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Starr N, Kornblith L. Prehospital balanced resuscitation may mitigate hypofibrinogenemia in traumatic hemorrhagic shock. Trauma Surg Acute Care Open 2024; 9:e001354. [PMID: 38596567 PMCID: PMC11002369 DOI: 10.1136/tsaco-2023-001354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Affiliation(s)
- Nichole Starr
- Surgery, University of California San Francisco, San Francisco, California, USA
- Surgery, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA
| | - Lucy Kornblith
- Surgery, University of California San Francisco, San Francisco, California, USA
- Surgery, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA
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Durbin S, Loss L, Buzzard L, Minoza K, Beiling M, Karsonovich C, Liu M, Garay J, Fields A, Mathews M, Kuhn B, Moskowitz K, Miyazawa B, Trivedi A, Kornblith L, Fitzpatrick M, Pati S, Schreiber M. Pilot study of frozen platelet extracellular vesicles as a therapeutic agent in hemorrhagic shock in rats. J Trauma Acute Care Surg 2024; 96:364-370. [PMID: 38011031 DOI: 10.1097/ta.0000000000004210] [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: 11/29/2023]
Abstract
BACKGROUND Hemorrhage accounts for the most preventable deaths after trauma. Resuscitation is guided by studies that demonstrate improved outcomes in patients receiving whole blood or balanced administration of blood products. Platelets present a logistical challenge due to short shelf life and need for refrigeration. Platelet-derived extracellular vesicles (PEVs) are a possible platelet alternative. Platelet-derived extracellular vesicles are secreted from platelets, have hemostatic effects and mitigate inflammation and vascular injury, similar to platelets. This pilot study aimed to elucidate the therapeutic effects of PEVs in a rat model of uncontrolled hemorrhage. METHODS Male rats were anesthetized and femoral vessels cannulated. Vital signs (MAP, HR, and RR) were monitored. Electrolytes, lactate and ABG were obtained at baseline, 1-hour and 3-hours post injury. Laparotomy was performed, 50% of the middle hepatic lobe excised and the abdomen packed with gauze. Rats received 2 mL PEVs or lactated Ringers (LR) over 6 minutes immediately after injury. Peritoneal blood loss was quantified using preweighed gauze at 5 minutes, 15 minutes, 30 minutes, 45 minutes, and 60 minutes. Laparotomy was closed 1-hour postinjury. Animals were monitored for 3 hours postinjury then euthanized. Generalized Linear Mixed Effects models were performed to assess effects of treatment and time on lactate and MAP. RESULTS Twenty-one rats were included (11 LR, 10 PEV). Overall blood loss was between 6 mL and 10 mL and not significantly different between groups. There was a 36% mortality rate in the LR group and 0% mortality in the PEV group ( p = 0.03). The LR group had significantly higher lactates at 1 hour ( p = 0.025). At 15 minutes, 45 minutes, 60 minutes, and 180 minutes, the MAP of the PEV group was significantly higher than the LR group. CONCLUSION Early studies are encouraging regarding the potential use of PEVs in uncontrolled hemorrhagic shock based on improved survival and hemodynamics.
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Affiliation(s)
- Samantha Durbin
- From the Department of Surgery (S.D., L.L., L.B., Ka.M., M.B., C.K., M.L., J.G., M.S.), Oregon Health & Science University, Portland, Oregon; Department of Laboratory Medicine (A.F., B.M., A.T., L.K., S.P.), University of California San Francisco, San Francisco, California; and Cellphire Therapeutics, Inc. (M.M., B.K., Ke.M., M.F.), Rockville, Maryland
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Lombardo S, McCrum M, Knudson MM, Moore EE, Kornblith L, Brakenridge S, Bruns B, Cipolle MD, Costantini TW, Crookes B, Haut ER, Kerwin AJ, Kiraly LN, Knowlton LM, Martin MJ, McNutt MK, Milia DJ, Mohr A, Rogers F, Scalea T, Sixta S, Spain D, Wade CE, Velmahos GC, Nirula R, Nunez J. Weight-based enoxaparin thromboprophylaxis in young trauma patients: analysis of the CLOTT-1 registry. Trauma Surg Acute Care Open 2024; 9:e001230. [PMID: 38420604 PMCID: PMC10900334 DOI: 10.1136/tsaco-2023-001230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/26/2023] [Indexed: 03/02/2024] Open
Abstract
Introduction Optimal venous thromboembolism (VTE) enoxaparin prophylaxis dosing remains elusive. Weight-based (WB) dosing safely increases anti-factor Xa levels without the need for routine monitoring but it is unclear if it leads to lower VTE risk. We hypothesized that WB dosing would decrease VTE risk compared with standard fixed dosing (SFD). Methods Patients from the prospective, observational CLOTT-1 registry receiving prophylactic enoxaparin (n=5539) were categorized as WB (0.45-0.55 mg/kg two times per day) or SFD (30 mg two times per day, 40 mg once a day). Multivariate logistic regression was used to generate a predicted probability of VTE for WB and SFD patients. Results Of 4360 patients analyzed, 1065 (24.4%) were WB and 3295 (75.6%) were SFD. WB patients were younger, female, more severely injured, and underwent major operation or major venous repair at a higher rate than individuals in the SFD group. Obesity was more common among the SFD group. Unadjusted VTE rates were comparable (WB 3.1% vs. SFD 3.9%; p=0.221). Early prophylaxis was associated with lower VTE rate (1.4% vs. 5.0%; p=0.001) and deep vein thrombosis (0.9% vs. 4.4%; p<0.001), but not pulmonary embolism (0.7% vs. 1.4%; p=0.259). After adjustment, VTE incidence did not differ by dosing strategy (adjusted OR (aOR) 0.75, 95% CI 0.38 to 1.48); however, early administration was associated with a significant reduction in VTE (aOR 0.47, 95% CI 0.30 to 0.74). Conclusion In young trauma patients, WB prophylaxis is not associated with reduced VTE rate when compared with SFD. The timing of the initiation of chemoprophylaxis may be more important than the dosing strategy. Further studies need to evaluate these findings across a wider age and comorbidity spectrum. Level of evidence Level IV, therapeutic/care management.
