Solid Organ Injury Research Articles

Comparison of fatal traumatic medico-legal cases with postmortem computed tomography and autopsy: A pilot study in Taiwan

In order to determine the performance of postmortem computed tomography (PMCT) in identifying traumatic-relevant macroscopic findings in medico-legal cases, this retrospective observational pilot study involving nine trauma casualties who had received PMCT prior to autopsy. The comparison of these findings in six anatomical regions as dictated in Injury Severity Score (ISS) were performed. 104 traumatic-relevant findings were identified with achievement of 51% congruent findings. PMCT and autopsy had additionally found 22 and 29 findings respectively. PMCT had highest sensitivity for extremity injury (81.82%), followed by chest (73.91%), head, neck and face (71.43%), and abdomino-pelvic area (50%). It had excellent detection rate in abnormal air collection, fracture, foreign body localization, internal ballistic and intracranial pathology. However, the solid organ and vascular injuries as well as integumentary lesions were the major drawback. In conclusion, incorporation of PMCT to autopsy in medico-legal investigation helps to preserve the most abundant traumatic-relevant injuries compared to either modality.

Evidence-based management of pediatric solid organ injury

Evidence-based management of pediatric solid organ injury

CLINICAL COURSE AND OUTCOME OF PATIENTS WITH SOLID ORGAN INJURY IN BLUNT ABDOMINAL TRAUMA

Background: Blunt abdominal trauma, one of the most common injuries caused by road traffic accident are usually not obvious hence often missed unless repeatedly looked for. In view of this, the study was aimed to diagnose the solid organ injury and its incidence, mode, age, sex distribution, time of presentation, clinical course, management, time interval between injury and surgery, postoperative complications and outcomes. Methods: This prospective observational study was conducted in the department of General surgery, Chitwan Medical College Teaching Hospital, from August 2020 to July 2021. Data were collected with clinical history/examination, injury assessment, appropriate investigations, modes and patterns. Documentation with identification, history, clinical findings, diagnosis, management, complications and outcomes were done and analyzed with SPSS version 16. Results: Among 83 patients, most of them aged between 16-30 years (57.8%). Male to female ratio was 1.96:1. The most common mode was road traffic accidents (55.5%). Commonly injured organ was spleen (51%) and liver (30%) with associated other organs (65%). Conservative management was done in 62% and operative in 38%. Majority of patients were operated after 4-6 hours of initial presentation. The more the time interval between injury and surgery, the more the complications, duration of hospital stay and mortality. Post-operative complications were noted in 38.5% and mortality in7.22%. Conclusions: Blunt abdominal trauma was common and mainly associated with road traffic accidents. Associated abdominal and extra abdominal injury, delay presentation, diagnosis and intervention significantly predict high mortality and poor outcomes.

Role of multi detector computed tomography (MDCT) in evaluation and management of blunt abdominal trauma

Background: The majority of all blunt and penetrating body injuries are abdominal injuries. Computed tomography is a significant and quick technology that provides information on the kind of abdominal damage quickly and aids in patient care in accordance with that information. The current study's objectives were to assess the value of Multidetector Computed Tomography (MDCT) in identifying intra-abdominal injuries in patients with acute abdominal trauma and to give knowledge that might precisely guide therapy decisions (non- operative versus operative). and to compare the computed tomography (CT) results to either clinical observation, a further CT scan (if necessary), or the results of surgery (wherever applicable). Objectives: To examine the utility of multidetector computed tomography (MDCT) in detecting intra-abdominal injuries in patients with blunt abdominal trauma and providing information to define the role of therapy (operative versus conservative). Materials and Methods: This two-year prospective study looked at 50 patients who had suffered blunt abdominal trauma. The MDCT findings were compared to clinical outcomes, follow-up CT scans (if needed), and surgical outcomes (whichever applicable). Results: Motor vehicular accidents were the commonest cause of abdomen blunt injury (68%). Abdominal injury was present in 38 (76%) patients and hemoperitoneum was seen on CT scan in 33 patients (85.8%). In 27 patients, hemoperitoneum was associated with solid organ injury. The commonest injury was splenic injury. In 6 patients (15.8%) who underwent surgery, CT findings of hemoperitoneum and solid organ injury were verified, and bowel injury was shown to be the origin of isolated hemoperitoneum in two cases. The CT scan was 100% accurate in detecting hemoperitoneum. During the follow-up period, all conservatively handled cases recovered without incident. As a result, OIS grading appeared to predict care methods in the majority of patients in this study's overall analysis of solid organ injuries, with the exception of those with bowel and mesenteric injuries. Conclusion: In the diagnosis and management of blunt abdominal trauma, CT is the imaging modality of choice. Keywords: Computed tomography; Blunt Abdominal Trauma; Organ Injury Scaling (OIS); splenic injury; liver injury, road traffic accidents.

