Publications by authors named "Nicole Fierro"
Article Synopsis
- The study examines the impact of illicit substance use during pregnancy, noting a 4-fold increase over two decades and its negative effects on mothers and fetuses.
- A multicenter retrospective analysis from 2016 to 2021 included 852 pregnant trauma patients (PTPs), with 9.8% testing positive for substances, primarily THC and methamphetamine.
- Findings showed that PTPs with positive urine toxicology had higher rates of blunt head injuries, extremity injuries, domestic violence incidents, and uterine contractions, but similar maternal complication rates compared to those who tested negative.
Article Synopsis
- Current guidelines suggest that patients with isolated sternal fractures (ISFs) and minor heart-related issues should undergo 24-hour telemetry monitoring, despite a single study indicating they might not need it.
- A study conducted across 8 trauma centers reviewed ISF patients with minor ECG changes or troponin elevation and found that very few (1.6%) experienced significant blunt cardiac injury (BCI), and none had BCI diagnosed via echocardiogram.
- The results imply that routine monitoring and echocardiography may not be necessary for ISF patients displaying minor ECG abnormalities and challenge existing medical protocols.
Article Synopsis
- Almost 10% of pregnant women experience serious injuries, but how serious injuries affect them and their babies isn’t well understood.
- A study looked at 950 pregnant women with injuries and found that about 3.4% had severe injuries, which led to more complications and higher risks for both the mother and baby.
- Severely injured women had more surgeries and a higher chance of losing their baby, so doctors need to be very careful when taking care of them.
Article Synopsis
- Doctors often use CT scans to check for injuries after car accidents, but for pregnant women, these scans can be risky for the baby.
- A study looked at how often pregnant women involved in car crashes got CT scans at 12 different hospitals from 2016 to 2021.
- The results showed a big difference in the number of scans given at each hospital, suggesting there should be clearer rules to keep both moms and babies safe while still finding any injuries.
Predictors of fetal delivery in pregnant trauma patients: A multicenter study.
J Trauma Acute Care Surg
January 2024
Background: Pregnant trauma patients (PTPs) undergo observation and fetal monitoring following trauma due to possible fetal delivery (FD) or adverse outcome. There is a paucity of data on PTP outcomes, especially related to risk factors for FD. We aimed to identify predictors of posttraumatic FD in potentially viable pregnancies.
View Article and Find Full Text PDFArticle Synopsis
- The study looked at the effects of pregnancy in older moms (35 years and older) who had trauma and compared them to younger pregnant moms.
- It found that older moms had more injuries to certain organs like the pancreas and stomach, but there was no difference in the chance of delivering the baby after trauma.
- Because of this, they decided that older moms don’t need extra monitoring compared to younger moms after a trauma.
Creatinine clearance predicts the goal enoxaparin dose in traumatic brain injury.
J Trauma Acute Care Surg
February 2024
Background: Patients with traumatic brain injury (TBI) are at high risk of venous thromboembolism (VTE). Recent guidelines recommend starting TBI patients on enoxaparin 30 mg twice daily and then considering weight-based dosing. Creatinine clearance may be better than weight for patients when considering high and low enoxaparin dose requirements.
View Article and Find Full Text PDFIntroduction: Guidelines encourage higher doses of low molecular weight heparin (LMWH) for prophylaxis in trauma patients. The risks of LMWH must be considered for patients who require an epidural catheter. We compared adequate and inadequate prophylaxis to determine if venous thromboembolism (VTE) and complication rates differed among patients with epidural catheters.
View Article and Find Full Text PDFThe futility of closed chest compressions after trauma: A multi-institutional study.
J Trauma Acute Care Surg
October 2023
Article Synopsis
- The study investigates survival rates of trauma patients who received closed chest compressions, focusing on different age groups from 2015 to 2020 across four trauma centers.
- Among the 247 patients analyzed, the overall mortality rate was 92%, with patients aged 70 and older showing 100% mortality and no survivors to hospital discharge.
