J Trauma Acute Care Surg [JOURNAL]
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Vose AK, Cavka K, Freeborn P
… +9 more
, Tonuzi G, Kerwin AJ, Yorkgitis BK, Fuller D, D'Alessandro A, Wauneka CN, Croft C, Fox EJ, Gainesville, Florida
J Trauma Acute Care Surg
· 2026 Jun · PMID 42257720
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BACKGROUND: Respiratory dysfunction is a leading cause of morbidity and mortality after cervical spinal cord injury (C-SCI). Respiratory impairment is exacerbated by mechanical ventilation, which is associated with highe...BACKGROUND: Respiratory dysfunction is a leading cause of morbidity and mortality after cervical spinal cord injury (C-SCI). Respiratory impairment is exacerbated by mechanical ventilation, which is associated with higher infection rates and diaphragm atrophy. Intramuscular stimulation of the diaphragm, that is, diaphragm pacing (DP), is a potential strategy to facilitate ventilator weaning, enhance respiratory function, and reduce complications. However, its impact on respiratory recovery and neuromuscular activation remains understudied. METHODS: This prospective observational case series evaluated changes in respiratory function and diaphragm activation over two months in 11 patients with acute traumatic C-SCI who underwent DP. Outcomes included tidal volume, respiratory rate, minute ventilation, maximal inspiratory/expiratory pressure generation (MIP/MEP), forced vital capacity (FVC), and diaphragm electromyography (EMG) recorded from the implanted electrodes. RESULTS: Participants demonstrated severe respiratory impairment at baseline, with tidal volumes averaging 2.8±1.3 mL/kg and FVC at 19±14% of predicted. Despite this, 89% weaned from mechanical ventilation within 41±19.8 days post-injury. Significant weekly improvements were evident in tidal volume (+0.26 mL/kg), respiratory rate (-0.66 breaths/min), and minute ventilation (+0.35 L/min). MIP and MEP increased by 3% predicted function per week, and FVC increased by 2% of predicted function per week. Diaphragm EMG amplitudes during quiet breathing decreased over time, particularly in patients with high baseline activation (>80% of maximum) possibly reflecting improved neuromuscular efficiency. CONCLUSIONS: These findings suggest that DP may support early respiratory recovery after C-SCI improving respiratory function and diaphragm activation. Future research is needed to elucidate the underlying mechanisms and optimize clinical use of DP for respiratory recovery after C-SCI. (J Trauma Acute Care Surg 2026;00:000-000. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). LEVEL OF EVIDENCE: Therapeutic Study; Level IV.
Wood EC, Gomez MK, Lane MR
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, Saxena J, Sullivan TJ, Laingen BE, Reid GR, Azar EA, Johnson A, Adams JY, Neff LP, Williams TK, Winston-Salem, North Carolina
J Trauma Acute Care Surg
· 2026 Jun · PMID 42246954
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BACKGROUND: Endovascular Perfusion Augmentation for Critical Care (EPACC) is a method of dynamic aortic balloon catheter titration for precision hemodynamic support. EPACC has the potential to augment hemodynamics in con...BACKGROUND: Endovascular Perfusion Augmentation for Critical Care (EPACC) is a method of dynamic aortic balloon catheter titration for precision hemodynamic support. EPACC has the potential to augment hemodynamics in conjunction with conventional resuscitation strategies. We previously described how even short periods of EPACC, along with an automated fluid and drug delivery system termed Precision Automated Critical Care Management (PACC-MAN) can reduce resuscitation requirements over the first few hours after severe ischemia-reperfusion injury (IRI). We sought to understand if an initial 180 minutes of EPACC+PACC-MAN can offset vasopressor requirements over 24 hours of critical care compared with PACC-MAN alone in an established IRI model. METHODS: Twelve swine underwent 30% hemorrhage, then 45 minutes of complete zone 1 aortic occlusion, inducing IRI and vasoplegia. Animals were then transfused to euvolemia and randomized to EPACC+PACC-MAN (180 min of dynamic partial aortic balloon pressure augmentation that autonomously adjusted based on the animal's physiology) or PACC-MAN automated critical care alone. Critical care lasted for 24 hours in both groups. Primary outcomes included duration of hypotension (mean arterial pressure <60 mm Hg), hypertension (mean arterial pressure >70 mm Hg), total crystalloid, and norepinephrine volumes. Secondary outcomes included lactate load, creatinine, urine output, biomarkers, and histopathology. RESULTS: Percent time spent in hypotension for EPACC+PACC-MAN versus PACC-MAN (3.10% vs. 3.75%, p=0.47) and hypertension (8.90% vs 5.58%, p=0.13) was not significantly different. Total crystalloid volume for EPACC+PACC-MAN versus PACC-MAN was not significant (198.3 mL/kg vs. 308.2 mL/kg, P=0.38). EPACC+PACC-MAN required significantly less norepinephrine during the study period (210.77 mcg/kg vs. 1102.0 mcg/kg, p=0.045). CONCLUSION: Supporting hemodynamics with EPACC to mitigate severe vasoplegia of initial resuscitation has a sustained effect on limiting vasopressor requirements in this 24-hour study, without compromising physiologic endpoints. Automation of endovascular devices may play an adjunctive role in managing severe shock states and augmenting autonomous resuscitation, particularly in resource-constrained care environments. (J Trauma Acute Care Surg 2026;00:000-000. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). LEVEL OF EVIDENCE: Level IV.
