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Robert Klein J, Rhee PM, Prabhakaran K. Bullets: A Leading Cause of Years of Potential Life Lost. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.08.610] [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: 10/23/2022]
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2
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Jehan FS, Prabhakaran K, Haider AA, Khan MN, Zeeshan M, Rhee PM, Latifi R. Gallstone-Related Complications after Untreated Biliary Colic: A 6-Month Readmissions Study. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.07.184] [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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Zeeshan M, Rhee PM, Anderson P, Jehan F, Khan MN, Bowers C. Frailty in Older Odontoid Fracture Patients Is an Independent Risk Factor for Increased Complication Rates and Longer Hospital Stays. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.07.289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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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Nguyen J, Bramwell C, Sheikh M, Koerner C, Tootla Y, Bashan A, Danner OK, Matthews LR, Taha A, Childs E, Rhee PM, Morse BC. Celiac Artery Dissection in the Setting of Blunt Abdominal Trauma. Am Surg 2018; 84:e335-e336. [PMID: 30842021] [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: 06/09/2023]
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Nguyen J, Bramwell C, Sheikh M, Koerner C, Tootla Y, Bashan A, Danner OK, Matthews LR, Taha A, Childs E, Rhee PM, Morse BC. Celiac Artery Dissection in the Setting of Blunt Abdominal Trauma. Am Surg 2018. [DOI: 10.1177/000313481808400826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | | | - Maaz Sheikh
- Morehouse School of Medicine Atlanta, Georgia
| | | | - Yasmin Tootla
- Emory University School of Medicine Atlanta, Georgia
| | | | | | | | - Assad Taha
- Morehouse School of Medicine Atlanta, Georgia
| | - Ed Childs
- Morehouse School of Medicine Atlanta, Georgia
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Vercruysse GA, Bauman ZM, Hennemeyer CT, Devis P, Rhee PM. Man Lured with Alcohol, Takes Bait, and Gets Caught: A Cautionary Fish Tale. Am Surg 2018. [DOI: 10.1177/000313481808400217] [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: 11/17/2022]
Affiliation(s)
- Gary A. Vercruysse
- Division of Trauma, Burns, Surgical Critical Care, and Emergency General Surgery Department of Surgery University of Arizona Tucson, Arizona
| | - Zachary M. Bauman
- Division of Trauma, Surgical Critical Care, and Emergency General Surgery Department of Surgery University of Nebraska Medical Center Omaha, Nebraska
| | - Charles T. Hennemeyer
- Division of Vascular and Interventional Radiology Department of Medical Imaging University of Arizona Tucson, Arizona
| | - Paola Devis
- Division of Vascular and Interventional Radiology Department of Medical Imaging University of Arizona Tucson, Arizona
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Vercruysse GA, Bauman ZM, Hennemeyer CT, Devis P, Rhee PM. Man Lured with Alcohol, Takes Bait, and Gets Caught: A Cautionary Fish Tale. Am Surg 2018; 84:e85-e86. [PMID: 30454489] [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: 06/09/2023]
Affiliation(s)
- Gary A Vercruysse
- Division of Trauma, Burns, Surgical Critical Care, and Emergency General Surgery, Department of Surgery, University of Arizona, Tucson, Arizona, USA
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Pandit V, Ibraheem K, Rhee PM, Jokar TO, O’Keeffe T, Vercruysse GA, Gries LM, Tang AL, Joseph B. Assessing Variability Among Pediatric and Adult Trauma Centers in Managing Colonic Injury. J Am Coll Surg 2016. [DOI: 10.1016/j.jamcollsurg.2016.08.495] [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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Jokar TO, Rhee PM, Ibraheem K, O’Keeffe T, Raney E, Gries LM, Kulvatunyou N, Tang AL, Hannallah J, Joseph B. Computed Tomography-Measured Waist to Hip Ratio: A Reliable Predictor af Outcomes after Trauma. J Am Coll Surg 2016. [DOI: 10.1016/j.jamcollsurg.2016.06.327] [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: 11/15/2022]
