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Article ; Online: Bone Anchor Fixation in the Repair of Blunt Traumatic Abdominal Wall Hernias: A Western Trauma Association Multicenter Study.

Harrell, Kevin N / Grimes, Arthur D / Gill, Harkanwar / Reynolds, Jessica K / Ueland, Walker R / Sciarretta, Jason D / Todd, Samual R / Trust, Marc D / Ngoue, Marielle / Thomas, Bradley W / Ayuso, Sullivan A / LaRiccia, Aimee / Spalding, Chance M / Collins, Michael J / Collier, Bryan R / Karam, Basil S / de Moya, Marc A / Lieser, Mark J / Chipko, John M /

Haan, James M / Lightwine, Kelly L / Cullinane, Daniel C / Falank, Carolyne R / Phillips, Ryan C / Kemp, Michael T / Alam, Hasan B / Udekwu, Pascal O / Sanin, Gloria D / Hildreth, Amy N / Biffl, Walter L / Schaffer, Kathryn B / Marshall, Gary / Muttalib, Omaer / Nahmias, Jeffry / Shahi, Niti / Moulton, Steven L / Maxwell, Robert A

The American surgeon

2024 Volume 90, Issue 6, Page(s) 1161–1166

Abstract: 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 ...

Abstract	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, 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.
MeSH term(s)	Humans ; Male ; Female ; Wounds, Nonpenetrating/surgery ; Herniorrhaphy/methods ; Adult ; Middle Aged ; Surgical Mesh ; Abdominal Injuries/surgery ; Suture Anchors ; Recurrence ; Retrospective Studies ; Treatment Outcome ; Hernia, Ventral/surgery ; Hernia, Abdominal/surgery ; Hernia, Abdominal/etiology ; Injury Severity Score ; Surgical Wound Infection/etiology ; Surgical Wound Infection/epidemiology
Language	English
Publishing date	2024-01-10
Publishing country	United States
Document type	Journal Article ; Multicenter Study
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
DOI	10.1177/00031348241227195
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Article ; Online: Eastern Association for the Surgery of Trauma Multicenter Trial: Comparison of pre-injury antithrombotic use and reversal strategies among severe traumatic brain injury patients.

Yorkgitis, Brian K / Tatum, Danielle M / Taghavi, Sharven / Schroeppel, Thomas J / Noorbakhsh, Matthew R / Philps, Frances Hite / Bugaev, Nikolay / Mukherjee, Kaushik / Bellora, Mellody / Ong, Adrian W / Ratnasekera, Asanthi / Nordham, Kristen D / Carrick, Matthew M / Haan, James M / Lightwine, Kelly L / Lottenberg, Lawrence / Borrego, Robert / Cullinane, Daniel C / Berne, John D /

Rodriguez Mederos, Dalier / Hayward, Thomas Z / Kerwin, Andy J / Crandall, Marie

The journal of trauma and acute care surgery

2021 Volume 92, Issue 1, Page(s) 88–92

Abstract: Background: Trauma teams are often faced with patients on antithrombotic (AT) drugs, which is challenging when bleeding occurs. We sought to compare the effects of different AT medications on head injury severity and hypothesized that AT reversal would ... ...