Davis RT, Galvin RM, Oag K
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, Vitale L, Hudson-Bradford C, Rosen RD, Patterson KN, Ridelman E, Donoghue L, Shanti C, Detroit, MI
J Trauma Acute Care Surg
· 2026 Jun · PMID 42246950
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BACKGROUND: Marijuana legalization may influence adolescent substance use patterns and injury mechanisms, but pediatric data remain limited. Michigan's 2018 legalization of recreational marijuana created a natural settin...BACKGROUND: Marijuana legalization may influence adolescent substance use patterns and injury mechanisms, but pediatric data remain limited. Michigan's 2018 legalization of recreational marijuana created a natural setting to evaluate these trends. This study examined changes in marijuana detection and associated clinical outcomes among adolescent trauma patients before and after legalization. METHODS: We conducted a retrospective cohort study of patients aged 12 to 18 years treated at a Level I pediatric trauma center from 2015 to 2024. Demographics, injury characteristics, toxicology results, and outcomes were compared between prelegalization and postlegalization eras. Urine drug screening and blood alcohol concentration results were reviewed. Multivariable logistic regression identified independent predictors of tetrahydrocannabinol (THC) positivity. RESULTS: Among 2,386 adolescents (1,123 prelegalization; 1,263 postlegalization), THC positivity increased from 19.5% to 34.4% among screened patients (p < 0.001) and from 4.6% to 8.7% across all trauma patients (p < 0.001). Violent mechanisms rose from 27.0% to 36.0% (p < 0.001). Independent predictors of THC positivity included postlegalization era [adjusted odds ratio (aOR) 2.39, 95% CI: 1.47-3.91], violent mechanism (aOR: 2.38, 95% CI: 1.45-3.91), older age (aOR: 1.21 per year, p = 0.002), and alcohol co-positivity (aOR: 10.19, 95% CI: 2.70-39.57). THC-positive adolescents were more often discharged to justice or psychiatric facilities (7.0% vs. 3.2%, p = 0.04), while length of stay, operative intervention, and mortality were similar. CONCLUSIONS: Following recreational marijuana legalization, THC detection among adolescent trauma patients increased alongside a higher proportion of violent injuries. Physiologic outcomes remained unchanged, but psychosocial sequelae were more common. Implementing standardized toxicology screening and early substance use counseling within pediatric trauma systems may enhance identification and prevention. (J Trauma Acute Care Surg. 2026;00: 00-00. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). LEVEL OF EVIDENCE: Prognostic/Epidemiologic; Level III. STUDY TYPE: Retrospective cohort study.
