American Surgeon最新文献

{"title":"Prehospital versus Emergency Department Glasgow Coma Scale in Blunt Traumatic Brain Injury: A Retrospective Review of the National Trauma Data Bank.","authors":"Taylor E Messick-Ngo, Bhani K Chawla-Kondal, Gabriel L Scally, Brittany R Sadoma, Nicholas W Sheets, David S Plurad, Emily D Dubina","doi":"10.1177/00031348251359122","DOIUrl":"https://doi.org/10.1177/00031348251359122","url":null,"abstract":"<p><p>IntroductionPrevious studies have demonstrated variability between prehospital (PH) and Emergency Department (ED) Glasgow Coma Scale (GCS) for patients suffering traumatic brain injuries (TBIs). Understanding the relationship between PH and ED GCS, as well as the factors that may contribute to any observed differences, is crucial for optimizing trauma triage protocols and resource allocation.MethodsThe National Trauma Data Bank (NTDB) was surveyed for adults aged ≥18 years following blunt TBI. PH and ED GCS scores were compared, including subgroup analysis of different TBI severities, Injury Severity Score (ISS), transport time, trauma verification level, intoxication, ICP monitor use, and mortality.Results419 145 patients were included. Overall, there was no difference in median PH and ED GCS (15 vs 15, z = 0.00, <i>P =</i> 1.00), with substantial agreement (κ_w = 0.759, <i>P</i> < .001). For mild TBI, there was fair agreement between PH and ED GCS (κ_w = 0.409, <i>P</i> < .001); for moderate TBI, there was moderate agreement (κ_w = 0.569, <i>P</i> < .001); and for severe TBI, there was substantial agreement (κ_w = 0.665, <i>P</i> < .001). Alcohol and drug intoxication, mortality, need for ICP monitor, and transport times were associated with differences in PH vs ED GCS, while ISS was not.DiscussionPH and ED providers overall score patients similarly for GCS. While some minor differences were seen for certain subgroups (mild and severe TBI, mortality, alcohol or drug intoxication, transport times), these differences are likely not clinically significant.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251359122"},"PeriodicalIF":1.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590288","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}

{"title":"Increasing Utilization of Palliative Care is Associated With Reduced Health Care Costs in Operative Trauma: A National Analysis.","authors":"Syed Shaheer Ali, Amulya Vadlakonda, Konmal Ali, Troy Coaston, Saad Mallick, Nam Yong Cho, Esteban Aguayo, Peyman Benharash, On Behalf Of The Academic Trauma Research Consortium Atrium","doi":"10.1177/00031348251359119","DOIUrl":"https://doi.org/10.1177/00031348251359119","url":null,"abstract":"<p><p>IntroductionPalliative care (PC) has been shown to improve comfort for surgical patients nearing the end of life. Although single-institution studies suggest PC to be a cost-effective strategy, the contemporary national trends in costs and utilization of this modality remain unknown.MethodsAdult patients (≥18 years) who did not survive following hospitalization for surgical management of traumatic injury were tabulated in the 2016 to 2020 Nationwide Readmissions Database. Patients were stratified by receipt of PC. Entropy balancing on key covariates was used to ensure an equivalent comparison of groups. A multivariable linear regression model was constructed to assess the association between PC and hospitalization costs per day across quintiles of injury severity.ResultsOf an estimated 56 431 patients who did not survive hospitalization for traumatic injury, 43.7% received PC. Compared to others, those receiving PC were older (77 [64-87] vs 73 years [55-85], <i>P</i> < 0.001), insured by Medicare (65.3 vs 58.6%, <i>P</i> < 0.001), and had a higher Elixhauser Comorbidity Index (4 [3-6] vs 4 [2-6], <i>P</i> < 0.001). Following multivariable adjustment and entropy balancing, PC was associated with a decrement in daily costs (β, $1,300, 95% confidence interval -1500 to -1,000, <i>P</i> < 0.001). Such difference was greatest among those in the highest quintile of injury severity.ConclusionWe demonstrate a potential cost benefit to the utilization of PC for trauma patients nearing end of life. In the context of known benefits of PC to quality of life for acutely ill patients, our findings highlight the economic feasibility of integrating PC into trauma services.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251359119"},"PeriodicalIF":1.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574668","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}

