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Cruz-De La Rosa KX, Ramos-Meléndez EO, Ruiz-Medina PE, Arrieta-Alicea A, Guerrios-Rivera L, Rodríguez-Ortiz P. Surgical Rib Fixation is Associated With Lower Mortality in Patients With Traumatic Rib Fractures. J Surg Res 2024; 295:647-654. [PMID: 38103322 DOI: 10.1016/j.jss.2023.11.046] [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: 02/27/2023] [Revised: 10/14/2023] [Accepted: 11/13/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Nonoperative management (NOM) along with supportive care has been the adopted approach for traumatic rib fractures; however, surgical approaches have emerged recently to treat this common pathology. Despite this, there are no guidelines for surgical rib fixation in patients with traumatic rib fractures. METHODS An institutional review board-approved retrospective cohort study was performed at the Puerto Rico Trauma Hospital aiming to compare the outcomes and complications between patients with traumatic rib fractures who undergo surgical fixation and their counterparts with NOM. The study period comprised from January 2016 through July 2020. Outcomes were evaluated with negative binomial and logistic regressions. RESULTS Fifty patients were identified for the surgical rib fixation group, who were matched to 150 patients who received NOM. The majority of patients were male (91.5%), with a median (interquartile range) age of 53 (29) years. Concomitant chest injuries were significantly more prevalent in the operative group, such as flail segment (P < 0.001), number of fractures (P < 0.001), and displaced rib fractures (P < 0.001). Although hospital length of stay was 25% (95% confidence interval: 1.02-1.54) longer in the surgical group, this intervention was associated with an 85% (95% confidence interval: 0.03-0.70) lower mortality rate when compared to conservative management. CONCLUSIONS Rib fixation may offer some benefits in selected patients with traumatic rib fractures, such as those with bilateral rib fractures, multiple displaced rib fractures, flail segment, and concomitant thoracic injuries. This study may serve as a guide for treatment strategy and patient selection regarding the surgical management of traumatic rib fractures.
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Affiliation(s)
- Kerwin X Cruz-De La Rosa
- Department of Surgery, Trauma Research Program, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico.
| | - Ediel O Ramos-Meléndez
- Department of Surgery, Trauma Research Program, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Pedro E Ruiz-Medina
- Department of Surgery, Trauma Research Program, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Antonio Arrieta-Alicea
- Department of Surgery, Trauma Research Program, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Lourdes Guerrios-Rivera
- Department of Surgery, Trauma Research Program, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Pablo Rodríguez-Ortiz
- Department of Surgery, Trauma Research Program, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico; Puerto Rico Trauma Hospital, San Juan, Puerto Rico
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Roque-Torres J, Ramírez-Martínez L, Ramos-Meléndez EO, García-Rodríguez O, Rodríguez-López A, Guerrios L, Rodríguez-Ortiz P. Trends and outcomes of trauma patients positive to marijuana and cocaine. Eur J Trauma Emerg Surg 2023; 49:1969-1979. [PMID: 37000193 PMCID: PMC10449943 DOI: 10.1007/s00068-023-02261-5] [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: 11/30/2022] [Accepted: 03/14/2023] [Indexed: 04/01/2023]
Abstract
PURPOSE Substance misuse has long been recognized as a major predisposing risk factor for traumatic injury. However, there still exists no clear scientific consensus regarding the impact of drug use on patient outcomes. Therefore, this study aims to evaluate the demographic profile, hospital-course factors, and outcomes of trauma patients based on their toxicology. METHODS This is a non-concurrent cohort study of 3709 patients treated at the Puerto Rico Trauma Hospital during 2002-2018. The sample was divided into four groups according to their toxicology status. Statistical techniques used included Pearson's chi-square test, Spearman correlation, and negative binomial and logistic regressions. RESULTS Admission rates for marijuana (rho = 0.87) and marijuana and cocaine positive (rho = 0.68) patients increased. Positive toxicology patients underwent surgery more often than negative testing patients (marijuana: 68.7%, cocaine: 65.6%, marijuana & cocaine: 69.8%, negative: 57.0%). Among patients with non-penetrating injuries, a positive toxicology for cocaine or marijuana was linked to a 48% and 42% increased adjusted risk of complications, 37% and 27% longer TICU LOS, and 32% and 18% longer hospital LOS, respectively. CONCLUSION Our results show an association between positive toxicology for either marijuana, cocaine, or both with higher need for surgery. Additionally, our results show an increase in complications, TICU LOS, and hospital LOS among non-penetrating trauma patients testing positive for marijuana or cocaine. Therefore, this study provides valuable information on the clinical profile of patients with positive toxicology, suggesting they might benefit from more aggressive management.
