1
|
Preston R, Christmass M, Lim E, McGough S, Heslop K. Diagnostic Overshadowing of Chronic Hepatitis C in People With Mental Health Conditions Who Inject Drugs: A Scoping Review. Int J Ment Health Nurs 2024. [PMID: 39101240 DOI: 10.1111/inm.13396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 06/28/2024] [Accepted: 07/01/2024] [Indexed: 08/06/2024]
Abstract
Diagnostic overshadowing refers to a phenomenon whereby people with mental health conditions encounter inadequate or delayed medical attention and misdiagnosis. This occurs when physical symptoms are mistakenly attributed to their mental health condition. This paper presents a scoping review focusing on direct causes and background factors of diagnostic overshadowing in the context of hepatitis C infection in people who inject drugs and have concurrent mental health conditions. Despite significant strides in hepatitis C treatment with direct-acting antiviral drugs, the complex interplay of mental health conditions and physical symptoms necessitates a nuanced approach for accurate diagnosis and effective screening. This review was conducted using Joanna Briggs Institute's methodology for scoping reviews. The databases searched included Medline, Embase, PsycInfo, Global Health, CINAHL and Scopus. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The search strategies identified 1995 records. Overall, 166 studies were excluded. Forty-two (42) studies met the inclusion criteria. Three (n = 3) studies represented direct causes, and 39 (n = 39) with background factors related to diagnostic overshadowing. Studies highlighted six key themes encompassing diagnostic overshadowing, with communication barriers, stigma and knowledge deficiencies being the most prominent. Recognising and addressing diagnostic overshadowing in chronic hepatitis C will lead to increased screening, diagnosis and timely administration of life-saving antiviral therapy, resulting in profound enhancements in well-being and health outcomes. Moreover, this proactive approach will play a pivotal role in advancing the global effort towards eliminating hepatitis C by 2030.
Collapse
Affiliation(s)
- Regan Preston
- Curtin School of Nursing, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Michael Christmass
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Eric Lim
- Curtin School of Nursing, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Shirley McGough
- Curtin School of Nursing, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Karen Heslop
- Curtin School of Nursing, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
| |
Collapse
|
2
|
Conners EE, Panagiotakopoulos L, Hofmeister MG, Spradling PR, Hagan LM, Harris AM, Rogers-Brown JS, Wester C, Nelson NP. Screening and Testing for Hepatitis B Virus Infection: CDC Recommendations - United States, 2023. MMWR Recomm Rep 2023; 72:1-25. [PMID: 36893044 PMCID: PMC9997714 DOI: 10.15585/mmwr.rr7201a1] [Citation(s) in RCA: 61] [Impact Index Per Article: 61.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
Chronic hepatitis B virus (HBV) infection can lead to substantial morbidity and mortality. Although treatment is not considered curative, antiviral treatment, monitoring, and liver cancer surveillance can reduce morbidity and mortality. Effective vaccines to prevent hepatitis B are available. This report updates and expands CDC's previously published Recommendations for Identification and Public Health Management of Persons with Chronic Hepatitis B Virus Infection (MMWR Recomm Rep 2008;57[No. RR-8]) regarding screening for HBV infection in the United States. New recommendations include hepatitis B screening using three laboratory tests at least once during a lifetime for adults aged ≥18 years. The report also expands risk-based testing recommendations to include the following populations, activities, exposures, or conditions associated with increased risk for HBV infection: persons incarcerated or formerly incarcerated in a jail, prison, or other detention setting; persons with a history of sexually transmitted infections or multiple sex partners; and persons with a history of hepatitis C virus infection. In addition, to provide increased access to testing, anyone who requests HBV testing should receive it, regardless of disclosure of risk, because many persons might be reluctant to disclose stigmatizing risks.
Collapse
Affiliation(s)
- Erin E. Conners
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| | | | - Megan G. Hofmeister
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Philip R. Spradling
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Liesl M. Hagan
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Aaron M. Harris
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Jessica S. Rogers-Brown
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Carolyn Wester
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Noele P. Nelson
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC
| |
Collapse
|
3
|
Tracy BM, Swift DA, Smith RN. HIV geospatially clusters with firearm trauma in 35 Atlanta zip codes. AIDS Care 2023; 35:238-243. [PMID: 35044265 DOI: 10.1080/09540121.2022.2029815] [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: 10/19/2022]
Abstract
The purpose of this study was to assess if rates of firearm trauma within Atlanta geospatially clustered with HIV prevalence and new HIV diagnosis rates. We retrospectively reviewed our Atlanta trauma center's registry for patients sustaining a ballistic firearm trauma from 2014 through 2018. Using the patient's zip code of home residence, we determined the rate of firearm trauma for that zip code. We obtained publicly available rates for HIV that corresponded with these select zip codes to perform a geospatial cluster analysis. The cohort was comprised of 1495 patients and represented 35 zip codes in Atlanta. The mean rate of firearm trauma for the 35 zip codes was 171.1 (±296.4) per 100,000 people. Compared to all Atlanta, the 35 zip codes' mean HIV prevalence (1863.9 vs 924.1, p < .0001) and new HIV diagnosis rate (396.9 vs 199.7, p < .0001) were significantly higher. Rates of firearm trauma and HIV prevalence demonstrated significant geospatial clustering (β 0.38, 95% CI 0.22-0.53, p < .0001) as did rates of firearm trauma and new HIV diagnoses (β 0.36, 95% CI 0.18-0.54, p = 0.0002). Our findings provide granular geographic data that could guide targeted HIV screening efforts in communities where our firearm-injured patients live.