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Jokar TO, Najafi B, Rhee PM, Mohler J, Toosizadeh N, Heusser MR, Kulvatunyou N, Hassan A, Gries LM, Joseph B. Motion Sensors Estimated Upper Extremity Frailty Score: A Practical Method to Identify 30-Day Recurrent Fall and Hospital Readmission in Elderly Trauma Patients. J Am Coll Surg 2016. [DOI: 10.1016/j.jamcollsurg.2016.06.105] [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: 11/27/2022]
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Hassan A, Rhee PM, Haider A, Jokar TO, Kulvatunyou N, Tang AL, O’Keeffe T, Vercruysse GA, Gries LM, Joseph B. Suprapubic Catheter Placement in Lower Genitourinary Tract Injury: Friend or Foe? J Am Coll Surg 2016. [DOI: 10.1016/j.jamcollsurg.2016.06.354] [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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Azim A, Rhee PM, Haider A, Afzal H, O’Keeffe T, Gries LM, Vercruysse GA, Tang AL, Kulvatunyou N, Joseph B. Score to Predict Failure-to-Rescue in Geriatric Emergency General Surgery Patients. J Am Coll Surg 2016. [DOI: 10.1016/j.jamcollsurg.2016.06.363] [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: 11/17/2022]
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Hadeed GJ, Smith J, O'Keeffe T, Kulvatunyou N, Wynne JL, Joseph B, Friese RS, Wachtel TL, Rhee PM, El-Menyar A, Latifi R. Early surgical intervention and its impact on patients presenting with necrotizing soft tissue infections: A single academic center experience. J Emerg Trauma Shock 2016; 9:22-7. [PMID: 26957822 PMCID: PMC4766759 DOI: 10.4103/0974-2700.173868] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Early diagnosis and emergent surgical debridement of necrotizing soft tissue infections (NSTIs) remains the cornerstone of care. We aimed to study the effect of early surgery on patients' outcomes and, in particular, on hospital length of stay (LOS) and Intensive Care Unit (ICU) LOS. MATERIALS AND METHODS Over a 6-year period (January 2003 through December 2008), we analyzed the records of patients with NSTIs. We divided patients into two groups based on the time of surgery (i.e., the interval from being diagnosed and surgical intervention): Early (<6 h) and late (≥6 h) intervention groups. For these two groups, we compared baseline demographic characteristics, symptoms, and outcomes. For our statistical analysis, we used the Student's t-test and Pearson Chi-square (χ(2)) test. To evaluate the clinical predictors of early diagnosis of NSTIs, we performed multivariate logistic regression analysis. RESULTS In the study population (n = 87; 62% males and 38% females), age, gender, wound locations, and comorbidities were comparable in the two groups. Except for higher proportion of crepitus, the clinical presentations showed no significant differences between the two groups. There were significantly shorter hospital LOS and ICU LOS in the early than late intervention group. The overall mortality rate in our study patients with NSTIs was 12.5%, but early intervention group had a mortality of 7.5%, but this did not reach statistical significance. CONCLUSIONS Our findings show that early surgery, within the first 6 h after being diagnosed, improves in-hospital outcomes in patients with NSTIs.
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Affiliation(s)
- George J Hadeed
- Department of Surgery, Division of Trauma, University of Arizona, Tucson, AZ, Qatar
| | - Judith Smith
- Department of Surgery, Division of Trauma, University of Arizona, Tucson, AZ, Qatar
| | - Terrence O'Keeffe
- Department of Surgery, Division of Trauma, University of Arizona, Tucson, AZ, Qatar
| | - Narong Kulvatunyou
- Department of Surgery, Division of Trauma, University of Arizona, Tucson, AZ, Qatar
| | - Julie L Wynne
- Department of Surgery, Division of Trauma, University of Arizona, Tucson, AZ, Qatar
| | - Bellal Joseph
- Department of Surgery, Division of Trauma, University of Arizona, Tucson, AZ, Qatar
| | - Randall S Friese
- Department of Surgery, Division of Trauma, University of Arizona, Tucson, AZ, Qatar
| | - Thomas L Wachtel
- Department of Surgery, Division of Trauma, University of Arizona, Tucson, AZ, Qatar
| | - Peter M Rhee
- Department of Surgery, Division of Trauma, University of Arizona, Tucson, AZ, Qatar
| | - Ayman El-Menyar
- Clinical Medicine, Weill Cornell Medical College, Doha, Qatar and Clinical Research, Hamad General Hospital, Doha, Qatar
