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Anandalwar SP, O'Meara L, Vesselinov R, Zhang A, Baum JN, Cooper A, Decker C, Schroeppel T, Cai J, Cullinane D, Catalano RD, Bugaev N, LeClair M, Feather C, McBride K, Sams V, Leung PS, Olafson S, Callahan DS, Posluszny J, Moradian S, Estroff J, Hochman B, Coleman N, Goldenberg-Sandau A, Nahmias J, Rosenbaum K, Pasley J, Boll L, Hustad L, Reynolds J, Truitt M, Ghneim M. Warfarin, not direct oral anticoagulants nor antiplatelet therapy, is associated with increased bleeding risk in emergency general surgery patients: implications in this new era of novel anticoagulants: An EAST Multicenter study. J Trauma Acute Care Surg 2024:01586154-990000000-00691. [PMID: 38595274 DOI: 10.1097/ta.0000000000004278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
INTRODUCTION To assess perioperative bleeding complications & in-hospital mortality in patients requiring emergency general surgery (EGS) presenting with a history of antiplatelet (AP) vs. direct oral anticoagulant (DOAC) vs warfarin use. METHODS Prospective observational study across 21 centers between 2019-2022. Inclusion criteria were age ≥ 18 years, & DOAC, warfarin or AP use within 24 hours of an EGSP. Outcomes included perioperative bleeding and in-hospital mortality. The study was conducted using ANOVA, Chi-square, and multivariable regression models. RESULTS Of the 413 patients, 221 (53.5%) reported AP use, 152 (36.8%) DOAC use, & 40 (9.7%) warfarin use. Most common indications for surgery were obstruction (23% (AP), 45% (DOAC), 28% (warfarin)), intestinal ischemia (13%, 17%, 23%), & diverticulitis/peptic ulcers (7%, 7%, 15%). Compared to DOAC use, warfarin use was associated with significantly higher perioperative bleeding complication (OR 4.4 [2.0, 9.9]). There was no significant difference in perioperative bleeding complication between DOAC & AP use (OR 0.7 [0.4, 1.1]). Compared to DOAC use, there was no significant difference in mortality between warfarin use (0.7 [0.2, 2.5]) or AP use (OR 0.5 [0.2, 1.2]). After adjusting for confounders, warfarin use (OR 6.3 [2.8, 13.9]), medical history and operative indication were associated with an increase in perioperative bleeding complications. However, warfarin was not independently associated with risk of mortality (OR 1.3 [0.39, 4.7]), whereas intraoperative vasopressor use (OR 4.7 [1.7, 12.8)), medical history & postoperative bleeding (OR 5.5 [2.4, 12.8]) were. CONCLUSIONS Despite ongoing concerns about the increase in DOAC use & lack of readily available reversal agents, this study suggests that warfarin, rather than DOACs, is associated with higher perioperative bleeding complications. However, that risk does not result in an increase in mortality, suggesting that perioperative decisions should be dictated by patient disease & comorbidities rather than type of antiplatelet or anticoagulant use.
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Affiliation(s)
- Seema P Anandalwar
- Department of Trauma Surgery, University of Maryland Medical Center, Baltimore, Maryland
| | - Lindsay O'Meara
- Department of Trauma Surgery, University of Maryland Medical Center, Baltimore, Maryland
| | - Roumen Vesselinov
- Department of Epidemiology & Public Health, University of Maryland Medical Center, Baltimore Maryland
| | - Ashling Zhang
- Department of Trauma Surgery, University of Maryland Medical Center, Baltimore, Maryland
| | | | - Amanda Cooper
- Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Cassandra Decker
- Department of Surgery, UCHealth Memorial Hospital, Colorado Springs
| | | | - Jenny Cai
- Department of Surgery, Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | | | - Nikolay Bugaev
- Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Madison LeClair
- Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | | | | | - Valerie Sams
- Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Pak Shan Leung
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Samantha Olafson
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Devon S Callahan
- Department of Surgery, Allina Health/Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Joseph Posluszny
