Cost-Effectiveness of Cell Salvage in Trauma Blood Transfusions.

INTRODUCTION: Despite the increasing amount of evidence supporting its use, cell salvage (CS) remains an underutilized resource in operative trauma care in many hospitals. We aim to evaluate the utilization of CS in adult trauma patients and associated outcomes to provide evidence-based recommendations. METHODS: A systematic review was conducted using PubMed, Google Scholar, and CINAHL. Articles evaluating clinical outcomes and the cost-effectiveness of trauma patients utilizing CS were included. The primary study outcome was mortality rates. The secondary outcomes included complication rates (sepsis and infection) and ICU-LOS. The tertiary outcome was the cost-effectiveness of CS. RESULTS: This systematic review included 9 studies that accounted for a total of 1119 patients that received both CS and allogeneic transfusion (n = 519), vs allogeneic blood transfusions only (n = 601). In-hospital mortality rates ranged from 13% to 67% in patients where CS was used vs 6%-65% in those receiving allogeneic transfusions only; however, these findings were not significantly different (P = .21-.56). Similarly, no significant differences were found between sepsis and infection rates or ICU-LOS in those patients where CS usage was compared to allogeneic transfusions alone. Of the 4 studies that provided comparisons on cost, 3 found the use of CS to be significantly more cost-effective. CONCLUSIONS: Cell salvage can be used as an effective method of blood transfusion for trauma patients without compromising patient outcomes, in addition to its possible cost advantages. Future studies are needed to further investigate the long-term effects of cell salvage utilization in trauma patients.

Traumatic Brain Injury, Electrolyte Levels, and Associated Outcomes: A Systematic Review.

INTRODUCTION: Although it has been established that electrolyte abnormalities are a consequence of traumatic brain injury (TBI), the degree to which electrolyte imbalances impact patient outcomes has not been fully established. We aim to determine the impact of sodium, potassium, calcium, and magnesium abnormalities on outcomes in patients with TBI. METHODS: Four databases were searched for studies related to the impact of electrolyte abnormalities on outcomes for TBI patients. Outcomes of interest were rates of mortality, Glasgow Outcome Scale (GOS), and intensive care unit length of stay (ICU-LOS). The search included studies published up to July 21, 2022. Articles were then screened and included if they met inclusion and exclusion criteria. RESULTS: In total, fourteen studies met inclusion and exclusion criteria for analysis in this systematic review. In patients with TBI, an increased mortality rate was associated with hypernatremia, hypokalemia, and hypocalcemia in the majority of studies. Both hyponatremia and hypomagnesemia were associated with worse GOS at 6 months. Whereas, both hyponatremia and hypernatremia were associated with increased ICU-LOS. There was no evidence to suggest other electrolyte imbalances were associated with either GOS or ICU-LOS. CONCLUSIONS: Hyponatremia and hypomagnesemia were associated with worse GOS. Hypernatremia was associated with increased mortality and ICU-LOS. Hypokalemia and hypocalcemia were associated with increased mortality. Given these findings, future practice guidelines should consider the effects of electrolytes' abnormalities on outcomes in TBI patients prior to establishing management strategies.

National analysis of motorcycle associated injuries and fatalities: Wearing helmet saves lives.

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.

Analysis of Racial and Gender Distribution of US MD Graduates Entering Into General Surgery and Surgical Subspecialties Residencies: The Need for Effective & Sustainable Diversity, Equity, and Inclusion Strategies.

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.

Patient Satisfaction With Medical Care for Chronic Low Back Pain: A Pain Research Registry Study.

