Evaluation of just-in-time trauma training for international surgical military preparedness at a US Civilian Levell Trauma Center: A proof of concept.

Background: Increasing global conflicts continue to heighten the need for increased focus on preparedness for military physicians and surgeons. Simulation has recently been adopted by civilian surgical trainees to offset the problem of increased work hour restrictions and shift the current focus toward minimally invasive techniques. We hypothesized that just-in-time trauma training, incorporating both focused clinical and simulated experience at our civilian Level I Trauma Center, would increase the competence and confidence of international military physicians in trauma care.

Rapid-onset cerebral fat embolism syndrome leading to brain death: A case report.

Background: Fat Embolism Syndrome (FES) is a rare clinical phenomenon attributed to fat droplet embolization and subsequent multisystem organ failure, typically following traumatic orthopedic injury. It classically presents with hypoxemia, transient neurologic deficits, and skin changes that appear a day or more after the initial insult. Its exact mechanism remains unclear, although the mechanical obstruction of capillaries or production of toxic intermediaries following fat hydrolysis and extravasation of marrow have been described.

Optimizing Mass Casualty Triage: Using Discrete Event Simulation to Minimize Time to Resuscitation.

Background: Urban areas in the US are increasingly focused on mass casualty incident (MCI) response. We simulated prehospital triage scenarios and hypothesized that using hospital-based blood product inventories for on-scene triage decisions would minimize time to treatment.

Study Design: Discrete event simulations modeled MCI casualty injury and patient flow after a simulated blast event in Boston, MA.

Outcomes in Post-operative Delirium Following Bowel Resection: A Single Center Retrospective Review.

Introduction: Delirium is associated with adverse post-operative outcomes, long-term cognitive dysfunction, and prolonged hospitalization. Risk factors for its development include longer surgical duration, increased operative complexity and invasiveness, and medical comorbidities. This study aims to further evaluate the incidence of delirium and its impact on outcomes among patients undergoing both elective and emergency bowel resections.

Evaluation of motor vehicle crash rates during and after the COVID-19-associated stay-at-home order in Connecticut.

Introduction: Recent research suggests that COVID-19 associated stay-at-home orders, or shelter-in-place orders, have impacted intra-and-interstate travel as well as motor vehicle crashes (crashes). We sought to further this research and to understand the impact of the stay-at-home order on crashes in the post order period in Connecticut.

Methods: We used a multiple-comparison group, interrupted time-series analysis design to compare crashes per 100 million vehicle miles traveled (VMT) per week in 2020 to the average of 2017-2019 from January 1-August 31.

Hospital-Acquired COVID-19: Case Discussions of Two Patients Treated at a Level I Trauma Center.

The community spread of COVID-19 is well known and has been rigorously studied since the onset of the pandemic; however, little is known about the risk of transmission to hospitalized patients. Many practices have been adopted by healthcare facilities to protect patients and staff by attempting to mitigate internal spread of the disease; however, these practices are highly variable among institutions, and it is difficult to identify which interventions are both practical and impactful. Our institution, for example, adopted the most rigorous infection control methods in an effort to keep patients and staff as safe as possible throughout the pandemic.

Emergency intraoperative vascular surgery consultations at a tertiary academic center.

Objective: Vascular surgeons are frequently called on to provide emergency assistance to surgical colleagues. Whereas previous studies have included elective preoperative vascular consultations, we sought to characterize the breadth of assistance provided during unplanned intraoperative consultations at a single tertiary academic center.

Methods: We queried our institutional billing department during a 15-year period and reviewed the records (January 1, 2002-December 31, 2016) and identified unanticipated unplanned vascular surgery intraoperative consultations from all surgical services.

Functional Superior Mesenteric Artery Syndrome Induced by an Optional IVC Filter.

This patient suffered multiple injuries in a motor vehicle crash. She had an optional IVC filter placed in the usual fashion and location which resulted in a functional obstruction of the third part of the duodenum much as one would expect with a Superior Mesenteric Artery (SMA) syndrome. The symptoms persisted over the sixteen-day filter dwell time and resolved completely with the retrieval of the filter.