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Affiliation(s)
| | - Marta McCrum
- Surgery, University of Utah, Salt Lake City, Utah, USA
| | - M Margaret Knudson
- Surgery, University of California San Francisco, San Francisco, California, USA
| | | | - Lucy Kornblith
- Surgery, University of California San Francisco, San Francisco, California, USA
| | - Scott Brakenridge
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Brandon Bruns
- Department of Surgery, UT Southwestern Medical School, Dallas, Texas, USA
| | - Mark D Cipolle
- Lehigh Valley Health Network, Allentown, Pennsylvania, USA
| | - Todd W Costantini
- Surgery, University of California San Francisco, San Francisco, California, USA
| | - Bruce Crookes
- Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Elliott R Haut
- Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Andrew J Kerwin
- Surgery, University of Florida College of Medicine–Jacksonville, Jacksonville, Florida, USA
| | | | | | - Matthew J Martin
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, Los Angeles, California, USA
| | - Michelle K McNutt
- Surgery, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - David J Milia
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Alicia Mohr
- Surgery, University of Florida College of Medicine–Jacksonville, Jacksonville, Florida, USA
| | | | - Thomas Scalea
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sherry Sixta
- St Anthony Hospital & Medical Campus, Lakewood, Colorado, USA
| | - David Spain
- Surgery, Stanford University, Stanford, California, USA
| | - Charles E Wade
- Surgery, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | | | - Ram Nirula
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Jade Nunez
- Surgery, University of Utah, Salt Lake City, Utah, USA
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Abella M, Hayashi J, Martinez B, Inouye M, Rosander A, Kornblith L, Elkbuli A. A National Analysis of Racial and Sex Disparities Among Interhospital Transfers for Emergency General Surgery Patients and Associated Outcomes. J Surg Res 2024; 294:228-239. [PMID: 37922643 DOI: 10.1016/j.jss.2023.09.043] [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: 03/04/2023] [Revised: 08/20/2023] [Accepted: 09/04/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Studies focusing on Emergency General Surgery (EGS) and Interhospital Transfer (IHT) and the association of race and sex and morbidity and mortality are yet to be conducted. We aim to investigate the association of race and sex and outcomes among IHT patients who underwent emergency general surgery. METHODS A retrospective review of adult patients who were transferred prior to EGS procedures using the National Surgery Quality Improvement Project from 2014 to 2020. Multivariable logistic regression models were used to compare outcomes (readmission, major and minor postoperative complications, and reoperation) between interhospital transfer and direct admit patients and to investigate the association of race and sex for adverse outcomes for all EGS procedures. A secondary analysis was performed for each individual EGS procedure. RESULTS Compared to patients transferred directly from home, IHT patients (n = 28,517) had higher odds of readmission [odds ratio (OR): 1.004, 95% confidence interval (CI) (1.002-1.006), P < 0.001], major complication [adjusted OR: 1.119, 95% CI (1.117-1.121), P < 0.001), minor complication [OR: 1.078, 95% CI (1.075-1.080), P < 0.001], and reoperation [OR: 1.014, 95% CI (1.013-1.015), P < 0.001]. In all EGS procedures, Black patients had greater odds of minor complication [OR 1.041, 95% CI (1.023-1.060), P < 0.001], Native Hawaiian and Pacific Islander patients had greater odds of readmission [OR 1.081, 95% CI (1.008-1.160), P = 0.030], while Asian and Hispanic patients had lower odds of adverse outcome, and female patients had greater odds of minor complication [OR 1.017, 95% CI (1.008-1.027), P < 0.001]. CONCLUSIONS Procedure-specific racial and sex-related disparities exist in emergency general surgery patients who underwent interhospital transfer. Specific interventions should be implemented to address these disparities to improve the safety of emergency procedures.
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Affiliation(s)
| | | | - Brian Martinez
- Dr Kiran C. Patel College of Allopathic Medicine, NOVA Southeastern University, Fort Lauderdale, Florida
| | | | - Abigail Rosander
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, Arizona
| | - Lucy Kornblith
- Division of Trauma and Surgical Critical Care, Department of Surgery, Zuckerberg Hospital and Trauma Center, San Francisco, California
| | - Adel Elkbuli
- Division of Trauma and Surgical Critical Care, Department of Surgery, Orlando Regional Medical Center, Orlando, Florida; Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida.
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Cuschieri J, Kornblith L, Pati S, Piliponsky A. The injured monocyte: The link to chronic critical illness and mortality following injury. J Trauma Acute Care Surg 2024; 96:195-202. [PMID: 37880827 PMCID: PMC10986485 DOI: 10.1097/ta.0000000000004173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
BACKGROUND This study aimed to understand the altered innate immune response in severely injured patients leading to chronic critical illness (CCI). Specifically, it focused on characterizing the monocyte populations and their correlation with CCI development and long-term complications. METHODS Over a 3-year period, we monitored patients with severe injuries for up to 1-year postinjury. Chronic critical illness was defined as an ICU stay exceeding 14 days with persistent organ failure. Blood samples were collected on Days 1 and 5 for monocyte phenotypic expression analysis using cytometry by time flight. The monocyte subpopulations studied were classical (CL), intermediate (INT), and nonclassical (NC), along with cell surface receptor expression and activation. RESULTS Out of 80 enrolled patients, 26 (32.5%) developed CCI. Patients with CCI had more severe injuries (Injury Severity Score, 32.4 + 5.2 vs. 29.6 + 4.1, p = 0.01) and received a higher number of red blood cells (8.9 + 4.1 vs. 4.7 + 3.8 units, p < 0.01) compared with those without CCI. In patients with CCI, the NC monocytes were significantly reduced by over twofold early, and significantly increased later, compared with those without CCI. Moreover, significant changes in intracellular cytokine expression and cell receptors were observed within each monocyte subpopulation in patients with CCI, indicating an increased proinflammatory phenotype but decreased phagocytic capacity and antigen presentation. The development of CCI and the presence of this unique monocyte phenotype were associated with a significantly increased risk of infection, discharge to a long-term care facility, and 1-year mortality of 27%. CONCLUSION Development of CCI following severe injury is associated with significant long-term morbidity and unacceptably high mortality. The altered NC phenotype with reduced phagocytic capacity and antigen presentation in patients developing CCI after severe injury is appears partially responsible. Early identification of this unique phenotype may help predict and treat patients at risk for CCI, leading to improved outcomes. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level III.
