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5. Emergency Department Pediatric Readiness Among US Trauma Centers: A Machine Learning Analysis of Components Associated With Survival.

Author

Newgard, Craig, Babcock, Sean, Song, Xubo, Remick, Katherine, Gausche-Hill, Marianne, Lin, Amber, Malveau, Susan, Mann, N, Nathens, Avery, Cook, Jennifer, Jenkins, Peter, Burd, Randall, Hewes, Hilary, Glass, Nina, Jensen, Aaron, Fallat, Mary, Ames, Stefanie, Salvi, Apoorva, McConnell, K, Ford, Rachel, Auerbach, Marc, Bailey, Jessica, Riddick, Tyne, Xin, Haichang, and Kuppermann, Nathan

Subjects
United States, Child, Humans, Emergency Service, Hospital, Retrospective Studies, Trauma Centers, Surveys and Questionnaires, Hospitals
Abstract

OBJECTIVE: We used machine learning to identify the highest impact components of emergency department (ED) pediatric readiness for predicting in-hospital survival among children cared for in US trauma centers. BACKGROUND: ED pediatric readiness is associated with improved short-term and long-term survival among injured children and part of the national verification criteria for US trauma centers. However, the components of ED pediatric readiness most predictive of survival are unknown. METHODS: This was a retrospective cohort study of injured children below 18 years treated in 458 trauma centers from January 1, 2012, through December 31, 2017, matched to the 2013 National ED Pediatric Readiness Assessment and the American Hospital Association survey. We used machine learning to analyze 265 potential predictors of survival, including 152 ED readiness variables, 29 patient variables, and 84 ED-level and hospital-level variables. The primary outcome was in-hospital survival. RESULTS: There were 274,756 injured children, including 4585 (1.7%) who died. Nine ED pediatric readiness components were associated with the greatest increase in survival: policy for mental health care (+8.8% change in survival), policy for patient assessment (+7.5%), specific respiratory equipment (+7.2%), policy for reduced-dose radiation imaging (+7.0%), physician competency evaluations (+4.9%), recording weight in kilograms (+3.2%), life support courses for nursing (+1.0%-2.5%), and policy on pediatric triage (+2.5%). There was a 268% improvement in survival when the 5 highest impact components were present. CONCLUSIONS: ED pediatric readiness components related to specific policies, personnel, and equipment were the strongest predictors of pediatric survival and worked synergistically when combined.

Published
2023

9. Patient and Hospital Characteristics Associated with Admission Among Patients With Minor Isolated Extremity Firearm Injuries: A Propensity-Matched Analysis

Author

Arielle C. Thomas, MD, MPH, MS, Regina Royan, MD, MPH, Avery B. Nathens, MD, PhD, Brendan T. Campbell, MD, MPH, Susheel Reddy, MPH, Sarabeth Spitzer, MD, Doulia Hamad, MD, Angie Jang, BA, and Anne M. Stey, MD, MSc

Subjects
Surgery, RD1-811
Abstract

Objective:. To quantify the association between insurance and hospital admission following minor isolated extremity firearm injury. Background:. The association between insurance and injury admission has not been examined. Methods:. This was an observational retrospective cohort study of minor isolated extremity firearm injury captured in the Healthcare Cost and Utilization Project State Inpatient and Emergency Department Databases in 6 states (New York, Arkansas, Wisconsin, Massachusetts, Florida, and Maryland) from 2016 to 2017 among patients aged 16 years or older. The primary exposure was insurance. Admitted patients were propensity score matched to nonadmitted patients on age, extremity Abbreviated Injury Score, and Elixhauser Comorbidity Index with exact matching within hospital to adjust for selection bias. A general estimating equation logistic regression estimated the association between insurance and odds of admission in the matched cohort while controlling for sex, race, injury intent, injury type, hospital profit type, and trauma center designation with observations clustered by propensity score-matched pairs within hospital. Results:. A total of 8151 patients presented to hospital with a minor isolated extremity firearm injury between 2016 and 2017 in 6 states. Patients were 88.0% male, 56.6% Black, and 71.7% aged 16 to 36 years old, and 22.1% were admitted. A total of 2090 patients were matched on propensity for admission. Privately insured matched patients had 1.70 higher adjusted odds of admission and 95% confidence interval of 1.30 to 2.22, compared with uninsured after adjusting for patient and hospital characteristics. Conclusions:. Insurance was associated with hospital admission for minor isolated extremity firearm injury.