Phytobezoar: A Brief Report with Surgical and Radiological Correlation.

Gastrointestinal bezoars, collections of incompletely digested material within the alimentary tract, can present as a diagnostic challenge and should be considered in the differential diagnosis and management of small bowel obstruction, ischemic bowel, or bowel perforation. We present a case of a 37-year-old man with a distant history of laparotomy for superior mesenteric artery thrombosis requiring partial small bowel resection of the jejunum who presented with worsening abdominal pain, nausea, vomiting, and hematemesis. An abdominal computed tomography revealed dilated loops of small bowel with a transition point at the ileum, distal to his prior bowel anastomosis.

A cadaveric procedural anatomy simulation course improves video-based assessment of operative performance.

Background: Inadequate anatomic knowledge has been cited as a major contributor to declining surgical resident operative competence. We analyzed the impact of a comprehensive, procedurally oriented cadaveric procedural anatomy dissection laboratory on the operative performance of surgery residents, hypothesizing that trainees' performance of surgical procedures would improve after such a dissection course.

Materials And Methods: Midlevel general surgery residents (n = 9) participated in an 8 wk, 16-h surgery faculty-led procedurally oriented cadaver simulation course.

Don't Forget the Abdominal Wall: Imaging Spectrum of Abdominal Wall Injuries after Nonpenetrating Trauma.

Abdominal wall injuries occur in nearly one of 10 patients coming to the emergency department after nonpenetrating trauma. Injuries range from minor, such as abdominal wall contusion, to severe, such as abdominal wall rupture with evisceration of abdominal contents. Examples of specific injuries that can be detected at cross-sectional imaging include abdominal muscle strain, tear, or hematoma, including rectus sheath hematoma (RSH); traumatic abdominal wall hernia (TAWH); and Morel-Lavallée lesion (MLL) (closed degloving injury).

How long should we fear? Long-term risk of venous thromboembolism in patients with traumatic brain injury.

Background: Although patients with traumatic brain injury (TBI) are known to be at high risk for venous thromboembolism (VTE), it is not clear how long this risk persists after injury. We aimed to determine the risk of VTE in patients with TBI during one year after injury and to identify associated factors.

Methods: Patients 18 years and older with International Classification of Diseases, Ninth Revision, Clinical Modification diagnoses of isolated TBI (head Abbreviated Injury Scale [AIS] ≥3 and AIS <3 for all other body regions) were identified in the California State Inpatient Database (2007-2011).

Are Older Adults With Hip Fractures Disadvantaged in Level 1 Trauma Centers?

Background: Large regional hospitals achieve good outcomes for patients with complex conditions. However, recent studies have suggested that some patient groups might not benefit from treatment in higher-level trauma centers.

Objective: To test the hypothesis that older adults with isolated hip fractures experience delayed surgical treatment and worse clinical outcomes when treated in higher-level trauma centers.

Explaining the excess morbidity of emergency general surgery: packed red blood cell and fresh frozen plasma transfusion practices are associated with major complications in nonmassively transfused patients.

Background: Intraoperative blood product transfusions carry risk but are often necessary in emergency general surgery (EGS).

Methods: We queried the American College of Surgery-National Surgical Quality Improvement Program database for EGS patients (2008 to 2012) at 2 tertiary academic hospitals. Outcomes included rates of high packed red blood cell (pRBC) use (estimated blood loss:pRBC < 350:1) and high fresh frozen plasma (FFP) use (FFP:pRBC >1:1.

Comparing Readmissions and Infectious Complications of Blunt Splenic Injuries Using a Statewide Database.

Background: Although non-operative management of blunt splenic injury (BSI) is increasingly common, the long-term infectious complications after adjunct splenic artery embolization (SAE) are not well described.

