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BACKGROUND: Diagnostic laparoscopy (DL) has decreased the rate of nontherapeutic laparotomy for patients suffering from penetrating injuries. We evaluated whether DL similarly lowers the rate of nontherapeutic laparotomy for patients with blunt injuries. METHODS: All patients undergoing DL over a 10-year period (ie, 2001-2010) in a single level 1 trauma center were classified by the mechanism of injury. Demographic and perioperative data were compared using the Student t and Fisher exact tests. RESULTS: There were 131 patients included, 22 of whom sustained blunt injuries. Patients suffering from blunt injuries were more severely injured (Injury Severity Score 18.0 vs 7.3, P =.0001). The most common indication for DL after blunt injury was a computed tomographic scan concerning for bowel injury (59.1%). The rate of nontherapeutic laparotomy for patients sustaining penetrating vs blunt injury was 1.8% and nil, respectively. CONCLUSIONS: DL, when coupled with computed tomographic findings, is an effective tool for the initial management of patients with blunt injuries. [ABSTRACT FROM AUTHOR]

BACKGROUND: Undertriage of elderly trauma patients to tertiary trauma centers is well docu-mented. This study evaluated the impact of directness of transport to a Level I trauma center on morbidity in geriatric trauma patients sustaining severe pelvic fractures. METHODS: This was a retrospective cohort study of 87 geriatric trauma patients diagnosed with potentially unstable pelvic fractures, treated at a Level I trauma center between 2008 and 2010. RESULTS: Of the 87 patients, 39% (34 of 87) initially were transported to a nontertiary trauma center. After adjusting for presence of comorbidity and injury severity, the 2-week incidence of complications was 54% higher in transferred patients compared with those directly transported (rate ratio, 1.54; 95% confidence interval, .95-2.54). In particular, transferred patients had increased odds of developing pneumonia/systemic inflammatory response syndrome. CONCLUSIONS: Despite lacking precision, results of this study suggest an increased risk of com-plications in transferred geriatric trauma patients with severe pelvic fractures compared with their directly transported counterparts. [ABSTRACT FROM AUTHOR]

Abstract: Background: Trauma patients at risk for pulmonary embolism, but with contraindications for anticoagulation therapy, often have retrievable inferior vena cava filters (RIVCF) placed. This study evaluated factors associated with the recovery rate of the device (RIVCFs) with the goal of developing an institutional protocol to ensure timely removal. Methods: This was a case-control study of 88 trauma patients who underwent RIVCF placement at a level 1 trauma center between 2006 and 2010. Results: The overall retrieval rate was 58%, declining from 89% in 2006 to 50% in 2009. Factors independently associated with filter nonretrieval included increasing age, increase in number of providers, comorbidity, hospital discharge from the intensive care unit, and discharge to a long-term acute care facility or skilled nursing facility. In 2010, a protocol was implemented and the retrieval rate increased to 73%. Conclusions: In a large institution where a number of providers may be responsible for filter management, implementation of a protocol appears to improve retrieval rates. [Copyright &y& Elsevier]

