Optimal Timing of Cholecystectomy for Acute Cholecystitis: A Retrospective Cohort Study.

Background Laparoscopic cholecystectomy performed less than 72 hours from hospital admission for acute cholecystitis has shown to decrease hospital cost without an increase in length of stay (LOS). Very few studies have examined clinical and cost outcomes of performing cholecystectomy less than 24 hours from hospital admission. The aim of this study was to examine the cost and LOS of laparoscopic cholecystectomy performed on an early (less than 24 hours from admission) and late (more than 24 hours from hospital admission) basis.

American Helicopter Emergency Medical Service Pilots Report to Work Despite High Rates of Sleepiness.

Objective: Previous studies on helicopter emergency medical service (HEMS) pilots found a positive correlation among fatigue, nodding off in flight, and accidents. We sought to quantify the amount of sleepiness in HEMS pilots using the Epworth Sleepiness Scale (ESS).

Methods: An anonymous survey was sent via the National EMS Pilots Association emergency medical services listserv including demographics, the ESS, and subjective effects of fatigue on flying.

Post-Discharge Mortality of Older Adults with Traumatic Brain Injury or Other Trauma.

Objectives: Prior studies of mortality following traumatic brain injury (TBI) have not focused specifically on older adults compared with a non-TBI trauma cohort or included specific causes of death. The objectives of this study were, among adults aged 65 years and older, to (1) generate standardized mortality ratios (SMRs) by cause of death for TBI and a non-TBI trauma cohort compared with a general population, and (2) assess risk of mortality associated with TBI compared with a non-TBI trauma cohort.

Design: Retrospective cohort study of adults aged 65 years and older who were treated at an urban trauma center from 1997 to 2008.

On equal footing: Trends in ankle/foot injuries for men vs. women.

Objectives: The objective of the current study was to examine trends in ankle/foot (A/F) injuries during the period 2001-2014, in order to determine whether the incidence of these injuries has changed and whether a previously identified difference in risk by gender still existed. In addition, other driver and crash-related risk factors were examined separately for men and women.

Methods: Passenger vehicle drivers aged 16+ were identified from NASS-CDS; weighted data were analyzed for model years 2001-2014.

S-100β does not predict outcome after mild traumatic brain injury.

Objective: To determine the usefulness of S-100β, a marker for central nervous system damage, in the prediction of long-term outcomes after mild traumatic brain injury (MTBI) Hypothesis: Mid- and long-term outcomes of MTBI (i.e. 3, 6 and 12 months post-injury and return-to-work or school (RTWS)) may be predicted based on pre-injury and injury factors as well as S-100β.

Declining statewide trends in motor vehicle crashes and injury-related hospital admissions.

Numbers of crashes, rates of police-reported injury severity, and hospital admission rates were calculated for the ten year period between 2001 and 2010 in Maryland. Comparisons were made for two 5-year periods of 2001-2005 and 2006-2010. Crash characteristics remained similar for the two five-year periods, but there was a significant increase in occupant age.

Changes in the Severity and Injury Sources of Thoracic Aorta Injuries due to Vehicular Crashes.

Research using the National Automotive Sampling System-Crashworthiness Data System (NASS-CDS) suggested a decreased adjusted risk of thoracic aorta injuries (TAI) for newer vehicles during near-side crashes and an increased adjusted TAI risk during frontal crashes. This study attempted to explore possible explanations of these findings. Adult front seat occupants in the Crash Injury Research and Engineering Network (CIREN) database through June 2012 were studied.

Aortic injuries in newer vehicles.

The occurrence of AI was studied in relation to vehicle model year (MY) among front seat vehicular occupants, age≥16 in vehicles MY≥1994, entered in the National Automotive Sampling System Crashworthiness Data System between 1997 and 2010 to determine whether newer vehicles, due to their crashworthiness improvements, are linked to a lower risk of aortic injuries (AI). MY was categorized as 1994-1997, 1998-2004, or 2005-2010 reflecting the introduction of newer occupant protection technology. Logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals for the association between AI and MY independent of possible confounders.

