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1. Wearable Sensors in Other Medical Domains with Application Potential for Orthopedic Trauma Surgery—A Narrative Review

Author

Carolina Vogel, Bernd Grimm, Meir T. Marmor, Sureshan Sivananthan, Peter H. Richter, Seth Yarboro, Andrew M. Hanflik, Tina Histing, and Benedikt J. Braun

Subjects
orthopedic surgery, digital, body worn sensor, outcome assessment, Medicine
Abstract

The use of wearable technology is steadily increasing. In orthopedic trauma surgery, where the musculoskeletal system is directly affected, focus has been directed towards assessing aspects of physical functioning, activity behavior, and mobility/disability. This includes sensors and algorithms to monitor real-world walking speed, daily step counts, ground reaction forces, or range of motion. Several specific reviews have focused on this domain. In other medical fields, wearable sensors and algorithms to monitor digital biometrics have been used with a focus on domain-specific health aspects such as heart rate, sleep, blood oxygen saturation, or fall risk. This review explores the most common clinical and research use cases of wearable sensors in other medical domains and, from it, derives suggestions for the meaningful transfer and application in an orthopedic trauma context.

Published
2024
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2. Usage of orthopaedic trauma registries among members of the International Orthopaedic Trauma Association: How are we doing?

Author

Mai P. Nguyen, MD, Thomas Z. Paull, MD, Theodore Miclau, MD, and Meir T. Marmor, MD

Subjects
Orthopedic surgery, RD701-811
Abstract

Abstract. Introduction: The use of national databases for orthopaedic research has increased significantly in the past decade. The purpose of this study was to report on the current state of orthopaedic trauma registries in 21 countries represented by 20 member societies of the International Orthopaedic Trauma Association (IOTA). Methods: A web-based survey was circulated to all IOTA member societies. The survey consisted of 10 questions (five open-ended and five multiple-choice). Results: Representatives from all 21 countries replied. Five countries (24%) do not currently have or plan to start a registry. One country (5%) had a registry that is now closed. Two countries (10%) are building a registry. Thirteen countries (62%) reported at least one active registry, including four countries with more than one registry. Of the 14 countries that reported the existence of a registry, there were 17 registries noted that included patients with fracture. There were seven registries dedicated to high-energy trauma and four registries that included elderly hip fractures. In addition, 9/17 representatives reported the utilization of a fracture classification and 9/17 noted some level of mandate from medical providers. All responders but one reported that data were manually entered into their registries. Conclusions: Despite the shared vision of quality control and outcome optimization, IOTA society representatives reported significant variability in the depth and format of the orthopaedic trauma registry among IOTA members. These findings represent an opportunity for collaboration across organizations in creating fracture registries. Level of Evidence: Level IV.

Published
2022
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3. Comparison of the Neer classification to the 2018 update of the Orthopedic Trauma Association/AO fracture classification for classifying proximal humerus fractures

Author

Meir T. Marmor, MD, Julie Agel, MA, ATC, Jarrod Dumpe, MD, James F. Kellam, MD, Geoffrey S. Marecek, MD, Eric Meinberg, MD, Mai P. Nguyen, MD, Stephen Sims, MD, Gillian L. Soles, MD, and Matthew D. Karam, MD

Subjects
Orthopedic surgery, RD701-811
Abstract

Abstract. Background:. The classification of fractures is necessary to ensure a reliable means of communication for clinical interaction, education and research. The Neer classification is the most commonly used classification for proximal humerus fractures. In 2018 the Orthopedic Trauma Association (OTA) and the AO Foundation provided an update to the OTA/AO Fracture Classification Scheme addressing many of the concerns about the previous versions of the classification. The objective of the present study was to evaluate the rater reliability of the 2 classifications and if the classifications subjectively better characterized the fracture patterns. Methods:. X-rays and CT scans of 24 proximal humerus fractures were given to 7 independent raters for classification according to the Neer and 2018 OTA/AO classification. Both full-forms and short-forms of the classifications were tested. The Fleiss Kappa statistic was used to assess inter-rater agreement and intra-rater consistency for the 2 classifications. For each case the raters subjectively commented on how well each classification was able to characterize the fracture pattern. Results:. All raters graded the 2018 OTA/AO classification as good as or better than the Neer classification for an adequate description of the fracture patterns. The short-form 2018 OTA/AO classification had the most 4 rater and 5 rater agreement cases and the second most 6 rater agreement cases. The short-form Neer classification had the second most 4 rater and 5 rater agreement cases and the most 6 rater agreement cases. The full 2018 OTA/AO had the least 4, 5, or 6 rater agreement cases of all the classification systems. Inter-rater agreement was fair for the full and short form of both the Neer and 2018 OTA/AO classification. The full and short Neer classifications together with the short 2018 OTA/AO classification had moderate intra-rater consistency, while the full 2018 OTA/AO classification only had slight intra-rater consistency. Conclusions:. The 2018 OTA/AO classification is equivalent in its short-form to the Neer classification in inter-rater reliability and intra-rater consistency; and is superior in its full form for characterizing specific fracture types. The low inter-rater reliability of the full 2018 OTA/AO classification is a concern that may need to be addressed in the future.

Published
2022
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4. 'Bring Your Own Device'—A New Approach to Wearable Outcome Assessment in Trauma

Author

Benedikt J. Braun, Tina Histing, Maximilian M. Menger, Julian Platte, Bernd Grimm, Andrew M. Hanflik, Peter H. Richter, Sureshan Sivananthan, Seth R. Yarboro, Boyko Gueorguiev, Dmitry Pokhvashchev, and Meir T. Marmor

Subjects
digital outcome assessment, fracture, traumatology, Medicine (General), R5-920
Abstract

Background and Objectives: Outcome data from wearable devices are increasingly used in both research and clinics. Traditionally, a dedicated device is chosen for a given study or clinical application to collect outcome data as soon as the patient is included in a study or undergoes a procedure. The current study introduces a new measurement strategy, whereby patients’ own devices are utilized, allowing for both a pre-injury baseline measure and ability to show achievable results. Materials and Methods: Patients with a pre-existing musculoskeletal injury of the upper and lower extremity were included in this exploratory, proof-of-concept study. They were followed up for a minimum of 6 weeks after injury, and their wearable outcome data (from a smartphone and/or a body-worn sensor) were continuously acquired during this period. A descriptive analysis of the screening characteristics and the observed and achievable outcome patterns was performed. Results: A total of 432 patients was continuously screened for the study, and their screening was analyzed. The highest success rate for successful inclusion was in younger patients. Forty-eight patients were included in the analysis. The most prevalent outcome was step count. Three distinctive activity data patterns were observed: patients recovering, patients with slow or no recovery, and patients needing additional measures to determine treatment outcomes. Conclusions: Measuring outcomes in trauma patients with the Bring Your Own Device (BYOD) strategy is feasible. With this approach, patients were able to provide continuous activity data without any dedicated equipment given to them. The measurement technique is especially suited to particular patient groups. Our study’s screening log and inclusion characteristics can help inform future studies wishing to employ the BYOD design.

Published
2023
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5. Wireless Measurements Using Electrical Impedance Spectroscopy to Monitor Fracture Healing

Author

Naomasa Fukase, Victoria R. Duke, Monica C. Lin, Ingrid K. Stake, Matthieu Huard, Johnny Huard, Meir T. Marmor, Michel M. Maharbiz, Nicole P. Ehrhart, Chelsea S. Bahney, and Safa T. Herfat

Subjects
bone fracture repair, electrical impedance spectroscopy, smart bone plate, wireless measurements, Bluetooth transmission, longitudinal monitoring, Chemical technology, TP1-1185
Abstract

There is an unmet need for improved, clinically relevant methods to longitudinally quantify bone healing during fracture care. Here we develop a smart bone plate to wirelessly monitor healing utilizing electrical impedance spectroscopy (EIS) to provide real-time data on tissue composition within the fracture callus. To validate our technology, we created a 1-mm rabbit tibial defect and fixed the bone with a standard veterinary plate modified with a custom-designed housing that included two impedance sensors capable of wireless transmission. Impedance magnitude and phase measurements were transmitted every 48 h for up to 10 weeks. Bone healing was assessed by X-ray, µCT, and histology. Our results indicated the sensors successfully incorporated into the fracture callus and did not impede repair. Electrical impedance, resistance, and reactance increased steadily from weeks 3 to 7—corresponding to the transition from hematoma to cartilage to bone within the fracture gap—then plateaued as the bone began to consolidate. These three electrical readings significantly correlated with traditional measurements of bone healing and successfully distinguished between union and not-healed fractures, with the strongest relationship found with impedance magnitude. These results suggest that our EIS smart bone plate can provide continuous and highly sensitive quantitative tissue measurements throughout the course of fracture healing to better guide personalized clinical care.

Published
2022
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6. Increased litigation burden among tibia, pelvis, and spine fractures

Author

Zachary M. Working, MD, Ashraf N. El Naga, MD, Joshua Slocum, BS, Allison Tucker, MD, FRCPC, Paul Hoogervorst, MD, and Meir T. Marmor, MD

Subjects
Orthopedic surgery, RD701-811
Abstract

Abstract. Objectives:. To analyze a series of claims from a large national malpractice insurer associated with fracture care to understand what parameters are associated with claims, defense costs, and paid indemnity. Design:. Review of claims in fracture care settings from a national database; case series. Setting:. Database draws from insured pool of 400,000 medical malpractice cases from 400 healthcare entities across the country, representing 165,000 physicians; both academic and private. Patients/Participants:. Fracture care patients bringing legal suit. Main Outcome Measurements:. Cost of legal proceedings and indemnity, ICD-9 codes, and contributing causes toward claims. Results:. A total of 756 fracture claims were asserted between 2005 and 2014 regarding fracture care within the database; 70% were brought for inaccurate, missed, or delayed diagnosis, while 22% addressed medical treatment and 8% were for surgical management. Orthopaedics was the primary service in 22%. Total cost (expenses and indemnity) to orthopaedic providers totaled $13.1MM (million). The most common claim against orthopaedics was for fractures of the tibia and fibula (11.4%). Impact factor (IF) analysis (as described by Matsen) of indemnity in these cases reveals 3 fracture regions of highest indemnity burden: fractures of the tibia and fibula (IF: 1.86, 11.4%), pelvis (IF: 1.77, 6.6%), and spine (IF 1.33, 6.6%). Analysis of contributing factors identifies the category of clinical judgement as the most common category (62%). Other common factors include patient noncompliance (31%), communication (28%), technical skill (17%), clinical systems (11%), and documentation (10%). The single most common specific cause of a claim in orthopaedic fracture care was misinterpretation of diagnostic imaging (25%). Conclusion:. This study is the first of its kind to identify fractures of the tibia and fibula as high risk for litigation against orthopaedic providers and provides general counseling of legal pitfalls in fracture care. Finally, we are able to identify the act of patient assessment as a key issue in over half of all fracture-related claims against orthopaedic providers. Providers in general and specialty settings can use this information to help guide their treatment and care ownership decisions in the care of patients with fractures. Level of Evidence:. Economic - Level III.

Published
2019
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10. Complex Orthopaedic Trauma Is Shifting Away From Level I to Non–Level I Trauma Centers: An Analysis of the National Trauma Data Bank

Author

Marmor, Meir T, Coufal, Sarah, Parel, Philip M, Rezaei, Arash, and Morshed, Saam

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Health Sciences, Physical Injury - Accidents and Adverse Effects, Patient Safety, Injuries and accidents, Humans, Orthopedics, Trauma Centers, Fractures, Bone, Surgeons, Orthopedic Surgeons, Skull Fracture, Basilar
Abstract

IntroductionAn increasing number of fellowship-trained orthopaedic trauma surgeons are working in non-Level I centers. This study aimed to examine trends of management of complex orthopaedic trauma in Level I centers versus non-Level I centers and its potential effect on patient outcomes.MethodsData from the National Trauma Data Bank from 2008 to 2017 were analyzed. Non-Level I to Level I center ratios for complex fractures and complication rates, median hours to procedure for time-sensitive fractures, and uninsured/underinsured rates of Level I and non-Level I centers were recorded.ResultsThree hundred one thousand patients were included. A statistically significant downward trend was identified in the percent of all complex orthopaedic trauma at Level I centers and per-hospital likelihood of seeing a complex orthopaedic fracture in a Level I versus non-Level I hospital. Per-hospital complication rates were consistently lower in non-Level I hospitals after controlling for injury severity and payer mix. Time-sensitive fractures were treated earlier in non-Level I centers.DiscussionThis study demonstrates a reduction of complex trauma treatment in Level I centers that did not translate to adverse effects on patient outcomes. Policymakers should notice this trend to ensure the continued quality of orthopaedic trauma training and maintenance of expertise in complex fracture management.

