Trauma updates: BIG head bleeds, blunt trauma in the elderly, chest tube irrigation, early interventions in trauma
This month's journal club will be another combined discussion, this time with our surgical colleagues. We will be discussing several articles on the management of trauma.
The first article is a reanalysis of a clinical decision rule termed BIG (Brain Injury Guidelines) on the management of intracranial hemorrhages.
Morris: Gallagher SP et. al. Modified Brain Injury Guidelines for preinjury anticoagulation in traumatic brain injury: An opportunity to reduce health care resource utilization. J Trauma Acute Care Surg. 2024 Feb 1;96(2):240-246. doi: 10.1097/TA.0000000000004171. Epub 2023 Oct 24. PMID: 37872672. Summary
The second is a newly derived clinical decision rule on the workup of the aged (>65) after blunt trauma that was developed by the EAST trauma association.
Johnston: Ho VP et al. Scanning the aged to minimize missed injury: An Eastern Association for the Surgery of Trauma multicenter study. J Trauma Acute Care Surg. 2025 Jan 1;98(1):101-110. doi: 10.1097/TA.0000000000004390. Epub 2024 Dec 14. PMID: 38797882; PMCID: PMC11599468. Summary
The third is a prospective observational trial by the Western Trauma Association on the use of irrigation with normal saline at the time of chest tube insertion and whether this reduces complications associated with thoracostomy.
Duggins. Carver TW et al. Thoracic irrigation for prevention of secondary intervention after thoracostomy tube drainage for hemothorax: A Western Trauma Association multicenter study. J Trauma Acute Care Surg. 2024 Nov 1;97(5):724-730. doi: 10.1097/TA.0000000000004364. Epub 2024 May 20. PMID: 38764139. Summary
The fourth is a reanalysis of two previous trials showing an association with earlier intervention in terms of TXA and blood products and lower mortality.
Winning: Deeb AP, Guyette FX, Daley BJ, Miller RS, Harbrecht BG, Claridge JA, Phelan HA, Eastridge BJ, Joseph B, Nirula R, Vercruysse GA, Sperry JL, Brown JB. Time to early resuscitative intervention association with mortality in trauma patients at risk for hemorrhage. J Trauma Acute Care Surg. 2023 Apr 1;94(4):504-512. doi: 10.1097/TA.0000000000003820. Epub 2023 Jan 11. PMID: 36728324; PMCID: PMC10038862. Summary