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1. Man with Pleuritic Chest Pain

Author

Greiving, Tanner George and Mehta, Sumeru G.

Subjects
Epipericardial fat necrosis, pericardial fat necrosis, epicardial fat necrosis
Abstract

Case Presentation: We describe a case of epipericardial fat necrosis.Discussion: Epipericardial fat necrosis is an inflammatory condition in which the pericardial fat pad necrotizes resulting in surrounding inflammation. This condition mimics more ominous pathology in clinical presentation and radiographic findings. Management is supportive with oral analgesics.

Published
2023

2. A Clinical Prediction Tool for MRI in Emergency Department Patients with Spinal Infection

Author

Shroyer, Steven R., Davis, William T., April, Michael D., Long, Brit, Boys, Gregory, Mehta, Sumeru G., and Mercaldo, Sarah F.

Subjects
spinal epidural abscess, discitis, vertebral osteomyelitis, septic facet, back pain, prediction tool
Abstract

Introduction: Patients with pyogenic spinal Infection (PSI) are often not diagnosed at their initial presentation, and diagnostic delay is associated with increased morbidity and medical-legal risk. We derived a decision tool to estimate the risk of spinal infection and inform magnetic resonance imaging (MRI) decisions. Methods: We conducted a two-part prospective observational cohort study that collected variables from spine pain patients over a six-year derivation phase. We fit a multivariable regression model with logistic coefficients rounded to the nearest integer and used them for variable weighting in the final risk score. This score, SIRCH (spine infection risk calculation heuristic), uses four clinical variables to predict PSI. We calculated the statistical performance, MRI utilization, and model fit in the derivation phase. In the second phase we used the same protocol but enrolled only confirmed cases of spinal infection to assess the sensitivity of our prediction tool. Results: In the derivation phase, we evaluated 134 non-PSI and 40 PSI patients; median age in years was 55.5 (interquartile range [IQR] 38-70 and 51.5 (42-59), respectively. We identified four predictors for our risk score: historical risk factors; fever; progressive neurological deficit; and C-reactive protein (CRP) ≥ 50 milligrams per liter (mg/L). At a threshold SIRCH score of ≥ 3, the predictive model’s sensitivity, specificity, and positive predictive value were, respectively, as follows: 100% (95% confidence interval [CI], 100-100%); 56% (95% CI, 48-64%), and 40% (95% CI, 36-46%). The area under the receiver operator curve was 0.877 (95% CI, 0.829-0.925). The SIRCH score at a threshold of ≥ 3 would prompt significantly fewer MRIs compared to using an elevated CRP (only 99/174 MRIs compared to 144/174 MRIs, P

Published
2021

3. Damage Control Resuscitation: A Narrative Review of Goals, Techniques, and Components

Author

Bridwell, Rachel E., Schaffrinna, Andrew M., Graybill, John Christopher, Mehta, Sumeru G., and Long, Brit

Subjects
Tranexamic acid -- Health aspects, Biological products -- Health aspects, Shock -- Health aspects, Blood coagulation factors -- Health aspects, Health
Abstract

Introduction Hemorrhage remains the leading cause of preventable death on the battlefield, necessitating early administration of fresh whole blood or blood component products as well as rapid hemorrhage control. (1) [...]