Published
2023

13. Mortality, perioperative complications and surgical timelines in hip fracture patients: Comparison of the Spanish with the non-Spanish Cohort of the HIP ATTACK-1 trial

Author

Veevaete, Laurent, Waroux, Bernard le Polain de, Lavand'homme, Patricia, Cornu, Olivier, Tribak, Karim, Yombi, Jean C, Touil, Nassim, Bhutia, Jigme T, Clinckaert, Carol, Clippeleir, Dirk De, Reul, Maike, Patel, Ameen, Tandon, Vikas, Gauthier, Leslie P, Avram, Victoria R.A., Winemaker, Mitchell, de Beer, Justin, Simpson, Diane L, Worster, Andrew, Alvarado, Kim A, Gregus, Krysten K, Lawrence, Kelly H, Leong, Darryl P, Joseph, Philip G, Magloire, Patrick, Deheshi, Benjamin, Bisland, Stuart, Wood, Thomas J, Tushinski, Daniel M., Wilson, David A.J., Haider, Shariq, Bali, Kamal, Kearon, Clive, Manach, Yannick Le, Adili, Anthony, Tiboni, Maria E, Neary, John D, Cowan, David D, Khanna, Vickas, Zaki, Amna, Farrell, Janet C, MacDonald, Anne Marie, Conen, David, Wong, Steven C.W., Karbassi, Arsha, Wright, Douglas S, Shanthanna, Harsha, Coughlin, Ryan, Khan, Moin, Wikkerink, Spencer, Quraishi, Faraaz A, Lawendy, Abdel-Rahman, Kishta, Waleed, Schemitsch, Emil, Carey, Timothy, Macleod, Mark D, Sanders, David W, Vasarhelyi, Edward, Bartley, Debra, Dresser, George K, Tieszer, Christina, Jenkinson, Richard J, Shadowitz, Steven, Lee, Jacques S, Choi, Stephen, Kreder, Hans J, Nousiainen, Markku, Kunz, Monica R, Tuazon, Ravianne, Shrikumar, Mopina, Ravi, Bheeshma, Wasserstein, David, Stephen, David J.G., Nam, Diane, Henry, Patrick D.G., Wood, Gavin C.A., Mann, Stephen M., Jaeger, Melanie T., Sivilotti, Marco L.A., Smith, Christopher A., Frank, Christopher C., Grant, Heather, Ploeg, Leone, Yach, Jeff D., Harrison, Mark M., Campbell, Aaron R., Bicknell, Ryan T., Bardana, Davide D., Feibel, Robert J., McIlquham, Katie, Gallant, Catherine, Halman, Samantha, Thiruganasambandamoorth, Venkatesh, Ruggiero, Sara, Hadden, William J., Chen, Brian P.J., Coupal, Stephanie A., McMahon, Stephen J., McLean, Lisa M., Shirali, Hemant R., Haider, Syed Y., Smith, Crystal A., Watts, Evan, Santone, David J., Koo, Kevin, Yee, Allan J., Oyenubi, Ademilola N., Nauth, Aaron, Schemitsch, Emil H., Daniels, Timothy R., Ward, Sarah E., Hall, Jeremy A., Ahn, Henry, Whelan, Daniel B., Atrey, Amit, Khoshbin, Amir, Puskas, David, Droll, Kurt, Cullinan, Claude, Payendeh, Jubin, Lefrancois, Tina, Mozzon, Lise, Marion, Travis, Jacka, Michael J., Greene, James, Menon, Matthew, Stiegelmahr, Robert, Dillane, Derek, Irwin, Marleen, Beaupre, Lauren, Coles, Chad P., Trask, Kelly, MacDonald, Shelley, Trenholm, J.A.I., Oxner, William, Richardson, C.G., Dehghan, Niloofar, Sadoughi, Mehdi, Sharma, Achal, White, Neil J., Olivieri, Loretta, Hunt, Stephen B., Turgeon, Thomas R., Bohm, Eric R., Tran, Sarah, Giilck, Stephen M., Hupel, Tom, Guy, Pierre, O'Brien, Peter J., Duncan, Andrew W., Crawford, Gordon A., hou, Junlin, Zhao, Yanrui, Liu, Yang, Shan, Lei, Wu, Anshi, Muñoz, Juan M., Chaudier, Philippe, Douplat, Marion, Fessy, Michel Henri, Piriou, Vincent, Louboutin, Lucie, David, Jean Stephane, Friggeri, Arnaud, Beroud, Sebastien, Fayet, Jean Marie, Landais, Paul, Leung, Frankie Ka Li, Fang, Christian Xinshuo, Yee, Dennis King Hang, Sancheti, Parag K., Pradhan, Chetan V., Patil, Atul A., Puram, Chetan P., Borate, Madhav P., Kudrimoti, Kiran B., Adhye, Bharati A., Dongre, Himanshu V., John, Bobby, Abraham, Valsamma, Pandey, Ritesh A., Rajkumar, Arti, George, Preetha E., Sigamani, Alen, Stephen, Manesh, Chandran, Nitheesh, Ashraf, Mohammed, Georgekutty, A.M., Sulthan, Ahamad S., Adinarayanan, S., Sharma, Deep, Barnawal, Satish P., Swaminathan, Srinivasan, Bidkar, Prasanna U., Mishra, Sandeep K., Menon, Jagdish, M, Niranjan, Zk, Varghese, Hiremath, Santosh A., Nc, Madhusudhan, Jawali, Abhijit, Gnanadurai, Kingsly R., George, Carolin E., Maddipati, Atarao, Kp, Mary, Sharma, Vijay, Farooque, Kamran, Malhotra, Rajesh, Mittal, Samarth, Sawhney, Chavi, Gupta, Babita, Mathur, Purva, Gamangati, Shivanand, Tripathy, Vijaylaxmi, Menon, Prem H., Dhillon, Mandeep S., Chouhan, Devendra K., Patil, Sharanu, Narayan, Ravi, Lal, Purushotham, Bilchod, Prashanth N., Singh, Surya U., Gattu, Uttam V., Dashputra, Ravi P., Rahate, Prashant V., Turiel, Maurizio, Blasio, Giuseppe De, Accetta, Riccardo, Perazzo, Paolo, Stella, Daniele, Bonadies, Marika, Colombo, Chiara, Fozzato, Stefania, Pino, Fabio, Morelli, Ilaria, Colnaghi, Eleonora, Salini, Vincenzo, Denaro, Giuseppe, Beretta, Luigi, Placella, Giacomo, Giardina, Giuseppe, Binda, Mirko, Marcato, Anna, Guzzetti, Luca, Piccirillo, Fabio, Cecconi, Maurizio, Khor, H.M., Lai, Hou Yee, Kumar, C.S., Chee, K.H., Loh, P.S., Tan, Kit Mun, Singh, Simmrat, Foo, Li Lian, Prakasam, Komella, Chaw, Sook Hui, Lee, Meng-Li, Ngim, Joanne H.L., Boon, Huck Wee, Chin, Im Im, Kleinlugtenbelt, Ydo V., Landman, Ellie B.M., Flikweert, Elvira R., Roerdink, Herbert W., Brokelman, Roy B.G., Elskamp-Meijerman, Hannie F., Horst, Maarten R., Cobben, Jan-Hein M.G., Umer, Masood, Begum, Dilshad, Anjum, Anila, Hashmi, Pervaiz M., Ahmed, Tashfeen, Rashid, Haroon U., Khattak, Mujahid J., Rashid, Rizwan H., Lakdawala, Riaz H., Noordin, Shahryar, Juman, Naveed M., Khan, Robyna I., Riaz, Muhammad M., Bokhari, Syedah S., Almas, Ayesha, Wahab, Hussain, Ali, Arif, Khan, Hammad N., Khan, Eraj K., Nur, Aamer Nabi, Janjua, Kholood A., Orakzai, Sajjad H., Khan, Abdus S., Mustafa, Khawaja J., Sohail, Mian A., Umar, Muhammad, Khan, Siddra A., Ashraf, Muhammad, Khan, Muhammad K., Shiraz, Muhammad, Furgan, Ahmad, Ślęczka, Paweł, Dąbek, Piotr, Kumoń, Adam, Satora, Wojciech, Ambroży, Wojciech, Święch, Mariusz, Rycombel, Jacek, Grzelak, Adrian, Nowak- Kózka, Ilona, Gucwa, Jaroslaw, Machala, Waldemar, Ramokgopa, Mmampapatla T., Firth, Gregory B., Karera, Mwalimu, Fourtounas, Maria, Singh, Virsen, Biscardi, Anna, Iqbal, Muhammad N., Campbell, Ryan J., Maluleke, Matimba L., Moller, Carien, Nhlapo, Lerato, Maqungo, Sithombo, Flint, Margot, Nejthardt, Marcin B., Chetty, Sean, Naidoo, Rubendren, Guerra-Farfan, Ernesto, Tomas-Hernandez, Jordi, Garcia-Sanchez, Yaiza, Clua, Miriam Garrido, Molero-Garcia, Vicente, Minguell-Monyart, Joan, Teixidor-Serra, Jordi, Villar-Casares, Maria del Mar, Marsa, Jordi Selga, Porcel-Vazquez, Juan A., Andres-Peiro, Jose-Vicente, Aguilar, Marc, Mestre-Torres, Jaume, Colomina, Maria J., Guilabert, Patricia, Gozalo, M Luisa Paños, Abarca, Luis, Martin, Nuria, Usua, Gemma, Martinez-Ripol, Pedro, Posada, M.A. Gonzalez, Lalueza-Broto, Pilar, Sanchez-Raya, Judith, Camarena, Jorge Nuñez, Fraguas-Castany, Antoni, Balaguer-Castro, Mariano, Torner, Pere, Jornet-Gibert, Montsant, Serrano-Sanz, Jorge, Cámara-Cabrera, Jaume, Salomó-Domènech, Mònica, Yela-Verdú, Christian, Peig-Font, Anna, Ricol, Laura, Carreras-Castañer, Anna, Martínez-Sañudo, Luis, Herranz, Susana, Feijoo-Massó, Carlos, Sianes-Gallén, Mònica, Castillόn, Pablo, Bernaus, Martí, Quintas, Saioa, Gόmez, Olga, Salvador, Jordi, Abarca, Javier, Estrada, Cristina, Novellas, Marga, Torra, Mercè, Dealbert, Alfred, Macho, Oscar, Ivanov, Alexia, Valldosera, Esther, Arroyo, Marta, Pey, Borja, Yuste, Antoni, Mateo, Llorenç, Caso, Julio De, Anaya, Rafael, Higa-Sansone, J.L., Millan, Angelica, Baños, Victoria, Herrera-Mateo, Sergio, Aguado, Hector, Martinez-Municio, Gonzalo, León, Ricardo, Santiago-Maniega, Silvia, Zabalza, Ana, Labrador, Gregorio, Guerado, Enrique, Ramirez-Roldan, Alicia, Cruz, Encarnacion, Cano, Juan R, Bogallo, Jose M, Sangasoongsong, Paphon, Kulachote, Noratep, Sirisreetreerux, Norachart, Pengrung, Nachapan, Chalacheewa, Theerawat, Arnuntasupakul, Vanlapa, Yingchoncharoen, Teerapat, Naratreekoon, Bundit, Kadry, Miriam A, Thayaparan, Surendini, Abdlaziz, Ihab, Aframian, Arash, Imbuldeniya, Arjuna, Movahedi, Roya, Omran, Sherif, Vizcaychipi, Marcela P, Correia, Patricia, Patil, Shashank, Haire, Kevin, Mayor, Amy S.E., Dillingham, Sally, Nicholson, Laura, Elnaggar, Mohamed, John, Joby, Nanjayan, Shashi K, Parker, Martyn J, O'Sullivan, Susan, Marmor, Meir T, Matityahu, Amir, McClellan, Robert T, Comstock, Curt, Ding, Anthony, Toogood, Paul, Slobogean, Gerard, Joseph, Katherine, O'Toole, Robert, Sciadini, Marcus, Ryan, Scott P, Clark, Molly E, Cassidy, Charles, Balonov, Konstantin, Bergese, Sergio D, Phieffer, Laura S, Gonzalez-Zacarias, Alicia A, Marcantonio, Andrew J, Borges, Flavia K., Bhandari, Mohit, Nuñez, Jorge H., Castillon, Pablo, De Caso Rodriguez, Julio, Aguado, Hector J., Popova, Ekaterine, Tonelli, Ana Claudia, Balasubramanian, Kumar, Vincent, Jessica, Harvey, Valerie, Kocaqi, Etri, and Devereaux, P.J.

Published
2024
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15. Usage of orthopaedic trauma registries among members of the International Orthopaedic Trauma Association: How are we doing?

Author

Nguyen, Mai P, Paull, Thomas Z, Miclau, Theodore, and Marmor, Meir T

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Health Sciences, Physical Injury - Accidents and Adverse Effects, fracture database, fracture registry, orthopaedic registry, trauma database, trauma registry
Abstract

Introduction: The use of national databases for orthopaedic research has increased significantly in the past decade. The purpose of this study was to report on the current state of orthopaedic trauma registries in 21 countries represented by 20 member societies of the International Orthopaedic Trauma Association (IOTA). Methods: A web-based survey was circulated to all IOTA member societies. The survey consisted of 10 questions (five open-ended and five multiple-choice). Results: Representatives from all 21 countries replied. Five countries (24%) do not currently have or plan to start a registry. One country (5%) had a registry that is now closed. Two countries (10%) are building a registry. Thirteen countries (62%) reported at least one active registry, including four countries with more than one registry. Of the 14 countries that reported the existence of a registry, there were 17 registries noted that included patients with fracture. There were seven registries dedicated to high-energy trauma and four registries that included elderly hip fractures. In addition, 9/17 representatives reported the utilization of a fracture classification and 9/17 noted some level of mandate from medical providers. All responders but one reported that data were manually entered into their registries. Conclusions: Despite the shared vision of quality control and outcome optimization, IOTA society representatives reported significant variability in the depth and format of the orthopaedic trauma registry among IOTA members. These findings represent an opportunity for collaboration across organizations in creating fracture registries. Level of Evidence: Level IV.

