days. Kidney-specific operative procedures (nephrectomy, cystoscopy with J/ureteral stent, percutaneous nephrostomy) were more common among urine leak patients (n = 17; 38.6%) compared with patients without urine leaks (n = 3; 1.0%; p = 0.001). Patients with urine leak had more frequent febrile episodes during hospital stay (n = 24; 54.5%; p = 0.001) and showed increased overall 90-day readmission rates (n = 14; 33.3%; p < 0.001). Independent risk factors that associated with urine leak were higher grade (odds ratio [OR], 7.9; 95% confidence interval [CI], 2.6-24.3; p < 0.001), upper-lateral quadrant injuries (OR, 2.9; 95% CI, 1.2-7.1; p = 0.02), and isolated BRT (OR, 2.6; 95% CI, 1.0-6.5; p = 0.04).</p><p><strong>Conclusion: </strong>In a large cohort of children sustaining BRT, urine leaks result in considerable morbidity, including more febrile episodes, greater 90-day readmission rates, and increased operative or image-guided procedures. This study is the first to examine the relationship between kidney quadrant injury and urine leaks. Higher grade (Grade 4-5) injury, upper lateral quadrant location, and isolated BRT were independently predictive of urine leaks.</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":"376-384"},"PeriodicalIF":3.4,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39790584","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":"Individual and neighborhood level characteristics of pediatric firearm injuries presenting at trauma centers in Colorado.","authors":"Jenny Stevens,&nbsp;Jan Leonard,&nbsp;Marina L Reppucci,&nbsp;Thomas Schroeppel,&nbsp;Denis Bensard,&nbsp;Maya Haasz","doi":"10.1097/TA.0000000000003520","DOIUrl":"https://doi.org/10.1097/TA.0000000000003520","url":null,"abstract":"<p><strong>Background: </strong>Firearm injuries are the second leading cause of death among children and adolescents in the United States. In Colorado, firearm injuries have surpassed motor vehicle accidents as the leading cause of death in youth. Local research is necessary to characterize risk factors associated with pediatric firearm injuries. We sought to categorize demographics, neighborhood characteristics, and trends in pediatric firearm injuries in Colorado.</p><p><strong>Methods: </strong>A review of pediatric firearm-injured patients (18 years or younger) evaluated at four trauma centers in Colorado from 2008 to 2019 was conducted. Clinical information, injury intent, and demographics were collected. Patient addresses were geocoded to census tracts to obtain neighborhood-level characteristics. Annual trends in firearm injury incidence per trauma evaluation were analyzed using regression modeling.</p><p><strong>Results: </strong>There were 446 firearm injuries during the study period. The median age was 16 years, and 87.0% were male. Assault was the most common injury intent (64.6%), and 92.0% of patients were from metropolitan (rural-urban continuum code 1-3) areas. Neighborhoods associated with firearm injuries were characterized by lower median household income ($47,112 vs. $63,443, p < 0.001) and higher levels of poverty (19.1% vs. 9.4%, p < 0.001) compared with median state levels. There was a 14.0% increase in firearm injuries compared with overall trauma evaluations for each year in the study period (incidence rate ratio, 1.14; 95% confidence interval, 1.08-1.20; p < 0.001).</p><p><strong>Conclusion: </strong>The incidence of pediatric firearm injuries increased significantly from 2008 to 2019 compared with overall trauma evaluations in Colorado. Children and adolescents who live in more socially vulnerable neighborhoods are disproportionately impacted, and injury prevention resources should be focused on these communities.</p><p><strong>Level of evidence: </strong>Prognostic and Epidemiolgic; Level III.