Abstract	Background: Trauma teams are often faced with patients on antithrombotic (AT) drugs, which is challenging when bleeding occurs. We sought to compare the effects of different AT medications on head injury severity and hypothesized that AT reversal would not improve mortality in severe traumatic brain injury (TBI) patients. Methods: An Eastern Association for the Surgery of Trauma-sponsored prospective, multicentered, observational study of 15 trauma centers was performed. Patient demographics, injury burden, comorbidities, AT agents, and reversal attempts were collected. Outcomes of interest were head injury severity and in-hospital mortality. Results: Analysis was performed on 2,793 patients. The majority of patients were on aspirin (acetylsalicylic acid [ASA], 46.1%). Patients on a platelet chemoreceptor blocker (P2Y12) had the highest mean Injury Severity Score (9.1 ± 8.1). Patients taking P2Y12 inhibitors ± ASA, and ASA-warfarin had the highest head Abbreviated Injury Scale (AIS) mean (1.2 ± 1.6). On risk-adjusted analysis, warfarin-ASA was associated with a higher head AIS (odds ratio [OR], 2.43; 95% confidence interval [CI], 1.34-4.42) after controlling for Injury Severity Score, Charlson Comorbidity Index, initial Glasgow Coma Scale score, and initial systolic blood pressure. Among patients with severe TBI (head AIS score, ≥3) on antiplatelet therapy, reversal with desmopressin (DDAVP) and/or platelet transfusion did not improve survival (82.9% reversal vs. 90.4% none, p = 0.30). In severe TBI patients taking Xa inhibitors who received prothrombin complex concentrate, survival was not improved (84.6% reversal vs. 84.6% none, p = 0.68). With risk adjustment as described previously, mortality was not improved with reversal attempts (antiplatelet agents: OR 0.83; 85% CI, 0.12-5.9 [p = 0.85]; Xa inhibitors: OR, 0.76; 95% CI, 0.12-4.64; p = 0.77). Conclusion: Reversal attempts appear to confer no mortality benefit in severe TBI patients on antiplatelet agents or Xa inhibitors. Combination therapy was associated with severity of head injury among patients taking preinjury AT therapy, with ASA-warfarin possessing the greatest risk. Level of evidence: Prognostic, level II.
MeSH term(s)	Aged ; Anticoagulant Reversal Agents/administration & dosage ; Aspirin/adverse effects ; Aspirin/therapeutic use ; Brain Injuries, Traumatic/complications ; Brain Injuries, Traumatic/diagnosis ; Brain Injuries, Traumatic/mortality ; Brain Injuries, Traumatic/therapy ; Cardiovascular Diseases/drug therapy ; Cardiovascular Diseases/epidemiology ; Comorbidity ; Deamino Arginine Vasopressin/administration & dosage ; Factor Xa Inhibitors/adverse effects ; Factor Xa Inhibitors/therapeutic use ; Female ; Fibrinolytic Agents/adverse effects ; Fibrinolytic Agents/classification ; Fibrinolytic Agents/therapeutic use ; Hemorrhage/etiology ; Hemorrhage/mortality ; Hemorrhage/therapy ; Hospital Mortality ; Humans ; Male ; Platelet Transfusion/statistics & numerical data ; Risk Assessment/methods ; Risk Assessment/statistics & numerical data ; Trauma Severity Indices ; Treatment Outcome ; United States/epidemiology ; Warfarin/adverse effects ; Warfarin/therapeutic use
Chemical Substances	Anticoagulant Reversal Agents ; Factor Xa Inhibitors ; Fibrinolytic Agents ; Warfarin (5Q7ZVV76EI) ; Deamino Arginine Vasopressin (ENR1LLB0FP) ; Aspirin (R16CO5Y76E)
Language	English
Publishing date	2021-09-23
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Observational Study ; 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.0000000000003421
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Article ; Online: A western trauma association multicenter comparison of mesh versus non-mesh repair of blunt traumatic abdominal wall hernias.

Harrell, Kevin N / Grimes, Arthur D / Gill, Harkanwar / Reynolds, Jessica K / Ueland, Walker R / Sciarretta, Jason D / Todd, Samual R / Trust, Marc D / Ngoue, Marielle / Thomas, Bradley W / Ayuso, Sullivan A / LaRiccia, Aimee / Spalding, M Chance / Collins, Michael J / Collier, Bryan R / Karam, Basil S / de Moya, Marc A / Lieser, Mark J / Chipko, John M /

Injury

2023 Volume 55, Issue 2, Page(s) 111204

Abstract: Background: Blunt traumatic abdominal wall hernias (TAWH) occur in <1 % of trauma patients. Optimal repair techniques, such as mesh reinforcement, have not been studied in detail. We hypothesize that mesh use will be associated with increased surgical ... ...

Abstract	Background: Blunt traumatic abdominal wall hernias (TAWH) occur in <1 % of trauma patients. Optimal repair techniques, such as mesh reinforcement, have not been studied in detail. We hypothesize that mesh use will be associated with increased surgical site infections (SSI) and not improve hernia recurrence. Materials and methods: A secondary analysis of the Western Trauma Association blunt TAWH multicenter study was performed. Patients who underwent TAWH repair during initial hospitalization (1/2012-12/2018) were included. Mesh repair patients were compared to primary repair patients (non-mesh). A logistic regression was conducted to assess risk factors for SSI. Results: 157 patients underwent TAWH repair during index hospitalization with 51 (32.5 %) having mesh repair: 24 (45.3 %) synthetic and 29 (54.7 %) biologic. Mesh patients were more commonly smokers (43.1 % vs. 22.9 %, p = 0.016) and had a larger defect size (10 vs. 6 cm, p = 0.003). Mesh patients had a higher rate of SSI (25.5 % vs. 9.5 %, p = 0.016) compared to non-mesh patients, but a similar rate of recurrence (13.7 % vs. 10.5%, p = 0.742), hospital length of stay (LOS), and mortality. Mesh use (OR 3.66) and higher ISS (OR 1.06) were significant risk factors for SSI in a multivariable model. Conclusion: Mesh was used more frequently in flank TAWH and those with a larger defect size. Mesh use was associated with a higher incidence and risk of SSI but did not reduce the risk of hernia recurrence. When repairing TAWH mesh should be employed judiciously, and prospective randomized studies are needed to identify clear indications for mesh use in TAWH.
MeSH term(s)	Humans ; Hernia, Ventral/etiology ; Hernia, Ventral/surgery ; Herniorrhaphy/adverse effects ; Herniorrhaphy/methods ; Prospective Studies ; Recurrence ; Surgical Mesh/adverse effects ; Surgical Wound Infection/etiology
Language	English
Publishing date	2023-11-14
Publishing country	Netherlands
Document type	Multicenter Study ; Journal Article
ZDB-ID	218778-4
ISSN	1879-0267 ; 0020-1383
ISSN (online)	1879-0267
ISSN	0020-1383
DOI	10.1016/j.injury.2023.111204
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Article ; Online: AAST multicenter prospective analysis of prehospital tourniquet use for extremity trauma.

