Journal of Trauma and Acute Care Surgery

BACKGROUND: This study evaluated performance of a tissue-engineered Human Acellular Vessel (HAV) in a porcine model of acute vascular injury and ischemia. The HAV is an engineered blood vessel comprised of human vascular extracellular matrix proteins. Limb reperfusion and vascular outcomes of the HAV were compared to those from synthetic expanded polytetrafluoroethylene (ePTFE) grafts. METHODS: Thirty-six pigs were randomly assigned to four treatment groups, receiving either the HAV or a PTFE graft following a hind limb ischemia period of either 0- or 6-hours...

Recent advances on trauma management from the prehospital setting to in hospital care led to a better surviving severe trauma rate. Mortality from exsanguination remains the first preventable mortality.Damage control resuscitation and surgery are evolving and thus some promising concepts are developing. Transfusion toolkit is brought on the prehospital scene while temporary bridge to hemostasis may be helpful. Panel transfusion products allow an individualized ratio assumed by fresh frozen or lyophilized plasma, fresh or cold-stored whole blood, fibrinogen, four-factor prothrombin complex concentrates...

The importance of diversity, equity, and inclusion (DEI) in trauma and acute care surgery (ACS) has become increasingly apparent in the field of medicine. Despite the growing diversity of the patient population, the surgical specialty has traditionally been dominated by white males. This involves increasing the representation of diverse individuals in leadership positions, professional societies, scholarships, graduate education, and practicing physicians. This opinion piece aims to address the gaps in the literature regarding diversity, equity, and inclusion (DEI) in trauma and acute care surgery and highlight the issues related to the workforce, gender gap, patient outcomes, and health services...

BACKGROUND: Readmission to a non-index hospital, or care discontinuity, has been shown to have worse outcomes among surgical patients. Little is known about its effect on geriatric trauma patients. Our goal was to determine predictors of care discontinuity and to evaluate its effect on mortality in this geriatric population. METHODS: This was a retrospective analysis of Medicare inpatient claims (2014-2015) of geriatric trauma patients. Care discontinuity was defined as readmission within 30 days to a non-index hospital...

BACKGROUND: Opioid use disorder (OUD) is common in the hospitalized trauma population, being a comorbid diagnosis in ~1% of operative trauma cases. The impact of an addiction consult service (ACS) in this population has been less well-studied, but may lead to increased provision of evidence-based OUD treatment and improved post-discharge outcomes. METHODS: One hundred thirteen patients with an ICD diagnosis of OUD who were admitted to the trauma service at a single academic hospital between January 2020-December 2021 were included in a retrospective chart review...

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No abstract text is available yet for this article.

BACKGROUND: There is a paucity of data on factors that influence the decision regarding withdrawal of life supporting treatment (WLST) in geriatric trauma patients. We aimed to identify predictors of WLST in geriatric trauma patients. METHODS: This retrospective analysis of the ACS-TQIP (2017-2019) included all severely injured (ISS >15) geriatric trauma patients (≥65 years). Multivariable logistic regression (MLR) was performed to identify independent predictors of WLST...

BACKGROUND: Motor vehicle collision (MVC) remains a leading cause of injury and death among children, but the proper use of child safety seats and restraints has lowered the risks associated with motor vehicle travel. Blunt cerebrovascular injury (BCVI) is rare but significant among children involved in MVC. This study reviewed the incidence of BCVI after MVC causing blunt injury to the head, face, or neck, comparing those that were properly restrained with those that were not. METHODS: A prospective, multi-institutional observational study of children less than 15 years old who sustained blunt trauma to the head, face, or neck (AIS > 0) and presented at one of six level I pediatric trauma centers from 2017 to 2020 was conducted...

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BACKGROUND: Appropriate prehospital trauma triage ensures transport of children to facilities that provide specialized trauma care. There is currently no objective and generalizable scoring tool for emergency medical services (EMS) to facilitate such decisions. An abnormal reverse shock index times Glasgow Coma Scale (rSIG), which is calculated using readily available parameters, has been shown to be associated with severely injured children. This study sought to determine if rSIG could be used in the prehospital setting to identify injured children who require the highest levels of care...

BACKGROUND: Thrombin generation kinetics are not well studied in children. This study aimed to assess how thrombin generation kinetics vary in pediatric and young adult (YA) trauma patients by clinical characteristics and injury pattern. METHODS: Prospective cohort study where plasma samples were obtained from pediatric (ages 0-17) and YA (ages 18-21) trauma patients upon Emergency Department arrival. Thrombin generation (Calibrated Automated Thrombogram, CAT) was quantified as lag time (LT, minutes), peak height (PH, nM), time to peak (ttPeak, minutes), and endogenous thrombin potential (ETP, nm*minute)...

No abstract text is available yet for this article.

BACKGROUND: Timely surgical decompression improves functional outcomes and survival among children with traumatic brain injury (TBI) and increased intracranial pressure. Previous scoring systems for identifying the need for surgical decompression after TBI in children and adults have had several barriers to use. These barriers include the inability to generate a score with missing data, a requirement for radiographic imaging that may not be immediately available, and limited accuracy...

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BACKGROUND: Team communication and bias in and out of the operating room has been shown to impact patient outcomes. Limited data exist regarding the impact of communication bias during trauma resuscitation and multidisciplinary team performance on patient outcomes. We sought to characterize bias in communication among healthcare clinicians during trauma resuscitations. METHODS: Participation from multidisciplinary trauma team members (emergency medicine and surgery faculty, residents, nurses, medical students, EMS personnel) was solicited from verified level 1 trauma centers...

BACKGROUND: Timely access to high level (I/II) trauma centers (HLTC) is essential to minimize mortality after injury. Over the last 15-years there has been a proliferation of HLTC nationally. The current study evaluates the impact of additional HLTC on population access and injury mortality. METHODS: A geocoded list of HLTC, with year designated, was obtained from the American Trauma Society, and 60-minute travel time polygons were created using OpenStreetMap data...

BACKGROUND: Trauma hemorrhage remains the most common cause of preventable mortality in trauma. In order to guide clinical practice, RCTs provide high-quality evidence to inform clinical decision making. The clinical relevance and inferences made by RCTs are dependent on assumptions made during sample size calculation. METHODS: To describe the quality of methodology for sample size determination, we conducted a systemic review RCTs evaluating interventions that aim to improve survival in adults with trauma related hemorrhage...

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BACKGROUND: Targeted rehabilitation within the acute inpatient setting could have a substantial impact on improving outcomes for major trauma patients. The aim of this study was to investigate the cost-effectiveness of the introduction of a purpose-built ward environment, and a new allied health model of care (AHMOC) delivered in the acute inpatient setting, in a major trauma population. METHODS: The state-wide trauma registry, the trauma center's data warehouse, and electronic medical record data were used for this observational study...