Journal of Trauma and Acute Care Surgery This is an RSS file. You can use it to subscribe to this data in your favourite RSS reader or to display this data on your own website or blog.

Radiologic predictors of in-hospital mortality after traumatic craniocervical dissociation
CONCLUSION Among patients who arrive alive to hospital after traumatic CCD, greater radiologic dissociation is not associated with increased mortality. However, increased soft tissue edema at the level of mid C1, particularly 10.86 mm or greater, is associated with in-hospital death. These findings improve our understanding of this highly lethal injury and impart the ability to better prognosticate for patients arriving alive to hospital with CCD. LEVEL OF EVIDENCE Prognostic and Epidemiological, Level III. (Source: Journal of Trauma and Acute Care Surgery)
Source: Journal of Trauma and Acute Care Surgery - August 21, 2020 Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research

Guns, scalpels, and sutures: The cost of gunshot wounds in children and adolescents
CONCLUSION The survivors of pediatric firearm injuries experience high operative and readmission rates, sustain long-term morbidities, and suffer from mental health sequelae. Combining these factors with the economic impact of these injuries highlights the immense burden of disease. This burden may be palliated by a multipronged approach, which includes the development and dissemination of injury prevention strategies and better follow-up care for these patients. LEVEL OF EVIDENCE Epidemiological, Level III. (Source: Journal of Trauma and Acute Care Surgery)
Source: Journal of Trauma and Acute Care Surgery - August 21, 2020 Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research

Combat thoracic surgery in Iraq and Afghanistan: 2002–2016
CONCLUSION Thoracic surgical skills are necessary in the deployed environment to manage combat-related injuries. Given the current trends in training and specialization, development and sustainment of thoracic surgical skills is challenging in the deployed US trauma system and likely for other nations, and humanitarian surgical care as well. Current training and practice paradigms pose both training and sustainment challenges for surgeons who deploy to a combat zone. LEVEL OF EVIDENCE Therapeutic/Care Management IV. (Source: Journal of Trauma and Acute Care Surgery)
Source: Journal of Trauma and Acute Care Surgery - August 21, 2020 Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research

Obesity and impaired barrier function after shock: A biomimetic in vitro model using microfluidics
CONCLUSION Our study supports that obesity impairs HS resuscitation. This may be due to microrheological differences between nonobese and obese individuals and may contribute to the poorer outcome in this patient population. (Source: Journal of Trauma and Acute Care Surgery)
Source: Journal of Trauma and Acute Care Surgery - August 21, 2020 Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research

Early treatment with exosomes following traumatic brain injury and hemorrhagic shock in a swine model promotes transcriptional changes associated with neuroprotection
This study was designed to investigate the transcriptomic changes in the brain that are associated with this treatment strategy. METHODS Yorkshire swine (40–45 kg) were subjected to a severe TBI (12-mm cortical impact) and hemorrhagic shock (40% estimated total blood volume). One hour into shock, animals were randomized (n = 5/cohort) to receive either lactated Ringer's (LR; 5 mL) or exosomes suspended in LR (LR + EXO; 1 × 1013 exosome particles in 5 mL LR). Animals then underwent additional shock (1 hour) followed by normal saline resuscitation. After 6 hours of observation, brain swelling (% increase compared with ...
Source: Journal of Trauma and Acute Care Surgery - August 21, 2020 Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research

Therapeutic anticoagulation in patients with traumatic brain injuries and pulmonary emboli
CONCLUSION This retrospective study failed to find instances of clinically significant progression of TBI in 46 patients with computed tomography–proven ICH after undergoing AC for PE. Therapeutic AC is not associated with worse outcomes in patients with TBI, even if initiated early. However, two patients died from PE despite AC, underlining the severity of the disease. Intracranial hemorrhage should not preclude AC treatment for PE, even early after injury. LEVEL OF EVIDENCE Care management, Level IV. (Source: Journal of Trauma and Acute Care Surgery)
Source: Journal of Trauma and Acute Care Surgery - August 21, 2020 Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research

Age-related differences in the impact of coagulopathy in patients with isolated traumatic brain injury: An observational cohort study
CONCLUSION There was a low impact of coagulopathy on functional and survival outcomes in geriatric patients with isolated TBI. LEVEL OF EVIDENCE Therapeutic study, Level IV. (Source: Journal of Trauma and Acute Care Surgery)
Source: Journal of Trauma and Acute Care Surgery - August 21, 2020 Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research

Comparison of direct oral anticoagulant and vitamin K antagonists on outcomes among elderly and nonelderly trauma patients
CONCLUSION In this matched cohort of anticoagulated trauma patients, DOACs were associated with the decreased in-hospital mortality and decreased administration of fresh frozen plasma compared with VKAs among trauma patients 65 years or older taking anticoagulant therapy. LEVEL OF EVIDENCE Prognostic/Epidemiological, level III. (Source: Journal of Trauma and Acute Care Surgery)
Source: Journal of Trauma and Acute Care Surgery - August 21, 2020 Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research