Collapse
Affiliation(s)
- Brett M Tracy
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus
| | - David A Swift
- Department of Surgery, Emory University School of Medicine, Atlanta
- Division of Acute Care Surgery, Grady Memorial Hospital, Atlanta
| | - Randi N Smith
- Department of Surgery, Emory University School of Medicine, Atlanta
- Division of Acute Care Surgery, Grady Memorial Hospital, Atlanta
- Rollins School of Public Health, Emory University, Atlanta
| |
Collapse
|
4
|
Ngo TB, Karkanitsa M, Adusei KM, Graham LA, Ricotta EE, Darrah JR, Blomberg RD, Spathies J, Pauly KJ, Klumpp-Thomas C, Travers J, Mehalko J, Drew M, Hall MD, Memoli MJ, Esposito D, Kozar RA, Griggs C, Cunningham KW, Schulman CI, Crandall M, Neavyn M, Dorfman JD, Lai JT, Whitehill JM, Babu KM, Mohr NM, Van Heukelom J, Fell JC, Rooke W, Kalish H, Thomas FD, Sadtler K. SARS-CoV-2 Seroprevalence and Drug Use in Trauma Patients from Six Sites in the United States. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.08.10.21261849. [PMID: 34401892 PMCID: PMC8366813 DOI: 10.1101/2021.08.10.21261849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
In comparison to the general patient population, trauma patients show higher level detections of bloodborne infectious diseases, such as Hepatitis and Human Immunodeficiency Virus. In comparison to bloodborne pathogens, the prevalence of respiratory infections such as SARS-CoV-2 and how that relates with other variables, such as drug usage and trauma type, is currently unknown in trauma populations. Here, we evaluated SARS-CoV-2 seropositivity and antibody isotype profile in 2,542 trauma patients from six Level-1 trauma centers between April and October of 2020 during the first wave of the COVID-19 pandemic. We found that the seroprevalence in trauma victims 18-44 years old (9.79%, 95% confidence interval/CI: 8.33 - 11.47) was much higher in comparison to older patients (45-69 years old: 6.03%, 4.59-5.88; 70+ years old: 4.33%, 2.54 - 7.20). Black/African American (9.54%, 7.77 - 11.65) and Hispanic/Latino patients (14.95%, 11.80 - 18.75) also had higher seroprevalence in comparison, respectively, to White (5.72%, 4.62 - 7.05) and Non-Latino patients (6.55%, 5.57 - 7.69). More than half (55.54%) of those tested for drug toxicology had at least one drug present in their system. Those that tested positive for narcotics or sedatives had a significant negative correlation with seropositivity, while those on anti-depressants trended positive. These findings represent an important consideration for both the patients and first responders that treat trauma patients facing potential risk of respiratory infectious diseases like SARS-CoV-2.
