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INTRODUCTION: This study aims to evaluate the association between trauma center type, verification level, and clinical outcomes in pediatric trauma patients with moderate and severe isolated blunt traumatic brain injury (TBI). METHODS: This is a retrospective cohort study utilizing the American College of Surgeons (ACS) Trauma Quality Program (TQP) Participant Use File (PUF) database from 2017 to 2021. Severely injured pediatric (<18 years) trauma patients with isolated moderate and severe TBI (AIS head >2, all other body regions <3) were included. Outcomes included in-hospital mortality, discharge disposition, intensive care unit length-of-stay (ICU-LOS), and ventilator-free days (VFDs). RESULTS: Patients treated at a level-I combined adult and pediatric trauma centers (CTCs) had significantly lower odds of in-hospital mortality than those treated at adult trauma centers (ATCs) (OR .495, 95% CI 0.291-.841, P = .009). Patients treated at level-I pediatric trauma centers (PTCs) (OR 2.726, 95% CI 2.059-3.609, P < .001) and level-II PTCs (OR 6.18, 95% CI 3.402-11.239, P < .001) were significantly more likely to be discharged home than equivalent-level ATCs. CONCLUSION: Pediatric patients with isolated blunt moderate and severe TBI treated at level-I PTCs and CTCs had reduced odds of in-hospital mortality compared to level-I ATCs. Patients at level I and II PTCs had significantly higher odds of discharge home than those at equivalent-level CTCs and ATCs.
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INTRODUCTION: This study aims to compare the outcomes of splenic artery embolization (SAE) versus splenectomy in adult trauma patients with high-grade blunt splenic injuries. METHODS: This retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program database (2017-2021) compared SAE versus splenectomy in adults with blunt high-grade splenic injuries (grade ≥ IV). Patients were stratified first by hemodynamic status then splenic injury grade. Outcomes included in-hospital mortality, intensive care unit length of stay (ICU-LOS), and transfusion requirements at four and 24 h from arrival. RESULTS: Three thousand one hundred nine hemodynamically stable patients were analyzed, with 2975 (95.7%) undergoing splenectomy and 134 (4.3%) with SAE. One thousand eight hundred sixty five patients had grade IV splenic injuries, and 1244 had grade V. Patients managed with SAE had 72% lower odds of in-hospital mortality (odds ratio [OR] 0.28; P = 0.002), significantly shorter ICU-LOS (7 versus 9 d, 95%, P = 0.028), and received a mean of 1606 mL less packed red blood cells at four h compared to those undergoing splenectomy. Patients with grade IV or V injuries both had significantly lower odds of mortality (IV: OR 0.153, P < 0.001; V: OR 0.365, P = 0.041) and were given less packed red blood cells within four h when treated with SAE (2056 mL versus 405 mL, P < 0.001). CONCLUSIONS: SAE may be a safer and more effective management approach for hemodynamically stable adult trauma patients with high-grade blunt splenic injuries, as demonstrated by its association with significantly lower rates of in-hospital mortality, shorter ICU-LOS, and lower transfusion requirements compared to splenectomy.
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Embolização Terapêutica , Mortalidade Hospitalar , Baço , Esplenectomia , Artéria Esplênica , Ferimentos não Penetrantes , Humanos , Ferimentos não Penetrantes/terapia , Ferimentos não Penetrantes/mortalidade , Ferimentos não Penetrantes/cirurgia , Ferimentos não Penetrantes/diagnóstico , Embolização Terapêutica/estatística & dados numéricos , Embolização Terapêutica/métodos , Estudos Retrospectivos , Feminino , Masculino , Esplenectomia/estatística & dados numéricos , Esplenectomia/métodos , Esplenectomia/mortalidade , Adulto , Pessoa de Meia-Idade , Baço/lesões , Baço/cirurgia , Baço/irrigação sanguínea , Artéria Esplênica/cirurgia , Resultado do Tratamento , Tempo de Internação/estatística & dados numéricos , Hemodinâmica , Escala de Gravidade do Ferimento , Adulto Jovem , Transfusão de Sangue/estatística & dados numéricosRESUMO
INTRODUCTION: This narrative review aims to evaluate the impact of current spinal immobilization practices on clinical outcomes in adult trauma patients with suspected or confirmed spinal injury to direct the creation of improved practice management guidelines. METHODS: PubMed, ProQuest, Embase, Google Scholar, and Cochrane were searched for studies that evaluated the impact of spine immobilization practices during resuscitation in adult trauma patients and reported associated clinical outcomes. Outcomes included neurological deficits, in-hospital mortality, hospital length of stay (HLOS), ICU length of stay (ICU-LOS), discharge disposition, long-term functional status (modified Rankin scale), vascular injury rate, and respiratory injury rate. RESULTS: Nine studies were included in this review, divided into two groups based on patient immobilization status. Patients compared with and without cervical immobilization had higher mortality, longer ICU-LOS, and a higher incidence of neurological deficits if immobilized. Immobilization only was associated with a higher incidence of indirect neurological injury and poor functional outcomes. CONCLUSION: Spinal immobilization during resuscitation in adult trauma patients is associated with a higher risk of neurological injury, in-hospital mortality, and longer ICU-LOS. Further research is needed to provide strong evidence for spinal immobilization guidelines and identify the optimal method and timing for immobilization practices in trauma patients.