Published
2022

20. Aqueous skin antisepsis before surgical fixation of open fractures (Aqueous-PREP): a multiple-period, cluster-randomised, crossover trial

Author

Slobogean, Gerard P., Sprague, Sheila, Wells, Jeffrey L., Bhandari, Mohit, Harris, Anthony D., Mullins, C. Daniel, Thabane, Lehana, Wood, Amber, Della Rocca, Gregory J., Hebden, Joan N., Jeray, Kyle J., Marchand, Lucas S., O'Hara, Lyndsay M., Zura, Robert D., Lee, Christopher, Patterson, Joseph T., Gardner, Michael J., Blasman, Jenna, Davies, Jonah, Liang, Stephen, Taljaard, Monica, Devereaux, PJ, Guyatt, Gordon, Heels-Ansdell, Diane, Marvel, Debra, Palmer, Jana E., Friedrich, Jeff, O'Hara, Nathan N., Grissom, Frances, Gitajn, I. Leah, Morshed, Saam, O'Toole, Robert V., Petrisor, Bradley, Mossuto, Franca, Joshi, Manjari G., D'Alleyrand, Jean-Claude G., Fowler, Justin, Rivera, Jessica C., Talbot, Max, Pogorzelski, David, Dodds, Shannon, Li, Silvia, Del Fabbro, Gina, Szasz, Olivia Paige, Bzovsky, Sofia, McKay, Paula, Minea, Alexandra, Murphy, Kevin, Howe, Andrea L., Demyanovich, Haley K., Hoskins, Wayne, Medeiros, Michelle, Polk, Genevieve, Kettering, Eric, Mahal, Nirmen, Eglseder, Andrew, Johnson, Aaron, Langhammer, Christopher, Lebrun, Christopher, Nascone, Jason, Pensy, Raymond, Pollak, Andrew, Sciadini, Marcus, Degani, Yasmin, Phipps, Heather, Hempen, Eric, Johal, Herman, Ristevski, Bill, Williams, Dale, Denkers, Matthew, Rajaratnam, Krishan, Al-Asiri, Jamal, Gallant, Jodi L., Pusztai, Kaitlyn, MacRae, Sarah, Renaud, Sara, Adams, John D., Beckish, Michael L., Bray, Christopher C., Brown, Timothy R., Cross, Andrew W., Dew, Timothy, Faucher, Gregory K., Gurich Jr, Richard W., Lazarus, David E., Millon, S. John, Moody, M. Christian, Palmer, M. Jason, Porter, Scott E., Schaller, Thomas M., Sridhar, Michael S., Sanders, John L., Rudisill Jr, L. Edwin, Garitty, Michael J., Poole, Andrew S., Sims, Michael L., Walker, Clark M., Carlisle, Robert, Hofer, Erin A., Huggins, Brandon, Hunter, Michael, Marshall, William, Ray, Shea B., Smith, Cory, Altman, Kyle M., Pichiotino, Erin R., Quirion, Julia C., Loeffler, Markus F., Cole, Austin A., Maltz, Ethan J., Parker, Wesley, Ramsey, T. Bennett, Burnikel, Alex, Colello, Michael, Stewart, Russell, Wise, Jeremy, Anderson, Matthew, Eskew, Joshua, Judkins, Benjamin, Miller, James M., Tanner, Stephanie L., Snider, Rebecca G., Townsend, Christine E., Pham, Kayla H., Martin, Abigail, Robertson, Emily, Bray, Emily, Sykes, J. Wilson, Yoder, Krystina, Conner, Kelsey, Abbott, Harper, Natoli, Roman M., McKinley, Todd O., Virkus, Walter W., Sorkin, Anthony T., Szatkowski, Jan P., Mullis, Brian H., Jang, Yohan, Lopas, Luke A., Hill, Lauren C., Fentz, Courteney L., Diaz, Maricela M., Brown, Krista, Garst, Katelyn M., Denari, Emma W., Osborn, Patrick, Pierrie, Sarah N., Kessler, Bradley, Herrera, Maria, Miclau, Theodore, Marmor, Meir T., Matityahu, Amir, McClellan, R. Trigg, Shearer, David, Toogood, Paul, Ding, Anthony, Murali, Jothi, El Naga, Ashraf, Tangtiphaiboontana, Jennifer, Belaye, Tigist, Berhaneselase, Eleni, Pokhvashchev, Dmitry, Obremskey, William T., Jahangir, Amir Alex, Sethi, Manish, Boyce, Robert, Stinner, Daniel J., Mitchell, Phillip P., Trochez, Karen, Rodriguez, Elsa, Pritchett, Charles, Hogan, Natalie, Fidel Moreno, A., Hagen, Jennifer E., Patrick, Matthew, Vlasak, Richard, Krupko, Thomas, Talerico, Michael, Horodyski, Marybeth, Pazik, Marissa, Lossada-Soto, Elizabeth, Gary, Joshua L., Warner, Stephen J., Munz, John W., Choo, Andrew M., Achor, Timothy S., Routt, Milton L. “Chip”, Kutzler, Michael, Boutte, Sterling, Warth, Ryan J., Prayson, Michael J., Venkatarayappa, Indresh, Horne, Brandon, Jerele, Jennifer, Clark, Linda, Boulton, Christina, Lowe, Jason, Ruth, John T., Askam, Brad, Seach, Andrea, Cruz, Alejandro, Featherston, Breanna, Carlson, Robin, Romero, Iliana, Zarif, Isaac, Dehghan, Niloofar, McKee, Michael, Jones, Clifford B., Sietsema, Debra L., Williams, Alyse, Dykes, Tayler, Guerra-Farfan, Ernesto, Tomas-Hernandez, Jordi, Teixidor-Serra, Jordi, Molero-Garcia, Vicente, Selga-Marsa, Jordi, Porcel-Vazquez, Juan Antonio, Andres-Peiro, Jose Vicente, Esteban-Feliu, Ignacio, Vidal-Tarrason, Nuria, Serracanta, Jordi, Nuñez-Camarena, Jorge, del Mar Villar-Casares, Maria, Mestre-Torres, Jaume, Lalueza-Broto, Pilar, Moreira-Borim, Felipe, Garcia-Sanchez, Yaiza, Marcano-Fernández, Francesc, Martínez-Carreres, Laia, Martí-Garín, David, Serrano-Sanz, Jorge, Sánchez-Fernández, Joel, Sanz-Molero, Matsuyama, Carballo, Alejandro, Pelfort, Xavier, Acerboni-Flores, Francesc, Alavedra-Massana, Anna, Anglada-Torres, Neus, Berenguer, Alexandre, Cámara-Cabrera, Jaume, Caparros-García, Ariadna, Fillat-Gomà, Ferran, Fuentes-López, Ruben, Garcia-Rodriguez, Ramona, Gimeno-Calavia, Nuria, Martínez-Álvarez, Marta, Martínez-Grau, Patricia, Pellejero-García, Raúl, Ràfols-Perramon, Ona, Peñalver, Juan Manuel, Salomó Domènech, Mònica, Soler-Cano, Albert, Velasco-Barrera, Aldo, Yela-Verdú, Christian, Bueno-Ruiz, Mercedes, Sánchez-Palomino, Estrella, Andriola, Vito, Molina-Corbacho, Matilde, Maldonado-Sotoca, Yeray, Gasset-Teixidor, Alfons, Blasco-Moreu, Jorge, Fernández-Poch, Núria, Rodoreda-Puigdemasa, Josep, Verdaguer-Figuerola, Arnau, Cueva-Sevieri, Heber Enrique, Garcia-Gimenez, Santiago, Viskontas, Darius G., Apostle, Kelly L., Boyer, Dory S., Moola, Farhad O., Perey, Bertrand H., Stone, Trevor B., Lemke, H. Michael, Spicer, Ella, Payne, Kyrsten, Hymes, Robert A., Schwartzbach, Cary C., Schulman, Jeff E., Malekzadeh, A. Stephen, Holzman, Michael A., Gaski, Greg E., Wills, Jonathan, Pilson, Holly, Carroll, Eben A., Halvorson, Jason J., Babcock, Sharon, Goodman, J. Brett, Holden, Martha B., Williams, Wendy, Hill, Taylor, Brotherton, Ariel, Romeo, Nicholas M., Vallier, Heather A., Vergon, Anna, Higgins, Thomas F., Haller, Justin M., Rothberg, David L., Olsen, Zachary M., McGowan, Abby V., Hill, Sophia, Dauk, Morgan K., Bergin, Patrick F., Russell, George V., Graves, Matthew L., Morellato, John, McGee, Sheketha L., Bhanat, Eldrin L., Yener, Ugur, Khanna, Rajinder, Nehete, Priyanka, Potter, David, VanDemark III, Robert, Seabold, Kyle, Staudenmier, Nicholas, Coe, Marcus, Dwyer, Kevin, Mullin, Devin S., Chockbengboun, Theresa A., DePalo Sr., Peter A., Phelps, Kevin, Bosse, Michael, Karunakar, Madhav, Kempton, Laurence, Sims, Stephen, Hsu, Joseph, Seymour, Rachel, Churchill, Christine, Mayfield, Ada, Sweeney, Juliette, Jaeblon, Todd, Beer, Robert, Bauer, Brent, Meredith, Sean, Talwar, Sneh, Domes, Christopher M., Gage, Mark J., Reilly, Rachel M., Paniagua, Ariana, Dupree, JaNell, Weaver, Michael J., von Keudell, Arvind G., Sagona, Abigail E., Mehta, Samir, Donegan, Derek, Horan, Annamarie, Dooley, Mary, Heng, Marilyn, Harris, Mitchel B., Lhowe, David W., Esposito, John G., Alnasser, Ahmad, Shannon, Steven F., Scott, Alesha N., Clinch, Bobbi, Weber, Becky, Beltran, Michael J., Archdeacon, Michael T., Sagi, Henry Claude, Wyrick, John D., Le, Theodore Toan, Laughlin, Richard T., Thomson, Cameron G., Hasselfeld, Kimberly, Lin, Carol A., Vrahas, Mark S., Moon, Charles N., Little, Milton T., Marecek, Geoffrey S., Dubuclet, Denice M., Scolaro, John A., Learned, James R., Lim, Philip K., Demas, Susan, Amirhekmat, Arya, and Dela Cruz, Yan Marco

Published
2022
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24. “Bring Your Own Device”—A New Approach to Wearable Outcome Assessment in Trauma

Author

Braun, Benedikt J., primary, Histing, Tina, additional, Menger, Maximilian M., additional, Platte, Julian, additional, Grimm, Bernd, additional, Hanflik, Andrew M., additional, Richter, Peter H., additional, Sivananthan, Sureshan, additional, Yarboro, Seth R., additional, Gueorguiev, Boyko, additional, Pokhvashchev, Dmitry, additional, and Marmor, Meir T., additional

Published
2023
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26. Out of hospital cardiac arrest - new insights and a call for a worldwide registry and guidelines

Author

Meir Tabi, Nimrod Perel, Louay Taha, Itshak Amsalem, Rafi Hitter, Tomer Maller, Mohamed Manassra, Mohammad Karmi, Netanel Zacks, Nir Levy, Maayan Shrem, David Marmor, David Gavriel, Amir Jarjoui, Mony Shuvy, Elad Asher, and For the Jerusalem Platelets Thrombosis and Intervention in Cardiology (JUPITER-9) Study Group

Subjects
Cardiac arrest, Acute coronary syndrome, Cardiac intensive care unit, Outcomes, Special situations and conditions, RC952-1245, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Introduction Out of hospital cardiac arrest (OHCA) is a major public health problem with substantial mortality rates worldwide. Genetic diseases and primary electrical disorders are the most common etiologies at younger ages, while ischemic heart disease and cardiomyopathies are common causes at older ages. Despite improvement in prevention and treatment in recent years, OHCA is still a major cause of cardiovascular death. Method We report prospective data regarding etiology, characteristics, clinical course, and outcomes of patients with OHCA who were admitted to a tertiary care center intensive cardiac care unit (ICCU) between 2020–2023. Results A total of 92 patients admitted after OHCA were included in the cohort. Mean age was 63.8 ± 13.8 years and 75 (82%) were males. The most common etiology of OHCA was acute coronary syndrome (ACS) in 54 (59%) patients, of whom 46 (85%) patients had ST elevation myocardial infarction and 8 (15%) had non-ST elevation myocardial infarction. During hospitalization, 42 (46%) patients underwent targeted temperature management and 13 (14%) received mechanical circulatory support. Interestingly, 77 (84%) patients underwent coronary angiography, while only 51 (55%) received percutaneous coronary intervention (PCI). Neurologic status was favorable in 49 (53%) patients with Cerebral Performance Category score of 1–2. Overall, mortality rates were relatively low, with 15 (16%) in-hospital deaths and 24 (26%) deaths at 30-day follow-up. Conclusion Although ACS was the most common etiology for OHCA, only 55% of patients underwent PCI. Most OHCA patients admitted to the ICCU survived hospitalization and were discharged. Increased awareness, public education, worldwide registries, and specific evidence-based guidelines for the treatment of OHCA patients may lead to improved outcomes for these patients who often carry poor prognoses.