Soltani T, Helderop E, Wei R
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, Mann NC, Alvarado F, Eid L, Bailey JA, Glass NE, Sifri ZC, Gore AV, DiMaggio CJ, Duncan DT, Sairamesh J, Berry C, Newark, NJ
J Trauma Acute Care Surg
· 2026 Jun · PMID 42246942
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BACKGROUND: Timely emergency medical services (EMS) response is critical to improving survival after trauma. However, concordance between EMS dispatch level and on-scene patient acuity remains poorly understood. This stu...BACKGROUND: Timely emergency medical services (EMS) response is critical to improving survival after trauma. However, concordance between EMS dispatch level and on-scene patient acuity remains poorly understood. This study evaluated the association between racial and ethnic residential segregation and concordance between EMS response level and on-scene acuity among critically injured trauma patients. METHODS: Using 2018-2022 National EMS Information System data, we analyzed trauma patient entries meeting CDC field triage criteria for transport to a trauma center. Concordance was defined as alignment between dispatch classification of response (emergent vs. nonemergent) and EMS providers' subsequent on-scene clinical assessment of acuity (critical/emergent vs. noncritical/low acuity). Racial and ethnic residential segregation at the ZIP Code level was measured using a multigroup dissimilarity index comparing neighborhood composition to county distribution. χ2 tests and multivariable logistic regression were used to assess the associations between segregation and under-triage, adjusting for region (Northeast, Midwest, South, West). RESULTS: Among 34.7 million critically injured patients over 5 years, 69% had concordant EMS responses, 6% were under-triaged, and 26% over-triaged. Concordance was highest in the Midwest (74%) and lowest in the Northeast (62%). Under-triage was most frequent in the West (10%) and least in the South (4%). Neighborhoods with medium and high segregation had twice the under-triage rates than low-segregation areas (8% and 7% vs. 4%, p<0.001). In adjusted analyses, medium and high segregation were 60% more likely to be associated with increased odds of under-triage (odds ratio: 1.61, 95% confidence: 1.60-1.61). CONCLUSIONS: This is the largest study to date demonstrating that racial and ethnic residential segregation was significantly associated with meaningfully and significantly increased risk of under-triage among critically injured trauma patients. Furthermore, structural inequities in neighborhood segregation may delay access to definitive trauma care. Equity-driven EMS policy reform, standardized dispatch protocols, and targeted training are needed to mitigate disparities in prehospital trauma response. (J Trauma Acute Care Surg 2026;00:000-000. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). LEVEL OF EVIDENCE: Prognostic and Epidemiological; Level IV.
Mathew PJ, Schuster KM
J Trauma Acute Care Surg
· 2026 Jul · PMID 42246394
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Large bowel obstruction (LBO) accounts for approximately one-quarter of all intestinal obstructions. LBO may arise from mechanical obstruction due to benign or malignant etiologies, or from functional obstruction such as...
Large bowel obstruction (LBO) accounts for approximately one-quarter of all intestinal obstructions. LBO may arise from mechanical obstruction due to benign or malignant etiologies, or from functional obstruction such as acute colonic pseudo-obstruction. Because clinical presentation varies by acuity, etiology, and ileocecal valve competency, early recognition and prompt evaluation are essential to prevent complications, including ischemia and perforation with potential for sepsis and mortality. Patients with acute obstruction typically present with abdominal pain, distension, and obstipation, whereas malignant obstruction often develops gradually with progressive constipation and abdominal distension, leading to dehydration, electrolyte abnormalities, and malnutrition. Computed tomography has become the preferred diagnostic modality due to its ability to identify the transition point, help define the cause and severity of obstruction, and potentially detect complications such as ischemia or perforation. Endoscopy serves both diagnostic and therapeutic roles in selected patients, including detorsion for sigmoid volvulus, decompression for pseudo-obstruction, and tissue diagnosis or stent placement in malignant obstruction. Initial management focuses on resuscitation, correction of electrolyte abnormalities, mitigation of aspiration risk, and gastrointestinal decompression. Definitive management depends on the underlying etiology. Malignant LBO requires individualized planning based on tumor location, patient physiology, and institutional expertise, with options including oncologic resection with or without colostomy, proximal surgical diversion and staged resection, or endoscopic stenting with staged resection. Self-expanding metallic stents may serve as bridges to surgery and reduce the need for a stoma. Benign causes, including diverticular strictures, volvulus, inflammatory bowel disease-related strictures, anastomotic strictures, and fecal impaction, require tailored endoscopic or operative interventions. Across etiologies, short delays to intervention may be appropriate for stable patients undergoing optimization; however, early definitive management should be the usual approach. In cases where intervention is delayed, careful surveillance for developing ischemia or perforation is mandatory. ( J Trauma Acute Care Surg . 2026;101: 1-12. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved).