Schroll, Rebecca / Smith, Alison / Alabaster, Kelsey / Schroeppel, Thomas J / Stillman, Zachery E / Teicher, Erik J / Lita, Elena / Ferrada, Paula / Han, Jinfeng / Fullerton, Robert D / McNickle, Allison G / Fraser, Douglas R / Truitt, Michael S / Grossman Verner, Heather M / Todd, S Rob / Turay, David / Pop, Andrew / Godat, Laura N / Costantini, Todd W /

Khor, Desmond / Inaba, Kenji / Bardes, James / Wilson, Alison / Myers, John G / Haan, James M / Lightwine, Kelly L / Berdel, Henrik O / Bottiggi, Anthony J / Dorlac, Warren / Zier, Linda / Chang, Grace / Lindner, Mae / Martinez, Benjamin / Tatum, Danielle / Fischer, Peter E / Lieser, Mark / Mabe, Robert C / Lottenberg, Lawrence / Velopoulos, Catherine G / Urban, Shane / Duke, Marquinn / Brown, Amy / Peckham, Merry / Gongola, AlleaBelle / Enniss, Toby M / Teixeira, Pedro / Kim, Dennis Y / Singer, George / Ekeh, Peter / Hardman, Claire / Askari, Reza / Okafor, Barbara / Duchesne, Juan

The journal of trauma and acute care surgery

2022 Volume 92, Issue 6, Page(s) 997–1004

Abstract: Background: Tourniquet use for extremity hemorrhage control has seen a recent increase in civilian usage. Previous retrospective studies demonstrated that tourniquets improve outcomes for major extremity trauma (MET). No prospective study has been ... ...

Abstract	Background: Tourniquet use for extremity hemorrhage control has seen a recent increase in civilian usage. Previous retrospective studies demonstrated that tourniquets improve outcomes for major extremity trauma (MET). No prospective study has been conducted to date. The objective of this study was to evaluate outcomes in MET patients with prehospital tourniquet use. We hypothesized that prehospital tourniquet use in MET decreases the incidence of patients arriving to the trauma center in shock. Methods: Data were collected prospectively for adult patients with MET at 26 Level I and 3 Level II trauma centers from 2015 to 2020. Limbs with tourniquets applied in the prehospital setting were included in the tourniquet group and limbs without prehospital tourniquets were enrolled in the control group. Results: A total of 1,392 injured limbs were enrolled with 1,130 tourniquets, including 962 prehospital tourniquets. The control group consisted of 262 limbs without prehospital tourniquets and 88 with tourniquets placed upon hospital arrival. Prehospital improvised tourniquets were placed in 42 patients. Tourniquets effectively controlled bleeding in 87.7% of limbs. Tourniquet and control groups were similarly matched for demographics, Injury Severity Score, and prehospital vital signs (p > 0.05). Despite higher limb injury severity, patients in the tourniquet group were less likely to arrive in shock compared with the control group (13.0% vs. 17.4%, p = 0.04). The incidence of limb complications was not significantly higher in the tourniquet group (p > 0.05). Conclusion: This study is the first prospective analysis of prehospital tourniquet use for civilian extremity trauma. Prehospital tourniquet application was associated with decreased incidence of arrival in shock without increasing limb complications. We found widespread tourniquet use, high effectiveness, and a low number of improvised tourniquets. This study provides further evidence that tourniquets are being widely and safely adopted to improve outcomes in civilians with MET. Level of evidence: Therapeutic/Care Management; Level IV.
MeSH term(s)	Adult ; Emergency Medical Services ; Extremities/injuries ; Hemorrhage/etiology ; Hemorrhage/prevention & control ; Hemorrhage/therapy ; Humans ; Prospective Studies ; Retrospective Studies ; Shock/prevention & control ; Tourniquets/adverse effects ; Trauma Centers ; Wounds and Injuries/complications
Language	English
Publishing date	2022-01-18
Publishing country	United States
Document type	Journal Article ; Multicenter Study
ZDB-ID	2651070-4
ISSN	2163-0763 ; 2163-0755
ISSN (online)	2163-0763
ISSN	2163-0755
DOI	10.1097/TA.0000000000003555
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Article ; Online: An analysis of police transport in an Eastern Association for the Surgery of Trauma multicenter trial examining prehospital procedures in penetrating trauma patients.