Published
2024
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28. Aqueous skin antisepsis before surgical fixation of open fractures (Aqueous-PREP): a multiple-period, cluster-randomised, crossover trial

Author

Gerard P. Slobogean, Sheila Sprague, Jeffrey L. Wells, Mohit Bhandari, Anthony D. Harris, C. Daniel Mullins, Lehana Thabane, Amber Wood, Gregory J. Della Rocca, Joan N. Hebden, Kyle J. Jeray, Lucas S. Marchand, Lyndsay M. O'Hara, Robert D. Zura, Christopher Lee, Joseph T. Patterson, Michael J. Gardner, Jenna Blasman, Jonah Davies, Stephen Liang, Monica Taljaard, PJ Devereaux, Gordon Guyatt, Diane Heels-Ansdell, Debra Marvel, Jana E. Palmer, Jeff Friedrich, Nathan N. O'Hara, Frances Grissom, I. Leah Gitajn, Saam Morshed, Robert V. O'Toole, Bradley Petrisor, Franca Mossuto, Manjari G. Joshi, Jean-Claude G. D'Alleyrand, Justin Fowler, Jessica C. Rivera, Max Talbot, David Pogorzelski, Shannon Dodds, Silvia Li, Gina Del Fabbro, Olivia Paige Szasz, Sofia Bzovsky, Paula McKay, Alexandra Minea, Kevin Murphy, Andrea L. Howe, Haley K. Demyanovich, Wayne Hoskins, Michelle Medeiros, Genevieve Polk, Eric Kettering, Nirmen Mahal, Andrew Eglseder, Aaron Johnson, Christopher Langhammer, Christopher Lebrun, Jason Nascone, Raymond Pensy, Andrew Pollak, Marcus Sciadini, Yasmin Degani, Heather Phipps, Eric Hempen, Herman Johal, Bill Ristevski, Dale Williams, Matthew Denkers, Krishan Rajaratnam, Jamal Al-Asiri, Jodi L. Gallant, Kaitlyn Pusztai, Sarah MacRae, Sara Renaud, John D. Adams, Michael L. Beckish, Christopher C. Bray, Timothy R. Brown, Andrew W. Cross, Timothy Dew, Gregory K. Faucher, Richard W. Gurich Jr, David E. Lazarus, S. John Millon, M. Christian Moody, M. Jason Palmer, Scott E. Porter, Thomas M. Schaller, Michael S. Sridhar, John L. Sanders, L. Edwin Rudisill Jr, Michael J. Garitty, Andrew S. Poole, Michael L. Sims, Clark M. Walker, Robert Carlisle, Erin A. Hofer, Brandon Huggins, Michael Hunter, William Marshall, Shea B. Ray, Cory Smith, Kyle M. Altman, Erin R. Pichiotino, Julia C. Quirion, Markus F. Loeffler, Austin A. Cole, Ethan J. Maltz, Wesley Parker, T. Bennett Ramsey, Alex Burnikel, Michael Colello, Russell Stewart, Jeremy Wise, Matthew Anderson, Joshua Eskew, Benjamin Judkins, James M. Miller, Stephanie L. Tanner, Rebecca G. Snider, Christine E. Townsend, Kayla H. Pham, Abigail Martin, Emily Robertson, Emily Bray, J. Wilson Sykes, Krystina Yoder, Kelsey Conner, Harper Abbott, Roman M. Natoli, Todd O. McKinley, Walter W. Virkus, Anthony T. Sorkin, Jan P. Szatkowski, Brian H. Mullis, Yohan Jang, Luke A. Lopas, Lauren C. Hill, Courteney L. Fentz, Maricela M. Diaz, Krista Brown, Katelyn M. Garst, Emma W. Denari, Patrick Osborn, Sarah N. Pierrie, Bradley Kessler, Maria Herrera, Theodore Miclau, Meir T. Marmor, Amir Matityahu, R. Trigg McClellan, David Shearer, Paul Toogood, Anthony Ding, Jothi Murali, Ashraf El Naga, Jennifer Tangtiphaiboontana, Tigist Belaye, Eleni Berhaneselase, Dmitry Pokhvashchev, William T. Obremskey, Amir Alex Jahangir, Manish Sethi, Robert Boyce, Daniel J. Stinner, Phillip P. Mitchell, Karen Trochez, Elsa Rodriguez, Charles Pritchett, Natalie Hogan, A. Fidel Moreno, Jennifer E. Hagen, Matthew Patrick, Richard Vlasak, Thomas Krupko, Michael Talerico, Marybeth Horodyski, Marissa Pazik, Elizabeth Lossada-Soto, Joshua L. Gary, Stephen J. Warner, John W. Munz, Andrew M. Choo, Timothy S. Achor, Milton L. 'Chip' Routt, Michael Kutzler, Sterling Boutte, Ryan J. Warth, Michael J. Prayson, Indresh Venkatarayappa, Brandon Horne, Jennifer Jerele, Linda Clark, Christina Boulton, Jason Lowe, John T. Ruth, Brad Askam, Andrea Seach, Alejandro Cruz, Breanna Featherston, Robin Carlson, Iliana Romero, Isaac Zarif, Niloofar Dehghan, Michael McKee, Clifford B. Jones, Debra L. Sietsema, Alyse Williams, Tayler Dykes, Ernesto Guerra-Farfan, Jordi Tomas-Hernandez, Jordi Teixidor-Serra, Vicente Molero-Garcia, Jordi Selga-Marsa, Juan Antonio Porcel-Vazquez, Jose Vicente Andres-Peiro, Ignacio Esteban-Feliu, Nuria Vidal-Tarrason, Jordi Serracanta, Jorge Nuñez-Camarena, Maria del Mar Villar-Casares, Jaume Mestre-Torres, Pilar Lalueza-Broto, Felipe Moreira-Borim, Yaiza Garcia-Sanchez, Francesc Marcano-Fernández, Laia Martínez-Carreres, David Martí-Garín, Jorge Serrano-Sanz, Joel Sánchez-Fernández, Matsuyama Sanz-Molero, Alejandro Carballo, Xavier Pelfort, Francesc Acerboni-Flores, Anna Alavedra-Massana, Neus Anglada-Torres, Alexandre Berenguer, Jaume Cámara-Cabrera, Ariadna Caparros-García, Ferran Fillat-Gomà, Ruben Fuentes-López, Ramona Garcia-Rodriguez, Nuria Gimeno-Calavia, Marta Martínez-Álvarez, Patricia Martínez-Grau, Raúl Pellejero-García, Ona Ràfols-Perramon, Juan Manuel Peñalver, Mònica Salomó Domènech, Albert Soler-Cano, Aldo Velasco-Barrera, Christian Yela-Verdú, Mercedes Bueno-Ruiz, Estrella Sánchez-Palomino, Vito Andriola, Matilde Molina-Corbacho, Yeray Maldonado-Sotoca, Alfons Gasset-Teixidor, Jorge Blasco-Moreu, Núria Fernández-Poch, Josep Rodoreda-Puigdemasa, Arnau Verdaguer-Figuerola, Heber Enrique Cueva-Sevieri, Santiago Garcia-Gimenez, Darius G. Viskontas, Kelly L. Apostle, Dory S. Boyer, Farhad O. Moola, Bertrand H. Perey, Trevor B. Stone, H. Michael Lemke, Ella Spicer, Kyrsten Payne, Robert A. Hymes, Cary C. Schwartzbach, Jeff E. Schulman, A. Stephen Malekzadeh, Michael A. Holzman, Greg E. Gaski, Jonathan Wills, Holly Pilson, Eben A. Carroll, Jason J. Halvorson, Sharon Babcock, J. Brett Goodman, Martha B. Holden, Wendy Williams, Taylor Hill, Ariel Brotherton, Nicholas M. Romeo, Heather A. Vallier, Anna Vergon, Thomas F. Higgins, Justin M. Haller, David L. Rothberg, Zachary M. Olsen, Abby V. McGowan, Sophia Hill, Morgan K. Dauk, Patrick F. Bergin, George V. Russell, Matthew L. Graves, John Morellato, Sheketha L. McGee, Eldrin L. Bhanat, Ugur Yener, Rajinder Khanna, Priyanka Nehete, David Potter, Robert VanDemark III, Kyle Seabold, Nicholas Staudenmier, Marcus Coe, Kevin Dwyer, Devin S. Mullin, Theresa A. Chockbengboun, Peter A. DePalo Sr., Kevin Phelps, Michael Bosse, Madhav Karunakar, Laurence Kempton, Stephen Sims, Joseph Hsu, Rachel Seymour, Christine Churchill, Ada Mayfield, Juliette Sweeney, Todd Jaeblon, Robert Beer, Brent Bauer, Sean Meredith, Sneh Talwar, Christopher M. Domes, Mark J. Gage, Rachel M. Reilly, Ariana Paniagua, JaNell Dupree, Michael J. Weaver, Arvind G. von Keudell, Abigail E. Sagona, Samir Mehta, Derek Donegan, Annamarie Horan, Mary Dooley, Marilyn Heng, Mitchel B. Harris, David W. Lhowe, John G. Esposito, Ahmad Alnasser, Steven F. Shannon, Alesha N. Scott, Bobbi Clinch, Becky Weber, Michael J. Beltran, Michael T. Archdeacon, Henry Claude Sagi, John D. Wyrick, Theodore Toan Le, Richard T. Laughlin, Cameron G. Thomson, Kimberly Hasselfeld, Carol A. Lin, Mark S. Vrahas, Charles N. Moon, Milton T. Little, Geoffrey S. Marecek, Denice M. Dubuclet, John A. Scolaro, James R. Learned, Philip K. Lim, Susan Demas, Arya Amirhekmat, and Yan Marco Dela Cruz

Subjects
Adult, Male, Canada, Cross-Over Studies, Chlorhexidine, General Medicine, Antisepsis, Middle Aged, Fractures, Open, Anti-Infective Agents, Local, Humans, Surgical Wound Infection, Female, Povidone-Iodine
Abstract

Chlorhexidine skin antisepsis is frequently recommended for most surgical procedures; however, it is unclear if these recommendations should apply to surgery involving traumatic contaminated wounds where povidone-iodine has previously been preferred. We aimed to compare the effect of aqueous 10% povidone-iodine versus aqueous 4% chlorhexidine gluconate on the risk of surgical site infection in patients who required surgery for an open fracture.We conducted a multiple-period, cluster-randomised, crossover trial (Aqueous-PREP) at 14 hospitals in Canada, Spain, and the USA. Eligible patients were adults aged 18 years or older with an open extremity fracture treated with a surgical fixation implant. For inclusion, the open fracture required formal surgical debridement within 72 h of the injury. Participating sites were randomly assigned (1:1) to use either aqueous 10% povidone-iodine or aqueous 4% chlorhexidine gluconate immediately before surgical incision; sites then alternated between the study interventions every 2 months. Participants, health-care providers, and study personnel were aware of the treatment assignment due to the colour of the solutions. The outcome adjudicators and data analysts were masked to treatment allocation. The primary outcome was surgical site infection, guided by the 2017 US Centers for Disease Control and Prevention National Healthcare Safety Network reporting criteria, which included superficial incisional infection within 30 days or deep incisional or organ space infection within 90 days of surgery. The primary analyses followed the intention-to-treat principle and included all participants in the groups to which they were randomly assigned. This study is registered with ClinicalTrials.gov, NCT03385304.Between April 8, 2018, and June 8, 2021, 3619 patients were assessed for eligibility and 1683 were enrolled and randomly assigned to povidone-iodine (n=847) or chlorhexidine gluconate (n=836). The trial's adjudication committee determined that 45 participants were ineligible, leaving 1638 participants in the primary analysis, with 828 in the povidone-iodine group and 810 in the chlorhexidine gluconate group (mean age 44·9 years [SD 18·0]; 629 [38%] were female and 1009 [62%] were male). Among 1571 participants in whom the primary outcome was known, a surgical site infection occurred in 59 (7%) of 787 participants in the povidone-iodine group and 58 (7%) of 784 in the chlorhexidine gluconate group (odds ratio 1·11, 95% CI 0·74 to 1·65; p=0·61; risk difference 0·6%, 95% CI -1·4 to 3·4).For patients who require surgical fixation of an open fracture, either aqueous 10% povidone-iodine or aqueous 4% chlorhexidine gluconate can be selected for skin antisepsis on the basis of solution availability, patient contraindications, or product cost. These findings might also have implications for antisepsis of other traumatic wounds.US Department of Defense, Canadian Institutes of Health Research, McMaster University Surgical Associates, PSI Foundation.

Published
2022

30. Use of Wearable Technology to Measure Activity in Orthopaedic Trauma Patients: A Systematic Review

Author

Meir T. Marmor, Bernd Grimm, Andrew M. Hanflik, Peter H. Richter, Sureshan Sivananthan, Seth Robert Yarboro, and Benedikt J. Braun

Subjects
Orthopedics and Sports Medicine, Review Article
Abstract

BACKGROUND: Patient-Reported Outcome Measures (PROMs) are widely used for measurement of functional outcomes after orthopaedic trauma. However, PROMs rely on patient collaboration and suffer from various types of bias. Wearable Activity Monitors (WAMs) are increasingly used to objectify functional assessment. The objectives of this systematic review were to identify and characterise the WAMs technology and metrics currently used for orthopaedic trauma research. METHODS: PubMed and Embase biomedical literature search engines were queried. Eligibility criteria included: Human clinical studies published in the English language between 2010 and 2019 involving fracture management and WAMs. Variables collected from each article included: Technology used, vendor/product, WAM body location, metrics measured, measurement time period, year of publication, study geographic location, phase of treatment studied, fractures studied, number of patients studied, sex and age of the study subjects, and study level of evidence. Six investigators reviewed the resulting papers. Descriptive statistics of variables of interest were used to analyse the data. RESULTS: One hundred and thirty-six papers were available for analysis, showing an increasing trend of publications per year. Accelerometry followed by plantar pressure insoles were the most commonly employed technologies. The most common location for WAM placement was insoles, followed by the waist. The most commonly studied fracture type was hip fractures followed by fragility fractures in general, ankle, "lower extremity", and tibial fractures. The rehabilitation phase following surgery was the most commonly studied period. Sleep duration, activity time or step counts were the most commonly reported WAM metrics. A preferred, clinically validated WAM metric was not identified. CONCLUSIONS: WAMs have an increasing presence in the orthopaedic trauma literature. The optimal implementation of this technology and its use to understand patients' pre-injury and post-injury functions is currently insufficiently explored and represents an area that will benefit from future study. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO ID:210344. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s43465-022-00629-0.

Published
2022

31. Wearable technology in orthopedic trauma surgery - An AO trauma survey and review of current and future applications

Author

Benedikt J Braun, Bernd Grimm, Andrew M Hanflik, Peter H. Richter, Sureshan Sivananthan, Seth Robert Yarboro, and Meir T. Marmor

Subjects
Wearable Electronic Devices, Cross-Sectional Studies, Surveys and Questionnaires, Accelerometry, General Earth and Planetary Sciences, Humans, General Environmental Science, Monitoring, Physiologic
Abstract

The use of wearable sensors to track activity is increasing. Therefore, a survey among AO Trauma members was conducted to provide an overview of their current utilization and determine future needs and directions. A cross sectional expert opinion survey was administered to members of AO Trauma. Respondents were surveyed concerning their experience, subspeciality, current use characteristics, as well as future needs concerning wearable technology. Three hundred and thirty-three survey sets were available for analysis (Response Rate 16.2%). 20.7% of respondents already use wearable technology as part of their clinical treatment. The most prevalent technology was accelerometry combined with smartphones (75.4%) to measure general patient activity. To facilitate the use of wearable technology in the future, the most pressing issues were cost, patient compliance and validity of results. Wearable activity monitors are currently being used in trauma surgery. Surgeons employing these technologies mostly measure simple activity or activity associated parameters. Cost was the greatest perceived barrier to implementation. Further research, especially concerning the interpretation of the outcome values obtained, is required to facilitate wearable activity monitoring as an objective patient outcome measurement tool.