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Affiliation(s)
- Joseph Cuschieri
- From the Department of Surgery (J.C.), Department of Surgery (L.K.), Department of Laboratory Medicine (S.P.), University of California San Francisco, San Francisco, California; and Department of Pediatrics (A.P.), University of Washington, Seattle, Washington
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Concepcion J, Newsome K, Alfaro S, Selvakumar S, Sen-Crowe B, Vallejo K, Andrade R, Yeager M, Kornblith L, Bilski T, Elkbuli A. Nationwide Analysis of Biomechanics of Motor Vehicle Collisions Involving Passenger Vehicle and Associated Outcomes: Towards Improving Vehicle Safety Standards and Regulations. Am Surg 2023; 89:4360-4366. [PMID: 35762303 DOI: 10.1177/00031348221111511] [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: 11/16/2022]
Abstract
BACKGROUND Motor vehicle collisions (MVCs) pose significant mortality and economic burden on the United States. Biomechanics research may guide future vehicle innovation. The objective of this study is to investigate the biomechanics of two-vehicle MVCs involving passenger vehicle (PV) to evaluate associated injury patterns and outcomes including mortality. METHODS A retrospective cohort study of cases from the Crash Injury Research Engineering Network database was performed to evaluate the biomechanics (angle of impact, seatbelt use, and airbag deployment) of two-vehicle MVCs involving at least one PV from 2005-2015. RESULTS Out of 629 MVCs evaluated, lateral collisions were most common (49.5%), followed by head-on (41.3%) and rear-end (9.2%) collisions. Thoracic injuries accounted for 30.1%, 31.4%, and 31.1% of injuries in lateral, head-on, and rear-end collisions, respectively, and were the most common body region injured for all collision types. Seatbelt use was associated with shorter ICU stay (10.9 vs 19.1 days, P = .036) and mortality (Cramer's V = .224, P < .001), but a greater average number of injuries (10.2 injuries vs 8.6 injuries, P = .011). CONCLUSION Passenger vehicle are commonly involved in MVCs nationwide and efforts are needed to prevent occupant injuries and fatalities. The incorporation of energy-absorbing material into common points of contact within the vehicle interior may decrease the severity of these injuries. Seatbelt use remains a protective factor against MVC-fatalities but is associated with collateral injuries and should be a focus of further innovation.
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Affiliation(s)
| | - Kevin Newsome
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Sophie Alfaro
- A.T. Still University School of Osteopathic Medicine, Mesa, AZ, USA
| | - Sruthi Selvakumar
- Dr Kiran, C. Patel College of Allopathic Medicine, NSU NOVA Southeastern University, Fort Lauderdale, FL, USA
| | - Brendon Sen-Crowe
- Dr Kiran, C. Patel College of Allopathic Medicine, NSU NOVA Southeastern University, Fort Lauderdale, FL, USA
| | - Kevin Vallejo
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Ryan Andrade
- A.T. Still University School of Osteopathic Medicine, Mesa, AZ, USA
| | - Matthew Yeager
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Lucy Kornblith
- Department of Surgery, Division of Trauma and Surgical Critical Care, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
- Department of Surgery, University of San Francisco, San Francisco, CA, USA
| | - Tracy Bilski
- Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, FL, USA
- Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL, USA
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, FL, USA
- Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL, USA
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Ngatuvai M, Zagales R, Khan A, Rosander A, Breeding T, Kornblith L, Bilski T, Elkbuli A. Analysis of Bicyclist Injuries and Fatalities in The United States: The Need for Effective & Sustainable Prevention Policies. Am Surg 2023; 89:4963-4966. [PMID: 36426880 DOI: 10.1177/00031348221142579] [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: 12/06/2023]
Abstract
We aim to investigate nationwide and state trends of bicyclist injuries, fatalities, and associated costs amongst adult and pediatric populations to assess the need for effective and strategic interventions. An epidemiologic study was performed investigating the injury and fatality rate of bicyclists from 2010 to 2020. The fatality rate was higher in adults compared to pediatric bicyclists (0.36 vs. 0.12 per population of 100,000, P < .001), but pediatric bicyclists suffered higher rates of injury (246.19 vs. 102.11 per population of 100,000, P < .001). The medical cost of fatalities for adult bicyclists was $139.1 million compared to $9.0 million for pediatric bicyclists. Bicyclist fatality rates are significantly higher per capita for adult bicyclists. States including Florida, South Carolina, and Louisiana had the highest bicyclist fatalities per capita for both adults and children.