{"title":"Disaggregation of Asian American Data Reveals Disparities in Pathologic Complete Response After Neoadjuvant Chemotherapy for Triple-Negative Breast Cancer.","authors":"Sarah W Yuen, Jenny Zhu, Kari J Kansal, Karen T Lane, Erin H Lin, Holly M Yong","doi":"10.1177/00031348251359118","DOIUrl":"https://doi.org/10.1177/00031348251359118","url":null,"abstract":"<p><p>IntroductionBreast cancer literature traditionally evaluated the Asian American Pacific Islander (AAPI) population in aggregate, masking its heterogeneity. This study evaluates the pathologic complete response (pCR) of disaggregated AAPI subgroups with triple-negative breast cancer (TNBC) to identify and address disparities within this population.MethodsThe 2018-2020 National Cancer Database identified women with TNBC who received neoadjuvant chemotherapy and surgical excision. pCR was compared amongst White, AAPI, and non-White non-Asian (NWNA) patients.ResultsOf 19,809 women, 71.6% were White, 4.1% were AAPI, and 24.3% were NWNA. Compared to White and NWNA, AAPI patients had the highest pCR (AAPI 43.0% vs White 39.5% vs NWNA 37.1%, <i>P</i> < 0.001). However, disaggregation revealed Koreans to have significantly lower pCR than all subgroups, including both White and NWNA patients, while Japanese and South Asians had the highest pCR of all subgroups. Notably, Koreans and Japanese patients had similar presentations of advanced disease, favorable demographics, and relatively short intervals to chemotherapy but demonstrated pCR rates on opposite extremes.ConclusionWhile AAPI patients with TNBC had a higher pCR than White and NWNA patients, disaggregation of AAPI subgroups reveals poorer pCR for specific subgroups than that of White and NWNA patients. While socioeconomic characteristics may partially explain these differences, the contrasting rates of pCR between Koreans and South Asians despite presenting with similar rates of advanced disease, demographics, and treatment characteristics highlight the contribution of tumor biology to treatment response and the importance of disaggregated data and targeted interventions to address disparities among unique ethnic subpopulations.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251359118"},"PeriodicalIF":1.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574667","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}

{"title":"Reattempting the Whipple: Surgical and Oncologic Outcomes After Failed Initial Resection.","authors":"Alfredo Verastegui, Alicia Amairan G Zamorano, Jared Mount, Carlos Chan, John A Stauffer","doi":"10.1177/00031348251358447","DOIUrl":"https://doi.org/10.1177/00031348251358447","url":null,"abstract":"<p><p>BackgroundPancreatoduodenectomy (PD) is the only curative treatment for pancreatic cancer. Neoadjuvant therapy (NAT) has enhanced survival, especially for downstaging advanced tumors, while also introducing complexities and new complications. Despite surgical advances, some PD attempts remain unsuccessful. The management of these cases is not well defined. This study analyzes outcomes of repeat PD performed by two high-volume surgeons following previously unsuccessful attempts.MethodsWe retrospectively analyzed patients with pancreatic neoplasm undergoing successful pancreaticoduodenectomy (2013-2024) at two high-volume centers under two experienced surgeons. Only cases with prior aborted PD attempts for non-metastatic disease were included. Data from institutional records provided outcomes on failure reasons, procedure timing, surgical details, and 90-day complications.ResultsOf the 858 PD cases, 18 patients (2.1%; 12 males, 6 females; median age 69 years) had prior unsuccessful PD attempts at other institutions. Initial tumors were borderline resectable (33.3%), resectable (22.2%), or locally advanced (22.2%). Main causes for initial failure were vascular involvement (41.2%) and tumor infiltration (17.6%). Median time between attempts was 246 days, with 77.8% receiving chemotherapy before the second attempt. The second procedure achieved R0 resection in 94.4% of cases. Major 90-day complications occurred in 23.5% of patients, with no perioperative mortality. Disease recurrence occurred in 38.9% within the first year.ConclusionRepeat PD after an aborted attempt is feasible in select patients at specialized centers. However, complication and recurrence rates emphasize the need for careful patient selection. Further research is needed to optimize management strategies.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251358447"},"PeriodicalIF":1.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574679","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}

