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Borowsky PA, Yoon K, Eroraha A, Bonsu JM, Kington D, Lawani PE, Smith RN, Bliton JN. General surgery textbooks and surgical disparities. J Natl Med Assoc 2024; 116:145-152. [PMID: 38245468 DOI: 10.1016/j.jnma.2023.12.009] [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: 12/07/2023] [Accepted: 12/23/2023] [Indexed: 01/22/2024]
Abstract
INTRODUCTION Some academic textbooks have previously disseminated simplistic or even incorrect conceptions of race. Propagation of such ideas in General Surgery could contribute to gaps in quality of care received by minority patients. This study aims to determine whether General Surgery textbooks provide a thorough understanding of racial disparities. METHODS General Surgery texts were drawn from Doody's list, an industry-standard list of textbooks for medical education. Technical guides, atlases, and books for non-General Surgery professionals were excluded. Passages mentioning medical differences amongst racial and ethnic groups were extracted. Six binary classifications were made, based on whether passages (a) described interventions to alleviate difference; (b) addressed environmental mediators of difference; (c) described the contribution of racism or discrimination; (d) used causal language to connect race to difference; (e) referred to known, heritable genetic mechanisms; and (f) directly provided a reference. Types of intervention were also extracted. A heuristic scale was calculated granting one point each for classifications a-c and losing one point for classification d. Three authors performed classifications, and raw agreement and Cohen's kappa were used to assess inter-rater reliability. RESULTS Thirteen textbooks from Doody's list contained 511 passages discussing medical differences among racial/ethnic groups. Among passages, 25% discussed white people, 22% Black people/African Americans, 19% Asians, 9% Latinos, 4% Jewish/Ashkenazi people, 3% Native Americans, and 18% other. Fifteen passages (2.9%) used language indicating race was the cause of medical difference, and only two explicitly discussed racism or discrimination. Most passages (370, 72.3%) received a scale of 0. 120 (23.5%) received a scale of 1, eight (1.2%) received a scale of 2, and zero received a scale of 3. The mean passage scale was 0.24 and is not changing with time (regression coefficient -0.006/year, p = 0.538). Agreement was 91.2% across all categories and overall Kappa was 0.62. CONCLUSIONS General Surgery textbooks do not provide readers with scientifically thorough understanding of health disparities. Teaching more comprehensive conceptions, including systemic causes and the role of racism, may prevent reflexive association of minority patients with poor outcomes. Future editions should include these details where disparities are discussed in an independent, comprehensive section.
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Affiliation(s)
- Peter A Borowsky
- Wellstar Kennestone Regional Medical Center, Department of Surgery, Marietta, GA, United States
| | | | | | - Janice M Bonsu
- Emory University School of Medicine, Department of ORthopaedic Surgery, Atlanta GA, United States
| | - Daniella Kington
- Wellstar Kennestone Regional Medical Center, Department of Surgery, Marietta, GA, United States
| | - Phyllis E Lawani
- NewYork-Presbyterian Brooklyn Methodist Hospital, Department of Women's Health, Brooklyn, NY, United States
| | - Randi N Smith
- Emory University School of Medicine, Department of Acute Care Surgery, Atlanta GA, United States
| | - John N Bliton
- Jamaica Hospital Medical Center, Department of Surgery, Queens, NY, United States.
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Grant AA, Moore C, Smith RN, Sciarretta JD, Sola R, Udobi K, Williams KN, Busby S, Butler C, Keeling B, Ghodsizad A, Nguyen J. Rigid Plate Fixation for Closure of Emergent Sternotomies for Trauma. Am Surg 2024; 90:648-654. [PMID: 37842929 DOI: 10.1177/00031348231206577] [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] [Indexed: 10/17/2023]
Abstract
BACKGROUND No studies to date have evaluated the use of rigid plate fixation for emergent sternotomy in trauma patients. We evaluated our use of rigid plate fixation vs wire cerclage in patients requiring emergent sternotomy. We hypothesized there would be no difference in complications related to sternal closure between the two groups. METHODS We performed a retrospective cohort study to include all patients who underwent emergent sternotomy from 1/1/2018 to 1/31/2021 and survived to have their sternum closed. Outcomes in patients closed with wire cerclage group (WC) were compared to patients who underwent rigid plate fixation (RPF). RESULTS Twenty-two patients underwent emergent sternotomy. There were 11 patients in each group. There was no significant difference in admission demographics, ISS, or admission characteristics between the two groups. Complication rates related to closure (wound infection and hardware removal) were not significantly different (WC 27% vs RPF 9%, P = .58). Neither hospital length of stay (WC: 29 days vs RPF: 13 days, P = .13), ICU length of stay (WC: 6 days vs RPF: 7 days, P = .62), nor the number of ventilator days (WC: 3 days vs RPF: 1 day, P .11) were statistically different. All patients survived to discharge. DISCUSSION This is the first study comparing RPF and WC for sternotomy closure in the setting of trauma. We found no difference in the rate of wound related complications. This study demonstrates the feasibility of rigid plate fixation for trauma sternotomy closure and lays the foundation for future prospective studies.
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Affiliation(s)
- April A Grant
- Department of Surgery, Saint Alphonsus Regional Medical Center, Boise, ID, USA
| | - Cameron Moore
- Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA
| | - Randi N Smith
- Department of Surgery at Grady, Emory University, Atlanta, GA, USA
| | | | - Richard Sola
- Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA
- Department of Surgery, Wellstar Health System, Marietta, GA
| | - Khadi Udobi
- Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA
| | - Keneeshia N Williams
- Department of Surgery, Grady Memorial Hospital, Atlanta, GA, USA
- Department of Surgery, Wellstar Health System, Marietta, GA
| | | | - Caroline Butler
- Department of Surgery, Morehouse School of Medicine, Atlanta, GA, USA
| | - Brent Keeling
- Emory University School of Medicine, Atlanta, GA, USA
| | - Ali Ghodsizad
- University of Miami School of Medicine, Miami, FL, USA
| | - Jonathan Nguyen
- Department of Surgery, Grady Memorial Hospital, Atlanta, GA, USA
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Meyer CH, Aworanti E, Santos A, Castater C, Bauman ZM, Archer-Arroyo K, Sola R, Grant A, Smith RN, Sciarretta JD, Nguyen JH. Is Traumatic Anterior Stove-In Chest Truly so Rare? A Single Institution Experience. Am Surg 2024; 90:695-702. [PMID: 37853722 PMCID: PMC10922850 DOI: 10.1177/00031348231209530] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
INTRODUCTION The anterior stove-in chest (ASIC) is a rare form of flail chest involving bilateral rib or sternal fractures resulting in an unstable chest wall that caves into the thoracic cavity. Given ASIC has only been described in a handful of case reports, this study sought to review our institution's experience in the surgical management of ASIC injuries. METHODS A retrospective review of patients with ASIC was conducted at our level I trauma center from 1//2021 to 3//2023. Information pertaining to patient demographics, fracture pattern, operative management, and outcomes was obtained and compared across patients in the case series. RESULTS 6 patients met inclusion criteria, all males aged 37-78 years. 5 suffered motor vehicle collisions, and 1 was a pedestrian struck by an automobile. The median injury severity score was 28. All received ORIF within 5 days of admission, most commonly for ongoing respiratory distress. Patients 2 and 4 underwent bilateral ORIF of the ribs and sternum while patients 1, 5, and 6 underwent left-sided repair. Patient 3 required ORIF of left ribs and the sternum to stabilize their injuries. 5 of 6 patients were liberated from the ventilator and survived to discharge. CONCLUSIONS This study demonstrates successful operative management of 6 patients with ASIC and suggests that early operative intervention with ORIF for affected segments may improve respiratory mechanics, ability to wean from the ventilator, and overall survival. Further research is needed to generate standardized guidelines for the management of this uncommon and complex thoracic injury.
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Affiliation(s)
- Courtney H. Meyer
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Health System, Atlanta, GA, USA
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Adora Santos
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Health System, Atlanta, GA, USA
| | - Christine Castater
- Grady Health System, Atlanta, GA, USA
- Morehouse School of Medicine, Atlanta, GA, USA
| | | | - Krystal Archer-Arroyo
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Health System, Atlanta, GA, USA
| | | | | | - Randi N. Smith
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Health System, Atlanta, GA, USA
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jason D. Sciarretta
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Health System, Atlanta, GA, USA
| | - Jonathan H. Nguyen
- Grady Health System, Atlanta, GA, USA
- Morehouse School of Medicine, Atlanta, GA, USA
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Meyer CH, Nguyen J, ElHabr A, Venkatayogi N, Steed T, Gichoya J, Sciarretta JD, Sikora J, Dente C, Lyons J, Coopersmith CM, Nguyen C, Smith RN. TiME OUT: Time-specific machine-learning evaluation to optimize ultramassive transfusion. J Trauma Acute Care Surg 2024; 96:443-454. [PMID: 37962139 PMCID: PMC10922246 DOI: 10.1097/ta.0000000000004187] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND Ultramassive transfusion (UMT) is a resource-demanding intervention for trauma patients in hemorrhagic shock, and associated mortality rates remains high. Current research has been unable to identify a transfusion ceiling or point where UMT transitions from lifesaving to futility. Furthermore, little consideration has been given to how time-specific patient data points impact decisions with ongoing high-volume resuscitation. Therefore, this study sought to use time-specific machine learning modeling to predict mortality and identify parameters associated with survivability in trauma patients undergoing UMT. METHODS A retrospective review was conducted at a Level I trauma (2018-2021) and included trauma patients meeting criteria for UMT, defined as ≥20 red blood cell products within 24 hours of admission. Cross-sectional data were obtained from the blood bank and trauma registries, and time-specific data were obtained from the electronic medical record. Time-specific decision-tree models predicating mortality were generated and evaluated using area under the curve. RESULTS In the 180 patients included, mortality rate was 40.5% at 48 hours and 52.2% overall. The deceased received significantly more blood products with a median of 71.5 total units compared with 55.5 in the survivors ( p < 0.001) and significantly greater rates of packed red blood cells and fresh frozen plasma at each time interval. Time-specific decision-tree models predicted mortality with an accuracy as high as 81%. In the early time intervals, hemodynamic stability, undergoing an emergency department thoracotomy, and injury severity were most predictive of survival, while, in the later intervals, markers of adequate resuscitation such as arterial pH and lactate level became more prominent. CONCLUSION This study supports that the decision of "when to stop" in UMT resuscitation is not based exclusively on the number of units transfused but rather the complex integration of patient and time-specific data. Machine learning is an effective tool to investigate this concept, and further research is needed to refine and validate these time-specific decision-tree models. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level IV.
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Affiliation(s)
- Courtney H Meyer
- Department of Trauma & Surgical Critical Care, Grady Health System, Atlanta, GA
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
- Department of Behavioral, Social and Health Sciences, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Jonathan Nguyen
- Department of Trauma & Surgical Critical Care, Grady Health System, Atlanta, GA
- Department of Surgery, Morehouse School of Medicine, Atlanta, GA
| | - Andrew ElHabr
- Department of Operations Research, Georgia Institute of Technology, Atlanta, GA
| | - Nethra Venkatayogi
- Department of Biomedical Engineering, University of Texas at Austin, Austin, TX
| | - Tyler Steed
- Department of Trauma & Surgical Critical Care, Grady Health System, Atlanta, GA
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Judy Gichoya
- Department of Trauma & Surgical Critical Care, Grady Health System, Atlanta, GA
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Jason D Sciarretta
- Department of Trauma & Surgical Critical Care, Grady Health System, Atlanta, GA
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - James Sikora
- Department of Trauma & Surgical Critical Care, Grady Health System, Atlanta, GA
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Christopher Dente
- Department of Trauma & Surgical Critical Care, Grady Health System, Atlanta, GA
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - John Lyons
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
- Department of Surgery and Emory Critical Care Center, Emory University School of Medicine, Atlanta, GA
| | - Craig M Coopersmith
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
- Department of Surgery and Emory Critical Care Center, Emory University School of Medicine, Atlanta, GA
| | - Crystal Nguyen
- Department of Trauma & Surgical Critical Care, Grady Health System, Atlanta, GA
| | - Randi N Smith
- Department of Trauma & Surgical Critical Care, Grady Health System, Atlanta, GA
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
- Department of Behavioral, Social and Health Sciences, Rollins School of Public Health, Emory University, Atlanta, GA
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Dantes G, Grady ZJ, Weeks A, Forrester N, Trinidad JB, Stokes A, Dutreuil VL, Cheng A, Kim P, Smith RN, Ramos CR, Todd SR, Smith A, Sciarretta JD. Management of Pediatric Lower Extremity Vascular Trauma: Adult vs Pediatric Level I Trauma Centers. J Trauma Acute Care Surg 2024:01586154-990000000-00632. [PMID: 38315049 DOI: 10.1097/ta.0000000000004262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
BACKGROUND Pediatric lower extremity vascular injury (PLEVI) is uncommon. Though epidemiologic studies exist, the availability of granular data is sparse. Additionally, few studies compare the management between adult (ATC) and pediatric (PTC) trauma centers. The objective of this study was to analyze the surgical management of PLEVIs between a Level I ATC and a Level 1 PTCs in our metropolitan area. METHODS We performed a retrospective review of all PLEVIs (age < 18 years) managed surgically between 01/2009-12/2022. Demographics, clinical and outcome data were obtained and compared between centers. Primary outcomes included amputation and fasciotomy rates. Secondary outcomes included type of vessel repair, mortality, and intensive care unit (ICU) and hospital length of stay. RESULTS Seventy-nine patients were identified, 41 at the ATC and 38 at the PTC totaling 111 vessels injured. Overall, 84.8% were male. ATC patients were older (median 16.0 vs 12.5) and almost exclusively (97.6% vs 29.0%) gunshot wounds. There was no difference in ISS. The popliteal artery was the most injured vessel, ATC (50%) and PTC (40%). Vascular surgeons managed 50% of injuries at ATC vs 60.5% of injuries at the PTC (p = 0.35). Rates of arterial or venous repair, ligation, or grafting were not significantly different. Amputations were uncommon at both centers and not significantly different. Seventeen patients (44.7%) required fasciotomies at the PTC vs 21 (51.2%) at the ATC (p = 0.56). There was no significant difference in mortality, ICU, or hospital length of stay. CONCLUSIONS PLEVI have acceptable outcomes (low amputation and/or fasciotomy rates, low mortality) and are managed uniformly between ATCs and PTCs. This data adds important context to the management of PLEVI. LEVEL OF EVIDENCE Retrospective Chart Review, Level IV.
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Affiliation(s)
| | | | - Ahna Weeks
- University of Washington School of Medicine, Department of Emergency Medicine
| | | | - Jose B Trinidad
- Emory University School of Medicine, Emory University, Atlanta, GA, USA
| | - Alexis Stokes
- Emory University School of Medicine, Emory University, Atlanta, GA, USA
| | - Valerie L Dutreuil
- Emory Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Annie Cheng
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Phillip Kim
- Department of Trauma and Acute Care Surgery, Grady Memorial Health, Atlanta, GA, USA
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Cornely RM, Williams JC, Smith RN, Greene WR. Georgia and the Diverse Physician Problem: The Need for More Radical Change in Medical Education. Am Surg 2024; 90:185-189. [PMID: 37850405 DOI: 10.1177/00031348231209529] [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: 10/19/2023]
Affiliation(s)
| | - Jeroson C Williams
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Randi N Smith
- Emory University School of Medicine, Atlanta, GA, USA
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Wendy R Greene
- Emory University School of Medicine, Atlanta, GA, USA
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
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Lamanna JJ, Gutierrez J, Alawieh A, Funk C, Rindler RS, Ahmad F, Howard BM, Gupta SK, Gimbel DA, Smith RN, Pradilla G, Grossberg JA. Association of Cerebrovascular Injury and Secondary Vascular Insult With Poor Outcomes After Gunshot Wound to the Head in a Large Civilian Population. Neurosurgery 2024; 94:240-250. [PMID: 37796002 DOI: 10.1227/neu.0000000000002700] [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] [Received: 01/25/2023] [Accepted: 08/02/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Cerebrovascular injury (CVI) after civilian gunshot wound to the head (GSWH) likely contributes to poor outcomes, but little supporting evidence exists. The purpose of this study was to determine whether intracranial CVI from GSWH and secondary vascular insult (stroke or rehemorrhage) were associated with poor outcomes in a large civilian population. METHODS This was a single-institution, retrospective cohort study on patients admitted between January 2014 and July 2022 at a large, metropolitan, level-1 trauma center. Multivariate regression models and propensity score matching were used. RESULTS A total of 512 civilian patients presented with GSWH, and a cohort of 172 (33.5%) met inclusion criteria, with 143 (83.1%) males and a mean (SD) age of 34.3 (±14.2) years. The incidence of intracranial CVI was 50.6% (87/172 patients), and that of secondary vascular insult was 32.2% (28/172 patients). Bifrontal trajectories (adjusted odds ratio [aOR] 13.11; 95% CI 2.45-70.25; P = .003) and the number of lobes traversed by the projectile (aOR 3.18; CI 1.77-5.71; P < .001) were associated with increased odds of resultant CVI. Patients with CVI suffered higher rate of mortality (34% vs 20%; odds ratio [OR] 2.1; CI 0.78-5.85; P = .015) and were less likely to achieve a good functional outcome with a Glasgow Outcome Score of 4-5 (34% vs 68%; OR 0.24; CI 0.1-0.6; P = .004) at follow-up. Furthermore, patients with CVI and resultant secondary vascular insult had even worse functional outcomes (Glasgow Outcome Score 4-5, 16.7% vs 39.0%; aOR 0.012; CI 0.001-0.169, P = .001). CONCLUSION Intracranial CVI from GSWH and associated secondary vascular insult are associated with poor outcomes. Given the high prevalence and potentially reversible nature of these secondary injuries, early screening with vascular imaging and treatment of underlying CVI may prove to be critical to improve outcomes by reducing stroke and rehemorrhage incidence.
