59 results on '"Sarah, Majercik"'
Search Results
2. Readmission for pleural space complications after chest wall injury: Who is at risk?
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Annika B. Kay, Sarah Majercik, David S. Morris, Thomas W. White, and Scott Gardner
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education.field_of_study ,medicine.medical_specialty ,Flail chest ,Abbreviated Injury Scale ,business.industry ,Pleural effusion ,Population ,Critical Care and Intensive Care Medicine ,medicine.disease ,Hemothorax ,Thoracostomy ,Surgery ,Scapular fracture ,Pneumothorax ,medicine ,business ,education - Abstract
BACKGROUND Little is known about patient characteristics predicting postdischarge pleural space complications (PDPSCs) after thoracic trauma. We sought to analyze the patient population who required unplanned hospital readmission for PDPSC. METHODS Retrospective review of adult patients admitted to a Level I Trauma Center with a chest Abbreviated Injury Scale (AIS) score of 2 or greater between January 2015 and August 2020. Those readmitted within 30 days of index hospitalization discharge for PDPSC were compared with those not readmitted. Demographics, injury characteristics, surgical procedures, imaging, and readmission data were retrieved. RESULTS Out of 17,192 trauma evaluations, 3,412 (19.8%) suffered a chest AIS score of 2 or greater injury and 155 experienced an unplanned 30-day hospital readmission. Of those, 49 (1.4%) were readmitted for the management of PDPSC (readmit PDPSC) and were compared with patients who were not readmitted (no readmit, n = 3,257). The readmit PDPSC group was significantly older age, heavier, comprised of fewer men, and suffered a higher mean chest AIS score. The readmit PDPSC group had a significantly higher incidence of rib fractures, flail chest, pneumothorax, hemothorax, scapula fractures, and a higher rate of tube thoracostomy placement during index admission. The discharge chest X-ray in the readmit PDPSC group demonstrated a pleural space abnormality in 36 (73%) of patients. Mean time to readmission was 10.2 (7.2) days, and hospital length of stay on readmission was 5.8 (3.7) days. Pleural effusion was the most common readmission diagnosis (44 [90%]), and 42 (86%) required tube thoracostomy. CONCLUSION We describe the subset of chest wall injury patients who require hospital readmission for PDPSC. Characteristics from index hospitalization associated with PDPSC include older age, female sex, heavier weight, presence of rib fractures, pleural space abnormality, scapular fracture, and chest tube placement. Further studies are needed to characterize this at-risk chest wall injury population, and to determine what interventions can facilitate outpatient management of postdischarge pleural space complications and mitigate readmission risk. LEVEL OF EVIDENCE Prognostic and epidemiologic, Level IV; Care management, Level V. more...
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- 2021
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3. Surgical stabilization of rib fractures in octogenarians and beyond—what are the outcomes?
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Zachary M. Bauman, Andrew R. Doben, Kiara Leasia, Brian Kim, Thomas W. White, Emily Cantrell, Matthew C. Hernandez, Sebastian D. Schubl, Matthew Barns, Evert A. Eriksson, Erika Tay Lasso, Sarah Majercik, D. Benjamin Christie, Angela Sauaia, Scott Gardner, Sean Dieffenbaugher, and Fredric M. Pieracci more...
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Male ,medicine.medical_specialty ,Rib Fractures ,Conservative Treatment ,Critical Care and Intensive Care Medicine ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Fracture Fixation ,law ,medicine ,Risk of mortality ,Humans ,Hospital Mortality ,Prospective cohort study ,Retrospective Studies ,Aged, 80 and over ,Abbreviated Injury Scale ,business.industry ,Age Factors ,030208 emergency & critical care medicine ,Retrospective cohort study ,Length of Stay ,Intensive care unit ,Confidence interval ,Surgery ,Intensive Care Units ,Treatment Outcome ,Relative risk ,Feasibility Studies ,Injury Severity Score ,Female ,business - Abstract
BACKGROUND Prospective studies of surgical stabilization of rib fractures (SSRF) have excluded elderly patients, and no study has exclusively addressed the ≥80-year-old subgroup. We hypothesized that SSRF is associated with decreased mortality in trauma patients 80 years or older. METHODS Multicenter retrospective cohort study involving eight centers. Patients who underwent SSRF from 2015 to 2020 were matched to controls by study center, age, injury severity score, and presence of intracranial hemorrhage. Patients with chest Abbreviated Injury Scale score less than 3, head Abbreviated Injury Scale score greater than 2, death within 24 hours, and desire for no escalation of care were excluded. A subgroup analysis compared early (0-2 days postinjury) to late (3-7 days postinjury) SSRF. Poisson regression accounting for clustered data by center calculated the relative risk (RR) of the primary outcome of mortality for SSRF versus nonoperative management. RESULTS Of 360 patients, 133 (36.9%) underwent SSRF. Compared with nonoperative patients, SSRF patients were more severely injured and more likely to receive locoregional analgesia. There were 31 hospital deaths among the entire sample (8.6%). Multivariable regression demonstrated a decreased risk of mortality for the SSRF group, as compared with the nonoperative group (RR, 0.41; 95% confidence interval, 0.24-0.69; p < 0.01). However, SSRF patients were more likely to develop pneumonia, and had an increased duration of both mechanical ventilation and intensive care unit stay. There were no differences in discharge destination, although the SSRF group was less likely to be discharged on narcotics (RR, 0.66; 95% confidence interval, 0.48-0.90; p = 0.01). There was no difference in adjusted mortality between the early and late SSRF subgroups. CONCLUSION Patients selected for SSRF were substantially more injured versus those managed nonoperatively. Despite this, SSRF was independently associated with decreased mortality. With careful patient selection, SSRF may be considered a viable treatment option in octogenarian/nonagenarians. LEVEL OF EVIDENCE Therapeutic, Level IV. more...
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- 2021
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4. Trauma patients at risk for venous thromboembolism who undergo routine duplex ultrasound screening experience fewer pulmonary emboli: A prospective randomized trial
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James F. Lloyd, Sarah Majercik, David S Morris, Annika B Kay, Dave S. Collingridge, Scott C. Woller, Scott M. Stevens, and Joseph Bledsoe
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,Population ,Critical Care and Intensive Care Medicine ,Risk Assessment ,law.invention ,03 medical and health sciences ,Injury Severity Score ,0302 clinical medicine ,Trauma Centers ,Randomized controlled trial ,Risk Factors ,law ,Internal medicine ,Humans ,Medicine ,Prospective Studies ,education ,Aged ,Aged, 80 and over ,Venous Thrombosis ,Ultrasonography, Doppler, Duplex ,education.field_of_study ,business.industry ,Trauma center ,030208 emergency & critical care medicine ,Middle Aged ,medicine.disease ,Pulmonary embolism ,Venous thrombosis ,Lower Extremity ,Blunt trauma ,Wounds and Injuries ,Female ,Surgery ,Pulmonary Embolism ,business ,Risk assessment - Abstract
BACKGROUND Although guidelines are established for the prevention and management of venous thromboembolism (VTE) in trauma, no consensus exists regarding protocols for the diagnostic approach. We hypothesized that at-risk trauma patients who undergo duplex ultrasound (DUS) surveillance for lower extremity deep venous thrombosis (DVT) will have a lower rate of symptomatic or fatal pulmonary embolism (PE) than those who do not undergo routine surveillance. METHODS Prospective, randomized trial between March 2017 and September 2019 of trauma patients admitted to a single, level 1 trauma center, with a risk assessment profile score of ≥5. Patients were randomized to receive either bilateral lower extremity DUS surveillance on days 1, 3, and 7 and weekly during hospitalization ultrasound group (US) or no surveillance no ultrasound group (NoUS). Rates of in-hospital and 90-day DVT and PE were reported as was DVT propagation and all-cause mortality. Standard care for the prevention and management of VTE per established institutional protocols was provided to all patients. RESULTS A total of 3,236 trauma service admissions were screened, and 1,989 moderate- and high-risk patients were randomized (US, 995; NoUS, 994). The mean ± SD age was 62 ± 20.1 years, Injury Severity Score was 14 ± 9.7, risk assessment profile was 7.1 ± 2.4, and 97% suffered blunt trauma. There was no difference in demographics or VTE risk factors between the groups. There were significantly fewer in-hospital PE in the US group than the NoUS group (1 [0.1%] vs. 9 [0.9%], p = 0.01). The US group experienced more in-hospital below-knee DVTs (124 [12.5%] vs. 8 [0.8%], p < 0.001) and above-knee DVTs (19 [1.9%] vs. 8 [0.8%], p = 0.05). There was no difference in 90-day PE or DVT, or overall mortality. CONCLUSION The implementation of a selective routine DUS protocol was associated with significantly fewer in-hospital PE. More DVTs were identified with routine screening; however, surveillance bias appears to exist primarily with distal DVT. Larger trials are needed to further characterize the relationship between routine DUS screening and VTE outcomes in the high-risk trauma population. LEVEL OF EVIDENCE Therapeutic/care management, level II. more...
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- 2021
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5. Current Management of Extraperitoneal Bladder Injuries: Results from the Multi-Institutional Genito-Urinary Trauma Study (MiGUTS)
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Michael E. Rezaee, Peter B. Thomsen, Clara M. Castillejo Becerra, Alexander P. Nocera, La Donna Allen, Brian P. Smith, Rachel Moses, Rachel L. Sensenig, Jay Simhan, Sarah Majercik, Katie Glavin, Erik S. DeSoucy, Ross E. Anderson, J. Patrick Selph, Brandi Miller, Bradley A. Erickson, Sorena Keihani, Sean P. Elliott, Raminder Nirula, Joshua A. Broghammer, Timothy Hewitt, Reza Askari, Xian Luo-Owen, Cameron N. Fick, Dennis Y. Kim, Christopher M. Dodgion, Scott Zakaluzny, Kaushik Mukherjee, Ian Schwartz, Chirag S. Arya, Seyyed Saeed Khabiri, Richard A. Santucci, Benjamin N. Breyer, Barbara U. Okafor, Joshua Piotrowski, Jeremy B. Myers, Jacob Lucas, Bradley J. Morris, Frank Burks, Scott H. Norwood, and Nima Baradaran more...
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Male ,030232 urology & nephrology ,Wounds, Penetrating ,Wounds, Nonpenetrating ,Penetrating ,trauma centers ,0302 clinical medicine ,Epidemiology ,Medicine ,Prospective Studies ,Drainage ,Prospective cohort study ,Urinary bladder ,Injuries and accidents ,Middle Aged ,Urology & Nephrology ,medicine.anatomical_structure ,Current management ,Wounds ,Female ,epidemiology ,Patient Safety ,6.4 Surgery ,urinary bladder ,Urologic Diseases ,Adult ,medicine.medical_specialty ,Physical Injury - Accidents and Adverse Effects ,Urology ,Urinary system ,Urinary Bladder ,Clinical Sciences ,Renal and urogenital ,wounds and injuries ,03 medical and health sciences ,Clinical Research ,Catheter drainage ,Nonpenetrating ,Humans ,Pelvic Bones ,Multiple Trauma ,business.industry ,Evaluation of treatments and therapeutic interventions ,United States ,Surgery ,multicenter study ,Multicenter study ,business - Abstract
PURPOSE:We studied the current management trends for extraperitoneal bladder injuries and evaluated the use of operative repair versus catheter drainage, and the associated complications with each approach. MATERIALS AND METHODS:We prospectively collected data on bladder trauma from 20 level 1 trauma centers across the United States from 2013 to 2018. We excluded patients with intraperitoneal bladder injury and those who died within 24 hours of hospital arrival. We separated patients with extraperitoneal bladder injuries into 2 groups (catheter drainage vs operative repair) based on their initial management within the first 4 days and compared the rates of bladder injury related complications among them. Regression analyses were used to identify potential predictors of complications. RESULTS:From 323 bladder injuries we included 157 patients with extraperitoneal bladder injuries. Concomitant injuries occurred in 139 (88%) patients with pelvic fracture seen in 79%. Sixty-seven patients (43%) initially underwent operative repair for their extraperitoneal bladder injuries. The 3 most common reasons for operative repair were severity of injury or bladder neck injury (40%), injury found during laparotomy (39%) and concern for pelvic hardware contamination (28%). Significant complications were identified in 23% and 19% of the catheter drainage and operative repair groups, respectively (p=0.55). The only statistically significant predictor for complications was bladder neck or urethral injury (RR 2.69, 95% 1.21-5.97, p=0.01). CONCLUSIONS:In this large multi-institutional cohort, 43% of patients underwent surgical repair for initial management of extraperitoneal bladder injuries. We found no significant difference in complications between the initial management strategies of catheter drainage and operative repair. The most significant predictor for complications was concomitant urethral or bladder neck injury. more...
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- 2020
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6. Prehospital decompression of tension pneumothorax: Have we moved the needle?
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Jordan Osterman, Annika Bickford Kay, David S. Morris, Shawn Evertson, Teresa Brunt, and Sarah Majercik
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Surgery ,General Medicine - Abstract
Needle thoracostomy (NT) is the first-line intervention for tension pneumothorax in the prehospital setting. This study examined the effect of ATLS curriculum and EMS protocol changes on patient selection and successful performance of the procedure.This is a retrospective chart review of all patients presenting to a Level One Trauma Center from 2015 to 2020 after undergoing prehospital NT.Lateral NT placement increased significantly from 5.1% to 38.9%. Proper patient selection, defined as presence decompensated shock, respiratory distress, and diminished breath sounds increased from 23.1% to 27.8%. There was no difference in radiographic confirmation of the catheter in the pleural space. Iatrogenic injury rates decreased slightly from 28.2% to 16.7%.Protocol and curriculum changes have fallen short in yielding improved NT success rates or patient selection. Continued development of EMS education on the performance of NT is indicated. more...
