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Svetanoff WJ, Fraser JA, Briggs KB, Staszak JK, Dekonenko C, Rentea RM, Juang D, Aguayo P, Fraser JD, Snyder CL, Hendrickson RJ, St Peter SD, Oyetunji T. A single institution experience with Laparoscopic Hernia repair in 791 children. J Pediatr Surg 2021; 56:1185-1189. [PMID: 33741178 DOI: 10.1016/j.jpedsurg.2021.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 02/05/2021] [Indexed: 01/10/2023]
Abstract
INTRODUCTION There are many described technique to performing laparoscopic inguinal hernia repair in children. We describe our outcomes using a percutaneous internal ring suturing technique. METHODS A retrospective review of patients under 18 years old who underwent repair between January 2014 - March 2019 was performed. A percutaneous internal ring suturing technique, involving hydro-dissection of the peritoneum, percutaneous suture passage, and cauterization of the peritoneum in the sac prior to high ligation, was used. p < 0.05 was considered significant during the analysis. RESULTS 791 patients were included. The median age at operation was 1.9 years (IQR 0.37, 5.82). The median operative time for a unilateral repair was 21 min (IQR 16, 28), while the median time for a bilateral repair was 30.5 min (IQR 23, 41). In total, 3 patients required conversion to an open procedure (0.4%), 4 (0.6%) experienced post-operative bleeding, 9 (1.2%) developed a wound infection, and iatrogenic ascent of testis occurred in 10 (1.3%) patients. Twenty patients (2.5%) developed a recurrent hernia. All but two were re-repaired laparoscopically. CONCLUSIONS The use of percutaneous internal ring suturing for laparoscopic repair of inguinal hernias in the pediatric population is safe and effective with a low rate of complications and recurrence.
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Affiliation(s)
| | - James A Fraser
- Department of Surgery, Children's Mercy, Kansas City, USA
| | - Kayla B Briggs
- Department of Surgery, Children's Mercy, Kansas City, USA
| | | | | | - Rebecca M Rentea
- Department of Surgery, Children's Mercy, Kansas City, USA; University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | - David Juang
- Department of Surgery, Children's Mercy, Kansas City, USA; University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | - Pablo Aguayo
- Department of Surgery, Children's Mercy, Kansas City, USA; University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | - Jason D Fraser
- Department of Surgery, Children's Mercy, Kansas City, USA; University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | - Charles L Snyder
- Department of Surgery, Children's Mercy, Kansas City, USA; University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | - Richard J Hendrickson
- Department of Surgery, Children's Mercy, Kansas City, USA; University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | - Shawn D St Peter
- Department of Surgery, Children's Mercy, Kansas City, USA; University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | - Tolulope Oyetunji
- Department of Surgery, Children's Mercy, Kansas City, USA; University of Missouri-Kansas City School of Medicine, Kansas City, USA.
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Shah AA, Shakoor A, Zogg CK, Oyetunji T, Ashfaq A, Garvey EM, Latif A, Riviello R, Qureshi FG, Mateen A, Haider AH, Zafar H. Influence of sub-specialty surgical care on outcomes for pediatric emergency general surgery patients in a low-middle income country. Int J Surg 2016; 29:12-8. [PMID: 26971828 DOI: 10.1016/j.ijsu.2016.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 02/29/2016] [Accepted: 03/06/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Whether adult general surgeons should handle pediatric emergencies is controversial. In many resource-limited settings, pediatric surgeons are not available. The study examined differences in surgical outcomes among children/adolescents managed by pediatric and adult general surgery teams for emergency general surgical (EGS) conditions at a university-hospital in South Asia. METHODS Pediatric patients (<18y) admitted with an EGS diagnosis (March 2009-April 2014) were included. Patients were dichotomized by adult vs. pediatric surgical management team. Outcome measures included: length of stay (LOS), mortality, and occurrence of ≥1 complication(s). Descriptive statistics and multivariable regression analyses with propensity scores to account for potential confounding were used to compare outcomes between the two groups. Quasi-experimental counterfactual models further examined hypothetical outcomes, assuming that all patients had been treated by pediatric surgeons. RESULTS A total of 2323 patients were included. Average age was 7.1y (±5.5 SD); most patients were male (77.7%). 1958 (84.3%) were managed by pediatric surgery. The overall probability of developing a complication was 1.8%; 0.9% died (all adult general surgery). Patients managed by adult general surgery had higher risk-adjusted odds of developing complications (OR [95%CI]: 5.42 [2.10-14.00]) and longer average LOS (7.98 vs. 5.61 days, p < 0.01). 39.8% fewer complications and an 8.2% decrease in LOS would have been expected if all patients had been managed by pediatric surgery. CONCLUSION Pediatric patients had better post-operative outcomes under pediatric surgical supervision, suggesting that, where possible in resource-constrained settings, resources should be allocated to promote development and staffing of pediatric surgical specialties parallel to adult general surgical teams.
