American Surgeon最新文献

Transcatheter Aortic Valve Replacement in Patients With Geographic and Socioeconomic Vulnerabilities. 地理和社会经济弱势患者的经导管主动脉瓣置换术。

IF 1 4区医学

American Surgeon Pub Date : 2025-08-01 Epub Date: 2024-11-12 DOI: 10.1177/00031348241300364

Jacob M Tupa, Hunter T Row, Greta C Schwartz, Ashley L Matter, Elena J Danielson, Abe E Sahmoun, Thomas A Haldis, Cornelius M Dyke

{"title":"Transcatheter Aortic Valve Replacement in Patients With Geographic and Socioeconomic Vulnerabilities.","authors":"Jacob M Tupa, Hunter T Row, Greta C Schwartz, Ashley L Matter, Elena J Danielson, Abe E Sahmoun, Thomas A Haldis, Cornelius M Dyke","doi":"10.1177/00031348241300364","DOIUrl":"10.1177/00031348241300364","url":null,"abstract":"BackgroundTranscatheter aortic valve replacement (TAVR) is an established treatment for patients with severe aortic stenosis (AS). It remains unclear whether disparities exist in rural or socially vulnerable populations undergoing TAVR. This study assessed whether outcomes differ based on geographic location or vulnerability of patients undergoing TAVR.MethodsPatients undergoing TAVR at a single institution from August 2012 to June 2023 were studied (n = 1565). Zip codes determined Social Vulnerability Index (SVI) and measured distance to our facility. Outcomes defined by the Valve Academic Research Consortium 3 (VARC-3) included stroke, transient ischemic attack (TIA)/delirium, pacemaker implantation, new atrial fibrillation/atrial flutter, and myocardial infarction (MI). Average time between preoperative coronary angiogram (CATH)/computed tomography angiography (CTA) and TAVR was calculated. Kaplan-Meier curves estimated survival probability.ResultsThe average time between CATH and TAVR in patients living furthest away was ∼9 days more than patients living closest to the implant site. The average number of days between CATH and TAVR for low and high SVI were 71 and 78 days, respectively. The average number of days between CTA and TAVR for low and high SVI were 40 and 39 days, respectively.DiscussionFurther distances traveled were associated with longer wait times between preoperative workup and TAVR. Patients with longer waits between CATH and TAVR had no differences in medium-term survival probability but had decreased long-term survival probability compared to patients with rapid pre-procedural evaluation. Although geographic and socioeconomic vulnerability can disadvantage patients, our study demonstrates that patients undergoing TAVR can have timely care and similar outcomes.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1276-1284"},"PeriodicalIF":1.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Ileocecectomy as an Acceptable Alternative to Right Hemicolectomy in Trauma: A Propensity Score Matched TQIP Analysis. 回肠切除术作为创伤中右半结肠切除术的可接受选择：倾向评分匹配TQIP分析。

IF 1 4区医学

American Surgeon Pub Date : 2025-08-01 Epub Date: 2025-03-01 DOI: 10.1177/00031348251323699

Devanshi D Patel, Andrew M Fleming, Andrew J Kerwin, Cory Evans, Emily K Lenart, Dina M Filiberto, Saskya Byerly

{"title":"Ileocecectomy as an Acceptable Alternative to Right Hemicolectomy in Trauma: A Propensity Score Matched TQIP Analysis.","authors":"Devanshi D Patel, Andrew M Fleming, Andrew J Kerwin, Cory Evans, Emily K Lenart, Dina M Filiberto, Saskya Byerly","doi":"10.1177/00031348251323699","DOIUrl":"10.1177/00031348251323699","url":null,"abstract":"BackgroundIleocecectomy (IC) as an alternative to right hemicolectomy (RH) for traumatic indication is controversial with limited comparison data. We sought to compare IC vs RH for traumatic injury and hypothesized there was no difference in outcomes.MethodsThe Trauma Quality Improvement Program database was queried from 2017 to 2022 with IC and RH patients evaluated using propensity score matching (PSM) in a 1:3 ratio. Presenting factors and outcomes were analyzed.ResultsAfter PSM, 558 RH and 186 IC patients had no difference in age, penetrating mechanism, time to OR and injury severity score. RH patients were more likely to have unplanned ICU admission (8.6% vs 3.8%, P = 0.03) and organ space infection (7.5% vs 3.2%, P = 0.04) but similar rates of acute kidney injury (P = 0.5), unplanned OR (P > 0.9) and mortality (P = 0.08) compared to IC patients.ConclusionsTraumatic colon injury managed by ileocecectomy had similar outcomes compared to right hemicolectomy and should be considered an acceptable alternative when anatomically feasible.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1310-1315"},"PeriodicalIF":1.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Surgeon-Performed Peripheral Nerve Blocks for the Identification of Thoracic Outlet Syndrome. 外科手术周围神经阻滞用于胸廓出口综合征的识别。

