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Journal of Trauma and Acute Care Surgery

Sara P Myers, Matthew E Kutcher, Matthew R Rosengart, Jason L Sperry, Andrew B Peitzman, Joshua B Brown, Matthew D Neal
BACKGROUND: Tranexamic acid (TXA) is used as a hemostatic adjunct for hemorrhage control in the injured patient and reduces early preventable death. But the risk of venous thromboembolism (VTE) has been incompletely explored. Previous studies investigating the effect of TXA on VTE vary in their findings. We performed a propensity matched analysis to investigate the association between TXA and VTE following trauma, hypothesizing that TXA is an independent risk factor for VTE. METHODS: This retrospective study queried trauma patients presenting to a single level I trauma center from 2012 to 2016...
September 19, 2018: Journal of Trauma and Acute Care Surgery
Steven R Shackford
No abstract text is available yet for this article.
September 13, 2018: Journal of Trauma and Acute Care Surgery
Stephanie D Chao, Zachary J Kastenberg, Sriraman Madhavan, Kristan L Staudenmayer
BACKGROUND: Legal firearm sales occur largely through suppliers that have Federal Firearm Licensees (FFLs). Since FFL density might reflect ease-of-access to firearm purchases, we hypothesized that the number of FFL dealers would be associated with firearm-related deaths. We further hypothesized that licensee-type subsets would be associated with differential risks for gun-related deaths. METHODS: We used data from the National Center for Health Statistics National Vital Statistics System (2008-2014) and national data on Federal Firearms Licensees for 2014...
September 13, 2018: Journal of Trauma and Acute Care Surgery
Todd O McKinley, Zhigang Lei, Yannik Kalbas, Fletcher A White, Zhongshang Shi, Fan Wu, Zao C Xu, Richard B Rodgers
BACKGROUND: Patients who sustain traumatic brain injury (TBI) and concomitant hemorrhagic shock (HS) are at high risk of high-magnitude inflammation which can lead to poor outcomes and death. Blood purification by hemoadsorption (HA) offers an alternative intervention to reduce inflammation after injury. We tested the hypothesis that HA would reduce mortality in a rat model of TBI and HS. METHODS: Male Sprague Dawley rats were subjected to a combined injury of a controlled cortical impact (CCI) to their brain and pressure-controlled hemorrhagic shock (HS)...
September 11, 2018: Journal of Trauma and Acute Care Surgery
Dawei Li, Yuru Shang, Chuanan Shen, Longzhu Li, Dongxu Zhao, Li Ma, Yongming Yu
BACKGROUND: It has been established that Glucagon-like peptide 1 (GLP 1) inhibits pancreatic β cell apoptosis, increases insulin secretion and improves glucose tolerance in scald injury. However, the effects of Exendin-4, a long-acting incretin similar to GLP 1, remained unclear in severe scald injury. Hence, this study attempted to investigate whether Exendin-4 had similar effects by protecting the histology of pancreas in severely scalded rats. METHODS: 162 adult Wistar rats were equally randomized to sham burn (SB) group, burn (B) group and burn with Exendin-4 treatment (BE) group...
September 11, 2018: Journal of Trauma and Acute Care Surgery
Luis R Taveras, Jonathan B Imran, Holly B Cunningham, Tarik D Madni, Roberto Taarea, Allison Tompeck, Audra T Clark, Natalie Provenzale, Folarin M Adeyemi, Christian T Minshall, Alexander L Eastman, Michael W Cripps
BACKGROUND: Open abdomen (OA) and temporary abdominal closure (TAC) are common techniques to manage several surgical problems in trauma and emergency general surgery (EGS). Patients with an OA are subjected to prolonged mechanical ventilation. This can lead to increased rates of ventilator-associated pneumonia (VAP). We hypothesized that patients who were extubated with an OA would have a decrease in ventilator hours and as a result would have a lower rate of VAP without an increase in extubation failures...
September 11, 2018: Journal of Trauma and Acute Care Surgery
Jordan R Wlodarczyk, Alexander S Thomas, Rebecca Schroll, Eric M Campion, Caroline Croyle, Jay Menaker, Matthew Bradley, John A Harvin, Morgan L Collum, Jayin Cho, Mark J Seamon, Jennifer Leonard, Michael Tiller, Kenji Inaba, Margaret M Moore
BACKGROUND: There exists a long established but not validated practice of placing temporary intravascular shunts (TIVS) in cases of combined vascular and orthopedic extremity trauma. Though logical to prioritize blood flow, large scale data to support this practice is lacking. We hypothesize that the order of repair yields no difference in outcomes in combined vascular and orthopedic extremity trauma and offer a larger scale analysis than is previously available. METHODS: A retrospective chart review was conducted at 6 Level 1 trauma centers from 2004-2015 comparing patients who received a TIVS during their initial surgery versus those who did not...
