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Awad KG, Nahmias J, Aryan N, Lucas AN, Fierro N, Dhillon NK, Ley EJ, Smith J, Burruss S, Dahan A, Johnson A, Ganske W, Biffl WL, Bayat D, Castelo M, Wintz D, Schaffer KB, Zheng DJ, Tillou A, Coimbra R, Tuli R, Santorelli JE, Emigh B, Schellenberg M, Inaba K, Duncan TK, Diaz G, Tay-Lasso E, Zezoff DC, Grigorian A. Outcomes of severely injured pregnant trauma patients: a multicenter analysis. Updates Surg 2024:10.1007/s13304-024-01817-3. [PMID: 38554224 DOI: 10.1007/s13304-024-01817-3] [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: 12/18/2023] [Accepted: 03/04/2024] [Indexed: 04/01/2024]
Abstract
Nearly 10% of pregnant women suffer traumatic injury. Clinical outcomes for pregnant trauma patients (PTPs) with severe injuries have not been well studied. We sought to describe outcomes for PTPs presenting with severe injuries, hypothesizing that PTPs with severe injuries will have higher rates of complications and mortality compared to less injured PTPs. A post-hoc analysis of a multi-institutional retrospective study at 12 Level-I/II trauma centers was performed. Patients were stratified into severely injured (injury severity score [ISS] > 15) and not severely injured (ISS < 15) and compared with bivariate analyses. From 950 patients, 32 (3.4%) had severe injuries. Compared to non-severely injured PTPs, severely injured PTPs were of similar maternal age but had younger gestational age (21 vs 26 weeks, p = 0.009). Penetrating trauma was more common in the severely injured cohort (15.6% vs 1.4%, p < 0.001). The severely injured cohort more often underwent an operation (68.8% vs 3.8%, p < 0.001), including a hysterectomy (6.3% vs 0.3%, p < 0.001). The severely injured group had higher rates of complications (34.4% vs 0.9%, p < 0.001), mortality (15.6% vs 0.1%, p < 0.001), a higher rate of fetal delivery (37.5% vs. 6.0%, p < 0.001) and resuscitative hysterotomy (9.4% vs. 0%, p < 0.001). Only approximately 3% of PTPs were severely injured. However, severely injured PTPs had a nearly 40% rate of fetal delivery as well as increased complications and mortality. This included a resuscitative hysterotomy rate of nearly 10%. Significant vigilance must remain when caring for this population.
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Affiliation(s)
- Kyrillos G Awad
- Department of Surgery, Desert Regional Medical Center, Palm Springs, CA, USA
| | - Jeffry Nahmias
- Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
| | - Negaar Aryan
- Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
| | - Alexa N Lucas
- Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
| | - Nicole Fierro
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Navpreet K Dhillon
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Eric J Ley
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jennifer Smith
- Division of Trauma and Critical Care, Harbor-UCLA Hospital, Torrance, CA, USA
| | - Sigrid Burruss
- Division of Trauma and Critical Care, Harbor-UCLA Hospital, Torrance, CA, USA
| | - Alden Dahan
- Department of Trauma, Acute Care Surgery, Surgical Critical Care, Loma Linda Medical Center, Loma Linda, CA, USA
| | - Arianne Johnson
- Cottage Health Research Institute, Santa Barbara Cottage Hospital, Santa Barbara, CA, USA
| | - William Ganske
- Cottage Health Research Institute, Santa Barbara Cottage Hospital, Santa Barbara, CA, USA
| | - Walter L Biffl
- Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, CA, USA
| | - Dunya Bayat
- Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, CA, USA
| | - Matthew Castelo
- Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, CA, USA
| | - Diane Wintz
- Department of Surgery, Sharp Memorial Hospital, San Diego, CA, USA
| | | | - Dennis J Zheng
- Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Areti Tillou
- Riverside University Health System Medical Center, Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Moreno Valley, CA, USA
| | - Raul Coimbra
- Riverside University Health System Medical Center, Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Moreno Valley, CA, USA
| | - Rahul Tuli
- Riverside University Health System Medical Center, Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Moreno Valley, CA, USA
| | - Jarrett E Santorelli
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, San Diego School of Medicine, University of California, San Diego, CA, USA
| | - Brent Emigh
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Morgan Schellenberg
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA
| | - Kenji Inaba
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA
| | - Thomas K Duncan
- Department of Trauma, Ventura County Medical Center, Ventura, CA, USA
| | - Graal Diaz
- Department of Trauma, Ventura County Medical Center, Ventura, CA, USA
| | - Erika Tay-Lasso
- Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
| | - Danielle C Zezoff
- Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA
| | - Areg Grigorian
- Division of Trauma, Burns, and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA.
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Lucas AN, Tay-Lasso E, Zezoff DC, Fierro N, Dhillon NK, Ley EJ, Smith J, Burruss S, Dahan A, Johnson A, Ganske W, Biffl WL, Bayat D, Castelo M, Wintz D, Schaffer KB, Zheng DJ, Tillou A, Coimbra R, Tuli R, Santorelli JE, Emigh B, Schellenberg M, Inaba K, Duncan TK, Diaz G, Kirby KA, Nahmias J. Significant variation in computed tomography imaging of pregnant trauma patients: a retrospective multicenter study. Emerg Radiol 2024; 31:53-61. [PMID: 38150084 PMCID: PMC10830714 DOI: 10.1007/s10140-023-02195-w] [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: 10/11/2023] [Accepted: 12/08/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE Following motor vehicle collisions (MVCs), patients often undergo extensive computed tomography (CT) imaging. However, pregnant trauma patients (PTPs) represent a unique population where the risk of fetal radiation may supersede the benefits of liberal CT imaging. This study sought to evaluate imaging practices for PTPs, hypothesizing variability in CT imaging among trauma centers. If demonstrated, this might suggest the need to develop specific guidelines to standardize practice. METHODS A multicenter retrospective study (2016-2021) was performed at 12 Level-I/II trauma centers. Adult (≥18 years old) PTPs involved in MVCs were included, with no patients excluded. The primary outcome was the frequency of CT. Chi-square tests were used to compare categorical variables, and ANOVA was used to compare the means of normally distributed continuous variables. RESULTS A total of 729 PTPs sustained MVCs (73% at high speed of ≥ 25 miles per hour). Most patients were mildly injured but a small variation of injury severity score (range 1.1-4.6, p < 0.001) among centers was observed. There was a variation of imaging rates for CT head (range 11.8-62.5%, p < 0.001), cervical spine (11.8-75%, p < 0.001), chest (4.4-50.2%, p < 0.001), and abdomen/pelvis (0-57.3%, p < 0.001). In high-speed MVCs, there was variation for CT head (12.5-64.3%, p < 0.001), cervical spine (16.7-75%, p < 0.001), chest (5.9-83.3%, p < 0.001), and abdomen/pelvis (0-60%, p < 0.001). There was no difference in mortality (0-2.9%, p =0.19). CONCLUSION Significant variability of CT imaging in PTPs after MVCs was demonstrated across 12 trauma centers, supporting the need for standardization of CT imaging for PTPs to reduce unnecessary radiation exposure while ensuring optimal injury identification is achieved.
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Affiliation(s)
- Alexa N Lucas
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Erika Tay-Lasso
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 3800 W. Chapman Ave., Suite 6200, Orange, CA, 92868, USA
| | - Danielle C Zezoff
- Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA
| | - Nicole Fierro
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Navpreet K Dhillon
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Eric J Ley
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jennifer Smith
- Division of Trauma and Critical Care, Harbor-UCLA Hospital, Torrance, CA, USA
| | - Sigrid Burruss
- Department of Trauma, Acute Care Surgery, Surgical Critical Care, Loma Linda Medical Center, Loma Linda, CA, USA
| | - Alden Dahan
- Riverside School of Medicine, University of California, Riverside, CA, USA
| | - Arianne Johnson
- Cottage Health Research Institute, Santa Barbara Cottage Hospital, Santa Barbara, CA, USA
| | - William Ganske
- Cottage Health Research Institute, Santa Barbara Cottage Hospital, Santa Barbara, CA, USA
| | - Walter L Biffl
- Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA, USA
| | - Dunya Bayat
- Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA, USA
| | - Matthew Castelo
- Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA, USA
| | - Diane Wintz
- Department of Surgery, Sharp Memorial Hospital, San Diego, CA, USA
| | | | - Dennis J Zheng
- Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Areti Tillou
- Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Raul Coimbra
- Comparative Effectiveness and Clinical Outcomes Research Center (CECORC), Riverside University Health System Medical Center, Riverside, CA, USA
| | - Rahul Tuli
- Comparative Effectiveness and Clinical Outcomes Research Center (CECORC), Riverside University Health System Medical Center, Riverside, CA, USA
| | - Jarrett E Santorelli
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Brent Emigh
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA
| | - Morgan Schellenberg
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA
| | - Kenji Inaba
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA
| | - Thomas K Duncan
- Department of Trauma, Ventura County Medical Center, Ventura, CA, USA
| | - Graal Diaz
- Department of Trauma, Ventura County Medical Center, Ventura, CA, USA
| | - Katharine A Kirby
- Center for Statistical Consulting, Department of Statistics, University of California Irvine, Irvine, CA, USA
| | - Jeffry Nahmias
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, 3800 W. Chapman Ave., Suite 6200, Orange, CA, 92868, USA.
