《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 Although several trauma centers have developed direct to operating room (DOR) trauma resuscitation programs, there is little published data on optimal patient selection, practices, and outcomes. We sought to analyze triage criteria and interventions associated with optimal DOR outcomes and resource utilization. METHODS Retrospective review of all adult DOR resuscitations for a 6-year period was performed. Triage criteria were analyzed individually and grouped into categories: mechanism, physiology, anatomy/injury, or other. The best univariate and multivariate predictors of requiring lifesaving interventions (LSIs) or emergent surgery (ES) were analyzed. Actual and predicted mortality were compared for all patients and for predefined time-sensitive subgroups. RESULTS There were 628 DOR patients (5% of all admissions) identified; the majority were male (79%), penetrating mechanism (70%), severely injured (40% ISS &gt;15), and 17% died. Half of patients required LSI and 23% required ES, with significantly greater need for ES and lower need for LSI after penetrating versus blunt injury ( p &lt; 0.01). Although injury mechanism criteria triggered most DOR cases and best predicted need for ES, the physiology and anatomy/injury criteria were associated with greater need for LSI and mortality. Observed mortality was significantly lower than predicted mortality with DOR for several key subgroups. Triage schemes for both ES and LSI could be simplified to four to six independent predictors by regression analysis. CONCLUSION The DOR program identified severely injured trauma patients at increased risk for requiring LSI and/or ES. Different triage variable categories drive the need for ES versus LSI and could be simplified or optimized based on local needs or preferences. Direct to operating room was associated with better than expected survival among specific time-sensitive subgroups. LEVEL OF EVIDENCE Therapeutic/Care Management, Level IV.

Amelia Johnson

Michael Rott

Andrea Kuchler

Emma Williams

Fredrick Cole

Ameen Ramzy

Ronald Barbosa

William Long

Matthew J. Martin

Direct to operating room trauma resuscitation: Optimizing patient selection and time-critical outcomes when minutes count

Delays in appropriate triage of bleeding trauma patients result in poor outcomes. Clinical gestalt is fallible and objective measures of risk stratification are needed. The objective of this review is to identify and assess prediction models and predictors for the early identification of traumatic hemorrhage patients requiring massive transfusion, surgery, or embolization.We searched electronic databases through to September 31, 2016, for studies describing clinical, laboratory, and imaging predictors available within the first hour of resuscitation for identifying patients requiring major intervention for hemorrhage within the first 24 hours.We included 84 studies describing any predictor-outcome association, including 47 multivariable models; of these, 26 (55%) were specifically designed for prediction. We identified 35 distinct predictors of which systolic blood pressure, age, heart rate, and mechanism of injury were most frequently studied. Quality of multivariable models was generally poor with only 21 (45%) meeting a commonly recommended sample size threshold of 10 events per predictor. From 21 models meeting this threshold, we identified seven predictors that were examined in at least two models: mechanism of injury, systolic blood pressure, heart rate, hemoglobin, lactate, and focussed abdominal sonography for trauma. Pooled odds ratios were obtained from random-effects meta-analyses.The majority of traumatic hemorrhagic prediction studies are of poor quality, as assessed by the Prognosis Research Strategy recommendations and Critical Appraisal and Data Extraction for Systematic Reviews of Modeling Studies checklist. There exists a need for a well-designed clinical prediction model for early identification of patients requiring intervention. The variables of clinical importance identified in this review are consistent with recent expert guideline recommendations and may serve as candidates for future derivation studies.

Alexandre Tran

Maher Matar

Jacinthe Lampron

Ewout Steyerberg

Monica Taljaard

Christian Vaillancourt

Early identification of patients requiring massive transfusion, embolization or hemostatic surgery for traumatic hemorrhage: A systematic review and meta-analysis

