The Journal of Trauma and Acute Care Surgery最新文献

{"title":"FEATURED ARTICLES FOR CME CREDIT AUGUST 2022.","authors":"","doi":"10.1097/01.ta.0000852772.89251.9d","DOIUrl":"https://doi.org/10.1097/01.ta.0000852772.89251.9d","url":null,"abstract":"","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":" ","pages":"e99-e100"},"PeriodicalIF":3.4,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40624527","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":"Understanding the geography of trauma: Combining spatial analysis and funnel plots to create comprehensive spatial injury profiles.","authors":"Peter J Abraham,&nbsp;Brandon M Crowley,&nbsp;Dylana Moore,&nbsp;Shannon W Stephens,&nbsp;Michael Minor,&nbsp;Russell L Griffin,&nbsp;Zain Hashmi,&nbsp;John B Holcomb,&nbsp;Jeffrey D Kerby,&nbsp;Jan O Jansen","doi":"10.1097/TA.0000000000003468","DOIUrl":"https://doi.org/10.1097/TA.0000000000003468","url":null,"abstract":"<p><strong>Background: </strong>Understanding geographic patterns of injury is essential to operating an effective trauma system and targeting injury prevention. Choropleth maps are helpful in showing spatial relationships but are unable to provide estimates of spread or degrees of confidence. Funnel plots overcome this issue and are a recommended graphical aid for comparisons that allow quantification of precision. The purpose of this project was to demonstrate the complementary roles of choropleth maps and funnel plots in providing a thorough representation of geographic trauma data.</p><p><strong>Methods: </strong>This is a retrospective analysis of emergency medical service transport data of adult patients in Alabama from July 2015 to June 2020. Choropleth maps of case volume and observed-to-expected ratios of incidence were created using US Census Bureau data. Funnel plots were created to relate incidence rate to county population. Subgroup analyses included patients with critical physiology, penetrating, blunt, and burn injuries.</p><p><strong>Results: </strong>We identified 65,247 trauma incidents during the study period. The overall statewide incidence rate was 133 per 10,000 persons. The highest number of incidents occurred in the most populous counties (Jefferson, 10,768; Mobile, 5,642). Choropleth maps for overall incidence and subgroups highlighted that spatial distribution of overall case volume and observed-to-expected ratios are not always congruent. Funnel plots identified possible and probable outliers, and revealed skewed or otherwise unique patterns among injury subgroups.</p><p><strong>Conclusion: </strong>This study demonstrates the complementarity of choropleth maps and funnel plots in describing trauma patterns. Comprehensive geospatial analyses may help guide a data-driven approach to trauma system optimization and injury prevention. Combining maps of case counts, incidence, and funnel plots helps to not only identify geographic trends in data but also quantify outliers and display how far results fall outside the expected range. The combination of these tools provides a more comprehensive geospatial analysis than either tool could provide on its own.</p><p><strong>Level of evidence: </strong>Prognostic and Epidemiologic; Level IV.</p>","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":" ","pages":"238-246"},"PeriodicalIF":3.4,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39633307","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 team approach to peripartum hemorrhage control incorporating resuscitative endovascular balloon occlusion of the aorta.","authors":"Rachel M Russo,&nbsp;Alissa Carver,&nbsp;Caitlin Clifford,&nbsp;Aimee Rolston,&nbsp;Shitanshu Uppal,&nbsp;Lena M Napolitano","doi":"10.1097/TA.0000000000003612","DOIUrl":"https://doi.org/10.1097/TA.0000000000003612","url":null,"abstract":"Development of a protocolized, multidisciplinary approach to the control of obstetric hemorrhage can facilitate expedient hemostasis in emergencies. We detail our protocol and the technique of using #REBOA in high-risk obstetric surgeries with #TraumaSurgery assistance.","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":" ","pages":"e89-e94"},"PeriodicalIF":3.4,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40315051","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":"Go big and go home.","authors":"Jeffrey A Claridge","doi":"10.1097/TA.0000000000003664","DOIUrl":"https://doi.org/10.1097/TA.0000000000003664","url":null,"abstract":"","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":" ","pages":"1-7"},"PeriodicalIF":3.4,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40141024","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":"Fluoxetine reduces organ injury and improves motor function after traumatic brain injury in mice.","authors":"Jessica L Weaver,&nbsp;Brian Eliceiri,&nbsp;Todd W Costantini","doi":"10.1097/TA.0000000000003646","DOIUrl":"https://doi.org/10.1097/TA.0000000000003646","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in trauma patients worldwide. Brain injury is associated with significant inflammation, both within the brain and in the peripheral organs. This inflammatory response in TBI leads to a secondary injury, worsening the effects of the original brain injury. Serotonin is also linked to inflammation in the intestine and inflammatory bowel disease, but its role in the gut-brain axis is not known. We hypothesized that using fluoxetine to block serotonin reuptake would reduce organ inflammation and improve outcomes after TBI.