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- 2022
7. A multicenter, prospective, controlled clinical trial of surgical stabilization of rib fractures in patients with severe, nonflail fracture patterns (Chest Wall Injury Society NONFLAIL)
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Babak Sarani, Kiara Leasia, Frank Zhao, Zach Bauman, Cornelius Dyke, Sarah Majercik, Gregory Semon, Lawrence Lottenberg, Evert A. Eriksson, Fredric M. Pieracci, Bradley W Thomas, Ledford Powell, and Andrew R. Doben more...
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Adult ,Male ,Flail chest ,medicine.medical_specialty ,Adolescent ,Rib Fractures ,Fractures, Multiple ,Critical Care and Intensive Care Medicine ,Pulmonary function testing ,law.invention ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Fracture Fixation ,law ,Fracture fixation ,Humans ,Medicine ,Prospective Studies ,Prospective cohort study ,Aged ,Pain Measurement ,Hemothorax ,Pain, Postoperative ,Trauma Severity Indices ,business.industry ,030208 emergency & critical care medicine ,Middle Aged ,medicine.disease ,Thoracostomy ,Empyema ,Surgery ,Treatment Outcome ,Female ,business - Abstract
BACKGROUND The efficacy of surgical stabilization of rib fracture (SSRF) in patients without flail chest has not been studied specifically. We hypothesized that SSRF improves outcomes among patients with displaced rib fractures in the absence of flail chest. METHODS Multicenter, prospective, controlled, clinical trial (12 centers) comparing SSRF within 72 hours to medical management. Inclusion criteria were three or more ipsilateral, severely displaced rib fractures without flail chest. The trial involved both randomized and observational arms at patient discretion. The primary outcome was the numeric pain score (NPS) at 2-week follow-up. Narcotic consumption, spirometry, pulmonary function tests, pleural space complications (tube thoracostomy or surgery for retained hemothorax or empyema >24 hours from admission) and both overall and respiratory disability-related quality of life (RD-QoL) were also compared. RESULTS One hundred ten subjects were enrolled. There were no significant differences between subjects who selected randomization (n = 23) versus observation (n = 87); these groups were combined for all analyses. Of the 110 subjects, 51 (46.4%) underwent SSRF. There were no significant baseline differences between the operative and nonoperative groups. At 2-week follow-up, the NPS was significantly lower in the operative, as compared with the nonoperative group (2.9 vs. 4.5, p < 0.01), and RD-QoL was significantly improved (disability score, 21 vs. 25, p = 0.03). Narcotic consumption also trended toward being lower in the operative, as compared with the nonoperative group (0.5 vs. 1.2 narcotic equivalents, p = 0.05). During the index admission, pleural space complications were significantly lower in the operative, as compared with the nonoperative group (0% vs. 10.2%, p = 0.02). CONCLUSION In this clinical trial, SSRF performed within 72 hours improved the primary outcome of NPS at 2-week follow-up among patients with three or more displaced fractures in the absence of flail chest. These data support the role of SSRF in patients without flail chest. LEVEL OF EVIDENCE Therapeutic, level II. more...
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- 2019
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8. It's sooner than you think: Blunt solid organ injury patients are already hypercoagulable upon hospital admission - Results of a bi-institutional, prospective study
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Hunter B. Moore, Eduardo Gonzalez, Mitchell J. Cohen, Annika B. Kay, Ernest E. Moore, Thomas W. White, Julia R. Coleman, Sarah Majercik, and Fredric M. Pieracci
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Adult ,Male ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Wounds, Nonpenetrating ,Tissue plasminogen activator ,Article ,Time-to-Treatment ,03 medical and health sciences ,0302 clinical medicine ,Blunt ,Trauma Centers ,Intensive care ,Fibrinolysis ,medicine ,Humans ,Prospective Studies ,Prospective cohort study ,business.industry ,Anticoagulants ,030208 emergency & critical care medicine ,Venous Thromboembolism ,General Medicine ,Blood Coagulation Disorders ,Middle Aged ,medicine.disease ,Thrombosis ,Thrombelastography ,Anesthesia ,Chemoprophylaxis ,Hospital admission ,Female ,Surgery ,business ,medicine.drug - Abstract
Introduction The optimal time to initiate venous thromboembolism (VTE) chemoprophylaxis in blunt solid organ injury (BSOI) patients is debated. We hypothesize that 1) BSOI patients are hypercoagulable within 12 h of injury and 2) hypercoagulability dominates in patients who develop clot complications (CC). Material and methods This is a prospective study of BSOI patients admitted to two Level-1 Trauma Centers’ trauma intensive care units (ICU). Serial kaolin thrombelastography (TEG) and tissue plasminogen activator (tPA)-challenge TEGs were performed. CC included VTE and cerebrovascular accidents. Results On ICU admission, all patients (n = 95) were hypercoagulable, 58% were in fibrinolysis shutdown, and 50% of patients were tPA-resistant. Twelve patients (13%) developed CC. Compared to those without CC, they demonstrated decreased fibrinolysis at 12 h and higher clot strength at 48 h Conclusions BSOI patients are universally hypercoagulable upon ICU admission. VTE chemoprophylaxis should be started immediately in BSOI patients with hypercoagulability on TEG. more...
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- 2019
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9. The associations between initial radiographic findings and interventions for renal hemorrhage after high-grade renal trauma: Results from the Multi-Institutional Genitourinary Trauma Study
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Douglas Rogers, Bradley J. Morris, Matthew M. Carrick, Frank Burks, Benjamin N. Breyer, Brandi Miller, Bradley A. Erickson, Nima Baradaran, Joshua Piotrowski, Sorena Keihani, Sean P. Elliott, Bryn Putbrese, Barbara U. Okafor, Richard A. Santucci, Reza Askari, Kaushik Mukherjee, Ian Schwartz, Jurek F. Kocik, Chong Zhang, Brian P. Smith, Brenton Sherwood, Jeremy B. Myers, Raminder Nirula, Timothy Hewitt, Erik S. DeSoucy, Sarah Majercik, Cameron N. Fick, Christopher M. Dodgion, Scott Zakaluzny, Marta E. Heilbrun, and Xian Luo-Owen more...
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Renal Hemorrhage ,Psychological intervention ,Hemorrhage ,Abdominal Injuries ,Kidney ,Wounds, Nonpenetrating ,Critical Care and Intensive Care Medicine ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Hematoma ,Predictive Value of Tests ,Epidemiology ,medicine ,Humans ,Retrospective Studies ,Genitourinary system ,business.industry ,030208 emergency & critical care medicine ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Nephrectomy ,Surgery ,Predictive value of tests ,Female ,Kidney Diseases ,business - Abstract
Background Indications for intervention after high-grade renal trauma (HGRT) remain poorly defined. Certain radiographic findings can be used to guide the management of HGRT. We aimed to assess the associations between initial radiographic findings and interventions for hemorrhage after HGRT and to determine hematoma and laceration sizes predicting interventions. Methods The Genitourinary Trauma Study is a multicenter study including HGRT patients from 14 Level I trauma centers from 2014 to 2017. Admission computed tomography scans were categorized based on multiple variables, including vascular contrast extravasation (VCE), hematoma rim distance (HRD), and size of the deepest laceration. Renal bleeding interventions included angioembolization, surgical packing, renorrhaphy, partial nephrectomy, and nephrectomy. Mixed-effect Poisson regression was used to assess the associations. Receiver operating characteristic analysis was used to define optimal cutoffs for HRD and laceration size. Results In the 326 patients, injury mechanism was blunt in 81%. Forty-seven (14%) patients underwent 51 bleeding interventions, including 19 renal angioembolizations, 16 nephrectomies, and 16 other procedures. In univariable analysis, presence of VCE was associated with a 5.9-fold increase in risk of interventions, and each centimeter increase in HRD was associated with 30% increase in risk of bleeding interventions. An HRD of 3.5 cm or greater and renal laceration depth of 2.5 cm or greater were most predictive of interventions. In multivariable models, VCE and HRD were significantly associated with bleeding interventions. Conclusion Our findings support the importance of certain radiographic findings in prediction of bleeding interventions after HGRT. These factors can be used as adjuncts to renal injury grading to guide clinical decision making. Level of evidence Prognostic and Epidemiological Study, Level III and Therapeutic/Care Management, Level IV. more...
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- 2019
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10. Age is just a number: A look at 'elderly' sport-related traumatic injuries at a level I trauma center
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Sarah Majercik, Annika B. Kay, Emily L. Wilson, Thomas W. White, and David S. Morris
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Male ,medicine.medical_specialty ,MEDLINE ,Trauma registry ,03 medical and health sciences ,0302 clinical medicine ,Trauma Centers ,Risk Factors ,Utah ,Humans ,Medicine ,Registries ,030212 general & internal medicine ,Elderly trauma ,Aged ,Retrospective Studies ,Aged, 80 and over ,Trauma Severity Indices ,business.industry ,Trauma Severity Indexes ,Trauma center ,Age Factors ,Case-control study ,030208 emergency & critical care medicine ,Retrospective cohort study ,General Medicine ,Prognosis ,Case-Control Studies ,Athletic Injuries ,Cohort ,Physical therapy ,Female ,Surgery ,business ,human activities - Abstract
We aimed to describe elderly engagement in recreational activities, their injury patterns, preinjury risks and outcomes.A 16-year retrospective trauma registry review. All trauma patients ≥65 years admitted after injury sustained during sport were evaluated, and compared to a non-sport cohort of elderly trauma patients.During the study period, 9697 admissions age ≥65 were identified. 526 (5%) were sport-related. Compared to the non-sport group, the sport cohort was younger, had fewer medical comorbidities, and was more severely injured. The common sport mechanisms were skiing, offroad vehicle use and bicycling, and common sport injuries involved lower extremity, chest, and head. Sport patients were more often discharged home than non-sport patients (73% vs 36%, p 0.001). There was no difference in ICU or hospital LOS between groups. The hospital mortality rate was 3% in sport and 5% in non-sport patients (p = 0.06).Over time, the number of elderly sport-related trauma patients increased. Our data suggest that being active may improve outcomes after trauma in older adults. more...
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- 2019
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11. A nomogram predicting the need for bleeding interventions after high-grade renal trauma: Results from the American Association for the Surgery of Trauma Multi-institutional Genito-Urinary Trauma Study (MiGUTS)
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Brian P. Smith, Brenton Sherwood, Rachel Moses, Xian Luo-Owen, Ian Schwartz, Erik S. DeSoucy, Brandi Miller, Kaushik Mukherjee, Matthew M. Carrick, Sorena Keihani, Jurek F. Kocik, Sean P. Elliott, Sarah Majercik, Raminder Nirula, Timothy Hewitt, Douglas Rogers, Benjamin N. Breyer, Bryn Putbrese, Scott Zakaluzny, Angela P Presson, Richard A. Santucci, Marta E. Heilbrun, James M. Hotaling, Nima Baradaran, Chong Zhang, Jeremy B. Myers, Joshua Piotrowski, Bradley J. Morris, Frank Burks, Christopher M. Dodgion, Reza Askari, Bradley A. Erickson, and Barbara U. Okafor more...
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Adult ,Male ,medicine.medical_specialty ,Urinary system ,Psychological intervention ,Hemorrhage ,Wounds, Stab ,Kidney ,Wounds, Nonpenetrating ,urologic and male genital diseases ,Critical Care and Intensive Care Medicine ,Risk Assessment ,Young Adult ,03 medical and health sciences ,Injury Severity Score ,0302 clinical medicine ,Trauma Centers ,Humans ,Medicine ,Kidney surgery ,Young adult ,Grading (tumors) ,business.industry ,030208 emergency & critical care medicine ,Middle Aged ,Nomogram ,United States ,Surgery ,Nomograms ,Treatment Outcome ,Female ,Kidney Diseases ,Risk assessment ,business - Abstract
The management of high-grade renal trauma (HGRT) and the indications for intervention are not well defined. The American Association for the Surgery of Trauma (AAST) renal grading does not incorporate some important clinical and radiologic variables associated with increased risk of interventions. We aimed to use data from a multi-institutional contemporary cohort to develop a nomogram predicting risk of interventions for bleeding after HGRT.From 2014 to 2017, data on adult HGRT (AAST grades III-V) were collected from 14 level 1 trauma centers. Patients with both clinical and radiologic data were included. Data were gathered on demographics, injury characteristics, management, and outcomes. Clinical and radiologic parameters, obtained after trauma evaluation, were used to predict renal bleeding interventions. We developed a prediction model by applying backward model selection to a logistic regression model and built a nomogram using the selected model.A total of 326 patients met the inclusion criteria. Mechanism of injury was blunt in 81%. Median age and injury severity score were 28 years and 22, respectively. Injuries were reported as AAST grades III (60%), IV (33%), and V (7%). Overall, 47 (14%) underwent interventions for bleeding control including 19 renal angioembolizations, 16 nephrectomies, and 12 other procedures. Of the variables included in the nomogram, a hematoma size of 12 cm contributed the most points, followed by penetrating trauma mechanism, vascular contrast extravasation, pararenal hematoma extension, concomitant injuries, and shock. The area under the receiver operating characteristic curve was 0.83 (95% confidence interval, 0.81-0.85).We developed a nomogram that integrates multiple clinical and radiologic factors readily available upon assessment of patients with HGRT and can provide predicted probability for bleeding interventions. This nomogram may help in guiding appropriate management of HGRT and decreasing unnecessary interventions.Prognostic and epidemiological study, level III. more...