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Affiliation(s)
- Micah Ngatuvai
- NOVA Southeastern University Kiran Patel College of Allopathic Medicine, NSUFort Lauderdale, FL, USA
| | - Ruth Zagales
- Florida International University, Miami, FL, USA
| | - Areeba Khan
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Abigail Rosander
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ, USA
| | - Tessa Breeding
- NOVA Southeastern University Kiran Patel College of Allopathic Medicine, NSUFort Lauderdale, FL, USA
| | - Lucy Kornblith
- Department of Surgery, Zuckerberg General Hospital and Trauma Center, San Francisco, CA, USA
| | - Tracy Bilski
- Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, FL, USA
- Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL, USA
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, FL, USA
- Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL, USA
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Biffl WL, Ball CG, Moore EE, West M, Russo RM, Balogh ZJ, Kornblith L, Castelo M. Current use and utility of magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography, and pancreatic duct stents: A secondary analysis from the Western Trauma Association multicenter trials group on pancreatic injuries. J Trauma Acute Care Surg 2023; 95:719-725. [PMID: 37125949 DOI: 10.1097/ta.0000000000003990] [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: 05/02/2023]
Abstract
INTRODUCTION The single most important predictor of pancreas-specific complications (PSCs) after pancreatic trauma is injury to the main pancreatic duct (MPD). Pancreatography has been recommended to evaluate the integrity of the MPD. In addition, pancreatic duct stents have been proposed to prevent or treat PSC. The primary purpose of this study was to determine the accuracy of magnetic resonance cholangiopancreatography (MRCP) in diagnosing MPD injury. We further sought to determine whether stents were effective in preventing PSC or facilitated the resolution of pancreatic leaks or fistulae. METHODS A secondary analysis of a multicenter retrospective review of pancreatic injuries in patients 15 years and older from 2010 to 2018, focusing on patients who underwent MRCP or endoscopic retrograde cholangiopancreatography (ERCP), was performed. Final pancreatic injury grade was determined based on all available assessments, ultimately adjudicated by the site principal investigator. Data were analyzed using various statistical tests where appropriate. RESULTS Thirty-three centers reported on 1,243 patients. A total of 216 underwent pancreatography-137 had MRCP and 115 ERCP, with 36 having both. The sensitivity of MRCP for MPD injury was 37%, the specificity was 94%, the positive predictive value was 77%, and the negative predictive value was 73%. When compared with ERCP, MRCP findings were discordant in 64% of cases. Pancreatic stents were placed in 77 patients; 48 (62%) were to treat PSC, with no clear benefit. Twenty-nine had prophylactic stents placed. There did not appear to be benefit in reduced PSC compared with the entire study group or among patients with high-grade pancreatic injuries. CONCLUSION The accuracy of MRCP to evaluate the integrity of the MPD does not appear to be superior to computed tomography scan. Consequently, the results of MRCP should be interpreted with caution. The current data do not support prophylactic use of pancreatic stents; they should be studied in a prospective trial. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
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Affiliation(s)
- Walter L Biffl
- From the Trauma Department (W.L.B., M.C.), Scripps Memorial Hospital La Jolla, La Jolla, California; Department of Surgery (C.G.B.), University of Calgary, Alberta, Canada; Ernest E. Moore Shock Trauma Center at Denver Health (E.E.M.), Denver, Colorado; Department of Trauma and Acute Care Surgery (M.W.), North Memorial Health Care, Minneapolis, Minnesota; Department of Surgery (R.M.R.), University of California-Davis, Sacramento, California; Department of Traumatology (Z.J.B.), John Hunter Hospital, University of Newcastle, New South Wales, Australia; and Department of Surgery (L.K.), San Francisco General Hospital, San Francisco, California
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Concepcion J, Alfaro S, Yeager M, Newsome K, Selvakumar S, Andrade R, Kornblith L, Bilski T, Ibrahim J, Elkbuli A. Analysis of Biomechanics of Motor Vehicle Collisions for Passenger Cars: Implications for Passenger Vehicle Safety and Future Car Design Innovations. J Surg Res 2023; 285:243-251. [PMID: 36192207 DOI: 10.1016/j.jss.2022.08.042] [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: 03/18/2022] [Revised: 07/28/2022] [Accepted: 08/21/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Investigating biomechanics of injury patterns from motor vehicle collisions (MVCs) informs improvements in vehicle safety. This study aims to investigate two-vehicle MVCs involving a passenger car and specific injury patterns associated with sources of injury, collision biomechanics, vehicle properties, and patient outcomes. METHODS Retrospective cohort study conducted to evaluate the biomechanics of specific injury patterns seen in MVCs involving passenger cars using the Crash Injury Research Engineering Network database between the years 2005 and 2015. RESULTS A total of 631 MVC cases were included from 2005 to 2015. The majority of cases involved injuries to the head or neck, the thorax, and the abdomen (80.5%). Head/neck injuries from the steering wheel were associated with significantly higher injury severity score compared to those from seatbelts (26.11 versus 18.28, P < 0.001) and airbags (26.11 versus 20.10, P = 0.006), as well as a >6-fold higher fatality rate (P = 0.019). Thoracic injuries caused by the center console were twice as likely to be fatal than those caused by the seatbelt (P = 0.09). CONCLUSIONS Occupants suffering injuries to the head/neck, the thorax, and the abdomen had higher injury severity score and fatality rates compared to other body regions, demonstrating that manufacturing and safety guidelines should focus on minimizing these injury patterns. Head/neck injuries caused by the steering wheel were associated with worse outcomes compared to those caused by seatbelts and airbags, further emphasizing the benefits of these critical safety features. Integration of innovative safety features like center-mounted airbags may improve occupant safety.
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Affiliation(s)
| | - Sophie Alfaro
- A.T. Still University School of Osteopathic Medicine, Mesa, Arizona
| | - Matthew Yeager
- Florida International University, Herbert Wertheim College of Medicine, Miami, Florida
| | - Kevin Newsome
- Florida International University, Herbert Wertheim College of Medicine, Miami, Florida
| | - Sruthi Selvakumar
- NSU NOVA Southeastern University, Dr Kiran.C. Patel College of Allopathic Medicine, Fort Lauderdale, Florida
| | - Ryan Andrade
- A.T. Still University School of Osteopathic Medicine, Mesa, Arizona
| | - Lucy Kornblith
- Department of Surgery, Division of Trauma and Surgical Critical Care, Zuckerberg San Francisco General Hospital & Trauma Center, San Francisco, California; Department of Surgery, University of San Francisco, San Francisco, California
| | - Tracy Bilski
- Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, Florida; Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida
| | - Joseph Ibrahim
- Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, Florida; Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, Florida; Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida.
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Ngatuvai M, Martinez B, Sauder M, Beeton G, Andrade R, Maka P, Smith CP, Kornblith L, Elkbuli A. Traumatic Brain Injury, Electrolyte Levels, and Associated Outcomes: A Systematic Review. J Surg Res 2023; 289:106-115. [PMID: 37087837 DOI: 10.1016/j.jss.2023.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/26/2023] [Accepted: 03/17/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Although it has been established that electrolyte abnormalities are a consequence of traumatic brain injury (TBI), the degree to which electrolyte imbalances impact patient outcomes has not been fully established. We aim to determine the impact of sodium, potassium, calcium, and magnesium abnormalities on outcomes in patients with TBI. METHODS Four databases were searched for studies related to the impact of electrolyte abnormalities on outcomes for TBI patients. Outcomes of interest were rates of mortality, Glasgow Outcome Scale (GOS), and intensive care unit length of stay (ICU-LOS). The search included studies published up to July 21, 2022. Articles were then screened and included if they met inclusion and exclusion criteria. RESULTS In total, fourteen studies met inclusion and exclusion criteria for analysis in this systematic review. In patients with TBI, an increased mortality rate was associated with hypernatremia, hypokalemia, and hypocalcemia in the majority of studies. Both hyponatremia and hypomagnesemia were associated with worse GOS at 6 months. Whereas, both hyponatremia and hypernatremia were associated with increased ICU-LOS. There was no evidence to suggest other electrolyte imbalances were associated with either GOS or ICU-LOS. CONCLUSIONS Hyponatremia and hypomagnesemia were associated with worse GOS. Hypernatremia was associated with increased mortality and ICU-LOS. Hypokalemia and hypocalcemia were associated with increased mortality. Given these findings, future practice guidelines should consider the effects of electrolytes' abnormalities on outcomes in TBI patients prior to establishing management strategies.