Collapse
Affiliation(s)
- Tran B. Ngo
- Section on Immuno-Engineering. National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda MD 20894
| | - Maria Karkanitsa
- Section on Immuno-Engineering. National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda MD 20894
| | - Kenneth M. Adusei
- Section on Immuno-Engineering. National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda MD 20894
| | | | - Emily E. Ricotta
- Epidemiology and Population Studies Unit, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda MD 20894
| | | | | | - Jacquelyn Spathies
- Bioengineering and Physical Sciences Shared Resource, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda MD 20894
| | - Kyle J. Pauly
- Bioengineering and Physical Sciences Shared Resource, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda MD 20894
| | - Carleen Klumpp-Thomas
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville MD 20852
| | - Jameson Travers
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville MD 20852
| | - Jennifer Mehalko
- Protein Expression Laboratory, Frederick National Laboratory for Cancer Research, Frederick MD 21702
| | - Matthew Drew
- Protein Expression Laboratory, Frederick National Laboratory for Cancer Research, Frederick MD 21702
| | - Matthew D Hall
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville MD 20852
| | - Matthew J Memoli
- Clinical Studies Unit, Laboratory of Infectious Diseases, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Bethesda MD 20894
| | - Dominic Esposito
- Protein Expression Laboratory, Frederick National Laboratory for Cancer Research, Frederick MD 21702
| | - Rosemary A. Kozar
- Shock Trauma Center, University of Maryland School of Medicine, Baltimore MD 21201
| | - Christopher Griggs
- Department of Emergency Medicine, Atrium Health’s Carolinas Medical Center, Charlotte NC 28203
| | - Kyle W. Cunningham
- Division of Acute Care Surgery, Atrium Health’s Carolinas Medical Center, Charlotte NC 28203
| | | | - Marie Crandall
- Department of Surgery, University of Florida College of Medicine, Jacksonville FL 33209
| | - Mark Neavyn
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester MA 01655
| | - Jon D. Dorfman
- Maine Medical Center, Department of Emergency Medicine, Tufts University School of Medicine, Portland ME 04102
| | - Jeffrey T. Lai
- Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, Worcester MA 01655
| | - Jennifer M. Whitehill
- Department of Health Promotion and Policy, University of Massachusetts Amherst, Amherst MA 01003
| | - Kavita M. Babu
- Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, Worcester MA 01655
| | - Nicholas M. Mohr
- Department of Emergency Medicine, Anesthesia Critical Care, and Epidemiology, University of Iowa Health Care, Iowa City IA 52242
| | - Jon Van Heukelom
- Department of Emergency Medicine, University of Iowa Health Care, Iowa City IA 52242
| | - James C. Fell
- NORC at the University of Chicago, Bethesda, MD 20814
| | | | - Heather Kalish
- Bioengineering and Physical Sciences Shared Resource, National Institute for Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda MD 20894
| | | | - Kaitlyn Sadtler
- Section on Immuno-Engineering. National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda MD 20894
| |
Collapse
|
5
|
Vrouwe SQ, Johnson MB, Pham CH, Lane CJ, Garner WL, Gillenwater TJ, Yenikomshian HA. The Homelessness Crisis and Burn Injuries: A Cohort Study. J Burn Care Res 2020; 41:820-827. [PMID: 32619013 DOI: 10.1093/jbcr/iraa023] [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: 11/15/2022]
Abstract
The United States is facing a growing homelessness crisis. We characterize the demographics and outcomes of homeless patients who sustain burn injury and compare them to a cohort of domiciled patients. A retrospective cohort study was performed at the Los Angeles County + University of Southern California Regional Burn Center for consecutive acute burn admissions in adults from June 1, 2015, to December 31, 2018. Patients were categorized as either domiciled or homeless at the time of their injury. Prevalence rates were estimated using data from the regional homeless count. From 881 admissions, 751 (85%) had stable housing and 130 (15%) were homeless. The rate of burn injury requiring hospitalization for homeless adults was estimated at 88 per 100,000 persons. Homeless patients had a significantly larger median burn size (7 vs 5%, P < .05) and a greater rate of flame burns (68 vs 42%, P < .001). For the homeless, rates of assault and self-inflicted injury were 4- (18 vs 4%, P < .001) and 2-fold higher (9 vs 4%, P < .001), respectively. Homeless patients had higher rates of mental illness (32 vs 12%, P < .001) and substance abuse (88 vs 22%, P < .001), and were less likely to follow-up as outpatients (54 vs 87%, P < .001). There was no difference in mortality. Homeless patients had a longer median length of stay (LOS; 11 vs 7 days, P < .001) without significant differences in LOS per percentage TBSA. Homeless individuals should be considered a high-risk population for burn injury. This distinction serves as a call to action for the development of burn prevention strategies.