| | - Rifat Latifi
- Department of Surgery, Division of Trauma, University of Arizona, Tucson, AZ, Qatar
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Pandit V, Joseph B, Khalil M, Kulvatunyou N, Jokar TO, O'Keeffe T, Tang AL, Latifi R, Friese RS, Rhee PM. Impact of admission hypothermia on outcomes in severe traumatic brain injury: not so cool! J Am Coll Surg 2015. [DOI: 10.1016/j.jamcollsurg.2015.08.358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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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Sadoum M, Zangbar B, Rhee PM, Kulvatunyou N, Khalil M, O'Keeffe T, Tang AL, Latifi R, Friese RS, Joseph B. NSQIP Surgical Risk Calculator and Frailty in Emergency General Surgery: A Measure of Surgical Resilience. J Am Coll Surg 2015. [DOI: 10.1016/j.jamcollsurg.2015.07.307] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Jokar TO, Rhee PM, Zangbar B, Kulvatunyou N, Khalil M, O'Keeffe T, Tang AL, Friese RS, Gries LM, Joseph B. Redefining the Association Between Old Age and Poor Outcomes after Trauma: The Impact of the Frailty Syndrome. J Am Coll Surg 2015. [DOI: 10.1016/j.jamcollsurg.2015.07.190] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ditillo MF, Joseph B, Rhee PM, Pandit V, Castanon L, Hadeed S, Zangbar B, Friese RS, Philip A. Morbidly obese patients and motor vehicle collisions: are protective devices really protective? J Am Coll Surg 2014. [DOI: 10.1016/j.jamcollsurg.2014.07.789] [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: 11/15/2022]
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Meyer D, Joseph B, Pandit V, Kulvatunyou N, Khalil M, O'Keeffe, MBchB T, Tang AL, Vercruysse GA, Friese RS, Rhee PM. Early Use of Venous Thromboembolic Prophylaxis in Traumatic Brain Injury: A Safe Practice. J Am Coll Surg 2014. [DOI: 10.1016/j.jamcollsurg.2014.07.160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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20
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Pandit V, Rhee PM, Zangbar B, Kulvatunyou N, O'Keeffe T, Tang AL, Green DJ, Gries L, Friese RS, Joseph B. The Burden of Firearm Violence in the United States: Stricter Laws Result in Safer States. J Am Coll Surg 2014. [DOI: 10.1016/j.jamcollsurg.2014.07.110] [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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Zangbar B, Joseph B, Pandit V, Kulvatunyou N, Bains SS, Tang AL, O'Keeffe T, Green DJ, Friese RS, Rhee PM. Injury Prevention Programs against Distracted Driving: Are They Effective? J Am Coll Surg 2014. [DOI: 10.1016/j.jamcollsurg.2014.07.241] [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: 10/24/2022]
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22
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Khalil M, Rhee PM, Pandit V, Tang AL, Kulvatunyou N, O'Keeffe T, Gries L, Green DJ, Friese RS, Joseph B. The Bimodal Effect: Impact of Admission Systolic Blood Pressure on Mortality in Isolated Traumatic Brain Injury. J Am Coll Surg 2014. [DOI: 10.1016/j.jamcollsurg.2014.07.156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Joseph B, Pandit V, Zangbar B, Kulvatunyou N, Tang AL, O'Keeffe T, Green DJ, Fain MJ, Friese RS, Rhee PM. Emergency General Surgery in the Elderly: Too Old or Too Frail? J Am Coll Surg 2014. [DOI: 10.1016/j.jamcollsurg.2014.07.121] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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24
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Michailidou M, Joseph B, Pandit V, Kulvatunyou N, Tang AL, O'Keeffe T, Friese RS, Abdullah F, Stewart D, Rhee PM. The Use of Whole Body CT Scans in Pediatric Trauma Patients: Are there Differences among Adult and Pediatric Centers? J Am Coll Surg 2014. [DOI: 10.1016/j.jamcollsurg.2014.07.185] [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: 10/24/2022]
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25
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Dehdashti N, Kulvatunyou N, Friese RS, Gries L, Joseph B, O'Keeffe T, Wynne JL, Tang AL, Vercruysse GA, Rhee PM. Incidence and pattern of cervical spine injury in patients who fall: don't worry about how high, worry about how old. J Am Coll Surg 2013. [DOI: 10.1016/j.jamcollsurg.2013.07.259] [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: 11/28/2022]
