Meetings/courses
No abstract available (Source: The Journal of Trauma: Injury, Infection, and Critical Care)
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 28, 2019 Category: Orthopaedics Tags: DEPARTMENT Source Type: research

Featured articles for cme credit december 2019
No abstract available (Source: The Journal of Trauma: Injury, Infection, and Critical Care)
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 28, 2019 Category: Orthopaedics Tags: CONTINUING MEDICAL EDUCATION PROGRAM Source Type: research

Authors' reply: Intermittent REBOA translational science articles
No abstract available (Source: The Journal of Trauma: Injury, Infection, and Critical Care)
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 28, 2019 Category: Orthopaedics Tags: LETTERS TO THE EDITOR Source Type: research

Letter to the editor RE: Intermittent REBOA translational science papers
No abstract available (Source: The Journal of Trauma: Injury, Infection, and Critical Care)
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 28, 2019 Category: Orthopaedics Tags: LETTERS TO THE EDITOR Source Type: research

Analysis of blunt cerebrovascular injury in pediatric trauma
BACKGROUND Blunt cerebrovascular injury (BCVI) occurs in (Source: The Journal of Trauma: Injury, Infection, and Critical Care)
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 28, 2019 Category: Orthopaedics Tags: ORIGINAL ARTICLES Source Type: research

Role of Tumor Necrosis Factor-α in vascular hyporeactivity following endotoxic shock and its mechanism
CONCLUSION TNF-α is involved in vascular hyporeactivity after endotoxic shock. Calcium desensitization plays an important role in TNF-α–induced vascular hyporeactivity after endotoxic shock. Rho-kinase/MLC20 phosphorylation pathway takes part in the regulation of calcium desensitization and vascular hyporeactivity induced by TNF-α. Arginine vasopressin is beneficial to endotoxic shock in TNF-α-induced vascular hyporeactivity. (Source: The Journal of Trauma: Injury, Infection, and Critical Care)
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 28, 2019 Category: Orthopaedics Tags: ORIGINAL ARTICLES Source Type: research

Role of resveratrol in protecting vasodilatation function in septic shock rats and its mechanism
CONCLUSION Resveratrol was beneficial for vasodilatation function in rats with septic shock, which is the major contribution to resveratrol improving hemodynamics and organ perfusion. The mechanism involved resveratrol upregulating the expression of eNOS by inhibiting Rac-1 and HIF-1α. (Source: The Journal of Trauma: Injury, Infection, and Critical Care)
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 28, 2019 Category: Orthopaedics Tags: ORIGINAL ARTICLES Source Type: research

The utility of magnetic resonance imaging in pediatric trauma patients suspected of having cervical spine injuries
CONCLUSION In pediatric trauma patients suspected of having a CSI, a normal cervical spine CT is sufficient to rule out a clinically significant CSI as no child with a normal cervical CT was found to be radiographically or clinically unstable. LEVEL OF EVIDENCE Diagnostic Test, level III. (Source: The Journal of Trauma: Injury, Infection, and Critical Care)
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 28, 2019 Category: Orthopaedics Tags: ORIGINAL ARTICLES Source Type: research

Life-saving interventions in pediatric trauma: A National Trauma Data Bank experience
CONCLUSION Life-saving interventions in the pediatric trauma population are uncommon and outcomes variable. Novel solutions to keep proficient at such interventions should be sought, especially for younger children. Guidelines to improve identification of appropriate candidates for LSI are critical given their rare occurrence. LEVEL OF EVIDENCE Retrospective cohort study, III. (Source: The Journal of Trauma: Injury, Infection, and Critical Care)
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 28, 2019 Category: Orthopaedics Tags: ORIGINAL ARTICLES Source Type: research

