《创伤和急性护理外科杂志》旨在为优化严重受伤和危重手术患者的护理提供科学依据。因此，该杂志对基础和翻译研究具有高度优先性，以实现这一目标。此外，该杂志热衷于发表随机前瞻性临床研究，以建立基于机械基础的护理。最后，《华尔街日报》正在寻求纳入现有最佳证据的系统评价、指南和算法。

The Journal of Trauma and Acute Care Surgery aims to provide a scientific basis for optimizing the care of severely injured and critically ill surgical patients. The journal places a high priority on both basic and translational research to achieve this goal. Additionally, it is keen to publish randomized prospective clinical studies to establish evidence-based care practices. Finally, the Journal of Trauma and Acute Care Surgery seeks to include systematic reviews, guidelines, and algorithms that incorporate existing best evidence.

《Journal of Trauma and Acute Care Surgery》旨在为优化重伤和危重手术患者的护理提供科学依据。该杂志高度重视基础和转化研究，以实现这一目标。此外，杂志热衷于发表随机前瞻性临床研究，以建立基于证据的护理方法。最后，《Journal of Trauma and Acute Care Surgery》也欢迎系统评价、指南和算法的投稿，这些内容应基于现有的最佳证据。

Journal of Trauma and Acute Care Surgery

BACKGROUND Early involvement of geriatrics is recommended for older trauma patients. OBJECTIVE This systematic review aimed to determine the impact of a geriatric assessment on mortality, hospital length of stay, discharge destination, and delirium incidence in patients 65 years and older admitted to a trauma center. METHODS The protocol was developed according to Preferred Reporting Items for Systematic Review and Meta-analysis guidelines and registered in PROSPERO (CRD42019131870). Search of five databases was completed April 2019. Two independent reviewers completed screening, full text review, and data abstraction. Meta-analysis was performed on outcomes with at least two studies. RESULTS A total of 928 unique citations were identified; eight were included in the final analysis. All were cohort studies, most of moderate to poor quality using the Newcastle-Ottawa Scale. We found hospital length of stay decreased by mean of 1.11 days (95% confidence interval, 0.79–1.43), but mortality was unchanged (odds ratio, 1.01; 95% confidence interval, 0.74–1.38) in older patients admitted to a trauma center who had a geriatric consultation. Meta-analysis of discharge destination and delirium incidence was not performed due to heterogeneity. CONCLUSIONS This is the first systematic review and meta-analysis to evaluate outcomes in older patients admitted to a trauma center after implementation of a geriatric trauma consultation service. We found a decrease in hospital length of stay but insufficient evidence of change in in-hospital mortality in older patients who received a geriatric consultation as part of their trauma care compared with those that received standard trauma care only. There is a need for more methodologically rigorous research in geriatric trauma. LEVEL OF EVIDENCE Systematic review and meta-analysis, level III.

Debra Eagles

Bradley Godwin

Wei Cheng

Joy Moors

Sonshire Figueira

Lara Khoury

Karine Fournier

Jacinthe Lampron

A systematic review and meta-analysis evaluating geriatric consultation on older trauma patients

Background: Respiratory dysfunction remains one of the major complications after burn surgery in extensively burned patients. We evaluated the relationship between the invasiveness of burn surgery and acute lung injury (ALI). Methods: Patients admitted to our burn unit between 2006 and 2007 with burns greater than or equal to 30% of the total body surface area without severe inhalation injury were entered into this study. Of sixteen patients (mean age, 49.4 ± 19.3 years, total body surface area 46.0% ± 14.9%) who underwent burn surgery (3–6 days postburn), vital signs, hemodynamic parameters, blood gas analysis, and peak inspiratory pressure were recorded. Lung injury severity (LIS) score was serially determined. Bronchoalveolar lavage (BAL) was performed before and 24 hour postoperatively. Results: Body temperature and LIS score preoperatively (baseline) were 37.1°C ± 0.9°C and 3.8°C ± 2.2°C, respectively. LIS score increased with increased polymorphonuclear neutrophil in BAL 24 hour postoperatively in 7 of 10 patients with intraoperative temperature decreasing more than 1°C. Extent of excision (20.3% ± 6.7%), transfusion (4.3 ± 3.0 units), or duration of surgery (147 ± 49 minutes) alone did not show significant correlation with the development of ALI postoperatively. Conclusion: In patients with severe burn injury, hypothermia during surgery despite aggressive intraoperative warming is significantly correlated with the development of ALI with increased polymorphonuclear neutrophil in BAL and may reflect the severity of invasiveness.

