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Article ; Online: Research priorities in venous thromboembolism after trauma: Secondary analysis of the National Trauma Research Action Plan.

Costantini, Todd W / Bulger, Eileen / Price, Michelle A / Haut, Elliott R

The journal of trauma and acute care surgery

2023 Volume 95, Issue 5, Page(s) 762–769

Abstract: Background: Venous thromboembolism (VTE) is a significant cause of morbidity and mortality during recovery from injury and can result in significant health care costs. Despite advances in the past several decades in our approach to VTE prophylaxis after ...

Abstract	Background: Venous thromboembolism (VTE) is a significant cause of morbidity and mortality during recovery from injury and can result in significant health care costs. Despite advances in the past several decades in our approach to VTE prophylaxis after injury, opportunities exist to improve the delivery and implementation of optimal VTE prophylaxis. Here, we aim to identify consensus research questions related to VTE across all National Trauma Research Action Plan (NTRAP) Delphi expert panels to further guide the research agenda aimed at preventing VTE after injury. Methods: This is a secondary analysis of consensus-based research priorities that were collected using a Delphi methodology by 11 unique NTRAP panels that were charged with unique topic areas across the spectrum of injury care. The database of questions was queried for the keywords "VTE," "venous thromboembo," and "DVT" and then grouped into relevant topic areas. Results: There were 86 VTE-related research questions identified across 9 NTRAP panels. Eighty-five questions reached consensus with 24 rated high priority; 60, medium priority; and 1, low priority. Questions related to the timing of VTE prophylaxis (n = 17) were most common, followed by questions related to risk factors for the development of VTE (n = 16), the effects of tranexamic acid on VTE (n = 11), the approach to dosing of pharmacologic prophylaxis (n = 8), and the pharmacologic prophylactic medication choice for optimal VTE prophylaxis (n = 6). Conclusion: National Trauma Research Action Plan panelists identified 85 consensus-based research questions that should drive dedicated extramural research funding opportunities to support quality studies aimed at optimizing VTE prophylaxis after injury. Level of evidence: Prognostic and Epidemiological; Level IV.
MeSH term(s)	Humans ; Venous Thromboembolism/etiology ; Venous Thromboembolism/prevention & control ; Prognosis ; Risk Factors ; Research Design ; Anticoagulants/therapeutic use
Chemical Substances	Anticoagulants
Language	English
Publishing date	2023-06-16
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2651070-4
ISSN	2163-0763 ; 2163-0755
ISSN (online)	2163-0763
ISSN	2163-0755
DOI	10.1097/TA.0000000000004074
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Article ; Online: How we built a hospital-based community whole blood program.

Addams, Joel / Arbabi, Saman / Bulger, Eileen M / Stansbury, Lynn G / Tuott, Erin E / Hess, John R

Transfusion

2022 Volume 62, Issue 9, Page(s) 1699–1705

Abstract: Background: Whole blood (WB) is an attractive product for prehospital treatment of hemorrhagic shock and for initial in-hospital resuscitation of patients likely to require massive transfusion. Neither our regional blood provider nor our hospital blood ... ...

Abstract	Background: Whole blood (WB) is an attractive product for prehospital treatment of hemorrhagic shock and for initial in-hospital resuscitation of patients likely to require massive transfusion. Neither our regional blood provider nor our hospital blood bank had recent experience collecting or using WB, so we developed a stepwise process to gather experience with WB in clinical practice. Methods: When our Transfusion Committee suggested a WB program, we worked with our regional blood provider to collect cold-stored, leukoreduced, low-titer anti-A, and anti-B group O RhD positive WB (low-titer group O WB [LTOWB]) and worked with our city Fire Department to integrate it into prehospital care. This work required planning, development of protocols, writing software for blood bank and electronic medical records, changes in paramedic scope of practice, public information, training of clinicians, and close clinical follow-up. Results: Between June 2019 and December 2021, we received 2269 units of LTOWB and transfused 2220 units; 24 (1%) were wasted, two were withdrawn, and 23 were in stock at the end of that time. Most (89%) were transfused to trauma patients. Usage has grown from 48 to 120 units/month, covers all 5 Fire Districts in the county, and represents about ¼ of all hospital trauma blood product use. Conclusions: Developing a WB program is complex but can be started slowly, including both pre-hospital and hospital elements, and expanded as resources and training progress. The investments of time, effort, and funding involved can potentially improve care, save blood bank and nursing effort, and reduce patient charges.
MeSH term(s)	Blood Banks ; Blood Transfusion/methods ; Hospitals ; Humans ; Resuscitation/methods ; Shock, Hemorrhagic/therapy ; Wounds and Injuries
Language	English
Publishing date	2022-07-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	208417-x
ISSN	1537-2995 ; 0041-1132
ISSN (online)	1537-2995
ISSN	0041-1132
DOI	10.1111/trf.17018
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Article ; Online: Evaluation of interdisciplinary care pathway implementation in older elective surgery patients.

