Echelon of Care at Time of External Fixation and Infection Risk in Military Combat Casualties.

Introduction: Role 2 (R2) U.S. military treatment facilities provide lifesaving far forward damage control resuscitation and surgery.

Nosocomial Infections in Trauma Patients Receiving Extracorporeal Membrane Oxygenation.

The risk of infections in acute trauma patients receiving extracorporeal membrane oxygenation (ECMO) has not been well defined, but this population is among the sickest in the hospital. This study characterizes the blood and respiratory pathogens in trauma patients receiving ECMO and tests the hypothesis that trauma patients receiving ECMO pose a unique risk for nosocomial infections. All trauma patients (n = 50) who required ECMO at a level 1 trauma center between July 2014 and September 2023 were retrospectively reviewed.

Marijuana Use in a Nationwide Survey of Burn Survivors.

There is growing interest in the role of marijuana and its derivatives in symptom management for chronic conditions including cancer and chronic pain. In burn survivors, marijuana use patterns are unknown. The objective of this study was to examine marijuana use in a nationwide sample of burn survivors.

Has the pendulum swung too far? Discretionary single-unit red blood cell transfusion in trauma is associated with infection, thromboembolic events, and mortality.

Objectives: Studies in elective surgery report adverse outcomes with transfusion of a solitary unit of red blood cells (RBC). We quantified the effect of discretionary transfusion of one unit of blood in trauma patients with borderline transfusion indications. We hypothesized that transfusion of a discretionary unit of RBCs would increase complications.

Nationwide Comparison of Epidural and Regional Analgesia Versus Intercostal Nerve Cryoablation in Pectus Repair.

Introduction: Pectus excavatum is the most common congenital chest wall deformity, occurring in 1 in 250-300 live births. Surgical correction of this pathology is traditionally associated with significant pain. We hypothesize intercostal nerve cryoablation is a superior analgesic modality that can improve patient comfort, improve healthcare resource utilization, and reduce opioid exposure in a high-risk population.

Liver Injury as a Risk Factor for Post-traumatic Venous Thromboembolism.

Background: Venous thromboembolism (VTE) remains a major source of morbidity and mortality in severely injured patients despite current methods of risk stratification and prophylaxis, suggesting incomplete understanding of VTE risk factors. Given the liver's role in coagulation, we hypothesized that liver injury (LI) is associated with increased rates of VTE in severely injured patients.

Study Design: The American College of Surgeons TQIP 2017 to 2021 was retrospectively reviewed for patients with a maximum abdominal Abbreviated Injury Score 4 or more with or without LI.

Venous thromboembolism in transfer trauma patients: A global problem.

Background: As air travel and immobility are risk factors for venous thromboembolism, we aimed to test the hypothesis that internationally transferred trauma patients have a high incidence of venous thromboembolism on arrival.

Methods: A prospectively maintained registry of all international transferred trauma patients who presented to our level I trauma center from January 2023 to June 2024 was retrospectively reviewed. Patients with either lower extremity venous duplex ultrasound or computed tomography scan of the chest with contrast on arrival were included.

Outcomes After Pectus Excavatum Repair: A Nationwide Comparison of Nuss Versus Ravitch Operations.

Introduction: Pectus excavatum is the most prevalent chest wall deformity. Repair may be offered via Nuss or Ravitch technique. This study aims to investigate the outcomes of these repairs using a national cohort.

Small versus large-bore thoracostomy for traumatic hemothorax: A systematic review and meta-analysis.

Background: Traumatic hemothorax (HTX) is common, and while it is recommended to drain it with a tube thoracostomy, there is no consensus on the optimal catheter size. We performed a systematic review to test the hypothesis that small bore tube thoracostomy (SBTT) (≤14 F) is as effective as large-bore tube thoracostomy (LBTT) (≥20F) for the treatment of HTX.

Methods: Pubmed, EMBASE, Scopus, and Cochrane review were searched from inception to November 2022 for randomized controlled trials or cohort studies that included adult trauma patients with HTX who received a tube thoracostomy.

Early Detection of Ventilator-associated Pneumonia From Exhaled Breath in Intensive Care Unit Patients.

Objective: Evaluate associations between volatile organic compounds (VOCs) in heat and moisture exchange (HME) filters and the presence of ventilator-associated pneumonia (VAP).

Background: Clinical diagnostic criteria for VAP have poor interobserver reliability, and cultures are slow to result. Exhaled breath contains VOCs related to gram-negative bacterial proliferation, the most identified organisms in VAP.

Optimal Timing for Initiation of Thromboprophylaxis After Hepatic Angioembolization.

Objective: To evaluate the optimal timing of thromboprophylaxis (TPX) initiation after hepatic angioembolization in trauma patients.

Background: TPX after hepatic trauma is complicated by the risk of bleeding, but the relative risk after hepatic angioembolization is unknown.

Methods: Patients who underwent hepatic angioembolization within 24 hours were retrospectively identified from the 2017 to 2019 American College of Surgeons Trauma Quality Improvement Project data sets.

A 20-year retrospective analysis of deep venous thrombosis and pulmonary embolism among combat casualties requiring damage-control laparotomy at US military Role 2 surgical units.

Background: Combat casualties receiving damage-control laparotomy at forward deployed, resource-constrained US military Role 2 (R2) surgical units require multiple evacuations, but the added risk of venous thromboembolism (VTE) in this population has not been defined. To fill this gap, we retrospectively analyzed 20 years of Department of Defense Trauma Registry data to define the VTE rate in this population.

Methods: Department of Defense Trauma Registry from 2002 to 2023 was queried for US military combat casualties requiring damage-control laparotomy at R2.

Mental Health Support Is an Unmet Need for Long-term Burn Survivors: A Web-based Survey.

A National Trauma Research Action Plan identified the involvement of burn survivors as critical informants to determine the direction of research. This study employed a web-based survey to identify care gaps in a sample of burn survivors. We surveyed burn survivors from around the United States through social media and email contact with the Phoenix Society for Burn Survivors.

Heterotopic Ossification of the Abdomen: A Rare Sequela Following Trauma and Damage Control Laparotomy.

Heterotopic ossification (HO) of the abdomen is a rare yet highly morbid complication following blunt and penetrating trauma requiring damage control laparotomy. We present the case of a 22-year-old man, 20 months after life-threatening motor vehicle crash with major vascular injury requiring multiple abdominal surgeries. The patient was initially treated at a community hospital and subsequently developed a chronic left lower quadrant enterocutaneous fistula, accompanied by a gradually worsening diffuse abdominal pain.

Outcomes After Pectus Excavatum Repair: Center Volume Matters.

Purpose: Pectus excavatum (Pectus) repair may be offered for those with significant cardiopulmonary compromise or severe cosmetic defects. The influence of hospital center volume on postoperative outcomes in children is unknown. This study aimed to investigate the outcomes of children undergoing Pectus repair, stratified by hospital surgical volume.

Flexion Space Balancing Through Component Positioning and Its Relationship to Traditional Anatomic Rotational Landmarks in Robotic Total Knee Arthroplasty.

Background: The use of the femoral component position to balance the flexion space and its relationship to the transepicondylar axis (TEA) and posterior condylar angle (PCA) has not been thoroughly evaluated.

Methods: A total of 233 patients undergoing robotic arm-assisted total knee arthroplasty were evaluated. Native TEA and PCA were established on preoperative computed tomography scans.