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Biesboer EA, Pokrzywa CJ, Karam BS, Chen B, Szabo A, Teng BQ, Bernard MD, Bernard A, Chowdhury S, Hayudini AHE, Radomski MA, Doris S, Yorkgitis BK, Mull J, Weston BW, Hemmila MR, Tignanelli CJ, de Moya MA, Morris RS. Prospective validation of a hospital triage predictive model to decrease undertriage: an EAST multicenter study. Trauma Surg Acute Care Open 2024; 9:e001280. [PMID: 38737811 PMCID: PMC11086287 DOI: 10.1136/tsaco-2023-001280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/23/2024] [Indexed: 05/14/2024] Open
Abstract
Background Tiered trauma team activation (TTA) allows systems to optimally allocate resources to an injured patient. Target undertriage and overtriage rates of <5% and <35% are difficult for centers to achieve, and performance variability exists. The objective of this study was to optimize and externally validate a previously developed hospital trauma triage prediction model to predict the need for emergent intervention in 6 hours (NEI-6), an indicator of need for a full TTA. Methods The model was previously developed and internally validated using data from 31 US trauma centers. Data were collected prospectively at five sites using a mobile application which hosted the NEI-6 model. A weighted multiple logistic regression model was used to retrain and optimize the model using the original data set and a portion of data from one of the prospective sites. The remaining data from the five sites were designated for external validation. The area under the receiver operating characteristic curve (AUROC) and the area under the precision-recall curve (AUPRC) were used to assess the validation cohort. Subanalyses were performed for age, race, and mechanism of injury. Results 14 421 patients were included in the training data set and 2476 patients in the external validation data set across five sites. On validation, the model had an overall undertriage rate of 9.1% and overtriage rate of 53.7%, with an AUROC of 0.80 and an AUPRC of 0.63. Blunt injury had an undertriage rate of 8.8%, whereas penetrating injury had 31.2%. For those aged ≥65, the undertriage rate was 8.4%, and for Black or African American patients the undertriage rate was 7.7%. Conclusion The optimized and externally validated NEI-6 model approaches the recommended undertriage and overtriage rates while significantly reducing variability of TTA across centers for blunt trauma patients. The model performs well for populations that traditionally have high rates of undertriage. Level of evidence 2.
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Affiliation(s)
- Elise A Biesboer
- Department of Surgery, Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Courtney J Pokrzywa
- Department of Surgery, Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Basil S Karam
- Department of Surgery, Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Benjamin Chen
- Department of Computer Science, University of Minnesota, Minneapolis, Minnesota, USA
| | - Aniko Szabo
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Bi Qing Teng
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Matthew D Bernard
- Department of Surgery, Division of Acute Care Surgery, Trauma, and Surgical Crtical Care, University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Andrew Bernard
- Department of Surgery, Division of Acute Care Surgery, Trauma, and Surgical Crtical Care, University of Kentucky Medical Center, Lexington, Kentucky, USA
| | | | | | | | | | - Brian K Yorkgitis
- Department of Surgery, Division of Acute Care Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, USA
| | - Jennifer Mull
- Department of Surgery, Division of Acute Care Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, USA
| | - Benjamin W Weston
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Mark R Hemmila
- Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | - Marc A de Moya
- Department of Surgery, Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Rachel S Morris
- Department of Surgery, Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Orozco G, Gupta M, Ancheta A, Shah MB, Warriner Z, Marti F, Mei X, Desai S, Bernard A, Gedaly R. Liver transplantation for severe hepatic trauma: A multicenter analysis from the UNOS data set. J Trauma Acute Care Surg 2024; 96:763-768. [PMID: 37994467 DOI: 10.1097/ta.0000000000004220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
BACKGROUND Orthotopic liver transplantation (OLT) is rarely indicated after hepatic trauma but it can be the only therapeutic option in some patients. There are scarce data analyzing the surgical outcomes of OLT after trauma. METHODS We used the UNOS data set to identify patients who underwent OLT for trauma from 1987 to 2022 and compared them to a cohort of patients transplanted for other indications. Cox proportional hazard and multivariable logistic regression analyses were performed to assess predictors of graft and patient survival. RESULTS Seventy-two patients underwent OLT for trauma during the study period. Patients with trauma were more frequently on mechanical ventilation at the time of transplantation (26.4% vs. 7.6%, p < 0.001) and had a greater incidence of pretransplant portal vein thrombosis (12.5% vs. 4%, p = 0.002). Our 4:1 matched analysis showed that trauma patients had significantly shorter wait times, higher incidence of pretransplant portal vein thrombosis and prolonged length of stay. Trauma was associated with decreased overall graft survival (hazards ratio, 1.42; 95% confidence interval, 1.01-1.98), and increased length of stay ( p = 0.048). There were no significant differences in long-term patient survival. CONCLUSION Unique physiological and vascular challenges after severe hepatic trauma might be associated with decreased graft survival in patients requiring liver transplantation. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level III.
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Affiliation(s)
- Gabriel Orozco
- From the Division of Transplantation, Department of Surgery (G.O., M.G., A.A., M.B.S., F.M., X.M., S.D., R.G.), and Division of Acute Care Surgery, Trauma & Surgical Critical Care, Department of Surgery (Z.W., A.B.), University of Kentucky, Lexington, Kentucky
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Bernard M, Dahlhausen CM, Kirk AM, Bernard A. Fragmenting projectiles: a case report and literature review of the G2 Radically Invasive Projectile. Trauma Surg Acute Care Open 2024; 9:e001355. [PMID: 38375026 PMCID: PMC10875469 DOI: 10.1136/tsaco-2023-001355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/31/2024] [Indexed: 02/21/2024] Open
Abstract
Innovations in projectile design present unique challenges for trauma surgeons when treating gunshot victims. The G2 Radically Invasive Projectile (G2 Research, Winder, Georgia, USA) (G2RIP) is a frangible, rapidly expanding bullet resulting in a distinct pattern of injury consisting of diffuse hemorrhage with multicavity trauma as well as unique radiographic features of the projectile. To efficiently manage patients injured by the G2RIP, trauma surgeons must be aware of these distinct characteristics, and of previous patterns in effective management such as liberal damage control and extensive use of CT. Understanding previous presentation and management of patients injured by the G2RIP can aid in improving patient care in the trauma center.
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Affiliation(s)
- Matthew Bernard
- Surgery, University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Christine M Dahlhausen
- Department of Surgery, The University of Texas Rio Grande Valley School of Medicine, Harlingen, Texas, USA
| | - Andrew M Kirk
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Andrew Bernard
- Trauma and Acute Care Surgery, University of Kentucky Medical Center, Lexington, Kentucky, USA
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Cheng V, Samakar K, Dobrowolsky AB, Nguyen JD, Abel SA, Pakula A, Bernard A, Martin MJ. Common postbariatric surgery emergencies for the acute care surgeon: What you need to know. J Trauma Acute Care Surg 2023; 95:817-831. [PMID: 37982794 DOI: 10.1097/ta.0000000000004125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
ABSTRACT The field of bariatric and metabolic surgery has changed rapidly over the past two decades, with an exponential increase in case volumes being performed because of its proven efficacy for morbid obesity and obesity-related comorbidities. Although this increased volume of procedures has been accompanied by significant decrease in postoperative complication rates, there are numerous potential complications after bariatric surgery that may require urgent or emergent surgical evaluation or interventions. Many of these risks extend well beyond the early postoperative period and can present months to years after the index procedure. Acute care surgeons are increasingly covering most or all of the emergency general surgery services at many centers and must be familiar with the numerous bariatric surgical procedures being performed and their individual complication profile to provide optimal care for these frequently challenging patients. This article provides a focused and concise review of the common bariatric procedures being performed, their early and late complication profiles, and a practical guide to the optimal diagnostic evaluations, surgical interventions, and perioperative management options. The author group includes both acute care surgeons and bariatric surgeons with significant experience in the emergency management of the complicated postbariatric surgical patient. LEVEL OF EVIDENCE Literature Synthesis and Expert Opinion; Level V.
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Affiliation(s)
- Vincent Cheng
- From the Division of Trauma and Surgical Critical Care (V.C., M.J.M.), Los Angeles County + USC Medical Center, University of Southern California; Division of Upper GI and General Surgery (V.C., K.S., A.B.D., J.D.N., S.A.A., M.J.M.), Keck School of Medicine of the University of Southern California, Los Angeles; Surgical Specialties (A.P.), Simi Valley Adventist Hospital, Simi Valley, California; and Division of Acute Care Surgery and Trauma (A.B.), University of Kentucky-Lexington, Lexington, Kentucky
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Moret A, Madelaine L, Hanna HA, Bernard A, Pagès PB. [Complications after pulmonary segmentectomy: Impact of the surgical approach]. Rev Mal Respir 2023; 40:666-674. [PMID: 37798174 DOI: 10.1016/j.rmr.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 06/14/2023] [Indexed: 10/07/2023]
Abstract
INTRODUCTION Pulmonary segmentectomy is becoming increasingly widespread but remains technically challenging. The aim of this study was to evaluate the impact of the surgical approach applied on postoperative complications after pulmonary segmentectomy. METHODS All patients having undergone pulmonary segmentectomy by thoracotomy, videothoracoscopy or robot-assisted surgery from 1st January 2018 to 31st December 2021 were included. The primary endpoint was the occurrence of postoperative complications. Secondary endpoints were operative time, length of hospital stay, 30-day readmission rate, 30-day and 90-day mortality. RESULTS Two hundred and twenty-three patients were included, 30% (n=67) in the thoracotomy group, 9.4% (n=21) in the videothoracoscopy group and 60.5% (n=135) in the robot-assisted surgery group. There was no difference in the occurrence of postoperative complications according to type of approach (P=0.564), 26.9% of patients (n=60) had at least one postoperative complication. There was no significant difference between the groups in terms of operative time (P=0.385), length of hospital stay (P=0.107), 30 and 90-day mortality (P=0.124 and P=0.249, respectively). Mini-invasive surgery significantly reduced the 30-day readmission rate (P=0.049). CONCLUSION The surgical approach applied does not influence the postoperative complications of pulmonary segmentectomy.
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Affiliation(s)
- A Moret
- Service de chirurgie thoracique, CHU de Dijon, Bocage central, 14, rue Gaffarel, 21079 Dijon, France; Service de chirurgie thoracique, centre hospitalier Métropole Savoie, Chambéry, France
| | - L Madelaine
- Service de chirurgie thoracique, CHU de Dijon, Bocage central, 14, rue Gaffarel, 21079 Dijon, France
| | - H Abou Hanna
- Service de chirurgie thoracique, CHU de Dijon, Bocage central, 14, rue Gaffarel, 21079 Dijon, France
| | - A Bernard
- Service de chirurgie thoracique, CHU de Dijon, Bocage central, 14, rue Gaffarel, 21079 Dijon, France
| | - P-B Pagès
- Service de chirurgie thoracique, CHU de Dijon, Bocage central, 14, rue Gaffarel, 21079 Dijon, France; Inserm, UMR 1231, CHU de Dijon, université de Bourgogne, Dijon, France.
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Braillon A, Bernard A, Leclercq T, Duloquin G, Comby PO, Loffroy R, Midulla M, Ricolfi F, Bejot Y, Guenancia C. Prediction of atrial fibrillation by cardiac imaging added to the acute stroke CT protocol. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Fuzeau A, Dion F, Angoulvant D, Ivanes F, Genet T, Delhommais A, Vermes E, Pucheux J, Cazeneuve N, Bernard A. Incidence, risk factors and multimodality imaging of post STEMI left ventricular thrombus, a monocentric one-year follow-up study. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Pezel T, Dreyfus J, Mouhat B, Thebaut C, Audureau E, Bernard A, Lavie Badie Y, Bohbot Y, Fard D, Biere L, Le Ven F, Fauvel C, Donal E, Mansencal N, Coisne A. Efficacy of simulation-based training on transoesophageal echocardiography learning in a multicentre randomised controlled trial: SIMULATOR study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Evidence on the impact of simulation-based training in transesophageal echocardiography (TEE) is scarce.
