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Byerly S, Inaba K, Biswas S, Cheng V, Cho J, Wang E, Strumwasser A, Matsushima K, Demetriades D. Hit by a Train: Injury Burden and Clinical Outcomes. J Emerg Med 2019; 57:6-12. [PMID: 31078347 DOI: 10.1016/j.jemermed.2019.03.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 03/17/2019] [Accepted: 03/30/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Few data exist regarding the train vs. pedestrian (TVP) injury burden and outcomes. OBJECTIVE This study aimed to examine the epidemiology and outcomes associated with TVP injuries. METHODS This is a retrospective National Trauma Databank study (January 2007 to July 2012) including trauma patients sustaining TVP injury. Demographics, injury data, interventions, and outcomes were abstracted. Patients injured by a train were compared to patients who sustained an automobile vs. pedestrian (AVP) injury. RESULTS Of the 152,631 patients struck by ground transportation during the study time frame, 1863 (1.2%) were TVP. Median TVP age was 38 years (interquartile range [IQR] 24-50 years), 81.6% were male, median Injury Severity Score (ISS) was 13 (IQR 6-24). TVP patients were more severely injured (ISS 13 vs. 9; p < 0.001) and required more proximal amputations (13.4% vs. 0.2%; p < 0.001) and cavitary operations (18.2% vs. 2.8%; p < 0.001). TVP patients had higher rates of intensive care unit admission, mechanical ventilation and transfusion, longer length of stay, and higher in-hospital mortality. On multivariable logistical regression, TVP was an independent predictor for higher injury burden, ISS ≥25 (adjusted odds ratio [AOR] 1.650), immediate operative need (AOR 7.535), and complications (AOR 1.317). CONCLUSIONS TVP is associated with a significant injury burden. These patients have a significantly higher need for immediate operation and more complicated hospital course.
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Affiliation(s)
- Saskya Byerly
- Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
| | - Kenji Inaba
- Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
| | - Subarna Biswas
- Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
| | - Vince Cheng
- Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
| | - Jayun Cho
- Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
| | - Eugene Wang
- Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
| | - Aaron Strumwasser
- Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
| | - Kazuhide Matsushima
- Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
| | - Demetrios Demetriades
- Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
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52
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Banks K, Biswas S, Wong M, Byerly S, Clark D, Lam L, Inaba K, Demetriades D. Cannabis Use Is Associated with Increased Mechanical Ventilation and Polysubstance Use in Trauma Patients. Am Surg 2019; 85:226-229. [PMID: 30819304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Recent policy changes in California regarding cannabis use underscore the need to study outcomes and prevalence of this drug in trauma. Our study aims to study the prevalence of cannabis use and associations with injury types and outcomes in Los Angeles County trauma patients. Data were reviewed from 21,276 adult patients from a Los Angeles countywide database spanning five years (2012-2016), who underwent urine toxicology testing in the ED after sustaining a traumatic injury. The percentage of trauma patients using marijuana increased from 36 to 43 per cent over the five-year period. On univariate analysis, cannabis-positive patients were significantly younger and more likely male, with lower median systolic blood pressure and heart rate on arrival in the ED. A higher proportion of cannabis users had penetrating trauma, and 48 per cent of cannabis users also tested positive for amphetamines, cocaine, opioids, or Phencyclidine. On multivariate analysis, cannabis was associated with an increase in need for mechanical ventilation after adjusting for age, admission Glasgow Coma Score, gender, polysubstance use, blunt or penetrating mechanism, and Injury Severity Score, and was not associated with increases in mortality or ICU length of stay.