Published
2021

9. Contributors

Author

Abrahamian, Greg A., primary, Allen, Jonathon, additional, Archer, Cullen, additional, Arocho, Michael A., additional, Ashworth, Simeon W., additional, Barry, Dave, additional, Bauer, Charles R., additional, Bautista, Roger Matthew, additional, Browning, Mary Ann, additional, Calhoon, John H., additional, Capra, Jason, additional, Carr, Barbara A., additional, Cloutier, Robert L., additional, Cooper, Jimmy, additional, Crandall, Stephen A., additional, Crowell, Christopher B., additional, Dagrosa, Richard L., additional, Davis, Charles P., additional, Daya, Mohamud, additional, Daymude, Marc L., additional, Deel, John T., additional, DePold, Carry, additional, DePold, Gerald D., additional, DeVita, Diane, additional, Ditzel, Amy K., additional, Docherty, Martin A., additional, Dufresne, Gary W., additional, Dunlavy, Jenny E., additional, Durning, Steve, additional, Emanuel, Terry, additional, Espinoza, Alfredo, additional, Esterl, Robert M., additional, Fishman, Barbara M., additional, Foxworth, Jeff, additional, Funk, Mark S., additional, Garner, Ryan, additional, Glendening, David, additional, Goyal, Vinita, additional, Graydon, Robert D., additional, Gruppo, Len, additional, Halff, Glenn, additional, Harrison, Benjamin P., additional, Harrison, Katherine Anne, additional, Hill, Guyon J., additional, Hnatow, David A., additional, Hobbs, Rex L., additional, Husley, Julie, additional, Jamul, Jennifer, additional, Johnson, Roy, additional, Johnson, Scott B., additional, Kagarise, Melissa, additional, Khandhar, Sandeep J., additional, King, C. Gordon, additional, Kodosky, John T., additional, Koertner, Adam Clay, additional, Krebs, Christopher M., additional, Kuhns, David W., additional, Lam, Khim K., additional, Lawrence, Linda L., additional, Linklater, Derek R., additional, Lopez, Reenie, additional, Lutz, Clifford C., additional, Madill, Justin, additional, Mallia, Anantha K., additional, Mann‐Zeballos, Margaret, additional, McBride, Daniel F., additional, McIlrath, Samuel Timothy, additional, McManus, John, additional, McNeil, Christopher R., additional, Mehta, Sumeru Ghanshyam, additional, Menckhoff, Carl, additional, Mihata, Kazuo, additional, Miller, Michael A., additional, Morgan, James Alan, additional, Morgan, Julie Ann, additional, Murphey, Kari, additional, Nakamura, Yoko, additional, Nasir, Alicia, additional, Nasir, Javed M., additional, Nolan, Robert, additional, Oswald, Brenda, additional, Pearlman, Stacey Black, additional, Pfaff, James A., additional, Plastino, Kristen A., additional, Presser, Eric R., additional, Ramey, Lon, additional, Roberts, Jake, additional, Rondeau, Dawn F., additional, Salyer, Steven W., additional, Samsey, Kathleen M., additional, Scott, John Robert, additional, Shafé, Michael K., additional, Short, Mark S., additional, Michael Siler, Sean, additional, Simonds, Jacquelyn L., additional, Smith, Howell J., additional, Speeg, K. Vincent, additional, Spitz, Richard J., additional, Spivak, Laura Ann, additional, Stevens, Mark, additional, Taylor, Benjamin H., additional, Terpolilli, Ralph, additional, Varney, Shawn M., additional, Veale, Brooke Ashley, additional, Wall, Shawna, additional, Washburn, Kenneth, additional, Wedmore, Ian, additional, Wells, Ryan, additional, Whitford, Allen, additional, Zeballos, Claudio F., additional, and Zinsmeister, David, additional

Published
2007
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10. CONTRIBUTORS