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- 2019
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12. Nephrectomy After High-Grade Renal Trauma is Associated With Higher Mortality: Results From the Multi-Institutional Genitourinary Trauma Study (MiGUTS)
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Rachel Moses, Kaushik Mukherjee, Ian Schwartz, Michael E. Rezaee, Bryan B. Voelzke, Reza Askari, S. Mitchell Heiner, Matthew M. Carrick, Nima Baradaran, Sarah Majercik, Sorena Keihani, Sean P. Elliott, Erik S. DeSoucy, Brandi Miller, Benjamin N. Breyer, Joshua A. Broghammer, Raminder Nirula, Jeremy B. Myers, Christopher M. Dodgion, Judith C. Hagedorn, Clara M. Castillejo Becerra, J. Patrick Selph, Alexander P. Nocera, Chirag S. Arya, Elisa Fang, Scott Zakaluzny, Brian P. Smith, Shubham Gupta, Bradley A. Erickson, Richard A. Santucci, Katie Glavin, Benjamin J. McCormick, Margaret Higgins, Rachel L. Sensenig, Frank Burks, and Scott H. Norwood more...
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Adult ,Male ,medicine.medical_specialty ,Urology ,medicine.medical_treatment ,Renal Hemorrhage ,Kidney ,Nephrectomy ,Young Adult ,Injury Severity Score ,medicine ,Humans ,Retrospective Studies ,Genitourinary system ,business.industry ,Mortality rate ,Head injury ,Middle Aged ,medicine.disease ,Surgery ,Blood pressure ,Shock (circulatory) ,Wounds and Injuries ,Female ,medicine.symptom ,business - Abstract
To test the hypothesis that undergoing nephrectomy after high-grade renal trauma is associated with higher mortality rates.We gathered data from 21 Level-1 trauma centers through the Multi-institutional Genito-Urinary Trauma Study. Patients with high-grade renal trauma were included. We assessed the association between nephrectomy and mortality in all patients and in subgroups of patients after excluding those who died within 24 hours of hospital arrival and those with GCS≤8. We controlled for age, injury severity score (ISS), shock (systolic blood pressure90 mmHg), and Glasgow Coma Scale (GCS).A total of 1181 high-grade renal trauma patients were included. Median age was 31 and trauma mechanism was blunt in 78%. Injuries were graded as III, IV, and V in 55%, 34%, and 11%, respectively. There were 96 (8%) mortalities and 129 (11%) nephrectomies. Mortality was higher in the nephrectomy group (21.7% vs 6.5%, P.001). Those who died were older, had higher ISS, lower GCS, and higher rates of shock. After adjusting for patient and injury characteristics nephrectomy was still associated with higher risk of death (RR: 2.12, 95% CI: 1.26-2.55).Nephrectomy was associated with higher mortality in the acute trauma setting even when controlling for shock, overall injury severity, and head injury. These results may have implications in decision making in acute trauma management for patients not in extremis from renal hemorrhage. more...
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- 2021
13. Less Is More: A Multimodal Pain Management Strategy Is Associated With Reduced Opioid Use in Hospitalized Trauma Patients
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Annika B. Kay, Tom White, Margaret Baldwin, Scott Gardner, Lynsie M. Daley, and Sarah Majercik
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Adult ,Analgesics, Opioid ,Pain, Postoperative ,Pregnancy ,Humans ,Pain ,Pain Management ,Surgery ,Female ,Analgesics, Non-Narcotic ,Opioid-Related Disorders ,Retrospective Studies - Abstract
Adequate pain control is critical to the management and recovery of acutely injured patients. Opioids are associated with various adverse effects, and drug overdose is the leading cause of injury-related death in the United States. We hypothesized that a multimodal pain management protocol would reduce opioid use while still optimizing pain control.The study included the preanalysis (August 2017-September 2018) and postanalysis (October 2018-August 2019) of a multimodal pain management strategy implemented in hospitalized adult patients admitted to the trauma service at a single American College of Surgeons-verified level-1 trauma center. Patients less than 18 y of age, pregnant patients, or imprisoned patients were excluded. The primary endpoint was opioid prescription on discharge (morphine milligram equivalent [MME]). The secondary endpoints included inpatient MMEs, nonopioid adjunct use, and pain scores. Subgroup analysis evaluating opioid use based on Injury Severity Score groups (mild, moderate, or severe) and by the Abbreviated Injury Scale body region was performed.There were 1755 patients in the PRE group and 1723 patients in the POST group. MMEs prescribed on discharge decreased from median 15 (interquartile range: 37.5) to 1.2 (interquartile range: 22.5) (P 0.001). More patients in the POST group were discharged opioid-free (44% versus 37%, P 0.001). There was a significant increase in the use of all nonopioid pain medications. Pain scores did not change. Subgroup analysis revealed a significant decrease in discharge MMEs in mild and moderate Injury Severity Score groups and in all injured body regions except the chest.The implementation of a multimodal pain management protocol in trauma patients targeting scheduled nonopioid medications and patient education is feasible and is associated with reduced opioid amount prescribed on discharge, without compromising pain control. more...
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- 2021
14. Clinical and Radiographic Factors Associated With Failed Renal Angioembolization: Results From the Multi-institutional Genitourinary Trauma Study (Mi-GUTS)
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Shubham Gupta, Ryan P. Joyce, Frank Burks, Reza Askari, Manuel Armas-Phan, Jeremy B. Myers, Christopher M. Dodgion, Matthew M. Carrick, Bradley A. Erickson, Douglas Rogers, Nnenaya Agochukwu-Mmonu, Benjamin N. Breyer, Sorena Keihani, Judith C. Hagedorn, Sean P. Elliott, Sarah Majercik, Rachel Moses, Kaushik Mukherjee, Ian Schwartz, Sherry S. Wang, Joel A. Gross, J. Patrick Selph, Richard A. Santucci, Nima Baradaran, Rachel L. Sensenig, Raminder Nirula, Bryan B. Voelzke, Brian P. Smith, and Andrew J. Cohen more...
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Adult ,Male ,medicine.medical_specialty ,Kidney Disease ,Physical Injury - Accidents and Adverse Effects ,Exploratory laparotomy ,Urology ,Radiography ,medicine.medical_treatment ,Clinical Sciences ,Renal and urogenital ,030232 urology & nephrology ,Wounds, Penetrating ,Kidney ,Wounds, Nonpenetrating ,Embolization ,03 medical and health sciences ,Young Adult ,Penetrating ,0302 clinical medicine ,Clinical Research ,medicine ,Nonpenetrating ,Humans ,Prospective Studies ,Treatment Failure ,medicine.diagnostic_test ,business.industry ,Genitourinary system ,Angiography ,Urology & Nephrology ,Middle Aged ,Embolization, Therapeutic ,Surgery ,030220 oncology & carcinogenesis ,Wounds ,Cohort ,Perirenal hematoma ,Female ,Therapeutic ,business - Abstract
Objective To find clinical or radiographic factors that are associated with angioembolization failure after high-grade renal trauma. Material and Methods Patients were selected from the Multi-institutional Genito-Urinary Trauma Study. Included were patients who initially received renal angioembolization after high-grade renal trauma (AAST grades III-V). This cohort was dichotomized into successful or failed angioembolization. Angioembolization was considered a failure if angioembolization was followed by repeat angiography and/or an exploratory laparotomy. Results A total of 67 patients underwent management initially with angioembolization, with failure in 18 (27%) patients. Those with failed angioembolization had a larger proportion ofgrade IV (72% vs 53%) and grade V (22% vs 12%) renal injuries. A total of 53 patients underwent renal angioembolization and had initial radiographic data for review, with failure in 13 cases. The failed renal angioembolization group had larger perirenal hematoma sizes on the initial trauma scan. Conclusion Angioembolization after high-grade renal trauma failed in 27% of patients. Failed angioembolization was associated with higher injury grade and a larger perirenal hematoma. Likely these characteristics are associated with high-grade renal trauma that may be less amenable to successful treatment after a single renal angioembolization. more...
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- 2020
15. Characterization and influence of ipsilateral scapula fractures among patients who undergo surgical stabilization of sub-scapular rib fractures
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Kiara Leasia, Thomas W. White, Fredric M. Pieracci, Cyril Mauffrey, Ernest E. Moore, Alvaro Gargur Assuncao, Scott Gardner, Josh Parry, and Sarah Majercik
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musculoskeletal diseases ,medicine.medical_specialty ,Rib Fractures ,Scapula fracture ,Ribs ,Implant removal ,Scapular fracture ,03 medical and health sciences ,Fractures, Bone ,0302 clinical medicine ,Scapula ,medicine ,Humans ,Orthopedics and Sports Medicine ,In patient ,Retrospective Studies ,030222 orthopedics ,Retrospective review ,business.industry ,030208 emergency & critical care medicine ,musculoskeletal system ,medicine.disease ,Surgery ,body regions ,Pulmonary contusion ,Quality of Life ,Injury Severity Score ,business - Abstract
Current decision algorithms involving surgical stabilization of rib fractures (SSRF) do not consider either specific fracture locations or other chest wall bony injuries. Our objective was to characterize the impact of scapula fractures on morbidity among patients who underwent fixation of sub-scapular rib fractures. We hypothesized that an ipsilateral scapula fracture was associated with poor acute and long-term outcomes. Retrospective review of two institutions’ prospectively maintained SSRF databases (October 2010 to January 2019). Patients who underwent repair of ≥ 1 sub-scapular rib fracture were included. Patients were grouped by the presence of an ipsilateral scapula fracture. Outcomes were acute SSRF complications, long-term rib implant removal, and quality of life via phone survey. A total of 144 patients were analyzed; 53 (36.8%) had an ipsilateral scapula fracture. Patients with a scapula fracture had a higher injury severity score (p = 0.02), degree of pulmonary contusion (p more...
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- 2020
16. Weight-based enoxaparin dosing and deep vein thrombosis in hospitalized trauma patients: A double-blind, randomized, pilot study
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Annika B. Kay, Jeff Sorensen, David S. Morris, Scott C. Woller, Scott M. Stevens, Margaret Baldwin, Thomas W. White, Sarah Majercik, and Joseph Bledsoe
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medicine.medical_specialty ,business.industry ,Deep vein ,Trauma center ,030208 emergency & critical care medicine ,030204 cardiovascular system & hematology ,medicine.disease ,Thrombosis ,Surgery ,03 medical and health sciences ,Regimen ,0302 clinical medicine ,medicine.anatomical_structure ,Chemoprophylaxis ,medicine ,Injury Severity Score ,Dosing ,business ,Body mass index - Abstract
Background Venous thromboembolism is a cause of morbidity and mortality in trauma patients. Chemoprophylaxis with low-molecular-weight heparin at a standardized dose is recommended. Conventional chemoprophylaxis may be inadequate. We hypothesized that a weight-adjusted enoxaparin prophylaxis regimen would reduce the frequency of venous thromboembolism in hospitalized trauma patients and at 90-day follow-up. Methods This prospective, randomized pilot study enrolled adult patients admitted to a level 1 trauma center between July 2013 and January 2015. Subjects were randomized to receive either standard (30 mg subcutaneously every 12 hours) or weight-based (0.5mg/kg subcutaneously every 12 hours) enoxaparin. Surveillance duplex ultrasound for lower extremity deep vein thrombosis was performed on hospital days 1, 3, and 7, and weekly thereafter. The primary outcome was deep vein thrombosis during hospitalization. Secondary outcomes included venous thromboembolism at 90 days and significant bleeding events. Results Two hundred thirty-four (124 standard, 110 weight-based) subjects were enrolled. There was no difference between standard and weight-based regarding age, body mass index, percentage female gender, injury severity score, or percentage that had surgery. There was a trend toward less in-hospital deep vein thrombosis in weight-based (12 [9.7%] standard vs 4 [3.6%] weight-based, P = .075). At 90 days, there was no difference in venous thromboembolism (12 [9.7%] standard vs 6 [5.5%] weight-based, P =.34). There was 1 bleeding event, which occurred in a standard subject. Conclusion Weight-based enoxaparin dosing for venous thromboembolism chemoprophylaxis in trauma patients may provide better protection against venous thromboembolism than standard. A definitive study is necessary to determine whether weight-based dosing is superior to standard. more...
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- 2018
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17. A multicenter evaluation of the optimal timing of surgical stabilization of rib fractures
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Andrew R. Doben, Elan Jeremitsky, Alicia Mangram, Sarah Majercik, Fredric M. Pieracci, Julia R. Coleman, Thomas W. White, and Francis Ali-Osman
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Rib Fractures ,medicine.medical_treatment ,Operative Time ,Critical Care and Intensive Care Medicine ,Logistic regression ,Time-to-Treatment ,Fracture Fixation, Internal ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Fracture fixation ,medicine ,Humans ,030212 general & internal medicine ,Young adult ,Aged ,Retrospective Studies ,Aged, 80 and over ,Mechanical ventilation ,Rib cage ,business.industry ,Confounding ,030208 emergency & critical care medicine ,Retrospective cohort study ,Middle Aged ,Surgery ,Hospitalization ,Logistic Models ,Treatment Outcome ,Female ,business ,Body mass index - Abstract
The optimal timing of surgical stabilization of rib fractures (SSRF) remains debated. We hypothesized that (1) demographic, radiologic, and clinical variables are associated with time to surgery and (2) shorter time to SSRF improves acute outcomes.Prospectively collected SSRF databases from four trauma centers were merged and analyzed (2006-2016). The independent variable was days from hospital admission to SSRF (early [1 day], mid [1-2 days], and late [3-10 days]). Outcomes included length of operation, number of ribs repaired, prolonged (24 hours) mechanical ventilation, pneumonia, tracheostomy, length of stay, and mortality. Multivariable logistic regression was used to control for significant differences in covariates between groups.Five hundred fifty-one patients were analyzed. The median time to SSRF was 1 day (range, 0-10); 207 (37.6%) patients were in the early group, 168 (30.5%) in the midgroup, and 186 (31.9%) in the late group. There was a significant shift toward earlier SSRF over the study period. Time to SSRF was significantly associated with study center (p0.01), year of surgery (p0.01), age (p = 0.02), mechanism of injury (p = 0.04), and body mass index (p = 0.02). Injury severity was not associated with time to surgery. Despite repairing the same median number of ribs (4; range, 1-13), median length of surgery was 68 minutes longer for the late as compared to the early group (p0.01). After controlling for the aforementioned significant covariates, each additional hospital day before SSRF was independently associated with a 31% increased likelihood of pneumonia (p0.01), a 27% increased likelihood of prolonged mechanical ventilation (p0.01), and a 26% increased likelihood of tracheostomy (p0.01).Surgical stabilization of rib fractures within 1 day of admission is associated with certain demographic and physiologic variables. After controlling for confounding factors, early SSRF was accomplished using less operative time, and was associated with favorable outcomes. When indicated and feasible, SSRF should occur as early as possible.Therapy, level III. more...