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Affiliation(s)
- Jason J Lamanna
- Department of Neurosurgery, Emory University School of Medicine, Atlanta , Georgia , USA
| | - Juanmarco Gutierrez
- Department of Neurosurgery, Emory University School of Medicine, Atlanta , Georgia , USA
| | - Ali Alawieh
- Department of Neurosurgery, Emory University School of Medicine, Atlanta , Georgia , USA
| | - Chadd Funk
- Department of Neurosurgery, Emory University School of Medicine, Atlanta , Georgia , USA
| | - Rima S Rindler
- Department of Neurosurgery, Emory University School of Medicine, Atlanta , Georgia , USA
- Sierra Neurosurgery Group, Reno , Nevada , USA
| | - Faiz Ahmad
- Department of Neurosurgery, Emory University School of Medicine, Atlanta , Georgia , USA
| | - Brian M Howard
- Department of Neurosurgery, Emory University School of Medicine, Atlanta , Georgia , USA
| | - Sanjay K Gupta
- Department of Neurosurgery, Emory University School of Medicine, Atlanta , Georgia , USA
| | - David A Gimbel
- Department of Neurosurgery, Emory University School of Medicine, Atlanta , Georgia , USA
| | - Randi N Smith
- Department of Surgery, Emory University School of Medicine, Atlanta , Georgia , USA
| | - Gustavo Pradilla
- Department of Neurosurgery, Emory University School of Medicine, Atlanta , Georgia , USA
| | - Jonathan A Grossberg
- Department of Neurosurgery, Emory University School of Medicine, Atlanta , Georgia , USA
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Meyer CH, Holstein R, McGeoch C, Hudak L, Smith RN. Patterns of firearm related injury in the elderly: A single institution analysis. Injury 2024:111307. [PMID: 38342701 DOI: 10.1016/j.injury.2023.111307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 12/14/2023] [Accepted: 12/29/2023] [Indexed: 02/13/2024]
Abstract
BACKGROUND Firearm-related violence (FRV) is a public health crisis in the United States that impacts individuals across the lifespan. This study sought to investigate patterns of injury and outcomes of firearm-related injury (FRI) in elderly victims and the impact of social determinants of health on this age demographic. METHODS A retrospective review of the trauma registry at a large Level I center was performed from 2016-2021. Patients over age 18 were included and FRI was defined by ICD 9 and 10 codes. Comparisons were then made between elderly (age > 65 years) and non-elderly (age 18-64 years) victims. The primary outcome was mortality. Secondary outcomes included hospital and intensive care unit length of stay, in-hospital complications and the impact of distressed community index (DCI) and insurance status on discharge disposition. RESULTS 23,975 patients were admitted for traumatic injury and 4,133 (6 %) were elderly. Of these, 134 had penetrating injuries and 72 (54 %) were FRI. The elderly patients had a median age of 69y and they were predominantly black (50 %) males (85%). Over 75 % had some form of government insurance compared to less than 20% in non-elderly (p<0.001). 33 % of elderly FRIs were self-inflicted compared to only 4 % in the non-elderly cohort and their overall mortality rate was 25 % versus 15 % in non-elderly with FRI (p = 0.038). The median DCI for the non-elderly victims was 72.3 [IQR 53.7-93.1] compared to 63.7 [IQR 33.2-83.6] in the elderly (p < 0.001), however, over 50 % of elderly victims were living in "at risk" or "distressed" communities. CONCLUSION FRV is a public health crisis across the lifespan and elderly individuals represent a vulnerable subset of patients with unique needs and public health considerations. While many interventions target youth and young adults, it is imperative to not overlook the elderly in injury prevention efforts, particularly self-directed violence. Additionally, given most elderly victims were on government funded insurance and had a higher likelihood of requiring more costly discharge dispositions, new policies should take into consideration the potential financial burden of FRV in the elderly.
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Affiliation(s)
- Courtney H Meyer
- Grady Health System, Atlanta, GA, US; Emory University School of Medicine, Atlanta, GA, US; Rollins School of Public Health, Emory University, Atlanta, GA, US
| | | | | | - Lauren Hudak
- Grady Health System, Atlanta, GA, US; Emory University School of Medicine, Atlanta, GA, US; Rollins School of Public Health, Emory University, Atlanta, GA, US
| | - Randi N Smith
- Grady Health System, Atlanta, GA, US; Emory University School of Medicine, Atlanta, GA, US; Rollins School of Public Health, Emory University, Atlanta, GA, US.
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Dantes G, Kolousek A, Doshi N, Dutreuil V, Sciarretta JD, Sola R, Shah J, Smith RN, Smith AD, Koganti D. Utilization of Angiography in Pediatric Blunt Abdominal Injury at Adult versus Pediatric Trauma Centers. J Surg Res 2024; 293:561-569. [PMID: 37832307 DOI: 10.1016/j.jss.2023.08.039] [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: 03/02/2023] [Revised: 07/24/2023] [Accepted: 08/26/2023] [Indexed: 10/15/2023]
Abstract
INTRODUCTION Angiography has been widely accepted as an adjunct in the management of blunt abdominal trauma in adults. However, the role of angiography with or without angioembolization (AE) is still being defined in pediatric solid organ injury. We sought to compare the use of angiography in solid organ injury (SOI) at pediatric trauma centers (PTCs) versus an adult trauma center (ATC) in a large metropolitan city. METHODS Data were drawn from a collaborative effort of three Trauma centers (one adult and two pediatric) in Atlanta, GA. All pediatric patients (ages 1-18) treated for SOI between January 1, 2016 and December 31, 2021 were included (n = 350). Registry data obtained included demographics, mechanism of injury, injury grade, injury severity score (ISS), procedures performed, and transfusions. Multivariate regression analysis was used to identify factors associated with angiography. RESULTS A total of 350 patients were identified during the study period with 101 treated at ATC and 249 treated at the two PTCs. The median age at the ATC was 17 y (IQR 16, 18) compared to nine (6, 13) at the PTCs. ISS was significantly higher at the ATC 22 (14, 34) compared to 16 (9, 22) at PTCs (P < 0.001). At the ATC, 11 (10.9%) patients underwent angiography, 4 (4.9%) of which underwent AE compared to seven (2.8%) patients who underwent angiography and AE at PTCs. In the multivariate analysis, factors associated with angiography use included age (OR 1.44, 95% CI 1.09-1.90, P = 0.010) and ISS (OR 1.05, 95% CI 1.02-1.09, P = 0.004). Through setting, ATC versus PTC was significant on univariable analysis, it did not remain a significant predictor of angiography on multivariable regression. CONCLUSIONS Our study demonstrated increased utilization of angiography for the management of SOI in pediatric patients treated at ATCs versus PTCs. On regression analysis, age and ISS remained significant predictors for angiography utilization, while setting (ATC versus PTC) was notably not a significant predictor. This data would suggest that differences in angiography utilization for pediatric SOI at PTCs and ATCs are influenced by differing patient populations (older and higher ISS), with otherwise uniform use. These findings provide a basis for future treatment algorithm revisions for pediatric blunt abdominal trauma that include angiography and provide support for the development of formal guidelines.
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Affiliation(s)
- Goeto Dantes
- Department of Surgery, Emory University, Atlanta, Georgia.
| | | | - Neil Doshi
- Morehouse School of Medicine, Morehouse University, Atlanta, Georgia
| | - Valerie Dutreuil
- Pediatric Biostatistics Core, Department of Pediatrics, Emory School of Medicine Atlanta, Georgia
| | - Jason D Sciarretta
- Department of Surgery, Emory University, Atlanta, Georgia; Department of Trauma Surgery, Emory University, Grady Memorial Hospital, Atlanta, Georgia
| | - Richard Sola
- Morehouse School of Medicine, Morehouse University, Atlanta, Georgia
| | - Jay Shah
- Division of Interventional Radiology and Image-Guided Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Randi N Smith
- Department of Surgery, Emory University, Atlanta, Georgia; Department of Trauma Surgery, Emory University, Grady Memorial Hospital, Atlanta, Georgia; Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Alexis D Smith
- Department of Surgery, Emory University, Atlanta, Georgia; Pediatric Biostatistics Core, Department of Pediatrics, Emory School of Medicine Atlanta, Georgia
| | - Deepika Koganti
- Department of Surgery, Emory University, Atlanta, Georgia; Department of Trauma Surgery, Emory University, Grady Memorial Hospital, Atlanta, Georgia; Rollins School of Public Health, Emory University, Atlanta, Georgia
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Sciarretta JD, Noorbakhsh S, Joung Y, Bailey DW, Freedberg M, Nguyen J, Smith RN, Ayoung-Chee P, Davis MA, Benjamin ER, Todd SR. Pneumopericardium following severe thoracic trauma. Injury 2023:111303. [PMID: 38218676 DOI: 10.1016/j.injury.2023.111303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/24/2023] [Accepted: 12/23/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND Traumatic pneumopericardium (PPC) is a rare clinical entity associated with chest trauma, resulting from a pleuropericardial connection in the presence of a pneumothorax, interstitial air tracking along the pulmonary perivascular sheaths from ruptured alveoli to the pericardium, or direct trachea-bronchial-pericardial communication. Our objectives were to describe the modern management approach to PPC and to identify variables that could improve survival with severe thoracic injury. METHODS We conducted a retrospective study of the trauma registry between 2015 and 2022 at a Level I verified adult trauma center for all patients with PPC. Demographics, injury patterns, and treatment characteristics were compared between blunt and penetrating trauma. This study focused on the management strategies and the physiologic status regarding PPC and the development of tension physiology. The main outcome measure was operative versus nonoperative management. RESULTS Over a seven-year period, there were 46,389 trauma admissions, of which 488 patients had pneumomediastinum. Eighteen patients were identified with PPC at admission. Median age was 39.5 years (range, 18-77 years), predominantly male (n = 16, 89 %), Black (n = 12, 67 %), and the majority from blunt trauma (78 %). Half had subcutaneous emphysema on presentation while 39 % had recognizable pneumomediastinum on chest x-ray. Tube thoracostomy was the most common intervention in this cohort (89 %). Despite tube thoracostomy, tension PPC was observed in three patients, two mandating emergent pericardial windows for progression to tension physiology, and the remaining requiring reconstruction of a blunt tracheal disruption. The majority of PPC patients recovered with expectant management (83 %), and no deaths were directly related to PPC. CONCLUSIONS Traumatic PPC is a rare radiographic finding with the majority successfully managed conservatively in a monitored ICU setting. These patients often have severe thoracic injury with concomitant injuries requiring thoracostomy alone; however, emergent surgical intervention may be required when PPC progresses to tension physiology to improve overall survival.
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Affiliation(s)
- Jason D Sciarretta
- Emory University School of Medicine, 2015 Uppergate Dr, Atlanta, GA 30307, US; Grady Memorial Hospital, 80 Jesse Hill Jr Drive SE Atlanta, GA 30303, US
| | - Soroosh Noorbakhsh
- Emory University School of Medicine, 2015 Uppergate Dr, Atlanta, GA 30307, US.
| | - Yoo Joung
- Morehouse School of Medicine, 720 Westview Dr SW, Atlanta, GA 30310, US
| | - Daniel W Bailey
- Emory University School of Medicine, 2015 Uppergate Dr, Atlanta, GA 30307, US; Grady Memorial Hospital, 80 Jesse Hill Jr Drive SE Atlanta, GA 30303, US
| | - Mari Freedberg
- Emory University School of Medicine, 2015 Uppergate Dr, Atlanta, GA 30307, US; Grady Memorial Hospital, 80 Jesse Hill Jr Drive SE Atlanta, GA 30303, US
| | - Jonathan Nguyen
- Morehouse School of Medicine, 720 Westview Dr SW, Atlanta, GA 30310, US; Grady Memorial Hospital, 80 Jesse Hill Jr Drive SE Atlanta, GA 30303, US
| | - Randi N Smith
- Emory University School of Medicine, 2015 Uppergate Dr, Atlanta, GA 30307, US; Grady Memorial Hospital, 80 Jesse Hill Jr Drive SE Atlanta, GA 30303, US
| | - Patricia Ayoung-Chee
- Morehouse School of Medicine, 720 Westview Dr SW, Atlanta, GA 30310, US; Grady Memorial Hospital, 80 Jesse Hill Jr Drive SE Atlanta, GA 30303, US
| | - Millard A Davis
- Emory University School of Medicine, 2015 Uppergate Dr, Atlanta, GA 30307, US; Grady Memorial Hospital, 80 Jesse Hill Jr Drive SE Atlanta, GA 30303, US
| | - Elizabeth R Benjamin
- Emory University School of Medicine, 2015 Uppergate Dr, Atlanta, GA 30307, US; Grady Memorial Hospital, 80 Jesse Hill Jr Drive SE Atlanta, GA 30303, US
| | - S Rob Todd
- Grady Memorial Hospital, 80 Jesse Hill Jr Drive SE Atlanta, GA 30303, US
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11
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Amin D, Manhan AJ, Pak-Harvey E, Roser SM, Smith RN, Abramowicz S. Which Method of Transportation Is Associated With Better Outcomes for Patients With Firearm Injuries to the Head and Neck? J Oral Maxillofac Surg 2023; 81:1383-1390. [PMID: 37572693 DOI: 10.1016/j.joms.2023.07.136] [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] [Received: 02/01/2023] [Revised: 07/12/2023] [Accepted: 07/19/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND In firearm injuries (FI), rapid transportation is important for survival. Information regarding different methods of transportation for head and neck FI is limited. PURPOSE The purpose of the study was to measure the association between method of transportation and the need for tracheostomy and/or intensive care unit (ICU). STUDY DESIGN, SETTING, SAMPLE This retrospective cross-sectional study reviewed patients in Trauma Registry at Grady Memorial Hospital (GMH) in Atlanta, Georgia, from January 2016 to June 2021. Patients ≥18 years old who sustained FI to the head and neck and were transported via ground emergency medical services (GEMS) or helicopter emergency medical services (HEMS) were included. Patients who arrived at the hospital by foot, private vehicle, or transported from a different hospital were excluded. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE The primary predictor variable was method of transportation (GEMS: ambulance transportation to GMH vs HEMS: helicopter transportation to GMH helipad). MAIN OUTCOME VARIABLE(S) The primary outcome variables were tracheostomy (yes/no) and ICU admission (yes/no). COVARIATES Patient, injury, and hospital-related covariates were collected. ANALYSES Univariate analysis, χ2 test for categorical variables, and independent t test for continuous variables were calculated. Statistical significance was P < .05. RESULTS Of total, 609 patients met the inclusion criteria. There were 560 patients (483 males) with a mean age of 33.6 years old (range, 18 to 90) transported by GEMS. There were 49 patients (40 males) with a mean age of 44 years old (range, 18 to 82) transported by HEMS. Patients transported by HEMS were statistically more likely to have longer transportation time in minutes [13.2 (range, 5 to 132) versus 24.2 (range, 9 to 46), P= <.001], lower Glasgow Coma Scale score [9.9 (range, 3 to 15) versus 6.3 (range, 3 to 15); P= <.001], higher Injury Severity Score [19.3 (range, 3.7 to 98) versus 24.2 (range, 10.3 to 98); P = .007], require transfusion [195 (34.8%); versus 26 (53.1%); P = .013], tracheostomy [46(8.2%) versus 13 (26.5%); P = <.001], and/or admitted to ICU [169, 30.2% versus 24 (49%); P = .007]. CONCLUSION AND RELEVANCE HEMS was positively associated with more tracheostomy and/or ICU admission. Additionally, patients transported by HEMS experienced longer transportation time and severe injuries. HEMS triage criteria specific for FI to the head and neck should be developed.