Published
2022

32. Accelerated surgery versus standard care in hip fracture (HIP ATTACK-1) : a kidney substudy of a randomized clinical trial

Author

Flavia K. Borges, P.J. Devereaux, Meaghan Cuerden, Jessica M. Sontrop, Mohit Bhandari, Ernesto Guerra-Farfán, Ameen Patel, Alben Sigamani, Masood Umer, John Neary, Maria Tiboni, Vikas Tandon, Mmampapatla Thomas Ramokgopa, Parag Sancheti, Abdel-Rahman Lawendy, Mariano Balaguer-Castro, Richard Jenkinson, Paweł Ślęczka, Aamer Nabi Nur, Gavin C.A. Wood, Robert J. Feibel, John Stephen McMahon, Bruce M. Biccard, Alessandro Ortalda, Wojciech Szczeklik, Chew Yin Wang, Jordi Tomás-Hernández, Jessica Vincent, Valerie Harvey, Shirley Pettit, Kumar Balasubramanian, Gerard Slobogean, Amit X. Garg, Laurent Veevaete, Bernard le Polain de Waroux, Patricia Lavand'homme, Olivier Cornu, Karim Tribak, Jean C. Yombi, Nassim Touil, Jigme T. Bhutia, Carol Clinckaert, Dirk De Clippeleir, Maike Reu, Leslie P. Gauthier, Victoria RA. Avram, Mitchell Winemaker, Daniel M. Tushinski, Justin de Beer, Andrew Worster, Diane L. Simpson, Kim A. Alvarado, Krysten K. Gregus, Kelly H. Lawrence, Darryl P. Leong, Philip G. Joseph, Patrick Magloire, Benjamin Deheshi, Stuart Bisland, Thomas J. Wood, David AJ. Wilson, Sandra N. Ofori, Jessica Spence, Emmanuelle Duceppe, Maria E. Tiboni, John D. Neary, Anthony Adili, David D. Cowan, Vickas Khanna, Amna Zaki, Janet C. Farrell, Anne Marie MacDonald, David Conen, Steven CW. Wong, Arsha Karbassi, Douglas S. Wright, Harsha Shanthanna, Javier Ganame, Andrew Cheung, Ryan Coughlin, Moin Khan, Spencer Wikkerink, Faraaz A. Quraishi, Waleed Kishta, Emil Schemitsch, Timothy Carey, Mark D. Macleod, David W. Sanders, Edward Vasarhelyi, Debra Bartley, George K. Dresser, Christina Tieszer, Richard J. Jenkinson, Steven Shadowitz, Jacques S. Lee, Stephen Choi, Hans J. Kreder, Markku Nousiainen, Monica R. Kunz, Ravianne Tuazon, Mopina Shrikumar, Bheeshma Ravi, David Wasserstein, David J.G. Stephen, Diane Nam, Patrick D.G. Henry, Gavin CA. Wood, Stephen M. Mann, Melanie T. Jaeger, Marco LA. Sivilotti, Christopher A. Smith, Christopher C. Frank, Heather Grant, Leone Ploeg, Jeff D. Yach, Mark M. Harrison, Aaron R. Campbell, Ryan T. Bicknell, Davide D. Bardana, Katie McIlquham, Catherine Gallant, Samantha Halman, Venkatesh Thiruganasambandamoorth, Sara Ruggiero, William J. Hadden, Brian PJ. Chen, Stephanie A. Coupal, Stephen J. McMahon, Lisa M. McLean, Hemant R. Shirali, Syed Y. Haider, Crystal A. Smith, Evan Watts, David J. Santone, Kevin Koo, Allan J. Yee, Ademilola N. Oyenubi, Aaron Nauth, Emil H. Schemitsch, Timothy R. Daniels, Sarah E. Ward, Jeremy A. Hall, Henry Ahn, Daniel B. Whelan, Amit Atrey, Amir Khoshbin, David Puskas, Kurt Droll, Claude Cullinan, Jubin Payendeh, Tina Lefrancois, Lise Mozzon, Travis Marion, Michael J. Jacka, James Greene, Matthew Menon, Robert Stiegelmahr, Derek Dillane, Marleen Irwin, Lauren Beaupre, Chad P. Coles, Kelly Trask, Shelley MacDonald, J.A.I. Trenholm, William Oxner, C.G. Richardson, Niloofar Dehghan, Mehdi Sadoughi, Achal Sharma, Neil J. White, Loretta Olivieri, Stephen B. Hunt, Thomas R. Turgeon, Eric R. Bohm, Sarah Tran, Stephen M. Giilck, Tom Hupel, Pierre Guy, Peter J. O'Brien, Andrew W. Duncan, Gordon A. Crawford, Junlin Zhou, Yanrui Zhao, Yang Liu, Lei Shan, Anshi Wu, Juan M. Muñoz, Philippe Chaudier, Marion Douplat, Michel Henri Fessy, Vincent Piriou, Lucie Louboutin, Jean Stephane David, Arnaud Friggeri, Anthony Viste, Charles Hervé Vacheron, Frankie Ka Li Leung, Christian Xinshuo Fang, Dennis King Hang Yee, Parag K. Sancheti, Chetan V. Pradhan, Atul A. Patil, Chetan P. Puram, Madhav P. Borate, Kiran B. Kudrimoti, Bharati A. Adhye, Himanshu V. Dongre, Bobby John, Valsamma Abraham, Ritesh A. Pandey, Arti Rajkumar, Preetha E. George, Manesh Stephen, Nitheesh Chandran, Mohammed Ashraf, A.M. Georgekutty, Ahamad S. Sulthan, S. Adinarayanan, Deep Sharma, Satish P. Barnawal, Srinivasan Swaminathan, Prasanna U. Bidkar, Sandeep K. Mishra, Jagdish Menon, M. Niranjan, Z.K. Varghese, Santosh A. Hiremath, N.C. Madhusudhan, Abhijit Jawali, Kingsly R. Gnanadurai, Carolin E. George, Tatarao Maddipati, K.P. Mary, Vijay Sharma, Kamran Farooque, Rajesh Malhotra, Samarth Mittal, Chavi Sawhney, Babita Gupta, Purva Mathur, Shivanand Gamangati, Vijaylaxmi Tripathy, Prem H. Menon, Mandeep S. Dhillon, Devendra K. Chouhan, Sharanu Patil, Ravi Narayan, Purushotham Lal, Prashanth N. Bilchod, Surya U. Singh, Uttam V. Gattu, Ravi P. Dashputra, Prashant V. Rahate, Maurizio Turiel, Riccardo Accetta, Paolo Perazzo, Daniele Stella, Marika Bonadies, Chiara Colombo, Giuseppe De Blasio, Stefania Fozzato, Fabio Pino, Ilaria Morelli, Francesco De Donato, Eleonora Colnaghi, Vincenzo Salini, Giacomo Placella, Giuseppe Giardina, Gaetano Lombardi, Anna Marcato, Luca Guzzetti, Ilaria Rivetti, Massimiliano Greco, H.M. Khor, Hou Yee Lai, C.S. Kumar, K.H. Chee, P.S. Loh, Kit Mun Tan, Simmrat Singh, Li Lian Foo, Komella Prakasam, Sook Hui Chaw, Meng-Li Lee, Joanne HL. Ngim, Huck Wee Boon, Im Im Chin, Ydo V. Kleinlugtenbelt, Ellie BM. Landman, Elvira R. Flikweert, Herbert W. Roerdink, Roy BG. Brokelman, Hannie F. Elskamp-Meijerman, Bas Staffhorst, Jan-Hein MG. Cobben, Dilshad Begum, Anila Anjum, Pervaiz M. Hashmi, Tashfeen Ahmed, Haroon U. Rashid, Mujahid J. Khattak, Rizwan H. Rashid, Riaz H. Lakdawala, Shahryar Noordin, Naveed M. Juman, Robyna I. Khan, Muhammad M. Riaz, Syedah S. Bokhari, Ayesha Almas, Hussain Wahab, Arif Ali, Hammad N. Khan, Eraj K. Khan, Kholood A. Janjua, Sajjad H. Orakzai, Abdus S. Khan, Khawaja J. Mustafa, Mian A. Sohail, Muhammad Umar, Siddra A. Khan, Muhammad Ashraf, Muhammad K. Khan, Muhammad Shiraz, Ahmad Furgan, Piotr Dąbek, Adam Kumoń, Wojciech Satora, Wojciech Ambroży, Mariusz Święch, Jacek Rycombel, Adrian Grzelak, Ilona Nowak-Kózka, Jaroslaw Gucwa, Waldemar Machala, Mmampapatla T. Ramokgopa, Gregory B. Firth, Mwalimu Karera, Maria Fourtounas, Virsen Singh, Anna Biscardi, Muhammad N. Iqbal, Ryan J. Campbell, Matimba L. Maluleke, Carien Moller, Lerato Nhlapo, Sithombo Maqungo, Margot Flint, Marcin B. Nejthardt, Sean Chetty, Stephen Venter, Ernesto Guerra-Farfan, Jordi Tomas-Hernandez, Yaiza Garcia-Sanchez, Miriam Garrido Clua, Vicente Molero-Garcia, Jordi Teixidor-Serra, Maria del Mar Villar-Casares, Jordi Selga Marsa, Juan A. Porcel-Vazquez, Jose-Vicente Andres- Peiro, Jaume Mestre-Torres, Patricia Guilabert, M Luisa Paños Gozalo, Luis Abarca, Nuria Martin, Gemma Usua, Pilar Lalueza-Broto, Judith Sanchez-Raya, Jorge Nuñez Camarena, Antoni Fraguas-Castany, Carlos Piedra Calle, Diego Soza Leiva, Maria Garcia Carrasco, Montsant Jornet-Gibert, Montserrat Monfort-Mira, Alfons Gasset-Teixidor, Francesc Antoni Marcano-Fernández, Isabel Simó- Sánchez, Begoña Mari-Alfonso, Christian Yela-Verdú, Raúl Pellejero-García, Júlia Casas-Codina, Ruben Iglesias- Sanjuan, Pau Balcells-Nolla, Oriol Vila-Sánchez, Mercè Bertrana de Bustos, Pablo Castillón, Martí Bernaus, Saioa Quintas, Olga Gómez, Jordi Salvador, Javier Abarca, Cristina Estrada, Marga Novellas, Francesc Anglès, Alfred Dealbert, Oscar Macho, Alexia Ivanov, Esther Valldosera, Marta Arroyo, Borja Pey, Antoni Yuste, Llorenç Mateo, Julio De Caso, Rafael Anaya, J.L. Higa-Sansone, Angelica Millan, Victoria Baños, Sergio Herrera-Mateo, Hector J. Aguado, Virginia García-Virto, Clarisa Simón-Pérez, Sergio Chavez, María Bragado, María Plata, Enrique Guerado, Encarnacion Cruz, Juan R. Cano, Jose M. Bogallo, Paphon Sa-ngasoongsong, Noratep Kulachote, Norachart Sirisreetreerux, Nachapan Pengrung, Theerawat Chalacheewa, Vanlapa Arnuntasupakul, Teerapat Yingchoncharoen, Bundit Naratreekoon, Miriam A. Kadry, Surendini Thayaparan, Victor Babu, Arash Aframian, Souad Bentoumi, Amrinder Sayan, Ihab Abdlaziz, Marcela P. Vizcaychipi, Patricia Correia, Shashank Patil, Kevin Haire, Amy SE. Mayor, Sally Dillingham, Laura Nicholson, Ben T. Brooke, Joby John, Shashi K. Nanjayan, Martyn J. Parker, Susan O'Sullivan, Meir T. Marmor, Amir Matityahu, Robert T. McClellan, Curt Comstock, Anthony Ding, Paul Toogood, Robert O’Toole, Marcus Sciadini, Jason Nascone, Nathan O’Hara, Scott P. Ryan, Molly E. Clark, Charles Cassidy, Konstantin Balonov, Tristan Weaver, Laura S. Phieffer, Sergio D. Bergese, Andrew J. Marcantonio, Shrikant I. Bangdiwala, Michael H. McGillion, Sanela Dragic-Taylor, Chelsea Maxwell, Sarah Molnar, Jennifer R. Wells, Patrice Forget, Paul Landais, Giovanni Landoni, Ekaterine Popova, Iain K. Moppett, Robin Roberts, null Chairperson, Finlay McAlister, David Sackett, James Wright, UCL - SSS/IONS/CEMO - Pôle Cellulaire et moléculaire, UCL - SSS/IREC/NMSK - Neuro-musculo-skeletal Lab, UCL - SSS/IREC/SLUC - Pôle St.-Luc, UCL - (SLuc) Service d'anesthésiologie, UCL - (SLuc) Service d'orthopédie et de traumatologie de l'appareil locomoteur, and UCL - (SLuc) Service de médecine interne générale

Subjects
Hip Fractures, Nephrology, Humans, Pelvic Bones, Kidney
Abstract

To the Editor: Acute kidney injury (AKI) is a lesser-known complication of hip fracture that may come about owing to decreased kidney perfusion and heightened inflammation from trauma, pain, bleeding, and fasting. Approximately 15%-20% of patients undergoing surgery for a hip fracture develop AKI, with 0.5%-1.8% receiving dialysis. [...]