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- 2018
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18. Quantifying and exploring the recent national increase in surgical stabilization of rib fractures
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Erica D. Kane, Elan Jeremitsky, Andrew R. Doben, Fredric M. Pieracci, and Sarah Majercik
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Adult ,Male ,medicine.medical_specialty ,Flail chest ,Time Factors ,Rib Fractures ,Patient demographics ,Prevalence ,Critical Care and Intensive Care Medicine ,03 medical and health sciences ,0302 clinical medicine ,Fracture Fixation ,Internal medicine ,Epidemiology ,Odds Ratio ,medicine ,Humans ,Hospital Mortality ,Retrospective Studies ,business.industry ,Incidence ,030208 emergency & critical care medicine ,Odds ratio ,Middle Aged ,medicine.disease ,United States ,Confidence interval ,Survival Rate ,030220 oncology & carcinogenesis ,Injury Severity Score ,Female ,Surgery ,Level ii ,business ,Follow-Up Studies - Abstract
BACKGROUND Surgical stabilization of rib fractures (SSRF) has become pivotal in the management of severe chest injuries. Recent literature supports improved outcomes and mortality in severe fracture and flail chest patients who undergo SSRF compared with nonoperative management (NOM). A 2014 National Trauma Data Bank review provided a point prevalence of 0.7% SSRF in flail patients. We hypothesize that this prevalence is increasing and that temporal, regional, and American College of Surgeons (ACS) trauma designation vary in SSRF utilization. METHODS Retrospective National Trauma Data Bank data were extracted for years 2007 to 2014 for patients with rib fractures. Cases were divided into SSRF versus NOM. SSRF frequencies were analyzed across year, region, and ACS level. Patient demographics, injury severity score, number of fractured ribs, and hospital characteristics were identified for multivariable analysis. RESULTS Between 2007 and 2014, 687,137 rib fracture patients were identified; 29,981 (4.36%) underwent SSRF. SSRF increased by 76% nationally during the review period (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.50-1.67; p < 0.001). Compared with the north, SSRF was used more in the west (OR, 1.6; 95% CI, 1.57-1.71), south (OR, 1.48; 95% CI, 1.43-1.54), then midwest (OR, 1.4; 95% CI, 1.34-1.46; p < 0.001). Although likelihood of SSRF is higher at ACS Level I (LI) centers compared with Level II (LII) centers (OR, 0.67; 95% CI, 0.65-0.69) or Level III (LIII) (OR, 0.24; 95% CI, 0.22-0.26); p < 0.001), frequency of SSRF increased dramatically at lower-level centers from 2007 to 2014 (LI, 41.4%; LII, 53.6%; LIII, 60.0%).Overall SSRF mortality was 1.58% (NOM, 5.3%; p < 0.001), decreasing significantly between 2007 and 2014 (p < 0.0001). ACS LII had higher mortality than LI (OR, 1.82; 95% CI, 1.39-2.39; p < 0.0001), controlled by Injury Severity Score. CONCLUSION Utilization of SSRF has risen considerably nationwide. Prevalence varies by region and ACS level. Although greatest growth is occurring at LII hospitals, mortality is also the highest at these centers. Further research is needed to determine the need for regionalization of care and center of excellence designation. LEVEL OF EVIDENCE Epidemiological study, level III. more...
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- 2017
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19. Chest Wall Trauma
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Fredric M. Pieracci and Sarah Majercik
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Pulmonary and Respiratory Medicine ,Sternum ,Flail chest ,medicine.medical_specialty ,Rib Fractures ,Pulmonary Dysfunction ,law.invention ,Pulmonary function testing ,03 medical and health sciences ,0302 clinical medicine ,Pain control ,Fracture Fixation ,law ,Flail Chest ,medicine ,Humans ,Pain Management ,Nonoperative management ,Thoracic Wall ,business.industry ,030208 emergency & critical care medicine ,medicine.disease ,Combined Modality Therapy ,Respiration, Artificial ,Intensive care unit ,Surgery ,Radiography ,030220 oncology & carcinogenesis ,Concomitant ,Radiology ,business - Abstract
Chest wall trauma is common, and contributes significantly to morbidity and mortality of trauma patients. Early identification of major chest wall and concomitant intrathoracic injuries is critical. Generalized management of multiple rib fractures and flail chest consists of adequate pain control (including locoregional modalities); management of pulmonary dysfunction by invasive and noninvasive means; and, in some cases, surgical fixation. Multiple studies have shown that patients with flail chest have substantial benefit (decreased ventilator and intensive care unit days, improved pulmonary function, and improved long-term functional outcome) when they undergo surgery compared with nonoperative management. more...
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- 2017
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20. Authors' Response to letter by Elkbuli et al
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Lawrence Lottenberg, Babak Sarani, Gregory Semon, Evert A. Eriksson, Kiara Leasia, Cornelius Dyke, Ledford Powell, Frank Zhao, Sarah Majercik, Zach Bauman, Andrew R. Doben, Fredric M. Pieracci, and Bradley W Thomas more...
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Rib Fractures ,Thoracic Injuries ,business.industry ,Critical Care and Intensive Care Medicine ,computer.software_genre ,Text mining ,Humans ,Medicine ,Surgery ,Prospective Studies ,Artificial intelligence ,Thoracic Wall ,business ,computer ,Natural language processing - Published
- 2020
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21. The American Association for the Surgery of Trauma renal injury grading scale: Implications of the 2018 revisions for injury reclassification and predicting bleeding interventions
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Bryn Putbrese, Douglas Rogers, Xian Luo-Owen, Scott Zakaluzny, Marta E. Heilbrun, Benjamin N. Breyer, Bradley J. Morris, Frank Burks, Jeremy B. Myers, Sorena Keihani, Sean P. Elliott, Matthew M. Carrick, Sarah Majercik, Ross E. Anderson, Kaushik Mukherjee, Ian Schwartz, Joel A. Gross, Richard A. Santucci, Erik S. DeSoucy, Brian P. Smith, Brenton Sherwood, La Donna Allen, Bradley A. Erickson, Reza Askari, Scott H. Norwood, Nima Baradaran, Joshua Piotrowski, Barbara U. Okafor, Brandi Miller, Gregory J. Stoddard, Cameron N. Fick, Christopher M. Dodgion, Raminder Nirula, and Timothy Hewitt more...
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Adult ,Male ,medicine.medical_specialty ,Psychological intervention ,Computed tomography ,Hemorrhage ,Critical Care and Intensive Care Medicine ,Kidney ,03 medical and health sciences ,0302 clinical medicine ,Injury Severity Score ,Renal injury ,medicine ,Humans ,Kidney surgery ,Grading (education) ,medicine.diagnostic_test ,business.industry ,Significant difference ,030208 emergency & critical care medicine ,Classification ,Surgery ,Female ,business ,Tomography, X-Ray Computed ,Grading scale - Abstract
Author(s): Keihani, Sorena; Rogers, Douglas M; Putbrese, Bryn E; Anderson, Ross E; Stoddard, Gregory J; Nirula, Raminder; Luo-Owen, Xian; Mukherjee, Kaushik; Morris, Bradley J; Majercik, Sarah; Piotrowski, Joshua; Dodgion, Christopher M; Schwartz, Ian; Elliott, Sean P; DeSoucy, Erik S; Zakaluzny, Scott; Sherwood, Brenton G; Erickson, Bradley A; Baradaran, Nima; Breyer, Benjamin N; Fick, Cameron N; Smith, Brian P; Okafor, Barbara U; Askari, Reza; Miller, Brandi D; Santucci, Richard A; Carrick, Matthew M; Allen, LaDonna; Norwood, Scott; Hewitt, Timothy; Burks, Frank N; Heilbrun, Marta E; Gross, Joel A; Myers, Jeremy B; in conjunction with the Trauma and Urologic Reconstruction Network of Surgeons | Abstract: BackgroundIn 2018, the American Association for the Surgery of Trauma (AAST) published revisions to the renal injury grading system to reflect the increased reliance on computed tomography scans and non-operative management of high-grade renal trauma (HGRT). We aimed to evaluate how these revisions will change the grading of HGRT and if it outperforms the original 1989 grading in predicting bleeding control interventions.MethodsData on HGRT were collected from 14 Level-1 trauma centers from 2014 to 2017. Patients with initial computed tomography scans were included. Two radiologists reviewed the scans to regrade the injuries according to the 1989 and 2018 AAST grading systems. Descriptive statistics were used to assess grade reclassifications. Mixed-effect multivariable logistic regression was used to measure the predictive ability of each grading system. The areas under the curves were compared.ResultsOf the 322 injuries included, 27.0% were upgraded, 3.4% were downgraded, and 69.5% remained unchanged. Of the injuries graded as III or lower using the 1989 AAST, 33.5% were upgraded to grade IV using the 2018 AAST. Of the grade V injuries, 58.8% were downgraded using the 2018 AAST. There was no statistically significant difference in the overall areas under the curves between the 2018 and 1989 AAST grading system for predicting bleeding interventions (0.72 vs. 0.68, p = 0.34).ConclusionAbout one third of the injuries previously classified as grade III will be upgraded to grade IV using the 2018 AAST, which adds to the heterogeneity of grade IV injuries. Although the 2018 AAST grading provides more anatomic details on injury patterns and includes important radiologic findings, it did not outperform the 1989 AAST grading in predicting bleeding interventions.Level of evidencePrognostic and Epidemiological Study, level III. more...
- Published
- 2019
22. MP04-01 OPTIMAL CUT-OFF POINTS FOR LACERATION SIZE AND PERI-RENAL HEMATOMA RIM DISTANCE TO PREDICT BLEEDING INTERVENTIONS AFTER HIGH-GRADE RENAL TRAUMA
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Matthew M. Carrick, Christopher M. Dodgion, Scott Zakaluzny, Sean Elliott, Marta E. Heilbrun, Erik S. DeSoucy, Frank Burks, Bradley A. Erickson, Benjamin N. Breyer, Chong Zhang, Rachel Moses, Jeremy B. Myers, Angela P. Presson, Brandi Miller, Jurek F. Kocik, Douglas Rogers, Richard A. Santucci, Raminder Nirula, Timothy Hewitt, James M. Hotaling, Nima Baradaran, Sarah Majercik, Brian J. Smith, Brenton Sherwood, Joshua Piotrowski, Bryn Putbrese, Sorena Keihani, Kaushik Mukherjee, and Ian Schwartz more...
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medicine.medical_specialty ,business.industry ,Urology ,Peri ,Renal hematoma ,medicine ,Psychological intervention ,business ,Surgery - Abstract
INTRODUCTION AND OBJECTIVES:Radiologic factors are important for predicting bleeding interventions after high-grade renal trauma (HGRT). We aimed to assess the associations between laceration size ... more...
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- 2019
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23. MP04-02 RELIABILITY OF THE AMERICAN ASSOCIATION FOR THE SURGERY OF TRAUMA (AAST) RENAL INJURY GRADING FOR HIGH-GRADE RENAL INJURIES
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Jurek F. Kocik, Raminder Nirula, Timothy Hewitt, Jeremy B. Myers, Richard A. Santucci, Scott Zakaluzny, James M. Hotaling, Brandi Miller, Christopher M. Dodgion, Erik S. DeSoucy, Benjamin N. Breyer, Kaushik Mukherjee, Ian Schwartz, Sean Elliott, Matthew M. Carrick, Frank Burks, Bradley A. Erickson, Gregory J. Stoddard, Sorena Keihani, Sarah Majercik, Brian J. Smith, Brenton Sherwood, Joshua Piotrowski, Bryn Putbrese, Douglas Rogers, Nima Baradaran, and Marta E. Heilbrun more...
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medicine.medical_specialty ,Renal injury ,business.industry ,Urology ,medicine ,business ,Grading (education) ,Surgery - Abstract
INTRODUCTION AND OBJECTIVES:The American Association for the Surgery of Trauma (AAST) injury scale is the most widely used grading system for renal trauma. However, reproducibility of the AAST grad... more...
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- 2019
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24. Platelet dysfunction on thromboelastogram is associated with severity of blunt traumatic brain injury
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Annika B. Kay, Sarah Majercik, David S. Morris, and Dave S. Collingridge
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Male ,Platelet dysfunction ,Traumatic brain injury ,Wounds, Nonpenetrating ,03 medical and health sciences ,0302 clinical medicine ,Blunt ,Injury Severity Score ,Disease severity ,Trauma Centers ,Brain Injuries, Traumatic ,medicine ,Humans ,Hospital Mortality ,Registries ,Retrospective Studies ,Retrospective review ,business.industry ,Trauma center ,Retrospective cohort study ,General Medicine ,Middle Aged ,medicine.disease ,nervous system diseases ,Thrombelastography ,nervous system ,030220 oncology & carcinogenesis ,Anesthesia ,Surgery ,Female ,Blood Platelet Disorders ,business ,Tomography, X-Ray Computed ,030217 neurology & neurosurgery - Abstract
Background Platelet dysfunction associated with isolated traumatic brain injury (TBI) can be measured using thromboelastography-platelet mapping (TEG-PM). We hypothesized that platelet dysfunction can be detected after blunt TBI, and the degree of dysfunction is associated with increased TBI severity and in-hospital mortality. Methods This was a retrospective review of adult trauma patients admitted to a single level 1 trauma center from August 2013 to March 2015 who suffered isolated severe blunt TBI. Subjects were included if they received a TEG-PM within 24 h from injury, and excluded if on preinjury antiplatelet medications. Results 119 subjects were analyzed. Severe TBI subjects (AIS-head 5) had ADPi 18.4 points higher than moderate TBI subjects (AIS-head 3) (p = 0.001). Platelet dysfunction was not associated with TBI progression. ADPi significantly predicted mortality (OR 1.033; 95% CI 1.005–1.061, p = 0.02). Conclusion Platelet dysfunction occurs immediately after isolated blunt TBI, is more pronounced with increasing TBI severity, and is associated with higher odds of in-hospital mortality. Further investigation is needed to determine whether this is a marker of disease severity or a therapeutic target. more...
