Survival Following Combined Intrapericardial Inferior Vena Cava and Thoracic Aortic Injury Caused by Blunt Trauma.

Inferior vena cava (IVC) rupture from blunt trauma is rare. It occurs most commonly in the retrohepatic location in association with liver trauma involving the hepatic veins.1,2 Rupture of the IVC has a reported mortality of up to 50% before arrival to the hospital and nearly 57% in patients who reach the hospital with signs of life.2 Traumatic transection of the thoracic aorta occurs more commonly. It remains a highly lethal injury with 85% of patients dying at the injury scene. If left untreated, approximately 50% of survivors die within the first 24 hours and 90% within the first 4 months.3–5 The most common location of thoracic aortic injury is immediately distal to the origin of the left subclavian artery at the attachment of the ligamentum arteriosum. We report an unusual case of a 19-year-old patient who survived combined intrapericardial rupture of the IVC with transection of the mid-thoracic aorta, and a grade-III splenic injury after a motor vehicle crash

Survival Following Combined Intrapericardial Inferior Vena Cava and Thoracic Aortic Injury Caused by Blunt Trauma.

Inferior vena cava (IVC) rupture from blunt trauma is rare. It occurs most commonly in the retrohepatic location in association with liver trauma involving the hepatic veins.1,2 Rupture of the IVC has a reported mortality of up to 50% before arrival to the hospital and nearly 57% in patients who reach the hospital with signs of life.2 Traumatic transection of the thoracic aorta occurs more commonly. It remains a highly lethal injury with 85% of patients dying at the injury scene. If left untreated, approximately 50% of survivors die within the first 24 hours and 90% within the first 4 months.3–5 The most common location of thoracic aortic injury is immediately distal to the origin of the left subclavian artery at the attachment of the ligamentum arteriosum. We report an unusual case of a 19-year-old patient who survived combined intrapericardial rupture of the IVC with transection of the mid-thoracic aorta, and a grade-III splenic injury after a motor vehicle crash

An Evaluation of the Use of Guidelines in Prehospital Management of Brain Injury

OBJECTIVES: The Brain Trauma Foundation (BTF) Guidelines for Prehospital Management of Traumatic Brain Injury (TBI) are intended to standardize treatment and improve outcomes in severe TBI patients. The key guideline components focus on airway management, blood pressure support, Glasgow Coma Score assessment, and transport. The purposes of this study were to determine if providers could learn and retain the guidelines (education), assess if providers would use the guidelines in practice (implementation), and evaluate the effect of guideline implementation on patients (outcomes). METHODS: Data were collected prospectively on all trauma patients for five months. Providers were then educated on the TBI guidelines over two months, and five additional months of data were collected. A knowledge test was given before and after the course and three months later to assess education. To assess implementation, data were analyzed to determine whether providers were using the key interventions more consistently after education. The clinical courses of TBI patients before and after guideline implementation were measured to assess outcomes. RESULTS: Knowledge of TBI care improved significantly after education and remained elevated at three months (62% vs. 82% vs. 79%, p \u3c 0.001). For the 1,044 patients seen, providers demonstrated higher rates of appropriate care, resulting in lower rates of hypoxia (2.8% vs. 1.1%, p=0.010) and hypotension (4.8% vs. 2.0%, p=0.018). Mortality was significantly decreased (34.6% vs. 17.0%, p=0.039), and rates of patients with maximum functional scores at 14 days significantly increased (Glasgow Outcome Score 44.2% vs. 66.0%, p=0.025; Rancho Los Amigos Scale 55.9% vs. 77.3%, p=0.045). CONCLUSION: Providers were able to learn and implement the BTF guidelines, and outcomes in TBI patients were significantly improved. All emergency medical services providers should be trained in these potentially lifesaving guidelines

Where Did All the Appendicitis Go? Impact of the COVID-19 Pandemic on Volume, Management, and Outcomes of Acute Appendicitis in a Nationwide, Multicenter Analysis