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Mortalidade Hospitalar , Imobilização , Guias de Prática Clínica como Assunto , Ressuscitação , Traumatismos da Coluna Vertebral , Humanos , Ressuscitação/métodos , Traumatismos da Coluna Vertebral/terapia , Adulto , Tempo de Internação/estatística & dados numéricosRESUMO
INTRODUCTION: This study aims to compare the impact of early initiation of enteral feeding initiation on clinical outcomes in critically ill adult trauma patients with isolated traumatic brain injuries (TBI). METHODS: A retrospective cohort analysis of the American College of Surgeons Trauma Quality Program Participant Use File 2017-2021 dataset of critically ill adult trauma patients with moderate to severe blunt isolated TBI. Outcomes included ICU length of stay (ICU-LOS), ventilation-free days (VFD), and complication rates. Timing cohorts were defined as very early (<6 hours), early (6-24 hours), intermediate (24-48 hours), and late (>48 hours). RESULTS: 9210 patients were included in the analysis, of which 952 were in the very early enteral feeding initiation group, 652 in the early, 695 in intermediate, and 6938 in the late group. Earlier feeding was associated with significantly shorter ICU-LOS (very early: 7.82 days; early: 11.28; intermediate 12.25; late 17.55; P < .001) and more VFDs (very early: 21.72 days; early: 18.81; intermediate 18.81; late 14.51; P < .001). Patients with late EF had a significantly higher risk of VAP than very early (OR .21, CI 0.12-.38, P < .001) or early EF (OR .33, CI 0.17-.65, P = .001), and higher risk of ARDS than the intermediate group (OR .23, CI 0.05-.925, P = .039). CONCLUSION: Early enteral feeding in critically ill adult trauma patients with moderate to severe isolated TBI resulted in significantly fewer days in the ICU, more ventilation-free days, and lower odds of VAP and ARDS the sooner enteral feeding was initiated, with the most optimized outcomes within 6 hours.
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Lesões Encefálicas Traumáticas , Estado Terminal , Nutrição Enteral , Tempo de Internação , Humanos , Nutrição Enteral/métodos , Lesões Encefálicas Traumáticas/terapia , Lesões Encefálicas Traumáticas/complicações , Masculino , Feminino , Estudos Retrospectivos , Estado Terminal/terapia , Pessoa de Meia-Idade , Adulto , Tempo de Internação/estatística & dados numéricos , Fatores de Tempo , Unidades de Terapia Intensiva , Resultado do TratamentoRESUMO
INTRODUCTION: This study aims to evaluate program signaling in surgical specialties, analyze its influence on residency applications, and provide recommendations for enhancing its consistency and effectiveness. METHODS: This cross-sectional study analyzed AAMC ERAS data from the 2021 to 2022 and 2023 residency match cycles, focusing on surgical specialties including general surgery, neurological surgery, obstetrics and gynecology, and orthopedic surgery. RESULTS: A positive correlation existed between the number of signals received and the number of applicants to a program across 4 surgical specialties. 10% of programs in each specialty received between 17% and 28% of all signals. There was a negative correlation between the number of current DO residents at a program and the number of signals received. Amongst surgical specialties, those with more signals per applicant had a more equitable distribution of signals across competitive programs. University programs received the most signals, programs were less likely to receive signals if they had a higher percentage of DO residents, and IMG applicants were less likely to send signals. CONCLUSION: Specialties with more signals per applicant had a more equitable distribution of signals across competitive programs, and university programs received proportionally more signals than community programs. Further research is required to investigate the disparities in signaling and the impact of signaling on successful matching.