IF 1 4区医学

American Surgeon Pub Date : 2025-08-01 Epub Date: 2025-05-17 DOI: 10.1177/00031348251341949

Josiah T Hardy, Anahita Shiva, Khanjan Nagarsheth

引用次数: 0

Nebulized Heparin and N-Acetylcysteine do Not Improve Outcomes of Intubated Burn Patients With Grade II or III Inhalation Injuries. 雾化肝素和n -乙酰半胱氨酸不能改善II级或III级吸入性损伤插管烧伤患者的预后。

IF 1 4区医学

American Surgeon Pub Date : 2025-08-01 Epub Date: 2025-05-10 DOI: 10.1177/00031348251337148

William B Risinger, Victoria R Hammond, Chinweotuto V Uma, Brittany L Sims, David D Keeven, Crystal N Dye, Glen A Franklin, Jason W Smith, Keith R Miller, Matthew V Benns, Nicholas A Nash, Samuel J Pera, George R Marshall, Jamie C Coleman, Brian G Harbrecht, Matthew C Bozeman

{"title":"Nebulized Heparin and N-Acetylcysteine do Not Improve Outcomes of Intubated Burn Patients With Grade II or III Inhalation Injuries.","authors":"William B Risinger, Victoria R Hammond, Chinweotuto V Uma, Brittany L Sims, David D Keeven, Crystal N Dye, Glen A Franklin, Jason W Smith, Keith R Miller, Matthew V Benns, Nicholas A Nash, Samuel J Pera, George R Marshall, Jamie C Coleman, Brian G Harbrecht, Matthew C Bozeman","doi":"10.1177/00031348251337148","DOIUrl":"10.1177/00031348251337148","url":null,"abstract":"Inhalation injuries heighten the morbidity and mortality associated with burn injury. Nebulized heparin and N-acetylcysteine have been proposed as adjunctive treatments for severe inhalation injury. In this study, a total of 100 inhalation injuries were identified over a 4-year period, with 40 patients suffering grade II-III inhalation injuries confirmed via fiberoptic bronchoscopy. 47.5% of patients received the inhalation protocol of nebulized heparin, N-acetylcysteine, and albuterol. Patient demographics and inhalation injury grade were similar between the groups (2 vs 2, P = .20). The utilization of the inhalation protocol did not shorten the number of ventilator days (5 vs 6, P = .76) or show survival benefit (57.9 vs 52.4%, P = .73). An inhalational protocol did not improve outcomes in burn patients suffering abbreviated injury score (AIS) grade II-III inhalation injuries at our institution. Moving forward, large, multicenter, randomized control trials are needed to determine the true efficacy of nebulized heparin and N-acetylcysteine for AIS grade II-III injuries.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1392-1395"},"PeriodicalIF":1.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A 20-Year Analysis of Risk Factors for Complicated Postoperative Course Following Laparoscopic Cholecystectomy. 腹腔镜胆囊切除术后并发症的20年危险因素分析。

IF 1 4区医学

American Surgeon Pub Date : 2025-08-01 Epub Date: 2025-06-21 DOI: 10.1177/00031348251351000

Ahmad Zeineddin, Jeduthun Harris, Mariana Olivencia-Delgado, Juan Carmona-Tamayo, Terrence M Fullum, Edward E Cornwell, Mallory Williams