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Affiliation(s)
- José Roque-Torres
- School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Laura Ramírez-Martínez
- Trauma Surgery Division, Department of Surgery, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Ediel O Ramos-Meléndez
- Trauma Surgery Division, Department of Surgery, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico.
| | - Omar García-Rodríguez
- Trauma Surgery Division, Department of Surgery, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Agustín Rodríguez-López
- Trauma Surgery Division, Department of Surgery, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Lourdes Guerrios
- Trauma Surgery Division, Department of Surgery, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Pablo Rodríguez-Ortiz
- Trauma Surgery Division, Department of Surgery, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
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Rivera-Delgado AI, Ramos-Meléndez EO, Ramírez-Martínez LV, Ruiz-Rodríguez JR, Ruiz-Medina PE, Guerrios-Rivera L, Rodríguez-Ortiz P. Elderly Admission Trends at the Puerto Rico Trauma Hospital: A Time-Series Analysis. J Surg Res 2022; 277:235-243. [DOI: 10.1016/j.jss.2022.04.009] [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] [Received: 03/09/2021] [Revised: 03/28/2022] [Accepted: 04/04/2022] [Indexed: 11/30/2022]
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Muns SM, Ramos-Meléndez EO, Guerrios L, Rodríguez-Ortiz P. Epidemiology of trauma in patients with mental disorders. Trauma Surg Acute Care Open 2022; 7:e000910. [PMID: 36072964 PMCID: PMC9396116 DOI: 10.1136/tsaco-2022-000910] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 06/01/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives We aimed to explore the influence of mental disorders on the risk of developing complications and in-hospital mortality after trauma. Methods We conducted an institutional review board-approved cohort study of 23 500 adult patients admitted to the Puerto Rico Trauma Hospital from 2002 to 2019. Participants were divided into 2 groups according to the presence or absence of psychiatric illnesses. Logistic regressions were employed to investigate the effect of mental illness on study outcomes. Results Psychiatric illness was associated with higher risk of complications; this risk increased with age. The pattern was accentuated for those with substance use disorders (SUD) and attenuated for those with non-substance-related diagnoses (NSRD). Psychiatric patients with Glasgow Coma Scale (GCS) scores of 15 had a 42% (95% CI 1.17 to 1.73) higher risk of dying, while the opposite was seen for those with scores <15 (adjusted OR=0.79; 95% CI 0.64 to 0.99). SUD was associated with a 51% (95% CI 1.21 to 1.88) higher risk of death in patients with GCS scores of 15, while NSRD was linked to a 49% (95% CI 0.33 to 0.79) lower odds of death among subjects with scores <15. Conclusions Our results suggest that trauma patients with SUD are at increased risk of developing complications and those with SUD and GCS scores of 15 are at increased risk of death. Mental health screening is an essential component of the management of trauma patients. Stratifying based on mental health disorders may be helpful during the clinical management of trauma patients, as those with SUD may benefit from more aggressive management. Level of evidence Level 4, prognostic and epidemiological study. Study type Original retrospective cohort study.