Taghavi, Sharven / Maher, Zoe / Goldberg, Amy J / Haut, Elliott R / Raza, Shariq / Chang, Grace / Tatebe, Leah C / Toraih, Eman / Mendiola, Michelle / Anderson, Christofer / Ninokawa, Scott / Maluso, Patrick / Keating, Jane / Burruss, Sigrid / Reeves, Matthew / Coleman, Lauren E / Shatz, David V / Goldenberg-Sandau, Anna / Bhupathi, Apoorva /

Spalding, M Chance / LaRiccia, Aimee / Bird, Emily / Noorbakhsh, Matthew R / Babowice, James / Nelson, Marsha C / Jacobson, Lewis E / Williams, Jamie / Vella, Michael / Dellonte, Kate / Hayward, Thomas Z / Holler, Emma / Lieser, Mark J / Berne, John D / Mederos, Dalier R / Askari, Reza / Okafor, Barbara / Etchill, Eric / Fang, Raymond / Roche, Samantha L / Whittenburg, Laura / Bernard, Andrew C / Haan, James M / Lightwine, Kelly L / Norwood, Scott H / Murry, Jason / Gamber, Mark A / Carrick, Matthew M / Bugaev, Nikolay / Tatar, Antony / Tatum, Danielle

The journal of trauma and acute care surgery

2022 Volume 93, Issue 2, Page(s) 265–272

Abstract: Background: Police transport (PT) of penetrating trauma patients in urban locations has become routine in certain metropolitan areas; however, whether it results in improved outcomes over prehospital Advanced life support (ALS) transport has not been ... ...

Abstract	Background: Police transport (PT) of penetrating trauma patients in urban locations has become routine in certain metropolitan areas; however, whether it results in improved outcomes over prehospital Advanced life support (ALS) transport has not been determined in a multicenter study. We hypothesized that PT would not result in improved outcomes. Methods: This was a multicenter, prospective, observational study of adults (18+ years) with penetrating trauma to the torso and/or proximal extremity presenting at 25 urban trauma centers. Police transport and ALS patients were allocated via nearest neighbor, propensity matching. Transport mode also examined by Cox regression. Results: Of 1,618 total patients, 294 (18.2%) had PT and 1,324 (81.8%) were by ALS. After matching, 588 (294/cohort) remained. The patients were primarily Black (n = 497, 84.5%), males (n = 525, 89.3%, injured by gunshot wound (n = 494, 84.0%) with 34.5% (n = 203) having Injury Severity Score of 16 or higher. Overall mortality by propensity matching was not different between cohorts (15.6% ALS vs. 15.0% PT, p = 0.82). In severely injured patients (Injury Severity Score ≥16), mortality did not differ between PT and ALS transport (38.8% vs. 36.0%, respectively; p = 0.68). Cox regression analysis controlled for relevant factors revealed no association with a mortality benefit in patients transported by ALS. Conclusion: Police transport of penetrating trauma patients in urban locations results in similar outcomes compared with ALS. Immediate transport to definitive trauma care should be emphasized in this patient population. Level of evidence: Prognostic and Epidemiologic; Level III.
MeSH term(s)	Adult ; Emergency Medical Services ; Humans ; Injury Severity Score ; Male ; Police ; Prospective Studies ; Retrospective Studies ; Transportation of Patients/methods ; Trauma Centers ; Wounds, Gunshot ; Wounds, Penetrating/surgery
Language	English
Publishing date	2022-01-31
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Observational Study
ZDB-ID	2651070-4
ISSN	2163-0763 ; 2163-0755
ISSN (online)	2163-0763
ISSN	2163-0755
DOI	10.1097/TA.0000000000003563
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Article ; Online: Risk factors for recurrence in blunt traumatic abdominal wall hernias: A secondary analysis of a Western Trauma association multicenter study.

