Elliot Richard Haut

INTRODUCTION: Homicide is a leading cause of childhood death, yet few studies distinguish child homicide from adolescent and adult patterns, challenging the development of prevention strategies. We sought to define how child homicide epidemiology differs from that of older age groups in Maryland. METHODS: In this cross-sectional study, we analyzed all homicide decedents in Maryland (2005–2017) using Office of the Chief Medical Examiner data. Age groups were defined per American Academy of Pediatrics: child/early adolescent (0–14), adolescent (15–22), young adult (23–30), and adult (31+). Descriptive statistics were calculated, and multinomial logistic regression (children as reference) assessed associations with sex, race, mechanism, site, and geography. Two interactions (race×sex and mechanism×site) were retained. RESULTS: Among 6,508 homicide decedents, 217 were children, 1,242 adolescents, 2,226 young adults, and 2,823 adults. Children were more often female (44% vs. 9%–19%) and less likely to die in Baltimore (25% vs. 40%–46%) than all older groups, and more likely to die at home (21% vs. 5%–7%) than adolescents and young adults. Firearm deaths were less common in children (28% vs. 65%–84%) while blunt trauma was more common (36% vs. 2%–9%). In regression, older groups were less likely than children to be female (OR, 0.6–0.8), die at home (OR, 0.1–0.5, p p p p p =0.001) among adults. CONCLUSIONS: Child homicide differs markedly from older groups, with victims more often female, killed by non-firearm mechanisms, at home, and outside Baltimore. By adolescence, decedents reflect a more “adult” profile in sex, mechanism, site, and geography. Homicide prevention strategies for children may need to diverge from those targeting community gun violence in older groups. ( J Trauma Acute Care Surg . 2026;00: 000–000. Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved.) LEVEL OF EVIDENCE: Cross-Sectional; Level IV.

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a resource-intensive therapy that can be used in severe cardiogenic shock (CS). Socioeconomic factors are known determinants of cardiovascular outcomes, yet their association with mortality among patients receiving mechanical circulatory support remains unclear. We conducted a retrospective cohort study using the Healthcare Cost and Utilization Project National Inpatient Sample, including adult hospitalizations with CS receiving VA-ECMO between 2018 and 2022. Exposure was Zone Improvement Plan (ZIP) code-level median household income quartile. The primary outcome was in-hospital mortality. We used multivariable regression to estimate risk ratios and Cox-proportional hazards for time-to-event analyses, adjusting for confounders. The 3,032 hospitalizations were evenly distributed across income quartiles. Compared with the lowest-income quartile, the adjusted mortality risk ratio of the second (adjusted risk ratio [aRR], 0.97; 95% confidence interval [CI], 0.86–1.09) and third quartiles (aRR, 0.94; 95% CI, 0.84–1.05) had no significant difference. The highest-income quartile had a significantly lower risk of in-hospital mortality (aRR, 0.83; 95% CI, 0.74–0.94). Time-to-event analyses showed a lower adjusted hazard of death for the fourth versus first quartile (adjusted hazard ratio [aHR], 0.76; 95% CI, 0.64–0.89), whereas second and third quartiles were not significantly different. These findings suggest that disparities persist among patients receiving resource-intensive life-support therapies, highlighting the need to measure socioeconomic variables and address structural factors influencing outcomes in critical care.