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Affiliation(s)
- Sofia M Muns
- School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Ediel O Ramos-Meléndez
- Department of Surgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Lourdes Guerrios
- Department of Surgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Pablo Rodríguez-Ortiz
- Department of Surgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
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De Ayala-Hillman R, Diaz-Marty C, Ramos-Meléndez E, García-Rodríguez O, Guerrios L, Rodríguez-Ortiz P. A Retrospective Cohort Study on Health Insurance: Related Disparities in Trauma Patients After Penetrating Injuries: 2000-2014. P R Health Sci J 2021; 40:120-126. [PMID: 34792925] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Although the lack of health insurance has been linked to poor health outcomes in several diseases, this relationship is still understudied in trauma. There exist differences between the Puerto Rico health care system and that of the United States. We therefore aimed to assess mortality disparities related to insurance coverage at the Puerto Rico Trauma Hospital (PRTH). METHODS A retrospective cohort study of patients who sustained penetrating injuries (presenting at the PRTH from 2000 to 2014) was performed. Individuals were classified by their insurance status. Study variables comprised demographics, clinical characteristics and outcomes. A logistic regression analysis was performed to identify the association between health insurance status and risk of dying. RESULTS Patients with public health insurance experienced more complications than did individuals who had private health insurance (PrHI) or who were uninsured. This group had longer durations of mechanical ventilation and spent more time in the hospital than did patients who had PrHI or who were uninsured. However, uninsured patients with gunshot wounds were 54% (adjusted odds ratio = 1.54; 95% CI: 1.01, 2.36) more likely to die than were their counterparts who had PrHI. CONCLUSION Our study suggests that having health insurance could reduce a given patient mortality risk in trauma settings. More studies with larger samples are warranted to confirm these findings. If these findings hold true, then providing equitable access to health services for the entire population could prevent patients suffering trauma from having premature, preventable deaths.
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Affiliation(s)
- Rafael De Ayala-Hillman
- Department of Surgery, School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
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Ruiz-Medina PE, Ramos-Meléndez EO, Cruz-De La Rosa KX, Arrieta-Alicea A, Guerrios-Rivera L, Nieves-Plaza M, Rodríguez-Ortiz P. The effect of the lockdown executive order during the COVID-19 pandemic in recent trauma admissions in Puerto Rico. Inj Epidemiol 2021; 8:22. [PMID: 33752760 PMCID: PMC7982880 DOI: 10.1186/s40621-021-00324-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 02/02/2021] [Accepted: 03/15/2021] [Indexed: 12/19/2022] Open
Abstract
Background The COVID-19 pandemic led to world-wide restrictions on social activities to curb the spread of this disease. Very little is known about the impact of these restrictions on trauma centers. Our objective was to determine the effect of the pandemic-associated lockdown on trauma admissions, patient’s demographics, mechanisms of injury, injury severity, and outcomes in the Puerto Rico Trauma Hospital. Methods An IRB-approved quasi-experimental study was performed to assess the impact of the restrictions by comparing trauma admissions during the lockdown (March 15, 2020 – June 15, 2020) with a control period (same period in 2017–2019). Comparisons were done using the Pearson’s chi-square test, Fisher exact test, or Mann-Whitney U test, as appropriate. A negative binomial model was fitted to estimate the incidence rate ratio for overall admissions among pre-lockdown and during-lockdown periods. Statistical significance was set at p < 0.05. Results A total of 308 subjects were admitted during the quarter of study for 2017; 323, for 2018; 347, for 2019; and 150, for 2020. The median (interquartile range) age of patients rose significantly from 40 (33) years to 49 (30) years (p < 0.001) for the lockdown period compared to the historical period. Almost all mechanisms of injury (i.e., motor vehicle accident, assault, pedestrian, burn, suicide attempt, other) had a slight non-significant reduction in the percentage of patients presenting with an injury. Instead, falls experienced an increase during the lockdown period (18.9% vs. 26.7%; p = 0.026). Moreover, the proportion of severe cases decreased, as measured by an injury severity score (ISS) > 15 (37.3% vs. 26.8%; p = 0.014); while there were no differences in the median hospital length of stay and the mortality rate between the comparison groups. Finally, the decrease in overall admissions registered during the lockdown accounts for a 59% (IRR 0.41; 95% CI 0.31–0.54) change compared to the pre-lockdown period, when controlling for sex, age, mechanism of injury, and ISS. Conclusions Following periods of social isolation and curfews, trauma centers can expect drastic reductions in their overall patient volume with associated changes in trauma patterns. Our findings will help inform new interventions and improve healthcare preparedness for future or similar circumstances.