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Affiliation(s)
- Micah Ngatuvai
- NOVA Southeastern University, Kiran Patel College of Allopathic Medicine, Fort Lauderdale, Florida
| | - Brian Martinez
- NOVA Southeastern University, Kiran Patel College of Allopathic Medicine, Fort Lauderdale, Florida
| | - Matthew Sauder
- NOVA Southeastern University, Kiran Patel College of Allopathic Medicine, Fort Lauderdale, Florida
| | - George Beeton
- University of North Texas Health Science Center, Fort Worth, Texas
| | - Ryan Andrade
- A.T. Still University School of Osteopathic Medicine, Mesa, Arizona
| | - Piueti Maka
- John A. Burns School of Medicine, Honolulu, Hawaii
| | - Chadwick P Smith
- Division of Trauma and Surgical Critical Care, Department of Surgery, Orlando Regional Medical Center, Orlando, Florida; Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida
| | - Lucy Kornblith
- Division of Trauma and Surgical Critical Care, Department of Surgery, Zuckerberg Hospital and Trauma Center, San Francisco, California
| | - Adel Elkbuli
- Division of Trauma and Surgical Critical Care, Department of Surgery, Orlando Regional Medical Center, Orlando, Florida; Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida.
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11
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Rosander A, Breeding T, Ngatuvai M, Alter N, Maka P, Beeton G, Kornblith L, Elkbuli A. National analysis of motorcycle associated injuries and fatalities: Wearing helmet saves lives. Am J Emerg Med 2023; 69:108-113. [PMID: 37086655 DOI: 10.1016/j.ajem.2023.04.018] [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: 12/03/2022] [Revised: 03/20/2023] [Accepted: 04/12/2023] [Indexed: 04/24/2023] Open
Abstract
INTRODUCTION Riding a motorcycle without a helmet represents a public health risk that can result in disabling injuries or death. We aim to provide a comprehensive analysis of the impact of helmet use on motorcycle injuries, injury types, and fatalities, to highlight areas requiring future intervention. METHODS We performed a retrospective cohort study utilizing the American College of Surgeons Trauma Quality Program Participant Use File between 2017 and 2020 analyzing motorcycle associated injuries and fatalities in adult patients with moderate and severe injury severity score in relation to helmet use. Multivariable regressions were utilized and adjusted for potential confounders. A subset analysis was performed for patients presenting with abbreviated injury scale (AIS) head ≥3 and all other body regions ≤2. RESULTS 43,225 patients met study criteria, of which 24,389 (56.4%) were helmet users and 18,836 (43.6%) were not. Helmet use was associated with a 35% reduction in the relative risk of expiring in the hospital due to motorcycle-related injuries (aOR 0.65; 95% CI [0.59-0.70]; p < 0.001) and a decreased intensive care unit length of stay (ICU-LOS) by half a day (B = -0.50; 95% CI [-0.77, -0.24]; p < 0.001). CONCLUSION Motorcycle riders without a helmet had significantly greater odds of increased in-hospital mortality and longer stays in the ICU than those who used a helmet. The results of this nationwide study support the need for continued research exploring the significance of helmet use and interventions aimed at improving helmet usage among motorcyclists. LEVEL OF EVIDENCE Prognostic and epidemiological, level III.
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Affiliation(s)
- Abigail Rosander
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ, USA
| | - Tessa Breeding
- NOVA Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA
| | - Micah Ngatuvai
- NOVA Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA
| | - Noah Alter
- NOVA Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA
| | - Piueti Maka
- John A. Burns School of Medicine, Honolulu, HI, USA
| | - George Beeton
- University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Lucy Kornblith
- Department of Surgery, Division of Trauma and Surgical Critical Care, Zuckerberg Hospital and Trauma Center, San Francisco, CA, USA
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, FL, USA; Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL, USA.
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12
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Ngatuvai M, Zagales I, Sauder M, Andrade R, Santos RG, Bilski T, Kornblith L, Elkbuli A. Outcomes of Transfusion With Whole Blood, Component Therapy, or Both in Adult Civilian Trauma Patients: A Systematic Review and Meta-Analysis. J Surg Res 2023; 287:193-201. [PMID: 36947979 DOI: 10.1016/j.jss.2023.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 12/18/2022] [Accepted: 02/17/2023] [Indexed: 03/22/2023]
Abstract
INTRODUCTION This systematic review and meta-analysis was conducted to compare outcomes, including transfusion volume, complications, intensive care unit length of stay, and mortality for adult civilian trauma patients transfused with whole blood (WB), components (COMP), or both (WB + COMP). METHODS A systematic review and meta-analysis were conducted using studies that evaluated outcomes of transfusion of WB, COMP, or WB + COMP for adult civilian trauma patients. A search of PubMed, Embase, and Cochrane from database inception to March 3, 2022 was conducted. The search resulted in 18,400 initial articles with 16 studies remaining after the removal of duplicates and screening for inclusion and exclusion criteria. RESULTS This study identified an increased risk of 24-h mortality with COMP versus WB + COMP (relative risk: 1.40 [1.10, 1.78]) and increased transfusion volumes of red blood cells with COMP versus WB at 6 and 24 h, respectively (-2.26 [-3.82, -0.70]; -1.94 [-3.22, -0.65] units). There were no differences in the calculated rates of infections or intensive care unit length of stay between WB and COMP, respectively (relative risks: 1.35 [0.53, 3.46]; -0.91 [-2.64, 0.83]). CONCLUSIONS Transfusion with WB + COMP is associated with lower 24-h mortality versus COMP and transfusion with WB is associated with a lower volume of red blood cells transfused at both 6 and 24 h. Based on these findings, greater utilization of whole blood in civilian adult trauma resuscitation may lead to improved mortality and reduced transfusion requirements.