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Affiliation(s)
- Dina Amin
- Clinical Associate Professor, Department of Oral and Maxillofacial Surgery, University of Rochester Medical School, Rochester, NY.
| | - Andrew J Manhan
- Medical Student Researcher, Department of Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA
| | - Ezra Pak-Harvey
- Medical Student, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA
| | - Steven M Roser
- DeLos Hill Chair and Professor of Surgery, Department of Surgery, Emory University School of Medicine Emory University Residency Program Director, Chef of service Grady Memorial Hospital, Atlanta, GA
| | - Randi N Smith
- Assistant Professor of Surgery, Emory University School of Medicine Assistant Professor of Public Health, Emory University Rollins School of Public Health, Atlanta, GA
| | - Shelly Abramowicz
- Professor of Surgery and Pediatrics, Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
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12
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Campbell B, Castater C, Smith RN, Sciaretta JD, Nguyen J. Use of Kaolin-Impregnated Gauze Aids in Hemostasis and Blood Loss Mitigation in a Penetrating Injury to the Bladder and Small Bowel. Cureus 2023; 15:e46583. [PMID: 37933362 PMCID: PMC10625728 DOI: 10.7759/cureus.46583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 11/08/2023] Open
Abstract
Hemorrhage control can be technically challenging in penetrating injuries to the pelvis. In an era of decreased availability of blood, rapid hemostasis is critical to minimize blood loss, limit transfusions, and control contamination from hollow viscus injuries. QuikClot Control+® 12x12 Hemostatic Device(C+) (Teleflex Medical OEM, Plymouth, MN), a form of kaolin-impregnated gauze, maybe a helpful adjunct to ebb the flow of hemorrhage from large surface area wounds. We present a case in which C+ was utilized in the preperitoneal packing of a gunshot wound to the pelvis and aided in obtaining hemostasis while simultaneously allowing the team time to complete the remainder of the case. Though further large randomized control trials are required to identify the role of C+ in trauma laparotomy, it remains a tool in the surgeon's armamentarium when dealing with hemorrhage.
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Affiliation(s)
| | | | - Randi N Smith
- Surgery, Emory University School of Medicine, Atlanta, USA
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13
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Noorbakhsh S, Gomez L, Joung Y, Meyer C, Hanos DS, Freedberg M, Klingensmith N, Grant AA, Koganti D, Nguyen J, Smith RN, Sciarretta JD. Hepatic Arterioportal Fistula Following Liver Trauma: Case Series and Review of the Literature. Vasc Endovascular Surg 2023; 57:749-755. [PMID: 36940466 PMCID: PMC10724846 DOI: 10.1177/15385744231165155] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
PURPOSE Hepatic arterioportal fistula (HAPF) is an uncommon complication of hepatic trauma, which can manifest with abdominal pain and the sequelae of portal hypertension months to years after injury. The purpose of this study is to present cases of HAPF from our busy urban trauma center and make recommendations for management. METHODS One hundred and twenty-seven patients with high-grade penetrating liver injuries (American Association for the Surgery of Trauma [AAST] - Grades IV-V) between January 2019 and October 2022 were retrospectively reviewed. Five patients were identified with an acute hepatic arterioportal fistula following abdominal trauma from our ACS-verified adult Level 1 trauma center. Institutional experience with overall surgical management is described and reviewed with the current literature. RESULTS Four of our patients presented in hemorrhagic shock requiring emergent operative intervention. The first patient had postoperative angiography and coil embolization of the HAPF. Patients 2 through 4 underwent damage control laparotomy with temporary abdominal closure followed by postoperative transarterial embolization with gelatin sponge particles (Gelfoam) or combined Gelfoam/n-butyl cyanoacrylate. The final patient went directly for angiography and Gelfoam embolization after identification of the HAPF. All 5 patients had resolution of HAPF on follow-up imaging with continued post management for traumatic injuries. CONCLUSION Hepatic arterioportal fistula can present as a complication of hepatic injury and manifest with significant hemodynamic aberrations. Although surgical intervention was required to achieve hemorrhage control in almost all cases, management of HAPF in the setting of high-grade liver injuries was achieved successfully with modern endovascular techniques. A multidisciplinary approach to such injuries is necessary to optimize care in the acute setting following traumatic injury.
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Affiliation(s)
- Soroosh Noorbakhsh
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Memorial Hospital, Atlanta, GA, USA
| | - Lissette Gomez
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Memorial Hospital, Atlanta, GA, USA
| | - Yoo Joung
- Grady Memorial Hospital, Atlanta, GA, USA
- Morehouse School of Medicine, Atlanta, GA, USA
| | - Courtney Meyer
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Memorial Hospital, Atlanta, GA, USA
| | - Dustin S. Hanos
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Memorial Hospital, Atlanta, GA, USA
| | - Mari Freedberg
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Memorial Hospital, Atlanta, GA, USA
| | - Nathan Klingensmith
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Memorial Hospital, Atlanta, GA, USA
| | - April A. Grant
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Memorial Hospital, Atlanta, GA, USA
| | - Deepika Koganti
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Memorial Hospital, Atlanta, GA, USA
| | - Jonathan Nguyen
- Grady Memorial Hospital, Atlanta, GA, USA
- Morehouse School of Medicine, Atlanta, GA, USA
| | - Randi N. Smith
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Memorial Hospital, Atlanta, GA, USA
- Morehouse School of Medicine, Atlanta, GA, USA
| | - Jason D. Sciarretta
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Memorial Hospital, Atlanta, GA, USA
- Morehouse School of Medicine, Atlanta, GA, USA
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14
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Santos AT, Jagiella-Lodise O, Kim P, Freedberg ME, Smith RN, Nguyen J, Davis MA, Ayoung-Chee P, Todd SR, Benjamin ER, Sciarretta JD. Blunt Traumatic Abdominal Wall Hernias: An Indicator for Emergent Laparotomy? Am Surg 2023; 89:3829-3834. [PMID: 37141202 DOI: 10.1177/00031348231172453] [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] [Indexed: 05/05/2023]
Abstract
BACKGROUND Traumatic abdominal wall hernias (TAWH) are relatively uncommon; however, the shearing force that results in fascial disruption could indicate an increased risk of visceral injury. The aim of our study was to evaluate whether the presence of a TAWH was associated with intra-abdominal injury requiring emergent laparotomy. METHODS The trauma registry was queried over an 8-year period (7/2012-7/2020) for adult patients with blunt thoracoabdominal trauma diagnosed with a TAWH. Those patients who were identified with a TAWH and greater than 15 years of age were included in the study. Demographics, mechanism of injury, ISS, BMI, length of stay, TAWH size, type of TAWH repair, and outcomes were analyzed. RESULTS Overall, 38,749 trauma patients were admitted over the study period, of which 64 (.17%) had a TAWH. Patients were commonly male (n = 42, 65.6%); the median age was 39 years (range 16-79 years) and a mean ISS of 21. Twenty-eight percent had a clinical seatbelt sign. Twenty-seven (42.2%) went emergently to the operating room, the majority for perforated viscus requiring bowel resection (n = 16, 25.0%), and 6 patients (9.4%) who were initially managed nonoperatively underwent delayed laparotomy. Average ventilator days was 14 days, with a mean ICU LOS of 14 days and mean hospital LOS of 18 days. About half of the hernias were repaired at the index operation, 6 of which were repaired primarily and 10 with mesh. CONCLUSION The presence of a TAWH alone was an indication for immediate laparotomy to evaluate for intra-abdominal injury. In the absence of other indications for exploration, nonoperative management may be safe.
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Affiliation(s)
- Adora T Santos
- Emory University School of Medicine, Atlanta, GA, USA
- Morehouse School of Medicine, Atlanta, GA, USA
| | - Olivia Jagiella-Lodise
- Emory University School of Medicine, Atlanta, GA, USA
- Morehouse School of Medicine, Atlanta, GA, USA
| | - Phillip Kim
- Emory University School of Medicine, Atlanta, GA, USA
- Morehouse School of Medicine, Atlanta, GA, USA
| | - Mari E Freedberg
- Emory University School of Medicine, Atlanta, GA, USA
- Morehouse School of Medicine, Atlanta, GA, USA
| | - Randi N Smith
- Emory University School of Medicine, Atlanta, GA, USA
- Morehouse School of Medicine, Atlanta, GA, USA
| | - Jonathan Nguyen
- Morehouse School of Medicine, Atlanta, GA, USA
- Morehouse School of Medicine, Atlanta, GA, USA
| | - M Andrew Davis
- Emory University School of Medicine, Atlanta, GA, USA
- Morehouse School of Medicine, Atlanta, GA, USA
| | - Patricia Ayoung-Chee
- Morehouse School of Medicine, Atlanta, GA, USA
- Morehouse School of Medicine, Atlanta, GA, USA
| | - S Rob Todd
- Morehouse School of Medicine, Atlanta, GA, USA
| | - Elizabeth R Benjamin
- Emory University School of Medicine, Atlanta, GA, USA
- Morehouse School of Medicine, Atlanta, GA, USA
| | - Jason D Sciarretta
- Emory University School of Medicine, Atlanta, GA, USA
- Morehouse School of Medicine, Atlanta, GA, USA
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15
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Bliton JN, Paul J, Smith AD, Duran RG, Sola R, Chaudhary S, Fraser Doh K, Koganti D, Dantes G, Hernandez Irizarry RC, Bonsu JM, Welch TT, Richard RA, Smith RN. Increases in adolescent firearm injuries were associated with school closures during COVID-19. Injury 2023; 54:110824. [PMID: 37296010 PMCID: PMC10246889 DOI: 10.1016/j.injury.2023.05.055] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 05/10/2023] [Accepted: 05/13/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Mitigation measures, including school closures, were enacted to protect the public during the COVID-19 pandemic. However, the negative effects of mitigation measures are not fully known. Adolescents are uniquely vulnerable to policy changes since many depend on schools for physical, mental, and/or nutritional support. This study explores the statistical relationships between school closures and adolescent firearm injuries (AFI) during the pandemic. METHODS Data were drawn from a collaborative registry of 4 trauma centers in Atlanta, GA (2 adult and 2 pediatric). Firearm injuries affecting adolescents aged 11-21 years from 1/1/2016 to 6/30/2021 were evaluated. Local economic and COVID data were obtained from the Bureau of Labor Statistics and the Georgia Department of Health. Linear models of AFI were created based on COVID cases, school closure, unemployment, and wage changes. RESULTS There were 1,330 AFI at Atlanta trauma centers during the study period, 1,130 of whom resided in the 10 metro counties. A significant spike in injuries was observed during Spring 2020. A season-adjusted time series of AFI was found to be non- stationary (p = 0.60). After adjustment for unemployment, seasonal variation, wage changes, county baseline injury rate, and county-level COVID incidence, each additional day of unplanned school closure in Atlanta was associated with 0.69 (95% CI 0.34- 1.04, p < 0.001) additional AFIs across the city. CONCLUSION AFI increased during the COVID pandemic. This rise in violence is statistically attributable in part to school closures after adjustment for COVID cases, unemployment, and seasonal variation. These findings reinforce the need to consider the direct implications on public health and adolescent safety when implementing public policy.
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Affiliation(s)
| | | | | | | | - Richard Sola
- Morehouse School of Medicine, USA; Grady Memorial Hospital, USA
| | - Sofia Chaudhary
- Children's Healthcare of Atlanta, USA; Emory University School of Medicine, USA
| | - Kiesha Fraser Doh
- Children's Healthcare of Atlanta, USA; Emory University School of Medicine, USA
| | - Deepika Koganti
- Grady Memorial Hospital, USA; Emory University School of Medicine, USA
| | | | | | | | | | | | - Randi N Smith
- Grady Memorial Hospital, USA; Emory University School of Medicine, USA; Emory University Rollins School of Public Health, USA
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16
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Meyer CH, Noorbakhsh S, Jackson K, Holstein R, Sola R, Koganti D, Bliton J, Smith A, Doh KF, Chaudhary S, Sciarretta JD, Smith RN. Trends in Adolescent Firearm-Related Injury: A Time Series Analysis. Am Surg 2023; 89:3429-3432. [PMID: 36916309 PMCID: PMC10696842 DOI: 10.1177/00031348231157905] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Firearm-related injury (FRI) became the leading cause of death among children/adolescents in 2019. PURPOSE This study sought to determine changes over time in the population of adolescents affected by FRI in Atlanta, Georgia, such that high risk cohorts could be identified. RESEARCH DESIGN City-wide retrospective cohort review. STUDY SAMPLE Adolescent victims (age 11-21 years of age) of FRI, defined by ICD9/10 codes, in Atlanta, Georgia. DATA ANALYSIS Descriptive, multivariate and time series analysis. RESULTS There were 1,453 adolescent FRI victims in this time period, predominantly Black (86%) and male (86.6%). Unintentional injury was higher among ages 11-14 years (43.1%) compared to 15-17 years (10.2%) and 18-21 years (9.3%) (P < .01). FRI affecting females increased at a rate of 8.1 injuries/year (P < .01), and unintentional injuries increased at by 7.6/year (P < .01). Mortality declined from 16% in 2016 to 7.7% in 2021. CONCLUSION Our data provides evidence for firearm policy reform. Interventions should target prevention of intentional injury among AQ4 females and seek to reverse the trend in unintentional injuries.
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Affiliation(s)
- Courtney H. Meyer
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Health System, Atlanta, GA, USA
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Soroosh Noorbakhsh
- Emory University School of Medicine, Atlanta, GA, USA
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Katie Jackson
- Emory University School of Medicine, Atlanta, GA, USA
| | | | - Richard Sola
- Grady Health System, Atlanta, GA, USA
- Morehouse University School of Medicine, Atlanta, GA, USA
| | - Deepika Koganti
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Health System, Atlanta, GA, USA
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - John Bliton
- Jamaica Hospital Medical Center, Queens, NY, USA
| | - Alexis Smith
- Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Kiesha Fraser Doh
- Emory University School of Medicine, Atlanta, GA, USA
- Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Sofia Chaudhary
- Emory University School of Medicine, Atlanta, GA, USA
- Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Jason D. Sciarretta
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Health System, Atlanta, GA, USA
| | - Randi N. Smith
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Health System, Atlanta, GA, USA
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
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17
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Meyer CH, Grant A, Sola R, Gills K, Mora A, Tracy BM, Muralidharan VJ, Koganti D, Todd SR, Butler C, Nguyen J, Hurst S, Udobi K, Sciarretta J, Williams K, Davis M, Dente C, Benjamin E, Ayoung-Chee P, Smith RN. Corrigendum to "Presentation, clinical course and complications in trauma patients with concomitant COVID-19 infection" [Am J Surg 224 (1 Pt B) (2022) 607-611]. Am J Surg 2023; 226:297. [PMID: 36384987 PMCID: PMC9659325 DOI: 10.1016/j.amjsurg.2022.10.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- C H Meyer
- Grady Health System, Atlanta, GA, United States; Emory University School of Medicine, Atlanta, GA, United States; Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - A Grant
- Grady Health System, Atlanta, GA, United States; Emory University School of Medicine, Atlanta, GA, United States
| | - R Sola
- Grady Health System, Atlanta, GA, United States; Morehouse School of Medicine, Atlanta, GA, United States
| | - K Gills
- Grady Health System, Atlanta, GA, United States; Morehouse School of Medicine, Atlanta, GA, United States
| | - A Mora
- Emory University School of Medicine, Atlanta, GA, United States; Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - B M Tracy
- The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | | | - D Koganti
- Grady Health System, Atlanta, GA, United States; Emory University School of Medicine, Atlanta, GA, United States
| | - S R Todd
- Grady Health System, Atlanta, GA, United States; Emory University School of Medicine, Atlanta, GA, United States
| | - C Butler
- Grady Health System, Atlanta, GA, United States; Morehouse School of Medicine, Atlanta, GA, United States
| | - J Nguyen
- Grady Health System, Atlanta, GA, United States; Morehouse School of Medicine, Atlanta, GA, United States
| | - S Hurst
- Grady Health System, Atlanta, GA, United States; Morehouse School of Medicine, Atlanta, GA, United States
| | - K Udobi
- Grady Health System, Atlanta, GA, United States; Morehouse School of Medicine, Atlanta, GA, United States
| | - J Sciarretta
- Grady Health System, Atlanta, GA, United States; Emory University School of Medicine, Atlanta, GA, United States
| | - K Williams
- Grady Health System, Atlanta, GA, United States; Emory University School of Medicine, Atlanta, GA, United States
| | - M Davis
- Grady Health System, Atlanta, GA, United States; Emory University School of Medicine, Atlanta, GA, United States
| | - C Dente
- Grady Health System, Atlanta, GA, United States; Emory University School of Medicine, Atlanta, GA, United States
| | - E Benjamin
- Grady Health System, Atlanta, GA, United States; Emory University School of Medicine, Atlanta, GA, United States
| | - P Ayoung-Chee
- Grady Health System, Atlanta, GA, United States; Morehouse School of Medicine, Atlanta, GA, United States
| | - R N Smith
- Grady Health System, Atlanta, GA, United States; Emory University School of Medicine, Atlanta, GA, United States; Rollins School of Public Health, Emory University, Atlanta, GA, United States.
