The contemporary use of emergency pericardiocentesis in trauma: A nationwide trend analysis.

Background: Pericardiocentesis is a critical skill taught by the Advanced Trauma Life Support (ATLS®) course, yet substantial knowledge gaps exist regarding recent practice changes and indications for pericardiocentesis. This study aims to characterize contemporary practice patterns and nationwide trends in the use of emergency pericardiocentesis in trauma.

Methods: A retrospective study of the National Trauma Data Bank (2011-2022) identified patients undergoing pericardiocentesis within 48 h of arrival prior to any cardiac repair surgery.

Drive to Survive: Dynamic Driving Pressure and Survival in the Trauma Population.

BackgroundDriving pressure (ΔP), the difference between peak inspiratory pressure (PIP) or plateau pressure (Pplat) and positive end-expiratory pressure (PEEP), has been proposed as a better target for avoiding ventilator-induced lung injury (VILI) in mechanically ventilated patients. This study aimed to determine if lower dynamic ΔP would correlate with reduced mortality and lower incidences of VILI.MethodsA single-center retrospective analysis identified 237 trauma patients admitted in 2020 who underwent ≥48 hours of mechanical ventilation and survived ≥72 hours.

Mechanisms underlying allosteric modulation of antiseizure medication binding to synaptic vesicle protein 2A (SV2A).

Brivaracetam (BRV) and levetiracetam (LEV) are antiseizure medications (ASMs); UCB-J is a PET tracer targeting synaptic vesicle protein 2A (SV2A); UCB7361 is closely related to padsevonil, an experimental anticonvulsant; while UCB1244283 acts as an allosteric modulator for BRV and LEV binding but not for these other ligands. The SV2A-BRV-UCB1244283 structure reveals how UCB1244283 allosterically enhances BRV binding by occupying an allosteric site near the primary binding site, preventing BRV dissociation. This allosteric site, formed by hydrophobic and uncharged residues, is an uncharacterized small-molecule binding site in SV2A.

Collaborative Synthesis for Neglected Diseases through the Open Synthesis Network: Structure-Activity Relationships of Arylaminopyrazoles as Chagas Disease Treatments.

Neglected tropical diseases (NTDs) make up a diverse group of debilitating illnesses disproportionately affecting impoverished communities in tropical and subtropical regions. Despite their significant global health burden, they are often overshadowed by more prominent diseases, resulting in a critical lack of investment in the research and development of new treatments. A renewed focus on NTDs is, therefore, urgently needed, particularly in terms of novel therapeutic strategies.

An Online Contraception Decision Aid for Transgender and Gender-Nonconforming Persons Assigned Female at Birth.

We launched a study to develop an online contraception decision aid to address the unique needs of TGNC AFAB individuals. Guided by user-centered design principles, we developed a prototype tool and conducted a preliminary evaluation that showed good system performance (94% accuracy and positive assessment of usefulness/usability). This research fills a critical knowledge gap, advocates health equity for gender-minority groups, and develops guiding principles for engaging them in participatory design of digital health tools.

Predicting Functional Outcomes in Adult Traumatic Brain Injuries Using the Base Deficit, International Normalized Ratio, and Glasgow Coma Scale Score.

Introduction: Up to 70% of early deaths in traumatic brain injuries are due to withdrawal of care. However, many of these patients could have made a good recovery. A reliable prognostic indicator would thus be useful for early decision-making.

Examining disparities in management and outcomes among unhoused patients with traumatic brain injury.

Objective: This study aims to investigate any differences in management and hospital outcomes between unhoused and housed patients with traumatic brain injury (TBI).

Methods: We conducted a 3-year retrospective study (2019-2021). Patients with a head Abbreviated Injury Scale≥3 were included and divided into two cohorts: unhoused (UH) and housed underinsured (HUI).

Whole blood use in patients with traumatic brain injury and hemorrhagic shock is not associated with decreased mortality.

Background: Traumatic brain injury (TBI) is a leading cause of trauma mortality worldwide. Whole blood (WB) is associated with decreased mortality compared with blood component therapy (BCT) alone in trauma patients with hemorrhagic shock (HS). The ideal resuscitation approach in patients with both TBI and HS remains unclear.

The role of kidney-preserving surgery in renal trauma: A nationwide analysis.

Background: Although renal trauma is commonly managed nonoperatively, surgical intervention may be necessary in some patients. Within operative management, the rationale for choosing between total nephrectomy and kidney-preserving approaches remains unclear. In this study, we aimed to define the role of kidney-preserving surgery within renal trauma management.

Far from Home: Patient preferences and acceptable risk tolerance for local vs regional trauma care.

Background: Regionalization of trauma care can improve outcomes but may conflict with patient preferences and risk tolerance. This study analyzed trauma patients' preferences for local care across different risk profiles.

Methods: Structured surveys and modified standard gamble utility assessments were conducted with trauma inpatients to gauge additional operative risks they would accept for local versus regional care.

Analysis of neighborhood socioeconomic disadvantage indices and injury mechanism Patterns: Does the index matter?

Introduction: The socioeconomic status has impact on trauma, but, how area deprivation index (ADI) or distressed communities index (DCI), relates to mechanisms of injury (MOI) is unknown.