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Internato e Residência , Especialidades Cirúrgicas , Internato e Residência/estatística & dados numéricos , Estudos Transversais , Especialidades Cirúrgicas/estatística & dados numéricos , Especialidades Cirúrgicas/educação , Humanos , Estados Unidos , Seleção de Pessoal/estatística & dados numéricosRESUMO
BACKGROUND: Patients with liver cirrhosis (LC) demonstrate significantly elevated mortality rates following a traumatic event. This study aims to examine and compare the clinical outcomes in adult trauma patients with pre-existing LC undergoing laparotomy or non-operative management (NOM). Additionally, the study aims to investigate various patient outcomes, including mortality rate based on transfusion needs and timing. METHODS: This retrospective cohort study utilized the American College of Surgeons Trauma Quality Program Participant Use File (ACS-TQIP-PUF) 2017-21 to compare laparotomy vs NOM in adults (≥18 years) with pre-existing LC who presented to trauma facilities with isolated blunt solid organ abdominal injuries (Injury Severity Score ≥16, Abbreviated Injury Scale solid organ abdomen ≥3). RESULTS: Among 929 patients, 38.2% underwent laparotomy, while 61.7% received NOM. The in-hospital mortality rate was lower for patients who received NOM (52.3% vs 20.0%, P < .01). The risk of in-hospital mortality was significantly associated with laparotomy (OR 5.22, 95% CI: 2.06-13.18, P < .01) and sepsis (OR 99.50, 95% CI: 6.99-1415.28, P < .01). On average an increase in blood units in 4 hours was observed among those who experienced an in-hospital mortality (OR 5.65, 95% CI: 3.05-8.24, P < .01) and those who underwent laparotomy (OR 3.85, 95% CI: 1.36-6.34, P < .01). CONCLUSION: Trauma patients with moderate to severe isolated organ injury and Liver cirrhosis had significantly higher mortality rates, acute renal failure, whole blood units received, as well as longer ICU-LOS when undergoing laparotomy compared to non-operative management.
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Traumatismos Abdominais , Transfusão de Sangue , Mortalidade Hospitalar , Laparotomia , Cirrose Hepática , Humanos , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Cirrose Hepática/mortalidade , Cirrose Hepática/complicações , Transfusão de Sangue/estatística & dados numéricos , Traumatismos Abdominais/mortalidade , Traumatismos Abdominais/cirurgia , Traumatismos Abdominais/complicações , Traumatismos Abdominais/terapia , Fatores de Risco , Adulto , Idoso , Estados Unidos/epidemiologia , Escala de Gravidade do Ferimento , Ferimentos não Penetrantes/mortalidade , Ferimentos não Penetrantes/terapia , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/cirurgiaRESUMO
BACKGROUND: ChatGPT has substantial potential to revolutionize medical education. We aim to assess how medical students and laypeople evaluate information produced by ChatGPT compared to an evidence-based resource on the diagnosis and management of 5 common surgical conditions. METHODS: A 60-question anonymous online survey was distributed to third- and fourth-year U.S. medical students and laypeople to evaluate articles produced by ChatGPT and an evidence-based source on clarity, relevance, reliability, validity, organization, and comprehensiveness. Participants received 2 blinded articles, 1 from each source, for each surgical condition. Paired-sample t-tests were used to compare ratings between the 2 sources. RESULTS: Of 56 survey participants, 50.9% (n = 28) were U.S. medical students and 49.1% (n = 27) were from the general population. Medical students reported that ChatGPT articles displayed significantly more clarity (appendicitis: 4.39 vs 3.89, P = .020; diverticulitis: 4.54 vs 3.68, P < .001; SBO 4.43 vs 3.79, P = .003; GI bleed: 4.36 vs 3.93, P = .020) and better organization (diverticulitis: 4.36 vs 3.68, P = .021; SBO: 4.39 vs 3.82, P = .033) than the evidence-based source. However, for all 5 conditions, medical students found evidence-based passages to be more comprehensive than ChatGPT articles (cholecystitis: 4.04 vs 3.36, P = .009; appendicitis: 4.07 vs 3.36, P = .015; diverticulitis: 4.07 vs 3.36, P = .015; small bowel obstruction: 4.11 vs 3.54, P = .030; upper GI bleed: 4.11 vs 3.29, P = .003). CONCLUSION: Medical students perceived ChatGPT articles to be clearer and better organized than evidence-based sources on the pathogenesis, diagnosis, and management of 5 common surgical pathologies. However, evidence-based articles were rated as significantly more comprehensive.