Methods: Patients aged 18-64 y with BSI were identified in the California State Inpatient Database (2007-2011) and categorized as receiving either non-operative management (NOM) without SAE, NOM with SAE, or operative management (OM). The cumulative incidence of infections (surgical site infections [SSI], pneumonia, urinary tract infections, and sepsis) requiring readmission at different times up to one y after injury were calculated.

A cadaveric procedural anatomy course enhances operative competence.

Background: Inadequate anatomy training has been cited as a major contributor to declines in surgical resident operative competence and confidence. We report the impact of a procedurally oriented general surgery cadaveric dissection course on trainee-operative confidence and competence.

Materials And Methods: After obtaining institutional review board approval, postgraduate year 2 and 3 general surgery residents were prospectively enrolled into two cohorts: (1) an intervention group (n = 7) participating in an 8-wk procedurally oriented cadaver course and (2) controls (n = 7) given access to course materials without participation in cadaver dissection.

Cost savings associated with transfer of trauma patients within an accountable care organization.

Background: The Patient Protection and Affordable Care Act supports the establishment of accountable care organizations (ACOs) as care delivery models designed to save costs. The potential for these cost savings has been demonstrated in the primary care and inpatient populations, but not for patients with emergency conditions or traumatic injuries.

Methods: Our study evaluated adult trauma patients transferred to the tertiary care hospitals of a pioneer ACO, comparing those who were transferred from within the ACO to those from outside the ACO in terms of overall cost of hospitalization.

Mortality and Resource Utilization After Critical Care Transport of Patients With Hypoxemic Respiratory Failure.

Introduction: We performed this study to quantify resources required by mechanically ventilated patients with hypoxemia after critical care transport (CCT) and to assess short-term clinical outcomes.

Methods: We performed a retrospective review of transports of patients with severe hypoxemic respiratory failure from referring hospitals to 3 tertiary care hospitals to assess the outcomes including in-hospital mortality, ventilator days, intensive care unit length of stay (LOS), hospital LOS, disposition, and reported neurologic status on hospital discharge as well as medical interventions specific to acute respiratory failure and critical care.

Results: Of 230 patients transported with hypoxemic respiratory failure, 152 survived to hospital discharge, for a mortality rate of 34.

BWH emergency radiology--surgical correlation: traumatic spigelian hernia with right colonic injury.

We present a case of a young man who fell off his motorbike 2 days before presentation to the hospital with a complaint of gastrointestinal upset and abdominal pain. Contrast-enhanced CT of the abdomen and pelvis demonstrated a right-sided traumatic spigelian hernia and an ascending colon injury necessitating operative repair of both.

BWH emergency radiology-surgical correlation: torsion of Meckel's diverticulum.

We present the radiologic findings and intraoperative correlation of a torsed Meckel's diverticulum leading to small-bowel obstruction in a 65-year-old male without prior abdominal surgery. As this is a rare entity and difficult to diagnose, an understanding of the clinical presentation and radiologic findings correlated with this pathology can help to expedite diagnosis and treatment.

Automated analysis of vital signs to identify patients with substantial bleeding before hospital arrival: a feasibility study.

Trauma outcomes are improved by protocols for substantial bleeding, typically activated after physician evaluation at a hospital. Previous analysis suggested that prehospital vital signs contained patterns indicating the presence or absence of substantial bleeding. In an observational study of adults (aged ≥18 years) transported to level I trauma centers by helicopter, we investigated the diagnostic performance of the Automated Processing of the Physiological Registry for Assessment of Injury Severity (APPRAISE) system, a computational platform for real-time analysis of vital signs, for identification of substantial bleeding in trauma patients with explicitly hemorrhagic injuries.

BWH emergency radiology--surgical correlation: sigmoid volvulus.

We describe the radiological and intraoperative correlation of large bowel obstruction due to sigmoid volvulus in a 52-year-old female. The purpose of this article is to emphasize the importance of recognizing sigmoid volvulus as a cause of bowel obstruction in patients presenting with abdominal pain, since it can lead to bowel ischemia and necrosis.