Predictors of transfer from a remote trauma facility to an urban level I trauma center for blunt splenic injuries: a retrospective observational multicenter study

BackgroundThe decision-making for admission versus emergent transfer of patients with blunt splenic injuries presenting to remote trauma centers with limited resources remains a challenge. Although splenectomy is standard for hemodynamically unstable patients, the specific criterion for non-operative management continues to be debated. Often, lower-level trauma centers do not have interventional radiology capabilities for splenic artery embolization, leading to transfer to a higher level of a care. Thus, the aim of this study was to identify specific characteristics of patients with blunt splenic injuries used for admittance or transfer at a remote trauma center.MethodsA retrospective observational study was performed to examine the management of splenic injuries at a mountainous and remote Level III trauma center. Trauma patients ≥ 18 years who had a blunt splenic injury and initially received care at a Level III trauma center prior to admittance or transfer were included. Data were collected over 4.5 years (January 1, 2016 – June 1, 2020). Patients who were transferred out in > 24 h were excluded. Patient demographics, injury severity, spleen radiology findings, and clinical characteristics were compared by decision to admit or transfer to a higher level of care ≤ 24 h of injury. Results were analyzed using chi-square, Fisher’s exact, or Wilcoxon tests. Multivariable logistic models were used to identify predictors of transfer.ResultsOf the 73 patients included with a blunt splenic injury, 48% were admitted and 52% were transferred to a Level I facility. Most patients were male (n = 58), were a median age of 26 (21–42) years old, most (n = 62) had no comorbidities, and 47 had been injured from a ski/snowboarding accident. Compared to admitted patients, transferred patients were significantly more likely to be female (13/38 vs. 3/36, p = 0.007), to have an abbreviated injury scale score ≥ 3 of the chest (31/38 vs. 7/35, p = 0.002), have a higher injury severity score (16 (16–22) vs. 13 (9–16), p = 0.008), and a splenic injury grade ≥ 3 (32/38 vs. 12/35, p < 0.001). After adjustment, splenic injury grade ≥ 3 was the only predictor of transfer (OR: 12.1, 95% CI: 3.9–37.3, p < 0.001). Of the 32 transfers with grades 3–5, 16 were observed, and 16 had an intervention. Compared to patients who were observed after transfer, significantly more who received an intervention had a blush on CT (1/16 vs. 7/16, p = 0.02) and a higher median spleen grade of 4 (3–5) vs. 3 (3–3.5), p = 0.01).ConclusionsOur data suggest that most patients transferred from a remote facility had a splenic injury grade ≥ 3, with concomitant injuries but were hemodynamically stable and were successfully managed non-operatively. Stratifying by spleen grade may assist remote trauma centers with refining transfer criteria for solid organ injuries.

Nonsteroidal Anti-inflammatory Drugs Are Not Associated With Increased Bleeding in Blunt Solid Organ Injury.

Nonsteroidal Anti-inflammatory Drugs Are Not Associated With Increased Bleeding in Blunt Solid Organ Injury.

Nonsteroidal Anti-inflammatory Drugs Are Not Associated With Increased Bleeding in Blunt Solid Organ Injury.