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Apendicite , Colecistite , Diverticulite , Educação Médica , Humanos , Reprodutibilidade dos TestesRESUMO
BACKGROUND: This study aimed to determine the impact of emergency medical service (EMS) scene time variability on adult and pediatric trauma patient outcomes with moderate or severe penetrating injuries. METHODS: This retrospective study analyzed the American College of Surgeons (ACS) Trauma Quality Improvement Program (TQIP) database between 2017 and 2020 to evaluate the relationship between EMS scene time on adult and pediatric patients with moderate to severe injuries. Primary outcomes included Dead on Arrival (DOA) to the Emergency Department (ED), ED mortality, 24-hour mortality, and in-hospital mortality. Multivariable logistic regression models were used to examine the association of each EMS scene time category and mortality. RESULTS: Adult patients with 10-30 minutes of EMS scene time had increased odds of experiencing ED mortality, 24-hour mortality, and in-hospital mortality. Adults with >30 minutes of EMS scene time were more likely to be DOA to the ED. There was no significant association with mortality for patients with <10 minutes of EMS scene time. In the pediatric subset of patients, those with 10-30 minutes of EMS scene time were more likely to experience ED mortality and in-hospital mortality. CONCLUSION: EMS scene times less than 10 minutes were associated with the greatest odds of survival, supporting the "load and go" theory for penetrating trauma. Our study suggests that even an EMS scene time of 10-30 minutes results in a significantly increased risk of mortality, and further efforts are needed to improve scene time through improved EMS and hospital policies.
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Serviços Médicos de Emergência , Ferimentos Penetrantes , Adulto , Humanos , Criança , Estudos Retrospectivos , Serviços Médicos de Emergência/métodos , Serviço Hospitalar de Emergência , Ferimentos Penetrantes/terapia , Mortalidade HospitalarRESUMO
INTRODUCTION: This review aims to evaluate current practices regarding spine immobilization in pediatric trauma patients to evaluate their efficacy, reliability, and impact on clinical outcomes to guide future research and improved evidence-based practice guidelines. METHODS: PubMed, ProQuest, Embase, Google Scholar, and Cochrane were queried for studies pertaining to spinal immobilization practices in pediatric trauma patients. Articles were separated into studies that explored both the efficacy and clinical outcomes of spine immobilization. Outcomes evaluated included frequency of spinal imaging, self-reported pain level, emergency department length of stay (ED-LOS), and ED disposition. RESULTS: Six articles were included, with two studies examining clinical outcomes and 4 studies evaluating the efficacy and reliability of immobilization techniques. Immobilized children were significantly more likely to undergo cervical spine imaging (OR 8.2, p < 0.001), be admitted to the floor (OR 4.0, p < 0.001), be taken to the ICU or OR (OR 5.3, p < 0.05) and reported a higher median pain score. Older children were significantly more likely to be immobilized. No immobilization techniques consistently achieved neutral positioning, and patients most often presented in a flexed position. Lapses in immobilization occurred in 71.4% of patients. CONCLUSION: Immobilized pediatric patients underwent more cervical radiographs, and had higher hospital and ICU admission rates, and higher mean pain scores than those without immobilization. Immobilization was inconsistent across age groups and often resulted in lapses and improper alignment. Further research is needed to identify the most appropriate immobilization techniques for pediatric patients and when to use them.