- Separtment of Surgery, Northwestern University, Evanston, Illinois
| | - Simon Moradian
- Separtment of Surgery, Northwestern University, Evanston, Illinois
| | - Jordan Estroff
- Department of Surgery, George Washington University, Washington D.C
| | - Beth Hochman
- Columbia University Irving Medical Center, New York, New York
| | - Natasha Coleman
- Columbia University Irving Medical Center, New York, New York
| | | | - Jeffry Nahmias
- University of California Irvine Medical Center, Irvine, California
| | | | | | | | | | | | | | - Mira Ghneim
- Department of Trauma Surgery, University of Maryland Medical Center, Baltimore, Maryland
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O'Meara L, Zhang A, Baum JN, Cooper A, Decker C, Schroeppel T, Cai J, Cullinane DC, Catalano RD, Bugaev N, LeClair MJ, Feather C, McBride K, Sams V, Leung PS, Olafson S, Callahan DS, Posluszny J, Moradian S, Estroff J, Hochman B, Coleman NL, Goldenberg-Sandau A, Nahmias J, Rosenbaum K, Pasley JD, Boll L, Hustad L, Reynolds J, Truitt M, Vesselinov R, Ghneim M. Anticoagulation in emergency general surgery: Who bleeds more? The EAST multicenter trials ACES study. J Trauma Acute Care Surg 2023; 95:510-515. [PMID: 37349868 DOI: 10.1097/ta.0000000000004042] [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: 06/24/2023]
Abstract
BACKGROUND While direct oral anticoagulant (DOAC) use is increasing in the Emergency General Surgery (EGS) patient population, our understanding of their bleeding risk in the acute setting remains limited. Therefore, the objective of this study was to determine the prevalence of perioperative bleeding complications in patients using DOACs versus warfarin and AP therapy requiring urgent/emergent EGS procedures (EGSPs). METHODS This was a prospective observational trial, conducted between 2019 and 2022, across 21 centers. Inclusion criteria were 18 years or older, DOAC, warfarin/AP use within 24 hours of requiring an urgent/emergent EGSP. Demographics, preoperative, intraoperative, and postoperative data were collected. ANOVA, χ 2 , and multivariable regression models were used to conduct the analysis. RESULTS Of the 413 patients enrolled in the study, 261 (63%) reported warfarin/AP use and 152 (37%) reported DOAC use. Appendicitis and cholecystitis were the most frequent indication for operative intervention in the warfarin/AP group (43.4% vs. 25%, p = 0.001). Small bowel obstruction/abdominal wall hernias were the main indication for operative intervention in the DOAC group (44.7% vs. 23.8%, p = 0.001). Intraoperative, postoperative, and perioperative bleeding complications and in-hospital mortality were similar between the two groups. After adjusting for confounders, a history of chemotherapy (odds ratio [OR], 4.3; p = 0.015) and indication for operative intervention including occlusive mesenteric ischemia (OR, 4.27; p = 0.016), nonocclusive mesenteric ischemia (OR, 3.13; p = 0.001), and diverticulitis (OR, 3.72; p = 0.019) were associated with increased perioperative bleeding complications. The need for an intraoperative transfusion (OR, 4.87; p < 0.001), and intraoperative vasopressors (OR, 4.35; p = 0.003) were associated with increased in-hospital mortality. CONCLUSION Perioperative bleeding complications and mortality are impacted by the indication for EGSPs and patient's severity of illness rather than a history of DOAC or warfarin/AP use. Therefore, perioperative management should be guided by patient physiology and indication for surgery rather than the concern for recent antiplatelet or anticoagulant use. LEVEL OF EVIDENCE Prognostic and Epidemiologic; Level III.
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Affiliation(s)
- Lindsay O'Meara
