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Background Some research suggests that physicians who are not neurosurgeons can safely place intracranial pressure (ICP) monitors. The purpose of this study was to compare intracranial pressure monitor placement complications between neurosurgeons, trauma physicians, and general surgery residents. We hypothesized that with appropriate training, general residents can safely place ICP monitors.Methods A 10-year retrospective chart review of all trauma patients that required ICP monitor placement between January 1, 2012, and December 31, 2021, was conducted. Comparisons were made between treatment groups.Results During the study period, 194 patients required ICP monitor placement. General surgery residents placed 94.3% of ICP monitors, 3.6% were placed by attending trauma physicians, and 2.1% by neurosurgeons. No ICP monitors were placed by attending trauma physicians or neurosurgeons between 2015 and 2018. Overall, minor complications during ICP monitor placement included device malfunction (2.7%) and inaccurate readings (.5%). There were no major complications during ICP monitor placement. Post-ICP monitor placement complications included one patient who experienced a central nervous system infection (.5%) and three patients who had mechanical problems (1.5%). No complications occurred among the neurosurgeon or attending trauma physician treatment groups.Conclusion Most intracranial pressure monitors in our study sample were safely placed by surgical residents. Based on our study findings and considering the shortage and downtrend of neurosurgery specialists, ICP bolt placement needs to become a core clinical skill in surgical resident programs across the United States.

Background Little is known about how the COVID-19 pandemic impacted older adults admitted to the hospital with fall-related injuries. This research sought to determine if there was a difference in patient characteristics and hospital outcomes among older adults with fall-related injuries during the COVID-19 pandemic compared to a non-pandemic period.Methods A retrospective chart review of patients 65 years or older admitted for traumatic falls before and during COVID-19 was undertaken. Data abstracted included demographics, fall details, injury data, and hospital course.Results Of 1598 patients, 50.5% presented during COVID-19 (cases), and 49.5% presented pre-pandemic (controls). Fewer cases fell in rural areas (28.6% vs 34.1%, P= .018) and were transferred from outside hospitals (32.1% vs 38.2%, P= .011). More cases experienced alcohol (4.6% vs 2.4%, P= .017) and substance use disorders (1.4% vs .4%, P= .029). Fewer cases had subdural hemorrhages (11.8% vs 16.4%, P= .007), and more had pneumothoraxes (3.5% vs 1.8%, P= .032). More patients admitted during COVID-19 experienced acute respiratory failure (2.0% vs .0%, P< .001), hypoxia (1.5% vs .3%, P= .005), and delirium (6.3% vs 1.0%, P< .001). Fewer cases were discharged to skilled nursing facilities (50.8% vs 57.3%, P= .009) and more to home with services (13.1% vs 8.3%, P= .002).Discussion This study suggested there was a similar frequency of presentation for falls among older adults during the two study periods. Older adults with fall-related injuries experienced differences in presenting comorbidities, injury patterns, complications, and discharge locations during the study periods.

Background This study aimed to describe patients admitted for attempted or completed suicide during the COVID-19 pandemic.Methods A 1-year retrospective review was performed of adult patients admitted for attempted or completed suicide.Results Of the 30 patients included, most injuries involved firearms (37%) and cutting/piercing (30%). Sixty-three percent of patients presented with an Injury Severity Score ≥16, and 37% of injuries involved the head. Upon admission, an alcohol test was completed for 83% of patients, 56% of whom tested positive. Thirty percent of patients died from their injuries, with all but one involving a firearm. Most of those who survived to discharge (62%) were discharged to an inpatient behavioral health facility.Discussion The current study indicated a large proportion of suicides during the COVID-19 pandemic involved firearms and alcohol use. These findings point to the need for interventions aimed at preventing suicide and substance abuse during pandemic situations.