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Affiliation(s)
- Micah Ngatuvai
- Dr Kiran.C. Patel College of Allopathic Medicine, NSU NOVA Southeastern University, Fort Lauderdale, Florida
| | - Israel Zagales
- Universidad Iberoamericana (UNIBE) Escuela de Medicina, Santo Domingo, Dominican Republic
| | - Matthew Sauder
- Dr Kiran.C. Patel College of Allopathic Medicine, NSU NOVA Southeastern University, Fort Lauderdale, Florida
| | - Ryan Andrade
- A.T. Still University School of Osteopathic Medicine, Mesa, Arizona
| | - Radleigh G Santos
- Department of Mathematics, NSU NOVA Southeastern University, Fort Lauderdale, Florida
| | - Tracy Bilski
- Division of Trauma and Surgical Critical Care, Department of Surgery, Orlando Regional Medical Center, Orlando, Florida; Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida
| | - Lucy Kornblith
- Division of Trauma and Surgical Critical Care, Department of Surgery, Zuckerberg San Francisco General Hospital & Trauma Center, San Francisco, California; Department of Surgery, University of San Francisco, San Francisco, California
| | - Adel Elkbuli
- Division of Trauma and Surgical Critical Care, Department of Surgery, Orlando Regional Medical Center, Orlando, Florida; Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida.
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13
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Sauder M, Kornblith L, Gurney J, Elkbuli A. Trauma care during times of conflict: Strategic targeting of medical resources & operational logistics to save more lives. Injury 2023; 54:271-273. [PMID: 36379738 DOI: 10.1016/j.injury.2022.11.017] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 09/30/2022] [Accepted: 11/07/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Matthew Sauder
- NSU NOVA Southeastern University School of Allopathic Medicine, Fort Lauderdale, FL, USA
| | - Lucy Kornblith
- Department of Surgery, Division of Trauma and Surgical Critical Care, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA; University of San Francisco, San Francisco, CA, USA
| | - Jennifer Gurney
- US Army Institute of Surgical Research and the DoD Joint Trauma System, San Antonio, TX, USA
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, FL, USA, 86 W Underwood St., Orlando, FL 32806, USA; Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL, USA.
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14
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Andrade R, Yeager M, Concepcion J, Spardy J, Ang D, Kornblith L, Elkbuli A. National analysis of whole blood and component versus component transfusions in civilian trauma patients who underwent a thoracotomy or laparotomy: Toward improving patient outcomes and quality of care. Surgery 2022; 172:1837-1843. [PMID: 36328825 DOI: 10.1016/j.surg.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/19/2022] [Accepted: 09/11/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND This study aimed to investigate the associations of whole blood and component versus component transfusions with in-hospital mortality, complication rates, intensive care unit length of stay, and packed red blood cells transfusion volumes in adult civilian trauma patients. METHODS We performed a retrospective cohort study of the American College of Surgeons Trauma Quality Program Participant Use File 2016 to 2019 dataset. Adult civilian trauma patients (aged >18 years) sustaining injuries of at least moderate severity who received whole blood and component or component within 4 hours of arrival and underwent thoracotomy or laparotomy were included. Multivariable regression analysis was used to compare outcomes between whole blood and component and component groups. RESULTS A total of 37,384 patients met eligibility criteria, of which 218 received whole blood and component and 37,166 received component. There was no significant difference in in-hospital mortality between whole blood and component and component groups for those who underwent thoracotomy (adjusted odds ratio = 0.408, P = .413) or laparotomy (adjusted odds ratio = 1.046, P = .857). Thoracotomy patients who received whole blood and component had no difference in 4-hour or 24-hour pack red blood cell volumes (3336 mL vs 3106 mL, P = .754; 3 658mL vs 3,636mL, P = .982), intensive care unit length of stay (10.68 days vs 8.63 days, P = .542), or complications rates compared to those who received component. Laparotomy patients who received whole blood and component had no difference in 4 hour or 24-hour packed red blood cell volumes (2,758 mL vs 2,721mL, P = .927; 3,538 mL vs 3,385 mL, P = .754), intensive care unit length of stay (11.78 days vs 9.90 days, P = .177), or complications rates compared to those who received component. CONCLUSION Study findings have indicated that a combined resuscitation with whole blood and component transfusion in adult civilian trauma patients is a viable alternative to component transfusion alone.
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Affiliation(s)
- Ryan Andrade
- School of Osteopathic Medicine, A.T. Still University, Mesa, AZ
| | - Matthew Yeager
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| | | | - Jeffrey Spardy
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| | - Darwin Ang
- Department of Surgery, Division of Trauma and Surgical Critical Care, Ocala Regional Medical Center, Ocala, FL; Department of Surgery, University of South Florida, Tampa, FL
| | - Lucy Kornblith
- Department of Surgery, Division of Trauma and Surgical Critical Care, Zuckerberg San Francisco General Hospital & Trauma Center, CA; Department of Surgery, University of San Francisco, CA
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, FL; Department of Surgical Education, Orlando Regional Medical Center, FL.
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Sauder M, Zagales I, Zagales R, Das S, Sen-Crowe B, Bilski T, Kornblith L, Elkbuli A. Comprehensive Assessment of Burnout Among Surgical Trainees and Practicing Surgeons: A Systematic Review. J Surg Educ 2022; 79:1188-1205. [PMID: 35624025 DOI: 10.1016/j.jsurg.2022.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/14/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Surgeon burnout has received increasing attention due to evidence of high prevalence across specialties. We aimed to (1) systematically characterize existing definitions of burnout, (2) evaluate tools to measure burnout, and (3) determine risk factors of surgical burnout. DESIGN PubMed, Google Scholar, and Embase databases were searched to identify burnout rates and tools used to measure the quality of life (QoL) published from January 2000-December 2021. PARTICIPANTS Surgical Trainees and Practicing Surgeons. RESULTS We identified 39 studies that defined surgical burnout, with 9 separate tools used to measure QoL. Surgeon burnout rates were found to be highest among general surgery trainees (20%-95%). Burnout among general surgery attendings ranged from 25% to 44%. Those most likely to experience burnout were younger and female. High rates of surgeon burnout were reported among all surgical specialties; however, these rates were lower than those of general surgeons. CONCLUSION Definitions of burnout vary throughout the surgical literature, but are consistently characterized by emotional exhaustion, depersonalization, and lack of personal accomplishment. The most utilized tool to measure surgical burnout has been the Maslach Burnout Inventory. Across specialties, there are high rates of burnout in both surgical trainees and attendings, indicating that this is a systemic issue within the field of surgery. Given the wide-scale nature of the problem, it is recommended that institutions provide support to surgical trainees and attending surgeons and that individual surgeons take steps toward mitigating burnout.