Fridrich L, Talmy T, Rudnicki Y
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, Radomislenski I, Aviad Beer Z, Klein Y, Benov A, Israel Trauma Group,, Ramat Gan, Israel, Israel Trauma Group, and Ramat Gan, Israel
J Trauma Acute Care Surg
· 2026 Jun · PMID 42240281
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BACKGROUND: Post-traumatic stress disorder (PTSD) is a well-documented consequence of combat-related trauma. While tourniquet application is a cornerstone of hemorrhage control in military settings, its mental health con...BACKGROUND: Post-traumatic stress disorder (PTSD) is a well-documented consequence of combat-related trauma. While tourniquet application is a cornerstone of hemorrhage control in military settings, its mental health consequences have not been explored. We aimed to assess the association between prehospital tourniquet application and subsequent PTSD among military personnel with extremity injuries. METHODS: In this retrospective cohort study, we utilized linked military and national trauma registries to identify military personnel with extremity injuries and Injury Severity Score (ISS) ≤8 between 2006 and 2021. Participants were grouped based on documented prehospital use of tourniquets. Service-connected PTSD diagnoses were retrieved from the Ministry of Defense Rehabilitation Department disability claim records and validated by the PTSD Checklist for DSM-5 (PCL-5). Logistic regression models were used to assess associations between tourniquet use and PTSD, adjusting for confounders including injury mechanism, event type, head injury, number of injured persons, and hospitalization status. RESULTS: During 31,690 person-years of follow-up, a total of 2,876 military personnel met the inclusion criteria, of whom 123 (4.3%) received a tourniquet. PTSD was diagnosed in 244 (8.5%) of all casualties, with a prevalence of 30.9% (n=38) among those who received a tourniquet, compared with 7.5% (n=206) among those who did not (p<0.0001). In unadjusted analyses, tourniquet use was strongly associated with increased odds of PTSD (odds ratio, 5.53; 95% confidence interval, 3.64-8.26). After adjusting for confounders, tourniquet use remained significantly associated with PTSD (odds ratio, 1.70; 95% confidence interval, 1.07-2.66). CONCLUSIONS: Tourniquet use was associated with increased odds of PTSD, even after accounting for key confounders. While essential for hemorrhage control, this association should be interpreted with caution, as it may reflect underlying injury context, operational intensity, or other unmeasured confounders rather than a direct causal effect. Tourniquet use was associated with increased odds of PTSD; however, this association should not be interpreted as causal and does not support changes to current point-of-injury tourniquet guidelines. Rather, it may reflect underlying injury context, operational intensity, or other unmeasured confounders. (J Trauma Acute Care Surg 2026;00:000-000 Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). LEVEL OF EVIDENCE: Prognostic/epidemiological, Level III.
Corcostegui SP, Coutillard P, Galant J
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, de la Bigne G, Lovi S, Thabouillot O, Derkenne C, Paris, France
J Trauma Acute Care Surg
· 2026 Jun · PMID 42240268
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BACKGROUND: The National Gendarmerie Intervention Group (GIGN) is the French National Gendarmerie's tactical unit, operating in high-risk environments involving armed suspects, hostage situations, or counterterrorism. Si...BACKGROUND: The National Gendarmerie Intervention Group (GIGN) is the French National Gendarmerie's tactical unit, operating in high-risk environments involving armed suspects, hostage situations, or counterterrorism. Since 1984, the GIGN has relied on an original medical support model integrating a military physician-nurse team within its tactical elements. The study aimed to describe this support within the specific context of a physician-led prehospital emergency medical system. METHODS: We conducted a retrospective, descriptive, observational study of all GIGN operations identified from a prospective registry and performed in the French homeland between July 12, 2018, and October 12, 2022. The primary outcome was the occurrence of at least one casualty, defined as receiving a medical evaluation during an operation. Operational characteristics, medical organization, casualty severity, and access times to medical resources were analyzed. Univariate analyses were performed to identify factors associated with casualty occurrence. RESULTS: Among 242 analyzed operations, at least one casualty occurred in 21% of missions (n=50), with a total of 90 casualties managed. Law enforcement missions were associated with a significantly higher risk of casualties compared with judicial missions (39% vs. 15%; OR: 3.64, 95% CI: 1.82-7.23). Armed or suspected armed adversaries were present in 79% of operations, with explosives linked to the highest risk. Median theoretical access times were 15 minutes (IQR, 9-22) to a physician-staffed prehospital emergency unit and 40 minutes (IQR, 22-63) to a trauma center, with 22% of operations located more than 1 hour away. Prehospital transfusion was potentially available in 66% of operations, mostly delivered within 60 minutes. CONCLUSIONS: GIGN operations are conducted in environments with substantial exposure to severe trauma. Its embedded support model enables early advanced medical care targeting preventable causes of death and plays a central role in operational planning, coordination with civilian emergency services, and casualty management. (J Trauma Acute Care Surg 2026;00:000-000 Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). LEVEL OF EVIDENCE: Care Management; Level IV.