{"title":"Does the 1:1:1 Transfusion Ratio Mortality Benefit Hold True in Ultra-massive Transfusion? A Study From the Product (Patient Related Outcomes During Ultra-massive transfusion multi-Center Trial) Consortium.","authors":"C H Meyer, Z Grady, R N Smith, T P Moran, M Rowh, A Zhang, M N Harfouche, P Greiffenstein, S Trinh, K Inaba, N Nekooei, D M Filiberto, C E Jones Sayyid, A Gutierrez, J Meizoso, W B Risinger, J W Smith, C L Jacovides, E D Trausch, A G McNickle, A Kumar, R L Choron, S W Ross, V C Sanderfer, J D Sciarretta, J H Nguyen","doi":"10.1177/00031348251358431","DOIUrl":"https://doi.org/10.1177/00031348251358431","url":null,"abstract":"<p><p>ObjectiveThe gold standard for resuscitation in traumatic hemorrhagic shock is 1:1:1 transfusion (FFP:PLT:RBC). However, this practice guideline was established based on patients who received low-volume blood transfusions. Therefore, this study sought to investigate the relationship of transfusion ratios on mortality in trauma patients undergoing ultra-massive transfusion (UMT) (≥20 units of red blood cell product/24 hours).MethodsA multicenter retrospective review of patients receiving UMT was conducted across 11 level I trauma centers from 2016 to 2024. Patients were analyzed based on the following categories: FFP:RBC or Platelet:RBC <1:2 (low), 1:2-1:1 (moderate), and ≥1:1 (high). The primary outcome of interest was mortality.ResultsAcross the centers, 1155 patients received UMT with an overall mortality rate of 62.9%. They were predominantly males (81.6%) with a median age of 32 years (IQR 25-48). The majority (72.4%) received moderate FFP:RBC transfusion ratios and either low (44.8%) or moderate (42.6%) Platelet:RBC ratios. As Platelet:RBC ratio trended higher, the mortality rate decreased with a 24-hour mortality of 70.8% in the low group, 59.1% in the moderate, and 47.6% in the high. Transfusion ratio of Platelet:RBC was an independent risk factor for mortality, with OR 0.54 in the moderate group (<i>P</i> < 0.001) and OR 0.39 in the higher group (<i>P</i> < 0.001).ConclusionOur analysis utilizes one of the largest, multicenter cohorts of UMT patients and found a statistically significant decrease in mortality with more balanced Platelet:RBC transfusion ratios. These findings suggest that perhaps earlier and more aggressive transfusion of platelets may confer a survival benefit for trauma patients undergoing UMT.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251358431"},"PeriodicalIF":1.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564303","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}

{"title":"Great Debates-Two Hands Versus Four: Open Abdominal Wall Reconstruction (AWR) Versus Robotic-Assisted AWR.","authors":"Kyuseok Im, Nicole Hanson, Anthony Carden, Louise Yeung","doi":"10.1177/00031348251355932","DOIUrl":"https://doi.org/10.1177/00031348251355932","url":null,"abstract":"<p><p>Abdominal wall reconstruction (AWR) represents a heterogeneous spectrum of operations, ranging from simple ventral hernia repairs to more complex hernia with loss of abdominal wall domain. Historically, AWR has been performed via the open approach, and eventually it was also performed via minimally invasive approaches with advancements in laparoscopic surgery. Compared to open AWR, laparoscopic AWR provided advantages of being less invasive, shorter hospital stays, and improved patient outcomes. With the emergence of robotic surgery, AWR has been increasingly performed via robotic approach, given that it provides all the advantages of laparoscopic AWR as well as better precision and superior surgeon ergonomics. However, robotic AWR can often be expensive, especially with high acquisition costs and longer operative times. Furthermore, data on long-term outcomes after robotic AWR do not yet clearly demonstrate its benefits. While open AWR remains the classic and widely available approach, robotic AWR is a promising approach with significant potential benefits. Ultimately, the best approach to AWR depends on thoughtful patient selection, access, and surgeons' technical capabilities and familiarity.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251355932"},"PeriodicalIF":1.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144551702","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}