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Banks K, Biswas S, Wong M, Byerly S, Clark D, Lam L, Inaba K, Demetriades D. Cannabis Use is Associated with Increased Mechanical Ventilation and Polysubstance Use in Trauma Patients. Am Surg 2019. [DOI: 10.1177/000313481908500234] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recent policy changes in California regarding cannabis use underscore the need to study outcomes and prevalence of this drug in trauma. Our study aims to study the prevalence of cannabis use and associations with injury types and outcomes in Los Angeles County trauma patients. Data were reviewed from 21,276 adult patients from a Los Angeles countywide database spanning five years (2012–2016), who underwent urine toxicology testing in the ED after sustaining a traumatic injury. The percentage of trauma patients using marijuana increased from 36 to 43 per cent over the five-year period. On univariate analysis, cannabis-positive patients were significantly younger and more likely male, with lower median systolic blood pressure and heart rate on arrival in the ED. A higher proportion of cannabis users had penetrating trauma, and 48 per cent of cannabis users also tested positive for amphetamines, cocaine, opioids, or Phencyclidine. On multivariate analysis, cannabis was associated with an increase in need for mechanical ventilation after adjusting for age, admission Glasgow Coma Score, gender, polysubstance use, blunt or penetrating mechanism, and Injury Severity Score, and was not associated with increases in mortality or ICU length of stay.
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Affiliation(s)
- Kian Banks
- From the LAC+USC Medical Center, Los Angeles, California
| | - Subarna Biswas
- From the LAC+USC Medical Center, Los Angeles, California
| | - Monica Wong
- From the LAC+USC Medical Center, Los Angeles, California
| | - Saskya Byerly
- From the LAC+USC Medical Center, Los Angeles, California
| | - Damon Clark
- From the LAC+USC Medical Center, Los Angeles, California
| | - Lydia Lam
- From the LAC+USC Medical Center, Los Angeles, California
| | - Kenji Inaba
- From the LAC+USC Medical Center, Los Angeles, California
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54
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Cheng V, Byerly S, Matsushima K, Inaba K, Magee GA. Popliteal Vein Ligation Is Not Associated with Worse Outcomes in Trauma Patients. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.07.558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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55
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Cheng V, Inaba K, Matsushima K, Schellenberg M, Byerly S, Strumwasser AM, Lam L, Demetriades D. Preoperative CT in Hemodynamically Unstable Trauma Patients Is Associated with Improved Clinical Outcomes. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.07.562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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56
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Barrett CD, Moore HB, Sriram G, Lim DC, Byerly S, Chapman MP, Moore EE, Yaffe MB. Tranexamic Acid Mediates Pro- and Anti-Inflammatory Signaling via Complement C5a Regulation in a Plasminogen Activator-Dependent Manner. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.07.567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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57
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Byerly S, Benjamin E, Biswas S, Wang E, Inaba K, Demetriades D. Creatinine Kinase and Stimulant Abuse in Trauma. Am Surg 2018; 84:13-16. [PMID: 29642979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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58
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Byerly S, Benjamin E, Biswas S, Wang E, Inaba K, Demetriades D. Creatinine Kinase and Stimulant Abuse in Trauma. Am Surg 2018. [DOI: 10.1177/000313481808400109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Saskya Byerly
- Division of Trauma and Critical Care Department of Surgery LAC+USC Medical Center University of Southern California Los Angeles, California
| | - Elizabeth Benjamin
- Division of Trauma and Critical Care Department of Surgery LAC+USC Medical Center University of Southern California Los Angeles, California
| | - Subarna Biswas
- Division of Trauma and Critical Care Department of Surgery LAC+USC Medical Center University of Southern California Los Angeles, California
| | - Eugene Wang
- Medstar Washington Hospital Center Department of Surgery Washington, DC
| | - Kenji Inaba
- Division of Trauma and Critical Care Department of Surgery LAC+USC Medical Center University of Southern California Los Angeles, California
| | - Demetrios Demetriades
- Division of Trauma and Critical Care Department of Surgery LAC+USC Medical Center University of Southern California Los Angeles, California