Stahel PF, Ziran N, Butler N
… +1 more
, Coimbra R
J Trauma Acute Care Surg
· 2026 Jun · PMID 42240221
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Woodle T, Patel N, Colonna A
… +4 more
, Enniss T, Myers J, Nirula R, Salt Lake City, Utah
J Trauma Acute Care Surg
· 2026 Jun · PMID 42233881
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Genitourinary (GU) trauma occurs in ~10% of polytrauma patients and ranges from immediately life-threatening injuries to delayed complications with significant morbidity. Effective management requires multidisciplinary c...
Genitourinary (GU) trauma occurs in ~10% of polytrauma patients and ranges from immediately life-threatening injuries to delayed complications with significant morbidity. Effective management requires multidisciplinary coordination among trauma surgery, urology, radiology, orthopedics, and critical care teams. Management of renal injury has continued to evolve, and up-to-date application of adjunctive therapy is essential to optimize outcomes. Bladder injury is often associated with pelvic fractures; diagnosis, categorization, and management of urine flow reduces infection and complications. Knowledge of ureteral and urethral injury management principles, strategy, and timing has been shown to reduce long-term complications and morbidity. Genital injuries, while less common and less severe, may be managed using systematic evaluation and intervention to improve functional outcome. Long-term follow-up is critical across all GU injuries to monitor for complications, including hypertension, fistula, stricture, incontinence, sexual dysfunction, and impaired renal function. Early recognition and adherence to structured management principles are essential to optimize outcomes and preserve genitourinary function.
Livingston DH, Salim A, Biffl WL
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, Costantini TW, Diaz JJ, Inaba K, Napolitano LM, Winchell RJ, Coimbra R, Aurora, Colorado
J Trauma Acute Care Surg
· 2026 Jun · PMID 42233863
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Gelman D, Akler D, Shimon G
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, Ogen S, Ketko I, Leibovitz M, Almog O, Benov A, Beer ZA, Nadler R, Ramat Gan, Israel
J Trauma Acute Care Surg
· 2026 Jun · PMID 42224833
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BACKGROUND: Incomplete prehospital documentation remains a major challenge, compromising continuity of care and data quality. Manual documentation is time-consuming and cognitively demanding, particularly under operation...BACKGROUND: Incomplete prehospital documentation remains a major challenge, compromising continuity of care and data quality. Manual documentation is time-consuming and cognitively demanding, particularly under operational stress. Speech-based artificial intelligence (AI) systems may enable real-time documentation without interrupting clinical workflow. METHODS: We conducted a feasibility study comparing AI-assisted speech-based documentation with conventional manual documentation during simulated prehospital trauma care. Eight teams completed trauma scenarios using both documentation methods in randomized order. AI outputs were structured into 40 predefined documentation fields derived from the standard combat casualty card. Documentation completeness and user-reported usability were compared between methods. Analyses were performed on paired team-scenario observations. RESULTS: Forty-four simulations were completed (22 per method), with successful AI output in 91% of cases. Overall documentation completeness was similar between AI-assisted and manual documentation [73.9% (interquartile range, 64.1-83.7) vs. 64.8% (interquartile range, 58.7-79.2); p=0.31], with no differences across scenarios or documentation categories (all p>0.05). Usability ratings favored the AI-assisted approach for overall ease of use (p=0.024) and data entry (p=0.015). CONCLUSIONS: In this simulated prehospital battlefield setting, AI-assisted speech-based documentation was feasible and achieved documentation completeness comparable to manual documentation while improving perceived usability. Further development and real-world evaluation are needed for operational implementation. (J Trauma Acute Care Surg 2026;00:000-000 Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). LEVEL OF EVIDENCE: Level III.