September 11, 2018: Journal of Trauma and Acute Care Surgery
Marc D Trust, Jacob Veith, Carlos V R Brown, John P Sharpe, Tashinga Musonza, John Holcomb, Eric Bui, Brandon Bruns, H Andrew Hopper, Michael Truitt, Clay Burlew, Morgan Schellenberg, Jack Sava, John Vanhorn, Brian Eastridge, Alicia M Cross, Richard Vasak, Gary Vercuysse, Eleanor E Curtis, James Haan, Raul Coimbra, Phillip Bohan, Stephen Gale, Peter G Bendix
BACKGROUND: There are no clear guidelines for the best test or combination of tests to identify traumatic rectal injuries. We hypothesize that computed tomography (CT) and rigid proctoscopy (RP) will identify all injuries. METHODS: American Association for the Surgery of Trauma multi-institutional retrospective study (2004-2015) of patients who sustained a traumatic rectal injury. Patients with known rectal injuries who underwent both CT and RP as part of their diagnostic workup were included...
September 11, 2018: Journal of Trauma and Acute Care Surgery
Bryant W Oliphant, Christopher J Tignanelli, Lena M Napolitano, James A Goulet, Mark R Hemmila
BACKGROUND: Pelvic ring fractures represent a complex injury that requires specific resources and clinical expertise for optimal trauma patient management. We examined the impact of treatment variability for this type of injury at Level 1 and 2 trauma centers on patient outcomes. METHODS: Trauma quality collaborative data (2011-2017) were analyzed. This includes data from 29 ACS-COT verified Level 1 and Level 2 trauma centers. Inclusion criteria were adult patients (≥ 16 years), ISS ≥ 5, blunt injury, and evidence of a partially stable or unstable pelvic ring fracture injury coding as classified using Abbreviated Injury Scale version 2005, with 2008 updates...
September 4, 2018: Journal of Trauma and Acute Care Surgery
Abid D Khan, Sean C Liebscher, Hannah C Reiser, Thomas J Schroeppel, Michael J Anstadt, Patrick L Bosarge, Shannon L Carroll, Jacob A Quick, Stephen L Barnes, Justin Sobrino, Jason Murry, Nicholas Morin, Mario Gomez, Heitor Consani, Richard P Gonzalez
BACKGROUND: Single institution studies have shown that clinical examination of the cervical spine (c-spine) is sensitive for clearance of the c-spine in blunt trauma patients with distracting injuries. Despite an unclear definition, most trauma centers still adhere to the notion that distracting injuries adversely affect the sensitivity of c-spine clinical examination. A prospective AAST multi-institutional trial was performed to assess the sensitivity of clinical examination screening of the c-spine in awake and alert blunt trauma patients with distracting injuries...
September 4, 2018: Journal of Trauma and Acute Care Surgery
Charles DiMaggio, Jacob Avraham, Cherisse Berry, Marko Bukur, Justin Feldman ScD, Michael Klein, Noor Shah, Manish Tandon, Spiros Frangos
BACKGROUND: A federal assault weapons ban has been proposed as a way to reduce mass shootings in the U.S. (U.S). The Federal Assault Weapons Ban (A.W.B.) of 1994 made the manufacture and civilian use of a defined set of automatic and semi-automatic weapons and large capacity magazines illegal. The ban expired in 2004. The period from 1994 to 2004 serves as a single-arm pre-post observational study to assess the effectiveness of this policy intervention. METHODS: Mass shooting data for 1981 to 2017 were obtained from three well-documented, referenced, and open-source sets of data, based on media reports...
September 4, 2018: Journal of Trauma and Acute Care Surgery
Gary Nieman, Joshua Satalin, Penny Andrews, Kailyn Wilcox, Hani Aiash, Sarah Baker, Michaela Kollisch-Singule, Maria Madden, Louis Gatto, Nader Habashi
The acute respiratory distress syndrome (ARDS) remains a serious clinical problem with the current treatment being supportive in the form of mechanical ventilation. However, mechanical ventilation can be a double-edged sword; if set properly, it can significantly reduce ARDS associated mortality but if set improperly it can have unintended consequences causing a secondary ventilator induced lung injury (VILI). The hallmark of ARDS pathology is a heterogeneous lung injury, which predisposes the lung to a secondary VILI...
August 17, 2018: Journal of Trauma and Acute Care Surgery
Elisa J Furay, Mitch J Daley, Pedro G Teixeira, Thomas B Coopwood, Jayson D Aydelotte, Natalia Malesa, Christian Tellinghuisen, Sadia Ali, Lawrence H Brown, Carlos Vr Brown
BACKGROUND: Platelet dysfunction, defined as adenosine diphosphate (ADP) inhibition greater than 60% on thromboelastogram (TEG), is an independent predictor of increased mortality in patients with severe traumatic brain injury (TBI). We changed our practice to transfuse platelets for all patients with severe TBI and platelet dysfunction. We hypothesized that platelet transfusions would correct platelet dysfunction and improve mortality in patients with severe TBI. METHODS: This retrospective review included adult trauma patients admitted to our Level 1 trauma center from July 2015 to October 2016 with severe TBI (Head AIS ≥ 3) who presented with platelet dysfunction and subsequently received a platelet transfusion...
