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Knod JL, Sathya C, Griggs CL, Henry MC, Froehlich M, Zallen G, Coakley BA, Masiakos PT, Gow KW, Naik-Mathuria B. Promoting Firearm Injury Prevention and Advocacy as Pediatric Surgeons: A Call to Action From the APSA/AAP Advocacy Committee. J Pediatr Surg 2024; 59:1135-1141. [PMID: 38160188 DOI: 10.1016/j.jpedsurg.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024]
Abstract
Firearm injuries have become the leading cause of death among American children. Here we review the scope of the problem, and the pivotal role pediatric surgeons have in preventing pediatric firearm injury. Specific methods for screening and counseling are reviewed, as well as how to overcome barriers. Community and hospital resources as well as organizational efforts are discussed. Finally, a path for surgeon advocacy is outlined as is a call to action for the pediatric surgeon, as we are uniquely poised to identify pediatric patients and deliver timely interventions to reduce the impact of firearm violence. LEVEL OF EVIDENCE: Level IV.
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Affiliation(s)
- J Leslie Knod
- Division of Pediatric Surgery, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106, United States.
| | - Chethan Sathya
- Center for Gun Violence Prevention, Northwell Health, Division of Pediatric Surgery, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell, 1111 Marcus, Suite M15, New Hyde Park, NY 11042, United States
| | - Cornelia L Griggs
- Harvard Medical School, Division of Pediatric Surgery, Massachusetts General Hospital, 55 Fruit Street GRB-11, Boston MA 02114, United States
| | - Marion C Henry
- University of Chicago, 5839 S. Maryland Ave/MC 4062/Suite A-426, Chicago, IL 60637, United States
| | - Mary Froehlich
- Kirk Kerkorian School of Medicine at UNLV, Department of General Surgery, 4505 South Maryland Pkwy, Las Vegas, NV 89154, United States
| | - Garret Zallen
- PeaceHealth Medical Center Springfield Oregon and Shriner's Hospital, Portland, OR, United States
| | - Brian A Coakley
- The Icahn School of Medicine at Mount Sinai, Division of Pediatric Surgery, Department of Surgery, 5 East 98th Street, 15th Floor, New York, NY 10029, United States
| | - Peter T Masiakos
- Harvard Medical School, Division of Pediatric Surgery, Massachusetts General Hospital, 55 Fruit Street GRB-11, Boston MA 02114, United States
| | - Kenneth W Gow
- University of Washington and Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, United States
| | - Bindi Naik-Mathuria
- Division of Pediatric Surgery, University of Texas Medical Branch, 301 University Blvd, Research Building 6, Suite 3.220, Galveston, TX 77555, United States
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2
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Rivara FP, Hink AB, Kuhls DA, Banks S, Agoubi LL, Kirkendoll S, Winchester A, Hoeft C, Patel B, Nathens A. Firearm injuries treated at trauma centers in the United States. J Trauma Acute Care Surg 2024; 96:955-964. [PMID: 37872675 DOI: 10.1097/ta.0000000000004172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
BACKGROUND While firearm injuries and deaths continue to be a major public health problem, the number of nonfatal firearm injuries and the characteristics of patients are not well-known. The American College of Surgeons Committee on Trauma leveraged an existing data system to collect additional data on fatal and nonfatal firearm injuries presenting to trauma centers. This report provides an overview of this initiative and highlights the challenges associated with capturing actionable data on firearm-injured patients. METHODS A total of 128 trauma centers that are part of the American College of Surgeons Trauma Quality Improvement Program collected data on individuals of any age arriving alive between March 1, 2021, and February 28, 2022, with a firearm injury. In addition to the standard data collected for Trauma Quality Improvement Program, abstractors also extracted additional data specific to this study. We linked data from the Distressed Community Index to patient records using zip code of residence. RESULTS A total of 17,395 patients were included, with mean (SD) age of 30.2 (13.5) years, 82.5% were male, and the majority were Black and non-Hispanic. The mean proportion of variables with missing data varied among trauma centers, with a mean of 20.7% missing data. Injuries occurred most commonly in homes (31.2%) or on the street (26.6%); 70.4% of injuries were due to assaults. Nearly one third of patients were discharged from the emergency department, 25.9% were admitted directly to the operating room, and 10.9% were admitted to the intensive care unit; 5.9% died in the emergency department, and 10.3% died overall during their course of care. Nearly two thirds of patients lived in the two highest distressed categories of communities; only 7.5% lived in the least distressed quintile. CONCLUSION Using trauma center data can be a valuable tool to improve our knowledge of firearm injuries if clinical practices and documentation of patient risks and circumstances are standardized. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level III.
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Affiliation(s)
- Frederick P Rivara
- From the Harborview Medical Center (F.P.R.); Department of Pediatrics (F.P.R.), Department of Epidemiology (F.P.R.), Firearm Injury and Policy Research Program (F.P.R.), University of Washington, Seattle, Washington; Department of Surgery (A.B.H.), Medical University of South Carolina, Charleston, South Carolina; Department of Surgery (D.A.K.), Kirk Kerkorian School of Medicine, University of Nevada Las Vegas, Las Vegas, Nevada; Firearm Injury and Policy Research Program (S.B.), Harborview Injury Prevention and Research Center (L.L.A.), Department of Surgery (L.L.A.), University of Washington, Seattle, Washington; Department of Surgery (S.K.), Northwestern Feinberg School of Medicine; American College of Surgeons (A.W., C.H., B.P.), Chicago, Illinois; and Sunnybrook Health Sciences Center (A.N.), University of Toronto, Toronto, Ontario, Canada
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Birk N, Russo J, Heagerty P, Parker L, Moloney K, Bulger E, Whiteside L, Moodliar R, Engstrom A, Wang J, Palinkas L, Abu K, Zatzick D. Can Baseline Patient Clinical and Demographic Characteristics Predict Response to Early Posttraumatic Stress Disorder Interventions After Physical Injury? Psychiatry 2024; 87:134-148. [PMID: 38497603 PMCID: PMC11116057 DOI: 10.1080/00332747.2024.2323367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
OBJECTIVE A growing evidence base supports stepped care interventions for the early treatment of posttraumatic stress disorder (PTSD) after physical injury. Few investigations have examined the characteristics of patients who do and do not respond to these interventions. METHOD This investigation was a secondary analysis that used previously collected data from three randomized clinical trials of stepped care interventions (patient N = 498). The study hypothesized that a subgroup of patients would manifest persistent PTSD symptoms regardless of randomization to intervention or control conditions, and that characteristics present at the time of baseline injury hospitalization could distinguish patients who would develop persistent symptoms from potential treatment responders. Regression analyses identified baseline patient clinical and demographic characteristics that were associated with persistent PTSD symptoms over the 6-months post-injury. Additional analyses identified treatment attributes of intervention patients who were and were not likely to demonstrate persistent symptoms. RESULTS A substantial subgroup of patients (n = 222, 44.6%) demonstrated persistent PTSD symptoms over time. Greater numbers of pre-injury trauma, pre-injury PTSD symptoms, elevated early post-injury PTSD symptoms, unemployment, and non-White race identified patients with persistent symptoms. Patients with ≥3 of these baseline risk characteristics demonstrated diminished treatment responses when compared to patients with <3 characteristics. Intervention patients with ≥3 risk characteristics were less likely to engage in treatment and required greater amounts of interventionist time. CONCLUSIONS Injured trauma survivors have readily identifiable characteristics at the time of hospitalization that can distinguish responders to PTSD stepped care interventions versus patients who may be treatment refractory.