- From the University of Maryland Medical Center (L.O.), Baltimore, Maryland; Mount Sinai South Nassau (J.N.B.), Oceanside, New York; Penn State Milton S. Hershey Medical Center (A.C.), Hershey, Pennsylvania; UCHealth Memorial Hospital (C.D.), Colorado Springs, Colorado; RWJMS, Rutgers at Newark (J.C.), Newark, New Jersey; Allina Health/Abbott Northwestern Hospital (D.S.C.), Minneapolis, Minnesota; Northwestern University (J.P.), Evanston, Illinois; George Washington University (J.E.), Washington, district of Columbia; Columbia University Irving Medical Center (B.H.), New York, New York; Cooper University (A.G.), Camden, New Jersey; Marshfield Clinic (D.C.C.), Marshfield, Wisconsin; Loma Linda University School of Medicine (R.D.C.), Loma Linda, California; Tufts Medical Center, Tuft University School of Medicine (N.B.), Boston, Massachusetts; Anne Arundel Medical Center (C.F.), Parole, Maryland; Memorial Health University Medical Center (K.M.), Savannah, Georgia; Brooke Army Medical Center (V.S.), Fort Sam Houston, Texas; Sidney Kimmel Medical College: Thomas Jefferson University (P.S.L.), Philadelphia, Pennsylvania; University of California Irvine Medical Center (J.N.), Irvine, California; McLaren Oakland Hospital (J.D.P.), Pontiac, Michigan; Sanford Health (L.H.), Sioux Falls, South Dakota; University of Kentucky Medical Center (J.R.), Lexington, Kentucky; and Methodist Medical Center (M.T.), Dallas, Texas
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Dumas RP, Vella MA, Maiga AW, Erickson CR, Dennis BM, da Luz LT, Pannell D, Quigley E, Velopulos CG, Hendzlik P, Marinica A, Bruce N, Margolick J, Butler DF, Estroff J, Zebley JA, Alexander A, Mitchell S, Grossman Verner HM, Truitt M, Berry S, Middlekauff J, Luce S, Leshikar D, Krowsoski L, Bukur M, Polite NM, McMann AH, Staszak R, Armen SB, Horrigan T, Moore FO, Bjordahl P, Guido J, Mathew S, Diaz BF, Mooney J, Hebeler K, Holena DN. MOVING THE NEEDLE ON TIME TO RESUSCITATION: AN EAST PROSPECTIVE MULTICENTER STUDY OF VASCULAR ACCESS IN HYPOTENSIVE INJURED PATIENTS USING TRAUMA VIDEO REVIEW. J Trauma Acute Care Surg 2023:01586154-990000000-00324. [PMID: 37012624 DOI: 10.1097/ta.0000000000003958] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
INTRODUCTION Vascular access in hypotensive trauma patients is challenging. Little evidence exists on the time required and success rates of vascular access types. We hypothesized that intraosseous (IO) access would be faster and more successful than peripheral IV (PIV) and central venous catheter (CVC) access in hypotensive patients. METHODS An EAST prospective multicenter trial was performed; 19 centers provided data. Trauma video review (TVR) was used to evaluate the resuscitations of hypotensive (systolic blood pressure ≤ 90 mmHg) trauma patients. Highly granular data from video recordings were abstracted. Data collected included vascular access attempt type, location, success rate, and procedural time. Demographic and injury-specific variables were obtained from the medical record. Success rates, procedural durations, and time to resuscitation were compared among access strategies (IO vs PIV vs CVC). RESULTS 1,410 access attempts occurred in 581 patients with a median age of 40[27-59] years and an ISS of 22[10-34]. 932 PIV, 204 IO and 249 CVC were attempted. 70% of access attempts were successful but were significantly less likely to be successful in females (64% vs. 71%, p = 0.01). Median time to any access was 5.0[3.2-8.0] minutes. IO had higher success rates than PIV or CVC (93% vs. 67% vs. 59%, p < 0.001) and remained higher after subsequent failures (second attempt 85% vs. 59% vs. 69%, p = 0.08; third attempt 100% vs 33% vs. 67%, p = 0.002). Duration varied by access type (IO 36[23-60]sec; PIV 44[31-61]sec; CVC 171[105-298]sec) and was significantly different between IO vs. CVC (p < 0.001) and PIV vs. CVC (p < 0.001) but not PIV vs. IO. Time to resuscitation initiation was shorter in patients whose initial access attempt was IO, 5.8 minutes vs. 6.7 minutes (p = 0.015). This was more pronounced in patients arriving to the hospital with no established access (5.7 minutes vs. 7.5 minutes, p = 0.001). CONCLUSIONS IO is as fast as PIV and more likely to be successful compared with other access strategies in hypotensive trauma patients. Patients whose initial access attempt was IO were resuscitated more expeditiously. IO access should be considered a first line therapy in hypotensive trauma patients. LEVEL OF EVIDENCE Level II Therapeutic/Care Management.