Background: Guiding risk-appropriate inpatient thromboprophylaxis requires venous thromboembolism (VTE) risk stratification; however, reliable risk determination remains inconsistent in routine care. Health systems increasingly pilot artificial intelligence (AI) tools, yet few studies demonstrate rigorous evaluation in the context of a learning health system (LHS). We evaluated the performance of a pilot electronic health record (EHR)-integrated generative AI (GenAI) system, inHealth General Reasoner (iHGR), for VTE risk stratification versus clinician order set classifications and physician-adjudicated chart review. Methods: This multisite retrospective validation study included adult inpatient admissions at Johns Hopkins Medicine between June 21, 2025, and Dec 18, 2025 (checklist-based order set from June 21, 2025 – November 19, 2025, and clinician judgement-based order set from November 29 – December 18, 2025). From 758 eligible admissions, we randomly sampled 500 balanced by site and order set periods. iHGR and clinician-selected order set classifications were compared with the reference standard (RS). Primary outcomes were iHGR sensitivity and specificity. Secondary analyses compared the order sets with the same RS to evaluate workflow comparators and error patterns. Results: iHGR achieved 81.8% sensitivity (95% CI 77.3–85.6) and 70.9% specificity (63.6–77.3). The checklist-based order set had 61.3% sensitivity (53.7–68.5) and 86.2% specificity (77.4–91.9). The clinician judgement-based order set had 78.1% sensitivity (71.3–83.7) and 65.4% specificity (54.3–75.0). False-negative iHGR classifications were associated with missed narrative risk factors. Conclusion: iHGR showed higher sensitivity for VTE risk than checklist-based order sets and clinician judgement without introducing systematic bias. In silico evaluation of pilot AI systems within LHSs can identify clinically important performance trade-offs and implementation targets before operational scale-up. Narrative clinical data abstraction remained a key limitation, supporting the use of GenAI to support rather than supplant clinician judgement.

Cystic fibrosis (CF) and sickle cell disease (SCD) are associated with an increased risk of venous thromboembolism (VTE), and this risk is exacerbated by hospitalization. VTE prophylaxis nonadministration is a VTE risk factor. The objective of this study was to characterize VTE prophylaxis nonadministration among patients with either CF or SCD compared with medically ill patients without CF or SCD. We conducted a single-center retrospective cohort study of hospitalized patients who were prescribed at least 2 doses of pharmacologic VTE prophylaxis. The primary outcome was the proportion of nonadministered VTE prophylaxis doses by cohort. Multivariable logistic regression was used to identify characteristics associated with nonadministration. A total of 13 316 patients were included, comprising 89 with CF, 246 with SCD, and 12 981 otherwise medically ill. During the study period, 95 697 doses were prescribed; nonadministration rates were 61.8% in the CF cohort, 32.7% in the SCD cohort, and 19.7% in the medically ill cohort (P< .01). In the multivariable logistic regression, CF or SCD diagnosis (odds ratio [OR], 2.03; 95% confidence interval [CI], 1.59-2.6), multiple admissions (OR, 2.4; 95% CI, 2.19-2.64), and >5 prescribed doses of VTE prophylaxis (OR, 2.48; 95% CI, 2.29-2.69) were associated with nonadministration of ≥1 dose. The percent of missed doses (median interquartile range [IQR]) per patient was highest in the CF cohort (66.7% [84.5]), followed by the SCD cohort (10.6% [50]), and medically ill cohort (0% [16.7]; P< .01). These findings suggest strategies to improve VTE prophylaxis administration rates during acute hospitalization in high-risk conditions such as CF and SCD are needed.

10 years ago today, Trauma Surgery & Acute Care Open (TSACO) published its first manuscript. The founding editor-in-chief, Dr Timothy Fabian, described the birth of a new journal at a time when open access publishing was rapidly reshaping the landscape.1 The American Association for the Surgery of Trauma (AAST) owned one traditional, subscription journal. But, the organization realized that to stay relevant, it had to join the open access revolution. They partnered with BMJ, launching TSACO on 24 May 2016. Dr Fabian wrote about the future of medical publishing1 and took on this new challenge. For 7 years, he led our fledgling journal through its formative years. He loves the birth analogy and slowly growing from infancy to toddlerhood. That first year, the journal published 33 manuscripts. We have grown that number exponentially ever since.

