Supratherapeutic vancomycin levels after trauma predict acute kidney injury and mortality.

Introduction: High-dose vancomycin is increasingly prescribed for critically ill trauma patients at risk for methicillin-resistant Staphylococcus aureus pneumonia. Although trauma patients have multiple known risk factors for acute kidney injury (AKI), a link between vancomycin and AKI or mortality has not been established. We hypothesize that high vancomycin trough concentration (VT) after trauma is associated with AKI and increased mortality.

Implementing acute care surgery at a level I trauma center: 1-year prospective evaluation of the impact of this shift on trauma volumes and outcomes.

Background: The purpose of this study was to evaluate the impact of the transition to acute care surgery (ACS) on trauma volumes and outcomes.

Methods: All admissions from 2 1-year periods from June 2008 to May 2010 (1 year before ACS and 1 year after ACS) to the LAC+USC Medical Center were prospectively collected. In anticipation of this change, trauma patient demographics, clinical data, and outcomes (trauma volume and preventable and potentially preventable deaths and complications) were prospectively collected.

Insurance type, not race, predicts mortality after pediatric trauma.

Background: In adult trauma, mortality varies with race and insurance status. In the elderly, insurance type has little impact on mortality after trauma and the influence of race is reduced. How race and insurance affect pediatric trauma requires further attention.

Emergency department blood transfusion: the first two units are free.

Introduction: Studies on blood product transfusions after trauma recommend targeting specific ratios to reduce mortality. Although crystalloid volumes as little as 1.5 L predict increased mortality after trauma, little data is available regarding the threshold of red blood cell (RBC) transfusion volume that predicts increased mortality.

Trauma center level impacts survival for cirrhotic trauma patients.

Background: Cirrhosis is known to be a significant risk factor for morbidity and mortality following trauma such that its presence is a requirement for trauma center transfer. The impact of trauma center level on post-injury survival in cirrhotic patients has not been well studied.

Methods: The National Trauma Databank (version 7) was used to identify patients admitted with cirrhosis as a preexisting comorbidity.

Insurance-and race-related disparities decrease in elderly trauma patients.

Background: Little focus is on health care disparities in the elderly, a population largely covered by public insurance. We characterized insurance type and race in elderly trauma patients to determine if lack of insurance or minority status predict increased mortality.

Methods: The National Trauma Data Bank (version 7.

Prevalence of HIV-1 infection in Zanzibar: results from a national HIV-1 serosurvey 2002.

Objective: To determine the prevalence of HIV-1 infection in Pemba and Zanzibar islands

Methods: We used an interviewer-administered questionnaire that consisted of pre-coded and open-ended questions consisting of 29 items. The questionnaire was developed in English and translated into Swahili language before use. The questionnaire was pilot tested and modified before use.

Impact of prehospital hypothermia on transfusion requirements and outcomes.

Background: Prehospital hypothermia (PH) is known to increase mortality following traumatic injury. PH relationship with transfusion requirements has not been documented. The purpose of this investigation was to analyze the impact of PH on blood product requirements and subsequent outcomes.

A focused educational program after religious services to improve organ donation in Hispanic Americans.

Religion is an important determinant in Hispanic Americans (HA) becoming organ donors as HA often believe religion forbids donation. We investigated the effect of an educational program targeting HA organ donation in places of worship. A prospective observational study was conducted at four Catholic churches with a high percentage of HA.

Support for blood alcohol screening in pediatric trauma.

Background: Alcohol intoxication in pediatric trauma is underappreciated. The aim of this study was to characterize alcohol screening rates in pediatric trauma.

Methods: The Los Angeles County Trauma System Database was queried for all patients aged ≤ 18 years who required admission between 2003 and 2008.

Decreased intracranial pressure monitor use at level II trauma centers is associated with increased mortality.

Previous investigations suggest outcome differences at Level I and Level II trauma centers. We examined use of intracranial pressure (ICP) monitors at Level I and Level II trauma centers after traumatic brain injury (TBI) and its effect on mortality. The 2007 to 2008 National Trauma Databank was reviewed for patients with an indication for ICP monitoring based on Brain Trauma Foundation (BTF) guidelines.

Influence of resident involvement on trauma care outcomes.

Hypothesis: Discrepancies exist in complications and outcomes at teaching trauma centers (TTCs) vs nonteaching TCs (NTCs).

Design: Retrospective review of the National Trauma Data Bank research data sets (January 1, 2007, through December 31, 2008).

Setting: Level II TCs.

General surgery resident remediation and attrition: a multi-institutional study.

Objective: To determine the rates and predictors of remediation and attrition among general surgery residents.

Design, Setting, And Participants: Eleven-year retrospective analysis of 348 categorical general surgery residents at 6 West Coast programs.

Main Outcome Measures: Rates and predictors of remediation and attrition.

The impact of meeting donor management goals on the number of organs transplanted per donor: results from the United Network for Organ Sharing Region 5 prospective donor management goals study.

Objective: Many organ procurement organizations have implemented critical care end points as donor management goals in efforts to increase organs transplanted per donor after neurologic determination of death. Although retrospective studies have demonstrated an association between meeting donor management goals and organ yield, prospective studies are lacking.