Collapse
Affiliation(s)
- Sebastian Q Vrouwe
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California
| | - Maxwell B Johnson
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California
| | - Christopher H Pham
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California
| | - Christianne J Lane
- Division of Biostatistics, University of Southern California, Los Angeles, California
| | - Warren L Garner
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California
| | - T Justin Gillenwater
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California
| | - Haig A Yenikomshian
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California
| |
Collapse
|
6
|
Fitch JL, Dieffenbaugher S, McNutt M, Miller CC, Wainwright DJ, Villarreal JA, Wilson CT, Todd SR. Are We Out of the Woods Yet? The Aftermath of Resuscitative Thoracotomy. J Surg Res 2019; 245:593-599. [PMID: 31499365 DOI: 10.1016/j.jss.2019.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/11/2019] [Accepted: 07/05/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND After traumatic arrest, resuscitative thoracotomy is lifesaving in appropriately selected patients, yet data are limited regarding hospital course after intensive care unit (ICU) admission. The objective of this study was to describe the natural history of resuscitative thoracotomy survivors admitted to the ICU. MATERIALS AND METHODS We conducted a retrospective review (January 1, 2012-June 30, 2017) of all adult trauma patients who underwent resuscitative thoracotomy after traumatic arrest at two adult level 1 trauma centers. Data evaluated include demographics, injury characteristics, hospital course, and outcome. RESULTS Over 66 mo, there were 52,624 trauma activations. Two hundred ninety-eight patients underwent resuscitative thoracotomy and 96 (32%) survived to ICU admission. At ICU admission, mean age was 35.8 ± 14.5 y, 79 (82%) were male, 36 (38%) sustained blunt trauma, and the mean injury severity score was 32.3 ± 13.7. Eight blunt and 20 penetrating patients (22% and 34% of ICU admissions, respectively) survived to discharge. 67% of deaths in the ICU occurred within the first 24 h, whereas 90% of those alive at day 21 survived to discharge. For the 28 survivors, mean ICU length of stay was 24.1 ± 17.9 d and mean hospital length of stay was 43.9 ± 32.1 d. Survivors averaged 1.9 ± 1.5 complications. Twenty-four patients (86% of hospital survivors) went home or to a rehabilitation center. CONCLUSIONS After resuscitative thoracotomy and subsequent ICU admission, 29% of patients survived to hospital discharge. Complications and a long hospital stay should be expected, but the functional outcome for survivors is not as bleak as previously reported.
Collapse
Affiliation(s)
- Jamie L Fitch
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Department of General Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia.
| | - Sean Dieffenbaugher
- Department of Surgery, The University of Texas McGovern Medical School, Houston, Texas
| | - Michelle McNutt
- Department of Surgery, The University of Texas McGovern Medical School, Houston, Texas
| | - C Cody Miller
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - D'Arcy J Wainwright
- Department of Surgery, The University of Texas McGovern Medical School, Houston, Texas
| | - Joshua A Villarreal
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Chad T Wilson
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - S Rob Todd
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
7
|
HIV Screening and Early Referral in the Trauma Population: The Experience of a Large Safety Net Hospital. J Surg Res 2019; 245:360-366. [PMID: 31425876 DOI: 10.1016/j.jss.2019.07.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/21/2019] [Accepted: 07/19/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND While the prevalence of HIV infection in the population is 0.5%, it is higher among trauma patients as are rates of unknown seropositivity. Routine HIV screening for all trauma evaluations was implemented at our urban level I center in 2009. We aimed to evaluate use and results of the program in our trauma population. METHODS This was a retrospective analysis of all trauma evaluations between July 2015 and February 2018. After passage of legislation rescinding the requirement for consent to perform HIV testing, our trauma service instituted an order set which automatically tested for HIV unless the ordering physician opted out. Patients found to be infected with HIV were to be counseled and referred to specialty care. RESULTS Of 6175 consecutive trauma evaluations during the study period, 449 (7.3%) patients had been screened within the prior year and were excluded. Of the remaining cohort, 2024 (35.3%) patients were screened with 27 (1.3%) testing positive. Among those testing positive for infection, 100% were male, 77% white, 63% non-Hispanic, and 70% lacked insurance. Twenty-five (92.6%) patients received counseling and 19 were referred to specialty care. Age, gender, race, ethnicity, Injury Severity Score, trauma activation level, and payor type were not significant predictors for positive HIV screen on logistic regression analysis. CONCLUSIONS Despite a significantly higher rate of HIV in the trauma population, only a third of patients are screened. Such high infection rates justify the existence of this screening program but steps must be taken to increase screening rate. LEVEL OF EVIDENCE Level 3.
