Pub Date : 2025-11-27DOI: 10.1016/j.amjsurg.2025.116755
Niranjna Swaminathan , ZhiXing Song , Christopher Wu , Ramsha Akhund , Jessica Fazendin , Brenessa Lindeman , Herbert Chen , Andrea Gillis
Background
Molecular testing (MT) aids in reducing unnecessary thyroidectomy for indeterminate thyroid nodules, primarily due to its high negative predictive value (NPV). However, its reliability in large nodules (≥4 cm), which carry a higher malignancy risk, remains unclear.
Methods
We performed a retrospective study of patients with thyroid nodules ≥4 cm who underwent fine-needle aspiration (FNA) at a tertiary care center from 2015 to 2023. Cytology was categorized using the Bethesda system. Molecular results (Afirma GEC and GSC) were matched with surgical pathology. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was classified as malignant.
Results
A total of 231 patients were included (mean age 52 ± 16 years; 69.7 % female). The median nodule size was 5.0 cm (IQR: 4.4–5.8). Malignancy was identified in 28.1 % of cases. Malignancy rates by Bethesda category were 4.3 % (Bethesda II), 33.8 % (III), and 50.0 % (IV), all Bethesda V and VI nodules were malignant. Among 96 patients with Bethesda III or IV cytology, 79 (82.3 %) underwent MT, 30 with GEC and 47 with GSC. GEC yielded 91.7 % sensitivity, 33.3 % specificity, and NPV of 85.7 %. GSC showed 88.9 % sensitivity, 58.6 % specificity, and NPV of 89.5 %. Malignancy occurred in 40.0 % (GEC) and 38.3 % (GSC) of tested nodules. False negatives included anaplastic carcinoma, oncocytic carcinoma, and NIFTP. Mutation testing revealed malignancy in 41.4 % of BRAF-negative and 44.8 % of RET/PTC-negative patients.
Conclusion
Molecular testing in nodules ≥4 cm may underestimate malignancy risk. Clinicians should interpret benign MT results in this subgroup with caution.
{"title":"Diagnostic value of molecular testing for evaluating thyroid nodules greater than 4 centimeters","authors":"Niranjna Swaminathan , ZhiXing Song , Christopher Wu , Ramsha Akhund , Jessica Fazendin , Brenessa Lindeman , Herbert Chen , Andrea Gillis","doi":"10.1016/j.amjsurg.2025.116755","DOIUrl":"10.1016/j.amjsurg.2025.116755","url":null,"abstract":"<div><h3>Background</h3><div>Molecular testing (MT) aids in reducing unnecessary thyroidectomy for indeterminate thyroid nodules, primarily due to its high negative predictive value (NPV). However, its reliability in large nodules (≥4 cm), which carry a higher malignancy risk, remains unclear.</div></div><div><h3>Methods</h3><div>We performed a retrospective study of patients with thyroid nodules ≥4 cm who underwent fine-needle aspiration (FNA) at a tertiary care center from 2015 to 2023. Cytology was categorized using the Bethesda system. Molecular results (Afirma GEC and GSC) were matched with surgical pathology. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was classified as malignant.</div></div><div><h3>Results</h3><div>A total of 231 patients were included (mean age 52 ± 16 years; 69.7 % female). The median nodule size was 5.0 cm (IQR: 4.4–5.8). Malignancy was identified in 28.1 % of cases. Malignancy rates by Bethesda category were 4.3 % (Bethesda II), 33.8 % (III), and 50.0 % (IV), all Bethesda V and VI nodules were malignant. Among 96 patients with Bethesda III or IV cytology, 79 (82.3 %) underwent MT, 30 with GEC and 47 with GSC. GEC yielded 91.7 % sensitivity, 33.3 % specificity, and NPV of 85.7 %. GSC showed 88.9 % sensitivity, 58.6 % specificity, and NPV of 89.5 %. Malignancy occurred in 40.0 % (GEC) and 38.3 % (GSC) of tested nodules. False negatives included anaplastic carcinoma, oncocytic carcinoma, and NIFTP. Mutation testing revealed malignancy in 41.4 % of BRAF-negative and 44.8 % of RET/PTC-negative patients.</div></div><div><h3>Conclusion</h3><div>Molecular testing in nodules ≥4 cm may underestimate malignancy risk. Clinicians should interpret benign MT results in this subgroup with caution.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"252 ","pages":"Article 116755"},"PeriodicalIF":2.7,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-26DOI: 10.1016/j.amjsurg.2025.116754
Niranjna Swaminathan, Sanya Nathani, Andrea Gillis, Sophie Dream, Brenessa Lindeman, Herbert Chen, Peter J Abraham