Jun Oda

Kosuke Kasai

Mitsuhiro Noborio

Masashi Ueyama

Tetsuo Yukioka

Hypothermia During Burn Surgery and Postoperative Acute Lung Injury in Extensively Burned Patients

In trauma patients, elevated body temperature is a common and noninfective procedure soon after injury. We hypothesized that the absence of this febrile response is associated with failure to meet metabolic demands and results in adverse outcomes.We collected retrospective data of 253 consecutive trauma patients admitted to the intensive care unit during a 3-year period. Patients were stratified according to their daily maximum body temperature from days 1 to 10 (Tmax 1-10): no fever (<37.5 degrees C), low fever (37.5-38.4 degrees C), moderate fever (38.5-39.0 degrees C), and high fever (>39.0 degrees C). The area under the curve (AUC) of core temperature during the first 24 hours after admission was calculated for each patient at a baseline of 36 degrees C. The infection and mortality rates were measured.Sixty-three patients (24.9%) developed an infection, and the overall mortality was 7.5% (19 patients). Patients with no Tmax 1 and a low or high Tmax 4 to 10 had a significantly high infection rate; those with no fever on days 1 and 2 had a significantly high mortality rate. A low AUC was also associated with significantly higher infection and mortality rates. Multiple logistic regression analysis controlled for age, injury severity score, Tmax 1, AUC, initial temperature at admission, and time taken to reach 36 degrees C (if hypothermia was present) revealed that age, injury severity score, low AUC (odds ratio, 0.96; 95% confidence interval, 0.94-0.99; p = 0.002), and initial temperature were independent predictors of infection. Age and lower AUC (odds ratio, 0.87; 95% confidence interval, 0.81-0.92; p < 0.001) were both predictors of mortality.A febrile response until day 4 after injury did not increase morbidity, and a low AUC is independently associated with adverse outcomes. These findings show that a nonfebrile response soon after injury results in poor prognosis.

Yasuaki Mizushima

Masato Ueno

Koji Idoguchi

Kazuo Ishikawa

Tetsuya Matsuoka

Fever in Trauma Patients: Friend or Foe?

Objective To evaluate left ventricular (LV) performance in patients with severe head injury during and after mild hypothermia. Patients and Methods Seven consecutive patients who underwent therapeutic mild hypothermia (age, 15 to 70 years; Glasgow Coma Scale score on admission, 4 to 8). LV performance was assessed by using M-mode, color tissue Doppler imaging tracings and pulsed Doppler echocardiography. LV contraction and relaxation were evaluated by using the peak velocity of LV posterior wall movement during systole (Smax) and diastole (Dmax), respectively, in addition to the conventional echocardiographic indices. Results Mild hypothermia increased LV ejection time and reciprocally reduced LV filling period as indicated by temperature-dependent shortening of the early diastolic filling and the total diastolic inflow time. The indices depending on temporal factors such as ejection time, Smax, or Dmax were significantly affected by mild hypothermia, whereas those depending on spatial factors such as fractional shortening or stroke volume index were not. The attenuated Smax was compensated for the prolonged ejection time resulting in the relatively consistent fractional shortening regardless of body temperature. There was no compensatory mechanism for the decreased Dmax during diastole. Conclusion The effect of mild hypothermia seemed to be predominantly negatively chronotropic. LV diastolic function was more vulnerable to mild hypothermia than LV systolic function was.

Yasuyuki Kuwagata

Norihisa Ninomiya

Tadahiko Shiozaki

Takeshi Shimazu

Hisashi Sugimoto

Changes in Left Ventricular Performance in Patients with Severe Head Injury during and after Mild Hypothermia

In patients with isolated severe traumatic brain injury (TBI), the effect of controlled, therapeutic hypothermia on outcomes has been studied extensively. What is not well understood, however, and the purpose of this study, was to examine the impact of noninduced, nontherapeutic hypothermia on outcomes in these patients.A retrospective review of the institutional trauma registry at the Los Angeles County + University of Southern California Medical Center was performed to identify all trauma patients admitted to the surgical intensive care unit (SICU) with isolated severe TBI from January 2000 to December 2008. Patients were classified as hypothermic (core temperature [Tc] ≤35°C) or normothermic (Tc >35°C) based on their first Tc recorded on SICU admission. The primary outcome measure was in-hospital mortality, and secondary outcomes included SICU and hospital length of stay.During the study period, 1,403 patients sustaining an isolated severe TBI were admitted to the SICU. After excluding 122 patients with missing temperature data, 1,281 patients were analyzed. Hypothermia (Tc ≤35°C) on SICU admission was identified in 10.9% (n = 140) of the study population, with the remaining 89.1% (n = 1,141) being normothermic (Tc >35°C). After adjusting for differences in baseline characteristics between the two groups, patients who were hypothermic on SICU admission were found to be significantly less likely to survive (odds ratio, 2.9; 95% confidence interval, 1.3, 6.7; p < 0.013). A penetrating mechanism of injury, Injury Severity Score ≥25, and undergoing an exploratory laparotomy before admission were found to be independent risk factors for the development of hypothermia on SICU admission.For patients who have sustained isolated severe TBI, the presence of noninduced, nontherapeutic hypothermia on SICU admission is associated with a significant increase in mortality. The impact of preventative measures used to avoid the development of hypothermia and the effectiveness of measures for restoring normothermia warrant further investigation.