Published
2024
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15. Superstition in Surgery: A Population-Based Cohort Study to Assess the Association Between Surgery on Friday the 13th and Postoperative Outcomes

Author

Sanjana Ranganathan, MBE, Carlos Riveros, MD, Michael Geng, BS, Courtney Chang, MD, Yusuke Tsugawa, MD, MPH, PhD, Bheeshma Ravi, MD, PhD, Zachary Melchiode, MD, Siqi Hu, MD, PhD, Kathleen Kobashi, MD, MBA, Brian J. Miles, MD, Zachary Klaassen, MD, MSc, Avery Nathens, MD, MPH, PhD, Natalie Coburn, MD, MPH, Allan S. Detsky, MD, PhD, CM, Angela Jerath, MD, MSc, FRCPC, FANZCA, Christopher J. D. Wallis, MD, PhD, FRCSC, and Raj Satkunasivam, MD, MS

Subjects
Surgery, RD1-811
Abstract

Objective:. We sought to examine whether the outcomes of patients who receive a surgical procedure on Friday the 13th differ from patients who receive surgery on flanking Fridays. Background:. Numerous studies have demonstrated that increased anxiety from the provider or patient around the time of surgery can lead to worse outcomes. Superstitious patients often express significant concern and anxiety when undergoing a surgical procedure on Friday the 13th. Methods:. A retrospective, population-based cohort study of 19,747 adults undergoing 1 of 25 common surgical procedures on Friday the 13th or flanking control Fridays (Friday the 6th and Friday the 20th) between January 1, 2007, and December 31, 2019, with 1 year of follow-up. The main outcomes included death, readmission, and complications at 30 days (short-term), 90 days (intermediate-term), and 1 year (long-term). Results:. A total of 7,349 (37.2%) underwent surgery on Friday the 13th, and 12,398 (62.8%) underwent surgery on a flanking Friday during the study period. Patient characteristics were similar between the 2 groups. We found no evidence that patients receiving surgery on Friday the 13th group were more likely to experience the composite primary outcome at 30 days [adjusted odds ratio (aOR) = 1.02 (95% CI = 0.94–1.09)], 90 days [aOR = 0.97 (95% CI = 0.90–1.04)], and 1 year [aOR = 0.99 (95% CI = 0.94–1.04)] after surgery. Conclusion:. Patients receiving surgery on Friday the 13th do not appear to fare worse than those treated on ordinary Fridays with respect to the composite outcome.

Published
2024
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19. Superstition in Surgery: A Population-Based Cohort Study to Assess the Association Between Surgery on Friday the 13th and Postoperative Outcomes

Author

Ranganathan, Sanjana, Riveros, Carlos, Geng, Michael, Chang, Courtney, Tsugawa, Yusuke, Ravi, Bheeshma, Melchiode, Zachary, Hu, Siqi, Kobashi, Kathleen, Miles, Brian J., Klaassen, Zachary, Nathens, Avery, Coburn, Natalie, Detsky, Allan S., Jerath, Angela, Wallis, Christopher J. D., and Satkunasivam, Raj

Published
2024
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29. Patient-centered outcomes research and the injured patient: a summary of application

Author

Godat, Laura N, Jensen, Aaron R, Stein, Deborah M, Arbabi, Saman, Bulger, Eileen, Cohen, Mitchell J, Costantini, Todd W, Crandall, Marie M, Dicker, Rochelle A, Haut, Elliott R, Joseph, Bellal, Kozar, Rosemary A, Malhotra, Ajai K, Nathens, Avery B, Nirula, Raminder, Price, Michelle A, Smith, Jason W, and Zarzaur, Ben L

