Trauma

Resuscitation

EMS

• Resuscitation with blood products in patients with trauma-related haemorrhagic shock receiving prehospital care (RePHILL): a multicentre, open-label, randomised, controlled, phase 3 trial
• Prehospital Procedures before Emergency Department Thoracotomy

Airway

• The difficult airway in trauma: What you need to know

Thoractomy

• Adult emergency resuscitative thoracotomy: A Western Trauma Association clinical decisions algorithm
• EAST Practice Management Guideline: An evidence-based approach to patient selection for emergency department thoracotomy
• FAST Ultrasound Examination as a Predictor of Outcomes After Resuscitative Thoracotomy: With a high degree of sensitivity for the detection of potential survivors after traumatic arrest, FAST represents an effective method of separating those that do not warrant the risk and resource burden of RT from those who may survive. The likelihood of survival if pericardial fluid and cardiac motion were both absent was zero.

REBOA

• Joint statement from the American College of Surgeons Committee on Trauma (ACS COT) and the American College of Emergency Physicians (ACEP) regarding the clinical use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)
• Determination of optimal deployment strategy for REBOA in patients with non-compressible hemorrhage below the diaphragm
• UK-REBOA Trial: In trauma patients with exsanguinating hemorrhage, a strategy of REBOA and standard care in the emergency department does not reduce, and may increase mortality compared with standard care alone.

Damage Control

• Immediate versus Delayed Fluid Resuscitation for Hypotensive Patients with Penetrating Torso Injuries: For hypotensive patients with penetrating torso injuries, delay of aggressive fluid resuscitation until operative intervention improves the outcome.
• Hypotensive Resuscitation during Active Hemorrhage: Impact on In-Hospital Mortality. Titration of initial fluid therapy to a lower than normal SBP during active hemorrhage did not affect mortality in this study. Reasons for the decreased overall mortality and the lack of differentiation between groups likely include improvements in diagnostic and therapeutic technology, the heterogeneous nature of human traumatic injuries, and the imprecision of SBP as a marker for tissue oxygen delivery.
• EAST Practice Management Guideline: Damage control resuscitation in patients with severe traumatic hemorrhage
• Damage control resuscitation in adult trauma patients: What you need to know

Neuro

TBI

• Guidelines
  • Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition
  • Brain Trauma Foundation Guidelines for the Surgical Management of TBI
  • ACS Best Practice Guidelines: Traumatic Brain Injury
  • A management algorithm for patients
    with intracranial pressure monitoring: the
    Seattle International Severe Traumatic Brain
    Injury Consensus Conference (SIBICC)
    • Infographic: SIBICC Severe TBI Algorithm for Patients with ICP Monitoring
  • A management algorithm for adult patients
    with both brain oxygen and intracranial
    pressure monitoring: the Seattle International
    Severe Traumatic Brain Injury Consensus
    Conference (SIBICC)
• Reviews:
  • Recovery after moderate to severe TBI and factors influencing functional outcome: What you need to know
  • The pressure reactivity index as a measure of cerebral autoregulation and its application in traumatic brain injury management
• BIG/Triage
  • Brief Description of BIG Grading
  • Validating The Brain Injury Guidelines (BIG): Results of An AAST Prospective Multi-Institutional Trial
  • Multicenter assessment of the Brain Injury Guidelines and a proposal of guideline modifications
• Neurosurgical Management
  • DECRA Trial: In adults with severe diffuse traumatic brain injury and refractory intracranial hypertension, early bifrontotemporoparietal decompressive craniectomy decreased intracranial pressure and the length of stay in the ICU but was associated with more unfavorable outcomes.
  • RESCUEicp Trial: At 6 months, decompressive craniectomy in patients with traumatic brain injury and refractory intracranial hypertension resulted in lower mortality and higher rates of vegetative state, lower severe disability, and upper severe disability than medical care. The rates of moderate disability and good recovery were similar in the two groups.
• Medical Management
  • CRASH 3 Trial: Our results show that tranexamic acid is safe in patients with TBI and that treatment within 3 h of injury reduces head injury-related death. Patients should be treated as soon as possible after injury.
  • COGiTATE Trial:Individualizing care by targeting a dynamic optimal CPP using CA guidance six times daily is feasible and safe in TBIicp patients. These findings encourage a larger phase III outcome study of this novel digital biomarker for precision medicine in these patients.
  • COBI Trial: Among patients with moderate to severe traumatic brain injury, treatment with continuous infusion of 20% hypertonic saline compared with standard care did not result in a significantly better neurological status at 6 months.
  • PROPHY-VAP Trial: In patients with acute brain injury, a single ceftriaxone dose decreased the risk of early VAP. On the basis of our findings, we recommend that an early, single dose of ceftriaxone be included in all bundles for the prevention of VAP in patients with brain injury who require mechanical ventilation.
  • Placebo-Controlled Trial of Amantadine for Severe Traumatic Brain Injury

SCI

• ACS Best Practices Guidelines: Spinal Cord Injury
• Mean arterial pressure maintenance following spinal cord injury: Does meeting the target matter? The proportion of MAP measurements ≥85 mm Hg was determined to be an independent predictor of neurologic improvement. Increased vigilance regarding MAP maintenance above 85 mm Hg is warranted to optimize neurologic recovery following SCI.