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Affiliation(s)
- Adil A Shah
- Mayo Clinic, Division of General Surgery, Phoenix, AZ, USA; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Surgery, Aga Khan University, Karachi, Pakistan.
| | - Amarah Shakoor
- Department of Pediatrics, West Virginia University School of Medicine, Charleston, WV, USA.
| | - Cheryl K Zogg
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | | | - Awais Ashfaq
- Mayo Clinic, Division of General Surgery, Phoenix, AZ, USA.
| | - Erin M Garvey
- Mayo Clinic, Division of General Surgery, Phoenix, AZ, USA.
| | - Asad Latif
- Department of Anesthesiology and Critical Care Medicine & Center for Global Health, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Robert Riviello
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Faisal G Qureshi
- Department of Pediatric Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Arif Mateen
- Department of Surgery, Aga Khan University, Karachi, Pakistan.
| | - Adil H Haider
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Hasnain Zafar
- Department of Surgery, Aga Khan University, Karachi, Pakistan.
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Antiel RM, Blinman TA, Rentea RM, Gonzalez KW, Knott EM, Juang D, Oyetunji T, Holcomb GW, Angelos P, Lantos JD. When a Surgical Colleague Makes an Error. Pediatrics 2016; 137:e20153828. [PMID: 26908678 DOI: 10.1542/peds.2015-3828] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2015] [Indexed: 11/24/2022] Open
Abstract
Professionalism requires that doctors acknowledge their errors and figure out how to avoid making similar ones in the future. Over the last few decades, doctors have gotten better at acknowledging mistakes and apologizing to patients when a mistake happens. Such disclosure is especially complicated when one becomes aware of an error made by a colleague. We present a case in which consultant surgeons became aware that a colleague seemed to have made a serious error. Experts in surgery and bioethics comment on appropriate responses to this situation.
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Affiliation(s)
- Ryan M Antiel
- Department of Surgery, Mayo Clinic, Rochester, Minnesota; Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thane A Blinman
- Division of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rebecca M Rentea
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Katherine W Gonzalez
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - E Marty Knott
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - David Juang
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Tolulope Oyetunji
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - G W Holcomb
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | | | - John D Lantos
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri;
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Udofia AAUB, Oyetunji T, Fossett D. 115 Risk Factors for Laminectomy Surgical Site Infection in a Majority Minority Patient Population. Neurosurgery 2014. [DOI: 10.1227/01.neu.0000452389.01049.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Hughes K, Boyd C, Oyetunji T, Tran D, Chang D, Rose D, Siram S, Cornwell E, Obisesan T. Racial/Ethnic Disparities in Revascularization for Limb Salvage. Vasc Endovascular Surg 2014; 48:402-5. [DOI: 10.1177/1538574414543276] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Previous reports have suggested that black patients have a higher rate of major lower extremity amputation and a lower rate of revascularization for limb salvage when compared to white patients. Objective: We undertook this study to determine the extent of this ethnic disparity in recent years and to evaluate whether the widespread adoption of endovascular techniques has had an impact on this disparity. Methods: The American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP) database was queried to identify all patients who had undergone an above- or below-knee amputation as well as all patients who had undergone an open or endovascular revascularization procedure for critical limb ischemia for the years 2005 to 2006. Patient demographics and 30-day outcomes were recorded, and comparisons were made among the different ethnic groups. Results: There were 1568 patients identified in the NSQIP database as having