Agathoklis Konstantinidis

Kenji Inaba

Joe Dubose

Galinos Barmparas

Peep Talving

Jean-Stephane David

Lydia Lam

Demetrios Demetriades

The Impact of Nontherapeutic Hypothermia on Outcomes After Severe Traumatic Brain Injury

BACKGROUND Hospital presumptive eligibility (HPE) emergency Medicaid programs offset patient bills at hospitalization and can provide long-term Medicaid coverage. We characterized postdischarge outpatient health care utilization among HPE Medicaid trauma patients and identified patient access facilitators and barriers once newly insured. We hypothesized utilization would be increased among HPE trauma patients compared with other HPE patients, but that challenges in access to care would remain. METHODS We performed a convergent mixed methods study of California HPE beneficiaries using a 2016 to 2021 customized statewide longitudinal claims dataset from the Department of Health Care Services. We compared adults 18 years and older with a diagnosis to other HPE patients. Patients were tracked for 2 months postdischarge to evaluate health care utilization: outpatient specialist visits, emergency room (ER) visits, readmissions, and mental health. Thematic analysis of semistructured interviews with HPE Medicaid patients aimed to understand facilitators and barriers to access to care (n = 20). RESULTS Among 199,885 HPE patients, 39,677 (19.8%) had a primary diagnosis of trauma. In the 2 months postdischarge, 40.8% of trauma vs. 36.6% of nontrauma accessed outpatient specialist services; 18.6% vs. 17.2% returned to ED, 8.4% vs. 10.2% were readmitted; and 1.4% vs. 1.8% accessed mental health services. In adjusted analyses, trauma HPE patients had 1.18 increased odds of accessing outpatient specialist services ( p &lt; 0.01). Patients cited HPE facilitators to accessing care: rapid insurance acquisition, outpatient follow-up, hospital staff support, as well as ongoing barriers to access (HPE program information recall, lack of hospital staff follow up postdischarge, and difficulty navigating a complex health care system). CONCLUSION Hospital presumptive eligibility Medicaid is associated with higher rates of outpatient specialist visits and fewer readmissions following injury, suggesting improved trauma patient access. Opportunities to improve appropriateness of health care utilization include more robust and longitudinal education and engagement with HPE Medicaid patients to help them navigate newfound access to services. LEVEL OF EVIDENCE Epidemiologic; Level II.

Lisa Marie Knowlton

Katherine Arnow

Zaria Cosby

Kristen Davis

Wesley D. Hendricks

Alexander B. Gibson

Peiqi Chen

Arden M. Morris

Todd H. Wagner

Do emergency Medicaid programs improve post-discharge health care access for trauma patients? A statewide mixed-methods study

急诊医疗补助计划是否改善了创伤患者出院后的医疗服务可及性？一项全州范围的混合方法研究

BACKGROUND Failure to rescue (FTR) is an indicator of the quality of care provided by trauma centers. The aim of this study was to examine the trends of FTR incidence in geriatric trauma patients over the years and to determine whether race, ethnicity, and sex impact the FTR incidence. METHODS This is a retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program database over 4 years (2017–2020). All geriatric (≥60 years) trauma patients were included. Patients who died within 24 hours of admission or whose length of stay was ≤1 day were excluded. Trend analysis was performed. Patients were stratified based on race, ethnicity, and sex, and multivariable regression analyses were performed. RESULTS Over the course of 4 years, 1,105,651 geriatric patients were identified, of whom 30,984 (2.8%) developed major complications and 10,684 (34.5% of those with complications) had FTR. The mean (SD) age was 75 (9) years, 46% were male, 86% were White, and 6% were Hispanic. The median (interquartile range) Injury Severity Score was 9 (4–10) with no change over the years ( p = 0.364) and 96.8% sustained a blunt injury. Over the 4 years, the rate of FTR increased from 0.55% in 2017 to 1.04% in 2020 ( p &lt; 0.001). An analysis of trends in FTR patients revealed no significant difference in the proportion of males and females over the years ( p = 0.482). However, there was a notable increase in the proportion of Black and Hispanic patients in comparison with White ( p &lt; 0.001) and non-Hispanic patients ( p = 0.023), respectively. The odds of developing FTR have been increasing over the years, with Black race and Hispanic ethnicity identified as the independent risk factors for FTR. CONCLUSION The risk-adjusted odds of developing FTR have been increasing over the years, with one in every three patients who developed complications not surviving to discharge. Our findings demonstrate that racial and ethnic factors significantly impact the incidence of FTR. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III