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59
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Byerly S, Benjamin E, Biswas S, Cho J, Wang E, Wong MD, Inaba K, Demetriades D. Peak creatinine kinase level is a key adjunct in the evaluation of critically ill trauma patients. Am J Surg 2017; 214:201-206. [DOI: 10.1016/j.amjsurg.2016.11.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/14/2016] [Accepted: 11/21/2016] [Indexed: 02/06/2023]
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60
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Wang E, Inaba K, Byerly S, Mendelsberg R, Sava J, Benjamin E, Lam L, Demetriades D. Safety of early ambulation following blunt abdominal solid organ injury: A prospective observational study. Am J Surg 2017; 214:402-406. [PMID: 28610936 DOI: 10.1016/j.amjsurg.2017.05.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 04/18/2017] [Accepted: 05/02/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is continued debate regarding the optimal period of bed-rest and in-hospital monitoring for non-operative management of solid organ injury following blunt trauma. METHODS Single center, prospective, observational study of blunt solid organ injuries from 07/2014-02/2016, managed initially without surgical or angiographic intervention. Early ambulation was defined as ≤24 h. RESULTS 79 patients met inclusion criteria, with 36 (45.6%) in the early ambulation group and 43 (54.4%) in the late ambulation group. There were zero complications in the early ambulation group, and three complications in the late ambulation group (complications, p = 0.246; further interventions, p = 0.498). Median ICU LOS was zero days and three days for early vs. late ambulation, p = 0.001. Median total LOS was two days and five days for early vs. late ambulation, p < 0.001. CONCLUSION Early ambulation is safe in patients undergoing non-operative management of their solid organ injury, and may result in a reduced length of stay.
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Affiliation(s)
- Eugene Wang
- Division of Trauma and Critical Care, LAC+USC Medical Center, Los Angeles, CA, USA.
| | - Kenji Inaba
- Division of Trauma and Critical Care, LAC+USC Medical Center, Los Angeles, CA, USA.
| | - Saskya Byerly
- Division of Trauma and Critical Care, LAC+USC Medical Center, Los Angeles, CA, USA.
| | - Ranan Mendelsberg
- Division of Trauma and Critical Care, LAC+USC Medical Center, Los Angeles, CA, USA.
| | - Jack Sava
- Division of Trauma and Critical Care, Medstar Washington Hospital Center, Washington, DC, USA.
| | - Elizabeth Benjamin
- Division of Trauma and Critical Care, LAC+USC Medical Center, Los Angeles, CA, USA.
| | - Lydia Lam
- Division of Trauma and Critical Care, LAC+USC Medical Center, Los Angeles, CA, USA.
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Byerly S, Inaba K, Biswas S, Wang E, Wong MD, Benjamin ER, Lam L, Demetriades D. Transfusion-Related Hypocalcemia after Trauma. J Am Coll Surg 2016. [DOI: 10.1016/j.jamcollsurg.2016.08.527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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62
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Johnson M, Inaba K, Byerly S, Falsgraf E, Lam L, Benjamin E, Strumwasser A, David JS, Demetriades D. Intraosseous Infusion as a Bridge to Definitive Access. Am Surg 2016. [DOI: 10.1177/000313481608201003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intraosseous (IO) needle placement is an alternative for patients with difficult venous access. The purpose of this retrospective study was to examine indications and outcomes associated with IO use at a Level 1 trauma center (January 2008–May 2015). Data points included demographics, time to insertion, intravenous (IV) access points, indications, infusions, hospital and intensive care unit length of stay, and mortality. Of 68 patients with IO insertion analyzed (63.2% blunt trauma, 29.4% penetrating trauma, and 7.4% medical), 56 per cent were hypotensive on arrival and 38.2 per cent asystolic. The most common indications for IO infusion were difficult IV access (69%) and rapid sequence intubation (20.6%). The median time to IO access was three minutes. IV access was gained after IO in 72.1 per cent of patients. Through IO access, 30.9 per cent patients received crystalloid, 29.4 per cent received Advanced Care Life Support (ACLS) medications, 25 per cent rapid sequence intubation medications, 20.6 per cent blood products, and 2.9 per cent seizure medications. Overall, 80.9 per cent were intubated in the Emergency Department (ED), 26.5 per cent had ED thoracotomy, and 20.6 per cent had a laparotomy. Median crystalloid infused through IO was 180 cc in pediatric patients and 1 L in adults, respectively. Extravasation, the most common complication, was experienced by 7.4 per cent of patients. Inhospital mortality was 72.9 per cent. IO access should be considered when there is a need for rapid intervention requiring vascular access.