{"title":"Differences in Care Practices and Outcomes for Adolescents With Severe TBI: Adult vs Pediatric Trauma Centers.","authors":"Kevin J Lang, Dina M Filiberto, Rachel M Landisch, Regan F Williams, Saskya E Byerly","doi":"10.1177/00031348251358438","DOIUrl":"https://doi.org/10.1177/00031348251358438","url":null,"abstract":"<p><p><b>Background:</b> Adolescent trauma patients (ATPs) with traumatic brain injury (TBI) are a population with challenges to standardizing treatment practices and optimizing outcomes. Adult trauma centers (ATCs) and pediatric trauma centers (PTCs) may have different care practices and outcomes for ATPs with severe TBI. <b>Methods:</b> A retrospective analysis was performed querying the 2020-2022 Trauma Quality Improvement Program database, observing treatments and outcomes for ATPs aged 10-19 years old with head Abbreviated Injury Scale (AIS) 3-5 and TBI diagnosis. Multivariable logistic regression (MLR) was performed for tracheostomy, neurosurgical interventions, and mortality. <b>Results:</b> 28,527 ATPs were included in the study. 3,744 (13%) and 24,783 (87%) were treated at PTCs and ATCs, respectively. Most patients (73%) were male and had a blunt mechanism (89%). Patients at ATCs had lower Glasgow Coma Scale scores (p<.0001), higher head AIS scores (p<.0001), and higher mortality (10% vs 6%, p<.0001). Pediatric trauma centers utilized less venous thromboembolism (VTE) prophylaxis (32% vs 15%, p<.0001), which was evident across all ages 10-19, and had fewer VTE events (p=.001). Adult trauma centers were more likely to perform intracranial pressure monitoring, tracheostomy, long-term enteral access device (LTEAD), and craniotomy (all p<0.0001). Adult trauma centers had shorter median times to tracheostomy and LTEAD. Multivariable logistic regression for tracheostomy and neurosurgical interventions were associated with ATCs, after controlling for severity of TBI and other covariates. Both tracheostomy and neurosurgical interventions were less likely in the uninsured (p<.0001). <b>Discussion:</b> Care for ATPs with severe TBI varies between ATCs and PTCs. Pathways are needed to optimize outcomes for all ATPs with TBI.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251358438"},"PeriodicalIF":1.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144551701","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}

{"title":"A Nomenclature for Surgical Knots and the Principles of Knot Security.","authors":"Thomas J O'Keefe, Bard C Cosman, Louis A Perkins, Isabella Guajardo, Laura M Adams, William D Ardill, Bruce M Potenza","doi":"10.1177/00031348251358436","DOIUrl":"https://doi.org/10.1177/00031348251358436","url":null,"abstract":"<p><p>A rise in knot-related complications in the 1970s due to the growing number of synthetic sutures available to surgeons led to the experimental study of the security of tied surgical knots. Great progress in the understanding of the effect of knot configuration on knot security has been made since that time, but the findings have had uneven penetration both among and within the various surgical specialties. The emergence of multiple different knot-tying lexicons as well as inconsistencies between the verbal descriptions and illustrations of some of these lexicons presents a challenge to surgeons interested in learning about the subject. This has contributed to the lack of dissemination of knowledge on sliding knots, which in turn almost certainly contributes to the many complications reported in the literature related to knot slippage that can be as devastating as patient mortality. Disentangling the divergent nomenclatures and understanding the reasons for their emergence allow for the critical appraisal of the existing landscape of knot-tying literature.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251358436"},"PeriodicalIF":1.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144558843","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}