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- 2019
25. Risk of Resistant Organisms and Clostridium difficile with Prolonged Systemic Antibiotic Prophylaxis for Central Nervous System Devices
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Stephanie Chauv, Quang P. Hoang, Courtney B. McKinney, Sarah Majercik, Gabriel V. Fontaine, Whitney R. Buckel, Margaret Baldwin, Dave S. Collingridge, and Paul Wohlt
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Adult ,Male ,Risk ,medicine.medical_specialty ,Intracranial Pressure ,medicine.drug_class ,Antibiotics ,Critical Care and Intensive Care Medicine ,03 medical and health sciences ,0302 clinical medicine ,Intensive care ,Internal medicine ,Drug Resistance, Bacterial ,medicine ,Humans ,030212 general & internal medicine ,Antibiotic prophylaxis ,Aged ,Retrospective Studies ,Aged, 80 and over ,Brain Diseases ,APACHE II ,Clostridioides difficile ,business.industry ,Odds ratio ,Antibiotic Prophylaxis ,Middle Aged ,Clostridium difficile ,Neurophysiological Monitoring ,Cerebrospinal Fluid Shunts ,Surgery ,Intensive Care Units ,Catheter-Related Infections ,Female ,Neurology (clinical) ,business ,Cefuroxime ,030217 neurology & neurosurgery ,Cohort study ,medicine.drug - Abstract
Prolonged systemic antibiotic prophylaxis for central nervous system (CNS) devices may be associated with increased risk of antimicrobial resistance. The primary objective of this study was to determine the impact of prolonged CNS device antibiotic prophylaxis on the growth of resistant microorganisms and Clostridium difficile. This retrospective, observational, cohort study included patients admitted to intensive care units with traumatic brain injury or other neurocritical illness. Patients who received a CNS device and antibiotic prophylaxis for at least 72 h were compared to patients with similar neurologic injuries who did not receive a CNS device. Study (n = 116) and control (n = 557) patients had mean APACHE II scores of 17.7 ± 9.2 and 15.1 ± 10.6 (p = 0.004) with 53.4 and 24.6 % receiving craniotomies (p more...
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- 2016
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26. Optimal timing of delayed excretory phase computed tomography scan for diagnosis of urinary extravasation after high-grade renal trauma
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Douglas Rogers, Xian Luo-Owen, Erik S. DeSoucy, Nima Baradaran, Joshua Piotrowski, Sorena Keihani, Bradley J. Morris, Frank Burks, Bradley A. Erickson, Sean P. Elliott, Jeremy B. Myers, Darshan P. Patel, Gregory J. Stoddard, Jurek F. Kocik, Matthew M. Carrick, Kaushik Mukherjee, Ian Schwartz, Richard A. Santucci, Reza Askari, Sarah Majercik, James M. Hotaling, Raminder Nirula, Timothy Hewitt, Cameron N. Fick, Christopher M. Dodgion, Barbara U. Okafor, Bryn Putbrese, Brandi Miller, Benjamin N. Breyer, Brian P. Smith, Brenton Sherwood, Scott Zakaluzny, and Marta E. Heilbrun more...
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Adult ,Male ,medicine.medical_specialty ,Computed tomography ,Critical Care and Intensive Care Medicine ,Kidney ,Wounds, Nonpenetrating ,03 medical and health sciences ,0302 clinical medicine ,Injury Severity Score ,Predictive Value of Tests ,medicine ,Humans ,Grading (tumors) ,medicine.diagnostic_test ,business.industry ,030208 emergency & critical care medicine ,Middle Aged ,Urinary extravasation ,Urinary Incontinence ,ROC Curve ,Excretory system ,Predictive value of tests ,Surgery ,Excretory phase ,Female ,Radiology ,Tomography ,business ,Tomography, X-Ray Computed - Abstract
Excretory phase computed tomography (CT) scan is used for diagnosis of renal collecting system injuries and accurate grading of high-grade renal trauma. However, optimal timing of the excretory phase is not well established. We hypothesized that there is an association between excretory phase timing and diagnosis of urinary extravasation and aimed to identify the optimal excretory phase timing for diagnosis of urinary extravasation.The Genito-Urinary Trauma Study collected data on high-grade renal trauma (grades III-V) from 14 Level I trauma centers between 2014 and 2017. The time between portal venous and excretory phases at initial CT scans was recorded. Poisson regression was used to measure the association between excretory phase timing and diagnosis of urinary extravasation. Predictive receiver operating characteristic analysis was used to identify a cutoff point optimizing detection of urinary extravasation.Overall, 326 patients were included; 245 (75%) had excretory phase CT scans for review either initially (n = 212) or only at their follow-up (n = 33). At initial CT with excretory phase, 46 (22%) of 212 patients were diagnosed with urinary extravasation. Median time between portal venous and excretory phases was 4 minutes (interquartile range, 4-7 minutes). Time of initial excretory phase was significantly greater in those diagnosed with urinary extravasation. Increased time to excretory phase was positively associated with finding urinary extravasation at the initial CT scan after controlling for multiple factors (risk ratio per minute, 1.15; 95% confidence interval, 1.09-1.22; p0.001). The optimal delay for detection of urinary extravasation was 9 minutes.Timing of the excretory phase is a significant factor in accurate diagnosis of renal collecting system injury. A 9-minute delay between the early and excretory phases optimized detection of urinary extravasation.Diagnostic tests/criteria study, level III. more...
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- 2019
27. Contemporary management of high-grade renal trauma: Results from the American Association for the Surgery of Trauma Genitourinary Trauma study
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Kaushik Mukherjee, Ian Schwartz, Erik S. DeSoucy, Angela P. Presson, Brandi Miller, Matthew M. Carrick, Sarah Majercik, Bradley A. Erickson, Jeremy B. Myers, Sorena Keihani, Nima Baradaran, Brian P. Smith, Sean P. Elliott, Joshua Piotrowski, Jurek F. Kocik, Scott Zakaluzny, Raminder Nirula, Timothy Hewitt, Benjamin N. Breyer, Yizhe Xu, Reza Askari, Christopher M. Dodgion, Cullen M. Black, Bradley J. Morris, Frank Burks, Peter B. Thomsen, Richard A. Santucci, and James M. Hotaling more...
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Male ,Time Factors ,Kidney Disease ,medicine.medical_treatment ,030232 urology & nephrology ,Wounds, Penetrating ,Traumatology ,Cardiorespiratory Medicine and Haematology ,Wounds, Nonpenetrating ,Kidney ,urologic and male genital diseases ,Critical Care and Intensive Care Medicine ,Penetrating ,Injury Severity Score ,trauma centers ,0302 clinical medicine ,Trauma Centers ,Renal trauma ,80 and over ,Prospective Studies ,Disease management (health) ,Young adult ,Prospective cohort study ,Societies, Medical ,Aged, 80 and over ,Trauma Severity Indices ,Disease Management ,Middle Aged ,Prognosis ,Nephrectomy ,Genito-Urinary Trauma Study Group ,Wounds ,Female ,Patient Safety ,6.4 Surgery ,Adult ,medicine.medical_specialty ,Physical Injury - Accidents and Adverse Effects ,Adolescent ,Clinical Sciences ,Urogenital System ,wounds and injuries ,Nursing ,Young Adult ,03 medical and health sciences ,Clinical Research ,Medical ,medicine ,Humans ,Nonpenetrating ,Aged ,Genitourinary system ,business.industry ,Prevention ,General surgery ,Evaluation of treatments and therapeutic interventions ,030208 emergency & critical care medicine ,renal injury grading ,Emergency & Critical Care Medicine ,multicenter study ,Surgery ,Observational study ,Societies ,business ,Follow-Up Studies - Abstract
© 2018 Wolters Kluwer Health, Inc. BACKGROUND The rarity of renal trauma limits its study and the strength of evidence-based guidelines. Although management of renal injuries has shifted toward a nonoperative approach, nephrectomy remains the most common intervention for high-grade renal trauma (HGRT). We aimed to describe the contemporary management of HGRT in the United States and also evaluate clinical factors associated with nephrectomy after HGRT. METHODS From 2014 to 2017, data on HGRT (American Association for the Surgery of Trauma grades III-V) were collected from 14 participating Level-1 trauma centers. Data were gathered on demographics, injury characteristics, management, and short-term outcomes. Management was classified into three groups-expectant, conservative/minimally invasive, and open operative. Descriptive statistics were used to report management of renal trauma. Univariate and multivariate logistic mixed effect models with clustering by facility were used to look at associations between proposed risk factors and nephrectomy. RESULTS A total of 431 adult HGRT were recorded; 79% were male, and mechanism of injury was blunt in 71%. Injuries were graded as III, IV, and V in 236 (55%), 142 (33%), and 53 (12%), respectively. Laparotomy was performed in 169 (39%) patients. Overall, 300 (70%) patients were managed expectantly and 47 (11%) underwent conservative/minimally invasive management. Eighty-four (19%) underwent renal-related open operative management with 55 (67%) of them undergoing nephrectomy. Nephrectomy rates were 15% and 62% for grades IV and V, respectively. Penetrating injuries had significantly higher American Association for the Surgery of Trauma grades and higher rates of nephrectomy. In multivariable analysis, only renal injury grade and penetrating mechanism of injury were significantly associated with undergoing nephrectomy. CONCLUSION Expectant and conservative management is currently utilized in 80% of HGRT; however, the rate of nephrectomy remains high. Clinical factors, such as surrogates of hemodynamic instability and metabolic acidosis, are associated with nephrectomy for HGRT; however, higher renal injury grade and penetrating trauma remain the strongest associations. LEVEL OF EVIDENCE Prognostic/epidemiologic study, level III; Therapeutic study, level IV. more...
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- 2018
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28. Epidemiology of Traumatic Brain Injury After Small-Wheeled Vehicle Trauma in Utah
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Mark H. Stevens, Joseph Bledsoe, Joel D. MacDonald, Sarah Majercik, and Suzanne Day
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Adult ,Male ,Risk ,medicine.medical_specialty ,Adolescent ,Critical Care ,Traumatic brain injury ,Poison control ,law.invention ,Young Adult ,International Classification of Diseases ,law ,Utah ,Epidemiology ,Injury prevention ,Concussion ,medicine ,Humans ,Glasgow Coma Scale ,Registries ,business.industry ,Emergency department ,Middle Aged ,medicine.disease ,Intensive care unit ,Brain Injuries ,Skating ,Emergency medicine ,Physical therapy ,Female ,Head Protective Devices ,Surgery ,Neurology (clinical) ,Emergency Service, Hospital ,business - Abstract
Recreational use of small-wheeled vehicles (SWVs), which include skateboards, longboards, nonmotorized scooters, ice skates, and roller skates or rollerblades, results in numerous injuries in the United States.To describe the nature and severity of traumatic brain injuries (TBIs) that result from the use of SWVs in Utah.Patients who were admitted to any Utah hospital after a SWV-related injury from 2001 through 2010 were identified from the Utah State Trauma Registry. Patients who sustained TBI were identified by International Classification of Diseases, Ninth Revision, codes.Of 907 patients admitted with SWV injury, 392 (43%) had a TBI (85% male). Their mean age was 19.8 ± 0.5 years, including 234 (60%) aged ≤18 and 119 (30%) aged 19 to 29. Most patients sustained TBI while using a skate- or longboard (87%). Mean Glasgow Coma Scale score in the emergency department was 12.8 ± 0.2. Thirty-nine percent were admitted to an intensive care unit, and 6% (23) underwent emergent neurosurgical intervention. Thirty-three (8.4%) patients had a concussion; the rest had nonoperative intracranial hemorrhage. Among patients for whom helmet use data were available, 8 out of 291 (2.7%) patients with TBI were wearing a helmet, whereas 24 out of 190 (12.6%) non-TBI patients were wearing helmets (P.001). Overall mortality was higher in TBI patients than in non-TBI patients (2.3% vs 0.2%, P = .003).Young people, especially males, who ride SWVs in Utah are at risk for serious TBI, admission to the intensive care unit, neurosurgical intervention, and death. Helmet use in these patients is likely rare, but may reduce the risk of TBI and death.ED, emergency departmentSWV, small-wheeled vehicleTBI, traumatic brain injury. more...
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- 2015
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29. MP79-01 NEPHRECTOMY AFTER HIGH-GRADE RENAL TRAUMA: RESULTS FROM THE AMERICAN ASSOCIATION FOR THE SURGERY OF TRAUMA (AAST) GENITOURINARY TRAUMA STUDY
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Xian Luo-Owen, Matthew M. Carrick, Barbara A. Shaffer, Bradley J. Morris, Frank Burks, Brandi Miller, Peter B. Thomsen, Erik S. DeSoucy, Bradley A. Erickson, Sarah Majercik, Scott Zakaluzny, Richard A. Santucci, Jeremy B. Myers, Brian P. Smith, Jurek F. Kocik, Patrick M. Reilly, Raminder Nirula, Timothy Hewitt, Sorena Keihani, Kaushik Mukherjee, Gregory Murphy, Benjamin N. Breyer, Yizhe Xu, LaDonna Allen, and Angela P. Presson more...
