Journal Of Trauma And Acute Care Surgery - Trauma Loupes Podcast

The lead article is by Dr. Naveen Sangji and colleagues from the Massachusetts General Hospital who propose an Emergency Surgery Acuity Score. Dr. Nakul Valsangkar et al from the Indiana University analyze the academic productivity of trauma/acute surgery faculty compared to general surgery and other specialty faculty. Dr. Martha Ingram and colleagues from Emory University evaluated the significance of hepatic or splenic blush on CT in children with blunt abdominal trauma. These conclusions are consistent with an accompanying paper by Dr. Stephen Fenton et al from the University of Utah who analyzed data from 20 participating centers in the Pediatric Emergency Care Applied Research Network. Dr. Sarah Sirajuddin and colleagues from the George Washington University evaluate the significance of platelet dysfunction identified in patients admitted with minor injury. Transcript

Dr. Ernest Moore discusses a roundup of papers first showcased at this year’s Eastern Association for the Surgery of Trauma annual meeting and published in the July 2016 issue of the Journal. The lead paper appropriately, is the presidential address by Dr. Stanley Kurek. Dr. Kurek provides a timely reflection on the challenges trauma surgeons face in maintaining their resilience. This is followed by the Oriens Lecture delivered by Dr. J. Don Jenkins. Dr. Jenkins offers a cogent perspective on leadership, reviewing the spectrum of leadership styles. Dr. Benjamin Miller et al from Vanderbilt University conducted a retrospective analysis of the impact of administering prehospital packed red cells in their helicopter service. In a related paper, Dr. Mark Yazer and colleagues from the Alleghany General Hospital review their initial ten months experience with transfusing cold-stored uncrossmatched whole blood, i.e., low titer group O positive blood that was leukoreduced with a platelet-sparing filter. Dr. David

This issue is dedicated to a call to action for control of gun violence in the United States. In addition, this issue contains a comprehensive review by Dr. Peter Rhee and colleagues from the University of Arizona, which addresses science relevant to gunshot wounds including weapons, bullets, and their related ballistics Transcript

The lead article is the presidential address by Dr. Richard Falcone from the Cincinnati Children’s Hospital. Dr. Falcone’s central theme was the critical role of teamwork and team communication in caring for the injured child. The ensuing paper is the keynote lecture by Dr. Joe Tepas from the University of Florida at Jacksonville. Dr. Tepas provides an informative overview of the past, present, and future of pediatric trauma surgery. The next paper is by Dr. Sheila Hanson and colleagues from multiple pediatric surgical programs who address the ongoing debate of the appropriate prophylaxis for venous thromboembolism in the pediatric trauma patient. In a related paper, Dr. Ioannis Liras and colleagues from the University of Texas in Houston evaluated age related hypercoagulability in their rapid TEG database of greater than 7000 trauma activations from 2010-2013. I will conclude by suggesting careful reading of the AAST multi-institutional of hemorrhage from severe pelvic fractures authored by Dr. Todd Consta

Welcome to the April issue of the Journal. The lead paper is by Dr. Junichi Inoue and colleagues from the Tokyo Medical University who analyze the Japan Trauma Data Bank to determine the impact of REBOA. REBOA has been used in Japan since 1990 and the national data bank was established in 2003. The next paper is by Dr. Vicente Undurraga and colleagues from the PROPPR group. In this subgroup the authors selected patients requiring emergency laparotomy, defined as within 90 minutes of hospital arrival, with the hypothesis that this high risk group would be most likely to benefit from an initial 1:1:1 transfusion strategy. The next paper by Dr. Shibani Pati and colleagues from the University of California at San Francisco and colleagues from Portland and Houston, examine the type of plasma to deliver to attenuate the endotheliopathy of trauma. Finally, I believe another timely report is by Dr. James Byrne and associates from the University of Toronto who analyze the impact of EMS prehospital times on trau