The Israel Defense Forces experience with freeze-dried plasma for the resuscitation of traumatized pediatric patients
CONCLUSION While the ideal resuscitation fluid for the pediatric population remains to be determined, it seems reasonable to pursue a similar approach to that of applied that for adults. In the IDF-MC, the resuscitation fluid of choice for trauma patients in hemorrhagic shock is freeze-dried plasma transfused at the point of injury. The current study demonstrates the feasibility of FDP administration in the prehospital scenario for injured children and further supports the growing confidence in the use of FDP for the treatment of pediatric trauma patients. LEVEL OF EVIDENCE Retrospective descriptive study, level IV. (...
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 28, 2019 Category: Orthopaedics Tags: ORIGINAL ARTICLES Source Type: research

Assessing the role of urologists and general surgeons in the open repair of bladder injuries: Analysis of a large, statewide trauma database
BACKGROUND Bladder injuries often occur in the setting of polytrauma, and if severe, may require open surgical repairs. We assess the role of urologists and general surgeons (GS) in the open surgical management of bladder injuries and their outcomes in a traumatic setting. METHODS Patients who underwent open bladder injury repair secondary to trauma from 2000 to 2017 by urology or GS were identified in the Pennsylvania Trauma Outcome Study database by International Classification of Diseases—9th Rev.—Clinical Modification procedure codes (57.19–57.93). Patient demographics, initial trauma assessment,...
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 28, 2019 Category: Orthopaedics Tags: ORIGINAL ARTICLES Source Type: research

Selective nonoperative management of renal gunshot wounds
BACKGROUND Selective nonoperative management (SNOM) of blunt kidney injuries has been the standard of care for decades. However, the role of SNOM after renal gunshot wounds (GSWs) remains unclear. The purpose of this study was to assess the safety and outcomes of SNOM of renal GSWs at a national level. METHODS The National Trauma Data Bank was queried for patients who sustained a GSW to the kidney (January 2007 to December 2014). Patients with emergency department death, transfer, nonsurvivable (Abbreviated Injury Scale score = 6) injuries, absent vitals on arrival, associated hollow viscus or major abdominal vascular...
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 28, 2019 Category: Orthopaedics Tags: ORIGINAL ARTICLES Source Type: research

Blame it on the injury: Trauma is a risk factor for pancreatic fistula following distal pancreatectomy compared with elective resection
BACKGROUND Postoperative pancreatic fistula (POPF) remains a significant source of morbidity following distal pancreatectomy (DP). There is a lack of information regarding the impact of trauma on POPF rates when compared with elective resection. We hypothesize that trauma will be a significant risk factor for the development of POPF following DP. METHODS A retrospective, single-institution review of all patients undergoing DP from 1999 to 2017 was performed. Outcomes were compared between patients undergoing DP for traumatic injury to those undergoing elective resection. Univariate and multivariable analyses were perf...
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 28, 2019 Category: Orthopaedics Tags: ORIGINAL ARTICLES Source Type: research

Determining the clinical significance of the Chest Wall Injury Society taxonomy for multiple rib fractures
This study aimed to validate the CWIS taxonomy using a single-instituion clinical database. METHODS Computed tomography (CT) scans, of 539 consecutive patients with MRFs admitted to a regional major trauma center over a 33-month period, were reviewed (blinded for clinical outcomes). Every rib fracture in every patient was assessed according to each of the CWIS criteria (the degree of displacement, characterization of the fracture line, location of each fracture, and the relationship to neighboring fractures). The clinical significance of the proposed CWIS definitions were determined from independently coded, routinely c...
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 28, 2019 Category: Orthopaedics Tags: CWIS 2019 SUMMIT ARTICLES Source Type: research

Characteristics of hardware failure in patients undergoing surgical stabilization of rib fractures: A Chest Wall Injury Society multicenter study
CONCLUSION Hardware failure after SSRF is rare and often asymptomatic. When present, it rarely requires redo SSRF. LEVEL OF EVIDENCE Therapeutic, level V. (Source: The Journal of Trauma: Injury, Infection, and Critical Care)
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 28, 2019 Category: Orthopaedics Tags: CWIS 2019 SUMMIT ARTICLES Source Type: research