Author

ALEXANDER, GEORGE A., primary, ANDERSON, ANGELA C., additional, ARTENSTEIN, ANDREW W., additional, BABU, KAVITA, additional, BARRUETO, FERMIN, additional, BARTON, CARRIE, additional, BECKER, BRUCE M., additional, BERKMAN, MATTHEW, additional, BERN, ANDREW I., additional, BOUKHMAN, MILANA, additional, BREWSTER, PETER, additional, BUDD, CHURTON, additional, BURKE, JAMES M., additional, BURKLE, FREDERICK M., additional, BURNETT, LYNNE BARKLEY, additional, CAGLIUSO, NICHOLAS VINCENT, additional, CAHILL, JOHN D., additional, CANEVA, DUANE C., additional, CASANI, JULIE ANN P., additional, CHAFFEE, MARY W., additional, CHANG, HENRY C., additional, CHANG, JAMES C., additional, CHEH, ANNA I., additional, CHEN, ESTHER H., additional, CICCONE, TERIGGI J., additional, CINAT, MARIANNE E., additional, CIOTTONE, GREGORY R., additional, CIOTTONE, ROBERT A., additional, COBERY, STEVEN T., additional, CONO, JOANNE, additional, CORRIGAN, KELLY J., additional, CORTE, FRANCESCO Della, additional, COURBAN, CHRISTO C., additional, CRANMER, HILARIE, additional, CUNNION, STEPHEN O., additional, DARLING, ROBERT G., additional, DAVIS, DAVID, additional, DAVIS, TIMOTHY, additional, DELAPENA, JENNIFER E., additional, DEY, CHAYAN, additional, DICKERSON, WILLIAM E., additional, DICKSON, ERIC W., additional, DILLING, SHARON, additional, DYER, K. SOPHIA, additional, DYLIK, JASON, additional, EDLOW, JONATHAN A., additional, EIDENBERG, MARSHALL, additional, ENNIS-HOLCOMB, KHAMA D., additional, FITZGERALD, DENIS J., additional, FOSHER, KERRY, additional, FREITAS, ROBERT L., additional, FRIEDBERG, RYAN, additional, FRIEDMAN, FRANKLIN D., additional, FUNG, FREDERICK, additional, FURBERG, ROBERT D., additional, GAASCH, WADE, additional, GALLAHUE, FIONA E., additional, GANS, LUCILLE, additional, GEDDO, ALESSANDRo, additional, GEILING, JAMES, additional, GIANNONE, PAUL, additional, GLUCKMAN, WILLIAM, additional, GORMAN, SUSAN E., additional, GOUDIE, J. SCOTT, additional, GOUGELET, ROBERT M., additional, GRABER, MARK A., additional, GRANT, JILL A., additional, GREENBERG, MICHAEL I., additional, GREENOUGH, P. GREGG, additional, GROSSMAN, SHAMAI A., additional, GUIDOTTI, TEE L., additional, GUTMAN, DEBORAH, additional, HALPERN, PINCHAS, additional, HANFLING, DAN, additional, HAROZ, RACHEL, additional, HARTSTEIN, BONNIE H., additional, HICK, JOHN L., additional, HOOD, STEPHEN F., additional, HOROWITZ, MICHAEL, additional, HORST, KURT R., additional, HOUSE, HANS R., additional, HUNTER, CURTIS J., additional, IMPERATO, JASON, additional, INGRASSIA, PIER LUIGi, additional, JACOBY, IRVING, additional, JAMES, THEA, additional, JASLOW, DAVID, additional, JAY, GREGORY D., additional, JOHN, MIRIAM, additional, JONES, MICHAEL D., additional, KASHUK, JEFFRY L., additional, KEIM, MARK E., additional, KENNEDY, KATHARYN E., additional, KIM, PAUL D., additional, KIM, SYLVIA H., additional, KOBAYASHI, LEO, additional, KULCHYCKI, LARA K., additional, KULKARNI, RICK G., additional, LANG, CHRISTOPHer R., additional, LARKIN, GREGORY L., additional, LeBosquet, THOMAS P., additional, LEE, BRUCE Y., additional, LEE, CATHERINE Y., additional, LEE, DAVID C., additional, LEMERY, JAY, additional, LEMKIN, DANIEL L., additional, LINDER, JEANETTE A., additional, LINDER, LAWRENCE S., additional, LIU, SHAN W., additional, LLEWELLYN, CRAIG H., additional, LOMBARDI, FRANCESCA, additional, LONG, HEATHER, additional, LUCCI, EDWARD B., additional, MACMILLAN, DONALD, additional, MACNOW, LAURA, additional, MADSEN, JAMES M., additional, MAGUIRE, BRIAN J., additional, MALONE, JOHN D., additional, MANISCALCO, PAUL M., additional, MARCOZZI, DAVID, additional, MARGHELLA, PIETRO D., additional, MARTIN, JAMES F., additional, MCKINNELL, JAMES, additional, MCMAHON-DOWNER, MICHELLE, additional, MECHEM, C. CRAWFOrd, additional, MEHTA, SUMERU, additional, MEINHARDT, PATRICIA L., additional, MELVILLE, LAURA DIAne, additional, METZGER, JEFFERY C., additional, MILLS, ANGELA M., additional, MILSTEN, ANDREW M., additional, MITCHELL, CLIFFORD S., additional, MITCHELL, ELIZABETH L., additional, MOLÉ, DALE M., additional, MOLINO, LOUIS N., additional, MOLONEY, JOHN, additional, MONTGOMERY, SEAN, additional, MOTHERSHEAD, JERRY L., additional, NELSON, LEWIS S., additional, NICHOLS, CONSTANCE G., additional, NOLAN, PATRICIA A., additional, NOLTKAMPER, DANIEL F., additional, NTABA, DZIWE W., additional, NUGENT, ANDREW S., additional, OSTER, NEILL S., additional, PANAGOS, PETER D., additional, PARTRIDGE, ROBERT, additional, PESIK, NICKI, additional, PFAFF, JAMES, additional, PORCARO, WILLIAM, additional, PROANO, LAWRENCE, additional, RAHMAN-KAHN, NAJMA, additional, RAHO, VITTORIO J., additional, RAMANUJAM, PRASANTHI, additional, REENSTRA, WENDE R., additional, REISNER, ANDREW, additional, RESTUCCIA, MARK C., additional, RILEY, JAMES MIChael, additional, ROMANOSKY, ALBERT J., additional, ROSEN, PETER, additional, ROSENTHAL, MARC S., additional, RUBIN, JONATHAN M., additional, SANCHEZ, LEON D., additional, SCHNELLE, DEBRA D., additional, SCHUUR, JEREMIAH D., additional, SERGIENKO, ERIC M., additional, SETHURAMAN, KINJAL, additional, SHAPIRO, MARC J., additional, SHEN, SAM, additional, SHEPHERD, SUZANNE M., additional, SHOFF, WILLIAM H., additional, SILER, SEAN MICHael, additional, SISITSKY, ALISON, additional, SISSON, CRAIG, additional, SMULOWITZ, PETER B., additional, SORENSON, JOHN H., additional, STEWART, CHARLES, additional, STEWART, M. KATHLEen, additional, STOCK, KENT J., additional, SULIS, CAROL, additional, SUTINGCO, NICHOLAS, additional, TANG, NELSON, additional, TEMIN, ELIZABETH, additional, TEMPEL, RICHARD A., additional, THORNE, CRAIG D., additional, TRACY, JASON A., additional, TRAUB, STEPHEN J., additional, VALENTE, JONATHAN Harris, additional, VANDERKAM, VICTORIA M., additional, VENABLE, CAROL L., additional, VILAS, FAITH, additional, VILKE, GARY M., additional, SORENSON, BARBARA Vogt, additional, WEINER, SCOTT G., additional, WEINSTEIN, ERIC S., additional, WERNER, ROY KARL, additional, WIENER, SAGE W., additional, WILLIAMS, ABIGAIL, additional, WILLIAMS, KENNETH A., additional, WIMBUSH, TRACY E., additional, WOOLARD, ROBERT H., additional, YESKEY, KEVIN, additional, YOON, SANDRA S., additional, and ZELLEY, PATRICK, additional