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Affiliation(s)
- Pedro E Ruiz-Medina
- Trauma Research Program, Department of Surgery, University of Puerto Rico, Medical Sciences Campus, PO Box 365067, San Juan, PR, 00967, USA. .,Puerto Rico Trauma Hospital, PO Box 2129, San Juan, PR, 00922, USA. .,, San Juan, USA.
| | - Ediel O Ramos-Meléndez
- Trauma Research Program, Department of Surgery, University of Puerto Rico, Medical Sciences Campus, PO Box 365067, San Juan, PR, 00967, USA.,Puerto Rico Trauma Hospital, PO Box 2129, San Juan, PR, 00922, USA
| | - Kerwin X Cruz-De La Rosa
- Trauma Research Program, Department of Surgery, University of Puerto Rico, Medical Sciences Campus, PO Box 365067, San Juan, PR, 00967, USA.,Puerto Rico Trauma Hospital, PO Box 2129, San Juan, PR, 00922, USA
| | | | | | - Mariely Nieves-Plaza
- Trauma Research Program, Department of Surgery, University of Puerto Rico, Medical Sciences Campus, PO Box 365067, San Juan, PR, 00967, USA.,Puerto Rico Trauma Hospital, PO Box 2129, San Juan, PR, 00922, USA
| | - Pablo Rodríguez-Ortiz
- Trauma Research Program, Department of Surgery, University of Puerto Rico, Medical Sciences Campus, PO Box 365067, San Juan, PR, 00967, USA.,Puerto Rico Trauma Hospital, PO Box 2129, San Juan, PR, 00922, USA
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Ramírez-Martínez L, Chamah-Nicolás M, Nieves-Plaza M, Ruiz-Rodríguez J, Ruiz-Medina P, Ramos-Melendez EO, Rodríguez-Ortiz P. Epidemiology of traumatic falls after Hurricane Maria in Puerto Rico. Inj Epidemiol 2020; 7:19. [PMID: 32475351 PMCID: PMC7262746 DOI: 10.1186/s40621-020-00236-3] [Citation(s) in RCA: 3] [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: 12/09/2019] [Accepted: 03/06/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Hurricanes are among the most devastating natural disasters, playing a significant role in public health. Currently, the epidemiology of fall-related injuries after the occurrence of a tropical storm is not well described. This study aims to compare the demographical patterns, clinical profile, hospital course, and costs of patients admitted to the Puerto Rico Trauma Hospital before and after Hurricane Maria. METHODS A retrospective study was performed to compare fall-related injuries after the hurricane (September 20, 2017 - January 20, 2018) with a control period (same period in 2014-2016). Comparison between the groups was done using chi-square, Mann-Whitney test, and logistical regression. RESULTS After the hurricane, there was an increase in the proportion of fall-related admissions in subjects aged 40-64 years (39.2% vs. 50.6%) and a decrease among those aged 18-39 years (16.0% vs. 5.9%), when compared with the previous years. A greater proportion of patients presented with work related injuries (3.9% vs. 9.4%). No significant differences were identified for sex, Glasgow Coma Scale, Injury Severity Score, and hospital outcomes (hospital and intensive care unit days, mechanical ventilation, and mortality). Intracranial injuries were marginally higher post-Maria (p = 0.06). In multivariate analysis, during the post-Maria period, an increased risk of fall-related injuries was observed among subjects ≥40 years (OR: 3.20) and injuries related to recovery work (OR: 2.64) (p < 0.05). CONCLUSIONS Our study shows that there is an increased risk of fall-related injuries among middle-aged individuals after a hurricane, causing significant changes in epidemiology. This study helps to elucidate the health consequences of falls and, in doing so, improves healthcare preparedness, interventions, and planning for future natural disasters.
