Placement of Surgical Feeding Tubes Among Patients With Severe Traumatic Brain Injury Requiring Exploratory Abdominal Surgery : Better Early Than Late.

OBJECTIVES: The purpose of this study was to identify trauma patients who would benefit from surgical placement of an enteral feeding tube during their index abdominal trauma operation. METHODS: We performed a retrospective analysis of all patients admitted to 2 level I trauma centers between January 2013 and February 2018 requiring urgent exploratory abdominal surgery. RESULTS: Six-hundred and one patients required exploratory abdominal surgery within 24 hours of admission after trauma activation. Nineteen (3% of total) patients underwent placement of a feeding tube after their initial exploratory surgery. On multivariate analysis, an intracranial Abbreviated Injury Scale ≥4 (odds ratio [OR] = 9.24, 95% CI 1.09-78.26, P = .04) and a Glasgow Coma Scale ≤8 (OR = 4.39, 95% CI 1.38-13.95, P = .01) were associated with increased odds of requiring a feeding tube. All patients who required a feeding tube had an Injury Severity Score ≥15. While not statistically significant, patients with an open surgical feeding tube compared with interventional radiology/percutaneous endoscopic gastrostomy placement had lower median intensive care unit length of stay, fewer ventilator days, and shorter median total hospital length of stay. CONCLUSIONS: Trauma patients with severe intracranial injury already requiring urgent exploratory abdominal surgery may benefit from early, concomitant placement of a feeding tube during the index abdominal operation, or at fascial closure.

Impact of shelter-in-place order for COVID-19 on trauma activations: Santa Clara County, California, March 2020.

INTRODUCTION: The shelter-in-place order for Santa Clara County, California on 16 March was the first of its kind in the USA. It was unknown what impact this order would have on trauma activations. METHODS: We performed a retrospective analysis of institutional trauma registries among the two American College of Surgeons Level 1 trauma centers serving Santa Clara County, California. Trauma activation volumes at the trauma centers from January to March 2020 were compared with month-matched historical cohorts from 2018 to 2019. RESULTS: Only 81 (3%) patients were trauma activations at the trauma centers in the 15 days after the shelter-in-place order went into effect on 16 March 2020, compared with 389 activations during the same time period in 2018 and 2019 (p<0.0001). There were no other statistically significant changes to the epidemiology of trauma activations. Only one trauma activation had a positive COVID-19 test. DISCUSSION: Overall trauma activations decreased 4.8-fold after the shelter-in-place order went into effect in Santa Clara County on 16 March 2020, with no other effect on the epidemiology of persons presenting after traumatic injury. CONCLUSION: Shelter-in-place orders may reduce strain on healthcare systems by diminishing hospital admissions from trauma, in addition to reducing virus transmission.

Recovery of a Missile Embolus From the Right Ventricle.

Missile embolism is a clinical entity in which a projectile object enters a blood vessel and is carried to a distant part of the body. We present a case of the discovery of an iliac vein to right ventricle missile embolus in a young man, with successful extraction through a right atriotomy. We provide a historical overview of the literature concerning missile embolism, and we argue that whereas acute embolized projectiles should be removed in almost all cases, it may be reasonable to simply observe an asymptomatic chronic missile embolus.

The relative impact and future burden of prostate cancer in the United States.

PURPOSE: In the last 2 decades there has been increasing awareness of and research on prostate cancer. We considered prostate cancer in the context of other major causes of morbidity and mortality. MATERIALS AND METHODS: Surveillance, Epidemiology, and End Results, and other government databases were used to 1) compare the incidence and mortality burden of prostate cancer with that of other cancers and major causes of death; 2) examine the changing trends in prostate cancer mortality using joinpoint analysis and 3) consider the future burden of prostate cancer in the United States due to aging. To project the future burden of prostate cancer year 2000 mortality rates were applied to age specific population projections from the United States Census Bureau. RESULTS: Prostate cancer continues to have the highest incidence rate and the second highest mortality rate of any cancer in American men and it ranks among the top 10 overall causes of death. The mortality rate of prostate cancer has been decreasing steadily at approximately 4% yearly since 1994, while the incidence rate has been increasing at slightly less than 2% yearly since 1995. CONCLUSIONS: The overall decrease in the mortality rate of prostate cancer since 1994 may be due to improvements in screening, diagnosis and treatments. Despite the decreasing mortality rate the aging of the American population and the exponential increase in prostate cancer incidence and mortality rates by age are important to consider when assessing the future morbidity and mortality burden of this disease and the appropriate allocation of health care resources.