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Advanced bleeding control in combat casualty care: An international, expert-based Delphi consensus
CONCLUSION Consensus was reached on the contents of a standard bleeding control toolbox, where it should be available, providers and training requirements, international registries and guidelines, and potential indications for REBOA in military environments. (Source: Journal of Trauma and Acute Care Surgery)
Source: Journal of Trauma and Acute Care Surgery - August 1, 2022 Category: Surgery Tags: INDEPENDENT SUBMISSION Source Type: research

When New York City was the COVID-19 pandemic epicenter: The impact on trauma care
BACKGROUND During early spring 2020, New York City (NYC) rapidly became the first US epicenter of the COVID-19 pandemic. With an unparalleled strain on health care resources, we sought to investigate the impact of the pandemic on trauma visits and mortality in the United States' largest municipal hospital system. METHODS We conducted a retrospective multicenter cohort study of the five level 1 trauma centers in NYC's public health care system, New York City's Health and Hospitals Corporation. Clinical characteristics, mechanism of injury, and mortality of trauma patients presenting during the early pandemic (Mar...
Source: Journal of Trauma and Acute Care Surgery - August 1, 2022 Category: Surgery Tags: INDEPENDENT SUBMISSION Source Type: research

Understanding the geography of trauma: Combining spatial analysis and funnel plots to create comprehensive spatial injury profiles
CONCLUSION 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. LEVEL OF EVIDENCE Prognostic and Epidemiologic; ...
Source: Journal of Trauma and Acute Care Surgery - August 1, 2022 Category: Surgery Tags: INDEPENDENT SUBMISSION Source Type: research

The ICEBERG: A score and visual representation to track the severity of traumatic brain injury: Design principles and preliminary results
This study was part of a larger prospective cohort study of 207 patients with severe TBI in the Parisian region (PariS-TBI study). The ICEBERG score included six variables from multimodal monitoring and treatment-related criteria: cerebral perfusion pressure, intracranial pressure, body temperature, sedation depth, arterial partial pressure of CO2, and blood osmolarity. The primary outcome measures included the ICEBERG score and its relationship with hospital mortality and Extended Glasgow Outcome Score. RESULTS The hospital mortality was 21% (45/207). The ICEBERG score baseline value and changes during the 72nd fir...
Source: Journal of Trauma and Acute Care Surgery - August 1, 2022 Category: Surgery Tags: INDEPENDENT SUBMISSION Source Type: research

Epidemiology, patterns of care and outcomes of traumatic brain injury in deployed military settings: Implications for future military operations
CONCLUSION While most TBI in the deployed setting are mild, TBI is frequently associated with hospitalization and multiple injuries. Overtriage of mild TBI is common. Improved TBI capabilities applicable to forward settings will be critical to the success of future multidomain operations with limitations in air superiority. LEVEL OF EVIDENCE Prognostic and Epidemiologic; Level III. (Source: Journal of Trauma and Acute Care Surgery)
Source: Journal of Trauma and Acute Care Surgery - August 1, 2022 Category: Surgery Tags: INDEPENDENT SUBMISSION Source Type: research

Developing a National Trauma Research Action Plan: Results from the geriatric research gap Delphi survey
CONCLUSION Among the questions prioritized as high priority, questions related to three types of injuries (i.e., rib fracture, traumatic brain injury, and lower extremity injury) occurred with the greatest frequency. Among the 25 highest priority questions, the key topics with the highest frequency were pain management, frailty, and anticoagulation-related interventions. The most common types of research proposed were interventional clinical trials and comparative effectiveness studies, outcome research, and health care systems research. (Source: Journal of Trauma and Acute Care Surgery)
Source: Journal of Trauma and Acute Care Surgery - August 1, 2022 Category: Surgery Tags: INDEPENDENT SUBMISSION Source Type: research

Developing a National Trauma Research Action Plan: Results from the acute resuscitation, initial patient evaluation, imaging, and management research gap Delphi survey
CONCLUSION This research gap analysis identified more than 300 high-priority research questions within the broad category of Acute Resuscitation, Initial Evaluation, Imaging, and Definitive Management. Research funding should be prioritized to address these high-priority topics in the future. (Source: Journal of Trauma and Acute Care Surgery)
Source: Journal of Trauma and Acute Care Surgery - August 1, 2022 Category: Surgery Tags: INDEPENDENT SUBMISSION Source Type: research

