Nationwide trends in mortality following penetrating trauma: Are we up for the challenge?

Sakran, Joseph V.; Mehta, Ambar; Fransman, Ryan; Nathens, Avery B.; Joseph, Bellal; Kent, Alistair; Haut, Elliott R.; Efron, David T.

doi:10.1097/ta.0000000000001907

Cited by 35 publications

(29 citation statements)

References 29 publications

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“…23,24 Previous studies have focused on clinical outcomes in the context of mortality or have compared outcomes on the basis of intent or race/ethnicity. 13,16,17,19,25,26,27 In addition, US society’s understanding of the potentially distinct medical consequences and morbidity of firearm injuries owing to their typically severe nature is limited to date. Previous studies have documented the high case fatality associated with firearm injuries; however, a robust comparison of indicators of severity between firearm injuries and other penetrating trauma mechanisms among children and adolescents is needed to capture a complete picture of the consequences of firearm injuries.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Injury Severity and Resource Utilization in Pediatric Firearm and Sharp Force Injuries

Wolf

Garrison²,

Mills

et al. 2019

JAMA Netw Open

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Key PointsQuestionDo injury severity and resource utilization differ between firearm injuries and other penetrating trauma mechanisms in children in the United States?FindingsIn this cohort study of 25 155 firearm and 21 270 cut or pierce encounters in US children 17 years or younger, critical and noncritical firearm injuries were associated with higher likelihood of intensive care unit admission, a higher Injury Severity Score, and higher likelihood of longer hospital or intensive care unit length of stay compared with cut or pierce injuries.MeaningThis study suggests greater injury severity and resource utilization associated with pediatric firearm injuries when compared with other penetrating trauma, even among children with critical injuries.

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Section: Introductionmentioning

confidence: 99%

Evaluation of Injury Severity and Resource Utilization in Pediatric Firearm and Sharp Force Injuries

Wolf

Garrison²,

Mills

et al. 2019

JAMA Netw Open

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“…Extremity vascular trauma has multiple causes and treatment options. It has varied etiology being motor vehicle accidents, street crimes, explosions, industrial accidents, and most common being penetrating trauma with increasing trends towards penetrating trauma by gunshot wounds [11][12][13]. Extremity vascular injuries among overall vascular trauma patients range from 30 to 45% to 50% [7,14].Penetrating trauma accounts for 64% to 82% cases [14][15][16].…”

Section: Spectrum Of Extremity Vascular Injuriesmentioning

confidence: 99%

The Utility of Therapeutic Anticoagulation in the Perioperative Period in Patients Presenting in Emergency Surgical Department With Extremity Vascular Injuries

Masood

Danawar

Mekaiel

et al. 2020

Cureus

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Extremity vascular trauma is a challenging surgical emergency in both civilian population and combat environment. It requires vigilant diagnosis and prompt treatment to minimize limb loss and mortality. A multidisciplinary team approach is required to deal with shock states, concomitant abdominal injuries, head injuries, and fractures with significant tissue loss and psychological stress. Anticoagulation is frequently used during traumatic vascular repair to avoid repair site thrombosis, postoperative deep venous thrombosis, and pulmonary embolism (PE). In this review article, we are going to search about how frequent is the use of anticoagulation in terms of limb salvage rates, and mortality rates or side effects of anticoagulation in terms of risk of bleeding episodes, and the need for future prospective studies. Extremity vascular trauma is managed by a variety of methods including open repairs, endovascular repairs, and nonoperative management. Most of the literature demonstrates the use of systemic or regional anticoagulation in the management of vascular injuries with the improvement in limb salvage rates and reduced morbidities but confounding factors lead to variable results. Some studies show an increased risk of bleeding in trauma patients with the use of anticoagulants in trauma settings without any significant effect on repair site thrombosis. More comprehensive studies and randomized controlled trials are needed to confirm the importance of perioperative anticoagulation while avoiding the confounding factors in terms of injury severity scores, ischemia time, demographics of patients, modes of injury, comorbidities, grades of shock, concomitant injuries that need anticoagulation like venous injuries or intracranial injuries that are contraindications to the use of anticoagulation, type of anticoagulation and expertise available as well as the experience level of the operating surgeon. Literature also reveals the use of new oral anticoagulants (e.g., dabigatran) to be associated with lesser bleeding episodes when compared to warfarin, so in future, we can check the feasibility of these agents to reduce the bleeding episodes and at the same time improve the limb salvage rates.

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“…Trauma is a leading cause of death for persons age 1 to 44 . Penetrating trauma continues to represent a particularly lethal problem with a higher prehospital and emergency department (ED) mortality compared to blunt trauma . Carefully selected patients presenting to the ED with penetrating thoracic or abdominal trauma may benefit from an emergency department thoracotomy (EDT) .…”

mentioning

confidence: 99%

Emergency Department Thoracotomy: Development of a Reliable, Validated Checklist for Procedural Training

Zaïdi

Dhake

Miller

et al. 2019

AEM Education and Training

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Objectives: Emergency department thoracotomy (EDT) is a rare and challenging procedure. Emergency medicine (EM) residents have limited opportunities to perform the procedure in clinical or educational settings. Standardized, reliable, validated checklists do not exist to evaluate procedural competency. The objectives of this project were twofold: 1) to develop a checklist containing the critical actions for performing an EDT that can be used for future procedural skills training and 2) to evaluate the reliability and validity of the checklist for performing EDT.Methods: After a literature review, a preliminary 22-item checklist was developed and disseminated to experts in EM and trauma surgery. A modified Delphi method was used to revise the checklist. To assess usability of the checklist, EM and trauma surgery faculty and residents were evaluated performing an EDT while inter-rater reliability was calculated with Cohen's kappa. A Student's t-test was used to compare the performance of participants who had or had not performed a thoracotomy in clinical practice. Item-total correlation was calculated for each checklist item to determine discriminatory ability.Results: A final 22-item checklist was developed for EDT. The overall inter-rater reliability was strong (j = 0.84) with individual item agreement ranging from moderate to strong (j = 0.61 to 1.00). Experts (attending physicians and senior residents) performed well on the checklist, achieving an average score of 80% on the checklist. Participants who had performed EDT in clinical practice performed significantly better than those that had not, achieving an average of 80.7% items completed versus 52.3% (p < 0.05). Seventeen of 22 items had an itemtotal correlation greater than 0.2. Conclusions:A final 22-item consensus-based checklist was developed for the EDT. Overall inter-rater reliability was strong. This checklist can be used in future studies to serve as a foundation for curriculum development around this important procedure.

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Nationwide trends in mortality following penetrating trauma: Are we up for the challenge?

Abstract: Prognostic and epidemiological, level IV.

Cited by 35 publications

References 29 publications

Evaluation of Injury Severity and Resource Utilization in Pediatric Firearm and Sharp Force Injuries

Evaluation of Injury Severity and Resource Utilization in Pediatric Firearm and Sharp Force Injuries

The Utility of Therapeutic Anticoagulation in the Perioperative Period in Patients Presenting in Emergency Surgical Department With Extremity Vascular Injuries

Emergency Department Thoracotomy: Development of a Reliable, Validated Checklist for Procedural Training

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