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32 results on '"Gandhi, Rajesh R."'

2. The EGS Grading Scale For Skin And Soft Tissue Infections Is Predictive Of Poor Outcomes

Author

Savage, Stephanie A, Li, Shi Wen, Utter, Garth H, Cox, Jessica A, Wydo, Salina M, Cahill, Kevin, Sarani, Babak, Holzmacher, Jeremy, Duane, Therese M, Gandhi, Rajesh R, Zielinski, Martin D, Ray-Zack, Mohamed, Tierney, Joshua, Chapin, Trinette, Murphy, Patrick B, Vogt, Kelly N, Schroeppel, Thomas J, Callaghan, Emma, Kobayashi, Leslie, Coimbra, Raul, Schuster, Kevin M, Gillaspie, Devin, Timsina, Lava, Louis, Alvancin, and Crandall, Marie

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Health Sciences, Clinical Research, Prevention, Infectious Diseases, Patient Safety, Good Health and Well Being, Abscess, Adult, Aged, Cellulitis, Emergency Treatment, Fasciitis, Female, General Surgery, Humans, Length of Stay, Male, Middle Aged, Necrosis, Observer Variation, Postoperative Complications, Prognosis, Retrospective Studies, Risk Assessment, Skin Diseases, Infectious, Soft Tissue Infections, Survival Rate, United States, EGS grading scales, skin and soft-tissue infections, necrotizing fasciitis, LRINEC score, Clinical sciences, Nursing
Abstract

IntroductionOver the last 5 years, the American Association for the Surgery of Trauma has developed grading scales for emergency general surgery (EGS) diseases. In a previous validation study using diverticulitis, the grading scales were predictive of complications and length of stay. As EGS encompasses diverse diseases, the purpose of this study was to validate the grading scale concept against a different disease process with a higher associated mortality. We hypothesized that the grading scale would be predictive of complications, length of stay, and mortality in skin and soft-tissue infections (STIs).MethodsThis multi-institutional trial encompassed 12 centers. Data collected included demographic variables, disease characteristics, and outcomes such as mortality, overall complications, and hospital and ICU length of stay. The EGS scale for STI was used to grade each infection and two surgeons graded each case to evaluate inter-rater reliability.Results1170 patients were included in this study. Inter-rater reliability was moderate (kappa coefficient 0.472-0.642, with 64-76% agreement). Higher grades (IV and V) corresponded to significantly higher Laboratory Risk Indicator for Necrotizing Fasciitis scores when compared with lower EGS grades. Patients with grade IV and V STI had significantly increased odds of all complications, as well as ICU and overall length of stay. These associations remained significant in logistic regression controlling for age, gender, comorbidities, mental status, and hospital-level volume. Grade V disease was significantly associated with mortality as well.ConclusionThis validation effort demonstrates that grade IV and V STI are significantly predictive of complications, hospital length of stay, and mortality. Though predictive ability does not improve linearly with STI grade, this is consistent with the clinical disease process in which lower grades represent cellulitis and abscess and higher grades are invasive infections. This second validation study confirms the EGS grading scale as predictive, and easily used, in disparate disease processes.Level of evidencePrognostic/Epidemiologic retrospective multicenter trial, level III.

Published
2019

3. Rates and risk factors for anastomotic leak following blunt trauma-associated bucket handle intestinal injuries: a multicenter study

Author

Grossman, Holly, primary, Dhanasekara, Chathurka Samudani, additional, Shrestha, Kripa, additional, Marschke, Brianna, additional, Morris, Erin, additional, Richmond, Robyn, additional, Ko, Ara, additional, Tennakoon, Lakshika, additional, Campion, Eric M, additional, Wood, Frank C, additional, Brandt, Maggie, additional, Ng, Grace, additional, Regner, Justin L, additional, Keith, Stacey L, additional, McNutt, Michelle K, additional, Kregel, Heather, additional, Gandhi, Rajesh R, additional, Schroeppel, Thomas J, additional, Margulies, Daniel R, additional, Hashim, Yassar M, additional, Herrold, Joseph, additional, Goetz, Mallory, additional, Simpson, LeRone, additional, Doan, Xuan-Lan, additional, and Dissanaike, Sharmila, additional

Published
2023
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5. Tranexamic acid administration in the field does not affect admission thromboelastography after traumatic brain injury

Author

Dixon, Alexandra L., McCully, Belinda H., Rick, Elizabeth A., Dewey, Elizabeth, Farrell, David H., Morrison, Laurie J., McMullan, Jason, Robinson, Bryce R.H., Callum, Jeannie, Tibbs, Brian, Dries, David J., Jui, Jonathan, Gandhi, Rajesh R., Garrett, John S., Weisfeldt, Myron L., Wade, Charles E., Aufderheide, Tom P., Frascone, Ralph J., Tallon, John M., Kannas, Delores, Williams, Carolyn, Rowell, Susan E., and Schreiber, Martin A.