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Santos JW, Grigorian A, Lucas AN, Fierro N, Dhillon NK, Ley EJ, Smith J, Burruss S, Dahan A, Johnson A, Ganske W, Biffl WL, Bayat D, Castelo M, Wintz D, Schaffer KB, Zheng DJ, Tillou A, Coimbra R, Tuli R, Santorelli JE, Emigh B, Schellenberg M, Inaba K, Duncan TK, Diaz G, Tay-Lasso E, Zezoff DC, Nahmias J. Predictors of fetal delivery in pregnant trauma patients: A multicenter study. J Trauma Acute Care Surg 2024; 96:109-115. [PMID: 37580875 DOI: 10.1097/ta.0000000000003964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
BACKGROUND Pregnant trauma patients (PTPs) undergo observation and fetal monitoring following trauma due to possible fetal delivery (FD) or adverse outcome. There is a paucity of data on PTP outcomes, especially related to risk factors for FD. We aimed to identify predictors of posttraumatic FD in potentially viable pregnancies. METHODS All PTPs (≥18 years) with ≥24-weeks gestational age were included in this multicenter retrospective study at 12 Level-I and II trauma centers between 2016 and 2021. Pregnant trauma patients who underwent FD ((+) FD) were compared to those who did not deliver ((-) FD) during the index hospitalization. Univariate analyses and multivariable logistic regression were performed to identify predictors of FD. RESULTS Of 591 PTPs, 63 (10.7%) underwent FD, with 4 (6.3%) maternal deaths. The (+) FD group was similar in maternal age (27 vs. 28 years, p = 0.310) but had older gestational age (37 vs. 30 weeks, p < 0.001) and higher mean injury severity score (7.0 vs. 1.5, p < 0.001) compared with the (-) FD group. The (+) FD group had higher rates of vaginal bleeding (6.3% vs. 1.1%, p = 0.002), uterine contractions (46% vs. 23.5%, p < 0.001), and abnormal fetal heart tracing (54.7% vs. 14.6%, p < 0.001). On multivariate analysis, independent predictors for (+) FD included abdominal injury (odds ratio [OR], 4.07; confidence interval [CI], 1.11-15.02; p = 0.035), gestational age (OR, 1.68 per week ≥24 weeks; CI, 1.44-1.95; p < 0.001), abnormal FHT (OR, 12.72; CI, 5.19-31.17; p < 0.001), and premature rupture of membranes (OR, 35.97; CI, 7.28-177.74; p < 0.001). CONCLUSION The FD rate was approximately 10% for PTPs with viable fetal gestational age. Independent risk factors for (+) FD included maternal and fetal factors, many of which are available on initial trauma bay evaluation. These risk factors may help predict FD in the trauma setting and shape future guidelines regarding the recommended observation of PTPs. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
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Affiliation(s)
- Jeffrey W Santos
- From the Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, (J.W.S., A.G., A.N.L., E.T.-L., D.C.Z., J.N.), University of California, Irvine, Orange; Department of Surgery (N.F., N.K.D., E.J.L.), Cedars-Sinai Medical Center, Los Angeles; Division of Trauma and Critical Care (J.S.), Harbor-UCLA Hospital, Torrance; Department of Trauma, Acute Care Surgery, Surgical Critical Care (S.B.), Loma Linda Medical Center, Loma Linda; Riverside School of Medicine (A.D.), University of California, Riverside; Cottage Health Research Institute (A.J., W.G.), Santa Barbara Cottage Hospital, Santa Barbara; Trauma and Acute Care Surgery, Scripps Memorial Hospital (W.L.B., D.B., M.C.), La Jolla; Department of Surgery (D.W., K.B.S.), Sharp Memorial Hospital, San Diego; Department of Surgery (D.J.Z., A.T.), UCLA David Geffen School of Medicine, Los Angeles; Department of Surgery, Comparative Effectiveness and Clinical Outcomes Research Center-CECORC (R.C., R.T.), Riverside University Health System Medical Center, Moreno Valley; Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery (J.E.S.), University of California San Diego School of Medicine, San Diego; Division of Acute Care Surgery (B.E., M.S., K.I.), LAC+USC Medical Center, University of Southern California, Los Angeles; and Department of Trauma (T.K.D., G.D.), Ventura County Medical Center, Ventura, California
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4
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Manasa M, Yeates EO, Grigorian A, Barrios C, Schellenberg M, Owattanapanich N, Barmparas G, Margulies D, Juillard C, Garber K, Cryer H, Tillou A, Burruss S, Penaloza-Villalobos L, Lin A, Figueras RA, Coimbra R, Brenner M, Costantini T, Santorelli J, Curry T, Wintz D, Biffl WL, Schaffer KB, Duncan TK, Barbaro C, Diaz G, Johnson A, Tay-Lasso E, Chinn J, Naaseh A, Leung A, Grabar C, Nahmias J. The Effect of 2019 Coronavirus Stay-at-Home Order on Geriatric Trauma Patients in Southern California. Am Surg 2023; 89:6053-6059. [PMID: 37347234 DOI: 10.1177/00031348221124329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
BACKGROUND California issued stay-at-home (SAH) orders to mitigate COVID-19 spread. Previous studies demonstrated a shift in mechanisms of injuries (MOIs) and decreased length of stay (LOS) for the general trauma population after SAH orders. This study aimed to evaluate the effects of SAH orders on geriatric trauma patients (GTPs), hypothesizing decreased motor vehicle collisions (MVCs) and LOS. METHODS A post-hoc analysis of GTPs (≥65 years old) from 11 level-I/II trauma centers was performed, stratifying patients into 3 groups: before SAH (1/1/2020-3/18/2020) (PRE), after SAH (3/19/2020-6/30/2020) (POST), and a historical control (3/19/2019-6/30/2019) (CONTROL). Bivariate comparisons were performed. RESULTS 5486 GTPs were included (PRE-1756; POST-1706; CONTROL-2024). POST had a decreased rate of MVCs (7.6% vs 10.6%, P = .001; vs 11.9%, P < .001) and pedestrian struck (3.4% vs 5.8%, P = .001; vs 5.2%, P = .006) compared with PRE and CONTROL. Other mechanisms of injury, LOS, mortality, and operations performed were similar between cohorts. However, POST had a lower rate of discharge to skilled nursing facility (SNF) (20% vs 24.5%, P = .001; and 20% vs 24.4%, P = .001). CONCLUSION This retrospective multicenter study demonstrated lower rates of MVCs and pedestrian struck for GTPs, which may be explained by decreased population movement as a result of SAH orders. Contrary to previous studies on the generalized adult population, no differences in other MOIs and LOS were observed after SAH orders. However, there was a lower rate of discharge to SNF, which may be related to a lack of resources due to the COVID-19 pandemic, and thus potentially negatively impacted recovery of GTPs.Keywords.
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Affiliation(s)
- Morgan Manasa
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
| | - Eric O Yeates
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
| | - Areg Grigorian
- Department of Surgery, University of Southern California (USC), Los Angeles, CA, USA
| | - Cristobal Barrios
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
| | - Morgan Schellenberg
- Department of Surgery, University of Southern California (USC), Los Angeles, CA, USA
| | | | - Galinos Barmparas
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel Margulies
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Catherine Juillard
- Department of Surgery, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Kent Garber
- Department of Surgery, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Henry Cryer
- Department of Surgery, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Areti Tillou
- Department of Surgery, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Sigrid Burruss
- Department of Surgery, Loma Linda University, Loma Linda, CA, USA
| | | | - Ann Lin
- Department of Surgery, Loma Linda University, Loma Linda, CA, USA
| | | | - Raul Coimbra
- Riverside University Health System, Moreno Valley, CA, USA
| | - Megan Brenner
- Riverside University Health System, Moreno Valley, CA, USA
| | - Todd Costantini
- Department of Surgery, University of California, San Diego (UCSD), San Diego, CA, USA
| | - Jarrett Santorelli
- Department of Surgery, University of California, San Diego (UCSD), San Diego, CA, USA
| | - Terry Curry
- Department of Surgery, University of California, San Diego (UCSD), San Diego, CA, USA
| | - Diane Wintz
- Department of Surgery, Sharp Memorial Hospital, San Diego, CA, USA
| | - Walter L Biffl
- Trauma Department, Scripps Memorial Hospital La Jolla, La Jolla, CA, USA
| | - Kathryn B Schaffer
- Trauma Department, Scripps Memorial Hospital La Jolla, La Jolla, CA, USA
| | - Thomas K Duncan
- Department of Surgery, Ventura County Medical Center, Ventura, CA, USA
| | - Casey Barbaro
- Department of Surgery, Ventura County Medical Center, Ventura, CA, USA
| | - Graal Diaz
- Department of Surgery, Ventura County Medical Center, Ventura, CA, USA
| | | | - Erika Tay-Lasso
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
| | - Justine Chinn
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
| | - Ariana Naaseh
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
| | - Amanda Leung
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
| | - Christina Grabar
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
| | - Jeffry Nahmias
- Department of Surgery, University of California, Irvine (UCI), Orange, CA, USA
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5
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Aryan N, Grigorian A, Lucas AN, Tay-Lasso E, Zezoff DC, Fierro N, Dhillon NK, Ley EJ, Smith J, Dahan A, Johnson A, Ganske W, Biffl WL, Bayat D, Castelo M, Wintz D, Schaffer KB, Zheng DJ, Tillou A, Coimbra R, Santorelli JE, Schellenberg M, Inaba K, Emigh B, Duncan TK, Diaz G, Burruss S, Tuli R, Nahmias J. Outcomes for advanced aged (35 and older) versus younger aged pregnant trauma patients: A multicenter study. Am J Surg 2023; 226:798-802. [PMID: 37355376 DOI: 10.1016/j.amjsurg.2023.06.004] [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: 03/24/2023] [Revised: 05/25/2023] [Accepted: 06/01/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Effects of advanced maternal age (AMA) pregnancies (defined as ≥35 years) on pregnant trauma patients (PTPs) are unknown. This study compared AMA versus younger PTPs, hypothesizing AMA PTPs have increased risk of fetal delivery (FD). METHODS A retrospective (2016-2021) multicenter study included all PTPs. Multivariable logistic regression was used to evaluate risk of FD after trauma. RESULTS A total of 950 PTPs were included. Both cohorts had similar gestational age and injury severity scores. The AMA group had increased injuries to the pancreas, bladder, and stomach (p < 0.05). There was no difference in rate or associated risk of FD between cohorts (5.3% vs. 11.4%; OR 0.59, CI 0.19-1.88, p > 0.05). CONCLUSION Compared to their younger counterparts, some intra-abdominal injuries (pancreas, bladder, and stomach) were more common among AMA PTPs. However, there was no difference in rate or associated risk of FD in AMA PTPs, thus they do not require increased observation.