Nonsteroidal anti-inflammatory drugs are an effective nonopiate option for pain control. However, the antiplatelet aggregation of cyclooxygenase-1 (COX-1) inhibitors presents a concern in that they may exacerbate bleeding in patients with solid organ injuries. The aim of the study is to evaluate the impact of nonsteroidal anti-inflammatory drugs on blunt solid organ injury. We hypothesized that nonsteroidal anti-inflammatory drugs would not contribute to intra-abdominal bleed progression. This is a retrospective cohort study of blunt solid organ injury evaluated from June 1, 2015, to June 30, 2019, at an urban midwestern Level I trauma center. Patients receiving and those not receiving nonsterioidal anti-inflammatory drugs were compared on intra-abdominal bleeding progression as assessed by surgical intervention, angioembolization, and blood transfusions. We analyzed 706 patients, of whom 206 were given nonsteroidal anti-inflammatory drugs during their hospital course. Compared with those who were not given nonsteroidal anti-inflammatory drugs, patients given nonsteroidal anti-inflammatory drugs were less likely to have an operation (odds ratio, OR 0.46, 95% confidence interval, CI [0.25, 0.85], p = .012) and were less likely to have an embolization (OR 0.27, 95% CI [0.11, 0.70], p = .004). There was no difference in the need for packed red blood cell transfusion between the nonsteroidal anti-inflammatory drug and non- nonsteroidal anti-inflammatory drug groups (95% CI [0.91, 1.99], p = .13). Patients given nonsteroidal anti-inflammatory drugs had a decreased likelihood of receiving an organ-specific procedure or needing a blood transfusion and had no difference in mortality. Our findings indicate that nonsteroidal anti-inflammatory drugs in patients with blunt solid organ injuries were not associated with an increased risk of adverse events related to intra-abdominal bleeding.

Current Trends of Conservative Management of Blunt Abdominal Solid Organ Injury

Introduction: Bangladesh is one of the most densely inhabited countries in the world. Road traffic accidents are one of the leading causes of morbidity, and the incidence of blunt abdominal injuries is on the rise. Over the last several years, the treatment of blunt abdominal injury (BAI) has changed dramatically. Conservative or non-operative treatment (NOM) of liver, spleen, and kidney injuries has proven to be quite effective. Methods of study: A prospective observational study was done in Dhaka medical college with 50 consecutive patients included from January 2010 to June 2010. Results: Within the 50 consecutive patients 88% were male, and 64% were motor vehicular crashes. 26 patients (52%) had a liver injury; 5 (10%) had a renal injury; 7 (14%) had a splenic injury and 3 (6%) had a pancreatic injury; 9(18%), 2 patients (4%) had both liver and spleen injury, 3 patients (6%) had both spleen and kidney injury. 39 (78%) patients were managed successfully by a conservative approach. Compared with these patients who underwent non-operative management (NOM) initially, patients in the operative group had a higher injury severity score. (p &lt; 0.001). Twenty-seven patients (high risk) were successfully treated without surgery. No serious complication was found on routine image follow-up. Conclusion: Conservative or non-operative management of blunt abdominal solid organ injury in hemodynamically stable patients is highly successful in many fields when compared with the operative group, including the outcomes of morbidity, mortality, and length of hospital stay.

Study of Treatment Modalities for Blunt Abdominal Trauma and its Medicolegal Aspect

Background: Blunt abdominal trauma management has changed drastically from surgical to conservative. In ourstudy we analyzed 100 patients visited hospital with blunt abdominal trauma and diagnostic and managementmodalities and medicolegal aspect are discussed.Study evaluate the incidence and clinical presentation, various available investigations, the organs affected inblunt abdominal trauma and management of complications, morbidity and mortality following blunt abdominalinjury.To handle such cases to save the patient and our self from litigation.Material and methods: This study consists an analysis of randomly selected 100 cases with blunt abdominaltrauma admitted during the period of May 2018 to August 2020. It is a prospective observational study.Conclusion: Blunt abdominal trauma is on rise due to excessive use of motor vehicles. From our study weconcluded that single solid organ injury patients with hemodynamic stability (specially Grade 1 to grade 3)managed conservatively more compared to multiple solid organ injury patients and best investigated by USGFAST and CT scan.Careful record keeping can assist to protect against bogus and false allegations and complaints,as in court of law documentation is considered as part of witness.