{"title":"Diagnostic localization techniques in Primary hyperparathyroidism: Is PET Choline the new gold standard?","authors":"Niranjna Swaminathan, Sanya Nathani, Andrea Gillis, Sophie Dream, Brenessa Lindeman, Herbert Chen, Peter J Abraham","doi":"10.1016/j.amjsurg.2025.116754","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116754","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116754"},"PeriodicalIF":2.7,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145740577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-26DOI: 10.1016/j.amjsurg.2025.116753
Alexandra Savage, Rachael Caretti, Hector Caceres, Madeleine Obuya, Zhixing Song, Sanajana Balachandra, Jessica Fazendin, Brenessa Lindeman, Andrea Gillis, Sophie Dream, Herbert Chen
{"title":"Patients with primary hyperparathyroidism who required three or more parathyroidectomies: Could this be prevented?","authors":"Alexandra Savage, Rachael Caretti, Hector Caceres, Madeleine Obuya, Zhixing Song, Sanajana Balachandra, Jessica Fazendin, Brenessa Lindeman, Andrea Gillis, Sophie Dream, Herbert Chen","doi":"10.1016/j.amjsurg.2025.116753","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116753","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116753"},"PeriodicalIF":2.7,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145666748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-25DOI: 10.1016/j.amjsurg.2025.116735
Haneen Kamran , Muhammad Umar Bhatti , Sameen Tahira , Umm E. Aimen Minhas , Farah Khan , Muhammad Ahsan Asif , Azeem Khalid , Juaquito Jorge , Kashaf Sherafgan
Background
Obesity increases mortality risk in emergency abdominal surgery patients, yet large-scale, population-level analyses remain scarce.
Methods
This study analyzed U.S. mortality trends (1999–2020) from the CDC WONDER database, assessing mortality both overall and in obese patients with acute abdominal surgical emergencies (ASE) using ICD-10 codes. Age-adjusted mortality rates (AAMRs) and annual percent changes (APCs) were calculated.
Results
Obesity-related ASE AAMR rose significantly from 2.05 to 5.5 per million, with a marked increase post-2018 (APC = 23.42). Mortality was higher in women but increased faster in men in the obesity group in contrast to higher ASE related mortality in males overall. Significant racial disparities were noted, with obesity related ASE mortality highest among non-Hispanic American Indians. Regionally, the South exhibited the steepest mortality increase.
Conclusion
Rising trends in obesity-related mortality in abdominal surgical emergencies, showing racial and regional disparities, call for targeted interventions.
{"title":"U.S. mortality in abdominal surgical emergencies: Comparative analysis of obesity-associated vs overall deaths (1999–2020)","authors":"Haneen Kamran , Muhammad Umar Bhatti , Sameen Tahira , Umm E. Aimen Minhas , Farah Khan , Muhammad Ahsan Asif , Azeem Khalid , Juaquito Jorge , Kashaf Sherafgan","doi":"10.1016/j.amjsurg.2025.116735","DOIUrl":"10.1016/j.amjsurg.2025.116735","url":null,"abstract":"<div><h3>Background</h3><div>Obesity increases mortality risk in emergency abdominal surgery patients, yet large-scale, population-level analyses remain scarce.</div></div><div><h3>Methods</h3><div>This study analyzed U.S. mortality trends (1999–2020) from the CDC WONDER database, assessing mortality both overall and in obese patients with acute abdominal surgical emergencies (ASE) using ICD-10 codes. Age-adjusted mortality rates (AAMRs) and annual percent changes (APCs) were calculated.</div></div><div><h3>Results</h3><div>Obesity-related ASE AAMR rose significantly from 2.05 to 5.5 per million, with a marked increase post-2018 (APC = 23.42). Mortality was higher in women but increased faster in men in the obesity group in contrast to higher ASE related mortality in males overall. Significant racial disparities were noted, with obesity related ASE mortality highest among non-Hispanic American Indians. Regionally, the South exhibited the steepest mortality increase.</div></div><div><h3>Conclusion</h3><div>Rising trends in obesity-related mortality in abdominal surgical emergencies, showing racial and regional disparities, call for targeted interventions.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"252 ","pages":"Article 116735"},"PeriodicalIF":2.7,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145675952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-25DOI: 10.1016/j.amjsurg.2025.116749
Brenda Feres , Sofia Wagemaker Viana , Gabriele Eckerdt Lech , Yasmin Biscola Da Cruz , Mecker G. Möller
Background
Inequitable representation on journal editorial boards (EB) may hinder females' career advancement in leadership positions.
