Pub Date : 2025-02-01DOI: 10.1016/j.amjsurg.2024.116121
Bahaa Succar , Nicole Lunardi , Kaustubh Gopal , Macy Afsari , Madhuri B. Nagaraj , Herbert J. Zeh III , Ryan P. Dumas
Introduction
Trauma team performance, measured by the non-technical skills scale T-NOTECHS, has been shown to impact patient outcomes. We assess how personnel movements affect non-technical skills and time of resuscitation(TOR) using trauma video review.
Methods
A prospective study of blunt and/or penetrating trauma activations recorded between May and November 2023 at a Level-I trauma center. Regressions controlling for confounders were used to measure the association between foot traffic and the outcomes of interest1: TOR2 T-NOTECHS score(Smith et al., 2015; Mackenzie et al., 2007; Maiga et al., 2024; Vella et al., 2024; Pucher et al., 2014; Dumas et al., 2020; Succar et al., 2024; Steinemann et al., 2012; Andersson et al., 2012; Conrad et al., 2010; Lies and Zhang, 2015) .5-155-15
Results
We identified 77 trauma activations, with 40 %(n = 32/77) penetrating injuries. There was a median of 17[14–18] individuals at the start of trauma activations. During resuscitations, individuals entered the room a median of 12[8–18] times and exited the room 17[11–22] times. The median TOR was 8[6–10] min and the median T-NOTECHS was 7[6–8]. Regression analysis showed foot traffic was independently associated with increased TOR(β 0.34, p-value <0.01) and worse total T-NOTECHS score(β 0.06, p < 0.01).
Conclusions
Higher foot traffic is associated with poorer team performance and delays in resuscitation. Future directions should further explore environmental and personal factors that may impede performance metrics.
简介：创伤团队的表现，由非技术技能量表T-NOTECHS衡量，已被证明影响患者的结果。我们评估人员流动如何影响非技术技能和复苏时间（TOR）使用创伤视频回顾。方法：对2023年5月至11月在一级创伤中心记录的钝性和/或穿透性创伤激活进行前瞻性研究。使用控制混杂因素的回归来测量人流量与感兴趣结果之间的关联1:TOR2 T-NOTECHS评分(Smith et al., 2015；Mackenzie et al., 2007；Maiga等，2024；Vella et al., 2024；Pucher et al., 2014；Dumas et al., 2020；Succar et al., 2024；Steinemann等人，2012；Andersson等人，2012；Conrad et al., 2010；结果：我们发现了77例创伤激活，其中40% （n = 32/77）为穿透性损伤。在创伤激活开始时，中位数为17人[14-18]。在复苏过程中，个体进入房间的平均次数为12次[8-18]，离开房间的平均次数为17次[11-22]。中位TOR为8[6-10]min，中位T-NOTECHS为7[6-8]。回归分析显示，人流量与TOR升高独立相关（β 0.34， p值）。结论：较高的人流量与较差的团队绩效和复苏延迟相关。未来的方向应该进一步探索可能阻碍绩效指标的环境和个人因素。
{"title":"Trauma video review analysis: Increased provider movement impedes trauma team performance","authors":"Bahaa Succar , Nicole Lunardi , Kaustubh Gopal , Macy Afsari , Madhuri B. Nagaraj , Herbert J. Zeh III , Ryan P. Dumas","doi":"10.1016/j.amjsurg.2024.116121","DOIUrl":"10.1016/j.amjsurg.2024.116121","url":null,"abstract":"<div><h3>Introduction</h3><div>Trauma team performance, measured by the non-technical skills scale T-NOTECHS, has been shown to impact patient outcomes. We assess how personnel movements affect non-technical skills and time of resuscitation(TOR) using trauma video review.</div></div><div><h3>Methods</h3><div>A prospective study of blunt and/or penetrating trauma activations recorded between May and November 2023 at a Level-I trauma center. Regressions controlling for confounders were used to measure the association between foot traffic and the outcomes of interest<sup>1</sup>: TOR<sup>2</sup> T-NOTECHS score(Smith et al., 2015; Mackenzie et al., 2007; Maiga et al., 2024; Vella et al., 2024; Pucher et al., 2014; Dumas et al., 2020; Succar et al., 2024; Steinemann et al., 2012; Andersson et al., 2012; Conrad et al., 2010; Lies and Zhang, 2015) .5-155-15</div></div><div><h3>Results</h3><div>We identified 77 trauma activations, with 40 %(n = 32/77) penetrating injuries. There was a median of 17[14–18] individuals at the start of trauma activations. During resuscitations, individuals entered the room a median of 12[8–18] times and exited the room 17[11–22] times. The median TOR was 8[6–10] min and the median T-NOTECHS was 7[6–8]. Regression analysis showed foot traffic was independently associated with increased TOR(β 0.34, p-value <0.01) and worse total T-NOTECHS score(β 0.06, p < 0.01).