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Traumatismos da Coluna Vertebral , Criança , Humanos , Adolescente , Reprodutibilidade dos Testes , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Traumatismos da Coluna Vertebral/terapia , Traumatismos da Coluna Vertebral/etiologia , Vértebras Cervicais/lesões , Radiografia , Dor/etiologia , Imobilização/métodosRESUMO
BACKGROUND: Hemodynamically unstable pelvic fractures are often life-threatening injuries; however, the optimal management remains uncertain. This systematic review and meta-analysis aim to evaluate the most appropriate primary management of hemorrhage in adult patients with hemodynamically unstable pelvic fractures by comparing outcomes following the initial use of preperitoneal packing (PPP) vs angioembolization (AE). METHODS: A systematic search of PubMed, Embase, Google Scholar, and ProQuest databases was conducted following PRISMA guidelines. Studies assessing hemorrhage management in trauma patients with hemodynamically unstable pelvic fractures were included. The data extracted from selected articles included patient demographics, study design, and outcomes such as 24-hour PRBC transfusions, in-hospital mortality, and DVT rate. RESULTS: Eight articles were included in the systematic review. Among the included studies, 2040 patients with hemodynamically unstable pelvic fractures were analyzed. Meta-analyses revealed that treatment with PPP was associated with fewer 24-hour PRBC transfusions (mean difference = -1.0, 95% CI: -1.8 to -.2) than AE. However, no significant differences were noted in in-hospital mortality (RR: .91, 95% CI: .80-1.05) and the rate of deep vein thrombosis (RR: .89, 95% CI: .62-1.28) between groups. CONCLUSION: The findings of this study suggest that primary management with PPP was associated with fewer 24-hour PRBC transfusions compared to AE. The choice of primary management with PPP or AE did not significantly impact in-hospital mortality. Future studies should address clinical outcomes and the factors that affect them to better understand the impact of different management strategies and direct the creation of practice management guidelines.
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Fraturas Ósseas , Ossos Pélvicos , Adulto , Humanos , Fixação de Fratura , Fraturas Ósseas/complicações , Fraturas Ósseas/terapia , Hemorragia/terapia , Hemorragia/complicações , Ossos Pélvicos/lesões , Técnicas Hemostáticas , Estudos RetrospectivosRESUMO
INTRODUCTION: Disparities in venous thromboembolism (VTE) incidence and prophylaxis have been observed across racial groups. This study investigates the relationship between race, injury type, and the timing of VTE prophylaxis in severe trauma patients, both with and without isolated traumatic brain injuries. The primary goal is to analyze how these factors interact and their potential impact on clinical outcomes. METHODS: A retrospective cohort study of the American College of Surgeons Trauma Quality Program Participant Use File (ACS-TQIP-PUF) from 2018 to 2021. Patient demographics, injury categories, VTE prophylaxis timing, injury severity, and in-hospital complications were collected. Multivariable regression models explored associations between race, injury type, VTE prophylaxis, and in-hospital mortality. Groups were analyzed by injury profile (isolated TBI vs non-TBI) and then by VTE prophylaxis timing (early ≤24 hours, late >24 hours). RESULTS: Of 68,504 trauma patients analyzed, the majority were non-Hispanic or Latino (83.3%), White (71.2%), and male (69.6%). Patients receiving late VTE prophylaxis had higher rates of DVT and PE across race groups than patients with early prophylaxis. Logistic regression showed Asian patients with TBI receiving early prophylaxis were significantly more likely to have in-hospital mortality (OR 16.27, CI = 1.11-237.43, P = .04) than other races. CONCLUSION: Patients who received late prophylaxis had higher VTE rates than early prophylaxis, independent of injury pattern or race. Additionally, assessing the implications of race in early VTE prophylaxis for isolated TBI showed that adult Asian patients had 16 times higher odds of in-hospital mortality compared to other races.