Methods
We conducted a cross-sectional study analyzing gender representation in EB of surgical oncology journals. Members were classified as “editor-in-chief”, “senior editorial leadership”, “board and advisory members”, and “editorial management and support”, with first names used to predict female representation.
Results
We included 24 surgical oncology journals and analyzed 2097 names. Females held 33.1 % (694/2097) of EB positions (p < 0.001). A chi-square analysis revealed a significant difference in gender representation across editorial roles (p < 0.001). Females held fewer editor-in-chief roles (17.9 %, 5/28) compared to board and advisory members (30.1 %, 473/1574). Overall, 4/24 journals had a statement about diversity/equity on the EB, despite none showing equal proportion.
Conclusion
Female surgeons remain underrepresented in leadership positions, underscoring the need to improve equity and females’ advancement.
{"title":"Confronting inequality: The Stark disparity of female representation in surgical oncology journals’ editorial boards","authors":"Brenda Feres , Sofia Wagemaker Viana , Gabriele Eckerdt Lech , Yasmin Biscola Da Cruz , Mecker G. Möller","doi":"10.1016/j.amjsurg.2025.116749","DOIUrl":"10.1016/j.amjsurg.2025.116749","url":null,"abstract":"<div><h3>Background</h3><div>Inequitable representation on journal editorial boards (EB) may hinder females' career advancement in leadership positions.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional study analyzing gender representation in EB of surgical oncology journals. Members were classified as “editor-in-chief”, “senior editorial leadership”, “board and advisory members”, and “editorial management and support”, with first names used to predict female representation.</div></div><div><h3>Results</h3><div>We included 24 surgical oncology journals and analyzed 2097 names. Females held 33.1 % (694/2097) of EB positions (p < 0.001). A chi-square analysis revealed a significant difference in gender representation across editorial roles (p < 0.001). Females held fewer editor-in-chief roles (17.9 %, 5/28) compared to board and advisory members (30.1 %, 473/1574). Overall, 4/24 journals had a statement about diversity/equity on the EB, despite none showing equal proportion.</div></div><div><h3>Conclusion</h3><div>Female surgeons remain underrepresented in leadership positions, underscoring the need to improve equity and females’ advancement.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"252 ","pages":"Article 116749"},"PeriodicalIF":2.7,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145733227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-23DOI: 10.1016/j.amjsurg.2025.116733
Kelsey B. Montgomery , Nicole Rademacher , Joshua S. Richman , Smita Bhatia , Kristy K. Broman
Background
Implementation of evidence-based practices (EBPs) can serve as an indicator of quality for common cancers. This study evaluated the impact of hospital volume on EBP implementation for common cancers.
Methods
This retrospective cohort study of adults who underwent curative-intent treatment for breast, colon, melanoma, and thyroid cancer from 2010 to 2020 used data from the National Cancer Database. Eight EBP measures, two per disease site, were evaluated across facility volume quartiles using mixed-effects logistic regression models adjusted for patient and facility characteristics.
Results
There were 2,893,655 patients (breast n = 1,731,433, colon n = 481,858, melanoma.
n = 418,841, thyroid n = 261,523) (median age 63). EBP implementation was higher at the highest-volume sites compared to lowest (range by measure: 71 %–95 % and 60 %–90 % respectively). The adjusted odds of receiving EBP was greater at higher-volume facilities for six of eight measures.
Conclusion
Volume-associations in EBP implementation may influence system-level decision making around care allocation for common cancers.
