The Stop the Bleed campaign gives bystanders an active role in prehospital hemorrhage control. Whether extending bystanders' role to private vehicle transport (PVT) for urban penetrating trauma improves survival is unknown, but past research has found benefit to police and PVT. We hypothesized that for penetrating trauma in an urban environment, where prehospital procedures have been proven harmful, PVT improves outcomes compared to any EMS or advanced life support (ALS) transport.
View Article and Find Full Text PDFBackground: Anti-inflammatory effects of tranexamic acid (TXA) in reducing trauma endotheliopathy may protect from acute lung injury. Clinical data showing this benefit in trauma patients is lacking. We hypothesized that TXA administration mitigates pulmonary complications in penetrating trauma patients.
View Article and Find Full Text PDFBackground: Active shooter events are horrific, unfortunate realities in American hospitals. Protecting patients and staff in an active shooter event is made more difficult in the cases of critically ill and otherwise immobile patients. Previous work has proposed theoretical mitigation strategies for active shooter events.
View Article and Find Full Text PDFBackground: Death from noncompressible torso hemorrhage (NCTH) may be preventable with improved prehospital care and shorter in-hospital times to hemorrhage control. We hypothesized that shorter times to surgical intervention for hemorrhage control would decrease mortality in hypotensive patients with NCTH.
Methods: This was an AAST-sponsored multicenter, prospective analysis of hypotensive patients aged 15+ years who presented with NCTH from May 2018 to December 2020.
Recent increases in firearm violence in U.S. cities are well-documented, however dynamic changes in the people, places and intensity of this public health threat during the COVID-19 pandemic are relatively unexplored.
View Article and Find Full Text PDFBackground: Police transport (PT) of penetrating trauma patients in urban locations has become routine in certain metropolitan areas; however, whether it results in improved outcomes over prehospital Advanced life support (ALS) transport has not been determined in a multicenter study. We hypothesized that PT would not result in improved outcomes.
Methods: This was a multicenter, prospective, observational study of adults (18+ years) with penetrating trauma to the torso and/or proximal extremity presenting at 25 urban trauma centers.
Objective: Residents often are involved in discussions with families regarding brain death/death by neurologic criteria (BD/DNC); however, they receive no standardized training on this topic. We hypothesized that residents are uncomfortable with explaining BD/DNC and that formal didactic and simulated training will improve residents' comfort and skill in discussions surrounding BD/DNC.
Design: We partnered with our organ procurement organization (OPO) to create an educational program regarding BD/DNC consisting of a didactic component, and role-play scenarios with immediate individualized feedback.
J Trauma Acute Care Surg
July 2021
Background: Police transport (PT) of penetrating trauma patients decreases the time between injury and trauma center arrival. Our study objective was to characterize trends in the rate of PT and its impact on mortality. We hypothesized that PT is increasing and that these patients are more injured.
View Article and Find Full Text PDFBackground: Prehospital procedures (PHP) by emergency medical services (EMS) are performed regularly in penetrating trauma patients despite previous studies demonstrating no benefit. We sought to examine the influence of PHPs on outcomes in penetrating trauma patients in urban locations where transport to trauma center is not prolonged. We hypothesized that patients without PHPs would have better outcomes than those undergoing PHP.
View Article and Find Full Text PDFThis study uses police department registry data to describe trends in incidence of firearm shootings and deaths in January-November 2020, before and after the closure of nonessential businesses in March, the killing of George Floyd in May, and the partial lifting of containment policies in June.
View Article and Find Full Text PDFIdentifying the people and places affected by mass shootings depends on how "mass shooting" is defined. From the perspective of urban neighborhoods, it is likely the number of people injured within a proximate time and space, which determines the event's impact on perceptions of safety and social cohesion. We aimed to describe the incidence of "neighborhood" mass shootings in one US city and to determine how these events were communicated to the public through news media.
View Article and Find Full Text PDFBackground: Recent attention has been paid to the role trauma centers play in responding to mass shootings. Although high-profile public events are the primary focus of media and policy makers, firearm-injured patients (FIPs) present in clusters to urban trauma centers every day. We examined the burden of FIP clusters from an urban trauma system perspective.
