Abdominal computed tomography scoring systems and experienced radiologists in the radiological diagnosis of small bowel and mesenteric injury.

PURPOSE: Blunt bowel and/or mesenteric injury requiring surgery presents a diagnostic challenge. Although computed tomography (CT) imaging is standard following blunt trauma, findings can be nonspecific. Most studies have focused on the diagnostic value of CT findings in identifying significant bowel and/or mesenteric injury (sBMI). Some studies have described scoring systems to assist with diagnosis. Little attention, has been given to radiologist interpretation of CT scans. This study compared the discriminative ability of scoring systems (BIPS and RAPTOR) with radiologist interpretation in identifying sBMI. METHODS: We conducted a retrospective chart review of trauma patients with suspected sBMI. CT images were reviewed in a blinded fashion to calculate BIPS and RAPTOR scores. Sensitivity and specificity were compared between BIPS, RAPTOR, and the admission CT report with respect to identifying sBMI. RESULTS: One hundred sixty-two patients were identified, 72 (44%) underwent laparotomy and 43 (26.5%) had sBMI. Sensitivity and specificity were: BIPS 49% and 87%, AUC 0.75 (0.67-0.81), P < 0.001; RAPTOR 46% and 82%, AUC 0.72 (0.64-0.79), P < 0.001; radiologist impression 81% and 71%, AUC 0.82(0.75-0.87), P < 0.001. The discriminative ability of the radiologist impression was higher than RAPTOR (P = 0.04) but not BIPS (P = 0.13). There was not a difference between RAPTOR vs. BIPS (P = 0.55). CONCLUSION: Radiologist interpretation of the admission CT scan was discriminative of sBMI. Although surgical vigilance, including evaluation of the CT images and patient, remains fundamental to early diagnosis, the radiologist's impression of the CT scan can be used in clinical practice to simplify the approach to patients with abdominal trauma.

Surgical Intervention is Associated with Improvement in Health-Related Quality of Life Outcomes in Patients with Symptomatic Sacral Tarlov Cysts: Results from a Prospective Longitudinal Cohort Study.

OBJECTIVE: The treatment of symptomatic Tarlov cysts remains a controversial topic within neurosurgery. We describe our experience with patients who underwent surgical intervention for sacral Tarlov cysts at a single institution. General and disease-specific outcome measures were used to assess health-related quality of life. METHODS: Patients who underwent surgical treatment for one or more sacral Tarlov cysts between 2018 and 2021 were included. The Tarlov Cyst Quality of Life (TCQoL), a validated disease-specific measure, was the primary outcome of the study. Secondary outcomes included general outcome measures: 36-Item Short Form Survey, the Oswestry Disability Index, and Visual Analog Scale. Patients were followed at 3, 6, and 12 months postoperatively. Repeated measures analyses were used to assess change from preoperative to 12 months postoperative. RESULTS: Data were obtained from 144 patients who underwent surgery for sacral Tarlov cysts, average age 52.3 ± 11.3 years, 90.3% female. Patients reported significant mean improvement on the TCQoL over time (preoperative 3.2 ± 0.1; 3-month postoperative 2.1 ± 0.1; 6-month 1.9 ± 0.1; 12-month 1.9 ± 0.1; P < 0.001). Patient age and duration of symptoms were not associated with outcome. A total of 82.3% of patients reported improvement on TCQoL. There was not a significant difference in the proportion of patients reporting improvement on TCQoL by cyst size (small 90.9% vs. large 77.9%; P = 0.066). CONCLUSIONS: Our longitudinal series demonstrated patient-reported improvement following surgery for symptomatic sacral Tarlov cysts using a validated disease-specific health-related quality of life scale through 12 months after surgery. Patient age and preoperative duration of symptoms were not correlated with outcome.

External Validation of the Modified Southwestern Aneurysm Severity Index in the Barrow Ruptured Aneurysm Trial Surgical Cohort.

BACKGROUND AND OBJECTIVES: Predicting functional outcomes after surgical management of ruptured aneurysms is essential. This study sought to validate the modified Southwestern Aneurysm Severity Index (mSASI), which predicts functional outcomes 1 year after treatment. METHODS: The surgical arm of a randomized controlled trial, the Barrow Ruptured Aneurysm Trial, was used to validate the mSASI model. mSASI scores incorporating the Hunt and Hess scale, Non-Neurological American Society of Anesthesiologists Physical Classification Status, imaging findings, and other modifiers were assigned and evaluated against the Glasgow Outcome Scale (GOS) score at 1 year. The model's performance was assessed for discrimination and calibration. Similar evaluations were constructed using the modified Rankin Scale (mRS) as the 1-year functional outcome measurement. Long-term outcomes (3, 6, 10 years) were also evaluated. RESULTS: Of 280 clinical trial patients treated surgically, 242 met the inclusion criteria. The mean age was 54.1 ± 12.9 years; 31% were men. Favorable GOS score (4-5) and mRS score (0-2) at 1 year were observed in 73.6% and 66.1% of patients, respectively. The mSASI model predicted unfavorable GOS score at 1 year with fair to good discrimination (area under the curve = 0.75, 95% CI = 0.68-0.82) and accurate calibration (R 2 = 0.98). Similar results were obtained when mRS was used as the outcome measure (area under the curve = 0.75, 95% CI = 0.68-0.82; R 2 = 0.95). CONCLUSION: The mSASI model was externally validated in our cohort to predict functional outcomes using the GOS or mRS scores 1 year after surgery. This index may be used for prognosticating outcomes of patients undergoing surgery for ruptured aneurysms at short-term and long-term intervals.

