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Background: In June 2021, the Injury Research Engagement Project (I-REP) was established. In 2022, we preformed focus group analysis with patients/caregiver and researchers that resulted in themes in preferences, motivations, and best practices to increase participation in trauma research. The importance of trust and well-established relationships was common across all groups. In this study, we aimed to further evaluate preferences regarding research procedures and outcomes, and develop a panel for sustained patient engagement., Methods: We performed a multiphase, mixed methods study to elicit trauma stakeholders' perspectives regarding aspects of research. Previously published phase 1 involved focus group analysis. Phase 2 vignette-based surveys and phase 3 panel formation are described here. One survey was completed by patients/caregivers, and the second by trauma researchers. We compared the responses using independent t-tests. This was followed by a webinar and development of an I-REP panel of patients/caregivers., Results: 60 patients/caregivers and 114 researchers participated in the online surveys, with completion rates of 68% and 69%, respectively. The majority of patients/caregivers were >45 years, female (66.7%), and >3 years out from their or their family member's injury (68.6%). The majority of the researchers were >35 years and male (56.2%). Participants were asked to gauge their perceptions of different research scenarios. The analysis identified themes emerging across groups. Several survey findings differed from phase 1, including motivations to participate (payment) and consent preferences (timing, approach). Racial and ethnic demographics of the participants were not collected., Conclusions: Engaging trauma stakeholders results in research more relevant to patients' needs and priorities. Qualitative engagement methods that intentionally include a more diverse population and determining the appropriate format for specific questions may lead to results that are be more generalizable. The educational webinar was well received, and several participants opted to serve as I-REP panelists to collaborate with trauma researchers moving forward., Level of Evidence: IV., Competing Interests: ABN is a board member of the American Trauma Society. KJ is an employee of the American Trauma Society. MAP and PJB are employees of the Coalition for National Trauma Research. RAD is a board member for the Health Alliance for Violence Intervention. RAK has grant funding from the NIH, DOD, and Airforce. She additionally receives royalties for being associate editor of Trauma textbook. RAK has leadership roles at the WTA, CNTR and serves as the deputy editor of J Trauma Acute Care Surgery and the associate editor of Trauma Surgery Acute Care Open. ERH has grant funding from PCORI, AHRQ, and NIH/NHLBI. He has leadership roles at CNTR, NBCA, and serves as the editor in chief of Trauma Surgery Acute Care Open. DMS has grant funding from PCORI, Airforce, and CNTR/DOD. She has leadership roles at EAST, WTA, and the American Board of Surgery., (Copyright © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: A recent clinical trial suggested aspirin is a viable alternative to enoxaparin for venous thromboembolism (VTE) prophylaxis in patients after orthopedic trauma. The initial impact of these findings on VTE prophylaxis prescribing is unknown. The study aimed to evaluate stated VTE prophylaxis prescribing patterns among clinicians who treat patients after orthopedic trauma., Methods: For this clinical vignette survey, we recruited surgeons and advanced practice providers who prescribed VTE prophylaxis to patients with orthopedic trauma across 40 states. Clinicians were shown seven clinical vignettes describing hypothetical patients with orthopedic trauma based on their fracture type, treatment, VTE risk factors, additional injuries and health insurance status. We assessed the stated VTE prophylaxis medications prescribed in-hospital and at discharge, patient factors associated with changes in medication prescribing preferences and practice variation by specialty and provider training., Results: Among the 287 respondents, the median age was 43 years (IQR, 38-50), and 154 (weighted average, 63%) were men. For in-hospital VTE prophylaxis, enoxaparin was prescribed in 83% of the presented scenarios, and aspirin was prescribed in 13% (p<0.001). At discharge, aspirin was prescribed more frequently than enoxaparin (50% vs 41%, p<0.001). Healthcare providers with an aspirin discharge preference were 12% more likely to switch to enoxaparin if the patient had additional VTE risk factors, such as obesity (95% CI 4% to 19%, p=0.005)., Conclusions: Despite new clinical evidence, in-hospital VTE prophylaxis prescribing practices for patients with