Purpose
We aimed to assess the efficacy of simulation-based versus traditional teaching on TEE knowledge and skills for cardiology residents.
Methods
Between November 2020 and November 2021, all consecutive cardiology residents inexperienced from TEE were randomised (1:1, n=324) through 42 French University Centers into two groups with or without simulation support (either a simulation group or a traditional group). The coprimary outcomes were the scores in the final theoretical and practical tests 3 months after the training. TEE duration and the feelings of residents were also assessed. An economic analysis was also performed.
Results
While the theoretical and practical test scores were similar between the two groups before the training (respectively P=0.80 and P=0.51), the residents in the simulation group displayed higher theoretical test and practical test scores after the training than those in the traditional group (respectively 47.2±15.6% vs. 38.3±19.8%, P<0.0001 and 74.5±17.7% vs. 59.0±25.1%, P<0.0001). Subgroups analyses showed that the efficacy of the simulation training was even greater when performed at the beginning of residency (P<0.0001). After the training, the duration to perform a complete TEE was significantly lower in the simulation group than in the traditional group (respectively 8.3±1.4 min vs. 9.4±1.2 min, P<0.0001). Finally, residents' feelings were better in the simulation group than in the traditional group across all components (P<0.0001). Compared to the traditional group, the average additional cost per resident of the simulation program was respectively €1,785, €942 or €662 for 20, 40 and 60 residents.
Conclusion
Simulation-based teaching on TEE showed a significant improvement in knowledge, skills, and feelings of cardiology residents as well as a reduction in the duration to complete the examination.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Pezel
- Hospital Lariboisiere , Paris , France
| | - J Dreyfus
- Centre Cardiologique du Nord (CCN) , Saint Denis , France
| | - B Mouhat
- University of Besançon , Besancon , France
| | - C Thebaut
- University Hospital of Limoges , Limoges , France
| | - E Audureau
- Henri-Mondor University Hospital, Unité de Recherche Clinique et Statistiques , Créteil , France
| | - A Bernard
- University of Tours - Faculty of Medicine , Tours , France
| | - Y Lavie Badie
- Toulouse Rangueil University Hospital (CHU) , Toulouse , France
| | - Y Bohbot
- University Hospital of Amiens , Amiens , France
| | - D Fard
- Henri-Mondor University Hospital, Unité de Recherche Clinique et Statistiques , Créteil , France
| | - L Biere
- University Hospital of Angers , Angers , France
| | - F Le Ven
- University Hospital of Brest , Brest , France
| | - C Fauvel
- University Hospital of Rouen , Rouen , France
| | - E Donal
- Hospital Pontchaillou of Rennes , Rennes , France
| | - N Mansencal
- Ambroise Pare Universitary Hospital, Cardiology , Paris , France
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Pialot B, Bernard A, Liebgott H, Varray F. Sensitivity Enhancement Using Chirp Transmission for an Ultrasound Arthroscopic Probe. IEEE Trans Ultrason Ferroelectr Freq Control 2022; 69:2776-2784. [PMID: 35312619 DOI: 10.1109/tuffc.2022.3160880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Meniscal tear in the knee joint is a highly common injury that can require an ablation. However, the success rate of meniscectomy is highly impacted by difficulties in estimating the thin vascularization of the meniscus, which determines the healing capacities of the patient. Indeed, vascularization is estimated using arthroscopic cameras that lack of high sensitivity to blood flow. Here, we propose an ultrasound method for estimating the density of vascularization in the meniscus during surgery. This approach uses an arthroscopic probe driven by ultrafast sequences. To enhance the sensitivity of the method, we propose to use a chirp-coded excitation combined with a mismatched compression filter robust to the attenuation. This chirp approach was compared to a standard ultrafast emission and a Hadamard-coded emission using a flow phantom. The mismatched filter was also compared to a matched filter. Results show that, for a velocity of a few millimeters per second, the mismatched filter gives a 4.4-10.4-dB increase of the signal-to-noise ratio (SNR) compared to the Hadamard emission and a 3.1-6.6-dB increase compared to the matched filter. Such increases are obtained for a loss of axial resolution of 13% when comparing the point spread functions (PSFs) of the mismatched and matched filters. Hence, the mismatched filter allows increasing significantly the probe capacity to detect slow flows at the cost of a small loss in axial resolution. This preliminary study is the first step toward an ultrasensitive ultrasound arthroscopic probe able to assist the surgeon during meniscectomy.
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Berrada-Gomez MP, Roch-Simon P, Bernard A, Rakotomalala S, Bigonne H, Ferret PJ. P22-22 Exposure data of cosmetic products for patients undergoing cancer treatments. Toxicol Lett 2022. [DOI: 10.1016/j.toxlet.2022.07.736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Aprile E, Abe K, Agostini F, Ahmed Maouloud S, Alfonsi M, Althueser L, Angelino E, Angevaare J, Antochi V, Antón Martin D, Arneodo F, Baudis L, Baxter A, Bellagamba L, Bernard A, Biondi R, Bismark A, Brown A, Bruenner S, Bruno G, Budnik R, Capelli C, Cardoso J, Cichon D, Cimmino B, Clark M, Colijn A, Conrad J, Cuenca-García J, Cussonneau J, D’Andrea V, Decowski M, Di Gangi P, Di Pede S, Di Giovanni A, Di Stefano R, Diglio S, Elykov A, Farrell S, Ferella A, Fischer H, Fulgione W, Gaemers P, Gaior R, Galloway M, Gao F, Glade-Beucke R, Grandi L, Grigat J, Higuera A, Hils C, Hoetzsch L, Howlett J, Iacovacci M, Itow Y, Jakob J, Joerg F, Joy A, Kato N, Kavrigin P, Kazama S, Kobayashi M, Koltman G, Kopec A, Landsman H, Lang R, Levinson L, Li I, Li S, Liang S, Lindemann S, Lindner M, Liu K, Lombardi F, Long J, Lopes J, Ma Y, Macolino C, Mahlstedt J, Mancuso A, Manenti L, Manfredini A, Marignetti F, Marrodán Undagoitia T, Martens K, Masbou J, Masson D, Masson E, Mastroianni S, Messina M, Miuchi K, Mizukoshi K, Molinario A, Moriyama S, Morå K, Mosbacher Y, Murra M, Müller J, Ni K, Oberlack U, Paetsch B, Palacio J, Peres R, Pienaar J, Pierre M, Pizzella V, Plante G, Qi J, Qin J, Ramírez García D, Reichard S, Rocchetti A, Rupp N, Sanchez L, dos Santos J, Sarnoff I, Sartorelli G, Schreiner J, Schulte D, Schulze Eißing H, Schumann M, Scotto Lavina L, Selvi M, Semeria F, Shagin P, Shi S, Shockley E, Silva M, Simgen H, Takeda A, Tan PL, Terliuk A, Thers D, Toschi F, Trinchero G, Tunnell C, Tönnies F, Valerius K, Volta G, Wei Y, Weinheimer C, Weiss M, Wenz D, Wittweg C, Wolf T, Xu Z, Yamashita M, Yang L, Ye J, Yuan L, Zavattini G, Zhang Y, Zhong M, Zhu T, Zopounidis J. Emission of single and few electrons in XENON1T and limits on light dark matter. Int J Clin Exp Med 2022. [DOI: 10.1103/physrevd.106.022001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Bernard A, Le May C, Martin JC, Delaby P, Le Bourgot C, Ledoux S, Besnard P. La voie tryptophan/Kynurenine : un nouveau lien entre obésité nutritionnelle, chirurgie bariatrique et perception orosensorielle des lipides. NUTR CLIN METAB 2022. [DOI: 10.1016/j.nupar.2021.12.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Byerly S, Nahmias J, Stein DM, Haut ER, Smith JW, Gelbard R, Ziesmann M, Boltz M, Zarzaur BL, Bala M, Bernard A, Brakenridge S, Brohi K, Collier B, Burlew CC, Cripps M, Crookes B, Diaz JJ, Duchesne J, Harvin JA, Inaba K, Ivatury R, Kasten K, Kerby JD, Lauerman M, Loftus T, Miller PR, Scalea T, Yeh DD. A core outcome set for damage control laparotomy via modified Delphi method. Trauma Surg Acute Care Open 2022; 7:e000821. [PMID: 35047673 PMCID: PMC8728413 DOI: 10.1136/tsaco-2021-000821] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 12/10/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Damage control laparotomy (DCL) remains an important tool in the trauma surgeon's armamentarium. Inconsistency in reporting standards have hindered careful scrutiny of DCL outcomes. We sought to develop a core outcome set (COS) for DCL clinical studies to facilitate future pooling of data via meta-analysis and Bayesian statistics while minimizing reporting bias. METHODS A modified Delphi study was performed using DCL content experts identified through Eastern Association for the Surgery of Trauma (EAST) 'landmark' DCL papers and EAST ad hoc COS task force consensus. RESULTS Of 28 content experts identified, 20 (71%) participated in round 1, 20/20 (100%) in round 2, and 19/20 (95%) in round 3. Round 1 identified 36 potential COS. Round 2 achieved consensus on 10 core outcomes: mortality, 30-day mortality, fascial closure, days to fascial closure, abdominal complications, major complications requiring reoperation or unplanned re-exploration following closure, gastrointestinal anastomotic leak, secondary intra-abdominal sepsis (including anastomotic leak), enterocutaneous fistula, and 12-month functional outcome. Despite feedback provided between rounds, round 3 achieved no further consensus. CONCLUSIONS Through an electronic survey-based consensus method, content experts agreed on a core outcome set for damage control laparotomy, which is recommended for future trials in DCL clinical research. Further work is necessary to delineate specific tools and methods for measuring specific outcomes. LEVEL OF EVIDENCE V, criteria.