{"title":"Assessing Socioeconomic Disparities in Outcomes: A Retrospective Analysis of Hartmann's Procedure vs PADLI Using the National Inpatient Sample.","authors":"Christopher Diaz, Amanda Zhao, Kevin Zhang, Aziz M Merchant","doi":"10.1177/00031348251354845","DOIUrl":"https://doi.org/10.1177/00031348251354845","url":null,"abstract":"<p><p>BackgroundDiverticular disease affects over half of individuals over 60, with 25% developing diverticulitis. While Hartmann's procedure has traditionally been the standard for unstable patients, resection with primary anastomosis and diverting loop ileostomy (PADLI) is associated with higher stoma reversal rates and improved long-term outcomes. Despite evidence supporting PADLI, socioeconomic factors may influence procedural selection, contributing to persistent disparities in care.MethodsA retrospective cohort study was conducted using the 2015-2021 National Inpatient Sample (NIS) to identify patients undergoing emergent surgery for acute diverticulitis. Patients who received left colectomy or sigmoidectomy were classified by procedure type (Hartmann's vs PADLI) using ICD-10 codes. Demographic and socioeconomic factors were analyzed including age, sex, race, insurance type, income quartile, in-hospital mortality, length of stay, discharge disposition, and urban vs rural residency. The impact of these factors on procedure choice was assessed using multivariate logistic regression.ResultsAmong 14 551 patients, 85.5% underwent Hartmann's procedure and 14.5% received PADLI. Older age (OR 1.014/year, <i>P</i> < 0.001), female sex (OR 1.129, <i>P</i> = 0.011), white race (OR 1.128, <i>P</i> = 0.041), and lower income (OR 1.223, <i>P</i> < 0.001) were associated with higher odds of receiving Hartmann's procedure. Private insurance reduced this likelihood (OR 0.747, <i>P</i> < 0.001). Primary anastomosis and diverting loop ileostomy was more common in metropolitan areas, younger patients, those with private insurance, and those discharged routinely.DiscussionSocioeconomic disparities significantly influence surgical management of acute diverticulitis. Lower-income and publicly insured patients are more likely to undergo Hartmann's procedure, while PADLI is more common in wealthier, urban populations. Addressing these disparities could promote more equitable care and improve patient outcomes.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251354845"},"PeriodicalIF":1.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144551699","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}

{"title":"Combined Qualitative Assessment of Admission Shock Index, Base Deficit, and Lactate to Enhance Mortality Predication After Blunt Trauma.","authors":"Sultan S Abdelhamid, Candace L Ward, Threshia Malcolm, Karla Luketic, Moshumi Godbole, Samantha N Olafson, Amit Joshi, Mark J Kaplan, Alexi Bloom, Benjamin J Moran, Afshin Parsikia, Pak S Leung","doi":"10.1177/00031348251358430","DOIUrl":"https://doi.org/10.1177/00031348251358430","url":null,"abstract":"<p><p>IntroductionThe role of elevated shock index is increasingly recognized as a vital indicator in the assessment of mortality rates in trauma patients. Its role in combination with other parameters is crucial yet underexplored in predicting outcomes. We hypothesized that qualitative assessment of elevated admission shock index, elevated base deficit/excess, and elevated lactate in combination would best predict mortality after blunt trauma.MethodsThis study was a retrospective review of trauma registry data on blunt trauma patients from 2012 to 2021 at a level 1 trauma center to evaluate the impact of <b>elevated SI</b> (>0.7), <b>elevated lactate</b> 2 mmol/L to 5 mmol/L, and <b>elevated base deficit</b> ≤-2 mmol/L at admission on predicting mortality. We used these parameters as qualitative and categorical predictors rather than continuous measures. A multivariate logistic regression model was developed, with shock index severity stratification and mortality as primary outcomes.ResultsA total of 4794 patients (151 non-survivors) were included in the analysis. Non-survivors had higher rates of elevated SI + elevated lactate + elevated BD (13.9% vs 5.8%, <i>P</i> < 0.001) with highest overall OR (11.7, <i>P</i> < 0.001) compared to other parameters (age 5.5, severe ISS 9.5, and GCS <8 10.3). When stratified by severity, patients with moderate SI (1.0 < SI <1.4) had a significantly increased risk of mortality in combination with elevated lactate and elevated base deficit (OR 21.1, <i>P</i> < 0.001).ConclusionWe previously reported a qualitative model predicting blunt trauma mortality rates using elevated lactate and elevated base deficit. Combining admission SI, whether mild and moderate, with elevated lactate and elevated base deficit as qualitative \"elevated\" biomarkers yielded a more robust predictive model and highest OR for predicting mortality in blunt trauma non-survivors, with an 11.7-fold increase compared to survivors. This was higher than the individual parameters or other combinations.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251358430"},"PeriodicalIF":1.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144551700","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}