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Purpose The purpose of the study was to find the factors that were associated with tracheostomy procedures in ventilated pediatric trauma patients.Methods The Trauma Quality Improvement Program (TQIP) database of the calendar year 2017 through 2019 was accessed for the study. All patients <18 years old and who were on mechanical ventilation for more than 96 hours were included in the study. Multiple logistic regression analysis was performed to find the factors that were associated with a tracheostomy.Results Out of 2653 patients, 1907 (71.88%) patients underwent tracheostomy. The patients who underwent tracheostomy had a lower median [IQR] of Glasgow Coma Scale (GCS) (3 [3-8] vs 5 [3-10], P< .001) and had a higher proportion of severe spine injury (On Abbreviated Injury Scale [AIS]≥3) (11.6% vs 8.8%, P= .044) when compared with patients who did not have tracheostomy. Lower GCS scores and severe spine injury were associated with higher odds of tracheostomy, with all Pvalues <.05. Higher proportion of tracheostomy procedures were performed at level I pediatric trauma centers as compared to non-designated pediatric centers (odds ratio [95% CI]: 1.848 [1.524-2.242], P< .001).Conclusion A lower GCS score, severe spine injury and highest level trauma centers were associated with a tracheostomy.

Background Alcohol withdrawal syndrome (AWS) is associated with increased occurrence of pneumonia and longer hospital stay. The purpose of the study is to find a national estimate of pulmonary complications in AWS patients using the National Trauma Quality Improvement Program (TQIP) database.Methods We accessed the TQIP database focusing on the calendar years 2013-2016 and included all adult admitted trauma patients. The two groups (AWS and no AWS) were compared on baseline characteristics, injury, comorbidities, and outcomes. We performed univariate analysis followed by propensity matching.Results Out of 534 880 patients who qualified for the study, 6929 (1.29%) patients had developed AWS. The propensity matching balanced the two groups on all the baseline characteristics, injury severity, and comorbidities and created 6929 pairs. One-to-one pair-matched analysis showed a significantly increased occurrence of pneumonia (12% vs 4.3%), acute respiratory distress syndrome (ARDS) (2.7% vs 1%), and sepsis (2.4% vs 1.1%) in AWS patients when compared with the patients without the AWS.Conclusion The study showed approximately a 3-fold increase inARDS and pneumonia and a more than two-fold increase in sepsis in AWS patients. Early intervention in high-risk AWS patients may reduce the complications.

Sarcopenia and frailty have both emerged as risk factors for elderly falls. We investigated whether radiologic sarcopenia or frailty are associated with falls in a high-risk geriatric outpatient population. We reviewed 114 patients followed at the Center for Healthy Senior Living who had undergone a computerized tomography (CT) of the abdomen and pelvis for any reason from 2013 to 2019. Sarcopenia was determined by psoas muscle cross-sectional area at L3 on CT scan. Their individual frailty score was calculated. The primary outcome was admission to hospital for falls. There were no statistical differences in frailty score or sarcopenia between the 2 groups (left/right psoas muscle: no hospital admission = 6.8 ± 2.4/6.4 ± 2.5 vs falls requiring hospital admission 6.5 ± 2.3/6.5 ± 2.3 cm2). We concluded that neither frailty score nor sarcopenia predicted the occurrence of falls in our high-risk geriatric outpatient population.

Introduction Investigations have demonstrated that trocar site hernia (TSH) is an under-appreciated complication of laparoscopic surgery, occurring in as many as 31%. We determined the incidence of fascial defects prior to laparoscopic appendectomy and its impact relative to other risk factors upon the development of TSH.Methods TSH was defined as a fascial separation of ≥ 1 cm in the abdominal wall umbilical region on abdominal computerized tomography scan (CT) following laparoscopic appendectomy. Patients admitted to our medical center who had both a preoperative CT and postoperative CT for any reason (greater than 30 days after surgery) were reviewed for the presence of TSH from May 2010 to December 2018. CT scans were measured for fascial defects, while investigators were blinded to film timing (preoperative or postoperative) and patient identity. Demographic information was collected.Results 241 patients undergoing laparoscopic appendectomy had both preoperative and late postoperative CT. TSH was identified in 49 (20.3%) patients. Mean preoperative fascial gap was 3.3 ± 4.3 mm in those not developing a postoperative hernia versus 14.8 ± 7.3 mm in those with a postoperative hernia (P< .0001). Preoperative fascial defect on CT was predictive of TSH (P< .001, OR = 1.44), with an Area Under the Curve (AUC) of .921 (95%CI: .88–.92). Other major risk factors for TSH were: age greater than 59 years (P< .031, OR = 2.48); and obesity, BMI > 30 (P< .012, OR = 2.14).Conclusions The incidence of trocar site hernia was one in five following laparoscopic appendectomy. The presence of a pre-existing fascial defect, advanced age, and obesity were strong predictors for the development of trocar site hernia.