undergone a major lower extremity amputation in 2005 and 2006. Of these patients, 54% were white, 29% black, 8% Hispanic, and 0.7% Asian. Eight percent of patients did not have identifying ethnic data. The group undergoing amputation was primarily male (61%) with a mean age of 65. Median length of stay was 11 days, and 30-day mortality was 9% following amputation. During this same time period, 4191 patients underwent an open surgical procedure and 569 patients underwent an endovascular procedure for the purposes of limb salvage. Of those patients undergoing an open procedure, 74% were white, 12% black, 4% Hispanic, 0.4% Asian, and 10% did not have identifying ethnic data. Open surgical patients were primarily male (63%) with a mean age of 66. Median length of stay was 6 days, and 30-day mortality was 3.3%. Of those patients undergoing an endovascular procedure, 79% were white, 10% black, 2% Hispanic, 1% Asian, and 8% did not have identifying ethnic data. The endovascular group was also primarily male (61%) with a mean age of 68. Median length of stay was 5 days, and 30-day mortality was 4%. Conclusion: There remains a significant ethnic disparity in limb-salvage revascularization. Blacks comprise 29% of patients undergoing a major lower extremity amputation, but only 12% of those undergoing an open surgical procedure and 10% of those undergoing an endovascular procedure for limb salvage. The widespread adoption of endovascular revascularization techniques appears not to have had much impact on this disparity.
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Affiliation(s)
- Kakra Hughes
- Department of Surgery, Howard University, Washington, DC, USA
| | | | | | - Daniel Tran
- Department of Surgery, Howard University, Washington, DC, USA
| | - David Chang
- Department of Surgery, University of California, San Diego, CA, USA
| | - David Rose
- Department of Surgery, Howard University, Washington, DC, USA
| | | | - Edward Cornwell
- Department of Surgery, Howard University, Washington, DC, USA
| | - Thomas Obisesan
- Department of Internal Medicine, Howard University, Washington, DC, USA
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Haider AH, Crompton JG, Oyetunji T, Risucci D, DiRusso S, Basdag H, Villegas CV, Syed ZU, Haut ER, Efron DT. Mechanism of injury predicts case fatality and functional outcomes in pediatric trauma patients: the case for its use in trauma outcomes studies. J Pediatr Surg 2011; 46:1557-63. [PMID: 21843724 DOI: 10.1016/j.jpedsurg.2011.04.055] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Revised: 04/26/2011] [Accepted: 04/27/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND/PURPOSE The mechanism of injury (MOI) may serve as a useful adjunct to injury scoring systems in pediatric trauma outcomes research. The objective is to determine the independent effect of MOI on case fatality and functional outcomes in pediatric trauma patients. METHODS Retrospective review of pediatric patients ages 2 to 18 years in the National Trauma Data Bank from 2002 through 2006 was done. Mechanism of injury was classified by the International Classification of Diseases, Ninth Revision, E codes. The main outcome measures were mortality, discharge disposition (home vs rehabilitation setting), and functional impairment at hospital discharge. Multiple logistic regression was used to adjust for injury severity (using the Injury Severity Score and the presence of shock upon admission in the emergency department), age, sex, and severe head or extremity injury. RESULTS Thirty-five thousand ninety-seven pediatric patients in the National Trauma Data Bank met inclusion criteria. Each MOI had differences in the adjusted odds of death or functional disabilities as compared with the reference group (fall). The MOI with the greatest risk of death was gunshot wounds (odds ratio [OR], 3.52; 95% confidence interval [CI], 2.23-5.54 95). Pediatric pedestrians struck by a motor vehicle have the highest risk of locomotion (OR, 3.30; 95% CI, 2.89-3.77) and expression (OR, 1.65; 95% CI, 1.22-2.23) disabilities. CONCLUSION Mechanism of injury is a significant predictor of clinical and functional outcomes at discharge for equivalently injured patients. These findings have implications for injury prevention, staging, and prognosis of traumatic injury and posttreatment planning.