View Article and Find Full Text PDFBackground: We sought to investigate associations between race, clinical characteristics, and outcomes among patients with malignant phyllodes of the breast.
Methods: Malignant phyllodes cases were identified using Surveillance Epidemiology and End Results database. We used chi-square tests to compare characteristics between racial groups and multinomial logistic regression to calculate relative risk ratios (RRR) and 95% confidence intervals (CI) comparing the likelihood of having particular characteristics by race.
Background: The association between regional breast cancer diagnostic rates, treatments, and outcomes is unclear. We sought to investigate the management and survival of women with invasive ductal carcinoma (IDC) from geographic regions with variable rates of diagnosis.
Methods: Data on women diagnosed with IDC years 2009-2010 were obtained from the Surveillance, Epidemiology, and End Results database.
Background: Stress management programs improve efficacy in aviation, military, and professional sports; however, similar educational strategies have not been adopted in surgical training. We have evaluated the effectiveness of a stress management program for surgical residents.
Methods: From 2011 to 2016, 137 surgical residents participated in a prospective, blinded study.
Background: The American College of Surgeons NSQIP has developed a risk calculator (RC) to assist patients and surgeons with difficult decisions. The aim of this analysis was to determine the accuracy of the RC in patients undergoing elective and emergent colorectal operations.
Study Design: From January 2013 through December 2015, seventy-five patients undergoing emergent colorectal operations were paired by date with 75 patients having elective colorectal operations.
Objective: First-year residents often obtain informed consent from patients. However, they typically receive no formal training in this area before residency. We wished to determine whether an educational program would improve residents' comfort with this process.
View Article and Find Full Text PDFBackground: Survival of surgical inpatients is a key quality metric. Patient, surgeon, and system factors all contribute to inpatient mortality, and sophisticated risk adjustment is required to assess outcomes. When the mortality of general surgery patients was determined to be high at a safety-net hospital, a comprehensive approach was undertaken to improve patient survival.
View Article and Find Full Text PDFBackground: This study was performed to evaluate the effect of socioeconomic status (SES) on outcomes after cholecystectomy.
Methods: The National Inpatient Sample (NIS) database (2005 to 2011) was queried for patients undergoing cholecystectomy. Clinically relevant variables were used to examine clinical characteristics, postoperative complications, and mortality.
Introduction: Impaired wound healing due to immunosuppression has led some surgeons to preferentially use open gastrostomy tube (OGT) over percutaneous gastrostomy tube (PEG) in heart transplant patients when long-term enteral access is deemed necessary.
Methods: The National Inpatient Sample (NIS) database (2005-2010) was queried for all heart transplant patients. Those receiving OGT were compared to those treated with PEG tube.
As left ventricular assist devices (LVADs) are increasingly used for patients with end-stage heart failure, the need for noncardiac surgical procedures (NCSs) in these patients will continue to rise. We examined the various types of NCS required and its outcomes in LVAD patients requiring NCS. The National Inpatient Sample Database was examined for all patients implanted with an LVAD from 2007 to 2010.
View Article and Find Full Text PDFBackground: Patient value (V) is enhanced when quality (Q) is increased and cost (C) is diminished (V = Q/C). However, calculating value has been inhibited by a lack of risk-adjusted cost data. The aim of this analysis was to measure patient value before and after implementation of quality improvement and cost reduction programs.
View Article and Find Full Text PDFIntroduction: Lung transplant patients require a high degree of immunosuppression, which can impair wound healing when surgical procedures are required. We hypothesized that because of impaired healing, lung transplant patients requiring gastrostomy tubes would have better outcomes with open gastrostomy tube (OGT) as compared to percutaneous endoscopic gastrostomy tube (PEG).
Methods: The National Inpatient Sample (NIS) Database (2005-2010) was queried for all lung transplant recipients requiring OGT or PEG.
Background: Controversy remains over the ideal way to transport penetrating trauma victims in an urban environment. Both advance life support (ALS) and basic life support (BLS) transports are used in most urban centers.
Methods: A retrospective cohort study was conducted at an urban Level I trauma center.
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