Subjects
Health Services and Systems, Biomedical and Clinical Sciences, Clinical Sciences, Health Sciences, Patient Safety, Physical Injury - Accidents and Adverse Effects, Clinical Research, Health Services, 8.1 Organisation and delivery of services, Health and social care services research, Good Health and Well Being, Coalition for National Trauma Research Scientific Advisory Council
Abstract

As trauma surgeons, we focus on the immediate care and needs of the injured patient every day. Historically, trauma and injury research has focused on outcomes such as mortality, complications, and length of stay; and process metrics such as time to CT scan, resuscitation checklist frequencies, or venous thromboembolism prophylaxis rates. These outcomes are perceived by healthcare providers to be important, but patients likely have different perceptions of what outcomes are most important to measure and improve. True patient-centered outcomes research involves the healthcare providers, and the entire team of stakeholders including patients and the community. Understanding the process of stakeholder engagement and the barriers trauma researchers must overcome to effectively enter this field of research is important. This summary aims to inform the trauma research community on the basics of patient-centered outcomes research, priorities for funding from the Patient-Centered Outcomes Research Institute, resources for collaboration around patient-centered outcomes research, and a unique career development and training opportunity for early career trauma surgeons to develop a skill set in patient-centered outcomes research.

Published
2020

30. Building the future for national trauma research

Author

Price, Michelle A, Kozar, Rosemary A, Bulger, Eileen M, Jurkovich, Gregory J, Arbabi, Saman, Bulger, Eileen, Cohen, Mitchell J, Costantini, Todd W, Crandall, Marie M, Dicker, Rochelle A, Haut, Elliott R, Joseph, Bellal, Malhotra, Ajai K, Nathens, Avery B, Nirula, Raminder, Smith, Jason W, Stein, Deborah M, and Zarzaur, Ben L

Subjects
Commerce, Management, Tourism and Services, Marketing, Physical Injury - Accidents and Adverse Effects, Coalition for National Trauma Research Scientific Advisory Council
Abstract

This paper describes the current funding, infrastructure growth and future state of trauma research. It also introduces a group of review articles generated from The Future of Trauma Research: Innovations in Research Methodology conference hosted by the American College of Surgeons Committee on Trauma in July 2019.

Published
2020

38. Initial Imaging of Pregnant Patients in the Trauma Bay—Discussion and Review of Presentations at a Level-1 Trauma Centre

Author

Roisin MacDermott, Ferco H. Berger, Andrea Phillips, Jason A. Robins, Michael E. O’Keeffe, Rawan Abu Mughli, David B. MacLean, Grace Liu, Heather Heipel, Avery B. Nathens, and Sadia Raheez Qamar

Subjects
trauma imaging, pregnancy, patient safety, radiation concerns, Medicine (General), R5-920
Abstract

Trauma is the leading non-obstetric cause of maternal and fetal mortality and affects an estimated 5–7% of all pregnancies. Pregnant women, thankfully, are a small subset of patients presenting in the trauma bay, but they do have distinctive physiologic and anatomic changes. These increase the risk of certain traumatic injuries, and the gravid uterus can both be the primary site of injury and mask other injuries. The primary focus of the initial management of the pregnant trauma patient should be that of maternal stabilization and treatment since it directly affects the fetal outcome. Diagnostic imaging plays a pivotal role in initial traumatic injury assessment and should not deviate from normal routine in the pregnant patient. Radiographs and focused assessment with sonography in the trauma bay will direct the use of contrast-enhanced computed tomography (CT), which remains the cornerstone to evaluate the potential presence of further management-altering injuries. A thorough understanding of its risks and benefits is paramount, especially in the pregnant patient. However, like any other trauma patient, if evaluation for injury with CT is indicated, it should not be denied to a pregnant trauma patient due to fear of radiation exposure.