</div></div><div><h3>Conclusions</h3><div>Higher foot traffic is associated with poorer team performance and delays in resuscitation. Future directions should further explore environmental and personal factors that may impede performance metrics.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"240 ","pages":"Article 116121"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142783606","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 : 2025-02-01DOI: 10.1016/j.amjsurg.2024.116123
Luis Adrian Alvarez-Lozada , Bernardo Alfonso Fernandez-Reyes , Francisco Javier Arrambide-Garza , Mariana García-Leal , Neri Alejandro Alvarez-Villalobos , Javier Humberto Martínez-Garza , Bernardo Fernández-Rodarte , Rodrigo E. Elizondo-Omaña , Alejandro Quiroga-Garza
Introduction
Early diagnosis of acute appendicitis is crucial to prevent complications. Numerous scores exist, but a comprehensive review comparing them is lacking. This systematic review aimed to compare all published clinical scoring systems for diagnosing acute appendicitis in adults.
Methods
A systematic review and meta-analysis included studies assessing the diagnostic accuracy of clinical scores compared to histopathological findings for appendicitis. Sensitivities, specificities, diagnostic odds ratios (DOR), and summary receiver operating characteristics (SROC) were calculated.
Results
A total of 40 studies were included. The RIPASA score showed superior sensitivity (0.93 [95 % CI 0.78–0.98]; I2 = 96 %), specificity (0.81 [95 % CI 0.62–0.91]; I2 = 86 %), and DOR (45.3 [95 % CI 10.9–187.2]; I2 = 89 %). The AUC for the SROC curve of the RIPASA score was 0.913. A significant difference was found between the RIPASA score and both the Alvarado score (p < 0.002) and the Modified Alvarado score (p < 0.004) in SROC curves.
Conclusions
Our findings indicate that RIPASA is the most effective scoring system. Although the Alvarado score is the most studied, many other scores possess higher diagnostic accuracy.
早期诊断是预防急性阑尾炎并发症的关键。虽然有很多分数，但还没有对它们进行全面的比较。本系统综述旨在比较所有已发表的诊断成人急性阑尾炎的临床评分系统。方法：系统回顾和荟萃分析纳入了评估阑尾炎临床评分与组织病理学结果诊断准确性的研究。计算敏感性、特异性、诊断优势比（DOR）和总受试者工作特征（SROC）。结果：共纳入40项研究。RIPASA评分显示出更高的敏感性(0.93 [95% CI 0.78-0.98]；I2 = 96%),特异性(0.81 (95% CI 0.62 - -0.91);I2 = 86%)和金龟子(45.3 (95% CI 10.9 - -187.2);i2 = 89%)。RIPASA评分的SROC曲线AUC为0.913。结论：我们的研究结果表明，RIPASA是最有效的评分系统。虽然阿尔瓦拉多评分是研究最多的，但许多其他评分具有更高的诊断准确性。
{"title":"Clinical scores for acute appendicitis in adults: A systematic review and meta-analysis of diagnostic accuracy studies","authors":"Luis Adrian Alvarez-Lozada , Bernardo Alfonso Fernandez-Reyes , Francisco Javier Arrambide-Garza , Mariana García-Leal , Neri Alejandro Alvarez-Villalobos , Javier Humberto Martínez-Garza , Bernardo Fernández-Rodarte , Rodrigo E. Elizondo-Omaña , Alejandro Quiroga-Garza","doi":"10.1016/j.amjsurg.2024.116123","DOIUrl":"10.1016/j.amjsurg.2024.116123","url":null,"abstract":"<div><h3>Introduction</h3><div>Early diagnosis of acute appendicitis is crucial to prevent complications. Numerous scores exist, but a comprehensive review comparing them is lacking. This systematic review aimed to compare all published clinical scoring systems for diagnosing acute appendicitis in adults.