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Affiliation(s)
- Saskya Byerly
- Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - Deborah M Stein
- Surgery, University of Maryland, Shock Trauma Center, Baltimore, Maryland, USA
| | - Elliott R Haut
- Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jason W Smith
- Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Rondi Gelbard
- Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Melissa Boltz
- Surgery, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Ben L Zarzaur
- Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Miklosh Bala
- Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel, USA
| | - Andrew Bernard
- Surgery, University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Scott Brakenridge
- Surgery, University of Washington Medicine/Harborview Medical Center, Seattle, WA, USA
| | - Karim Brohi
- Centre for Trauma Sciences, Queen Mary University of London, London, UK
| | - Bryan Collier
- Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | | | - Michael Cripps
- Surgery, UCHealth University of Colorado Hospital, Aurora, CO, USA
| | - Bruce Crookes
- Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jose J Diaz
- Acute Care Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Juan Duchesne
- Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - John A Harvin
- Surgery, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Kenji Inaba
- Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Rao Ivatury
- Surgery, Virginia Commonwealth University Health System, Richmond, Virginia, USA
| | - Kevin Kasten
- Department of Surgery, Carolinas Medical Center, Carolinas HealthCare System, Charlotte, North Carolina, USA
| | - Jeffrey D. Kerby
- Surgery, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Tyler Loftus
- Surgery, University of Florida Health, Gainesville, Florida, USA
| | - Preston R. Miller
- Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Thomas Scalea
- Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - D Dante Yeh
- Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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Pezel T, Bernard A, Lavie-Badie Y, Dreyfus J, Bohbot Y, Fard D, Nguyen L, Biere L, Le Ven F, Canu M, Ribeyrolles S, Mion B, Fauvel C, Ternacle J, Cautela J, Le Tourneau T, Donal E, Lafitte S, Mansencal N, Coisne A. SIMULATOR study: Multicentre randomized study to assess the impact of SIMULation-bAsed Training on transoesophageal echocardiOgraphy leaRning for cardiology residents. Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2021.09.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Vallejo Bustamante J, Wu NJ, Fermon C, Pannetier-Lecoeur M, Wakamura T, Watanabe K, Taniguchi T, Pellegrin T, Bernard A, Daddinounou S, Bouchiat V, Guéron S, Ferrier M, Montambaux G, Bouchiat H. Detection of graphene's divergent orbital diamagnetism at the Dirac point. Science 2021; 374:1399-1402. [PMID: 34882473 DOI: 10.1126/science.abf9396] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- J Vallejo Bustamante
- Université Paris-Saclay, CNRS, Laboratoire de Physique des Solides, 91405 Orsay, France
| | - N J Wu
- Université Paris-Saclay, CNRS, Laboratoire de Physique des Solides, 91405 Orsay, France.,Université Paris-Saclay, CNRS, Institut des Sciences Moléculaires d'Orsay, Orsay, France
| | - C Fermon
- SPEC, CEA, CNRS, Université Paris-Saclay, 91191 Gif-sur-Yvette, France
| | | | - T Wakamura
- Université Paris-Saclay, CNRS, Laboratoire de Physique des Solides, 91405 Orsay, France.,NTT Basic Research Laboratories, NTT Corporation, Atsugi, Kanagawa, Japan
| | - K Watanabe
- Research Center for Functional Materials, National Institute for Materials Science, 1-1 Namiki, Tsukuba 305-0044, Japan
| | - T Taniguchi
- International Center for Materials Nanoarchitectonics, National Institute for Materials Science, 1-1 Namiki, Tsukuba 305-0044, Japan
| | - T Pellegrin
- Université Paris-Saclay, CNRS, Laboratoire de Physique des Solides, 91405 Orsay, France
| | - A Bernard
- Université Paris-Saclay, CNRS, Laboratoire de Physique des Solides, 91405 Orsay, France
| | - S Daddinounou
- Université Paris-Saclay, CNRS, Laboratoire de Physique des Solides, 91405 Orsay, France
| | - V Bouchiat
- Néel Institute, CNRS, 38000 Grenoble, France
| | - S Guéron
- Université Paris-Saclay, CNRS, Laboratoire de Physique des Solides, 91405 Orsay, France
| | - M Ferrier
- Université Paris-Saclay, CNRS, Laboratoire de Physique des Solides, 91405 Orsay, France
| | - G Montambaux
- Université Paris-Saclay, CNRS, Laboratoire de Physique des Solides, 91405 Orsay, France
| | - H Bouchiat
- Université Paris-Saclay, CNRS, Laboratoire de Physique des Solides, 91405 Orsay, France
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Fauchier L, Bisson A, Bodin A, Herbert J, Spiesser PH, Pierre B, Clementy N, Babuty D, Bernard A, Lip GYH. All-cause mortality and cardiovascular death in 52091 patients with hypertrophic cardiomyopathy. A nationwide cohort study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Patients with hypertrophic cardiomyopathy (HCM) have high risk of death related to cardiovascular (CV) death. Improvements in risk stratification are needed to help identify those HCM patients at higher risk of all-cause death and cardiovascular death.
Methods
This French longitudinal cohort study from the database covering hospital care from 2010 to 2019 analyzed adultshospitalized with isolated HCM. The overall sample of 52,091 patients was randomly partitioned into derivation (n=26,067) and validation (n=26,024) populations. A logistic regression model was used to construct HCM death and CV-death scores in the derivation sample, which were compared to the Charlson index, Frailty index and CHA2DS2VASc scores using c-indexes and calibration analysis.
Results
In 52,091 patients with isolated HCM, 12,676 (24.0%) died during follow-up of 3.0±2.8 years (median 2.3, interquartile range 0.4–5.0). Rate of all-cause death was 8.10%/year (7.96–8.24) and was 2.76%/year (2.68–2.84) for CV death.Independent predictors of CV death in HCM were older age, diabetes mellitus, heart failure, history of pulmonary edema, atrial fibrillation, ventricular tachycardia or fibrillation, ischemic stroke, while smoking and poor nutrition were associated with better survival (all p<0.05). In addition to these, male sex, vascular disease, alcohol related diagnoses, kidney disease, lung disease, liver disease anemia and cancer were independent predictors of all-cause death. In the derivation cohort, c-indexes for the HCM death score were 0.720 (0.713–0.727) for all-cause death and 0.695 (0.685–0.705) for CV death. For the HCM CV-death score, c-indexes were 0.679 (0.671–0.686) for all-cause death and 0.723 (0.712–0.733) for CV death. Performances were very similar in the validation cohort. Both scores had good calibrations. Charlson and Frailty indexes however had a better clinical usefulness than the HCM death score and HCM CV-death scores for predicting all-cause death. Decision curve analysis for CV death demonstrated that the HCM CV-death score had the best clinical usefulness of all the tested risk scores.
Conclusion
HCM patients have a high risk of all-cause and CV mortality. Independent predictors of CV-mortality in HCM were used to derive and validate a simple risk prediction model (French HCM CV-mortality score) which performed better than clinical scores, Charlson Index and Frailty Index; showing the best clinical usefulness, with good calibration.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L Fauchier
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Bisson
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Bodin
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - J Herbert
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - P H Spiesser
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - B Pierre
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - N Clementy
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - D Babuty
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Bernard
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - G Y H Lip
- City Hospital, Centre for Cardiovascular Sciences, Birmingham, United Kingdom
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Bernard A, Poupon-Nedelec M, Robichon C, Gommez-Berrada MP, Ferret PJ. Usage patterns of facial cosmetic products in Asia. Toxicol Lett 2021. [DOI: 10.1016/s0378-4274(21)00420-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Levron A, El Chehab H, Agard E, Bernard A, Verrecchia S, Badri Y, Dot C. Impact of estimated total keratometry on the refractive outcomes of the XY1AT toric intraocular lens in cataract surgery. J Fr Ophtalmol 2021; 44:e487-e492. [PMID: 34340885 DOI: 10.1016/j.jfo.2021.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/10/2021] [Accepted: 02/17/2021] [Indexed: 10/20/2022]
Affiliation(s)
- A Levron
- Military Hospital of Desgenettes, 108, boulevard Pinel, 69003 Lyon, France.
| | - H El Chehab
- Military Hospital of Desgenettes, 108, boulevard Pinel, 69003 Lyon, France
| | - E Agard
- Military Hospital of Desgenettes, 108, boulevard Pinel, 69003 Lyon, France
| | - A Bernard
- Military Hospital of Desgenettes, 108, boulevard Pinel, 69003 Lyon, France
| | - S Verrecchia
- Military Hospital of Desgenettes, 108, boulevard Pinel, 69003 Lyon, France
| | - Y Badri
- Military Hospital of Desgenettes, 108, boulevard Pinel, 69003 Lyon, France
| | - C Dot
- Military Hospital of Desgenettes, 108, boulevard Pinel, 69003 Lyon, France; French Military Health Service Academy of Val-de-Grâce, 74, boulevard de Port-Royal, 75005 Paris, France
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19
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Moret A, Madelaine L, Cottenet J, Sophie Mariet A, Quantin C, Bernard A, Pagès PB. [Readmissions after lung resection in France: The PMSI database]. Rev Mal Respir 2021; 38:673-680. [PMID: 34175166 DOI: 10.1016/j.rmr.2021.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Readmission within 30 days is an indicator of the quality of care, because it often reflects post-discharge care that is not optimal. The objective of this work is to measure over time on the one hand the readmission rate and on the other hand the number of hospitals with a standardized readmission rate beyond the national average. METHOD All patients with major pulmonary resection for lung cancer in France were extracted from the PMSI national database. Readmission within 30 days was defined as any new hospitalization either in the same hospital or in another establishment. RESULTS From January 1, 2005 to December 31, 2018, 110,603 patients were included. The 30-day all-cause readmissions rate was 24.9% (n=27,540). Patients after pneumonectomy had a readmission rate of 37% (n=4918) and 23% after lobectomy (n=2684) (P<0.0001). For the first period, we counted 10 hospitals with a standardized readmissions rate above the 99.8 limit and 10 hospitals above the 95% limit. For the second period, 8 hospitals had a standardized readmission rate above the 99.8% limit and 11 hospitals above the 95% limit. For the third period, 7 hospitals had a standardized readmission rate above the 99.8% limit and 6 hospitals above the 95% limit. CONCLUSION Readmissions to hospital 30 days after major lung resection for cancer in France declined little during these three periods. Measures to prevent readmissions should be introduced.
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Affiliation(s)
- A Moret
- Service de chirurgie thoracique et cardio-vasculaire, CHU Dijon, Dijon, France
| | - L Madelaine
- Service de chirurgie thoracique et cardio-vasculaire, CHU Dijon, Dijon, France; Inserm UMR 1231, université de Bourgogne, Dijon, France
| | - J Cottenet
- Departement de biostatistique, CHU Bocage, Université de Bourgogne, Dijon, France
| | - A Sophie Mariet
- Departement de biostatistique, CHU Bocage, Université de Bourgogne, Dijon, France
| | - C Quantin
- Departement de biostatistique, CHU Bocage, Université de Bourgogne, Dijon, France; Inserm, CIC 1432, Centre d'investigation clinique, hôpital de Dijon, université de Bourgogne, Dijon, France; Inserm, UVSQ, Institut Pasteur, université Paris-Saclay, Paris, France
| | - A Bernard
- Service de chirurgie thoracique et cardio-vasculaire, CHU Dijon, Dijon, France.
| | - P B Pagès
- Service de chirurgie thoracique et cardio-vasculaire, CHU Dijon, Dijon, France; Inserm UMR 1231, université de Bourgogne, Dijon, France
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20
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Lacout M, David C, Bernard A, Saint Etienne C, Clerc JM, Quilliet L, Dion F, Caze C. prognostic evaluation of patients benefiting from a trans aortic valve replacement according to the type of aortic stenosis. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Aortic Stenosis (AS) is a common condition in patients over 75 years. Latest ESC recommendations differentiate 4 types of AS according to: Indexed Stroke Volume (SVi), mean gradient and left ventricular ejection fraction (LVEF). The aim of our study is to evaluate prognosis of patients who have had a transcatheter aortic valve replacement (TAVR), in terms of mortality, according to the 4 types of AS.
Methods
This study compares prognosis of 620 patients who had TAVR between January 1, 2015 and December 31, 2018. Patients were classified into 4 groups according to AS type: high gradient; low gradient, low flow, low LVEF; low gradient, low flow, normal LVEF; low gradient, normal flow.
Results
69 patients (11.1%) died within 12 months of the procedure: 49 in the high gradient group (9.4%); 13 in the low gradient, low flow, low LVEF group (47.1%); 1 in the low gradient, low flow, normal LVEF group (5%); 6 in the low gradient, normal flow, normal LVEF group (18.2%). All-cause mortality at one year follow-up is higher in low-gradient, low-flow, altered LVEF group (p = 0.0004) than in other groups. Patients in this group were significantly more often admitted for heart failure than patients in high-gradient group (p = 0.009).
Conclusion
A complete echocardiography evaluation is needed to evaluate AS, its severity and type. Patients in the low gradient, low flow, low LVEF group have an independent risk of mortality at 12 months higher than other groups and are more hospitalized than patients in the high gradient group.
