Outcomes With Overlapping Surgery at a Large Academic Medical Center.

Objective: The aim of the study was to evaluate the efficiency and safety of overlapping surgery (OS) at a training institution by comparing it with nonoverlapping surgery (NO) with respect to operative time, mortality, readmissions, and complications.

Background: OS is the practice of an attending physician providing supervision to 2 surgeries that are scheduled at overlapping times. Recent media and government attention have raised concerns about this practice and the need for informed patient consent.

A Role for the Early Warning Score in Early Identification of Critical Postoperative Complications.

Objective: We examined whether an early warning score (EWS) could predict inpatient complications in surgical patients.

Background: Abnormal vitals often precede in-hospital mortality. The EWS calculated using vital signs has been developed to identify patients at risk for mortality.

Use of a Bundle Checklist Combined With Physician Confirmation Reduces Risk of Nosocomial Complications and Death in Trauma Patients Compared to Documented Checklist Use Alone.

Background: Bundle checklists are increasingly utilized in patient care, but data are inconsistent regarding their efficacy in reducing nosocomial complication rates. We examined whether checklist usage was associated with nosocomial complications; when documented, elements were verified by provider bedside rounds.

Methods: We performed a retrospective cohort study of trauma patients admitted to our hospital during a three-phase implementation of a quality improvement project.

A 100% departmental mortality review improves observed-to-expected mortality ratios and University HealthSystem Consortium rankings.

Background: Public reporting of mortality, Patient Safety Indicators (PSI) and hospital-acquired conditions (HACs) is the reality of quality measurement. A review of our department's data identified opportunities for improvement. We began a surgeon-led 100% review of mortality, PSIs, and HACs to improve patient care and surgeon awareness of these metrics.

The deleterious effect of red blood cell storage on microvascular response to transfusion.

Background: The transfusion of relatively older red blood cells (RBCs) has been associated with both morbidity and mortality in trauma patients in observational studies. Although the mechanisms responsible for this phenomenon remain unclear, alterations in the microcirculation as a result of the transfusion of relatively older blood may be a causative factor. To assess this hypothesis, we evaluated microvascular perfusion in trauma patients during RBC transfusion.

Pediatric obesity and traumatic lower-extremity long-bone fracture outcomes.

Background: Pediatric obesity is associated with lower-extremity injuries and poor outcomes after blunt trauma. Our aim was to determine if obese pediatric patients with femur and tibia fractures have more severe injury patterns and worse outcomes compared with those of nonobese patients.

Methods: We performed a retrospective cohort study of obese and nonobese pediatric patients with femur or tibia fractures treated at two Level I trauma centers from 2004 to 2010.

Stress-induced hyperglycemia, not diabetic hyperglycemia, is associated with higher mortality in trauma.

Objectives: To identify all trauma patients with diabetes and compare diabetic hyperglycemia (DH) patients with those with stress-induced hyperglycemia (SIH).

Background: SIH has been shown to result in worse outcomes after trauma. The presence of diabetes mellitus (DM) or occult DM within the cohort confounded previous studies.

Microvascular response to red blood cell transfusion in trauma patients.

Trauma patients are often transfused allogeneic red blood cells (RBCs) in an effort to augment tissue oxygen delivery. However, the effect of RBC transfusion on microvascular perfusion in this patient population is not well understood. To this end, we investigated the effect of RBC transfusion on sublingual microvascular perfusion in trauma patients.

Intubation patterns and outcomes in patients with computed tomography-verified traumatic brain injury.

Background: Studies evaluating traumatic brain injury (TBI) patients have shown an association between prehospital (PH) intubation and worse outcomes. However, previous studies have used surrogates, e.g.

Prospective identification of patients at risk for massive transfusion: an imprecise endeavor.

Most retrospective studies evaluating fresh-frozen plasma:packed red blood cell ratios in trauma patients requiring massive transfusion (MT) are limited by survival bias. As prospective resource-intensive studies are being designed to better evaluate resuscitation strategies, it is imperative that patients with a high likelihood of MT are identified early. The objective of this study was to develop a predictive model for MT in civilian trauma patients.

Identifying risk for massive transfusion in the relatively normotensive patient: utility of the prehospital shock index.

Background: In the prehospital environment, the failure of medical providers to recognize latent physiologic derangement in patients with compensated shock may risk undertriage. We hypothesized that the shock index (SI; heart rate divided by systolic blood pressure [SBP]), when used in the prehospital setting, could facilitate the identification of such patients. The objective of this study was to assess the association between the prehospital SI and the risk of massive transfusion (MT) in relatively normotensive blunt trauma patients.

Duration of red cell storage influences mortality after trauma.

Background: Although previous studies have identified an association between the transfusion of relatively older red blood cells (RBCs) (storage ≥ 14 days) and adverse outcomes, they are difficult to interpret because the majority of patients received a combination of old and fresh RBC units. To overcome this limitation, we compared in-hospital mortality among patients who received exclusively old versus fresh RBC units during the first 24 hours of hospitalization.

Methods: Patients admitted to a Level I trauma center between January 2000 and May 2009 who received ≥ 1 unit of exclusively old (≥ 14 days) vs.

Computed tomography identification of latent pseudoaneurysm after blunt splenic injury: pathology or technology?