Readmission rates and associated factors following rib cage injury
CONCLUSION Moderate to severe rib cage injury is associated with high rates of reevaluation and readmission. Younger patients who smoke and required a return to the ICU are at greater risk for readmission. LEVEL OF EVIDENCE Level IV, Prognostic and Epidemiologic. (Source: The Journal of Trauma: Injury, Infection, and Critical Care)
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 28, 2019 Category: Orthopaedics Tags: CWIS 2019 SUMMIT ARTICLES Source Type: research

The Sequential Clinical Assessment of Respiratory Function (SCARF) score: A dynamic pulmonary physiologic score that predicts adverse outcomes in critically ill rib fracture patients
BACKGROUND Rib fracture scoring systems are limited by a lack of serial pulmonary physiologic variables. We created the Sequential Clinical Assessment of Respiratory Function (SCARF) score and hypothesized that admission, maximum, and rising scores predict adverse outcomes among critically ill rib fracture patients. METHODS Prospective cohort study of rib fracture patients admitted to the surgical intensive care unit (ICU) at a Level I trauma center from August 2017 to June 2018. The SCARF score was developed a priori and validated using the cohort. One point was assigned for: 20, numeric pain score ≥5, and inadequ...
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 28, 2019 Category: Orthopaedics Tags: CWIS 2019 SUMMIT ARTICLES Source Type: research

Use of ShotSpotter detection technology decreases prehospital time for patients sustaining gunshot wounds
BACKGROUND Shorter prehospital time in patients sustaining penetrating trauma has been shown to be associated with improved survival. Literature has also demonstrated that police transport (vs. Emergency Medical Services [EMS]) shortens transport times to a trauma center. The purpose of this study was to determine if ShotSpotter, which triangulates the location of gunshots and alerts police, expedited dispatch and transport of injured victims to the trauma center. METHODS All shootings which occurred in Camden, NJ, from 2010 to 2018 were reviewed. Demographic, geographic, response time, transport time, and field inter...
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 28, 2019 Category: Orthopaedics Tags: AAST 2018 PODIUM PAPERS Source Type: research

Endothelial cell dysfunction during anoxia-reoxygenation is associated with a decrease in adenosine triphosphate levels, rearrangement in lipid bilayer phosphatidylserine asymmetry, and an increase in endothelial cell permeability
BACKGROUND Phosphatidylserine (PS) is normally confined in an energy-dependent manner to the inner leaflet of the lipid cell membrane. During cellular stress, PS is exteriorized to the outer layer, initiating a cascade of events. Because cellular stress is often accompanied by decreased energy levels and because maintaining PS asymmetry is an energy-dependent process, it would make sense that cellular stress associated with decreased energy levels is also associated with PS exteriorization that ultimately leads to endothelial cell dysfunction. Our hypothesis was that anoxia-reoxygenation (A-R) is associated with decrease...
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 28, 2019 Category: Orthopaedics Tags: AAST 2018 PODIUM PAPERS Source Type: research

Meetings/Courses
No abstract available (Source: The Journal of Trauma: Injury, Infection, and Critical Care)
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 1, 2019 Category: Orthopaedics Tags: DEPARTMENT Source Type: research

The Journal of Trauma and Acute Care Surgery 3-Minute Expert Consult Video: “Forget the Fecal Transplant! Operative Management for C.: Difficile: Related Toxic Megacolon”
No abstract available (Source: The Journal of Trauma: Injury, Infection, and Critical Care)
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 1, 2019 Category: Orthopaedics Tags: 3-MINUTE EXPERT CONSULT VIDEO Source Type: research

Featured articles for cme credit november 2019
No abstract available (Source: The Journal of Trauma: Injury, Infection, and Critical Care)
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 1, 2019 Category: Orthopaedics Tags: CONTINUING MEDICAL EDUCATION PROGRAM Source Type: research

Blunt Rupture of Two Cardiac Chambers Following a Motor Vehicle Collision: Erratum
No abstract available (Source: The Journal of Trauma: Injury, Infection, and Critical Care)
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 1, 2019 Category: Orthopaedics Tags: ERRATUM Source Type: research