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Affiliation(s)
- M Lacout
- Hospital Pontchaillou of Rennes, cardiology, Rennes, France
| | - C David
- University Hospital Pasteur of Nice, cardiology, Nice, France
| | - A Bernard
- Regional University Hospital Centre TROUSSEAU - CHAMBRAY, cardiology, Chambray Les Tours, France
| | - C Saint Etienne
- Regional University Hospital Centre TROUSSEAU - CHAMBRAY, cardiology, Chambray Les Tours, France
| | - JM Clerc
- Regional University Hospital Centre TROUSSEAU - CHAMBRAY, cardiology, Chambray Les Tours, France
| | - L Quilliet
- Regional University Hospital Centre TROUSSEAU - CHAMBRAY, cardiology, Chambray Les Tours, France
| | - F Dion
- Regional University Hospital Centre TROUSSEAU - CHAMBRAY, cardiology, Chambray Les Tours, France
| | - C Caze
- Regional University Hospital Centre TROUSSEAU - CHAMBRAY, cardiology, Chambray Les Tours, France
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Hanna K, Harris C, Trust MD, Bernard A, Brown C, Hamidi M, Joseph B. Multicenter Validation of the Revised Assessment of Bleeding and Transfusion (RABT) Score for Predicting Massive Transfusion. World J Surg 2021; 44:1807-1816. [PMID: 32006133 DOI: 10.1007/s00268-020-05394-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Massive transfusion (MT) is a lifesaving treatment for hemorrhaging patients. Predicting the need for MT is crucial to improve survival. The aim of our study was to validate the Revised Assessment of Bleeding and Transfusion (RABT) score to predict MT in a multicenter cohort of trauma patients. METHODS We performed a (2015-2017) analysis of adult (age ≥ 18 year) trauma patients who had a high-level trauma team activation at three Level I trauma centers. The RABT was calculated using the 4-point score [blunt (0)/penetrating trauma (1), shock index ≥ 1 (1), pelvic fracture (1), and FAST positive (1)]. A RABT score of ≥ 2 was used to predict MT (≥ 10 units of packed red blood cells within 24 h). The area under the receiver operating characteristic curve (AUROC) was calculated to assess the score's predictive power compared to the Assessment of Blood Consumption (ABC) score. RESULTS We analyzed 1018 patients: 216 (facility I), 363 (facility II), and 439 (facility III). The mean age was 41 ± 19 year, and the injury severity score (ISS) was 29 [22-36]. The overall MT rate was 19%. The overall AUROC of RABT ≥ 2 was 0.89. The sensitivity of the RABT ≥ 2 was 78%, and the specificity was 91%. The RABT score had a higher sensitivity (78% vs. 69%) and specificity (91% vs. 82%) than the ABC score. CONCLUSION The RABT score is a valid tool to predict MT in severely injured trauma patients. It is an objective score that aids clinicians in predicting the need for MT to mobilize blood products and minimize the waste of resources.
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Affiliation(s)
- Kamil Hanna
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, 1501 N. Campbell Ave, Room 5411, P.O. Box 245063, Tucson, AZ, 85724, USA
| | - Charles Harris
- Divsion of Trauma, Acute Care Surgery, and Critical Care, Tulane University School of Medicine, New Orleans, LA, USA
| | - Marc D Trust
- Department of Surgery and Perioperative Care, The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Andrew Bernard
- Section of Trauma and Acute Surgery, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Carlos Brown
- Department of Surgery and Perioperative Care, The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Mohammad Hamidi
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, 1501 N. Campbell Ave, Room 5411, P.O. Box 245063, Tucson, AZ, 85724, USA
| | - Bellal Joseph
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, 1501 N. Campbell Ave, Room 5411, P.O. Box 245063, Tucson, AZ, 85724, USA.
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Marchand L, Luyton C, Bernard A. Glucagon-like peptide-1 (GLP-1) receptor agonists in type 2 diabetes and long-term complications: FOCUS on retinopathy. Diabet Med 2021; 38:e14390. [PMID: 32799379 DOI: 10.1111/dme.14390] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/16/2020] [Accepted: 08/12/2020] [Indexed: 01/22/2023]
Affiliation(s)
- L Marchand
- Department of Endocrinology and Diabetes, Centre Hospitalier Saint Joseph Saint Luc, Lyon
| | - C Luyton
- Department of Endocrinology and Diabetes, Centre Hospitalier Saint Joseph Saint Luc, Lyon
| | - A Bernard
- Department of Ophthalmology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite
- Department of Ophthalmology, Centre Hospitalier Saint Joseph Saint Luc, Lyon, France
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Tung L, Long AM, Bonne S, Tseng ES, Bruns B, Joseph B, Williams BH, Stein D, Freischlag JA, Goulet N, Khandelwal C, Kiselak E, Hoofnagle M, Gelbard R, Rattan R, Joseph D, Bernard A, Zakrison TL. Equity on the frontlines of trauma surgery: An #EAST4ALL roundtable. J Trauma Acute Care Surg 2021; 90:129-136. [PMID: 33009339 DOI: 10.1097/ta.0000000000002965] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Inequity exists in surgical training and the workplace. The Eastern Association for the Surgery of Trauma (EAST) Equity, Quality, and Inclusion in Trauma Surgery Ad Hoc Task Force (EAST4ALL) sought to raise awareness and provide resources to combat these inequities. METHODS A study was conducted of EAST members to ascertain areas of inequity and lack of inclusion. Specific problems and barriers were identified that hindered inclusion. Toolkits were developed as resources for individuals and institutions to address and overcome these barriers. RESULTS Four key areas were identified: (1) harassment and discrimination, (2) gender pay gap or parity, (3) implicit bias and microaggressions, and (4) call-out culture. A diverse panel of seven surgeons with experience in overcoming these barriers either on a personal level or as a chief or chair of surgery was formed. Four scenarios based on these key areas were proposed to the panelists, who then modeled responses as allies. CONCLUSION Despite perceived progress in addressing discrimination and inequity, residents and faculty continue to encounter barriers at the workplace at levels today similar to those decades ago. Action is needed to address inequities and lack of inclusion in acute care surgery. The EAST is working on fostering a culture that minimizes bias and recognizes and addresses systemic inequities, and has provided toolkits to support these goals. Together, we can create a better future for all of us.
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Affiliation(s)
- Lily Tung
- From the Division of Trauma (L.T.), Vancouver General Hospital, Vancouver, British Columbia, Canada; Acute Care Surgery(A.M.D.), University of California San Francisco Fresno, Fresno, California; Division of Trauma and Surgical Critical Care (S.B.), Rutgers New Jersey Medical School, Newark, New Jersey; Division of Trauma, Critical Care, Burns, and Emergency General Surgery, Department of Surgery (E.S.T.), MetroHealth Medical Center, Cleveland, Ohio; R Adams Cowley Shock Trauma Center (B.B.), University of Maryland, Baltimore, Maryland; Trauma, Critical Care, Burn and Emergency Surgery (B.J.), University of Arizona College of Medicine, Tucson, Arizona; Section for Trauma and Acute Care Surgery (B.H.W., T.L.Z.), The University of Chicago Medicine, Chicago, Illinois; Department of Surgery (D.S.), University of California San Francisco, San Francisco, California; CEO Wake Forest Baptist Health, Dean Wake Forest School of Medicine (J.E.F.), Winston-Salem, North Carolina; Division of Trauma, Critical Care and Emergency of Surgery (N.G.), NYU Langone, New York University School of Medicine, New York, New York; Department of Surgery (C.K.), Cleveland Clinic, Cleveland, Ohio; Department of Trauma, Surgical Critical Care and Injury Prevention (E.K.), Hackensack University Medical Center, Hackensack University Medical Center, Hackensack, New Jersey; Division of Acute and Critical Care Surgery (M.H.), Washington University in St. Louis, St. Louis, Missouri; Division of Trauma (R.G.), University of Alabama at Birmingham, Birmingham, Alabama; Division of Trauma Surgery and Critical Care (R.R.), DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida; Division of Trauma and Acute Care Surgery, Department of Surgery (DA.J.), NYU Winthrop Hospital & NYU Long Island School of Medicine, Mineola, New York; Acute Care Surgery (A.B.), University of Kentucky College of Medicine, Lexington, Kentucky
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Bernard A, Leclercq T, Béjot Y, Duloquin G, Comby P, Ricolfi F, Guenancia C. High rate of cardiac thrombus diagnosed by adding cardiac imaging in acute stroke CT protocol. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Quignon P, da Mata P, Faraj F, Guibert S, Bernard A, Léonardi J, Loundou AD, Vitte J, Charpin D. Altitude healing effect in severe asthmatic children. Respir Med Res 2020; 79:100810. [PMID: 33540154 DOI: 10.1016/j.resmer.2020.100810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/25/2020] [Accepted: 12/12/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The beneficial effect of a climatic treatment in children with asthma was established quite some time ago, but the mechanism of this beneficial effect has not been fully elucidated. We investigated the role of the cytokines of the TH2 pathway, reactive oxygen species (ROS) and reactive nitrogen species (RNS) over the course of a high-altitude climatic therapy. METHODS A group of 67 children originating from various French towns suffering from uncontrolled severe asthma was sent via their medical specialists, to the Briançon climatic area. They were monitored over the course of an entire school year. During this time, they returned home for 15 days during the Christmas holidays. At each stage, assessment of asthma control, lung function examination (peak flow meter and spirometry), and measurement of exhaled NO, ROS and RNS in exhaled breath condensate (EBC), and the level of cytokines in the plasma of the TH2 pathway were carried out. RESULTS The degree of asthma control improved at high altitude and worsened upon returning home. The average value of the peak expiratory flow also improved during the first 3 months but then worsened upon returning home, while the other spirometric parameters did not change. The level of expired NO and the scores for quality of life underwent a similar change. The level of RNS and ROS in the EBC did not change significantly. Besides, a marked and statistically significant decrease in the level of IL-13 and IL-10 was noted. CONCLUSION The beneficial effect of a climatic stay of children suffering from allergic asthma at altitude appears to be linked with less allergenic stimulation.
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Affiliation(s)
- P Quignon
- CEMBREU, 35, rue Croix de Bretagne, 05100 Briançon, France.
| | - P da Mata
- Instituto Clínico de Alergologia, avenue de Berna No. 30, 4(e) B 1050-042, Lisbon, Portugal.
| | - F Faraj
- Centre Les Jeunes Pousses, 34 A, avenue de la République, 05100 Briançon, France
| | - S Guibert
- Centre Les Hirondelles, 17, rue Maisonnette, 05100 Villar-Saint-Pancrace, France
| | - A Bernard
- Centre La Guisane, rue de la Croix de Bretagne, 05100 Villar-Saint-Pancrace, France
| | - J Léonardi
- Centre La Guisane, rue de la Croix de Bretagne, 05100 Villar-Saint-Pancrace, France
| | - A D Loundou
- Department of Medical Statistics, Aix Marseille University, 27, boulevard Jean-Moulin, 13005 Marseille, France.
| | - J Vitte
- Aix-Marseille University IRD, AP-HM, MEPHI, Immunology Department, 19-21, boulevard Jean-Moulin, 13005 Marseille, France.
| | - D Charpin
- Pulmonology Unit, La Timone Hospital, Aix Marseille University, 264, rue Saint-Pierre, Marseille, France.
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Lantelme P, Bisson A, Lacour T, Herbert J, Ivanes F, Bourguignon T, Quilliet L, Angoulvant D, Harbaoui B, Bonnet M, Bernard A, Babuty D, Saint-Etienne C, Deharo P, Fauchier L. Impact of the timing of coronary revascularization relative to the transcatheter aortic valve implantation procedure: insights from a propensity score analysis based on a nationwide analysis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The significance and the management of coronary artery disease (CAD) are disputed in patients treated by transcatheter aortic valve implantation (TAVI). In the presence of a significant CAD eligible for percutaneous coronary intervention (PCI), the issue of the timing of PCI relative to TAVI is unsettled. To answer this question, the present study aimed at comparing the short-term and long-term outcome in patients treated by staged PCI within a 90-day time interval before or after TAVI.
Methods
Based on the French administrative hospital-discharge database, the study collected information for all consecutive patients treated with TAVI between 2014 and 2018. Patients treated with PCI in the preceding 90 days before the TAVI procedure (pre-TAVI PCI) or subsequent 90 days after the TAVI procedure (post-TAVI PCI) were included. All-cause mortality, cardiovascular mortality, stroke, myocardial infarction and a combined cardiovascular endpoint were assessed at 30 days after the last procedure (short-term) and during the whole follow-up (long-term). Propensity score matching was used for the analysis of outcomes.
Results
8613 patients met the inclusion criteria with a vast majority of pre-TAVI PCI patients (N=8324) as opposed to post-TAVI PCI (N=229). After propensity score matching, 2 groups of 227 patients with comparable characteristics were obtained. At 30 days, no significant difference was observed for any of the outcome tested with the exception of myocardial infarction more frequent in post-TAVI PCI (OR 2.43 [1.17–5.07]). After a mean [SD] follow-up of 459 [569] days, all outcomes were identical between subgroups. The figure below illustrates the Kaplan Meier curve for all-cause mortality.