PURPOSE: The process and outcomes of delivering medical care for chronic low back pain might affect patient satisfaction. We aimed to determine the associations of process and outcomes with patient satisfaction. METHODS: We conducted a cross-sectional study of patient satisfaction among adult participants with chronic low back pain in a national pain research registry using self-reported measures of physician communication, physician empathy, current physician opioid prescribing for low back pain, and outcomes pertaining to pain intensity, physical function, and health-related quality of life. We used simple and multiple linear regression models to measure factors associated with patient satisfaction, including a subgroup of participants having both chronic low back pain and the same treating physician for >5 years. RESULTS: Among 1,352 participants, only physician empathy (standardized ß, 0.638; 95% CI, 0.588-0.688; t = 25.14; P < .001) and physician communication (standardized ß, 0.182; 95% CI, 0.133-0.232; t = 7.22; P < .001) were associated with patient satisfaction in the multivariable analysis that controlled for potential confounders. Similarly, in the subgroup of 355 participants, physician empathy (standardized ß, 0.633; 95% CI, 0.529-0.737; t = 11.95; P < .001) and physician communication (standardized ß, 0.208; 95% CI, 0.105-0.311; t = 3.96; P < .001) remained associated with patient satisfaction in the multivariable analysis. CONCLUSIONS: Process measures, notably physician empathy and physician communication, were strongly associated with patient satisfaction with medical care for chronic low back pain. Our findings support the view that patients with chronic pain highly value physicians who are empathic and who make efforts to more clearly communicate treatment plans and expectations.

Outcomes of Pigtail Catheter Placement versus Chest Tube Placement in Adult Thoracic Trauma Patients: A Systematic Review and Meta-Analysis.

INTRODUCTION: A debate currently exists regarding the efficacy of pigtail catheters vs chest tubes in the management of thoracic trauma. This meta-analysis aims to compare the outcomes of pigtail catheters vs chest tubes in adult trauma patients with thoracic injuries. METHODS: This systematic review and meta-analysis were conducted using PRISMA guidelines and registered with PROSPERO. PubMed, Google Scholar, Embase, Ebsco, and ProQuest electronic databases were queried for studies comparing the use of pigtail catheters vs chest tubes in adult trauma patients from database inception to August 15th, 2022. The primary outcome was the failure rate of drainage tubes, defined as requiring a second tube placement or VATS, unresolved pneumothorax, hemothorax, or hemopneumothorax requiring additional intervention. Secondary outcomes were initial drainage output, ICU-LOS, and ventilator days. RESULTS: A total of 7 studies satisfied eligibility criteria and were assessed in the meta-analysis. The pigtail group had higher initial output volumes vs the chest tube group, with a mean difference of 114.7 mL [95% CI (70.6 mL, 158.8 mL)]. Patients in the chest tube group also had a higher risk of requiring VATS vs the pigtail group, with a relative risk of 2.77 [95% CI (1.50, 5.11)]. CONCLUSIONS: In trauma patients, pigtail catheters rather than chest tubes are associated with higher initial output volume, reduced risk of VATS, and shorter tube duration. Considering the similar rates of failure, ventilator days, and ICU length-of-stay, pigtail catheters should be considered in the management of traumatic thoracic injuries. STUDY TYPE: Systematic Review and meta-analysis.

Nationwide Analysis of Motorcycle-Associated Injuries and Fatalities in the United States: Insufficient Prevention Policies or Abandoned Laws?

BACKGROUND: Motorcycle road traffic collisions are a major cause of mortality in the United States. We aimed to analyze the temporal and statewide trends in motorcycle collision fatalities (MCFs) nationwide and their association with state laws regarding motorcycle helmet requirements, lane splitting, speeding, intoxicating driving, and red light cameras. METHODS: A retrospective review of United States MCF/capita from 2015 to 2019 was performed using the Fatality Analysis Reporting System database. MCF/capita was defined as a motorcyclist death per 100 000 motorcyclist registrations. Independent-samples t-test and ANOVA were used to determine differences, with significance defined as P < .05. Linear regression analysis and Pearson's correlation were used to further determine associations between variables. RESULTS: The majority of fatalities occurred in males (n = 21 354, 91.0%), ages 25-54 (n = 13 728, 58.5%), and Caucasians (n = 19 195, 81.8%). A total of 24 states and DC exhibited positive trends in MCF/capita from 2015 to 2019. There was no significant difference in MCF/capita between states who had mandatory helmet laws for all, partial requirements, and states with no law (63.4 vs 54.3 vs 33.6, P = .360). Among fatalities involving alcohol, a significantly greater number of MCF/capita were found above the legal limit of .08 compared to the group with a blood alcohol concentration of .01-.07 (17.8 vs 4.5, P < .001). CONCLUSION: Motorcyclist fatalities continue to pose a public health risk, with 24 states showing an upward trend. Additional interventions and laws are needed to decrease the number of motorcyclist deaths. Further strategy on implementation and enforcement of helmet laws and alcohol consumption may be an essential component.