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Affiliation(s)
- Laura Ramírez-Martínez
- Puerto Rico Trauma Hospital, PO Box 2129, San Juan, 00922, Puerto Rico. .,Department of Surgery, Trauma Research Program, Medical Sciences Campus, University of Puerto Rico, PO Box 365067, San Juan, 00967, Puerto Rico.
| | - Mariella Chamah-Nicolás
- Department of Surgery, Trauma Research Program, Medical Sciences Campus, University of Puerto Rico, PO Box 365067, San Juan, 00967, Puerto Rico
| | - Mariely Nieves-Plaza
- Puerto Rico Trauma Hospital, PO Box 2129, San Juan, 00922, Puerto Rico.,Department of Surgery, Trauma Research Program, Medical Sciences Campus, University of Puerto Rico, PO Box 365067, San Juan, 00967, Puerto Rico
| | - Javier Ruiz-Rodríguez
- Puerto Rico Trauma Hospital, PO Box 2129, San Juan, 00922, Puerto Rico.,Department of Surgery, Trauma Research Program, Medical Sciences Campus, University of Puerto Rico, PO Box 365067, San Juan, 00967, Puerto Rico
| | - Pedro Ruiz-Medina
- Puerto Rico Trauma Hospital, PO Box 2129, San Juan, 00922, Puerto Rico.,Department of Surgery, Trauma Research Program, Medical Sciences Campus, University of Puerto Rico, PO Box 365067, San Juan, 00967, Puerto Rico
| | - Ediel O Ramos-Melendez
- Puerto Rico Trauma Hospital, PO Box 2129, San Juan, 00922, Puerto Rico.,Department of Surgery, Trauma Research Program, Medical Sciences Campus, University of Puerto Rico, PO Box 365067, San Juan, 00967, Puerto Rico
| | - Pablo Rodríguez-Ortiz
- Puerto Rico Trauma Hospital, PO Box 2129, San Juan, 00922, Puerto Rico.,Department of Surgery, Trauma Research Program, Medical Sciences Campus, University of Puerto Rico, PO Box 365067, San Juan, 00967, Puerto Rico
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Layrisse V, García-Rodríguez O, Ramos-Meléndez E, Rodríguez-Ortiz P. A Comparative Analysis of the Injury Patterns and In-Hospital Mortality Rates of Belted and Unbelted Motor-Vehicle Occupants - Puerto Rico, January 2000 to December 2014. P R Health Sci J 2019; 37:213-219. [PMID: 30548057] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Motor vehicle collisions (MVCs) constitute a leading source of morbidity and mortality worldwide. Seatbelt use has been associated with reduced mortality in MVCs. In Puerto Rico, the impact of seatbelt use on MVC deaths has not been evaluated, although they represent a major public health threat. Therefore, this study aimed to assess the association between seatbelt use and in-hospital mortality at Puerto Rico Trauma Hospital (PRTH). MATERIALS AND METHODS A retrospective cohort study of 2,685 MVC patients aged 1 to 96 years was conducted using the Trauma Registry at PRTH, with data collected from 2000 through 2014. The patient data included sociodemographic and clinical variables and outcomes. Logistic regression analyses were used to evaluate the mortality risk of patients of severe MVC-related trauma who had been wearing seatbelts and compare it to the risk sustained by their unbelted counterparts. RESULTS Seatbelt use was more common in females than it was in males (71% vs.62%; p < 0.001) and more prevalent in older as opposed to younger patients (p < 0.001). Belted severe trauma victims suffered less frequently from head injuries than did their unbelted counterparts (p < 0.001). The proportions of patients with Glasgow coma scale (GCS) scores of 8 or lower (17% vs. 6%; p < 0.001) and Injury Severity Scores (ISSs) of 25 or higher (24% vs. 15%; p < 0.001) were greater for the unbelted group. Belted severe trauma victims had a 30% lower in-hospital mortality risk compared to their unbelted peers (ORunadj = 0.70; 95% CI: 0.52-0.92). After adjusting for confounders, this difference in risk was eliminated (ORadj = 1.04; 95% CI: 0.72-1.52). CONCLUSION Our findings demonstrate that seatbelt use is associated with fewer head injuries, lower ISSs, and higher GCS scores. This suggests that using seatbelts mitigates trauma severity, thereby reducing the likelihood of in-hospital mortality for those MVC victims who were wearing seatbelts at the time of their accident.