Causation and outcomes of diaphragmatic injuries in vehicular crashes.

Background: This study aimed to identify vehicular and crash factors associated with diaphragmatic injuries (DIs).

Methods: DI presence was analyzed among Crash Injury Research and Engineering Network vehicular occupants (age ≥ 16 years) in relation to occupant and crash factors. Contact points (i.

Ideal timing of surgery for acute uncomplicated appendicitis.

Background: Early surgery for appendicitis is thought to avoid complications associated with appendiceal rupture.

Aims: This study was to evaluate the effect of timing of surgery on complications, length of stay (LOS) and cost in patients undergoing appendectomy.

Materials And Methods: Retrospective review of 396 patients with appendectomies from January 1, 2005 to December 31, 2007 was performed.

Does helicopter transport improve outcomes independently of emergency medical system time?

Background: Helicopter emergency medical systems (HEMS) have been reported to improve trauma survival. This study seeks to determine HEMS effect on survival across different subpopulations in relation to injury severity, degree of physiologic derangement, and transportation time (TT).

Methods: The 2007 National Trauma Data Bank adult patients transported directly to hospitals by ground ambulance or HEMS were compared in relation to their survival with discharge and other possible confounders.

Degree of urbanization and mortality from motor vehicular crashes.

Purpose: : The purpose of this study is to establish whether motor vehicular crash (MVC) case fatality varies across different urbanization levels in the USA using a representative sample of crashes.

Methods: : Odds ratios (ORs) and 95% confidence intervals (CIs) for the association between urbanization level [i.e.

Frailty and injury causation.

Purpose: : The current study will attempt to elucidate whether frailty has a role in motor vehicle crash injury causation.

Methods: : The association between frailty and injury was studied among Crash Injury Research Engineering Network (CIREN) cases. The baseline "physical functioning" (PF) score of the SF-36 was used as a marker of frailty (i.

Delayed trauma team activation: patient characteristics and outcomes.

Background: The study aimed to characterize factors linked to delayed trauma team activation (DTTA) and to establish whether these delays are linked to worse outcomes.

Methods: Registry data were analyzed in regard to DTTA for years 2008 to 2010 at a Level II trauma center. DTTA was defined as cases when a trauma team activation or trauma consult occurred more than 30 minutes after arrival at the emergency department in the presence of triaging criteria or clinical evidence of traumatic injury.

Prospective randomized comparison of onabotulinumtoxinA (Botox) and abobotulinumtoxinA (Dysport) in the treatment of forehead, glabellar, and periorbital wrinkles.

Background: There are several commercially available neurotoxins to improve facial aesthetics, but few prospective, randomized trials have been conducted without commercial support to compare these agents.

Objectives: The authors present the results of a study examining and comparing the effects of onabotulinumtoxinA (BoNT-ONA; Botox, Allergan, Inc., Irvine, California) and abobotulinumtoxinA (BoNT-ABO; Dysport, Ipsen Ltd, Slough, UK).

Improving trauma triage using basic crash scene data.

Objective: to analyze the occurrence of severe injuries and deaths among crash victims transported to hospitals in relation to occupant and scene characteristics, including on-scene patient mobility, and their potential use in triaging patients to the appropriate level of care.

Methods: the occurrence of death and ISS>15 were studied in relation to occupant, crash and mobility data readily available to EMS at the scene, using weighted NASS-CDS data. Data set was randomly split in two for model development and evaluation.

Crash-related mortality and model year: are newer vehicles safer?

Objective: The objective of this study was to determine whether occupants of newer vehicles experience a lower risk of crash-related mortality.

Methods: The occurrence of death was studied in relation to vehicle model year (MY) among front seat vehicular occupants, age ≥ 16 captured in the National Automotive Sampling System Crashworthiness Data System (NASS-CDS) between 2000 and 2008. The associations between death and other occupant, vehicular and crash characteristics were also explored.