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Ibrahim-zada I, Gomez C, Rhee PM, Friese RS. Inhibition of sepsis-induced inflammatory response by beta1-adrenergic antagonists. J Am Coll Surg 2013. [DOI: 10.1016/j.jamcollsurg.2013.07.092] [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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Michailidou M, Kulvatunyou N, Joseph B, Tang AL, O'Keeffe T, Wynne JL, Green D, Gries L, Friese RS, Rhee PM. Time and cost analysis of gallbladder surgery under acute care surgery model. J Am Coll Surg 2013. [DOI: 10.1016/j.jamcollsurg.2013.07.263] [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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Villegas CV, Dineen HA, Sadoun M, Wynne JL, Friese RS, Tang A, O'Keeffe T, Kulvatunyou N, Rhee PM, Joseph BA. Are all trauma centers equal: Analyzing pediatric outcomes. J Am Coll Surg 2012. [DOI: 10.1016/j.jamcollsurg.2012.06.266] [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: 10/28/2022]
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Latifi R, Joseph B, Kulvatunyou N, Wynne JL, O'Keeffe T, Tang A, Friese R, Rhee PM. Enterocutaneous fistulas and a hostile abdomen: reoperative surgical approaches. World J Surg 2012; 36:516-23. [PMID: 21976011 DOI: 10.1007/s00268-011-1306-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Damage-control surgery and open-abdomen is an acceptable—and often lifesaving—approach to the treatment of patients with severe trauma, abdominal compartment syndrome, necrotizing soft tissue catastrophes, and other abdominal disasters, when closing the abdomen is not possible, ill advised, or will have serious sequelae. However, common consequences of open-abdomen management include large abdominal wall defects, enterocutaneous fistulas (ECFs), and enteroatmospheric fistulas (EAFs). Furthermore, in such patients, a frozen and hostile abdomen (alone or combined with ECFs) is not uncommon. Adding biologic mesh to our surgical armamentarium has revolutionized hernia surgery.
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Affiliation(s)
- R Latifi
- Division of Trauma, Surgical Critical Care, and Emergency Surgery, Department of Surgery, University of Arizona, 1501 N. Campbell Avenue, Tucson, AZ 85724, USA.
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Kulvatunyou N, Rhee PM, Carter SN, Roberts PM, Lees JS, Bender JS, Albrecht RM. Defining incidence and outcome of contrast-induced nephropathy among trauma: is it overhyped? Am Surg 2011; 77:686-689. [PMID: 21679633] [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: 05/30/2023]
Abstract
Contrast-induced nephropathy (CIN) in trauma patients is uncommon and the incidence is unknown. We studied the incidence of CIN and its outcome. A retrospective chart review of trauma patients 16 years of age and older who were admitted to our Level I trauma center during 2005 was performed. Patients who received the intravenous contrast CT scan and had their serum creatinine (Cr) monitored at admission and at 48 to 72 hours were identified. CIN was defined as a 0.5-mg/dL rise of serum Cr or a 25 per cent increase from the baseline if the baseline Cr was abnormal. We excluded patients transferred from an outside facility, patients without repeated serum Cr measurements, patients who had cardiac arrest or persistent hypotension, and patients who had received N-acetylcysteine (Mucomyst) before their CT scan. We compared CIN and non-CIN groups. During 2005, 543 fit our study criteria, of whom 19 (3.5%) had CIN. CIN (vs non-CIN) had a higher baseline serum Cr (1.48 + 0.23 vs 1.06 + 0.02, P < 0.001), a longer intensive care unit stay (17 vs 5 days, P < 0.001), and a longer hospital stay (19 vs 8 days, P < 0.001); the mortality rate was not different (10 vs 4%, P = 0.2). We found elevated baseline serum Cr (OR, 1.92; 95% CI, 1.13 to 3.27; P = 0.016) to be associated with increased risk for CIN. All but two serum Cr levels peaked within 48 hours; all returned to baseline. One patient with an underlying congenital kidney disease required temporary dialysis. CIN incidence in trauma is low and the clinical course is benign.
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Affiliation(s)
- Narong Kulvatunyou
- Division of Acute Care Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA.
