Trauma Surgery & Acute Care Open最新文献

Background: The healthcare burden and fatality rate associated with pediatric firearm injuries is increasing substantially. Most published studies evaluating outcomes and disparities of pediatric firearm-related injuries have focused primarily on hospital-level data. This study aimed to investigate mortality indicators among pediatric decedents referred to the Tennessee Chief Medical Examiner (CME) having a confirmed firearm-related cause of death.

Methods: In this retrospective cross-sectional study, the Tennessee CME database was queried to reveal 643 death certificates of children ages 17 years and younger who died from a firearm-related injury between 2012 and 2022. Death certificates were surveyed for demographics and residential data. Autopsy reports were reviewed for anatomic injury patterns. The neighborhood of residence for each decedent was geocoded for analysis using the Child Opportunity Index (COI). Pearson, Kruskal-Wallis, Wilcoxon, and linear regression modeling were completed.

Results: Significant increases in both homicide (n=369; p<0.0001) and suicide (n=202; p=0.001) were documented over time. Firearm deaths increased with age (median age, 16.0 years; IQR (13-17)), with ≥70% of homicide and suicide cases occurring between ages 15 years and 17 years. 272 homicide decedents (76%) were black, and 165 (82%) suicides were white (p<0.001). Over half of decedents sustained a head wound (p<0.001). Geocoded density maps indicated a correlation between pediatric population race density and predominating manners of firearm death. Residences with a lower COI level were associated with a higher risk of homicide.

Conclusion: In this query of the Tennessee CME registry, homicide rates increased and remained higher than all other firearm manners of death impacting children. This study revealed opportunities to affect meaningful change regarding different ages and manners of lethal firearm injuries among children.

Level of evidence: III.

Introduction: Acute myocardial infarction (MI), ischemic cerebrovascular accident (CVA), and peripheral vascular disease (PVD) are significant global health burdens that have been associated with cholelithiasis by multiple studies. However, the relationship between cholecystectomy and these vascular morbidities remains unclear. This study aims to investigate the long-term impact of cholecystectomy on MI, CVA and PVD.

Methods: This nationwide study analyzed data, which accounted for 59% of the Israeli population. Adult patients with cholelithiasis and no prior vascular morbidity (MI, CVA, and PVD) were followed for over 8 years and categorized into two groups: those who underwent cholecystectomy and those who did not. Incidence rates of MI, ischemic CVA (including transient ischemic attack), and PVD were compared between the groups using Cox regression models adjusted for demographics and comorbidities.

Results: Among the 142 834 eligible patients with cholelithiasis, 37 173 underwent cholecystectomy. Cholecystectomy cohort was associated with a modest protective effect on MI, ischemic CVA, and PVD, with lower incidence rates of MI (HR 0.91, 95% CI 0.86 to 0.96), ischemic CVA (HR 0.94, 95% CI 0.89 to 0.99), and PVD (HR 0.87, 95% CI 0.80 to 0.95) compared with the No-cholecystectomy cohort. Kaplan-Meier curves demonstrated significant separation in cumulative incidence rates favoring the cholecystectomy group for all three outcomes.

Conclusion: Cholecystectomy appears to be associated with reduced cumulative incidences of MI, ischemic CVA, and PVD in patients with cholelithiasis. Nonetheless, the relatively modest risk reduction observed in our study raises questions about the procedure's overall benefit versus the potential risks in the context of risk reduction measures.

Level of evidence: Level IV.

Background: 'Exception from informed consent' research requires community consultation to ensure that the views of the local population have been considered. Using market research companies to distribute surveys across local populations is attractive because it ensures adequate response rates. It is not known whether individuals who respond to surveys are typical of the targeted communities. The purpose of this study is to compare the demographics of the survey respondents with that of the general population in the same area.

Methods: This is an analysis of data collected as part of the 'Trauma Resuscitation with Group O Whole Blood or Products' (TROOP) trial. The surveys used a commercial market research service to reach the communities of interest and consisted of 18 questions designed to evaluate respondents' willingness to be enrolled in the TROOP trial and the demographics of survey respondents.

Results: Catchment populations varied from 0.5 to 9.4 million residents, with a total of 33.5 million. The racial and ethnic composition of the population (and the survey respondents, in brackets) was 44.8% (57.0%) white, 25.7% (13.4%) Hispanic, 12.7% (19.4%) black, 8.0% (2.5%) multiracial, 7.9% (4.4%) Asian, 0.7% (0.9%) Native American, and 0.2% (0.5%) Islanders. Of the male population (and survey respondents, in brackets), 12.2% (15.3%) were aged 18years to 24 years, 20.5% (22.3%) aged 25 years to 34 years, 18.1% (24.9%) aged 35 years to 44 years, 16.3% (18.5%) aged 45 years to 54 years, 15.5% (14.8%) aged 55 years to 64 years, and 17.4% (4.3%) aged 65 years and over. Of the female population (and survey respondents, in brackets), 11.0% (18.5%) were aged 18 years to 24 years, 18.4% (22.6%) aged 25 years to 34 years, 16.4% (23.5%) aged 35 years to 44 years, 15.0% (17.3%) aged 45 years to 54 years, 18.5% (14.1%) aged 55 years to 64 years, and 20.6% (3.9%) aged 65 years and over.

Conclusions: For this trial, using a market research company to distribute community surveys resulted in respondents that are broadly representative of the geographic areas where the trial will be conducted, except for individuals over the age of 65 years and older. This finding provides reassurance to investigators and institutional review boards that the views expressed by respondents are representative of the population where the trial will be conducted.

Level of evidence: III.