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medicine.medical_specialty ,business.industry ,Genitourinary system ,Urology ,medicine.medical_treatment ,medicine ,business ,Nephrectomy ,Surgery - Published
- 2017
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30. PD63-02 COMPLIANCE WITH AUA GUIDELINES WITH EXCRETORY PHASE IMAGING FOR EVALUATION OF HIGH-GRADE RENAL TRAUMA: RESULTS FROM THE AMERICAN ASSOCIATION FOR SURGERY OF TRAUMA (AAST) GENITOURINARY TRAUMA STUDY
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Brandi Miller, Bradley J. Morris, Frank Burks, Patrick M. Reilly, Benjamin N. Breyer, Brian P. Smith, Erik S. DeSoucy, Jurek F. Kocik, Jeremy B. Myers, Raminder Nirula, Timothy Hewitt, Bradley A. Erickson, Scott Zakaluzny, Sarah Majercik, Peter B. Thomsen, Richard A. Santucci, Gregory Murphy, Xian Luo-Owen, Kaushik Mukherjee, LaDonna Allen, and Sorena Keihani more...
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0301 basic medicine ,medicine.medical_specialty ,Genitourinary system ,business.industry ,Urology ,Surgery ,Compliance (physiology) ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,030220 oncology & carcinogenesis ,medicine ,Excretory phase ,business - Published
- 2017
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31. Cleared for takeoff
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Karen Conner, Lindell K. Weaver, Don H. Van Boerum, Joseph Bledsoe, Emily L. Wilson, Thomas W. White, Steven R. Granger, and Sarah Majercik
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endocrine system ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Radiography ,Vital signs ,Cardiorespiratory fitness ,Critical Care and Intensive Care Medicine ,medicine.disease ,Chest tube ,Pneumothorax ,Anesthesia ,Medicine ,Surgery ,business ,Chest radiograph ,Contraindication ,Clearance - Abstract
BACKGROUND Current guidelines suggest that traumatic pneumothorax (tPTX) is a contraindication to commercial airline travel, and patients should wait at least 2 weeks after radiographic resolution of tPTX to fly. This recommendation is not based on prospective, physiologic study. We hypothesized that despite having a radiographic increase in pneumothorax size while at simulated altitude, patients with a recently treated tPTX would not exhibit any adverse physiologic changes and would not report any symptoms of cardiorespiratory compromise. METHODS This is a prospective, observational study of 20 patients (10 in Phase 1, 10 in Phase 2) with tPTX that has been treated by chest tube (CT) or high flow oxygen therapy. CT must have been removed within 48 hours of entering the study. Subjects were exposed to 2 hours of hypobaria (554 mm Hg in Phase 1, 471 mm Hg in Phase 2) in a chamber in Salt Lake City, Utah. Vital signs and subjective symptoms were recorded during the "flight." After 2 hours, while still at simulated altitude, a portable chest radiograph (CXR) was obtained. tPTX sizes on preflight, inflight, and postflight CXR were compared. RESULTS Sixteen subjects (80%) were male. Mean (SD) age and ISS were 49 (5) years and 10.5 (4.6), respectively. Fourteen (70%) had a CT to treat tPTX, which had been removed 19 hours (range, 4-43 hours) before the study. No subject complained of any cardiorespiratory symptoms while at altitude. Radiographic increase in tPTX size at altitude was 5.6 (0.61) mm from preflight CXR. No subject developed a tension tPTX. No subject required procedural intervention during the flight. Four hours after the study, all tPTX had returned to baseline size. CONCLUSION Patients with recently treated tPTX have a small increase in the size of tPTX when subjected to simulated altitude. This is clinically well tolerated. Current prohibitions regarding air travel following traumatic tPTX should be reconsidered and further studied. LEVEL OF EVIDENCE Therapeutic study, level IV. more...
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- 2014
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32. Re: Rib fractures fixation: Always worthwhile?
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Alicia Mangram, Thomas W. White, Fredric M. Pieracci, Francis Ali-Osman, Sarah Majercik, and Andrew R. Doben
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03 medical and health sciences ,Fixation (surgical) ,medicine.medical_specialty ,0302 clinical medicine ,business.industry ,030220 oncology & carcinogenesis ,medicine ,030208 emergency & critical care medicine ,Surgery ,Critical Care and Intensive Care Medicine ,business - Published
- 2018
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33. Re: Urethral Trauma following Pelvic Fracture from Horseback Saddle Horn Injury versus Other Mechanisms of Pelvic Trauma
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Sorena Keihani, Rachel Moses, Jeremy B. Myers, James M. Hotaling, Sarah Majercik, and David L. Rothberg
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Male ,medicine.medical_specialty ,business.industry ,Pubic Symphysis Diastasis ,Urology ,Trauma center ,030232 urology & nephrology ,Poison control ,medicine.disease ,Surgery ,Perineum ,body regions ,Fractures, Bone ,03 medical and health sciences ,0302 clinical medicine ,Urethra ,medicine.anatomical_structure ,Injury prevention ,medicine ,Pelvic fracture ,Humans ,Injury Severity Score ,Pelvic Bones ,business - Abstract
Objective To examine the rate of urethral trauma and pubic symphysis diastasis in saddle horn injury, which occurs when horseback riders are bucked into the air and land with their perineum striking the rigid saddle horn, compared to pelvic fracture from other mechanisms. Methods A retrospective review was performed of male patients presenting to our level-1 trauma center with pelvic ring fractures between January 1, 2001 and December 30, 2016. Demographics, injury severity score, mechanism of injury (saddle horn vs other), pubic symphysis diastasis, and lower genitourinary (GU) injuries (bladder and urethra) were identified in the trauma registry. Chart review confirmed accuracy of lower GU trauma. Results A total of 1195 males presented with pelvic ring fractures, average age 43 years (SD 19 years). Of these, 87 of 1195 (7%) presented with lower GU injuries. Saddle horn injuries had a higher rate of lower GU injuries, 12/60 (20%) versus 75 of 1135 (7%) [P = .001]. In those with lower GU injuries, 47 of 87 (54%) had urethral injury. The rate of urethral injury was significantly higher in the saddle horn cohort, 10 of 12 (83%) versus 37 of 75 (49%) [P = .03]. Furthermore, rate of pubic symphysis diastasis was higher amongst saddle horn injuries, 12 of 12 (100%) versus other mechanisms 39 of 75 (52%) [P = .001]. Conclusion We found that urethral injury and pubic symphysis diastasis were higher in patients with saddle horn injury compared to other mechanisms of pelvic ring disruption. Clinicians should be aware of these associations when treating pelvic fracture following equestrian injuries. more...
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- 2019
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34. Red cell distribution width is predictive of mortality in trauma patients
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Jolene Fox, Stacey Knight, Benjamin D. Horne, and Sarah Majercik
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Anemia ,Complete blood count ,Red blood cell distribution width ,Retrospective cohort study ,Critical Care and Intensive Care Medicine ,medicine.disease ,Blood cell ,medicine.anatomical_structure ,Internal medicine ,Predictive value of tests ,Cardiology ,Medicine ,Injury Severity Score ,Surgery ,In patient ,business - Abstract
BACKGROUNDRed blood cell distribution width (RDW) is a component of the complete blood count (CBC) that is traditionally used to identify iron-deficiency anemia. RDW has been shown to predict mortality in patients with multiple different medical conditions and in general populations. It is unknown w more...
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- 2013
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35. Consensus statement: Surgical stabilization of rib fractures rib fracture colloquium clinical practice guidelines
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Thomas W. White, Bruce G. French, John G. Edwards, Mario Gasparri, Fredric M. Pieracci, Babak Sarani, Francis Ali-Osman, Christian T. Minshall, Darwin Ang, Andrew R. Doben, Silvana Marasco, Don H. VanBoerum, Sarah Majercik, and William B. Tisol more...
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Adult ,medicine.medical_specialty ,Consensus ,Rib Fractures ,Thoracic Injuries ,Statement (logic) ,Wounds, Nonpenetrating ,03 medical and health sciences ,Fracture Fixation, Internal ,0302 clinical medicine ,medicine ,Humans ,030212 general & internal medicine ,General Environmental Science ,Aged ,Evidence-Based Medicine ,business.industry ,General surgery ,030208 emergency & critical care medicine ,Evidence-based medicine ,Middle Aged ,United States ,Wounds nonpenetrating ,Surgery ,Clinical Practice ,Fracture (geology) ,General Earth and Planetary Sciences ,business - Published
- 2016
36. Seizure Prophylaxis in Patients with Traumatic Brain Injury: A Single-Center Study
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Shannon Inglet, Sarah Majercik, Margaret Baldwin, Amie H Quinones, Dave S. Collingridge, and Joel D. MacDonald
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medicine.medical_specialty ,Traumatic brain injury ,seizure ,Neurosurgery ,Poison control ,Single Center ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,Internal medicine ,medicine ,business.industry ,traumatic brain injury ,Mortality rate ,Trauma center ,General Engineering ,Glasgow Coma Scale ,030208 emergency & critical care medicine ,medicine.disease ,Intensive care unit ,Surgery ,Cohort ,outcome ,prophylaxis ,business ,030217 neurology & neurosurgery - Abstract
The use of prophylactic anticonvulsants to prevent early post-traumatic seizures (PTSs) is recommended but inconsistently employed in patients with traumatic brain injury (TBI). The authors evaluated outcomes associated with prophylaxis administration in patients with TBI at a Level 1 trauma center. All patients admitted with TBI from October 2007 through May 2012 were included. Our primary outcome was the incidence of early PTSs. Secondary outcomes included mortality, length of hospital and intensive care unit (ICU) stays, and incidence of late seizures. Of the 2,111 patients with TBI, 557 (26.4%) received seizure prophylaxis and 1,554 (73.6%) did not. Two early PTSs occurred in the prophylaxis group (0.4%), whereas 21 occurred in the non-prophylaxis group (1.4%) (p = 0.05). The overall mortality rate was higher in patients who received prophylaxis (14.2% vs. 6.2%; p < 0.001), and the mean hospital length of stay (LOS) was longer (6.8 ± 6.9 vs. 3.8 ± 5 days; p < 0.001). In patients with severe and moderate TBI, the rate of prophylaxis administration was approximately half, whereas significantly fewer patients with mild TBI received prophylaxis than did not (20.2% vs 79.8%, p < 0.001). Lower Glasgow Coma Scale (GCS) score and longer hospital LOS were associated with early PTS (p = 0.008 for both comparisons), but sex and age were not. Brain hemorrhage was present in 78.3% of those patients who experienced early seizures. In our cohort, patients who received seizure prophylaxis had a lower GCS score, higher overall mortality rate, longer LOS, and more frequent ICU admissions, suggesting that patients who received prophylaxis were likely more severely injured. more...
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- 2016
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37. The salutary effect of an integrated system on the rate of repeat CT scanning in transferred trauma patients: Improved costs and efficiencies
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Li Dong, Jamon Hemingway, Scott Gardner, Todd L. Allen, Joseph Bledsoe, Sarah Majercik, Mark H. Stevens, and Amy E. Liepert
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Male ,Patient Transfer ,medicine.medical_specialty ,Total cost ,Computed tomography ,Efficiency ,Unnecessary Procedures ,03 medical and health sciences ,0302 clinical medicine ,Cost Savings ,Health care ,Medicine ,Humans ,030212 general & internal medicine ,Prospective Studies ,Prospective cohort study ,Patient transfer ,medicine.diagnostic_test ,business.industry ,Delivery of Health Care, Integrated ,Trauma center ,030208 emergency & critical care medicine ,General Medicine ,Middle Aged ,Cost savings ,Surgery ,Emergency medicine ,Wounds and Injuries ,Female ,business ,Tomography, X-Ray Computed ,Healthcare system - Abstract
Background Duplication of Computed Tomography (CT) scanning in trauma patients has been a source of quality waste in healthcare and potential harm for patients. Integrated and regional health systems have been shown to promote opportunities for efficiencies, cost savings and increased safety. Methods This study evaluated traumatically injured patients who required transfer to a Level One Trauma Center (TC) from either within a vertically integrated healthcare system (IN) or from an out-of-network (OON) hospital. Results We found the rate of repeat CT scanning, radiology costs and total costs for day one of hospitalization to be significantly lower for trauma patients transferred from an IN hospital as compared to those patients transferred from OON hospitals. Conclusion The inefficiencies and waste often associated with transferred patients can be mitigated and strategies to do so are necessary to reduce costs in the current healthcare environment. more...
- Published
- 2016
38. The Impact of Surgeon Specialization on Patient Mortality
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Esther Y. Hsiao, Mitzi Hirbe, Sarah Majercik, Bruce L. Hall, and Barton H. Hamilton
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Adult ,Male ,Gerontology ,Index (economics) ,Case volume ,business.industry ,Mortality rate ,Logit ,Odds ratio ,Patient data ,Middle Aged ,Specialties, Surgical ,Continuous variable ,Specialization (functional) ,Humans ,Medicine ,Female ,Surgery ,Mortality ,business ,Aged ,Demography - Abstract
Objective: To examine the effect of surgeon specialization on patient outcomes, controlling for volume. Background: There is great interest in the degree to which surgical specialization affects outcomes, particularly considering drives to measure and reward quality in healthcare. Although surgical specialization has been previously analyzed with respect to outcomes, most studies have treated it as a dichotomous variable based on academic credentials. We treat it here as a continuous variable defined quantitatively by procedural diversity. Methods: We used 2002 to 2005 patient data from the National Surgical Quality Improvement Program for the Department of Surgery, Barnes Jewish Hospital, St. Louis, Missouri. To quantitate procedural specialization, Herfindahl-Hirschman indices for surgeons were calculated using billing codes. These indices were calculated according to 3 different levels of procedural aggregation. Using conditional logit models, we examined the relationship between these indices and 30-day postoperative mortality rates. Results: Surgeon specialization was inversely related to mortality rates after adjusting for case volume when indices were calculated using medium procedural aggregation (odds ratio for mortality = 0.580 per 0.1 unit Herfindahl increase; P = 0.025) or low aggregation (odds ratio for mortality = 0.510 per 0.1 unit Herfindahl increase; P = 0.015). No relationship was observed at the high level of aggregation. Conclusions: The procedural concentration component of surgical specialization is correlated with improved mortality rates independently of case volume. However, how broadly or narrowly "specialization" is defined has an impact on this relationship. more...