ISOLATED PANCREATIC INJURIES: A CASE SERIES

Context: Pancreatic injuries constitutes a set of rare abdominal solid organ injuries. Isolated pancreatic injuries are even more rare injuries and are often missed in initial clinical and radiological evaluation . such injuries present late and denitive guidelines to manage such injuries are lacking, considering rarity of such injuries. Unpredictable course involves traumatic pancreatitis, pancreatic necrosis, peripancreatic collections, infective complications and extra abdominal complication The aim of this study is to present clinical details and management outcomes of such casesAims: at our institute This study is a retrospective analytical study In this retrospective study medicalSettings and Design: Methods and Material: records of all the admissions were collected from trauma registry from may 2016 to april 2022 at Thanjavur medical college. All these records were screened for patients with isolated pancreatic injuries All continuous variables were analyzed with descriptive statisticsStatistical analysis used: and their mean, median, mode, range and frequencies were calculated. All categorical data are analyzed with frequencies. Comparison of data is done using: all nominal data is analyzed with parametric tests (Chi-square test, unpaired t test) and non-nominal data is analyzed with non- parametric tests (Fischer's exact test and Mann-whitney U test). In our study a total of 22 cases were included. Mean age being 33.91yearsResults: among which 81.8% were males. 72.7% of the patients suffered road trafc accidents. 77.3% of the patients had BMI less than 25. Main pancreatic duct (MPD) involvement was noticed in 22.7% patients. median levels of serum amylase levels were 390U/L. 22.7% patients underwent operative management were as rest were managed non-operatively. Two patients died due to severe pancreatitis. Isolated pancreatic injuries inConclusions: patients where surgery is otherwise not indicated due to other causes needs management tailored to the clinical needs of the patient. Diagnostic ambiguity is best resolved by combining computed tomography (CT) and Magnetic resonance cholangiopancreatography (MRCP). Patients with distal MPD injury are usually operated when presented early and pancreatic stenting is considered when proximal ductal injury is noticed. In selected cases conservative approach is not a contraindication, even in patients with MPD injury, considering high stula and peripancreatic collection rates in distal pancreatectomy.

Indications for the surgical management of pancreatic trauma: An update.

Pancreatic trauma is rare compared to other abdominal solid organ injuries, accounting for 0.2%-0.3% of all trauma patients. Moreover, this type of injury may frequently be overlooked or not readily appreciated on initial clinical examinations and investigations. The organ injury scale determines the severity of the trauma. Nonetheless, there are conflicting recommendations for the best strategy in severe cases. Overall, conservative management of induced severe traumatic pancreatitis is adequate. Modern imaging modalities such as ultrasound scanning and computed tomography scanning can detect injuries in fewer than 60% of patients. However, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP) have diagnostic accuracies approaching 90%-100%. Thus, management options include ERCP and stent placement or distal pancreatectomy in cases of complete gland transection and wide drainage only for damage control surgery, which can prevent mortality but increases the risk of morbidity. In the majority of cases, surgical intervention is not required and should be reserved for only severe grade III to grade V injuries.

Nonoperative management of blunt abdominal solid organ injury: Are we paying enough attention to patients on preinjury anticoagulation?

BackgroundThis study aims to assess the impact of pre-injury anticoagulant use on outcomes of isolated blunt abdominal SOI patients who underwent NOM. MethodsA 1-year(2017) analysis of the ACS-TQIP. We included all ≥18yrs trauma patients with isolated blunt abdominal-SOI who underwent NOM. Patients were stratified into two groups based on their history of pre-injury anticoagulant use. Propensity score matching was performed. ResultsA matched cohort of 2709 patients (AC, 903; No-AC,1806) was analyzed. Compared to the No-AC group, the AC group had higher rates of failure of NOM(2.6% vs. 4.5%, p = 0.03), cardiac arrest (1.2%vs. 3.1%, p = 0.02), acute kidney injury (2.4% vs. 4.2%, p < 0.01), myocardial infarction (0.6% vs. 1.4%,p = 0.03), and mortality (5.1%vs. 7.6%,p = 0.01), and longer hospital LOS (17[10–24]vs.17[12–26]days,p = 0.04) and ICU LOS (11[6–17]vs.11[7–18]days,p = 0.01). ConclusionAmong nonoperatively managed blunt abdominal SOI patients, preinjury use of anticoagulants negatively impacts outcomes. Extra surveillance is required while managing patients with blunt abdominal SOI on pre-injury anticoagulants. Level of evidenceLevel III. Study typeTherapeutic/care management.