The Geriatric Nutritional Risk Index as a predictor of complications in geriatric trauma patients
CONCLUSIONS Major GNRI risk is associated with increased mortality and infectious complications in geriatric trauma patients. Further studies should target interventional strategies for those at highest risk based on GNRI. LEVEL OF EVIDENCE Prognostic and Epidemiologic; Level III. (Source: Journal of Trauma and Acute Care Surgery)
Source: Journal of Trauma and Acute Care Surgery - August 1, 2022 Category: Surgery Tags: EAST QUICK SHOT 2022 Source Type: research

Machine learning and murine models explain failures of clinical sepsis trials
CONCLUSION Hydrocortisone, ascorbic acid, and thiamine therapy has minimal benefits in pneumonia. The inflammatory response induced by pulmonary sepsis is unique compared with the response during intra-abdominal sepsis. Consequently, different etiologies of sepsis respond differently to HAT therapy. (Source: Journal of Trauma and Acute Care Surgery)
Source: Journal of Trauma and Acute Care Surgery - August 1, 2022 Category: Surgery Tags: EAST PODIUM 2022 Source Type: research

Failure to rescue in trauma: Early and late mortality in low- and high-performing trauma centers
BACKGROUND Failure to rescue (FTR) is defined as mortality following a complication. Failure to rescue has come under scrutiny as a quality metric to compare trauma centers. In contrast to elective surgery, trauma has an early period of high expected mortality because of injury sequelae rather than a complication. Here, we report FTR in early and late mortality using an externally validated trauma patient database, hypothesizing that centers with higher risk-adjusted mortality rates have higher risk-adjusted FTR rates. METHODS The study included 114,220 patients at 34 Levels I and II trauma centers in a statewid...
Source: Journal of Trauma and Acute Care Surgery - August 1, 2022 Category: Surgery Tags: EAST PODIUM 2022 Source Type: research

Dynamic use of fibrinogen under viscoelastic assessment results in reduced need for plasma and diminished overall transfusion requirements in severe trauma
The objective of the study is twofold, first to analyze changes in transfusion practices overtime and second to identify the impact of these changes on coagulation parameters and clinical outcomes. We hypothesized that progressive VHA implementation results in a higher administration of fibrinogen concentrate (FC) and lower use of blood products transfusion, especially plasma. METHODS A total of 135 severe trauma patients (January 2008 to July 2019), all requiring and initial assessment for high risk of trauma-induced coagulopathy based on high-energy injury mechanism, severity of bleeding and hemodynamic instabilit...
Source: Journal of Trauma and Acute Care Surgery - August 1, 2022 Category: Surgery Tags: AAST PODIUM 2020 Source Type: research

Validating the Brain Injury Guidelines: Results of an American Association for the Surgery of Trauma prospective multi-institutional trial
CONCLUSION Brain Injury Guidelines is safe and defines the management of TBI patients by trauma and acute care surgeons without the routine need for RHCT and neurosurgical consultation. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III. (Source: Journal of Trauma and Acute Care Surgery)
Source: Journal of Trauma and Acute Care Surgery - August 1, 2022 Category: Surgery Tags: AAST Podium 2021 Source Type: research

Prospective randomized trial of metal versus resorbable plates in surgical stabilization of rib fractures
BACKGROUND Surgical stabilization of rib fractures has gained popularity as both metal and resorbable plates have been approved for fracture repair. Is there a difference between metal and resorbable plate rib fixation regarding rib fracture alignment, control of pain, and quality-of-life (QOL) scores (Rand SF-36 survey)? METHODS Eligible patients (pts) included 18 years or older with one or more of the following: flail chest, one or more bicortical displaced fractures (3–10), nondisplaced fractures with failure of medical management. Patients were randomized to either metal or resorbable plate fixation. Prima...
Source: Journal of Trauma and Acute Care Surgery - August 1, 2022 Category: Surgery Tags: AAST Podium 2021 Source Type: research

Sex differences associate with late microbiome alterations after murine surgical sepsis
BACKGROUND Sepsis-induced gut microbiome alterations contribute to sepsis-related morbidity and mortality. Given evidence for improved postsepsis outcomes in females compared with males, we hypothesized that female mice maintain microbiota resilience versus males. METHODS Mixed-sex C57BL/6 mice underwent cecal ligation and puncture (CLP) with antibiotics, saline resuscitation, and daily chronic stress and were compared with naive (nonsepsis/no antibiotics) controls. For this work, the results of young (3–5 months) and old (18–22 months) adult mice were analyzed by sex, independent and dependent of age. Mice ...
Source: Journal of Trauma and Acute Care Surgery - August 1, 2022 Category: Surgery Tags: AAST Podium 2021 Source Type: research

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Source: Journal of Trauma and Acute Care Surgery - March 31, 2022 Category: Surgery Tags: DEPARTMENT Source Type: research