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Affiliation(s)
- Verónica Layrisse
- Interdisciplinary Program of General Sciences, University of Puerto Rico Río Piedras Campus, San Juan, PR
| | - Omar García-Rodríguez
- Puerto Rico Trauma Hospital, Puerto Rico Medical Center, San Juan, PR; Department of Surgery, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR
| | - Ediel Ramos-Meléndez
- Puerto Rico Trauma Hospital, Puerto Rico Medical Center, San Juan, PR; Department of Surgery, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR
| | - Pablo Rodríguez-Ortiz
- Puerto Rico Trauma Hospital, Puerto Rico Medical Center, San Juan, PR; Department of Surgery, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR
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Pelet-Del-Toro N, Ramos-Meléndez EO, García-Rodríguez O, Mejías JP, Rodríguez-Ortiz P. Morbidity and mortality patterns of pedestrian injuries by age at the Puerto Rico Trauma Hospital from 2000 to 2014. Cogent Medicine 2019. [DOI: 10.1080/2331205x.2019.1600211] [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: 10/27/2022] Open
Affiliation(s)
- Natalia Pelet-Del-Toro
- School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Ediel O. Ramos-Meléndez
- Department of Surgery, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
- Department of Surgery, Puerto Rico Trauma Hospital, San Juan, Puerto Rico
| | - Omar García-Rodríguez
- Department of Surgery, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
- Department of Surgery, Puerto Rico Trauma Hospital, San Juan, Puerto Rico
| | - Jorge Pelet Mejías
- Department of Surgery, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
- Department of Surgery, Puerto Rico Trauma Hospital, San Juan, Puerto Rico
| | - Pablo Rodríguez-Ortiz
- Department of Surgery, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
- Department of Surgery, Puerto Rico Trauma Hospital, San Juan, Puerto Rico
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Muns-Aponte S, García-Rodríguez O, Ramos-Meléndez EO, Rodríguez-Ortiz P. Trauma Epidemiology of Women in Puerto Rico, 2002-2011. P R Health Sci J 2017; 36:159-164. [PMID: 28915305] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Recent literature has suggested that trauma is heterogenic and that physiological response to it differs between sexes. The study represented in this manuscript aimed to describe gender differences in the mortality rates of trauma patients at the Puerto Rico Trauma Hospital (PRTH). MATERIALS AND METHODS This was a cross-sectional study performed at PRTH. A total of 14,874 injured patients admitted to the hospital from 2002 to 2011 were included in the sample and divided into 2 groups, based on sex. Pearson's chi-square test was employed for categorical variables and the Mann-Whitney U test for continuous ones. A logistic regression model was undertaken to estimate the association between gender and study outcomes, after adjusting for confounders. A p-value lower than 0.05 was an indication of statistical significance. IRB approval was received. RESULTS The most common injury areas for women were the chest (32.50%), followed by the extremities (25.83%) and the head/neck (21.51%). Road traffic collisions (RTCs) (45.08%), falls (19.62%), and pedestrian accidents (16.08%) were the most common injury mechanisms for women. The highest frequency of RTC injuries (57.52%) among females occurred in patients who were from 18 to 39 years old. Females 65 years old and older exhibited the highest frequency of falls (39.78%) and pedestrian injuries (25.14%). Males 17 years and under were more likely to have an Injury Severity Score (ISS) of 15 or greater (AOR = 1.56; 95% CI: 1.19-2.03) than were their female counterparts; and, overall, males were more likely to have a Glasgow coma score (GCS) under 9 (AOR = 1.30; 95% CI: 1.11-1.53) than females were. Despite these results, there were no differences between gender mortality rates (AOR = 1.04; 95% CI: 0.86-1.25). CONCLUSION Our results suggest that there is no sex dimorphism conferring protection on females. Future studies should be conducted to assess this issue.