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Lesões Encefálicas Traumáticas , Tromboembolia Venosa , Adulto , Humanos , Masculino , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/prevenção & controle , Tromboembolia Venosa/epidemiologia , Estudos Retrospectivos , Anticoagulantes/uso terapêutico , Modelos LogísticosRESUMO
INTRODUCTION: This systematic review and meta-analysis aimed to compare clinical outcomes in patients with complicated acute cholecystitis undergoing laparoscopic total vs subtotal cholecystectomy. METHODS: This systematic review and meta-analysis was conducted according to PRISMA guidelines and queried PubMed, Embase, ProQuest, Google Scholar, and Cochrane databases from inception to May 2023. The primary outcome was complication rates including common bile duct injury, wound infection, reoperation, bile leak, retained stones, and subhepatic collection, whereas secondary outcomes were in-hospital mortality and hospital length of stay. RESULTS: A total of 7 studies with 135,233 cases were included for meta-analysis. Patients who underwent laparoscopic total cholecystectomy had a significantly lower risk of postoperative bile leaks (RR: .15; 95% CI: .03, .80) and subhepatic fluid collection (RR: 0.19; 95% CI: .06, .63) and were 2.94 times less likely to die compared to those who underwent subtotal cholecystectomy (RR .34; 95% CI: .15, .77). Patients who underwent subtotal cholecystectomy had significantly longer hospital length of stay (mean difference 1.0 days; 95% CI: .5 days, 1.4 days). CONCLUSIONS: In adult patients presenting with complicated cholecystitis, management with laparoscopic subtotal cholecystectomy presents a unique complication profile with increased risk of postoperative bile leak and subhepatic fluid collection, in-hospital mortality, and longer hospital length-of-stay when used as an alternative approach to laparoscopic total cholecystectomy. Further research into the most appropriate clinical scenarios and patient populations for the use of the subtotal cholecystectomy approach may prove useful in improving its associated outcomes.
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Colecistectomia Laparoscópica , Colecistite Aguda , Colecistite , Laparoscopia , Adulto , Humanos , Colecistectomia/efeitos adversos , Colecistectomia Laparoscópica/efeitos adversos , Colecistite Aguda/cirurgia , Colecistite Aguda/etiologia , Colecistite/cirurgiaRESUMO
INTRODUCTION: Traumatic brain injuries (TBIs) are a significant cause of morbidity and mortality in the United States. but have a disproportionate impact on patients based on gender. This systematic review and meta-analysis aim to compare gender differences in clinical outcomes between male and female adult trauma patients with moderate and severe TBI. METHODS: Studies assessing gender differences in outcomes following TBIs on PubMed, Google Scholar, EMBASE, and ProQuest were searched. Meta-analysis was performed for outcomes including in-hospital mortality, hospital length of stay, intensive care unit length of stay, and Glasgow outcome scale (GOS) at 6 mo. RESULTS: Eight studies were included for analysis with 26,408 female and 63,393 male patients. Meta-analysis demonstrated that males had a significantly lower risk of mortality than females (RR: 0.88; 95% CI 0.78, 0.99; P = 0.0001). Females had a shorter hospital length of stay (mean difference -1.4 d; 95% CI - 1.6 d, -1.2 d). No significant differences were identified in intensive care unit length of stay (mean difference -3.0 d; 95% CI -7.0 d, 1.1 d; P = 0.94) or GOS at 6 mo (mean difference 0.2 d; 95% CI -0.9 d, 1.4 d; P = 1). CONCLUSIONS: Compared to male patients, female patients with moderate and severe TBI had a significantly higher in-hospital mortality risk. There were no significant differences in long-term outcomes between genders based on GOS at 6 mo. These findings warrant further investigation into the etiology of these gender disparities and their impact on additional clinical outcome measures.
