DAVID H. LIVINGSTON, M.D.

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Researchers used a structured expert consensus process to identify 12 key outcomes that should be measured in every liver trauma study, covering decisions about surgery, non-surgical management, liver-specific complications, and healthcare use. Before this work, studies used inconsistent measures, making it nearly impossible to compare results or combine data across trials. These standardized outcomes give future researchers a common language and will make liver trauma evidence far more useful.

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A trauma center tracked every patient seen by its emergency general surgery service over a year and found that 60% never had an operation — a group almost entirely absent from existing research and databases. Insurance status and race differed between the surgical and non-surgical groups, pointing to potential inequities. The findings show that registries must capture non-operative patients to accurately measure the true workload and needs of emergency surgery services.

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The study tested whether asking trauma patients to perform an active straight leg raise could replace CT scanning to rule out spinal fractures. The test performed poorly, with a negative predictive value of only 86% and sensitivity of 47% at the highest elevation tested. CT scanning remains necessary for blunt trauma patients with pain or concerning injury mechanisms — the physical exam alone cannot safely exclude spinal fractures.

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A trauma center compared financial outcomes before and after opening a Center for Trauma Survivorship and found each enrolled patient generated $7,752 more in net revenue than patients in the prior period, driven by more follow-up visits and additional surgeries. The center produced a positive contribution margin, disproving the common assumption that such programs are financial liabilities. Dedicated survivorship care pays for itself while improving outcomes for seriously injured patients.

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A review of 16 studies on post-trauma care programs found that coordinated, multi-disciplinary follow-up models — most including mental health providers and lasting around nine months — improved patient engagement and mental health screening after hospital discharge. Results on pain relief and healthcare use were mixed across programs. The review concludes that a standard set of program elements and cost data are needed before these models can be widely adopted.

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This address calls on every trauma center in the country to create a dedicated outpatient program for trauma survivors that provides coordinated physical health, mental health, and social support after hospital discharge. It frames survivorship care as the next frontier in trauma medicine. The argument is direct: saving lives in the hospital is only part of the job.

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An analysis of over 666,000 surgeries at Veterans Affairs teaching hospitals found that surgical residents actually perform more cases independently during off-hours, but the pattern differs by case type — emergency surgery cases give residents more independence on weekdays, while elective cases give more independence on nights. The findings challenge assumptions about off-hours training and have implications for how acute care surgery rotations and night float systems should be structured.

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This review identifies three priorities for improving long-term trauma care: better data collection after discharge, greater attention to traumatic brain injury's lasting effects, and a clearer understanding of how recovery trajectories vary across patients. It maps where current knowledge falls short and what research is needed. The piece frames long-term outcomes as the central unfinished challenge in patient-centered trauma care.

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Older trauma patients with low pre-injury function scores (Palliative Performance Scale at or below 70) were more than three times as likely to die and nearly three times as likely to have poor functional recovery one year after injury compared to those with higher scores. Most patients in both groups still reported persistent pain and anxiety at one year. The PPS score measured before injury is a strong, practical tool for predicting long-term outcomes in older trauma patients.

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Among elderly patients admitted to the ICU solely for rib fractures, 87% did not experience the serious complications that warrant ICU-level care, and those who did develop problems did so around day five. Changing the threshold for ICU admission from any rib fracture to three or more would have freed 50 ICU days with only a 3% rate of missing patients who truly needed intensive care. Smarter triage criteria could significantly reduce unnecessary ICU use in this population.

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A Center for Trauma Survivorship raised outpatient follow-up rates from 73% to 91%, doubled the rate of trauma service visits, and led to significantly more secondary operations — even though the follow-up period coincided with the COVID-19 pandemic. The center also improved access to specialist care beyond the trauma team. These results show that a structured survivorship program can meaningfully change how seriously injured patients navigate recovery.

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This paper describes how a newly formed group of early-career trauma surgeons within the American Association for the Surgery of Trauma built a functioning organization from scratch in its first year, producing bylaws, a mission, a strategic vision, and a leadership succession plan. The experience offers a practical template for other professional groups starting similar initiatives. Mentorship and collaboration among junior faculty and trainees were key to the group's success.

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In over 1,500 trauma patients, men developed sepsis three to five times more often than women after injury, while a specific genetic variant on the X chromosome (IRAK1) influenced which types of infections each sex was prone to. Male patients with the standard IRAK1 gene produced much higher levels of inflammatory proteins after injury than females. The findings suggest that sex-based outcome differences in trauma are driven partly by genetics, not just hormones.

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A hospital-based violence intervention program achieved patient-stated goals for nearly half of its enrollees and reduced PTSD symptoms by the time of hospital discharge, outperforming outcomes in violently injured patients who did not have access to the program. Patients in the program were more likely to complete crime victim compensation paperwork and return to school. The authors argue that short-term health and social outcomes — not repeat injury rates — should be the primary measure of success for these programs.