Hypothermia is associated with poor outcomes after injury. The relationship between hypothermia during contemporary large volume resuscitation and blood product consumption is unknown. We evaluated this association, and the predictive value of hypothermia on mortality.Patients predicted to receive massive transfusion at 12 level 1 trauma centers were randomized in the Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial and were grouped into those who were hypothermic (<36°C) or normothermic (36-38.5°C) within the first 6 hours of emergency department arrival. The impact of hypothermia or normothermia on the volume of blood product required during the first 24 hours was determined via negative binomial regression, adjusting for treatment arm, injury severity score, mechanism, demographics, pre-emergency department fluid volume, blood administered before becoming hypothermic, pulse and systolic blood pressure on arrival, and the time exposed to hypothermic or normothermic temperatures.Of 680 patients, 590 had a temperature measured during the first 6 hours in hospital, and 399 experienced hypothermia. The mean number of red blood cell (RBC) units given to all patients in the first 24 hours of admission was 8.8 (95% confidence interval [CI], 7.9-9.6). In multivariable analysis, every 1°C decrease in temperature below 36.0°C was associated with a 10% increase (incidence rate ratio, 0.90; 95% CI, 0.89-0.92; p < 0.00) in consumption of RBCs during the first 24 hours of admission. There was no association between RBC administration and a temperature above 36°C. Hypothermia on arrival was an independent predictor of mortality, with an adjusted odds ratio of 2.7 (95% CI, 1.7-4.5; p < 0.00) for 24-hour mortality and 1.8 (95% CI, 1.3-2.4; p < 0.00) for 30-day mortality.Hypothermia is associated with increase in blood product consumption and mortality. These findings support the maintenance of normothermia in trauma patients and suggest that further investigation on the impact of cooling or rewarming during massive transfusion is warranted.Prognostic, level III.

Erica Louise Walsh Lester

Erin E. Fox

John B. Holcomb

Karen J. Brasel

Eileen M. Bulger

Mitchell J. Cohen

Bryan A. Cotton

Timothy C. Fabian

Jeffery D. Kerby

Terrence O'Keefe

Sandro B. Rizoli

Thomas M. Scalea

Martin A. Schreiber

Kenji Inaba

The impact of hypothermia on outcomes in massively transfused patients

大量输血患者低温对预后的影响

BACKGROUND Rib fractures are a common traumatic injury affecting more than 350,000 patients a year. Early stabilization has shown to be effective in reducing pulmonary complications. Platelet-rich plasma (PRP) is a growth factor–rich blood product known to improve soft tissue and bone healing. We hypothesized that the addition of PRP to a rib fracture site would accelerate callus formation and improve callus strength. METHODS Platelet-rich plasma was isolated from pooled Lewis rat blood and quantified. Thirty-two Lewis rats underwent fracture of the sixth rib and were treated with 100 μL PRP (1 × 10 6 platelets/μL) or saline. At 2 weeks, ribs were harvested and underwent a 3-point bend, x-ray, and microcomputed tomography, and callus sections were stained with 4′,6-diamidino-2-phenylindole and Alcian blue and picrosirius red. At 6 weeks, ribs were harvested and underwent a 3-point bend test, x-ray, microcomputed tomography, and Alcian blue and picrosirius red staining. RESULTS At 2 weeks, PRP increased callus diameter (9.3 mm vs. 4.3 mm, p = 0.0002), callus index (4.5 vs. 2.1, p = 0.0002), bone volume/total volume (0.0551 vs. 0.0361, p = 0.0024), cellularization (2,364 vs. 1,196, p &lt; 0.0001), and cartilage (12.12% vs. 3.11%, p = 0.0001) and collagen (6.64% vs. 4.85%, p = 0.0087) content compared with controls. At 6 weeks, PRP increased fracture callus diameter (5.0 mm vs. 4.0 mm, 0.0466), callus index (2.5 vs. 2.0, p = 0.0466), BV/TV (0.0415 vs. 0.0308, p = 0.0358), and higher cartilage (8.21% vs. 3.26%, p &lt; 0.0001) and collagen (37.61% vs. 28.00%, p = 0.0022) content compared with controls. At 6 weeks, PRP samples trended toward improved mechanical characteristics; however, these results did not reach significance ( p &gt; 0.05). CONCLUSION Rib fractures are a common injury, and accelerated stabilization could improve clinical outcomes. Platelet-rich plasma significantly increased callus size, calcium deposition, and cartilage and collagen content at 2 and 6 weeks and trended toward improved strength and toughness on mechanical analysis at 6 weeks compared with controls, although this did not reach significance. These findings suggest that PRP may be a useful adjunct to accelerate and improve fracture healing in high-risk patients.