Background:Worksite wellness programs that target individual employees, rather than worksites, have demonstrated limited long-term success. The purpose of this overview was to describe the theoretical basis for implementing an effective worksite wellness initiative, WorkWell Kansas (WorkWell KS). WorkWell KS is not a traditional worksite wellness initiative, as its goal is to create healthy worksites, rather than target workers. Methods: The WorkWell KS Strategic Framework is based on academic research that identified successful worksite wellness elements that produce sustainably healthy worksites. The curricula were built around the 3-4-80: three modifiable behaviors (tobacco use, poor access to nutritious foods and beverages, and physical inactivity) contribute to at least four chronic diseases (heart disease, type II diabetes, lung disease, and some cancers), which in turn contribute to approximately 80% of the premature deaths in the United States. Findings: To properly address these modifiable behaviors, the WorkWell KS Strategic Framework was developed to guide worksites to first build a solid worksite wellness foundation, which consists of five elements: the wellness committee, exercising leadership, communications, incentives, and data. Once built, worksites are then encouraged to employ a socio-ecological approach to developing a comprehensive, multi-strategy (information, program, benefit design, policy, and environment) intervention, focusing on one health behavior at a time. Conclusions/Application to Practice: The goal of WorkWell KS was to create healthy worksites, which creates environments for employees to practice these healthy behaviors. Worksite wellness committees, occupational health professionals, and others interested in altering health behaviors at worksites have an opportunity to reframe their approach using this framework.

The effects of methamphetamines (MAs) on trauma patient outcomes have been evaluated, but with discordant results. The purpose of this study was to identify hospital outcomes associated with MA use after traumatic injury. Retrospective review of adult trauma patients admitted to an American College of Surgeons verified–Level I trauma center who received a urine drug screen (UDS) between January 1, 2004 and December 31, 2013. Logistic regression analysis was used to identify factors associated with mortality. Patients with a negative UDS were used as controls. Among the 2321 patients included, 75.1 per cent were male, 81.9 per cent were white, and the average age was 39. Patients were grouped by UDS results (negative, MA only, other drug plus MA, or other drug without MA). A positive drug screen result of other drug without MA demonstrated a significantly lower risk for mortality, but longer intensive care unit and hospital length of stay, as well as increased ventilator days than negative results. Results of MA only did not alter the risk of mortality. These findings suggest that patients who test positive for MAs are not at an increased risk of in-hospital mortality when compared with patients having a negative drug screen.

Most emergency medical service personnel rely on one of two techniques to extricate motor vehicle crash victims; the Rapid Extrication Maneuver (REM) or the Kendrick Extrication Device (KED). The purpose of this study was to compare pre- and postextrication neurological outcomes between these two techniques. A retrospective review was conducted of all adult patients with a vertebral column injury resulting from motor vehicle collision and admitted to a Level I trauma center between January 1, 2003 and December 31, 2010. Standardized pre- and postextrication neurological examinations were reviewed for all patients. More than half of patients (N = 81) were extricated using the KED (53.1%, n = 43) and 46.9 per cent (n = 38) were extricated with the REM. Except for the thoracic Abbreviated Injury Score, no differences between groups emerged related to the Glasgow Coma Scale score, Injury Severity Score or Abbreviated Injury Score. There were no pre- and postextrication changes for motor to all extremities and sensation to all extremities using either method. The results of this study suggest that the REM and the KED are equivalent in protecting the patient from neurologic injury after motor vehicle collision.

Sedgwick County, KS, has one of the highest infant mortality rates (IMR) in the USA, of which sudden infant death syndrome (SIDS) is a large component. The purpose of this study was to assess local key informants’ awareness of the high IMR overall, their knowledge and beliefs about SIDS risk factors specifically, and their recommendations for ways to increase physician and community awareness of SIDS within Sedgwick County, KS. Structured interviews were conducted with key informants from Sedgwick County, KS. Four themes emerged from key informant interviews: low level of awareness of infant mortality and SIDS, target population most at risk for SIDS/infant mortality, and barriers to and importance of SIDS education. Key informants were in consensus that there was a lack of general community awareness surrounding the high IMR in Sedgwick County. Strategies were identified to address this issue, including consistent SIDS education of medical providers and parents, social support to moms, use of social media, and involving the faith community in educating target populations about risk factors. Health and public health key informants provided an overall view of their perception of the SIDS problem in Sedgwick County, KS. Based on collected interviews, the consensus was there are significant problems within Sedgwick County around the issue of SIDS awareness (severity of the problem), SIDS risk, and barriers to increasing SIDS education among professional and community members. African-Americans were identified as the population with the highest infant mortality and SIDS rates in Sedgwick County by health and public health key informant participants. A concerted, educational approach was recommended as the best way forward to reduce SIDS risk within this community.