{"title":"A 20-Year Analysis of Risk Factors for Complicated Postoperative Course Following Laparoscopic Cholecystectomy.","authors":"Ahmad Zeineddin, Jeduthun Harris, Mariana Olivencia-Delgado, Juan Carmona-Tamayo, Terrence M Fullum, Edward E Cornwell, Mallory Williams","doi":"10.1177/00031348251351000","DOIUrl":"10.1177/00031348251351000","url":null,"abstract":"BackgroundCholecystectomy is the most common surgical intervention performed in the United States with over 300,000 annual cases. We aim to describe risk factors for complications and prolonged stay after cholecystectomy in a 20-year analysis of a national database.MethodsThe Nationwide Inpatient Sample (NIS) was queried for years 2000-2019 for patients who underwent cholecystectomy within 7 days of admission. Complicated stay was defined as postoperative stay longer than 3 days or an ICU admission. Outcomes were postoperative complications, hospital length of stay, hospital charges, and mortality.ResultsThere were 901,205 patients who underwent laparoscopic cholecystectomy. Mean age was 50 ± 19 years, 68% were female. Complicated stay was identified in 13% of patients. These patients were older (61 ± 19 vs 49 ± 19), more likely to be male (47% vs 32%), and to have Medicare insurance (51% vs 26%). Acute presentation as indication for surgery (acute cholecystitis, choledocholithiasis, and pancreatitis) were more common in complicated stays compared to chronic cholecystitis or cholelithiasis only. They were more likely to undergo subtotal cholecystectomy (1.2% vs 0.54%) or conversion to open surgery (0.98% vs 0.08%), to suffer common bile duct injury (0.54% vs 0.04%), and have higher mortality (2.4% vs 0.06%). On multivariate regression, the strongest predictors for complicated stay were CBDI (OR 12.9), conversion to open (OR 11.4), and subtotal cholecystectomy (OR 1.8).ConclusionOpen or subtotal cholecystectomy, older age, pancreatitis, and delayed operation from admission were associated with complicated course. This data highlights careful preoperative risk stratification and early operative intervention to reduce complications.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1258-1262"},"PeriodicalIF":1.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144339838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Congenital Peritoneal Encapsulation: A Review. 先天性腹膜包封：综述。

IF 1 4区医学

American Surgeon Pub Date : 2025-08-01 Epub Date: 2025-05-09 DOI: 10.1177/00031348251342076

Alison M Schultz, Paul E Creger, Trey J Mathews, Christian T Minshall, Kristine A Lombardozzi

{"title":"Congenital Peritoneal Encapsulation: A Review.","authors":"Alison M Schultz, Paul E Creger, Trey J Mathews, Christian T Minshall, Kristine A Lombardozzi","doi":"10.1177/00031348251342076","DOIUrl":"10.1177/00031348251342076","url":null,"abstract":"Congenital peritoneal encapsulation (CPE), a rare developmental anomaly in which the small intestines are enclosed within an accessory peritoneal sac, is an uncommon but important cause of abdominal pain and small bowel obstruction. With fewer than 60 reported cases, the demographics, imaging findings, and symptoms of CPE remain elusive, as most cases are diagnosed intraoperatively during treatment for bowel obstruction. We report a case of a 34-year-old male with no significant medical history who presented with acute abdominal pain and nausea. He was hemodynamically stable and afebrile, and CT imaging indicated a possible small bowel obstruction. Surgical intervention was required when his condition worsened, with large-volume emesis following oral contrast administration during a small bowel follow-through study. Explorative laparotomy revealed a peritoneal encapsulation of the entire small bowel as the cause of obstruction. Complete removal of the membrane was performed, and histopathology confirmed findings consistent with an intraperitoneal sac with reactive changes, supporting the diagnosis of CPE. This review highlights the challenges in diagnosing CPE due to its lack of associated comorbidities, minimal symptoms, and nonspecific imaging findings. A detailed discussion of 21 recent cases of CPE emphasizes patient demographics, presentation history, imaging, physical exam, intraoperative findings, and surgical management. This modern analysis underscores the importance of considering CPE in the differential diagnosis for unexplained abdominal pain or bowel obstruction, particularly when conventional diagnostic methods fail to identify a cause.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1378-1387"},"PeriodicalIF":1.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143954317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Mesenteric Ischemia: Predicting Problems. 肠系膜缺血：预测问题。

IF 1 4区医学

American Surgeon Pub Date : 2025-08-01 Epub Date: 2025-03-23 DOI: 10.1177/00031348251329475

Bonnie E Holley, Laura A Peterson, Barbara A Bennie, Isaiah I Fitzmaurice, Benjamin T Jarman

