Importance: The discipline of burn care has been challenged by a declining professional workforce, resulting from changes in general surgery residency training, simultaneous with a multidisciplinary but siloed approach to care. Secondary effects on children’s burn care include decreased awareness of where children receive care outside of the American Burn Association (ABA)-verified burn centers, loss of bidirectional education and communication inherent to patient and family-centered care, and good outcome measures. These factors affect disaster planning. Observations: A system of care must be capable of addressing “everyday” pediatric burn care availability before the nation can manage multiple burn victims in a disaster. Pediatric burn care is delivered by a variety of clinicians with complementary skill levels, knowledge, and resources at several types of centers, including verified burn centers caring for children and adults or only children and nonverified children’s or acute care hospitals providing pediatric burn care. The current ABA verification process is rigorous but not tiered, making it difficult for many children’s hospitals to satisfy these standards. Conclusions: The current landscape of children’s burn care has strengths and opportunities in terms of access to care, care delivery, workforce and training, education, data and quality, and research. A national pediatric burn system will: (1) improve the understanding of “everyday” and expert burn care for children, (2) define gaps in children’s burn care, including preparedness of the emergency care system where children initially receive care, and (3) anticipate action and implementation strategies to address these gaps.

Objective: The goal of this study was to assess 2 analytic strategies for comparing hospital outcomes among those with emergency general surgery (EGS) conditions, comparing a conventional risk stratification method with a less utilized, but equally informative strategy. Background: EGS is a complex set of heterogeneous, time-sensitive conditions that require expeditious treatment. Patients need a mechanism to evaluate how hospitals perform for similar populations treated within the hospital and a reliable metric that benchmarks outcomes across institutions. Methods: We performed a retrospective cohort study assessing hospital outcomes for EGS Medicare beneficiaries from July 1, 2015, to June 30, 2018. Using direct standardization with balancing weights and indirect standardization with logistic regression, we compare hospital performance on a risk-adjusted composite adverse event rate. Performance based on each standardization modality was correlated using the Spearman rank coefficient. Results: There were 536,284 patients with a median (interquartile interval) age of 74.2 (72.9, 75.6) years treated at 1866 study hospitals. Direct and indirect standardization showed agreement on 92 low- and 76 high-performing hospitals. Adverse event rates for hospital rankings were strongly correlated between the 2 methods of standardization (0.83, P < 0.001). Rankings based on operative (0.75) and nonoperative (0.77) groups were also highly correlated (all P < 0.001). Conclusions: Significant variation exists in EGS outcomes. Hospital performance is inconsistent between operative and nonoperative treatment. A small number of hospitals can be distinguished based on risk-adjusted outcomes regardless of analytic technique, suggesting opportunities for optimized care standardization and quality improvement.

Objective: Postdischarge transitions from the hospital to home in older (≥65 years) colorectal surgery patients have a high risk of medication errors, complications, and worsening of existing conditions. Up to 14% are readmitted within 30 days, costing ~$180 million annually. The anticipated 50% increase in colorectal cancer surgeries in older adults by 2040 necessitates an improvement in care transitions and outcomes. Methods: We conducted semi-structured qualitative interviews with 10 surgeons from 8 US health systems to inform the design of a multicomponent care transition model. We selected participants through stratified purposive sampling based on experience with older surgical patients and/or leadership roles. Consolidated Criteria for Reporting Qualitative Studies guidelines were followed, and a detailed line-by-line editing and organizing style was used to analyze transcripts. Results: The interviews identified challenges in care transitions and potential solutions, and 4 themes emerged: (1) Discharge planning should start before surgery and incorporate preoperative geriatrics evaluation and planning; (2) Coordinated communication and collaboration among multidisciplinary care teams are necessary but often lacking; (3) Educating older surgical patients and their care partners and involving them in care decisions is needed for successful management of care responsibilities after discharge; and (4) The complex and fragmented healthcare system creates care challenges postdischarge. Conclusions: Discharge planning that begins preoperatively, integrates geriatrics domains, ensures timely and coordinated interdisciplinary communication postdischarge, and emphasizes patient and family education is essential to improve care transitions in older colorectal surgery patients. A multilevel care transition model incorporating these elements may enhance outcomes and reduce readmissions.

