Age-related mortality in blunt traumatic hemorrhagic shock: the killers and the life savers.

Background: There are sparse data on the association between age and mortality in hemorrhagic shock (HS). We examined this association in this study.

Materials And Methods: The Glue Grant database was analyzed.

Abdominal compartment syndrome in traumatic hemorrhagic shock: is there a fluid resuscitation inflection point associated with increased risk?

Background: The volume of fluid administered during trauma resuscitation correlates with the risk of abdominal compartment syndrome (ACS). The exact volume at which this risk rises is uncertain. We established the inflection point for ACS risk during shock resuscitation.

Trauma associated splenic artery aneurysms: an analysis of the National Trauma Data Bank.

Background: Trauma associated splenic artery aneurysm (SAA) is potentially life threatening and infrequently studied. We evaluated the subject using a large trauma database.

Methods: The National Trauma Data Bank (2002 to 2006) was queried.

Body mass index in blunt trauma patients with hemorrhagic shock: opposite ends of the body mass index spectrum portend poor outcome.

Background: There are controversial data on the relationship between trauma and body mass index. We investigated this relationship in traumatic hemorrhagic shock.

Methods: The "Glue Grant" database was analyzed, stratifying patients into underweight, normal weight (NW), overweight, Class I obesity, Class II obesity, and Class III obesity.

Racial/ethnic disparities in revascularization for limb salvage: an analysis of the National Surgical Quality Improvement Program database.

Introduction: Previous reports have suggested that black patients have a higher rate of major lower extremity amputation and a lower rate of revascularization for limb salvage when compared to white patients.

Objective: We undertook this study to determine the extent of this ethnic disparity in recent years and to evaluate whether the widespread adoption of endovascular techniques has had an impact on this disparity.

Methods: The American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) database was queried to identify all patients who had undergone an above- or below-knee amputation as well as all patients who had undergone an open or endovascular revascularization procedure for critical limb ischemia for the years 2005 to 2006.

Pneumoperitoneum 48 days after laparoscopic hysterectomy.

Background And Objectives: Postoperative pneumoperitoneum following laparoscopic surgery is self-limited, typically resolving within days.

Methods: We analyzed the case of a 48-y-old woman who presented with acute abdominal pain 48 d after a total laparoscopic hysterectomy. Imaging studies revealed free air under the diaphragm suggesting a perforated viscus.

Associated injuries in traumatic sternal fractures: a review of the National Trauma Data Bank.

Sternal fractures occur infrequently with blunt force trauma. The demographics and epidemiology of associated injuries have not been well characterized from a national trauma database. The National Trauma Data Bank was queried for patients with closed sternal fractures.

Disparities in trauma care: are fewer diagnostic tests conducted for uninsured patients with pelvic fracture?

Background: Research from other medical specialties suggests that uninsured patients experience treatment delays, receive fewer diagnostic tests, and have reduced health literacy when compared with their insured counterparts. We hypothesized that these disparities in interventions would not be present among patients experiencing trauma. Our objective was to examine differences in diagnostic and therapeutic procedures administered to patients undergoing trauma with pelvic fractures using a national database.

Living on a prayer: religious affiliation and trauma outcomes.

Research has shown that religious affiliation is associated with reduced all cause mortality. The aim of this study was to determine if religious affiliation predicts trauma-specific mortality and length of stay. Patients admitted to our urban Level I trauma center in 2008 were examined; the main study categorization was based on endorsement of a specific religious affiliation during a standard intake procedure.

T4b breast masses: a retrospective review of 12 cases presenting to a metropolitan tertiary care center.

Introduction: Due to increased awareness of breast cancer resulting in early detection, there is a decreased incidence nationwide of late-stage breast cancer, including that which presents with skin involvement (T4b).

Methods: A retrospective analysis of a 10-month period from August 2007 to May 2008 at Howard University Hospital (HUH), Washington, DC, revealed 12 patients diagnosed with T4b breast cancer and compared to similarly staged patients in the Surveillance, Epidemiology, and End Results (SEER) database. Finally, a logistic regression for the likelihood of T4b diagnosis was performed patients in the SEER database.

Early-stage gallbladder cancer in the Surveillance, Epidemiology, and End Results database: effect of extended surgical resection.

Hypothesis: Extended surgical resection (ESR) may improve survival in patients with early-stage primary gallbladder cancer.

Design: Retrospective analysis of findings in the Surveillance, Epidemiology, and End Results (SEER) database.

Setting: Academic research.

Treatment outcomes of injured children at adult level 1 trauma centers: are there benefits from added specialized care?

Background: Accidental traumatic injury is the leading cause of morbidity and mortality in children. The authors hypothesized that no mortality difference should exist between children seen at ATC (adult trauma centers) versus ATC with added qualifications in pediatrics (ATC-AQ).

Methods: The National Trauma Data Bank, version 7.

Negative appendectomy: a 10-year review of a nationally representative sample.

Background: Appendectomy remains one of the most common emergency surgical procedures encountered throughout the United States. With improvements in diagnostic techniques, the efficiency of diagnosis has increased over the years. However, the entity of negative appendectomies still poses a dilemma because these are associated with unnecessary risks and costs to both patients and institutions.

Does the pattern of injury in elderly pedestrian trauma mirror that of the younger pedestrian?