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Affiliation(s)
- Navneet Birk
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Patrick Heagerty
- Department of Biostatistics University of Washington School of Medicine, Seattle, Washington, USA
| | - Lea Parker
- Department of Psychology Drexel University College of Arts and Sciences, Philadelphia, Pennsylvania, USA
| | - Kathleen Moloney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Eileen Bulger
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lauren Whiteside
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Rddhi Moodliar
- Department of Psychology, University of California, Los Angeles, California, USA
| | - Allison Engstrom
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jin Wang
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lawrence Palinkas
- Department of Public Health and Longevity Science, University of California, San Diego, California, USA
| | - Khadijah Abu
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
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Scott JW, Anderson GA, Conatser A, de Souza C, Evans E, Goodwin Z, Jakubus JL, Kelm J, Mekled I, Monahan J, Oh EJ, Oliphant BW, Hemmila MR. Multicenter evaluation of financial toxicity and long-term health outcomes after injury. J Trauma Acute Care Surg 2024; 96:54-61. [PMID: 37867247 DOI: 10.1097/ta.0000000000004161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
BACKGROUND Despite the growing awareness of the negative financial impact of traumatic injury on patients' lives, the association between financial toxicity and long-term health-related quality of life (hrQoL) among trauma survivors remains poorly understood. METHODS Patients from nine trauma centers participating in a statewide trauma quality collaborative had responses from longitudinal survey data linked to inpatient trauma registry data. Financial toxicity was defined based on patient-reported survey responses regarding medical debt, work or income loss, nonmedical financial strain, and forgone care due to costs. A financial toxicity score ranging from 0 to 4 was calculated. Health-related quality of life was assessed using the EuroQol 5 Domain tool. Multivariable regression models evaluated the association between financial toxicity and hrQoL outcomes while adjusting for patient demographics, injury severity and inpatient treatment intensity, and health systems variables. RESULTS Among the 403 patients providing 510 completed surveys, rates of individual financial toxicity elements ranged from 21% to 46%, with 65% of patients experiencing at least one element of financial toxicity. Patients with any financial toxicity had worse summary measures of hrQoL and higher rates of problems in all five EuroQol 5 Domain domains ( p < 0.05 for all). Younger age, lower household income, lack of insurance, more comorbidities, discharge to a facility, and air ambulance transportation were independently associated with higher odds of financial toxicity ( p < 0.05 for all). Injury traits and inpatient treatment intensity were not independently associated with financial toxicity. CONCLUSION A majority of trauma survivors in this study experienced some level of financial toxicity, which was independently associated with worse risk-adjusted health outcomes across all hrQoL measures. Risk factors for financial toxicity are not related to injury severity or treatment intensity but rather to sociodemographic variables and measures of prehospital and posthospital health care resource utilization. Targeted interventions and policies are needed to address financial toxicity and ensure optimal recovery for trauma survivors. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level III.
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Affiliation(s)
- John W Scott
- From the Department of Surgery (J.W.S.), Harborview Medical Center, University of Michigan, Ann Arbor, Michigan; Department of Surgery (J.W.S., A.C., C.d.S., Z.G., J.L.J., J.K., I.M., J.M., E.J.O., M.R.H.), Center for Healthcare Outcomes and Policy (J.W.S., E.J.O., B.W.O., M.R.H.), University of Michigan, Ann Arbor, Michigan; Department of Surgery (G.A.A.), Brigham and Women's Hospital, Boston, Massachusetts; University of Michigan Medical School (E.E.); and Department of Orthopedic Surgery (B.W.O.), University of Michigan, Ann Arbor, Michigan
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Henry MC, Ehrlich PF, Flynn O'Brien KT, Griggs C, Hartman HA, Kotagal M, Masiakos P, Naik-Mathuri B, Sathya C, Stevens J, Thomas A, Trinidad S, Williams R, Campbell BT. Pediatric Surgery Firearm Injury Collaborative Symposium. J Pediatr Surg 2024; 59:68-73. [PMID: 37875380 DOI: 10.1016/j.jpedsurg.2023.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 10/26/2023]
Abstract
Injury from a firearm is now the leading cause of death of children and youth under age 19 in the United States (U.S.) [1] and the incidence of these deaths continues to increase each year [2]. For every death from firearm violence, there are several young people who have been injured by a bullet but not killed. As pediatric surgeons, we are on the front lines of treating these young patients. We have the unforgettable memories of delivering the horrible news to parents in "quiet rooms." [3]. As these injuries fall within our scope of practice, it is incumbent on us as professionals to work to prevent these injuries, apply best practices and work for the best pathways to recovery for our patients who do survive. There is a diverse community of pediatric surgeons tackling this public health problem in a variety of ways [4]. In a pre-meeting symposium at the APSA 2023 Annual meeting, we brought together a community of pediatric surgeons working on this critical area. The following summarizes the presentations of the symposium, with topics including Risk Factors, Injury Prevention, Treatment, Public Initiatives, and National Collaborative Efforts. TYPE OF STUDY: Review Article, Proceedings of a Symposium. LEVEL OF EVIDENCE: 1 through 4 all presented.
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Affiliation(s)
- Marion C Henry
- Section of Pediatric Surgery, The University of Chicago Medicine, Comer Children's Hospital, Chicago, IL, USA.
| | - Peter F Ehrlich
- Section of Pediatric Surgery, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | | | - Cornelia Griggs
- Division of Pediatric Surgery, Massachusetts General Hospital, Boston, MA, USA; Massachusetts General Hospital Center for Gun Violence Prevention, Boston, MA, USA
| | - Heather A Hartman
- Section of Pediatric Surgery, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Meera Kotagal
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, USA; Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Peter Masiakos
- Division of Pediatric Surgery, Massachusetts General Hospital, Boston, MA, USA; Massachusetts General Hospital Center for Gun Violence Prevention, Boston, MA, USA
| | - Bindi Naik-Mathuri
- Department of Surgery, Division of Pediatric Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Chethan Sathya
- Cohen Children's Medical Center at Northwell Health, Zucker-Hofstra School of Medicine, Queens, NY, USA
| | - Jenny Stevens
- Department of Surgery, Louisiana State University, New Orleans, LA, USA
| | - Arielle Thomas
- Department of Surgery, Medical College of Wisconsin, Milwaukee, USA
| | - Stephen Trinidad
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, USA; Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Regan Williams
- Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Brendan T Campbell
- Division of Pediatric Surgery, Connecticut Children's Medical Center, Hartford, CT, USA; Department of Surgery, University of Connecticut School of Medicine, Farmington, CT, USA
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6
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Trinidad S, Goldshore M, Kotagal M. Addressing health equity in pediatric surgical care in the United States- Progress and challenges. Semin Pediatr Surg 2023; 32:151354. [PMID: 37967486 DOI: 10.1016/j.sempedsurg.2023.151354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
There are notable inequities in health outcomes for children based on their social determinants of health (SDOH), including where they are born and live, their primary language, their race and ethnicity, socioeconomic status, and more. These health inequities are not restricted to resource limited settings; here we highlight three broad topics that are relevant to pediatric surgeons in the United States (US): access to care and disparities, and examples of inequities in firearm-related injuries and appendicitis. Most of our patients will at some point require operative interventions, yet there can be significant challenges in accessing this care and navigating our health systems, particularly around complex perioperative care. There are significant opportunities to improve equitable care by helping patients navigate our health systems and connecting them with additional resources, including screening for primary care services. Firearm-related injuries are now the leading cause of death in children in the US, with significant associated morbidity for non-fatal injuries. There are notable inequities in the risk of injury and types of injuries experienced by children based on their SDOH. Appendicitis is one of the most common pathologies managed by pediatric surgeons, with similar inequities in the rates of perforated appendicitis based on a child's SDOH. For both issues, addressing the inequities our patients experience requires moving upstream and working towards prevention. Key opportunities include better research and data to understand the drivers for observed inequities, multidisciplinary collaboration, community engagement, and public health advocacy among others. As a profession, we have a responsibility to work to address the health inequities our patients experience.