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Affiliation(s)
- Matthew Sauder
- Dr. Kiran.C. Patel College of Allopathic Medicine, NSU NOVA Southeastern University, Fort Lauderdale, Florida
| | - Israel Zagales
- Universidad Iberoamericana (UNIBE) Escuela de Medicina, Santo Domingo, Dominican Republic
| | - Ruth Zagales
- Florida International University, Miami, Florida
| | - Snigdha Das
- Dr. Kiran.C. Patel College of Allopathic Medicine, NSU NOVA Southeastern University, Fort Lauderdale, Florida
| | - Brendon Sen-Crowe
- Dr. Kiran.C. Patel College of Allopathic Medicine, NSU NOVA Southeastern University, Fort Lauderdale, Florida
| | - Tracy Bilski
- Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, Florida; Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida
| | - Lucy Kornblith
- Department of Surgery, Division of Trauma and Surgical Critical Care, Zuckerberg San Francisco General Hospital, San Francisco, California; University of San Francisco, San Francisco, California
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, Florida; Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida.
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16
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Concepcion J, Alfaro S, Selvakumar S, Newsome K, Sen-Crowe B, Andrade R, Yeager M, Kornblith L, Ibrahim J, Bilski T, Elkbuli A. Nationwide analysis of proximity of America College of Surgeons--verified and state-designated trauma centers to the nearest highway exit and associated prehospital motor vehicle collision fatalities. Surgery 2022; 172:1584-1591. [PMID: 36028381 DOI: 10.1016/j.surg.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 07/08/2022] [Accepted: 07/14/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Motor vehicle collisions remain a leading cause of trauma-related deaths. We aim to investigate the relationship between the proximity of trauma centers to the nearest highway exit and prehospital motor vehicle collision fatalities at the county level nationwide. METHODS This was a cross-sectional study evaluating the association between the distance of trauma centers to the nearest highway exit and prehospital motor vehicle collision fatalities between the years 2014 and 2019. Prehospital motor vehicle collision fatalities were obtained from National Highway Traffic Safety Administration. Mapping software was used to determine the distance of trauma center to the nearest highway exit and transport time. Linear regression analysis was performed. RESULTS A total of 2,019 American College of Surgeons-verified and/or state-designated trauma centers were included (211 Level 1, 356 Level 2, 491 Level 3, and 961 Level 4 trauma centers). Prehospital motor vehicle collision fatalities were positively correlated with the distance of trauma center to the nearest highway exit for counties with trauma centers located ≤5 miles from the nearest highway exit (r = 0.328; P < .001). In the 612 counties with a 10% increase in prehospital motor vehicle collision fatalities from 2014 to 2019, prehospital motor vehicle collision fatalities were also positively correlated with distance to the nearest highway exit (r = 0.302; P < .001). The counties with more dispersed distributions of trauma centers were significantly associated with motor vehicle collision fatalities (Spearman's rank coefficient = 0.456; 95% confidence interval, 0.163-0.675; P = .003). CONCLUSION Shorter distances between trauma centers and the nearest highway exit are associated with fewer prehospital motor vehicle collision fatalities for counties with trauma centers ≤5 miles of the nearest highway exit. Further enhancement of existing highway infrastructure and standardization of emergency medical services transport protocols are needed to address the burden of prehospital motor vehicle collision fatalities in the United States.
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Affiliation(s)
| | - Sophie Alfaro
- A.T. Still University School of Osteopathic Medicine, Mesa, AZ
| | - Sruthi Selvakumar
- NOVA Southeastern University, Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, FL
| | - Kevin Newsome
- Florida International University, Herbert Wertheim College of Medicine, Miami, FL
| | - Brendon Sen-Crowe
- NOVA Southeastern University, Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, FL
| | - Ryan Andrade
- A.T. Still University School of Osteopathic Medicine, Mesa, AZ
| | - Matthew Yeager
- Florida International University, Herbert Wertheim College of Medicine, Miami, FL
| | - Lucy Kornblith
- Department of Surgery, Division of Trauma and Surgical Critical Care, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA; Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Joseph Ibrahim
- Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, FL; Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL
| | - Tracy Bilski
- Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, FL; Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, FL; Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL.
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17
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Selvakumar S, Zagales I, Newsome K, Spardy J, Santos R, Boneva D, Stein DM, Kornblith L, Bilski T, Elkbuli A. Gender Distribution & Rank of Authorship in Surgical Literature. Am Surg 2022:31348221121536. [PMID: 35976619 DOI: 10.1177/00031348221121536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Authorship of surgical literature is important for the career advancement of surgeons, and gender disparities in authorship may hinder the representation and leadership of women within academic surgery. The aim of this systematic review and meta-analysis was to evaluate the gender distribution of first, senior, and overall authorship in peer-reviewed surgical journal studies across all surgical specialties to determine if disparities exist. METHODS PubMed, EMBASE, and Google Scholar databases were searched for studies investigating the gender distribution of authorship of surgical literature published before December 10th, 2021. Meta-analysis was performed and Cohen's Q test for heterogenous effects was used to determine whether random or fixed-effects models were appropriate. RESULTS Fifteen studies investigating gender distribution of authorship met inclusion, which included a total of 136,627 pooled studies. The meta-analysis demonstrated the meta-proportion of first authorship for women to be 20.6% (95% CI: 13.9, 28.2), the meta-proportion of senior authorship for women to be 11.9% (95% CI: 6.6, 18.5), and the meta-proportion of overall authorship for women to be 23% (95% CI: 16.2, 30.7). In addition, the proportion of senior authorship for women was found to be significantly lower than the proportion of overall authorship for women (11.9% versus 23.0%, P = .0106). CONCLUSION There is a significantly smaller proportion of women who are first, senior, and overall authors in surgical literature compared to their colleagues who are men. Sustainable and effective solutions aimed at improving the representation of women surgeons in surgical research and research leadership are necessary.