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis included studies assessing the diagnostic accuracy of clinical scores compared to histopathological findings for appendicitis. Sensitivities, specificities, diagnostic odds ratios (DOR), and summary receiver operating characteristics (SROC) were calculated.</div></div><div><h3>Results</h3><div>A total of 40 studies were included. The RIPASA score showed superior sensitivity (0.93 [95 % CI 0.78–0.98]; I<sup>2</sup> = 96 %), specificity (0.81 [95 % CI 0.62–0.91]; I<sup>2</sup> = 86 %), and DOR (45.3 [95 % CI 10.9–187.2]; I<sup>2</sup> = 89 %). The AUC for the SROC curve of the RIPASA score was 0.913. A significant difference was found between the RIPASA score and both the Alvarado score (p < 0.002) and the Modified Alvarado score (p < 0.004) in SROC curves.</div></div><div><h3>Conclusions</h3><div>Our findings indicate that RIPASA is the most effective scoring system. Although the Alvarado score is the most studied, many other scores possess higher diagnostic accuracy.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"240 ","pages":"Article 116123"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142816987","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 : 2025-02-01DOI: 10.1016/j.amjsurg.2024.116125
Jefferson A. Proaño-Zamudio , Ikemsinachi C. Nzenwa , May Abiad , Dias Argandykov , Anne-Sophie C. Romijn , Emanuele Lagazzi , Wardah Rafaqat , Charudutt N. Paranjape , George C. Velmahos , Haytham M.A. Kaafarani , John O. Hwabejire
Background
Intraoperative adverse events (iAEs) during general surgery can lead to significant morbidity and healthcare burden, yet their impact remains underexplored. We aimed to estimate the nationwide incidence of iAEs in general surgery and explore their associations with mortality, complications, length of stay, and costs.
Methods
We conducted a retrospective cohort study using the Nationwide Readmissions Database 2019 and included adult patients (aged 18 years and older) who underwent general surgical procedures. Eligible patients were grouped based on the presence of an iAE, defined as an unrecognized abdominopelvic accidental puncture or laceration. The primary outcome was in-hospital mortality, while secondary outcomes included 30-day post-operative complications, length of stay, and total inpatient costs. Multivariable logistic and linear regression models were used to examine the association between the presence of an iAE and post-operative outcomes and costs.
Results
A total of 701,866 patients were included. The mean age was 55.1 years, and 60.0 % were female. 6350 (0.9 %) experienced an iAE. The procedure with the highest incidence of iAE was small bowel resection (2.3 %). On univariate analysis, patients who experienced an iAE had higher mortality (3.8 % vs. 1.5 %, P < 0.001), 30-day complications, length of stay, and inpatient costs. After multivariable regression, iAEs were independently associated with an increase in in-hospital mortality, length of stay, unplanned readmission, wound complications, acute kidney injury, sepsis, surgical site infection, ileus, and inpatient costs.
Conclusions
Despite their low incidence, iAEs are associated with heightened rates of complications and healthcare utilization. Incorporating iAEs into surgical quality initiatives and developing iAE reporting standards is warranted.
