Introduction and objectives: The trauma foundation (FT) promotes training, with scientific support through a Scholarship Program. From 2009 to 2015, TF awarded 7,021 scholarships to 3,944 professionals (1.8 scholarship/person with an average of 1000 scholarships/year), registering an absenteeism (nonattendance) of 18.2%. The objective of the present work was to analyze the causes of absenteeism and to implement strategies to reduce it. Methods: An online survey was prepared with 12 multiple choice questions, which was sent to the 756 absentees who had email (the total number of absentees was 1,184), of which 168 (22%) responded. Results: Of the total survey responses, 66.7% were women and most of the respondents were in the age range of 31–40 years (34.5%). 51.8% were doctors, and 44% reported having a formal employment relationship. The causes of absenteeism: 39.9% due to challenges at work; 14.9% for personal reasons; 3% due to lack of time to study; 3% due to lack of interest in the course; 2.4% due to difficulties in accessing/downloading the reading material and 36.9% did not specify. 15.5% responded that they had been absent in more than one course, 15.5% that they did not remember which course they were absent and 12.5% mentioned ACLS®. Conclusion: The results of the survey allowed us to create strategies to reduce absenteeism. Since the main cause of absenteeism was work-related issues, it is necessary to negotiate with the health authorities to provide protected time to the scholars to leave work and attend the courses (through replacements, permissions or flexibility in work hours). Despite the Scholarship Program eliminating one economic barrier (training costs are paid for), we observed that it is not enough to guarantee access to the courses. This finding does not eliminate the importance of promoting individual commitment of the scholars to attend the training and reduce absenteeism, with the aim of improving the performance of their role in the healthcare field.

Severe traumatic brain injury (TBI) is a major public health issue, responsible for high rates of long-term disability and mortality. Although severe TBI is a leading cause of death worldwide, even mild head injuries can adversely impact the functional outcome. It is well described that trauma produces a complex stress response to reestablishing homeostasis. The activation of the stress response (i.e., the hypothalamic–pituitary–adrenal axis and the sympathetic nervous system) leads to the release of glucocorticoids and catecholamines. Although fundamental for survival, the stress response is one of the major players in the development of posttraumatic complications. TBI in particular leads to a fast and intense sympathetic nervous system's activation with huge liberation of both central and peripheral catecholamines, including epinephrine (Epi) and norepinephrine (NE). Since catecholamine levels increase exponentially after TBI, they have been appraised as possible prognostic biomarkers and a target for intervention in this clinical setting. Currently, there is no particular pharmacological treatment available to reduce or limit the progression of secondary brain injury after TBI. However, preliminary data on the use of β-blockers after TBI have shown promising results. A recent meta-analysis estimated an in-hospital mortality reduction of 65%, while a matched case–control study described that the exposure to a β-blocker were associated with improved functional outcome. Despite these promising and interesting results, the use of β-blockage in the acute phase of TBI remains experimental, requiring further evaluation in a well-designed multicenter randomized clinical trial.

Background: Previous studies have demonstrated an association between lack of insurance and outcomes after trauma. However, it is not clear if this is merely a surrogate for socioeconomic status. The purpose of this study is to investigate the relationship between household income and mortality among injured patients. Methods: The Arizona Inpatient State Database was used to identify all trauma patients over a representative 1-year period. Demographics, clinical data, and outcomes were extracted. Median household income (MHI) for patients’ domiciliary zip code was extracted. Patients were divided into four quartiles according to MHI (lowest, low, high, and highest). The standard statistical analysis was used to compare groups. Results: A total of 58,743 were available for analysis (lowest: 27.6%; low: 25.9%; high: 26.3%; and highest: 20.2%). There was a decrease in the proportion of males as MHI increased (lowest: 53.4%, low: 48.8%, high: 49.2%, and highest: 48.7%, p <0.001). Similarly, there was a decrease in the proportion of Hispanics and Native Americans (Hispanics: lowest: 23.6%, low: 14.9%, high: 12.9%, and highest: 5.9%, p <0.001; Native Americans: lowest: 10.8%, low: 2.5%, high: 2.9%, and highest: 0.8%, p <0.001). There was also a decrease in the incidence of penetrating trauma as MHI increased (lowest: 9.6%, low: 8.4%, high: 7.6%, and highest: 6.6%, p <0.001), in particular for gunshot wound (GSWs) (lowest: 5.7%, low: 5.4%, high: 5.0%, highest: 4.5%, p <0.001). After adjustment for demographics and clinical data, when outcomes were analyzed, there was a stepwise decrease in mortality as MHI increased (Log rank = 0.002). Conclusion: Patients with low MHI have a higher adjusted mortality rate after trauma. To address health-related disparities, socioeconomic disparities must be ameliorated. Further evaluation of these results is warranted.

Aim: We present two patients with bullet emboli to the pulmonary artery and discuss their management based on a review of the literature. Background: Bullet emboli to the pulmonary arteries from abdominal gunshot wounds are rare. It is unclear whether these bullets should be removed in stable, asymptomatic patients. Case description: We discuss the management of two cases of bullet emboli to the pulmonary arteries and the associated morbidity and mortality, based on a thorough review of the relevant literature. Conclusion: We recommend elective removal of the asymptomatic bullet to the pulmonary artery once patients have been appropriately resuscitated or on a close follow-up of the compliant patient. Clinical significance: The complex management of these patients necessitates an individualized management with a collaborative approach between cardiothoracic and trauma surgeons.