Raymond Huang

Omar Hejazi

Muhammad Haris Khurshid

Adam Nelson

Collin Stewart

Tanya Anand

Marc R. Matthews

Stanley E. Okosun

Louis J. Magnotti

Bellal Joseph

Diversity in crisis: The impact of race and ethnicity on failure to rescue among geriatric trauma patients over the years

危机中的多样性：种族和民族对老年创伤患者抢救失败的影响多年变化

BACKGROUND Quality benchmarking has recently evolved from a historical focus on short-term morbidity and mortality as the key metrics to assessing long-term outcomes. Long-term quality metrics have been shown to provide a more complete assessment of geriatric trauma care. Among these metrics, patients' average number of healthy days at home (HDAH) proports to be a useful administrative claims-based marker of patient functional status. Our goal was to determine the predictors of HDAH among injured older adults. METHODS Medicare inpatient claims (2014–2015) were used to identify all geriatric trauma patients. Patients' number of HDAH was measured from the date of discharge and calculated as the total sum of patients' time during that period less any time spent in the hospital or emergency department, step-down/rehabilitation/nursing care, home health, or after death within a 365-period after index admission. Controlling for demographic, injury severity, and hospital-level characteristics, multivariable regression analyses were performed to identify the factors associated with increased HDAH. RESULTS We included 772,109 geriatric trauma patients. The mean age was 82.15 years (SD, 8.49 years), 68.3% were female, and 91.6% were White. The median HDAH was 351 days (interquartile range, 351–355 days). After adjusted analysis, age, Black race, Charlson Comorbidity Index (CCI), and care at a level 3/nontrauma center were associated with fewer HDAH within 365 days after discharge. CONCLUSION This study suggests that higher level trauma centers provide more HDAH after index admission for injured older adults. Future studies should focus on correlating HDAH with more granular but less readily accessible quality of life metrics. LEVEL OF EVIDENCE Prognostic and Epidemiological; III.

Manuel Castillo-Angeles

Cheryl K. Zogg

Charlotte B. Smith

James C. Etheridge

Christine Wu

Molly P. Jarman

Stephanie Nitzschke

Reza Askari

Zara Cooper

Ali Salim

Joaquim M. Havens

Predictors of healthy days at home: Benchmarking long-term outcomes in geriatric trauma

居家健康日数的预测因素：老年创伤长期结果的基准测试

ABSTRACT Since the 1990s, there has been a slow but steady adoption of selective nonoperative management (SNOM) for abdominal gunshot wounds (GSW). Multiple studies have shown that SNOM is feasible and can be performed safely, even at trauma centers with low penetrating trauma volumes. The principles of SNOM for abdominal GSW consists of (1) careful patient selection, (2) diagnostic workup with CT, and (3) clinical observation. By implementing SNOM, the number of patients undergoing a nontherapeutic laparotomy can significantly be improved to less than 10%. Overall, approximately one third of patients with abdominal GSW can be managed nonoperatively. This review article provides a practical approach to the management of patients with an abdominal GSW.

Kazuhide Matsushima

Selective nonoperative management of abdominal gunshot wounds: What you need to know

腹部枪伤的选择性非手术管理：你需要了解的内容

LEVEL OF EVIDENCE Therapeutic/Care Management; Level IV.

Joseph D. Forrester

Muhammad Saad Choudhry

Joseph Fernandez-Moure

Jason Kurle

Bhavik Patel

Jamie Tung

Susan Kartiko

Chest Wall Injury Society recommendations for long-term follow-up after nonoperatively and operatively managed traumatic rib and sternal fractures

胸部损伤学会关于非手术和手术治疗创伤性肋骨及胸骨骨折后长期随访的建议

Abbreviation	J Trauma Acute Care Surg
Journal Impact	2.88
Quartiles(Global)	SURGERY(Q1)

ISSN	0022-5282, 1529-8809, 2163-0755, 2163-0763
h-index	212

Publication Information	Publisher: Lippincott Williams and Wilkins，Publishing cycle: ，Journal Type: journal，Open Access Journals: No
Basic data	Year of publication: 2012，Proportion of original research papers: 0.00%，Self Citation Rate:N.A.， Gold OA Rate: 0.00%

Journal of Trauma and Acute Care Surgery

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