背景：普通外科手术中的术中不良事件（iae）可导致显著的发病率和医疗负担，但其影响仍未得到充分探讨。我们的目的是估计全国普通外科的iae发生率，并探讨其与死亡率、并发症、住院时间和费用的关系。方法：我们使用2019年全国再入院数据库进行了一项回顾性队列研究，纳入了接受普通外科手术的成年患者（18岁及以上）。符合条件的患者根据iAE的存在进行分组，iAE定义为未被识别的腹部骨盆意外穿刺或撕裂。主要结局是住院死亡率，次要结局包括术后30天并发症、住院时间和总住院费用。使用多变量logistic和线性回归模型来检查iAE的存在与术后结果和成本之间的关系。结果：共纳入701866例患者。平均年龄55.1岁，女性占60.0%。6350例（0.9%）发生iAE。iAE发生率最高的手术是小肠切除术（2.3%）。在单变量分析中，经历过iAE的患者死亡率更高（3.8% vs. 1.5%）。结论：尽管iAE的发病率较低，但其与并发症和医疗保健使用率的增加有关。将iAE纳入手术质量计划并制定iAE报告标准是有必要的。
{"title":"Impact of intraoperative adverse events in general and gastrointestinal surgery: A nationwide study","authors":"Jefferson A. Proaño-Zamudio , Ikemsinachi C. Nzenwa , May Abiad , Dias Argandykov , Anne-Sophie C. Romijn , Emanuele Lagazzi , Wardah Rafaqat , Charudutt N. Paranjape , George C. Velmahos , Haytham M.A. Kaafarani , John O. Hwabejire","doi":"10.1016/j.amjsurg.2024.116125","DOIUrl":"10.1016/j.amjsurg.2024.116125","url":null,"abstract":"<div><h3>Background</h3><div>Intraoperative adverse events (iAEs) during general surgery can lead to significant morbidity and healthcare burden, yet their impact remains underexplored. We aimed to estimate the nationwide incidence of iAEs in general surgery and explore their associations with mortality, complications, length of stay, and costs.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using the Nationwide Readmissions Database 2019 and included adult patients (aged 18 years and older) who underwent general surgical procedures. Eligible patients were grouped based on the presence of an iAE, defined as an unrecognized abdominopelvic accidental puncture or laceration. The primary outcome was in-hospital mortality, while secondary outcomes included 30-day post-operative complications, length of stay, and total inpatient costs. Multivariable logistic and linear regression models were used to examine the association between the presence of an iAE and post-operative outcomes and costs.</div></div><div><h3>Results</h3><div>A total of 701,866 patients were included. The mean age was 55.1 years, and 60.0 % were female. 6350 (0.9 %) experienced an iAE. The procedure with the highest incidence of iAE was small bowel resection (2.3 %). On univariate analysis, patients who experienced an iAE had higher mortality (3.8 % vs. 1.5 %, P < 0.001), 30-day complications, length of stay, and inpatient costs. After multivariable regression, iAEs were independently associated with an increase in in-hospital mortality, length of stay, unplanned readmission, wound complications, acute kidney injury, sepsis, surgical site infection, ileus, and inpatient costs.</div></div><div><h3>Conclusions</h3><div>Despite their low incidence, iAEs are associated with heightened rates of complications and healthcare utilization. Incorporating iAEs into surgical quality initiatives and developing iAE reporting standards is warranted.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"240 ","pages":"Article 116125"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142816989","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 : 2025-02-01DOI: 10.1016/j.amjsurg.2024.116148
Hana Shafique , Christina L. Cui , Roberto S. Loanzon , Young Kim
The impact of the coronavirus disease COVID-19 pandemic on surgical training in the United States remains a controversial topic. In this study, we examined resident and fellow operative volumes in the pre-COVID-19 and COVID-19 periods across ten different surgical specialties. Accreditation Council for Graduate Medical Education (ACGME) national data reports were collected for ten surgical specialties, including general surgery, neurological surgery, ophthalmology, orthopedic surgery, pediatric surgery, plastic surgery (independent), thoracic surgery, urology, vascular surgery (integrated), and vascular surgery (traditional). Operative volumes were compared between graduates from the pre-COVID-19 (2013–2019) and COVID-19 (2020–2022) periods. Linear regression analysis was used to calculate trends in operative volume. Surgical residents and fellows graduating during the COVID-19 pandemic have greater or similar case volumes, when compared with graduates from the pre-pandemic period. These data suggest that surgical training in the United States has not been compromised by COVID-19 with regard to operative experience.
