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Journal of Trauma and Acute Care Surgery

George Ramsay, Jared M Wohlgemut, Jan O Jansen
BACKGROUND: The provision of emergency general surgery services is a global issue, with important implications for patients and workforce. The aim of this study was to analyze the characteristics of emergency general surgical patients in the United Kingdom, with reference to diagnostic case mix, operative workload, comorbidity, discharge destination, and outcomes, in order to facilitate comparisons, and future service development. METHODS: This is a cross-sectional, population-based study based in the National Health Service (NHS) in Scotland, one of the home nations of the United Kingdom...
July 17, 2018: Journal of Trauma and Acute Care Surgery
Juan Pablo Herrera-Escobar, Michel Apoj, Christina Weed, Alyssa Fitzpatrick Harlow, Syeda Sanam Al Rafai, Elizabeth Lilley, George Kasotakis, Karen Brasel, Haytham Ma Kaafarani, George Velmahos, Ali Salim, Adil Hussein Haider
BACKGROUND: Chronic pain after trauma is associated with serious clinical, social, and economic burden. Due to limitations in trauma registry data and previous studies, the current prevalence of chronic pain after trauma is unknown, and little is known about the association of pain with other long-term outcomes. We sought to describe the long-term burden of self-reported pain after injury, and determine its association with positive screen for posttraumatic stress disorder (PTSD), functional status, and return to work...
July 17, 2018: Journal of Trauma and Acute Care Surgery
David S Kauvar, Diane Miller, Thomas J Walters
BACKGROUND: The effect of battlefield extremity tourniquet (TK) use on limb salvage and long-term complications following vascular repair is unknown. This study explores the influence of TK use on limb outcomes in military lower extremity arterial injury. METHODS: The study database includes cases of lower extremity vascular injury from 2004-2012 with data recorded until discharge from military service. We analyzed all limbs with at least one named arterial injury from the femoral to the tibial level...
July 17, 2018: Journal of Trauma and Acute Care Surgery
Matthew D Neal, Benjamin R Reynolds, David Bertoty, Keith J Murray, Andrew B Peitzman, Raquel M Forsythe
BACKGROUND: Hemorrhage is the leading cause of preventable death in trauma, and nearly 40% of prehospital deaths can be attributable to blood loss. The Stop The Bleed program provides a structured curriculum for teaching hemorrhage control and the use of bleeding control kits. In order to overcome implementation barriers and to achieve the goal of making education on bleeding control as common as cardiopulmonary resuscitation, widespread implementation with outreach to the public and law enforcement is necessary...
July 17, 2018: Journal of Trauma and Acute Care Surgery
Fabian Blanc, Yaser Najaf, Renaud Garrel
No abstract text is available yet for this article.
July 17, 2018: Journal of Trauma and Acute Care Surgery
Timothy K Williams, Emily M Tibbits, Guillaume L Hoareau, Meryl A Simon, Anders J Davidson, Erik S DeSoucy, E Robert Faulconer, J Kevin Grayson, Lucas P Neff, M Austin Johnson
BACKGROUND: Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is effective at limiting hemorrhage from non-compressible sources and restoring, yet causes progressive distal ischemia, supraphysiologic pressures and increased cardiac afterload. Endovascular Variable Aortic Control (EVAC) addresses these limitations, while still controlling hemorrhage. Previous work demonstrated improved outcomes following a 90-minute intervention period in an uncontrolled hemorrhage model...
July 17, 2018: Journal of Trauma and Acute Care Surgery
Delniotis Ioannis, Ktenidis Kiriakos
PURPOSE: Although the pulseless supracondylar humeral fracture (SHF) in children is well known in the bibliography controversy still exists regarding the treatment strategy. The purpose of this study was: a) to describe our policy with pulseless hands following SHF and b) evaluate the functional outcome in a 1-year follow-up. PATIENTS AND METHODS: During the years 2013-2018 in our department, 23 children out of 210 with type III SHF, presented with a pulseless hand (20 with a PPH and 3 with a cold, pulseless hand)...