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Affiliation(s)
- Sofía Muns-Aponte
- Interdisciplinary Program of General Sciences, University of Puerto Rico Rio Piedras Campus
| | | | | | - Pablo Rodríguez-Ortiz
- Puerto Rico Trauma Hospital, San Juan, Puerto Rico; Department of Surgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
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Pascual-Marrero A, Ramos-Meléndez EO, García-Rodríguez O, Morales-Quiñones JE, Rodríguez-Ortiz P. Trauma epidemiology in Puerto Rico: in-hospital morbidity and mortality from 2002 to 2011. Int J Inj Contr Saf Promot 2017; 25:14-22. [PMID: 28417686 DOI: 10.1080/17457300.2017.1310738] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 10/19/2022]
Abstract
This study aimed to describe the distribution of injury mechanisms and to assess the impact of those mechanisms on the morbidity and mortality of trauma. All patients admitted to Puerto Rico Trauma Hospital (2002-2011) for road-traffic collisions (RTCs, 5,371), gunshot wounds (GSWs, 2,946), falls (2,319), pedestrian accidents (1,652), and stab wounds (SWs, 1,073) were selected. Gunshot victims were 1.19 (95%CI: 1.07-1.33) times as likely as road-traffic victims to have an ISS ≥25. Pedestrians were 1.76 (95%CI: 1.49-2.09) times more likely to have a GCS ≤8 than road-traffic victims were. The risk of dying was 2.64 (95%CI: 2.20-3.16) times higher for gunshot victims and 1.51 (95%CI: 1.23-1.86) times higher for pedestrians compared to patients who had had RTCs. Gunshot victims and pedestrians had the worst clinical outcomes. Accordingly, these patients should receive the most aggressive clinical management. Furthermore, it is imperative to develop public health campaigns on trauma prevention.