</p>","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":" ","pages":"385-393"},"PeriodicalIF":3.4,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40720090","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 bay virtual reality-A game changer for ATLS instruction and assessment.","authors":"Alexander L Colonna,&nbsp;Riann Robbins,&nbsp;Jeanine Stefanucci,&nbsp;Sarah Creem-Regeh,&nbsp;Brandon Patterson,&nbsp;Benjamin T Engel,&nbsp;Aaron Fischer,&nbsp;Raminder Nirula","doi":"10.1097/TA.0000000000003569","DOIUrl":"https://doi.org/10.1097/TA.0000000000003569","url":null,"abstract":"<p><strong>Background: </strong>Medical educational research highlights the need for high-fidelity, multidisciplinary simulation training to teach complex decision-making skills, such as those taught in Advanced Trauma Life Support (ATLS). This approach is, however, expensive and time-intensive. Virtual reality (VR) education simulation may improve skill acquisition in a cost-effective and time-sensitive manner. We developed a novel trauma VR simulator (TVRSim) for providers to apply ATLS principles. We hypothesized in this pilot study that TVRSim could differentiate practitioner competency with increasing experience and would be well accepted.</p><p><strong>Methods: </strong>Providers at a Level I trauma center (acute care surgeons, novice (MS4 & PGY1), junior (PGY2 & 3), senior (PGY4-6) residents) ran a blunt, polytrauma VR code. Ten critical decision points were assessed: intubation, cricothyroidotomy, chest tube, intravenous access, focused abdominal sonography for trauma examination, pelvic binder, activation of massive transfusion protocol, administration of hypertonic saline, hyperventilation and decision to go to the operating room (OR). Learner assessment was based on frequency and time to correct decisions. Participant satisfaction was measured using validated surveys.</p><p><strong>Results: </strong>All 31 providers intubated and obtained intravenous access. Novices and juniors frequently failed at hypertonic saline and hyperventilation decisions. Juniors often failed at cricothyroidotomy (60%) and OR (100%) decisions. Mean time to all decisions except going to the OR was longer for all groups compared to acute care surgeons. Mean number of decisions/min was significantly higher for surgeons and seniors compared to juniors and novices. Mortality was 92.3% for novices, 80% for juniors, 25% for seniors and 0% for the attendings. Participants found TVRSim comfortable, easy to use/interact with/performance enhancing, and helped develop skills and learning.</p><p><strong>Conclusions: </strong>In this pilot study using a sample of convenience, TVRSim was able to discern decision-making abilities among trainees with increasing experience. All trainees felt that the platform enhanced their performance and facilitated skill acquisition and learning. TVRSim could be a useful adjunct to teach and assess ATLS skills.</p><p><strong>Level of evidence: </strong>Diagnostic Test or Criteria; Level IV.</p>","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":" ","pages":"353-359"},"PeriodicalIF":3.4,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39789807","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":"Building a sustainable Mil-Civ partnership to ensure a ready medical force: A single partnership site's experience.","authors":"Daniel J Stinner,&nbsp;A Alex Jahangir,&nbsp;Christopher Brown,&nbsp;Christopher R Bickett,&nbsp;Joshua P Smith,&nbsp;Bradley M Dennis","doi":"10.1097/TA.0000000000003632","DOIUrl":"https://doi.org/10.1097/TA.0000000000003632","url":null,"abstract":"<p><strong>Abstract: </strong>One of the challenges in military medicine is ensuring that the medical force deployed to the theater of combat operations is prepared to perform life, limb, and eyesight saving care at a level of care comparable to our top civilian Level I trauma centers. There is increasingly more evidence demonstrating that the majority of military physicians are not exposed to trauma or combat casualty care-relevant surgical cases on a consistent basis in their daily practice at their garrison military treatment facility (MTF). To prevent this widening skills and experience gap from become more of a reality, the 2017 National Defense Authorization Act called for the expansion of military and civilian (Mil-Civ) medical partnerships, working toward embedding military medical providers and surgical teams in busy civilian trauma centers. Vanderbilt University Medical Center is one of the busiest trauma centers in the country and being in close proximity to the local MTF at Fort Campbell, KY, it is primed to become one of the premier Mil-Civ partnerships. Creating a strategy that builds the partnership in a calculated and stepwise fashion through multiple avenues with centralized leadership has resulted in the early success of the program. However, Vanderbilt University Medical Center is not immune to challenges similar to those at other Mil-Civ partnerships, but only by sharing best practices can we continue to make progress.