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Affiliation(s)
- Adil H Haider
- Center for Trials and Outcomes Research, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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7
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Crompton JG, Bone C, Oyetunji T, Pollack KM, Bolorunduro O, Villegas C, Stevens K, Cornwell III EE, Efron DT, Haut ER. Motorcycle Helmets Associated with Lower Risk of Cervical Spine Injury: Debunking the Myth. J Am Coll Surg 2011; 212:295-300. [DOI: 10.1016/j.jamcollsurg.2010.09.032] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 09/01/2010] [Accepted: 09/01/2010] [Indexed: 10/18/2022]
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Crompton JG, Pollack KM, Oyetunji T, Chang DC, Efron DT, Haut ER, Cornwell EE, Haider AH. Racial disparities in motorcycle-related mortality: an analysis of the National Trauma Data Bank. Am J Surg 2010; 200:191-6. [PMID: 20678618 DOI: 10.1016/j.amjsurg.2009.07.047] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Revised: 07/08/2009] [Accepted: 07/08/2009] [Indexed: 11/17/2022]
Abstract
BACKGROUND Studies have shown racial disparities in outcomes after motor vehicle crashes; however, it is currently unknown if race impacts the likelihood of mortality after a motorcycle crash (MCC). The primary objective of this study was to determine if race is associated with MCC mortality. METHODS We performed a retrospective cross-sectional analysis of MCCs included in the National Trauma Data Bank between 2002 and 2006. Multiple logistic regression was used to adjust for age, sex, insurance status, year, helmet use, and injury severity characteristics. RESULTS Black patients had a 1.58 (95% confidence interval, 1.28-1.97) increased odds of mortality after a MCC, but were more likely to use a helmet (1.30; 95% confidence interval, 1.19-1.43) compared with their white counterparts (n = 62,840). CONCLUSIONS Black motorcyclists appear more likely to die after a MCC compared with whites. Although the reasons for this disparity are unclear, these data suggest that resources beyond encouraging helmet use are necessary to reduce fatalities among black motorcyclists.
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Affiliation(s)
- Joseph G Crompton
- Department of Surgery, The Johns Hopkins University, Baltimore, MD 21287, USA.
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9
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Callender CO, Cherikh WS, Traverso P, Hernandez A, Oyetunji T, Chang D. Effect of donor ethnicity on kidney survival in different recipient pairs: an analysis of the OPTN/UNOS database. Transplant Proc 2010; 41:4125-30. [PMID: 20005353 DOI: 10.1016/j.transproceed.2009.06.182] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Accepted: 06/24/2009] [Indexed: 01/01/2023]
Abstract
BACKGROUND Previous multivariate analysis performed between April 1, 1994, and December 31, 2000 from the Organ Procurement Transplant Network/United Network for Organ Sharing (OPTN/UNOS) database has shown that kidneys from black donors were associated with lower graft survival. We compared graft and patient survival of different kidney donor-to-recipient ethnic combinations to see if this result still holds on a recent cohort of US kidney transplants. METHODS We included 72,495 recipients of deceased and living donor kidney alone transplants from 2001 to 2005. A multivariate Cox regression method was used to analyze the effect of donor-recipient ethnicity on graft and patient survival within 5 years of transplant, and to adjust for the effect of other donor, recipient, and transplant characteristics. Results are presented as hazard ratios (HR) with the 95% confidence limit (CL) and P values. RESULTS Adjusted HRs of donor-recipient patient survival were: white to white (1); and white to black (1.22; P = .001). Graft survival HRs were black to black (1.40; P <.001); black to white (1.35; P <.001); black to Hispanic (0.87; P = .18); and black to Asian (0.69; P =.05). SUMMARY Black donor kidneys are associated with significantly lower graft survival when transplanted into whites or blacks and are only associated with lower patient survival when these kidneys are transplanted into white recipients. The graft and patient survival rates for Asian and Latino/Hispanic recipients, however, were not affected by donor ethnicity. This analysis underscores the need for research to better understand the reasons for these disparities and how to improve the posttransplant graft survival rates of black kidney recipients.
