Contemporary Management of Blunt Splenic Trauma in Adults: An Analysis of the Trauma Quality Improvement Program Registry

PURPOSE

The aim of this study was to evaluate the effectiveness of management strategies for blunt splenic injuries in adult patients.

METHODS

Patients 18 years and older with blunt splenic injuries registered via the Trauma Quality Improvement Program (2013-2019) were identified. Management strategies initiated within 24 hours of hospital presentation were classified as watchful waiting, embolization, surgery, or combination therapy. Patients were stratified by injury grade. Linear models estimated each strategy's effect on hospital length of stay (LOS), intensive care unit (ICU) LOS, and mortality.

RESULTS

Of 81,033 included patients, 86.3%, 10.9%, 2.5%, and 0.3% of patients received watchful waiting, surgery, embolization, and combination therapy, respectively. Among patients with low-grade injuries and compared with surgery, embolization was associated with shorter hospital LOS (9.4 days, Q < .001, Cohen's d = .30) and ICU LOS (5.0 days, Q < .001, Cohen's d = .44). Among patients with high-grade injuries and compared with surgery, embolization was associated with shorter hospital LOS (8.7 days, Q < .001, Cohen's d = .12) and ICU LOS (4.5 days, Q < .001, Cohen's d = .23). Among patients with low- and high-grade injuries, the odds ratios for in-hospital mortality associated with surgery compared with embolization were 4.02 (Q < .001) and 4.38 (Q < .001), respectively.

CONCLUSIONS

Among patients presenting with blunt splenic injuries and compared with surgery, embolization was associated with shorter hospital LOS, shorter ICU LOS, and lower risk for mortality.

Contemporary Use of Prophylactic Inferior Vena Cava Filters in Patients With Severe Traumatic Injuries and High Thromboembolic Event Risk

PURPOSE

The aim of this study was to evaluate the relationship between prophylactic inferior vena cava filter (IVCF) implantation and in-hospital deep vein thrombosis (DVT), pulmonary embolism (PE), and mortality among adults with intracranial, pelvic or lower extremity, and spinal cord injuries.

METHODS

Patients 18 years and older with severe intracranial, pelvic or lower extremity, or spinal cord injuries captured by the Trauma Quality Improvement Program (2010-2019) were identified. IVCFs implanted ≤72 hours after hospital presentation and before performance of lower extremity ultrasonography were defined as prophylactic. Patients were stratified by pharmacologic venous thromboembolism (VTE) prophylaxis status. Logistic regression models estimated prophylactic inferior vena cava (IVC) filtration's effect on selected outcomes and identified attributes associated with prophylactic IVCF implantation.

RESULTS

Of 544,739 included patients, 1.3% (n = 7,247) underwent prophylactic IVCF implantation. Among patients who received pharmacologic VTE prophylaxis, prophylactic IVC filtration compared with expectant management was positively associated with DVT (odds ratio [OR], 4.30; P < .001) and PE (OR, 4.30; P < .001) but not associated with mortality (OR, 0.92; P = .43). Among patients who received no pharmacologic prophylaxis, prophylactic IVC filtration was positively associated with DVT (OR, 4.63; P < .001) and PE (OR, 5.02; P < .001) but negatively associated with mortality (OR, 0.43; P < .001).

CONCLUSIONS

Prophylactic IVC filtration was associated with increased likelihood of VTE among all adults with severe intracranial, pelvic or lower extremity, and spinal cord injuries. In patients who received no pharmacologic VTE prophylaxis, prophylactic IVC filtration was associated with decreased likelihood of in-hospital mortality.

Contemporary Management of Blunt Liver Trauma: An Analysis of the Trauma Quality Improvement Program Registry (2007-19)

PURPOSE

To evaluate the effectiveness of management strategies for blunt liver injuries in adult patients.

MATERIALS AND METHODS

Patients 18 years and older with blunt liver injuries registered via the Trauma Quality Improvement Program (2007-19) were identified. Management strategies initiated within 24 hours of hospital presentation were classified as non-operative management (NOM), embolization, surgery, or combination therapy. Patients were stratified by injury grade. Linear models estimated each strategy's effect on hospital length of stay (LOS), intensive care unit (ICU) LOS, ventilator dependence, and mortality.

RESULTS

Of 78,127 included patients, 88.7%, 8.7%, 1.8%, and 0.8% of patients received NOM, surgery, embolization, and combination therapy, respectively. Among patients with low- (n = 62,237) and high-grade (n = 15,890) injuries and compared to all other management strategies, NOM was associated with the shortest hospital LOS and ICU LOS. Among patients with low-grade injuries and compared to surgery, embolization was associated with a shorter hospital LOS (9.7 days, P < .001, Cohen's d = .32) and ICU LOS (5.3 days, P < .001, Cohen's d = .36). Among patients with high-grade injuries and compared to surgery, embolization was associated with a shorter ICU LOS (6.0 days, P < .01, Cohen's d = .24). Among patients with low- and high-grade injuries and compared to embolization, surgery was associated with higher odds of mortality (P < .001).

CONCLUSIONS

Among patients presenting with blunt liver injuries and compared to surgery, embolization was associated with a shorter ICU LOS and lower risk of mortality.

Carrying capacity in a heterogeneous environment with habitat connectivity

A large body of theory predicts that populations diffusing in heterogeneous environments reach higher total size than if non-diffusing, and, paradoxically, higher size than in a corresponding homogeneous environment. However, this theory and its assumptions have not been rigorously tested. Here, we extended previous theory to include exploitable resources, proving qualitatively novel results, which we tested experimentally using spatially diffusing laboratory populations of yeast. Consistent with previous theory, we predicted and experimentally observed that spatial diffusion increased total equilibrium population abundance in heterogeneous environments, with the effect size depending on the relationship between r and K. Refuting previous theory, however, we discovered that homogeneously distributed resources support higher total carrying capacity than heterogeneously distributed resources, even with species diffusion. Our results provide rigorous experimental tests of new and old theory, demonstrating how the traditional notion of carrying capacity is ambiguous for populations diffusing in spatially heterogeneous environments.