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Trauma Survivors Network: history and evolution of a program empowering survivors and families impacted by traumatic injury.
IF 2.1 Q3 CRITICAL CARE MEDICINE Pub Date : 2025-01-07 eCollection Date: 2025-01-01 DOI: 10.1136/tsaco-2024-001576
Eileen M Flores, Christopher P Michetti, Samir M Fakhry, Katherine Joseph, Elizabeth Wysocki, Anna Newcomb

The Trauma Survivors Network (TSN), a program of the American Trauma Society (ATS), has a unique history spanning decades with a vision to continue expanding and strengthening services to support survivors and families impacted by traumatic injury. Since the COVID-19 pandemic, the ATS has adapted TSN services to provide both virtual and in-person services for trauma survivors, increasing equity and inclusion for many survivors to access TSN services for the first time. The recent policy changes in the American College of Surgeons Committee on Trauma New Standards for Care of the Injured Patient provide an impetus for the TSN to grow and expand services in support of a diverse group of trauma survivors and their loved ones. This paper highlights the collateral impact of traumatic injury, the history and ongoing growth of the TSN and its services to date, the challenges encountered in establishing and maintaining the TSN program, and the equity and inclusion that the TSN offers internationally to support a diverse range of survivors with various forms of trauma and polytrauma.

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引用次数: 0
Optimizing robotic utilization: the role of preoperative grading scales in prioritizing robotic surgery for minimally invasive cholecystectomy.
IF 2.1 Q3 CRITICAL CARE MEDICINE Pub Date : 2025-01-04 eCollection Date: 2025-01-01 DOI: 10.1136/tsaco-2024-001713
Kristy Lynn Hawley, Madhuri Nagaraj, William Aaron Marshall
{"title":"Optimizing robotic utilization: the role of preoperative grading scales in prioritizing robotic surgery for minimally invasive cholecystectomy.","authors":"Kristy Lynn Hawley, Madhuri Nagaraj, William Aaron Marshall","doi":"10.1136/tsaco-2024-001713","DOIUrl":"10.1136/tsaco-2024-001713","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001713"},"PeriodicalIF":2.1,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Association between prophylactic intermittent non-invasive positive pressure ventilation and incidence of pneumonia in patients with cervical spinal cord injury: a retrospective single-center cohort study.
IF 2.1 Q3 CRITICAL CARE MEDICINE Pub Date : 2025-01-04 eCollection Date: 2025-01-01 DOI: 10.1136/tsaco-2024-001631
Yuita Fukuyama, Kazuhiro Okada, Takashi Tagami, Yoshiaki Hara, Shoji Yokobori

Background: Patients with cervical spinal cord injuries (CSCIs) have a high incidence of respiratory complications. The effectiveness of non-invasive positive pressure ventilation (NPPV) in preventing respiratory complications such as pneumonia in acute CSCIs remains unclear. We evaluated whether intermittent NPPV (iNPPV) could prevent pneumonia in patients with acute CSCIs.

Methods: This single-center, retrospective study evaluated patients diagnosed with CSCIs with American Spinal Injury Association Impairment Scale scores of A-C between January 2012 and December 2022. Patients were categorized based on receipt of iNPPV into the iNPPV and usual care groups. Prophylactic iNPPV was defined as the initiation of iNPPV within 72 hours of admission. The primary outcome was the development of pneumonia. The secondary outcomes were other respiratory complications (tracheal intubation and tracheostomy) and adverse events (delirium and vomiting). The groups were compared with regard to outcomes after adjustment for patient backgrounds using inverse probability of treatment weighting (IPTW) with propensity scores.

Results: Of the 213 patients during the study period, 94 were included. Of these, 61 (64.9%) received prophylactic iNPPV. The incidence of pneumonia was 27.9% in the iNPPV group and 48.5% in the usual care group in the unadjusted cohort. In the propensity score analysis using IPTW, the iNPPV group showed a lower incidence of pneumonia than the usual care group (29.0% vs 56.5%, p<0.001). Tracheal intubation and tracheostomy were less common in the iNPPV group than those in the usual care group (10.6% vs 29%; p=0.001 and 10.6% vs 27.1%; p=0.003, respectively). The incidences of delirium and vomiting did not increase in the iNPPV group.