Epidemiology of abdominal trauma: An age- and sex-adjusted incidence analysis with mortality patterns

PurposeAbdominal injuries may occur in up to one-third of all patients who suffer severe trauma, but little is known about epidemiological trends and characteristics in a Northern European setting. This study investigated injury demographics, and epidemiological trends in trauma patients admitted with abdominal injuries. MethodsThis was an observational cohort study of all consecutive patients admitted to Stavanger University Hospital (SUH) with a documented abdominal injury between January 2004 and December 2018. Injury demographics, age- and sex-adjusted incidence, and mortality patterns are analyzed across three time periods. ResultsAmong 7202 admitted trauma patients, 449 (6.2%) suffered abdominal injuries. The median age was 31 years, and the age increased significantly over time (from a median of 25 years to a median of 38.5 years; p = 0.020). Patients with ASA 2 and 3 increased significantly over time. Men accounted for 70% (316/449). The injury mechanism was blunt in 91% (409/449). Transport-related accidents were the most frequent cause of injury in 57% (257/449). The median Injury Severity Score (ISS) was 21, and the median New Injury Severity Score (NISS) was 25. The annual adjusted incidence of all abdominal injuries was 7.2 per 100,000. Solid-organ injuries showed an annual adjusted incidence of 5.7 per 100,000. The most frequent organ injury was liver injury, found in 38% (169/449). Multiple abdominal injuries were recorded in 44% (197/449) and polytrauma in 51% (231/449) of the patients. Overall 30-day mortality was 12.5% (56/449) and 90-day mortality 13.6% (61/449). ConclusionThe overall adjusted incidence rate of abdominal injuries remained stable. Age at presentation increased by over a decade, more often presenting with pre-existing comorbidities (ASA 2 and 3). The proportion of polytrauma patients was significantly reduced over time. Mortality rates were declining, although not statistically significant.

Intraosseus administration of an ultrasound contrast agent in a case of pediatric blunt abdominal trauma

Adding an ultrasound contrast agent to the Focused Assessment with Sonography in Trauma (FAST) exam can substantially improve the diagnostic accuracy of identifying solid organ injuries and rapidly identify significant organ lacerations and active intraperitoneal hemorrhage. The standard recommendations are to use a 20g peripheral IV for administration to prevent microbubble breakage associated with high infusion pressures. In time-critical trauma resuscitations however, rapid vascular access often necessitates the use of intraosseous catheters (IO). We describe the first use of IO access to successfully administer an ultrasound contrast agent in a critically injured 16 month-old toddler. The cFAST exam identified a liver laceration and provided superior diagnostic information compared the non-contrast abdominal CT obtained at an outside facility. • Adding an ultrasound contrast agent to the FAST exam can help to rapidly diagnose significant solid abdominal organ injuries. • Ultrasound contrast arrival times and organ opacification appear to be similar to the intravenous route. • A contrast-enhanced FAST exam (cFAST) can provide superior diagnostic information compared to an unenhanced abdominal CT.

