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Impact of helmet laws on motorcycle crash mortality rates
This study assesses the impact of helmet laws on the motorcycle (MC) fatality rate in the United States from 1999 to 2015. METHODS Fatality Analysis Reporting System MC fatalities (aged ≥16 years), crash characteristics, and MC-related laws were collected by year for all 50 states from 1999 to 2015 to create a pooled time series. Generalized linear autoregressive modeling was applied to assess the relative contribution of helmet laws to the MC fatality rate while controlling for other major driver laws and crash characteristics. RESULTS Universal helmet laws were associated with a 36% to 45% decline in the motorcyc...
Source: Journal of Trauma and Acute Care Surgery - October 27, 2020 Category: Surgery Tags: WTA PODIUM - 2020 Source Type: research

How repetitive traumatic injury alters long-term brain function
CONCLUSION Recurrent traumatic brain injury causes significant long-term alteration in brain health leading to permanent motor deficits, cortical and corpus callosum thinning, and expansion of the lateral ventricles. Gene expression and BDNF analysis suggest a significant drop in pathways associated with neuroplasticity and neuroprotection. Although rTBI may not cause immediate neurological abnormalities, continued brain deterioration occurs after the initial trauma in part due to a decline in genes associated with neuroplasticity and neuroprotection. (Source: Journal of Trauma and Acute Care Surgery)
Source: Journal of Trauma and Acute Care Surgery - October 27, 2020 Category: Surgery Tags: WTA PODIUM - 2020 Source Type: research

Spirometry not pain level predicts outcomes in geriatric patients with isolated rib fractures
BACKGROUND Geriatric patients with rib fractures are at risk for developing complications and are often admitted to a higher level of care (intensive care units [ICUs]) based on existing guidelines. Forced vital capacity (FVC) has been shown to correlate with outcomes in patients with rib fractures. Complete spirometry may quantify pulmonary capacity, predict outcome, and potentially assist with admission triage decisions. METHODS We prospectively enrolled 86 patients, 60 years or older with three or more isolated rib fractures presenting after injury. After informed consent, patients were assessed with respect to pai...
Source: Journal of Trauma and Acute Care Surgery - October 27, 2020 Category: Surgery Tags: WTA PODIUM - 2020 Source Type: research

The Center for Trauma Survivorship: Addressing the great unmet need for posttrauma center care
BACKGROUND Returning patients to preinjury status is the goal of a trauma system. Trauma centers (TCs) provide inpatient care, but postdischarge treatment is fragmented with clinic follow-up rates of (Source: Journal of Trauma and Acute Care Surgery)
Source: Journal of Trauma and Acute Care Surgery - October 27, 2020 Category: Surgery Tags: WTA PODIUM - 2020 Source Type: research

Histone deacetylase 6 inhibition improves survival in a swine model of lethal hemorrhage, polytrauma, and bacteremia
CONCLUSION A single dose of ACY-1083 markedly improves survival in an otherwise lethal model of polytrauma, hemorrhagic shock, and bacteremia. (Source: Journal of Trauma and Acute Care Surgery)
Source: Journal of Trauma and Acute Care Surgery - October 27, 2020 Category: Surgery Tags: WTA PODIUM - 2020 Source Type: research

A rat model of orthopedic injury-induced hypercoagulability and fibrinolytic shutdown
BACKGROUND Postinjury hypercoagulability occurs in>25% of injured patients, increasing risk of thromboembolic complications despite chemoprophylaxis. However, few clinically relevant animal models of posttraumatic hypercoagulability exist. We aimed to evaluate a rodent model of bilateral hindlimb injury as a preclinical model of postinjury hypercoagulability. METHODS Forty Wistar rats were anesthetized with isoflurane: 20 underwent bilateral hindlimb fibula fracture, soft tissue and muscular crush injury, and bone homogenate injection intended to mimic the physiological severity of bilateral femur fracture. Twenty sha...
Source: Journal of Trauma and Acute Care Surgery - October 27, 2020 Category: Surgery Tags: WTA PODIUM - 2020 Source Type: research

Are all trauma centers created equal? Level 1 to level 1 trauma center patient transfers in the setting of rapid trauma center proliferation
CONCLUSION The number of level 1 to level 1 transfers observed imply a disparity in resources and capability among level 1 trauma centers in the region. The majority of transfers were for neurosurgical care, suggestive of a deficit of adequate neurosurgical coverage in the setting of trauma center proliferation. Both patients and established trauma centers bear the burden for these transfers with respect to increased cost and length of stay. LEVEL OF EVIDENCE Care management, level IV. (Source: Journal of Trauma and Acute Care Surgery)
Source: Journal of Trauma and Acute Care Surgery - October 27, 2020 Category: Surgery Tags: WTA PODIUM - 2020 Source Type: research

Improved outcomes utilizing a novel pectin-based pleural sealant following acute lung injury
CONCLUSION Pectin-based bioadhesives effectively seal traumatic air leaks upon application in a porcine model. Further testing is warranted as they may provide a superior parenchymal-sparing treatment option for traumatic air leaks. (Source: Journal of Trauma and Acute Care Surgery)
Source: Journal of Trauma and Acute Care Surgery - October 27, 2020 Category: Surgery Tags: WTA PODIUM - 2020 Source Type: research