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31
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Kulvatunyou N, Rhee PM, Carter SN, Roberts PM, Lees JS, Bender JS, Albrecht RM. Defining Incidence and Outcome of Contrast-Induced Nephropathy Among Trauma: Is It Overhyped? Am Surg 2011. [DOI: 10.1177/000313481107700620] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Contrast-induced nephropathy (CIN) in trauma patients is uncommon and the incidence is unknown. We studied the incidence of CIN and its outcome. A retrospective chart review of trauma patients 16 years of age and older who were admitted to our Level I trauma center during 2005 was performed. Patients who received the intravenous contrast CT scan and had their serum creatinine (Cr) monitored at admission and at 48 to 72 hours were identified. CIN was defined as a 0.5-mg/dL rise of serum Cr or a 25 per cent increase from the baseline if the baseline Cr was abnormal. We excluded patients transferred from an outside facility, patients without repeated serum Cr measurements, patients who had cardiac arrest or persistent hypotension, and patients who had received N-acetylcysteine (Mucomyst) before their CT scan. We compared CIN and non-CIN groups. During 2005, 543 fit our study criteria, of whom 19 (3.5%) had CIN. CIN (vs non-CIN) had a higher baseline serum Cr (1.48 + 0.23 vs 1.06 + 0.02, P < 0.001), a longer intensive care unit stay (17 vs 5 days, P < 0.001), and a longer hospital stay (19 vs 8 days, P < 0.001); the mortality rate was not different (10 vs 4%, P = 0.2). We found elevated baseline serum Cr (OR, 1.92; 95% CI, 1.13 to 3.27; P = 0.016) to be associated with increased risk for CIN. All but two serum Cr levels peaked within 48 hours; all returned to baseline. One patient with an underlying congenital kidney disease required temporary dialysis. CIN incidence in trauma is low and the clinical course is benign.
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Affiliation(s)
- Narong Kulvatunyou
- Division of Acute Care Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Peter M. Rhee
- Division of Acute Care Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Steven N. Carter
- Division of Trauma, Critical Care & Emergency Surgery, University of Oklahoma, Oklahoma City, Oklahoma
| | - Pamela M. Roberts
- Department of Anesthesiology, University of Oklahoma, Oklahoma City, Oklahoma
| | - Jason S. Lees
- Division of Trauma, Critical Care & Emergency Surgery, University of Oklahoma, Oklahoma City, Oklahoma
| | - Jeffrey S. Bender
- Division of Trauma, Critical Care & Emergency Surgery, University of Oklahoma, Oklahoma City, Oklahoma
| | - Roxie M. Albrecht
- Division of Trauma, Critical Care & Emergency Surgery, University of Oklahoma, Oklahoma City, Oklahoma
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Kulvatunyou N, Albrecht RM, Bender JS, Friese RS, Joseph B, Latifi R, O'Keefe T, Wynn JL, Rhee PM. Seatbelt Triad: Severe Abdominal Wall Disruption, Hollow Viscus Injury, and Major Vascular Injury. Am Surg 2011; 77:534-8. [DOI: 10.1177/000313481107700509] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The triad of seatbelt-related severe abdominal wall disruption, hollow viscus injury, and distal abdominal aortic injury after a motor vehicle collision is uncommon. We present a small case series involving those three clinical features with the goal of preventing a future missed diagnosis of the distal abdominal aortic injury in particular.
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Affiliation(s)
- Narong Kulvatunyou
- Division of Acute Care Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Roxie M. Albrecht
- Department of Surgery, University of Oklahoma, Oklahoma City, Oklahoma
| | - Jeffrey S. Bender
- Department of Surgery, University of Oklahoma, Oklahoma City, Oklahoma
| | - Randy S. Friese
- Division of Acute Care Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Bellal Joseph
- Division of Acute Care Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Rifat Latifi
- Division of Acute Care Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Terrance O'Keefe
- Division of Acute Care Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Julie L. Wynn
- Division of Acute Care Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Peter M. Rhee
- Division of Acute Care Surgery, University of Arizona College of Medicine, Tucson, Arizona
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Lin T, Koustova E, Chen H, Rhee PM, Kirkpatrick J, Alam HB. Energy Substrate-Supplemented Resuscitation Affects Brain Monocarboxylate Transporter Levels and Gliosis in a Rat Model of Hemorrhagic Shock. ACTA ACUST UNITED AC 2005; 59:1191-202; discussion 1202. [PMID: 16385299 DOI: 10.1097/01.ta.0000188646.86995.9d] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [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: 11/25/2022]