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Affiliation(s)
- Ryan P Dumas
- UT Southwestern Medical Center, Division of Burn Trauma Acute and Critical Care Surgery, Dallas TX
| | - Michael A Vella
- University of Rochester Medical Center Division of Acute Care Surgery, Rochester, NY
| | - Amelia W Maiga
- Vanderbilt University Medical Center, Division of Acute Care Surgery, Nashville, TN
| | - Caroline R Erickson
- Vanderbilt University Medical Center, Division of Acute Care Surgery, Nashville, TN
| | - Brad M Dennis
- Vanderbilt University Medical Center, Division of Acute Care Surgery, Nashville, TN
| | | | | | - Emily Quigley
- University of Colorado, Section of Trauma, Acute Care Surgery and Critical Care, Aurora, CO
| | - Catherine G Velopulos
- University of Colorado, Section of Trauma, Acute Care Surgery and Critical Care, Aurora, CO
| | - Peter Hendzlik
- University of Rochester Medical Center Division of Acute Care Surgery, Rochester, NY
| | - Alexander Marinica
- UT Southwestern Medical Center, Division of Burn Trauma Acute and Critical Care Surgery, Dallas TX
| | - Nolan Bruce
- University of Arkansas for Medical Sciences, Trauma and Acute Care Surgery, Little Rock, AR
| | - Joseph Margolick
- University of Arkansas for Medical Sciences, Trauma and Acute Care Surgery, Little Rock, AR
| | - Dale F Butler
- University of Pennsylvania, Traumatology, Surgical Critical Care and Emergency Surgery, Philadelphia, PA
| | - Jordan Estroff
- George Washington University, Center for Trauma and Critical Care, Washington DC
| | - James A Zebley
- George Washington University, Center for Trauma and Critical Care, Washington DC
| | | | | | | | | | - Stepheny Berry
- University of Kansas, Acute Care Surgery, Trauma, and Surgical Critical Care, Kansas City, KS
| | - Jennifer Middlekauff
- University of Kansas, Acute Care Surgery, Trauma, and Surgical Critical Care, Kansas City, KS
| | - Siobhan Luce
- UC Davis Medical Center - Trauma, Acute Care Surgery and Surgical Critical Care, Sacramento, CA
| | - David Leshikar
- UC Davis Medical Center - Trauma, Acute Care Surgery and Surgical Critical Care, Sacramento, CA
| | | | | | | | | | - Ryan Staszak
- Penn State Health Medical Center, Division of Trauma, Acute Care and Critical Care Surgery, Hershey PA
| | - Scott B Armen
- Penn State Health Medical Center, Division of Trauma, Acute Care and Critical Care Surgery, Hershey PA
| | | | | | | | | | | | | | | | | | - Daniel N Holena
- Medical College of Wisconsin Division of Trauma and Acute Care Surgery Milwaukee, WI
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Angelo JL, Kaji AH, Spence LH, Plurad DS, Asis M, Barber A, Schroeppel TJ, Callaghan EC, Grover BT, Regner JL, Truitt M, Kim DY. Follow-up trends after emergency department discharge for acutely symptomatic hernias: A southwestern surgical congress multi-center trial. Am J Surg 2019; 218:1079-1083. [PMID: 31506167 DOI: 10.1016/j.amjsurg.2019.08.012] [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: 03/16/2019] [Revised: 07/24/2019] [Accepted: 08/16/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The objective of this multi-center study was to examine the follow-up trends after emergency department (ED) discharge in a large and socioeconomically diverse patient population. METHODS We performed a 3-year retrospective analysis of adult patients with acutely symptomatic hernias who were discharged from the EDs of five geographically diverse hospitals. RESULTS Of 674 patients, 288 (43%) were evaluated in the clinic after discharge from the ED and 253 (37%) underwent repair. Follow-up was highest among those with insurance. A total of 119 patients (18%) returned to the ED for hernia-related complaints, of which 25 (21%) underwent urgent intervention. CONCLUSION The plan of care for patients with acutely symptomatic hernias discharged from the ED depends on outpatient follow-up, but more than 50% of patients are lost to follow-up, and nearly 1 in 5 return to the ED. The uninsured are at particularly high risk.
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Affiliation(s)
- Jillian L Angelo
- Harbor-UCLA Medical Center, 1000 W Carson St., Torrance, CA, 90509, USA; Los Angeles Biomedical Research Institute, 1000 W Carson St., Torrance, CA, 90509, USA
| | - Amy H Kaji
- Harbor-UCLA Medical Center, 1000 W Carson St., Torrance, CA, 90509, USA; Los Angeles Biomedical Research Institute, 1000 W Carson St., Torrance, CA, 90509, USA
| | - Lara H Spence
- Harbor-UCLA Medical Center, 1000 W Carson St., Torrance, CA, 90509, USA; Los Angeles Biomedical Research Institute, 1000 W Carson St., Torrance, CA, 90509, USA
| | - David S Plurad
- Riverside Community Hospital, 1200 N State St, Los Angeles, CA, 90033, USA
| | - Marlo Asis
- University of Nevada Las Vegas School of Medicine, 2040 West Charleston BLvd., Las Vegas, NV, 89119, USA
| | - Annabel Barber
- University of Nevada Las Vegas School of Medicine, 2040 West Charleston BLvd., Las Vegas, NV, 89119, USA
| | - Thomas J Schroeppel
- University of Colorado Health Memorial Hospital, 1400 E Boulder St, Colorado Springs, CO, 80909, USA
| | - Emma C Callaghan
- University of Colorado Health Memorial Hospital, 1400 E Boulder St, Colorado Springs, CO, 80909, USA
| | - Brandon T Grover
- Gundersen Health System, 1900 South Ave., La Crosse, WI, 54601, USA
| | - Justin L Regner
- Baylor Scott & White Research Institute, 2401 South 31st St, Temple, TX, 76508, USA
| | - Michael Truitt
- Methodist Dallas Medical Center, 1441 N Beckley Ave, Dallas, TX, 75203, USA
| | - Dennis Y Kim
- Harbor-UCLA Medical Center, 1000 W Carson St., Torrance, CA, 90509, USA; Los Angeles Biomedical Research Institute, 1000 W Carson St., Torrance, CA, 90509, USA.