Dynamic impact of transfusion ratios on outcomes in severely injured patients: Targeted machine learning analysis of the Pragmatic, Randomized Optimal Platelet and Plasma Ratios randomized clinical trial
CONCLUSION Our results suggest that the impact of transfusion ratios on hemostasis is dynamic. Overall, the transfusion ratios had no significant impact on mortality over time. However, receiving higher ratios of platelets and plasma relative to red blood cells hastens hemostasis in subjects who have yet to achieve hemostasis within 3 hours after hospital admission. LEVEL OF EVIDENCE Therapeutic IV. (Source: Journal of Trauma and Acute Care Surgery)
Source: Journal of Trauma and Acute Care Surgery - August 21, 2020 Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research

Blood product needs and transfusion timelines for the multisite massive Paris 2015 terrorist attack: A retrospective analysis
CONCLUSION Our data suggest that improving transfusion procedures in mass casualty setting should rely more on shortening the time to bring LBP to the bedside than in increasing the stockpile. LEVEL OF EVIDENCE Epidemiological study, Therapeutic IV. (Source: Journal of Trauma and Acute Care Surgery)
Source: Journal of Trauma and Acute Care Surgery - August 21, 2020 Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research

Liquid plasma: A solution to optimizing early and balanced plasma resuscitation in massive transfusion
BACKGROUND Early and balanced resuscitation for traumatic hemorrhagic shock is associated with decreased mortality, making timely plasma administration imperative. However, fresh frozen plasma (FFP) thaw time can delay administration, and the shelf life of thawed FFP limits supply and may incur wastage. Liquid plasma (LP) offers an attractive alternative given immediate transfusion potential and extended shelf life. As such, we hypothesized that the use of LP in the massive transfusion protocol (MTP) would improve optimal plasma/red blood cell (RBC) ratios, initial plasma transfusion times, and clinical outcomes in the s...
Source: Journal of Trauma and Acute Care Surgery - August 21, 2020 Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research

Penetrating injury to the cardiac box
This study aims to evaluate the relationship between penetrating trauma to the cardiac box and a clinically significant injury. METHODS All patients presenting to a Level I trauma center from January 2009 to June 2015 who sustained a penetrating injury isolated to the thorax were retrospectively identified. Patients were categorized according to the location of injury: within or outside the historical cardiac box. Patients with concurrent injuries both inside and outside the cardiac box were excluded. Clinical demographics, injuries, procedures, and outcomes were compared. RESULTS During this 7-year period, 330 patie...
Source: Journal of Trauma and Acute Care Surgery - August 21, 2020 Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research

Resuscitative endovascular balloon occlusion of the aorta for thoracic trauma: A translational swine study
CONCLUSION In this animal study of hemorrhage and major thoracic bleeding, the addition of zone 1 REBOA did not significantly affect short-term survival or blood loss, while providing hemodynamic stabilization. Therefore, in noncompressible thoracic bleeding, without immediate surgical capability, long-term outcomes may be improved with REBOA, and thoracic hemorrhage should not be considered contraindications to REBOA use. (Source: Journal of Trauma and Acute Care Surgery)
Source: Journal of Trauma and Acute Care Surgery - August 21, 2020 Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research

Use of bilobed partial resuscitative endovascular balloon occlusion of the aorta is logistically superior in prolonged management of a highly lethal aortic injury
BACKGROUND Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a viable technique for management of noncompressible torso hemorrhage. The major limitation of the current unilobed fully occlusive REBOA catheters is below-the-balloon ischemia-reperfusion complications. We hypothesized that partial aortic occlusion with a novel bilobed partial (p)REBOA-PRO would result in the need for less intraaortic balloon adjustments to maintain a distal goal perfusion pressure as compared with currently available unilobed ER-REBOA. METHODS Anesthetized (40–50 kg) swine randomized to control (no intervention), ER-R...
Source: Journal of Trauma and Acute Care Surgery - August 21, 2020 Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research

Radial versus femoral arterial access for trauma endovascular interventions: A noninferiority study
CONCLUSION Transradial access in a cohort of trauma patients undergoing endovascular intervention does not appear to be inferior to TFA in relation to technical success and complications. For patients where groin access may be challenging, TRA is a useful, efficacious, and safe alternative. Longer-term study is required to fully characterize the advantages and disadvantages of TRA compared with TFA. LEVEL OF EVIDENCE Therapeutic V. (Source: Journal of Trauma and Acute Care Surgery)
Source: Journal of Trauma and Acute Care Surgery - August 21, 2020 Category: Surgery Tags: ORIGINAL ARTICLES Source Type: research