Objective:. The study objective was to evaluate effects of the COVID-19 pandemic on rates of emergency department (ED) acute appendicitis presentation, management strategies, and patient outcomes. Summary Background Data:. Acute appendicitis is the most commonly performed emergency surgery in the United States and is unlikely to improve without medical or surgical intervention. Dramatic reductions in ED visits prompted concern that individuals with serious conditions, such as acute appendicitis, were deferring treatment for fear of contracting COVID-19. Methods:. Patients from 146 hospitals with diagnosed appendicitis and arrival between March 2016 and May 2020 were selected. Electronic medical records data were retrospectively reviewed to retrieve patient data. Daily admissions were averaged from March 2016 through May 2019 and compared with March 2020. April-specific admissions were compared across the 5-year pre-COVID-19 period to April 2020 to identify differences in volume, demographics, disease severity, and outcomes. Results:. Appendicitis patient admissions in 2020 decreased throughout March into April, with April experiencing the fewest admissions. April 2020 experienced a substantial decrease in patients who presented with appendicitis, dropping 25.4%, from an average of 2030 patients (2016–2019) to 1516 in 2020. An even greater decrease of 33.8% was observed in pediatric patients (age <18). Overall, 77% of the 146 hospitals experienced a reduction in appendicitis admissions. There were no differences between years in percent of patients treated nonoperatively (P = 0.493) incidence of shock (P = 0.95), mortality (P = 0.24), or need for postoperative procedures (P = 0.81). Conclusions:. Acute appendicitis presentations decreased significantly during the COVID-19 pandemic, while overall management and patient outcomes did not differ from previous years. Further research is needed focusing on putative explanations for decreased hospital presentations unrelated to COVID-19 infection and possible implications for surgical management of uncomplicated acute appendicitis. Keywords: acute appendicitis, COVID-19, decreasing volumes, multicenter stud

Geriatric traumatic brain injury – What we know and what we don’t

The issue of geriatric trauma is a significant and growing concern among trauma surgeons. The outcomes of geriatric patients with traumatic brain injury are worse than younger cohorts and the number of traumatic brain injury (TBI)-related hospitalizations and fatalities in elderly patients will continue to increase as the world’s population ages. Although guidelines for the treatment of TBI have been established, they do not address the challenges of managing TBI in older patients. Issues of anticoagulation reversal, confounding of clinical exam by premorbid conditions, and optimal timing and frequency of imaging remain poorly studied. Additionally, current guidelines for optimal management of blood pressure, intracranial monitoring, cerebral perfusion pressure and operative management fail to address the unique concerns in the geriatric patient. Prognostication of acceptable outcomes in older patients with TBI is more challenging compared to younger cohorts and require early palliative care approaches targeted to the geriatric patient. Geriatric-specific research is sorely needed in nearly all aspects of TBI care. Given the paucity of data available, this non-systematic review seeks to outline the unique considerations of the geriatric patient with TBI and highlight what is currently unknown about the best way to care for elderly patients with TBI

Contribution of age and gender to outcome of blunt splenic injury in adults: multicenter study of the eastern association for the surgery of trauma.

BACKGROUND: The purpose of this study was to examine the contribution of age and gender to outcome after treatment of blunt splenic injury in adults. METHODS: Through the Multi-Institutional Trials Committee of the Eastern Association for the Surgery of Trauma (EAST), 1488 adult patients from 27 trauma centers who suffered blunt splenic injury in 1997 were examined retrospectively. RESULTS: Fifteen percent of patients were 55 years of age or older. A similar proportion of patients \u3e or = 55 went directly to the operating room compared with patients \u3c 55 (41% vs. 38%) but the mortality for patients \u3e or = 55 was significantly greater than patients \u3c 55 (43% vs. 23%). Patients \u3e or = 55 failed nonoperative management (NOM) more frequently than patients \u3c 55 (19% vs. 10%) and had increased mortality for both successful NOM (8% vs. 4%, p \u3c 0.05) and failed NOM (29% vs. 12%, p = 0.054). There were no differences in immediate operative treatment, successful NOM, and failed NOM between men and women. However, women \u3e or = 55 failed NOM more frequently than women \u3c 55 (20% vs. 7%) and this was associated with increased mortality (36% vs. 5%) (both p \u3c 0.05). CONCLUSION: Patients \u3e or = 55 had a greater mortality for all forms of treatment of their blunt splenic injury and failed NOM more frequently than patients \u3c 55. Women \u3e or = 55 had significantly greater mortality and failure of NOM than women \u3c 55