Western Trauma Association critical decisions in trauma: Preferred triage and initial management of the burned patient
This is a recommended management algorithm from the Western Trauma Association addressing the management of victims of burn injury. Because there is a paucity of published prospective randomized clinical trials that have generated Class I data, these recommendations are based primarily on published retrospective studies, clinical guidelines, and the expert opinion of members of the Western Trauma Association in conjunction with partner members of the American Burn Association. The algorithm and accompanying comments represent one safe and sensible approach that can be followed at most trauma centers. We recognize that ther...
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 1, 2019 Category: Orthopaedics Tags: ALGORITHM Source Type: research

Western Trauma Association critical decisions in trauma: Management of the open abdomen after damage control surgery
No abstract available (Source: The Journal of Trauma: Injury, Infection, and Critical Care)
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 1, 2019 Category: Orthopaedics Tags: ALGORITHM Source Type: research

Prehospital resuscitation in adult patients following injury: A Western Trauma Association critical decisions algorithm
No abstract available (Source: The Journal of Trauma: Injury, Infection, and Critical Care)
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 1, 2019 Category: Orthopaedics Tags: 2019 WTA PODIUM PAPERS Source Type: research

Evaluation and management of abdominal gunshot wounds: A Western Trauma Association critical decisions algorithm
No abstract available (Source: The Journal of Trauma: Injury, Infection, and Critical Care)
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 1, 2019 Category: Orthopaedics Tags: 2019 WTA PODIUM PAPERS Source Type: research

The health literacy of hospitalized trauma patients: We should be screening for deficiencies
In this study, we sought to determine if HL deficiency was associated with comprehension of discharge instructions. METHODS In this prospective study, hospitalized trauma patients underwent evaluation of HL prior to discharge. Newest Vital Sign (NVS) instrument was used to score HL as deficient, marginal, or proficient. Three days postdischarge, patients were telephonically administered a six-point scored questionnaire regarding comprehension of discharge instructions. A general linear model was used to determine the association between HL and comprehension of discharge instructions. RESULTS Sixty-three patients were...
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 1, 2019 Category: Orthopaedics Tags: 2019 WTA PODIUM PAPERS Source Type: research

Helmet use is associated with higher Injury Severity Scores in alpine skiers and snowboarders evaluated at a Level I trauma center
BACKGROUND There is uncertainty regarding the efficacy of ski helmets in preventing traumatic injury. We investigated the relationship between helmet use, injury types, and injury severity among skiers and snowboarders. METHODS The trauma registry at a Northeast American College of Surgeons Level I trauma center was queried by International Classification of Diseases Codes—9th or 10th Revision for skiing and snowboarding injury between 2010 and 2018. The primary exposure was helmet use and primary outcome was severe injury (Injury Severity Score>15). We performed univariate and multivariable logistic regressi...
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 1, 2019 Category: Orthopaedics Tags: 2019 WTA PODIUM PAPERS Source Type: research

Critical call for hospital-based domestic violence intervention: The Davis Challenge
CONCLUSION Critical call for hospital-based IPV intervention programs as a priority for trauma centers to adopt cannot be underestimated but can be answered in a comprehensive integrated model. LEVEL OF EVIDENCE Therapeutic, level I. (Source: The Journal of Trauma: Injury, Infection, and Critical Care)
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 1, 2019 Category: Orthopaedics Tags: 2019 WTA PODIUM PAPERS Source Type: research

Financial toxicity is associated with worse physical and emotional long-term outcomes after traumatic injury
CONCLUSION Financial toxicity following injury is extremely common and is associated with worse psychological and physical outcomes. Age, lack of insurance, and large household size are associated with financial toxicity. Patients at risk for financial toxicity can be identified, and interventions to counteract the negative effects should be developed to improve long-term outcomes. LEVEL OF EVIDENCE Prognostic/epidemiologic study, level III. (Source: The Journal of Trauma: Injury, Infection, and Critical Care)
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 1, 2019 Category: Orthopaedics Tags: 2019 WTA PODIUM PAPERS Source Type: research