{"title":"Mesenteric Ischemia: Predicting Problems.","authors":"Bonnie E Holley, Laura A Peterson, Barbara A Bennie, Isaiah I Fitzmaurice, Benjamin T Jarman","doi":"10.1177/00031348251329475","DOIUrl":"10.1177/00031348251329475","url":null,"abstract":"BackgroundMesenteric ischemia is an uncommon diagnosis that is often overlooked until patients present with non-salvageable bowel. Our objective was to identify risk factors for mesenteric ischemia, clinical warning signs, and imaging findings that could suggest earlier diagnosis and intervention.MethodsWe queried our health system's electronic health record (EHR) to identify patients with ischemic bowel and/or a diagnosis of mesenteric ischemia between November 2013 and December 2020. Using stringent exclusion criteria, we included patients whose event was likely caused by atherosclerotic disease. From the EHR, we abstracted these patients' comorbidities and symptoms from the previous 6 months. We evaluated relevant computed tomography scans (CTs) obtained up to 2 years prior to admission and graded stenosis of the celiac artery and the superior mesenteric artery (SMA).ResultsForty-five patients met inclusion criteria. The most prevalent comorbidities were hypertension, hyperlipidemia, and heart disease. Over half of the patients in the cohort had mentioned suspicious abdominal symptoms during the 6 months preceding admission. Of the patients who had a CT within the 2 years prior to admission, there was discordance between the formal interpretations and independent reviews with significant stenosis being noted more commonly on independent review. Furthermore, in-hospital mortality was significantly higher when pre-presentation imaging noted SMA stenosis >70%.DiscussionThese data suggest that patients who were at risk of developing mesenteric ischemia had underlying vascular disease, a history of concerning symptoms, and prior CT imaging consistent with mesenteric atherosclerotic disease which could potentially be acted upon before the manifestation of an acute event.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1292-1297"},"PeriodicalIF":1.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Effectiveness of a Dedicated Rural General Surgery Residency Track: A 13-Year Analysis of the First ACGME Designated Rural Track. 专门的农村普外科住院医师轨道的有效性：第一个ACGME指定的农村轨道的13年分析。

IF 1 4区医学

American Surgeon Pub Date : 2025-08-01 Epub Date: 2025-01-08 DOI: 10.1177/00031348251313992

Jude C Barber, David R Velez, Stefan W Johnson, Robert P Sticca

{"title":"Effectiveness of a Dedicated Rural General Surgery Residency Track: A 13-Year Analysis of the First ACGME Designated Rural Track.","authors":"Jude C Barber, David R Velez, Stefan W Johnson, Robert P Sticca","doi":"10.1177/00031348251313992","DOIUrl":"10.1177/00031348251313992","url":null,"abstract":"BackgroundThe shortage of general surgeons in rural America is well documented. The North Dakota community-based general surgery residency program initiated a unique approach to training for rural practice through a dedicated rural track. The rural track included 9 months of rotations in specialty rotations beneficial for rural practice. This study analyzed practice patterns and satisfaction of residents completing rural track training.MethodsAn anonymous voluntary survey was sent to rural track graduates between 2010 and 2022 via the Qualtrics Web site.Data Collection IncludedSpecialty rotations completed, specialty procedures currently performing, satisfaction with rural track training, and recommended specialty rotations for future rural track graduates.ResultsTwelve of fifteen graduates (80%) responded. Eighty-three percent of respondents chose the rural track because they desired practice in rural areas and/or desired broad-spectrum surgical practice. One hundred percent of the graduates were satisfied with their training. Seventy-five percent of the graduates came from a rural background, and 75% either previously practiced or currently practice in a rural community. Procedural data demonstrated that 67% of the graduates performed endoscopy procedures, 42% performed hand procedures, and 47% performed C-sections. Rural track graduates desired more experience in urology (50%), ENT, OBGYN, and advanced endoscopy (33%). Experience in plastic surgery, GI, hand surgery, dermatology, and IR was cited as beneficial.ConclusionThe rural track graduates found significant value in their rural track training that benefited them in practice. Three quarters of the graduates entered rural surgery practice, performing a broad spectrum of procedures.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1298-1302"},"PeriodicalIF":1.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

National Prevalence and Associated Outcomes of Substance Use in Scooter-Related Trauma. 滑板车相关创伤中物质使用的全国患病率和相关结果。

IF 1 4区医学

American Surgeon Pub Date : 2025-08-01 Epub Date: 2025-04-18 DOI: 10.1177/00031348251337140

Hannah Benharash, Nam Yong Cho, Troy Coaston, Sara Sakowitz, Saad Mallick, Giselle Porter, Areti Tillou