{"title":"Healthcare facility volume and evidence-based practice implementation in surgical care of patients with common cancers","authors":"Kelsey B. Montgomery , Nicole Rademacher , Joshua S. Richman , Smita Bhatia , Kristy K. Broman","doi":"10.1016/j.amjsurg.2025.116733","DOIUrl":"10.1016/j.amjsurg.2025.116733","url":null,"abstract":"<div><h3>Background</h3><div>Implementation of evidence-based practices (EBPs) can serve as an indicator of quality for common cancers. This study evaluated the impact of hospital volume on EBP implementation for common cancers.</div></div><div><h3>Methods</h3><div>This retrospective cohort study of adults who underwent curative-intent treatment for breast, colon, melanoma, and thyroid cancer from 2010 to 2020 used data from the National Cancer Database. Eight EBP measures, two per disease site, were evaluated across facility volume quartiles using mixed-effects logistic regression models adjusted for patient and facility characteristics.</div></div><div><h3>Results</h3><div>There were 2,893,655 patients (breast n = 1,731,433, colon n = 481,858, melanoma.</div><div>n = 418,841, thyroid n = 261,523) (median age 63). EBP implementation was higher at the highest-volume sites compared to lowest (range by measure: 71 %–95 % and 60 %–90 % respectively). The adjusted odds of receiving EBP was greater at higher-volume facilities for six of eight measures.</div></div><div><h3>Conclusion</h3><div>Volume-associations in EBP implementation may influence system-level decision making around care allocation for common cancers.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"252 ","pages":"Article 116733"},"PeriodicalIF":2.7,"publicationDate":"2025-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145616367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-22DOI: 10.1016/j.amjsurg.2025.116711
Isabella Faria, Camila R Guetter, Morgan Hopp, Rachna Sridhar, Chantal Reyna, Charlotte Kvasnovsky, Yangyang Ru Yu, Asanthi Ratnasekera, Catherine H Davis
Background: Mentorship, coaching, and sponsorship are critical for professional advancement in surgical careers. This study examines these different forms of support among surgeons and trainees.
Methods: An electronic survey was developed and disseminated on social media and was hosted by the Association of Women Surgeons (AWS). Members and non-members of the AWS from diverse backgrounds, including trainees and students and those in academic and community practices were queried on various demographic and professional characteristics. The primary outcome of interest was access to mentorship, sponsorship and coaching. Chi-square, Fisher's exact tests, and logistic regression models were applied to analyze survey responses.
Results: Of 93 respondents, 48 % reported knowing the difference between mentors, coaches, and sponsors. 65 % of participants reported having a mentor, 28 % a sponsor, and 17 % a coach. Community-based surgeons were less likely to have mentors compared to academic surgeons (OR 0.09, 95 % CI 0.01-0.69, p = 0.02). Administrative leaders were more likely to have sponsors (admin leaders 44.8 % vs. non admin 21.3 %, p = 0.02) and coaches (admin leaders 31 % vs. non admin 11.5 %, p = 0.02). Identifying people within one's organization and time constraints were the most common barriers to having that support.
Conclusions: Efforts by institutions and surgical societies are needed to increase the availability of mentors, sponsors and coaches, particularly for community-based and early-career surgeons.
背景：指导、指导和赞助是外科职业发展的关键。本研究考察了外科医生和实习生之间这些不同形式的支持。方法：由女性外科医生协会（AWS）主办的电子调查在社交媒体上进行了开发和传播。来自不同背景的AWS会员和非会员，包括学员和学生以及从事学术和社区实践的人员，被问及各种人口和专业特征。兴趣的主要结果是获得指导、赞助和指导。采用卡方检验、Fisher精确检验和逻辑回归模型对调查结果进行分析。结果：在93名受访者中，48%的人表示知道导师、教练和赞助商之间的区别。65%的参与者报告有导师，28%的人有赞助商，17%的人有教练。社区外科医生比学术外科医生更不可能有导师（OR 0.09, 95% CI 0.01-0.69, p = 0.02）。行政领导更有可能有赞助者（行政领导44.8%，非行政领导21.3%,p = 0.02）和教练（行政领导31%，非行政领导11.5%,p = 0.02）。确定组织内的人员和时间限制是获得这种支持的最常见障碍。结论：机构和外科学会需要努力增加导师、赞助者和教练的可用性，特别是对社区和早期职业外科医生。
{"title":"Mapping pathways to professional support: The role of mentorship, coaching, and sponsorship in surgical careers.","authors":"Isabella Faria, Camila R Guetter, Morgan Hopp, Rachna Sridhar, Chantal Reyna, Charlotte Kvasnovsky, Yangyang Ru Yu, Asanthi Ratnasekera, Catherine H Davis","doi":"10.1016/j.amjsurg.2025.116711","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116711","url":null,"abstract":"<p><strong>Background: </strong>Mentorship, coaching, and sponsorship are critical for professional advancement in surgical careers. This study examines these different forms of support among surgeons and trainees.