A 22-year history of treating intentional falls from the Golden Gate Bridge at Marin Health Medical Center

BackgroundThe historical mortality rate after falling from the Golden Gate Bridge has been approximately 98%. We report on 14 recent survivors treated at Marin Health Medical Center. MethodsWe retrospectively reviewed the 22-year experience of treating patients after Golden Gate Bridge falls. Patients with signs of life when recovered by the Coast Guard were included. ResultsMarin General Hospital treated 26 patients with an average age of 28.2 years. The mortality rate was 46.2% with an increased survival over the past decade compared to the first 12 years, 61% vs 37%, P = not significant. The average injury severity score was 29.3 and was significantly lower over the past decade (43.9 vs 22.8, P = .004). The leading injuries were hemothorax/pneumothorax (73%), spine fractures (65%), lung contusions (50%), rib fractures (50%), and solid organ injury (46%). Patients with major cardiovascular injuries were significantly more likely to expire, 88% vs 28%, P = .009. ConclusionThe pattern of injury leading to death after an intentional fall from the Golden Gate Bridge has not changed significantly over the decades.

Liver injuries in blunt abdominal trauma

Background and Aim: Liver trauma can occur as a result of fall from height, vehicular accidents,bull gore injury, assault and in sports injuries . The present study was conducted to identify the etiology, modes of presentation, diagnostic modalities, and validity of grading systems and to analyze the different modalities of management and final outcome in patients of liver trauma due to blunt abdominal injuries. Materials &amp; Methods: Over a 36-month period, 30 hemodynamically stable patients with blunt hepatic were evaluated prospectively. ISS was used to assess the extent of overall injury. Hepatic injuries were graded using AAST grading for solid organ injuries. Frequent measurement of vitals and estimation of hemoglobin and hematocrit was done. Results: Patients with AAST grade IV splenic injury, massive hemoperitoneum and increased transfusion requirements were associated with a higher risk of failing conservative management. Initial pulse rate, systolic blood pressure, ISS and hemoglobin did not appear to influence the outcome of the study. There were no deaths reported in the study. Conclusion: On the basis of the present investigation, it can be concluded that conservative management of blunt splenic and/or hepatic injury is safe and effective in a carefully chosen set of patients.

Difference in Presentation and Concomitant Intra-Abdominal Injury with Chance Fracture in Pediatric and Adult Populations.

Chance fracture (CFx) with concomitant intra-abdominal injury has variable occurrence rates ranging from 33 to 89%. No single study has compared the incidence of simultaneous abdominal injury between pediatric and adult populations. This study compares the rate of simultaneous intra-abdominal injury and chance fracture in these populations. A retrospective review of pediatric and adult patients with chance fracture in comparable pediatric and adult trauma centers was performed. Patient demographics, mechanism of injury (MOI), and injury patterns were collected from 2002 to 2019 for pediatric patients and 2015 to 2018 for adults. Student t-test analyses were performed to determine statistical significance between the cohorts. The pediatric group had a similar incidence of abdominal solid organ injuries compared to adults (16 [20.5%] vs. 40 [19.7%], p<0.879), but the pediatric group had a greater number of total intra-abdominal (49 [62.8%] vs. 47 [23.1%], p < 0.001) and hollow organ injuries (40 [51.3%] vs. 17 [8.4%], p < 0.001). Motor vehicle collision was the most common mechanism of injury for both groups (72 pediatric [92.3%] vs. 85 adult [41.7%]) but adults suffered from more falls (3 pediatric vs. 81 adult, p < 0.001). Pediatric patients with CFx caused by MVCs had more intra-abdominal injuries (48 [66.7%] vs. 25[29.8%], p < 0.001) and hollow organ injuries compared to adults (39 [54.2%] vs. 8[9.5%], p < 0.001). In the setting of Chance fracture after trauma, pediatric patients are more likely to have a concomitant intra-abdominal organ injury (63% vs. 23%), especially hollow viscus injury (51.3% vs. 8.4%) compared with adults regardless of mechanism.

