Nicole L. Werner

Level of Evidence: Therapeutic/Care Management; Level V. ( J Trauma Acute Care Surg . 2026;00: 000–000 Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved).

Emergency general surgery (EGS) represents a significant portion of admissions to hospitals and overall surgical care delivery, yet comprehensive outcome tracking and quality improvement efforts have lagged behind elective surgery and trauma care. This article outlines the gap in data and provides three practical solutions to registry development: third-party registry software with dedicated registrars, leveraging existing National Surgical Quality Improvement Program (NSQIP) infrastructure through the EGS-NSQIP module, and automated data extraction from electronic medical records. Each approach offers unique advantages in addressing the dual challenges of case identification and risk-adjusted outcome measurement for both local quality improvement and national benchmarking. The aim of this white paper is to provide pragmatic, scalable data solutions for EGS leaders seeking to implement contemporary quality improvement and verification efforts.

The spleen is a frequently injured organ, with over 40,000 adult splenic injuries occurring yearly. It plays an important role in the body's immune system, so surgeons should make every effort to perform splenic salvage when able. In blunt injury, indications for emergent splenectomy have not recently changed and include hemodynamic instability and peritonitis. A computed tomography (CT) scan with intravenous contrast is the preferred imaging modality for hemodynamically normal patients and should be used to classify the grade of injury and identify active bleeding and its stigmata. Nonoperative management has been successful for all grades of blunt injury (80–95%), but it is the job of the surgeon to carefully select the patient, in the context of their age, other associated injuries, and splenic CT findings, so this success rate remains high. Angioembolization is an important tool for splenic salvage that should be used when an actively bleeding vessel is observed on CT scan. Both proximal and distal embolizations are effective with no data to suggest that one is superior to the other. All patients selected for nonoperative management require close monitoring, which can include interval CT scans for high-grade injuries. Penetrating splenic injuries differ from blunt injuries because they are more likely to be surgically explored on presentation and they have a higher operative splenorrhaphy rate.

LEVEL OF EVIDENCE: Therapeutic/Care Management: Level V.

Objectives: The purpose of this study was to compare prenatal versus postnatal markers of congenital diaphragmatic hernia (CDH) severity at a single fetal‐care center.Methods: A retrospective study was performed of patients having a complete prenatal evaluation and surgical repair (n = 55). Observed‐to‐expected lung‐to‐head ratio (o/eLHR), observed‐to‐expected total lung volume (o/eTLV), liver position (LP), a predictive dependent variable from logistic regression of o/eLHR and liver position (o/eLHR + LP), and diaphragmatic defect size per the CDH Study Group A–D classification were plotted into receiver–operating characteristics (ROC) curves. Survival and need for extracorporeal membrane oxygenation (ECMO) were primary outcomes.Results: Survival was 69%, and ECMO utilization was 56%. Distribution was 80% left‐sided defects. In the survival ROC curve, the area under the curve (AUC) for o/eLHR was 0.73, o/eTLV 0.74, LP 0.73, o/eLHR + LP 0.78, and defect size 0.84 (p = 0.23). The ROC curve for ECMO support showed o/eLHR had an AUC of 0.82, o/eTLV 0.89, LP 0.79, o/eLHR + LP 0.87, and defect size 0.90 (p = 0.19). The AUCs were similar when only left‐sided CDH was analyzed.Conclusions: These data suggest that prenatal evaluation was equivalent to the postnatal diaphragmatic defect classification for predicting survival and need for ECMO in CDH patients. © 2015 John Wiley & Sons, Ltd.