</p><p><strong>Methods: </strong>An electronic survey was developed and disseminated on social media and was hosted by the Association of Women Surgeons (AWS). Members and non-members of the AWS from diverse backgrounds, including trainees and students and those in academic and community practices were queried on various demographic and professional characteristics. The primary outcome of interest was access to mentorship, sponsorship and coaching. Chi-square, Fisher's exact tests, and logistic regression models were applied to analyze survey responses.</p><p><strong>Results: </strong>Of 93 respondents, 48 % reported knowing the difference between mentors, coaches, and sponsors. 65 % of participants reported having a mentor, 28 % a sponsor, and 17 % a coach. Community-based surgeons were less likely to have mentors compared to academic surgeons (OR 0.09, 95 % CI 0.01-0.69, p = 0.02). Administrative leaders were more likely to have sponsors (admin leaders 44.8 % vs. non admin 21.3 %, p = 0.02) and coaches (admin leaders 31 % vs. non admin 11.5 %, p = 0.02). Identifying people within one's organization and time constraints were the most common barriers to having that support.</p><p><strong>Conclusions: </strong>Efforts by institutions and surgical societies are needed to increase the availability of mentors, sponsors and coaches, particularly for community-based and early-career surgeons.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116711"},"PeriodicalIF":2.7,"publicationDate":"2025-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145666792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-22DOI: 10.1016/j.amjsurg.2025.116739
Cornelia L Griggs, Andrea L Merrill
{"title":"The hidden reason many women are leaving surgery: They're being pushed out.","authors":"Cornelia L Griggs, Andrea L Merrill","doi":"10.1016/j.amjsurg.2025.116739","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116739","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116739"},"PeriodicalIF":2.7,"publicationDate":"2025-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-21DOI: 10.1016/j.amjsurg.2025.116729
Tyler J. Johnston , Dina M. Filiberto , Peter B. DePhillips , Chandler E. Morel , Peter E. Fischer , Andy J. Kerwin , Emily K. Lenart , Saskya E. Byerly
Background
Pre-hospital triage is critical for resource-allocation and patient-outcomes. This study aimed to assess the sensitivity (SN) of updated 2021 Field Triage Guidelines (FTGs) and trauma center activation criteria (TAC) related to Need for Trauma Intervention (NFTI).
Methods
Data were collected to identify FTGs Red Criteria (RC) and Yellow Criteria (YC) and NFTI: pRBC within 4 h, operating room within 90 min, interventional radiology, ICU length-of-stay ≥3 days, mechanical ventilation within 3 days, or death within 60 h. SN was analyzed for RC and TAC. Lastly, logistic regressions assessed covariates associated with under-triage (UT).
Results
319 patients were included. SN of RC and TAC were 79 % and 77 %, respectively. Regression analysis showed UT by RC and TAC was associated with blunt mechanism.
Conclusions
FTGs did not meet ACS goals of ≤5 % UT and ≤35 % OT with blunt mechanism being associated with UT.
{"title":"Assessing the performance of the updated 2021 Field Triage Guidelines with the Need For Trauma Intervention (NFTI) metric","authors":"Tyler J. Johnston , Dina M. Filiberto , Peter B. DePhillips , Chandler E. Morel , Peter E. Fischer , Andy J. Kerwin , Emily K. Lenart , Saskya E. Byerly","doi":"10.1016/j.amjsurg.2025.116729","DOIUrl":"10.1016/j.amjsurg.2025.116729","url":null,"abstract":"<div><h3>Background</h3><div>Pre-hospital triage is critical for resource-allocation and patient-outcomes. This study aimed to assess the sensitivity (SN) of updated 2021 Field Triage Guidelines (FTGs) and trauma center activation criteria (TAC) related to Need for Trauma Intervention (NFTI).</div></div><div><h3>Methods</h3><div>Data were collected to identify FTGs Red Criteria (RC) and Yellow Criteria (YC) and NFTI: pRBC within 4 h, operating room within 90 min, interventional radiology, ICU length-of-stay ≥3 days, mechanical ventilation within 3 days, or death within 60 h. SN was analyzed for RC and TAC. Lastly, logistic regressions assessed covariates associated with under-triage (UT).</div></div><div><h3>Results</h3><div>319 patients were included. SN of RC and TAC were 79 % and 77 %, respectively. Regression analysis showed UT by RC and TAC was associated with blunt mechanism.</div></div><div><h3>Conclusions</h3><div>FTGs did not meet ACS goals of ≤5 % UT and ≤35 % OT with blunt mechanism being associated with UT.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"252 ","pages":"Article 116729"},"PeriodicalIF":2.7,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145659833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号