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Affiliation(s)
- C O Callender
- Howard University Hospital, 2041 Georgia Ave, NW, Suite 3100, Washington, DC 20060, USA.
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10
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Siram S, Oyetunji T, Johnson SM, Khoury AL, White PM, Chang DC, Greene WR, Frederick WAI. Predictors for survival of penetrating trauma using emergency department thoracotomy in an urban trauma center: the Cardiac Instability Score. J Natl Med Assoc 2010; 102:126-30. [PMID: 20191925 DOI: 10.1016/s0027-9684(15)30500-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Emergency department thoracotomy (EDT) is a procedure used in an attempt to save lives of patients in extremis. This study aims to determine predictors of survival and futility by proposing a scoring scale that measures cardiac instability and its use in predicting survival of victims of penetrating trauma undergoing EDT. METHODS This retrospective study analyzes patients who underwent EDT during a 45-month period at Howard University Hospital, Washington, DC. Vital signs and Glasgow Coma scale (GCS) scores were analyzed at the scene and in the emergency department. A cardiac instability score (CIS) was devised to assign values to vital signs, and the GCS was based on scores from the emergency department. RESULTS Emergency department vital signs, female gender, absence of cardiopulmonary resuscitation (CPR), and high CIS were found to be statistically significant predictors of survival. CONCLUSIONS The CIS correlated with survival of patients who underwent EDT and was found to be statistically significant in determining the outcome of an EDT.
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Affiliation(s)
- Suryanarayana Siram
- Department of Surgery, Howard University College of Medicine, Washington, DC 20060, USA
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11
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Crompton JG, Oyetunji T, Stevens KA, Efron DT, Haut ER, Haider AH. Motorcycle helmets save lives, but not limbs: a National Trauma Data Bank analysis of functional outcomes after motorcycle crash. J Surg Res 2010; 158:1-5. [PMID: 19815235 DOI: 10.1016/j.jss.2009.06.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2009] [Revised: 06/16/2009] [Accepted: 06/18/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND The incidence of motorcycle fatalities over the last 10 y has nearly doubled. There is considerable evidence that motorcycle helmets save lives, but there are little data regarding the impact that helmets have on functional outcomes after a motorcycle crash. The objective of this study was to determine the difference between helmeted and non-helmeted motorcyclists in the odds of developing a functional deficit at discharge in three domains: speech, locomotion, and feeding. METHODS Reviewed cases in the National Trauma Databank v7.0 involved in motorcycle collisions. Multiple logistic regression was used to analyze the effect of helmets on mortality and functional outcomes, adjusting for age, race, gender, insurance status, anatomic and physiologic injury severity, and head injury. RESULTS The adjusted odds of mortality (0.75; 95% CI 0.65-0.86) and functional deficits in speech (0.82; 95% CI 0.69-0.97), locomotion (1.19; 95% CI 1.11-1.29), and feeding (0.96 95% CI 0.84-1.08) among helmeted riders was compared with non-helmeted motorcyclists with equivalent injuries. CONCLUSION Helmeted motorcyclists are less likely to die and develop a deficit in speech after a motorcycle collision. These data support that motorcycle helmets are important in preventing functional deficits related to head injury.