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18
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Castater C, Noorbakhsh S, Harousseau W, Klingensmith N, Koganti D, Nguyen J, Smith RN, Benarroch-Gampel J, Ramos CR, Rajani R, Sciarretta JD. Missing Bullets: Bullet Embolization Case Series and Review of the Literature. Vasc Endovascular Surg 2023; 57:281-284. [PMID: 36408888 PMCID: PMC10696720 DOI: 10.1177/15385744221141295] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Bullet embolization is a rare but dangerous phenomenon. Based on the location of embolization, migration of bullets can cause limb or intra-abdominal ischemia, pulmonary infarction, cardiac valve injury, or cerebrovascular accident. Bullet emboli can present a diagnostic challenge given the varied nature of complications based on location of embolization, which may not coincide with the site of initial injury. The purpose of this study is to present several cases of bullet embolization from our busy urban trauma center and make recommendations for management. METHODS We present 3 cases of bullet embolization seen in injured patients at our Level 1 trauma center. We describe our management of these injuries and make recommendations for management in the context of our institutional experience and comment on the available literature regarding bullet embolization. RESULTS Two of our patients presented in extremis and required operative intervention to achieve stability. The intravascular missile was discovered intraoperatively in one patient and removed in the operating room, while the missile was discovered on postoperative imaging in another patient and again removed operatively after an unsuccessful attempt at minimally invasive retrieval. Our third patient remained hemodynamically stable throughout his hospitalization and had endovascular management of his bullet embolus. CONCLUSION Bullet emboli present a challenging complication of penetrating trauma. We recommend removal of all arterial bullet emboli and those within the pulmonary venous system. In hemodynamically stable patients, we recommend initial attempts of endovascular retrieval followed by open surgical removal. We recommend open removal in cases of hemodynamic instability.
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Affiliation(s)
| | - Soroosh Noorbakhsh
- Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
| | - William Harousseau
- Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
| | - Nathan Klingensmith
- Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
| | - Deepika Koganti
- Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
| | - Jonathan Nguyen
- Morehouse School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
| | - Randi N. Smith
- Morehouse School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
- Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
| | | | | | - Ravi Rajani
- Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
| | - Jason D. Sciarretta
- Morehouse School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
- Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
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19
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Hendrix E, Narasimhan S, Ripkey CE, Zeidan A, Smith RN, Evans DP. " Boiling Water but There's No Pop-Off Valve": Health Care Provider Perceptions of the Effects of COVID-19 on Intimate Partner Violence. Violence Against Women 2023:10778012231162043. [PMID: 36942416 PMCID: PMC10033505 DOI: 10.1177/10778012231162043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
This study sought to understand the effects of COVID-19, including movement-related restrictions such as shelter-in-place, quarantine, and isolation orders, on intimate partner violence (IPV) from the perspective of health care providers (HCPs) working at a public hospital in Atlanta, Georgia. From November 2020 to May 2021, we conducted 12 interviews. Three themes emerged: (1) HCPs perceived that COVID-19 movement-related restrictions likely exacerbated IPV; (2) HCPs encountered many practice-oriented and community barriers in IPV care provision during COVID-19; and (3) HCPs suggested process and partnership improvements for IPV response. These findings can inform future pandemic preparedness including improved communication, improved IPV screening and follow-up, and strengthened hospital-community partnerships.
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Affiliation(s)
- Ellen Hendrix
- Hubert Department of Global Health,
Emory University, Atlanta, Georgia, USA
| | - Subasri Narasimhan
- Hubert Department of Global Health,
Emory University, Atlanta, Georgia, USA
- The Center for Reproductive Health
Research in the Southeast (RISE), Emory University, Atlanta, Georgia, USA
| | - Carrie E. Ripkey
- Hubert Department of Global Health,
Emory University, Atlanta, Georgia, USA
| | - Amy Zeidan
- Department of Emergency Medicine, Emory University School of
Medicine, Atlanta, Georgia, USA
| | - Randi N. Smith
- Department of Behavioral, Social, and
Health Education Sciences, Emory University, Atlanta, Georgia, USA
- Department of Surgery, Emory University School of
Medicine, Atlanta, Georgia, USA
| | - Dabney P. Evans
- Hubert Department of Global Health,
Emory University, Atlanta, Georgia, USA
- The Center for Reproductive Health
Research in the Southeast (RISE), Emory University, Atlanta, Georgia, USA
- Department of Behavioral, Social, and
Health Education Sciences, Emory University, Atlanta, Georgia, USA
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20
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Yoon K, Eroraha A, Lutton E, Kington D, Bonsu JM, Lawani PE, Smith RN, Bliton JN. What do Trauma Surgery Textbooks Teach About Racial Disparities and the Roots of Violence? Am Surg 2023:31348231161675. [PMID: 36912008 DOI: 10.1177/00031348231161675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
This study presents a formal text analysis of trauma surgery textbooks. We examine passages that describe disparities or mechanisms of injury, and we report types of underlying causes and preventative interventions discussed. Trauma textbooks were drawn from an industry-standard list used by medical libraries. Chi-square testing was used to determine whether different types of underlying causes or preventative interventions were discussed by disparity type (those affecting racial minorities vs rural populations) and injury mechanism (accidental injuries vs intentional interpersonal injury). 146 passages were extracted from 7 textbooks, totaling 5576 pages of text. Passages discussing rural disadvantages or unintentional injury were substantially more likely to describe structural risk factors or governmental interventions than those discussing racial disadvantages or intentional injury, respectively. Textbook authors should consider enriching discussion of violence prevention or racial disparities to emphasize structural causes and interventions.
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Affiliation(s)
- Kyung Yoon
- 4129Ross University School of Medicine, Miramar, FL, USA
| | - Ajiri Eroraha
- 4129Ross University School of Medicine, Miramar, FL, USA
| | - Evan Lutton
- Weill Cornell Medical College, New York Presbyterian Hospital, General Surgery Residency, New York NY, USA
| | - Daniella Kington
- 24444Wellstar Atlanta Medical Center, Department of Surgery, Atlanta, GA, USA
| | - Janice M Bonsu
- Emory College of Medicine, Department of Orthopaedic Surgery, Atlanta, GA, USA
| | - Phyllis E Lawani
- 23303Lifebridge Health Sinai Hospital, Department of Obstetrics and Gynecology, Baltimore MD, USA
| | - Randi N Smith
- 1371Emory University, Department of Acute Care Surgery, Atlanta, GA, USA
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21
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Abdullahi D, Zeidan A, Koganti D, Feinberg I, O'Connor MH, Asker S, Butler J, Meyer C, Rasheed M, Herard K, Smith RN. Cultural and Linguistic Adaptations of Stop the Bleed in Multi-Ethnic Refugee Communities. Am Surg 2023:31348231162708. [PMID: 36894880 DOI: 10.1177/00031348231162708] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
INTRODUCTION Stop the Bleed (STB), and other trainings that promote health education in basic trauma management techniques, is offered mostly in English and Spanish in the United States. Limited access to injury prevention training may contribute to inequities in health outcomes for individuals with limited English proficiency (LEP). Our study aims to determine the feasibility and effectiveness of STB training in 4 languages spoken in a super diverse refugee settlement community, Clarkston, GA. METHODS Written STB educational materials were culturally adapted, translated, and back translated into 4 languages: Arabic, Burmese, Somali, and Swahili. Four 90-minute in-person STB trainings were conducted by medical personnel with community-based interpreters at a central and familiar location in the Clarkston community. Pre- and post-tests were administered in participant's preferred language to evaluate change in knowledge and beliefs as well as the effectiveness of the training method. RESULTS A total of 46 community members were trained in STB, the majority of which were women (63%). Participants demonstrated improvement in their knowledge, confidence, and comfort using STB techniques. Participants reported that 2 aspects of the training were particularly beneficial: the presence of language concordant interpreters from the community and small group hands on sessions that allowed for practicing STB techniques. CONCLUSION Cultural and linguistic adaptation of STB training is a feasible, cost-effective, and effective method for disseminating life-saving information and trauma education to immigrant populations who have LEP. Expansion of community training and partnerships to support the needs of diverse communities is both necessary and urgent.
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Affiliation(s)
- Dirir Abdullahi
- Department of Surgery, 1374Morehouse School of Medicine, Atlanta, GA, USA
| | - Amy Zeidan
- Department of Emergency Medicine, 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Deepika Koganti
- Department of Acute Care Surgery and General Surgery, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Iris Feinberg
- Associate Director of Adult Literacy Research Center, 1373Georgia State University, Atlanta, GA, USA
| | - Mary Helen O'Connor
- Department of English and Community Health Engagement, 1373Georgia State University, Atlanta, GA, USA
| | - Samira Asker
- Department of Emergency Medicine, 1371Emory University, Atlanta, GA, USA
| | - Jennifer Butler
- Department of Surgery, 1374Morehouse School of Medicine, Atlanta, GA, USA
| | - Courtney Meyer
- Department of Surgery, 1371Emory University, Atlanta, GA, USA
| | - Mustafa Rasheed
- Department of Emergency Medicine, 1371Emory University, Atlanta, GA, USA
| | - Kimberly Herard
- Department of Emergency Medicine, 1371Emory University, Atlanta, GA, USA
| | - Randi N Smith
- Department of Surgery, 1371Emory University, Atlanta, GA, USA
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22
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Schultebraucks K, Stevens JS, Michopoulos V, Maples-Keller J, Lyu J, Smith RN, Rothbaum BO, Ressler KJ, Galatzer-Levy IR, Powers A. Development and validation of a brief screener for posttraumatic stress disorder risk in emergency medical settings. Gen Hosp Psychiatry 2023; 81:46-50. [PMID: 36764261 PMCID: PMC10866012 DOI: 10.1016/j.genhosppsych.2023.01.012] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Predicting risk of posttraumatic stress disorder (PTSD) in the acute care setting is challenging given the pace and acute care demands in the emergency department (ED) and the infeasibility of using time-consuming assessments. Currently, no accurate brief screening for long-term PTSD risk is routinely used in the ED. One instrument widely used in the ED is the 27-item Immediate Stress Reaction Checklist (ISRC). The aim of this study was to develop a short screener using a machine learning approach and to investigate whether accurate PTSD prediction in the ED can be achieved with substantially fewer items than the IRSC. METHOD This prospective longitudinal cohort study examined the development and validation of a brief screening instrument in two independent samples, a model development sample (N = 253) and an external validation sample (N = 93). We used a feature selection algorithm to identify a minimal subset of features of the ISRC and tested this subset in a predictive model to investigate if we can accurately predict long-term PTSD outcomes. RESULTS We were able to identify a reduced subset of 5 highly predictive features of the ISRC in the model development sample (AUC = 0.80), and we were able to validate those findings in the external validation sample (AUC = 0.84) to discriminate non-remitting vs. resilient trajectories. CONCLUSION This study developed and validated a brief 5-item screener in the ED setting, which may help to improve the diagnostic process of PTSD in the acute care setting and help ED clinicians plan follow-up care when patients are still in contact with the healthcare system. This could reduce the burden on patients and decrease the risk of chronic PTSD.
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Affiliation(s)
- K Schultebraucks
- Department of Psychiatry, NYU Grossman School of Medicine, New York, USA; Department of Population Health, NYU Grossman School of Medicine, New York, USA.
| | - J S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA; Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans' Affairs Health Care System, Atlanta, GA, USA
| | - V Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - J Maples-Keller
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - J Lyu
- Department of Biostatistics, Columbia University, Mailman School of Public Health, New York, NY, USA
| | - R N Smith
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA; Department of Behavioral, Social and Health Education Sciences, Emory University School of Public Health, Atlanta, GA, USA
| | - B O Rothbaum
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - K J Ressler
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; McLean Hospital, Belmont, MA, USA
| | - I R Galatzer-Levy
- Department of Psychiatry, NYU Grossman School of Medicine, New York, USA
| | - A Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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23
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Amin D, Manhan AJ, Stern E, Smith RN, Abramowicz S. Socioeconomic Profile is Associated with the Type of Firearm Injuries to the Head and Neck. J Oral Maxillofac Surg 2023; 81:292-298. [PMID: 36481275 DOI: 10.1016/j.joms.2022.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/07/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Socioeconomic status (SES) describes social standing of an individual or a group. SES has been directly associated with violence. The purpose of this study is to measure the association between SES profiles and firearm injuries (FIs) to the head and neck. METHODS This cross-sectional study reviewed patients at Grady Memorial Hospital in Atlanta, Georgia from January 2016 to June 2021. The study included patients who sustained FIs to the head and neck. The primary predictor variable was Distressed Community Index as a surrogate for SES. The primary outcome variable was type of FI (assault-induced firearm injury [AFI] or self-inflicted firearm injury [SFI]). Covariates were patient characteristics, distribution, and severity of FI. Univariate and bivariate analyses were calculated. The χ2 test was used for categorical variables. Independent t test was used for continuous variables. Statistical significance was P < .05. RESULTS Six hundred ninety-four patients met inclusion criteria. AFIs were statistically more frequent in young (AFI = 32.2; SFI = 42.2; P ≤ .001) and/or Black patients (AFI: n = 483, 86.3%; SFI: n = 40, 29.9%; P ≤ .001). Patients who sustained AFIs were statistically more likely to live in areas associated with high Distressed Community Index score (AFI: 64.8, range = 3.7 to 99.7; SFI: 54.4, range = 2.8 to 98; P ≤ .001). A statistically significant number of SFI patients presented with lower Glasgow Coma Scale score (AFI: 10.7, range = 3 to 15; SFI: 5.5, range = 3 to 15; P ≤ .001), and/or required tracheostomy (AFI: n = 56, 10%; SFI: n = 27, 20.1%; P = .005). CONCLUSIONS Patients who lived in economically distressed areas were positively associated with AFIs to the head and neck. However, SFIs were statistically more sever. More studies on the impact of current gun prevention programs and how to be addressed to at-risk populations is needed.
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Affiliation(s)
- Dina Amin
- Clinical Associate Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Texas A & M University, Dallas, TX.
| | - Andrew J Manhan
- Medical Student Researcher, Department of Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA
| | - Elinor Stern
- Medical Student, Department of Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA
| | - Randi N Smith
- Assistant Professor of Surgery, Department of Surgery, Emory University School of Medicine; Assistant Professor of Public Health, Emory University Rollins School of Public Health, Atlanta, GA
| | - Shelly Abramowicz
- Professor in Oral and Maxillofacial Surgery and Pediatrics, Division of Oral and Maxillofacial Surgery, Emory University, School of Medicine; Chief of Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA
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24
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Teichman AL, Bonne S, Rattan R, Dultz L, Qurashi FA, Goldenberg A, Polite N, Liveris A, Freeman JJ, Colosimo C, Chang E, Choron RL, Edwards C, Arabian S, Haines KL, Joseph D, Murphy PB, Schramm AT, Jung HS, Lawson E, Fox K, Mashbari HNA, Smith RN. Screening and intervention for intimate partner violence at trauma centers and emergency departments: an evidence-based systematic review from the Eastern Association for the Surgery of Trauma. Trauma Surg Acute Care Open 2023; 8:e001041. [PMID: 36967863 PMCID: PMC10030790 DOI: 10.1136/tsaco-2022-001041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/16/2023] [Indexed: 03/18/2023] Open
Abstract
BackgroundIntimate partner violence (IPV) is a serious public health issue with a substantial burden on society. Screening and intervention practices vary widely and there are no standard guidelines. Our objective was to review research on current practices for IPV prevention in emergency departments and trauma centers in the USA and provide evidenced-based recommendations.MethodsAn evidence-based systematic review of the literature was conducted to address screening and intervention for IPV in adult trauma and emergency department patients. The Grading of Recommendations, Assessment, Development and Evaluations methodology was used to determine the quality of evidence. Studies were included if they addressed our prespecified population, intervention, control, and outcomes questions. Case reports, editorials, and abstracts were excluded from review.ResultsSeven studies met inclusion criteria. All seven were centered around screening for IPV; none addressed interventions when abuse was identified. Screening instruments varied across studies. Although it is unclear if one tool is more accurate than others, significantly more victims were identified when screening protocols were implemented compared with non-standardized approaches to identifying IPV victims.ConclusionOverall, there were very limited data addressing the topic of IPV screening and intervention in emergency medical settings, and the quality of the evidence was low. With likely low risk and a significant potential benefit, we conditionally recommend implementation of a screening protocol to identify victims of IPV in adults treated in the emergency department and trauma centers. Although the purpose of screening would ultimately be to provide resources for victims, no studies that assessed distinct interventions met our inclusion criteria. Therefore, we cannot make specific recommendations related to IPV interventions.PROSPERO registration numberCRD42020219517.