Published
2020
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6. Evaluation of a Device Combining an Inferior Vena Cava Filter and a Central Venous Catheter for Preventing Pulmonary Embolism Among Critically Ill Trauma Patients

Author

Tapson, Victor F., Hazelton, Joshua P., Myers, John, Robertson, Claudia, Gilani, Ramyar, Dunn, Julie A., Bukur, Marko, Croce, Martin A., Peick, Ann, West, Sonlee, Lottenberg, Lawrence, Doucet, Jay, Miller, Preston R., Crookes, Bruce, Gandhi, Rajesh R., Croft, Chasen A., Manasia, Anthony, Hoey, Brian A., Lieberman, Howard, Guillamondegui, Oscar D., Novack, Victor, Piazza, Gregory, and Goldhaber, Samuel Z.

Published
2017
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7. The EGS grading scale for skin and soft-tissue infections is predictive of poor outcomes: a multicenter validation study

Author

Savage, Stephanie A., Li, Shi Wen, Utter, Garth H., Cox, Jessica A., Wydo, Salina M., Cahill, Kevin, Sarani, Babak, Holzmacher, Jeremy, Duane, Therese M., Gandhi, Rajesh R., Zielinski, Martin D., Ray-Zack, Mohamed, Tierney, Joshua, Chapin, Trinette, Murphy, Patrick B., Vogt, Kelly N., Schroeppel, Thomas J., Callaghan, Emma, Kobayashi, Leslie, Coimbra, Raul, Schuster, Kevin M., Gillaspie, Devin, Timsina, Lava, Louis, Alvancin, and Crandall, Marie

Published
2019
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11. TXA Administration in the Field Does Not Affect Admission TEG after Traumatic Brain Injury

Author

Dixon, Alexandra L., McCully, Belinda H., Rick, Elizabeth A., Dewey, Elizabeth, Farrell, David H., Morrison, Laurie J., McMullan, Jason, Robinson, Bryce R. H., Callum, Jeannie, Tibbs, Brian, Dries, David J., Jui, Jonathan, Gandhi, Rajesh R., Garrett, John S., Weisfeldt, Myron L., Wade, Charles E., Aufderheide, Tom P., Frascone, Ralph J., Tallon, John M., Kannas, Delores, Williams, Carolyn, Rowell, Susan E., Schreiber, Martin A., Meier, Eric N., May, Susanne, Sheehan, Kellie, Bulger, Eileen M., Idris, Ahamed H., Christenson, Jim, Bosarge, Patrick L., Colella, M. Riccardo, Johannigman, Jay, Cotton, Bryan A., Richmond, Neal J., Zielinski, Martin D., Schlamp, Rob, Klein, Lauren, Rizoli, Sandro, Gamber, Mark, Fleming, Michael, Hwang, Jun, Vincent, Laura E., Hendrickson, Audrey, Simonson, Robert, Klotz, Patricia, Ferrara, Michael, Sopko, George, and Witham, William

Subjects
Adult, Male, alpha-2-Antiplasmin, Adolescent, Fibrinolysis, Blood Coagulation Disorders, Middle Aged, Article, Antifibrinolytic Agents, Thrombelastography, Time-to-Treatment, Fibrin Fibrinogen Degradation Products, Young Adult, Treatment Outcome, Tranexamic Acid, Abbreviated Injury Scale, Brain Injuries, Traumatic, Injections, Intravenous, Humans, Female, Fibrinolysin, Infusions, Intravenous, Blood Coagulation
Abstract

No Food and Drug Administration-approved medication improves outcomes following traumatic brain injury (TBI). A forthcoming clinical trial that evaluated the effects of two prehospital tranexamic acid (TXA) dosing strategies compared with placebo demonstrated no differences in thromboelastography (TEG) values. We proposed to explore the impact of TXA on markers of coagulation and fibrinolysis in patients with moderate to severe TBI.Data were extracted from a placebo-controlled clinical trial in which patients 15 years or older with TBI (Glasgow Coma Scale, 3-12) and systolic blood pressure of ≥90 mm Hg were randomized prehospital to receive placebo bolus/placebo infusion (placebo), 1 g of TXA bolus/1 g of TXA infusion (bolus maintenance), or 2 g of TXA bolus/placebo infusion (bolus only). Thromboelastography was performed, and coagulation measures including prothrombin time, activated partial thromboplastin time, international ratio, fibrinogen, D-dimer, plasmin-antiplasmin (PAP), thrombin antithrombin, tissue plasminogen activator, and plasminogen activator inhibitor 1 were quantified at admission and 6 hours later.Of 966 patients receiving study drug, 700 had laboratory tests drawn at admission and 6 hours later. There were no statistically significant differences in TEG values, including LY30, between groups (p0.05). No differences between prothrombin time, activated partial thromboplastin time, international ratio, fibrinogen, thrombin antithrombin, tissue plasminogen activator, and plasminogen activator inhibitor 1 were demonstrated across treatment groups. Concentrations of D-dimer in TXA treatment groups were less than placebo at 6 hours (p0.001). Concentrations of PAP in TXA treatment groups were less than placebo on admission (p0.001) and 6 hours (p = 0.02). No differences in D-dimer and PAP were observed between bolus maintenance and bolus only.While D-dimer and PAP levels reflect a lower degree of fibrinolysis following prehospital administration of TXA when compared with placebo in a large prehospital trial of patients with TBI, TEG obtained on admission and 6 hours later did not demonstrate any differences in fibrinolysis between the two TXA dosing regimens and placebo.Diagnostic test, level III.