Anderson GA, Kashikar A, Inaba K
… +1 more
, Los Angeles, California
J Trauma Acute Care Surg
· 2026 Jun · PMID 42224714
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Cervical spine clearance is a fundamental component of the trauma evaluation. These injuries can be stable and asymptomatic or lead to devastating outcomes including permanent paralysis. The ideal process for clearance o...
Cervical spine clearance is a fundamental component of the trauma evaluation. These injuries can be stable and asymptomatic or lead to devastating outcomes including permanent paralysis. The ideal process for clearance of the cervical spine has been a longstanding challenge. This is particularly relevant for obtunded patients, in whom the need for imaging should be balanced against the potential complication burden of extended collar use. Prolonged cervical immobilization is associated with higher risks of elevated intracranial pressure, aspiration, respiratory compromise, thromboembolic events, pressure ulcers, longer intensive care stays, and higher health care-related costs. This review will provide a pragmatic set of recommendations for cervical spine clearance, summarizing the existing data. In alert, examinable patients without neurological deficits, clinical assessment using validated decision-making tools allows safe clearance without further radiographic studies. When clinical reliability is compromised, due to altered mental status, intoxication, or distracting injuries, multidetector computed tomography (CT) has emerged as the primary screening imaging modality, offering high sensitivity for clinically significant injuries. In obtunded patients, an adequate and normal high-quality CT supports collar removal without the need for adjunctive imaging. The use of magnetic resonance imaging should be reserved for patients with neurological deficits or CT findings suggestive of soft tissue or ligamentous injury. A timely, evidence-informed, and standardized approach to cervical spine clearance is essential to ensure patient safety, reduce preventable harm, and support efficient trauma workflows.
Wrenn-Maresh K, Cannon KA, Schermerhorn SMV
… +2 more
, Tadlock MD, San Diego, California
J Trauma Acute Care Surg
· 2026 Jun · PMID 42224632
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BACKGROUND: US Navy general surgeons deployed on naval warships routinely provide a wide spectrum of surgical care-a vastly different experience compared with military and civilian hospitals. The Maritime Surgical Qualit...BACKGROUND: US Navy general surgeons deployed on naval warships routinely provide a wide spectrum of surgical care-a vastly different experience compared with military and civilian hospitals. The Maritime Surgical Quality Improvement Program gathers and analyzes case log data; however, no specific clinical practice guidelines exist for deployed naval surgeons and their chains of command. We sought to close this gap by seeking the consensus of experienced maritime surgeons. METHODS: A modified Delphi method with three rounds was used. A cohort of physician leaders and surgeons with warship deployment experience was asked to state their level of agreement for statements involving elective and emergency surgical care using a 5-point Likert scale. In the first two rounds, open-ended comments were used to generate additional clarifying statements. Consensus was defined as 70% of respondents answering strongly agree/agree or strongly disagree/disagree. Statements not reaching consensus were repeated in subsequent rounds. RESULTS: Of 91 participants, 90% were surgeons. Across all rounds, a final list of 76 statements was evaluated; 58 (76%) reached consensus. Of these, 52 (90%) had a strong agreement between respondents based on median Likert scores with narrow interquartile ranges. There was broad consensus on the management of urgent/emergent conditions and on nongeneral surgery and systems factors, but less consensus on the elective management of surgical conditions. CONCLUSIONS: A consensus regarding the management of surgical conditions was reached for many disease processes. Despite the varied strength of that consensus, this is an important first step to developing guidance for surgery at sea aboard a naval warship. The iterative nature of the process elucidated situational nuances within specific disease processes, increasing its applicability. These statements will be used to create a comprehensive, expeditionary surgery at sea guidelines ("SeaPG"), aiding surgeons and their chains of command in ensuring a safe, reasonable approach to expeditionary surgery at sea. (J Trauma Acute Care Surg 2026;00:000-000 Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). LEVEL OF EVIDENCE: Therapeutic Care Management; Level V.