{"title":"National Prevalence and Associated Outcomes of Substance Use in Scooter-Related Trauma.","authors":"Hannah Benharash, Nam Yong Cho, Troy Coaston, Sara Sakowitz, Saad Mallick, Giselle Porter, Areti Tillou","doi":"10.1177/00031348251337140","DOIUrl":"10.1177/00031348251337140","url":null,"abstract":"IntroductionElectric scooters have rapidly gained popularity as a sustainable mode of transportation, but this rise has coincided with an increase in scooter-related injuries (SRI) and associated health care costs. Despite growing evidence of adverse outcomes, the role of substance use (SU) in SRI remains underexplored.MethodsThis was a retrospective cohort study utilizing the 2016-2021 National Inpatient Sample. Patients aged 18-64 for SRI were identified and stratified by age groups: 18-25, 26-40, and 41-64 years. SU consisted of alcohol, opioid, marijuana and cocaine use. The primary outcome of the study was temporal trends in SU among patients hospitalized with SRI. In-hospital mortality, traumatic brain injury (TBI), length of stay (LOS), hospitalization costs and non-home discharge rates were secondarily assessed. Multivariable regression models were developed to evaluate the association between SU and outcomes of interest.ResultOf 7350 patients admitted for SRI, 24.8% had SU. SRI hospitalizations increased from 330 cases in 2016 to 2705 in 2021 (P < 0.001). SU patients had higher odds of TBI (AOR 1.91, 95% CI 1.26-2.91) and perioperative complications (AOR 1.98, 95% CI 1.07-3.67) but similar mortality rates and LOS compared to non-SU patients. SU was associated with increased hospitalization costs by $4600 (95% CI $300-$8800).ConclusionOur findings showed a rising prevalence of SU among SRI patients as well as an increased risk of TBI and resource utilization. Public health strategies, including helmet mandates, substance use prevention, and infrastructure improvements, are critical to mitigating these risks and alleviating the burden on the trauma care system.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1331-1335"},"PeriodicalIF":1.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

CT vs MRI C-Spine Imaging for C-Spine Clearance in Obtunded Patients in Low-Energy Trauma Mechanisms. CT与MRI c -脊柱成像对低能损伤机制下钝化患者c -脊柱清除的影响。

IF 1 4区医学

American Surgeon Pub Date : 2025-08-01 Epub Date: 2025-04-18 DOI: 10.1177/00031348251337146

Robert Rakosi, Jera Davis, Jordan Miller, Henry Krasner, Kavita Batra, Sukanta Maitra, Douglas R Fraser, Allison G McNickle

{"title":"CT vs MRI C-Spine Imaging for C-Spine Clearance in Obtunded Patients in Low-Energy Trauma Mechanisms.","authors":"Robert Rakosi, Jera Davis, Jordan Miller, Henry Krasner, Kavita Batra, Sukanta Maitra, Douglas R Fraser, Allison G McNickle","doi":"10.1177/00031348251337146","DOIUrl":"10.1177/00031348251337146","url":null,"abstract":"BackgroundCurrent guidelines from trauma societies recommend cervical spine (c-spine) clearance for obtunded blunt trauma patients after negative CT c-spine (CS-CT). However, the value of additional c-spine MRI (CS-MRI) in patients with low-energy trauma mechanisms is unclear and controversial. This study hypothesizes that obtunded blunt low-energy mechanism trauma patients would not have c-spine injuries requiring surgery on CS-MRI after negative CS-CT.MethodsA retrospective review was conducted at a level 1 trauma center, analyzing adults with low-energy blunt trauma from 2018-2022. Inclusion criteria encompassed individuals over 18 years old admitted to the ICU following assault/fall 10 feet or less requiring intubation for 24+ hours. Exclusion criteria included patients with high-energy trauma or intubated later in their admission/less than 24 hours. Primary outcomes were c-spine injuries identified on MRI following negative CS-CT and percentage of patients requiring surgery. Statistical significance was set at 5%.ResultsOf 1462 charts, 300 patients met inclusion criteria. Of these 300 patients, 194 underwent only CS-CT (64.7%), while 106 underwent both CT and MRI (35.3%). Among the 82 patients with negative CS-CT who received CS-MRI, only 1 (1.2%) was found to have an unstable c-spine injury. Patients who underwent CS-MRI had increased ICU length of stay (7.52 vs 11.87 days) and ventilator days (6.12 vs 9.43 days) compared CS-CT alone.DiscussionThe findings suggest that negative CS-CT is typically sufficient for clearance in low-energy trauma patients. Additional CS-MRI may increase health care resource use without revealing significant injuries, supporting streamlined c-spine clearance protocols based on trauma mechanism.","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"1341-1347"},"PeriodicalIF":1.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0