Ketamine infusion for pain control in elderly patients with multiple rib fractures: Results of a randomized controlled trial
CONCLUSION Low-dose ketamine failed to affect NPS or OME within the overall cohort, but a decrease in OME was observed in those with an Injury Severity Score greater than 15. Additional studies are necessary to confirm whether LDK benefits severely injured elderly patients. LEVEL OF EVIDENCE Therapeutic, level I. (Source: The Journal of Trauma: Injury, Infection, and Critical Care)
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 1, 2019 Category: Orthopaedics Tags: 2019 WTA PODIUM PAPERS Source Type: research

Prospective evaluation and comparison of the predictive ability of different frailty scores to predict outcomes in geriatric trauma patients
CONCLUSION There are significant differences in the predictive ability of the four commonly used frailty scores. The TSFI and the RFS are better predictors of outcomes compared with the mFI and the FS. The TSFI is easy to calculate and might be used as a universal frailty score in geriatric trauma patients. LEVEL OF EVIDENCE Prognostic, level III. (Source: The Journal of Trauma: Injury, Infection, and Critical Care)
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 1, 2019 Category: Orthopaedics Tags: 2019 WTA PODIUM PAPERS Source Type: research

Vancomycin dosing in critically ill trauma patients: The VANCTIC Study
CONCLUSION Our incidence of initial therapeutic troughs was slightly below previously reported studies. Based on our results, which are consistent with previous literature, it would appear that our guideline-adherent protocol of intermittent vancomycin is insufficient to achieve troughs of 15 mg/L to 20 mg/L. LEVEL OF EVIDENCE Therapeutic, level III. (Source: The Journal of Trauma: Injury, Infection, and Critical Care)
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 1, 2019 Category: Orthopaedics Tags: 2019 WTA PODIUM PAPERS Source Type: research

Palliative Care in trauma: Not just for the dying
CONCLUSION The PC utilization was very high for older trauma patients who died in hospital. In contrast, the majority of those who were discharged alive, but with poor outcomes, did not have PC. Development of triggers to identify older trauma patients, who would benefit from PC, could close this gap and improve quality of care and outcomes. (Source: The Journal of Trauma: Injury, Infection, and Critical Care)
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 1, 2019 Category: Orthopaedics Tags: 2019 WTA PODIUM PAPERS Source Type: research

One-year mortality in geriatric trauma patients: Improving upon the geriatric trauma outcomes score utilizing the social security death index
BACKGROUND Geriatric Trauma Outcomes Score (GTOS) predicts in-patient mortality in geriatric trauma patients and has been validated in a prospective multicenter trial and expanded to predict adverse discharge (GTOS II). We hypothesized that these formulations actually underestimate the downstream sequelae of injury and sought to predict longer-term mortality in geriatric trauma patients. METHODS The Parkland Memorial Hospital Trauma registry was queried for patients 65 years or older from 2001 to 2013. Patients were then matched to the Social Security Death Index. The primary outcome was 1-year mortality. The original...
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 1, 2019 Category: Orthopaedics Tags: 2019 WTA PODIUM PAPERS Source Type: research

Propranolol attenuates cognitive, learning, and memory deficits in a murine model of traumatic brain injury
CONCLUSION Postinjury propranolol administration results in improved memory, learning and cognitive functions in a murine model of moderate TBI. Propranolol increases the expression of antiapoptotic protein (Hsp-70) and decreases cell death in the hippocampal-CA1 area compared with the placebo. (Source: The Journal of Trauma: Injury, Infection, and Critical Care)
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 1, 2019 Category: Orthopaedics Tags: 2019 WTA PODIUM PAPERS Source Type: research

Dose optimization of valproic acid in a lethal model of traumatic brain injury, hemorrhage, and multiple trauma in swine
BACKGROUND Trauma is a leading cause of death, and traumatic brain injury is one of the hallmark injuries of current military conflicts. Valproic acid (VPA) administration in high doses (300–400 mg/kg) improves survival in lethal trauma models, but effectiveness of lower doses on survival is unknown. This information is essential for properly designing the upcoming clinical trials. We, therefore, performed the current study to determine the lowest dose at which VPA administration improves survival in a model of lethal injuries. METHODS Swine were subjected to traumatic brain injury (10-mm cortical impact), 40% b...
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 1, 2019 Category: Orthopaedics Tags: 2019 WTA PODIUM PAPERS Source Type: research