{"title":"Impact of COVID-19 pandemic on surgical training in the United States","authors":"Hana Shafique , Christina L. Cui , Roberto S. Loanzon , Young Kim","doi":"10.1016/j.amjsurg.2024.116148","DOIUrl":"10.1016/j.amjsurg.2024.116148","url":null,"abstract":"<div><div>The impact of the coronavirus disease COVID-19 pandemic on surgical training in the United States remains a controversial topic. In this study, we examined resident and fellow operative volumes in the pre-COVID-19 and COVID-19 periods across ten different surgical specialties. Accreditation Council for Graduate Medical Education (ACGME) national data reports were collected for ten surgical specialties, including general surgery, neurological surgery, ophthalmology, orthopedic surgery, pediatric surgery, plastic surgery (independent), thoracic surgery, urology, vascular surgery (integrated), and vascular surgery (traditional). Operative volumes were compared between graduates from the pre-COVID-19 (2013–2019) and COVID-19 (2020–2022) periods. Linear regression analysis was used to calculate trends in operative volume. Surgical residents and fellows graduating during the COVID-19 pandemic have greater or similar case volumes, when compared with graduates from the pre-pandemic period. These data suggest that surgical training in the United States has not been compromised by COVID-19 with regard to operative experience.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"240 ","pages":"Article 116148"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885086","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 : 2025-02-01DOI: 10.1016/j.amjsurg.2024.115908
Toluwani Akinpelu , Aaron I. Dadzie , Victoria M. Jacobsen , Valentine S. Alia , Nikhil R. Shah , Edward M. Diaz , Daniel Bolton
Introduction
The Rio Grande Valley (RGV) has historically high incidence of congenital defects (CDs) necessitating intervention by pediatric surgical specialties. We examined mortality in this region and related workforce patterns.
Methods
Mortality data related to CDs (2007–2021) and surgical workforce trends/projections (2024–2032) were collected using multiple databases: National Vital Statistics System, Texas Department of State Health Services, Texas Medical Board, Center for Disease Control.
Results
Nationally, RGV counties rank as high as 5th in CD mortality rates. Between 2020 and 2024, 3 of 4 studied pediatric surgical specialties experienced stagnant/decreasing workforces ranging from 0 to 66 %. Furthermore, the RGV is projected to have some of the most marked state-wide disparities in surgical providers over the next 8 years.
Conclusion
High infant mortality rates along with ongoing and future shortages of surgical specialists is concerning. These results may inform allocation of public health resources and workforce distribution to improve outcomes.
简介：里奥格兰德河谷（RGV）的先天性缺陷（CD）发病率历来很高，需要小儿外科专业人员进行干预。我们研究了该地区的死亡率和相关的劳动力模式：我们使用多个数据库收集了与 CD 相关的死亡率数据（2007-2021 年）和外科劳动力趋势/预测（2024-2032 年）：方法：通过多个数据库收集与 CD 相关的死亡率数据（2007-2021 年）和外科劳动力趋势/预测（2024-2032 年）：在全国范围内，RGV 各县的 CD 死亡率高居第五位。2020 年至 2024 年期间，在所研究的 4 个儿科外科专科中，有 3 个专科的医务人员数量将停滞不前或减少，幅度从 0% 到 66% 不等。此外，预计在未来 8 年内，RGV 在全州范围内将出现一些最明显的手术提供者差异：结论：婴儿死亡率居高不下，同时外科专家持续短缺，未来也会出现短缺，这令人担忧。这些结果可为公共卫生资源的分配和劳动力的分布提供参考，以改善结果。