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Affiliation(s)
- Stephen Trinidad
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Matthew Goldshore
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Meera Kotagal
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
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7
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Raman U, Coupet E, Dodington J. Assault Injury and Community Violence. Pediatr Clin North Am 2023; 70:1103-1114. [PMID: 37865433 DOI: 10.1016/j.pcl.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Community violence happens between unrelated individuals, who may or may not know each other, generally outside the home, and often results in assaultive injuries. Community violence interventions can prevent assaultive injuries and assist victims of community violence. Trauma-informed care is foundational to the success of community violence intervention. Place-based environmental interventions can decrease community violence on the population level, and further research and developments are needed in this area. Substance use is a significant barrier to intervention program involvement and greater research and program development is needed to support substance use treatment of those impacted by community violence.
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Affiliation(s)
- Uma Raman
- Pediatric Critical Care, Yale New Haven Hospital, Yale School of Medicine, 100 York Street, Suite 1F, New Haven, CT 06511, USA
| | - Edouard Coupet
- Yale School of Medicine, Core Faculty, Addiction Medicine, 464 Congress Avenue, Suite 260, New Haven, CT 06890, USA
| | - James Dodington
- Yale School of Medicine, Yale New Haven Center for Injury and Violence Prevention, 100 York Street, Suite 1F, New Haven, CT 06511, USA.
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8
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Rivara FP, Hink AB, Kuhls D, Banks S, Agoubi LL, Kirkendoll S, Winchester A, Hoeft C, Patel B, Nathens A. Firearm injuries in Missouri. PLoS One 2023; 18:e0294737. [PMID: 37992058 PMCID: PMC10664957 DOI: 10.1371/journal.pone.0294737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/05/2023] [Indexed: 11/24/2023] Open
Abstract
Firearm deaths continue to be a major public health problem, but the number of non-fatal firearm injuries and the characteristics of patients and injuries is not well known. The American College of Surgeons Committee on Trauma, with support from the National Collaborative on Gun Violence Research, leveraged an existing data system to capture lethal and non-lethal injuries, including patients treated and discharged from the emergency department and collect additional data on firearm injuries that present to trauma centers. In 2020, Missouri had the 4th highest firearm mortality rate in the country at 23.75/100,000 population compared to 13.58/100,000 for the US overall. We examined the characteristics of patients from Missouri with firearm injuries in this cross-sectional study. Of the overall 17,395 patients, 1,336 (7.7%) were treated at one of the 11 participating trauma centers in Missouri during the 12-month study period. Patients were mostly male and much more likely to be Black and uninsured than residents in the state as a whole. Nearly three-fourths of the injuries were due to assaults, and overall 7.7% died. Few patients received post-discharge services.
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Affiliation(s)
- Frederick P. Rivara
- Departments of Pediatrics and Epidemiology and the Firearm Injury and Policy Research Program, University of Washington, Seattle, Washington, United States of America
| | - Ashley B. Hink
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Deborah Kuhls
- Department of Surgery, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, United States of America
| | - Samantha Banks
- Firearm Injury and Policy Research Program, University of Washington, Seattle, Washington, United States of America
| | - Lauren L. Agoubi
- Harborview Injury Prevention and Research Center and the Department of Surgery, University of Washington, Seattle, Washington, United States of America
| | - Shelbie Kirkendoll
- Department of Surgery, Northwestern Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Alex Winchester
- American College of Surgeons, Chicago, Illinois, United States of America
| | - Christopher Hoeft
- American College of Surgeons, Chicago, Illinois, United States of America
| | - Bhavin Patel
- American College of Surgeons, Chicago, Illinois, United States of America
| | - Avery Nathens
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
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9
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Golisch KB, Tatebe LC. Supporting Victims of Firearm Violence and Structural Racism Beyond the Hospital Walls and Journal Pages. JAMA Surg 2023; 158:1040. [PMID: 37466976 DOI: 10.1001/jamasurg.2023.2853] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Affiliation(s)
- Kimberly B Golisch
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Leah C Tatebe
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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10
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Dicker R, Brohi K. Violence and surgeons. Br J Surg 2023; 110:1247-1248. [PMID: 37548285 DOI: 10.1093/bjs/znad246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 08/08/2023]
Affiliation(s)
- Rochelle Dicker
- Department of Surgery, University of California San Francisco, San Francisco, California, USA, and Centre for Trauma Sciences, Queen Mary University of London, London, UK
| | - Karim Brohi
- Department of Surgery, University of California San Francisco, San Francisco, California, USA, and Centre for Trauma Sciences, Queen Mary University of London, London, UK
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11
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Freeman J. Invited Commentary: Gun Control and the US: What Works? J Am Coll Surg 2023; 237:418-419. [PMID: 37184095 DOI: 10.1097/xcs.0000000000000742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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12
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Morgan A, Burns C, Terrell S, Kwakye G, Hughes T. Beyond physical trauma: A call for research in trauma-informed care education in surgical spaces. Am J Surg 2023; 226:284-285. [PMID: 37328326 DOI: 10.1016/j.amjsurg.2023.05.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/13/2023] [Accepted: 05/30/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Anna Morgan
- University of Michigan Medical School, United States.