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Affiliation(s)
- Amanda L Teichman
- Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Stephanie Bonne
- Trauma and Surgical Critical Care, Hackensack Meridian Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Rishi Rattan
- Trauma Surgery and Critical Care, University of Miami School of Medicine, Miami, Florida, USA
| | - Linda Dultz
- Burns, Trauma, Acute and Critical Care Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Anna Goldenberg
- Trauma, Acute Care Surgery, and Surgical Critical Care, Cooper University Hospital Regional Trauma Center, Camden, New Jersey, USA
| | - Nathan Polite
- Trauma, Acute Care Surgery & Burns, University of South Alabama, Mobile, Alabama, USA
| | - Anna Liveris
- Trauma and Critical Care Services, Jacobi Medical Center, Bronx, New York, USA
| | - Jennifer J Freeman
- General Surgery, Trauma, and Surgical Critical Care, TCU School of Medicine, Fort Worth, Texas, USA
| | - Christina Colosimo
- Trauma, Surgical Critical Care, & Acute Care Surgery, University of Arizona Medical Center-University Campus, Tucson, Arizona, USA
| | - Erin Chang
- Acute Care Surgery, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Rachel L Choron
- Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Courtney Edwards
- Burns, Trauma, Acute and Critical Care Surgery, Parkland Health and Hospital System, Dallas, Texas, USA
| | - Sandra Arabian
- Trauma and Emergency Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Krista L Haines
- Trauma, Critical Care, and Acute Care Surgery, Duke University Hospital, Durham, North Carolina, USA
| | - D'Andrea Joseph
- Surgery, NYU Langone Hospital-Long Island, Mineola, New York, USA
| | - Patrick B Murphy
- Trauma & Acute Care Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Andrew T Schramm
- Trauma & Acute Care Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Hee Soo Jung
- Acute Care Surgery and Regional General Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Emily Lawson
- Woodruff Health Sciences Center Library, Emory University Woodruff Health Sciences Center, Atlanta, Georgia, USA
| | - Kathleen Fox
- Woodruff Health Sciences Center Library, Emory University Woodruff Health Sciences Center, Atlanta, Georgia, USA
| | | | - Randi N Smith
- Trauma/Surgical Critical Care, Emory University School of Medicine, Atlanta, Georgia, USA
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25
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Novack JC, Whitton EL, Smith RN, Sciarretta JD, Nguyen J. Abdominal Wall Evisceration Coupled With Iliac Vascular Injury After Blunt Trauma. Cureus 2023; 15:e34917. [PMID: 36938169 PMCID: PMC10016732 DOI: 10.7759/cureus.34917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
Abdominal evisceration after blunt trauma is uncommon and rarely survivable when coupled with a concomitant iliac vascular injury. Blunt abdominal injury is rarely a cause of abdominal evisceration but may, on occasion, present in patients affected by a unique or high-energy traumatic injury. In these instances, major vascular injury is exceedingly rare but is associated with a high mortality rate. Damage to important vessels that may present more subtly, such as iliac arterial injury, can still be lethal and are important to evaluate in the trauma workup for blunt evisceration. We report the case of a 20-year-old woman who survived an abdominal wall and vascular injury in a motor vehicle accident. Management of this unusual association is discussed.
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Affiliation(s)
- Joseph C Novack
- Department of Medicine, Emory University School of Medicine, Atlanta, USA
| | - Eric L Whitton
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, USA
| | - Randi N Smith
- Department of Surgery, Emory University School of Medicine, Atlanta, USA
| | - Jason D Sciarretta
- Department of Surgery, Emory University School of Medicine, Atlanta, USA
| | - Jonathan Nguyen
- Department of Surgery, Morehouse School of Medicine, Atlanta, USA
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26
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Sharma B, Kolousek A, Lian B, Koganti D, Smith RN, Sola R. Cervical Spine Computed Tomography in Adolescent Blunt Trauma Patients: Are They Being Overutilized? J Surg Res 2023; 282:155-159. [PMID: 36279708 DOI: 10.1016/j.jss.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/18/2022] [Accepted: 09/18/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Cervical spine computed tomography (CSCT) scans are used to evaluate cervical spine traumatic injuries; however, recent evidence demonstrates that adult trauma centers (ATCs) overutilize CSCT when evaluating adolescent patients. This leads to unnecessary radiation exposure. The aim of this study is to review a level 1 ATC's use of CSCT in the adolescent blunt trauma population. METHODS A retrospective chart review was conducted of a level 1 ATC's trauma database. Blunt trauma patients between the ages of 11 and 18 who receive a CSCT between January 2015 to December 2019 were included. The primary outcome was the prevalence of positive findings on CSCT scans. Data were analyzed using Fischer-Exact analysis and multivariate logistic regression where appropriate. RESULTS Three-hundred thirty-seven of 546 (61.7%) adolescent blunt trauma patients received CSCT. Of those, 68.2% (230) were male; the mean age was 16.6 ± 1.0 y old. Twenty-eight patients (8.3%) had a positive finding on CSCT. All patients with a positive CSCT failed the National Emergency X-Radiography Utilization study (NEXUS) criteria while 123 patients (36.5%) with a negative CSCT met NEXUS criteria. CONCLUSIONS CSCT was overutilized in our trauma center. There is a low positive CSCT scan rate among adolescent patients, which aligns with the current literature. All patients with positive CSCT passed NEXUS criteria suggesting that a quality improvement project focusing on the use of the NEXUS criteria to assess the risk of cervical spine injury could potentially reduce the use of CSCT scans by nearly 40%.
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Affiliation(s)
- Bharath Sharma
- Morehouse School of Medicine, Department of Surgery, Atlanta, Georgia
| | | | - Brad Lian
- Mercer University School of Medicine, Department of Community Medicine, Macon, Georgia
| | - Deepika Koganti
- Emory University School of Medicine, Department of Surgery, Atlanta, Georgia
| | - Randi N Smith
- Emory University School of Medicine, Department of Surgery, Atlanta, Georgia
| | - Richard Sola
- Morehouse School of Medicine, Department of Surgery, Atlanta, Georgia.
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27
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Woods-Jaeger B, Gaylord-Harden N, Dinizulu SM, Elder A, Jahangir T, Smith RN. Developing practices for hospital-based violence intervention programs to address anti-Black racism and historical trauma. Am Psychol 2023; 78:199-210. [PMID: 37011170 DOI: 10.1037/amp0001088] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
To promote health equity among Black youth exposed to community violence, it is critical that psychologists partner with other health care professionals and communities with lived experience to explicitly address anti-Black racism and historical trauma as fundamental contributors to violence-related health inequities. This article describes our community-based participatory research (CBPR) approach to develop practices for hospital-based violence intervention programs that mitigate violence-related health inequities among Black youth. Current conceptualizations of trauma-related symptoms among Black youth exposed to community violence often fail to consider the role of anti-Black racism and historical trauma in creating and maintaining traumatic stress. Our CBPR formative studies highlight the importance of and priorities to address community violence within the context of anti-Black racism and historical trauma. In describing our process and developed tools and practices, we aim to highlight the important contributions psychologists can make through interdisciplinary and community partnerships to advance health equity. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Briana Woods-Jaeger
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University
| | | | | | - Amy Elder
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University
| | - Tasfia Jahangir
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University
| | - Randi N Smith
- Department of Surgery, Emory University School of Medicine
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28
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Tracy BM, Swift DA, Smith RN. HIV geospatially clusters with firearm trauma in 35 Atlanta zip codes. AIDS Care 2023; 35:238-243. [PMID: 35044265 DOI: 10.1080/09540121.2022.2029815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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
The purpose of this study was to assess if rates of firearm trauma within Atlanta geospatially clustered with HIV prevalence and new HIV diagnosis rates. We retrospectively reviewed our Atlanta trauma center's registry for patients sustaining a ballistic firearm trauma from 2014 through 2018. Using the patient's zip code of home residence, we determined the rate of firearm trauma for that zip code. We obtained publicly available rates for HIV that corresponded with these select zip codes to perform a geospatial cluster analysis. The cohort was comprised of 1495 patients and represented 35 zip codes in Atlanta. The mean rate of firearm trauma for the 35 zip codes was 171.1 (±296.4) per 100,000 people. Compared to all Atlanta, the 35 zip codes' mean HIV prevalence (1863.9 vs 924.1, p < .0001) and new HIV diagnosis rate (396.9 vs 199.7, p < .0001) were significantly higher. Rates of firearm trauma and HIV prevalence demonstrated significant geospatial clustering (β 0.38, 95% CI 0.22-0.53, p < .0001) as did rates of firearm trauma and new HIV diagnoses (β 0.36, 95% CI 0.18-0.54, p = 0.0002). Our findings provide granular geographic data that could guide targeted HIV screening efforts in communities where our firearm-injured patients live.
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Affiliation(s)
- Brett M Tracy
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus
| | - David A Swift
- Department of Surgery, Emory University School of Medicine, Atlanta
- Division of Acute Care Surgery, Grady Memorial Hospital, Atlanta
| | - Randi N Smith
- Department of Surgery, Emory University School of Medicine, Atlanta
- Division of Acute Care Surgery, Grady Memorial Hospital, Atlanta
- Rollins School of Public Health, Emory University, Atlanta
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29
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Wyckoff KG, Narasimhan S, Stephenson K, Zeidan AJ, Smith RN, Evans DP. "COVID gave him an opportunity to tighten the reins around my throat": perceptions of COVID-19 movement restrictions among survivors of intimate partner violence. BMC Public Health 2023; 23:199. [PMID: 36717878 PMCID: PMC9885388 DOI: 10.1186/s12889-023-15137-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 01/19/2023] [Accepted: 01/25/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Intimate Partner Violence (IPV) poses a serious public health threat globally and within the United States. Preliminary evidence highlighted surges in IPV during the COVID-19 pandemic. The pandemic offers a unique context, with many states and countries enacting movement-restrictions (i.e., shelter-in-place orders) that exacerbated IPV. Although these movement restrictions and other infection control methods (i.e., isolation, quarantine orders) have proven successful in reducing the spread of COVID-19, their impacts on IPV have not been thoroughly investigated. Specifically, public health measures restricting movement reinforce and socially legitimize isolation and coercive control tactics enacted by perpetrators of abuse. The purpose of this study was to understand the impacts of COVID-19, including the impacts of movement restrictions (i.e., shelter in place orders, quarantine, isolation orders) on experiences of IPV from the perspective of survivors. METHODS In-depth interviews were conducted with ten survivors who presented at a large, public hospital or sought community IPV resources (i.e., domestic violence shelter, therapy services) in Atlanta, Georgia between March and December 2020. Thematic analysis was carried out to describe the impact of COVID-19 movement restrictions on IPV and help-seeking behaviors among survivors, in addition to identifying resources to improve IPV response during pandemics. RESULTS Through discussion of their experiences, survivors indicated how movement restrictions, social distancing measures, and the repercussions of the pandemic influenced their relationship challenges, including the occurrence of new or a higher frequency and/or severity of IPV episodes. Survivors cited relationship challenges that were amplified by either movement restrictions or consequences of COVID-19, including reinforced control tactics, and increased financial or life stressors resulting from the pandemic. COVID-19 movement restrictions catalyzed new relationships quickly and sparked new or intensified violence in existing relationships, revealing gaps in IPV support services. CONCLUSION These findings suggest COVID-19 movement restrictions and social distancing measures amplify IPV and experiences of trauma due to new or exacerbated relationship challenges. Further, results highlight how partners cited COVID-19 movement restrictions to justify methods of coercive control. Public health professionals engaged in pandemic preparedness must give serious consideration to how social distancing measures may amplify trauma in those experiencing IPV.
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Affiliation(s)
- Kathryn G. Wyckoff
- grid.189967.80000 0001 0941 6502Department of Behavioral Social and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Rd, 30322 Atlanta, USA
| | - Subasri Narasimhan
- grid.189967.80000 0001 0941 6502Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd, 30322 Atlanta, USA
| | - Kaylee Stephenson
- grid.189967.80000 0001 0941 6502Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd, 30322 Atlanta, USA
| | - Amy J. Zeidan
- grid.189967.80000 0001 0941 6502Emory School of Medicine, Department of Emergency Medicine, Atlanta, USA
| | - Randi N. Smith
- grid.189967.80000 0001 0941 6502Emory School of Medicine, Department of Surgery, Atlanta, USA
| | - Dabney P. Evans
- grid.189967.80000 0001 0941 6502Department of Behavioral Social and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Rd, 30322 Atlanta, USA ,grid.189967.80000 0001 0941 6502Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd, 30322 Atlanta, USA
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Amin D, Manhan AJ, Zeidan AJ, Evans DP, Abramowicz S, Smith RN. Do Gender Differences Exist Among Victims of Head and Neck Injuries due to Intimate Partner Violence? J Oral Maxillofac Surg 2023; 81:49-55. [PMID: 36351477 DOI: 10.1016/j.joms.2022.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 10/04/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE The frequency of intimate partner violence (IPV) is much lower in males than females. Data regarding IPV-related injuries patterns and characteristics in males are scant. The purpose of this study was to characterize and compare patterns of IPV-related head and neck injuries between men and women. MATERIALS AND METHODS This cross-sectional study reviewed cases of IPV at Grady Memorial Hospital in Atlanta, Georgia from January 2016 to August 2019. The study sample was collected from electronic medical records by identifying IPV subjects using a natural language processing algorithm and then cross-referencing the trauma registry to identify patients who sustained head and neck injuries. The primary analyses of interest were to measure the association between gender and the following covariates: age, race, insurance status, setting of injury, day of injury, social history, report of physical abuse, mechanism of injury, injury location, brain injuries, soft tissue injuries, facial fractures, other associated injuries, Glasgow Coma Scale, Injury Severity Score, hospital length of stay, intensive care unit length of stay, and discharge status. Univariate and bivariate analyses were calculated. Statistical significance was P < .05. RESULTS One hundred fifty six patients met inclusion criteria. There were 120 (76.9%) female patients with a mean age of 34.5 years (range, 16 to 67 years). There were 36 (23%) male patients with a mean age of 43.8 years (range, 18 to 77 years). Women were statistically more likely than men to have government-subsidized insurance (47 [39.2%] vs 7 [19.4%]; P = .03), positive alcohol exposure (27 [22.5%] vs 19 [52.8%]; P = .0001), positive illicit drugs toxicology screen (25 [20.8%] vs 13 [36.1%]; P < .02), report physical abuse (24 [20%] vs 0; P = .004), have subarachnoid hemorrhage (14 [11.7%] vs 0; P = .04), and/or lower extremity injuries (39 [32.5%] vs 5 [13.9%]; P = .03). CONCLUSION Males tend not to report physical abuse; this behavior contributes to IPV under-reporting in males.