Abstract
BACKGROUND Monocarboxylate (MC)-supplemented resuscitation has been shown to attenuate cellular injury after hemorrhagic shock. However, little is known about its effect on the central nervous system. The brain can use MCs such as lactate, pyruvate, and beta-hydroxybutyrate as energy substrates. The transit of MCs into the central nervous system is facilitated by the monocarboxylate transporters (MCTs), and their blockage can exacerbate neuronal damage. We examined the expression of MCT1 and markers specific for activation of astroglia and microglia in the brains of rats subjected to hemorrhagic shock and resuscitation. The hypothesis was that resuscitation with MC-based fluids would be accompanied by MCT1 up-regulation and glial response. METHODS Rats (n = 30) were subjected to volume-controlled hemorrhage. Test groups included: sham, no resuscitation, resuscitation with normal saline, resuscitation with racemic lactated Ringer's solution, resuscitation with pyruvate Ringer's solution, and resuscitation with beta-hydroxybutyrate-containing ketone Ringer's solution. Plasma levels of MC were measured serially. The brains were investigated using GFAP, CD11b, CD43, MCT1, and GLUT1 immunohistochemistry. RESULTS Rats resuscitated with MC-containing fluids had increased levels of MCT1 in brain endothelial cells and neuropil compared with sham rats. Enhanced staining was localized to the choroid plexus, astrocytic end feet, and white matter structures. None of the resuscitation treatment induced astrocytic hyperplasia, and pyruvate Ringer's solution and ketone Ringer's solution resuscitation led to hypertrophy of astrocytes. CONCLUSION In hemorrhagic shock, resuscitation with MC-based fluids increased brain MCT1 level and led to activation of astrocytes. Enhanced MC trafficking could be an essential route for energy supply to neurons under adverse circulatory conditions.
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Affiliation(s)
- Tom Lin
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Wright FL, Hua HT, Velmahos G, Thoman D, Demitriades D, Rhee PM. Intracorporeal use of the hemostatic agent QuickClot in a coagulopathic patient with combined thoracoabdominal penetrating trauma. ACTA ACUST UNITED AC 2004; 56:205-8. [PMID: 14749593 DOI: 10.1097/01.ta.0000074349.88275.c4] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Franklin L Wright
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, USA
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Rhee PM, Bridgeman A, Acosta JA, Kennedy S, Wang DSY, Sarveswaran J, Rhea JT. Lumbar fractures in adult blunt trauma: axial and single-slice helical abdominal and pelvic computed tomographic scans versus portable plain films. J Trauma 2002; 53:663-7; discussion 667. [PMID: 12394863 DOI: 10.1097/00005373-200210000-00007] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Our hypothesis was that abdominal and pelvic computed tomographic (AP-CT) scans are equivalent to portable two-view plain films in detecting lumbar spine fractures in adults. Since many trauma patients often undergo AP-CT scanning to evaluate for possible intra-abdominal injuries, using the AP-CT scan to screen for lumbar fractures could make the trauma evaluation process more efficient. METHODS The institutional trauma registry at a Level I trauma center was used to identify all blunt lumbar fractures during a 6-year period. Medical records were reviewed. RESULTS A total of 7,216 adult blunt trauma patients were evaluated, and 115 patients were identified as having a lumbar fracture, for an incidence rate of 1.6%. Missed fracture rates were high for both AP-CT scans (23.2%, 13 of 56) and portable two-view films (12.7%, 14 of 110, = 0.08). Fifty-two patients had both AP-CT scans and plain films. In this group, AP-CT scans missed 23.1% (12 of 52) of the lumbar fractures and plain films missed 15.4% (8 of 52). However, the combination of the two diagnostic methods did not miss any fractures (0 of 52). The missed fractures required surgery or brace in 50% (7 of 14) patients who had fractures missed by plain films and 46% (6 of 13) patients whose fractures were missed by AP-CT scanning. CONCLUSION Both AP-CT scans and plain films failed to diagnose significant lumbar fractures that required therapy. When screening for lumbar fractures, obtaining both AP-CT scans and portable two-view plain films may decrease missed lumbar fractures in blunt adult trauma.
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Affiliation(s)
- Peter M Rhee
- Department of Surgery, Trauma Services, Washington Hospital Center, DC 20010, USA.