| | | | | | - Gifty Kwakye
- Department of Surgery, University of Michigan, United States
| | - Tasha Hughes
- Department of Surgery, University of Michigan, United States
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13
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Sakran JV, Bornstein SS, Dicker R, Rivara FP, Campbell BT, Cunningham RM, Betz M, Hargarten S, Williams A, Horwitz JM, Nehra D, Burstin H, Sheehan K, Dreier FL, James T, Sathya C, Armstrong JH, Rowhani-Rahbar A, Charles S, Goldberg A, Lee LK, Stewart RM, Kerby JD, Turner PL, Bulger EM. Proceedings from the Second Medical Summit on Firearm Injury Prevention, 2022: Creating a Sustainable Healthcare Coalition to Advance a Multidisciplinary Public Health Approach. J Am Coll Surg 2023; 236:1242-1260. [PMID: 36877809 DOI: 10.1097/xcs.0000000000000662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Affiliation(s)
- Joseph V Sakran
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
- Department of Surgery, Johns Hopkins Medicine, Baltimore, MD (Sakran)
| | - Sue S Bornstein
- American College of Physicians, Philadelphia, PA (Bornstein)
| | - Rochelle Dicker
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
- Department of Surgery, University of California Los Angeles, Los Angeles, CA (Dicker)
| | - Frederick P Rivara
- Department of Pediatrics, University of Washington, Seattle, WA (Rivara)
| | - Brendan T Campbell
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
- Department of Pediatric Surgery, Connecticut Children's Medical Center, Hartford, CT (Campbell)
| | - Rebecca M Cunningham
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI (Cunningham)
| | - Marian Betz
- Department of Emergency Medicine, University of Colorado, Aurora, CO (Betz)
| | - Stephen Hargarten
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI (Hargarten)
| | - Ashley Williams
- Department of Surgery, University of South Alabama, Mobile, AL (Williams)
| | - Joshua M Horwitz
- Johns Hopkins Center for Gun Violence Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (Horwitz)
| | - Deepika Nehra
- Department of Surgery, University of Washington, Seattle, WA (Nehra, Bulger)
| | - Helen Burstin
- Council of Medical Specialty Societies, Washington, DC (Burstin)
| | - Karen Sheehan
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL (Sheehan)
| | - Fatimah L Dreier
- The Health Alliance for Violence Intervention, Jersey City, NJ (Dreier)
| | - Thea James
- Department of Emergency Medicine, Boston University School of Medicine, Boston, MA (James)
| | - Chethan Sathya
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
- Department of Surgery, Cohen Children's Medical Center, Northwell Health, Queens, NY (Sathya)
| | - John H Armstrong
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL (Armstrong)
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA (Rowhani-Rahbar)
| | - Scott Charles
- Department of Surgery, Temple University, Philadelphia, PA (Charles, Goldberg)
| | - Amy Goldberg
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
- Department of Surgery, Temple University, Philadelphia, PA (Charles, Goldberg)
| | - Lois K Lee
- Department of Emergency Medicine, Boston Children's Hospital, Boston, MA (Lee)
| | - Ronald M Stewart
- Department of Surgery, University of Texas San Antonio, San Antonio, TX (Stewart)
| | - Jeffrey D Kerby
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
- Department of Surgery, The University of Alabama at Birmingham, Birmingham, AL (Kerby)
| | - Patricia L Turner
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
| | - Eileen M Bulger
- From the American College of Surgeons Committee on Trauma, Chicago, IL (Sakran, Dicker, Cambell, Sathya, Armstrong, Goldberg, Stewart, Kerby, Turner, Bulger)
- Department of Surgery, University of Washington, Seattle, WA (Nehra, Bulger)
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14
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Gottumukkala V, Vetter TR, Gan TJ. Perioperative Medicine: What the Future Can Hold for Anesthesiology. Anesth Analg 2023; 136:628-635. [PMID: 36928147 DOI: 10.1213/ane.0000000000006412] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Affiliation(s)
- Vijaya Gottumukkala
- From the Department of Anesthesiology and Perioperative Medicine, Division of Anesthesiology, Critical Care and Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Thomas R Vetter
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, Texas
| | - Tong J Gan
- Division of Anesthesiology, Critical Care and Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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15
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Tatebe LC, Cone JT, Slidell MB, Chang G, Jonikas M, Stewart A, Doherty J, Arunkumar P, Schlanser V, Dennis AJ. When public health crises collide: 5 years of pediatric firearm injury prevention opportunities. Trauma Surg Acute Care Open 2023; 8:e001026. [PMID: 37303982 PMCID: PMC10254944 DOI: 10.1136/tsaco-2022-001026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 03/08/2023] [Indexed: 06/13/2023] Open
Abstract
Objectives Prior publications on pediatric firearm-related injuries have emphasized significant social disparities. The pandemic has heightened a variety of these societal stresses. We sought to evaluate how we must now adapt our injury prevention strategies. Patients and methods Firearm-related injuries in children 15 years old and under at five urban level 1 trauma centers between January 2016 and December 2020 were retrospectively reviewed. Age, gender, race/ethnicity, Injury Severity Score, situation, timing of injury around school/curfew, and mortality were evaluated. Medical examiner data identified additional deaths. Results There were 615 injuries identified including 67 from the medical examiner. Overall, 80.2% were male with median age of 14 years (range 0-15; IQR 12-15). Black children comprised 77.2% of injured children while only representing 36% of local schools. Community violence (intentional interpersonal or bystander) injuries were 67.2% of the cohort; 7.8% were negligent discharges; and 2.6% suicide. Median age for intentional interpersonal injuries was 14 years (IQR 14-15) compared with 12 years (IQR 6-14, p<0.001) for negligent discharges. Far more injuries were seen in the summer after the stay-at-home order (p<0.001). Community violence and negligent discharges increased in 2020 (p=0.004 and p=0.04, respectively). Annual suicides also increased linearly (p=0.006). 5.5% of injuries were during school; 56.7% after school or during non-school days; and 34.3% were after legal curfew. Mortality rate was 21.3%. Conclusions Pediatric firearm-related injuries have increased during the past 5 years. Prevention strategies have not been effective during this time interval. Prevention opportunities were identified specifically in the preteenage years to address interpersonal de-escalation training, safe handling/storage, and suicide mitigation. Efforts directed at those most vulnerable need to be reconsidered and examined for their utility and effectiveness. Level of evidence Level III; epidemiological study type.
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Affiliation(s)
- Leah C Tatebe
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jennifer T Cone
- Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Mark B Slidell
- Department of Surgery, University of Chicago Comer Children's Hospital, Chicago, Illinois, USA
| | - Grace Chang
- Department of Surgery, Mount Sinai Hospital, Chicago, Illinois, USA
| | - Meghan Jonikas
- Department of Surgery, Mount Sinai Hospital, Chicago, Illinois, USA
| | - Amy Stewart
- Department of Surgery, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA
| | - James Doherty
- Department of Surgery, Advocate Christ Medical Center, Oak Lawn, Illinois, USA
| | - Ponni Arunkumar
- Department of Pathology, Northwestern University, Chicago, Illinois, USA
| | | | - Andrew J Dennis
- Department of Trauma, Cook County Health, Chicago, Illinois, USA
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16
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Timmer-Murillo SC, Schroeder ME, Trevino C, Geier TJ, Schramm AT, Brandolino AM, Hargarten S, Holena D, de Moya M, Milia D, deRoon-Cassini TA. Comprehensive Framework of Firearm Violence Survivor Care: A Review. JAMA Surg 2023; 158:541-547. [PMID: 36947025 DOI: 10.1001/jamasurg.2022.8149] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Importance Firearm violence is a public health crisis placing significant burden on individuals, communities, and health care systems. After firearm injury, there is increased risk of poor health, disability, and psychopathology. The newest 2022 guidelines from the American College of Surgeons Committee on Trauma require that all trauma centers screen for risk of psychopathology and provide referral to intervention. Yet, implementing these guidelines in ways that are responsive to the unique needs of communities and specific patient populations, such as after firearm violence, is challenging. Observations The current review highlights important considerations and presents a model for trauma centers to provide comprehensive care to survivors of firearm injury. This model highlights the need to enhance standard practice to provide patient-centered, trauma-informed care, as well as integrate inpatient and outpatient psychological services to address psychosocial needs. Further, incorporation of violence prevention programming better addresses firearm injury as a public health concern. Conclusions and Relevance Using research to guide a framework for trauma centers in comprehensive care after firearm violence, we can prevent complications to physical and psychological recovery for this population. Health systems must acknowledge the socioecological context of firearm violence and provide more comprehensive care in the hospital and after discharge, to improve long-term recovery and serve as a means of tertiary prevention of firearm violence.