</p>","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":" ","pages":"S174-S178"},"PeriodicalIF":3.4,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40538703","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 specialty of surgical critical care: A white paper from the American Association for the Surgery of Trauma Critical Care Committee.","authors":"Christopher P Michetti,&nbsp;Jeffry Nahmias,&nbsp;Erika L Rangel,&nbsp;Joseph F Rappold,&nbsp;Richard P Gonzalez,&nbsp;Abhijit S Pathak,&nbsp;Krista Kaups","doi":"10.1097/TA.0000000000003629","DOIUrl":"https://doi.org/10.1097/TA.0000000000003629","url":null,"abstract":"","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":" ","pages":"e80-e88"},"PeriodicalIF":3.4,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40315052","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":"Epidemiology, patterns of care and outcomes of traumatic brain injury in deployed military settings: Implications for future military operations.","authors":"Bradley A Dengler,&nbsp;Yll Agimi,&nbsp;Katharine Stout,&nbsp;Krista L Caudle,&nbsp;Kenneth C Curley,&nbsp;Sarah Sanjakdar,&nbsp;Malena Rone,&nbsp;Brian Dacanay,&nbsp;Jonathan C Fruendt,&nbsp;James B Phillips,&nbsp;Ana-Claire L Meyer","doi":"10.1097/TA.0000000000003497","DOIUrl":"https://doi.org/10.1097/TA.0000000000003497","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) is prevalent and highly morbid among Service Members. A better understanding of TBI epidemiology, outcomes, and care patterns in deployed settings could inform potential approaches to improve TBI diagnosis and management.</p><p><strong>Methods: </strong>A retrospective cohort analysis of Service Members who sustained a TBI in deployed settings between 2001 and 2018 was conducted. Among individuals hospitalized with TBI, we compared the demographic characteristics, mechanism of injury, injury type, and severity between combat and noncombat injuries. We compared diagnostic tests and procedures, evacuation patterns, return to duty rates and days in care between individuals with concussion and those with severe TBI.</p><p><strong>Results: </strong>There were 46,309 service members with TBI and 9,412 who were hospitalized; of those hospitalized, 55% (4,343) had isolated concussion and 9% (796) had severe TBI, of whom 17% (132/796) had multiple injuries. Overall mortality was 2% and ranged from 0.1% for isolated concussion to 18% for severe TBI. The vast majority of TBI were evacuated by rotary wing to role 3 or higher, including those with isolated concussion. As compared with severe TBI, individuals with isolated concussion had fewer diagnostic or surgical procedures performed. Only 6% of service members with severe TBI were able to return to duty as compared with 54% of those with isolated concussion. Traumatic brain injury resulted in 123,677 lost duty days; individuals with isolated concussion spent a median of 2 days in care and those with severe TBI spent a median of 17 days in care and a median of 6 days in the intensive care unit.</p><p><strong>Conclusion: </strong>While most TBI in the deployed setting are mild, TBI is frequently associated with hospitalization and multiple injuries. Overtriage of mild TBI is common. Improved TBI capabilities applicable to forward settings will be critical to the success of future multidomain operations with limitations in air superiority.