Harrell, Kevin N / Grimes, Arthur D / Gill, Harkanwar / Reynolds, Jessica K / Ueland, Walker R / Sciarretta, Jason D / Todd, Samual R / Trust, Marc D / Ngoue, Marielle / Thomas, Bradley W / Ayuso, Sullivan A / LaRiccia, Aimee / Spalding, M Chance / Collins, Michael J / Collier, Bryan R / Karam, Basil S / de Moya, Marc A / Lieser, Mark J / Chipko, John M /

American journal of surgery

2022 Volume 225, Issue 6, Page(s) 1069–1073

Abstract: Background: Few studies have investigated risk factors for recurrence of blunt traumatic abdominal wall hernias (TAWH).: Methods: Twenty trauma centers identified repaired TAWH from January 2012 to December 2018. Logistic regression was used to ... ...

Abstract	Background: Few studies have investigated risk factors for recurrence of blunt traumatic abdominal wall hernias (TAWH). Methods: Twenty trauma centers identified repaired TAWH from January 2012 to December 2018. Logistic regression was used to investigate risk factors for recurrence. Results: TAWH were repaired in 175 patients with 21 (12.0%) known recurrences. No difference was found in location, defect size, or median time to repair between the recurrence and non-recurrence groups. Mesh use was not protective of recurrence. Female sex, injury severity score (ISS), emergency laparotomy (EL), and bowel resection were associated with hernia recurrence. Bowel resection remained significant in a multivariable model. Conclusion: Female sex, ISS, EL, and bowel resection were identified as risk factors for hernia recurrence. Mesh use and time to repair were not associated with recurrence. Surgeons should be mindful of these risk factors but could attempt acute repair in the setting of appropriate physiologic parameters.
MeSH term(s)	Humans ; Female ; Abdominal Injuries/epidemiology ; Abdominal Injuries/surgery ; Abdominal Injuries/complications ; Wounds, Nonpenetrating/surgery ; Wounds, Nonpenetrating/complications ; Hernia, Abdominal/surgery ; Laparotomy/adverse effects ; Risk Factors ; Abdominal Wall/surgery ; Surgical Mesh/adverse effects ; Hernia, Ventral/surgery
Language	English
Publishing date	2022-12-07
Publishing country	United States
Document type	Multicenter Study ; Journal Article
ZDB-ID	2953-1
ISSN	1879-1883 ; 0002-9610
ISSN (online)	1879-1883
ISSN	0002-9610
DOI	10.1016/j.amjsurg.2022.12.006
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Article ; Online: An Eastern Association for the Surgery of Trauma multicenter trial examining prehospital procedures in penetrating trauma patients.

Taghavi, Sharven / Maher, Zoe / Goldberg, Amy J / Chang, Grace / Mendiola, Michelle / Anderson, Christofer / Ninokawa, Scott / Tatebe, Leah C / Maluso, Patrick / Raza, Shariq / Keating, Jane J / Burruss, Sigrid / Reeves, Matthew / Coleman, Lauren E / Shatz, David V / Goldenberg-Sandau, Anna / Bhupathi, Apoorva / Spalding, M Chance / LaRiccia, Aimee /

Bird, Emily / Noorbakhsh, Matthew R / Babowice, James / Nelson, Marsha C / Jacobson, Lewis E / Williams, Jamie / Vella, Michael / Dellonte, Kate / Hayward, Thomas Z / Holler, Emma / Lieser, Mark J / Berne, John D / Mederos, Dalier R / Askari, Reza / Okafor, Barbara U / Haut, Elliott R / Etchill, Eric W / Fang, Raymond / Roche, Samantha L / Whittenburg, Laura / Bernard, Andrew C / Haan, James M / Lightwine, Kelly L / Norwood, Scott H / Murry, Jason / Gamber, Mark A / Carrick, Matthew M / Bugaev, Nikolay / Tatar, Antony / Duchesne, Juan / Tatum, Danielle

The journal of trauma and acute care surgery

2021 Volume 91, Issue 1, Page(s) 130–140

Abstract: Background: Prehospital procedures (PHP) by emergency medical services (EMS) are performed regularly in penetrating trauma patients despite previous studies demonstrating no benefit. We sought to examine the influence of PHPs on outcomes in penetrating ... ...