Mathew PJ, Moore M, Bhattacharya B
… +4 more
, Schneider E, Davis K, Schuster KM, Bridgeport, CT
J Trauma Acute Care Surg
· 2026 Jun · PMID 42224507
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BACKGROUND: Use of nonoperative management for uncomplicated appendicitis is increasing. We hypothesized that health care costs would be lower for patients who underwent appendectomy than for those with an in situ append...BACKGROUND: Use of nonoperative management for uncomplicated appendicitis is increasing. We hypothesized that health care costs would be lower for patients who underwent appendectomy than for those with an in situ appendix over the year after initial diagnosis. METHODS: Using MarketScan, an all-payers claims insurance database, we extracted patients presenting to the emergency department with acute appendicitis and without perforation from 2017 to 2021, and either underwent appendectomy during index presentation or nonoperative treatment. We examined differences in the cost of the initial encounter and within one-year. RESULTS: Of 26,469 patients presenting with uncomplicated appendicitis, 24,005 (90.6%) underwent appendectomy. The median cost of the index encounter was higher at $15,248 in the operative group compared with $5,753 in the nonoperative group (p < 0.001). However, the median cost of follow-up encounters in the nonoperative group was higher at $3,946 compared with $3,338 in the operative group (p = 0.003). For the 78 (3.1%) patients who were initially managed nonoperatively and subsequently underwent follow-up appendectomy, the median cost was an additional $16,348. Based on average costs, nonoperative management must therefore succeed 68% of the time to be less costly than operative management. CONCLUSIONS: Nonoperative management of uncomplicated appendicitis was associated with higher costs for follow-up encounters and total costs of care that were 70% greater if they eventually underwent follow-up appendectomy. Based on average costs in our population, if nonoperative management failed more than 32% of the time, it became the more costly strategy. (J Trauma Acute Care Surg 2026;00:000-000. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). LEVEL OF EVIDENCE: Therapeutic/Care Management; Level III.
Chawla S, Rodha MS, Patel S
J Trauma Acute Care Surg
· 2026 Jun · PMID 42224479
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Russo RM, Joseph B, Sacramento, CA
J Trauma Acute Care Surg
· 2026 Jun · PMID 42222899
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Recent updates to the Joint Trauma System clinical practice guidelines for resuscitative endovascular balloon occlusion of the aorta incorporate partial aortic occlusion (PAO) for up to two hours in combat casualty care...
Recent updates to the Joint Trauma System clinical practice guidelines for resuscitative endovascular balloon occlusion of the aorta incorporate partial aortic occlusion (PAO) for up to two hours in combat casualty care following US Food and Drug Administration 510(k) clearance of the pREBOA-PRO catheter for partial Zone 1 occlusion under defined physiologic parameters. The FDA clearance specifies physiologic targets, including proximal systolic blood pressure of 90 to 110 mm Hg and distal systolic blood pressure >20 mm Hg with pulsatility, indicating that extended occlusion duration is contingent on active titration and physiologic monitoring. These parameters suggest that PAO may be better conceptualized as delivery of a controlled "ischemic dose" determined by both occlusion intensity and duration rather than elapsed time alone. However, real-time ischemic monitoring is limited, distal arterial pressure represents only a surrogate for distal flow, and the relationship between pressure and flow during partial occlusion may vary across catheter designs. This opinion reviews the physiologic basis of PAO, the device-specific context of the two-hour safety window, and the limitations of current monitoring technologies. We also discuss implications for resuscitation strategy and reperfusion planning in austere and prolonged casualty care environments and outline future research priorities.
Davis N, West MA
J Trauma Acute Care Surg
· 2026 Jul · PMID 42212949
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Costantini TW, McEachron KR, Biffl WL
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, Diaz JJ, Inaba K, Livingston DH, Napolitano L, Salim A, Winchell R, Coimbra R, Minneapolis, Minnesota
J Trauma Acute Care Surg
· 2026 Jul · PMID 42206861
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Uren HD, Berrey BH, Holcomb JB
J Trauma Acute Care Surg
· 2026 May · PMID 42186930
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Quilly B, Cloe JS, Nicolas H
J Trauma Acute Care Surg
· 2026 May · PMID 42185070
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