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Affiliation(s)
- Negaar Aryan
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, California, USA.
| | - Areg Grigorian
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, California, USA.
| | - Alexa N Lucas
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, California, USA.
| | - Erika Tay-Lasso
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, California, USA.
| | - Danielle C Zezoff
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, California, USA.
| | - Nicole Fierro
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Navpreet K Dhillon
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Eric J Ley
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Jennifer Smith
- Division of Trauma and Critical Care, Harbor-UCLA Hospital, Torrance, CA, USA.
| | - Alden Dahan
- University of California, Riverside School of Medicine, Riverside, CA, USA.
| | - Arianne Johnson
- Cottage Health Research Institute, Santa Barbara Cottage Hospital, Santa Barbara, CA, USA.
| | - William Ganske
- Cottage Health Research Institute, Santa Barbara Cottage Hospital, Santa Barbara, CA, USA.
| | - Walter L Biffl
- Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA, USA.
| | - Dunya Bayat
- Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA, USA.
| | - Matthew Castelo
- Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA, USA.
| | - Diane Wintz
- Department of Surgery, Sharp Memorial Hospital, San Diego, CA, USA.
| | | | - Dennis J Zheng
- Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
| | - Areti Tillou
- Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
| | - Raul Coimbra
- Riverside University Health System Medical Center, Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, CA, USA.
| | - Jarrett E Santorelli
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California San Diego School of Medicine, San Diego, CA, USA.
| | - Morgan Schellenberg
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA.
| | - Kenji Inaba
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA.
| | - Brent Emigh
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA; Warren Alpert Medical School at Brown University, Department of Surgery, Division of Trauma, USA.
| | - Thomas K Duncan
- Department of Trauma, Ventura County Medical Center, Ventura, CA, USA.
| | - Graal Diaz
- Department of Trauma, Ventura County Medical Center, Ventura, CA, USA.
| | - Sigrid Burruss
- Department of Trauma, Acute Care Surgery, Surgical Critical Care, Loma Linda Medical Center, Loma Linda, CA, USA.
| | - Rahul Tuli
- Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, University of California Riverside School of Medicine, CA, USA.
| | - Jeffry Nahmias
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, California, USA.
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Singh JK, Duncan TK. Examining the Domestic Violence Crisis in Ventura County in the Wake of the COVID-19 Pandemic. Am Surg 2023; 89:4353-4359. [PMID: 35757933 PMCID: PMC9243968 DOI: 10.1177/00031348221111509] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Domestic violence (DV) worsened during COVID-19 and Family Justice Centers (FJCs) were, even more so than before, a critical part of providing services to DV victims. This study characterizes the clinical and sociodemographic features of the clients that come to the Ventura County FJC (VCFJC) and examines the effect of COVID-19, thus informing awareness of services available to victims of DV. METHODS This was a retrospective cohort study utilizing the VCFJC database from 2019 to 2021. All client data normally collected was studied. A comparison of pre-COVID and post-COVID data was also conducted. RESULTS There were 3488 client entries. Clients were mostly female (79% [2755]; n = 3488), aged 25-40 (31.73% [1106]; n = 3448), white/Caucasian (44.42% [1531]; n = 3448) or Hispanic/Latinx (42.41% [1462]; n = 3448). Clients most often requested restraining orders (72.41% [2496]; n = 3448), and most commonly reported DV [physical] (47.90% [1651]; n = 3448). Most health-insured clients were covered by MediCal (45.06% [1231]; n = 2732). Pre- and post-COVID analysis showed the highest increases in DV [physical] (odds ratio = 1.26, P < .0007) and stalking/harassment (odds ratio = 2.45, P < .0007), and decreases in all Initial Service Request categories except one. DISCUSSION In serving clients affected by DV, FJCs are an important service for health care providers to be aware of. Post-COVID, clients reported DV and stalking/harassment at much higher percentages, which is consistent with national studies on the pandemic. The most alarming finding was the steep decrease in Initial Service Requests.Conclusion: This study shows the importance of collaboration and awareness of services, especially in a world of COVID-19.
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Affiliation(s)
- Jupneet K. Singh
- Massachusetts Institute of Technology, Cambridge, MA, USA
- Ventura County Family Justice Center, Ventura, CA, USA
| | - Thomas K. Duncan
- Department of Surgery, Ventura County Medical Center, Ventura, CA, USA
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7
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Lopez J, Fong K, Chow E, Romero J, Duncan TK, Diaz G. Victims of Violence, How a Trauma Center and Family Justice Center Can Provide Continued Care After Initial Hospitalization. Am Surg 2023; 89:4147-4152. [PMID: 37272838 DOI: 10.1177/00031348231180930] [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: 06/06/2023]
Abstract
BACKGROUND Intentional injuries are the second leading cause of death in the U.S. between the ages of 1 and 44. Each traumatic event is approached best with a multiagency and multidisciplinary approach. Family Justice Centers (FJCs) are structured as one-stop centers for victims of all forms of violence to provide services. OBJECTIVE The purpose of this study is to describe trauma patients evaluated in an FJC and determine the effect of the referrals on injury-related hospital recidivism. METHOD This is a cross-sectional descriptive study of traumatically injured patients that were evaluated in an adult level II trauma center for 3 years and were referred to Ventura County's FJC. RESULTS There were 415 trauma admissions for intentional injuries, which accounted for 10.4% of the total trauma-related hospital admissions. Of these patients, 203 (49%) were evaluated in Ventura County's FJC. The remaining 212 (51%) had an open judicial case, thus, were not processed through the FJC due to conflict of interest. The mechanisms of injuries of patients that were evaluated at the FJC (N = 203) were mostly assaults (83%). Majority of the patients were of the Hispanic race (70%), males (69%), English speaking (77%), and aged 18-59 (84%). 573 individual services were provided to these patients. The patients evaluated through the FJC (N = 203) had zero recidivism, while those with open cases had a 1% recidivism rate (P = NS). CONCLUSION By collaborating with FJCs, trauma center outcomes contribute to a pathway for healing and may prevent future acts of intentional injuries.
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Affiliation(s)
| | | | - Erica Chow
- Community Memorial Hospital, Ventura, CA, USA
| | | | | | - Graal Diaz
- Ventura County Medical Center, Ventura, CA, USA
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8
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Duncan TK. Invited Commentary: Violence Intervention Program Outcomes. J Am Coll Surg 2022; 235:939. [PMID: 36129188 DOI: 10.1097/xcs.0000000000000390] [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: 12/15/2022]
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9
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Ruhi-Williams P, Yeates EO, Grigorian A, Schellenberg M, Owattanapanich N, Barmparas G, Margulies D, Juillard C, Garber K, Cryer H, Tillou A, Burruss S, Penaloza-Villalobos L, Lin A, Figueras RA, Coimbra R, Brenner M, Costantini T, Santorelli J, Curry T, Wintz D, Biffl WL, Schaffer KB, Duncan TK, Barbaro C, Diaz G, Johnson A, Chinn J, Naaseh A, Leung A, Grabar C, Nahmias J. Adolescent Trauma During the COVID Pandemic: Just Like Adults, Children, or Someone Else? Am Surg 2022; 88:2429-2435. [PMID: 35583103 PMCID: PMC9127450 DOI: 10.1177/00031348221101475] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
COVID-19 stay-at-home (SAH) orders were impactful on adolescence, when social
interactions affect development. This has the potential to change adolescent
trauma. A post-hoc multicenter retrospective analysis of adolescent
(13-17 years-old) trauma patients (ATPs) at 11 trauma centers was performed.
