11 results on '"Neideen T"'
Search Results
2. Minimal aortic injury after blunt trauma: selective nonoperative management is safe.
- Author
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Paul JS, Neideen T, Tutton S, Milia D, Tolat P, Foley D, and Brasel K
- Published
- 2011
- Full Text
- View/download PDF
3. Time to stroke: A Western Trauma Association multicenter study of blunt cerebrovascular injuries.
- Author
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Burlew CC, Sumislawski JJ, Behnfield CD, McNutt MK, McCarthy J, Sharpe JP, Croce MA, Bala M, Kashuk J, Spalding MC, Beery PR, John S, Hunt DJ, Harmon L, Stein DM, Callcut R, Wybourn C, Sperry J, Anto V, Dunn J, Veith JP, Brown CVR, Celii A, Zander TL, Coimbra R, Berndtson AE, Moss TZ, Malhotra AK, Hazelton JP, Linden K, West M, Alam HB, Williams AM, Kim J, Inaba K, Moulton S, Choi YM, Warren HL, Collier B, Ball CG, Savage S, Hartwell JL, Cullinane DC, Zielinski MD, Ray-Zack MD, Morse BC, Rhee P, Rutherford EJ, Udekwu P, Reynolds C, Toschlog E, Gondek S, Ju T, Haan JM, Lightwine KL, Kulvatunyou N, Coates B, Khouqeer AF, Todd SR, Zarzaur B, Waller CJ, Kallies KJ, Neideen T, Eddine SBZ, Peck KA, Dunne CE, Kramer K, Bokhari F, Dhillon TS, Galante JM, and Cohen MJ
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Cerebrovascular Trauma complications, Child, Child, Preschool, Female, Humans, Injury Severity Score, Male, Middle Aged, Nervous System Diseases etiology, Stroke diagnostic imaging, Stroke drug therapy, Time Factors, Young Adult, Carotid Artery Injuries complications, Fibrinolytic Agents therapeutic use, Stroke etiology, Wounds, Nonpenetrating complications
- Abstract
Background: Screening for blunt cerebrovascular injuries (BCVIs) in asymptomatic high-risk patients has become routine. To date, the length of this asymptomatic period has not been defined. Determining the time to stroke could impact therapy including earlier initiation of antithrombotics in multiply injured patients. The purpose of this study was to determine the time to stroke in patients with a BCVI-related stroke. We hypothesized that the majority of patients suffer stroke between 24 hours and 72 hours after injury., Methods: Patients with a BCVI-related stroke from January 2007 to January 2017 from 37 trauma centers were reviewed., Results: During the 10-year study, 492 patients had a BCVI-related stroke; the majority were men (61%), with a median age of 39 years and ISS of 29. Stroke was present at admission in 182 patients (37%) and occurred during an Interventional Radiology procedure in six patients. In the remaining 304 patients, stroke was identified a median of 48 hours after admission: 53 hours in the 144 patients identified by neurologic symptoms and 42 hours in the 160 patients without a neurologic examination and an incidental stroke identified on imaging. Of those patients with neurologic symptoms, 88 (61%) had a stroke within 72 hours, whereas 56 had a stroke after 72 hours; there was a sequential decline in stroke occurrence over the first week. Of the 304 patients who had a stroke after admission, 64 patients (22%) were being treated with antithrombotics when the stroke occurred., Conclusions: The majority of patients suffer BCVI-related stroke in the first 72 hours after injury. Time to stroke can help inform clinicians about initiation of treatment in the multiply injured patient., Level of Evidence: Prognostic/Epidemiologic, level III.