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Affiliation(s)
| | - Mary E Schroeder
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee
| | - Colleen Trevino
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee
| | - Timothy J Geier
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee
| | - Andrew T Schramm
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee
| | - Amber M Brandolino
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee
| | - Stephen Hargarten
- Division of Emergency Medicine, Medical College of Wisconsin, Milwaukee
| | - Daniel Holena
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee
| | - Marc de Moya
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee
| | - David Milia
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee
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17
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Schombs M, Khedr S, Sullivan F, Alkattan A, Brown C, Morgan L, Norful AA, Sample J, Chen CC. Forum Theater: An Innovative Strategy to Enhance Clinician Communication With Marginalized Trauma Patients. J Trauma Nurs 2023; 30:123-128. [PMID: 36881706 DOI: 10.1097/jtn.0000000000000712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND Marginalized groups experience a higher frequency of traumatic injury and are more likely to report negative experiences in the health care setting. Trauma center staff are prone to compassion fatigue, which impairs patient and clinician interactions for these groups. Forum theater (a form of interactive theater designed for addressing social issues) is proposed as an innovative method of exploring bias and has never been applied in the trauma setting. OBJECTIVE This article aims to determine the feasibility of implementing forum theater as an adjunct to enhance clinician understanding of bias and its influence on communication between clinicians and trauma populations. METHODS This is a descriptive qualitative analysis of adopting forum theater at a Level I trauma center in a New York City borough with a racially and ethnically diverse population. The implementation of a forum theater workshop was described, including our work with a theater company to address bias in the health care setting. Volunteer staff members and theater facilitators participated in an 8-hr workshop leading to a 2-hr multipart performance. Participant experiences were collected in a postsession debrief to understand the utility of forum theater. RESULTS Debriefing sessions after forum theater performances demonstrated that forum theater is a more engaging and effective method for dialogue surrounding bias than personal past experiences with other educational models. CONCLUSION Forum theater was feasible as a tool to enhance cultural competency and bias training. Future research will examine the impact it has on levels of staff empathy and its impact on participants' level of comfort communicating with diverse trauma populations.
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Affiliation(s)
- Michele Schombs
- Department of Surgery (Mss Schombs, Khedr, and Sullivan and Drs Alkattan, Sample, and Chen), and Department of Emergency Medicine (Ms Brown), New York-Presbyterian Queens, Flushing; Department of Surgery, New York-Presbyterian Weill Cornell Medical Center, New York, New York (Drs Alkattan, Sample, and Chen); Theater of the Oppressed NYC, New York, New York (Ms Morgan); Columbia University School of Nursing, New York, New York (Dr Norful); and Department of Nursing, New York-Presbyterian Hospital, New York, New York (Dr Norful)
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18
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Trinidad S, Brokamp C, Sahay R, Moody S, Gardner D, Parsons AA, Riley C, Sofer N, Beck AF, Falcone RA, Kotagal M. Children from disadvantaged neighborhoods experience disproportionate injury from interpersonal violence. J Pediatr Surg 2023; 58:545-551. [PMID: 35787891 DOI: 10.1016/j.jpedsurg.2022.05.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/24/2022] [Accepted: 05/31/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Disparities in pediatric injury have been widely documented and are driven, in part, by differential exposures to social determinants of health (SDH). Here, we hypothesized that neighborhood socioeconomic deprivation and specific sociodemographic characteristics would be associated with interpersonal violence-related injury admission. METHODS We conducted a retrospective cohort study of all patients ≤16 years, residing in Hamilton County, admitted to our level 1 pediatric trauma center. Residential addresses were geocoded to link admissions with a census tract-level socioeconomic deprivation index. Admissions were categorized as resulting from interpersonal violence or not - based on a mechanism of injury (MOI) of abuse or assault. The percentage of interpersonal violence-related injury admissions was compared across patient demographics and neighborhood deprivation index tertiles. These factors were then evaluated with multivariable regression analysis. RESULTS Interpersonal violence accounted for 6.2% (394 of 6324) of all injury-related admissions. Interpersonal violence-related injury admission was associated with older age, male sex, Black race, public insurance, and living in tertiles of census tracts with higher socioeconomic deprivation. Those living in the most deprived tertile experienced 62.2% of all interpersonal violence-related injury admissions but only 36.9% of non-violence related injury admissions (p < 0.001). After adjustment, insurance and neighborhood deprivation accounted for much of the increase in interpersonal violence-related admissions for Black compared to White children. CONCLUSIONS Children from higher deprivation neighborhoods, who are also disproportionately Black and publicly insured, experience a higher burden of interpersonal violence-related injury admissions. Level of evidence Level III.
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Affiliation(s)
- Stephen Trinidad
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2023, Cincinnati, OH 45229, United States
| | - Cole Brokamp
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States; Division of Biostatistics and Epidemiology at Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Rashmi Sahay
- Division of Biostatistics and Epidemiology at Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Suzanne Moody
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2023, Cincinnati, OH 45229, United States
| | - Dawne Gardner
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2023, Cincinnati, OH 45229, United States
| | - Allison A Parsons
- Division of Critical Care, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Carley Riley
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States; Division of Critical Care, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Nicole Sofer
- James M. Anderson Center for Health System Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Andrew F Beck
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States; Division of General & Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Richard A Falcone
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2023, Cincinnati, OH 45229, United States; Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Meera Kotagal
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2023, Cincinnati, OH 45229, United States; Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
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19
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Bernard DL, O’Loughlin K, Davidson TM, Rothbaum A, Anton MT, Ridings LE, Cooley JL, Gavrilova Y, Hink AB, Ruggiero KJ. Differences in mental health engagement and follow-up among Black and White patients after traumatic injury. J Trauma Acute Care Surg 2023; 94:117-124. [PMID: 35358156 PMCID: PMC9525457 DOI: 10.1097/ta.0000000000003604] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Severe injury necessitating hospitalization is experienced by nearly three million US adults annually. Posttraumatic stress disorder and depression are prevalent clinical outcomes. The mechanisms by which programs equitably promote mental health recovery among trauma-exposed patients are understudied. We evaluated clinical outcomes and engagement among a cohort of Black and White patients enrolled in the Trauma Resilience and Recovery Program (TRRP), a stepped-care model to accelerate mental health recovery after traumatic injury. METHODS Trauma Resilience and Recovery Program is a four-step model that includes (1) bedside psychoeducation about mental health recovery following traumatic injury, (2) a text-messaging symptom tracking system, (3) a 30-day postinjury mental health screen, and (4) referrals to mental health services. Data describe 1,550 patients enrolled in TRRP within a Level I trauma center ( Mage = 40.86; SD, 17.32), 611 of whom identified as Black (74.5% male) and 939 of whom identified as White (67.7% male). RESULTS Enrollment in TRRP was nearly universal (97.9%) regardless of race or injury mechanism. Enrollment and usage of the text-message system were statistically similar between Black (35.7%) and White patients (39.5%). Trauma Resilience and Recovery Program reengaged Black and White patients at a similar rate at the 30-day postinjury follow-up. However, Black patients were more likely to report peritraumatic distress at the bedside and clinical elevations in posttraumatic stress disorder and depression on the 30-day screen. Referrals were more likely to be accepted by Black patients relative to White patients with clinically elevated symptoms. CONCLUSION Enrollment and engagement were comparable among Black and White patients served by TRRP. Data provide preliminary evidence to suggest that TRRP is feasible and acceptable and engages patients in mental health follow-up equitably. However, research that includes careful measurement of social determinants of health and long-term follow-up examining initiation, completion, and benefit from treatment is needed. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