</p><p><strong>Methods: </strong>C57/B6 mice were given a severe TBI using a controlled cortical impact. To measure intestinal permeability, a piece of terminal ileum was resected, the lumen was filled with 4-kDa fluorescein isothiocyanate (FITC)-dextran, and the ends were tied. The intestinal segment was submerged in buffer and fluorescence in the buffer measured over time. To measure lung permeability, 70-kDa FITC-dextran is injected retro-orbitally. Thirty minutes later, the left lung was homogenized and the fluorescence was measured. To measure performance on the rota-rod, mice were placed on a spinning rod, and the time to fall off was measured. Those treated with fluoxetine received a single dose of 5 mg/kg via intraperitoneal injection immediately after injury.</p><p><strong>Results: </strong>Traumatic brain injury was associated with an increase in intestinal permeability to FITC-dextran, increased lung vascular permeability, and worse performance on the rota-rod. Fluoxetine significantly reduced lung and intestinal permeability after TBI and improved performance on the rota-rod after TBI.</p><p><strong>Conclusion: </strong>Use of fluoxetine has the potential to reduce lung injury and improve motor coordination in severe TBI patients. Further study will be needed to elucidate the mechanism behind this effect.</p>","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":" ","pages":"38-42"},"PeriodicalIF":3.4,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40141025","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":"Delayed splenic pseudoaneurysm identification with surveillance imaging.","authors":"Taylor E Wallen,&nbsp;Katherine Clark,&nbsp;Matthew R Baucom,&nbsp;Rebecca Pabst,&nbsp;Jennifer Lemmink,&nbsp;Timothy A Pritts,&nbsp;Amy T Makley,&nbsp;Michael D Goodman","doi":"10.1097/TA.0000000000003615","DOIUrl":"https://doi.org/10.1097/TA.0000000000003615","url":null,"abstract":"<p><strong>Background: </strong>Recent studies have shown that nonoperative management of patients with splenic injury has up to a 90% success rate. However, delayed hemorrhage secondary to splenic artery pseudoaneurysm occurs in 5% to 10% of patients with up to 27% of patients developing a pseudoaneurysm on delayed imaging. The goal of our study was to evaluate the safety and utility of delayed computed tomography (CT) imaging for blunt splenic injury patients.</p><p><strong>Methods: </strong>A retrospective evaluation of all traumatic splenic injuries from 2018 to 2020 at a single level 1 trauma center was undertaken. Patients were subdivided into four groups based on the extent of splenic injury: grades I and II, grade III, grade IV, and grade V. Patient injury characteristics along with hospital length of stay, imaging, procedures, and presence/absence of pseudoaneurysm were documented.</p><p><strong>Results: </strong>A total of 588 trauma patients were initially included for evaluation, with 539 included for final analysis. Two hundred ninety-seven patients sustained grades I and II; 123 patients, grade III; 61 patients, grade IV; and 58 patients, grade V splenic injuries. One hundred twenty-nine patients (24%) underwent either emergent or delayed (>6 hours) splenectomy with an additional six patients having a splenorrhaphy on initial operation. Of the patients who were treated nonoperatively, 98% of grade III, 91% of grade IV, and 100% of grade V splenic injury patients underwent follow-up CT imaging. The mean ± SD time from admission to follow-up abdominal CT scan was 5 ± 4.4 days. Twenty-two pseudoaneurysms were identified including grade III (10 of 84), grade IV (7 of 22), and grade V (2 of 5) patients; of these patients, 33% of grade III and 30% of grade IV required subsequent splenectomy.</p><p><strong>Conclusion: </strong>Routine follow-up CT imaging after high-grade splenic injury identifies splenic artery pseudoaneurysm in a significant proportion of patients. Standardized surveillance imaging for high-grade splenic trauma promotes prospective identification of pseudoaneurysms, allowing for interventions to minimize delayed splenic injury complications.</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":"113-117"},"PeriodicalIF":3.4,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40315049","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 reproducible strategy to solve problems.","authors":"Lenworth Jacobs","doi":"10.1097/TA.0000000000003568","DOIUrl":"https://doi.org/10.1097/TA.0000000000003568","url":null,"abstract":"The strategy of successfully identifying and solving significant problems such as Implementing Advanced Prehospital Care. Increasing competence in trauma surgical operative procedures and training the public to stop severe bleeding is described","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":" ","pages":"e5-e11"},"PeriodicalIF":3.4,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39609827","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":"Higher risk of auto versus pedestrian crashes in school-age children on school days.","authors":"Chad Morrison,&nbsp;Ty Olson,&nbsp;Allison G McNickle,&nbsp;Douglas R Fraser,&nbsp;Deborah A Kuhls,&nbsp;Laura K Gryder-Culver,&nbsp;Samantha Slinkard-Barnum,&nbsp;Syed F Saquib,&nbsp;Joseph T Carroll,&nbsp;Paul J Chestovich","doi":"10.1097/TA.0000000000003523","DOIUrl":"https://doi.org/10.1097/TA.0000000000003523","url":null,"abstract":"<p><strong>Background: </strong>This study examines the rates of pediatric auto versus pedestrian collision (APCs) and determined ages and periods of greatest risk. We hypothesized that the rate of APC in children would be higher on school days and in the timeframes correlating with travel to and from school.