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Fernandez L, Baptiste RC, Bjorklund R, Alkhatib A, Sheriff N, Sanchez C, Obst MA, Swindall R. The clinical application of incisional negative pressure wound therapy in severe subcutaneous emphysema: A case series. Trauma Case Rep 2024; 51:101026. [PMID: 38618148 PMCID: PMC11011215 DOI: 10.1016/j.tcr.2024.101026] [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: 04/06/2024] [Indexed: 04/16/2024] Open
Abstract
Severe subcutaneous emphysema (SSE) is the presence of a high-volume accumulation of air in the subcutaneous tissue caused by traumatic injuries, infections, iatrogenic causes, or can also manifest spontaneously. A variety of techniques have been reported, with varying levels of success. We present a multicenter case series detailing four patients who developed SSE and were treated with Incisional Negative Pressure Wound Therapy (INPWT). All patients significantly improved with the INPWT treatment within 6 to 48 h. Our experience suggests INPWT is a valuable procedure available for treating SSE and recommend prospective randomized studies be conducted to determine targeted patient selection and clinical application of INPWT among the SSE patient population.
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Affiliation(s)
- Luis Fernandez
- Department of Surgery, UT Health East Texas, 1000 S Beckham, Tyler, TX 75701, USA
| | - Reginald Carl Baptiste
- Cardiothoracic Surgery, CHRISTUS St. Michael Hospital, 2600 St. Michael Dr., Texarkana, TX 75503, USA
| | - Rebekah Bjorklund
- General Surgery Resident, University of Texas Health Science Center at Tyler, 11937 U.S. Highway 271, Tyler, TX 75708, USA
| | - Ala'a Alkhatib
- General Surgery Resident, University of Texas Health Science Center at Tyler, 11937 U.S. Highway 271, Tyler, TX 75708, USA
| | - Nesiya Sheriff
- University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, USA
| | - Claudia Sanchez
- University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, USA
| | - Mary Anne Obst
- Regions Hospital, 640 Jackson St, Saint Paul, MN 55101, USA
| | - Rebecca Swindall
- Department of Surgery, UT Health East Texas, 1000 S Beckham, Tyler, TX 75701, USA
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Cook A, Swindall R, Spencer K, Wadle C, Cage SA, Mohiuddin M, Desai Y, Norwood S. Hospitalization and readmission after single-level fall: a population-based sample. Inj Epidemiol 2023; 10:49. [PMID: 37858271 PMCID: PMC10588028 DOI: 10.1186/s40621-023-00463-4] [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: 06/15/2023] [Accepted: 10/08/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Single-level falls (SLFs) in the older US population is a leading cause of hospital admission and rates are increasing. Unscheduled hospital readmission is regarded as a quality-of-care indication and a preventable burden on healthcare systems. We aimed to characterize the predictors of 30-day readmission following admission for SLF injuries among patients 65 years and older. METHODS We conducted a retrospective cohort study using the Nationwide Readmission Database from 2018 to 2019. Included patients were 65 and older, admitted emergently following a SLF with a primary injury diagnosis. Hierarchical logit regression was used to model factors associated with readmission within 30 days of discharge. RESULTS Of 1,338,905 trauma patients, 65 years or older, 61.3% had a single-level fall as the mechanism of injury. Among fallers, the average age was 81.1 years and 68.5% were female. SLF patients underwent more major therapeutic procedures (56.3% vs. 48.2%), spent over 2 million days in the hospital and incurred total charges of over $28 billion annually. Over 11% of SLF patients were readmitted within 30 days of discharge. Increasing income had a modest effect, where the highest zip code quartile was 9% less likely to be readmitted. Decreasing population density had a protective effect of readmission of 16%, comparing Non-Urban to Large Metropolitan. Transfer to short-term hospital, brain and vascular injuries were independent predictors of 30-day readmission in multivariable analysis (OR 2.50, 1.31, and 1.42, respectively). Palliative care consultation was protective (OR 0.41). The subsequent hospitalizations among those 30-day readmissions were primarily emergent (92.9%), consumed 260,876 hospital days and a total of $2.75 billion annually. CONCLUSIONS SLFs exact costs to patients, health systems, and society. Transfer to short-term hospitals at discharge, along with brain and vascular injuries were strong predictors of 30-day readmission and warrant mitigation strategy development with consideration of expanded palliative care consultation.