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Affiliation(s)
- Megan Johnson
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Kenji Inaba
- Division of Trauma Surgery and Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California; and
| | - Saskya Byerly
- Division of Trauma Surgery and Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California; and
| | - Erika Falsgraf
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | - Elizabeth Benjamin
- Division of Trauma Surgery and Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California; and
| | - Aaron Strumwasser
- Division of Trauma Surgery and Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California; and
| | - Jean-Stephane David
- Department of Anesthesia and Intensive Care, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre Benite and Lyon Sud School of Medicine, Claude Bernard Lyon 1 University, Oullins, France
| | - Demetrios Demetriades
- Division of Trauma Surgery and Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California; and
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63
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Wang E, Inaba K, Cho J, Byerly S, Rowe V, Benjamin E, Lam L, Demetriades D. Do Antiplatelet and Anticoagulation Agents Matter after Repair of Traumatic Arterial Injuries? Am Surg 2016; 82:968-972. [PMID: 27779985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Thrombosis is a devastating complication after repair of traumatic vascular injury. Although thrombosis rates have been described, the value of anticoagulation in preventing postrepair thrombosis is unknown. We hypothesize that postoperative anticoagulation reduces thrombosis rates. A total of 1524 consecutive patients with traumatic arterial injuries from January 2005 to June 2015 were identified, and 381 patients underwent the following repair types: direct suture of vessel wall, primary anastomosis, extra-anatomic reconstruction, tissue and synthetic interposition reconstruction. Twenty six patients received postoperative heparin at therapeutic levels, and 29 patients received postoperative aspirin for five consecutive days. The heparin and aspirin groups were matched with patients without postoperative anticoagulation by the following variables: anatomic arterial injury, type of vascular repair, and age. These groups were then compared using the following outcome measures: mortality, thrombosis of repaired vessel, amputation, hemorrhage, cerebral vascular accident, and extremity compartment syndrome. The demographics between the heparin, aspirin, and respectively matched groups were not statistically different. There was no statistically significant difference in the rate of thrombosis, bleeding, compartment syndrome, cerebral vascular accident, limb amputation, or mortality. Although there was no increase in bleeding complications with the use of heparin or aspirin, there was also no impact on the rate of thrombosis.