Conclusions
Our study based on a French nationwide database shows that PCI is performed pre-TAVI in a majority of cases, with no significant impact on outcome. Deferring PCI after TAVI seems safe and may provide an opportunity to make the decision on more objective parameters while the stenosis has been removed (such as FFR or IFR). In any case, the timing of PCI relative to TAVI does not seem to represent a concern and should be decided on an individual basis.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- P Lantelme
- Croix-Rousse Hospital - HCL, Lyon, France
| | - A Bisson
- University Hospital of Tours, Cardiology, Tours, France
| | - T Lacour
- University Hospital of Tours, Cardiology, Tours, France
| | - J Herbert
- University Hospital of Tours, Cardiology, Tours, France
| | - F Ivanes
- University Hospital of Tours, Cardiology, Tours, France
| | - T Bourguignon
- University Hospital of Tours, Cardiology, Tours, France
| | - L Quilliet
- University Hospital of Tours, Cardiology, Tours, France
| | - D Angoulvant
- University Hospital of Tours, Cardiology, Tours, France
| | - B Harbaoui
- Croix-Rousse Hospital - HCL, Lyon, France
| | - M Bonnet
- Croix-Rousse Hospital - HCL, Lyon, France
| | - A Bernard
- University Hospital of Tours, Cardiology, Tours, France
| | - D Babuty
- University Hospital of Tours, Cardiology, Tours, France
| | | | - P Deharo
- Hospital La Timone of Marseille, Cardiology, Marseille, France
| | - L Fauchier
- University Hospital of Tours, Cardiology, Tours, France
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Fauchier L, Bisson A, Deharo P, Bodin A, Herbert J, Lacour T, Quilliet L, Ivanes F, Clerc J, Saint Etienne C, Bourguignon T, Babuty D, Bernard A. Development of a claims-based EuroSCORE II in patients with aortic stenosis needing surgical or transcatheter aortic valve replacement using electronic hospital records: a nationwide study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Prediction of operative risk in patients with aortic stenosis (AS) undergoing surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI) remains a challenge, particularly in high-risk patients. The EuroSCORE II is now commonly used to improve risk prediction. Large analyses from administrative database have provided opportunities for conducting health research in the field of structural heart disease interventions but may have a lack of granularity and do not routinely include EuroSCORE II, which may result in a risk of uncontrolled biases. We sought to approximate the EuroSCORE II using only administrative claims data to enable the operative risk to be assessed without clinical or paraclinical performance measures.
Methods
Based on the administrative hospital-discharge database, we collected information for all patients with AS treated with SAVR or TAVI between 2010 and 2019 in France. A total of 78,085 SAVR and 60,821 patients with AS treated with transcatheter aortic valve replacement (TAVR) were found in the database. For each patient, the EuroSCORE II was estimated using the formulas available at the EuroSCORE website. Age, gender, extracardiac arteriopathy, poor mobility, previous cardiac surgery, chronic lung disease, active endocarditis, diabetes on insulin, recent MI, dialysis are items available in the PMSI database using the ICD-10 or CCAM codes. For renal impairment, NYHA class, LVEF, pulmonary hypertension, “critical preoperative state” and urgent intervention, different proxies were built based on ICD-10 codes likely to represent increasing severity of these items.
Results
In the cohort of patients with SAVR, mean estimated EuroSCORE II was 3.3±1.1 while all-cause death at day 30 after SAVR was 3.8%. In the cohort of patients with TAVI, mean estimated EuroSCORE II was 3.8±1.0 while all-cause death at day 30 after TAVI was 5.5%. In the whole cohort, the area under the curve (AUC) of the estimated EuroSCORE II for predicting the risk of all-cause death at day 30 was 0.72 (95% CI 0.71–0.73) and was higher in patients treated with SAVR (AUC 0.76, 95% CI 0.75–0.77) than in those treated with TAVI (AUC 0.67, 95% CI 0.65–0.68, p<0.00001 for DeLong test). The observed versus predicted risks of all-cause death at day 30 post-TAVI OR SAVR within risk deciles are shown in Figure 1. Calibration of the prediction score was satisfying across the 10 deciles and a predicted 30-day mortality rate of approximately 15%.
Conclusions
Claims data alone can be used to identify individuals with AS at operative risk when they are considered for SAVR or TAVI. The Claims-based EuroSCORE II might be used in research with large datasets for confounding adjustment or risk prediction. It provides hospitals and health systems with a low-cost, systematic way to identify a group of patients who are at greater risk of adverse outcomes with these interventions and for whom a more specific approach might be useful.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- L Fauchier
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Bisson
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - P Deharo
- APHM La Timone Hospital, Marseille, France
| | - A Bodin
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - J Herbert
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - T Lacour
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - L Quilliet
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - F Ivanes
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - J.M Clerc
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - C Saint Etienne
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - T Bourguignon
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - D Babuty
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Bernard
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
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Collins C, Dudas L, Johnson M, Davenport D, Bernard A, Beck S, Muchow R, Pittman T, Talley C. ACGME Operative Case Log Accuracy Varies Among Surgical Programs. J Surg Educ 2020; 77:e78-e85. [PMID: 32950429 DOI: 10.1016/j.jsurg.2020.08.045] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/29/2020] [Accepted: 08/29/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE This study evaluates the accuracy of reported the Accreditation Council for Graduate Medical Education (ACGME) operative case logs from graduated residents compared to institutional operating room electronic records (ORER). We hope this will help guide review committees and institutions develop complete, accurate resident case logs. DESIGN This is a retrospective, cross-sectional study of general surgery (GS), neurosurgery (NS), and orthopedic surgery (OS) resident physicians. ACGME and ORER cases from 2009 to 2010 were analyzed and each case and current procedural terminology (CPT) code directly compared (ORER vs. ACGME). SETTING Single academic tertiary-care medical center (University of Kentucky, Lexington, KY). PARTICIPANTS Eleven thousand nine hundred and twenty-three cases for 46 residents among the 3 residency programs were analyzed. RESULTS There was an overall logging accuracy of 72% for ORER cases reflected in the ACGME case logs. OS residents had a higher rate of logging accuracy (OS 91%, GS 69%, NS 58%, chi-square p = 0.014) and mean annual number of cases compared to the other 2 programs (OS 452, GS 183, NS 237, ANOVA p = 0.001). NS residents had higher accuracy of CPT codes than post-graduate years 2 to 5 in other programs (p < 0.017). There was a strong positive correlation between the number of cases completed per resident and case logging accuracy, (rho = 0.769, p < 0.001) consistent for NS and GS, but not OS. CONCLUSIONS This study shows only 72% of a residents' operative experience is captured in the ACGME case log across 3 surgical programs. There is significant variability among surgical programs and among post-graduate year cohorts regarding case log and CPT code accuracy. There is a strong correlation with the total number of cases performed and increasing case log accuracy. Low case log accuracy may reflect individual resident behavior instead of program operative exposure. Further studies are needed to determine if ORER may serve as a more complete assessment of the operative experience of a resident and program.
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Affiliation(s)
- Courtney Collins
- University of Kentucky, Department of Surgery, Lexington, Kentucky
| | - Lauren Dudas
- West Virginia University, Department of Surgery, Morgantown, West Virginia
| | - Mason Johnson
- University of Kentucky, Department of Surgery, Lexington, Kentucky
| | - Daniel Davenport
- University of Kentucky, Department of Surgery, Lexington, Kentucky
| | - Andrew Bernard
- University of Kentucky, Department of Surgery, Lexington, Kentucky
| | - Sandra Beck
- University of Kentucky, Department of Surgery, Lexington, Kentucky
| | - Ryan Muchow
- University of Kentucky, Department of Orthopaedic Surgery & Sports Medicine, Lexington, Kentucky
| | - Thomas Pittman
- University of Kentucky, Department of Neurosurgery, Lexington, Kentucky
| | - Cynthia Talley
- Medical University of South Carolina, Charleston, South Carolina.
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Nguyen PT, Boral LI, O’Brien J, Zhang D, Gao Y, Bernard A. Reducing Inappropriate Overutilization of the Massive Transfusion Protocol. Am J Clin Pathol 2020. [DOI: 10.1093/ajcp/aqaa161.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction/Objective
Massive transfusion protocols (MTPs) make it possible to deliver blood products to exsanguinating patients in an efficient, sustained, and immediate manner. However, overutilization of MTPs continues to remain a significant problem for hospital blood banks. The study aims to address the characteristics of possibly inappropriate MTP activations during the first phase (cooler) at a level 1 trauma academic medical center.
Methods
This was a retrospective review of 328 phase 1 MTPs out of 696 total MTPs performed during a two-year period (Jan 1, 2017 and Dec 31, 2018) and divided into three categories: trauma, non-trauma surgery, and medicine services. We assumed that a possibly inappropriate MTP for trauma cases would show an Assessment of Blood Component (ABC) score of 1 or less and physicians used clinical discretion. For possibly inappropriate MTP non- trauma surgical and medicine cases, we devised a new system where we looked at only whether the blood pressure was equal to or less than 90 mm Hg and/or the pulse was greater than or equal to 120 beats per minute. If there was a score of 0 where there were neither vital sign criteria, then the MTP was considered possibly inappropriate.
Results
For trauma service, there were 43/168 (25.6%) cases that had an ABC score of 0, 49/168 (29.2%) cases that had an ABC score of 1, 53/168 (31.5%) cases that had an ABC score of 2, 21/168 (12.5%) cases that had an ABC score of 3, and only 2/168 (1.2%) case that had an ABC score of 4. Non-trauma surgery service had 31/51 (60.8%) cases with a new score of 0, 20/51 (39.2%) cases with a new score of 1, and 0/51 (0%) cases with a new score of 2. Medicine services had 57/109 (52.3%) patients with a new score of 0, 47/109 (43.1%) patients with a new score of 1, and 5/109 (4.6%) patients with a new score of 2. Non-trauma surgery service had the greatest possibly inappropriate MTP activations [31/51 cases (60.8%)], followed by trauma [92/168 (54.8%) cases] and medicine [57/109 (52.3%) cases].
Conclusion
Our study shows greater overutilization with MTPs using clinical judgment than with using the ABC criteria. Non-trauma surgery service had the greatest number of possibly inappropriate MTP activations at our hospital without having a significantly abnormal pulse or blood pressure. While ABC criteria is already liberal for activating an MTP, physician discretion appears to be more liberal in activating a possibly inappropriate MTP.