Collapse
|
8
|
Occupational exposure during emergency department thoracotomy: A prospective, multi-institution study. J Trauma Acute Care Surg 2019; 85:78-84. [PMID: 29664893 DOI: 10.1097/ta.0000000000001940] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Occupational exposure is an important consideration during emergency department thoracotomy (EDT). While human immunodeficiency virus/hepatitis prevalence in trauma patients (0-16.8%) and occupational exposure rates during operative trauma procedures (1.9-18.0%) have been reported, exposure risk during EDT is unknown. We hypothesized that occupational exposure risk during EDT would be greater than other operative trauma procedures. METHODS A prospective, observational study at 16 US trauma centers was performed (2015-2016). All bedside EDT resuscitation providers were surveyed with a standardized data collection tool and risk factors analyzed with respect to the primary end point, EDT occupational exposure (percutaneous injury, mucous membrane, open wound, or eye splash). Provider and patient variables and outcomes were evaluated with single and multivariable logistic regression analyses. RESULTS One thousand three hundred sixty participants (23% attending, 59% trainee, 11% nurse, 7% other) were surveyed after 305 EDTs (gunshot wound, 68%; prehospital cardiopulmonary resuscitation, 57%; emergency department signs of life, 37%), of which 15 patients survived (13 neurologically intact) their hospitalization. Overall, 22 occupational exposures were documented, resulting in an exposure rate of 7.2% (95% confidence interval [CI], 4.7-10.5%) per EDT and 1.6% (95% CI, 1.0-2.4%) per participant. No differences in trauma center level, number of participants, or hours worked were identified. Providers with exposures were primarily trainees (68%) with percutaneous injuries (86%) during the thoracotomy (73%). Full precautions were utilized in only 46% of exposed providers, while multiple variable logistic regression determined that each personal protective equipment item utilized during EDT correlated with a 34% decreased risk of occupational exposure (odds ratio, 0.66; 95% CI, 0.48-0.91; p = 0.010). CONCLUSIONS Our results suggest that the risk of occupational exposure should not deter providers from performing EDT. Despite the small risk of viral transmission, our data revealed practices that may place health care providers at unnecessary risk of occupational exposure. Regardless of the lifesaving nature of the procedure, improved universal precaution compliance with personal protective equipment is paramount and would further minimize occupational exposure risks during EDT. LEVEL OF EVIDENCE Therapeutic/care management study, level III.
Collapse
|
9
|
Simoncini GM, Oyola-Jimenez J, Singleton D, Volgraf J, Ramsey FV, Goldberg A. HIV and HCV screening among trauma patients. Int J STD AIDS 2019; 30:663-670. [PMID: 30961465 DOI: 10.1177/0956462419829590] [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: 11/16/2022]
Abstract
The purpose of this study was to develop a hepatitis C virus (HCV) and HIV screening program for patients evaluated by the trauma service and link to care. Patients were offered screening for HCV antibody and HIV. Demographics were collected on gender, race, age, and history of intravenous drug use. A navigator connected patients to treatment. In total, 1160 trauma patients were screened for HCV and/or HIV. There were 162 (14%) patients with HCV antibodies. Patients who inject drugs comprised 39.5% (64) of the HCV antibody positive group. Forty-six (68.7%) patients received linkage to care services and 55 (34%) patients were actively engaged in treatment. There were 155 (10.5%) of all eligible patients screened for HIV. Twenty-one (13.5%) patients were living with HIV (PLWH) and there were two (1.3%) new HIV infections. All new PLWH were linked to care and a total of 14 (73.7%) PLWH were on antiretroviral therapy. This is the first HCV and HIV screening and linkage to care program of trauma surgery patients. In this interim program evaluation, we found high prevalence of HCV antibody and HIV prevalence and high linkage to care rates. Trauma service HCV and HIV screening is an opportunity to diagnose, link, and re-engage a vulnerable population.
Collapse
Affiliation(s)
- Gina M Simoncini
- 1 Department of Medicine, Section of General Internal Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Josue Oyola-Jimenez
- 1 Department of Medicine, Section of General Internal Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Davone Singleton
- 1 Department of Medicine, Section of General Internal Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Jill Volgraf
- 2 Department of Nursing, Temple University Hospital, Philadelphia, PA, USA
| | - Frederick V Ramsey
- 3 Department of Clinical Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Amy Goldberg
- 4 Department of Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| |
Collapse
|
10
|
Universal insurance and an equal access healthcare system eliminate disparities for Black patients after traumatic injury. Surgery 2018; 163:651-656. [DOI: 10.1016/j.surg.2017.09.045] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/05/2017] [Accepted: 09/13/2017] [Indexed: 11/23/2022]
|
11
|
Resuscitative Thoracotomy. CURRENT TRAUMA REPORTS 2018. [DOI: 10.1007/s40719-018-0117-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
12
|
Abstract
Purpose of Review This article reviews the new definitions of pneumonia, discusses risk factors for pneumonia among trauma patients, presents the latest evidence for prevention strategies, discusses the best ways to make the diagnosis, and reviews the microbiology and treatment for trauma patients with pneumonia. Recent Findings Pneumonia can be prevented by decreasing the duration of mechanical ventilation using daily paired spontaneous awakening and breathing trials, but not with early tracheostomy placement. Other useful prevention strategies include semirecumbent positioning and oral care. Mini-BAL is a sensitive and specific means of securing the diagnosis of pneumonia that does not require a physician to be present and is therefore especially useful in busy trauma centers. Summary Pneumonia is a frequent complication among trauma patients. Risk factors are largely unmodifiable. However, trauma centers can institute routine daily paired spontaneous awakening and breathing trials to decrease the duration of ventilation and incidence of pneumonia. Future research is needed to further characterize the microbiology of pneumonia among trauma patients.