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Affiliation(s)
- Eugene Wang
- Division of Trauma and Critical Care, University of Southern California, Los Angeles, California, USA
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64
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Wang E, Benjamin ER, Byerly S, Llaquet H, Matsushima K, Inaba K, Demetriades D. Liberal Use of Pelvic Binders in the Pre-Hospital and Emergency Room Setting may be Harmful. J Am Coll Surg 2016. [DOI: 10.1016/j.jamcollsurg.2016.08.505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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65
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Johnson M, Inaba K, Byerly S, Falsgraf E, Lam L, Benjamin E, Strumwasser A, David JS, Demetriades D. Intraosseous Infusion as a Bridge to Definitive Access. Am Surg 2016; 82:876-880. [PMID: 27779964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Intraosseous (IO) needle placement is an alternative for patients with difficult venous access. The purpose of this retrospective study was to examine indications and outcomes associated with IO use at a Level 1 trauma center (January 2008-May 2015). Data points included demographics, time to insertion, intravenous (IV) access points, indications, infusions, hospital and intensive care unit length of stay, and mortality. Of 68 patients with IO insertion analyzed (63.2% blunt trauma, 29.4% penetrating trauma, and 7.4% medical), 56 per cent were hypotensive on arrival and 38.2 per cent asystolic. The most common indications for IO infusion were difficult IV access (69%) and rapid sequence intubation (20.6%). The median time to IO access was three minutes. IV access was gained after IO in 72.1 per cent of patients. Through IO access, 30.9 per cent patients received crystalloid, 29.4 per cent received Advanced Care Life Support (ACLS) medications, 25 per cent rapid sequence intubation medications, 20.6 per cent blood products, and 2.9 per cent seizure medications. Overall, 80.9 per cent were intubated in the Emergency Department (ED), 26.5 per cent had ED thoracotomy, and 20.6 per cent had a laparotomy. Median crystalloid infused through IO was 180 cc in pediatric patients and 1 L in adults, respectively. Extravasation, the most common complication, was experienced by 7.4 per cent of patients. Inhospital mortality was 72.9 per cent. IO access should be considered when there is a need for rapid intervention requiring vascular access.
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Affiliation(s)
- Megan Johnson
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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66
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Wang E, Inaba K, Cho J, Byerly S, Rowe V, Benjamin E, Lam L, Demetriades D. Do Antiplatelet and Anticoagulation Agents Matter after Repair of Traumatic Arterial Injuries? Am Surg 2016. [DOI: 10.1177/000313481608201024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Thrombosis is a devastating complication after repair of traumatic vascular injury. Although thrombosis rates have been described, the value of anticoagulation in preventing postrepair thrombosis is unknown. We hypothesize that postoperative anticoagulation reduces thrombosis rates. A total of 1524 consecutive patients with traumatic arterial injuries from January 2005 to June 2015 were identified, and 381 patients underwent the following repair types: direct suture of vessel wall, primary anastomosis, extra-anatomic reconstruction, tissue and synthetic interposition reconstruction. Twenty six patients received postoperative heparin at therapeutic levels, and 29 patients received postoperative aspirin for five consecutive days. The heparin and aspirin groups were matched with patients without postoperative anticoagulation by the following variables: anatomic arterial injury, type of vascular repair, and age. These groups were then compared using the following outcome measures: mortality, thrombosis of repaired vessel, amputation, hemorrhage, cerebral vascular accident, and extremity compartment syndrome. The demographics between the heparin, aspirin, and respectively matched groups were not statistically different. There was no statistically significant difference in the rate of thrombosis, bleeding, compartment syndrome, cerebral vascular accident, limb amputation, or mortality. Although there was no increase in bleeding complications with the use of heparin or aspirin, there was also no impact on the rate of thrombosis.
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Affiliation(s)
- Eugene Wang
- From the Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
| | - Kenji Inaba
- From the Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
| | - Jayun Cho
- From the Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
| | - Saskya Byerly
- From the Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
| | - Vincent Rowe
- From the Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
| | - Elizabeth Benjamin
- From the Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
| | - Lydia Lam
- From the Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
| | - Demetrios Demetriades
- From the Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
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67
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Byerly S, Chopra S, Nassif NA, Chen P, Sener SF, Eisenberg BL, Tseng WW. The role of margins in extremity soft tissue sarcoma. J Surg Oncol 2015; 113:333-8. [PMID: 26662660 DOI: 10.1002/jso.24112] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 11/14/2015] [Indexed: 12/13/2022]
Abstract
For extremity soft tissue sarcomas, limb salvage is now standard of care. The extent of surgical margins is balanced with functionality of the resected limb. Although negative margins are the goal, the necessary width is unclear. Additional considerations for margin adequacy include presence of anatomic barriers such as fascia and periosteum, proximity of critical structures, receipt of adjuvant and neoadjuvant therapies, and histologic subtype. Multidisciplinary team discussion is critical for treatment planning.