The diagnostic value of laboratory tests in detecting solid organ injuries in pediatric patients with blunt abdominal trauma

BackgroundComputed tomography of the abdomen (CT) is used as the gold standard for detecting solid organ injuries (SOI) after blunt abdominal trauma (BAT). However, patient selection for CT is still controversial due to its potential risks. In this study, we aimed to investigate the usefulness of laboratory tests in the detection or exclusion of SOI in pediatric patients evaluated in the emergency department due to BAT. MethodsThe study was planned as a prospective, observational study and was conducted in the emergency department of a university hospital between February 2018 and February 2019. Patients under the age of 18 who were evaluated for BAT in the emergency department were included in the study. In the study, the diagnostic value of abnormal laboratory tests in detecting SOI was calculated by accepting CT results as the gold standard. ResultsOf the 323 patients included in the study, 118 (36%) were male. There were 283 patients who underwent CT. SOI was detected in 18 (6%) patients. Abnormal alanine aminotransferase, aspartate aminotransferase, amylase and lipase tests were found to be statistically significant in predicting SOI (p < 0.05). However, none of the tests were found to have sufficient sensitivity and specificity. Hemoglobin, hematocrit, lactate and base excess values were not found to be statistically significant in predicting SOI (p > 0.005). ConclusionsThe hematologic laboratory tests are insufficient to rule out solid organ injury in pediatric patient with BAT.

Surgical Skills in General Surgery Residency Program: Current Trends and Future Directions

Today, general surgery residents (GSR) face unorthodox challenges due to variation in caseloads and the implementation of duty hour restrictions. It has been stated that the most concerning change in the education of GSRs was the downward trend in weekly operative cases. The integration of surgical skills labs utilizing human body donors could prove to be beneficial for education. The use of human body donors for anatomy education is not a novel idea, however research needs to be done to better understand pros and cons of different preservation methods for surgical skill training. Traditionally formaldehyde is used as the main preservative however soft‐preservation techniques (such as alcohol and Thiel) and fresh‐frozen methods have been gaining popularity as an educational tool for professional students and surgical residents due to the many lifelike qualities the tissue retains during preservation. Studies using soft preserved donors have investigated skill confidence of GSR which all showed an increase in confidence for surgical skills for all PGY residents. Some of these skills include: surgical airway, tracheoesophageal injuries, thoracotomy‐cardiac injury, solid abdominal organ injury, and more. Integration of human body donors into GSR programs has proven to be advantageous for development of surgical skills and confidence in the capabilities of surgical residents. In an effort to improve anatomy education and surgical skill development for general surgery residents additional research should be done. Future studies need to compare the various educational anatomical models and preservation methods could prove to be advantageous.

Timing of pharmacologic venous thromboembolism prophylaxis initiation for trauma patients with nonoperatively managed blunt abdominal solid organ injury: a systematic review and meta-analysis

BackgroundBlunt abdominal solid organ injury is common and is often managed nonoperatively. Clinicians must balance risk of both hemorrhage and thrombosis. The optimal timing of pharmacologic venous thromboembolism prophylaxis (VTEp) initiation in this population is unclear. The objective was to evaluate early (< 48 h) compared to late initiation of VTEp in adult trauma patients with blunt abdominal solid organ injury managed nonoperatively.MethodsEmbase, MEDLINE, and the Cochrane Central Register of Controlled Trials were searched from inception to March 2021. Studies comparing timeframes of VTEp initiation were considered. The primary outcome was failure of nonoperative management (NOM) after VTEp initiation. Secondary outcomes included risk of transfusion, other bleeding complications, risk of deep vein thrombosis (DVT) and pulmonary embolism, and mortality.ResultsTen cohort studies met inclusion criteria, with a total of 4642 patients. Meta-analysis revealed a statistically significant increase in the risk of failure of NOM among patients receiving early VTEp (OR 1.76, 95% CI 1.01–3.05, p = 0.05). There was no significant difference in risk of transfusion. Odds of DVT were significantly lower in the early group (OR 0.36, 95% CI 0.22–0.59, p < 0.0001). There was no difference in mortality (OR 1.50, 95% CI 0.82–2.75, p = 0.19). All studies were at serious risk of bias due to confounding.ConclusionsInitiation of VTEp earlier than 48 h following hospitalization is associated with an increased risk of failure of NOM but a decreased risk of DVT. Absolute failure rates of NOM are low. Initiation of VTEp at 48 h may balance the risks of bleeding and VTE.