Hu, Frances Y / Rowe, Katherine A / O'Mara, Lynne M / Bulger, Amy / Bleday, Ronald / Groff, Michael W / Cooper, Zara / Bernacki, Rachelle E

Journal of the American Geriatrics Society

2023 Volume 71, Issue 4, Page(s) 1310–1322

Abstract: Background: The American College of Surgeons Geriatric Surgery Verification Program outlines best practices for surgical care in older adults. These recommendations have guided institutions to create workflows to better support needs specific to older ... ...

Abstract	Background: The American College of Surgeons Geriatric Surgery Verification Program outlines best practices for surgical care in older adults. These recommendations have guided institutions to create workflows to better support needs specific to older surgical patients. This qualitative study explored clinician experiences to understand influences on implementation of frailty screening and an interdisciplinary care pathway in older elective colorectal surgery and neurosurgery patients. Study design: Semi-structured in-person and video-based interviews were conducted from July 2021 to March 2022 with clinicians caring for patients ≥70 years on the colorectal surgery and neurosurgery services. Interviews addressed familiarity with and beliefs about the intervention, intervention alignment with routine workflow and workflow adaptations, and barriers and facilitators to performing the intervention. Interviews were analyzed using the consolidated framework for implementation research (CFIR) to find themes related to ongoing implementation. Results: Thirty-two clinicians participated (56.3% female, 58.8% White). Fifteen relevant CFIR constructs were identified. Key themes to implementation success included strong participant belief in effectiveness of the intervention and its advantage over standard care; the importance of training, reference materials, and champions; and the need for institution-level investment in resources to amplify the impact of the intervention on patients and expand the capacity to address their needs. Conclusion: Systematic evaluation found implementation of frailty screening and an interdisciplinary care pathway in elective colorectal surgery and neurosurgery patients to be supported by participating clinicians, yet sustainability of the intervention and further adoption across surgical services to better meet the needs of older patients would necessitate organizational resource allocation.
MeSH term(s)	Humans ; Female ; Aged ; Male ; Primary Health Care ; Frailty ; Critical Pathways ; Qualitative Research ; Patients
Language	English
Publishing date	2023-01-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	80363-7
ISSN	1532-5415 ; 0002-8614
ISSN (online)	1532-5415
ISSN	0002-8614
DOI	10.1111/jgs.18244
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Article ; Online: Dynamic associations between glucose and ecological momentary cognition in Type 1 Diabetes.

Hawks, Z W / Beck, E D / Jung, L / Fonseca, L M / Sliwinski, M J / Weinstock, R S / Grinspoon, E / Xu, I / Strong, R W / Singh, S / Van Dongen, H P A / Frumkin, M R / Bulger, J / Cleveland, M J / Janess, K / Kudva, Y C / Pratley, R / Rickels, M R / Rizvi, S R /

Chaytor, N S / Germine, L T

NPJ digital medicine

2024 Volume 7, Issue 1, Page(s) 59

Abstract: Type 1 diabetes (T1D) is a chronic condition characterized by glucose fluctuations. Laboratory studies suggest that cognition is reduced when glucose is very low (hypoglycemia) and very high (hyperglycemia). Until recently, technological limitations ... ...