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Affiliation(s)
- Dina Amin
- Assistant Professor in Oral and Maxillofacial Surgery, Emory University School of Medicine; Associate Chief Oral and Maxillofacial Surgery Service, Director of Oral and Maxillofacial Surgery Outpatient Clinic, Grady Memorial Hospital, Atlanta, GA.
| | - Andrew J Manhan
- Medical Student Researcher, Department of Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA
| | - Amy J Zeidan
- Assistant Professor, Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA
| | - Dabney P Evans
- Assistant Professor, Hubert Department of Global Health & Director, Center for Humanitarian Emergencies, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Shelly Abramowicz
- Associate Professor in Oral and Maxillofacial Surgery and Pediatrics, Emory University, School of Medicine; Chief of Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA
| | - Randi N Smith
- Assistant Professor of Surgery, Emory University School of Medicine; Assistant Professor of Public Health, Emory University Rollins School of Public Health, Atlanta, GA
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Kolousek A, Sharma B, Lian B, Koganti D, Smith RN, Sola R. Understanding abdominal pelvic computerized tomography scan usage amongst adolescent blunt trauma patients treated at adult trauma centers. Injury 2023; 54:100-104. [PMID: 35999064 DOI: 10.1016/j.injury.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 07/25/2022] [Accepted: 08/03/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The algorithm for evaluating adolescent patients with blunt trauma includes abdominal pelvic CT (APCT). The aim of this study is to evaluate the utility of APCT in this context. METHODS We performed a retrospective review of adolescent (11 to 18 years of age) blunt trauma patients at an urban adult level 1 trauma center from January 2015 to December 2019. The primary outcome was the prevalence of positive findings on APCT scan. Additionally, clinical risk factors concerning for intra-abdominal injury were analyzed. RESULTS There were 546 patients evaluated for blunt trauma and the prevalence of APCT within the population was 59.3% (95% CI 54.2%-64.9%). Of the patients who received APCT, 123 (37.9%) had positive findings on APCT. Only 25 patients (7.7% of those who underwent APCT) required abdominal surgery while 40 patients (12.3%) had intraabdominal injury that did not require surgery. Risk factors were present in 100% of patients with intraabdominal injury and absent in 28.7% of patients without intraabdominal injury. Abnormal abdominal exam, abnormal FAST, positive chest x-ray and elevated transaminases were independently associated with intraabdominal injury. CONCLUSIONS Our study found that adolescent blunt trauma patients treated at our trauma center had a higher rate of APCT usage, but a comparable rate of positive findings when compared with the most recent literature. Future studies should focus on reducing the number of patients who undergo APCT despite an absence of clinical risk factors.
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Affiliation(s)
- Anastasia Kolousek
- Morehouse School of Medicine, Department of Surgery, 720 Westview Drive, Atlanta, GA 30310, United States.
| | - Bharath Sharma
- Morehouse School of Medicine, Department of Surgery, 720 Westview Drive, Atlanta, GA 30310, United States.
| | - Brad Lian
- Mercer University School of Medicine, Department of Community Medicine, 1501 Mercer University Drive, Macon, GA 30341, United States.
| | - Deepika Koganti
- Emory University School of Medicine, Department of Surgery, 69 Jesse Hill Jr. Dr. SE, Atlanta, GA 30303, United States.
| | - Randi N Smith
- Emory University School of Medicine, Department of Surgery, 69 Jesse Hill Jr. Dr. SE, Atlanta, GA 30303, United States.
| | - Richard Sola
- Morehouse School of Medicine, Department of Surgery, 720 Westview Drive, Atlanta, GA 30310, United States.
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Tung L, Seamon MJ, Dauer E, Alabi O, Benarroch-Gampel J, Passman J, Fitzgerald C, Lobichusky B, Mazzei M, Rodriguez W, Smith RN. Using Arterial Pressure Index to Predict Arterial Injuries in Penetrating Trauma to the Upper Extremities. Am Surg 2023; 89:108-112. [PMID: 33876999 DOI: 10.1177/00031348211011142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Upper extremity (UE) vascular injuries account for 18.4% of all traumatic vascular injuries. Arterial pressure index (API) use in lower extremity injuries to determine the need for further investigations is well established. However, due to collateral circulation in UEs, it is unclear if the same algorithm can be applied. The purpose of this study was to determine if APIs can be used to determine the need for computed tomography angiogram (CTA) in penetrating UE trauma. METHODS All adult trauma patients with penetrating UE trauma and APIs from 2006 to 2016 were identified at 3 urban US level 1 trauma centers. Sensitivity, specificity, and positive and negative predictive values of APIs <.9 in detecting UE arterial injuries were calculated. RESULTS During the 11-year study period, 218 patients met our inclusion criteria. Gunshot wounds comprised 76.6% and stab wounds 17.9%. Median injury severity score and API were 9 and 1, respectively. Seventy-two of our patients underwent evaluation with CTA. Of the injuries, the most common were thrombus or occlusion (46.7%), transection (23.1%), and dissection (15.4%), radiographically. Ultimately, 32 patients underwent surgical.
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Affiliation(s)
- Lily Tung
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, 14640University of Pennsylvania, Philadelphia, PA, USA
| | - Mark J Seamon
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, 14640University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth Dauer
- Lewis Katz School of Medicine, 12314Temple University, Philadelphia, PA, USA
| | - Olamide Alabi
- 12239Emory University School of Medicine, Atlanta, GA, USA
| | | | - Jesse Passman
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, 14640University of Pennsylvania, Philadelphia, PA, USA
| | | | - Brone Lobichusky
- Lewis Katz School of Medicine, 12314Temple University, Philadelphia, PA, USA
| | - Michael Mazzei
- Lewis Katz School of Medicine, 12314Temple University, Philadelphia, PA, USA
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Jacoby SF, Smith RN, Beard JH. Rethinking "recidivism" in firearm injury research and prevention. Prev Med 2022; 165:107221. [PMID: 36002055 DOI: 10.1016/j.ypmed.2022.107221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/29/2022]
Abstract
Interpersonal firearm injuries pose a persistent public health threat in the United States (US). Strategic interventions to curb these injuries require evaluation of measurable outcomes that prove effectiveness and substantiate efforts for wider scaling and implementation. One common outcome of interest used among injury prevention researchers and practitioners is 'recidivism' referring to recurrent injury from acts of violence in a previously firearm injured person. In this commentary we urge that the term which can insinuate racialized criminality and reinforce stigma, no longer be used to describe people who experience firearm injuries. We also advocate for reconsideration of 'recidivism' as an ideal evaluation metric for the success of tertiary firearm injury prevention programs.
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Affiliation(s)
- Sara F Jacoby
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, USA.
| | - Randi N Smith
- Department of Surgery, Emory University School of Medicine, USA
| | - Jessica H Beard
- Division of Trauma and Surgical Critical Care, Department of Surgery, Lewis Katz School of Medicine, Temple University, USA
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Nguyen J, Ude N, Holloway N, Tootla Y, Archer-Arroyo K, Novack J, Tran J, Isaacson A, Drake M, Smith RN, Sciarretta J, Udobi K, Sola R, Williams K, Butler C, Grant AA, Morse BC, Herr KD. Correction to: Severity of traumatic adrenal injury does not meaningfully affect clinical outcomes. Emerg Radiol 2022; 29:935. [PMID: 35859029 DOI: 10.1007/s10140-022-02078-6] [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: 11/30/2022]
Affiliation(s)
- Jonathan Nguyen
- MSM Department of Surgery, Morehouse School of Medicine, 80 Jesse Hill Jr St SE, Suite 2c, Atlanta, GA, 30303, USA.
| | - Ndidi Ude
- MSM Department of Surgery, Morehouse School of Medicine, 80 Jesse Hill Jr St SE, Suite 2c, Atlanta, GA, 30303, USA
| | - Nikolas Holloway
- MSM Department of Surgery, Morehouse School of Medicine, 80 Jesse Hill Jr St SE, Suite 2c, Atlanta, GA, 30303, USA
| | - Yasmin Tootla
- Advocate Health Care, 4440 West 95th St, Suite 183 South, Oak Lawn, IL, 60453, USA
| | - Krystal Archer-Arroyo
- Emory University School of Medicine, 69 Jesse Hill Jr Dr SE, Suite 3c, Atlanta, GA, 30303, USA
| | - Joseph Novack
- Emory University School of Medicine, 69 Jesse Hill Jr Dr SE, Suite 3c, Atlanta, GA, 30303, USA
| | - James Tran
- MSM Department of Surgery, Morehouse School of Medicine, 80 Jesse Hill Jr St SE, Suite 2c, Atlanta, GA, 30303, USA
| | - Andrew Isaacson
- Wayne State University, 4201 St Antoine, 4S‑13, Detroit, MI, 48201, USA
| | - Mack Drake
- Virginia Commonwealth University, 1201 E. Marshall St, Suite 4‑100, Richmond, VA, 23298, USA
| | - Randi N Smith
- Emory University School of Medicine, 69 Jesse Hill Jr Dr SE, Suite 3c, Atlanta, GA, 30303, USA
| | - Jason Sciarretta
- Emory University School of Medicine, 69 Jesse Hill Jr Dr SE, Suite 3c, Atlanta, GA, 30303, USA
| | - Kahdi Udobi
- MSM Department of Surgery, Morehouse School of Medicine, 80 Jesse Hill Jr St SE, Suite 2c, Atlanta, GA, 30303, USA
| | - Richard Sola
- MSM Department of Surgery, Morehouse School of Medicine, 80 Jesse Hill Jr St SE, Suite 2c, Atlanta, GA, 30303, USA
| | - Kenisha Williams
- Emory University School of Medicine, 69 Jesse Hill Jr Dr SE, Suite 3c, Atlanta, GA, 30303, USA
| | - Caroline Butler
- MSM Department of Surgery, Morehouse School of Medicine, 80 Jesse Hill Jr St SE, Suite 2c, Atlanta, GA, 30303, USA
| | - April A Grant
- Emory University School of Medicine, 69 Jesse Hill Jr Dr SE, Suite 3c, Atlanta, GA, 30303, USA
| | - Bryan C Morse
- Maine Medical Center, 22 Bramhall St, Portland, ME, 04102, USA
| | - Keith D Herr
- Emory University School of Medicine, 69 Jesse Hill Jr Dr SE, Suite 3c, Atlanta, GA, 30303, USA
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Bakshi AS, Hardy SL, Moore E, Nicely KW, Koganti D, Hanos D, Thompson AN, Grant A, Nguyen J, Sola R, Williams KN, Sciarretta JD, Dente CJ, Castater CA, Smith RN. Second Victim Syndrome in Trauma Practitioners and Other Ancillary Staff. Am Surg 2022; 88:2258-2260. [PMID: 35838277 DOI: 10.1177/00031348221083955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In health care, second victims are traumatized clinicians involved in unanticipated or untoward patient events. Programs that address second victim syndrome are sparse and its diagnosis often goes unrecognized. Consistently, literature has identified gaps in support resources, leading to compromised patient care and provider health. This project evaluates the need for second victim resources in trauma care providers at a tertiary public level 1 trauma hospital by electronically implementing a validated second victim survey over 5 weeks. Our results illustrate that second victim syndrome is prevalent among 57.1% of trauma care providers, of which 22.9% agree that second victim syndrome results in some form of undesirable work intentions.
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Affiliation(s)
- Arjun S Bakshi
- 138565Department of Medicine, Mercer University School of Medicine, GA, USA
| | - Sierra L Hardy
- 15792Department of Nursing, Emory University School of Nursing, Atlanta, GA, USA
| | - Erica Moore
- 15792Department of Nursing, Emory University School of Nursing, Atlanta, GA, USA
| | - Kelly Wiltse Nicely
- 15792Department of Nursing, Emory University School of Nursing, Atlanta, GA, USA
| | - Deepika Koganti
- 12239Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Dustin Hanos
- 12239Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Alexis N Thompson
- 12239Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - April Grant
- 12239Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Jonathan Nguyen
- Department of Surgery, 1374Morehouse School of Medicine, Atlanta, GA, USA
| | - Richard Sola
- Department of Surgery, 1374Morehouse School of Medicine, Atlanta, GA, USA
| | - Keneeshia N Williams
- 12239Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Jason D Sciarretta
- 12239Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Christopher J Dente
- 12239Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Christine A Castater
- 12239Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Randi N Smith
- 12239Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
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Nguyen J, Ude N, Holloway N, Tootla Y, Archer-Arroyo K, Novack J, Tran J, Isaacson A, Drake M, Smith RN, Sciarretta J, Udobi K, Sola R, Williams K, Butler C, Grant AA, Morse BC, Herr KD. Severity of traumatic adrenal injury does not meaningfully affect clinical outcomes. Emerg Radiol 2022; 29:895-901. [PMID: 35829928 DOI: 10.1007/s10140-022-02069-7] [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: 02/28/2022] [Accepted: 06/07/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE There are limited data comparing the severity of traumatic adrenal injury (TAI) and the need for interventions, such as transfusions, hospitalization, or incidence of adrenal insufficiency (AI) and other clinical outcomes. The aim of this study was to analyze the relationship between the grade of TAI and the need for subsequent intervention and clinical outcomes following the injury. METHODS After obtaining Institutional Review Board approval, our trauma registry was queried for patients with TAI between 2009 and 2017. Contrast-enhanced computed tomography (CT) examinations of the abdomen and pelvis were evaluated by a board-certified radiologist with subspecialty expertise in abdominal and trauma imaging, and adrenal injuries were classified as either low grade (American Association for the Surgery of Trauma (AAST) grade I-III) or high grade (AAST grade IV-V). Patients without initial contrast-enhanced CT imaging and those with indeterminate imaging findings on initial CT were excluded. RESULTS A total of 129 patients with 149 TAI were included. Eight-six patients demonstrated low-grade injuries and 43 high grade. Age, gender, and Injury Severity Score (ISS) were not statistically different between the groups. There was an increased number of major vascular injuries in the low-grade vs. high-grade group (23% vs. 5%, p < 0.01). No patient required transfusions or laparotomy for control of adrenal hemorrhage. There was no statistical difference in hospital length of stay (LOS), ventilator days, or mortality. Low-grade adrenal injuries were, however, associated with shorter ICU LOS (10 days vs. 16 days, p = 0.03). CONCLUSION The need for interventions and clinical outcomes between the low-grade and high-grade groups was similar. These results suggest that, regardless of the TAI grade, treatment should be based on a holistic clinical assessment and less focused on specific interventions directed at addressing the adrenal injury.
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Affiliation(s)
- Jonathan Nguyen
- MSM Department of Surgery, Morehouse School of Medicine, 80 Jesse Hill Jr St SE, Suite 2c, Atlanta, GA, 30303, USA.
| | - Ndidi Ude
- MSM Department of Surgery, Morehouse School of Medicine, 80 Jesse Hill Jr St SE, Suite 2c, Atlanta, GA, 30303, USA
| | - Nikolas Holloway
- MSM Department of Surgery, Morehouse School of Medicine, 80 Jesse Hill Jr St SE, Suite 2c, Atlanta, GA, 30303, USA
| | - Yasmin Tootla
- Advocate Health Care, 4440 West 95th St, Suite 183 South, Oak Lawn, IL, 60453, USA
| | - Krystal Archer-Arroyo
- Emory University School of Medicine, 69 Jesse Hill Jr Dr SE, Suite 3c, Atlanta, GA, 30303, USA
| | - Joseph Novack
- Emory University School of Medicine, 69 Jesse Hill Jr Dr SE, Suite 3c, Atlanta, GA, 30303, USA
| | - James Tran
- MSM Department of Surgery, Morehouse School of Medicine, 80 Jesse Hill Jr St SE, Suite 2c, Atlanta, GA, 30303, USA
| | - Andrew Isaacson
- Wayne State University, 4201 St Antoine, 4S-13, Detroit, MI, 48201, USA
| | - Mack Drake
- Virginia Commonwealth University, 1201 E. Marshall St, Suite 4-100, Richmond, VA, 23298, USA
| | - Randi N Smith
- Emory University School of Medicine, 69 Jesse Hill Jr Dr SE, Suite 3c, Atlanta, GA, 30303, USA
| | - Jason Sciarretta
- Emory University School of Medicine, 69 Jesse Hill Jr Dr SE, Suite 3c, Atlanta, GA, 30303, USA
| | - Kahdi Udobi
- MSM Department of Surgery, Morehouse School of Medicine, 80 Jesse Hill Jr St SE, Suite 2c, Atlanta, GA, 30303, USA
| | - Richard Sola
- MSM Department of Surgery, Morehouse School of Medicine, 80 Jesse Hill Jr St SE, Suite 2c, Atlanta, GA, 30303, USA
| | - Kenisha Williams
- Emory University School of Medicine, 69 Jesse Hill Jr Dr SE, Suite 3c, Atlanta, GA, 30303, USA
| | - Caroline Butler
- MSM Department of Surgery, Morehouse School of Medicine, 80 Jesse Hill Jr St SE, Suite 2c, Atlanta, GA, 30303, USA
| | - April A Grant
- Emory University School of Medicine, 69 Jesse Hill Jr Dr SE, Suite 3c, Atlanta, GA, 30303, USA
| | - Bryan C Morse
- Maine Medical Center, 22 Bramhall St, Portland, ME, 04102, USA
| | - Keith D Herr
- Emory University School of Medicine, 69 Jesse Hill Jr Dr SE, Suite 3c, Atlanta, GA, 30303, USA
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Meyer CH, Grant AA, Enofe N, Matey A, Frankinburger E, Sola R, Nguyen J, Andrade IFP, Veselsky SL, Sciarretta J, Williams KN, Kim S, Smith RN. Organ donation after self-inflicted injury: A single institution analysis. Clin Transplant 2022; 36:e14679. [PMID: 35533053 DOI: 10.1111/ctr.14679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 04/06/2022] [Accepted: 04/12/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study sought to determine the contribution of self-inflicted injury-related deaths to local organ donation rates and analyze contributing factors. METHODS A retrospective review of adult patients with traumatic self-inflicted injuries was performed at a Level I trauma center from 2013 to 2017. Data were obtained from the institutional trauma registry and cross-referenced with the local organ procurement organization (OPO). Referral rates were analyzed and outcomes, demographics and injury characteristics were compared between patients who underwent donation versus those who did not. RESULTS 142 adult patients presented with traumatic self-inflicted injury, and 100 (70.4%) had referral calls made to the local OPO. These patients were predominantly male (83%), and gunshot injuries accounted for 75% of all mechanisms. Sixty-four percent had organ referrals versus tissue referrals (34%), and 17 (26.6%) of those patients went on to donate. The median number of organs procured was 4 [IQR 0-5]. In multivariate analysis, for each year increase in age, patients were less likely to have an organ referral (OR = .96 [95% CI .93-.99]; p = .0134) and less likely to undergo donation (OR = .95 [95% CI .90-.99]; p = .0308). CONCLUSIONS Self-inflicted injury, though tragic, may provide a significant contribution to the limited organ donor registry.