Random forest modeling can predict infectious complications following trauma laparotomy
CONCLUSION Random forests with RFE can help identify clinical and biomarker profiles predictive of SS and OSI after trauma laparotomy. Once validated, these models could be used as clinical decision support tools for earlier detection and treatment of infectious complications following injury. LEVEL OF EVIDENCE Prognostic, level III. (Source: The Journal of Trauma: Injury, Infection, and Critical Care)
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 1, 2019 Category: Orthopaedics Tags: 2019 WTA PODIUM PAPERS Source Type: research

End-tidal carbon dioxide underestimates plasma carbon dioxide during emergent trauma laparotomy leading to hypoventilation and misguided resuscitation: A Western Trauma Association Multicenter Study
CONCLUSION Nearly one half (45%) of patients were found to have an ETCO2 level greater than 10 mm Hg discordant from their PCO2 level. Reliance on the discordant values may have contributed to the 40% of patients in the operating room that were both acidotic and hypercarbic. Early blood gas analysis is warranted, and a lower early goal of ETCO2 should be considered. LEVEL OF EVIDENCE Therapeutic, level IV. (Source: The Journal of Trauma: Injury, Infection, and Critical Care)
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 1, 2019 Category: Orthopaedics Tags: 2019 WTA PODIUM PAPERS Source Type: research

Removal of retrievable inferior vena cava filters before discharge: Is it associated with increased incidence of pulmonary embolism?
CONCLUSION Our results suggest that removal of rIVCFs before discharge once patients are appropriately anticoagulated is a safe strategy to improve retrieval rates. LEVEL OF EVIDENCE Therapeutic, level V. (Source: The Journal of Trauma: Injury, Infection, and Critical Care)
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 1, 2019 Category: Orthopaedics Tags: 2019 WTA PODIUM PAPERS Source Type: research

Is early chemical thromboprophylaxis in patients with solid organ injury a solid decision?
CONCLUSION Our results suggest that in patients undergoing NOM of blunt abdominal SOI, early initiation of CTP should be considered. It is associated with decreased rates of DVT and PE, with no significant difference in post prophylaxis pRBC transfusion, failure of nonoperative management, and mortality. LEVEL OF EVIDENCE Therapeutic, level V. (Source: The Journal of Trauma: Injury, Infection, and Critical Care)
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 1, 2019 Category: Orthopaedics Tags: 2019 WTA PODIUM PAPERS Source Type: research

Missing expectations: Windlass tourniquet use without formal training yields poor results
CONCLUSION No one should die of extremity hemorrhage, and civilians are our first line of defense. We demonstrate that when an untrained layperson is handed a commonly accepted tourniquet, failure is unacceptably high. Current devices are not intuitive and require training beyond the enclosed instructions. Plans to further evaluate this cohort after formal “Stop the Bleed” training are underway. (Source: The Journal of Trauma: Injury, Infection, and Critical Care)
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 1, 2019 Category: Orthopaedics Tags: 2019 WTA PODIUM PAPERS Source Type: research

Big problems in little patients: Nationwide blunt cerebrovascular injury outcomes in the pediatric population
BACKGROUND Blunt cerebrovascular injuries (BCVI) are uncommon but potentially devastating. The epidemiology, outcomes, and screening criteria are well described in adults, but data in pediatric patients are extremely limited. The purpose of this study was to characterize pediatric BCVI in a large nationwide sample. We hypothesized that outcomes of BCVI in the pediatric blunt trauma population will vary by age. METHODS We conducted a retrospective cohort study of the Kids' Inpatient Database for pediatric BCVI from 2000 to 2012. Epidemiology, associated injuries, outcomes (including stroke and mortality), and the utili...
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 1, 2019 Category: Orthopaedics Tags: 2019 WTA PODIUM PAPERS Source Type: research