July 5, 2018: Journal of Trauma and Acute Care Surgery
Niels V Johnsen, Alex J Vanni, Bryan B Voelzke
BACKGROUND: There exists significant controversy regarding the use of suprapubic tubes (SPT) in pelvic fracture urethral injury (PFUI) patients undergoing internal fixation (IF) as to the potential risk of infection. Utilizing the National Trauma Data Bank (NTDB), we sought to examine if placement of a SPT in patients with traumatic urethral injuries undergoing IF of pelvic fractures increases the risks of infectious complications during the index hospitalization. PATIENTS AND METHODS: Utilizing ICD-9 and AIS codes, patients with PFUI were identified in the NTDB between 2002 and 2014...
July 5, 2018: Journal of Trauma and Acute Care Surgery
Brenda M Zosa, Charles W Elliott, David E Kurlander, Freedom Johnson, Vanessa P Ho, Jeffrey A Claridge
BACKGROUND: To evaluate the role of initial prophylactic antibiotics on facial fractures, outcomes were compared between a short course (≤24 hours) of antibiotics to those who received an extended course (>24 hours). METHODS: Adults admitted (2010-2015) to a level 1 trauma center intensive care unit with at least 1 facial bone fracture and major injuries isolated to the head and neck were included. Our primary analysis compared infectious complications of the head or neck (H/N infection) between patients given short or extended courses of antibiotic prophylaxis...
July 5, 2018: Journal of Trauma and Acute Care Surgery
Bobby Darnell Robinson, Claire Larson Isbell, Chinchusha Anasooya Shaji, Stanley Kurek, Justin L Regner, Binu Tharakan
BACKGROUND: The integrity of the blood-brain barrier (BBB) is paramount in limiting vasogenic edema following traumatic brain injury (TBI). The purpose of this study was to ascertain if quetiapine, an atypical antipsychotic commonly used in trauma/critical care for delirium, protects the BBB and attenuates hyperpermeability in TBI. METHOD: The effect of quetiapine on hyperpermeability was examined through molecular modeling, cellular models in vitro and small animal models in vivo...
July 5, 2018: Journal of Trauma and Acute Care Surgery
(no author information available yet)
No abstract text is available yet for this article.
July 5, 2018: Journal of Trauma and Acute Care Surgery
Allison G McNickle, Timothy Dickhudt, Jorge A Vega, Paul J Chestovich, Douglas R Fraser
No abstract text is available yet for this article.
July 5, 2018: Journal of Trauma and Acute Care Surgery
David E Meyer, Bryan A Cotton, Erin E Fox, Deborah Stein, John B Holcomb, Mitchell Cohen, Kenji Inaba, Elaheh Rahbar
BACKGROUND: To address deficiencies associated with the classic definition of massive transfusion, Critical Administration Threshold and Resuscitation Intensity were developed to better quantify the overall severity of illness and predict the need for transfusions and early mortality. We sought to evaluate these as more appropriate replacements for MT in defining mortality risk in patients undergoing major transfusions. METHODS: Patients predicted to receive MT at 12 Level-1 trauma centers were randomized in the PROPPR trial...
July 5, 2018: Journal of Trauma and Acute Care Surgery
Anke H Scultetus, Michelle A Jefferson, Ashraful Haque, Lam Thuy Vi Tran Ho, Brittany Hazzard, Biswajit K Saha, Steve J Chun, Charles R Auker, Paula F Moon-Massat, Richard M McCarron, Debra L Malone
BACKGROUND: Aeromedical evacuation to definitive care is standard in current military conflicts. However, there is minimal knowledge on the effects of hypobaria on either the flight crew or patients. The effects of hypobaria was investigated using healthy swine. METHODS: Anesthetized Yorkshire swine underwent a simulated 4 h "transport" to an altitude of 2,441 m (8,000 ft.; HYPO, N = 6) or at normobaric conditions (NORMO, N = 6). Physiological and biochemical data were collected...