- Findings suggest that closed chest compressions may have limited effectiveness in older adults, potentially guiding decisions on whether to proceed with such interventions in this population.
Background: Guidelines for enoxaparin dosing after trauma recommend an initial dose of 40 mg twice daily for most patients and then adjusting by anti-Xa levels. Previous studies indicated higher enoxaparin doses are necessary with higher levels of creatinine clearance (CrCl). We sought to determine if the goal enoxaparin dose correlates with the admission CrCl to reduce the reliance on measuring anti-Xa levels.
View Article and Find Full Text PDFIntroduction: Although indications and outcomes for trauma patients who require resuscitative thoracotomies are well studied, little is known about how prehospital chest compressions support survival in patients who do not meet criteria for subsequent resuscitative thoracotomy.
Methods: Data from a single institutional retrospective review of trauma patients who required prehospital chest compressions from 1/2015 to 12/2020 were collected. Patients who underwent compressions only were compared to those who underwent subsequent resuscitative thoracotomy.
Introduction: Trauma patients who develop indications for therapeutic anticoagulation (TAC) present a challenge due to concern for bleeding. Transfusion requirement has been described as a common complication of TAC after trauma but its clinical relevance is unclear.
Objective: Determine risk factors for and clinical outcomes associated with transfusion requirement on TAC after trauma.
Background: Bleeding from pelvic fractures can result in a high mortality rate unless quickly triaged by the trauma surgeon. Upon presentation, pelvic radiography may identify fractures that require angiography with possible embolization. We sought to address which fracture patterns seen on initial x-ray are associated with extravasation on angiography.
View Article and Find Full Text PDFBackground: Central and systemic immune dysfunction after traumatic brain injury (TBI) can lead to infectious-related complications, which may result in delayed mortality. The role of early empiric antibiotics after TBI has not been characterized to date, but is recommended in select cases to decrease complications. We aimed to determine the relationship between early antibiotic use and in-hospital mortality in TBI patients.
View Article and Find Full Text PDFBackground: Traumatic brain injury (TBI) results in an elaborate systemic cascade of secondary injury elicited in part by an intrinsic catecholamine response, which ultimately leads to changes in inflammation and coagulopathy. Attenuation of this catecholamine response with agents such as propranolol confers a survival advantage. The related impact of propranolol on venous thromboembolism (VTE) after TBI is largely unknown.
View Article and Find Full Text PDFBackground: Motocross-related injury patterns and outcomes are poorly understood. The purpose of this analysis was to characterize the epidemiology, injury patterns, and outcomes of motocross collisions. These parameters were compared with motorcycle collisions for context.
View Article and Find Full Text PDFBackground: Thrombocytosis following splenectomy is a common occurrence. Whether this thrombocytosis leads to a higher risk for venous thromboembolism (VTE) remains unclear. This investigation aimed to determine if splenectomy increases the risk for VTE.
View Article and Find Full Text PDFObjective: Offering undergraduate students research opportunities may enhance their interest in pursuing a surgical career and lead to increased academic productivity. We characterize the benefits of participating in the Trauma Research Associates Program.
Design: A 19-point Web-based survey.
Background: Inflammatory bowel disease is associated with a higher risk for venous thromboembolism (VTE). Whether Clostridium difficile infection similarly increases this risk is unknown.
Methods: This was a retrospective analysis of patients admitted to the surgical intensive care unit (ICU) at the Cedars-Sinai Medical Center from February 2011 to July 2013.
Article Synopsis
- The study investigates how postoperative fluid balance (FB) affects outcomes in acute care surgery patients in the surgical ICU.
- It followed 144 ACS patients from June 2012 to January 2013, categorizing them into FB-positive and FB-negative groups based on their fluid status by day 5 or discharge.
- Results revealed that achieving FB-negative status by day 5 significantly improved survival rates by nearly 70% and reduced complications, especially if achieved as early as day 1.