Abdominal adhesions are a globally disruptive problem to patients and healthcare systems, with limited preventative strategies. Multiple discovery prophylactics have been evaluated previously for adhesions prevention with inadequate transfer to patient care. Clinical translation is fundamentally restricted by the ability of a discovery prophylactic to simultaneously navigate 3 key components of adhesions formation throughout the entire abdomen: the innate immune system, the coagulation system, and the local peritoneal cell populations. Furthermore, challenging handling characteristics and product restrictions have decreased the utilization of clinically available prophylactics by surgeons. The success of future adhesions prevention strategies must also be anchored in clinically valid animal modeling with attention towards future regulatory approval. The purpose of the present roadmap article is to provide a state-of-the-art review of adhesions pathophysiology, hydrogel development, animal modeling, and regulatory science, from which a framework for future developmental strategies may be outlined.

Objective:To evaluate the long-term impact of the Trauma and Disaster Team Response (TDTR) course—supported by McGill University’s Center for Global Surgery (CGS) and endorsed by the United Nations Institute for Training and Research’s Surgical Hub—on Tanzanian clinicians’ self-assessed confidence in trauma care skills taught in 2023.Background:Locally led, context-specific team training, such as the TDTR course, is essential in resource-limited settings to strengthen trauma care systems, prepare for unforeseeable natural or man-made disasters, and reduce preventable injury-related harm. In 2023, a 3-day, simulation-based, multidisciplinary TDTR course was conducted to equip Tanzanian clinicians with essential trauma management skills.Methods:This longitudinal cohort study tracked participants of the 2023 TDTR course. That year, in collaboration with the CGS, faculty from Tanzania’s Muhimbili Orthopedic Institute trained 22 clinicians, including surgeons, residents, anesthetists, general physicians, and nurses. Participants completed self-assessments before and immediately after the course, evaluating their confidence in general skills (leadership, teamwork, and communication) and trauma-specific competencies. In 2025, the same questionnaires were emailed to all 22 trainees for a 2-year follow-up. Additionally, a separate questionnaire was sent to the 8 course instructors, inviting them to provide feedback on the course’s long-term impact. Reminders were sent to nonresponders after 3 weeks. Instructor feedback was collected through structured surveys and open-ended questions, and was analyzed thematically to assess perceptions of participant progress, team dynamics, and areas for improvement. Changes in trainee confidence scores across the 3 time points (precourse, postcourse, and 2-year follow-up) were analyzed using mean comparisons and mixed-effects models.Results:Participants demonstrated short-term improvements in self-assessed trauma skills, with partial retention at 2 years. The surgical team retained gains (general skills: 3.93–4.69; specific skills: 38–57, P < 0.002). Anesthesia providers showed improvement (general: 3.40–4.21; specific: 32.33–52, P < 0.04). Physicians improved the most (general: 3.67–4.20; specific: 33.57–51.29, P < 0.003), while nurses showed moderate gains (general: 3.25–3.82; specific: 32–46, P < 0.05). Participants perceived a 4.5% reduction in trauma-related deaths, which was corroborated by supervising instructors, who also highlighted observed improvements in care quality, teamwork, and outcomes. While the perceived reduction in trauma-related mortality is notable, it is based on subjective assessment and cannot be solely attributed to the training without further controlled analysis. Furthermore, trainees and instructors emphasized the need for regular refresher sessions.Conclusions:The TDTR course was associated with sustained improvements in self-assessed trauma care confidence and perceived enhancements in clinical outcomes over 2 years. These findings underscore the value of ongoing, team-based training in resource-limited settings. However, regular refresher courses and future studies using objective performance measures are essential to confirm and quantify the long-term clinical impact.

Objective:To develop and evaluate a computer vision model for automating the identification of trauma resuscitation phases and procedures during trauma video review (TVR).Background:TVR is a valuable tool for assessing trauma resuscitation quality and identifying improvement opportunities. However, its labor-intensive nature limits widespread adoption.Methods:Ninety-five de-identified trauma resuscitation videos from a Level I trauma center were analyzed. Thirty videos (32%) were manually annotated to define 4 trauma phases—pre-arrival, paramedic handover, acute resuscitation, and pre-departure—and procedures, including X-rays, ultrasound, and intravenous access. A multi-institutional research group guided the annotation framework development. Interrater reliability was assessed using temporal intersection over union (tIoU). Model performance metrics included frame-wise accuracy, edit score, F1 scores (tIoU thresholds: 0.1, 0.25, 0.5), average precision (AP), and average recall.Results:The cohort included 65 (68.4%) male patients, median [interquartile range (IQR)] age 31 (23–44.5) years, with 75 (78.9%) blunt injuries and a median (IQR) injury severity score of 22 (12–29). Annotators achieved a high interrater reliability [mean (standard deviation) tIoU: 0.89 (0.19)]. The model achieved a frame-wise accuracy of 98.3%, edit score of 92.1%, and F1 scores of 94.5%, 94.1%, and 86.3% at tIoU thresholds of 0.1, 0.25, and 0.5, respectively. Procedure detection AP exceeded 66% for X-rays and central line placements.Conclusions:Computer vision can effectively automate TVR, enabling accurate phase segmentation and procedure detection. This approach has the potential to streamline TVR, promote adoption, and improve trauma care quality.

