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53. Injured adolescents, not just large children: Difference in care and outcome between adult and pediatric trauma centers

Author

Matsushima, K., Schaefer, E., Won, E., Nichols, Pam, Frankel, H., Matsushima, K., Schaefer, E., Won, E., Nichols, Pam, and Frankel, H.

Abstract

Adolescent injury victims receive care at adult trauma centers (ATCs) and pediatric trauma centers (PTCs). The purpose of this study was to identify care variations and their impact on the outcome of adolescent trauma patients treated at PTC versus ATC. We queried the Pennsylvania Trauma Systems Foundation database for trauma patients between 13 and 18 years of age from 2005 to 2010. Mortality and hospital complication rates between ATC and PTC were compared in univariable and multivariable analysis. In addition, the differences in the delivery of care were also compared. Of 9033 total patients, 6027 (67%) received care at an ATC. Patients in the ATC group were older (16.7 vs 14.9 years, P < 0.001) and more severely injured (Injury Severity Score: 14.5 vs 12.2, P < 0.001). Admission diagnostic computed tomography (CT), emergent laparotomy and craniotomy, blood transfusion, and drug screening were more frequently performed at an ATC. After adjustment for potential confounders in multivariable regression models, treatment at a PTC was significantly associated with fewer CTs for transferred patients (odds ratio [OR], 0.28; P \ 0.001) and with less frequent emergent laparotomy for all patients (OR, 0.65; P = 0.007). The ATC group had a significantly higher hospital mortality rate (2.9 vs 0.9%, P < 0.001) and complication rate (9.7 vs 4.8%, P < 0.001). However, these outcomes were not significantly different between PTC and ATC in multivariable regression models. In the state of Pennsylvania, there were no significant differences in risk-adjusted outcomes between PTC and ATC despite significant difference in use of CT scanning and emergent laparotomy.

Published
2013

54. Suicide and traumatic spinal cord injury—a cohort study

Author

Savic, G, DeVivo, M J, Frankel, H L, Jamous, M A, Soni, B M, and Charlifue, S

Abstract

Study design:Retrospective and prospective observational.Objective:The main objective of this study was to analyse suicide attempt as a cause of traumatic spinal cord injury (tSCI) and suicide as a cause of death after tSCI.Setting:This study was conducted at two British spinal centres, Stoke Mandeville and Southport.Methods:Long-term survival of patients who were newly admitted between 1991 and 2010, had survived the first post-injury year and had neurological deficit on discharge. Follow-up was discontinued on 31 December 2014.Results:Among the 2304 newly admitted cases of tSCI, suicide attempt was the cause of injury in 63 cases (2.7%). By the end of 2014 there were 533 deaths of which 4.2% deaths were by suicide, with 91% of suicides happening in the first 10 years post injury. Multiple logistic regression analyses showed a higher mortality odds ratio (OR=4.32, P<0.001) and a much higher suicide OR (9.46, P<0.001) for persons injured in suicide attempts when compared with all other SCI aetiologies. The overall age-standardised suicide mortality rate was 62.5 per 100 000 persons per year (95% confidence interval=36.4–88.6), five times higher than the general population suicide rate for England and Wales in 2014 (12.2 per 100 000).Conclusions:Suicide attempt was the cause of tSCI in 2.7% of the sample and suicide was the cause of death in 4.2% of all deaths. The overall mortality and death by suicide were significantly higher in persons whose tSCI was caused by an attempted suicide when compared with the rest of the sample. Continued psychological attention following SCI, especially to those who were injured by suicide attempt, is warranted.

Published
2018
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55. Preoperative radiographic staging for ureteral injuries is not warranted in patients undergoing celiotomy for trauma

Author

Jody DiGiacomo, Frankel H, Mf, Rotondo, Cw, Schwab, and Gw, Shaftan

Subjects
Adult, Male, Radiography, Injury Severity Score, Adolescent, Preoperative Care, Humans, Wounds, Penetrating, Ureter, Retrospective Studies
Abstract

Preoperative radiographic staging of the urinary tract has been shown to be inaccurate with regard to the ureter. The purpose of this study was to assess the need for radiographic staging of the injured patient for the diagnosis of ureteral injury before operative exploration. We conducted a retrospective review of all patients who sustained injury of the ureter as the result of external trauma over an 8 Y2-year period at an urban and suburban Level I trauma center. All patients were injured through penetrating mechanisms and underwent laparotomy. Only three patients had preoperative radiographic staging of the urinary tract. No ureteral injuries were missed. We conclude that surgical exploration of the ureter is sufficiently accurate to obviate the need for preoperative radiographic staging of the ureters in patients who have sustained penetrating injury and warrant laparotomy.