Abstract	Background: Prehospital procedures (PHP) by emergency medical services (EMS) are performed regularly in penetrating trauma patients despite previous studies demonstrating no benefit. We sought to examine the influence of PHPs on outcomes in penetrating trauma patients in urban locations where transport to trauma center is not prolonged. We hypothesized that patients without PHPs would have better outcomes than those undergoing PHP. Methods: This was an Eastern Association for the Surgery of Trauma-sponsored, multicenter, prospective, observational trial of adults (18+ years) with penetrating trauma to the torso and/or proximal extremity presenting at 25 urban trauma centers. The impact of PHPs and transport mechanism on in-hospital mortality were examined. Results: Of 2,284 patients included, 1,386 (60.7%) underwent PHP. The patients were primarily Black (n = 1,527, 66.9%) males (n = 1,986, 87.5%) injured by gunshot wound (n = 1,510, 66.0%) with 34.1% (n = 726) having New Injury Severity Score of ≥16. A total of 1,427 patients (62.5%) were transported by Advanced Life Support EMS, 17.2% (n = 392) by private vehicle, 13.7% (n = 312) by police, and 6.7% (n = 153) by Basic Life Support EMS. Of the PHP patients, 69.1% received PHP on scene, 59.9% received PHP in route, and 29.0% received PHP both on scene and in route. Initial scene vitals differed between groups, but initial emergency department vitals did not. Receipt of ≥1 PHP increased mortality odds (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.01-1.83; p = 0.04). Logistic regression showed increased mortality with each PHP, whether on scene or during transport. Subset analysis of specific PHP revealed that intubation (OR, 10.76; 95% CI, 4.02-28.78; p < 0.001), C-spine immobilization (OR, 5.80; 95% CI, 1.85-18.26; p < 0.01), and pleural decompression (OR, 3.70; 95% CI, 1.33-10.28; p = 0.01) had the highest odds of mortality after adjusting for multiple variables. Conclusion: Prehospital procedures in penetrating trauma patients impart no survival advantage and may be harmful in urban settings, even when performed during transport. Therefore, PHP should be forgone in lieu of immediate transport to improve patient outcomes. Level of evidence: Prognostic, level III.
MeSH term(s)	Adult ; Emergency Medical Services/methods ; Emergency Medical Services/statistics & numerical data ; Female ; Hospital Mortality ; Humans ; Injury Severity Score ; Logistic Models ; Male ; Middle Aged ; Prospective Studies ; Trauma Centers/statistics & numerical data ; United States/epidemiology ; Urban Health Services ; Wounds, Gunshot/mortality ; Wounds, Gunshot/therapy ; Wounds, Penetrating/mortality ; Wounds, Penetrating/therapy ; Young Adult
Language	English
Publishing date	2021-03-01
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Observational Study ; 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.0000000000003151
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Article ; Online: Management of blunt traumatic abdominal wall hernias: A Western Trauma Association multicenter study.

Harrell, Kevin N / Grimes, Arthur D / Albrecht, Roxie M / Reynolds, Jessica K / Ueland, Walker R / Sciarretta, Jason D / Todd, Samual R / Trust, Marc D / Ngoue, Marielle / Thomas, Bradley W / Ayuso, Sullivan A / LaRiccia, Aimee / Spalding, M Chance / Collins, Michael J / Collier, Bryan R / Karam, Basil S / de Moya, Marc A / Lieser, Mark J / Chipko, John M /

The journal of trauma and acute care surgery

2021 Volume 91, Issue 5, Page(s) 834–840

Abstract: Background: Blunt traumatic abdominal wall hernias (TAWH) occur in approximately 15,000 patients per year. Limited data are available to guide the timing of surgical intervention or the feasibility of nonoperative management.: Methods: A ... ...

Abstract	Background: Blunt traumatic abdominal wall hernias (TAWH) occur in approximately 15,000 patients per year. Limited data are available to guide the timing of surgical intervention or the feasibility of nonoperative management. Methods: A retrospective study of patients presenting with blunt TAWH from January 2012 through December 2018 was conducted. Patient demographic, surgical, and outcomes data were collected from 20 institutions through the Western Trauma Association Multicenter Trials Committee. Results: Two hundred and eighty-one patients with TAWH were identified. One hundred and seventy-six (62.6%) patients underwent operative hernia repair, and 105 (37.4%) patients underwent nonoperative management. Of those undergoing surgical intervention, 157 (89.3%) were repaired during the index hospitalization, and 19 (10.7%) underwent delayed repair. Bowel injury was identified in 95 (33.8%) patients with the majority occurring with rectus and flank hernias (82.1%) as compared with lumbar hernias (15.8%). Overall hernia recurrence rate was 12.0% (n = 21). Nonoperative patients had a higher Injury Severity Score (24.4 vs. 19.4, p = 0.010), head Abbreviated Injury Scale score (1.1 vs. 0.6, p = 0.006), and mortality rate (11.4% vs. 4.0%, p = 0.031). Patients who underwent late repair had lower rates of primary fascial repair (46.4% vs. 77.1%, p = 0.012) and higher rates of mesh use (78.9% vs. 32.5%, p < 0.001). Recurrence rate was not statistically different between the late and early repair groups (15.8% vs. 11.5%, p = 0.869). Conclusion: This report is the largest series and first multicenter study to investigate TAWHs. Bowel injury was identified in over 30% of TAWH cases indicating a significant need for immediate laparotomy. In other cases, operative management may be deferred in specific patients with other life-threatening injuries, or in stable patients with concern for bowel injury. Hernia recurrence was not different between the late and early repair groups. Level of evidence: Therapeutic/care management, Level IV.
MeSH term(s)	Abdominal Injuries/complications ; Abdominal Injuries/surgery ; Abdominal Wall/surgery ; Adult ; Female ; Hernia, Ventral/etiology ; Hernia, Ventral/surgery ; Herniorrhaphy/methods ; Herniorrhaphy/statistics & numerical data ; Humans ; Injury Severity Score ; Male ; Middle Aged ; Recurrence ; Retrospective Studies ; Time-to-Treatment/statistics & numerical data ; Treatment Outcome ; Wounds, Nonpenetrating/complications ; Wounds, Nonpenetrating/surgery ; Young Adult
Language	English
Publishing date	2021-10-06
Publishing country	United States
Document type	Journal Article ; Multicenter Study
ZDB-ID	2651070-4
ISSN	2163-0763 ; 2163-0755
ISSN (online)	2163-0763
ISSN	2163-0755
DOI	10.1097/TA.0000000000003250
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: The why and how our trauma patients die: A prospective Multicenter Western Trauma Association study.