July 5, 2018: Journal of Trauma and Acute Care Surgery
Stephanie Bonne, Iesha Suber, Arnold Anderson, David H Livingston
BACKGROUND: Graduated Drivers License (GDLs) are required in most states. GDLs are intermediate licenses requiring a supervisory period prior to full licensure. Surveys suggests poor acceptance of GDL restrictions high variability in GDL compliance. New Jersey initiated GDLs in 2002 and introduced a comprehensive public health campaign in 2010. This study analyzed the effect of GDL and the campaign on teen driver related fatalities and hypothesized that implementation alone was insufficient to decrease deaths...
July 5, 2018: Journal of Trauma and Acute Care Surgery
Andreas Brännström, David Rocksén, Johan Hartman, Niklas Nyman, Jenny Gustavsson BSc, Ulf P Arborelius, Mattias Günther
BACKGROUND: Uncontrolled hemorrhage is a leading cause of tactical trauma related deaths. Hemorrhage from the pelvis and junctional regions are particularly difficult to control due to the inability of focal compression. The Abdominal Aortic and Junctional Tourniquet (AAJT) occludes aortic blood flow by compression of the abdomen. The survivability of tourniquet release beyond 120 min is unknown and fluid requirements to maintain sufficient blood pressure during prolonged application are undetermined...
July 5, 2018: Journal of Trauma and Acute Care Surgery
Andrew J Kerwin, Brian K Yorkgitis, David J Ebler, Firas G Madbak, Albert T Hsu, Marie L Crandall
BACKGROUND: Cervical spinal cord injury (CSCI) is devastating. Respiratory failure, ventilator associated pneumonia (VAP), sepsis, and death frequently occur. Case reports of diaphragm pacing (DPS) have suggested earlier liberation from mechanical ventilation in acute CSCI patients. We hypothesized DPS implantation would decrease VAP and facilitate liberation from ventilation. METHODS: We performed a retrospective review of acute CSCI patients managed at a single level 1 trauma center between 1/2005-5/2017...
July 5, 2018: Journal of Trauma and Acute Care Surgery
Lucy Z Kornblith, Anamaria J Robles, Amanda S Conroy, Carolyn M Hendrickson, Carolyn S Calfee, Alexander T Fields, Rachael A Callcut, Mitchell J Cohen
BACKGROUND: Injury to the blood brain barrier exposes endothelium rich in von Willebrand factor (vWF) which may play a role in altered platelet aggregation following traumatic brain injury (TBI). Ristocetin is an antimicrobial substance which induces vWF-mediated aggregation of platelets. We examined these mechanisms in injured patients by measuring the aggregation response of platelets to stimulating agonists (including ristocetin) via whole blood multiple electrode platelet aggregometry...
July 5, 2018: Journal of Trauma and Acute Care Surgery
Jonathan B Imran, Tarik D Madni, Audra T Clark, Paul Rizk, Emily Huang, Christian T Minshall, Luis R Taveras, Holly B Cunningham, Alexander L Eastman, Jojo P Koshy, Cory D Kacir, Michael W Cripps
BACKGROUND: Standard low molecular-weight heparin dosing may be suboptimal for venous thromboembolism prophylaxis. We aimed to identify independent predictors of sub-prophylactic Xa (subXa) levels in trauma patients treated under a novel early chemoprophylaxis algorithm. METHODS: A retrospective analysis of trauma patients from July 2016 to June 2017 who received enoxaparin 40 mg BID and had peak Xa levels drawn was performed. Patients were divided into cohorts based on having a subXa (<0...
July 5, 2018: Journal of Trauma and Acute Care Surgery
Enrique Ginzburg, Tanya Zakrison, Gerd Daniel Pust, April Grant, Ning Lu, Rishi Rattan, Nicholas Namias
No abstract text is available yet for this article.
June 12, 2018: Journal of Trauma and Acute Care Surgery
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