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Gushchin V, Stegalkina S, Alam HB, Kirkpatrick JR, Rhee PM, Koustova E. Cytokine expression profiling in human leukocytes after exposure to hypertonic and isotonic fluids. J Trauma 2002; 52:867-71. [PMID: 11988651 DOI: 10.1097/00005373-200205000-00008] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Resuscitation from hemorrhagic shock causes profound immunologic changes. The tonicity of fluids used for resuscitation clearly influences the immune response. Our study was designed to determine whether isotonic and hypertonic fluids exert their differential effects on immune response by altering the cytokine gene profile of human leukocytes. The cDNA array method was used to profile transcriptional responses after exposure to hypertonic and isotonic fluids. METHODS Blood from seven healthy volunteers was incubated for 30 minutes with isotonic (10% dextran-40 and lactated Ringer's [LR] solution) and hypertonic (7.5% hypertonic saline and hypertonic dextran [HTD]) fluids. The volumes of isotonic fluids used were equal to the volume of blood, whereas the volumes of hypertonic fluids were adjusted to keep the salt load identical to the LR group. The cDNA array technique was used to measure the gene expression of 23 common cytokines. RESULTS Increased gene transcription of proinflammatory cytokines (interleukin [IL]-1alpha, IL-6, IL-10, and tumor necrosis factor-alpha) as well as others (IL-5, IL-7, and IL-16) was found after incubation with resuscitation fluids. Variances were noted depending on the type of fluid: HTD and LR solution did not induce expression of IL-5, and HTD also did not induce IL-1beta expression. Genes encoding IL-1alpha, IL-6, IL-9, and tumor necrosis factor-alpha had low level baseline expression in leukocytes isolated from unstimulated blood, and their expression increased markedly after exposure to resuscitation fluids. The inducible transcripts included IL-1beta, IL-7, IL-10, and IL-16. However, there was no difference in cytokine expression profile between isotonic and hypertonic fluids. CONCLUSION Exposure of human leukocytes to resuscitation fluids causes an increase in cytokine gene expressions compared with undiluted blood. This expression profile is largely independent of the type of fluid used.
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Affiliation(s)
- Vadim Gushchin
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814, USA
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Abstract
BACKGROUND The standard lactated Ringer's (LR) solution contains racemic lactate, an equal mixture of D(-)- and L(+)-isomers. The aim of this study was to investigate whether racemic LR solution (containing both isomers, dl-LR) differs from LR containing L-isomer only (L-LR). METHODS Blood from 20 volunteers was incubated for 30 minutes with lactated Ringer's solutions containing the DL- or L-form of lactate, Hank's balanced salt solution, normal saline, and ketone Ringer's (lactate replaced with ketone bodies). Neutrophil "oxidative burst" was measured using flow cytometry. Gene expression of 23 genes associated with leukocyte function was determined with cDNA array technique. The arraying procedure was repeated four times to obtain four sets of data. RESULTS Compared with the L-LR and ketone Ringer's, DL-LR causes an increased production of reactive oxygen species by neutrophils and affects expression of leukocyte genes known to be involved in inflammation, cell migration, and apoptosis. CONCLUSION Lactated Ringer's solution in commonly used formulation (racemic mixture, DL-LR) influences neutrophil function and leukocyte gene expression.
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Affiliation(s)
- Elena Koustova
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814, USA.
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Rhee PM, Acosta J, Bridgeman A, Wang D, Jordan M, Rich N. Survival after emergency department thoracotomy: review of published data from the past 25 years. J Am Coll Surg 2000; 190:288-98. [PMID: 10703853 DOI: 10.1016/s1072-7515(99)00233-1] [Citation(s) in RCA: 273] [Impact Index Per Article: 11.4] [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 Emergency department thoracotomy (EDT) has become standard therapy for patients who acutely arrest after injury. Patient selection is vitally important to achieve optimal outcomes without wasting valuable resources. The aim of this study was to determine the main factors that most influence survival after EDT. STUDY DESIGN Twenty-four studies that included 4,620 cases from institutions that reported EDT for both blunt and penetrating trauma during the past 25 years were reviewed. The primary outcomes analyzed were in-hospital survival rates. RESULTS EDT had an overall survival rate of 7.4%. Normal neurologic outcomes were noted in 92.4% of surviving patients. Factors reported as influencing outcomes were the mechanism of injury (MOI), location of major injury (LOMI), and signs of life (SOL). Survival rates for MOI were 8.8% for penetrating injuries and 1.4% for blunt injuries. When penetrating injuries were further separated, the survival rates were 16.8% for stab wounds and 4.3% for gunshot wounds. For the LOMI, survival rates were 10.7% for thoracic injuries, 4.5% for abdominal injuries, and 0.7% for multiple injuries. If the LOMI was the heart, the survival rate was the highest at 19.4%. The third factor influencing outcomes was SOL. If SOL were present on arrival at the hospital, survival rate was 11.5% in contrast to 2.6% if none were present. SOL present during transport resulted in a survival rate of 8.9%. Absence of SOL in the field yielded a survival rate of 1.2%. There was no clear single independent preoperative factor that could uniformly predict death. CONCLUSIONS The best survival results are seen in patients who undergo EDT for thoracic stab injuries and who arrive with SOL in the emergency department. All three factors-MOI, LOMI, and SOL-should be taken into account when deciding whether to perform EDT. Uniform reporting guidelines are needed to further elucidate the role of EDT taking into account the combination of MOI, LOMI, and SOL.