Adrian Camarena

Lillian Kang

Anthony J Mirando

Emily Augustine

Najerie S McMillian

Natasha C Stinson

Suresh M Agarwal

Matthew L Becker

Matthew J Hilton

Joseph S Fernandez-Moure

Platelet-rich plasma enhances rib fracture strength and callus formation in vivo

富血小板血浆增强体内肋骨骨折强度和骨痂形成

In Brief This work details the process of developing the updated field triage guideline, the supporting evidence, and the final version of the 2021 National Guideline for the Field Triage of Injured Patients.

Craig D. Newgard

Peter E. Fischer

Mark Gestring

Holly N. Michaels

Gregory J. Jurkovich

E. Brooke Lerner

Mary E. Fallat

Theodore R. Delbridge

Joshua B. Brown

J Trauma Acute Care Surg

National guideline for the field triage of injured patients: Recommendations of the National Expert Panel on Field Triage, 2021

2021年国家创伤患者现场分诊指南：国家现场分诊专家组建议

BACKGROUND Abdominal adhesions are networks of fibrotic tissues that form between organs postoperatively. Current prophylactic strategies do not reproducibly prevent adhesive small bowel obstruction across the entire abdomen. Human placental-derived stem cells produce an anti-inflammatory secretome that has been applied to multiple fibrosing diseases. The purpose of this project is to test human placental stem cell (hPSC)–based therapies for prevention of abdominal adhesions in a clinically relevant rat model. METHODS Fifty-four (n = 54, n = 6/group) male Sprague-Dawley rats (250–350 g) underwent model creation and treatment randomization under anesthesia. Experimental groups included human placental-derived stem cells (hPSC, 5 × 10 6 cells/10 mL Plasmalyte A), human placental-derived stem cells in a hyaluronic acid (HA-Mal-hPSC) hydrogel, the human placental-derived stem cell secretome from conditioned media in 10 mL Plasmalyte A, human placental-derived stem cells' conditioned media in a hyaluronic acid (HA-Mal-CM) hydrogel, Plasmalyte A (media alone, 10 mL), hyaluronic acid hydrogel alone (HA-Mal), Seprafilm (Baxter, Deerfield, IL), and the control groups, model with no treatment (MNT) and sham animals. Treatments were administered intraperitoneally, and the study period was 14 days postoperation. Adhesions were scored at necropsy and analyzed as the difference between means of an index statistic (Animal Index Score) versus MNT. Underlying molecular mechanisms were explored by functional genomic analysis and histology of peritoneal tissues. RESULTS Hyaluronic acid hydrogel alone, HA-Mal-CM hydrogel, and Seprafilm significantly reduced the overall appearance of abdominal adhesions by mean Animal Index Score at 14 days versus MNT. Human placental stem cell, HA-Mal-hPSC hydrogel, HA-Mal-CM hydrogel, HA-Mal hydrogel alone, and Seprafilm significantly reduced the collagen content of injured peritoneal tissues. Human placental stem cell and HA-Mal-hPSC hydrogel suppressed expression of the most profibrotic genes. Conditioned media, HA-Mal hydrogel alone, and media alone significantly altered the expression of proteins associated with peritoneal fibrotic pathways. CONCLUSION Human placental stem cell–based therapies reduce abdominal adhesions in a prospective randomized preclinical trial. This effect is supported by suppression of profibrotic genomic and proteomic pathways.