Published
2020

12. Effect of Out-of-Hospital Tranexamic Acid vs Placebo on 6-Month Functional Neurologic Outcomes in Patients With Moderate or Severe Traumatic Brain Injury

Author

Rowell, Susan E., primary, Meier, Eric N., additional, McKnight, Barbara, additional, Kannas, Delores, additional, May, Susanne, additional, Sheehan, Kellie, additional, Bulger, Eileen M., additional, Idris, Ahamed H., additional, Christenson, Jim, additional, Morrison, Laurie J., additional, Frascone, Ralph J., additional, Bosarge, Patrick L., additional, Colella, M. Riccardo, additional, Johannigman, Jay, additional, Cotton, Bryan A., additional, Callum, Jeannie, additional, McMullan, Jason, additional, Dries, David J., additional, Tibbs, Brian, additional, Richmond, Neal J., additional, Weisfeldt, Myron L., additional, Tallon, John M., additional, Garrett, John S., additional, Zielinski, Martin D., additional, Aufderheide, Tom P., additional, Gandhi, Rajesh R., additional, Schlamp, Rob, additional, Robinson, Bryce R. H., additional, Jui, Jonathan, additional, Klein, Lauren, additional, Rizoli, Sandro, additional, Gamber, Mark, additional, Fleming, Michael, additional, Hwang, Jun, additional, Vincent, Laura E., additional, Williams, Carolyn, additional, Hendrickson, Audrey, additional, Simonson, Robert, additional, Klotz, Patricia, additional, Sopko, George, additional, Witham, William, additional, Ferrara, Michael, additional, and Schreiber, Martin A., additional

Published
2020
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13. Can Firefighters be Taught Ultrasound?

Author

Workman, Ashleigh, primary, Hecht, Carrie, additional, Crawford, Callie, additional, Sewell, Bobby, additional, Rippy, Wes, additional, Palla, David, additional, Yamada, Roy, additional, Duane, Therese M., additional, and Gandhi, Rajesh R., additional

Published
2018
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14. Traumatic colon injury in damage control laparotomy—A multicenter trial

Author

Tatebe, Leah Carey, primary, Jennings, Andrew, additional, Tatebe, Ken, additional, Handy, Alexandra, additional, Prajapati, Purvi, additional, Smith, Michael, additional, Do, Tai, additional, Ogola, Gerald O., additional, Gandhi, Rajesh R., additional, Duane, Therese M., additional, Luk, Stephen, additional, and Petrey, Laura Bruce, additional

Published
2017
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19. Optimal timing of femur fracture stabilization in polytrauma patients

Author

Gandhi, Rajesh R., primary, Overton, Tiffany L., additional, Haut, Elliott R., additional, Lau, Brandyn, additional, Vallier, Heather A., additional, Rohs, Thomas, additional, Hasenboehler, Erik, additional, Lee, Jane Kayle, additional, Alley, Darrell, additional, Watters, Jennifer, additional, Rogers, Frederick B., additional, and Shafi, Shahid, additional

Published
2014
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23. Distracted driving: prevalence, problems, and prevention.

Author

Overton, Tiffany L., Rives, Terry E., Hecht, Carrie, Shafi, Shahid, and Gandhi, Rajesh R.

Subjects
DISTRACTED driving, TRAFFIC safety, TRAFFIC accidents, CELL phones & traffic accidents, COLLISION damage to automobiles
Abstract

While the number of motor vehicle crashes has declined over the years, crashes resulting from distracted driving are increasing in the United States resulting in significant morbidity and mortality. The national public seems to be aware of the dangers associated with using technology while driving, but continues to engage in this dangerous behaviour, and may be unaware of or underestimate the impact of cell phone use on their own driving performance. Problems associated with distracted driving are not limited to novice or teenage drivers; multifaceted universal prevention efforts aimed at impacting large segments of the population may have the greatest impact. Legislation limiting drivers’ cell phone use has had little impact, possibly due to low regulation and enforcement. Behaviour change programmes, improved vehicle safety, and public awareness campaigns have been developed as potential preventive efforts to reduce accidents caused by distracted drivers. [ABSTRACT FROM PUBLISHER]

Published
2015
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