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A surgical skills competition held annually at a residency program improved resident scores in suturing, advanced laparoscopy, and bowel anastomosis over four years, and faculty reported increased engagement in technical training. The competition was structured so each training year practiced skills matched to their level. A low-cost, competitive format can motivate surgical trainees to practice and improve technical skills.

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Hospitals that performed more than 30 REBOA procedures (balloon catheter aorta occlusion for bleeding control) over five years had 10 percentage points lower mortality than low-volume centers, deployed the device faster, and used it in more critically unstable patients. High-volume centers also placed the balloon more often in the emergency department. Experience with this technique appears to matter — patients treated at centers that use it more often are more likely to survive.

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Among elderly patients hospitalized with severe traumatic brain injury, 78% died in the hospital and only 35% received palliative care consultations — despite the fact that palliative care was associated with lower use of life-sustaining interventions and shorter hospital stays for survivors. Those who had surgery were even less likely to receive palliative care. Palliative care is underused in this high-mortality population and should be integrated more consistently.

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This study developed a genetic test to determine which copy of the X chromosome is active in white blood cells of women who carry both a standard and a variant form of the IRAK1 gene — a gene that regulates immune responses. After injury, trauma patients showed increased circulation of the white blood cell subset carrying the more active X chromosome copy, without reversing direction. The work advances understanding of how immune responses are shaped by genetics and sex in injured patients.

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Nationally, safety-net hospitals — which serve the most uninsured and Medicaid patients — performed index cholecystectomy at similar rates to other hospitals except in the Northeast, where rates were lower. Patients at safety-net hospitals had longer hospital stays regardless of when surgery occurred. These findings point to geographic and resource-related disparities in care quality for one of the most common emergency abdominal conditions.

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A survey of acute care surgery fellowship graduates found that trauma was the top career motivation across all fellowship types, and that the two-year fellowship approved by the American Association for the Surgery of Trauma was the most preferred option among those who would choose differently. Fellowship type did not predict academic output or practice patterns after graduation. Newer graduates were more likely to value schedule predictability when choosing their career path.

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A dedicated Center for Trauma Survivorship enrolled seriously injured patients after discharge and achieved a 17% no-show rate — far better than the under-30% follow-up typical in trauma care. Of patients who screened positive for PTSD or depression, 86% successfully received behavioral health services, and unplanned emergency department visits dropped compared to a prior similar group. The center demonstrated that comprehensive, coordinated post-discharge care is feasible and reduces downstream healthcare burden.

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As COVID-19 cases rose in New Jersey, a trauma center reconfigured its resuscitation bay to treat every incoming patient as potentially infected — reorganizing supplies, restricting access to protective equipment, and streamlining the space to reduce exposure. The changes addressed both the physical layout and staffing approach. The piece shares practical lessons for adapting trauma resuscitation areas during a respiratory pandemic.

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This guidance document outlines how trauma and acute care surgeons should place, manage, and remove chest tubes safely during the COVID-19 pandemic, when standard procedures create aerosolization risks. It was produced jointly by two major surgical committees in response to the early pandemic. The goal is to protect surgical teams from viral exposure during a common but aerosol-generating procedure.

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This article summarizes the 50-year history of the Western Trauma Association, tracing how the organization shaped trauma care, produced influential leaders, and built a distinctive culture of collegiality. It reviews the group's scientific contributions and the values its founders established. The piece marks the anniversary by looking both backward at what was built and forward at the organization's continued relevance.

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Trauma patients with obstructive sleep apnea who underwent surgery for pelvic or leg injuries were significantly more likely to need ventilator support, develop blood clots in the lungs, develop respiratory distress syndrome, or experience respiratory failure than patients without sleep apnea. Sleep apnea raised the odds of respiratory failure by 90%. Trauma teams should screen more aggressively for sleep apnea and monitor these patients more closely around surgery.

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Among older trauma patients with poor outcomes, those who died in the hospital almost universally had goals-of-care conversations and do-not-resuscitate orders, but the majority of patients who survived with severe disability did not — leaving most of that group without palliative care support. Half of patients who died within six months of discharge never had a goals-of-care conversation during their hospital stay. Structured triggers are needed to identify living patients with poor functional outcomes who would benefit from palliative care.

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Low skeletal muscle mass (sarcopenia), measured from CT scans taken on admission, independently predicted poor functional status at hospital discharge in older trauma ICU patients, even after accounting for age, brain injury, and injury severity. About one-third of the 230 patients studied were sarcopenic, and more than half of sarcopenic survivors had poor functional outcomes. Measuring muscle mass from routine trauma CT scans is a practical way to identify older patients at high risk for poor recovery.