Applying brain injury guidelines to patients with traumatic brain injury: A contemporary, consecutive series.

Objectives: Traumatic brain injury (TBI) is a significant contributor to long-term disability and imposes substantial costs, which may include excess, duplicative, or unnecessary imaging, hospitalizations or transfers, and superfluous consultations. We examined the use of the Brain Injury Guidelines (BIG) in 144 consecutive patients presenting with TBI.

Methods: Patients with TBI evaluated consecutively between April 2024 and September 2024 were prospectively classified into BIG 1, 2, and 3 categories and retrospectively assessed.

Application of Evidence into Practice in Trauma: The Purpose to Practice (P2P) Approach to Consensus Generation.

Introduction: In trauma care, there is a need to increase communication to ensure evidence-informed, best practice care guidelines are easily accessible to all providers to yield continuity of care. Clinical guidance use is one way to address this need while employing a patient-centered team approach.

Methods: During year two of the conference series, participants gathered in person and virtually to further develop the Minimum Viable Product (MVP) created during year one.

A Better Way: Initial Acceptability Testing of Using Artificial Intelligence Tools to Accelerate Development of Trauma Clinical Guidance.

Introduction: Representatives of the trauma community have voiced a need for a new approach to developing clinical guidance. In this study, we test the initial acceptability of a proposed 12-step approach that aims to reduce the current clinical guidance timeline from more than 24 months to 24 weeks.

Methods: Investigators hypothesized that artificial intelligence (AI) tools could be leveraged to improve and make the process of clinical guidance development more efficient, facilitating AI initial output that could later be reviewed by subject matter experts (SMEs).

Rib Healing and Heterotopic Ossification After Surgical Stabilization of Rib Fractures.

: Little is known about the rate of rib fracture healing after Surgical Stabilization of Rib Fractures (SSRFs). We sought to evaluate the radiographic evidence of rib healing and hypertrophic ossification (HO) in patients after SSRFs. A single-center retrospective cohort study was conducted on all patients who had undergone SSRFs from 1 January 2010 to 31 March 2023 and had a computed tomography (CT) of the chest performed greater than 6 months after SSRFs.

Anatomy of the intercostal nerves of ribs in the lower rib cage: A pilot study.

Background: Traditional intercostal nerve anatomy teaching describes nerves crossing directly across the costal margin. Significant variability in costal margin bony anatomy has been described. Our cadaveric study evaluated variability, branching, and coursing patterns of intercostal nerves at the costal margin.

Chest wall injury surgeon, know thyself.

The use of surgical stabilization of rib fractures (SSRF) for non-flail fracture patterns continues to rise. However, multiple, recent randomized controlled trials in this patient population have failed to show a clear benefit to surgery. Rather than widening the gap between research and practice, we must embrace these trials, learn from them, and continue to refine the indications for surgery.

Factors associated with discharge to home after traumatic rib fractures.

Background: Chest wall injury is common among trauma patients. Generally, patients with more medical problems tend to have worse outcomes with rib fractures. Our aim was to determine if surgical stabilization of rib fractures (SSRF) increases the likelihood of discharge to home.

Thoracostomy for removal of excess fluid in surgical stabilization of rib fractures: the T-REX trial.

Background: Management of the pleural space during and after SSRF is a matter of debate. Tube thoracostomy (TT), intra-operative pleural lavage (PL) and video assisted thoracoscopic surgery (VATS) use varies between surgeons. The purpose of this study is to describe differences in practice patterns of pleural space management (TT, PL, VATS) after SSRF at institutions with extensive experience in chest wall reconstruction.

Reconstruction of a Sternal Cleft and Ventral Hernia in an Adolescent with Pentalogy of Cantrell Utilizing Titanium Plates.

Pentalogy of Cantrell (PC) is a rare congenital disorder that presents with several midline defects including the abdominal wall, sternum, diaphragm, pericardium, and heart. Surgical intervention for omphaloceles and cardiac defects typically occur in infancy, but the optimal surgical repair for thoracoabdominal wall defects varies by patient. We present a 15-year-old female with PC, who underwent previous omphalocele, diaphragm, and cardiac repair as an infant, with recurrent ventral and diaphragmatic defects as well as a large sternal cleft with ectopia cordis.

Anatomy of the interchondral joints and the effects on mobility of ribs.