orthopedic trauma remain consistent with those reported a decade ago. However, compared with historical data, clinicians have significantly increased their preference for aspirin for thromboprophylaxis at discharge-unless the patient has additional thromboembolic risk factors., Level of Evidence: 5-expert opinion., Competing Interests: NNO receives stock or stock options from Arbutus Medical, Inc. DMS is a paid consultant for CSL Behring, LLC. ERH receives royalties from Lippincott Williams and Wilkins. GPS is a paid consultant for Smith & Nephew and Zimmer. RF is a paid consultant for DePuy Synthes, SI Bone, Smith & Nephew, and Tyber Medical; and receives royalties from Innomed. RVO is a paid consultant for Stryker, receives royalties from Lincotek, and receives stock or stock options from Imagen. The remaining authors report no conflicts., (Copyright © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: Competing interests: RG reports honoraria for lectures/presentations: Morristown Memorial Hospital—keynote speaker honorarium, payments made to the author; Leadership in Board/Society: Chair, Scientific Studies Committee, Surgical Infection Society—unpaid; Payment for Expert Testimony: Billing, Cochran, Lyles, Mauro & Ramsey PA; Rafi Law Firm; Foy & Associates PC. SM reports UpToDate—author royalty; AHRQ grant funding, but not related to this topic. TR reports receiving an honorarium from Stanford Hospital/Santa Clara Valley Medical Center for speaking at their annual trauma; support from the author's home institution (UC Davis) for attendance at meetings (WTA in 2022, 2023). DMS reports grant funding from PCORI, DoD, NIH, and NHTSA and consultant fees from CSL Behring.

The evaluation and workup of fever and the use of antibiotics to treat infections is part of daily practice in the surgical intensive care unit (ICU). Fever can be infectious or non-infectious; it is important to distinguish between the two entities wherever possible. The evidence is growing for shortening the duration of antibiotic treatment of common infections. The purpose of this clinical consensus document, created by the American Association for the Surgery of Trauma Critical Care Committee, is to synthesize the available evidence, and to provide practical recommendations. We discuss the evaluation of fever, the indications to obtain cultures including urine, blood, and respiratory specimens for diagnosis of infections, the use of procalcitonin, and the decision to initiate empiric antibiotics. We then describe the treatment of common infections, specifically ventilator-associated pneumonia, catheter-associated urinary infection, catheter-related bloodstream infection, bacteremia, surgical site infection, intra-abdominal infection, ventriculitis, and necrotizing soft tissue infection., Competing Interests: Competing interests: TC reports: Innovital—funding paid to my institution related to research performed; Cytovale—direct payments to me for research-related medical monitoring. SM reports: UpToDate—Author Royalty; AHRQ grant funding, but not related to this topic. LK reports: Eastern Association for the Surgery of Trauma Vice Chair Guidelines Committee; American Association for the Surgery of Trauma Palliative Care Committee, American Association for the Surgery of Trauma Critical Care Committee, American College of Surgeons Geriatric Surgery Verification Standards and Verification Committee, Journal of Surgical Research Editorial Board Member. DMS reports: grant funding from PCORI, DoD, NIH, NHTSA and consultant fees—CSL Behring., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

The use of prophylactic measures, including perioperative antibiotics, for the prevention of surgical site infections is a standard of care across surgical specialties. Unfortunately, the routine guidelines used for routine procedures do not always account for many of the factors encountered with urgent/emergent operations and critically ill or high-risk patients. This clinical consensus document created by the American Association for the Surgery of Trauma Critical Care Committee is one of a three-part series and reviews surgical and procedural antibiotic prophylaxis in the surgical intensive care unit. The purpose of this clinical consensus document is to provide practical recommendations, based on expert opinion, to assist intensive care providers with decision-making for surgical prophylaxis. We specifically evaluate the current state of periprocedural antibiotic management of external ventricular drains, orthopedic operations (closed and open fractures, silver dressings, local, antimicrobial adjuncts, spine surgery, subfascial drains), abdominal operations (bowel injury and open abdomen), and bedside procedures (thoracostomy tube, gastrostomy tube, tracheostomy)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)