Samuel P. Carmichael

Prafulla K. Chandra

John W. Vaughan

David M. Kline

Anthony Atala

Human placental stem cell–based therapies for prevention of abdominal adhesions: A prospective randomized preclinical trial

基于人胎盘干细胞的腹部粘连预防疗法：一项前瞻性随机临床前试验

ABSTRACT Tracheal injuries can be immediately life-threatening. Fiberoptic bronchoscopy in the operating room can make the diagnosis and satisfy the principle of achieving an airway distal to the injury. Repair is performed with a single layer of absorbable suture. Esophageal injuries are diagnosed with imaging, endoscopy, or intraoperatively. In the chest, esophageal injuries are best repaired through posterolateral incisions. Repairs are performed in one or two layers, and drains are routinely used. For a damage-control approach to esophageal injuries, wide drainage can be considered. For both tracheal and esophageal injuries, the operative approach is based on the anatomic location of the injury and muscle flap buttressing of the repairs is routinely employed.

Matthew J. Wall

Kenneth L. Mattox

Tips and tricks in the operative management of esophageal, trachea, and bronchial injuries: What you need to know

食管、气管和支气管损伤手术管理中的技巧与窍门：你需要知道的关键点

Department of General, Visceral and Transplantation Surgery University Medical Center Munich, Germany Department of Anaesthesiology Intensive Care Emergency and Pain Medicine University Hospital Würzburg Würzburg, Germany Department of Anaesthesiology and Intensive Care Medicine University Medical Center Schleswig-Holstein Kiel, Germany

Wolfgang H. Hartl

Christian Stoppe

Gunnar Elke

Comment on: Nutritional support for the trauma and emergency general surgery patient: What you need to know

评论：创伤和急诊普通外科患者的营养支持：你需要了解的内容

Flatley, Meaghan MD; Sams, Valerie G. MD; Deshpande, Shyam J. MD; Cannon, Jeremy W. MD, SM Author Information

Meaghan Flatley

Valerie G. Sams

Shyam J. Deshpande

Jeremy W. Cannon

Response to letter to the editor, “ECMO in trauma care: What you need to know”

致编辑的回信：“创伤护理中的ECMO：你需要知道的事”

BACKGROUND Traumatic spinal injuries are associated with a high risk of morbidity and mortality. The aim of this study is to investigate which variables best predict adverse outcomes in patients who had surgery for isolated traumatic spinal injury without spinal cord injury. METHODS The American College of Surgeons Trauma Quality Improvement Program database was used to identify adult (18 years or older) surgically managed patients with an isolated traumatic spinal injury, without spinal cord injury admitted between 2013 and 2021. An isolated injury was defined as a spine Abbreviated Injury Scale score ≥2 and an Abbreviated Injury Scale score ≤1 in the remaining body regions, as well as corresponding International Classification of Diseases, Ninth and Tenth Revision , codes. The predictive value of demographic, clinical, and comorbidity data was evaluated using logistic regression models and ranked using the permutation importance method. RESULTS A total of 39,457 patients were included in the study, of whom 554 died during hospitalization. The most important variables for predicting in-hospital mortality were age, sex, Glasgow Coma Scale on admission, Orthopedic Frailty Score, and cervical spine injury. The most important variables for predicting complications were age, cervical spine injury, the need for cervical spine surgery, Revised Cardiac Risk Index, and alcohol use disorder. Finally, age, cervical spine injury, sex, Glasgow Coma Scale on admission, and Orthopedic Frailty Score had the highest relative importance when predicting failure to rescue. Models based on the five most important variables for each outcome demonstrated an excellent predictive ability for in-hospital mortality (area under the receiver operating characteristic curve [AUROC], 0.84; 95% confidence interval [CI], 0.82–0.86) and failure to rescue (AUROC [95% CI], 0.86 [0.84–0.87]) as well as an acceptable predictive ability for complications (AUROC [95% CI], 0.72 [0.71–0.73]). CONCLUSION The most important factors identified to predict mortality, complications, and failure to rescue in traumatic spinal injury patients without spinal cord injury who undergo surgery were patients' age, sex, frailty, cervical spine injury that necessitated surgical intervention, and cardiovascular risk. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level III.

Ahmad Mohammad Ismail

Maximilian Peter Forssten

Yang Cao

Ioannis Ioannidis

Sebastian Peter Forssten

Babak Sarani

Shahin Mohseni

Predicting morbidity and mortality after surgery for isolated traumatic spinal injury without spinal cord injury

预测无脊髓损伤的孤立性创伤性脊柱损伤手术后的发病率和死亡率

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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