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Affiliation(s)
- P T Nguyen
- Pathology and Laboratory Medicine, University of Kentucky Healthcare, Lexington, Kentucky, UNITED STATES
| | - L I Boral
- Pathology and Laboratory Medicine, University of Kentucky Healthcare, Lexington, Kentucky, UNITED STATES
| | - J O’Brien
- Pathology and Laboratory Medicine, University of Kentucky Healthcare, Lexington, Kentucky, UNITED STATES
| | - D Zhang
- Pathology and Laboratory Medicine, University of Kentucky Healthcare, Lexington, Kentucky, UNITED STATES
| | - Y Gao
- Pathology and Laboratory Medicine, University of Kentucky Healthcare, Lexington, Kentucky, UNITED STATES
| | - A Bernard
- Pathology and Laboratory Medicine, University of Kentucky Healthcare, Lexington, Kentucky, UNITED STATES
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Heren-Le Bastard C, Bernard A, Fliss R, Legouvello S, Allain P. [Psychometric validation of an Assessment Questionnaire on the Perception of and Adaptation to Visual Handicap in Adults (QUEPAHVA). French translation of the article]. J Fr Ophtalmol 2020; 44:S0181-5512(20)30447-2. [PMID: 34756385 DOI: 10.1016/j.jfo.2020.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/16/2020] [Accepted: 01/21/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE Handicap evaluation in adults with acquired or progressive congenital visual loss allows for identification of the individual's specific needs and targeted therapy (medical, technical, rehabilitative and psychological). Currently, the subjective dimension of the handicap remains poorly explored in the field of visual loss. Our questionnaire aims to understand the whole of these subjective impacts. It differs from existing quality of life scales in ophthalmology in its approach centered on the process of adaptation, individual resources (technical, cognitive, psychic and environmental), and investigation of the perception of the handicap. The goal of the present study is to validate this questionnaire, which could be used in any adult with a visual handicap, regardless of the extent of the visual loss, its etiology, or the type of treatment or compensatory mechanisms. MATERIALS AND METHODS The Assessment Questionnaire on the Perception of and Adaptation to Visual Handicap in Adults (QUEPAHVA) is composed of 28 items relating to perception of the visual impairment, its impact, and adaptive resources. They are divided into 3 sub-categories: perception of daily life and relationships (10 items), Perception of visual status and compensatory mechanisms (8 items), and Psychological impact of the visual handicap (10 items). The responses are graded on a Likert scale. Factor analysis and verification of psychometric qualities were performed based on the responses of 446 subjects. The discriminatory validity of the NEI-VFQ 25 was proven with 99 subjects. Reliability over time (mean interval between T1 and T2=49.43 days) was measured in 31 subjects. Sensitivity to change between pre- and post-management (mean interval between T1 and T2=410 days) was tested in 123 subjects. RESULTS Internal consistency was very good for the global scale (α=.90) as well as for the 3 sub-dimensions (α=.86; α=.79; α=.80). The discriminatory validity was satisfactory (r=.70). This result had to be interpreted as a function of the qualitative specificity of the questionnaire. The questionnaire enjoyed good reproducibility over time with regard to its total score and relatively satisfactory reproducibility with regard to its sub-dimensions. Sensitivity to change was very high and accounted for adaptations to the disability over time. CONCLUSION The QUEPAHVA displays good psychometric qualities. It constitutes a new means of evaluation. Its potential applications are many. It permits evaluation of the needs of the individual and adaptation of the protocol of care. Its use in institutions may support a step forward in the science of evaluation and continued improvement in quality of care.
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Affiliation(s)
- C Heren-Le Bastard
- Centre régional basse vision et troubles de l'audition, 4, rue de l'Abbé-Frémond, 49100 Angers, France; Laboratoire de psychologie des Pays de la Loire, LPPL EA 4638, SFR Confluences, Maison de la recherche Germaine Tillion, université Angers, université Nantes, 5, bis boulevard Lavoisier, 49045 Angers cedex 01, France.
| | - A Bernard
- Équipe BePsyLab, université d'Angers, 5, bis boulevard Lavoisier, 49045 Angers cedex 01, France
| | - R Fliss
- Département de neurologie, CHU Angers, 49033 Angers, France; Centre de réadaptation Les Capucins, 49100 Angers, France
| | - S Legouvello
- Centre régional basse vision et troubles de l'audition, 4, rue de l'Abbé-Frémond, 49100 Angers, France
| | - P Allain
- Laboratoire de psychologie des Pays de la Loire, LPPL EA 4638, SFR Confluences, Maison de la recherche Germaine Tillion, université Angers, université Nantes, 5, bis boulevard Lavoisier, 49045 Angers cedex 01, France; Département de neurologie, CHU Angers, 49033 Angers, France
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Heren-Le Bastard C, Bernard A, Fliss R, Legouvello S, Allain P. Psychometric validation of an Assessment Questionnaire on the Perception of and Adaptation to Visual Handicap in Adults (QUEPAHVA). J Fr Ophtalmol 2020; 43:e341-e350. [PMID: 33020020 DOI: 10.1016/j.jfo.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Handicap evaluation in adults with acquired or progressive congenital visual loss allows for identification of the individual's specific needs and targeted therapy (medical, technical, rehabilitative and psychological). Currently, the subjective dimension of the handicap remains poorly explored in the field of visual loss. Our questionnaire aims to understand the whole of these subjective impacts. It differs from existing quality of life scales in ophthalmology in its approach centered on the process of adaptation, individual resources (technical, cognitive, psychic and environmental), and investigation of the perception of the handicap. The goal of the present study is to validate this questionnaire, which could be used in any adult with a visual handicap, regardless of the extent of the visual loss, its etiology, or the type of treatment or compensatory mechanisms. MATERIALS AND METHODS The Assessment Questionnaire on the Perception of and Adaptation to Visual Handicap in Adults (QUEPAHVA) is composed of 28 items relating to perception of the visual impairment, its impact, and adaptive resources. They are divided into 3 sub-categories: Perception of daily life and relationships (10 items), Perception of visual status and compensatory mechanisms (8 items), and Psychological impact of the visual handicap (10 items). The responses are graded on a Likert scale. Factor analysis and verification of psychometric qualities were performed based on the responses of 446 subjects. The discriminatory validity of the NEI-VFQ 25 was proven with 99 subjects. Reliability over time (mean interval between T1 and T2=49.43 days) was measured in 31 subjects. Sensitivity to change between pre- and post-management (mean interval between T1 and T2=410 days) was tested in 123 subjects. RESULTS Internal consistency was very good for the global scale (α=.90) as well as for the 3 sub-dimensions (α=.86; α=.79; α=.80). The discriminatory validity was satisfactory (r=.70). This result had to be interpreted as a function of the qualitative specificity of the questionnaire. The questionnaire enjoyed good reproducibility over time with regard to its total score and relatively satisfactory reproducibility with regard to its sub-dimensions. Sensitivity to change was very high and accounted for adaptations to the disability over time. CONCLUSION The QUEPAHVA displays good psychometric qualities. It constitutes a new means of evaluation. Its potential applications are many. It permits evaluation of the needs of the individual and adaptation of the protocol of care. Its use in institutions may support a step forward in the science of evaluation and continued improvement in quality of care.
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Affiliation(s)
- C Heren-Le Bastard
- Centre Régional Basse Vision et Troubles de l'Audition, 4, rue de l'Abbé-Frémond, 49100 Angers, France; Laboratoire de Psychologie des Pays-de-la-Loire, LPPL EA 4638, SFR Confluences, UNIV Angers, UNIV Nantes, Maison de la recherche Germaine Tillion, 5 bis Boulevard Lavoisier, 49045 Angers cedex 01, France.
| | - A Bernard
- Équipe BePsyLab, Université d'Angers, 5 bis, Boulevard Lavoisier, 49045 Angers cedex 01, France
| | - R Fliss
- Département de Neurologie, CHU Angers, 49033 Angers, France; Centre de réadaptation Les Capucins, 49100 Angers, France
| | - S Legouvello
- Centre Régional Basse Vision et Troubles de l'Audition, 4, rue de l'Abbé-Frémond, 49100 Angers, France
| | - P Allain
- Laboratoire de Psychologie des Pays-de-la-Loire, LPPL EA 4638, SFR Confluences, UNIV Angers, UNIV Nantes, Maison de la recherche Germaine Tillion, 5 bis Boulevard Lavoisier, 49045 Angers cedex 01, France; Département de Neurologie, CHU Angers, 49033 Angers, France
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Gupta M, Dugan A, Chacon E, Davenport DL, Shah MB, Marti F, Roth JS, Bernard A, Zwischenberger JB, Gedaly R. Detailed perioperative risk among patients with extreme obesity undergoing nonbariatric general surgery. Surgery 2020; 168:462-470. [DOI: 10.1016/j.surg.2020.03.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/28/2020] [Accepted: 03/21/2020] [Indexed: 12/23/2022]
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May AK, Talisa VB, Wilfret DA, Bulger E, Dankner W, Bernard A, Yende S. Estimating the Impact of Necrotizing Soft Tissue Infections in the United States: Incidence and Re-Admissions. Surg Infect (Larchmt) 2020; 22:509-515. [PMID: 32833599 DOI: 10.1089/sur.2020.099] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Previous estimates of the incidence of necrotizing soft tissue infections (NSTI) in the United States have substantial limitations and underestimate its occurrence. Improvements in hospital mortality after NSTI have increased the number of survivors at risk for long-term sequelae. This study estimates the incidence of NSTI and the burden of re-admission and associated healthcare spending in patients who survived admission for NSTI. Methods: Index admissions for NSTI were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes combined with either Current Procedural Technology (CPT) or diagnosis-related group codes to increase specificity. Two separate datasets were used to provide primary and secondary estimates of the annual incidence of NSTIs in the United States: the National Inpatient Sample (NIS) for the years 2012-2016 and the Watson Health dataset for 2009-2013, respectively, and extrapolated to estimate the incidence for 2018. The Nationwide Readmissions Database (NRD) from 2013-2015 was used to estimate of the risk for re-admission, cost of re-admissions, and to compare 90-day re-admission rates for NSTI to common medical conditions. Results: National Inpatient Sample and Watson Health datasets demonstrated an increasing annual incidence and estimated 33,600 and 28,500 cases in 2018, respectively. The estimated annual incidences in the United States in 2018 were 10.3 and 8.7 per 100,000 persons, respectively. Risk of 90-day re-admission ranged from 24%-29% over the 3 years, 89% of which were unplanned. Of those re-admitted, 90% had one or more comorbidities, the most common diagnoses associated with re-admission were infection in 65%, acute kidney injury in 22%, and shock in 10%. The median re-admission length of stay was seven days (interquartile range [IQR]: 4-13 days) with a median cost of re-admission of $13,590 (IQR: $7186-$27440). Conclusion: The incidence of NSTI is more common than generally reported. Re-admission within 90 days is common, occurring in more than one in four survivors resulting in high healthcare costs.
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Affiliation(s)
- Addison K May
- Carolinas Medical Center, Atrium Health, Charlotte, North Carolina, USA
| | - Victor B Talisa
- The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center and Department of Critical Care Medicine, University of Pittsburgh, Pennsylvania, USA
| | | | - Eileen Bulger
- University of Washington, Harborview Medical Center, Seattle, Washington, USA
| | | | - Andrew Bernard
- Department of Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Sachin Yende
- The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center and Department of Critical Care Medicine, University of Pittsburgh, Pennsylvania, USA
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Troutman Adams E, Cohen EL, Bernard A, Darnell WH, Oyler DR. Can opioid vigilance and patient-centered care coexist? A qualitative study of communicative tensions encountered by surgical trainees. J Opioid Manag 2020; 16:91-101. [PMID: 32329884 DOI: 10.5055/jom.2020.0555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The American health care system's adoption of the patient-centered care (PCC) model has transformed how medical pro-viders communicate with patients about prescription pain medication. Concomitantly, the nation's opioid epidemic has necessitated a proactive response from the medical profession, requiring providers who frequently dispense opioids for acute pain to exercise vigi-lance in monitoring and limiting outpatient prescriptions. This qualitative study explores how surgical trainees balance PCC directives, including shared decision making, exchanging information with patients, and relationship maintenance, with opioid prescribing vigi-lance. DESIGN Investigators conducted interviews with 17 surgical residents and fellows (trainees) who routinely prescribe opioids at an ac-ademic medical center. RESULTS A qualitative descriptive analysis produced four codes, which were reduced to themes depicting problematic intersections between PCC imperatives and opioid vigilance during post-operative opioid-prescribing communication: (a) sharing the deci-sion-making process contended with exerting medical authority, (b) reciprocating information contended with negotiating opioid prescribing terms with patients, (c) maintaining symbiotic relationships contended with prescribing ethics, and (d) achieving patient satisfaction contended with safeguarding opioid medications. CONCLUSION Surgical training programs must supply trainees with post-surgical prescribing guidelines and communication skills training. Training should emphasize how PCC directives may work in tandem with-not in opposition to-opioid vigilance.