Veterinarians have unique skills and abilities that could be useful in preparing for and responding to disasters and emergencies. However, veterinarians are often absent from emergency preparedness planning and exercises, and little is known about veterinarians’ perceptions of emergency preparedness. A focus group was conducted among veterinarians to explore issues such as previous emergency-preparedness education, types of training needed, barriers to participation in training, and future steps to overcome identified barriers. Focus-group participants reported that they had had little to no emergency-preparedness training and had no clear understanding of what their specific role should be in an emergency. Participants also reported several barriers to participation in training and expressed significant concerns about their ability to respond in an emergency. The concerns reported include limited knowledge of zoonotic diseases, confusion about providing care for animals displaced during natural disasters, and poor relationships with other health professions. In order to respond to disasters, veterinarians require training tailored to their concerns and needs. Furthermore, partnerships between veterinarians and health care workers need to be further developed and strengthened.

Context:Coronary heart disease causes approximately 45% of firefighter deaths annually. Although firefighters have clinically significant cardiac risks, a paucity of research and data exists.

Introduction:Atrial fibrillation (AF) is the leading cause of arrhythmia among hospitalized patients. Altered hemodynamics with new-onset non-valvular atrial fibrillation, especially during sepsis/septic shock, causes decreased organ perfusion, lowers cardiac output, and increases the risk of organ dysfunction leading to increased intensive care unit (ICU) length of stay and mortality. However, little is known about the outcomes of patients hospitalized with septic shock and underlying chronic atrial fibrillation (UCAF).Hypothesis:Does UCAF increase in-hospital mortality in patients who have a diagnosis of septic shock during hospitalization.Methods:This was a retrospective analysis of the 2016 and 2017 Nationwide Readmission Database. ICD-10 codes were used to identify patients with septic shock, and these patients were stratified into those with and without a UCAF. Propensity matching analyses were performed to compare in-hospital mortality and clinical cardiovascular outcomes between the two groups.Results:A total of 353,422 patients with hospitalization for septic shock were identified, 5.8% of whom (n=20,772) had UCAF. After 2:1 propensity matching, 41,438 patients were identified as having septic shock without UCAF, and 20,719 patients were identified as having septic shock with UCAF. In hospital mortality [34.4% vs. 34.1%, p= 0.049], incidence of ischemic stroke [2.5% vs. 2.2%, p = 0.012], acute heart failure [1.8% vs. 1.4%, p < 0.001], length of stay [11.46 days vs. 10.93 days, p< 0.001], mean total charges [$150 4094 vs. $140 4037, p < 0.001] were significantly higher in patients with septic shock and UCAF compared to patients with septic shock without UCAF.Conclusions:The study identified UCAF as an adverse prognosticator for inpatient mortality and severe cardiovascular clinical outcomes. The study suggests the need for future research to improve patient outcomes of patients with septic shock and UCAF.