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Affiliation(s)
- Donte L. Bernard
- Department of Psychological Sciences, University of Missouri, Columbia, MO, 65211, USA
- Department of Psychiatry and Behavioral Sciences, National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, SC, USA
| | - Kerry O’Loughlin
- Department of Psychiatry and Behavioral Sciences, National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, SC, USA
| | - Tatiana M. Davidson
- Departments of Nursing and Psychiatry and Behavioral Sciences, College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Alex Rothbaum
- Department of Psychiatry and Behavioral Sciences, National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, SC, USA
| | | | - Leigh E. Ridings
- Departments of Nursing and Psychiatry and Behavioral Sciences, College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - John L. Cooley
- Department of Psychological Sciences, Texas Tech University
| | - Yulia Gavrilova
- Department of Surgery, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Ashley B. Hink
- Department of Surgery, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Kenneth J. Ruggiero
- Departments of Nursing and Psychiatry and Behavioral Sciences, College of Nursing, Medical University of South Carolina, Charleston, SC, USA
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20
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Thomas AC, Campbell BT, Subacius H, Orlas CP, Bulger E, Stewart RM, Stey AM, Jang A, Hamad D, Bilimoria KY, Nathens AB. National evaluation of the association between stay-at-home orders on mechanism of injury and trauma admission volume. Injury 2022; 53:3655-3662. [PMID: 36167686 PMCID: PMC9467931 DOI: 10.1016/j.injury.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/11/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The COVID-19 pandemic had numerous negative effects on the US healthcare system. Many states implemented stay-at-home (SAH) orders to slow COVID-19 virus transmission. We measured the association between SAH orders on the injury mechanism type and volume of trauma center admissions during the first wave of the COVID-19 pandemic. METHODS All trauma patients aged 16 years and older who were treated at the American College of Surgeons Trauma Quality Improvement Program participating centers from January 2018-September 2020. Weekly trauma patient volume, patient demographics, and injury characteristics were compared across the corresponding SAH time periods from each year. Patient volume was modeled using harmonic regression with a random hospital effect. RESULTS There were 166,773 patients admitted in 2020 after a SAH order and an average of 160,962 patients were treated over the corresponding periods in 2018-2019 in 474 centers. Patients presenting with a pre-existing condition of alcohol misuse increased (13,611 (8.3%) vs. 10,440 (6.6%), p <0.001). Assault injuries increased (19,056 (11.4%) vs. 15,605 (9.8%)) and firearm-related injuries (14,246 (8.5%) vs. 10,316 (6.4%)), p<0.001. Firearm-specific assault injuries increased (10,748 (75.5%) vs. 7,600 (74.0%)) as did firearm-specific unintentional injuries (1,318 (9.3%) vs. 830 (8.1%), p<0.001. In the month preceding the SAH orders, trauma center admissions decreased. Within a week of SAH implementation, hospital admissions increased (p<0.001) until a plateau occurred 10 weeks later above predicted levels. On regional sub-analysis, admission volume remained significantly elevated for the Midwest during weeks 11-25 after SAH order implementation, (p<0.001).
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Affiliation(s)
- Arielle C. Thomas
- Medical College of Wisconsin, Milwaukee, WI, USA,American College of Surgeons, Chicago, IL, USA,Corresponding author at: Medical College of Wisconsin, Milwaukee, WI, USA
| | - Brendan T. Campbell
- American College of Surgeons, Chicago, IL, USA,Department of Pediatric Surgery, Connecticut Children's Medical Center and University of Connecticut School of Medicine, Hartford, CT, USA
| | - Haris Subacius
- American College of Surgeons, Chicago, IL, USA,Society of Thoracic Surgeons, Chicago, IL, USA
| | - Claudia P. Orlas
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eileen Bulger
- American College of Surgeons, Chicago, IL, USA,Department of Surgery, University of Washington, Seattle, WA, USA
| | - Ronald M. Stewart
- American College of Surgeons, Chicago, IL, USA,Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Anne M. Stey
- Medical College of Wisconsin, Milwaukee, WI, USA,American College of Surgeons, Chicago, IL, USA
| | - Angie Jang
- Northwestern University, Chicago, IL, USA
| | - Doulia Hamad
- Department of Surgery, Sunnybrook Health Sciences Center and the University of Toronto, Canada
| | - Karl Y. Bilimoria
- Medical College of Wisconsin, Milwaukee, WI, USA,American College of Surgeons, Chicago, IL, USA
| | - Avery B. Nathens
- American College of Surgeons, Chicago, IL, USA,Department of Surgery, Sunnybrook Health Sciences Center and the University of Toronto, Canada
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21
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Tatebe LC, Thomas A, Regan S, Stone L, Dicker R. Language of violence: Do words matter more than we think? Trauma Surg Acute Care Open 2022; 7:e000973. [PMCID: PMC9616003 DOI: 10.1136/tsaco-2022-000973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/29/2022] [Indexed: 11/03/2022] Open
Abstract
Firearm violence is a leading cause of morbidity and mortality among young adults. Identification of intervention targets is crucial to developing and implementing effective prevention efforts. Hospital Violence Intervention Programs (HVIPs) have used a multiprong social care approach to mediate the cycle of interpersonal violence. One struggle continually encountered is how to change the conversation around the future. Speech patterns have been associated with health outcomes and overall behavior modification. During violence prevention efforts, young victims of violence say things such as ‘I’m living on borrowed time’ and ‘why should I worry about getting an education when I’ll likely die soon anyway?’ Such speech patterns may contribute to the cycle of violence and increase the likelihood of reinjury. Presented is a narrative review of the impact language has on health outcomes and how psychotherapy may be able to change thought patterns, alter language structure, and ultimately reduce risk of reinjury. The biopsychosocial model of health posits that a person’s health is dictated by a combination of biological, psychological, and social factors. By understanding that language exists in the personal context, it can serve as both an indicator and a tool for targeted interventions. Cognitive–behavioral therapy (CBT) works by retraining thought and speech patterns to affect change in emotion, physiology, and behavior. It is proposed here that CBT could be used in the HVIPs’ multidisciplinary case management model by involving trained psychotherapists. Language is an important indicator of a patient’s psychological state and approach to life-changing decisions. As such, language alteration through CBT could potentially be used as a novel method of injury prevention. This concept has not before been explored in this setting and may be an effective supplement to HVIPs’ success.
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Affiliation(s)
- Leah C Tatebe
- Department of Surgery, Northwestern University, Chicago, Illinois, USA
| | - Arielle Thomas
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | | | - Rochelle Dicker
- Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
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22
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Dukleska K, Borrup K, Campbell BT. Childhood injury prevention: Where we've been and where we need to be. Semin Pediatr Surg 2022; 31:151220. [PMID: 36371841 DOI: 10.1016/j.sempedsurg.2022.151220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Injury remains the leading cause of death for children and adolescents in the US, and firearm injury has overtaken motor-vehicle crashes as the leading mechanism in the US since the topic of injury prevention was last reviewed in this journal. The success of injury prevention efforts relies on multidisciplinary collaboration, and pediatric surgeons play a central role as clinicians who provide and coordinate the care for injured children, as trauma program leaders, and as advocates for children's health and safety. This review will provide a concise history of injury prevention in the US and highlights three areas where pediatric surgeons have an opportunity to impart impactful change in their communities that could lead to lower injury rates.