Published
2006
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15. The Effectiveness of a Damage Control Resuscitation Strategy for Vascular Injury in a Combat Support Hospital: Results of a Case Control Study

Author

WALTER REED ARMY MEDICAL CENTER WASHINGTON DC, Fox, Charles J., Gillespie, David L., Cox, E. D., Mehta, Sumeru G., Kragh, Jr., John J., Salinas, Jose, Holcomb, John B., WALTER REED ARMY MEDICAL CENTER WASHINGTON DC, Fox, Charles J., Gillespie, David L., Cox, E. D., Mehta, Sumeru G., Kragh, Jr., John J., Salinas, Jose, and Holcomb, John B.

Abstract

Advancements in combat casualty care have resulted in a significant reduction in mortality when compared with previous wars as current research has focused much attention on preventable death. Hemorrhage from extremity vascular injury remains a leading cause of potentially preventable death on the modern battlefield and recent estimates suggest an increase in this injury pattern compared with previous wars. Injuries of this severity cause an early and profound coagulopathy that is often present at admission to the emergency department (ED). Standard damage control principles are routinely applied to achieve rapid hemorrhage control, and to initiate a hemostatic resuscitation plan that will correct metabolic imbalances and prevent the onset or progression of a traumatic coagulopathy. Only when this lifesaving sequence is properly executed, can the military trauma patient be expected to withstand the metabolic perturbations of a complicated operation like extremity revascularization. Standard surgical doctrine and experience has taught surgeons that the operative patient needs to be adequately resuscitated before embarking on a taxing operative course. The time needed for adequate resuscitation was the single greatest barrier to limb salvage during the Korean conflict. Convincing modern data show that acidosis and traditional resuscitation techniques using liberal amounts of crystalloid and packed red blood cells (PRBCs) can exacerbate coagulopathy. One report has recently demonstrated a survival benefit with early correction of these physiologic derangements. Given modern advances, it seems logical to optimize those strategies that promote early recovery from the metabolic consequences of hemorrhagic shock., Published in the Jnl. of Trauma Injury, Infection, and Critical Care, Feb Supplement 2008, v64, n2, p599-S107.