Design: In June 2008, nine donor management goals were prospectively implemented as a checklist and every donor after neurologic determination of death was managed to meet them.

β-adrenergic receptor inhibition affects cerebral glucose metabolism, motor performance, and inflammatory response after traumatic brain injury.

Background: The purpose of this study was to evaluate how β-adrenergic receptor inhibition after traumatic brain injury (TBI) alters changes in early cerebral glucose metabolism and motor performance, as well as cerebral cytokine and heat shock protein (HSP) expression.

Methods: Mouse cerebral glucose metabolism was measured by microPET fluorodeoxyglucose uptake and converted into standardized uptake values (SUV). Four groups of C57/Bl6 mice (wild type [WT]) were initially evaluated: sham or TBI, followed by tail vein injection of either saline or a nonselective β-adrenergic receptor inhibitor (propranolol, 4 mg/kg).

Incidence of venous thromboembolism after inferior vena cava injury.

Background: Complications after inferior vena cava (IVC) injury, including venous thromboembolism (VTE), are expected, but the exact incidence is poorly defined. The purpose of this study is to examine the VTE rate following ligation versus repair of IVC injuries.

Materials And Methods: The California State Inpatient Database was queried for all adult patients (age >14 y) admitted between 2005 and 2008 with IVC injuries.

Elevated systolic blood pressure after trauma: tolerated in the elderly.

Background: We undertook the current study to determine the impact of elevated admission systolic blood pressure (SBP) on trauma patients without severe brain injury.

Materials And Methods: We conducted a retrospective review of the Los Angeles County Trauma System database to identify all patients with moderate to severe injuries (injury severity score >9) admitted between 2003 and 2008. Patients with head abbreviated injury score >3 were excluded.

Impact of compliance with the American College of Surgeons trauma center verification requirements on organ donation-related outcomes.

Background: In order to maximize organ donation opportunities, the American College of Surgeons (ACS) requires verified trauma centers to have a relationship with an organ procurement organization (OPO), a policy for notification of the OPO, a process to review organ donation rates, and a protocol for declaring neurologic death. We hypothesized that meeting the ACS requirements will be associated with improved donation outcomes.

Study Design: Twenty-four ACS-verified Level I and Level II trauma centers were surveyed for the following registry data points from 2004 to 2008: admissions, ICU admissions, patients with a head Abbreviated Injury Score ≥ 5, deaths, and organ donors.

Beta-blocker exposure in the absence of significant head injuries is associated with reduced mortality in critically ill patients.

Background: The effect of β-blockade in trauma patients without significant head injuries is unknown. The purpose of this investigation was to determine the impact of β-blocker exposure on mortality in critically injured trauma patients who did not sustain significant head injuries.

Methods: Critically ill trauma patients (Injury Severity Score ≥ 25) admitted to the surgical intensive care unit from January 2000 to December 2008 without severe traumatic brain injuries (head Abbreviated Injury Score ≥ 3) were included in this retrospective review.

The effect of trauma center designation on organ donor outcomes in Southern California.

We sought to investigate the effect of trauma center designation on organ donor outcomes during a 5-year period. A retrospective study of the southern California regional Organ Procurement Organization database comparing trauma centers (n = 25) versus nontrauma centers (n = 171) and Level I (n = 7) versus Level II (n = 18) trauma centers between 2004 and 2008 was performed. A total of 16,830 referrals were evaluated and 44 per cent were from trauma centers.

Long-term effect of trauma splenectomy on blood glucose.

Background: Increasing evidence suggests that the spleen harbors stem cells that act as precursors to insulin-producing pancreas cells. Additionally, small studies with short-term follow-up associate splenectomy with increased rates of diabetes mellitus. The purpose of this study was to analyze the long-term effect of trauma splenectomy on blood glucose.

The impact of early hormonal therapy in catastrophic brain-injured patients and its effect on organ procurement.

The purpose of this study was to evaluate the impact of early hormonal therapy on organ procurement from catastrophic brain-injured patients. All catastrophic brain-injured patients admitted to a high-volume academic Level I trauma center who underwent successful organ procurement over a 3-year period (2006 to 2008) were reviewed. Patients were divided into two groups, those who received hormone therapy (HT) before brain death (BD) declaration and those who received HT after BD declaration.

Efficacy of beta-blockade after isolated blunt head injury: does race matter?

Background: Several retrospective clinical studies and recent prospective animal models demonstrate improved outcomes with beta-blocker administration after isolated blunt head injury. However, no investigations to date have examined the influence of race on the potential therapeutic effectiveness of these medications. Our hypothesis was that mortality benefits associated with beta-blocker exposure after isolated blunt head injury varies based on ethnicity.

Admission heart rate is a predictor of mortality.

Background: The association between admission heart rate (AHR) and mortality after trauma can assist initial emergency department triage and resuscitation. In addition, increased AHR is often associated with sympathetic hyperactivity which may require targeted treatment. We determined whether AHR was a predictor for mortality in trauma patients.