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Affiliation(s)
- Katerina Dukleska
- Division of Pediatric Surgery, Connecticut Children's Medical Center, Hartford, CT, USA; Department of Surgery, University of Connecticut School of Medicine, Farmington, CT, USA.
| | - Kevin Borrup
- Injury Prevention Center, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Brendan T Campbell
- Division of Pediatric Surgery, Connecticut Children's Medical Center, Hartford, CT, USA; Department of Surgery, University of Connecticut School of Medicine, Farmington, CT, USA; Injury Prevention Center, Connecticut Children's Medical Center, Hartford, CT, USA
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23
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Suicide versus homicide firearm injury patterns on trauma systems in a study of the National Trauma Data Bank (NTDB). Sci Rep 2022; 12:15672. [PMID: 36123380 PMCID: PMC9485125 DOI: 10.1038/s41598-022-17280-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/22/2022] [Indexed: 11/24/2022] Open
Abstract
Firearm related mortality in the USA surpassed all other developed countries. This study hypothesizes that injury patterns, weapon type, and mortality differ between suicide groups as opposed to homicide. The American College of Surgeons National Trauma Database was queried from January 2017 to December 2019. All firearm related injuries were included, and weapon type was abstracted. Differences between homicide and suicide groups by sex, age, race, and injury severity were compared using a Mann–Whitney test for numerical data and Fisher’s exact test for categorical data. The association between weapon type and mortality relative to suicide as opposed to homicide was assessed in Fisher’s exact tests. Significance was defined as p < 0.05. There were 100,031 homicide and 11,714 suicide subjects that met inclusion criteria. Homicides were mostly assault victims (97.6%), male (88%), African–American (62%), had less severe injury (mean (ISS) 12.07) and a median age of 20 years old (IQR: 14, 30, p < 0.01). Suicides were mostly male (83%), white (79%), had more severe injury (mean ISS 20.73), and a median age of 36 years old (IQR: 19, 54, p < 0.01). Suicide group had higher odds of head/neck (OR = 13.6) or face (OR = 5.7) injuries, with lower odds of injury to chest (OR = 0.55), abdominal or pelvic contents (OR = 0.25), extremities or pelvic girdle (OR = 0.15), or superficial soft tissue (OR = 0.32). Mortality rate was higher for suicide group (44.8%; 95% confidence interval (CI) 43.9%, 45.7%) compared to the homicide group (11.5%; 95% CI 11.3%, 11.7%). Suicide had higher mortality, more severe injuries, and more head/neck/facial injuries than homicide. Majority of suicides were with handguns.
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24
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Bliton JN, Zakrison TL, Vong G, Johnson DA, Rattan R, Hanos DS, Smith RN. Ethical Care of the Traumatized: Conceptual Introduction to Trauma-Informed Care for Surgeons and Surgical Residents. J Am Coll Surg 2022; 234:1238-1247. [PMID: 35703822 DOI: 10.1097/xcs.0000000000000183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Trauma-informed care (TIC) is a set of principles and practices designed to improve the ways professionals treat people who have been traumatized. This study reviews fundamental concepts of TIC and applies them to the work of surgeons. TIC is described in relation to fundamental medical ethical concepts, and evidence for TIC-based intervention is reviewed. Implementation of TIC in medical education is also described, and recommendations for practice changes are made.
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Affiliation(s)
- John N Bliton
- From the Wellstar Atlanta Medical Center, Atlanta, GA (Bliton)
| | - Tanya L Zakrison
- Trauma and Acute Care Surgery, University of Chicago Medicine, Chicago, IL (Zakrison, Johnson)
| | - Gerard Vong
- Emory University, Center for Ethics, Atlanta, GA (Vong)
| | - Dwane A Johnson
- Trauma and Acute Care Surgery, University of Chicago Medicine, Chicago, IL (Zakrison, Johnson)
| | - Rishi Rattan
- Division of Trauma and Surgical Critical Care, University of Miami Miller School of Medicine, Miami, FL (Rattan)
| | - Dustin S Hanos
- Emory University School of Medicine, Grady Hospital, Atlanta, GA (Hanos, Smith)
| | - Randi N Smith
- Emory University School of Medicine, Grady Hospital, Atlanta, GA (Hanos, Smith)
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25
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Invited Commentary: Health Equity Requires Surgeons to Implement Trauma-Informed Care. J Am Coll Surg 2022; 234:1247-1248. [PMID: 35703823 DOI: 10.1097/xcs.0000000000000164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Neiman PU, Flaherty MM, Salim A, Sangji NF, Ibrahim A, Fan Z, Hemmila MR, Scott JW. Evaluating the complex association between Social Vulnerability Index and trauma mortality. J Trauma Acute Care Surg 2022; 92:821-830. [PMID: 35468113 DOI: 10.1097/ta.0000000000003514] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Social determinants of health are known to impact patient-level outcomes, but they are often difficult to measure. The Social Vulnerability Index was created by the Centers for Disease Control to identify vulnerable communities using population-based measures. However, the relationship between SVI and trauma outcomes is poorly understood. METHODS In this retrospective study, we merged SVI data with a statewide trauma registry and used three analytic models to evaluate the association between SVI quartile and inpatient trauma mortality: (1) an unadjusted model, (2) a claims-based model using only covariates available to claims datasets, and (3) a registry-based model incorporating robust clinical variables collected in accordance with the National Trauma Data Standard. RESULTS We identified 83,607 adult trauma admissions from January 1, 2017, to September 30, 2020. Higher SVI was associated with worse mortality in the unadjusted model (odds ratio, 1.72 [95% confidence interval, 1.30-2.29] for highest vs. lowest SVI quintile). A weaker association between SVI and mortality was identified after adjusting for covariates common to claims data. Finally, there was no significant association between SVI and inpatient mortality after adjusting for covariates common to robust trauma registries (adjusted odds ratio, 1.10 [95% confidence interval, 0.80-1.53] for highest vs. lowest SVI quintile). Higher SVI was also associated with a higher likelihood of presenting with penetrating injuries, a shock index of >0.9, any Abbreviated Injury Scale score of >5, or in need of a blood transfusion (p < 0.05 for all). CONCLUSION Patients living in communities with greater social vulnerability are more likely to die after trauma admission. However, after risk adjustment with robust clinical covariates, this association was no longer significant. Our findings suggest that the inequitable burden of trauma mortality is not driven by variation in quality of treatment, but rather in the lethality of injuries. As such, improving trauma survival among high-risk communities will require interventions and policies that target social and structural inequities upstream of trauma center admission. LEVEL OF EVIDENCE Prognostic / Epidemiologic, Level IV.
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Affiliation(s)
- Pooja U Neiman
- From the Department of Surgery (P.U.N., A.S.), Brigham and Women's Hospital, Boston, Massachusetts; Center for Healthcare Outcomes and Policy (P.U.N., N.F.S., A.I., Z.F., M.R.H., J.W.S.), National Clinical Scholars Program (P.U.N.), University of Michigan Medical School (M.M.F.), and Department of Surgery (A.I., M.R.H., J.W.S.), University of Michigan, Ann Arbor, Michigan
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27
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Janeway M, Wilson S, Sanchez SE, Arora TK, Dechert T. Citizenship and Social Responsibility in Surgery: A Review. JAMA Surg 2022; 157:532-539. [PMID: 35385071 DOI: 10.1001/jamasurg.2022.0621] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Social determinants of health have been shown to be key drivers of disparities in access to surgical care and surgical outcomes. Though the concept of social responsibility has received growing attention in the medical field, little has been published contextualizing social responsibility in surgery. In this narrative review, we define social responsibility as it relates to surgery, explore the duty of surgeons to society, and provide examples of social factors associated with adverse surgical outcomes and how they can be mitigated. Observations The concept of social responsibility in surgery has deep roots in medical codes of ethics and evolved alongside changing views on human rights and the role of social factors in disease. The ethical duty of surgeons to society is based on the ethical principles of benevolence and justice and is grounded within the framework of the social contract. Surgeons have a responsibility to understand how factors such as patient demographics, the social environment, clinician awareness, and the health care system are associated with inequitable patient outcomes. Through education, we can empower surgeons to advocate for their patients, address the causes and consequences of surgical disparities, and incorporate social responsibility into their daily practice. Conclusions and Relevance One of the greatest challenges in the field of surgery is ensuring that surgical care is provided in an equitable and sustainable way. Surgeons have a duty to understand the factors that lead to health care disparities and use their knowledge, skills, and privileged position to address these issues at the individual and societal level.