Published
2022

37. Comparison of the Neer classification to the 2018 update of the Orthopedic Trauma Association/AO fracture classification for classifying proximal humerus fractures

Author

Meir T. Marmor, Julie Agel, Jarrod Dumpe, James F. Kellam, Geoffrey S. Marecek, Eric Meinberg, Mai P. Nguyen, Stephen Sims, Gillian L. Soles, and Matthew D. Karam

Subjects
General Medicine
Abstract

The classification of fractures is necessary to ensure a reliable means of communication for clinical interaction, education and research. The Neer classification is the most commonly used classification for proximal humerus fractures. In 2018 the Orthopedic Trauma Association (OTA) and the AO Foundation provided an update to the OTA/AO Fracture Classification Scheme addressing many of the concerns about the previous versions of the classification. The objective of the present study was to evaluate the rater reliability of the 2 classifications and if the classifications subjectively better characterized the fracture patterns.X-rays and CT scans of 24 proximal humerus fractures were given to 7 independent raters for classification according to the Neer and 2018 OTA/AO classification. Both full-forms and short-forms of the classifications were tested. The Fleiss Kappa statistic was used to assess inter-rater agreement and intra-rater consistency for the 2 classifications. For each case the raters subjectively commented on how well each classification was able to characterize the fracture pattern.All raters graded the 2018 OTA/AO classification as good as or better than the Neer classification for an adequate description of the fracture patterns. The short-form 2018 OTA/AO classification had the most 4 rater and 5 rater agreement cases and the second most 6 rater agreement cases. The short-form Neer classification had the second most 4 rater and 5 rater agreement cases and the most 6 rater agreement cases. The full 2018 OTA/AO had the least 4, 5, or 6 rater agreement cases of all the classification systems. Inter-rater agreement was fair for the full and short form of both the Neer and 2018 OTA/AO classification. The full and short Neer classifications together with the short 2018 OTA/AO classification had moderate intra-rater consistency, while the full 2018 OTA/AO classification only had slight intra-rater consistency.The 2018 OTA/AO classification is equivalent in its short-form to the Neer classification in inter-rater reliability and intra-rater consistency; and is superior in its full form for characterizing specific fracture types. The low inter-rater reliability of the full 2018 OTA/AO classification is a concern that may need to be addressed in the future.

Published
2021

39. Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an international, randomised, controlled trial

Author

Flavia K Borges, Mohit Bhandari, Ernesto Guerra-Farfan, Ameen Patel, Alben Sigamani, Masood Umer, Maria E Tiboni, Maria del Mar Villar-Casares, Vikas Tandon, Jordi Tomas-Hernandez, Jordi Teixidor-Serra, Victoria RA Avram, Mitchell Winemaker, Mmampapatla T Ramokgopa, Wojciech Szczeklik, Giovanni Landoni, Chew Yin Wang, Dilshad Begum, John D Neary, Anthony Adili, Parag K Sancheti, Abdel-Rahman Lawendy, Mariano Balaguer-Castro, Paweł Ślęczka, Richard J Jenkinson, Aamer Nabi Nur, Gavin CA Wood, Robert J Feibel, Stephen J McMahon, Alen Sigamani, Ekaterine Popova, Bruce M Biccard, Iain K Moppett, Patrice Forget, Paul Landais, Michael H McGillion, Jessica Vincent, Kumar Balasubramanian, Valerie Harvey, Yaiza Garcia-Sanchez, Shirley M Pettit, Leslie P Gauthier, Gordon H Guyatt, David Conen, Amit X Garg, Shrikant I Bangdiwala, Emilie P Belley-Cote, Maura Marcucci, Andre Lamy, Richard Whitlock, Yannick Le Manach, Dean A Fergusson, Salim Yusuf, PJ Devereaux, Laurent Veevaete, Bernard le Polain de Waroux, Patricia Lavand'homme, Olivier Cornu, Karim Tribak, Jean Cyr Yombi, Nassim Touil, Maike Reul, Jigme Tshering Bhutia, Carol Clinckaert, Dirk De Clippeleir, Justin de Beer, Diane L Simpson, Andrew Worster, Kim A Alvarado, Krysten K Gregus, Kelly H Lawrence, Darryl P Leong, Philip G Joseph, Patrick Magloire, Benjamin Deheshi, Stuart Bisland, Thomas J Wood, Daniel M Tushinski, David AJ Wilson, Clive Kearon, David D Cowan, Vickas Khanna, Amna Zaki, Janet C Farrell, Anne Marie MacDonald, Steven CW Wong, Arsha Karbassi, Douglas Steven Wright, Harsha Shanthanna, Ryan Coughlin, Moin Khan, Spencer Wikkerink, Faraaz A Quraishi, Waleed Kishta, Emil Schemitsch, Timothy Carey, Mark D Macleod, David W Sanders, Edward Vasarhelyi, Debra Bartley, George K Dresser, Christina Tieszer, Steven Shadowitz, Jacques S Lee, Stephen Choi, Hans J Kreder, Markku Nousiainen, Monica R Kunz, Ravianne Tuazon, Mopina Shrikumar, Bheeshma Ravi, David Wasserstein, David JG Stephen, Diane Nam, Patrick DG Henry, Stephen M Mann, Melanie T Jaeger, Marco LA Sivilotti, Christopher A Smith, Christopher C Frank, Heather Grant, Leone Ploeg, Jeff D Yach, Mark M Harrison, Aaron R Campbell, Ryan T Bicknell, Davide D Bardana, Katie McIlquham, Catherine Gallant, Samantha Halman, Venkatesh Thiruganasambandamoorth, Sara Ruggiero, William J Hadden, Brian P-J Chen, Stephanie A Coupal, Lisa M McLean, Hemant R Shirali, Syed Y Haider, Crystal A Smith, Evan Watts, David J Santone, Kevin Koo, Allan J Yee, Ademilola N Oyenubi, Aaron Nauth, Emil H Schemitsch, Timothy R Daniels, Sarah E Ward, Jeremy A Hall, Henry Ahn, Daniel B Whelan, Amit Atrey, Amir Khoshbin, David Puskas, Kurt Droll, Claude Cullinan, Jubin Payendeh, Tina Lefrancois, Lise Mozzon, Travis Marion, Michael J Jacka, James Greene, Matthew Menon, Robert Stiegelmahr, Derek Dillane, Marleen Irwin, Lauren Beaupre, Chad P Coles, Kelly Trask, Shelley MacDonald, J Andrew I Trenholm, William Oxner, C Glen Richardson, Niloofar Dehghan, Mehdi Sadoughi, Achal Sharma, Neil J White, Loretta Olivieri, Stephen B Hunt, Thomas R Turgeon, Eric R Bohm, Sarah Tran, Stephen M Giilck, Tom Hupel, Pierre Guy, Peter J O'Brien, Andrew W Duncan, Gordon A Crawford, Junlin Zhou, Yanrui Zhao, Yang Liu, Lei Shan, Anshi Wu, Juan Manuel Muñoz, Philippe Chaudier, Marion Douplat, Michel Henri Fessy, Vincent Piriou, Lucie Louboutin, Jean Stephane David, Arnaud Friggeri, Sebastien Beroud, Jean Marie Fayet, Frankie Ka Li Leung, Christian Xinshuo Fang, Dennis King Hang Yee, Parag Kantilal Sancheti, Chetan Vijay Pradhan, Atul Ashok Patil, Chetan Prabhakar Puram, Madhav Pandurang Borate, Kiran Bhalchandra Kudrimoti, Bharati Anil Adhye, Himanshu Vijaykumar Dongre, Bobby John, Valsamma Abraham, Ritesh Arvind Pandey, Arti Rajkumar, Preetha Elizabeth George, Manesh Stephen, Nitheesh Chandran, Mohammed Ashraf, AM Georgekutty, Ahamad Shaheel Sulthan, S Adinarayanan, Deep Sharma, Satish Prasad Barnawal, Srinivasan Swaminathan, Prasanna Udupi Bidkar, Sandeep Kumar Mishra, Jagdish Menon, Niranjan M, Varghese Zachariah K, Santosh Angad Hiremath, Madhusudhan NC, Abhijit Jawali, Kingsly Robert Gnanadurai, Carolin Elizabeth George, Tatarao Maddipati, Mary KP KP, Vijay Sharma, Kamran Farooque, Rajesh Malhotra, Samarth Mittal, Chavi Sawhney, Babita Gupta, Purva Mathur, Shivanand Gamangati, Vijaylaxmi Tripathy, Prem Haridas Menon, Mandeep S Dhillon, Devendra K Chouhan, Sharanu Patil, Ravi Narayan, Purushotham Lal, Prashanth Nabhirajappa Bilchod, Surya Udai Singh, Uttam Vaidya Gattu, Ravi Prabhakar Dashputra, Prashant Vitthal Rahate, Maurizio Turiel, Giuseppe De Blasio, Riccardo Accetta, Paolo Perazzo, Daniele Stella, Marika Bonadies, Chiara Colombo, Stefania Fozzato, Fabio Pino, Ilaria Morelli, Eleonora Colnaghi, Vincenzo Salini, Giuseppe Denaro, Luigi Beretta, Giacomo Placella, Giuseppe Giardina, Mirko Binda, Anna Marcato, Luca Guzzetti, Fabio Piccirillo, Maurizio Cecconi, HM Khor, Hou Yee Lai, CS Kumar, KH Chee, PS Loh, Kit Mun Tan, Simmrat Singh, Li Lian Foo, Komella Prakasam, Sook Hui Chaw, Meng-Li Lee, Joanne HL Ngim, Huck Wee Boon, Im Im Chin, Ydo V Kleinlugtenbelt, Ellie BM Landman, Elvira R Flikweert, Herbert W Roerdink, Roy B.G. Brokelman, Hannie F Elskamp-Meijerman, Maarten R Horst, Jan-Hein MG Cobben, Anila Anjum, Pervaiz Mehmood Hashmi, Tashfeen Ahmed, Haroon Ur Rashid, Mujahid Jamil Khattak, Rizwan Haroon Rashid, Riaz Hussain Lakdawala, Shahryar Noordin, Naveed Muhammed Juman, Robyna Irshad Khan, Muhammad Mehmood Riaz, Syedah Saira Bokhari, Ayesha Almas, Hussain Wahab, Arif Ali, Hammad Naqi Khan, Eraj Khurshid Khan, Kholood Abid Janjua, Sajjad Hassan Orakzai, Abdus Salam Khan, Khawaja Junaid Mustafa, Mian Amjad Sohail, Muhammad Umar, Siddra Ahmed Khan, Muhammad Ashraf, Muhammad Kashif Khan, Muhammad Shiraz, Ahmad Furgan, Piotr Dąbek, Adam Kumoń, Wojciech Satora, Wojciech Ambroży, Mariusz Święch, Jacek Rycombel, Adrian Grzelak, Jaroslaw Gucwa, Waldemar Machala, Mmampapatla Thomas Ramokgopa, Gregory Bodley Firth, Mwalimu Karera, Maria Fourtounas, Virsen Singh, Anna Biscardi, Muhammad Nasir Iqbal, Ryan Jonathan Campbell, Matimba Lenny Maluleke, Carien Moller, Lerato Nhlapo, Sithombo Maqungo, Margot Flint, Marcin B Nejthardt, Sean Chetty, Rubendren Naidoo, Miriam Garrido Clua, Vicente Molero-Garcia, Joan Minguell-Monyart, Jordi Selga Marsa, Juan A Porcel-Vazquez, Jose-Vicente Andres-Peiro, Marc Aguilar, Jaume Mestre-Torres, Maria J Colomina, Patricia Guilabert, M Luisa Paños Gozalo, Luis Abarca, Nuria Martin, Gemma Usua, Pedro Martinez-Ripol, MA Gonzalez Posada, Pilar Lalueza-Broto, Judith Sanchez-Raya, Jorge Nuñez Camarena, Antoni Fraguas-Castany, Pere Torner, Monsant Jornet-Gibert, Jorge Serrano-Sanz, Jaume Cámara-Cabrera, Mònica Salomó-Domènech, Christian Yela-Verdú, Anna Peig-Font, Laura Ricol, Anna Carreras-Castañer, Luis Martínez-Sañudo, Susana Herranz, Carlos Feijoo-Massó, Mònica Sianes-Gallén, Pablo Castillón, Martí Bernaus, Saioa Quintas, Olga Gómez, Jordi Salvador, Javiera Abarca, Cristina Estrada, Marga Novellas, Mercè Torra, Alfred Dealbert, Oscar Macho, Alexia Ivanov, Esther Valldosera, Marta Arroyo, Borja Pey, Antoni Yuste, Llorenç Mateo, Julio De Caso, Rafael Anaya, JL Higa-Sansone, Angelica Millan, Victoria Baños, Sergio Herrera-Mateo, Hector J Aguado, Gonzalo Martinez-Municio, Ricardo León, Silvia Santiago-Maniega, Ana Zabalza, Gregorio Labrador, Enrique Guerado, Encarnacion Cruz, Juan Ramon Cano, Jose Manuel Bogallo, Paphon Sa-ngasoongsong, Noratep Kulachote, Norachart Sirisreetreerux, Nachapan Pengrung, Theerawat Chalacheewa, Vanlapa Arnuntasupakul, Teerapat Yingchoncharoen, Bundit Naratreekoon, Miriam Adel Kadry, Surendini Thayaparan, Ihab Abdlaziz, Arash Aframian, Arjuna Imbuldeniya, Souad Bentoumi, Sherif Omran, Marcela Paola Vizcaychipi, Patricia Correia, Shashank Patil, Kevin Haire, Amy SE Mayor, Sally Dillingham, Laura Nicholson, Mohamed Elnaggar, Joby John, Shashi Kumar Nanjayan, Martyn J Parker, Susan O'Sullivan, Meir T Marmor, Amir Matityahu, Robert Trigg McClellan, Curt Comstock, Anthony Ding, Paul Toogood, Gerard Slobogean, Katherine Joseph, Robert O'Toole, Marcus Sciadini, Scott P Ryan, Molly E Clark, Charles Cassidy, Konstantin Balonov, Sergio D Bergese, Laura S Phieffer, Alicia A Gonzalez Zacarias, Andrew J Marcantonio, Sanela Dragic-Taylor, Chelsea Maxwell, Sarah Molnar, Jennifer R Wells, Sandra N Ofori, Stephen S Yang, Michael K Wang, Emmanuelle Duceppe, Jessica Spence, Javiera P Vasquez, Francesc Marcano-Fernández, Hyungjoo Ham, Carlos Prada, Terence CH Yung, Isidro Sanz Pérez, Michael J Bosch, Michael R Prystajecky, Chinmoy Chowdhury, James S Khan, Steffan F Stella, Behrouz Heidary, Allen Tran, Katarzyna Wawrzycka-Adamczyk, Yu Chiao Peter Chen, Aránzazu González-Osuna, Grzegorz Biedroń, Anna Wludarczyk, Marco Lefebvre, Jaclyn A Ernst, Bas Staffhorst, Jason D Woodfine, Emad M Alwafi, Marko Mrkobrada, Simon Parlow, Robin Roberts, Finlay McAlister, David Sackett, James Wright, (HIP ATTACK, Investigators), Landoni, G., Faculty of Medicine and Pharmacy, Orthopaedics - Traumatology, Supporting clinical sciences, Emergency Medicine, UCL - SSS/IONS - Institute of NeuroScience, UCL - SSS/IONS/CEMO - Pôle Cellulaire et moléculaire, UCL - SSS/IREC/NMSK - Neuro-musculo-skeletal Lab, UCL - SSS/IREC/SLUC - Pôle St.-Luc, UCL - (SLuc) Service d'anesthésiologie, UCL - (SLuc) Service d'orthopédie et de traumatologie de l'appareil locomoteur, and UCL - (SLuc) Service de médecine interne générale