Collapse
Affiliation(s)
- Morgan Schellenberg
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo St, IPT C5L100, Los Angeles, CA 90033 USA
| | - Kenji Inaba
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, 2051 Marengo St, IPT C5L100, Los Angeles, CA 90033 USA
| |
Collapse
|
13
|
Bessey JT, Le HV, Leonard DA, Bono CM, Harris MB, Kang JD, Schoenfeld AJ. The effect of chronic liver disease on acute outcomes following cervical spine trauma. Spine J 2016; 16:1194-1199. [PMID: 27288882 DOI: 10.1016/j.spinee.2016.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 05/10/2016] [Accepted: 06/03/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The adverse impact of chronic liver diseases, including chronic hepatitis and cirrhosis, on outcomes following orthopedic surgery has been increasingly recognized in recent years. The impact of these conditions on acute outcomes following spinal trauma remains unknown. STUDY DESIGN This is a cohort control study that uses patient records in the Massachusetts Statewide Inpatient Dataset (2003-2010). PURPOSE The study aimed to evaluate whether chronic liver disease increased the odds of mortality, complications, failure to rescue (FTR), reoperation, and hospital length of stay (LOS) following cervical spine trauma. PATIENT SAMPLE The sample is composed of 10,841 patients with cervical spine trauma. OUTCOME MEASURES Posttreatment morbidity, mortality, reoperation, and LOS were the outcome measures. METHODS Differences between patients with and without chronic liver disease were evaluated using chi-square or Wilcoxon rank-sum tests. Logistic and negative binomial regression techniques were used to adjust for confounders, including whether a surgical intervention was performed. Receiver operator characteristic curves were used to assess final model discrimination. RESULTS There were 117 patients with chronic liver disease identified in the cohort. The rate of surgical intervention for cervical trauma was not significantly different between patients with and without chronic liver disease (odds ratio [OR]: 0.82, 95% confidence interval [CI]: 0.52-1.29). Mortality (OR: 2.12, 95% CI: 1.23-3.66), FTR (OR: 2.86, 95% CI: 1.34-6.11), complications (OR: 1.65, 95% CI: 1.12-2.45), and LOS (regression coefficients: 0.31, 95% CI: 0.14-0.48) were all significantly increased for patients with chronic liver disease in final adjusted models that controlled for differences in case-mix and whether a surgical procedure was performed. Final models explained approximately 72% of the variation in mortality and FTR. CONCLUSIONS Our novel findings indicate that patients with chronic liver disease may be at elevated risk of posttreatment morbidity and mortality following cervical spine trauma. Medical comanagement in the acute period following injury and optimization before surgery may diminish the potential for adverse events.
Collapse
Affiliation(s)
- Jason T Bessey
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
| | - Hai V Le
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
| | - Dana A Leonard
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
| | - Christopher M Bono
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
| | - Mitchel B Harris
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
| | - James D Kang
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
| |
Collapse
|
14
|
|
15
|
An evidence-based approach to patient selection for emergency department thoracotomy: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg 2015; 79:159-73. [PMID: 26091330 DOI: 10.1097/ta.0000000000000648] [Citation(s) in RCA: 196] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Within the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework, we performed a systematic review and developed evidence-based recommendations to answer the following PICO (Population, Intervention, Comparator, Outcomes) question: should patients who present pulseless after critical injuries (with and without signs of life after penetrating thoracic, extrathoracic, or blunt injuries) undergo emergency department thoracotomy (EDT) (vs. resuscitation without EDT) to improve survival and neurologically intact survival? METHODS All patients who underwent EDT were included while those involving either prehospital resuscitative thoracotomy or operating room thoracotomy were excluded. Quantitative synthesis via meta-analysis was not possible because no comparison or control group (i.e., survival or neurologically intact survival data for similar patients who did not undergo EDT) was available for the PICO questions of interest. RESULTS The 72 included studies provided 10,238 patients who underwent EDT. Patients presenting pulseless after penetrating thoracic injury had the most favorable EDT outcomes both with (survival, 182 [21.3%] of 853; neurologically intact survival, 53 [11.7%] of 454) and without (survival, 76 [8.3%] of 920; neurologically intact survival, 25 [3.9%] of 641) signs of life. In patients presenting pulseless after penetrating extrathoracic injury, EDT outcomes were more favorable with signs of life (survival, 25 [15.6%] of 160; neurologically intact survival, 14 [16.5%] of 85) than without (survival, 4 [2.9%] of 139; neurologically intact survival, 3 [5.0%] of 60). Outcomes after EDT in pulseless blunt injury patients were limited with signs of life (survival, 21 [4.6%] of 454; neurologically intact survival, 7 [2.4%] of 298) and dismal without signs of life (survival, 7 [0.7%] of 995; neurologically intact survival, 1 [0.1%] of 825). CONCLUSION We strongly recommend that patients who present pulseless with signs of life after penetrating thoracic injury undergo EDT. We conditionally recommend EDT for patients who present pulseless and have absent signs of life after penetrating thoracic injury, present or absent signs of life after penetrating extrathoracic injury, or present signs of life after blunt injury. Lastly, we conditionally recommend against EDT for pulseless patients without signs of life after blunt injury. LEVEL OF EVIDENCE Systematic review/guideline, level III.