Background: Walking is the primary mode of transportation for people aged 65 y and over; hence pedestrian injuries are a substantial source of morbidity and mortality among elderly patients in the United States. This study is aimed at evaluating the pattern of injury in the elderly pedestrians and how it differs from younger patients.

Methods: Retrospective analysis of the National Trauma Data Bank (2002-2006) was performed, with inclusion criteria defined as pedestrian injuries based on ICD-9 codes, excluding age < 15 y.

Pediatric trauma at an adult trauma center.

Background: Accidental traumatic injury is the number 1 cause of morbidity and mortality in the pediatric population. In this study, we aim to prove that certain pediatric patients can be treated with good outcomes at an adult level 1 trauma center.

Methods: Retrospective analysis using the Howard University Hospital trauma registry identified 71 patients treated at Howard University Hospital between the ages of 1 and 17 years old.

Ureteral trauma: patterns and mechanisms of injury of an uncommon condition.

Background: Traumatic ureteral injuries are uncommon, thus large series are lacking.

Methods: We performed a retrospective analysis of the National Trauma Data Bank (2002-2006).

Results: Of the 22,706 genitourinary injuries, 582 ureteral injury patients were identified (38.

Insurance status is a potent predictor of outcomes in both blunt and penetrating trauma.

Background: Patients with penetrating injuries are known to have worse outcomes than those with blunt trauma. We hypothesize that within each injury mechanism there should be no outcome difference between insured and uninsured patients.

Methods: The National Trauma Data Bank version 7 was analyzed.

Predictors for survival of penetrating trauma using emergency department thoracotomy in an urban trauma center: the Cardiac Instability Score.

Background: Emergency department thoracotomy (EDT) is a procedure used in an attempt to save lives of patients in extremis. This study aims to determine predictors of survival and futility by proposing a scoring scale that measures cardiac instability and its use in predicting survival of victims of penetrating trauma undergoing EDT.

Methods: This retrospective study analyzes patients who underwent EDT during a 45-month period at Howard University Hospital, Washington, DC.

Treatment and survival outcome for molecular breast cancer subtypes in black women.

Objective: To analyze whether the local-regional surgical treatments (breast-conserving therapy, mastectomy) resulted in different overall survival, distant metastasis-free survival, and locoregional recurrence-free survival rates for the various molecular breast cancer subtypes.

Summary Background Data: Molecular gene expression profiling has been proposed as a new classification and prognostication system for breast cancer. Current recommendation for local-regional treatment of breast cancer is based on traditional clinicopathologic variables.

Basal cell-like (triple-negative) breast cancer, a predictor of distant metastasis in African American women.

Background: The aim of this study was to evaluate the prognostic significance of the basal cell-like molecular breast cancer subtype with respect to locoregional recurrence and distant metastasis in African American women treated for breast cancer.

Methods: A retrospective analysis was performed of the tumor registry database for all African American women diagnosed and treated for breast cancer from 1998 to 2005 who had assessable data for all 3 markers: estrogen, progesterone, and Her-2/neu.

Results: A total of 372 patients were included in our study sample.

Epidemiology of trauma deaths in an urban level-1 trauma center predominantly among African Americans--implications for prevention.

This is a retrospective review to determine demographics, presentation and injury characteristics of trauma deaths at Howard University Hospital over an 1-year period (1994-2005) and to make recommendations for education and prevention in the community based on our findings. Data was obtained from the Howard University Hospital trauma registry. From the study period 1994-2005, there was a total of 365 trauma deaths.

Aminoglycoside pharmacokinetics in African-Americans with normal renal function.

Objective: To compare aminoglycoside pharmacokinetics in African-Americans with normal renal function with published adult population values.

Design: An Institutional Review Board approved concurrent study.

Setting: The study was conducted at Howard University Hospital, Washington DC.

Appropriateness of a 4 mg/kg gentamicin or tobramycin loading dose in post-operative septic shock patients.

Objective: To determine the frequency with which early adequate peak serum concentrations (6-12 mg/ litre) can be achieved following a 4 mg/kg loading dose of gentamicin or tobramycin in post-operative septic shock patients.

Method: Eleven post-operative septic shock patients were grouped into (i) a control group (n=7) who received the conventional gentamicin or tobramycin dosing regimen of 2 mg/kg loading dose followed by a maintenance dose of approximately 1.5mg/kg (peak and trough levels were measured after the third dose), and (ii) a study group (n = 4) who received a tobramycin or gentamicin 4 mg/kg loading dose, followed by 30 min, 3 h and 16 h serum drug level measurements.

Venous thromboembolism after penetrating chest trauma is not a cause of early death.

Background: Venous thromboembolism has been recognized as a potentially life-threatening complication following major thoracic trauma. Little or no attention has been directed at the difference in rates of venous thromboembolism in subjects with penetrating and nonpenetrating chest trauma.

Methods: The reported experience with venous thromboembolism in subjects with chest trauma has not segregated the effect penetrating vs.

Consumer product-related ocular trauma.

Leading causes of consumer product-related ocular trauma have not been well described. To delineate these causes in a nationally representative sample, data collected by the US Consumer Product Safety Commission (USCPSC) were reviewed. Data were obtained from the National Electronic Injury Surveillance System (NEISS), a national probability sample survey conducted by USCPSC that continuously monitors consumer product-related injuries treated in hospital emergency rooms across the United States.