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Affiliation(s)
- Courtney H Meyer
- Emory University School of Medicine, Atlanta, Georgia, USA.,Grady Health System, Atlanta, Georgia, USA.,Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - April A Grant
- Emory University School of Medicine, Atlanta, Georgia, USA.,Grady Health System, Atlanta, Georgia, USA
| | - Nosayaba Enofe
- Emory University School of Medicine, Atlanta, Georgia, USA.,Grady Health System, Atlanta, Georgia, USA
| | | | - Emil Frankinburger
- Grady Health System, Atlanta, Georgia, USA.,Lifelink Foundation, Atlanta, Georgia, USA
| | - Richard Sola
- Grady Health System, Atlanta, Georgia, USA.,Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Jonathan Nguyen
- Grady Health System, Atlanta, Georgia, USA.,Morehouse School of Medicine, Atlanta, Georgia, USA
| | | | - Steven L Veselsky
- Emory University School of Medicine, Atlanta, Georgia, USA.,Grady Health System, Atlanta, Georgia, USA.,West Virginia School of Osteopathic Medicine, Lewisburg, West Virginia, USA
| | - Jason Sciarretta
- Emory University School of Medicine, Atlanta, Georgia, USA.,Grady Health System, Atlanta, Georgia, USA
| | - Keneeshia N Williams
- Emory University School of Medicine, Atlanta, Georgia, USA.,Grady Health System, Atlanta, Georgia, USA
| | - Steven Kim
- Emory University School of Medicine, Atlanta, Georgia, USA.,University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Randi N Smith
- Emory University School of Medicine, Atlanta, Georgia, USA.,Grady Health System, Atlanta, Georgia, USA.,Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Meyer CH, Grant A, Sola R, Gills K, Mora AN, Tracy BM, Muralidharan VJ, Koganti D, Todd SR, Butler C, Nguyen J, Hurst S, Udobi K, Sciarretta J, Williams K, Davis M, Dente C, Benjamin E, Ayoung-Chee P, Smith RN. Presentation, clinical course and complications in trauma patients with concomitant COVID-19 infection. Am J Surg 2022; 224:607-611. [PMID: 35534294 PMCID: PMC8978444 DOI: 10.1016/j.amjsurg.2022.03.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/20/2022] [Accepted: 03/23/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND This study investigated the impact of COVID-19 infection on hospitalized trauma patients. METHODS A retrospective review of hospitalized trauma patients at a level I trauma center was performed from March-December 2020. Data pertaining to patient demographics, presentation and hospital course was compared between COVID positive and negative trauma patients. RESULTS There were 4,912 patients and 179 (3.64%) were COVID-19 positive. Demographics and clinical presentation did not differ significantly between those with and without concomitant COVID-19. However, COVID positive trauma patients had higher rates of acute kidney injury (p = 0.016), sepsis (p = 0.016), unplanned intubation (p = 0.002) and unplanned return to the ICU (p = 0.01). The COVID positive cohort also had longer hospital stays (p < 0.01) with no significant difference in mortality. CONCLUSIONS In the setting of an ongoing pandemic, awareness of the complications COVID positive trauma patients are predisposed to is important for providers.
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Affiliation(s)
- C H Meyer
- Grady Health System, Atlanta, GA, USA; Emory University School of Medicine, Atlanta, GA, USA; Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - A Grant
- Grady Health System, Atlanta, GA, USA; Emory University School of Medicine, Atlanta, GA, USA.
| | - Richard Sola
- Grady Health System, Atlanta, GA, USA; Morehouse School of Medicine, Atlanta, GA, USA.
| | - K Gills
- Grady Health System, Atlanta, GA, USA; Morehouse School of Medicine, Atlanta, GA, USA.
| | - Ariana N Mora
- Emory University School of Medicine, Atlanta, GA, USA; Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - B M Tracy
- The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | | | - D Koganti
- Grady Health System, Atlanta, GA, USA; Emory University School of Medicine, Atlanta, GA, USA.
| | - S R Todd
- Grady Health System, Atlanta, GA, USA; Emory University School of Medicine, Atlanta, GA, USA.
| | - C Butler
- Grady Health System, Atlanta, GA, USA; Morehouse School of Medicine, Atlanta, GA, USA.
| | - J Nguyen
- Grady Health System, Atlanta, GA, USA; Morehouse School of Medicine, Atlanta, GA, USA.
| | - S Hurst
- Grady Health System, Atlanta, GA, USA; Emory University School of Medicine, Atlanta, GA, USA.
| | - K Udobi
- Grady Health System, Atlanta, GA, USA; Morehouse School of Medicine, Atlanta, GA, USA.
| | - J Sciarretta
- Grady Health System, Atlanta, GA, USA; Emory University School of Medicine, Atlanta, GA, USA.
| | - K Williams
- Grady Health System, Atlanta, GA, USA; Emory University School of Medicine, Atlanta, GA, USA.
| | - M Davis
- Grady Health System, Atlanta, GA, USA; Emory University School of Medicine, Atlanta, GA, USA.
| | - C Dente
- Grady Health System, Atlanta, GA, USA; Emory University School of Medicine, Atlanta, GA, USA.
| | - E Benjamin
- Grady Health System, Atlanta, GA, USA; Emory University School of Medicine, Atlanta, GA, USA.
| | - P Ayoung-Chee
- Grady Health System, Atlanta, GA, USA; Morehouse School of Medicine, Atlanta, GA, USA.
| | - R N Smith
- Grady Health System, Atlanta, GA, USA; Emory University School of Medicine, Atlanta, GA, USA; Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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Bliton JN, Zakrison TL, Vong G, Johnson DA, Rattan R, Hanos DS, Smith RN. Ethical Care of the Traumatized: Conceptual Introduction to Trauma-Informed Care for Surgeons and Surgical Residents. J Am Coll Surg 2022; 234:1238-1247. [PMID: 35703822 DOI: 10.1097/xcs.0000000000000183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Trauma-informed care (TIC) is a set of principles and practices designed to improve the ways professionals treat people who have been traumatized. This study reviews fundamental concepts of TIC and applies them to the work of surgeons. TIC is described in relation to fundamental medical ethical concepts, and evidence for TIC-based intervention is reviewed. Implementation of TIC in medical education is also described, and recommendations for practice changes are made.
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Affiliation(s)
- John N Bliton
- From the Wellstar Atlanta Medical Center, Atlanta, GA (Bliton)
| | - Tanya L Zakrison
- Trauma and Acute Care Surgery, University of Chicago Medicine, Chicago, IL (Zakrison, Johnson)
| | - Gerard Vong
- Emory University, Center for Ethics, Atlanta, GA (Vong)
| | - Dwane A Johnson
- Trauma and Acute Care Surgery, University of Chicago Medicine, Chicago, IL (Zakrison, Johnson)
| | - Rishi Rattan
- Division of Trauma and Surgical Critical Care, University of Miami Miller School of Medicine, Miami, FL (Rattan)
| | - Dustin S Hanos
- Emory University School of Medicine, Grady Hospital, Atlanta, GA (Hanos, Smith)
| | - Randi N Smith
- Emory University School of Medicine, Grady Hospital, Atlanta, GA (Hanos, Smith)
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Vera L, Reed KK, Rose E, DeYampert L, Woodard J, Cortes J, Henry A, Thompson AN, Williams KN, Blount Q, Castater C, Schenker M, Smith RN. Prevalence of Housing Insecurity in Survivors of Traumatic Injury. Am Surg 2022; 88:2274-2279. [PMID: 35608389 DOI: 10.1177/00031348221101575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Almost 20% of the US population are housing insecure (HI) due to inadequate living conditions, imbalanced costs to income, nonsustainable shelter, or overcrowding. Housing insecure and physical trauma share similar risk factors, but their direct association is not well elucidated. The objective of our study was to determine the prevalence of HI in survivors of traumatic injury. METHODS We conducted a prospective cohort study at an urban, level 1 trauma center. A survey on social determinants of health was administered to adult patients, and demographic, injury specifics, and clinical outcomes data were collected. HI was defined by affirmative answers to questions related to history of homelessness or concern about sustainable shelter. The cohort was stratified by HI; groups were compared using the Mann-Whitney U and Fisher exact tests, as appropriate. RESULTS Of 116 study participants, four were excluded due to missing data. Of the 112, 42 (37.8%) reported HI and most were black (69%) males (73.8%). There were no demographic differences between groups. Conversely, HI patients had a higher rate of penetrating traumatic injury (34.1% vs 14.5%, P-value = .03) and were significantly less educated compared to secure participants (P-value = .03) [no degree (26.2% vs 10.3%), high school degrees (21.4% vs 41.2%)] with concomitant illicit drug use (63.4% vs 27.9%, P < .001), and history of addiction (52.4% vs 7.2%, P < .001). CONCLUSION HI far exceeds national averages in our cohort. Although difficult to ascertain a cause-effect relationship, HI may be a modifiable risk factor for trauma that negatively influences outcomes.
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Affiliation(s)
- Luis Vera
- 12239Emory University School of Medicine, Atlanta, GA, USA
| | | | - Elizabeth Rose
- 19911Eisenhower Army Medical Center, Fort Gordon, GA, USA
| | | | | | | | - Antonio Henry
- 25798Rollins School of Public Health, Atlanta, GA, USA
| | | | | | - Quinton Blount
- 12239Emory University School of Medicine, Atlanta, GA, USA
| | | | - Mara Schenker
- 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Randi N Smith
- 12239Emory University School of Medicine, Atlanta, GA, USA
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41
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Castater C, Raney E, Nguyen J, Reed KK, Thompson AN, Greene WR, Sola R, Grant AA, Sciarretta JD, Todd SR, Williams KN, Hurst S, Butler C, Udobi K, Ayoung-Chee P, Benjamin ER, Davis MA, Koganti D, Smith RN. Screening, Brief Intervention, and Referral to Treatment to Prevent Post-Traumatic Stress Disorder After Gunshot Wounds. Am Surg 2022; 88:2215-2217. [PMID: 35503305 DOI: 10.1177/00031348221091955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Screening, brief intervention, and referral to treatment (SBIRT) is an intervention originally developed to prevent and deter substance abuse. Adaptation of the SBIRT model to prevent post-traumatic stress disorder (PTSD) may potentially reduce acute stress symptoms after traumatic injury. We conducted a prospective randomized control study of adult patients admitted for gunshot wounds. Patients were randomized to intervention (INT) vs. treatment as usual (TAU) groups. INT received the newly developed SBIRT Intervention for Trauma Patients (SITP)-a 15-minute session with elements of cognitive behavioral therapy techniques. SITP took place during the index hospitalization; both groups had followup at 30 and 90 days at which time a validated PTSD screening tool, PCL-5, was administered. Most of the 46 participants were young (mean age = 30.5y), male (91.3%), and black (86.9%). At three-month follow-up, SBIRT and TAU patients had similar physical healing scores but the SBIRT arm showed reductions in PTSD symptoms.
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Affiliation(s)
| | - Emma Raney
- 12239Emory University School of Medicine, Atlanta, GA, USA
| | | | - Kendal K Reed
- 12239Emory University School of Medicine, Atlanta, GA, USA
| | | | - Wendy R Greene
- 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Richard Sola
- 1374Morehouse School of Medicine, Atlanta, GA, USA
| | - April A Grant
- 12239Emory University School of Medicine, Atlanta, GA, USA
| | | | - S Rob Todd
- 71741Grady Memorial Hospital, Atlanta, GA, USA
| | | | - Stuart Hurst
- 12239Emory University School of Medicine, Atlanta, GA, USA
| | | | - Khadi Udobi
- 1374Morehouse School of Medicine, Atlanta, GA, USA
| | | | | | | | | | - Randi N Smith
- 12239Emory University School of Medicine, Atlanta, GA, USA
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42
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Crichton ES, Manhan AJ, Wang Z, Woodard J, Thompson AN, Sheaffer K, Williams K, Schenker ML, Smith RN. The Potential Impact of Food Insecurity in an Urban Trauma Population. Am Surg 2022; 88:2045-2049. [PMID: 35487593 DOI: 10.1177/00031348221094217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Food insecurity (FI) has been defined as a lack of consistent access to enough food for a healthy active lifestyle. As of 12.7% of the United States are suffering from FI, which has been correlated with increased hospital costs and poorer health outcomes. Currently, limited data exists examining the relationship between trauma populations and FI despite both having similar root causes. We sought to determine this and validate a screening tool for FI in this population. METHODS A cross-sectional survey study of trauma patients was conducted at a level 1 trauma center in Atlanta, Georgia. Survey questions included the first two items of the Core Food Security Module. Zip codes were used to determine FI, defined by the USDA Food Access Research and compared to individual participant survey responses. Binary classification test metrics were calculated to validate the two items as a screening tool in this population. RESULTS The cohort included 136 patients, of which the majority were black (60.3%) and male (60.3%). Thirty-one respondents affirmed food security (22.8%) despite over half (51.5%) living in a food insecure community. The sensitivity and specificity for this screening to predict FI were 25 and 80%, respectively. CONCLUSION Although the specificity is high, this screening tool has a low sensitivity, accuracy, NPV, and PPV to determine food insecurity in this population. Community-level statistics suggests that food insecurity is a significant public problem amongst trauma patients. Prevention efforts should, therefore, aim to address both issues simultaneously.
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Affiliation(s)
| | | | - Zhensheng Wang
- 12239Emory University School of Medicine, Atlanta, GA, USA
| | | | | | | | | | | | - Randi N Smith
- 12239Emory University School of Medicine, Atlanta, GA, USA
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43
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Nguyen J, Bashan KA, Jiang C, Lin M, Tootla Y, Udobi K, Williams KN, Gelbard R, Nguyen CT, Sola R, Smith RN, Sciarretta JD, Butler C, Morse BC, Grant AA, Rhee P. Rectal Contrast CT Scans of Limited Utility in Diagnosing Colonic Injuries in Penetrating Trauma: A Meta-Analysis. Am Surg 2022:31348221086792. [PMID: 35437027 DOI: 10.1177/00031348221086792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Using rectal contrast computed tomography (CT) to identify traumatic colorectal injuries has become commonplace; however, these injuries remain relatively infrequent findings on CTs obtained for penetrating back and flank trauma. We conducted a meta-analysis to ascertain the efficacy of rectal contrast CT in identifying such injuries in victims penetrating injuries. METHODS PubMed and Embase were queried for relevant articles between 1974 and 2022. Review articles, case studies, and non-English manuscripts were excluded. Studies without descriptive CT and operative findings were excluded. Positive scans refer to rectal contrast extravasation. Sensitivity and specificity of rectal contrast CT scans were calculated with aggregated CT findings that were cross-referenced with laparotomy findings. RESULTS Only 8 manuscripts representing 506 patients quantified colorectal injuries and specified patients with rectal contrast extravasation. Seven patients with true colorectal injuries had no contrast extravasation on CT. There was one true positive scan. Another scan identified contrast extravasation, but laparotomy revealed no colorectal injury. Rectal contrast had sensitivity of 12.5%, specificity 99.8%, positive predictive value (PPV) 50%, negative predictive value (NPV) 99%, and a false negative rate of 88% in identifying colonic injuries. DISCUSSION The summation of 8 manuscripts suggest that the addition of rectal contrast in identifying colonic and rectal injuries may be of limited utility given its poor sensitivity and may be unnecessary. In its absence, subtle clues such as hematomas, extraluminal air, IV-dye extravasation, and trajectory may be additional indicators of injury. Further investigations are required to demonstrate a true benefit for the addition of rectal contrast.