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Affiliation(s)
- Alan Cook
- Trauma Services, UT Health East Texas, 1020 E. Idel St., Tyler, TX, 75701, USA
| | - Rebecca Swindall
- Department of Epidemiology and Biostatistics, The University of Texas Health Science Center at Tyler, 11937 US Highway 271, Room H252, Tyler, TX, 75708, USA
| | - Katherine Spencer
- CHRISTUS Health-Texas A&M Spohn Emergency Medicine Residency, Texas A&M University-Corpus Christi, 600 Elizabeth Street, 9B, Corpus Christi, TX, 78404, USA
| | - Carly Wadle
- Department of Epidemiology and Biostatistics, The University of Texas Health Science Center at Tyler, 11937 US Highway 271, Room H252, Tyler, TX, 75708, USA
| | - S Andrew Cage
- Department of Sports Medicine, The University of Texas at Tyler, 3900 University Blvd., Tyler, TX, 75799, USA
| | - Musharaf Mohiuddin
- Department of Epidemiology and Biostatistics, The University of Texas Health Science Center at Tyler, 11937 US Highway 271, Room H252, Tyler, TX, 75708, USA.
| | - Yagnesh Desai
- Department of Emergency Medicine, UT Health East Texas, 1000 S. Beckham Ave., Tyler, TX, 75701, USA
| | - Scott Norwood
- Trauma Services, UT Health East Texas, 1020 E. Idel St., Tyler, TX, 75701, USA
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Fernandez LG, Norwood SH, Orsi C, Heck M, Gonzalez K, Williams N, Matthews MR, Scalea TM, Swindall R. Use of a Modified ABTHERA ADVANCE™ Open Abdomen Dressing with Intrathoracic Negative-Pressure Therapy for Temporary Chest Closure After Damage Control Thoracotomy. Am J Case Rep 2022; 23:e937207. [PMID: 36153642 PMCID: PMC9520634 DOI: 10.12659/ajcr.937207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Case series
Patient: Male, 33-year-old • Male, 51-year-old
Final Diagnosis: Cardio thoracic trauma
Symptoms: Hemorrhagic shock
Medication: —
Clinical Procedure: Intrathoracic negative pressure therapy • thoracotomy
Specialty: Biotechnology • Cardiac Surgery • Critical Care Medicine • Surgery
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Affiliation(s)
| | | | - Carolina Orsi
- Department of Surgery, University of Texas Health Science Center, Tyler, USA, TX
| | - Marvin Heck
- Department of Surgery, University of Texas Health Science Center, Tyler, USA, TX
| | - Katherine Gonzalez
- School of Medicine, The University of Texas Medical Branch, Galveston, USA, TX
| | | | - Marc R. Matthews
- Burn Emergency Services, Respiratory Care Services, Arizona Burn Center, Maricopa Medical Center, University of Arizona College of Medicine, Phoenix, USA, AZ
| | - Thomas M. Scalea
- University of Maryland School of Medicine, University of Maryland Medical Center, Baltimore, USA, MD
| | - Rebecca Swindall
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center, Tyler, USA, TX
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Swindall R, Roden-Forman JW, Conflitti J, Cook A, Wadle C, Boyle J, Ward J, Gross B, Rogers F, Le TD, Norwood S. Elderly trauma associated with high-risk recreational activity: A population-based study, United States, 2010 through 2016. Surgery 2021; 171:1677-1686. [PMID: 34955287 DOI: 10.1016/j.surg.2021.11.014] [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: 08/26/2021] [Revised: 10/26/2021] [Accepted: 11/16/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Understanding trends in prevalence and etiology is critical to public health strategies for prevention and management of injury related to high-risk recreation in elderly Americans. METHODS The National Emergency Department Sample from 2010 through 2016 was queried for patients with a principal diagnosis of trauma (ICD-9 codes 800.0-959.9) and who were 55 years and older. High-risk recreation was determined from e-codes a priori. Primary outcome measures were mortality and total hospital charges. RESULTS Of the 29,491,352 patient cohort, 458,599 (1.56%) engaged in high-risk activity, including those age 85 and older. High-risk cases were younger (median age 61 vs 70) and majority male (71.87% vs 39.24%). The most frequent activities were pedal cycling (45.81%), motorcycling (29.08%), and off-road vehicles (9.13%). Brain injuries (8.82% vs 3.88%), rib/sternal fractures (13.35% vs 3.53%), and cardiopulmonary injury (5.25% vs 0.57%) were more common among high-risk cases. Mortality (0.75% vs 0.40%) and total median hospital charges ($3,360 vs $2,312) were also higher for high-risk admissions, where the odds of mortality increased exponentially per year of age (odds ratio, 1.06; 99.5% CI, 1.05-1.08). High-risk recreation was associated with more than $1 billion in total hospital charges and more than 100 deaths among elderly Americans per year. CONCLUSION Morbidity, mortality, and resource utilization due to high-risk recreation extend into the ninth decade of life. The patterns of injury described here offer opportunities for targeted injury prevention education to minimize risk among this growing segment of the United States population.
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Affiliation(s)
- Rebecca Swindall
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center Tyler, TX.
| | - Jacob W Roden-Forman
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center Tyler, TX
| | - Joseph Conflitti
- Department of Surgery, Trauma Program, UT Health East Texas, Tyler, TX
| | - Alan Cook
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center Tyler, TX
| | - Carly Wadle
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center Tyler, TX
| | - Julianna Boyle
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center Tyler, TX
| | - Jeanette Ward
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
| | - Brian Gross
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
| | - Fred Rogers
- Department of Surgery, University of Vermont College of Medicine, Burlington, VT
| | - Tuan D Le
- United States Army Institute of Surgical Research, Fort Sam Houston, TX
| | - Scott Norwood
- Department of Surgery, Trauma Program, UT Health East Texas, Tyler, TX
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