Abstract	Type 1 diabetes (T1D) is a chronic condition characterized by glucose fluctuations. Laboratory studies suggest that cognition is reduced when glucose is very low (hypoglycemia) and very high (hyperglycemia). Until recently, technological limitations prevented researchers from understanding how naturally-occurring glucose fluctuations impact cognitive fluctuations. This study leveraged advances in continuous glucose monitoring (CGM) and cognitive ecological momentary assessment (EMA) to characterize dynamic, within-person associations between glucose and cognition in naturalistic environments. Using CGM and EMA, we obtained intensive longitudinal measurements of glucose and cognition (processing speed, sustained attention) in 200 adults with T1D. First, we used hierarchical Bayesian modeling to estimate dynamic, within-person associations between glucose and cognition. Consistent with laboratory studies, we hypothesized that cognitive performance would be reduced at low and high glucose, reflecting cognitive vulnerability to glucose fluctuations. Second, we used data-driven lasso regression to identify clinical characteristics that predicted individual differences in cognitive vulnerability to glucose fluctuations. Large glucose fluctuations were associated with slower and less accurate processing speed, although slight glucose elevations (relative to person-level means) were associated with faster processing speed. Glucose fluctuations were not related to sustained attention. Seven clinical characteristics predicted individual differences in cognitive vulnerability to glucose fluctuations: age, time in hypoglycemia, lifetime severe hypoglycemic events, microvascular complications, glucose variability, fatigue, and neck circumference. Results establish the impact of glucose on processing speed in naturalistic environments, suggest that minimizing glucose fluctuations is important for optimizing processing speed, and identify several clinical characteristics that may exacerbate cognitive vulnerability to glucose fluctuations.
Language	English
Publishing date	2024-03-18
Publishing country	England
Document type	Journal Article
ISSN	2398-6352
ISSN (online)	2398-6352
DOI	10.1038/s41746-024-01036-5
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Article ; Online: Higher Oxygenation Is Associated with Improved Survival in Severe Traumatic Brain Injury but Not Traumatic Shock.

Davis, Daniel P / McKnight, Barbara / Meier, Eric / Drennan, Ian R / Newgard, Craig / Wang, Henry E / Bulger, Eileen / Schreiber, Martin / Austin, Michael / Vaillancourt, Christian

Neurotrauma reports

2023 Volume 4, Issue 1, Page(s) 51–63

Abstract: Pre-hospital resuscitation of critically injured patients traditionally includes supplemental oxygen therapy to address potential hypoxemia. The objective of this study was to explore the association between pre-hospital hypoxemia, hyperoxemia, and ... ...

Abstract	Pre-hospital resuscitation of critically injured patients traditionally includes supplemental oxygen therapy to address potential hypoxemia. The objective of this study was to explore the association between pre-hospital hypoxemia, hyperoxemia, and mortality in patients with traumatic brain injury (TBI) and traumatic shock. We hypothesized that both hypoxemia and hyperoxemia would be associated with increased mortality. We used the Resuscitation Outcomes Consortium Prospective Observational Prehospital and Hospital Registry for Trauma (ROC PROPHET) database of critically injured patients to identify a severe TBI cohort (pre-hospital Glasgow Coma Scale [GCS] 3-8) and a traumatic shock cohort (systolic blood pressure ≤90 mm Hg and pre-hospital GCS >8). Arterial blood gas (ABG) obtained within 30 min of hospital arrival was required for inclusion. Patients with hypoxemia (PaO
Language	English
Publishing date	2023-01-23
Publishing country	United States
Document type	Journal Article
ISSN	2689-288X
ISSN (online)	2689-288X
DOI	10.1089/neur.2022.0065
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Article ; Online: Prehospital and emergency department pediatric readiness for injured children: A statement from the American College of Surgeons Committee on Trauma Emergency Medical Services Committee.

Ross, Samuel Wade / Campion, Eric / Jensen, Aaron R / Gray, Lisa / Gross, Toni / Namias, Nicholas / Goodloe, Jeffrey M / Bulger, Eileen M / Fischer, Peter E / Fallat, Mary E

The journal of trauma and acute care surgery

2023 Volume 95, Issue 2, Page(s) e6–e10

Abstract: Abstract: Injury is the leading cause of death in children older than 1 year, and children make up 22% of the population. Pediatric readiness (PR) of the nation's emergency departments and state trauma and emergency medical services (EMS) systems is ... ...