{"title":"Pediatric surgical border health: Supply may not be meeting demand in South Texas communities","authors":"Toluwani Akinpelu , Aaron I. Dadzie , Victoria M. Jacobsen , Valentine S. Alia , Nikhil R. Shah , Edward M. Diaz , Daniel Bolton","doi":"10.1016/j.amjsurg.2024.115908","DOIUrl":"10.1016/j.amjsurg.2024.115908","url":null,"abstract":"<div><h3>Introduction</h3><div>The Rio Grande Valley (RGV) has historically high incidence of congenital defects (CDs) necessitating intervention by pediatric surgical specialties. We examined mortality in this region and related workforce patterns.</div></div><div><h3>Methods</h3><div>Mortality data related to CDs (2007–2021) and surgical workforce trends/projections (2024–2032) were collected using multiple databases: National Vital Statistics System, Texas Department of State Health Services, Texas Medical Board, Center for Disease Control.</div></div><div><h3>Results</h3><div>Nationally, RGV counties rank as high as 5th in CD mortality rates. Between 2020 and 2024, 3 of 4 studied pediatric surgical specialties experienced stagnant/decreasing workforces ranging from 0 to 66 %. Furthermore, the RGV is projected to have some of the most marked state-wide disparities in surgical providers over the next 8 years.</div></div><div><h3>Conclusion</h3><div>High infant mortality rates along with ongoing and future shortages of surgical specialists is concerning. These results may inform allocation of public health resources and workforce distribution to improve outcomes.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"240 ","pages":"Article 115908"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142091399","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 : 2025-02-01DOI: 10.1016/j.amjsurg.2024.115989
Tega Ebeye , Chantal R. Valiquette , Natalia Ziolkowski
{"title":"Exploring consent for animal-derived products in surgery","authors":"Tega Ebeye , Chantal R. Valiquette , Natalia Ziolkowski","doi":"10.1016/j.amjsurg.2024.115989","DOIUrl":"10.1016/j.amjsurg.2024.115989","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"240 ","pages":"Article 115989"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364031","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 : 2025-02-01DOI: 10.1016/j.amjsurg.2024.116124
Anna Mary Jose, Aryan Rafieezadeh, Jordan Kirsch, Mikaiel Ebanks, Ilya Shnaydman, Gabriel Froula, Kartik Prabhakaran, Bardiya Zangbar
Background
Pregnant trauma patients present unique challenges in terms of assessment and management. This study assesses the impact of traumatic injuries on pregnant patients using a national trauma database.
Methods
ACS-TQIP (2020–2021) identified traumatically injured females aged ≥15 and ≤ 55. Propensity score matching compared pregnant and not-pregnant patients. Primary outcome was mortality, with secondary outcomes including length of stay (LOS), emergency department and discharge disposition, interventions, and complications.
Results
Of 947,000 traumatically injured females, 8421 (0.9 %) were pregnant. Pregnant patients (6.0 %) sustained firearm injuries more than not-pregnant patients (5.4 %) (p = 0.02). Pregnant patients had more severe thoracic (47.2%vs.9.4 %) and abdominal injuries (7.1%vs.4.8 %) compared to not-pregnant patients (p < 0.001). Among pregnant patients, 5.6 % had preterm labor, 2.6 % had cesarean sections, and 1.9 % had abortions. After matching, there was no significant difference in mortality between both groups (p = 0.40). Pregnant patients had longer ICU LOS (p < 0.05) and higher rates of unplanned return to ICU (p < 0.05).
Conclusions
Pregnant patients are more often victims of firearm violence, sustaining critical thoracic and abdominal injuries. These injuries demand increased interventions, introduce complications, and can be fatal.