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Affiliation(s)
- Jonathan Nguyen
- MSM Dept of Surgery, 1374Morehouse School of Medicine, Atlanta, GA, USA
| | | | - Cecilia Jiang
- Perelman School of Medicine at the 14640University of Pennsylvania, Philadelphia, PA, USA
| | - Mung Lin
- 12239Emory University School of Medicine, Atlanta, GA, USA
| | | | - Kahdi Udobi
- MSM Dept of Surgery, 1374Morehouse School of Medicine, Atlanta, GA, USA
| | | | - Rondi Gelbard
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Richard Sola
- MSM Dept of Surgery, 1374Morehouse School of Medicine, Atlanta, GA, USA
| | - Randi N Smith
- 12239Emory University School of Medicine, Atlanta, GA, USA
| | | | - Caroline Butler
- MSM Dept of Surgery, 1374Morehouse School of Medicine, Atlanta, GA, USA
| | | | - April A Grant
- 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Peter Rhee
- 497001Westchester Medical Center Medical Center, Valhalla NY, USA
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44
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Smith RN, Nyame-Mireku A, Zeidan A, Tabaie A, Meyer C, Muralidharan V, Kamaleswaran R, Williams K, Grant A, Nguyen J, Hurst S, Hanos D, Benjamin E, Sola R, Evans DP. Intimate Partner Violence at a Level-1 Trauma Center During the COVID-19 Pandemic: An Interrupted Time Series Analysis. Am Surg 2022; 88:1551-1553. [PMID: 35422131 PMCID: PMC9014330 DOI: 10.1177/00031348221083939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Risks of intimate partner violence (IPV) escalated during the COVID-19 pandemic given mitigation measures, socioeconomic hardships, and isolation concerns. The objective of this study was to explore the impact of COVID-19 on the incidence of IPV. We conducted an interrupted time series analysis for IPV incidence at a single level 1 trauma center located in the United States. IPV cases were identified by triangulation of institutional data sources. There were 4,624 traumatic injuries of which 292 (6.3%) were due to IPV. IPV-related injury admissions increased 17% in the weeks following the COVID lockdown (RR = 1.17; 95% CI: 1.16, 1.19). Over a quarter of victims (27.4%) were male. Compared to before COVID, victims of IPV during the pandemic were younger (p = .04); no difference in mechanism or severity of injury was found. Our results suggest an ongoing need for universal IPV screening during health emergencies to avoid missed opportunities for IPV detection and referral to support services.
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Affiliation(s)
- Randi N. Smith
- Emory University School of Medicine, Atlanta, GA, USA
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | | | - Amy Zeidan
- Emory University School of Medicine, Atlanta, GA, USA
| | - Azade Tabaie
- Emory University School of Medicine, Atlanta, GA, USA
| | | | | | | | | | - April Grant
- Emory University School of Medicine, Atlanta, GA, USA
| | | | - Stuart Hurst
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Dustin Hanos
- Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Dabney P. Evans
- Emory University Rollins School of Public Health, Atlanta, GA, USA
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Adler RR, Smith RN, Fowler KJ, Gates J, Jefferson NM, Adler JT, Patzer RE. Community Based Participatory Research (CBPR): An Underutilized Approach to Address Surgical Disparities. Ann Surg 2022; 275:496-499. [PMID: 34913903 DOI: 10.1097/sla.0000000000005329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/26/2022]
Abstract
Disparities are well-documented across the continuum of surgical care. Counteracting such disparities requires new multidisciplinary approaches that utilize the expertise of affected individuals, such as community-based participatory research (CBPR). CBPR is an approach to research that is anchored in equitable, sustainable community-academic partnerships, and has been shown to improve intervention implementation and outcomes. In this article, community stakeholders and researchers outline the principles and benefits of CBPR, examples of CBPR in trauma and transplant, and future directions for CBPR within surgery.
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Affiliation(s)
- Rachel R Adler
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Randi N Smith
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | | | | | | | - Joel T Adler
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX
| | - Rachel E Patzer
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
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46
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Tracy BM, Victor M, Smith RN, Hinrichs MJ, Gelbard RB. Examining the accuracy of the AM-PAC "6-clicks" at predicting discharge disposition in traumatic brain injury. Brain Inj 2022; 36:52-58. [PMID: 35113734 DOI: 10.1080/02699052.2022.2034967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To assess the accuracy of the AM-PAC "6-Clicks" in predicting discharge dispositions among severely injured patients with an acute traumatic brain injury (TBI). METHODS We performed a retrospective review of patients with a TBI who presented to our trauma center from 2016 through 2018 and received a "6-Clicks" assessment. Outcomes were hospital length of stay (LOS) and discharge disposition: home, inpatient rehabilitation facility (IRF), subacute location (SL), or death/hospice. Subgroup analyses evaluated patients with concomitant mobility-limiting injuries (CM-LI). RESULTS There were 432 patients with a TBI; 42.6% (n = 184) had CM-LI. CM-LI patients had lower "6-Clicks" scores compared to patients with an isolated TBI (9 vs 14, p < .0001) and a longer hospital LOS (16.5 d vs 9 d, p < .0001). Increasing "6-Clicks" scores were associated with a home discharge (OR 1.21, 95% CI 1.15-1.28, p < .0001) while decreasing scores were predictive of an IRF or SL discharge or death/hospice. Increasing scores correlated with decreasing hospital LOS for the cohort (β - 8.93, 95% CI -10.24 - -7.62, p < .0001). CONCLUSION Among patients with an acute TBI, increasing "6 Clicks" scores were associated with a shorter hospital LOS and greater likelihood of home discharge. Decreasing mobility scores correlated with discharge to an IRF, SL, and death/hospice.
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Affiliation(s)
- Brett M Tracy
- Department of Surgery, Division of Trauma, Critical Care, Burn, The Ohio State University Wexner Medical Center; Columbus, Ohio, USA
| | - Melissa Victor
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health; Atlanta, Georgia, USA
| | - Randi N Smith
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health; Atlanta, Georgia, USA.,Department of Surgery, Division of Acute Care Surgery at Grady Memorial Hospital; Atlanta, Emory University School of Medicine, Georgia, USA
| | - Mark J Hinrichs
- Department of Rehabilitation Medicine at Grady Memorial Hospital; Atlanta, Emory University School of Medicine, Georgia, USA
| | - Rondi B Gelbard
- Department of Surgery, Division of Acute Care Surgery; Birmingham, University of Alabama at Birmingham, AL, USA
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47
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Smith RN, Tracy BM, Smith S, Johnson S, Martin ND, Seamon MJ. Retained Bullets After Firearm Injury: A Survey on Surgeon Practice Patterns. J Interpers Violence 2022; 37:NP306-NP326. [PMID: 32370593 DOI: 10.1177/0886260520914557] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Retained bullets are common after firearm injuries, yet their management remains poorly defined. Surgeon members of the Eastern Association for the Surgery of Trauma (N = 427) were surveyed using an anonymous, web-based questionnaire during Spring 2016. Indications for bullet removal and practice patterns surrounding this theme were queried. Also, habits around screening and diagnosing psychological illness in victims of firearm injury were asked. Most respondents were male (76.5%, n = 327) and practiced at urban (84.3%, n = 360), academic (88.3%, n = 377), Level 1 trauma centers (72.8%, n = 311). Only 14.5% (n = 62) of surgeons had institutional policies for bullet removal and 5.6% (n = 24) were likely to remove bullets. Half of the surgeons (52.0%, n = 222) preferred to remove bullets after the index hospitalization and pain (88.1%, n = 376) and a palpable bullet (71.2%, n = 304) were the most frequent indications for removal. Having the opportunity to follow-up with patients to discuss bullet removal was significantly predictive of removal (odds ratio (OR) = 2.25, 95% confidence interval (CI) = [1.05, 4.85], p = .04). Furthermore, routinely asking about retained bullets during outpatient follow-up was predictive of new psychological illness screening (OR = 1.94, 95% CI [1.19, 3.16], p = .01) and diagnosis (OR = 1.86, 95% CI = [1.12, 3.09], p = .02) in victims of firearm injury. Thus, surgeons should be encouraged to allot time for patients concerning retained bullet management so that a shared decision can be reached.
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Affiliation(s)
- Randi N Smith
- Emory University School of Medicine, Atlanta, GA, USA
| | - Brett M Tracy
- Emory University School of Medicine, Atlanta, GA, USA
| | | | - Sean Johnson
- University of Pennsylvania, Philadelphia, PA, USA
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48
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Castater C, Hazen B, Barrett GS, Davis C, Butler C, Ramos C, Smith RN. Femoral-Femoral Bypass for Limb Salvage to Correct Common Iliac Occlusion after Lower Extremity Trauma. Am Surg 2021; 88:981-983. [PMID: 34855530 DOI: 10.1177/00031348211058634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Roadway injuries are a leading cause of lower extremity vascular trauma. Treating these injuries involves controlling life-threatening hemorrhage and restoring distal perfusion. MATERIALS AND METHODS We describe a unique presentation of chronic iliac artery occlusion in the setting of blunt trauma requiring extra-anatomic bypass for maximal limb salvage. RESULTS A 50-year-old male presented after a pedestrian versus auto accident. He had mangled bilateral lower extremities and was taken emergently for lower extremity amputations. He was found to have chronic left common iliac occlusion and a femoral-femoral bypass was performed to assist with healing his left below-the-knee amputation. DISCUSSION Lack of adequate perfusion can cause poor outcomes in limb salvage. This case demonstrated that lower extremity trauma can be complicated by chronic vascular disease. Reperfusion and adequate wound healing can be accomplished by using bypass grafting after more traditional reperfusion techniques fail.
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Affiliation(s)
- Christine Castater
- Grady Memorial Hospital, Atlanta, GA, USA.,1371Emory University School of Medicine, Atlanta, GA, USA
| | - Ben Hazen
- Grady Memorial Hospital, Atlanta, GA, USA.,1371Emory University School of Medicine, Atlanta, GA, USA
| | - G Stewart Barrett
- Grady Memorial Hospital, Atlanta, GA, USA.,Morehouse School of Medicine, Atlanta, GA, USA
| | - Carolyn Davis
- Grady Memorial Hospital, Atlanta, GA, USA.,1371Emory University School of Medicine, Atlanta, GA, USA
| | - Caroline Butler
- Grady Memorial Hospital, Atlanta, GA, USA.,Morehouse School of Medicine, Atlanta, GA, USA
| | - Christopher Ramos
- Grady Memorial Hospital, Atlanta, GA, USA.,1371Emory University School of Medicine, Atlanta, GA, USA
| | - Randi N Smith
- Grady Memorial Hospital, Atlanta, GA, USA.,1371Emory University School of Medicine, Atlanta, GA, USA
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49
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Amin D, Manhan AJ, Smith RN, Roser SM, Abramowicz S. Frequency of Firearm Injuries to Head and Neck Increased During Covid-19 Pandemic. J Oral Maxillofac Surg 2021; 79:2299-2305. [PMID: 34756303 PMCID: PMC8554223 DOI: 10.1016/j.joms.2021.06.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/30/2021] [Accepted: 06/30/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE During coronavirus disease-19 (COVID-19) pandemic, hospitals faced challenges which were different than previous years. The purpose this study was to report frequency of firearm injuries (FI) to head and neck during the COVID-19 pandemic. MATERIALS AND METHODS This cross-sectional study reviewed patients in the Trauma Registry at Grady Memorial Hospital (GMH) in Atlanta, GA. Patients were included if they sustained FI to head and neck, were listed in TR, and were treated at GMH. Patients were stratified according to date of injury into 1) before COVID-19 pandemic, (BC19) or 2) during initial 5 months of COVID-19 pandemic, (C19). Variables were patient demographics, illegal substance use, etiology, place of injury, distressed communities index, location of injury, Glasgow Coma scale on arrival, cardiopulmonary resuscitation in Emergency Department (ED), shock on admission, disposition from ED, length of stay, days on mechanical ventilation and discharge status. Descriptive, univariate, and bivariate analysis were completed. Chi square test was used for categorical variables. Statistical significance was P < .05. RESULTS There were 215 patients who met inclusion criteria. There were 96 patients (78 males) with a mean age of 31.5 years old during BC19. There were 119 patients (101 males) with a mean age 32.7 years old during C19. There was a 10.4% increase in FI to head and neck during COVID-19. Our data showed that alcohol use was associated with FI during C19 (P≤ .0001). FI to base of skull occurred 34.5% more often during C19 (P = .002). Cranial injuries occurred 26% more often during BC19 (P = .03). During BC19, 85.4% of the patients arrived alive to GMH, but only 16% arrived alive during C19 (P ≤ .0001). CONCLUSIONS There were more FI to head and neck during COVID-10 pandemic than during the previous time period.
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Affiliation(s)
- Dina Amin
- Assistant Professor in Oral and Maxillofacial Surgery, Emory University School of Medicine; Director of Oral and Maxillofacial Surgery Outpatient Clinic, Grady Memorial Hospital, Atlanta, GA,Address correspondence and reprint requests to Dr. Amin, Emory University, School of Medicine, 1365 Clifton Road NE, Building B, Suite 2300, Atlanta, GA 30322
| | - Andrew J. Manhan
- Medical Student Researcher, Department of Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA
| | - Randi N. Smith
- Assistant Professor of Surgery, Emory University School of Medicine; Assistant Professor of Public Health, Emory University Rollins School of Public Health, Atlanta, GA
| | - Steven M. Roser
- DeLos Hill Chair and Professor of Surgery, Department of Surgery, Emory University School of Medicine Emory University; Chief of Oral and Maxillofacial Surgery, Grady Memorial Hospital, Atlanta, GA
| | - Shelly Abramowicz
- Associate Professor in Oral and Maxillofacial Surgery and Pediatrics, Emory University School of Medicine; Chief of Oral and Maxillofacial Surgery, Children's Healthcare of Atlanta, Atlanta, GA
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Melmer PD, Clatterbuck B, Parker V, Castater CA, Klingensmith NJ, Ramos CR, Busby S, Hurst SD, Koganti D, Williams KN, Grant AA, Smith RN, Benarroch-Gampel J, Dente CJ, Rajani RR, Todd SR, Sciarretta JD. Superior Mesenteric Artery and Vein Injuries: Operative Strategies and Outcomes. Vasc Endovascular Surg 2021; 56:40-48. [PMID: 34533371 DOI: 10.1177/15385744211042491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Traumatic injuries to the mesenteric vessels are rare and often lethal. Visceral vessels, such as the superior mesenteric artery (SMA) and vein (SMV), supply blood to the small and large bowel by a rich system of collaterals. Because fewer than 100 such injuries have been described in the literature, they pose challenges in both diagnosis and management and can unfortunately result in high mortality rates. Prompt diagnosis, surgical intervention, and resuscitation can lead to improved outcomes. Here, we review the literature surrounding traumatic injuries of the SMA/SMV and discuss management strategies.
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Affiliation(s)
- Patrick D Melmer
- Grand Strand Medical Center, University of South Carolina, Myrtle Beach, SC, USA
| | - Brant Clatterbuck
- Emory University School of Medicine, Marcus Trauma Center, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | | | - Christine A Castater
- Emory University School of Medicine, Marcus Trauma Center, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Nathan J Klingensmith
- Emory University School of Medicine, Marcus Trauma Center, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Christopher R Ramos
- Emory University School of Medicine, Marcus Trauma Center, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Stephanie Busby
- Emory University School of Medicine, Marcus Trauma Center, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Stuart D Hurst
- Emory University School of Medicine, Marcus Trauma Center, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Deepika Koganti
- Emory University School of Medicine, Marcus Trauma Center, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Keneesha N Williams
- Emory University School of Medicine, Marcus Trauma Center, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - April A Grant
- Emory University School of Medicine, Marcus Trauma Center, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Randi N Smith
- Emory University School of Medicine, Marcus Trauma Center, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Jaime Benarroch-Gampel
- Emory University School of Medicine, Marcus Trauma Center, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Christopher J Dente
- Emory University School of Medicine, Marcus Trauma Center, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Ravi R Rajani
- Emory University School of Medicine, Marcus Trauma Center, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Samual R Todd
- Emory University School of Medicine, Marcus Trauma Center, 71741Grady Memorial Hospital, Atlanta, GA, USA
| | - Jason D Sciarretta
- Emory University School of Medicine, Marcus Trauma Center, 71741Grady Memorial Hospital, Atlanta, GA, USA
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