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Background: This study aimed to assess the medical costs, and the combined costs of fatal firearm injury and fatal falls during a 5 year period. While fatal firearm injury represents a significant public health concern, the healthcare community is faced with the significant challenge of fatal falls, particularly in light of the elderly population growth., Methods: Data were exported from the Web-based Injury Statistics Query and Reporting System database for fatal firearm and falls in patients aged between 15-85 years-old. The primary outcome was medical cost and the secondary outcome was combined costs (combination of medical costs and value of statistical life)., Results: The medical cost of fatal falls was significantly higher in 2015-2020 in all age groups. The combined cost was significantly higher in fatal firearm injury overall. We found the combined cost was higher in fatal falls after 2019 for patients in the 45-85+ age range. During 2015-2019, the percentage of fatal falls had a significant increase in all age ranges, with a rise in the slope in 2019 for patients over 65 years. The annual percent change (APC) for the proportion of fatal falls increased from 2015 to 2020, there was a significant increase in the slope after 2019 (2.81% APC before 2019 vs 6.95% after 2019)., Conclusion: Geriatric fatal falls have significantly higher medical costs compared with fatal firearm injury. The combined cost for fatal falls exceeded fatal firearm injury after 2019 which highlights the increasing socioeconomic burden of an aging population., Level of Evidence: Level III retrospective study., Competing Interests: None declared., (Copyright © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The evaluation and workup of fever and the use of antibiotics to treat infections is part of daily practice in the surgical intensive care unit (ICU). Fever can be infectious or non-infectious; it is important to distinguish between the two entities wherever possible. The evidence is growing for shortening the duration of antibiotic treatment of common infections. The purpose of this clinical consensus document, created by the American Association for the Surgery of Trauma Critical Care Committee, is to synthesize the available evidence, and to provide practical recommendations. We discuss the evaluation of fever, the indications to obtain cultures including urine, blood, and respiratory specimens for diagnosis of infections, the use of procalcitonin, and the decision to initiate empiric antibiotics. We then describe the treatment of common infections, specifically ventilator-associated pneumonia, catheter-associated urinary infection, catheter-related bloodstream infection, bacteremia, surgical site infection, intra-abdominal infection, ventriculitis, and necrotizing soft tissue infection., Competing Interests: Competing interests: TC reports: Innovital—funding paid to my institution related to research performed; Cytovale—direct payments to me for research-related medical monitoring. SM reports: UpToDate—Author Royalty; AHRQ grant funding, but not related to this topic. LK reports: Eastern Association for the Surgery of Trauma Vice Chair Guidelines Committee; American Association for the Surgery of Trauma Palliative Care Committee, American Association for the Surgery of Trauma Critical Care Committee, American College of Surgeons Geriatric Surgery Verification Standards and Verification Committee, Journal of Surgical Research Editorial Board Member. DMS reports: grant funding from PCORI, DoD, NIH, NHTSA and consultant fees—CSL Behring., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Competing Interests: Competing interests: RG reports honoraria for lectures/presentations: Morristown Memorial Hospital—keynote speaker honorarium, payments made to the author; Leadership in Board/Society: Chair, Scientific Studies Committee, Surgical Infection Society—unpaid; Payment for Expert Testimony: Billing, Cochran, Lyles, Mauro & Ramsey PA; Rafi Law Firm; Foy & Associates PC. SM reports UpToDate—author royalty; AHRQ grant funding, but not related to this topic. TR reports receiving an honorarium from Stanford Hospital/Santa Clara Valley Medical Center for speaking at their annual trauma; support from the author's home institution (UC Davis) for attendance at meetings (WTA in 2022, 2023). DMS reports grant funding from PCORI, DoD, NIH, and NHTSA and consultant fees from CSL Behring.