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Affiliation(s)
- Megan Janeway
- Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Spencer Wilson
- Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Sabrina E Sanchez
- Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Tania K Arora
- Augusta University at the Medical College of Georgia, Augusta
| | - Tracey Dechert
- Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
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Tamargo R, Moschenross D, Clark T, Novoa K, Gopalan P. C-L Case Conference: Psychiatric Evaluation and Management Following Gunshot Injury. J Acad Consult Liaison Psychiatry 2022; 63:426-433. [PMID: 35301160 DOI: 10.1016/j.jaclp.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/18/2022] [Accepted: 02/28/2022] [Indexed: 11/28/2022]
Abstract
We present the case of a 23-year-old female presenting to CL Psychiatry after admission for multiple gunshot wounds. Top experts in the CL field provide guidance for this commonly encountered clinical case based on their experience and a review of the available literature. Key teaching topics include risk factors for gun violence victimization, assessment of psychiatric diagnoses associated with gunshot injury, and management challenges including access to psychiatric care. Specifically, we highlight the high prevalence of trauma-related disorders, substance use disorders, and functional impairment after gunshot injury. We also provide practical guidance on issues of lethality assessment, trauma-informed care, psychiatric management, and community resources that support recovery.
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Affiliation(s)
- Rafael Tamargo
- Psychiatry Consultation-Liaison Service, Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA.
| | - Darcy Moschenross
- Psychiatry Consultation-Liaison Service, Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Tiffany Clark
- Psychiatry Consultation-Liaison Service, Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Priya Gopalan
- Psychiatry Consultation-Liaison Service, Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA
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Thomas A, Borrup K, Campbell BT. Moving Toward a Better Understanding of Why Interpersonal Firearm Violence Increased During the Pandemic. JAMA Netw Open 2022; 5:e2146116. [PMID: 35133440 DOI: 10.1001/jamanetworkopen.2021.46116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Arielle Thomas
- Firearm Clinical Scholar in Residence, American College of Surgeons, Chicago, Illinois
| | - Kevin Borrup
- Injury Prevention Center, Connecticut Children's Medical Center, Hartford
| | - Brendan T Campbell
- Pediatric Surgery and Injury Prevention Center, Connecticut Children's Medical Center, Hartford
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Boeck MA, Wei W, Robles AJ, Nwabuo AI, Plevin RE, Juillard CJ, Bibbins-Domingo K, Hubbard A, Dicker RA. The Structural Violence Trap: Disparities in Homicide, Chronic Disease Death, and Social Factors Across San Francisco Neighborhoods. J Am Coll Surg 2022; 234:32-46. [PMID: 34662736 PMCID: PMC8719511 DOI: 10.1016/j.jamcollsurg.2021.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/26/2021] [Accepted: 09/22/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND On average, a person living in San Francisco can expect to live 83 years. This number conceals significant variation by sex, race, and place of residence. We examined deaths and area-based social factors by San Francisco neighborhood, hypothesizing that socially disadvantaged neighborhoods shoulder a disproportionate mortality burden across generations, especially deaths attributable to violence and chronic disease. These data will inform targeted interventions and guide further research into effective solutions for San Francisco's marginalized communities. STUDY DESIGN The San Francisco Department of Public Health provided data for the 2010-2014 top 20 causes of premature death by San Francisco neighborhood. Population-level demographic data were obtained from the US American Community Survey 2015 5-year estimate (2011-2015). The primary outcome was the association between years of life loss (YLL) and adjusted years of life lost (AYLL) for the top 20 causes of death in San Francisco and select social factors by neighborhood via linear regression analysis and heatmaps. RESULTS The top 20 causes accounted for N = 15,687 San Francisco resident deaths from 2010-2014. Eight neighborhoods (21.0%) accounted for 47.9% of city-wide YLLs, with 6 falling below the city-wide median household income and many having a higher percent population Black, and lower education and higher unemployment levels. For chronic diseases and homicides, AYLLs increased as a neighborhood's percent Black, below poverty level, unemployment, and below high school education increased. CONCLUSIONS Our study highlights the mortality inequity burdening socially disadvantaged San Francisco neighborhoods, which align with areas subjected to historical discriminatory policies like redlining. These data emphasize the need to address past injustices and move toward equal access to wealth and health for all San Franciscans.
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Affiliation(s)
- Marissa A Boeck
- From the Department of Surgery, Zuckerberg San Francisco General Hospital (Boeck, Robles, Nwabuo, Plevin, Juillard, Dicker), University of California, San Francisco, CA
| | - Waverly Wei
- the Department of Biostatistics, University of California Berkeley, Berkeley, CA (Wei, Hubbard)
| | - Anamaria J Robles
- From the Department of Surgery, Zuckerberg San Francisco General Hospital (Boeck, Robles, Nwabuo, Plevin, Juillard, Dicker), University of California, San Francisco, CA
| | - Adaobi I Nwabuo
- From the Department of Surgery, Zuckerberg San Francisco General Hospital (Boeck, Robles, Nwabuo, Plevin, Juillard, Dicker), University of California, San Francisco, CA
| | - Rebecca E Plevin
- From the Department of Surgery, Zuckerberg San Francisco General Hospital (Boeck, Robles, Nwabuo, Plevin, Juillard, Dicker), University of California, San Francisco, CA
| | - Catherine J Juillard
- From the Department of Surgery, Zuckerberg San Francisco General Hospital (Boeck, Robles, Nwabuo, Plevin, Juillard, Dicker), University of California, San Francisco, CA
- the Department of Surgery, University of California, Los Angeles, CA (Juillard, Dicker)
| | - Kirsten Bibbins-Domingo
- the Department of Epidemiology and Biostatistics (Bibbins-Domingo), University of California, San Francisco, CA
| | - Alan Hubbard
- the Department of Biostatistics, University of California Berkeley, Berkeley, CA (Wei, Hubbard)
| | - Rochelle A Dicker
- From the Department of Surgery, Zuckerberg San Francisco General Hospital (Boeck, Robles, Nwabuo, Plevin, Juillard, Dicker), University of California, San Francisco, CA
- the Department of Surgery, University of California, Los Angeles, CA (Juillard, Dicker)
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Spain DA. "Be Worthy". J Trauma Acute Care Surg 2022; 92:4-11. [PMID: 34932038 DOI: 10.1097/ta.0000000000003428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- David A Spain
- From the Department of Surgery, Stanford University, Stanford, California
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Tatebe LC. Trauma Informed Care Saves Patients from Physical and Psychological Reinjury. J Am Coll Surg 2021; 233:478-479. [PMID: 34446220 DOI: 10.1016/j.jamcollsurg.2021.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
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