Journal of Trauma and Acute Care Surgery

No abstract text is available yet for this article.

BACKGROUND: Activated Protein C (aPC) plays dual roles after injury, driving both trauma-induced coagulopathy (TIC) by cleaving, and thus inactivating, factors Va and VIIIa and depressing fibrinolysis while also mediating an inflammomodulatory milieu via protease activated receptor-1 (PAR-1) cytoprotective signaling. Because of this dual role, it represents and ideal target for study and therapeutics after trauma. A known aPC variant, 3K3A-aPC, has been engineered to preserve cytoprotective activity while retaining minimal anticoagulant activity rendering it potentially ideal as a cytoprotective therapeutic after trauma...

BACKGROUND: Rib fractures are common injuries which can be associated with acute pain and chronic disability. While most rib fractures ultimately go on to achieve bony union, a subset of patients may go on to develop non-union. Management of these non-united rib fractures can be challenging and variability in management exists. METHODS: The Chest Wall Injury Society's Publication Committee convened to develop recommendations for use of surgical stabilization of non-united rib fractures (SSNURF) to treat traumatic rib fracture non-unions...

Acute pancreatitis and management of its complications is a common consult for the acute care surgeon. With the ongoing development of both operative and endoscopic treatment modalities, management recommendations continue to evolve. We describe the current diagnostic and treatment guidelines for acute pancreatitis through the lens of acute care surgery. Topics including optimal nutrition, timing of cholecystectomy in gallstone pancreatitis and the management of peripancreatic fluid collections are discussed...

INTRODUCTION: Surgical stabilization of rib fractures(SSRF) continues to gain popularity due to patient benefits. However, little has been produced regarding the economic benefits of SSRF and its impact on hospital metrics such as Vizient. The aim of this study was to explore these benefits hypothesizing SSRF will demonstrate positive return on investment(ROI) for a healthcare institution. METHODS: This is a retrospective review of all rib fracture patients over 5 years at our Level 1 trauma center...

BACKGROUND: Mortality for pelvic fracture patients presenting with hemorrhagic shock ranges from 21-57%. The objective of this study was to develop a lethal and clinically-relevant pelvic hemorrhage animal model with and without bony fracture for evaluating therapeutic interventions. ResQFoam is a self-expanding foam that has previously been described to significantly decrease mortality in large-animal models of abdominal exsanguination. We hypothesized that administration of ResQFoam into the pre-peritoneal space could decrease mortality in exsanguinating pelvic hemorrhage...

BACKGROUND: Impaired coagulation is associated with elevated risk of mortality in trauma patients. Prior studies have demonstrated increased mortality in patients with hyperfibrinolysis (HF) and fibrinolysis shutdown (SD). Additionally, prior studies have demonstrated no effect of tranexamic acid (TXA) on fibrinolysis phenotypes. We examined the association of admission fibrinolysis phenotype with traumatic brain injury (TBI) patient outcomes. METHODS: Data were extracted from a placebo-controlled multicenter clinical trial...

Therapeutic/Care Management; Level V.TYPE: Algorithms / Guidelines / Clinical Protocol.

BACKGROUND: Surgical stabilization of rib fractures (SSRF) has become an emerging therapy for treatment of patients with rib fractures. More commonly it is used in the acute setting, however delayed SSRF can be utilized for symptomatic rib fracture nonunions. Here we describe our institution's experience with delayed SSRF, hypothesizing it is safe and resolves patient symptoms. METHODS: This is a retrospective review of patients presenting to our level 1 trauma center to undergo delayed SSRF for symptomatic nonunions from January 2017 to September 2022...

Choledocholithiasis is a common presentation of symptomatic cholelithiasis encountered by the acute care surgeon. There is a wide spectrum of variation in management of this disease due to evolutions in laparoscopic and endoscopic techniques. Intricacies in management are related to the timing of diagnosis as well as locally available imaging modalities, surgical expertise, and ancillary advanced endoscopy and interventional radiological support. While individual patient demographics and institutional characteristics will determine management of choledocholithiasis, it is incumbent for the treating surgeon to be well versed in all manners of therapy currently available...

No abstract text is available yet for this article.

Limb tourniquets are among the most effective lifesaving interventions after severe injury. Tourniquets used for less than two hours have proven safe, even when in hindsight the tourniquet was determined not to have been necessary. However, tourniquets used for longer than 2 hours may result in severe ischemic changes, fasciotomy rhabdomyolysis, renal failure, amputation and death.Given their frequent use after even minor limb injury (>50%), as soon as safely feasible all limb tourniquets must be reassessed...

PURPOSE: Balanced blood product resuscitation with red blood cells, plasma, and platelets can be achieved using whole blood (WB) or component therapy (CT). However, balanced resuscitation of younger children with severe traumatic hemorrhage may be complicated by delays in delivering all blood components and concerns regarding multiple product exposures. We hypothesized that WB achieves balanced resuscitation faster than CT, with fewer product exposures and improved clinical outcomes. METHODS: Children <12 years old receiving balanced resuscitation within four hours of arrival were identified from the 2017-2019 Trauma Quality Improvement Program database...

BACKGROUND: Disruption of the vascular endothelium and endothelial glycocalyx (EG) has been described after severe trauma. Plasma has been suggested to restore microvascular integrity by preservation and repair of the EG. We sought to evaluate whether plasma administered in a 1:1:1 ratio was associated with less endothelial marker circulation than a 1:1:2 ratio. METHODS: This is a secondary analysis of the PROPPR trial which investigated post-traumatic resuscitation with platelets, plasma, and red blood cells in a 1:1:1 ratio compared with a 1:1:2 ratio...

Patients with emergency general surgery (EGS) diagnoses comprise over 10% of all hospital admissions, resulting in a projected number of 4.2 million admissions for 2023. Approximately 25% will require emergency surgical intervention, half will sustain a postoperative complication, and 15% will have a readmission within the first 30 days of surgery. In the face of this growing public health burden and to better meet the needs of these acutely ill patients, it was recognized that a formal quality improvement program, including standardization of data collection and the development of systems of care specifically for EGS have been lacking...

BACKGROUND: Acute left-sided colonic diverticulitis is one of the most common clinical conditions encountered by surgeons in the acute setting. Currently, the most popular classifications, based on radiological findings, are the modified Hinchey, AAST, and WSES classifications. We hypothesize that all classifications are equivalent in predicting outcomes. METHODS: This is a retrospective study of 597 patients from four medical centers between 2014 and 2021. Based on clinical, radiological, and intraoperative findings, patients were graded according to the three classifications...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

No abstract text is available yet for this article.

No abstract text is available yet for this article.