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Harmon LA, Haase DJ, Kufera JA, Adnan S, Cabral D, Lottenberg L, Cunningham KW, Bonne S, Burgess J, Etheridge J, Rehbein JL, Semon G, Noorbakhsh MR, Cragun BN, Agrawal V, Truitt M, Marcotte J, Goldenberg A, Behbahaninia M, Keric N, Hammer PM, Nahmias J, Grigorian A, Turay D, Chakravarthy V, Lalchandani P, Kim D, Chapin T, Dunn J, Portillo V, Schroeppel T, Stein DM. Infection after penetrating brain injury-An Eastern Association for the Surgery of Trauma multicenter study oral presentation at the 32nd annual meeting of the Eastern Association for the Surgery of Trauma, January 15-19, 2019, in Austin, Texas. J Trauma Acute Care Surg 2019; 87:61-67. [PMID: 31033883 DOI: 10.1097/ta.0000000000002327] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Fatality rates following penetrating traumatic brain injury (pTBI) are extremely high and survivors are often left with significant disability. Infection following pTBI is associated with worse morbidity. The modern rates of central nervous system infections (INF) in civilian survivors are unknown. This study sought to determine the rate of and risk factors for INF following pTBI and to determine the impact of antibiotic prophylaxis. METHODS Seventeen institutions submitted adult patients with pTBI and survival of more than 72 hours from 2006 to 2016. Patients were stratified by the presence or absence of infection and the use or omission of prophylactic antibiotics. Study was powered at 85% to detect a difference in infection rate of 5%. Primary endpoint was the impact of prophylactic antibiotics on INF. Mantel-Haenszel χ and Wilcoxon's rank-sum tests were used to compare categorical and nonparametric variables. Significance greater than p = 0.2 was included in a logistic regression adjusted for center. RESULTS Seven hundred sixty-three patients with pTBI were identified over 11 years. 7% (n = 51) of patients developed an INF. Sixty-six percent of INF patients received prophylactic antibiotics. Sixty-two percent of all patients received one dose or greater of prophylactic antibiotics and 50% of patients received extended antibiotics. Degree of dural penetration did not appear to impact the incidence of INF (p = 0.8) nor did trajectory through the oropharynx (p = 0.18). Controlling for other variables, there was no statistically significant difference in INF with the use of prophylactic antibiotics (p = 0.5). Infection was higher in patients with intracerebral pressure monitors (4% vs. 12%; p = <0.001) and in patients with surgical intervention (10% vs. 3%; p < 0.001). CONCLUSION There is no reduction in INF with prophylactic antibiotics in pTBI. Surgical intervention and invasive intracerebral pressure monitoring appear to be risk factors for INF regardless of prophylactic use. LEVEL OF EVIDENCE Therapeutic, level IV.
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Affiliation(s)
- Laura A Harmon
- From the Department of Surgery, University of Colorado Anschutz Medical Center (L.A.H.), Aurora, Colorado; Department of Surgery, Trauma, R Adams Cowley Shock Trauma Center (D.J.H., J.A.K., D.M.S.), University of Maryland (S.A.), School of Medicine, Baltimore MD; St Mary's Medical Center, Florida Atlantic University, Charles E. Schmidt School of Medicine (D.C., L.L.), Boca Raton, Florida; Department of Surgery, Carolinas Medical Center (K.W.C.), Charlotte, North Carolina; Department of Surgery, Division of Trauma, Rutgers, The State University of New Jersey (S.B.), Newark New Jersey; Department of Surgery, Division of Trauma, Eastern Virginia Medical School (J.B., J.E., J.L.R.), Norforlk, Virginia; Department of Surgery, Wright State Boonshoft School of Medicine, (G.S.), Beavercreek, Ohio; Department of Surgery, Division of Trauma, Allegheny General Hospital (M.R.N., B.N.C.), Pittsburgh, Pennsylvania; Department of Surgery, Division of Trauma, Methodist Hospital (V.A., M.T.), Dallas, Texas; Department of Surgery, Division of Trauma, Cooper Health (J.M., A.G.), Camden, New Jersey; Banner Health System (M.B., N.K.), Phoenix, Arizona; Department of Surgery, Division of Trauma, Indiana University School of Medicine (P.M.H.), Indianapolis, Indiana; Department of Surgery, Division of Trauma, University of California Irvine (J.N., A.G.), Orange County; Department of Surgery, Division of Trauma, Loma Linda Medical Center (D.T., V.C.), Loma Linda; Department of Surgery, Division of Trauma, LA County Harbor-UCLA Medical Center (P.L., D.K.), Los Angeles, California; Department of Surgery, Division of Trauma, UC Health Northern Colorado (T.C., J.D.), Loveland, Colorado; Medical City Plano Hospital (V.P.), Plano, Texas; and Department of Surgery, Division of Trauma, University of Colorado Health (T.S.), Colorado Springs, Colorado