Patients were divided into 3 groups based on injury date: historical control
(CONTROL:3/19/2019-6/30/2019, before SAH (PRE:1/1/2020-3/18/2020), and after SAH
(POST:3/19/2020-6/30/2020). The POST group was compared to both PRE and CONTROL
groups in separate analyses. 726 ATPs were identified across the 3
time periods. POST had a similar penetrating trauma rate compared to both PRE
(15.8% vs 13.8%, P = .56) and CONTROL (15.8% vs 14.5%,
P = .69). POST also had a similar rate of suicide attempts
compared to both PRE (1.2% vs 1.5%, P = .83) and CONTROL (1.2%
vs 2.1%, P = .43). However, POST had a higher rate of drug
positivity compared to CONTROL (28.6% vs 20.6%, P = .032), but
was similar in all other comparisons of alcohol and drugs to PRE and POST
periods (all P > .05). Hence ATPs were affected differently
than adults and children, as they had a similar rate of penetrating trauma,
suicide attempts, and alcohol positivity after SAH orders. However, they had
increased drug positivity compared to the CONTROL, but not PRE group.
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Affiliation(s)
- Perisa Ruhi-Williams
- Department of Surgery, 21769University of California, Irvine (UCI), Orange, CA, USA
| | - Eric O Yeates
- Department of Surgery, 21769University of California, Irvine (UCI), Orange, CA, USA
| | - Areg Grigorian
- Department of Surgery, 21769University of California, Irvine (UCI), Orange, CA, USA.,Department of Surgery, University of Southern California (USC), Los Angeles, CA, USA
| | - Morgan Schellenberg
- Department of Surgery, University of Southern California (USC), Los Angeles, CA, USA
| | | | - Galinos Barmparas
- Department of Surgery, 22494Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel Margulies
- Department of Surgery, 22494Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Catherine Juillard
- Department of Surgery, 8783University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Kent Garber
- Department of Surgery, 8783University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Henry Cryer
- Department of Surgery, 8783University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Areti Tillou
- Department of Surgery, 8783University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Sigrid Burruss
- Department of Surgery, 4608Loma Linda University, Loma Linda, CA, USA
| | | | - Ann Lin
- Department of Surgery, 4608Loma Linda University, Loma Linda, CA, USA
| | | | - Raul Coimbra
- Department of Surgery, 4608Loma Linda University, Loma Linda, CA, USA.,472028Riverside University Health System Medical CenterUniversity, Moreno Valley, CA, USA
| | - Megan Brenner
- University of California, Riverside/Riverside University Health System Department of Surgery, Moreno Valley, CA, USA
| | - Todd Costantini
- Department of Surgery, 8784University of California, San Diego (UCSD), San Diego, CA, USA
| | - Jarrett Santorelli
- Department of Surgery, 8784University of California, San Diego (UCSD), San Diego, CA, USA
| | - Terry Curry
- Department of Surgery, 8784University of California, San Diego (UCSD), San Diego, CA, USA
| | - Diane Wintz
- Department of Surgery, 21380Sharp Memorial Hospital, San Diego, CA, USA
| | - Walter L Biffl
- Trauma Department, 24146Scripps Memorial Hospital La Jolla, La Jolla, CA, USA
| | - Kathryn B Schaffer
- Trauma Department, 24146Scripps Memorial Hospital La Jolla, La Jolla, CA, USA
| | - Thomas K Duncan
- Department of Surgery, 25352Ventura County Medical Center, Ventura, CA, USA
| | - Casey Barbaro
- Department of Surgery, 25352Ventura County Medical Center, Ventura, CA, USA
| | - Graal Diaz
- Department of Surgery, 25352Ventura County Medical Center, Ventura, CA, USA
| | - Arianne Johnson
- Cottage Health Research Institute, 22854Santa Barbara Cottage Hospital, Santa Barbara, CA, USA
| | - Justine Chinn
- Department of Surgery, 21769University of California, Irvine (UCI), Orange, CA, USA
| | - Ariana Naaseh
- Department of Surgery, 21769University of California, Irvine (UCI), Orange, CA, USA
| | - Amanda Leung
- Department of Surgery, 21769University of California, Irvine (UCI), Orange, CA, USA
| | - Christina Grabar
- Department of Surgery, 21769University of California, Irvine (UCI), Orange, CA, USA
| | - Jeffry Nahmias
- Department of Surgery, 21769University of California, Irvine (UCI), Orange, CA, USA
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10
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Yeates EO, Grigorian A, Schellenberg M, Owattanapanich N, Barmparas G, Margulies D, Juillard C, Garber K, Cryer H, Tillou A, Burruss S, Penaloza-Villalobos L, Lin A, Figueras RA, Coimbra R, Brenner M, Costantini T, Santorelli J, Curry T, Wintz D, Biffl WL, Schaffer KB, Duncan TK, Barbaro C, Diaz G, Johnson A, Chinn J, Naaseh A, Leung A, Grabar C, Nahmias J. Decreased hospital length of stay and intensive care unit admissions for non-COVID blunt trauma patients during the COVID-19 pandemic. Am J Surg 2022; 224:90-95. [PMID: 35219493 PMCID: PMC8863305 DOI: 10.1016/j.amjsurg.2022.02.055] [Citation(s) in RCA: 4] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 02/16/2022] [Accepted: 02/20/2022] [Indexed: 01/08/2023]
Abstract
Background The COVID-19 pandemic overwhelmed hospitals, forcing adjustments including discharging patients earlier and limiting intensive care unit (ICU) utilization. This study aimed to evaluate ICU admissions and length of stay (LOS) for blunt trauma patients (BTPs). Methods A retrospective review of COVID (3/19/20-6/30/20) versus pre-COVID (3/19/19-6/30/19) BTPs at eleven trauma centers was performed. Multivariable analysis was used to identify risk factors for ICU admission. Results 12,744 BTPs were included (6942 pre-COVID vs. 5802 COVID). The COVID cohort had decreased mean LOS (3.9 vs. 4.4 days, p = 0.029), ICU LOS (0.9 vs. 1.1 days, p < 0.001), and rate of ICU admission (22.3% vs. 24.9%, p = 0.001) with no increase in complications or mortality compared to the pre-COVID cohort (all p > 0.05). On multivariable analysis, the COVID period was associated with decreased risk of ICU admission (OR = 0.82, CI 0.75–0.90, p < 0.001). Conclusions BTPs had decreased LOS and associated risk of ICU admission during COVID, with no corresponding increase in complications or mortality.
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Affiliation(s)
- Eric O Yeates
- University of California, Irvine (UCI), Department of Surgery, Orange, CA, USA.
| | - Areg Grigorian
- University of California, Irvine (UCI), Department of Surgery, Orange, CA, USA; University of Southern California (USC), Department of Surgery, Los Angeles, CA, USA.
| | - Morgan Schellenberg
- University of Southern California (USC), Department of Surgery, Los Angeles, CA, USA.
| | | | - Galinos Barmparas
- Cedars-Sinai Medical Center, Department of Surgery, Los Angeles, CA, USA.
| | - Daniel Margulies
- Cedars-Sinai Medical Center, Department of Surgery, Los Angeles, CA, USA.
| | - Catherine Juillard
- University of California, Los Angeles (UCLA), Department of Surgery, Los Angeles, CA, USA.
| | - Kent Garber
- University of California, Los Angeles (UCLA), Department of Surgery, Los Angeles, CA, USA.
| | - Henry Cryer
- University of California, Los Angeles (UCLA), Department of Surgery, Los Angeles, CA, USA.
| | - Areti Tillou
- University of California, Los Angeles (UCLA), Department of Surgery, Los Angeles, CA, USA.
| | - Sigrid Burruss
- Loma Linda University, Department of Surgery, Loma Linda, CA, USA.
| | | | - Ann Lin
- Loma Linda University, Department of Surgery, Loma Linda, CA, USA.
| | | | - Raul Coimbra
- Loma Linda University, Department of Surgery, Loma Linda, CA, USA; Riverside University Health System Medical Center, Moreno Valley, CA, USA.
| | - Megan Brenner
- University of California, Riverside/Riverside University Health System Department of Surgery, Moreno Valley, CA, USA.
| | - Todd Costantini
- University of California, San Diego (UCSD), Department of Surgery, San Diego, CA, USA.
| | - Jarrett Santorelli
- University of California, San Diego (UCSD), Department of Surgery, San Diego, CA, USA.
| | - Terry Curry
- University of California, San Diego (UCSD), Department of Surgery, San Diego, CA, USA.
| | - Diane Wintz
- Sharp Memorial Hospital, Department of Surgery, San Diego, CA, USA.
| | - Walter L Biffl
- Scripps Memorial Hospital La Jolla, Trauma Department, La Jolla, CA, USA.
| | - Kathryn B Schaffer
- Scripps Memorial Hospital La Jolla, Trauma Department, La Jolla, CA, USA.
| | - Thomas K Duncan
- Ventura County Medical Center, Department of Surgery, Ventura, CA, USA.
| | - Casey Barbaro
- Ventura County Medical Center, Department of Surgery, Ventura, CA, USA.
| | - Graal Diaz
- Ventura County Medical Center, Department of Surgery, Ventura, CA, USA.
| | - Arianne Johnson
- Santa Barbara Cottage Hospital, Cottage Health Research Institute, Santa Barbara, CA, USA.
| | - Justine Chinn
- University of California, Irvine (UCI), Department of Surgery, Orange, CA, USA.
| | - Ariana Naaseh
- University of California, Irvine (UCI), Department of Surgery, Orange, CA, USA.
| | - Amanda Leung
- University of California, Irvine (UCI), Department of Surgery, Orange, CA, USA.
| | - Christina Grabar
- University of California, Irvine (UCI), Department of Surgery, Orange, CA, USA.
| | - Jeffry Nahmias
- University of California, Irvine (UCI), Department of Surgery, Orange, CA, USA.