Published
2008

16. The Effect of Recombinant Activated Factor VII on Mortality in Combat-Related Casualties With Severe Trauma and Massive Transfusion

Author

ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX, Spinella, Philip C., Perkins, Jeremy G., McLaughlin, Daniel F., Niles, Sarah E., Grathwohl, Kurt W., Beekley, Alec C., Salinas, Jose, Mehta, Sumeru, Wade, Charles E., Holcomb, John B., ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX, Spinella, Philip C., Perkins, Jeremy G., McLaughlin, Daniel F., Niles, Sarah E., Grathwohl, Kurt W., Beekley, Alec C., Salinas, Jose, Mehta, Sumeru, Wade, Charles E., and Holcomb, John B.

Abstract

Background: The majority of patients with potentially survivable combat-related injuries die from hemorrhage. Our objective was to determine whether the use of recombinant activated factor VII (rFVIIa) decreased mortality in combat casualties with severe trauma who received massive transfusions and if its use was associated with increased severe thrombotic events. Methods: We retrospectively reviewed a database of combat casualty patients with severe trauma (Injury Severity Score [ISS] >15) and massive transfusion (red blood cell [RBCs] >10 units/24 hours) admitted to one combat support hospital in Baghdad, Iraq, between December 2003 and October 2005. Admission vital signs and laboratory data, blood products, ISS, 24-hour and 30-day mortality, and severe thrombotic events were compared between patients who received rFVIIa (rFVIIa+) and did not receive rFVIIa (rFVIIa-). Conclusions: The early use of rFVIIa was associated with decreased 30- mortality in severely injured combat casualties requiring massive transfusion, was not associated with increased risk severe thrombotic events., Presented at the Annual Meeting of the American Association for the Surgery of Trauma (66th) held in Las Vegas, NV on 27-29 Sep 2007. Pub. in The Journal of Trauma: Injury, Infection, and Critical Care, v64 n2 p286-294, Feb 2008.

Published
2008

17. Gallstone Ileus

Author

Williams, Justin B., primary, Mehta, Sumeru G., additional, Vu, Tim, additional, Wonderlich, David A., additional, and McDermott, Dustin M., additional

Published
2010
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27. Damage Control Resuscitation: Directly Addressing the Early Coagulopathy of Trauma

Author

Holcomb, John B., primary, Jenkins, Don, additional, Rhee, Peter, additional, Johannigman, Jay, additional, Mahoney, Peter, additional, Mehta, Sumeru, additional, Cox, E Darrin, additional, Gehrke, Michael J., additional, Beilman, Greg J., additional, Schreiber, Martin, additional, Flaherty, Stephen F., additional, Grathwohl, Kurt W., additional, Spinella, Phillip C., additional, Perkins, Jeremy G., additional, Beekley, Alec C., additional, McMullin, Neil R., additional, Park, Myung S., additional, Gonzalez, Ernest A., additional, Wade, Charles E., additional, Dubick, Michael A., additional, Schwab, C William, additional, Moore, Fred A., additional, Champion, Howard R., additional, Hoyt, David B., additional, and Hess, John R., additional

Published
2007
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30. Damage Control Resuscitation: A Narrative Review of Goals, Techniques, and Components.

Author

Bridwell RE, Schaffrinna AM, Long B, Graybill JC, and Mehta SG

Subjects
Crystalloid Solutions, Hemorrhage prevention & control, Humans, Resuscitation, Blood Coagulation Disorders therapy, Goals
Abstract

Damage control resuscitation (DCR) simultaneously tackles hemorrhage control and balanced resuscitation in complex multisystem trauma patients. This technique can improve patient outcomes. This review outlines the importance of DCR with hemorrhage control and administration of fresh whole blood or component therapy if not available and avoiding crystalloid administration. Additionally, administration of tranexamic acid and calcium prove beneficial in critically ill trauma patients. Avoidance of acidosis, hypothermia, and coagulopathy remains a key but challenging goal of DCR.

Published
2021

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