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Joseph B, Khan M, Truitt M, Jehan F, Kulvatunyou N, Azim A, Jain A, Zeeshan M, Tang A, O'Keeffe T. Massive Transfusion: The Revised Assessment of Bleeding and Transfusion (RABT) Score. World J Surg 2018; 42:3560-3567. [PMID: 29785693 DOI: 10.1007/s00268-018-4674-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 01/10/2023]
Abstract
BACKGROUND Massive transfusion (MT) is a lifesaving treatment for trauma patients with hemorrhagic shock, assessed by Assessment of Blood Consumption (ABC) Score based on mechanism of injury, systolic blood pressure (SBP), tachycardia, and FAST exam. The aim of this study was to assess the performance of ABC score by replacing hypotension and tachycardia; with Shock Index (SI) > 1.0 and including pelvic fractures. METHODS We performed a 2-year (2014-2015) analysis of all high-level trauma activations and excluded patients dead on arrival. The ABC score was calculated using the 4-point score [blunt (0)/penetrating trauma (1), HR ≥ 120 (1), SBP ≤ 90 mmHg (1), and FAST positive (1)]. The Revised Assessment of Bleeding and Transfusion (RABT) score also included 4 points, calculated by replacing HR and SBP with SI > 1.0 and including pelvic fracture. AUROC compared performances of the two scores. RESULTS A total of 380 patients were included. The overall MT was 27%. Patients receiving MT had higher median ABC scores [1.1 (0-2) vs. 1 (0-2), p = 0.15] and RABT scores [2 (1-3) vs. 1 (0-2), p < 0.001]. The RABT score had better discriminative power (AUROC = 0.828) compared to ABC score (AUROC = 0.617) for predicting the need for MT. Cutoff of RABT score ≥ 2 had a sensitivity of 84% and specificity of 77% for predicting need for MT compared to ABC score with 39% sensitivity and 72% specificity. CONCLUSION Replacement of hypotension and tachycardia with a SI > 1.0 and inclusion of pelvic fracture enhanced discrimination of ABC score for predicting the need for MT. The current ABC score would benefit from revision to more appropriately identify patients requiring MT.
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Affiliation(s)
- Bellal Joseph
- Division of Trauma, Critical Care, Emergency Surgery and Burns, Department of Surgery, University of Arizona, 1501 N. Campbell Ave, Room 5411, P.O. Box 245063, Tucson, AZ, 85724, USA.
| | - Muhammad Khan
- Division of Trauma, Critical Care, Emergency Surgery and Burns, Department of Surgery, University of Arizona, 1501 N. Campbell Ave, Room 5411, P.O. Box 245063, Tucson, AZ, 85724, USA
| | - Michael Truitt
- Division of Trauma and Acute Care, Methodist Dallas Medical Center, Dallas, TX, USA
| | - Faisal Jehan
- Division of Trauma, Critical Care, Emergency Surgery and Burns, Department of Surgery, University of Arizona, 1501 N. Campbell Ave, Room 5411, P.O. Box 245063, Tucson, AZ, 85724, USA
| | - Narong Kulvatunyou
- Division of Trauma, Critical Care, Emergency Surgery and Burns, Department of Surgery, University of Arizona, 1501 N. Campbell Ave, Room 5411, P.O. Box 245063, Tucson, AZ, 85724, USA
| | - Asad Azim
- Division of Trauma, Critical Care, Emergency Surgery and Burns, Department of Surgery, University of Arizona, 1501 N. Campbell Ave, Room 5411, P.O. Box 245063, Tucson, AZ, 85724, USA
| | - Arpana Jain
- Division of Trauma, Critical Care, Emergency Surgery and Burns, Department of Surgery, University of Arizona, 1501 N. Campbell Ave, Room 5411, P.O. Box 245063, Tucson, AZ, 85724, USA
| | - Muhammad Zeeshan
- Division of Trauma, Critical Care, Emergency Surgery and Burns, Department of Surgery, University of Arizona, 1501 N. Campbell Ave, Room 5411, P.O. Box 245063, Tucson, AZ, 85724, USA
| | - Andrew Tang
- Division of Trauma, Critical Care, Emergency Surgery and Burns, Department of Surgery, University of Arizona, 1501 N. Campbell Ave, Room 5411, P.O. Box 245063, Tucson, AZ, 85724, USA
| | - Terence O'Keeffe
- Division of Trauma, Critical Care, Emergency Surgery and Burns, Department of Surgery, University of Arizona, 1501 N. Campbell Ave, Room 5411, P.O. Box 245063, Tucson, AZ, 85724, USA
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Evans RM, Antal C, Truitt M, Liang G, Sherman M, O'Dwyer P, Drebin J, Downes M, Tuveson D. Corralling Pancreatic Cancer through Epigenetic Reprogramming. FASEB J 2018. [DOI: 10.1096/fasebj.2018.32.1_supplement.250.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ronald M. Evans