The lead paper is by Dr. Kenji Inaba and colleagues from the AAST who performed a multicenter review of temporary intravascular shunts in civilian trauma centers from 2005-2013. Next, we have Dr. Rachel Russo and colleagues from the Air Force conducted studies in a swine model of controlled hemorrhage that demonstrated the concept of partial REBOA inflation in Zone I for extending the golden hour. Joining Drs. Inaba and Russo, we have Dr. Jamie Coleman and associates from the trauma services at Indiana University describe a series of traumatic abdominal wall hernias from 2002-2014. Dr. Jamie Coleman and associates from the trauma services at Indiana University describe a series of traumatic abdominal wall hernias from 2002-2014. Finally, I would highlight the paper by Dr. Thomas Schroeppel et al from the Presley Trauma Center at the University of Tennessee. This was a review of penetrating wounds from 1996 to 2014 that involve the duodenal. Transcript

The lead article is an AAST presentation by Dr. Fred Pieracci and colleagues from Denver Health/University of Colorado who report a prospective, controlled clinical study of rib fracture stabilization. Another timely AAST presentation was by Dr. Jennifer Hubbard et al from Fresno Community/University of California who report a retrospective review of the use of endotracheal tubes with subglottic secretion drainage. Dr. Daisy Chou and associates from Cedars-Sinai in Los Angeles analyze the impact of field intubation in patients with hemorrhagic shock. Finally, I would like to highlight the systematic review of REBOA in the management of hemorrhagic shock written by Dr. Jonathan Morrison from the Glasgow Royal Infirmary and colleagues from around the world. Transcript

As you know, we begin the year with some of the AAST presentations. Dr. L.D. Britt presented the AAST Fitz Lecture entitled acute care surgery. Is it time for a victory lap? Dr. Tom Scalea’s presidential address touched on these topics nostalgically. Dr. Josh Brown and colleagues from the University of Pittsburgh detail their AAST presentation on the impact of geographic distribution of trauma centers and their relationship to injury-related mortality. Dr. Brandon Chapman et al at Denver Health/University of Colorado described a chest CT based scoring system of rib fractures that are associated with pneumonia, mechanical ventilation, and need for a tracheostomy. Dr. Geoffrey Dobson from the James Cook University in Queensland provides a comprehensive review of a new impressive resuscitative adjunct adenosine, lidocaine, and magnesium (ALM). Transcript

The lead article is the Presidential Address of Dr. Chris Cocanour from the UC Davis Medical Center in Sacramento. The Earl Young Awardee was Hunter Moore from the University of Colorado Denver who, with his colleagues, has shown in a rodent model of severe hemorrhagic shock that plasma versus crystalloid resuscitation attenuates systemic hyperfibrinolysis. In the ensuing paper, Dr. Hasan Alam and his colleagues from the University of Michigan continue their innovative work with histone deacetylase inhibition by employing the selective inhibition of histone deacetylase 6 in rodent models of hemorrhagic shock. Dr. Alexis Moren and his colleagues from the PROMMT Study Group who employed their database of 1245 patients to identify massive transfusion based on rate of bleeding. Dr. Joseph Lopez and associates from the Baptist Medical Center at Wake Forest enlighten us with the implication of subcapsular hematomas in the management of blunt splenic trauma. Dr. Erik Olsen and colleagues from Scripps Mercy Hospita

In the wake of the American College of Surgeons Committee on Trauma suggesting patient outcome is the same for Level I and Level II trauma centers, I believe a timely message is report by Dr. Jan Jansen from the Aberdeen Royal Infirmary and colleagues throughout Scotland who describe their comprehensive geospatial analysis of greater than 80,000 trauma patients over a year. Dr. Samuel Ross and associates from the Carolinas Medical Center in Charlotte, provide insight into the impact of normal saline versus Ringer’s lactate on resuscitation endpoints for hemorrhagic shock. Another interesting resuscitation paper was by Dr. Martin Ponschab et al from the Trauma Research Center in Salzburg. Dr. Elizabeth Benjamin and colleagues from the LA County Medical Center, investigate the risk of deep organ space infection after emergent bowel resection and anastomosis. The second paper is by Dr. Daniel Yeh et al from the Massachusetts General Hospital who focus on the clinical implications of gangrenous cholecystiti