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11
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Allee L, Faul M, Guntipalli P, Burke PA, Rao SR, Reed DN, Gross R, Duncan TK, Palmieri TL, Cooper Z, Bulger EM, Stewart RM, Kuhls DA. The Role of the US Trauma Centers in Older Adult Fall Prevention: A National Survey. Am Surg 2021:31348211047509. [PMID: 34748452 DOI: 10.1177/00031348211047509] [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
INTRODUCTION Approximately 27.5% of adults 65 and older fall each year, over 3 million are treated in an emergency department, and 32 000 die. The American College of Surgeons and its Committee on Trauma (ACSCOT) have urged trauma centers (TCs) to screen for fall risk, but information on the role of TC in this opportunity for prevention is largely unknown. METHODS A 29-item survey was developed by an ACSCOT Injury Prevention and Control Committee, Older Adult Falls workgroup, and emailed to 1000 trauma directors of the National Trauma Data Bank using Qualtrics. US TCs were surveyed regarding fall prevention, screening, intervention, and hospital discharge practices. Data collected and analyzed included respondent's role, location, population density, state designation or American College of Surgeons (ACS) level, if teaching facility, and patient population. RESULTS Of the 266 (27%) respondents, 71% of TCs include fall prevention as part of their mission, but only 16% of TCs use fall risk screening tools. There was no significant difference between geographic location or ACS level. The number of prevention resources (F = 31.58, P < .0001) followed by the presence of a formal screening tool (F = 21.47, P < .0001) best predicted the presence of a fall prevention program. CONCLUSION Older adult falls remain a major injury risk and injury prevention opportunity. The majority of TCs surveyed include prevention of older adult falls as part of their mission, but few incorporate the components of a fall prevention program. Development of best practices and requiring TCs to screen and offer interventions may prevent falls.
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Affiliation(s)
- Lisa Allee
- 12259Boston University School of Medicine, Boston, MA, USA
| | - Mark Faul
- Liaison to ACS COT, 1242Injury Prevention and Control Committee, USA
| | | | - Peter A Burke
- 12259Boston University School of Medicine, Boston, MA, USA
| | - Sowmya R Rao
- 12259Boston University School of Medicine, Boston, MA, USA
| | - Donald N Reed
- Texas Health Resources, 2910Texas Woman's University, Dallas, TX, USA
| | | | | | - Tina L Palmieri
- Shriners Hospital for Children, 8789UC Davis Health, Davis, CA, USA
| | - Zara Cooper
- 1861Brigham and Women's Hospital, Boston, MA, USA
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12
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Bonne SL, Violano P, Duncan TK, Pappas PA, Baltazar GA, Dultz LA, Schroeder ME, Capella J, Hirsh M, Conrad-Schnetz K, Rattan R, Como JJ, Jewell S, Crandall ML. Prevention of Firearm Violence Through Specific Types of Community-based Programming: An Eastern Association for the Surgery of Trauma Evidence-based Review. Ann Surg 2021; 274:298-305. [PMID: 33914467 DOI: 10.1097/sla.0000000000004837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this review was to provide an evidence-based recommendation for community-based programs to mitigate gun violence, from the Eastern Association for the Surgery of Trauma (EAST). SUMMARY BACKGROUND DATA Firearm Injury leads to >40,000 annual deaths and >115,000 injuries annually in the United States. Communities have adopted culturally relevant strategies to mitigate gun related injury and death. Two such strategies are gun buyback programs and community-based violence prevention programs. METHODS The Injury Control and Violence Prevention Committee of EAST developed Population, Intervention, Comparator, Outcomes (PICO) questions and performed a comprehensive literature and gray web literature search. Using GRADE methodology, they reviewed and graded the literature and provided consensus recommendations informed by the literature. RESULTS A total of 19 studies were included for analysis of gun buyback programs. Twenty-six studies were reviewed for analysis for community-based violence prevention programs. Gray literature was added to the discussion of PICO questions from selected websites. A conditional recommendation is made for the implementation of community-based gun buyback programs and a conditional recommendation for community-based violence prevention programs, with special emphasis on cultural appropriateness and community input. CONCLUSIONS Gun violence may be mitigated by community-based efforts, such as gun buybacks or violence prevention programs. These programs come with caveats, notably community cultural relevance and proper support and funding from local leadership.Level of Evidence: Review, Decision, level III.
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Affiliation(s)
- Stephanie L Bonne
- Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ
- The New Jersey Center for Gun Violence Research at Rutgers, Piscataway, NJ
| | - Pina Violano
- Department of Surgery, Yale New Haven Hospital, New Haven CT
| | - Thomas K Duncan
- Department of Surgery, Ventura County Medical Center, Ventura, CA
| | - Peter A Pappas
- Department of Surgery, University of Central Florida College of Medicine, Sanford, FL
| | - Gerard A Baltazar
- Department of Surgery, New York University Langone Hospital Long Island, Mineola, NY
| | - Linda A Dultz
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Mary E Schroeder
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | | | - Michael Hirsh
- Department of Surgery, University of Massachusetts Children's Medical Center, Worcester, MA
| | | | - Rishi Rattan
- Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - John J Como
- Department of Surgery, MetroHealth Medical Center, Cleveland OH
| | - Sarah Jewell
- George Smith Library, Rutgers New Jersey Medical School, Newark, NJ
| | - Marie L Crandall
- Department of Surgery, University of Florida College of Medicine, Jacksonville, FL
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13
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Duncan TK, Stewart R, Joseph K, Kuhls DA, Dechert T, Taghavi S, Bonne S, Matsushima K. American Association for the Surgery of Trauma Prevention Committee review: Family Justice Centers-a not-so-novel, but unknown gem. Trauma Surg Acute Care Open 2021; 6:e000725. [PMID: 34179511 PMCID: PMC8186750 DOI: 10.1136/tsaco-2021-000725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/13/2021] [Indexed: 11/18/2022] Open
Abstract
The American College of Surgeons Committee on Trauma requires that trauma centers demonstrate adequate financial support for an injury prevention program as part of the verification process. With the ongoing challenges that arise with important social determinants of health, trauma centers have the important task of navigating a patient through the complex process of obtaining services and tools for success. This summary from the American Association for the Surgery of Trauma Prevention Committee focuses on a model that has been present for several years, but has not been brought to full awareness in the trauma world. It highlights the importance of the Family Justice Center concept that brings a multitude of organizations under one roof, thus eliminating the hurdles encompassed by trauma patients, seeking life-changing resources necessary to mitigate the impact of both community violence exposure and intimate partner/domestic violence. It discusses the potential benefits of a partnership between trauma centers and Family Justice Centers and similar models. Finally, it also raises awareness of important programmatic evaluation research required in the arena of injury prevention targeting a population whose outcomes are difficult to measure.