- Gene Expression Lab.The Salk Inst.for Biological StudiesLa JollaCA
- Howard Hughes Medical Inst.The Salk Inst.for Biological StudiesLa JollaCA
| | - C. Antal
- Gene Expression Lab.The Salk Inst.for Biological StudiesLa JollaCA
| | - M. Truitt
- Gene Expression Lab.The Salk Inst.for Biological StudiesLa JollaCA
| | - G. Liang
- Gene Expression Lab.The Salk Inst.for Biological StudiesLa JollaCA
| | - M. Sherman
- Gene Expression Lab.The Salk Inst.for Biological StudiesLa JollaCA
| | - P. O'Dwyer
- Abramson Cancer Ctr.Univ. of Pennsylvania Sch. of Med.PhiladelphiaPA
| | - J. Drebin
- Dept. of SurgeryMemorial Sloan Kettering Cancer Ctr.New YorkNY
| | - M. Downes
- Gene Expression Lab.The Salk Inst.for Biological StudiesLa JollaCA
| | - D. Tuveson
- Cold Spring Harbor Lab.Cold Spring HarborNY
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8
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Stawicki S, Sims C, Sharma R, Weger N, Truitt M, Cipolla J, Schrag S, Lorenzo M, Chaar MEL, Torigian D, Kim P, Sarani B. Vena Cava Filters: A Synopsis of Complications and Related Topics. J Vasc Access 2018. [DOI: 10.1177/112972980800900204] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Deep venous thrombosis and pulmonary embolism constitute common preventable causes of morbidity and mortality. The incidence of venous thromboembolism (VTE) continues to increase. Standard anticoagulation therapy may reduce the risk of fatal PE by 75% and that of recurrent VTE by over 90%. For patients who are not candidates for anticoagulation, a vena cava filter (VCF) may be beneficial. Despite a good overall safety record, significant complications related to VCF are occasionally seen. This review discusses both procedural and non-procedural complications associated with VCF placement and use. We will also discuss VCF use in the settings of pregnancy, malignancy, and the clinical need for more than one filter.
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Affiliation(s)
- S.P. Stawicki
- Department of Surgery, Division of Critical Care, Trauma and Burns, The Ohio State University Medical Center, Columbus, OH - USA
- OPUS 12 Foundation, Inc, King of Prussia, PA - USA
| | - C.A. Sims
- Department of Surgery, Division of Traumatology and Surgical Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA - USA
- OPUS 12 Foundation, Inc, King of Prussia, PA - USA
| | - R. Sharma
- Department of Surgery, Easton Hospital, Easton, PA - USA
- OPUS 12 Foundation, Inc, King of Prussia, PA - USA
| | - N.S. Weger
- Beth Israel Medical Center, Newark, NJ - USA
- OPUS 12 Foundation, Inc, King of Prussia, PA - USA
| | - M. Truitt
- Department of Surgery, Methodist Hospital, Dallas, TX - USA
- OPUS 12 Foundation, Inc, King of Prussia, PA - USA
| | - J. Cipolla
- St. Luke's Regional Resource Level I Trauma Center, Bethlehem, PA - USA
- OPUS 12 Foundation, Inc, King of Prussia, PA - USA
| | - S.P. Schrag
- Department of Surgery, Division of Trauma and Surgical Critical Care, Vanderbilt University School of Medicine, Nashville, TN - USA
- OPUS 12 Foundation, Inc, King of Prussia, PA - USA
| | - M. Lorenzo
- Department of Surgery, Methodist Hospital, Dallas, TX - USA
- OPUS 12 Foundation, Inc, King of Prussia, PA - USA
| | - M. EL Chaar
- Department of Surgery, Methodist Hospital, Dallas, TX - USA
- OPUS 12 Foundation, Inc, King of Prussia, PA - USA
| | - D.A. Torigian
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA - USA
| | - P.K. Kim
- Department of Surgery, Division of Traumatology and Surgical Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA - USA
- OPUS 12 Foundation, Inc, King of Prussia, PA - USA
| | - B. Sarani
- Department of Surgery, Division of Traumatology and Surgical Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA - USA
- OPUS 12 Foundation, Inc, King of Prussia, PA - USA
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9
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Murry J, Sladek P, Pandit R, Truitt M, Dunn E. Acute Tracheal Tear: An Open and Shut Case? Am Surg 2014. [DOI: 10.1177/000313481408000310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jason Murry
- Methodist Dallas Medical Center Dallas, Texas
| | - Phil Sladek
- Methodist Dallas Medical Center Dallas, Texas
| | | | | | - Ernest Dunn
- Methodist Dallas Medical Center Dallas, Texas
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10