Subjects
Postoperative Complications/epidemiology, Male, Internationality, Femoral Neck Fractures/epidemiology, Arthroplasty, Replacement, Hip, Myocardial Ischemia, Comorbidity, Time-to-Treatment/statistics & numerical data, 030204 cardiovascular system & hematology, law.invention, Fracture Fixation, Internal, Postoperative Complications, 0302 clinical medicine, Randomized controlled trial, Residence Characteristics, law, Activities of Daily Living, Fracture fixation, Risk of mortality, Medicine and Health Sciences, Fracture Fixation, Internal/methods, Sepsis/epidemiology, 030212 general & internal medicine, Cardiovascular Diseases/mortality, Stroke, Aged, 80 and over, Hip fracture, Residence Characteristics/statistics & numerical data, Infections/epidemiology, General Medicine, Middle Aged, Open Fracture Reduction, Treatment Outcome, Cardiovascular Diseases, Diabetes Mellitus/epidemiology, Female, medicine.medical_specialty, Hip Fractures/epidemiology, Postoperative Hemorrhage, Infections, Early Medical Intervention/methods, Time-to-Treatment, 03 medical and health sciences, Arthroplasty, Replacement, Hip/methods, Early Medical Intervention, Sepsis, Diabetes Mellitus, medicine, Humans, Mortality, Myocardial Ischemia/epidemiology, Aged, Proportional Hazards Models, Postoperative Hemorrhage/epidemiology, Hip Fractures, Proportional hazards model, business.industry, Hemiarthroplasty/methods, Dementia/epidemiology, Delirium, Delirium/epidemiology, medicine.disease, Femoral Neck Fractures, Nursing Homes, Surgery, Open Fracture Reduction/methods, Dementia, Observational study, Hemiarthroplasty, business
Abstract

© 2020 Elsevier Ltd Background: Observational studies have suggested that accelerated surgery is associated with improved outcomes in patients with a hip fracture. The HIP ATTACK trial assessed whether accelerated surgery could reduce mortality and major complications. Methods: HIP ATTACK was an international, randomised, controlled trial done at 69 hospitals in 17 countries. Patients with a hip fracture that required surgery and were aged 45 years or older were eligible. Research personnel randomly assigned patients (1:1) through a central computerised randomisation system using randomly varying block sizes to either accelerated surgery (goal of surgery within 6 h of diagnosis) or standard care. The coprimary outcomes were mortality and a composite of major complications (ie, mortality and non-fatal myocardial infarction, stroke, venous thromboembolism, sepsis, pneumonia, life-threatening bleeding, and major bleeding) at 90 days after randomisation. Patients, health-care providers, and study staff were aware of treatment assignment, but outcome adjudicators were masked to treatment allocation. Patients were analysed according to the intention-to-treat principle. This study is registered at ClinicalTrials.gov (NCT02027896). Findings: Between March 14, 2014, and May 24, 2019, 27 701 patients were screened, of whom 7780 were eligible. 2970 of these were enrolled and randomly assigned to receive accelerated surgery (n=1487) or standard care (n=1483). The median time from hip fracture diagnosis to surgery was 6 h (IQR 4–9) in the accelerated-surgery group and 24 h (10–42) in the standard-care group (p

Published
2020

41. Immature Platelet Fraction and Clinical Outcomes in Patients Undergoing Transcatheter Aortic Valve Implantation

Author

Lee Oppenheim MD, Ranel Loutati MD, David Marmor MD, Nimrod Perel MD, Meir Tabi MD, Louay Taha MD, Danny Dvir MD, Mony Shuvy MD, Rami Jubeh MD, Michael Glikson MD, and Elad Asher MD, MHA

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Introduction Immature platelets or reticulated platelets are newly released thrombocytes. They can be identified by their large size and high RNA cytoplasm concentration. Immature platelet fraction (IPF) represents the percentage of immature circulative platelets relative to the total number of platelets. The role of IPF in patients undergoing transcatheter aortic valve implantation (TAVI) is unknown. The aim of the current trial was to assess the levels of IPF in patients undergoing TAVI and correlation with clinical outcomes. Material and Methods Immature platelet fraction levels were measured 3 times in all patients (preprocedure, 1-2 days post-procedure and 1-month post-procedure). Immature platelet fraction measurement was carried out using an autoanalyzer (Sysmex XE-2100). Patients were followed for 12 months. Primary outcomes were defined as complications during hospitalizations, rehospitalization, and mortality. Results Fifty-one patients were included in the study. Mean age was 79.8 (±9.6), and 28 (55%) were women. Twenty-one patients (41%) had complications: Of them, 6 of 21 (29%) occurred during hospitalizations (2—vascular complications; 2—sepsis, 2—implantation of a pacemaker), 9 of 21 (43%) patients were rehospitalized after the index admission, and 6 patients died during the follow-up period. Multivariate Cox regression analysis found that IPF 7% in patients undergoing TAVI is associated with worse outcomes. Further studies are needed to better understand this phenomenon.

Published
2024
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44. Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an international, randomised, controlled trial