The lead paper presented at the AAST, is authored by Dr. Laura Moore from UT Houston along with colleagues from the Cowley Shock Trauma Center in Baltimore. In a related paper, presented at EAST, Dr. Sundeep Guliani et al from Virginia Commonwealth University demonstrated the reliability of ultrasound guided central aortic wire placement, thus, theoretically avoiding, the need for fluoroscopy for REBOA placement. Dr. David Notrica and colleagues from ATOMAC (which apparently is an abbreviation for Arizona-Texas-Oklahoma-Memphis-Arkansas Consortium), a group of ACS verified Level I pediatric trauma centers, reviewed the relevant literature with respective grading their recommendations for organ injuries ATOMAC proposed practice management guideline based on hemodynamic status rather than organ injury score formally employed in the American Pediatric Surgery Association guidelines that have been considered the standard for over two decades. Dr. Carl Wahlgren and Dr. Bjorn Kagsterman from the Karolinski Inst

Dr. Gene Moore presents highlights from the September 2015 issue. Selected articles include an AAST 2014 plenary paper by Dr. Ben Zarzaur et al, who conducted a prospective observational trial to determine risk of splenectomy after nonoperative management. In another recommended article, Dr. Sandy Arabian and Eastern Association for the Surgery of Trauma colleagues investigated interhospital variability and accuracy in data coding and scoring by registrars. Dr. Ting Li’s team at the University of Calgary analyzed the incidence of small bowel obstruction and incisional hernia following both laparotomy and nonoperative management. Dr. Hyun Jin Cho et al’s present a retrospective review of traumatic pulmonary pseudocysts treated at their South Korea hospital.

Dr. Moore’s highlights for the August 2015 issue include: an AAST presentation by Dr. Konstantinos Chouliaras and colleagues from the LA County/USC Medical Center who analyze the need for evaluation of mediastinal air following blunt trauma. Dr. Ashley Zander et al from the Scripps Mercy Center in San Diego illuminate on the limitations of risk assessment models to determine VTE prophylaxis following injury. Dr. Dave Wisner and colleagues from a multitude of well-known institutions provide a comprehensive overview of the current management of children with solid organ injuries following blunt trauma. Dr. Kenji Inaba and colleagues review their seven years’ experience of 87 patients who had tourniquets applied; 15% of these were prehospital, 39% in the ED, and 10% in the OR. Transcript

Dr. Moore’s highlights for the July 2015 issue include: the lead article is the presidential address by Dr. Kimberly Davis from Yale who provides an insightful overview of decision-making applied to our discipline of trauma and acute care surgery. Dr. Rebecca Schroll and the colleagues from EAST review a multi-institutional experience with prehospital use of tourniquets from 2010 to 2013. Dr. Diane Schwartz et al from the Brigham and Women’s Hospital in Boston provide compelling support for performing laparoscopic cholecystectomy within 24 hours of admission. Dr. Chethan Sathya and colleagues from the Sunnybrook Research Institute in Toronto review the challenges in assessing the quality of care provided by trauma centers caring for injured children. Dr. Marie Crandall and her EAST colleagues suggest the areas that warrant concentrated efforts include 1) car engineering advances, 2) behavioral interventions, and 3) risk screening. Transcript

Dr. Gene Moore presents recommended reading from the June 2015 issue of The Journal of Trauma, which features first papers from last year’s inaugural meeting of the Pediatric Trauma Society. Meeting highlights include the historic presidential address by Dr. Barbara Gaines, who delves into the history of the society against the backdrop of pediatric trauma systems development. On a related note, an AAST plenary paper by Dr. Robert Winchell and colleagues from the ACS Committee reassesses the effects of COT consultation on regional trauma system development. Featured research papers include Dr. Margaret Lauerman et al’s study of Grade 4 blunt cerebrovascular injuries and Dr. Paul Chestovich et al’s experience with laparoscopy for penetrating abdominal wounds. On the statistical side, Dr. Angela Sauaia highlights Dr. Lynne Moore et al’s model for evaluating the quality of trauma care as a point of departure for discussing the use of MICE for missing data. Transcript