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Affiliation(s)
- Thomas K Duncan
- Department of Surgery, Ventura County Medical Center, Ventura, California, USA
| | - Ronald Stewart
- Department of Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Kimberly Joseph
- Department of Trauma, John H Stroger Hospital of Cook County, Chicago, Illinois, USA.,Chair, ATLS Subcommittee Committee of Trauma of the American College of Surgeons, American College of Surgeons, Chicago, Illinois, USA
| | - Deborah A Kuhls
- Department of Surgery, University of Nevada Las Vegas School of Medicine, Las Vegas, Nevada, USA
| | - Tracey Dechert
- Department of Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Sharven Taghavi
- Division of Trauma and Critical Care, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Stephanie Bonne
- Department of Surgery, Rutgers University, Newark, New Jersey, USA
| | - Kazuhide Matsushima
- Department of Surgery, Los Angeles County University of Southern California Medical Center, Los Angeles, California, USA
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14
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Young KN, Yeates EO, Grigorian A, Schellenberg M, Owattanapanich N, Barmparas G, Margulies D, Juillard C, Garber K, Cryer H, Tillou A, Burruss S, Penaloza-Villalobos L, Lin A, Figueras RA, Brenner M, Firek C, Costantini T, Santorelli J, Curry T, Wintz D, Biffl WL, Schaffer KB, Duncan TK, Barbaro C, Diaz G, Johnson A, Chinn J, Naaseh A, Leung A, Grabar C, Nahmias J. Drug and alcohol positivity of traumatically injured patients related to COVID-19 stay-at-home orders. Am J Drug Alcohol Abuse 2021; 47:605-611. [PMID: 34087086 DOI: 10.1080/00952990.2021.1904967] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: COVID-19 related stay-at-home (SAH) orders created many economic and social stressors, possibly increasing the risk of drug/alcohol abuse in the community and trauma population.Objectives: Describe changes in alcohol/drug use in traumatically injured patients after SAH orders in California and evaluate demographic or injury pattern changes in alcohol or drug-positive patients.Methods: A retrospective analysis of 11 trauma centers in Southern California (1/1/2020-6/30/2020) was performed. Blood alcohol concentration, urine toxicology results, demographics, and injury characteristics were collected. Patients were grouped based on injury date - before SAH (PRE-SAH), immediately after SAH (POST-SAH), and a historical comparison (3/19/2019-6/30/2019) (CONTROL) - and compared in separate analyses. Groups were compared using chi-square tests for categorical variables and Mann-Whitney U tests for continuous variables.Results: 20,448 trauma patients (13,634 male, 6,814 female) were identified across three time-periods. The POST-SAH group had higher rates of any drug (26.2% vs. 21.6% and 24.7%, OR = 1.26 and 1.08, p < .001 and p = .035), amphetamine (10.4% vs. 7.5% and 9.3%, OR = 1.43 and 1.14, p < .001 and p = .023), tetrahydrocannabinol (THC) (13.8% vs. 11.0% and 11.4%, OR = 1.30 and 1.25, p < .001 and p < .001), and 3,4-methylenedioxy methamphetamine (MDMA) (0.8% vs. 0.4% and 0.2%, OR = 2.02 and 4.97, p = .003 and p < .001) positivity compared to PRE-SAH and CONTROL groups. Alcohol concentration and positivity were similar between groups (p > .05).Conclusion: This Southern California multicenter study demonstrated increased amphetamine, MDMA, and THC positivity in trauma patients after SAH, but no difference in alcohol positivity or blood concentration. Drug prevention strategies should continue to be adapted within and outside of hospitals during a pandemic.
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Affiliation(s)
- Kirsten N Young
- Department of Surgery, University of California, Irvine, CA, USA
| | - Eric O Yeates
- Department of Surgery, University of California, Irvine, CA, USA
| | - Areg Grigorian
- Department of Surgery, University of California, Irvine, CA, USA.,Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Morgan Schellenberg
- Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | | | - Galinos Barmparas
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel Margulies
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Kent Garber
- Department of Surgery, University of California, Los Angeles, CA, USA
| | - Henry Cryer
- Department of Surgery, University of California, Los Angeles, CA, USA
| | - Areti Tillou
- Department of Surgery, University of California, Los Angeles, CA, USA
| | - Sigrid Burruss
- Department of Surgery, Loma Linda University, Loma Linda, CA, USA
| | | | - Ann Lin
- Department of Surgery, Loma Linda University, Loma Linda, CA, USA
| | | | - Megan Brenner
- Riverside/Riverside University Health System Department of Surgery, University of California, Moreno Valley, CA, USA
| | - Christopher Firek
- Riverside University Health System, Comparative Effectiveness and Clinical Outcomes Research Center (CECORC), Moreno Valley, CA, USA
| | - Todd Costantini
- Department of Surgery, University of California, San Diego, CA, USA
| | | | - Terry Curry
- Department of Surgery, University of California, San Diego, CA, USA
| | - Diane Wintz
- Department of Surgery, Sharp Memorial Hospital, San Diego, CA, USA
| | - Walter L Biffl
- Trauma Department, Scripps Memorial Hospital La Jolla, La Jolla, CA, USA
| | - Kathryn B Schaffer
- Trauma Department, Scripps Memorial Hospital La Jolla, La Jolla, CA, USA
| | - Thomas K Duncan
- Department of Surgery, Ventura County Medical Center, Ventura, CA, USA
| | - Casey Barbaro
- Department of Surgery, Ventura County Medical Center, Ventura, CA, USA
| | - Graal Diaz
- Department of Surgery, Ventura County Medical Center, Ventura, CA, USA
| | - Arianne Johnson
- Department of Trauma, Santa Barbara Cottage Hospital, Cottage Health Research Institute, Santa Barbara, CA, USA
| | - Justine Chinn
- Department of Surgery, University of California, Irvine, CA, USA
| | - Ariana Naaseh
- Department of Surgery, University of California, Irvine, CA, USA
| | - Amanda Leung
- Department of Surgery, University of California, Irvine, CA, USA
| | - Christina Grabar
- Department of Surgery, University of California, Irvine, CA, USA
| | - Jeffry Nahmias
- Department of Surgery, University of California, Irvine, CA, USA
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15
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Yeates EO, Grigorian A, Schellenberg M, Owattanapanich N, Barmparas G, Margulies D, Juillard C, Garber K, Cryer H, Tillou A, Burruss S, Figueras RA, Mladenov G, Brenner M, Firek C, Costantini T, Santorelli J, Curry T, Wintz D, Biffl WL, Schaffer KB, Duncan TK, Barbaro C, Diaz G, Johnson A, Chinn J, Naaseh A, Leung A, Grabar C, Nahmias J. COVID-19 in trauma: a propensity-matched analysis of COVID and non-COVID trauma patients. Eur J Trauma Emerg Surg 2021; 47:1335-1342. [PMID: 34031703 PMCID: PMC8143988 DOI: 10.1007/s00068-021-01699-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/13/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE There is mounting evidence that surgical patients with COVID-19 have higher morbidity and mortality than patients without COVID-19. Infection is prevalent amongst the trauma population, but any effect of COVID-19 on trauma patients is unknown. We aimed to evaluate the effect of COVID-19 on a trauma population, hypothesizing increased mortality and pulmonary complications for COVID-19-positive (COVID) trauma patients compared to propensity-matched COVID-19-negative (non-COVID) patients. METHODS A retrospective analysis of trauma patients presenting to 11 Level-I and II trauma centers in California between 1/1/2019-6/30/2019 and 1/1/2020-6/30/2020 was performed. A 1:2 propensity score model was used to match COVID to non-COVID trauma patients using age, blunt/penetrating mechanism, injury severity score, Glasgow Coma Scale score, systolic blood pressure, respiratory rate, and heart rate. Outcomes were compared between the two groups. RESULTS A total of 20,448 trauma patients were identified during the study period. 53 COVID trauma patients were matched with 106 non-COVID trauma patients. COVID patients had higher rates of mortality (9.4% vs 1.9%, p = 0.029) and pneumonia (7.5% vs. 0.0%, p = 0.011), as well as a longer mean length of stay (LOS) (7.47 vs 3.28 days, p < 0.001) and intensive care unit LOS (1.40 vs 0.80 days, p = 0.008), compared to non-COVID patients. CONCLUSION This multicenter retrospective study found increased rates of mortality and pneumonia, as well as a longer LOS, for COVID trauma patients compared to a propensity-matched cohort of non-COVID patients. Further studies are warranted to validate these findings and to elucidate the underlying pathways responsible for higher mortality in COVID trauma patients.