Methods: All trauma cases in 2021 with 9 or 5-zip codes of living location were included. MOI patterns based on ADI or DCI score was examined.

Prioritizing circulation over airway to improve survival in trauma patients with exsanguinating injuries: a world society of emergency surgery-panamerican trauma consensus statement.

Introduction: Hemorrhage is one of the leading causes of preventable death in trauma patients. For decades, the Airway-Breathing-Circulation (ABC) approach has been the cornerstone of trauma care. However, emerging evidence suggests that prioritizing airway management in exsanguinating patients may worsen hypotension and increase mortality.

Justice and triage in military medical ethics: A brief report.

Background: The American Association for the Surgery of Trauma Military Liaison Committee held the second Military Fallen Surgeons Educational Symposium in conjunction with the 2024 American Association for the Surgery of Trauma meeting, which once again included an ethics segment.

Methods: This case-based session guided discussion of complex and unique ethical challenges that arise in military medical practice when in a deployed environment.

Results: Central themes included justice in triage, beneficence versus nonbeneficial care, dual agency, and moral injury.

Great Debates-Shift Work Versus One Day at a Time: 12- Versus 24-Hour Call Duration in Acute Care Surgery.

Optimal shift length for acute care surgery remains an ongoing debate that takes into consideration the impact of fatigue on performance, patient outcomes, and provider well-being. The data is conflicting on whether 12- or 24-hour calls are best. Proponents for the 24-hour shift model cite that it fosters superior continuity of care with fewer handoffs, enhances surgical training and does not negatively impact patient outcomes.

Original scientific paper in-hospital and post-discharge outcomes with autologous versus prosthetic repair of traumatic abdominal vascular injuries: a 10-year review of the PROOVIT registry.

Purpose: Abdominal vascular injury (AVI) often coincides with bowel injury and abdominal contamination. Prosthetic materials may be necessary for vascular reconstruction, but outcomes are poorly understood. We examined outcomes in patients undergoing autologous vs.

Trauma Sternotomy Closure: Drain Size May Matter.

BackgroundSternotomy for trauma (ST) can be life-saving, but optimal chest closure techniques and their impact on outcomes remain unclear. This study examines the association between mediastinal drain size used during ST closure and patient outcomes to determine if larger bore drain placement may mitigate need for reintervention after definitive chest closure.MethodsA retrospective review (2015-2023) of all ST patients at an ACS-verified Level 1 trauma center was conducted, excluding intraoperative deaths.

Impact of Systemic Anticoagulation During Traumatic Peripheral Arterial Repair on Re-Intervention and Amputation: An Analysis of 11 Years of PROOVIT Data.

IntroductionSystemic anticoagulation (SAC) is widely used during peripheral arterial repair (PAR) to mitigate thrombotic risks, but its efficacy in trauma patients remains unclear. This study evaluated the association of SAC with re-intervention and amputation rates in traumatic PAR.MethodsThis retrospective study queried the Prospective Observational Vascular Injury Treatment (PROOVIT) database (2012-2023) for traumatic PAR cases.

Decompressive craniectomy for traumatic brain injury: a review of recent landmark trials.

Traumatic brain injury (TBI) is a leading cause of trauma-related morbidity and mortality worldwide, with decompressive craniectomy (DC) serving as a critical surgical intervention. This article reviews the recent studies evaluating the role of DC in the management of elevated intracranial pressures (ICPs) associated with TBI and its impact on functional outcomes. Decompressive Craniectomy in Diffuse Traumatic Brain Injury (DECRA), Randomized Evaluation of Surgery with Craniectomy for Uncontrollable Elevation of intracranial pressure (RESCUEicp), and Randomized Evaluation of Surgery with Craniectomy for patients Undergoing Evacuation of Acute Subdural Hematoma (RESCUE-ASDH) are three landmark trials that used varying thresholds for surgical intervention after TBI and examined how functional outcomes improved with time.

Reclaim the duct! Laparoscopic common bile duct exploration for the acute care surgeon.

Laparoscopic common bile duct exploration (LCBDE) has emerged as a viable and effective alternative to the traditional multistage management of choledocholithiasis involving preoperative or postoperative endoscopic retrograde cholangiopancreatography (ERCP). Despite its advantages, LCBDE remains underused, particularly among trauma and acute care surgeons, due to its technical challenges and limited training opportunities. This practical review examines advancements in LCBDE technology, exploring its clinical applications, outlining key steps for its successful implementation, and evaluating selected current literature.

Current practice variations in venous thromboembolism prophylaxis for adolescents with severe traumatic brain injury: Trauma center type matters.

Background: While severe traumatic brain injury (TBI) faces an increased risk of venous thromboembolism (VTE), pharmacological VTE prophylaxis might be significantly delayed because of concerns for TBI progression. We aimed to assess practice variations in the rate and timing of VTE prophylaxis for adolescent patients with severe TBI between different trauma center types.

Methods: This retrospective cohort study using the American College of Surgeon Trauma Quality Improvement Program database (2017-2021) included patients aged 14 to 18 years with severe TBI.