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Affiliation(s)
- Joseph G Crompton
- Department of Surgery, Division of Acute Care Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
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Oyetunji T, Crompton JG, Efron DT, Haut ER, Chang DC, Cornwell EE, Baker SP, Haider AH. Simplifying physiologic injury severity measurement for predicting trauma outcomes. J Surg Res 2009; 159:627-32. [PMID: 20036392 DOI: 10.1016/j.jss.2009.08.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Revised: 08/25/2009] [Accepted: 08/28/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND The Revised Trauma Score (RTS) is commonly used to assess physiologic injury; however its use is limited by missing data. This study compares different parameters of physiologic injury assessment in their ability to predict mortality after trauma. METHODS Adult patients in the National Trauma Data Bank (NTDB version 7.0) were analyzed, and the following physiologic injury parameters were compared: RTS, systolic blood pressure (SBP), shock (SBP <or= 90 mm Hg), Glasgow coma scale-total (GCS-T), and GCS-motor (GCS-M). Areas under the receiver-operating characteristic curves (AUROC) were calculated for unadjusted and multivariate regression models to predict mortality after trauma. RESULTS There were 1,484,648 patients who met inclusion criteria. In unadjusted analyses, RTS had the highest proportion of missing data (21%) and was highly predictive of mortality (AUROC = 0.85). SBP and shock had a much lower AUROC of 0.67 and 0.66, respectively, but had many fewer missing cases. The combination parameters of GCS-M with SBP or GCS-M with shock showed AUROC comparable to RTS (0.85) with approximately 80,000 fewer missing cases. CONCLUSION The discriminatory power of RTS is significantly better than SBP, shock, or GCS alone. Given the limitation of missing data associated with RTS, the combination of SBP and GCS-M is a more reliable and equally effective method of assessing physiologic injury severity in studying trauma outcomes.
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Affiliation(s)
- Tolulope Oyetunji
- Department of Surgery, Howard University College of Medicine, Washington, D.C
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13
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Haider AH, Crompton JG, Oyetunji T, Stevens KA, Efron DT, Kieninger AN, Chang DC, Cornwell EE, Haut ER. Females have fewer complications and lower mortality following trauma than similarly injured males: a risk adjusted analysis of adults in the National Trauma Data Bank. Surgery 2009; 146:308-15. [PMID: 19628090 DOI: 10.1016/j.surg.2009.05.006] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [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: 01/08/2009] [Accepted: 05/08/2009] [Indexed: 11/17/2022]
Abstract
BACKGROUND Studies of sexual dimorphism in trauma outcomes suggest that women have a survival advantage compared to equivalently injured men. It is unknown if this gender disparity is mediated by potentially life-threatening complications. OBJECTIVE To determine (1) if there is a sex-based differences in the odds of developing inpatient complications after trauma, and (2) if are these complications associated with death among trauma patients. METHODS Review of adult trauma patients admitted to hospitals in the National Trauma Data Bank that report complications. Patient and injury severity covariates were adjusted using multiple logistic regression and the independent effect of sex on developing complications and associated mortality was determined. RESULTS A total of 681,730 adult patients met the inclusion criteria of hospital admission > or =3 days. Women demonstrated a 21% lower adjusted risk of death compared to males (OR 0.79, 95% CI 0.76-0.83). Females had decreased adjusted odds of developing life-threatening complications including pneumonia, acute respiratory distress syndrome, acute renal failure and pulmonary embolism. However, when compared to males with life-threatening complications, females with complications were found to be at greater risk of dying. CONCLUSION This study demonstrates that women are less likely than men to develop inpatient complications, suggesting that the survival advantage among women after traumatic injury may involve a reduced susceptibility to developing life-threatening complications.
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Affiliation(s)
- Adil H Haider
- Trauma Outcomes Research Group-Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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Nixon MKC, Chang D, Oyetunji T, Downing S, Mukherjee D, Brem H, Cornwell EE, Quinones-Hinojosa A. Is There a Gender Difference in Mortality Risk Among Traumatic Brain Injury Patients? Neurosurgery 2009. [DOI: 10.1227/01.neu.0000358711.57067.c8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Crompton J, Oyetunji T, Haut E, Efron D, Haider A. QS229. Motorcycle Helmets Save Lives, But Not Limbs: A National Trauma Data Bank Analysis of Functional Outcomes After Motorcycle Crash. J Surg Res 2009. [DOI: 10.1016/j.jss.2008.11.531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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