Conclusions: Prophylactic iNPPV was associated with a lower incidence of pneumonia in patients with acute CSCIs.

Level of evidence: Ⅳ.

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引用次数: 0
Safety or speed? Assessing alternative vascular access for angiography after resuscitative endovascular balloon occlusion of the aorta (REBOA) in severe pelvic trauma patients.
IF 2.1 Q3 CRITICAL CARE MEDICINE Pub Date : 2025-01-04 eCollection Date: 2025-01-01 DOI: 10.1136/tsaco-2024-001530
Yau-Ren Chang, Yu-Tung Wu, Szu An Chen, Chih-Yuan Fu, Chi-Tung Cheng, Ling-Wei Kuo, Jen Fu Huang, Chien-Hung Liao, Chi-Hsun Hsieh
<p><strong>Introduction: </strong>Pelvic fractures often result in life-threatening bleeding and hemodynamic instability. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as a promising strategy for patients with severe pelvic fractures, facilitating subsequent hemostatic interventions. Transcatheter arterial embolization (TAE) is a well-established procedure for managing pelvic fractures accompanied by hemorrhage.Ideally, an angiographic access point distinct from the initial REBOA placement is sought to maintain REBOA deflation without complete removal, thereby preventing hemodynamic instability during the procedure. However, in cases of extreme and severe pelvic trauma, gaining access for REBOA is already challenging, not to mention the additional difficulty posed by subsequent angiographic access.This study aims to assess the challenges associated with gaining access in cases where successful TAE was ultimately performed, particularly in the context of severe pelvic trauma. We investigate the complexities surrounding access management and its implications for patient outcomes.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of patients who presented with pelvic fractures and underwent sequential REBOA and TAE procedures at our institution between 2017 and 2023. We excluded patients with Abbreviated Injury Scores (AIS) ≥3 in systems other than the pelvis, those who underwent TAE prior to REBOA, and cases of suboptimal REBOA insertion.We collected demographic data, injury characteristics, details of the REBOA and TAE procedures, information on complications, and data on patient survival. The primary endpoints of our analysis included overall survival and the success of TAE (defined as post TAE mean arterial pressure (MAP) ≥65 mm Hg). Secondary endpoints encompassed the duration details of two interventions.</p><p><strong>Results: </strong>Between 2017 and 2023, a total of 17 patients were included in this study. Among this cohort, 12 (70.6%) were male, with a median age of 51 years. Overall survival was 23.5%. Patients were grouped into angiography after REBOA deflation (AAD) or angiography after REBOA removal (AAR). AAR group was younger (39.0 vs 63.0, p=0.030) and had higher Shock Index at triage (2.30 vs 1.10, p=0.015). More patient whose post TAE MAP >=65 mm Hg was found in the AAR group, although no significant difference on overall survival (25.0% vs 22.2%, p=1.000). Angiographic cannulation times, pre-angiographic MAP, and amount of pre-angiographic transfusion of packed red blood cell were similar across groups.</p><p><strong>Conclusion: </strong>Our findings provide empirical insights into vascular access selection and suggest that AAR in the management of severe pelvic fractures can be beneficial, particularly when pre-angiographic resuscitation is sufficient. Larger studies are required to validate these observations and assess long-term outcomes.</p><p><strong>Level of evidence: </s
{"title":"Safety or speed? Assessing alternative vascular access for angiography after resuscitative endovascular balloon occlusion of the aorta (REBOA) in severe pelvic trauma patients.","authors":"Yau-Ren Chang, Yu-Tung Wu, Szu An Chen, Chih-Yuan Fu, Chi-Tung Cheng, Ling-Wei Kuo, Jen Fu Huang, Chien-Hung Liao, Chi-Hsun Hsieh","doi":"10.1136/tsaco-2024-001530","DOIUrl":"10.1136/tsaco-2024-001530","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Pelvic fractures often result in life-threatening bleeding and hemodynamic instability. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as a promising strategy for patients with severe pelvic fractures, facilitating subsequent hemostatic interventions. Transcatheter arterial embolization (TAE) is a well-established procedure for managing pelvic fractures accompanied by hemorrhage.Ideally, an angiographic access point distinct from the initial REBOA placement is sought to maintain REBOA deflation without complete removal, thereby preventing hemodynamic instability during the procedure. However, in cases of extreme and severe pelvic trauma, gaining access for REBOA is already challenging, not to mention the additional difficulty posed by subsequent angiographic access.This study aims to assess the challenges associated with gaining access in cases where successful TAE was ultimately performed, particularly in the context of severe pelvic trauma. We investigate the complexities surrounding access management and its implications for patient outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a retrospective analysis of patients who presented with pelvic fractures and underwent sequential REBOA and TAE procedures at our institution between 2017 and 2023. We excluded patients with Abbreviated Injury Scores (AIS) ≥3 in systems other than the pelvis, those who underwent TAE prior to REBOA, and cases of suboptimal REBOA insertion.We collected demographic data, injury characteristics, details of the REBOA and TAE procedures, information on complications, and data on patient survival. The primary endpoints of our analysis included overall survival and the success of TAE (defined as post TAE mean arterial pressure (MAP) ≥65 mm Hg). Secondary endpoints encompassed the duration details of two interventions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Between 2017 and 2023, a total of 17 patients were included in this study. Among this cohort, 12 (70.6%) were male, with a median age of 51 years. Overall survival was 23.5%. Patients were grouped into angiography after REBOA deflation (AAD) or angiography after REBOA removal (AAR). AAR group was younger (39.0 vs 63.0, p=0.030) and had higher Shock Index at triage (2.30 vs 1.10, p=0.015). More patient whose post TAE MAP &gt;=65 mm Hg was found in the AAR group, although no significant difference on overall survival (25.0% vs 22.2%, p=1.000). Angiographic cannulation times, pre-angiographic MAP, and amount of pre-angiographic transfusion of packed red blood cell were similar across groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Our findings provide empirical insights into vascular access selection and suggest that AAR in the management of severe pelvic fractures can be beneficial, particularly when pre-angiographic resuscitation is sufficient. Larger studies are required to validate these observations and assess long-term outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Level of evidence: &lt;/s","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"10 1","pages":"e001530"},"PeriodicalIF":2.1,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Feasibility of ultraportable US in detecting clinically concerning recurrent pneumothorax in patients with chest trauma. 超便携超声检测胸外伤患者复发性气胸的临床可行性。
IF 2.1 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-12-31 eCollection Date: 2024-01-01 DOI: 10.1136/tsaco-2024-001464
Abdul Hafiz Al Tannir, Courtney Pokrzywa, Patrick B Murphy, Elise A Biesboer, Juan Figueroa, Basil S Karam, Marc DeMoya, Thomas Carver