</p><p><strong>Methods: </strong>Retrospective case-control study of APC on school and nonschool days for patients younger than 18 years at an urban Level II pediatric trauma center from January 2011 to November 2019. Frequency of APC by hour of the day was plotted overall, for school versus nonschool days and for age groups: 0 year to 4 years, 5 years to 9 years, 10 years to 13 years, and 14 years to 17 years. t Test was used with a p value less than 0.05, which was considered significant.</p><p><strong>Results: </strong>There were 441 pediatric APC in the study period. Frequency of all APC was greater on school days (0.174 vs. 0.101; relative risk [RR], 1.72, p < 0.001), and APC with Injury Severity Score greater than 15 (0.039 vs. 0.024; p = 0.014; RR, 1.67; 95% confidence interval, 1.10-2.56). Comparing school day with nonschool day, the 0-year to 4-year group had no significant difference in APC frequency (0.021 vs. 0.014; p = 0.129), APC frequency was higher on school days in all other age groups: 5 years to 9 years (0.036 vs. 0.019; RR, 1.89; p = 0.0134), 10 years to 13 years (0.055 vs. 0.024; RR, 2.29; p < 0.001), and 14 years to 17 years (0.061 vs. 0.044; RR, 1.39; p = 0.045). The greatest increase in APC on school days was in the 10-year to 13-year age group.</p><p><strong>Discussion: </strong>All school age children are at higher risk of APC on school days. The data support our hypothesis that children are at higher risk of APC during transit to and from school. The age 10-year to 13-year group had a 129% increase in APC frequency on school days. This age group should be a focus of injury prevention efforts.</p><p><strong>Level of evidence: </strong>Prognostic and Epidemiologic; Level IV.</p>","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":" ","pages":"130-134"},"PeriodicalIF":3.4,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40141026","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":"Traumatic brain injury provokes low fibrinolytic activity in severely injured patients.","authors":"Jonathan P Meizoso,&nbsp;Hunter B Moore,&nbsp;Ernest E Moore,&nbsp;Gareth P Gilna,&nbsp;Arsen Ghasabyan,&nbsp;James Chandler,&nbsp;Fredric M Pieracci,&nbsp;Angela Sauaia","doi":"10.1097/TA.0000000000003559","DOIUrl":"https://doi.org/10.1097/TA.0000000000003559","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) in combination with shock has been associated with hypocoagulability. However, recent data suggest that TBI itself can promote a systemic procoagulant state via the release of brain-derived extracellular vesicles. The objective of our study was to identify if TBI was associated with differences in thrombelastography indices when controlling for other variables associated with coagulopathy following trauma. We hypothesized that TBI is independently associated with a less coagulopathic state.</p><p><strong>Methods: </strong>Prospective study includes all highest-level trauma activations at an urban Level I trauma center, from 2014 to 2020. Traumatic brain injury was defined as Abbreviated Injury Scale head score greater than 3. Blood samples were drawn at emergency department admission. Linear regression was used to assess the role of independent predictors on trauma induced coagulopathy. Models adjusted for Injury Severity Score (ISS), shock (defined as ED SBP<70, or ED SBP<90 and ED HR>108, or first hospital base deficit >10), and prehospital Glasgow Coma Scale score.</p><p><strong>Results: </strong>Of the 1,023 patients included, 291 (28%) suffered a TBI. Traumatic brain injury patients more often were female (26% vs. 19%, p = 0.01), had blunt trauma (83% vs. 43%, p < 0.0001), shock (33% vs. 25%, p = 0.009), and higher median ISS (29 vs. 10, p < 0.0001). Fibrinolysis shutdown (25% vs. 18%) was more common in the TBI group (p < 0.0001). When controlled for the confounding effects of ISS and shock, the presence of TBI independently decreases lysis at 30 minutes (LY30) (beta estimate: -0.16 ± 0.06, p = 0.004). This effect of TBI on LY30 persisted when controlling for sex and mechanism of injury in addition to ISS and shock (beta estimate: -0.13 ± 0.06, p = 0.022).</p><p><strong>Conclusion: </strong>Traumatic brain injury is associated with lower LY30 independent of shock, tissue injury, sex, and mechanism of injury. These findings suggest a propensity toward a hypercoagulable state in patients with TBI, possibly due to fibrinolysis shutdown.</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":"8-12"},"PeriodicalIF":3.4,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39803986","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, shiftwork and suicide: 2022 Scott B. Frame Memorial Lecture.","authors":"Sharmila Dissanaike","doi":"10.1097/TA.0000000000003586","DOIUrl":"https://doi.org/10.1097/TA.0000000000003586","url":null,"abstract":"","PeriodicalId":501845,"journal":{"name":"The Journal of Trauma and Acute Care Surgery","volume":" ","pages":"e1-e4"},"PeriodicalIF":3.4,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39945786","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}