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Affiliation(s)
- P M Rhee
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Abstract
BACKGROUND Wide variances exist in reports of survival rates after penetrating cardiac injuries because most are hospital-based reports and thus are affected by the local trauma system. The objective of this study was to report population-based, as well as hospital-based, survival rates after penetrating cardiac injury. METHODS Retrospective cohort analysis was performed during a 7-year period of 20,181 consecutive trauma admissions to a regional Level I trauma center and 6,492 medical examiner's reports. A meta-analysis was performed comparing survival rates with available population-based reports. RESULTS There were 212 penetrating cardiac injuries identified, for an incidence of approximately 1 per 100,000 man years and 1 per 210 admissions. The overall survival rate was 19.3% (41 of 212) for the population studied, with survival rates of 9.7% (12 of 123) for gunshot wounds and 32.6% (29 of 89) for stab wounds. Ninety-six of the 212 patients were transported to the trauma center for treatment, resulting in an overall hospital survival rate of 42.7% (41 of 96), with a hospital survival rate of 29.3% (12 of 41) for gunshot wounds and 52.7% (29 of 55) for stab wounds. CONCLUSION Review of population-based studies indicates that there has been only a minor improvement in the survival rates for the treatment of penetrating cardiac injuries.
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Affiliation(s)
- P M Rhee
- Harborview Injury Prevention Center, Seattle, WA, USA
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Sturtz DL, Rhee PM, Rich NM. Unique aspects of anticipated shipboard vascular trauma. Cardiovasc Surg 1998; 6:337-41. [PMID: 9725510 DOI: 10.1016/s0967-2109(98)00011-8] [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] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This article mentions notable historical examples of vascular injuries that occur at sea. It traces the development of modern ships and the concomitant capability to provide medical care to the personnel who go in harm's way on these ships. The importance of vascular surgery training for the general surgeon assigned to sea duty is stressed.
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Affiliation(s)
- D L Sturtz
- Department of Surgery, F. Edward Herbert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814-4799, USA
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Abstract
OBJECTIVE To determine the effect of payer status on outcome and resource utilization in motor vehicle-related trauma patients. DESIGN Retrospective cohort analysis that assessed the effect of payer status on outcome and resource utilization. SETTING The single level I trauma center in a regionalized statewide system. PATIENTS Consecutive patients (N = 3141) who were hospitalized after a motor vehicle crash during a 3-year period. MAIN OUTCOME MEASURES The mortality rate, disposition, total hospital length of stay (LOS), total intensive care unit LOS, and total hospital charges were examined for 2 categories of payers: "commercial insurance" (commercial, labor and industry, and contract pay) and "noncommercial insurance" (Medicaid and self-pay). RESULTS After controlling for age, sex, race, and the Injury Severity Score, the payer status had no overall effect on the mortality rate, disposition, total hospital charges, total hospital LOS, or total intensive care unit LOS. However, there was a significantly (11.4%; P < .05) longer LOS for those patients with noncommercial insurance who required transfer to another facility for rehabilitation or long-term care. CONCLUSIONS The utilization of hospital trauma care resources in a level I facility in a regionalized system was not associated with insurance status. Patients with noncommercial insurance who required transfer to elective long-term care facilities had a longer LOS due to delays in obtaining subsequent access. Health care policy should provide appropriate reimbursement for all aspects of regionalized trauma care systems to ensure maintenance of an egalitarian approach to care.
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Affiliation(s)
- P M Rhee
- Harborview Injury Prevention Center, University of Washington, Seattle, USA
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