Published
2024
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39. Access to trauma center care: A statewide system-based approach

Author

Medrano, Nicolas W., Villarreal, Cynthia Lizette, Price, Michelle A., Bixby, Pamela J., Bulger, Eileen M., Eastridge, Brian J., Albrecht, Roxie M., Bailey, Jeffrey A., Benjamin, Elizabeth R., Bernard, Andrew C., Blackwell, Thomas H., Braithwaite, Sabina A., Brasel, Karen J., Brice, Jane H., Burlew, Clay C., Butler, Frank K., Callaway, David W., Cannon, Jeremy W., Champion, Howard R., Chang, Michael, Coimbra, Raul S., Davis, Gregory G., Demarest, Gerald B., Dorlac, Warren C., Drake, Stacy A., Eastman, Alex L., Elster, Eric A., Epley, Eric, Esposito, Thomas J., Ficke, James R., Fisher, Andrew D., Fowler, David R., Gaines, Barbara A., Gallagher, John M., Gary, Joshua L., Gestring, Mark L., Gill, James R., Goodloe, Jeffrey M., Gurney, Jennifer M., Harrell, Andrew J., Henry, Sharon M., Holcomb, John B., Jenkins, Donald H., Johannigman, Jay A., Kerby, Jeffrey D., Kharod, Chetan U., Kotwal, Russ S., Kozar, Rosemary A., Kuhls, Deborah A., Lathrop, Sarah L., Latimer, Andrew J., Levy, Michael, Mabry, Robert L., MacKenzie, Ellen J., Martin, Matthew J., Maxson, R. Todd, Mazuchowski, Edward L., Minei, Joseph P., Mitchell, Roger A., Jr, Moore, Ernest E., Moores, Leon E., Nashelsky, Marcus B., Nathens, Avery B., Nolte, Kurt B., OʼKeefe, Grant E., Phillips, Monica J., Robinson, James L., Sagraves, Scott G., Scalea, Thomas M., Schenarts, Paul J., Schreiber, Martin A., Shackelford, Stacy A., Sperry, Jason L., Stassen, Nicole A., Staudenmayer, Kristan L., Stewart, Ronald M., Stuke, Lance E., Valadka, Alex B., Winchell, Robert J., Zonies, David, and Yelon, Jay A.

Published
2023
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44. History of the Department of Surgery at the University of Toronto: celebrating a centennial of progress and innovation

Author

Mcleod, Robin, Keshavjee, Shaf, Ahmed, Najma, Richards, Robin, Fehlings, Michael G., Nathens, Avery, Rotstein, Ori D., and Rutka, James T.

Subjects
Medical colleges -- History -- Officials and employees, Universities and colleges -- Departments, Surgery -- Study and teaching, Health, Health care industry, University of Toronto -- History -- Officials and employees
Abstract

Now in its centennial year since inauguration, the Department of Surgery at the University of Toronto lays claim to more than 500 faculty, 270 residents, and 250 clinical fellows. There are 7 direct entry residency training programs, and 4 subspecialty programs accredited by the Royal College of Physicians and Surgeons of Canada. There have been 10 chairs of the department since 1921. This article chronicles the life and times of the previous chairs in sequence; the success of the department originates from its many talented and luminary surgeons who have innovated and shaped their fields of surgery. In recent years, the department's academic productivity has been characterized by more than 1400 peer-reviewed publications per year, and annual research grant capture in excess of $90 million. Since the time of William Gallie, surgical trainees have been enabled to develop careers in surgery and science through the Gallie Program and, more recently, the Surgeon Scientist Training Program (SSTP) to attain higher graduate degrees. Providing quaternary surgical care at multiple hospital sites in Toronto, the Department of Surgery takes great pride in its robust clinical fellowship programs across all specialties that continue to attract trainees from around the world., The tradition of surgery in Toronto dates back to the founding of the University of King's College Medical School in 1843, but scant details are available from that time. Early [...]

Published
2022
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45. Firearm injuries in Missouri

Author

Frederick P. Rivara, Ashley B. Hink, Deborah Kuhls, Samantha Banks, Lauren L. Agoubi, Shelbie Kirkendoll, Alex Winchester, Christopher Hoeft, Bhavin Patel, and Avery Nathens

Subjects
Medicine, Science
Published
2023

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