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Affiliation(s)
- Saskya Byerly
- Department of Surgery, Section of Surgical Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Shefali Chopra
- Department of Surgery, Section of Surgical Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Nader A Nassif
- Sarcoma Program, Hoag Memorial Hospital Presbyterian, Newport Beach, California
| | - Peter Chen
- Sarcoma Program, Hoag Memorial Hospital Presbyterian, Newport Beach, California
| | - Stephen F Sener
- Department of Surgery, Section of Surgical Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Burton L Eisenberg
- Sarcoma Program, Hoag Memorial Hospital Presbyterian, Newport Beach, California
| | - William W Tseng
- Department of Surgery, Section of Surgical Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California.,Sarcoma Program, Hoag Memorial Hospital Presbyterian, Newport Beach, California
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68
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Resnick S, Inaba K, Karamanos E, Pham M, Byerly S, Talving P, Reddy S, Linnebur M, Demetriades D. Clinical Relevance of Magnetic Resonance Imaging in Cervical Spine Clearance. JAMA Surg 2014; 149:934-9. [DOI: 10.1001/jamasurg.2014.867] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Shelby Resnick
- Division of Acute Care Surgery, Department of Surgery, Los Angeles County + University of Southern California Medical Center, Los Angeles
| | - Kenji Inaba
- Division of Acute Care Surgery, Department of Surgery, Los Angeles County + University of Southern California Medical Center, Los Angeles
| | - Efstathios Karamanos
- Division of Acute Care Surgery, Department of Surgery, Los Angeles County + University of Southern California Medical Center, Los Angeles
| | - Martin Pham
- Department of Neurosurgery, Los Angeles County + University of Southern California Medical Center, Los Angeles
| | - Saskya Byerly
- Division of Acute Care Surgery, Department of Surgery, Los Angeles County + University of Southern California Medical Center, Los Angeles
| | - Peep Talving
- Division of Acute Care Surgery, Department of Surgery, Los Angeles County + University of Southern California Medical Center, Los Angeles
| | - Sravanthi Reddy
- Department of Radiology, Los Angeles County + University of Southern California Medical Center, Los Angeles
| | - Megan Linnebur
- Division of Acute Care Surgery, Department of Surgery, Los Angeles County + University of Southern California Medical Center, Los Angeles
| | - Demetrios Demetriades
- Division of Acute Care Surgery, Department of Surgery, Los Angeles County + University of Southern California Medical Center, Los Angeles
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69
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Joos E, Inaba K, Karamanos E, Byerly S, Nozanov L, Vogt K, Grabo D, Demetriades D. Ocular trauma at a level I trauma center: the burden of penetrating injuries. Am Surg 2014; 80:207-209. [PMID: 24480225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Emilie Joos
- LAC+USC Medical Center, Division of Acute Care Surgery, Los Angeles, California, USA
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70
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Joos E, Inaba K, Karamanos E, Byerly S, Nozanov L, Vogt K, Grabo D, Demetriades D. Ocular Trauma at a Level I Trauma Center: The Burden of Penetrating Injuries. Am Surg 2014. [DOI: 10.1177/000313481408000233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Emilie Joos
- LAC+USC Medical Center Division of Acute Care Surgery Los Angeles, California
| | - Kenji Inaba
- LAC+USC Medical Center Division of Acute Care Surgery Los Angeles, California
| | | | - Saskya Byerly
- LAC+USC Medical Center Division of Acute Care Surgery Los Angeles, California
| | - Lauren Nozanov
- LAC+USC Medical Center Division of Acute Care Surgery Los Angeles, California
| | - Kelly Vogt
- LAC+USC Medical Center Division of Acute Care Surgery Los Angeles, California
| | - Daniel Grabo
- LAC+USC Medical Center Division of Acute Care Surgery Los Angeles, California
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Byerly S. FORE resource update: clinical data management. J AHIMA 1997; 68:47-8. [PMID: 10168982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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