Abstract	Abstract: Injury is the leading cause of death in children older than 1 year, and children make up 22% of the population. Pediatric readiness (PR) of the nation's emergency departments and state trauma and emergency medical services (EMS) systems is conceptually important and vital to mitigate mortality and morbidity in this population. The extension of PR to the trauma community has become a focused area for training, staffing, education, and equipment at all levels of trauma center designation, and there is evidence that a higher level of emergency department PR is independently associated with long-term survival among injured children. Although less well studied, there is an associated need for EMS PR, which is relevant to the injured child who needs assessment, treatment, triage, and transport to a trauma center. We outline a blueprint along with recommendations for incorporating PR into trauma system development in this opinion from the EMS Committee of the American College of Surgeons Committee on Trauma. These recommendations are particularly pertinent in the rural and underserved areas of the United States but are directed toward all levels of professionals who care for an injured child along the trauma continuum of care.
MeSH term(s)	Child ; Humans ; United States ; Child, Preschool ; Emergency Medical Services ; Triage ; Emergency Service, Hospital ; Trauma Centers ; Surgeons
Language	English
Publishing date	2023-05-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2651070-4
ISSN	2163-0763 ; 2163-0755
ISSN (online)	2163-0763
ISSN	2163-0755
DOI	10.1097/TA.0000000000003997
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Article ; Online: Can Baseline Patient Clinical and Demographic Characteristics Predict Response to Early Posttraumatic Stress Disorder Interventions After Physical Injury?

Birk, Navneet / Russo, Joan / Heagerty, Patrick / Parker, Lea / Moloney, Kathleen / Bulger, Eileen / Whiteside, Lauren / Moodliar, Rddhi / Engstrom, Allison / Wang, Jin / Palinkas, Lawrence / Abu, Khadijah / Zatzick, Douglas

Psychiatry

2024 , Page(s) 1–15

Abstract: Objective: A growing evidence base supports stepped care interventions for the early treatment of posttraumatic stress disorder (PTSD) after physical injury. Few investigations have examined the characteristics of patients who do and do not respond to ... ...

Abstract	Objective: A growing evidence base supports stepped care interventions for the early treatment of posttraumatic stress disorder (PTSD) after physical injury. Few investigations have examined the characteristics of patients who do and do not respond to these interventions. Method: This investigation was a secondary analysis that used previously collected data from three randomized clinical trials of stepped care interventions (patient Results: A substantial subgroup of patients ( Conclusions: Injured trauma survivors have readily identifiable characteristics at the time of hospitalization that can distinguish responders to PTSD stepped care interventions versus patients who may be treatment refractory.
Language	English
Publishing date	2024-03-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	209433-2
ISSN	1943-281X ; 0033-2747
ISSN (online)	1943-281X
ISSN	0033-2747
DOI	10.1080/00332747.2024.2323367
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Article ; Online: Traumatic Suprahepatic inferior vena cava injury survival of a rare case.

Rooke, Douglas A / Burke, Christopher R / Bulger, Eileen M / Van Eaton, Erik / Nandate, Koichiro

Trauma case reports

2021 Volume 36, Page(s) 100535

Abstract: Traumatic supra-hepatic inferior vena cava (IVC) injury is rare and nearly universally fatal. We report an excellent outcome from a case involving severe injury of the suprahepatic and intra-pericardial IVC utilizing emergency cardiopulmonary bypass (CPB) ...

Abstract	Traumatic supra-hepatic inferior vena cava (IVC) injury is rare and nearly universally fatal. We report an excellent outcome from a case involving severe injury of the suprahepatic and intra-pericardial IVC utilizing emergency cardiopulmonary bypass (CPB) with deep hypothermic circulatory arrest. The goal of this case report is to outline key factors that facilitated the patient's survival of extensive IVC injury. We conclude that aggressive prehospital fluid resuscitation, facile transfer to the operating room, early detection of anatomy and pathology of the injury, an early decision to call for perfusion and cardiothoracic surgery, and prompt blood transfusion were the key factors that allowed for the patient to survive without deficits.
Language	English
Publishing date	2021-09-10
Publishing country	Netherlands
Document type	Case Reports
ZDB-ID	2835433-3
ISSN	2352-6440 ; 2352-6440
ISSN (online)	2352-6440
ISSN	2352-6440
DOI	10.1016/j.tcr.2021.100535
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Article ; Online: Association of Trauma Molecular Endotypes With Differential Response to Transfusion Resuscitation Strategies.

Thau, Matthew R / Liu, Ted / Sathe, Neha A / O'Keefe, Grant E / Robinson, Bryce R H / Bulger, Eileen / Wade, Charles E / Fox, Erin E / Holcomb, John B / Liles, W Conrad / Stanaway, Ian B / Mikacenic, Carmen / Wurfel, Mark M / Bhatraju, Pavan K / Morrell, Eric D

JAMA surgery

2023 Volume 158, Issue 7, Page(s) 728–736

Abstract: Importance: It is not clear which severely injured patients with hemorrhagic shock may benefit most from a 1:1:1 vs 1:1:2 (plasma:platelets:red blood cells) resuscitation strategy. Identification of trauma molecular endotypes may reveal subgroups of ... ...