Callcut, Rachael A / Kornblith, Lucy Z / Conroy, Amanda S / Robles, Anamaria J / Meizoso, Jonathan P / Namias, Nicholas / Meyer, David E / Haymaker, Amanda / Truitt, Michael S / Agrawal, Vaidehi / Haan, James M / Lightwine, Kelly L / Porter, John M / San Roman, Janika L / Biffl, Walter L / Hayashi, Michael S / Sise, Michael J / Badiee, Jayraan / Recinos, Gustavo /

The journal of trauma and acute care surgery

2019 Volume 86, Issue 5, Page(s) 864–870

Abstract: Background: Historically, hemorrhage has been attributed as the leading cause (40%) of early death. However, a rigorous, real-time classification of the cause of death (COD) has not been performed. This study sought to prospectively adjudicate and ... ...

Abstract	Background: Historically, hemorrhage has been attributed as the leading cause (40%) of early death. However, a rigorous, real-time classification of the cause of death (COD) has not been performed. This study sought to prospectively adjudicate and classify COD to determine the epidemiology of trauma mortality. Methods: Eighteen trauma centers prospectively enrolled all adult trauma patients at the time of death during December 2015 to August 2017. Immediately following death, attending providers adjudicated the primary and contributing secondary COD using standardized definitions. Data were confirmed by autopsies, if performed. Results: One thousand five hundred thirty-six patients were enrolled with a median age of 55 years (interquartile range, 32-75 years), 74.5% were male. Penetrating mechanism (n = 412) patients were younger (32 vs. 64, p < 0.0001) and more likely to be male (86.7% vs. 69.9%, p < 0.0001). Falls were the most common mechanism of injury (26.6%), with gunshot wounds second (24.3%). The most common overall primary COD was traumatic brain injury (TBI) (45%), followed by exsanguination (23%). Traumatic brain injury was nonsurvivable in 82.2% of cases. Blunt patients were more likely to have TBI (47.8% vs. 37.4%, p < 0.0001) and penetrating patients exsanguination (51.7% vs. 12.5%, p < 0.0001) as the primary COD. Exsanguination was the predominant prehospital (44.7%) and early COD (39.1%) with TBI as the most common later. Penetrating mechanism patients died earlier with 80.1% on day 0 (vs. 38.5%, p < 0.0001). Most deaths were deemed disease-related (69.3%), rather than by limitation of further aggressive care (30.7%). Hemorrhage was a contributing cause to 38.8% of deaths that occurred due to withdrawal of care. Conclusion: Exsanguination remains the predominant early primary COD with TBI accounting for most deaths at later time points. Timing and primary COD vary significantly by mechanism. Contemporaneous adjudication of COD is essential to elucidate the true understanding of patient outcome, center performance, and future research. Level of evidence: Epidemiologic, level II.
MeSH term(s)	Accidental Falls/mortality ; Adult ; Age Factors ; Aged ; Brain Injuries, Traumatic/mortality ; Cause of Death ; Emergency Medical Services/statistics & numerical data ; Exsanguination/mortality ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Prospective Studies ; Risk Factors ; Sex Factors ; Statistics, Nonparametric ; Time Factors ; Trauma Centers/statistics & numerical data ; Wounds and Injuries/mortality ; Wounds, Gunshot/mortality
Language	English
Publishing date	2019-01-10
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Research Support, N.I.H., Extramural
ZDB-ID	2651070-4
ISSN	2163-0763 ; 2163-0755
ISSN (online)	2163-0763
ISSN	2163-0755
DOI	10.1097/TA.0000000000002205
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Time to stroke: A Western Trauma Association multicenter study of blunt cerebrovascular injuries.