ABSTRACTBackground:On May 4, 2007 an EF5 tornado hit the rural community of Greensburg, KS, destroying 95% of the town and resulting in 12 fatalities.Methods:Data was requested from the emergency medical services units that initially responded and the regional hospitals that received people injured in the tornado within 24 hours following the tornado. Requested data included patient age and sex, and injury severity score or ICD-9codes. Critical mortality, or the number of deaths of critically injured patients, was also calculated.Results:The extensive damage caused by the tornado effectively destroyed the infrastructure of the community and created enormous challenges for emergency medical services responders, who were unable to record any triage data. Area hospitals treated 90 patients, who had an average injury severity score of 6.4. Age was found to be related to injury severity, but no relationship between sex and injury severity was found. Critical mortality was found to be 18% for this event.Conclusions:Injury severity score has seldom been used to analyze natural disasters, especially tornadoes, although such analysis is helpful for understanding the magnitude of the disaster, comparing to other disasters, and preparing for future incidents. Advanced warning and personal preparedness are important factors in reducing tornado-related injuries and deaths. (Disaster Med Public Health Preparedness. 2007;1:90–95)

Recent studies have assessed preparedness training and the resource needs of public health and clinical professionals in responding to a crisis, but few have assessed the needs of the general public, especially in rural areas. The present study, based in a risk assessment and information-seeking theoretical framework, assessed the preparedness awareness, knowledge, and attitudes of the general public in a rural state through a series of focus groups. Six focus groups were conducted with 34 participants in 4 locations in Kansas (2 urban and 2 rural). Focus group interviews followed a standardized script. Participants from all 4 locations reported training and knowledge needs and desired training, knowledge, and emergency preparedness plans. Certain groups also reported a lack of familiarity with preparedness terminology, as well as different ideas about trusted sources and agencies responsible for providing preparedness training or information. Some diverging opinions from these focus groups were stratified by urban/rural status, indicating possible implications for future all-hazards training in rural regions of the nation. These results may be used for planning and improving training for the general public in both urban and rural areas.

Case management is a rapidly growing strategy to help vulnerable populations access the health care they need in a fragmented U.S. service delivery system. A number of lessons can be learned from the successes and challenges of a developing, hospital-based, community-focused case management group in Sedgwick County, Kansas. The Community Case Management program has a case management team based at each of four hospitals. Each team has a social worker and a nurse, whose main goal is to help the uninsured find a primary health care home. This dynamic combination has several benefits. Each team member brings a vital skill set in helping the clients change behavior and access the care and support they need. Also, the nurse-social worker team concept creates a synergy in which team members support each other and create the best solution to their clients’ needs.

Introduction:Stroke after transcatheter aortic valve replacement (TAVR) increases the risk of 1-year mortality three-fold. It is also associated with a higher risk of disability and increased health care costs. A validated tool for predicting 1-year stroke after TAVR is lacking and is needed for pre-procedural risk stratification to guide clinical management and research. The purpose of this study was to develop and internally validate a new risk prediction score for predicting stroke within one year of TAVR.Methods:This was a retrospective cohort study using data from the TAVR program of a midwestern academic medical center. Patients who underwent TAVR from 2012 to the first quarter of 2018 who had one-year follow-up data were included in the study. The association between candidate variables and stroke was estimated using the Firth multivariable logistic regression method. Integer points for variables that were included in the score were calculated based on the model βcoefficients, using a commonly used method described by Sullivan et al. Internal validation was performed using the bootstrapping method. The model discrimination and calibration were assessed using the area under the receiver operating characteristic curve (c-statistic) and the Hosmer-Lemeshow test respectively.Results:Stroke occurred in 3.4% of the 664 patients included in the study. Eight variables were included in the score, forming the acronym B2AND2SV2ASc. The number of points for each variable in the score is shown in parentheses as follows; Bicuspid/unicuspid valve (2), Aortic valve area of <0.5 cm2(1), Number of diseased coronary vessels ≥2 (1), Diabetes mellitus (2), prior Stroke/transient ischemic attack (1), peripheral Vascular disease (2), body surface Area ≤1.75 m2(1), and Sex category [female] (1). The score had a c-statistic of 0.709 (0.640 on internal validation) and a Hosmer-Lemeshow χ2p-value of 0.146.Conclusion:The B2AND2SV2ASc score had a good discrimination and calibration for the prediction of stroke within one year of TAVR.