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Lesões Encefálicas Traumáticas , Mortalidade Hospitalar , Tempo de Internação , Humanos , Lesões Encefálicas Traumáticas/mortalidade , Lesões Encefálicas Traumáticas/terapia , Lesões Encefálicas Traumáticas/epidemiologia , Feminino , Masculino , Fatores Sexuais , Tempo de Internação/estatística & dados numéricos , Escala de Resultado de Glasgow , Unidades de Terapia Intensiva/estatística & dados numéricos , Resultado do TratamentoRESUMO
INTRODUCTION: This study aims to re-evaluate the GCS threshold for intubation in patients presenting to the ED with a traumatic brain injury to optimize outcomes and provide evidence for future practice management guidelines. METHODS: We retrospectively reviewed the ACS-TQIP-Participant Use File (PUF) 2015-2019 for adult trauma patients 18 years and older who experienced a blunt traumatic head injury and received computerized tomography. Multivariable regressions were performed to assess associations between outcomes and GCS intubation thresholds of 5, 8, and 10. RESULTS: In patients with a GCS ≤5, there were no differences in mortality (GCS ≤5: 26.3% vs GCS >5: 28.3%, adjusted P = .08), complication rates (GCS ≤5: 9.1% vs GCS >5: 10.3%, adjusted P = .91), or ICU length of stay (GCS ≤5: 5.4 vs GCS >5: 4.7, adjusted P = .36) between intubated and non-intubated patients. Intubated patients at GCS thresholds ≤8 (26.2% vs 19.1%, adjusted P < .0001) and ≤10 (25.6% vs 15.8%, adjusted P < .0001) had significantly higher mortality rates than non-intubated patients. Intubation at all GCS thresholds >5 resulted in higher rates of complications, H-LOS, and ICU-LOS when compared to non-intubated patients with the same GCS score. CONCLUSION: A GCS ≤5 was the threshold at which intubation in TBI patients conferred an additional benefit in disposition without worsened outcomes of mortality, H-LOS, or ICU-LOS. Trauma societies and hospital institutions should consider revisiting existing guidelines and protocols concerning the appropriate GCS threshold for safer intubation and better outcomes among these patient population.
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Lesões Encefálicas Traumáticas , Traumatismos Cranianos Fechados , Ferimentos não Penetrantes , Adulto , Humanos , Escala de Coma de Glasgow , Estudos Retrospectivos , Intubação Intratraqueal , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/terapiaRESUMO
ABSTRACT: This is a 10-year review of The Journal of Trauma and Acute Care Surgery (JTACS) literature related to health care disparities, health care inequities, and patient outcomes. A retrospective review of articles published in JTACS between January 1, 2013, and July 15, 2022, was performed. Articles screened included both adult and pediatric trauma populations. Included articles focused on patient populations related to trauma, surgical critical care, and emergency general surgery. Of the 4,178 articles reviewed, 74 met the inclusion criteria. Health care disparities related to gender (n = 10), race/ethnicity (n = 12), age (n = 14), income status (n = 6), health literacy (n = 6), location and access to care (n = 23), and insurance status (n = 13) were described. Studies published on disparities peaked in 2016 and 2022 with 13 and 15 studies respectively but dropped to one study in 2017. Studies demonstrated a significant increase in mortality for patients in rural geographical regions and in patients without health insurance and a decrease in patients who were treated at a trauma center. Gender disparities resulted in variable mortality rates and studied factors, including traumatic brain injury mortality and severity, venous thromboembolism, ventilator-associated pneumonia, firearm homicide, and intimate partner violence. Under-represented race/ethnicity was associated with variable mortality rates, with one study demonstrating increased mortality risk and three finding no association between race/ethnicity and mortality. Disparities in health literacy resulted in decreased discharge compliance and worse long-term functional outcomes. Studies on disparities in JTACS over the last decade primarily focused on location and access to health care, age, insurance status, and race, with a specific emphasis on mortality. This review highlights the areas in need of further research and funding in the Journal of Trauma and Acute Care Surgery regarding health care disparities in trauma aimed at interventions to reduce disparities in patient care, ensure equitable care, and inform future approaches targeting health care disparities. LEVEL OF EVIDENCE: Systematic Review; Level IV.