August 17, 2018: Journal of Trauma and Acute Care Surgery
Cyril S Gary, Chrisovalantis Lakhiani, Michael V DeFazio, Derek L Masden, David H Song
Smartphone ownership among the American populace has more than doubled over the past decade. Despite significant improvements in global connectivity and accessibility of information associated with smartphone technology, there has been a concurrent rise in pedestrian traumas secondary to smartphone-related distracted behaviors over the same time period. The prevalence of smartphone-related distraction among ambulating pedestrians, the impact of smartphone-related distracted ambulation on gait, attention, and cognition, and the most common mechanisms of injury resulting from distracted ambulation have been well-established in the literature...
August 17, 2018: Journal of Trauma and Acute Care Surgery
Dario Tartaglia, Rita Fantacci, Caterina Corsini, Luigi Cobuccio, Giuseppe Zocco, Christian Galatioto, Massimo Chiarugi
No abstract text is available yet for this article.
August 17, 2018: Journal of Trauma and Acute Care Surgery
Joshua J Sumislawski, Lucy Z Kornblith, Amanda S Conroy, Rachael A Callcut, Mitchell Jay Cohen
BACKGROUND: Severely injured patients often progress from early hypocoagulable to normal and eventually hypercoagulable states, developing increased risk for venous thromboembolism (VTE). Prophylactic anticoagulation can decrease this risk, but its initiation is frequently delayed for extended periods due to concerns for bleeding. To facilitate timely introduction of VTE chemoprophylaxis, we characterized the transition from hypo- to hypercoagulability and hypothesized that trauma-induced coagulopathy (TIC) resolves within 24 hours after injury...
August 17, 2018: Journal of Trauma and Acute Care Surgery
Forest R Sheppard, Leasha J Schaub, Andrew P Cap, Antoni R Macko, Hunter B Moore, Ernest E Moore, Jacob J Glaser
INTRODUCTION: The contributions of type and timing of fluid resuscitation to coagulopathy in trauma remain controversial. As part of a multifunctional resuscitation fluid research effort we sought to further characterize the coagulation responses to resuscitation; specifically as compared to whole blood. We hypothesized that early whole blood administration mitigates the acute coagulopathy of trauma by avoiding the coagulopathy of crystalloid resuscitation. METHODS: Anesthetized rhesus macaques underwent poly-traumatic, hemorrhagic shock, then a crossover study design resuscitation (n=6 each) with either whole-blood-first (WB-1) followed by crystalloid (CR); or CR-1st followed by WB...
August 17, 2018: Journal of Trauma and Acute Care Surgery
Claudia Patricia Lozano Guzman, Kevin A Chen, Joshua A Marks, Jay S Jenoff, Murray J Cohen, Michael S Weinstein
BACKGROUND: Cervical spine injuries (CSI) can have major effects on the respiratory system and carry a high incidence of pulmonary complications. Respiratory failure can be due to spinal cord injuries, concomitant facial fractures or chest injury, airway obstruction, or cognitive impairments. Early tracheostomy (ET) is often indicated in patients with CSI. However, in patients with anterior cervical fusion (ACF), concerns about cross-contamination often delay tracheostomy placement. This study aims to demonstrate the safety of ET within four days of ACF METHODS: Retrospective chart review was performed for all trauma patients admitted to our institution between 2001-2015 with diagnosis of CSI who required both ACF and tracheostomy, +/- posterior cervical fusion (PCF), during the same hospitalization...
August 7, 2018: Journal of Trauma and Acute Care Surgery
Mary Condron, Susan Rowell, Elizabeth Dewey, Taylor Anderson, Lelani Lealiiee, David Farrell, Holly Hinson
BACKGROUND: Traumatic injury is associated with an increased risk of coagulopathy and venous thrombosis. PAI-1 is a procoagulant molecule that inhibits tPA/uPA, thrombomodulin, and activated protein C. We hypothesized that elevated PAI-1 levels would be associated with increased Injury Severity Score (ISS) in injured patients with and without traumatic brain injury and that PAI-1 levels would vary with injury type. METHODS: We retrospectively analyzed demographic, ISS, and hemodynamic data from a prospectively collected database...
August 6, 2018: Journal of Trauma and Acute Care Surgery
Theodore G Karrison, L Philip Schumm, Masha Kocherginsky, Ronald Thisted, Douglas R Dirschl, Selwyn Rogers
BACKGROUND: The purpose of this study was to evaluate the effects of ambulance driving distance and transport time on mortality among trauma incidents occurring in the City of Chicago, a large metropolitan area. METHODS: We studied individuals >16 years old who suffered a Level I or II injury and were taken to a Level I trauma center. The outcome was in-hospital mortality, including those dead on arrival but excluding those deemed dead on scene. Driving distance was calculated from the scene of injury to the trauma center where the patient was taken...
August 6, 2018: Journal of Trauma and Acute Care Surgery
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