Background: Variations in the anatomy of the anterior rib cage and costal margin have been observed. We sought to evaluate the location of interchondral joints and evaluate their effect on mobility of the rib cage.

Methods: Cadaveric dissections were performed to evaluate the anatomy of the anterior ribs and the composition of the costal margin.

Blood on the drapes: A multispecialty comparison of blood spill estimates.

Introduction: Estimated blood loss (EBL) is an important part of the perioperative process. This project aims to determine the accuracy of perioperative team members to estimate blood volume on drapes and the operating room floor.

Methods: Aliquots of unused human blood were used to create surgical scenarios, and standardized pictures and videos were taken.

Intercostal nerve electrodiagnostic testing in rib fractures.

Introduction/aims: Intercostal nerve injury can occur after rib fractures, resulting in denervation of the abdominal musculature. Loss of innervation to the rectus abdominis and intercostal muscles can cause pain, atrophy, and eventual eventration, which may be an underrecognized and thus undertreated complication of rib fractures. We investigated the clinical utility of intercostal nerve electrodiagnostic testing following rib fractures to diagnose and localize nerve injury at levels T7 and below.

Safety and efficacy of fixed versus variable-dose prothrombin complex concentrate for emergent reversal of vitamin K antagonists: A systematic review and meta-analysis.

Study Objective: Four-factor prothrombin complex concentrate (4F-PCC) is standard of care for emergent vitamin K antagonist (VKA) reversal but optimal dosing is uncertain. This meta-analysis estimated the proportion of patients treated with fixed dose (FD) 4F-PCC who achieved adequate reversal and compared safety and efficacy of FD versus weight-based dose (WB) strategies.

Methods: This review was conducted according to PRISMA guidelines.

Characterizing re-triage guidelines: A scoping review of states' rules and regulations.

Background: State guidelines for re-triage, or emergency inter-facility transfer, have never been characterized across the United States.

Methods: All 50 states' Department of Health and/or Trauma System websites were reviewed for publicly available re-triage guidelines within their rules and regulations. Communication was made via phone or email to state agencies or trauma advisory committees to obtain or confirm the absence of guidelines where public data was unavailable.

An initiative to assess and improve the resources and patient care processes used among Chest Wall Injury Society collaborative centers study (CWIS-CC2).

Background: Over the last two decades, the acute management of rib fractures has changed significantly. In 2021, the Chest Wall injury Society (CWIS) began recognizing centers that epitomize their mission as CWIS Collaborative Centers. The primary aim of this study was to determine the resources, surgical expertise, access to care, and institutional support that are present among centers.

A Novel Approach to Sternal Fracture Repair With the Implementation of a Compression/Distraction Device.

Sternal fractures are common following blunt traumatic injury. Most sternal fractures can be managed successfully nonoperatively; however, surgical fixation should be considered in certain scenarios. Specifically, surgery may be indicated in cases of severe pain, respiratory failure or dependency on mechanical ventilation, cosmetic deformity, malunion, disunion, and compression of the heart.

Rib fixation for flail chest physiology and the facilitation of safe prone spinal surgery: illustrative case.

Background: Spine fractures are frequently associated with additional injuries in the trauma setting, with chest wall trauma being particularly common. Limited literature exists on the management of flail chest physiology with concurrent unstable spinal injury. The authors present a case in which flail chest physiology precluded safe prone surgery and after rib fixation the patient tolerated spinal fixation without further issue.

The evolution of a chest wall injury and reconstruction clinic during a pandemic.

Background: In 2019, we sought to develop a chest wall injury and reconstruction clinic (CWIRC) to treat patients with chest wall pain and rib fractures. This initiative was fueled by the recognition of an unmet need and evolving research demonstrating improved patient care and experience. We will describe the evolution of this clinic program from an acute care surgery/general surgery (ACS/GS) clinic to a CWIRC.

Surgical stabilization of rib fractures versus nonoperative treatment in patients with multiple rib fractures following cardiopulmonary resuscitation: An international, retrospective matched case-control study.

Background: The presence of six or more rib fractures or a displaced rib fracture due to cardiopulmonary resuscitation (CPR) has been associated with longer hospital and intensive care unit (ICU) length of stay (LOS). Evidence on the effect of surgical stabilization of rib fractures (SSRF) following CPR is limited. This study aimed to evaluate outcomes after SSRF versus nonoperative management in patients with multiple rib fractures after CPR.