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- 2018
- Full Text
- View/download PDF
4. An AAST-MITC analysis of pancreatic trauma: Staple or sew? Resect or drain?
- Author
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Byrge N, Heilbrun M, Winkler N, Sommers D, Evans H, Cattin LM, Scalea T, Stein DM, Neideen T, Walsh P, Sims CA, Brahmbhatt TS, Galante JM, Phan HH, Malhotra A, Stovall RT, Jurkovich GJ, Coimbra R, Berndtson AE, O'Callaghan TA, Gaspard SF, Schreiber MA, Cook MR, Demetriades D, Rivera O, Velmahos GC, Zhao T, Park PK, Machado-Aranda D, Ahmad S, Lewis J, Hoff WS, Suleiman G, Sperry J, Zolin S, Carrick MM, Mallory GR, Nunez J, Colonna A, Enniss T, and Nirula R
- Subjects
- Abdominal Injuries classification, Abdominal Injuries diagnostic imaging, Abdominal Injuries epidemiology, Adult, Aged, Drainage adverse effects, Drainage methods, Female, Humans, Injury Severity Score, Male, Middle Aged, Pancreas diagnostic imaging, Pancreas pathology, Pancreatectomy adverse effects, Pancreatectomy methods, Pancreatic Ducts diagnostic imaging, Pancreatic Ducts injuries, Pancreatic Ducts pathology, Pancreatic Ducts surgery, Pancreatic Fistula complications, Pancreatic Pseudocyst complications, Respiratory Distress Syndrome complications, Retrospective Studies, Surgical Stapling adverse effects, Surgical Stapling methods, Sutures adverse effects, Tomography, X-Ray Computed methods, Wounds, Penetrating classification, Wounds, Penetrating complications, Wounds, Penetrating diagnostic imaging, Wounds, Penetrating pathology, Abdominal Injuries surgery, Pancreas injuries, Pancreas surgery
- Abstract
Introduction: Pancreatic trauma results in high morbidity and mortality, in part caused by the delay in diagnosis and subsequent organ dysfunction. Optimal operative management strategies remain unclear. We therefore sought to determine CT accuracy in diagnosing pancreatic injury and the morbidity and mortality associated with varying operative strategies., Methods: We created a multicenter, pancreatic trauma registry from 18 Level 1 and 2 trauma centers. Adult, blunt or penetrating injured patients from 2005 to 2012 were analyzed. Sensitivity and specificity of CT scan identification of main pancreatic duct injury was calculated against operative findings. Independent predictors for mortality, adult respiratory distress syndrome (ARDS), and pancreatic fistula and/or pseudocyst were identified through multivariate regression analysis. The association between outcomes and operative management was measured., Results: We identified 704 pancreatic injury patients of whom 584 (83%) underwent a pancreas-related procedure. CT grade modestly correlated with OR grade (r 0.39) missing 10 ductal injuries (9 grade III, 1 grade IV) providing 78.7% sensitivity and 61.6% specificity. Independent predictors of mortality were age, Injury Severity Score (ISS), lactate, and number of packed red blood cells transfused. Independent predictors of ARDS were ISS, Glasgow Coma Scale score, and pancreatic fistula (OR 5.2, 2.6-10.1). Among grade III injuries (n = 158, 22.4%), the risk of pancreatic fistula/pseudocyst was reduced when the end of the pancreas was stapled (OR 0.21, 95% CI 0.05-0.9) compared with sewn and was not affected by duct stitch placement. Drainage alone in grades IV (n = 25) and V (n = 24) injuries carried increased risk of pancreatic fistula/pseudocyst (OR 8.3, 95% CI 2.2-32.9)., Conclusion: CT is insufficiently sensitive to reliably identify pancreatic duct injury. Patients with grade III injuries should have their resection site stapled instead of sewn and a duct stitch is unnecessary. Further study is needed to determine if drainage alone should be employed in grades IV and V injuries., Level of Evidence: Epidemiologic/Diagnostic study, level III.