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Etnicidade , Seguro Saúde , Adulto , Criança , Humanos , Estados Unidos , Disparidades em Assistência à Saúde , Cuidados Críticos , HomicídioRESUMO
INTRODUCTION: We aim to investigate disparities & inequities based on race, sex, graduating age, and the number of peer-reviewed publications among allopathic U.S. Doctor of Medicine graduates who reported entering a surgical training program over a span of 5 y. METHODS: A retrospective cohort analysis of the Association of American Medical Colleges student records system and Electronic Residency Application Service for graduates entering a surgical specialty residency during graduate medical education training cycles 2015-2020. RESULTS: African American, Asian, and Hispanic applicants each accounted for less than 1% of graduates who reported entering a surgical training program. Asians (OR = 0.58, P = 0.01) and those identifying as other races (OR = 0.74, P = 0.01) were significantly less likely to enter a surgical subspecialty when compared to Caucasians. Orthopedic surgery contained the lowest proportion of minorities; African Americans 0.5% (n = 18), Asians 0.3% (n = 11), Hispanics 0.1% (n = 4), and others with 2% (n = 68). Females who reported entering Orthopedic surgery training represented the smallest female population in surgical specialties (17%, n = 527). The number of peer-reviewed publications was significantly associated with male sex (ß = 0.28, P < 0.01), age between 30 and 32 at graduation (ß = 1.76, P < 0.01), and identification as other races (ß = 1.53, P < 0.01). CONCLUSIONS: Racial minorities represented only 5.1% of graduates who reported entering a surgical specialty graduate medical education training program. Minority races and females were significantly less likely to enter a surgical subspecialty training program compared to Caucasian graduates and males, especially in orthopedic surgery. Implementation of specialty-specific programs and diversity, equity, and inclusion departments that promote mentorship and guidance toward residency programs is needed to combat continued race and sex disparities.
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Internato e Residência , Ortopedia , Humanos , Masculino , Feminino , Estados Unidos , Adulto , Estudos Retrospectivos , Diversidade, Equidade, Inclusão , Educação de Pós-Graduação em MedicinaRESUMO
INTRODUCTION: Riding a motorcycle without a helmet represents a public health risk that can result in disabling injuries or death. We aim to provide a comprehensive analysis of the impact of helmet use on motorcycle injuries, injury types, and fatalities, to highlight areas requiring future intervention. METHODS: We performed a retrospective cohort study utilizing the American College of Surgeons Trauma Quality Program Participant Use File between 2017 and 2020 analyzing motorcycle associated injuries and fatalities in adult patients with moderate and severe injury severity score in relation to helmet use. Multivariable regressions were utilized and adjusted for potential confounders. A subset analysis was performed for patients presenting with abbreviated injury scale (AIS) head ≥3 and all other body regions ≤2. RESULTS: 43,225 patients met study criteria, of which 24,389 (56.4%) were helmet users and 18,836 (43.6%) were not. Helmet use was associated with a 35% reduction in the relative risk of expiring in the hospital due to motorcycle-related injuries (aOR 0.65; 95% CI [0.59-0.70]; p < 0.001) and a decreased intensive care unit length of stay (ICU-LOS) by half a day (B = -0.50; 95% CI [-0.77, -0.24]; p < 0.001). CONCLUSION: Motorcycle riders without a helmet had significantly greater odds of increased in-hospital mortality and longer stays in the ICU than those who used a helmet. The results of this nationwide study support the need for continued research exploring the significance of helmet use and interventions aimed at improving helmet usage among motorcyclists. LEVEL OF EVIDENCE: Prognostic and epidemiological, level III.
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Traumatismos Craniocerebrais , Motocicletas , Adulto , Humanos , Dispositivos de Proteção da Cabeça , Estudos Retrospectivos , Acidentes de Trânsito , Tempo de Internação , Traumatismos Craniocerebrais/epidemiologiaRESUMO
ABSTRACT: The importance of diversity, equity, and inclusion (DEI) in trauma and acute care surgery (ACS) has become increasingly apparent in the field of medicine. Despite the growing diversity of the patient population, the surgical specialty has traditionally been dominated by White males. This involves increasing the representation of diverse individuals in leadership positions, professional societies, scholarships, graduate education, and practicing physicians. This opinion piece aims to address the gaps in the literature regarding DEI in trauma and acute care surgery and highlight the issues related to the workforce, gender gap, patient outcomes, and health services. To effectively guide DEI interventions, it is essential to capture patient-reported experience data and stratify outcomes by factors including race, ethnicity, ancestry, language, sexual orientation, and gender identity. Only then can generalizable findings effectively inform DEI strategies. Using validated measurement tools, it is essential to conduct these assessments with methodological rigor. Collaboration between health care institutions can also provide valuable insights into effective and ineffective intervention practices through information exchange and constructive feedback. These recommendations aim to address the multifactorial nature of health care inequities in trauma and ACS. However, successful DEI interventions require a deeper understanding of the underlying mechanisms driving observed disparities, necessitating further research. LEVEL OF EVIDENCE: Level V.