Background: Although clinical guidelines endorse enoxaparin for the prevention of venous thromboembolism in patients with orthopaedic trauma, recent evidence from a large clinical trial has demonstrated that aspirin provides comparable protection against death and pulmonary embolism. This study evaluated the cost-effectiveness of thromboprophylaxis with enoxaparin compared with that with aspirin in patients with orthopaedic trauma from the perspective of the U.S. health-care system. Methods: The study modeled a hypothetical cohort of adult patients with an operatively treated extremity, pelvic, or acetabular fracture based on data from a recent clinical trial and national databases. We used a decision analysis model to compare 30 mg of enoxaparin with 81 mg of aspirin, administered twice daily in-hospital and prescribed for 21 days after discharge. Health-care costs and quality-adjusted life-years (QALYs) within 1 year after the injury derived from published research and publicly available cost data were based on potential disease states, including death or a combination of pulmonary embolism, proximal deep vein thrombosis, distal deep vein thrombosis, or a bleeding complication. We assessed cost-effectiveness compared with a willingness-to-pay threshold of $150,000 per QALY. Results: Our model estimated that the 1-year health-care costs among patients prescribed enoxaparin were $35,301, producing 0.6705 QALYs. Aspirin was associated with $35,067 in 1-year health-care costs and 0.6701 QALYs. The overall health-care costs were $234 higher with enoxaparin but yielded only a 0.0004 improvement in QALYs, for an incremental cost-effectiveness ratio for enoxaparin of $635,340 per QALY, indicating that enoxaparin is not cost-effective compared with aspirin. In a sensitivity analysis, the probability of enoxaparin thromboprophylaxis being cost-effective compared with aspirin was 9.8% in 10,000 iterations. Conclusions: The findings suggest that enoxaparin is not cost-effective relative to aspirin for thromboprophylaxis in patients with orthopaedic trauma. The results support consideration of aspirin as a preferred agent in future guidelines, especially given the consistent patient preference for its oral administration. Level of Evidence: Economic and Decision Analysis Level I . See Instructions for Authors for a complete description of levels of evidence.

As the new Associate Editors of Patient Engagement and Education at Trauma Surgery & Acute Care Open (TSACO), we are honoured to comment on the important article by Mahajan et al titled ‘Content assessment and readability of online injury prevention resources on firearm safety: a cross-sectional analysis of hospital and national injury prevention literature’.1 While firearm safety often centers on advocacy and legislation, this manuscript highlights a broader and critical issue: healthcare literacy.1

Background: Enhanced recovery after surgery (ERAS) has been hypothesized to improve surgical outcomes following colorectal surgery; however, the long‐term sustainability of improvement remains unclear. Materials and Methods: A comprehensive ERAS program was implemented for patients undergoing colorectal surgery at Johns Hopkins Hospital (JHH) in 2014. This study investigated inpatient elective colorectal surgery outcomes at JHH during three two‐year postimplementation periods (2014–19) relative to a two‐year baseline (2012–2013) via pre–post analyses and using difference‐in‐differences (DID) regression comparing JHH with a national sample of > 700 hospitals participating in the National Surgical Quality Improvement Program (NSQIP). Length of stay (LOS) was evaluated using multivariable zero‐truncated negative binomial regression, whereas Surgical Site Infections (SSIs) and readmission rates were analyzed using multivariable logistic regression. Analyses controlled for ASA score, procedure type, age, sex, race, and surgical approach. Results: The study included 1851 patients at JHH and 303,175 patients from the national sample. In pre–post analyses comparing JHH from baseline (2012–2013) to the final period (2018–2019), statistically significant improvements were seen for SSIs with a 4.4% reduction (OR 0.54 and 95% CI 0.35–0.86) and for readmissions with a 5.6% reduction (OR 0.57 and 95% CI 0.39–0.85), while LOS was statistically unchanged (0.41 days reduction; IRR 0.93 and 95% CI 0.85–1.01). DID analyses showed statistical equivalence for SSIs (OR 0.80 and 95% CI 0.51–1.26), greater improvement for readmission rates at JHH (OR 0.62 and 95% CI 0.42–0.92), and lower improvement for LOS at JHH (IRR 1.17 and 95% CI 1.07–1.27). Conclusions: ERAS implementation at JHH was associated with sustained improvement that was comparable (SSIs) or superior (readmissions) to national improvement trends over a period of 6 years (postimplementation), suggesting ERAS adoption in colorectal surgery is warranted for long‐term outcomes improvement. Results were suggestive of a tradeoff between readmission rates and LOS.