- Published
- 2018
- Full Text
- View/download PDF
5. Role of the Open Abdomen in Critically Ill Patients.
- Author
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Beckman M, Paul J, Neideen T, and Weigelt JA
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- Critical Care methods, Humans, Intra-Abdominal Hypertension therapy, Postoperative Complications therapy, Treatment Outcome, Abdominal Injuries diagnosis, Abdominal Injuries surgery, Abdominal Wound Closure Techniques, Critical Illness therapy, Intra-Abdominal Hypertension etiology, Negative-Pressure Wound Therapy, Postoperative Complications etiology
- Abstract
An open abdomen is common used in critically ill patients to temporize permanent abdominal closure. The most common reason for leaving the abdomen open by reopening a laparotomy, not closing, or creating a fresh laparotomy is the abdominal compartment syndrome. The open abdomen technique is also used in damage control operations and intra-abdominal sepsis. Negative pressure wound therapy may be associated with better outcomes than other temporary abdominal closure techniques. The open abdomen is associated with many early and late complications, including infections, gastrointestinal fistulas, and ventral hernias. Clinicians should be vigilant regarding the development of these complications., (Copyright © 2016 Elsevier Inc. All rights reserved.)
- Published
- 2016
- Full Text
- View/download PDF
6. Monitoring devices in the intensive care unit.
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Neideen T
- Subjects
- Critical Care, Humans, Intensive Care Units, Monitoring, Physiologic instrumentation
- Abstract
Monitors in the intensive care unit are imperative to taking adequate care of these critically ill patients. Cardiovascular, pulmonary, and neurologic monitors are key to performing these tasks. This article gives an overview of the most common monitors that are used in the intensive care unit., (Copyright © 2012. Published by Elsevier Inc.)
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- 2012
- Full Text
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7. The impact of discharging minimally injured trauma patient: does age play a role in trauma admission?
- Author
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Peschman J, Neideen T, and Brasel K
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- Age Factors, Aged, Blood Pressure, Chi-Square Distribution, Female, Glasgow Coma Scale, Humans, Injury Severity Score, Length of Stay statistics & numerical data, Logistic Models, Male, Retrospective Studies, Risk Factors, Triage, Patient Admission, Patient Discharge, Trauma Centers organization & administration
- Abstract
Background: Age is suggested as a triage criteria for transfer to a trauma center, despite poor outcomes after similar injury regardless of trauma center level. The effect of differential triage based on age to a trauma center has not been evaluated. We hypothesized that there would be a difference in the admission rates of geriatric patients compared with the rest of the adult trauma population independent of injury severity., Methods: Records of 1,970 adult patients evaluated by the trauma team at a Level I trauma center and discharged directly from the emergency department were reviewed. Data abstracted included demographics, injuries, and physiologic information. These data were compared with 3,232 trauma patients admitted over the same time period who had similar information abstracted via record review. χ analysis of the admission rates of geriatric patients was performed, followed by a binomial logistic regression to determine factors that affected the odds of admission., Results: A total of 451 (8.68%) patients were 65 years or older; 62.2% of the total population was admitted. Significantly more geriatric patients (82%) were admitted (χ = 126.24; p < 0.001). Multivariate analysis showed that age, head injury, Injury Severity Score, Glasgow Coma Scale, and initial blood pressure were significant independent factors in predicting hospital admission (p < 0.001)., Conclusions: Age alone is associated with increased odds of being admitted to the hospital, independent of injury severity and other physiologic parameters. This has implications for trauma centers that see a significant proportion of geriatric trauma patients and for trauma systems that must prepare for the "aging of America."