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Murry J, Sladek P, Pandit R, Truitt M, Dunn E. Acute tracheal tear: an open and shut case? Am Surg 2014; 80:E92-E93. [PMID: 24666856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Jason Murry
- Methodist Dallas Medical Center, Dallas, Texas, USA
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11
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Mooty RC, Mangram A, Johnson V, Truitt M, Jefferson H, Dunn E. Blunt traumatic abdominal aortic dissection and concomitant traumatic abdominal wall hernia and small bowel injury: a surgical conundrum. Am Surg 2010; 76:911-912. [PMID: 20726431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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12
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Mooty RC, Mangram A, Johnson V, Truitt M, Jefferson H, Dunn E. Blunt Traumatic Abdominal Aortic Dissection and Concomitant Traumatic Abdominal Wall Hernia and Small Bowel Injury: A Surgical Conundrum. Am Surg 2010. [DOI: 10.1177/000313481007600845] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- R. Clark Mooty
- Methodist Health Systems Department of General Surgery Dallas, Texas
| | - Alicia Mangram
- Methodist Health Systems Department of General Surgery Dallas, Texas
| | - Van Johnson
- Methodist Health Systems Department of General Surgery Dallas, Texas
| | - Michael Truitt
- Methodist Health Systems Department of General Surgery Dallas, Texas
| | - Henry Jefferson
- Methodist Health Systems Department of General Surgery Dallas, Texas
| | - Ernest Dunn
- Methodist Health Systems Department of General Surgery Dallas, Texas
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13
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Silviera ML, Seamon MJ, Porshinsky B, Prosciak MP, Doraiswamy VA, Wang CF, Lorenzo M, Truitt M, Biboa J, Jarvis AM, Narula VK, Steinberg SM, Stawicki SP. Complications related to endoscopic retrograde cholangiopancreatography: a comprehensive clinical review. J Gastrointestin Liver Dis 2010. [PMID: 19337638 DOI: 10.1111/j.1440-1746.2009.05821.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most commonly performed endoscopic procedures. It provides the treating physician with both diagnostic and therapeutic options. The recent shift towards interventional uses of ERCP is largely due to the emergence of advanced imaging techniques, including magnetic resonance cholangiopancreatography and ultrasonography. With over 500,000 ERCP procedures performed yearly in the United States alone, it is important that all medical and surgical practitioners be well versed in indications, contraindications, potential complications, benefits, and alternatives to ERCP. The authors present an in-depth review of ERCP-related complications (pancreatitis, bleeding, perforation, etc) as well as special topics related to ERCP (periprocedural antibiotic use, performance of intraoperative ERCP, performance of ERCP during pregnancy, etc).
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Affiliation(s)
- Matthew L Silviera
- Department of Surgery, Div. of Trauma and Surgical Critical Care, Temple University School of Medicine, Philadelphia, PA, USA
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14
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Stawicki SP, Sims CA, Sharma R, Weger NS, Truitt M, Cipolla J, Schrag SP, Lorenzo M, El Chaar M, Torigian DA, Kim PK, Sarani B. Vena cava filters: a synopsis of complications and related topics. J Vasc Access 2008; 9:102-110. [PMID: 18609524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Deep venous thrombosis and pulmonary embolism constitute common preventable causes of morbidity and mortality. The incidence of venous thromboembolism (VTE) continues to increase. Standard anticoagulation therapy may reduce the risk of fatal PE by 75% and that of recurrent VTE by over 90%. For patients who are not candidates for anticoagulation, a vena cava filter (VCF) may be beneficial. Despite a good overall safety record, significant complications related to VCF are occasionally seen. This review discusses both procedural and non-procedural complications associated with VCF placement and use. We will also discuss VCF use in the settings of pregnancy, malignancy, and the clinical need for more than one filter.
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Affiliation(s)
- S P Stawicki
- Department of Surgery, The Ohio State University Medical Center, Columbus, OH, USA.
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