Anna Tatakis

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BACKGROUND: Traumatic hemothorax (HTX) contributes significantly to trauma morbidity and is frequently managed with tube thoracostomy (TT). However, TT placement has complications and some HTXs can be successfully observed. Optimal observation criteria remain unclear, and management practices vary. This multicenter study aimed to characterize current practices, determine observation failure rates, and identify predictors of safe observation. METHODS: We conducted a prospective observational study from July 2023 to June 2025 across 16 trauma centers. Adult patients with computed tomography-confirmed HTX were included. Exclusions included age under 18 years, TT before computed tomography, concurrent pneumothorax >35 mm, death within 48 hours, or observation failure due to operative intervention. HTX volume was calculated using Mergo’s formula ( V =d ² ×L). Each hemithorax was analyzed independently. The primary outcome was observation failure. HTX >300 mL was evaluated as a predictor of failure in a multivariable logistic regression model. RESULTS: Among 962 HTXs in 932 patients, 68% (n=657) were initially observed. The observation group had shorter hospital (7 vs. 9 d) and intensive care unit stays (1 vs. 3 d) compared with immediate TT ( p p 300 mL strongly predicted observation failure (adjusted odds ratio, 16.01; 95% confidence interval, 8.25–31.06). Management practices varied: 52% received antibiotics with TT, 16% underwent irrigation, and thoracostomy tube sizes ranged from 8 to 36 Fr. CONCLUSIONS: Initial observation of HTX is frequently successful, with HTX volume >300 mL being the strongest predictor of failure. Failed observation patients experience longer stays but similar outcomes to early TT placement. Notable practice variation highlights opportunities for research and standardization through unified practice management guidelines. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level III.

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) tubes are used for patients requiring long-term feeding access but are often placed to facilitate hospital disposition. Given the associated procedural risks and potential for patient recovery, we aimed to investigate the rate of return to oral intake after PEG placement, procedural indications, and complications to better elucidate the risk-benefit balance of PEG placement. METHODS: We conducted a retrospective review of all patients who underwent nonelective PEG tube placement at our Level 1 trauma center from January 1, 2023, to March 1, 2024. Patient demographics, procedure details, time to resumption of oral intake, and outcome data were collected. Primary outcome was return to oral intake at discharge. Secondary outcomes included placement for disposition purposes and complication rate. Patients were followed for 1 year after discharge. RESULTS: Of 233 patients identified, 59.7% resumed oral intake by time of discharge, 18.7% of which had returned to normal feeding. The median time to discharge from PEG placement was 11 days (interquartile range, 3–30 days). Furthermore, 37.3% of PEGs were placed for hospital disposition. The overall complication rate was 24.5% (46% Clavien-Dindo grade 3 or higher). Patients who had a PEG placed for disposition resumed an oral diet at a median of 5.5 days versus 17.5 days in those not done for disposition ( p < 0.01). There were similar overall complication rates but a significantly higher proportion of Clavien-Dindo grade ≥3 complications ( p = 0.02) in the PEG placed for disposition group. Overall, 19.7% of PEGs were placed in patients who were nutritionally independent by discharge, experienced in-hospital mortality, or were discharged to hospice. CONCLUSION: Most patients who received a nonelective PEG resumed oral intake prior to discharge. Over one third of procedures were done to facilitate patient disposition, and nearly half of all complications required procedural intervention. Delaying PEG placement until closer to discharge may reduce unnecessary procedures and the associated complications. LEVEL OF EVIDENCE: Therapeutic/Care Management; Level IV.

Violent injury imposes substantial economic, health, and social burdens on survivors, yet little is known about awareness and access to state-run Crime Victims Compensation (CVC) programs among those most affected. This study examined CVC awareness, application patterns, and barriers among violently injured patients at an urban Level I trauma center. We conducted a prospective cohort study of adults (≥ 18 years) admitted between February 1, 2024 and February 1, 2025 for injuries due to firearm assault, pedestrian–motor vehicle collision, physical assault, or reckless injury. Data from the electronic medical record, participant surveys, and the Wisconsin Department of Justice CVC database were analyzed to identify factors associated with CVC application and outcomes. Of 2,200 trauma patients screened, 141 were enrolled. Participants were predominantly male (74%) and Black (68%), with 62% residing in neighborhoods in the highest deciles of socioeconomic disadvantage. Only 9% were aware of the CVC program prior to enrollment, yet 50% applied for funds. Applicants were more likely to be younger, Black, employed, and survivors of gunshot wounds. Among applicants, 55% were approved and 30% denied; delinquent child support accounted for 67% of denials, and discomfort engaging with law enforcement for 14%. Most participants (93%) anticipated injury-related costs (median $1,500). CVC awareness among violently injured patients remains extremely low. Integrating CVC education and assistance into hospital workflows and reforming punitive eligibility criteria are essential to promote equitable financial recovery and community reintegration after violent injury.