- Published
- 2011
- Full Text
- View/download PDF
8. Screening for blunt cerebrovascular injuries is cost-effective.
- Author
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Kaye D, Brasel KJ, Neideen T, and Weigelt JA
- Subjects
- Adult, Aged, Cost-Benefit Analysis, Head Injuries, Closed complications, Head Injuries, Closed diagnosis, Humans, Middle Aged, Sensitivity and Specificity, Stroke diagnosis, Stroke economics, United States, Cerebral Angiography economics, Head Injuries, Closed economics, Magnetic Resonance Angiography economics, Models, Economic, Stroke etiology, Tomography, X-Ray Computed economics
- Abstract
Background: Screening for blunt carotid and vertebral injury (BCVI) is increasing without a clear understanding of whether the chosen screening approach is cost-effective. We hypothesized that screening for BCVI using computed tomography angiography (CTA) was cost-effective in populations at high risk for BCVI., Methods: A decision analysis was performed modeling current BCVI screening approaches: no screening, duplex ultrasound, magnetic resonance angiography, angiography, and CTA. Treatment options included antiplatelet therapy, anticoagulation, stents for pseudoaneurysm, and no treatment. Probability estimates for incidence of injury and stroke, sensitivity and specificity of the screening modality, and type of treatment were taken from published data. Average wholesale price and medicare reimbursement costs were used. Two populations were analyzed; high-risk and overall blunt trauma populations. Two perspectives were taken; societal (including lifetime stroke costs) and institutional (ignoring lifetime stroke costs)., Results: In the high-risk population, from a societal perspective, CTA has the lowest cost and stroke rate; $3,727 per patient screened with a 1% stroke rate. No treatment has the highest cost and stroke rate. From an institutional perspective, no screening is the least costly option but has an 11% stroke rate. Duplex ultrasound is the most cost-effective screening modality; $8,940 per stroke prevented., Conclusion: From the societal perspective, CTA is the most cost-effective screening strategy for patients at high risk for BCVI. From an institutional perspective, CTA prevents the most strokes at a reasonable cost.
- Published
- 2011
- Full Text
- View/download PDF
9. Preinjury beta blockers are associated with increased mortality in geriatric trauma patients.
- Author
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Neideen T, Lam M, and Brasel KJ
- Subjects
- Aged, Aged, 80 and over, Comorbidity, Female, Humans, Male, Registries, Wounds and Injuries epidemiology, Adrenergic beta-Antagonists adverse effects, Wounds and Injuries mortality
- Abstract
Introduction: Beta-blockade decreases mortality and morbidity in selected older patient populations undergoing noncardiac general surgery. We hypothesized that preinjury beta blockade would increase mortality in geriatric trauma patients, given beta-blockers inhibit patient's physiologic responses to hypovolemic shock., Methods: Patients older than 65 years admitted to a level I trauma center were identified by the trauma registry. Medical records were reviewed for demographic and injury information. Preinjury beta blockade was determined by review of nurse and pharmacy admission histories. Logistic regression was used to determine whether there was any correlation between mortality and the use of preinjury beta blockers. Separate models were developed based on the presence or the absence of head injury., Results: Of the 1,598 patients older than 65 years admitted between 1996 and 2006, 1,479 met inclusion criteria. Primary reason for exclusion was lack of documentation. Two hundred seventy-three patients were taking beta blockers before their trauma, and 14.7% died before discharge. Mortality in patients not taking beta blockers was 13.4%. Mortality in patients with head injury was 25.9%, significantly associated with warfarin use (OR 2.5, 95% CI 1.3-4.8). In patients without head injury, preinjury beta blockade had a significant association with mortality (OR 2.1, 95% CI 1.1-4.3)., Conclusions: Many factors associated with mortality in elderly trauma patients are similar to the younger patient population. Unique to this population are increased comorbidities and use of prescription medications. Beta blockers, one of these common medications, are associated with increased mortality in the elderly.
- Published
- 2008
- Full Text
- View/download PDF
10. Understanding statistical tests.
- Author
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Neideen T and Brasel K
- Subjects
- Analysis of Variance, Chi-Square Distribution, Humans, Statistics as Topic classification, Statistics, Nonparametric, Statistics as Topic methods
- Published
- 2007
- Full Text
- View/download PDF
11. Video-assisted thoracic surgical applications in thoracic trauma.
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Cetindag IB, Neideen T, and Hazelrigg SR
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- Diaphragm injuries, Humans, Pleural Diseases etiology, Thoracic Injuries complications, Pleural Diseases surgery, Thoracic Injuries surgery, Thoracic Surgery, Video-Assisted
- Abstract
VATS is a valuable and safe way to manage many problems in thoracic trauma. It may allow earlier diagnosis and treatment of posttraumatic complications of chest injuries with less morbidity. This approach has already demonstrated advantages in such entities as retained hemothorax. The reduced pain and morbidity are attractive features compared with open thoracotomy. VATS continues to evolve in thoracic trauma, but unquestionably has proved value.
- Published
- 2007
- Full Text
- View/download PDF
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