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- 2009
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39. In-hospital outcomes and costs of surgical stabilization versus nonoperative management of severe rib fractures
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Thomas W. White, Emily L. Wilson, Steven R. Granger, Scott Gardner, Sarah Majercik, and Don H. VanBoerum
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Adult ,Male ,medicine.medical_specialty ,Critical Care ,Rib Fractures ,Treatment outcome ,Critical Care and Intensive Care Medicine ,Injury Severity Score ,Trauma Centers ,medicine ,Humans ,Orthopedic Procedures ,Nonoperative management ,Propensity Score ,Aged ,Abbreviated Injury Scale ,business.industry ,Length of Stay ,Middle Aged ,Hospital Charges ,Respiration, Artificial ,Surgery ,Treatment Outcome ,Hospital outcomes ,Case-Control Studies ,Propensity score matching ,Female ,business - Abstract
One factor that has precluded the wide adoption of surgical stabilization of rib fractures (SSRF) is the perception that it is too expensive to surgically repair an injury that will eventually heal without intervention. The purpose of this study was to compare in-hospital outcomes, costs, and charges for SSRF patients with a series of propensity-matched, nonoperatively managed rib fracture (NON-OP) patients at a single Level 1 trauma center.All patients admitted with rib fractures between January 2009 and June 2013 were identified. Patient demographics, injury, cost, and charge data were collected. Two-to-one propensity score matching was used to identify NON-OP patients who were similar to the SSRF patients. Zero-inflated negative binomial regression was conducted to assess the relationship among SSRF, intensive care unit (ICU) length of stay (LOS), and ventilator days. Cost and charge information was compared using Wilcoxon rank-sum tests.A total of 411 patients (137 SSRF, 274 NON-OP) were included in the analysis. Ventilator days and ICU LOS in days were not different between the SSRF and NON-OP groups when compared using the Wilcoxon rank-sum test. Ventilator and ICU days were less for SSRF by 2.24 days and 1.62 days, respectively, using zero-inflated negative binomial analysis to exclude the large number of patients who had 0 day on the ventilator and/or in the ICU. SSRF patients had higher hospital costs and total relevant charges compared with the NON-OP patients. Subgroup analysis of patients requiring mechanical ventilation who did not have head injury showed decreased ventilator days (median, 3 days vs. 5 days; p = 0.03) and need for tracheostomy (5% vs. 23%, p = 0.02) in SSRF versus NON-OP, respectively. In this subgroup, there was no difference in hospital costs and charges between SSRF and NON-OP.SSRF patients have shorter ICU LOS and less ventilator days than NON-OP across a diverse group of patients. Hospital costs and charges for SSRF patients are higher. In mechanically ventilated patients who do not have head injury, in-hospital outcomes are better, and there is no difference in hospital costs and charges. Further prospective cost-effectiveness research will determine whether improved quality of life and ability to return to meaningful activity sooner outweighs the increased costs of the acute care episode for SSRF patients.Epidemiologic study, level III. more...
- Published
- 2015
40. High-grade renal injuries are often isolated in sports-related trauma
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James M. Hotaling, Jeffrey D. Redshaw, Darshan P. Patel, Scott Gardner, Bradley A. Erickson, James R. Craig, Chong Zhang, Thomas G. Smith, Benjamin N. Breyer, Jeremy B. Myers, William O. Brant, Sarah Majercik, Thomas W. Gaither, and Angela P. Presson more...
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Male ,Kidney Disease ,Wounds, Nonpenetrating ,urologic and male genital diseases ,Cardiovascular ,Kidney ,Injury Severity Score ,Trauma Centers ,Medicine ,General Environmental Science ,Pediatric ,Abbreviated Injury Scale ,Injuries and accidents ,Prognosis ,medicine.anatomical_structure ,Athletic Injuries ,Wounds ,Public Health and Health Services ,Female ,6.4 Surgery ,Sports ,Adult ,Abdominal injuries ,medicine.medical_specialty ,Clinical Sciences ,Nursing ,Article ,Blunt ,Renal injury ,Clinical Research ,Snow sports ,Humans ,Nonpenetrating ,Retrospective Studies ,business.industry ,Evaluation of treatments and therapeutic interventions ,Retrospective cohort study ,United States ,Wounds nonpenetrating ,Surgery ,Good Health and Well Being ,Orthopedics ,Concomitant ,Non-penetrating ,Injury (total) Accidents/Adverse Effects ,General Earth and Planetary Sciences ,business ,human activities - Abstract
© 2015 Elsevier Ltd. All rights reserved. Introduction: Most high-grade renal injuries (American Association for Surgery of Trauma (AAST) grades III-V) result from motor vehicle collisions associated with numerous concomitant injuries. Sports-related blunt renal injury tends to have a different mechanism, a solitary blow to the flank. We hypothesized that high-grade renal injury is often isolated in sports-related renal trauma. Material and methods: We identified patients with AAST grades III-V blunt renal injuries from four level 1 trauma centres across the United States between 1/2005 and 1/2014. Patients were divided into "Sport" or "Non-sport" related groups. Outcomes included rates of hypotension (systolic blood pressure 110 bpm), concomitant abdominal injury, and procedural/surgical intervention between sports and non-sports related injury. Results: 320 patients met study criteria. 18% (59) were sports-related injuries with the most common mechanisms being skiing, snowboarding and contact sports (25%, 25%, and 24%, respectively). Median age was 24 years for sports and 30 years for non-sports related renal injuries (p = 0.049). Males were more commonly involved in sports related injuries (85% vs. 72%, p = 0.011). Median injury severity score was lower for sports related injuries (10 vs. 27, p < 0.001). There was no difference in renal abbreviated injury scale scores. Sports related trauma was more likely to be isolated without other significant injury (69% vs. 39% (p < 0.001)). Haemodynamic instability was present in 40% and 51% of sports and non-sports renal injuries (p = 0.30). Sports injuries had lower transfusion (7% vs. 47%, p < 0.001) and lower mortality rates (0% vs. 6%, p = 0.004). There was no difference in renal-specific procedural interventions between the two groups (17% sports vs. 18% non-sports, p = 0.95). Conclusions: High-grade sports-related blunt renal trauma is more likely to occur in isolation without other abdominal or thoracic injuries and clinicians must have a high suspicion of renal injury with significant blows to the flank during sports activities. more...
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- 2015
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41. Surgical stabilization of severe rib fractures decreases incidence of retained hemothorax and empyema
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Steven R. Granger, Sathya Vijayakumar, Scott Gardner, Griffin Olsen, Thomas W. White, Emily L. Wilson, Sarah Majercik, and Don H. Van Boerum
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Male ,medicine.medical_specialty ,Rib Fractures ,symbols.namesake ,Injury Severity Score ,medicine ,Humans ,Registries ,Empyema ,Propensity Score ,Thoracic trauma ,Fisher's exact test ,Hemothorax ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Tomography x ray computed ,symbols ,Female ,Radiography, Thoracic ,business ,Tomography, X-Ray Computed - Abstract
Background Retained hemothorax (RH) is relatively common after chest trauma and can lead to empyema. We hypothesized that patients who have surgical fixation of rib fractures (SSRF) have less RH and empyema than those who have medical management of rib fractures (MMRF). Methods Admitted rib fracture patients from January 2009 to June 2013 were identified. A 2:1 propensity score model identified MMRF patients who were similar to SSRF. RH, and empyema and readmissions, were recorded. Variables were compared using Fisher exact test and Wilcoxon rank–sum tests. Results One hundred thirty-seven SSRF and 274 MMRF were analyzed; 31 (7.5%) had RH requiring 35 interventions; 3 (2.2%) SSRF patients had RH compared with 28 (10.2%) MMRF ( P = .003). Four (14.3%) MMRF subjects with RH developed empyema versus zero in the SSRF group ( P = .008); 6 (19.3%) RH patients required readmission versus 14 (3.7%) in the non-RH group ( P = .002). Conclusions Patients with rib fractures who have SSRF have less RH compared with similar MMRF patients. Although not a singular reason to perform SSRF, this clinical benefit should not be overlooked. more...
- Published
- 2015
42. Halo-Vest Immobilization Increases Early Morbidity and Mortality in Elderly Odontoid Fractures
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Robert Z. Tashjian, Mark A. Palumbo, Walter L. Biffl, Sarah Majercik, and William G. Cioffi
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Male ,Orthotic Devices ,medicine.medical_specialty ,Cervical orthosis ,Critical Care and Intensive Care Medicine ,Fracture Fixation ,Odontoid Process ,Epidemiology ,medicine ,Humans ,Hospital Mortality ,Aged ,Retrospective Studies ,Aged, 80 and over ,Trauma Severity Indices ,business.industry ,Treatment options ,Retrospective cohort study ,Cervical spine ,Orthotic device ,Orthopedic Fixation Devices ,Surgery ,Treatment Outcome ,Halo vest ,Spinal Fractures ,Female ,business ,Operative fixation - Abstract
Odontoid fractures are the most common cervical spine fractures in elderly patients. Treatment options included operative fixation (OP) or nonoperative management with either a halo-vest (HV) or rigid cervical orthosis (CO). Our previous study suggested increased morbidity and mortality with the use of HV in the treatment of elderly patients with cervical spine fractures. We review a series of odontoid fractures in elderly patients and evaluate for predictors for in-hospital morbidity and mortality.There were 78 patients65 years of age who sustained a type II or III odontoid fracture from January 1997 to June 2004 identified from the Rhode Island Hospital Trauma registry. Demographic, mechanism, injury pattern, treatment, and outcome data were recorded. Patients were analyzed according to treatment method.The mean age was 80.7 +/- 0.9 years. There were 50 type II, 17 type III, and 11 combined fractures. There were 38 (49%) patients treated with HV: 34 with halo alone, and 4 after OP; 40 (51%) patients were treated without HV: 27 with CO, and 13 with OP. There was no difference in injury severity or baseline medical condition between HV and non-HV patients. There were 24 (31%) patients who died during their hospital stay. Of the HV patients, 42% died compared with 20% in the non-HV group (p = 0.03). Major complications occurred in 66% of HV patients compared with 36% of non-HV patients (p = 0.003).Odontoid fractures are associated with significant morbidity and mortality in elderly patients. Outcomes after treatment with HV appear inferior to those achieved with CO or OP. more...
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- 2006
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43. Halo Vest Immobilization in the Elderly: A Death Sentence?
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Robert Z. Tashjian, David T. Harrington, William G. Cioffi, Walter L. Biffl, and Sarah Majercik
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Adult ,Male ,medicine.medical_specialty ,Population ,Respiratory arrest ,Critical Care and Intensive Care Medicine ,Immobilization ,Injury Severity Score ,Internal medicine ,Odontoid Process ,Epidemiology ,medicine ,Humans ,Glasgow Coma Scale ,education ,Aged ,Retrospective Studies ,Coma ,education.field_of_study ,business.industry ,Trauma center ,Age Factors ,Retrospective cohort study ,Surgery ,Treatment Outcome ,Cervical Vertebrae ,Spinal Fractures ,Female ,medicine.symptom ,business - Abstract
Background: Cervical spine fractures (CSFs) in elderly patients are increasingly common as the population ages. In many centers, halo vest immobilization (HVI) is the treatment of choice. Our anecdotal experience suggested that elderly patients treated with HVI have frequent bad outcomes. The purpose of this study was to compare the outcomes of elderly and younger CSF patients as related to treatment (HVI, surgery, or hard collar). Methods: Registry data from our Level I trauma center were reviewed to identify patients admitted with CSFs during an 80-month period. We excluded those with Glasgow Coma Scale (GCS) score of 3 at admission or death within 24 hours of admission. Patients were grouped as OLD (aged ≥ 66 years) or YNG (aged 18-65 years). Data were compared using X 2 and Student's t test, with p < 0.05 considered statistically significant. Results: One hundred twenty-nine OLD (aged 79.7 ± 0.7 years) and 289 YNG (aged 383 ± 0.8 years) patients met study criteria. Injury Severity Score was higher in YNG (18.9 ± 0.8 vs. 14.8 ± 1.0, p < 0.05), and GCS score was the same (OLD, 13.7 ± 0.2; YNG, 13.0 ± 0.2; p = 0.06) in both, but mortality was higher in OLD patients (21% vs. 5%, p < 0.05). OLD HVI patients had higher mortality than YNG HVI (40% vs. 2%). Among OLD patients, age, Injury Severity Score, GCS, and number of comorbidities were the same for each treatment subgroup. Despite this, mortality for the HVI subgroup was higher than either the surgery or collar subgroup. Of the OLD HVI patients that died, 14 died with pneumonia and 10 had a cardiac or respiratory arrest that preceded death. Conclusion: OLD patients with CSFs have higher mortality than YNG. HVI in OLD patients is associated with the worst outcomes, irrespective of injury severity, and should be considered a last resort. Further study is warranted to determine the optimal treatment for CSF in OLD patients. more...
