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l, the survey and its results can help hospital administrators to focus on categories of transfer activities that are most problematic for clinicians and to track trends for quality improvement.

Overall, the survey was feasible to implement and built to optimize content, construct, and response process validity. Survey results drove practical improvement work, such as informing a verbal transfer protocol to improve nursing preparedness to receive patients on general medicine units. As a practical tool, the survey and its results can help hospital administrators to focus on categories of transfer activities that are most problematic for clinicians and to track trends for quality improvement.

The Israeli National Program for Quality Indicators (INPQ) sets as its primary goal to promote high-quality health care within selected core areas in the Israeli health system. Surgical site infection is one of the most common types of acquired infections. The INPQ supports 3 distinct indicators concerning suitable antibiotic treatment in colorectal surgery, cesarean sections, and surgery for femoral neck fractures.

We measured the number of patients who received prophylactic antibiotics, beginning an hour before the first cut and stopping after 24 hours in 1 of the 3 operations, according to the International Classification of Diseases, Ninth Revision (ICD-9) codes. Goals for success have been established annually according to the results of the previous year. Data computed for each operation included socioeconomic status, dates of hospitalization and release, date of death, date of birth, gender, date of operation, time of beginning and end of the operation, and time of beginning and end of anesthesia.

who have been properly treated.

In the last three decades, the dramatic worldwide increase in incidence and severity of Clostridioides difficile infection (CDI) (formerly Clostridium difficile infection) has made CDI a global public health challenge. Surgery is a known risk factor for development of CDI yet surgery is also a treatment option in severe cases of CDI. The World Society of Emergency Surgery (WSES) guidelines for management of CDI in surgical patients were published in 2015(1). In 2019(2) the guidelines were revised and updated according to the GRADE methodology.This executive summary is intended to consolidate knowledge on the management of CDI focusing on aspects that a general and emergency surgeon should know about the prevention and the management of CDI, by providing a practical and concise version of the original guidelines.

In the last three decades, the dramatic worldwide increase in incidence and severity of Clostridioides difficile infection (CDI) (formerly Clostridium difficile infection) has made CDI a global public health challenge. Surgery is a known risk factor for development of CDI yet surgery is also a treatment option in severe cases of CDI. The World Society of Emergency Surgery (WSES) guidelines for management of CDI in surgical patients were published in 2015(1). In 2019(2) the guidelines were revised and updated according to the GRADE methodology.This executive summary is intended to consolidate knowledge on the management of CDI focusing on aspects that a general and emergency surgeon should know about the prevention and the management of CDI, by providing a practical and concise version of the original guidelines.

Pediatric adjusted shock index (SIPA) has demonstrated the ability to prospectively identify children at the highest risk for early mortality. The addition of neurological status to shock index has shown promise as a reliable triage tool in adult trauma populations. This study sought to assess the utility of combining SIPA with Glasgow Coma Scale (GCS) for predicting early trauma related outcomes.

Retrospective review of the 2017 Trauma Quality Improvement Program Database was performed for all severely injured patients less than 18 years old. SIPA and reverse SIPA x GCS (rSIG) were calculated. Age-specific cut off values were derived for rSIG and compared to their SIPA counterparts for early mortality assessment using area under the receiver operator characteristic (AUROC) curve analyses.

10,389 pediatric patients with an average age of 11.4 years old, 67% male, average ISS 24.1, and 4% sustaining a major penetrating injury were included in the analysis. The overall mortality was 9.3%. 32.1% of patients displayed an elevated SIPA score while only 27.5% displayed a positive rSIG. On AUROC analysis, rSIG was found to be superior to SIPA as a predictor for in hospital mortality with values of 0.854 versus 0.628, respectively.

rSIG more readily predicted in hospital mortality for pediatric trauma patients when compared to SIPA. Borussertib These findings suggest neurological status should be an important factor during initial patient assessment. Further study to assess the applicability of rSIG for expanded trauma related outcomes in pediatric trauma is necessary.

Level IV.

Level IV.

The rationale for Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is to control life-threatening sub-diaphragmatic bleeding and facilitate resuscitation, however, incorporating this into the resuscitative practices of a trauma service remains challenging. The objective of this study is to describe the process of successful implementation of REBOA use in an academic urban level I trauma center. All REBOA procedures from April 2014 through December 2019 were evaluated; REBOA was implemented after surgical faculty attended a required and internally developed Advanced Endovascular Strategies for Trauma Surgeons course (AESTS). Success was defined by sustained early adoption rates.

An institutional protocol was published, and a REBOA supply cart was placed in the emergency department(ED) with posters attached to depict technical and procedural details. A focused professional practice evaluation was utilized for the first three REBOA procedures performed by each faculty member, leading to internal privileging.

REBOA was performed in 97 patients by 9 trauma surgeons, which is 1% of the total trauma admissions during this time. Each surgeon performed a median of 12 REBOAs (IQR 5,14). Blunt (77/97, 81%) or penetrating abdominopelvic injuries (15/97, 15%) comprised the main injury mechanisms; 4% were placed for other reasons (4/97) including ruptured abdominal aortic aneurysms (AAA, n=3) and pre-operatively for a surgical oncologic resection (n=1). Overall survival was 65% (63/97) with a steady early adoption trend that resulted in participation in a Department of Defense (DoD) multicenter trial.

Strategies for how departments adopt new procedures require clinical guidelines, a training program focused on competence, and a hospital education and privileging process for those acquiring new skills.

Level V.

Original Article, Diagnostic.

Original Article, Diagnostic.