Multimodal Deep Learning for ARDS Detection.

Objective: Poor outcomes in acute respiratory distress syndrome (ARDS) can be alleviated with tools that support early diagnosis. Current machine learning methods for detecting ARDS do not take full advantage of the multimodality of ARDS pathophysiology. We developed a multimodal deep learning model that uses imaging data, continuously collected ventilation data, and tabular data derived from a patient's electronic health record (EHR) to make ARDS predictions.

Percutaneous radial access is safe and effective for subclavian branch treatment during zone 2 endovascular aortic repair with thoracic branch endoprosthesis.

The thoracic branch endoprosthesis (TBE, W. L. Gore & Associates) provides an off-the-shelf endovascular solution for zone 2 aortic pathology that maintains perfusion to the arm.

Alveolar Extracellular Vesicles May Protect Some Patients With Chronic Aspiration From Pneumonia.

Objectives: Aspiration pneumonia (PNA) is a significant cause of morbidity and mortality. Up to 30% of healthy older adults may aspirate; however, many individuals with chronic aspiration do not develop PNA. We hypothesize that some patients with chronic aspiration may have distinct immune profiles that protect against PNA.

Treatment with Allogenic Mesenchymal Stromal Cells for Moderate to Severe Acute Respiratory Distress Syndrome: A Double-Blind, Placebo-controlled, Multi-Center, Phase 2b Clinical Trial (STAT).

Background: Prior clinical trials established the safety, but not the efficacy of bone marrow-derived mesenchymal stromal cells (MSCs) in the acute respiratory distress syndrome (ARDS).

Methods: We conducted a prospective, double-blind, multi-center randomized phase 2b clinical trial of one dose of intravenous MSCs (10 x 10/kg predicted body weight) versus placebo in 120 ventilated patients with ARDS (PaO/FiO < 250 mmHg). The primary endpoint was change in oxygenation index (OI) over 36 hours from baseline.

Single retrograde thoracic branch endoprosthesis versus standard endovascular repair with subclavian coverage for treatment of blunt thoracic aortic injuries.

Objective: The Gore TAG thoracic branch endoprosthesis (TBE) allows zone 2 thoracic endovascular aortic repair (TEVAR), maintaining left subclavian artery (LSA) patency via side branch. We compared TBE for blunt thoracic aortic injuries (BTAIs) with TEVAR with subclavian artery coverage when seal into zone 2 was required.

Methods: We retrospectively identified patients with repair for BTAI between 2011 and 2024.

Access, delivery and outcomes: the summit on the advancement of Focused Equity Research in Trauma (SAFER-Trauma).

On August 2-3, 2023, the Summit on the Advancement of Focused Equity Research in Trauma (SAFER-Trauma) was convened in Chicago, Illinois, USA. Thought leaders comprised of over 50 in-person and over 80 virtual attendees, including trauma surgeons, nurses, trauma program managers, researchers, and survivors convened at the American College of Surgeons headquarters in Chicago to take stock of existing disparities in injury care and research and consider innovative solutions to address them. To achieve these goals, the first day of the conference focused on the Current State of Trauma Research and Disparities, and the second day focused on A Unified Response to Address Disparities in Trauma Research.

Innovative approaches to equity research in trauma: current work and aspirations from the Summit on the Advancement of Focused Equity Research in Trauma (SAFER-Trauma).

On August 2-3, 2023, the Summit on the Advancement of Focused Equity Research in Trauma (SAFER-Trauma) convened to discuss strategies to support research to eliminate disparities in trauma care. An ongoing challenge for performing high-quality equity-based research is the uncomfortable recognition that implicit bias and structural racism are deeply ingrained in our society and culture and are therefore often unrecognized in medicine and research practices. Throughout SAFER-Trauma, several examples of strategies to overcome these challenges were presented.

Examining our lens: how bias heightens disparities in trauma research.

Trauma research is an expansive discipline that informs injury prevention, best practices in care, and novel interventions. However, implicit bias, or the unconscious stereotypical beliefs about groups of people, can have profound implications for traumatic injury research. Several forms of implicit bias can emerge in trauma research, which deepens existing disparities based on race or ethnicity, sex, ability status, socioeconomic status, and other factors.

Elevated cell-free hemoglobin: A novel early biomarker following traumatic injury.

Background: Cell-free hemoglobin (CFH) and free heme are potent mediators of endotheliopathy and organ injury in sepsis, but their roles in other hemolytic pathologies are not well-defined. A prime example is trauma where early hemolysis may initiate damage and predict outcome. Here, we investigated the presence of plasma CFH, heme, and their major scavengers after traumatic injury.