Background: Bedside thoracic ultrasound (US) offers numerous advantages over chest X-ray (CXR) for identification of recurrent pneumothoraces (PTX) after tube thoracostomy (TT) removal. Technologic advancements have led to the development of hand-held devices capable of producing high-quality images termed ultra-portable US (UPUS). We hypothesized that UPUS would be as successful as CXR in detecting post-TT removal PTX and would be preferred by patients.

Methods: We conducted a single-center prospective, feasibility, study at a level I trauma center investigating the use of UPUS in patients with trauma with TT placement. UPUS images were obtained daily while the TT was in place and post-TT removal (ranging from 1 through 6 hours). A clinically concerning PTX on UPUS was defined as the absence of lung sliding on two or more intercostal spaces. Poststudy Likert surveys were administered to assess patient preferences.

Results: Ninety-two patients were included in the analysis. The majority were men (87%), and the median age was 47 years. Thirty-five patients (36%) had discordant imaging findings. There were 11 clinically concerning PTX, of which 10 (91%) were detected on UPUS and 8 (73%) on CXR. Three patients required an intervention for post-pull PTX, all of whom were identified on UPUS. Eighty-four percent (N=70) of surveyed patients preferred UPUS over CXR with 92% reporting no discomfort with UPUS compared with 49% with CXR.

Conclusion: Bedside UPUS is preferred by patients and can successfully identify clinically concerning post-TT removal PTX. Implementation of UPUS as a post-TT removal diagnostic tool is a safe and effective alternative to CXR.