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Affiliation(s)
- Elizabeth Troutman Adams
- School of Media and Journalism, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Elisia L Cohen
- Hubbard School of Journalism and Mass Communication, University of Minnesota, Minneapolis, Minnesota
| | - Andrew Bernard
- Department of Trauma and Surgery, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Whittney H Darnell
- College of Communication and Information, University of Kentucky, Lexington, Kentucky
| | - Douglas R Oyler
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, Kentucky
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Abstract
Gout is a chronic disease due to the deposition of monosodium urate microcrystals in joints and tissues. Its incidence and prevalence are increasing worldwide in close relation with the epidemic of obesity and metabolic syndrome. Gout is related to chronic hyperuricemia that should be treated to ensure the reduction or even the disappearance of acute attacks ("gout flares") and to reduce the size and number of tophi. If arthritis of the first metatarsophalangeal joint is the most typical form, other joints may be affected, including the spine. Demonstration of urate microcrystals arthritis allows diagnosis of gout but, in the absence of possibility of performing joint puncture, imaging may be useful for providing complementary diagnostic elements. Appropriate care is essential to reduce the number of flares and the evolution towards gouty arthropathy but also in terms of public health in order to reduce costs related to this pathology.
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Affiliation(s)
- A Scuiller
- Service de médecine interne et polyvalente, centre hospitalier de Polynésie française, 98714 Pirae, Tahiti
| | - T Pascart
- Service de rhumatologie, hôpital Saint-Philibert, université de Lille, 59462 Lomme cedex, France
| | - A Bernard
- Service de médecine interne et polyvalente, centre hospitalier de Polynésie française, 98714 Pirae, Tahiti
| | - E Oehler
- Service de médecine interne et polyvalente, centre hospitalier de Polynésie française, 98714 Pirae, Tahiti.
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Abstract
Communication about organ donation at the time of imminent death is a meaningful, yet less understood, area of health communication. We employed a multiple goals framework to explore family normative perceptions of organ donation and the conversational goal tensions experienced during a family member's imminent death. Semi-structured interviews were conducted with 14 family members who refused to donate when approached by an organ procurement coordinator (OPC) upon the imminent death of a family member. Thematic analysis revealed that family members described their decisions to refuse donation as (a) last acts of love, (b) responses to unnecessary requests, and (c) consistent with the known beliefs of the patient. Participants described several goal tensions operating within the organ donation conversation itself, including (a) the management of frequent requests, (b) pressure to donate, and (c) enduring unwanted requests from the OPC. Communication goals frameworks offer practical insights for improving organ-related conversations.
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Affiliation(s)
| | - Kevin Real
- University of Kentucky, Lexington, Kentucky, USA
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Medvecz A, Bernard A, Hamilton C, Schuster KM, Guillamondegui O, Davenport D. Transfusion rates in emergency general surgery: high but modifiable. Trauma Surg Acute Care Open 2020; 5:e000371. [PMID: 32154373 PMCID: PMC7046949 DOI: 10.1136/tsaco-2019-000371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 12/13/2019] [Accepted: 12/18/2019] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Transfusion of red blood cells (RBC) increases morbidity and mortality, and emergency general surgery (EGS) cases have increased risk for transfusion and complication given case complexity and patient acuity. Transfusion reduction strategies and blood-conservation technology have been developed to decrease transfusions. This study explores whether transfusion rates in EGS have decreased as these new strategies have been implemented. METHODS This is a retrospective review of the American College of Surgeons' National Surgical Quality Improvement Program (ACS NSQIP) data from three academic medical centers. Operations performed by general surgeons on adults (aged ≥18 years) were selected. Data were analyzed from two periods: 2011-2013 and 2014-2016. Cases were grouped by the first four digits of the primary procedure Current Procedural Terminology code. Transfusion was defined as any RBC transfusion during or within 72 hours following the operation. Composite morbidity was defined as any NSQIP complication within 30 days following the operation. RESULTS Overall general surgery transfusion rates decreased from 6.4% to 4.8% from period 1 to period 2 (emergent: 16.6%-11.5%; non-emergent 4.9%-3.7%; Fisher's exact p values <0.001). Among patients transfused, the number of units received decreased slightly (median 2 U (IQR 2-3) to median 2 U (IQR 1-3), Mann-Whitney U test p=0.005). Morbidity decreased (overall: 13.8%-12.3%, p=0.001; emergent: 26.3%-20.6%, p<0.001) while mortality did not change. DISCUSSION Rates of RBC transfusion decreased in both emergent and non-emergent cases. Efforts to reduce transfusion may have been successful in the EGS population. Morbidity improved over the time periods while mortality was unchanged. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Andrew Medvecz
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Andrew Bernard
- Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Courtney Hamilton
- Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Kevin M Schuster
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Oscar Guillamondegui
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Daniel Davenport
- Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky, USA
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Fauchier L, Bisson A, Herbert J, Lacour T, Bourguignon T, Etienne CS, Bernard A, Deharo P, Bernard L, Babuty D. Incidence and outcomes of infective endocarditis after transcatheter aortic valve implantation versus surgical aortic valve replacement. Clin Microbiol Infect 2020; 26:1368-1374. [PMID: 32036047 DOI: 10.1016/j.cmi.2020.01.036] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/26/2020] [Accepted: 01/30/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Transcatheter aortic valve implantation (TAVI) is an alternative to surgical aortic valve replacement (AVR) in aortic stenosis (AS). Infective endocarditis (IE) in patients with prosthetic heart valves is associated with significant morbidity and mortality. Data on the incidence, risk factors, and outcomes of IE after TAVI are conflicting. We evaluated these issues in patients with percutaneous TAVI vs. isolated surgical AVR (SAVR) at a nationwide level. METHODS Based on the administrative hospital discharge database, the study collected information for all patients with aortic stenosis treated with AVR in France between 2010 and 2018. RESULTS A total of 47 553 patients undergoing TAVI and 60 253 patients undergoing isolated SAVR were identified. During a mean follow-up of 2.0 years (median (25th to 75th percentile) 1.2 (0.1-3.4) years), the incidence rates of IE were 1.89 (95% confidence interval (CI) 1.78-2.00) and 1.40 (95% CI 1.34-1.46) events per 100 person-years in unmatched TAVI and SAVR patients, respectively. In 32 582 propensity-matched patients (16 291 with TAVI and 16 291 with SAVR), risk of IE was not different in patients treated with TAVI vs. SAVR (incidence rates of IE 1.86 (95% CI 1.70-2.04) %/year vs 1.71 (95% CI 1.58-1.85) %/year respectively, relative risk (RR) 1.09, 95% CI 0.96-1.23). In these matched patients, total mortality was higher in TAVI patients with IE (43.0% 95% CI 37.3-49.3) than in SAVR patients with IE (32.8% 95% CI 28.6-37.3; RR 1.32, 95% CI 1.08-1.60). DISCUSSION In a nationwide cohort of patients with AS, treatment with TAVI was associated with a risk of IE similar to that following SAVR. Mortality was higher for patients with IE following TAVI than for those with IE following SAVR.
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Affiliation(s)
- L Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, EA7505, Université de Tours, France.
| | - A Bisson
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, EA7505, Université de Tours, France
| | - J Herbert
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, EA7505, Université de Tours, France; Service d'information Médicale, d'épidémiologie et d'économie de la santé, Centre Hospitalier Universitaire et Faculté de Médecine, EA7505, Université de Tours, France
| | - T Lacour
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, EA7505, Université de Tours, France
| | - T Bourguignon
- Service de Chirurgie Cardiaque, Centre Hospitalier Universitaire et Faculté de Médecine, Université de Tours, France
| | - C Saint Etienne
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, EA7505, Université de Tours, France
| | - A Bernard
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, EA7505, Université de Tours, France
| | - P Deharo
- Département de Cardiologie, Centre Hospitalier Universitaire Timone, Inserm, Inra, C2VN, France et Faculté de Médecine, Université Aix-Marseille, Marseille, France
| | - L Bernard
- Service de Médecine interne et Maladies Infectieuses, Centre Hospitalier Universitaire et Faculté de Médecine, Université de Tours, France
| | - D Babuty
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Faculté de Médecine, EA7505, Université de Tours, France
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Bernard C, Morgant M, Jazayeri A, Bernard A, Bouchot O. Optimal timing of coronary artery bypass grafting in hemodynamically stable patients after myocardial infarction and definition of poor prognostic factors. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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40
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Fauchier L, Bernard A, Bisson A, Lacour T, Herbert J, Ivanes F, Bourguignon T, Clerc JM, Quilliet L, Guillon Grammatico L, Angoulvant D, Saint Etienne C, Babuty D. 4070Clinical impact of mitral regurgitation before or following transcatheter aortic valve replacement in patients with aortic stenosis: a nationwide multivariable analysis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Patients undergoing transcatheter aortic valve replacement (TAVR) may have concomitant mitral regurgitation (MR). The impact of MR at baseline or after TAVR on subsequent prognosis remains to be more precisely determined. We analysed the impact of MR before or after TAVR on prognosis in the systematic analysis of patients treated with TAVR at a nationwide level.
Methods
Based on the French administrative hospital-discharge database, the study collected information for all consecutive patients with aortic stenosis treated with transfemoral TAVR in France between 2008 and 2018. Cox regression was used for the analysis of predictors of events during follow-up.
Results
A total of 47,872 patients with transfemoral TAVR were included in the analysis (mean age 83±7 years). Moderate/severe MR was present at baseline (MRb) in 9.5% of the patients. Few patients (1.6%) revealed moderate/severe MR post-TAVR (MRpt). Mean follow-up was 1.31±1.61 years. MRb was associated with an increased cardiovascular mortality (Hazard ratio 1.29, 95% CI 1.20–1.39) and total mortality (Hazard ratio 1.15, 95% CI 1.10–1.21). However, MRb was not an independent predictor in multivariable analysis, neither for cardiovascular mortality (adjusted HR 1.06, 95% CI 0.98–1.14) nor for total mortality (adjusted HR 1.01, 95% CI 0.96–1.07). MRpt was not a predictor of cardiovascular or total mortality. Older age, male sex, history of pulmonary edema/cardiogenic shock, atrial fibrillation, myocardial infarction, diabetes, renal failure, liver disease, pulmonary disease, previous cancer and anemia at baseline independently predicted mortality during follow-up. All of them (but history of cancer) were also independent predictor of cardiovascular death.
Conclusion
Baseline MR was associated with increased cardiovascular and totality mortality following TAVR but was not an independent predictor of any of them. By contrast, several other predictors of cardiovascular and total mortality were identified. This suggests that MR should not be directly considered to establish the strategy for TAVR decision or for avoiding TAVR-related futility.
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Affiliation(s)
- L Fauchier
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Bernard
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Bisson
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - T Lacour
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - J Herbert
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - F Ivanes
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - T Bourguignon
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - J M Clerc
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - L Quilliet
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | | | - D Angoulvant
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - C Saint Etienne
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - D Babuty
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
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Fauchier L, Bisson A, Herbert J, Lacour T, Ivanes F, Bourguignon T, Clerc JM, Quilliet L, Lantelme P, Angoulvant D, Babuty D, Guillon Grammatico L, Bernard A, Saint Etienne C. P1794Futility risk model development and validation among patients with aortic stenosis treated with transcatheter aortic valve replacement. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Risk-benefit assessment for transcatheter aortic valve replacement (TAVR) is still a matter of debate. A sizeable group of patients do not fully benefit from intervention despite a technically successful procedure. We therefore sought to identify patients with a bad outcome early after the procedure, and to develop a prediction model and calculator for identification of these patients.
Methods
Based on the French administrative hospital-discharge database, the study collected information for all consecutive patients with aortic stenosis treated with transfemoral TAVR in France between 2008 and 2018. Multivariate logistic regression was used to select the risk factors of early all-cause death in first year after TAVR procedure (considered as futility) for the overall population. Score points were assigned to each risk factor using the β coefficient. Internal validation was performed by a bootstrap method. Calibration was assessed with the Hosmer-Lemeshow goodness of fit test and accuracy with the C-statistic.