Collapse
|
16
|
Abstract
BACKGROUND Resuscitative thoracotomy is a heroic procedure that may offer the only survival hope for trauma patients in extremis. However, this operation has been the subject of much debate and its use, feasibility, outcomes, and cost are being continuously re-evaluated. METHODS This is a review of the most current (after 2000) literature on resuscitative thoracotomy, based on computer database searches for studies on resuscitative thoracotomy, emergency department thoracotomy, and emergency thoracotomy. Studies were selected for inclusion in this review based on their relevance and contribution to our understanding of resuscitative thoracotomy. RESULTS A total of 37 studies were included, and the following resuscitative thoracotomy-related topics were critically discussed: indications, biochemical profile, long-term outcome, organ donation, pre-hospital use, military use, international aspects, intra-aortic balloon occlusion, suspended animation, and cost and occupational exposure. CONCLUSIONS This review demonstrates that the indications for resuscitative thoracotomy become clearer and that new information is available regarding its use in the pre-hospital urban environment and military settings. Furthermore, it points to new strategies to supplement resuscitative thoracotomy including intra-aortic balloon occlusion and suspended animation. Finally, it sheds light on the long-term outcomes, organ donation, and cost and occupational exposure following resuscitative thoracotomy.
Collapse
Affiliation(s)
- R Rabinovici
- Division of Trauma and Acute Care Surgery, Tufts Medical Center, Boston, MA, USA
| | - N Bugaev
- Division of Trauma and Acute Care Surgery, Tufts Medical Center, Boston, MA, USA
| |
Collapse
|
17
|
Life after near death: long-term outcomes of emergency department thoracotomy survivors. J Trauma Acute Care Surg 2013; 74:1315-20. [PMID: 23609284 DOI: 10.1097/ta.0b013e31828c3db4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Predictors of hospital survival after emergency department thoracotomy (EDT) are well established, but little is known of long-term outcomes after hospital survival. Our primary study objective was to analyze the long-term social, cognitive, functional, and psychological outcomes in EDT survivors. METHODS Review of our Level I trauma center registry (2000-2010) revealed that 37 of 448 patients survived hospitalization after EDT. Demographics and clinical characteristics were analyzed. After attempts to contact survivors, 21 patients or caretakers were invited to an outpatient study evaluation; 16 were unreachable (none of whom were present in the Social Security Death Index). Study evaluation included demographic and social data and an outpatient multidisciplinary assessment with validated scoring instruments (Mini-Mental Status Exam, Glasgow Outcome Scores, Timed Get-Up and Go Test, Functional Independence Measure Scoring, SF-36 Health Survey, and civilian posttraumatic stress disorder checklist). RESULTS After extended hospitalization (43 ± 41 days), disposition varied (home, 62%; rehabilitation, 32%; skilled nursing facility, 6%), but readmission was common (33%) in the 37 EDT hospital survivors. Of the 21 contacted, 16 completed the study evaluation, 2 had died, 1 remained in a comatose state, and 2 were available by telephone only. While unemployment (75%), daily alcohol (50%), and drug use (38%) were common, of the 16 patients who underwent the comprehensive, multidisciplinary outpatient assessment after a median of 59 months following EDT, 75% had normal cognition and returned to normal activities, 81% were freely mobile and functional, and 75% had no evidence of posttraumatic stress disorder upon outpatient screening. CONCLUSION Despite the common belief that EDT survivors often live with severe neurologic or functional impairment, we have found that most of our sampled EDT survivors had no evidence of long-term impairment. It is our hope that these results are considered by physicians making life or death decisions regarding the "futility" of EDT in our most severely injured patients.
Collapse
|
18
|
Krueger A, Frink M, Kiessling A, Ruchholtz S, Kühne C. [Emergency room management : in the era of the White Paper, S3 guidelines, Advanced Trauma Life Support® and TraumaNetwork DGU® of the German Society of Trauma Surgery]. Chirurg 2013; 84:437-50. [PMID: 23553150 PMCID: PMC7096044 DOI: 10.1007/s00104-012-2384-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The treatment of the severely injured is, just as the injury severity and combinations, often highly complex and leaves little leeway for delay, dissent or even error. In order to reduce this to a minimum, trained emergency room teams in addition to optimal technical and structural prerequisites are necessary. This must function in an interdisciplinary fashion according to fixed consensus algorithms which are known to all team members and have been agreed by all participants. The White Paper on treatment of the severely injured of the German Society of Trauma Surgery (DGU) and the recently published S3 guidelines offer evidence-based recommendations on the structural, technical, organizational and personnel prerequisites.
