Udsenhead8542

y, level IV.

Prognostic study, level IV.

Although several centers have "Direct to OR" (DOR) resuscitation programs, there are no published prospective studies on optimal patient selection, interventions, outcomes, or real-time surgeon assessments.

DOR cases over 1 year were prospectively enrolled. Demographics, injury types/severity, triage criteria, interventions, and outcomes including Glasgow Outcome Score (GOS) were collected. Detailed time-to-event and sequence data on initial lifesaving interventions (LSI) or emergent surgeries (ES) were analyzed. A structured real-time attending surgeon assessment tool (SAT) for each case was collected. DOR activation criteria were grouped into categories mechanism, physiology, injury pattern, or EMS suspicion.

There were 104 DOR cases; 84% male, 80% penetrating, and 39% severely injured (ISS>15). The majority (65%) required at least one LSI (median of 7 mins from arrival), and 41% underwent immediate emergent surgery (median 26 mins). Blunt patients were more severely injured, more likely to undergo LSI (86% vs 59%), but less likely to require ES (19% vs 47%, all p<0.05). Analysis of DOR criteria categories showed unique patterns in each group for interventions and outcomes (Figure), with EMS suspicion associated with the lowest need for DOR. SAT results found DOR was indicated in 84% and improved care in 63%, with a small subset identified (9%) where DOR had a negative impact.

DOR resuscitation facilitated timely emergent interventions in penetrating truncal trauma and a select subset of critically ill blunt patients. Unique intervention/outcome profiles were identified by activation criteria groups, with little utility among activations for EMS suspicion. Real-time SAT identified high and low yield DOR groups.

Level III, prospective observational study.

Level III, prospective observational study.

Avoidance of hypoxia and hyperoxia may reduce morbidity and mortality in critically ill civilian and military trauma patients. The objective of this study is to determine if a multimodal quality improvement intervention increases adherence to a consensus-based, targeted normoxia strategy. We hypothesized that this intervention would safely improve compliance with targeted normoxia.

This is a pre/post quasi-experimental pilot study to improve adherence to normoxia, defined as a pulse oximetry (SpO2) of 90-96% or an arterial partial pressure oxygen (PaO2) of 60-100mmHg. We used a multimodal informatics and educational intervention guiding clinicians to safely titrate supplemental oxygen to normoxia based on SpO2 monitoring in critically ill trauma patients admitted to the surgical-trauma or neurosurgical intensive care unit within 24 hours of emergency department arrival. The primary outcome was effectiveness in delivering targeted normoxia (i.e., an increase in the probability of being in the targeted normprotocol on patient-centered clinical outcomes.

Therapeutic/Care Management, level II.

Therapeutic/Care Management, level II.

Adequate cerebral perfusion is crucial for a positive neurological outcome in trauma; however, it is difficult to characterize in the acute setting with non-invasive methods. Intra-arterial computed tomography perfusion (IA-CTP) may offer a solution. The aim of this study is to develop an IA-CTP protocol for resuscitation research.

The study examined intra-arterial contrast administration for CTP acquisition. It consisted of 3 phases IA contrast dose finding, evaluation of reproducibility, and evaluation during hypotension. Blood pressure and laser doppler flow data were collected. In phase 1, animals underwent CTPs using several IA contrast injection protocols. In phase 2, animals underwent two CTPs seven hours apart using the 2.5mL/s for 3 second protocol. Selleckchem Filgotinib In phase 3, animals underwent CTPs at several pressures following a computer-controlled bleed including euvolemia and at systolic pressures of 60, 40, and 20mmHg. Phase 1 CTPs were evaluated for contrast-to-noise ratio. In phase 2, CTPs were compared asic science paper and, therefore, does not require a level of evidence.

Basic Science.

Basic Science.

Pelvic trauma disproportionately affects a younger population and has the potential to cause long-term sexual dysfunction. We hypothesized that the presence of sexual dysfunction after traumatic pelvic fracture negatively impacts health-related quality of life in men.

228 patients with traumatic pelvic fractures treated at a level 1 trauma center between 2012 and 2017 completed a survey that evaluated post-injury health-related quality of life and sexual function. Inverse probability weighting was utilized to adjust for survey non-response. Pelvic fracture characteristics were classified based on the Orthopaedic Trauma Association (OTA) classification system. Sexual function was evaluated utilizing the International Index of Erectile Function (IIEF) and health-related quality of life (HrQOL) was evaluated utilizing the EuroQol 5 Dimensions Questionnaire (EQ-5D). Quality-adjusted life years were determined based on calculated EQ-5D utility indices. Multiple regression models were created to evaluate the association between sexual health and HrQOL.

After inverse probability weighting and adjustment for potential confounders, a decrease in IIEF was associated with a decline in overall HrQOL as measured by the EQ-5D visual analog scale (ß=0.28, p=0.02). No association was identified between OTA pelvic fracture configuration and risk of post-injury erectile dysfunction (ED) (p=0.99). 53.3% of men reported persistent ED at a median of 42.6 months (IQR 28.0, 63.3) following injury. The presence of ED was independently associated with a decrease in HrQOL (ß=10.92, p<0.001). This difference equates to a loss of 1.6 quality-adjusted life years per 10-years for men with ED following pelvic fracture relative to those without.

Sexual dysfunction is an independent risk factor for decreased HrQOL in pelvic trauma survivors. Further work is needed to create appropriate patient-centered survivorship care pathways that incorporate sexual health evaluation.

IV, prognostic.

IV, prognostic.