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Affiliation(s)
- Eric O. Yeates
- Department of Surgery, University of California, Irvine (UCI), 333 The City Blvd West, Suite 1600, Orange, CA 92868-3298 USA
| | - Areg Grigorian
- Department of Surgery, University of California, Irvine (UCI), 333 The City Blvd West, Suite 1600, Orange, CA 92868-3298 USA
- Department of Surgery, University of Southern California (USC), Los Angeles, CA USA
| | - Morgan Schellenberg
- Department of Surgery, University of Southern California (USC), Los Angeles, CA USA
| | | | - Galinos Barmparas
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Daniel Margulies
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA USA
| | - Catherine Juillard
- Department of Surgery, University of California, Los Angeles (UCLA), Los Angeles, CA USA
| | - Kent Garber
- Department of Surgery, University of California, Los Angeles (UCLA), Los Angeles, CA USA
| | - Henry Cryer
- Department of Surgery, University of California, Los Angeles (UCLA), Los Angeles, CA USA
| | - Areti Tillou
- Department of Surgery, University of California, Los Angeles (UCLA), Los Angeles, CA USA
| | - Sigrid Burruss
- Department of Surgery, Loma Linda University, Loma Linda, CA USA
| | | | - Georgi Mladenov
- Department of Surgery, Loma Linda University, Loma Linda, CA USA
| | - Megan Brenner
- Department of Surgery, University of California, Riverside/Riverside University Health System, Moreno Valley, CA USA
| | - Christopher Firek
- Comparative Effectiveness and Clinical Outcomes Research Center (CECORC), Riverside University Health System, Moreno Valley, CA USA
| | - Todd Costantini
- Department of Surgery, University of California, San Diego (UCSD), San Diego, CA USA
| | - Jarrett Santorelli
- Department of Surgery, University of California, San Diego (UCSD), San Diego, CA USA
| | - Terry Curry
- Department of Surgery, University of California, San Diego (UCSD), San Diego, CA USA
| | - Diane Wintz
- Department of Surgery, Sharp Memorial Hospital, San Diego, CA USA
| | - Walter L. Biffl
- Trauma Department, Scripps Memorial Hospital La Jolla, La Jolla, San Diego, CA USA
| | - Kathryn B. Schaffer
- Trauma Department, Scripps Memorial Hospital La Jolla, La Jolla, San Diego, CA USA
| | - Thomas K. Duncan
- Department of Surgery, Ventura County Medical Center, Ventura, CA USA
| | - Casey Barbaro
- Department of Surgery, Ventura County Medical Center, Ventura, CA USA
| | - Graal Diaz
- Department of Surgery, Ventura County Medical Center, Ventura, CA USA
| | - Arianne Johnson
- Santa Barbara Cottage Hospital, Cottage Health Research Institute, Santa Barbara, CA USA
| | - Justine Chinn
- Department of Surgery, University of California, Irvine (UCI), 333 The City Blvd West, Suite 1600, Orange, CA 92868-3298 USA
| | - Ariana Naaseh
- Department of Surgery, University of California, Irvine (UCI), 333 The City Blvd West, Suite 1600, Orange, CA 92868-3298 USA
| | - Amanda Leung
- Department of Surgery, University of California, Irvine (UCI), 333 The City Blvd West, Suite 1600, Orange, CA 92868-3298 USA
| | - Christina Grabar
- Department of Surgery, University of California, Irvine (UCI), 333 The City Blvd West, Suite 1600, Orange, CA 92868-3298 USA
| | - Jeffry Nahmias
- Department of Surgery, University of California, Irvine (UCI), 333 The City Blvd West, Suite 1600, Orange, CA 92868-3298 USA
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16
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Abstract
How can public policy best deal with infectious disease? In answering this question, scholarship on the optimal control of infectious disease adopts the model of a benevolent social planner who maximizes social welfare. This approach, which treats the social health planner as a unitary "public health brain" standing outside of society, removes the policymaking process from economic analysis. This paper opens the black box of the social health planner by extending the tools of economics to the policymaking process itself. We explore the nature of the economic problem facing policymakers and the epistemic constraints they face in trying to solve that problem. Additionally, we analyze the incentives facing policymakers in their efforts to address infectious diseases and consider how they affect the design and implementation of public health policy. Finally, we consider how unanticipated system effects emerge due to interventions in complex systems, and how these effects can undermine well-intentioned efforts to improve human welfare. We illustrate the various dynamics of the political economy of state responses to infectious disease by drawing on a range of examples from the COVID-19 pandemic.
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Affiliation(s)
| | | | - Abigail R. Hall
- Department of Economics and FinanceBellarmine UniversityLouisvilleKentuckyUSA
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17
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Yeates EO, Grigorian A, Barrios C, Schellenberg M, Owattanapanich N, Barmparas G, Margulies D, Juillard C, Garber K, Cryer H, Tillou A, Burruss S, Penaloza-Villalobos L, Lin A, Figueras RA, Brenner M, Firek C, Costantini T, Santorelli J, Curry T, Wintz D, Biffl WL, Schaffer KB, Duncan TK, Barbaro C, Diaz G, Johnson A, Chinn J, Naaseh A, Leung A, Grabar C, Nahmias J. Changes in traumatic mechanisms of injury in Southern California related to COVID-19: Penetrating trauma as a second pandemic. J Trauma Acute Care Surg 2021; 90:714-721. [PMID: 33395031 PMCID: PMC7996056 DOI: 10.1097/ta.0000000000003068] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/04/2020] [Accepted: 12/18/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND The COVID-19 pandemic resulted in a statewide stay-at-home (SAH) order in California beginning March 19, 2020, forcing large-scale behavioral changes and taking an emotional and economic toll. The effects of SAH orders on the trauma population remain unknown. We hypothesized an increase in rates of penetrating trauma, gunshot wounds, suicide attempts, and domestic violence in the Southern California trauma population after the SAH order. METHODS A multicenter retrospective analysis of all trauma patients presenting to 11 American College of Surgeons levels I and II trauma centers spanning seven counties in California was performed. Demographic data, injury characteristics, clinical data, and outcomes were collected. Patients were divided into three groups based on injury date: before SAH from January 1, 2020, to March 18, 2020 (PRE), after SAH from March 19, 2020, to June 30, 2020 (POST), and a historical control from March 19, 2019, to June 30, 2019 (CONTROL). POST was compared with both PRE and CONTROL in two separate analyses. RESULTS Across all periods, 20,448 trauma patients were identified (CONTROL, 7,707; PRE, 6,022; POST, 6,719). POST had a significantly increased rate of penetrating trauma (13.0% vs. 10.3%, p < 0.001 and 13.0% vs. 9.9%, p < 0.001) and gunshot wounds (4.5% vs. 2.4%, p = 0.002 and 4.5% vs. 3.7%, p = 0.025) compared with PRE and CONTROL, respectively. POST had a suicide attempt rate of 1.9% and a domestic violence rate of 0.7%, which were similar to PRE (p = 0.478, p = 0.514) and CONTROL (p = 0.160, p = 0.618). CONCLUSION This multicenter Southern California study demonstrated an increased rate of penetrating trauma and gunshot wounds after the COVID-19 SAH orders but no difference in attempted suicide or domestic violence rates. These findings may provide useful information regarding resource utilization and a target for societal intervention during the current or future pandemic(s). LEVEL OF EVIDENCE Epidemiological, level IV.
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18
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Yeates EO, Juillard C, Grigorian A, Schellenberg M, Owattanapanich N, Barmparas G, Margulies D, Garber K, Cryer H, Tillou A, Burruss S, Penaloza-Villalobos L, Lin A, Figueras RA, Brenner M, Firek C, Costantini T, Santorelli J, Curry T, Wintz D, Biffl WL, Schaffer KB, Duncan TK, Barbaro C, Diaz G, Johnson A, Chinn J, Naaseh A, Leung A, Grabar C, Yeates TO, Nahmias J. The coronavirus disease 2019 (COVID-19) stay-at-home order's unequal effects on trauma volume by insurance status in Southern California. Surgery 2021; 170:962-968. [PMID: 33849732 DOI: 10.1016/j.surg.2021.02.060] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/02/2021] [Accepted: 02/22/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The rapid spread of coronavirus disease 2019 in the United States led to a variety of mandates intended to decrease population movement and "flatten the curve." However, there is evidence some are not able to stay-at-home due to certain disadvantages, thus remaining exposed to both coronavirus disease 2019 and trauma. We therefore sought to identify any unequal effects of the California stay-at-home orders between races and insurance statuses in a multicenter study utilizing trauma volume data. METHODS A posthoc multicenter retrospective analysis of trauma patients presenting to 11 centers in Southern California between the dates of January 1, 2020, and June 30, 2020, and January 1, 2019, and June 30, 2019, was performed. The number of trauma patients of each race/insurance status was tabulated per day. We then calculated the changes in trauma volume related to stay-at-home orders for each race/insurance status and compared the magnitude of these changes using statistical resampling. RESULTS Compared to baseline, there was a 40.1% drop in total trauma volume, which occurred 20 days after stay-at-home orders. During stay-at-home orders, the average daily trauma volume of patients with Medicaid increased by 13.7 ± 5.3%, whereas the volume of those with Medicare, private insurance, and no insurance decreased. The average daily trauma volume decreased for White, Black, Asian, and Latino patients with the volume of Black and Latino patients dropping to a similar degree compared to White patients. CONCLUSION This retrospective multicenter study demonstrated that patients with Medicaid had a paradoxical increase in trauma volume during stay-at-home orders, suggesting that the most impoverished groups remain disproportionately exposed to trauma during a pandemic, further exacerbating existing health disparities.