Published
2001

56. International expert statement on training standards for critical care ultrasonography

Author

Cholley, BP, Mayo, PH, Poelaert, J, Vieillard-Baron, A, Vignon, P, Alhamid, S, Balik, M, Beaulieu, Y, Breitkreutz, R, Canivet, J-L, Doelken, P, Flaatten, H, Frankel, H, Haney M, Michael, Hilton, A, Maury, E, McDermid, RC, McLean, AS, Mendes, C, Pinsky, MR, Price, S, Schmidlin, D, Slama, M, Talmor, D, Teles, JM, Via, G, Voga, G, Wouters, P, Yamamoto, T, Cholley, BP, Mayo, PH, Poelaert, J, Vieillard-Baron, A, Vignon, P, Alhamid, S, Balik, M, Beaulieu, Y, Breitkreutz, R, Canivet, J-L, Doelken, P, Flaatten, H, Frankel, H, Haney M, Michael, Hilton, A, Maury, E, McDermid, RC, McLean, AS, Mendes, C, Pinsky, MR, Price, S, Schmidlin, D, Slama, M, Talmor, D, Teles, JM, Via, G, Voga, G, Wouters, P, and Yamamoto, T

Abstract

Training in ultrasound techniques for intensive care medicine physicians should aim at achieving competencies in three main areas: (1) general critical care ultrasound (GCCUS), (2) "basic" critical care echocardiography (CCE), and (3) advanced CCE. A group of 29 experts representing the European Society of Intensive Care Medicine (ESICM) and 11 other critical care societies worldwide worked on a potential framework for organizing training adapted to each area of competence. This framework is mainly aimed at defining minimal requirements but is by no means rigid or restrictive: each training organization can be adapted according to resources available. There was 100% agreement among the participants that general critical care ultrasound and "basic" critical care echocardiography should be mandatory in the curriculum of intensive care unit (ICU) physicians. It is the role of each critical care society to support the implementation of training in GCCUS and basic CCE in its own country., Expert Round Table on Ultrasound in ICU United States Intensive care medicine Intensive Care Med. 2011 Jul;37(7):1077-83. Epub 2011 May 26.

Published
2011
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58. Orthostatic hypotension: Causes, mechanisms, and influencing factors

Author

Mathias, C. J., Senard, J. M., Valeta, P., Durrten, G., Frankel, L., Robertson, D., Hollister, A. S., Biaggioni, I., Armstrong, E., Browse, N., Bannister, R., Cortelli, P., Mathias, C. T., Christensen, N. J., Frankel, H. L., Brooks, D. J., Redmond, S., Wieling, W., Van Lieshout, J. J., Van Leeuwen, A. M., Smith, G. D.P., and General Internal Medicine

Abstract

Blood pressure homeostasis is particularly challenged by moving to an upright position.The autonomic nervous system, structural factors, infravascular volume, and circulating and local hormones influence the body's response to a change in posture. Disorders of the autonomic nervous system can result in orthostatic hypotension. Both neurogenic and nonneurogenic disorders can contribute, and distinguishing between the two causes is important for both diagnosis and management. It is also important to recognize various factors in daily life that influence orthostatic hypotension.

Published
1995

59. Long-term survival after traumatic spinal cord injury: a 70-year British study

Author

Savic, G, DeVivo, M J, Frankel, H L, Jamous, M A, Soni, B M, and Charlifue, S

Abstract

Study design:Retrospective and prospective observational.Objectives:Analyse long-term survival after traumatic spinal cord injury (SCI) in Great Britain over the 70-year study period, identify mortality risk factors and estimate current life expectancy.Setting:Two spinal centres in Great Britain.Methods:The sample consisted of patients with traumatic SCI injured 1943–2010 who survived the first year post-injury, had residual neurological deficit on discharge and were British residents. Life expectancy and trends over time were estimated by neurological grouping, age and gender, using logistic regression of person-years of follow-up combined with standard life table calculations.Results:For the 5483 cases of traumatic SCI the mean age at injury was 35.1 years, 79.7% were male, 31.1% had tetraplegia AIS/Frankel ABC, 41.2% paraplegia ABC,and 27.7% functionally incomplete lesion (all Ds). On 31 December 2014, 54% were still alive, 42.3% had died and 3.7% were lost to follow-up. Estimated life expectancies improved significantly between the 1950s and 1980s, plateaued during the next two decades, before slightly improving again since 2010. The estimated current life expectancy, compared with the general British population, ranged from 18.1 to 88.4% depending on the ventilator dependency, level and completeness of injury, age and gender.Conclusions:Life expectancy after SCI improved significantly between the 1950s and 1980s, plateaued during the 1990s and 2000s, before slightly improving again since 2010, but still remains well below that of the general British population.Sponsorship:Buckinghamshire Healthcare NHS Trust Charitable Spinal Fund and Ann Masson Legacy for Spinal Research Fund, UK.

Published
2017
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72. Effect of vacuum on materials

Author

Frankel, H. E

Subjects
Materials, Metallic
Abstract

High vacuum effects on materials for use in space environments

Published
1969

73. An analysis of failures in spacecraft.

Author

Babecki, A. J, Frankel, H. E, and Grimsley, J. D

Subjects
Machine Elements And Processes
Abstract

Spacecraft failures noting iron concentration, poor machining, nitriding and anisotropy as causes

Published
1967

74. Materials problems in satellites.

Author

Babecki, A. J and Frankel, H. E

Subjects
Materials, Metallic
Abstract

Satellite material problems in corrosion, fatigue failure, vacuum degradation, etc

Published
1967

75. Some failure problems in spacecraft and space boosters

Author

Babecki, A. J, Frankel, H. E, and Grimsley, J. D

Subjects
Space Vehicles
Abstract

Failure modes of metallic components in unmanned spacecraft and rocket boosters during simulated service testing

Published
1966

77. Fatigue phenomena in small metallurgically- bonded joints.

Author

Babecki, A. J, Frankel, H. E, and Predmore, R. E

Subjects
Machine Elements And Processes
Abstract

Fatigue failure analysis in small metallurgically- bonded joints in very small electronic components, using statistical analysis of random forces and dynamic response of member

Published
1966

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