Level of evidence: Level II, diagnostic tests or criteria.

背景:胸旁超声(US)在诊断胸腔插管(TT)术后复发性气胸(PTX)方面比x线胸片(CXR)有许多优势。技术的进步导致了能够产生高质量图像的手持设备的发展,称为超便携式美国(UPUS)。我们假设UPUS在检测tt术后PTX方面与CXR一样成功,并且会受到患者的青睐。方法:我们在一家一级创伤中心进行了一项单中心前瞻性、可行性研究,调查UPUS在创伤放置TT患者中的应用。在TT放置期间和TT移除后(1至6小时)每天获取UPUS图像。临床上关注UPUS的PTX被定义为肺在两个或多个肋间隙上没有滑动。研究后进行李克特调查以评估患者的偏好。结果:92例患者纳入分析。大多数为男性(87%),中位年龄为47岁。35例(36%)患者影像学表现不一致。临床有PTX 11例,其中UPUS检出10例(91%),CXR检出8例(73%)。3例患者需要对牵拉后PTX进行干预,所有患者均在UPUS上被识别。84% (N=70)的受访患者更喜欢UPUS而不是CXR, 92%的患者报告UPUS没有不适,而CXR则为49%。结论:床边UPUS是患者的首选,可以成功识别临床tt术后PTX。UPUS作为tt后切除诊断工具的实施是CXR安全有效的替代方案。证据级别:II级,诊断测试或标准。
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引用次数: 0
Clinical utility of routine postoperative labs in emergency general surgery patients. 普通外科急诊病人术后常规化验室的临床应用。
IF 2.1 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-12-31 eCollection Date: 2024-01-01 DOI: 10.1136/tsaco-2024-001568
Rebecca Empey, Hyunkyu Ko, Ram Nirula

Background: Morning postoperative labs are often obtained for emergency general surgery (EGS) patients. Studies in other surgical fields indicate that routine postoperative day 1 (POD1) labs are sometimes being performed excessively and do not require intervention. The purpose of this study is to identify predictors indicating the need for POD1 labs in EGS patients based on likelihood of intervention.

Methods: This is a retrospective review of non-critically ill EGS patients from 2022 to 2023 who received POD1 morning labs. The odds of having an abnormal result and likelihood of intervention were measured through multivariate logistic regression accounting for patient characteristics and procedure. Least absolute shrinkage and selection operator (LASSO) regression analysis was performed to determine significant predictors of an abnormal result and intervention.

Results: 502 EGS patients were included. LASSO revealed that procedure duration, fever, lysis of adhesions, preoperative systolic blood pressure <90 mm Hg, older age, heart failure, operative blood loss, chronic kidney disease, and anticoagulation use were independent predictors for any abnormal result (area under the receiver operation curve (AUC)=0.785). Independent predictors of intervention were procedure duration, older age, higher estimated blood loss (EBL), anticoagulant use, and lysis of adhesions (AUC=0.704). Procedures >400 min carried an 84.3% chance of an abnormal lab requiring intervention. EBL >200 mL carried a 75.5% chance of an abnormal lab requiring intervention.

Conclusion: POD1 labs for non-critically ill EGS patient rarely require intervention and can be safely omitted. Labs should be considered for longer procedures, higher EBLs, older patients, those on anticoagulation, or after lysis of adhesions.