Abstract	Importance: It is not clear which severely injured patients with hemorrhagic shock may benefit most from a 1:1:1 vs 1:1:2 (plasma:platelets:red blood cells) resuscitation strategy. Identification of trauma molecular endotypes may reveal subgroups of patients with differential treatment response to various resuscitation strategies. Objective: To derive trauma endotypes (TEs) from molecular data and determine whether these endotypes are associated with mortality and differential treatment response to 1:1:1 vs 1:1:2 resuscitation strategies. Design, setting, and participants: This was a secondary analysis of the Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) randomized clinical trial. The study cohort included individuals with severe injury from 12 North American trauma centers. The cohort was taken from the participants in the PROPPR trial who had complete plasma biomarker data available. Study data were analyzed on August 2, 2021, to October 25, 2022. Exposures: TEs identified by K-means clustering of plasma biomarkers collected at hospital arrival. Main outcomes and measures: An association between TEs and 30-day mortality was tested using multivariable relative risk (RR) regression adjusting for age, sex, trauma center, mechanism of injury, and injury severity score (ISS). Differential treatment response to transfusion strategy was assessed using an RR regression model for 30-day mortality by incorporating an interaction term for the product of endotype and treatment group adjusting for age, sex, trauma center, mechanism of injury, and ISS. Results: A total of 478 participants (median [IQR] age, 34.5 [25-51] years; 384 male [80%]) of the 680 participants in the PROPPR trial were included in this study analysis. A 2-class model that had optimal performance in K-means clustering was found. TE-1 (n = 270) was characterized by higher plasma concentrations of inflammatory biomarkers (eg, interleukin 8 and tumor necrosis factor α) and significantly higher 30-day mortality compared with TE-2 (n = 208). There was a significant interaction between treatment arm and TE for 30-day mortality. Mortality in TE-1 was 28.6% with 1:1:2 treatment vs 32.6% with 1:1:1 treatment, whereas mortality in TE-2 was 24.5% with 1:1:2 treatment vs 7.3% with 1:1:1 treatment (P for interaction = .001). Conclusions and relevance: Results of this secondary analysis suggest that endotypes derived from plasma biomarkers in trauma patients at hospital arrival were associated with a differential response to 1:1:1 vs 1:1:2 resuscitation strategies in trauma patients with severe injury. These findings support the concept of molecular heterogeneity in critically ill trauma populations and have implications for tailoring therapy for patients at high risk for adverse outcomes.
MeSH term(s)	Humans ; Male ; Adult ; Hemostatics ; Blood Transfusion ; Resuscitation/methods ; Shock, Hemorrhagic/therapy ; Injury Severity Score
Chemical Substances	Hemostatics
Language	English
Publishing date	2023-04-26
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S. ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2701841-6
ISSN	2168-6262 ; 2168-6254
ISSN (online)	2168-6262
ISSN	2168-6254
DOI	10.1001/jamasurg.2023.0819
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Article ; Online: The association between arterial-end-tidal carbon dioxide difference and outcomes after out-of-hospital cardiac arrest.

Abrahamowicz, Aleksandra A / Counts, Catherine R / Danielson, Kyle R / Bulger, Natalie E / Maynard, Charles / Carlbom, David J / Swenson, Erik R / Latimer, Andrew J / Yang, Betty / Sayre, Michael R / Johnson, Nicholas J

Resuscitation

2022 Volume 181, Page(s) 3–9

Abstract: ... sustained ROSC and qualifying E: Conclusion: Neither P ...

Abstract	Aim: We sought to determine if the difference between P Methods: This was a retrospective cohort study of adult patients who achieved return of spontaneous circulation (ROSC) after OHCA over 3 years. The primary exposure was the P Results: Of 698 OHCA patients transported to the hospitals, 381 had sustained ROSC and qualifying E Conclusion: Neither P
MeSH term(s)	Adult ; Humans ; Out-of-Hospital Cardiac Arrest/therapy ; Carbon Dioxide ; Cardiopulmonary Resuscitation ; Retrospective Studies ; Tidal Volume
Chemical Substances	Carbon Dioxide (142M471B3J)
Language	English
Publishing date	2022-09-29
Publishing country	Ireland
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	189901-6
ISSN	1873-1570 ; 0300-9572
ISSN (online)	1873-1570
ISSN	0300-9572
DOI	10.1016/j.resuscitation.2022.09.019
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