The benefits and clinical application of the digital rectal exam in trauma populations: Towards enhancing patient safety and quality outcomes.

INTRODUCTION: Current literature contains an extensive number of analyses on the diagnostic value and utilization of the direct rectal exam in trauma patients. Presently, ATLS recommends the application of the digital rectal exam in trauma patients following a primary assessment of traumatic injuries. We aim to assess the validity and diagnostic value of the digital rectal exam in trauma populations. METHODS: PubMed, Google Scholar, EMBASE, ProQuest, and CINAHL databases were searched for studies from the date of database conception to August 6th, 2022. Studies that assessed the validity of the digital rectal exam performed in the emergency department or trauma bay, in both adult and pediatric trauma patients were included. Study outcomes and measurements of validity were summarized and compared. RESULTS: A total of 9 studies met inclusion criteria for both adult and pediatric trauma populations. The sensitivity of the digital rectal exam in detecting both spinal cord and urethral injuries in adult trauma populations ranged from 0 to 50%, while the sensitivity in detecting gastrointestinal injuries ranged from 0% to 51%. When compared to other clinical indicators, the digital rectal exam was consistently worse at detecting injuries. Within the pediatric trauma populations, the digital rectal exam resulted in high false negative rates ranging from 66% to 100%, failing to detect all urethral and gastrointestinal injuries and pelvic fractures. CONCLUSION: The use of digital rectal exams in trauma patients illustrates limited to no validity and reliability in assessing pertinent injuries and does not influence the management of injuries. Trauma societies should consider creating guidelines and algorithms to clarify the use of digital rectal exams in specific situations and injury types.

Analysis of Electric Vehicle Collisions in the United States: An Epidemiological Study.

INTRODUCTION: Despite the increase in electric vehicle sales in the US, their impact on injuries and fatalities is still understudied. We aim to evaluate injuries and fatalities associated with electric vehicle collisions in the US. METHODS: The study utilized electric vehicle injury and fatality data from the Fatality Analysis Reporting System (FARS). All electric vehicle models available within the FARS database and sold in the US from 2014 to 2020 were selected. Electric vehicle models were matched to analogous motor vehicles when possible. RESULTS: No significant increase in electric vehicle fatality per capita (FPC) was found during the study period (2014: .41 vs 2020: 1.42, per 100 000 electric cars, P = .080). However, 82% of all fatalities occurred on non-intersectional local roadways with 46% occurring in the presence of speeding, 14% in the presence of fire, and 38% involving a driver with an elevated blood alcohol content (BAC). The Tesla Model S, Kia Niro, and Hyundai IONIQ accounted for the most fatality per capita (17.89 vs 10.27 vs 8.42, per 100 000 electric cars). Upon comparison of electric vehicles to analogous motor vehicles produced within the same year, the Hyundai IONIQ had a significantly lower FPC compared to the Hyundai Elantra (7.33 vs 23.51, per 100 000 electric cars P = .034). CONCLUSION: While no significant increase in electric vehicle fatality per capita (FPC) was found, the total number of electric vehicle fatalities did increase significantly during the study period (2014-2020). Furthermore, a significant proportion of these fatalities is directly related to speeding, fire, and intoxicated driving.