Not all in your head (and neck): Stroke after blunt cerebrovascular injury is associated with systemic hypercoagulability
CONCLUSION Patients who suffer BCVI-related stroke are hypercoagulable compared with those with BCVI who remain asymptomatic. Increased angle or MA should be considered when assessing the risk of thrombosis and determining the optimal time to initiate antithrombotic therapy in patients with BCVI. LEVEL OF EVIDENCE Prognostic, Level III. (Source: The Journal of Trauma: Injury, Infection, and Critical Care)
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 1, 2019 Category: Orthopaedics Tags: 2019 WTA PODIUM PAPERS Source Type: research

Implementation of a prehospital air medical thawed plasma program: Is it even feasible?
CONCLUSION A prehospital plasma program utilizing thawed plasma is resource intensive. Plasma waste can be minimized depending on trauma center and blood bank specific logistics. Implementation of a thawed plasma program can occur with financial cost. Products with a longer shelf life, such as liquid plasma or freeze-dried plasma, may provide a more cost-effective prehospital product relative to thawed plasma. LEVEL OF EVIDENCE Therapeutic, level III. (Source: The Journal of Trauma: Injury, Infection, and Critical Care)
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 1, 2019 Category: Orthopaedics Tags: 2019 WTA PODIUM PAPERS Source Type: research

Hypoxia/reoxygenation decreases endothelial glycocalyx via reactive oxygen species and calcium signaling in a cellular model for shock
CONCLUSION In our cellular model for shock, we demonstrate that although hypoxia alone is sufficient to produce glycocalyx loss, H/R causes a greater decrease in glycocalyx thickness. Under both conditions damage is dependent on ROS and Ca2+ signaling. Notably, we found that ROS are generated upstream of Ca2+, but that ROS-mediated damage to the glycocalyx is dependent on Ca2+. (Source: The Journal of Trauma: Injury, Infection, and Critical Care)
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 1, 2019 Category: Orthopaedics Tags: 2019 WTA PODIUM PAPERS Source Type: research

Protective effects of plasma products on the endothelial-glycocalyx barrier following trauma-hemorrhagic shock: Is sphingosine-1 phosphate responsible?
CONCLUSION A biomimetic model of the microcirculation following T/HS demonstrated endothelial glycocalyx and endothelial cellular injury/activation as well as a profibrinolytic phenotype. These effects were abrogated by all plasma products except the 5-day thawed plasma. Plasma thawed longer than 5 days had diminished S1-P concentrations. Our data suggest that S1-P protein is critical to the protective effect of plasma products on the endothelial-glycocalyx barrier following T/HS. (Source: The Journal of Trauma: Injury, Infection, and Critical Care)
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 1, 2019 Category: Orthopaedics Tags: 2019 WTA PODIUM PAPERS Source Type: research

Female platelets have distinct functional activity compared with male platelets: Implications in transfusion practice and treatment of trauma-induced coagulopathy
CONCLUSION Male and female platelets have differential response to stimuli, suggesting sex-dependent signaling and cellular activation. Female platelets have both increased aggregation and activation potential, and estradiol pretreatment feminizes male platelets to approximate female platelet activation with PAF. These findings offer potential explanation for sex-based differences in hemostatic potential in TIC and question whether donor sex of transfused platelets should be considered in resuscitation. Estradiol may also serve as a novel therapeutic adjunct in TIC. (Source: The Journal of Trauma: Injury, Infection, and Critical Care)
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 1, 2019 Category: Orthopaedics Tags: 2019 WTA PODIUM PAPERS Source Type: research

It's About Time: Transfusion effects on postinjury platelet aggregation over time
CONCLUSION Controversy exists on whether transfusions improve impaired postinjury platelet aggregation. Using regression modeling, we identified that expected transfusion effects on subsequent platelet aggregation are maximal with platelet transfusion given late after injury. This is critical for tailored resuscitation, identifying a potential early period of resistance to platelet transfusion that resolves by 96 hours. LEVEL OF EVIDENCE Therapeutic, level V. (Source: The Journal of Trauma: Injury, Infection, and Critical Care)
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 1, 2019 Category: Orthopaedics Tags: 2019 WTA PODIUM PAPERS Source Type: research