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Affiliation(s)
- Annette Pascual-Marrero
- a Department of Surgery , Medical Sciences Campus , University of Puerto Rico , San Juan , Puerto Rico
| | | | | | - José E Morales-Quiñones
- c Department of Biology , Rio Piedras Campus , University of Puerto Rico , San Juan , Puerto Rico
| | - Pablo Rodríguez-Ortiz
- a Department of Surgery , Medical Sciences Campus , University of Puerto Rico , San Juan , Puerto Rico.,b Puerto Rico Trauma Hospital , San Juan , Puerto Rico
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Cedeño A, Echeverría K, Vázquez J, Delgado A, Rodríguez-Ortiz P. Intrathoracic esophageal rupture distal to the carina after blunt chest trauma: Case-report. Int J Surg Case Rep 2015; 16:184-6. [PMID: 26492358 PMCID: PMC4643336 DOI: 10.1016/j.ijscr.2015.08.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 06/05/2015] [Revised: 08/11/2015] [Accepted: 08/12/2015] [Indexed: 12/05/2022] Open
Abstract
Introduction Esophageal rupture caused by blunt chest trauma is a very rare entity, with an incidence of 0.001%. Eighty two percent of the esophageal perforation secondary to blunt chest trauma occur above the level of the carina, with the lowest reported incidence in the intrathoracic region distal to the carina. Presentation of case We report on the case of a 48-year-old Hispanic male with intrathoracic esophageal rupture. Exploration revealed a right lateral, mid esophageal, longitudinal 1.5 cm perforation. The defect was repaired using a double-layered primary closure reinforced with an intercostal muscle flap. The patient tolerated the procedure and the recovery was complicated by a pneumonic process which was treated accordingly. No leakage was found. Discussion A five-year retrospective review (2009–2013) at our institution identified 5586 trauma cases with only one case with esophageal rupture. This represents a 0.0002% of incidence of blunt esophageal rupture. This estimate is consistent with what has been previously reported in the medical literature. Our case represents a uniquely rare presentation of traumatic esophageal rupture due to the underline mechanism of injury and its anatomical location. A high index of suspicion and early intervention are critical in assuring a favorable outcome. Conclusion Diagnosis and surgical intervention with primary repair completed in the first twenty-four hours after presentation is fundamental to achieve a good outcome after esophageal rupture.
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Affiliation(s)
- Alex Cedeño
- Division of Trauma Critical Care Surgery, School of Medicine, University of Puerto Rico, San Juan, Puerto Rico and University of Puerto Rico, Rio Piedras Campus, San Juan, PR, United States
| | - Karla Echeverría
- Division of Trauma Critical Care Surgery, School of Medicine, University of Puerto Rico, San Juan, Puerto Rico and University of Puerto Rico, Rio Piedras Campus, San Juan, PR, United States
| | - Jan Vázquez
- Division of Trauma Critical Care Surgery, School of Medicine, University of Puerto Rico, San Juan, Puerto Rico and University of Puerto Rico, Rio Piedras Campus, San Juan, PR, United States
| | - Aura Delgado
- Division of Trauma Critical Care Surgery, School of Medicine, University of Puerto Rico, San Juan, Puerto Rico and University of Puerto Rico, Rio Piedras Campus, San Juan, PR, United States
| | - Pablo Rodríguez-Ortiz
- Division of Trauma Critical Care Surgery, School of Medicine, University of Puerto Rico, San Juan, Puerto Rico and University of Puerto Rico, Rio Piedras Campus, San Juan, PR, United States.
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Figueroa-Ramos MI, Arroyo-Novoa CM, Padilla G, Rodríguez-Ortiz P, Cooper BA, Puntillo KA. Feasibility of a sedation wake-up trial and spontaneous breathing trial in critically ill trauma patients: a secondary analysis. Intensive Crit Care Nurs 2012; 29:20-7. [PMID: 22705052 DOI: 10.1016/j.iccn.2012.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 04/05/2012] [Accepted: 05/04/2012] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To determine the feasibility of conducting a sedation wake-up trial (SWT) plus a spontaneous breathing trial (SBT) in critically ill trauma patients based on the ability to implement the combined intervention; to measure and describe patients' physiological responses; and to maintain patient safety. METHODS A secondary analysis of the intervention group from a trial of 20 mechanically ventilated patients receiving SWT plus SBT in a trauma-intensive care unit. RESULTS Patients passed 67% of the 39 SWTs performed; those who failed presented RASS scores of +1 and +2 (70%), tachycardia (15%) or ventilator asynchrony (15%). Eighteen patients tolerated their first SBT, and after the second SBT, more than half of the patients were discontinued from the mechanical ventilator. A significant increase from the beginning to the end of the SWT was found in heart rate (p=.021), respiratory rate (p=.043) and systolic blood pressure (p=.04). Although these measures increased significantly, their overall mean did not increase by 20%. CONCLUSION SWT plus SBT was well tolerated and successfully implemented. Our data showed that it is not necessary to withhold continuous-infusion analgesia during the SWT.
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