Predicting immediate lordosis restoration after anterior lumbar interbody fusion and the effect of posterior column osteotomies.

OBJECTIVES: Anterior lumbar interbody fusion (ALIF) can be combined with posterior column osteotomies (PCOs) to maximize lordotic correction. This study compares radiographic changes in regional and segmental lordosis in patients undergoing ALIF with and without PCOs. METHODS: Patients >18 years old who underwent ALIF at 1 or 2 segments at a single institution (January 2014-July 2020) were included. Preoperative and postoperative radiographic parameters were determined, and a propensity-matched analysis was performed. RESULTS: Ninety-nine patients (53 [54%] men) underwent ALIF at 129 levels (mean [SD], 1.3 [0.46] levels; median [range] age, 61 [32-83] years). PCOs were performed in 13 (13%) patients at 19 (15%) segments. PCOs included 13 Schwab grade 1 and 6 grade 2 osteotomies. All measures, including lumbar lordosis, segmental lordosis, disc angle, and neural foramen height, increased significantly after surgery (p≤0.003). In the propensity-matched analysis, PCO was associated with greater increases in lumbar lordosis (14.9° vs. 8.2°, p=0.02), segmental lordosis (14.0° vs. 9.6°, p=0.03), and disc angle (15.0° vs. 10.2°, p=0.046). The change in disc angle more closely approximated the inherent lordosis of the cage when PCO was performed (94% vs. 62%, p=0.004). CONCLUSIONS: Performing PCOs and ALIFs significantly increased the radiographic correction of overall and segmental lordosis in the selected patient cohort. The disc angle achieved with ALIF without PCOs was approximately 60% of the cage lordosis. The addition of PCO allowed for greater segmental compression, enabling the disc angle to reach nearly 100% of the inherent interbody cage lordosis.

Unleashing surgical skills: Ultra-high fidelity trauma thoracotomy training on knowledge donor platform.

BACKGROUND: Resuscitative thoracotomies are a time-sensitive emergency surgical procedure with an immediate risk of mortality. We hypothesize that a high-fidelity whole-body donor simulation model, referred to as a Knowledge Donor (KD), with mechanical lung ventilation and expired human blood perfusion could increase learner confidence in performing this critical procedure. METHODS: General surgery residents and faculty were invited to participate in KD training. Surveys were collected to track participation and confidence. RESULTS: Simulated resuscitative thoracotomies were performed involving PGY levels I-IV. Mean confidence was highest for residents with both KD and Live Patient experience (5.6 â€‹± â€‹1.7), followed by Live Patient only (4.3 â€‹± â€‹2.5), and KD only (2.6 â€‹± â€‹1.3). The mean confidence rating for residents with neither training opportunity was 1.4 â€‹± â€‹1.0. CONCLUSIONS: The KD platform is a hyper-realistic training modality that closely replicates live surgery. This platform allows residents to practice complex surgical procedures in a safe environment, without risking patient safety. This pilot program yielded early results in improving resident procedural confidence for high-risk surgical procedures, specifically resuscitative thoracotomies.

Marijuana may lead to increased platelet activity in trauma patients.

INTRODUCTION: Delta-9-tetraydrocannabinol (THC) usage is associated with venous thromboembolic events (VTE) in trauma patients. We hypothesized that THC â€‹+ â€‹trauma patients would have less platelet inhibition than THC - patients using thromboelastography with platelet mapping (TEG-PM). METHODS: Results from initial TEG- PM assays and patient's UDS were reviewed between 2019 and 2023. Mean levels of arachidonic acid (AA) and adenosine diphosphate (ADP) percent inhibition were compared by THC status. RESULTS: 793 patients had TEG-PM and UDS data. Mean levels of arachidonic acid (AA) percentage inhibition were 32.6 â€‹± â€‹34.2. AA inhibition was lower for THC â€‹+ â€‹vs THC- patients (THC+ 23.9 â€‹± â€‹27.0 vs THC- 34.3 â€‹± â€‹35.3, P â€‹< â€‹0.001). There was no association between THC status and ADP inhibition (THC+ 32.5 â€‹± â€‹27.1 vs THC- 30.8 â€‹± â€‹28.4, P â€‹= â€‹0.536). DISCUSSION: To our knowledge, our data are the first to suggest a clinically measurable increase in platelet reactivity in THC â€‹+ â€‹trauma patients. More work is needed to determine if addition of aspirin to the chemoprophylaxis strategy for THC â€‹+ â€‹patients would mitigate the known association of THC with VTE.