Characterization of unexpected survivors following a prehospital plasma randomized trial
BACKGROUND Prehospital plasma improves survival for severely injured trauma patients transported by air ambulance. We sought to characterize the unexpected survivors, patients who survived despite having high predicted mortality after traumatic injury. METHODS The Prehospital Air Medical Plasma trial randomized severely injured patients (n = 501) to receive either standard care (crystalloid) or two units of prehospital plasma followed by standard care fluid resuscitation. We built a generalized linear model to estimate patient mortality. Area under the receiver operating characteristic curve was used to evaluate model...
Source: Journal of Trauma and Acute Care Surgery - October 27, 2020 Category: Surgery Tags: WTA PODIUM - 2020 Source Type: research

Tranexamic acid administration in the field does not affect admission thromboelastography after traumatic brain injury
BACKGROUND No Food and Drug Administration–approved medication improves outcomes following traumatic brain injury (TBI). A forthcoming clinical trial that evaluated the effects of two prehospital tranexamic acid (TXA) dosing strategies compared with placebo demonstrated no differences in thromboelastography (TEG) values. We proposed to explore the impact of TXA on markers of coagulation and fibrinolysis in patients with moderate to severe TBI. METHODS Data were extracted from a placebo-controlled clinical trial in which patients 15 years or older with TBI (Glasgow Coma Scale, 3–12) and systolic blood pressure of â...
Source: Journal of Trauma and Acute Care Surgery - October 27, 2020 Category: Surgery Tags: WTA PODIUM - 2020 Source Type: research

Closing the gap in care of blunt solid organ injury in children
INTRODUCTION Cross-sectional data of pediatric blunt solid organ injury demonstrates higher rates of nonoperative management and shorter lengths of stay (LOSs) in pediatric trauma centers (PTCs) versus adult trauma centers (ATCs) or dual trauma centers (DTCs). Recent iterations of guidelines (McVay 2008, J Pediatr Surg 2008;43(6):1072-1076 J Trauma Acute Care Surg 2015;79(4):683–693) have emphasized physiologic parameters rather than injury grade in clinical decision making, improving resource allocation and decreasing LOS. We sought to evaluate how these guidelines have influenced care. METHODS The National Trauma ...
Source: Journal of Trauma and Acute Care Surgery - October 27, 2020 Category: Surgery Tags: WTA PODIUM - 2020 Source Type: research

Isolated low-grade solid organ injuries in children following blunt abdominal trauma: Is it time to consider discharge from the emergency department?
INTRODUCTION Acute intervention (AI) for solid organ injury (SOI) is rare in hemodynamically stable children. Pediatric guidelines recommend admission with follow-up laboratories, even for low-grade injuries. METHODS Data sets from two large multicenter prospective observational studies were used to analyze a cohort of children (age, (Source: Journal of Trauma and Acute Care Surgery)
Source: Journal of Trauma and Acute Care Surgery - October 27, 2020 Category: Surgery Tags: WTA PODIUM - 2020 Source Type: research

Blunt cerebrovascular injury: The case for universal screening
CONCLUSION Almost 20% of patients with BCVI, including a quarter of those with BCVI grade 3 or higher, would have gone undiagnosed by even the most extensive and sensitive BCVI screening criteria. Implementation of universal screening should strongly be considered to ensure the detection of all clinically relevant BCVIs. LEVEL OF EVIDENCE Diagnostic study, level III. (Source: Journal of Trauma and Acute Care Surgery)
Source: Journal of Trauma and Acute Care Surgery - October 27, 2020 Category: Surgery Tags: WTA PODIUM - 2020 Source Type: research

Dynamic effects of calcium on in vivo and ex vivo platelet behavior after trauma
BACKGROUND Mobilization of intra and extracellular calcium is required for platelet activation, aggregation, and degranulation. However, the importance of alterations in the calcium-platelet axis after injury is unknown. We hypothesized that in injured patients, in vivo initial calcium concentrations (pretransfusion) predict ex vivo platelet activation and aggregation, viscoelastic clot strength, and transfusion of blood products. We additionally hypothesized that increasing calcium concentrations ex vivo increases the expression of platelet activation surface receptors and platelet aggregation responses to agonist stimu...
Source: Journal of Trauma and Acute Care Surgery - October 27, 2020 Category: Surgery Tags: WTA PODIUM - 2020 Source Type: research

Liquid plasma reduces waste and health care expenses compared with thawed plasma at a Level I trauma center
BACKGROUND Balanced resuscitation strategies have led to increased utilization of plasma. Fresh frozen plasma that is thawed and never used is a large source of blood component wastage. Thawed plasma (TP) and can only be stored for 5 days. Liquid plasma (LP) has never been frozen and can be stored for 26 days. Due to longer storage duration, we hypothesized that using LP would result in decreased waste and cost savings compared with TP. METHODS We performed a retrospective review of all trauma patients at our Level I trauma center in the years 2015 to 2016. We compared 2015 when only TP was used to 2016 when both TP a...
Source: Journal of Trauma and Acute Care Surgery - October 27, 2020 Category: Surgery Tags: WTA PODIUM - 2020 Source Type: research