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Requiring ACS consultation followed by ACS verification for level I and II trauma centers improves outcomes and decreases variation. #GeorgiaTraumaCommission and Georgia Research Institute for Trauma Study Group

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjsurg.2010.07.036 Byline: Laura Jane Moore, Krista L. Turner, Samual R. Todd, Bruce McKinley, Frederick A. Moore Keywords: Sepsis; Computerized clinical decision support; Surgical sepsis; Outcomes; Evidence-based guidelines Abstract: The management of surgical sepsis is challenging because of the complexity of interventions. The authors therefore created a computerized clinical decision support program to facilitate this process, with the goal of improving abdominal sepsis mortality. Author Affiliation: Weill Cornell Medical College, Surgical Critical Care and Acute Care Surgery, Department of Surgery, Houston, TX, USA Article History: Received 9 March 2010; Revised 8 July 2010

Visceral vascular injuries are relatively uncommon even in busy urban trauma centers. The inferior vena cava (IVC) is the most frequently injured visceral vein and can be a complex operative challenge. Despite advances in early volume resuscitation, improved transport times, prompt operative intervention, and hemorrhage control, mortality rates have remained largely unchanged. This article conducts an in-depth review of the literature surrounding IVC injuries and a detailed discussion of operative strategies and management as survivability is ultimately dependent on the grade of injury, location, and the presence of hemorrhagic shock.

Background Blunt traumatic abdominal wall hernias (TAWHs) are rare but require a variety of operative techniques to repair including bone anchor fixation (BAF) when tissue tears off bony structures. This study aimed to provide a descriptive analysis of BAF technique for blunt TAWH repair. Bone anchor fixation and no BAF repairs were compared, hypothesizing increased hernia recurrence with BAF repair.Methods A secondary analysis of the WTA blunt TAWH multicenter study was performed including all patients who underwent repair of their TAWH. Patients with BAF were compared to those with no BAF with bivariate analyses.Results 176 patients underwent repair of their TAWH with 41 (23.3%) undergoing BAF. 26 (63.4%) patients had tissue fixed to bone, with 7 of those reinforced with mesh. The remaining 15 (36.6%) patients had bridging mesh anchored to bone. The BAF group had a similar age, sex, body mass index, and injury severity score compared to the no BAF group. The time to repair (1 vs 1 days, P= .158), rate of hernia recurrence (9.8% vs 12.7%, P= .786), and surgical site infection (SSI) (12.5% vs 15.6%, P= .823) were all similar between cohorts.Conclusions This largest series to date found nearly one-quarter of TAWH repairs required BAF. Bone anchor fixation repairs had a similar rate of hernia recurrence and SSI compared to no BAF repairs, suggesting this is a reasonable option for repair of TAWH. However, future prospective studies are needed to compare specific BAF techniques and evaluate long-term outcomes including patient-centered outcomes such as pain and quality of life.