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Affiliation(s)
- Eric O Yeates
- University of California, Irvine (UCI), Department of Surgery, Orange, CA
| | - Catherine Juillard
- University of California, Los Angeles (UCLA), Department of Surgery, Los Angeles, CA
| | - Areg Grigorian
- University of California, Irvine (UCI), Department of Surgery, Orange, CA; University of Southern California (USC), Department of Surgery, Los Angeles, CA
| | - Morgan Schellenberg
- University of Southern California (USC), Department of Surgery, Los Angeles, CA
| | | | | | - Daniel Margulies
- Cedars-Sinai Medical Center, Department of Surgery, Los Angeles, CA
| | - Kent Garber
- University of California, Los Angeles (UCLA), Department of Surgery, Los Angeles, CA
| | - Henry Cryer
- University of California, Los Angeles (UCLA), Department of Surgery, Los Angeles, CA
| | - Areti Tillou
- University of California, Los Angeles (UCLA), Department of Surgery, Los Angeles, CA
| | - Sigrid Burruss
- Loma Linda University, Department of Surgery, Loma Linda, CA
| | | | - Ann Lin
- Loma Linda University, Department of Surgery, Loma Linda, CA
| | | | - Megan Brenner
- University of California, Riverside/Riverside University Health System Department of Surgery, Moreno Valley, CA
| | - Christopher Firek
- Comparative Effectiveness and Clinical Outcomes Research Center (CECORC), Riverside University Health System, Moreno Valley, CA
| | - Todd Costantini
- University of California, San Diego (UCSD), Department of Surgery, San Diego, CA
| | - Jarrett Santorelli
- University of California, San Diego (UCSD), Department of Surgery, San Diego, CA
| | - Terry Curry
- University of California, San Diego (UCSD), Department of Surgery, San Diego, CA
| | - Diane Wintz
- Sharp Memorial Hospital, Department of Surgery, San Diego, CA
| | - Walter L Biffl
- Scripps Memorial Hospital La Jolla, Trauma Department, La Jolla, CA
| | | | - Thomas K Duncan
- Ventura County Medical Center, Department of Surgery, Ventura, CA
| | - Casey Barbaro
- Ventura County Medical Center, Department of Surgery, Ventura, CA
| | - Graal Diaz
- Ventura County Medical Center, Department of Surgery, Ventura, CA
| | - Arianne Johnson
- Santa Barbara Cottage Hospital, Cottage Health Research Institute, Santa Barbara, CA
| | - Justine Chinn
- University of California, Irvine (UCI), Department of Surgery, Orange, CA
| | - Ariana Naaseh
- University of California, Irvine (UCI), Department of Surgery, Orange, CA
| | - Amanda Leung
- University of California, Irvine (UCI), Department of Surgery, Orange, CA
| | - Christina Grabar
- University of California, Irvine (UCI), Department of Surgery, Orange, CA
| | - Todd O Yeates
- University of California, Los Angeles (UCLA), Department of Chemistry and Biochemistry, Los Angeles, CA
| | - Jeffry Nahmias
- University of California, Irvine (UCI), Department of Surgery, Orange, CA.
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19
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Dhillon NK, Juillard C, Barmparas G, Lin TL, Kim DY, Turay D, Seibold AR, Kaminski S, Duncan TK, Diaz G, Saad S, Hanpeter D, Benjamin ER, Tillou A, Demetriades D, Inaba K, Ley EJ. Electric Scooter Injury in Southern California Trauma Centers. J Am Coll Surg 2020; 231:133-138. [PMID: 32240771 DOI: 10.1016/j.jamcollsurg.2020.02.047] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [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: 01/05/2020] [Revised: 02/20/2020] [Accepted: 02/20/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Electric scooters are popular in Southern California due to their ease of use, affordability, and availability. The objective of this study was to characterize how hospital admissions and outcomes varied due to electric scooter injury among Southern California trauma centers. STUDY DESIGN Trauma registry data from 9 urban trauma centers were queried for patients sustaining injury while operating an electric scooter from January to December 2018. Data collection included patient demographics, diagnoses, interventions, and outcomes. RESULTS During the 1-year study period, 87 patients required trauma surgeon care due to scooter-related injury, with a mean age of 35.1 years; 71.3% were male with 20.7% and 17.2% of patients requiring ICU admission and a surgical intervention, respectively. One (1.1%) patient died. The head and face were most commonly injured, followed by the extremities. Helmet use was uncommon (71.3%). High variability in patient volume was noted, with 2 centers considered high-incidence and the remaining low-incidence. CONCLUSIONS Injuries from electric scooter crashes are primarily to the head, face, and extremities, with approximately 1 in 5 patients requiring ICU admission and/or a surgical intervention. There is significant variation in patient volume among Southern California trauma centers that could affect the delivery of care with the abrupt introduction of this technology. Targeted public health interventions and policies might better address community use of the electric scooter.
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Affiliation(s)
- Navpreet K Dhillon
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Catherine Juillard
- Department of Surgery, Ronald Reagan UCLA Medical Center, Santa Monica, CA
| | - Galinos Barmparas
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Ting-Lung Lin
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA; Departments of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Dennis Y Kim
- Division of Trauma and Critical Care, Harbor UCLA, Torrance, CA
| | - David Turay
- Department of Surgery, Division of Trauma, Loma Linda University Medical Center, Loma Linda, CA
| | - Alyssa R Seibold
- Department of Surgery, Division of Trauma, Loma Linda University Medical Center, Loma Linda, CA
| | - Stephen Kaminski
- Trauma Division, Santa Barbara Cottage Hospital, Santa Barbara, CA
| | - Thomas K Duncan
- Division of Trauma, Ventura County Medical Center, Ventura, CA
| | - Graal Diaz
- Division of Trauma, Ventura County Medical Center, Ventura, CA
| | - Shawki Saad
- General Surgery, Northridge Hospital Medical Center, Northridge, CA
| | - David Hanpeter
- General Surgery, Providence Holy Cross Medical Center, Mission Hills, CA
| | - Elizabeth R Benjamin
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Keck Medicine of University of Southern California, Los Angeles, CA
| | - Areti Tillou
- Department of Surgery, Ronald Reagan UCLA Medical Center, Santa Monica, CA
| | - Demetrios Demetriades
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Keck Medicine of University of Southern California, Los Angeles, CA
| | - Kenji Inaba
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Keck Medicine of University of Southern California, Los Angeles, CA
| | - Eric J Ley
- Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA.
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20
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Losh J, Duncan TK, Diaz G, Lee H, Romero J. Multidisciplinary Patient Management Improves Mortality in Geriatric Trauma Patients. Am Surg 2019; 85:230-233. [PMID: 30819305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Improvement in the care of the traumatically injured patient should be a goal at all trauma centers. One purpose of the data generated by the Trauma Quality Improvement Program is to provide insight which will lead to quality improvement initiatives and to promote intrinsic improvement on a center by center basis. The primary objective of this study was to measure the efficacy of instituting a multidisciplinary Trauma Medicine (T-MED) program to improve geriatric mortality at Ventura County Medical Center (VCMC). Trauma Quality Improvement Program data at VCMC before October 2013 demonstrated poor performance in treating geriatric patients. To attempt to improve outcomes, a multidisciplinary T-MED program was instituted in October 2013, which included a mandatory consultation and collaborative management with hospitalist medicine physicians for all trauma patients 65 years of age or older. The T-MED program increased focus on preexisting conditions, medication management, and discharge planning, including rehabilitation and continuity of care. Institution of a T-MED program at VCMC resulted in significant improvement in mortality rates for geriatric trauma patients.
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21
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Abstract
Improvement in the care of the traumatically injured patient should be a goal at all trauma centers. One purpose of the data generated by the Trauma Quality Improvement Program is to provide insight which will lead to quality improvement initiatives and to promote intrinsic improvement on a center by center basis. The primary objective of this study was to measure the efficacy of instituting a multidisciplinary Trauma Medicine (T-MED) program to improve geriatric mortality at Ventura County Medical Center (VCMC). Trauma Quality Improvement Program data at VCMC before October 2013 demonstrated poor performance in treating geriatric patients. To attempt to improve outcomes, a multidisciplinary T-MED program was instituted in October 2013, which included a mandatory consultation and collaborative management with hospitalist medicine physicians for all trauma patients 65 years of age or older. The T-MED program increased focus on preexisting conditions, medication management, and discharge planning, including rehabilitation and continuity of care. Institution of a T-MED program at VCMC resulted in significant improvement in mortality rates for geriatric trauma patients.
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Affiliation(s)
- Joseph Losh
- Ventura County Medical Center Department of General Surgery, Ventura California, Ventura, California
| | - Thomas K. Duncan
- Ventura County Medical Center Department of General Surgery, Ventura California, Ventura, California
| | - Graal Diaz
- Ventura County Medical Center Department of General Surgery, Ventura California, Ventura, California
| | - Hyesun Lee
- California State University Channel Islands Psychology Program, Camarillo, California
| | - Javier Romero
- Ventura County Medical Center Department of General Surgery, Ventura California, Ventura, California
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22
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Duncan TK. SEXUAL DIMORPHISM AND REPRODUCTIVE BEHAVIOR IN ALMYRACUMA PROXIMOCULI (CRUSTACEA: CUMACEA): THE EFFECT OF HABITAT. Biol Bull 1983; 165:370-378. [PMID: 28368230 DOI: 10.2307/1541202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Individuals of Almyracuma proximoculi are the least sexually dimorphic cumaceans known, because the males are progenetic, i.e., they are precociously sexually mature at a morphologically immature state. This species lives in dense aggregations in the upper intertidal zone and has eliminated the morphologically complex, apparently pheromone-sensitive, and highly motile terminal male stage found in other cumacean species. The sexually dimorphic characters that are present are predominantly ones that facilitate the rapid removal of the female's exuviae by the male during her fertilization molt. The removal rate is critical, because the partially detached exuviae blocks access to the female's ventrum. With the exception of the rudimentary penes found in two genera, male cumaceans do not possess an intromittent organ and apparently must deposit one or more spermatophores on the female's ventrum before the developing oostegites completely enclose this area.
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