Results
A total of 47,872 patients with transfemoral TAVR were included in the analysis (mean age 83±7 years). Mean follow-up was 1.31±1.61 years and 9,338 deaths were recorded (yearly rate 14.9%), among which 4,562 (49%) occurred in first year after TAVR procedure. The final logistic regression model included older age, male sex, history of hospital stay with heart failure, history of acute pulmonary oedema, atrial fibrillation, previous stroke, vascular disease, diabetes, renal disease, liver disease, pulmonary disease, anemia, history of cancer, metastasis and denutrition,. The area under the curve (AUC) for the score was 0.696 (95% CI 0.688–0.704). This score outperformed frailty index and Charlson comorbidity index for identifying futility. AUC was 0.677 (95% CI 0.669–0.86) for internal validation. The Hosmer–Lemeshow goodness of fit test had a p-value of 0.10 suggesting that the model was accurate. We further divided the model into 4 groups with 5%, 12%, 19% and 30% futility, respectively. The low-risk group consisted of 60% of the patients and the high-risk group consisted of 4% of these patients.
Conclusion
This futility prediction score established from a large nationwide cohort of patients treated with TAVR may provide a relevant insight for optimizing healthcare decision. It may facilitate identification of patients who, despite an apparently successful procedure, have risk of death that may outweigh the benefit of an anticipated TAVR.
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Affiliation(s)
- L Fauchier
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - A Bisson
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - J Herbert
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - T Lacour
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - F Ivanes
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - T Bourguignon
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - J M Clerc
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - L Quilliet
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - P Lantelme
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - D Angoulvant
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - D Babuty
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | | | - A Bernard
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
| | - C Saint Etienne
- Tours Regional University Hospital, Hospital Trousseau, Tours, France
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Trada Y, Law P, Bernard A, Foote M, Barbour A, Lambie D, Smithers M, Burmeister B, Pinkham M. FDG-PET Response Assessment in Patients with Locally Advanced Nodal Melanoma Undergoing High-Dose Neo-Adjuvant or Definitive Radiotherapy. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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43
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David C, Lacout M, Caze C, Saint Etienne C, Clerc J, Quilliet L, Ivanes F, Bernard A. Transaortic valvular replacement prognosis according to aortic stenosis category. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2019.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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44
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Achour S, Iken I, Abidi K, Dumont X, Messouak O, Belhcen F, Bernard A. Dépistage du saturnisme chez une famille travaillant dans la fabrication artisanale du Khôl. Toxicologie Analytique et Clinique 2019. [DOI: 10.1016/j.toxac.2019.03.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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45
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Bernard A, Staudenmayer K, Minei JP, Doucet J, Haider A, Scherer T, Davis KA. Macroeconomic trends and practice models impacting acute care surgery. Trauma Surg Acute Care Open 2019; 4:e000295. [PMID: 31058241 PMCID: PMC6461137 DOI: 10.1136/tsaco-2018-000295] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 01/03/2019] [Indexed: 12/01/2022] Open
Abstract
Acute care surgery (ACS) diagnoses are responsible for approximately a quarter of the costs of inpatient care in the US government, and individuals will be responsible for a larger share of the costs of this healthcare as the population ages. ACS as a specialty thus has the opportunity to meet a significant healthcare need, and by optimizing care delivery models do so in a way that improves both quality and value. ACS practice models that have maintained or added emergency general surgery (EGS) and even elective surgery have realized more operative case volume and surgeon satisfaction. However, vulnerabilities exist in the ACS model. Payer mix in a practice varies by geography and distribution of EGS, trauma, critical care, and elective surgery. Critical care codes constitute approximately 25% of all billing by acute care surgeons, so even small changes in reimbursement in critical care can have significant impact on professional revenue. Staffing an ACS practice can be challenging depending on reimbursement and due to uneven geographic distribution of available surgeons. Empowered by an understanding of economics, using team-oriented leadership inherent to trauma surgeons, and in partnership with healthcare organizations and regulatory bodies, ACS surgeons are positioned to significantly influence the future of healthcare in the USA.
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Affiliation(s)
- Andrew Bernard
- Surgery, University of Kentucky Medical Center, Lexington, Kentucky, USA
| | | | | | - Jay Doucet
- Department of Surgery, University of California San Diego Health System, San Diego, California, USA
| | - Adil Haider
- Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Tres Scherer
- Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Waucquier L, Rochepeau C, Bernard A, Burillon C, Kocaba V. [Partial optic nerve avulsion secondary to forced rotation of the ocular globe: A case report]. J Fr Ophtalmol 2019; 42:e117-e120. [PMID: 30833007 DOI: 10.1016/j.jfo.2018.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 06/22/2018] [Accepted: 06/27/2018] [Indexed: 10/27/2022]
Affiliation(s)
- L Waucquier
- Service d'ophtalmologie, Pavillon C, hôpital Edouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France
| | - C Rochepeau
- Service d'ophtalmologie, Pavillon C, hôpital Edouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France
| | - A Bernard
- Service d'ophtalmologie, Pavillon C, hôpital Edouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France
| | - C Burillon
- Service d'ophtalmologie, Pavillon C, hôpital Edouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France; Université Claude-Bernard Lyon 1, 69100 Villeurbanne, France
| | - V Kocaba
- Service d'ophtalmologie, Pavillon C, hôpital Edouard-Herriot, hospices civils de Lyon, 5, place d'Arsonval, 69003 Lyon, France; Université Claude-Bernard Lyon 1, 69100 Villeurbanne, France; Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute (SERI), Singapore.
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47
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Bisson A, Bodin A, Clementy N, Bernard A, Pierre B, Babuty D, Lip G, Fauchier L. Thromboembolic and bleeding risk stratification according to the EHRA valvular heart disease classification in patients with atrial fibrillation. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2018.10.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Adams ET, Cohen EL, Bernard A, Darnell W, Helme DW. Trauma Trainees' Multiple Competing Goals in Opioid Prescription Communication. Qual Health Res 2018; 28:1983-1996. [PMID: 29984621 DOI: 10.1177/1049732318784896] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Prescription opioids and heroin account for more than half of all drug overdose fatalities, costing an estimated 115 American lives every day. The ongoing opioid epidemic devastates communities and represents a tremendous burden to the national economy and health care system. In 2016, the Centers for Disease Control and Prevention and the White House Office of National Drug Control Policy proposed action to train prescribers on the proper dispensing of opioids, which are indispensable pharmacologic resources for treating acute pain resulting from a traumatic injury or surgery. Trauma surgeons who prescribe opioids for severe pain embark on patient consultations with multiple and conflicting goals respective to their roles as a healers of the suffering, regulators of illicit substances, members of a greater medical system working to contain an opioid epidemic, and moral beings with a distinct set of preferences, experiences, social norms, and practice philosophies. Semistructured interviews with 17 trauma and surgical residents and fellows at a southeastern academic medical center in the United States generated descriptive data regarding prescribing practices and patient communication. Guided by the multiple goals framework, the current research presents three prominent themes depicting the problematic convergence of identity, task, and relational goals during opioid-prescribing conversations between trauma trainees and their patients.
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Bernard M, Wright R, Anderson H, Bernard A. Wilderness Falls: An Analysis and Comparison of Rock Climbers and Nonclimbers. J Surg Res 2018; 234:149-154. [PMID: 30527467 DOI: 10.1016/j.jss.2018.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/23/2018] [Accepted: 09/04/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Wilderness travel and rock climbing are increasingly popular. Urban falls from height have been reported from trauma centers; however, there have been no trauma center reports of rock climbing or wilderness falls (WFs) in the United States. We sought to describe the injury pattern of WF and to determine whether rock climbers represent a distinct pattern of injury. MATERIALS AND METHODS The trauma database from our level 1 trauma center was queried from 1/1/06 to 12/31/16 for the diagnosis of "fall from cliff" (ICD9: e884.1, ICD10: w15.xx). Demographics, injury characteristics, and trauma center care were analyzed. Data were analyzed using two sample unequal variance T-tests, two sample Z-tests for proportions, and Fisher's exact tests. RESULTS One hundred fifty-one falls were analyzed (40 climbers, 111 nonclimbers). WF victims were predominantly male (79%), moderately injured (mean injury severity score = 13.2), frequently intoxicated (34%), and fell from an average of 43 feet (7-200 ft). The most frequent injures were soft tissue (55%), spine (50%), head (43%), lower extremity (38%), and chest (39%). Climbers were younger, more often sustained upper extremity and soft tissue injuries, more often flown from the scene, injured during daytime, and were better insured. Helmet use was rare (one climber and one nonclimber). There were 3 (2%) deaths, including one climber. CONCLUSIONS WFs have a distinct injury pattern and demographic and occur from a height greater than twice those reported in urban falls. Rock climbing falls involve another distinct demographic and pattern of injury. Injury prevention strategies may include helmet use and avoiding nighttime wilderness travel and drug/alcohol use.
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Affiliation(s)
- Matthew Bernard
- Department of Surgery, University of Kentucky College of Medicine, UK Healthcare, Lexington, Kentucky.
| | - Raymond Wright
- Department of Surgery, University of Kentucky College of Medicine, UK Healthcare, Lexington, Kentucky
| | - Hannah Anderson
- Department of Surgery, University of Kentucky College of Medicine, UK Healthcare, Lexington, Kentucky
| | - Andrew Bernard
- Department of Surgery, University of Kentucky College of Medicine, UK Healthcare, Lexington, Kentucky
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Harris CT, Totten M, Davenport D, Ye Z, O'Brien J, Williams D, Bernard A, Boral L. Experience with uncrossmatched blood refrigerator in emergency department. Trauma Surg Acute Care Open 2018; 3:e000184. [PMID: 30402556 PMCID: PMC6203135 DOI: 10.1136/tsaco-2018-000184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/20/2018] [Accepted: 08/14/2018] [Indexed: 12/05/2022] Open
Abstract
Background Uncrossmatched packed red blood cell (PRBC) transfusion is fundamental in resuscitation of hemorrhagic shock. Ready availability of uncrossmatched blood can be achieved by storing uncrossmatched blood in a blood bank refrigerator in the emergency department (ED), but could theoretically lead to inappropriate uncrossmatched use. Methods This retrospective study was performed at a level I trauma center from January 2013 to March 2014. Possibly inappropriate transfusion was defined as patients who received at least one unit of blood from the ED refrigerator and no more than two units of PRBC in the first 24 hours. Deaths within the first 24 hours were excluded. Patients who received blood from the ED refrigerator who received ≤2 units total in 24 hours were compared with those who received >2 units. Results 158 adults received blood from the ED refrigerator. 140 (88.6%) were trauma patients. 37 (23.4%) received massive transfusion (MT). 42 (26.6%) deaths were excluded. 29 patients received ≤2 units and 87 received >2 units in the first 24 hours. The ≤2 units group had a higher systolic blood pressure (116 mm Hg vs. 102 mm Hg, p=0.042), lower base deficit (6.4 mEq/L vs. 9.4 mEq/L, p=0.032), higher hematocrit (34% vs. 30%, p=0.024), lower rate of MT protocol activation (27.6% vs. 58.6%, p=0.005), and lower rates of transfusion of fresh frozen plasma (17.2% vs. 54.0%, p=0.001) and platelets (13.8% vs. 39.1%, p=0.012). Appropriately transfused patients were more likely to have evidence of shock with active, non-compressible hemorrhage. Potentially inappropriate uses were more likely in patients either without evidence of hemorrhage or without signs of shock. Discussion Storing uncrossmatched blood in the ED is an effective way to get PRBCs transfused quickly in hemorrhaging patients and is associated with a low rate of unnecessary uncrossmatched transfusion. Provider education and good clinical judgment are imperative to prevent unnecessary use. Level of evidence Level III, therapeutic.
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Affiliation(s)
- Charles T Harris
- Department of Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Michael Totten
- Department of Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Daniel Davenport
- Department of Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Zhan Ye
- Department of Pathology and Laboratory Medicine, University of Kansas, Lawrence, Kansas, USA
| | - Julie O'Brien
- Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Dennis Williams
- Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Andrew Bernard
- Department of Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Leonard Boral
- Department of Pathology and Laboratory Medicine, University of Kentucky, Lexington, Kentucky, USA
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