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Time to stroke: A Western Trauma Association multicenter study of blunt cerebrovascular injuries
CONCLUSIONS The majority of patients suffer BCVI-related stroke in the first 72 hours after injury. Time to stroke can help inform clinicians about initiation of treatment in the multiply injured patient. LEVEL OF EVIDENCE Prognostic/Epidemiologic, level III.
Source: The Journal of Trauma: Injury, Infection, and Critical Care - October 26, 2018 Category: Orthopaedics Tags: 2018 WTA PODIUM PAPER Source Type: research

Unfractionated heparin after TBI reduces in vivo cerebrovascular inflammation, brain edema and accelerates cognitive recovery
BACKGROUND: Severe traumatic brain injury (TBI) may increase the risk of venous thromboembolic complications; however, early prevention with heparinoids is often withheld for its anticoagulant effect. New evidence suggests low molecular weight heparin reduces cerebral edema and improves neurological recovery after stroke and TBI, through blunting of cerebral leukocyte (LEU) recruitment. It remains unknown if unfractionated heparin (UFH) similarly affects brain inflammation and neurological recovery post-TBI. We hypothesized that UFH after TBI reduces cerebral edema by reducing LEU-mediated inflammation and improves neurolo...
Source: The Journal of Trauma: Injury, Infection, and Critical Care - November 24, 2016 Category: Orthopaedics Tags: WTA 2016 Plenary Papers Source Type: research

Contemporary management of civilian penetrating cervicothoracic arterial injuries
CONCLUSIONS: Experience with penetrating arterial cervicothoracic injuries at a high-volume urban trauma center remained remarkably similar with respect to both anatomic distribution of injury and treatment. Conventional operative exposure and repair remain the cornerstone of treatment for most civilian cervicothoracic arterial injuries. LEVEL OF EVIDENCE: Therapeutic study, level V.
Source: The Journal of Trauma: Injury, Infection, and Critical Care - July 29, 2016 Category: Orthopaedics Tags: Original Articles Source Type: research

Early antithrombotic therapy is safe and effective in patients with blunt cerebrovascular injury and solid organ injury or traumatic brain injury
CONCLUSION: Initiation of early AT for patients with BCVI and concomitant TBI or SOI does not increase risk of worsening TBI or SOI above baseline. Close monitoring is required, but our results suggest that appropriate antiplatelet or heparin therapy should not be withheld in patients with BCVI and concomitant TBI or SOI. In fact, prompt treatment with either antiplatelet or heparin therapy remains the mainstay for prevention of stroke-related morbidity and mortality in these patients. LEVEL OF EVIDENCE: Therapeutic/care management study, level IV.
Source: The Journal of Trauma: Injury, Infection, and Critical Care - June 22, 2016 Category: Orthopaedics Tags: Original Articles Source Type: research

Embedding a trauma hospitalist in the trauma service reduces mortality and 30-day trauma-related readmissions
CONCLUSION: Our study provides evidence that embedding a hospitalist on the trauma service reduces mortality and trauma-related readmissions. A reason for these improved outcomes may be related to THOSP “vigilance.” LEVEL OF EVIDENCE: Therapeutic/care management study, level IV.
Source: The Journal of Trauma: Injury, Infection, and Critical Care - June 22, 2016 Category: Orthopaedics Tags: Original Articles Source Type: research

Intraoperative hypotensive resuscitation for patients undergoing laparotomy or thoracotomy for trauma: Early termination of a randomized prospective clinical trial
Conclusion: This study was unable to demonstrate that hypotensive resuscitation at a target MAP of 50 mm Hg could significantly improve 30-day mortality. Further study is necessary to fully realize the benefits of hypotensive resuscitation. LEVEL OF EVIDENCE: Therapeutic study, level II.
Source: The Journal of Trauma: Injury, Infection, and Critical Care - May 21, 2016 Category: Orthopaedics Tags: AAST 2015 Plenary Papers Source Type: research

A safe and effective management strategy for blunt cerebrovascular injury: Avoiding unnecessary anticoagulation and eliminating stroke
CONCLUSION: This management scheme using 64-channel CTA for screening coupled with DSA for definitive diagnosis was proven to be safe and effective in identifying clinically significant BCVIs and maintaining a low stroke rate. Definitive diagnosis by DSA led to avoidance of potentially harmful anticoagulation in 45% of CTA-positive patients (false-positive results). No strokes resulted from injuries missed by CTA. LEVEL OF EVIDENCE: Diagnostic study, level III.
Source: The Journal of Trauma: Injury, Infection, and Critical Care - May 21, 2016 Category: Orthopaedics Tags: AAST 2015 Plenary Papers Source Type: research

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