Head/neck

• Penetrating Neck Trauma
  • Outdated 2013 WTA Algorithm: Western Trauma Association Critical Decisions in Trauma, Penetrating neck trauma
  • 2024 WTA Update: Diagnostic approach to penetrating neck trauma: What you need to know
  • Penetrating neck trauma: a comprehensive review
  • Foley Catheter Balloon Tamponade for Actively Bleeding Wounds Following Penetrating Neck Injury is an Effective Technique for Controlling Non-Compressible Junctional External Haemorrhage

Thoracic

Damage Control Thoracic Surgery

• Damage control thoracic surgery: What you need to know

Cardiac injury

• Diagnosis and management of blunt cardiac injury: What you need to know

Rib fractures

• EAST Practice Management Guideline: Operative fixation of rib fractures after blunt trauma
• Contemporary management of patients with multiple rib fractures: What you need to know

Abdominal/Gastrointestinal

• Guidelines
  • Contemporary management of adult splenic injuries: What you need to know
  • EAST Practice Management Guideline: Management of adult pancreatic injuries
  • Western Trauma Association Critical Decisions in Trauma: Diagnosis and management of esophageal injuries
  • Western Trauma Association Critical Decisions in Trauma: Diagnosis and management of duodenal injuries
  • EAST Practice Management Guidelines: Management of penetrating extraperitoneal rectal injuries
• Trials
  • Abdominal injury/laparotomy
    • Routine computed tomography after recent operative exploration for penetrating trauma: What injuries do we miss? We recommend the use of immediate postoperative CT after emergent laparotomy especially when there is a high index of suspicion for spine or genitourinary injuries and in patients who have sustained ballistic penetrating injuries.
    • Selective Nonoperative Management of Abdominal Gunshot Wounds from Heresy to Adoption: A Multicenter Study of the Research Consortium of New England Centers for Trauma (ReCoNECT)
  • Hepatic injury
    • Endoscopic retrograde cholangiopancreatography is an effective treatment for bile leak after severe liver trauma
  • Renal injury
    • High grade renal injuries: application of Parkland Hospital predictors of intervention for renal hemorrhage

Hemorrhage

• PROPPR Trial: Among patients with severe trauma and major bleeding, early administration of plasma, platelets, and red blood cells in a 1:1:1 ratio compared with a 1:1:2 ratio did not result in significant differences in mortality at 24 hours or at 30 days. However, more patients in the 1:1:1 group achieved hemostasis and fewer experienced death due to exsanguination by 24 hours. Even though there was an increased use of plasma and platelets transfused in the 1:1:1 group, no other safety differences were identified between the 2 groups.
• CRASH-2 Trial: Tranexamic acid safely reduced the risk of death in bleeding trauma patients in this study. On the basis of these results, tranexamic acid should be considered for use in bleeding trauma patients.
• CRYOSTAT-2 Trial: Among patients with trauma and bleeding who required activation of a major hemorrhage protocol, the addition of early and empirical high-dose cryoprecipitate to standard care did not improve all cause 28-day mortality.
• Trauma-induced coagulopathy: What you need to know

Hematology

VTE

• Updated guidelines to reduce venous thromboembolism in trauma patients: A Western Trauma Association critical decisions algorithm

Vascular Trauma

Aortic Injury

• EAST Practice Management Guideline: Evaluation and management of blunt traumatic aortic injury

Angioembolization

• Prospective trial of angiography and embolization for all grade III to V blunt splenic injuries: nonoperative management success rate is significantly improved. Use of a protocol requiring angiography and embolization for all high-grade spleen injuries slated for NOM leads to a significantly decreased failure rate. We recommend angiography and embolization as an adjunct to NOM for all grade III to V splenic injuries.

Vascular Injury

• Western Trauma Association Critical Decisions in Trauma: Management of abdominal vascular trauma

BCVI

• Treatment for Blunt Cerebrovascular InjuriesEquivalence of Anticoagulation and Antiplatelet Agents: With an overall CVA risk of 21% and a documented latent period, comprehensive screening, early diagnosis, and institution of antithrombotic therapy for BCVI are clearly warranted. The type of treatment, heparin vs antiplatelet agents, does not appear to affect either stroke risk or injury healing rates.

Orthopedics

• Pelvis
  • Pelvic fracture bleeding control: What you need to know
• Extremities
  • Western Trauma Association Critical Decisions in Trauma: Management of the mangled extremity
  • Contemporary management of open extremity fractures: What you need to know
  • Damage-control orthopedics or early total care: What you need to know

Infectious Disease

• Invasive Fungal Infections in War Wounds

Pediatrics

• Test Characteristics of Focused Assessment of Sonography for Trauma for Clinically Significant Abdominal Free Fluid in Pediatric Blunt Abdominal Trauma

Obstetrics

• Perimortem cesarean section after severe injury: What you need to know
• Trauma in pregnancy: A systematic review, meta-analysis, and practice management guideline from the Eastern Association for the Surgery of Trauma