</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":"220-228"},"PeriodicalIF":3.4,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39727332","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 ICEBERG: A score and visual representation to track the severity of traumatic brain injury: Design principles and preliminary results.","authors":"Fabrice Vallée,&nbsp;Hélène Nougue,&nbsp;Jérome Cartailler,&nbsp;Paul Robert Koundé,&nbsp;Alexandre Mebazaa,&nbsp;Etienne Gayat,&nbsp;Philippe Azouvi,&nbsp;Joaquim Mateo","doi":"10.1097/TA.0000000000003515","DOIUrl":"https://doi.org/10.1097/TA.0000000000003515","url":null,"abstract":"<p><strong>Background: </strong>Establishing neurological prognoses in traumatic brain injury (TBI) patients remains challenging. To help physicians in the early management of severe TBI, we have designed a visual score (ICEBERG score) including multimodal monitoring and treatment-related criteria. We evaluated the ICEBERG scores among patients with severe TBI to predict the 28-day mortality and long-term disability (Extended Glasgow Outcome Scale score at 3 years). In addition, we made a preliminary assessment of the nurses and doctors on the uptake and reception to the use of the ICEBERG visual tool.</p><p><strong>Methods: </strong>This study was part of a larger prospective cohort study of 207 patients with severe TBI in the Parisian region (PariS-TBI study). The ICEBERG score included six variables from multimodal monitoring and treatment-related criteria: cerebral perfusion pressure, intracranial pressure, body temperature, sedation depth, arterial partial pressure of CO 2 , and blood osmolarity. The primary outcome measures included the ICEBERG score and its relationship with hospital mortality and Extended Glasgow Outcome Score.</p><p><strong>Results: </strong>The hospital mortality was 21% (45/207). The ICEBERG score baseline value and changes during the 72nd first hours were more strongly associated with TBI prognosis than the ICEBERG parameters measured individually. Interestingly, when the clinical and computed tomography parameters at admission were combined with the ICEBERG score at 48 hours using a multimodal approach, the predictive value was significantly increased (area under the curve = 0.92). Furthermore, comparing the ICEBERG visual representation with the traditional numerical readout revealed that changes in patient vitals were more promptly detected using ICEBERG representation ( p < 0.05).</p><p><strong>Conclusion: </strong>The ICEBERG score could represent a simple and effective method to describe severity in TBI patients, where a high score is associated with increased mortality and disability. In addition, ICEBERG representation could enhance the recognition of unmet therapeutic goals and dynamic evolution of the patient's condition. These preliminary results must be confirmed in a prospective manner.</p><p><strong>Level of evidence: </strong>Diagnostic Tests or Criteria; Level III.</p>","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":" ","pages":"229-237"},"PeriodicalIF":3.4,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39798984","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":"A mixed methods end-user assessment to determine the ideal supraglottic airway device for inclusion into the medic's aid bag.","authors":"Steven G Schauer,&nbsp;Ashley D Tapia,&nbsp;Ian L Hudson,&nbsp;Erika A Jeschke,&nbsp;Jessica Mendez,&nbsp;Mireya A Escandon,&nbsp;Nguvan Uhaa,&nbsp;Michael D April,&nbsp;Robert A De Lorenzo","doi":"10.1097/TA.0000000000003596","DOIUrl":"https://doi.org/10.1097/TA.0000000000003596","url":null,"abstract":"<p><strong>Background: </strong>Many advancements in supraglottic airway technology have occurred since the start of the Global War on Terrorism. While the Tactical Combat Casualty Care guidelines previously recommend the i-gel device, this is based on little data and minimal end-user input.</p><p><strong>Objective: </strong>We sought to use a mixed methods approach to investigate the properties of an ideal device for inclusion into the medic's aid bag.</p><p><strong>Methods: </strong>We performed prospective, serial qualitative studies to uncover and articulate themes relative to airway device usability with 68W-combat medics. 68W are trained roughly to the level of a civilian advanced emergency medical technician with a heavier focus on trauma care. Physicians with airway expertise demonstrated the use of each device and provided formal training on all the presented devices. We then administered performed focus groups to solicit end-user feedback along with survey data.