Background: Serial computed tomography (CT) imaging of blunt splenic injury can identify the latent formation of splenic artery pseudoaneurysms (PSAs), potentially contributing to improved success in nonoperative management. However, it remains unclear whether the delayed appearance of such PSAs is truly pathophysiologic or attributable to imaging quality and timing. The objective of this study was to evaluate the influence of recent advancements in imaging technology on the incidence of the latent PSA.

Lactate is a better predictor than systolic blood pressure for determining blood requirement and mortality: could prehospital measures improve trauma triage?

Background: Standard hemodynamic evaluation of patients in shock may underestimate severity of hemorrhage given physiologic compensation. Blood lactate (BL) is an important adjunct in characterizing shock, and point-of-care devices are currently available for use in the prehospital (PH) setting. The objective of this study was to determine if BL levels have better predictive value when compared with systolic blood pressure (SBP) for identifying patients with an elevated risk of significant transfusion and mortality in a hemodynamically indeterminant cohort.

Prospective implementation of an algorithm for bedside intravascular ultrasound-guided filter placement in critically ill patients.

Background: Although contrast venography is the standard imaging method for inferior vena cava (IVC) filter insertion, intravascular ultrasound (IVUS) imaging is a safe and effective option that allows for bedside filter placement and is especially advantageous for immobilized critically ill patients by limiting resource use, risk of transportation, and cost. This study reviewed the effectiveness of a prospectively implemented algorithm for IVUS-guided IVC filter placement in this high-risk population.

Methods: Current evidence-based guidelines were used to create a clinical decision algorithm for IVUS-guided IVC filter placement in critically ill patients.

A comparison of wakeboard-, water skiing-, and tubing-related injuries in the United States, 2000-2007.

The purpose of the study was to compare tubing-related injuries to wakeboarding- and water skiing-related injuries. Data was collected from the 2000-2007 National Electronic Injury Surveillance Survey for 1,761 individuals seeking care at an emergency department due to a tubing-, wakeboarding, or water skiing-related injury. Data included patient age and sex, as well as injury characteristics including body region injured (i.

Epidemiology of tree stand-related injuries in the United States from 2000 to 2007.

Background: : Tree stands have remained popular among hunters because of the increased vantage point for the hunter. Although stand styles vary, the typical stand is very minimalistic in design, comprising a seat and an area for the hunter to place his feet. Although there have been studies using state trauma registry data, to date, there has not been a study on the epidemiology of tree stand-related injuries in the national population.

Management of colon wounds in the setting of damage control laparotomy: a cautionary tale.

Background: Although colon wounds are commonly treated in the setting of damage control laparotomy (DCL), a paucity of data exist to guide management. The purpose of this study was to evaluate our experience with the management of colonic wounds in the context of DCL, using colonic wound outcomes after routine, single laparotomy (SL) as a benchmark.

Methods: Consecutive patients during a 7-year period with full-thickness or devitalizing colon injury were identified.

Blood utilization at a level I trauma center: is this as good as it gets?

Recognition of the adverse effects of allogeneic blood resulted in the decreased use of red blood cell (RBC) transfusion in surgical practice in the 1990s. Our objective was to evaluate patterns of RBC transfusion utilization among trauma patients during the current decade. Blunt trauma patients admitted to a regional trauma center between 2000 and 2007 were identified (n = 16,011).

The association between price of regular-grade gasoline and injury and mortality rates among occupants involved in motorcycle- and automobile-related motor vehicle collisions.

Motorcyclists have been reported to be more likely to die in a motor vehicle collision (MVC) than automobile occupants. With the recent increase in the pump price of gasoline, it has been reported that people are switching to motorcycles as main modes of transportation. This study evaluated the association between motor vehicle collision-related injury and mortality rates and increases in gasoline prices for occupants of automobiles and riders of motorcycles.

Transfusion and pneumonia in the trauma intensive care unit: an examination of the temporal relationship.

Background: Transfusion has been demonstrated to be associated with pneumonia in injured patients, and blood of older storage age may potentiate this morbidity. It remains unclear, however, whether this association is causal, as prior studies have not accounted for prepneumonia versus postpneumonia transfusion. We sought to evaluate the temporal relationship between transfusion and pneumonia and the influence of blood age on this relationship.

Sodium nitrite therapy attenuates the hypertensive effects of HBOC-201 via nitrite reduction.

Hypertension secondary to scavenging of NO remains a limitation in the use of HBOCs (haemoglobin-based oxygen carriers). Recent studies suggest that nitrite reduction to NO by deoxyhaemoglobin supports NO signalling. In the present study we tested whether nitrite would attenuate HBOC-mediated hypertension using HBOC-201 (Biopure), a bovine cross-linked, low-oxygen-affinity haemoglobin.

Body mass index affects time to definitive closure after damage control surgery.

Background: A growing body of literature demonstrates that irrespective of the mechanism of injury, obesity is associated with significantly worse morbidity and mortality after trauma. Among patients requiring damage control laparotomy (DCL), clinical experience suggests that obesity affects time to definitive closure though this association has never been demonstrated quantitatively.

Methods: All patients at an academic Level I trauma center requiring a DCL between January 2002 and December 2006 (N = 148) were included.

Traumatic brain injury is associated with the development of deep vein thrombosis independent of pharmacological prophylaxis.

Introduction: Deep venous thrombosis (DVT) is common among trauma patients. If left untreated it may result in lethal pulmonary thromboembolism. Previous studies have suggested that intracranial hemorrhage serves as an independent risk factor for the development of DVT.