Background: Despite the importance of social justice advocacy, surgeon attitudes toward individual involvement vary. We hypothesized that the majority of surgeons in this study, regardless of gender or training level, believe that surgeons should be involved in social justice movements., Methods: A survey was distributed to surgical faculty and trainees at three academic tertiary care centers. Participation was anonymous with 123 respondents. Chi-square and Fisher's exact test were used for analysis with significance accepted when p < 0.05. Thematic analysis was performed on free responses., Results: The response rate was 46%. Compared to men, women were more likely to state that surgeons should be involved (86% vs 64%, p = 0.01) and were personally involved in social justice advocacy (86% vs 51%, p = 0.0002). Social justice issues reported as most important to surgeons differed significantly by gender (p = 0.008). Generated themes for why certain types of advocacy involvement were inappropriate were personal choices, professionalism and relationships., Conclusions: Social justice advocacy is important to most surgeons in this study, especially women. This emphasizes the need to incorporate advocacy into surgical practice., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Penetrating injury independently predicts the need for surgeon presence (NSP) upon arrival. Penetrating injury is often used as a trauma triage indicator, however, it includes a wide range of specific mechanisms of injury. We sought to compare firearm-related and non-firearm related pediatric penetrating injuries with respect to NSP, ISS and mortality., Methods: Patients <18 from the 2016 National Trauma Quality Improvement Program Database were included. Penetrating injury was identified and grouped using ICD-10 mechanism codes into firearm and non-firearm related injury. NSP, ISS, and mortality were compared between the two groups., Results: A total of 1715 (4.2%) patients with penetrating injury were; 832 firearm-related and 883 non-firearm. No deaths occurred among the non-firearm group compared to 94 (11.3%) among firearm-related patients. Among non-firearm patients, 22.7% had a NSP indicator compared to 51.2% of patients injured by a firearm., Conclusion: There is a significantly higher proportion of severe injury and mortality with firearm penetrating injury when compared to non-firearm pediatric penetrating injury. Consideration should be given to dividing it into firearm and non-firearm penetrating injury., Competing Interests: Declaration of competing interest The authors declare there are no conflicts of interest to report., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: When to transport pediatric trauma patients directly from scene to a trauma center via helicopter (HT) has been a long debated topic. This study proposes Need for Surgeon Presence (NSP) matrix as an alternative method to assess appropriate utilization of HT of pediatric trauma patients directly from the scene of injury., Method: We utilized the 2016 TQIP database. NSP was defined as having one or more of the following: intubation, transfusion, operation for hemorrhage control/craniotomy, vasopressors, interventional radiology, spinal cord injury, tube thoracostomy, emergency thoracotomy, intracranial pressure monitor, or pericardiocentesis. The outcome of interest was the presence or absence of a NSP indicator., Results: The NSP + patients had a: longer LOS, GCS<14, positive SIPA index value, went to OR/ICU from the ED, and had penetrating injury. Among patient with an ISS≥16, mortality for those also NSP+ was 18.8% versus 1.4% among the NSP-., Conclusion: The disparity between NSP and traditional ISS thresholds supports NSP as an additional metric to validate pre-hospital triage criteria and may be a better indicator of overall hospital resource utilization., Competing Interests: Declaration of competing interest The authors declare there are no conflicts of interest to report., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: While negative pressure wound therapy (NPWT) has been used for decades, there is a paucity of data regarding the appropriate length of time between dressing changes., Methods: This was a prospective, randomized control trial examining time to wound closure in open midline laparotomy wounds treated with NPWT. The control group received the standard thrice weekly sponge changes (thrice) and the treatment group received once weekly sponge changes (once)., Results: 44 patients met study criteria over a 3-year period. There was no difference in NPWT duration between the two groups (37.1 vs 34.7 days, p = 0.7324), even after adjusting for potential confounders (p = 0.8091). No differences were found in initial wound size or reduction. The wound complication profile was similar for both groups., Conclusion: There is no difference in time to wound closure or complications with NPWT dressing changes once a week compared to the standard three times a week., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: To determine whether lack of insurance is a predictor of poor outcomes and increased healthcare expenditure for SCI patients., Methods: Retrospective cohort study of trauma patients admitted with an acute, severe (AIS ≥ 3) SCI and admission score of ASIA-A to a Level 1 trauma center (2012-2016). Patient characteristics and outcomes (LOS, complications) were compared between insured and uninsured patients. Multivariable adjustment was performed using linear regression., Results: Of 76 patients who met eligibility, 44 had insurance and 32 were uninsured (NOINSUR). Despite having similar ventilator days (13 vs. 12.1) and ICU LOS (20.1 vs. 16.8), the NOINSUR group had more ventilator-free days (22.3 vs 6.6; p < 0.0001), longer Stepdown Unit length of stay (10.2 vs 2.3; p = 0.0036), and a longer hospital length of stay (35.3 vs 18.7; p = 0.0062)., Conclusion: Uninsured SCI patients face longer hospital LOS due to their insurance status and lack of funding for timely rehabilitation placement. This utilizes valuable hospital resources and puts them at risk for hospital related complications and further increased healthcare expenditures., (Published by Elsevier Inc.)

Background: Elderly patients are at an increased risk of protein-energy malnutrition (PEM) which increases the risk of morbidity/mortality. We evaluated the association between hypoalbuminemia at the time of emergency department (ED) admission and in-hospital complications among geriatric trauma patients., Methods: This was an ambidirectional cohort study of geriatric (≥55 years) trauma patients treated at a Level I trauma center between May 2013 and March 2014. The exposure of interest was albumin level at ED admission (<3.6 g/dL [PEM] or ≥3.6 g/dL (No PEM)]. The outcome of interest was 30-day incidence of complications., Results: A total of 130 patients met study eligibility. Of these, 85 (65%) patients were in the PEM group. After adjusting for tube feeding and injury severity score, PEM at admission was associated with a 2-fold increase in the risk of 30-day overall hospital complications (hazard ratio 2.1, 95% confidence interval 1.1 to 3.8)., Conclusion: Serum albumin level at ED admission, but not prealbumin level, is a significant predictor of in-hospital complications in geriatric trauma patients., (Copyright © 2015 Elsevier Inc. All rights reserved.)