Objective: To summarise the literature on healthcare interventions to reduce harm to patients caused by the COVID-19 pandemic across six domains: medication safety, diagnostic safety, surgical safety, healthcare-associated infections, pressure injuries and falls. Methods: We performed a mixed-methods systematic review, with the intention to present results narratively. We combined parallel searches and expert input across each domain of interest, identifying 13 019 unique articles across the six domains. Of these, 590 full texts were assessed for eligibility. 7 were included for the medication safety domain; 7 for diagnostic safety; 32 for surgical safety; 11 for healthcare-associated infections; 5 for the pressure injuries and 2 for falls. Overall, a total of 61 unique articles were included—4 articles were represented across more than one domain. Findings: There were few rigorous evaluations of specific interventions to reduce patient harm caused by the pandemic. Adjustments in treatments, triage and procedures, and use of risk stratification tools reduced delays and permitted more elective surgery and diagnostic testing to proceed. These changes also led to improvements in medication safety practices and prevention of healthcare-associated infections. Conclusion: There has been little research on interventions to reduce patient harm caused in healthcare settings during the COVID-19 pandemic. Interventions focused on preventing nosocomial transmission of COVID-19 and on permitting access to urgent surgical and diagnostic needs. A few studies tested strategies to reduce new risks imposed by the pandemic for medication safety, healthcare-associated infections, pressure injuries and falls. Development of high-reliability health systems and healthcare organisations to protect patients and health workers from harm will be essential to mitigating the impact of future pandemics within the objectives of the Global Patient Safety Action Plan 2021–2030.

Background: Tracheostomy is a life-saving procedure associated with complex long-term care needs and potential complications, including stoma infections, respiratory challenges, and impaired quality of life (QoL). While follow-up care is widely recommended, its impact on adherence to maintenance practices, clinical outcomes, and long-term recovery has not been thoroughly evaluated. Objectives: This study examined the influence of follow-up care on tracheostomy management, adherence to care routines, clinical outcomes, and QoL three months and three-years post-discharge. Key objectives included assessing adherence to stoma cleaning and tube changes, evaluating complication rates, tracheostomy retention, and analyzing QoL outcomes in patients who received follow-up care compared to those who did not. Methods: A longitudinal cohort study was conducted at The Johns Hopkins Hospital, including 220 adult patients who underwent tracheostomy between 2007 and 2017. Data were collected through electronic health records and structured telephone surveys. Primary outcomes included adherence to maintenance practices, clinical complications, and health-related quality of life (HRQoL) measured using the SF-8 Health Survey. Statistical analyses included chi-square tests, t-tests, and multivariate regression. Results: Among 220 patients who completed the study, 166 (75.5%) received follow-up care. Patients with follow-up care demonstrated significantly higher adherence to stoma cleaning protocols (p = 0.001), although tube change frequency did not differ between groups (p = 0.37). Follow-up care was associated with more frequent identification of complications, including stoma infections (7.8% vs. 1.9%, p = 0.11) and respiratory difficulties (39.1% vs. 22.2%, p = 0.05). However, these differences were not statistically significant except for breathing difficulties. HRQoL analyses revealed marginally lower physical component scores (PCS) in the follow-up group (44.4 vs. 48.0, p = 0.03), while mental component scores (MCS) were comparable between groups (42.1 vs. 42.8, p = 0.66). At three years post-discharge, tracheostomy tube retention was low (6.8%), with stenosis being the most common reason for long-term tracheostomy dependence. Follow-up care was associated with a higher likelihood of timely tracheostomy tube removal and improved cosmetic outcomes. Conclusions: Follow-up care plays a critical role in improving adherence to tracheostomy maintenance and ensuring timely management of complications. However, disparities in QoL outcomes and care protocols highlight the need for standardized, multidisciplinary follow-up systems. Future research should explore scalable interventions, such as telehealth, to optimize care for tracheostomy patients and address barriers to equitable access.