Author

Borges, Flavia K, primary, Bhandari, Mohit, additional, Guerra-Farfan, Ernesto, additional, Patel, Ameen, additional, Sigamani, Alben, additional, Umer, Masood, additional, Tiboni, Maria E, additional, Villar-Casares, Maria del Mar, additional, Tandon, Vikas, additional, Tomas-Hernandez, Jordi, additional, Teixidor-Serra, Jordi, additional, Avram, Victoria RA, additional, Winemaker, Mitchell, additional, Ramokgopa, Mmampapatla T, additional, Szczeklik, Wojciech, additional, Landoni, Giovanni, additional, Wang, Chew Yin, additional, Begum, Dilshad, additional, Neary, John D, additional, Adili, Anthony, additional, Sancheti, Parag K, additional, Lawendy, Abdel-Rahman, additional, Balaguer-Castro, Mariano, additional, Ślęczka, Paweł, additional, Jenkinson, Richard J, additional, Nur, Aamer Nabi, additional, Wood, Gavin CA, additional, Feibel, Robert J, additional, McMahon, Stephen J, additional, Sigamani, Alen, additional, Popova, Ekaterine, additional, Biccard, Bruce M, additional, Moppett, Iain K, additional, Forget, Patrice, additional, Landais, Paul, additional, McGillion, Michael H, additional, Vincent, Jessica, additional, Balasubramanian, Kumar, additional, Harvey, Valerie, additional, Garcia-Sanchez, Yaiza, additional, Pettit, Shirley M, additional, Gauthier, Leslie P, additional, Guyatt, Gordon H, additional, Conen, David, additional, Garg, Amit X, additional, Bangdiwala, Shrikant I, additional, Belley-Cote, Emilie P, additional, Marcucci, Maura, additional, Lamy, Andre, additional, Whitlock, Richard, additional, Le Manach, Yannick, additional, Fergusson, Dean A, additional, Yusuf, Salim, additional, Devereaux, PJ, additional, Veevaete, Laurent, additional, le Polain de Waroux, Bernard, additional, Lavand'homme, Patricia, additional, Cornu, Olivier, additional, Tribak, Karim, additional, Yombi, Jean Cyr, additional, Touil, Nassim, additional, Reul, Maike, additional, Bhutia, Jigme Tshering, additional, Clinckaert, Carol, additional, De Clippeleir, Dirk, additional, de Beer, Justin, additional, Simpson, Diane L, additional, Worster, Andrew, additional, Alvarado, Kim A, additional, Gregus, Krysten K, additional, Lawrence, Kelly H, additional, Leong, Darryl P, additional, Joseph, Philip G, additional, Magloire, Patrick, additional, Deheshi, Benjamin, additional, Bisland, Stuart, additional, Wood, Thomas J, additional, Tushinski, Daniel M, additional, Wilson, David AJ, additional, Kearon, Clive, additional, Cowan, David D, additional, Khanna, Vickas, additional, Zaki, Amna, additional, Farrell, Janet C, additional, MacDonald, Anne Marie, additional, Wong, Steven CW, additional, Karbassi, Arsha, additional, Wright, Douglas Steven, additional, Shanthanna, Harsha, additional, Coughlin, Ryan, additional, Khan, Moin, additional, Wikkerink, Spencer, additional, Quraishi, Faraaz A, additional, Kishta, Waleed, additional, Schemitsch, Emil, additional, Carey, Timothy, additional, Macleod, Mark D, additional, Sanders, David W, additional, Vasarhelyi, Edward, additional, Bartley, Debra, additional, Dresser, George K, additional, Tieszer, Christina, additional, Shadowitz, Steven, additional, Lee, Jacques S, additional, Choi, Stephen, additional, Kreder, Hans J, additional, Nousiainen, Markku, additional, Kunz, Monica R, additional, Tuazon, Ravianne, additional, Shrikumar, Mopina, additional, Ravi, Bheeshma, additional, Wasserstein, David, additional, Stephen, David JG, additional, Nam, Diane, additional, Henry, Patrick DG, additional, Mann, Stephen M, additional, Jaeger, Melanie T, additional, Sivilotti, Marco LA, additional, Smith, Christopher A, additional, Frank, Christopher C, additional, Grant, Heather, additional, Ploeg, Leone, additional, Yach, Jeff D, additional, Harrison, Mark M, additional, Campbell, Aaron R, additional, Bicknell, Ryan T, additional, Bardana, Davide D, additional, McIlquham, Katie, additional, Gallant, Catherine, additional, Halman, Samantha, additional, Thiruganasambandamoorth, Venkatesh, additional, Ruggiero, Sara, additional, Hadden, William J, additional, Chen, Brian P-J, additional, Coupal, Stephanie A, additional, McLean, Lisa M, additional, Shirali, Hemant R, additional, Haider, Syed Y, additional, Smith, Crystal A, additional, Watts, Evan, additional, Santone, David J, additional, Koo, Kevin, additional, Yee, Allan J, additional, Oyenubi, Ademilola N, additional, Nauth, Aaron, additional, Schemitsch, Emil H, additional, Daniels, Timothy R, additional, Ward, Sarah E, additional, Hall, Jeremy A, additional, Ahn, Henry, additional, Whelan, Daniel B, additional, Atrey, Amit, additional, Khoshbin, Amir, additional, Puskas, David, additional, Droll, Kurt, additional, Cullinan, Claude, additional, Payendeh, Jubin, additional, Lefrancois, Tina, additional, Mozzon, Lise, additional, Marion, Travis, additional, Jacka, Michael J, additional, Greene, James, additional, Menon, Matthew, additional, Stiegelmahr, Robert, additional, Dillane, Derek, additional, Irwin, Marleen, additional, Beaupre, Lauren, additional, Coles, Chad P, additional, Trask, Kelly, additional, MacDonald, Shelley, additional, Trenholm, J Andrew I, additional, Oxner, William, additional, Richardson, C Glen, additional, Dehghan, Niloofar, additional, Sadoughi, Mehdi, additional, Sharma, Achal, additional, White, Neil J, additional, Olivieri, Loretta, additional, Hunt, Stephen B, additional, Turgeon, Thomas R, additional, Bohm, Eric R, additional, Tran, Sarah, additional, Giilck, Stephen M, additional, Hupel, Tom, additional, Guy, Pierre, additional, O'Brien, Peter J, additional, Duncan, Andrew W, additional, Crawford, Gordon A, additional, Zhou, Junlin, additional, Zhao, Yanrui, additional, Liu, Yang, additional, Shan, Lei, additional, Wu, Anshi, additional, Muñoz, Juan Manuel, additional, Chaudier, Philippe, additional, Douplat, Marion, additional, Fessy, Michel Henri, additional, Piriou, Vincent, additional, Louboutin, Lucie, additional, David, Jean Stephane, additional, Friggeri, Arnaud, additional, Beroud, Sebastien, additional, Fayet, Jean Marie, additional, Leung, Frankie Ka Li, additional, Fang, Christian Xinshuo, additional, Yee, Dennis King Hang, additional, Sancheti, Parag Kantilal, additional, Pradhan, Chetan Vijay, additional, Patil, Atul Ashok, additional, Puram, Chetan Prabhakar, additional, Borate, Madhav Pandurang, additional, Kudrimoti, Kiran Bhalchandra, additional, Adhye, Bharati Anil, additional, Dongre, Himanshu Vijaykumar, additional, John, Bobby, additional, Abraham, Valsamma, additional, Pandey, Ritesh Arvind, additional, Rajkumar, Arti, additional, George, Preetha Elizabeth, additional, Stephen, Manesh, additional, Chandran, Nitheesh, additional, Ashraf, Mohammed, additional, Georgekutty, AM, additional, Sulthan, Ahamad Shaheel, additional, Adinarayanan, S, additional, Sharma, Deep, additional, Barnawal, Satish Prasad, additional, Swaminathan, Srinivasan, additional, Bidkar, Prasanna Udupi, additional, Mishra, Sandeep Kumar, additional, Menon, Jagdish, additional, M, Niranjan, additional, K, Varghese Zachariah, additional, Hiremath, Santosh Angad, additional, NC, Madhusudhan, additional, Jawali, Abhijit, additional, Gnanadurai, Kingsly Robert, additional, George, Carolin Elizabeth, additional, Maddipati, Tatarao, additional, KP, Mary KP, additional, Sharma, Vijay, additional, Farooque, Kamran, additional, Malhotra, Rajesh, additional, Mittal, Samarth, additional, Sawhney, Chavi, additional, Gupta, Babita, additional, Mathur, Purva, additional, Gamangati, Shivanand, additional, Tripathy, Vijaylaxmi, additional, Menon, Prem Haridas, additional, Dhillon, Mandeep S, additional, Chouhan, Devendra K, additional, Patil, Sharanu, additional, Narayan, Ravi, additional, Lal, Purushotham, additional, Bilchod, Prashanth Nabhirajappa, additional, Singh, Surya Udai, additional, Gattu, Uttam Vaidya, additional, Dashputra, Ravi Prabhakar, additional, Rahate, Prashant Vitthal, additional, Turiel, Maurizio, additional, De Blasio, Giuseppe, additional, Accetta, Riccardo, additional, Perazzo, Paolo, additional, Stella, Daniele, additional, Bonadies, Marika, additional, Colombo, Chiara, additional, Fozzato, Stefania, additional, Pino, Fabio, additional, Morelli, Ilaria, additional, Colnaghi, Eleonora, additional, Salini, Vincenzo, additional, Denaro, Giuseppe, additional, Beretta, Luigi, additional, Placella, Giacomo, additional, Giardina, Giuseppe, additional, Binda, Mirko, additional, Marcato, Anna, additional, Guzzetti, Luca, additional, Piccirillo, Fabio, additional, Cecconi, Maurizio, additional, Khor, HM, additional, Lai, Hou Yee, additional, Kumar, CS, additional, Chee, KH, additional, Loh, PS, additional, Tan, Kit Mun, additional, Singh, Simmrat, additional, Foo, Li Lian, additional, Prakasam, Komella, additional, Chaw, Sook Hui, additional, Lee, Meng-Li, additional, Ngim, Joanne HL, additional, Boon, Huck Wee, additional, Chin, Im Im, additional, Kleinlugtenbelt, Ydo V, additional, Landman, Ellie BM, additional, Flikweert, Elvira R, additional, Roerdink, Herbert W, additional, Brokelman, Roy B.G., additional, Elskamp-Meijerman, Hannie F, additional, Horst, Maarten R, additional, Cobben, Jan-Hein MG, additional, Anjum, Anila, additional, Hashmi, Pervaiz Mehmood, additional, Ahmed, Tashfeen, additional, Rashid, Haroon Ur, additional, Khattak, Mujahid Jamil, additional, Rashid, Rizwan Haroon, additional, Lakdawala, Riaz Hussain, additional, Noordin, Shahryar, additional, Juman, Naveed Muhammed, additional, Khan, Robyna Irshad, additional, Riaz, Muhammad Mehmood, additional, Bokhari, Syedah Saira, additional, Almas, Ayesha, additional, Wahab, Hussain, additional, Ali, Arif, additional, Khan, Hammad Naqi, additional, Khan, Eraj Khurshid, additional, Janjua, Kholood Abid, additional, Orakzai, Sajjad Hassan, additional, Khan, Abdus Salam, additional, Mustafa, Khawaja Junaid, additional, Sohail, Mian Amjad, additional, Umar, Muhammad, additional, Khan, Siddra Ahmed, additional, Ashraf, Muhammad, additional, Khan, Muhammad Kashif, additional, Shiraz, Muhammad, additional, Furgan, Ahmad, additional, Dąbek, Piotr, additional, Kumoń, Adam, additional, Satora, Wojciech, additional, Ambroży, Wojciech, additional, Święch, Mariusz, additional, Rycombel, Jacek, additional, Grzelak, Adrian, additional, Gucwa, Jaroslaw, additional, Machala, Waldemar, additional, Ramokgopa, Mmampapatla Thomas, additional, Firth, Gregory Bodley, additional, Karera, Mwalimu, additional, Fourtounas, Maria, additional, Singh, Virsen, additional, Biscardi, Anna, additional, Iqbal, Muhammad Nasir, additional, Campbell, Ryan Jonathan, additional, Maluleke, Matimba Lenny, additional, Moller, Carien, additional, Nhlapo, Lerato, additional, Maqungo, Sithombo, additional, Flint, Margot, additional, Nejthardt, Marcin B, additional, Chetty, Sean, additional, Naidoo, Rubendren, additional, Garrido Clua, Miriam, additional, Molero-Garcia, Vicente, additional, Minguell-Monyart, Joan, additional, Selga Marsa, Jordi, additional, Porcel-Vazquez, Juan A, additional, Andres-Peiro, Jose-Vicente, additional, Aguilar, Marc, additional, Mestre-Torres, Jaume, additional, Colomina, Maria J, additional, Guilabert, Patricia, additional, Paños Gozalo, M Luisa, additional, Abarca, Luis, additional, Martin, Nuria, additional, Usua, Gemma, additional, Martinez-Ripol, Pedro, additional, Gonzalez Posada, MA, additional, Lalueza-Broto, Pilar, additional, Sanchez-Raya, Judith, additional, Nuñez Camarena, Jorge, additional, Fraguas-Castany, Antoni, additional, Torner, Pere, additional, Jornet-Gibert, Monsant, additional, Serrano-Sanz, Jorge, additional, Cámara-Cabrera, Jaume, additional, Salomó-Domènech, Mònica, additional, Yela-Verdú, Christian, additional, Peig-Font, Anna, additional, Ricol, Laura, additional, Carreras-Castañer, Anna, additional, Martínez-Sañudo, Luis, additional, Herranz, Susana, additional, Feijoo-Massó, Carlos, additional, Sianes-Gallén, Mònica, additional, Castillón, Pablo, additional, Bernaus, Martí, additional, Quintas, Saioa, additional, Gómez, Olga, additional, Salvador, Jordi, additional, Abarca, Javiera, additional, Estrada, Cristina, additional, Novellas, Marga, additional, Torra, Mercè, additional, Dealbert, Alfred, additional, Macho, Oscar, additional, Ivanov, Alexia, additional, Valldosera, Esther, additional, Arroyo, Marta, additional, Pey, Borja, additional, Yuste, Antoni, additional, Mateo, Llorenç, additional, De Caso, Julio, additional, Anaya, Rafael, additional, Higa-Sansone, JL, additional, Millan, Angelica, additional, Baños, Victoria, additional, Herrera-Mateo, Sergio, additional, Aguado, Hector J, additional, Martinez-Municio, Gonzalo, additional, León, Ricardo, additional, Santiago-Maniega, Silvia, additional, Zabalza, Ana, additional, Labrador, Gregorio, additional, Guerado, Enrique, additional, Cruz, Encarnacion, additional, Cano, Juan Ramon, additional, Bogallo, Jose Manuel, additional, Sa-ngasoongsong, Paphon, additional, Kulachote, Noratep, additional, Sirisreetreerux, Norachart, additional, Pengrung, Nachapan, additional, Chalacheewa, Theerawat, additional, Arnuntasupakul, Vanlapa, additional, Yingchoncharoen, Teerapat, additional, Naratreekoon, Bundit, additional, Kadry, Miriam Adel, additional, Thayaparan, Surendini, additional, Abdlaziz, Ihab, additional, Aframian, Arash, additional, Imbuldeniya, Arjuna, additional, Bentoumi, Souad, additional, Omran, Sherif, additional, Vizcaychipi, Marcela Paola, additional, Correia, Patricia, additional, Patil, Shashank, additional, Haire, Kevin, additional, Mayor, Amy SE, additional, Dillingham, Sally, additional, Nicholson, Laura, additional, Elnaggar, Mohamed, additional, John, Joby, additional, Nanjayan, Shashi Kumar, additional, Parker, Martyn J, additional, O'Sullivan, Susan, additional, Marmor, Meir T, additional, Matityahu, Amir, additional, McClellan, Robert Trigg, additional, Comstock, Curt, additional, Ding, Anthony, additional, Toogood, Paul, additional, Slobogean, Gerard, additional, Joseph, Katherine, additional, O'Toole, Robert, additional, Sciadini, Marcus, additional, Ryan, Scott P, additional, Clark, Molly E, additional, Cassidy, Charles, additional, Balonov, Konstantin, additional, Bergese, Sergio D, additional, Phieffer, Laura S, additional, Gonzalez Zacarias, Alicia A, additional, Marcantonio, Andrew J, additional, Borges, Flavia K, additional, Dragic-Taylor, Sanela, additional, Maxwell, Chelsea, additional, Molnar, Sarah, additional, Wells, Jennifer R, additional, Ofori, Sandra N, additional, Yang, Stephen S, additional, Wang, Michael K, additional, Duceppe, Emmanuelle, additional, Spence, Jessica, additional, Vasquez, Javiera P, additional, Marcano-Fernández, Francesc, additional, Ham, Hyungjoo, additional, Prada, Carlos, additional, Yung, Terence CH, additional, Sanz Pérez, Isidro, additional, Bosch, Michael J, additional, Prystajecky, Michael R, additional, Chowdhury, Chinmoy, additional, Khan, James S, additional, Stella, Steffan F, additional, Heidary, Behrouz, additional, Tran, Allen, additional, Wawrzycka-Adamczyk, Katarzyna, additional, Chen, Yu Chiao Peter, additional, González-Osuna, Aránzazu, additional, Biedroń, Grzegorz, additional, Wludarczyk, Anna, additional, Lefebvre, Marco, additional, Ernst, Jaclyn A, additional, Staffhorst, Bas, additional, Woodfine, Jason D, additional, Alwafi, Emad M, additional, Mrkobrada, Marko, additional, Parlow, Simon, additional, Roberts, Robin, additional, McAlister, Finlay, additional, Sackett, David, additional, and Wright, James, additional

Published
2020
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46. Association between the shock index on admission and in-hospital mortality in the cardiac intensive care unit.

Author

Mitchell Padkins, Kianoush Kashani, Meir Tabi, Ognjen Gajic, and Jacob C Jentzer

Subjects
Medicine, Science
Abstract

BackgroundAn elevated shock index (SI) predicts worse outcomes in multiple clinical arenas. We aimed to determine whether the SI can aid in mortality risk stratification in unselected cardiac intensive care unit patients.MethodsWe included admissions to the Mayo Clinic from 2007 to 2015 and stratified them based on admission SI. The primary outcome was in-hospital mortality, and predictors of in-hospital mortality were analyzed using multivariable logistic regression.ResultsWe included 9,939 unique cardiac intensive care unit patients with available data for SI. Patients were grouped by SI as follows: < 0.6, 3,973 (40%); 0.6-0.99, 4,810 (48%); and ≥ 1.0, 1,156 (12%). After multivariable adjustment, both heart rate (adjusted OR 1.06 per 10 beats per minute higher; CI 1.02-1.10; p-value 0.005) and systolic blood pressure (adjusted OR 0.94 per 10 mmHg higher; CI 0.90-0.97; p-value < 0.001) remained associated with higher in-hospital mortality. As SI increased there was an incremental increase in in-hospital mortality (adjusted OR 1.07 per 0.1 beats per minute/mmHg higher, CI 1.04-1.10, p-Value < 0.001). A higher SI was associated with increased mortality across all examined admission diagnoses.ConclusionThe SI is a simple and universally available bedside marker that can be used at the time of admission to predict in-hospital mortality in cardiac intensive care unit patients.

Published
2024
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47. Increased litigation burden among tibia, pelvis, and spine fractures: An analysis of 756 fracture-related malpractice cases

Author

Zachary M. Working, Ashraf N. El Naga, Joshua Slocum, Allison Tucker, Paul Hoogervorst, and Meir T. Marmor

Subjects
medicine.medical_specialty, business.industry, litigation, Specialty, Medical malpractice, pelvis, Evidence-based medicine, Indemnity, medicine.disease, spine, Clinical/Basic Science Research Article, Malpractice, Orthopedic surgery, Health care, medicine, Tibia, Medical emergency, fracture care, business, tibia
Abstract

Objectives: To analyze a series of claims from a large national malpractice insurer associated with fracture care to understand what parameters are associated with claims, defense costs, and paid indemnity. Design: Review of claims in fracture care settings from a national database; case series. Setting: Database draws from insured pool of 400,000 medical malpractice cases from 400 healthcare entities across the country, representing 165,000 physicians; both academic and private. Patients/Participants: Fracture care patients bringing legal suit. Main Outcome Measurements: Cost of legal proceedings and indemnity, ICD-9 codes, and contributing causes toward claims. Results: A total of 756 fracture claims were asserted between 2005 and 2014 regarding fracture care within the database; 70% were brought for inaccurate, missed, or delayed diagnosis, while 22% addressed medical treatment and 8% were for surgical management. Orthopaedics was the primary service in 22%. Total cost (expenses and indemnity) to orthopaedic providers totaled $13.1MM (million). The most common claim against orthopaedics was for fractures of the tibia and fibula (11.4%). Impact factor (IF) analysis (as described by Matsen) of indemnity in these cases reveals 3 fracture regions of highest indemnity burden: fractures of the tibia and fibula (IF: 1.86, 11.4%), pelvis (IF: 1.77, 6.6%), and spine (IF 1.33, 6.6%). Analysis of contributing factors identifies the category of clinical judgement as the most common category (62%). Other common factors include patient noncompliance (31%), communication (28%), technical skill (17%), clinical systems (11%), and documentation (10%). The single most common specific cause of a claim in orthopaedic fracture care was misinterpretation of diagnostic imaging (25%). Conclusion: This study is the first of its kind to identify fractures of the tibia and fibula as high risk for litigation against orthopaedic providers and provides general counseling of legal pitfalls in fracture care. Finally, we are able to identify the act of patient assessment as a key issue in over half of all fracture-related claims against orthopaedic providers. Providers in general and specialty settings can use this information to help guide their treatment and care ownership decisions in the care of patients with fractures. Level of Evidence: Economic - Level III.

Published
2018

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