{"title":"Unveiling the impact of trauma during pregnancy","authors":"Anna Mary Jose, Aryan Rafieezadeh, Jordan Kirsch, Mikaiel Ebanks, Ilya Shnaydman, Gabriel Froula, Kartik Prabhakaran, Bardiya Zangbar","doi":"10.1016/j.amjsurg.2024.116124","DOIUrl":"10.1016/j.amjsurg.2024.116124","url":null,"abstract":"<div><h3>Background</h3><div>Pregnant trauma patients present unique challenges in terms of assessment and management. This study assesses the impact of traumatic injuries on pregnant patients using a national trauma database.</div></div><div><h3>Methods</h3><div>ACS-TQIP (2020–2021) identified traumatically injured females aged ≥15 and ≤ 55. Propensity score matching compared pregnant and not-pregnant patients. Primary outcome was mortality, with secondary outcomes including length of stay (LOS), emergency department and discharge disposition, interventions, and complications.</div></div><div><h3>Results</h3><div>Of 947,000 traumatically injured females, 8421 (0.9 %) were pregnant. Pregnant patients (6.0 %) sustained firearm injuries more than not-pregnant patients (5.4 %) (p = 0.02). Pregnant patients had more severe thoracic (47.2%vs.9.4 %) and abdominal injuries (7.1%vs.4.8 %) compared to not-pregnant patients (p < 0.001). Among pregnant patients, 5.6 % had preterm labor, 2.6 % had cesarean sections, and 1.9 % had abortions. After matching, there was no significant difference in mortality between both groups (p = 0.40). Pregnant patients had longer ICU LOS (p < 0.05) and higher rates of unplanned return to ICU (p < 0.05).</div></div><div><h3>Conclusions</h3><div>Pregnant patients are more often victims of firearm violence, sustaining critical thoracic and abdominal injuries. These injuries demand increased interventions, introduce complications, and can be fatal.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"240 ","pages":"Article 116124"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142783611","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 : 2025-01-31DOI: 10.1016/j.amjsurg.2025.116232
Jihun Cha, Thomas W Clements, Chad G Ball, Andrew W Kirkpatrick, Timothy Bax, John Mayberry
Damage control (DC) packing is used selectively in patients in shock with extensive abdominal, thoracic, perineal/genital/perirectal, neck/axillae/groin (junctional), and extremity injury to stop bleeding. In multiple casualty scenarios, DC packing may be used to facilitate an abbreviated surgery and thus "buy time". The packing is by guideline or military doctrine removed or exchanged 1-3 days later in a planned reoperation. In remote environments, however, where timely evacuation cannot occur and resources are limited, it may be necessary for packing to be left in place longer than 3 days. Also, in Large Scale Combat Operations, Multi-Domain Operations, and Distributed Maritime Operations, evacuation will be accomplished by nonsurgeons and may last several days. Prolonged retention of packing is associated with complications, but significant rebleeding may occur upon removal. This article reviews the benefits and hazards of DC packing removal to inform decision making by both surgeons and nonsurgeons. We conclude that except for Dismounted Complex Blast Injury most DC gauze packing does not mandatorily need to be removed or exchanged within a three-day window.
{"title":"Damage control packing: How long can it stay?","authors":"Jihun Cha, Thomas W Clements, Chad G Ball, Andrew W Kirkpatrick, Timothy Bax, John Mayberry","doi":"10.1016/j.amjsurg.2025.116232","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116232","url":null,"abstract":"<p><p>Damage control (DC) packing is used selectively in patients in shock with extensive abdominal, thoracic, perineal/genital/perirectal, neck/axillae/groin (junctional), and extremity injury to stop bleeding. In multiple casualty scenarios, DC packing may be used to facilitate an abbreviated surgery and thus \"buy time\". The packing is by guideline or military doctrine removed or exchanged 1-3 days later in a planned reoperation. In remote environments, however, where timely evacuation cannot occur and resources are limited, it may be necessary for packing to be left in place longer than 3 days. Also, in Large Scale Combat Operations, Multi-Domain Operations, and Distributed Maritime Operations, evacuation will be accomplished by nonsurgeons and may last several days. Prolonged retention of packing is associated with complications, but significant rebleeding may occur upon removal. This article reviews the benefits and hazards of DC packing removal to inform decision making by both surgeons and nonsurgeons. We conclude that except for Dismounted Complex Blast Injury most DC gauze packing does not mandatorily need to be removed or exchanged within a three-day window.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116232"},"PeriodicalIF":2.7,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370143","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}
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