Collapse
Affiliation(s)
- A. Krueger
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinika Gießen und Marburg GmbH, Standort Marburg, 35043 Marburg, Deutschland
| | - M. Frink
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinika Gießen und Marburg GmbH, Standort Marburg, 35043 Marburg, Deutschland
| | - A. Kiessling
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinika Gießen und Marburg GmbH, Standort Marburg, 35043 Marburg, Deutschland
| | - S. Ruchholtz
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinika Gießen und Marburg GmbH, Standort Marburg, 35043 Marburg, Deutschland
| | - C.A. Kühne
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinika Gießen und Marburg GmbH, Standort Marburg, 35043 Marburg, Deutschland
| |
Collapse
|
19
|
Life after near death: Long-term outcomes of emergency department thoracotomy survivors. J Trauma Acute Care Surg 2013. [DOI: 10.1097/01586154-201305000-00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
20
|
Seamon MJ, Chovanes J, Fox N, Green R, Manis G, Tsiotsias G, Warta M, Ross SE. The use of emergency department thoracotomy for traumatic cardiopulmonary arrest. Injury 2012; 43:1355-61. [PMID: 22560130 DOI: 10.1016/j.injury.2012.04.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 03/30/2012] [Accepted: 04/07/2012] [Indexed: 02/02/2023]
Abstract
Despite the establishment of evidence-based guidelines for the resuscitation of critically injured patients who have sustained cardiopulmonary arrest, rapid decisions regarding patient salvageability in these situations remain difficult even for experienced physicians. Regardless, survival is limited after traumatic cardiopulmonary arrest. One applicable, well-described resuscitative technique is the emergency department thoracotomy-a procedure that, when applied correctly, is effective in saving small but significant numbers of critically injured patients. By understanding the indications, technical details, and predictors of survival along with the inherent risks and costs of emergency department thoracotomy, the physician is better equipped to make rapid futile versus salvageable decisions for this most severely injured subset of patients.
Collapse
Affiliation(s)
- Mark J Seamon
- Division of Trauma and Surgical Critical Care, Department of Surgery, Cooper University Hospital, Camden, NJ 08103 , USA.
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Kelleher DC, Carter EA, Waterhouse LJ, Burd RS. Compliance with barrier precautions during paediatric trauma resuscitations. Resuscitation 2012; 84:314-8. [PMID: 22841609 DOI: 10.1016/j.resuscitation.2012.07.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 05/14/2012] [Accepted: 07/15/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE Barrier precautions protect patients and providers from blood-borne pathogens. Although barrier precaution compliance has been shown to be low among adult trauma teams, it has not been evaluated during paediatric resuscitations in which perceived risk of disease transmission may be low. The purpose of this study was to identify factors associated with compliance with barrier precautions during paediatric trauma resuscitations. METHODS Video recordings of resuscitations performed on injured children (<18 years old) were reviewed to determine compliance with an established policy requiring gowns and gloves. Depending on activation level, trauma team members included up to six physicians, four nurses, and a respiratory therapist. Multivariate logistic regression was used to determine the effect of team role, resuscitation factors, and injury mechanism on barrier precaution compliance. RESULTS Over twelve weeks, 1138 trauma team members participated in 128 resuscitations (4.7% penetrating injuries, 9.4% highest level activations). Compliance with barrier precautions was 81.3%, with higher compliance seen among roles primarily at the bedside compared to positions not primarily at the bedside (90.7% vs. 65.1%, p<0.001). Bedside residents (98.4%) and surgical fellows (97.6%) had the highest compliance, while surgical attendings (20.8%) had the lowest (p<0.001). Controlling for role, increased compliance was observed during resuscitations of patients with penetrating injuries (OR=3.97 [95% CI: 1.35-11.70], p=0.01), during resuscitations triaged to the highest activation level (OR=2.61 [95% CI: 1.34-5.10], p=0.005), and among team members present before patient arrival (OR=4.14 [95% CI: 2.29-7.39], p<0.001). CONCLUSIONS Compliance with barrier precautions varies by trauma team role. Team members have higher compliance when treating children with penetrating and high acuity injuries and when arriving before the patient. Interventions integrating barrier precautions into the workflow of team members are needed to reduce this variability and improve compliance with universal precautions during paediatric trauma resuscitations.
Collapse
Affiliation(s)
- Deirdre C Kelleher
- Division of Trauma and Burns, Children's National Medical Center, Washington, DC 20010, United States
| | | | | | | |
Collapse
|