Disparities in trauma center access of older injured motor vehicular crash occupants.

Background: To evaluate whether older injured motor vehicular crash (MVC) occupants' access to trauma centers (TC) reflects the lower threshold suggested in triaging recommendations.

Methods: Adult front seat occupants of MVCs transported to a hospital from 1999 through 2006 included in the National Automotive Sampling System (NASS) were studied. Cases were classified by their age in years (≤60 years or >60 years).

Scene mobility status as a predictor of injury severity and mortality due to vehicular crashes.

Background: To examine the association of scene mobility status (SMS) and injury severity and mortality among motor vehicular crash (MVC) victims.

Methods: Adult MVC victims transported to medical facilities between 1997 and 2008 and included in the National Automotive Sampling System were studied. SMS was classified as follows: "ejected," "self-exited," "exited with assistance," "removed from the vehicle with decreased mental status," "removed due to perceived serious injury," and "removed for other reasons.

Occupant and crash characteristics for case occupants with cervical spine injuries sustained in motor vehicle collisions.

Background: Motor vehicle collisions (MVCs) are the leading cause of spine and spinal cord injuries in the United States. Traumatic cervical spine injuries (CSIs) result in significant morbidity and mortality. This study was designed to evaluate both the epidemiologic and biomechanical risk factors associated with CSI in MVCs by using a population-based database and to describe occupant and crashes characteristics for a subset of severe crashes in which a CSI was sustained as represented by the Crash Injury Research Engineering Network (CIREN) database.

Impulsive or depressive personality traits do not impede behavioral change after brief alcohol interventions.

The authors investigated whether impulsivity and depression affect the success of interventions to reduce alcohol use. Unadjusted and adjusted regression models were constructed to analyze the effect of impulsivity and depression on 12-month outcomes of participants of a trauma center based randomized trial of brief personalized motivational interventions versus information and advice. Of 497 problem drinkers enrolled in the program, 248 completed the 12-month follow-up.

Is spine consultation needed for all thoracolumbar fractures? Evaluation of a subspecialist-sparing protocol for screening and management of stable fractures.

Background: The shortage of neurosurgeons is a problem in many US trauma centers. Most thoracolumbar spine fractures are treated conservatively, and at our institution, we found that most patients did not require surgery. We hypothesize that most spine fractures can be treated safely and effectively by the trauma team, without neurosurgical consultation, using a protocol to guide diagnosis and treatment.

Race/ethnicity and acute respiratory distress syndrome: a National Trauma Data Bank study.

Background: A study in the general population has shown a higher acute respiratory distress syndrome (ARDS) mortality among blacks. We studied whether black blunt-trauma patients experience different ARDS incidence, ARDS-associated mortality, or ARDS case fatality rates.

Methods: National Trauma Data Bank (NTDB) extracts of blunt-trauma patients with Injury Severity Score (ISS) greater than 16 and length of stay greater than 3 days were used for this study.

Self-reported health indicators in the year following a motor vehicle crash: a comparison of younger versus older subjects.

Motor vehicle crash injuries among the elderly are an important public health problem. We sought to determine if older individuals (65 years and older) had worse self-reported physical functioning and mental health status than younger adults (18-64 years) at 6 and 12 months post-injury, while controlling for pre-injury functional status, comorbidity, and injury severity. We used data from two sites of the Crash Injury Research and Engineering Network (CIREN) study.

Crash test ratings and real-world frontal crash outcomes: a CIREN study.

Objective: To establish whether the Insurance Institute for Highway Safety (IIHS) offset crash test ratings are linked to different mortality rates in real world frontal crashes.

Methods: The study used Crash Injury Research Engineering Network drivers of age older than 15 years who were involved in frontal crashes. The Crash Injury Research Engineering Network is a convenience sample of persons injured in crashes with at least one Abbreviated Injury Scale score of 3+ injury or two Abbreviated Injury Scale score of 2+ injuries who were either treated at a Level I trauma center or died.