Dr. Gene Moore’s highlights for the May 2015 issue include the lead article by Dr. Nobuyuki Saito and colleagues from the Nippon Medical Center Chiba Hokuso Hospital, Inzai, Japan who evaluated their complications of REBOA. An AAST paper by Dr. John Harvin and colleagues from the Memorial Hermann Hospital in Houston who evaluate the impact of TXA on mortality in their patients with hyperfibrinolysis documented by TEG. Another timely issue is addressed by Dr. Diane Hale and associates from the University of San Antonio who assess whether clinical findings can be used to exclude unstable cervical spine injuries in children less than six years of age. The final paper is by Dr. Annika Blaser from Lucerne, Switzerland along with colleagues from Estonia, Sweden, and Australia. This team provides a comprehensive review of abdominal compliance and its implications in the development of intra-abdominal hypertension and compromised laparoscopic workspace. Transcript

Dr. Gene Moore’s highlights for the April 2015 issue include: The lead articles are the AAST Presidential Address entitled “Responsibility” by Dr. Bill Cioffi and the Fitts Lecture “Genomics of Injury: The Glue Grant Experience” by Dr. Ron Tompkins. Dr. Marty Schreiber and colleagues of the Resuscitation Outcome Consortium who completed a randomized trial comparing prehospital limited crystalloid versus standard crystalloid resuscitation. Dr. Tatsuyo Norii and colleagues who examine the impact of resuscitation endovascular balloon occlusion of the aorta on survival following blunt trauma using the Japanese Trauma Data Bank from 2004-2011. Dr. Peter Rhee and colleagues from the University of Arizona and the University of Southern California who review their experience with transfusion of auto transfused whole blood from hemothoraces, The final paper to highlight is authored by Dr. Ben Howard and colleagues from the San Francisco General who fundamentally demonstrate that patients with isolated hypoxemia (Pa02

Dr. Gene Moore’s highlights for the March 2015 issue include: The first paper by Dr. John Sharpe et al from the University of Tennessee Memphis is based on their long-term interest in ventilator-associated pneumonia. The next paper, also an AAST presentation, is by Dr. Laura Godat and colleagues from the University of California at San Diego who queried the California Statewide Hospital Discharge Database to determine the time course of VTE in high-risk trauma patients. In a related paper, Dr. Casey Allen and associates from the University of Miami review their experience with major venous injuries following penetrating trauma, 74% of these were gunshot wounds, to determine the relative risk of pulmonary embolus with repair versus ligation. The final paper that generated considerable interest was a large animal study by Dr. Mohamad Tiba and colleagues from the University of Michigan who introduced a modified pelvic binder for hemostasis. Transcript

Dr. Gene Moore’s highlights for the February 2015 issue include: The paper that generated most discussion was the EAST guideline developed for cervical spine collar clearance in the obtunded adult blunt trauma patient, authored by Dr. Mayur Patel and a host of EAST participants. Dr. Stephanie Savage and colleagues from the University of Tennessee in Memphis who presented a prospective validation of their critical administration threshold (CAT). The third most discussed paper, gratifyingly to the editorial office, was experimental work. Dr. Stephen Davies et al from the University of Virginia designed a swine model of combined lung and brain injury to determine if airway pressure release ventilation, (APRV) improved outcome compared to the standard ARDS Net practice. Dr. Daniel McIlroy and colleagues from the John Hunter Hospital in Newcastle, New South Wales, Australia who characterize the release of mitochondrial and nuclear DNA release in 35 seriously injured patients (median ISS of 14) who required opera

Dr. Gene Moore’s highlights for the January 2015 issue include: Master Surgeon’s Lecture by Dr. Andy Peitzman from the University of Pittsburgh; report by Dr. Tyler Loftus and colleagues from the University of Florida addressing another common challenge for acute care surgeons; review of a common dilemma for acute care surgeons – risk of recurrence following hospitalization for acute diverticulitis by Dr. Vanessa Ho and colleagues from Jamaica, Sloan Kettering, and Cornell Medical Centers in New York; report by Dr. Brent Pottenger et al from Johns Hopkins and UC Davis; and a potentially useful technique for damage control of severe lung injuries suggested by Dr. Alberto Garcia and colleagues from Cali, Columbia. Transcript