Affecting over 230 million people worldwide, peripheral artery disease (PAD) is a chronic disease that can lead to significant functional deficits, amputation, and death. Early detection of PAD is critical as risk factor modification and medical management can slow disease progression. It was not until the mid-twentieth century that arterial reconstruction surgery was developed for PAD but even then there was no tool to objectively and reliably assess postoperative success. At the beginning of his career, James S.T. Yao, M.D., Ph.D., published groundbreaking work on the ankle-brachial index (ABI) as a reliable diagnostic tool that would change the field of vascular surgery forever. In 1969, Yao pioneered the ABI, which objectively assessed the presence and severity of PAD by comparing a patient’s ankle and brachial systolic blood pressures. His landmark paper revealed that the ABIs of patients with PAD correlated with clinical severity, and patients with successful revascularization experienced an increase in ABI. These measurements were effective and accessible, requiring minimal equipment and training to perform. Over 50 years later, the ABI is still recognized as the leading diagnostic tool for PAD by current American Heart Association, American College of Cardiology, and Center for Disease Control guidelines.

Background:Resident workload can significantly influence resident education, resident well-being, and patient care. Components of workload include duty hours and patient census, though their roles within the complexities of workload and subsequent effects remain underexplored. This scoping review aims to investigate how patient census impacts patient outcomes.Methods:Our scoping review searched multiple databases in April 2022 using a query framework that captured articles reporting the effect of inpatient service census on patient outcomes. English-language studies conducted in the United States were included. Three authors independently screened results, followed by full-text review. The data extracted contained study characteristics, characterization of census, patient outcomes, and intervention utilization.Results:Thirteen articles met the inclusion criteria. The majority of articles (92.3%) were published after 2003, the time of the initial Accreditation Council for Graduate Medical Education duty hour restrictions mandate. All studies were conducted in internal medicine programs. Most commonly studied outcomes were readmission, length of stay, mortality, quality and safety measures, and patient satisfaction. Five studies performed an intervention to optimize census, which included adding residents to the team and implementing census caps. The overall paucity and heterogeneity of the present literature led to variable findings on how census affects patient outcomes.Conclusions:There remains an incomplete understanding of the impact of patient census on patient outcomes and its role in workload, particularly among surgical specialties. Further efforts are needed to characterize the complexities of workload, compare differences in workload between surgical and nonsurgical specialties, and evaluate its impact on resident education, resident well-being, and patient care.

Objective:This systematic review provides a comprehensive overview of evidence-based clinical practice guidelines (CPGs) for geriatric trauma care through the utilization of a novel artificial intelligence (AI) methodology.Background:With a growing proportion of trauma cases involving geriatric patients, there is a need for tailored management considering their unique challenges related to multimorbidity and frailty. Evidence-based recommendations support clinical decision-making in this population.Methods:MEDLINE Ovid and 8 guideline databases were searched on December 18, 2021, for CPGs published after January 1, 2016. Eligible CPGs were required to be published in German or English, have an evidence assessment (such as Grading of Recommendations, Assessment, Development and Evaluation (GRADE)), report at least 1 recommendation for older patients (≥60 years, frail, or with dementia/delirium) applicable in an acute inpatient trauma setting, and achieve an Appraisal of Guidelines for Research & Evaluation II (AGREE II) overall quality rating of at least 4 points rated by 2 independent experts. The extracted CPG recommendations underwent semantic analysis with AI-based natural language processing, followed by dimensional reduction and grouping via k-means clustering.Results:After screening, full-text review, and AGREE II appraisal, 95 CPGs out of 12,106 records were included, yielding 821 CPG recommendations relevant to geriatric trauma care. Most recommendations addressed dementia, delirium, adverse drug reactions, deprescribing, multimorbidity, frailty, and cardiovascular disease. The clustering analysis identified 27 clusters of semantically similar recommendations, and each cluster was consolidated into a single meta-recommendation.Conclusions:Our systematic review provides a comprehensive summary of evidence-based CPG recommendations for geriatric trauma care, offering clinicians a solid foundation for managing this vulnerable patient population.