Burlew, Clay Cothren / Sumislawski, Joshua J / Behnfield, Charles D / McNutt, Michelle K / McCarthy, James / Sharpe, John P / Croce, Martin A / Bala, Miklosh / Kashuk, Jeffry / Spalding, M Chance / Beery, Paul R / John, Scott / Hunt, Darren J / Harmon, Laura / Stein, Deborah M / Callcut, Rachael / Wybourn, Chris / Sperry, Jason / Anto, Vincent /

Dunn, Julie / Veith, Jacob P / Brown, Carlos V R / Celii, Amanda / Zander, Tyler L / Coimbra, Raul / Berndtson, Allison E / Moss, Tovah Z / Malhotra, Ajai K / Hazelton, Joshua P / Linden, Kimberly / West, Michaela / Alam, Hasan B / Williams, Aaron M / Kim, Jennie / Inaba, Kenji / Moulton, Steve / Choi, Young Mee / Warren, Harry L / Collier, Bryan / Ball, Chad G / Savage, Stephanie / Hartwell, Jennifer L / Cullinane, Daniel C / Zielinski, Martin D / Ray-Zack, Mohamed D / Morse, Bryan C / Rhee, Peter / Rutherford, Edmund J / Udekwu, Pascal / Reynolds, Cassandra / Toschlog, Eric / Gondek, Steve / Ju, Tammy / Haan, James M / Lightwine, Kelly L / Kulvatunyou, Narong / Coates, Brian / Khouqeer, Ahmed F / Todd, S Rob / Zarzaur, Ben / Waller, Christine J / Kallies, Kara J / Neideen, Todd / Eddine, Savo Bou Zein / Peck, Kimberly A / Dunne, Casey E / Kramer, Kristina / Bokhari, Faran / Dhillon, Tejveer S / Galante, Joseph M / Cohen, Mitchell J

The journal of trauma and acute care surgery

2018 Volume 85, Issue 5, Page(s) 858–866

Abstract: Background: Screening for blunt cerebrovascular injuries (BCVIs) in asymptomatic high-risk patients has become routine. To date, the length of this asymptomatic period has not been defined. Determining the time to stroke could impact therapy including ... ...

Abstract	Background: Screening for blunt cerebrovascular injuries (BCVIs) in asymptomatic high-risk patients has become routine. To date, the length of this asymptomatic period has not been defined. Determining the time to stroke could impact therapy including earlier initiation of antithrombotics in multiply injured patients. The purpose of this study was to determine the time to stroke in patients with a BCVI-related stroke. We hypothesized that the majority of patients suffer stroke between 24 hours and 72 hours after injury. Methods: Patients with a BCVI-related stroke from January 2007 to January 2017 from 37 trauma centers were reviewed. Results: During the 10-year study, 492 patients had a BCVI-related stroke; the majority were men (61%), with a median age of 39 years and ISS of 29. Stroke was present at admission in 182 patients (37%) and occurred during an Interventional Radiology procedure in six patients. In the remaining 304 patients, stroke was identified a median of 48 hours after admission: 53 hours in the 144 patients identified by neurologic symptoms and 42 hours in the 160 patients without a neurologic examination and an incidental stroke identified on imaging. Of those patients with neurologic symptoms, 88 (61%) had a stroke within 72 hours, whereas 56 had a stroke after 72 hours; there was a sequential decline in stroke occurrence over the first week. Of the 304 patients who had a stroke after admission, 64 patients (22%) were being treated with antithrombotics when the stroke occurred. Conclusions: The majority of patients suffer BCVI-related stroke in the first 72 hours after injury. Time to stroke can help inform clinicians about initiation of treatment in the multiply injured patient. Level of evidence: Prognostic/Epidemiologic, level III.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Carotid Artery Injuries/complications ; Cerebrovascular Trauma/complications ; Child ; Child, Preschool ; Female ; Fibrinolytic Agents/therapeutic use ; Humans ; Injury Severity Score ; Male ; Middle Aged ; Nervous System Diseases/etiology ; Stroke/diagnostic imaging ; Stroke/drug therapy ; Stroke/etiology ; Time Factors ; Wounds, Nonpenetrating/complications ; Young Adult
Chemical Substances	Fibrinolytic Agents
Language	English
Publishing date	2018-05-26
Publishing country	United States
Document type	Journal Article ; Multicenter Study
ZDB-ID	2651070-4
ISSN	2163-0763 ; 2163-0755
ISSN (online)	2163-0763
ISSN	2163-0755
DOI	10.1097/TA.0000000000001989
Database	MEDical Literature Analysis and Retrieval System OnLINE

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