Using microfluidic shear to assess transfusion requirements in trauma patients.

Background: Viscoelastic assays have widely been used for evaluating coagulopathies but lack the addition of shear stress important to clot formation. Stasys technology subjects whole blood to shear forces over factor-coated surfaces. Microclot formation is analyzed to determine clot area (CA) and platelet contractile forces (PCFs).

Do serial troponins predict the need for cardiac evaluation in trauma patients after ground-level fall?

Purpose: Troponin T levels are routinely checked in trauma patients after experiencing a ground-level fall to identify potential cardiac causes of syncope. An elevated initial troponin prompts serial testing until the level peaks. However, the high sensitivity of the test may lead to repeat testing that is of little clinical value.

Cell-Free Hemoglobin in the Pathophysiology of Trauma: A Scoping Review.

Objectives: Cell-free hemoglobin (CFH) is a potent mediator of endothelial dysfunction, organ injury, coagulopathy, and immunomodulation in hemolysis. These mechanisms have been demonstrated in patients with sepsis, hemoglobinopathies, and those receiving transfusions. However, less is known about the role of CFH in the pathophysiology of trauma, despite the release of equivalent levels of free hemoglobin.

Comparison of treatment and outcomes in blunt thoracic aortic injury based on different vascular surgery guidelines.

Objective: Society for Vascular Surgery (SVS) recommendations for managing intimal (grade 1) blunt thoracic aortic injuries (BTAIs) include observation and medical management. University of Washington (UW) revised criteria suggest that intimal injuries with ≥1 cm flap should be upgraded to a moderate injury and treatment be considered. We sought to evaluate and compare SVS and UW criteria for BTAI and determine how discordance in grading affected treatment and outcome.

Developing a National Trauma Research Action Plan: Results from the postadmission critical care research gap Delphi survey.

Introduction: The 2016 National Academies of Science, Engineering and Medicine report included a proposal to establish a National Trauma Research Action Plan. In response, the Department of Defense funded the Coalition for National Trauma Research to generate a comprehensive research agenda spanning the continuum of trauma and burn care from prehospital care to rehabilitation as part of an overall strategy to achieve zero preventable deaths and disability after injury. The Postadmission Critical Care Research panel was 1 of 11 panels constituted to develop this research agenda.

A Delphi consensus statement for digital surgery.

The use of digital technology is increasing rapidly across surgical specialities, yet there is no consensus for the term 'digital surgery'. This is critical as digital health technologies present technical, governance, and legal challenges which are unique to the surgeon and surgical patient. We aim to define the term digital surgery and the ethical issues surrounding its clinical application, and to identify barriers and research goals for future practice.

Growing the next generation of trauma surgeon-scientists: Reflections on 20 years of research investment.

Introduction: The Eastern Association for the Surgery of Trauma mission includes fostering research and providing career development opportunities. Eastern Association for the Surgery of Trauma has awarded for 20 years a research scholarship to a promising young investigator. The research mentorship efforts were expanded 5 years ago with the INVEST-C Hack-a-thon.

Postinjury platelet aggregation and venous thromboembolism.

Background: Posttraumatic venous thromboembolism (VTE) remains prevalent in severely injured patients despite chemoprophylaxis. Importantly, although platelets are central to thrombosis, they are not routinely targeted in prevention of posttraumatic VTE. Furthermore, platelets from injured patients show ex vivo evidence of increased activation yet impaired aggregation, consistent with functional exhaustion.

Trauma and COVID-Induced Severe Rhabdomyolysis.

The novel coronavirus COVID-19 has been implicated in a number of extra-pulmonary manifestations including rhabdomyolysis. It is hypothesized to be secondary to direct muscle damage from the virus. The usual treatment of rhabdomyolysis is resuscitation with aggressive fluid management to prevent acute renal failure.

A Parallel Pandemic: Increased Firearm Injuries at Five Northern California Trauma Centers During the COVID-19 Pandemic: An Interrupted Time-series Analysis.

Objective: This study aimed to characterize changes in firearm injuries at 5 level 1 trauma centers in Northern California in the 12 months following the start of the COVID-19 pandemic compared with the preceding 4 years, accounting for regional variations and seasonal trends.

Summary And Background Data: Increased firearm injuries have been reported during the early peaks of the COVID-19 pandemic despite shelter-in-place restrictions. However, these data are overwhelmingly from singlecenter studies, during the initial phase of the pandemic prior to lifting of shelter-in-place restrictions, or do not account for seasonal trends.