背景:急诊普外科(EGS)患者经常需要早晨的术后化验室。其他外科领域的研究表明,常规术后第1天(POD1)实验室有时被过度进行,不需要干预。本研究的目的是根据干预的可能性确定EGS患者需要POD1实验室的预测因素。方法:回顾性分析2022 - 2023年接受POD1晨检的非危重EGS患者。出现异常结果的几率和干预的可能性通过考虑患者特征和程序的多变量逻辑回归来测量。进行最小绝对收缩和选择算子(LASSO)回归分析,以确定异常结果和干预的显著预测因子。结果:纳入EGS患者502例。LASSO显示,手术时间、发热、粘连溶解、术前收缩压400 min有84.3%的机会出现异常,需要干预。EBL >200 mL有75.5%的可能性出现异常,需要干预。结论:非危重期EGS患者的POD1实验室无需干预,可安全省略。实验室应考虑手术时间较长、EBLs较高、年龄较大、抗凝治疗或粘连溶解后的患者。
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引用次数: 0
Patient education series: exploratory laparotomy. 患者教育系列:剖腹探查术。
IF 2.1 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-12-31 eCollection Date: 2024-01-01 DOI: 10.1136/tsaco-2024-001685
Aimee LaRiccia, Caitlin Anne Fitzgerald
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引用次数: 0
Delayed fascial closure for prolonged open abdomen. 延长开腹期延迟筋膜闭合。
IF 2.1 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-12-27 eCollection Date: 2024-01-01 DOI: 10.1136/tsaco-2024-001524
Taiki Yamataka, Shokei Matsumoto, Masayuki Shimizu
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引用次数: 0
Robotic versus Laparoscopic Emergency and Acute Care Surgery: Redefining Novelty (RLEARN): feasibility and benefit of robotic cholecystectomy for acute cholecystitis at a level 1 trauma center. 机器人与腹腔镜急诊和急性护理手术:重新定义新颖性(RLEARN):在一级创伤中心,机器人胆囊切除术治疗急性胆囊炎的可行性和益处。
IF 2.1 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-12-27 eCollection Date: 2024-01-01 DOI: 10.1136/tsaco-2024-001522
Joshua Klein, Mekedes Lemma, Kartik Prabhakaran, Aryan Rafieezadeh, Jordan Michael Kirsch, Gabriel Rodriguez, Ilyse Blazar, Anna Jose, Bardiya Zangbar

Background: This study aims to compare outcomes of robotic cholecystectomy (RC) versus laparoscopic cholecystectomy (LC) in the setting of a level 1 trauma center.

Methods: We performed a retrospective study of our hospital data (2021-2024) on patients who underwent LC or RC. Using a previously validated intraoperative grading system, four grades of cholecystitis were defined as mild (A), moderate (B), severe (C), and extreme (D). Outcomes were operative times and rates of conversion to open surgery.

Results: In total, 260 patients (n=130 RC and n=130 LC) were included. Patients were primarily female (69.2%), with mean age of 47±18.3 years. The majority of cases had grade B cholecystitis (41.2%). Patients undergoing RC had lower operative times compared with LC in grade B (101.87±17.54 vs 114.96±29.44 min, p=0.003) and grade C (134.68±26.97 vs 152.06±31.3 min, p=0.038). Conversion rate to open cholecystectomy were similar in both groups (p=0.19).

Conclusion: RC had similar results as LC in terms of operative time and in fact has significantly lower operative time in patients with grade B and grade C cholecystitis.

Level of evidence: Level III-retrospective study.

背景:本研究旨在比较机器人胆囊切除术(RC)与腹腔镜胆囊切除术(LC)在一级创伤中心的效果。方法:我们对我院(2021-2024)接受LC或RC的患者进行了回顾性研究。使用先前验证的术中分级系统,将胆囊炎分为轻度(a)、中度(B)、重度(C)和重度(D)四个级别。结果是手术时间和转向开放手术的比率。结果:共纳入260例(n=130例RC和n=130例LC)。患者以女性为主(69.2%),平均年龄47±18.3岁。多数病例为B级胆囊炎(41.2%)。与LC相比,RC患者在B级(101.87±17.54 vs 114.96±29.44 min, p=0.003)和C级(134.68±26.97 vs 152.06±31.3 min, p=0.038)的手术时间更短。两组转开腹胆囊切除术的发生率相似(p=0.19)。结论:RC与LC在手术时间上有相似的结果,事实上,在B级和C级胆囊炎患者中,RC的手术时间明显更短。证据等级:iii级-回顾性研究。
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引用次数: 0
Trauma-informed language as a tool for health equity. 创伤知情语言作为卫生公平的工具。
IF 2.1 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-12-24 eCollection Date: 2024-01-01 DOI: 10.1136/tsaco-2024-001558
Lucy Hart, John N Bliton, Christine Castater, Jessica H Beard, Randi N Smith
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引用次数: 0
期刊
Trauma Surgery & Acute Care Open
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