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- 2005
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44. Transfer Times to Definitive Care Facilities Are Too Long
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William G. Cioffi, David T. Harrington, Walter L. Biffl, Sarah Majercik, and Michael D. Connolly
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Adult ,Patient Transfer ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Psychological intervention ,MEDLINE ,Hospitals, Community ,Regional Medical Programs ,Injury Severity Score ,Clinical Protocols ,Trauma Centers ,Transfer (computing) ,Laparotomy ,Intervention (counseling) ,parasitic diseases ,medicine ,Humans ,Glasgow Coma Scale ,business.industry ,Medical record ,Rhode Island ,Original Articles ,Middle Aged ,Surgery ,Logistic Models ,Emergency medicine ,business ,human activities - Abstract
The purpose of this study was to review our experience with interfacility transfers to identify problems that could be addressed in the development of a statewide trauma system.The fundamental tenet of a trauma system is to get the right patient to the right hospital at the right time. This hinges on well-defined prehospital destination criteria, interfacility transfer protocols, and education of caregivers. Patients arriving at local community hospitals (LOCs) benefit from stabilization and transfer to trauma centers (TCs) for definitive care. However, in the absence of a formalized trauma system, patients may not reach the TC in a timely fashion and may not be appropriately treated or stabilized at LOCs prior to transfer.Our facility is a level I TC and regional referral center for a compact geographic area without a formal trauma system. The Trauma Registry was queried for adult patients admitted to the trauma service between January 1, 2001 and March 30, 2003. Patients were divided into 2 groups: those received directly from the scene (DIR) and those transferred from another institution (TRAN). Medical records were reviewed to elucidate details of the early care. Data are presented as mean +/- SEM. Continuous data were compared using Student t test, and categorical data using chi2. Transfer times were analyzed by one-way ANOVA.A total of 3507 patients were analyzed. The TRAN group had a higher Injury Severity Score (ISS) (17.5 versus 11.0, P0.05), lower Glasgow Coma Score (GCS) (13.3 versus 14.1, P0.05), lower initial systolic blood pressure (SBP) (130 versus 140, P0.05), and higher mortality (10% versus 79%, P0.05) than the DIR group. The average time spent at the LOC was 162 +/- 8 minutes. The subgroup of patients with hypotension spent an average of 134 minutes at the LOC, often receiving numerous diagnostic tests despite unavailability of surgeons to provide definitive care. Severe head injury (GCS = 3) triggered more prompt transfer, but high ISS was underappreciated and did not result in a prompt transfer in all but the most severely injured group (ISS40). Some therapeutic interventions were initiated at the LOCs, but many were required at the TC. A total of 23 (8%) TRAN patients required critical interventions within 15 minutes of arrival; mortality in this group was 52%. Mortality among those requiring laparotomy after transfer was 33%.All but the most severely injured patients spend prolonged periods of time in LOCs, and many require critical interventions upon arrival at the TC. It is unreasonable to expect immediate availability of surgeons or operating rooms in LOCs. Thus, trauma system planning efforts should focus on 1) prehospital destination protocols that allow direct transport to the TC; and 2) education of caregivers in LOCs to enhance intervention skill sets and expedite transfer to definitive care. more...
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- 2005
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45. The Evolution of Trauma Care at a Level I Trauma Center
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William G. Cioffi, Walter L. Biffl, Sarah Majercik, Jayne Starring, and David T. Harrington
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Adult ,Male ,Patient Transfer ,medicine.medical_specialty ,Multiple Organ Failure ,Wounds, Penetrating ,Wounds, Nonpenetrating ,Severity of Illness Index ,Sepsis ,Blunt ,Trauma Centers ,Injury prevention ,Severity of illness ,Humans ,Medicine ,Registries ,Intensive care medicine ,business.industry ,Trauma center ,Age Factors ,Rhode Island ,Emergency department ,Trauma care ,medicine.disease ,Treatment Outcome ,Brain Injuries ,Emergency medicine ,Wounds and Injuries ,Injury Severity Score ,Female ,Surgery ,business - Abstract
Background My colleagues and I compared trauma patient demographics and outcomes between two time periods in the last 10 years in our Level I trauma center to evaluate the impact of the marked evolution in trauma care and determine additional opportunities for improvement. Methods Our trauma registry was queried for adult trauma patients admitted from 1991 to 1993 (EARLY) and 1999 to 2001 (LATE). The EARLY period predated creation and maturation of a dedicated trauma service and Level I trauma center verification. Continuous data were compared using Student's t-test, and categorical data using chi-square. Results Increased transfers of severely injured patients from regional hospitals, combined with fewer admissions for "observation," resulted in fewer, but sicker, patients admitted in the LATE period. Patients were considerably older in the LATE period and mortality was higher. Despite higher acuity of patients, hospital and ICU lengths of stay were shorter in the LATE period. Nonoperative management of solid organ injuries was more common in the LATE period, but the overall operative volume was similar. Nonsurvivors in the LATE period had higher Injury Severity Scores and were older compared with the EARLY period. Mortality attributable to blunt CNS injury was higher, and that attributed to late sepsis and multiple organ failure was lower in the LATE period. Conclusions Over the past decade, more older, severely injured patients have been admitted to our Level I trauma center. Overall mortality among these higher acuity patients has increased, with a marked shift in attributable mortality to CNS injury and away from late sepsis and multiple organ failure. This highlights the need for continued efforts to identify optimal management strategies for severe brain injury. Additional areas for improvement include enhancement of our regional trauma network and injury prevention initiatives. more...
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- 2005
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46. The prevalence and impact of defensive medicine in the radiographic workup of the trauma patient: a pilot study
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Thomas W. White, Brad J. Morris, Casey Scully, Emily L. Wilson, Sarah Majercik, Karen Connor, Justin Dickerson, Jennwood Chen, Joseph Bledsoe, Douglas Dillon, and Scott Gardner
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Defensive Medicine ,medicine.medical_specialty ,Radiography ,Computed tomography ,Pilot Projects ,Unnecessary Procedures ,Radiation Dosage ,Defensive medicine ,Trauma Centers ,medicine ,Prevalence ,Humans ,Prospective Studies ,Practice Patterns, Physicians' ,Trauma patient ,medicine.diagnostic_test ,business.industry ,Trauma center ,General Medicine ,United States ,Surgery ,Radiation exposure ,Wounds and Injuries ,Observational study ,Radiology ,business ,Tomography, X-Ray Computed ,Trauma surgery - Abstract
Background Defensive medicine is estimated to cost the United States $210 billion annually. Trauma surgeons are at risk of practicing defensive medicine in the form of reflexively ordering computed tomography (CT) scans. The aim of this study is to quantify the monetary impact and radiation exposure related to the radiographic workup of trauma patients. Methods We conducted a prospective, observational study involving 295 trauma patients at Level I trauma center. Physicians were surveyed regarding specific CT scans ordered, likelihood of significant injuries found on scans, and which scans would have been ordered in a hypothetical, litigation-free environment. Results Four hundred sixteen of 1,097 CT scans (38%) were ordered out of defensive purposes. Nine CT scans (2.2%) that would not have been ordered resulted in a change in management. Defensively ordered CT scans resulted in nearly $120,000 in excess charges and 8.8 mSv of unnecessary radiation per patient. Conclusion Defensively ordered CT scan in the workup of trauma patients is a prevalent and costly practice that exposes patients to potentially unnecessary and harmful radiation. more...
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- 2014
47. Regarding: Long-term patient outcomes after surgical stabilization of rib fractures
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Thomas W. White, Quinn Cannon, Steven R. Granger, Sarah Majercik, and Don H. Van Boerum
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Male ,medicine.medical_specialty ,Rib Fractures ,business.industry ,MEDLINE ,General Medicine ,Term (time) ,Surgery ,Fracture Fixation, Internal ,Text mining ,Fracture fixation ,Humans ,Medicine ,Female ,business - Published
- 2015
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48. The Intermountain Risk Score predicts mortality in trauma patients
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Stacey Knight, Benjamin D. Horne, and Sarah Majercik
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Male ,Risk ,medicine.medical_specialty ,Population ,Poison control ,Wounds, Penetrating ,Critical Care and Intensive Care Medicine ,Wounds, Nonpenetrating ,Risk Assessment ,Injury Severity Score ,Sex Factors ,Trauma Centers ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,education ,education.field_of_study ,Framingham Risk Score ,medicine.diagnostic_test ,business.industry ,Proportional hazards model ,Incidence ,Trauma center ,Hazard ratio ,Complete blood count ,Length of Stay ,Middle Aged ,United States ,Surgery ,ROC Curve ,Area Under Curve ,Female ,business - Abstract
Purpose Intermountain Risk Score (IMRS) uses the admission complete blood count and basic metabolic profile to predict mortality. Intermountain Risk Score has been validated in medical patients but has not been evaluated in trauma. This study tested whether IMRS is predictive of mortality in a trauma population at a level I trauma center. Methods Admitted trauma patients with complete blood count and basic metabolic profile from October 2005 to December 2011 were evaluated. Thirty-day and 1-year IMRS were calculated using multivariable modeling. Mortality was determined using the medical record and Social Security Administration death data. Results Three thousand six hundred thirty-seven females and 5901 males were evaluated. Intermountain Risk Score was highly predictive of death at 30 days (c-statistics, c = 0.772 for females; c = 0.783 males) and 1 year (c = 0.778 for females; c = 0.831 males). Cox regression analysis, adjusted for injury severity score, blunt vs penetrating, and length of stay, showed increased mortality risks among patients in the moderate- and high-risk IMRS-defined groups at both 30 days and 1 year, with hazard ratios ranging from 4.96 to 57.88 (all P Conclusion Intermountain Risk Score strongly predicts mortality in trauma patients at this single level I trauma center. The ability to accurately determine a patient’s mortality risk at admission makes IMRS a potentially clinically important tool. more...
- Published
- 2013
49. Weight-based enoxaparin dosing for venous thromboembolism prophylaxis in the obese trauma patient
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Justin Dickerson, Rob Johnston, Thomas W. White, Annika Bickford, Joseph Bledsoe, Sarah Majercik, and Katie Smith
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Male ,medicine.medical_specialty ,Deep vein ,Injections, Subcutaneous ,Vte prophylaxis ,Body Mass Index ,Medicine ,Humans ,Dosing ,Obesity ,Enoxaparin ,Retrospective Studies ,Leg ,Ultrasonography, Doppler, Duplex ,Dose-Response Relationship, Drug ,business.industry ,Incidence (epidemiology) ,Anticoagulants ,General Medicine ,Heparin ,Venous Thromboembolism ,Middle Aged ,medicine.disease ,Thrombosis ,Surgery ,Regimen ,medicine.anatomical_structure ,Treatment Outcome ,Anesthesia ,Wounds and Injuries ,Female ,business ,Venous thromboembolism ,medicine.drug ,Follow-Up Studies - Abstract
Background Limited data exist regarding the efficacy of weight-based dosing of low–molecular weight heparin for venous thromboembolism (VTE) prophylaxis in obese trauma patients. Methods Consecutive obese trauma patients were placed on a weight-based protocol for VTE prophylaxis (enoxaparin .5 mg/kg subcutaneously every 12 hours). Peak anti-Xa levels were drawn, and bilateral lower extremity duplex ultrasound was performed. The incidence of VTE and bleeding complications were recorded. Results Eighty-six patients met the study criteria. Seventy-four patients achieved target prophylactic anti-Xa concentrations, with a mean level of .42 ± .01 IU/mL. Eighteen patients were found to have deep vein thrombosis. However, in 16 of these patients, deep vein thrombosis was diagnosed before weight-based low–molecular weight heparin initiation. No bleeding complications occurred, and no symptomatic pulmonary emboli were identified. Conclusions In obese trauma patients, weight-based enoxaparin is an efficacious regimen that provides adequate VTE prophylaxis, as measured by anti-Xa levels, and appears to be safe without bleeding complications. more...
- Published
- 2013
50. Rib fracture repair
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Thomas W. White and Sarah Majercik
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musculoskeletal diseases ,Pulmonary and Respiratory Medicine ,Surgical repair ,medicine.medical_specialty ,Rib cage ,Flail chest ,Engineering ,Osteosynthesis ,business.industry ,medicine.medical_treatment ,musculoskeletal system ,medicine.disease ,Surgery ,Pulmonary contusion ,Blunt ,medicine ,Thoracotomy ,Cardiology and Cardiovascular Medicine ,business ,Contraindication - Abstract
Blunt chest wall trauma and the resultant fracture of ribs is exceedingly common and is the source of significant morbidity and potential mortality. Surgical repair for markedly displaced rib fractures, particularly in the setting of flail chest has been attempted sporadically for over 50 years. In the last decade, rib-specific plating systems have been introduced. These have helped to usher in the era of modern rib repair and have made surgical stabilization of rib fractures (SSRF) technically easier, safer, and arguably more effective. Recently published consensus statements have attempted to codify the indications, contra-indications, timing, and technical aspects of SSRF. Patients with three or more severely displaced rib fractures or flail chest should be considered for repair whether they require mechanical ventilation or not. Other candidates may include patients who fail optimal nonoperative management regardless of fracture pattern, and patients with rib fractures who require thoracotomy for another reason. Severe traumatic brain injury and unstable spine fracture are absolute contraindications to immediate SSRF. The role of pulmonary contusion in the decision to repair the unstable chest wall remains controversial, but in general is not a contraindication. Several rib-specific plating systems are now commercially available. They share multiple design features; notably, semi-rigid fixation with anterior plate positioning and locking screws. The flexible nature of ribs makes locking screws critical to minimize failure. These systems are low profile, made from titanium, and easily shapeable. Most rib repairs in the United States are performed by trauma or thoracic surgeons, although this varies from by center. Surgeons new to the principles of osteosynthesis may wish to enlist the help of an orthopedist colleague as they navigate their early experience. more...
- Published
- 2017
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