Application of the Geriatric Trauma Outcome Score in a Rural Setting.

OBJECTIVE: To retrospectively apply the Geriatric Trauma Outcome (GTO) score to the patient population of a rural South Central Appalachian level 1 trauma center and identify the potential utility of the GTO score in guiding goals of care discussions. METHODS: Trauma registry data was extracted for 5,627 patients aged 65+ from 2017 to 2021. GTO score was calculated for each patient. Descriptive statistics were calculated for age, Injury Severity Score (ISS), GTO score, receipt of red blood cells, discharge status, and code status. A simple logistic regression model was used to determine the relationship between GTO score and discharge status. The probability of mortality was then calculated using GTO score, and the distribution of code status among patients with ≤50, 51-75%, and >75% probability of mortality was examined. RESULTS: For every 10-point increase in GTO score, odds of mortality increased by 79% (OR = 1.79; P < .001). Patients had an estimated 50% probability of mortality with a GTO score of 156, 75% with 174, and 99% with a score of 234, respectively. Seventeen patients had a GTO score associated with >75% probability of mortality. Of those 17 patients, four retained a full code status. CONCLUSIONS: Our analysis demonstrates that the GTO score is a validated measure in a rural setting and can be an easily calculated metric to help determine a geriatric patient's probability of mortality following a trauma. The results of our study also found that GTO score can be used to inform goals of care discussions with patients.

Sclerosing Encapsulating Peritonitis: A Rare Cause of Bowel Obstruction.

Sclerosing encapsulating peritonitis (SEP), also referred to as abdominal cocoon syndrome, is a rare cause of bowel obstruction characterized by a thickened fibrous peritoneum that encapsulates the intestines. The exact etiology is idiopathic but may be associated with long-term peritoneal dialysis (PD). In the absence of risk factors for adhesive disease, preoperative diagnosis can be difficult and may require operative intervention or advanced imaging to diagnose. Thus, the inclusion of SEP in the differential diagnosis for bowel obstruction is essential for early detection. Existing literature is focused on renal disease as an origin, but it can be multifactorial. Here, we discuss a case of sclerosing encapsulating peritonitis in a patient without known risk factors.

A National Survey Assessing the Variability in the Management of Traumatic Cardiac Arrest.

BACKGROUND: Resuscitation of traumatic cardiac arrest (TCA) is variable, with approaches that overlap Advanced Trauma Life Support (ATLS) and Advanced Cardiac Life Support (ACLS) algorithms. There is no standard algorithm for TCA, with some withholding ACLS protocols given abysmal outcomes. This study aims to assess surgeon practices and attitudes toward resuscitation practices in TCA. MATERIALS AND METHODS: A 16-question web-based survey was distributed to the membership of a national trauma association. Respondent demographics and management of TCA were analyzed. Chi-squared tests determined statistical significance. Open-ended responses were coded and analyzed inductively. RESULTS: Two hundred and three surveys were completed. 73.4% of respondents reported utilizing ACLS, while 26.6% reported they never utilized ACLS. A statistically significant difference in the performance of ACLS was found based on number of years in practice (P = .025) and the state of practice (P = .006). There was no significant difference in self-reported survival rates or legal, ethical, or interpersonal conflicts. Qualitative data highlighted themes of interpersonal conflict and futility. DISCUSSION: This study shows that one-quarter of respondents never utilize ACLS in TCA. Of those that utilize ACLS, there was variability in the technique, indication, and duration of resuscitation. Despite significant variability in technique, there appears to be similar survival rates and incidence of conflict. The association between years in practice and ACLS use suggests this may represent an emerging change in practice. The low response rate limits generalizability; however, there is significant variability in practice, highlighting a need for evidence-based guidelines.

Incidental Finding of Appendiceal Mucinous Neoplasm After Trauma: A Case Report.

Appendiceal neoplasms are uncommon; most are identified by pathologic examination after appendectomy for presumed appendicitis or as an incidental finding. When found incidentally, patients are typically asymptomatic. If the neoplasm has perforated, patients may present with symptoms that mimic acute appendicitis. In advanced disease, patients may have systemic symptoms associated with peritoneal disease, including abdominal distension, weight loss, and diffuse abdominal pain. Because of their rarity, as well as rapidly evolving research on the subject, the nomenclature of appendiceal mucinous neoplasms has proven challenging. This lesion was identified as a low-grade appendiceal mucinous neoplasm (LAMN), previously termed mucoceles or mucinous cystadenomas. LAMNs are non-invasive neoplasms that have the potential to proliferate outside the appendix in a malignant fashion. All mucinous appendiceal neoplasms can perforate and spread mucin production throughout the abdominal cavity, known as pseudomyxoma peritonei (PMP). The presence of PMP designates LAMNs as malignant, though the neoplasm itself is non-invasive. When appendiceal neoplasms have peritoneal involvement, cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is the standard of care. Complete cytoreduction has been shown to be an independent predictor of survival. Here we describe a case of a 30-year-old male involved in a motor vehicle collision with a grade IV splenic laceration, who is also found to have a large appendiceal mass. His traumatic injuries required emergent intervention, which delayed treatment of his malignancy.