</p><p><strong>Results: </strong>We enrolled 250 medics during the study. The preponderance of medics were of the rank E4 (28%) and E5 (44%). Only 35% reported ever placing a supraglottic airway in a real human. When reporting on usability, the i-gel had the highest median score, ease of manipulation, grip comfort and ease of insertion while also scoring the best in regard to requiring minimal training. The other compared devices had no clear highest score. Qualitative data saturated around a strong preference for the BaskaMask and/or the i-gel airway device, with the least favorite being the AirQ and the LMA Fastrach airway devises. There was a strong qualitative alignment in how both the BaskaMask and i-gel provided ease of use and simplicity of training.</p><p><strong>Conclusion: </strong>There were strong qualitative preferences for two specific airway devices: Baska Mask and i-gel. However, many medics commented on their previous experience with the i-gel compared with the other devices, which may have biased them toward the i-gel. The overall data suggest that medics would prefer a device engineered with features from several devices.</p><p><strong>Level of evidence: </strong>Therapeutic/care management; Level V.</p>","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":" ","pages":"S64-S70"},"PeriodicalIF":3.4,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40315053","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":"Relationship between anti-Xa level achieved with prophylactic low-molecular weight heparin and venous thromboembolism in trauma patients: A systematic review and meta-analysis.","authors":"Kevin Verhoeff,&nbsp;Kendra Raffael,&nbsp;Matthew Connell,&nbsp;Janice Y Kung,&nbsp;Matt Strickland,&nbsp;Arabesque Parker,&nbsp;Ram V Anantha","doi":"10.1097/TA.0000000000003580","DOIUrl":"https://doi.org/10.1097/TA.0000000000003580","url":null,"abstract":"<p><strong>Background: </strong>Trauma patients have simultaneously high venous thromboembolism (VTE) and bleeding risk. Optimal chemoprophylaxis regimens remain unclear. This study aims to answer three questions for trauma patients. Is there any association between anti-Xa and VTE? Does dose adjustment improve prophylactic anti-Xa rates? Does dose adjustment improve anti-Xa adequacy and VTE compared with standard dosing?</p><p><strong>Methods: </strong>Systematic search of MEDLINE, Embase, Scopus, and Web of Science occurred in May 2021. Two author reviews included trauma studies that evaluated low molecular weight heparin chemoprophylaxis, reported anti-Xa level, and evaluated more than one outcome. Data were dually extracted and estimated effects were calculated using RevMan 5.4 applying the Mantel-Haenszel method. Analysis 1 compared patients with peak anti-Xa of 0.2 IU/mL or greater or trough 0.1 IU/mL or greater to those with lower anti-Xa using VTE as the primary outcome. Analysis 2 reported the effect of dose adjustment on anti-Xa. Analysis 3 compared standard dosing to dose adjustment with the primary outcome being anti-Xa adequacy; secondary outcomes were VTE, pulmonary embolism, and bleeding complications.</p><p><strong>Results: </strong>There were 3,401 studies evaluated with 24 being included (19 retrospective studies, 5 prospective studies). In analysis 1, achieving adequate anti-Xa was associated with reduced odds of VTE (4.0% to 3.1%; odds ratio [OR], 0.52; p = 0.03). Analysis 2 demonstrated that 768 (75.3%) patients achieved prophylactic anti-Xa with adjustment protocols. Analysis 3 suggested that dose-adjusted chemoprophylaxis achieves prophylactic anti-Xa more frequently (OR, 4.05; p = 0.007) but without VTE (OR, 0.72; p = 0.15) or pulmonary embolism (OR, 0.48; p = 0.10) differences. In subgroup analysis, anti-Xa dose adjustment also suggested no VTE reduction (OR, 0.68; p = 0.08).</p><p><strong>Conclusion: </strong>Patients with higher anti-Xa levels are less likely to experience VTE, and anti-Xa guided chemoprophylaxis increases anti-Xa adequacy. However, dose adjustment, including anti-Xa guided dosing, may not reduce VTE.</p><p><strong>Level of evidence: </strong>Systematic Review Meta-Analysis, Level IV.</p>","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":" ","pages":"e61-e70"},"PeriodicalIF":3.4,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39945787","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}