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Affiliation(s)
- Sruthi Selvakumar
- 2814NSU NOVA Southeastern University, Dr. Kiran.C. Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA
| | - Israel Zagales
- Universidad Iberoamericana (UNIBE) Escuela de Medicina, Santo Domingo, Dominican Republic
| | - Kevin Newsome
- Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Jeffrey Spardy
- Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Radleigh Santos
- Department of Mathematics, 2814NSU NOVA Southeastern University, Fort Lauderdale, FL, USA
| | - Dessy Boneva
- 2814NSU NOVA Southeastern University, Dr. Kiran.C. Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA
| | - Deborah M Stein
- 12264University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lucy Kornblith
- Department of Surgery, Division of Trauma and Surgical Critical Care, Zuckerberg San Francisco General Hospital & Trauma Center, San Francisco, CA, USA.,Department of Surgery, University of San Francisco, San Francisco, CA, USA
| | - Tracy Bilski
- Department of Surgery, Division of Trauma and Surgical Critical Care, 25105Orlando Regional Medical Center, Orlando, FL, USA.,Department of Surgical Education, 25105Orlando Regional Medical Center, Orlando, FL, USA
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, 25105Orlando Regional Medical Center, Orlando, FL, USA.,Department of Surgical Education, 25105Orlando Regional Medical Center, Orlando, FL, USA
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18
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Zagales I, Selvakumar S, Ngatuvai M, Fanfan D, Kornblith L, Santos RG, Ibrahim J, Elkbuli A. Beta-Blocker Therapy in Patients With Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Am Surg 2022:31348221101583. [PMID: 35575287 DOI: 10.1177/00031348221101583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Traumatic brain injury (TBI), a leading cause of morbidity and mortality among trauma patients worldwide, poses the risk of secondary neurological insult due to significant catecholamine surge. We aim to investigate the effectiveness and outcomes of beta-blocker administration in patients with severe TBI. METHODS A search through PubMed, EMBASE, JAMA network, and Google Scholar databases was conducted for relevant peer-reviewed original studies published before February 15, 2022. A standard random-effects model was used, as justified by a high Cohen's Q test. RESULTS Twelve studies met inclusion criteria and were included in the meta-analysis. Severe TBI patients who were administered beta-blockers had a significantly reduced incidence of in-hospital mortality compared to the non-beta-blocker group (14.5% vs 19.2%). However, the beta-blocker group was reported to have a significantly greater number of ventilator days (5.58 vs 2.60 days). Similarly, intensive care unit (9.00 vs 6.84 days) and hospital (17.30 vs 11.02 days) lengths of stay (LOS) were increased in the beta-blocker group compared to those who were not administered beta-blocker therapy, but only the difference in hospital-LOS was significant. CONCLUSIONS Beta-blockers have significantly decreased in-hospital mortality in patients with severe TBI despite being associated with an increase in ventilator days and hospital-LOS. The administration of beta-blocker therapy in the management of severe TBI may be warranted and should be discussed in future guidelines.
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Affiliation(s)
- Israel Zagales
- Universidad Iberoamericana (UNIBE) Escuela de Medicina, Santo Domingo, Dominican Republic
| | - Sruthi Selvakumar
- Dr. Kiran.C. Patel College of Allopathic Medicine, 2814NSU NOVA Southeastern University, Fort Lauderdale, FL, USA
| | - Micah Ngatuvai
- Dr. Kiran.C. Patel College of Allopathic Medicine, 2814NSU NOVA Southeastern University, Fort Lauderdale, FL, USA
| | - Dino Fanfan
- Herbert Wertheim College of Medicine,5450Florida International University, Miami, FL, USA
| | - Lucy Kornblith
- Division of Trauma and Surgical Critical Care, Department of Surgery, 36558Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA.,Department of Surgery, University of San Francisco, San Francisco, CA, USA
| | - Radleigh G Santos
- Department of Mathematics, 2814NSU NOVA Southeastern University, Fort Lauderdale, FL, USA
| | - Joseph Ibrahim
- Division of Trauma and Surgical Critical Care, Department of Surgery, 25105Orlando Regional Medical Center, Orlando, FL, USA.,Department of Surgical Education, 25105Orlando Regional Medical Center, Orlando, FL, USA
| | - Adel Elkbuli
- Division of Trauma and Surgical Critical Care, Department of Surgery, 25105Orlando Regional Medical Center, Orlando, FL, USA.,Department of Surgical Education, 25105Orlando Regional Medical Center, Orlando, FL, USA
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19
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Spardy J, Kornblith L, Elkbuli A. Surgical stabilization of iatrogenic rib fractures following cardiopulmonary resuscitation. Am J Emerg Med 2022; 59:195-197. [DOI: 10.1016/j.ajem.2022.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/06/2022] [Accepted: 05/14/2022] [Indexed: 11/27/2022] Open
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20
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Moazed F, Hendrickson C, Jauregui A, Gotts J, Conroy A, Delucchi K, Zhuo H, Arambulo M, Vessel K, Ke S, Deiss T, Ni A, Leligdowicz A, Abbott J, Cohen MJ, Sinha P, Gomez A, Kangelaris K, Kornblith L, Matthay M, Benowitz N, Liu K, Calfee CS. Cigarette Smoke Exposure and Acute Respiratory Distress Syndrome in Sepsis: Epidemiology, Clinical Features, and Biologic Markers. Am J Respir Crit Care Med 2022; 205:927-935. [PMID: 35050845 PMCID: PMC9838633 DOI: 10.1164/rccm.202105-1098oc] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 01/19/2023] Open
Abstract
Rationale: Cigarette smoke exposure is associated with an increased risk of developing acute respiratory distress syndrome (ARDS) in trauma, transfusion, and nonpulmonary sepsis. It is unknown whether this relationship exists in the general sepsis population. Furthermore, it is unknown if patients with ARDS have differences in underlying biology based on smoking status. Objectives: To assess the relationship between cigarette smoke exposure and ARDS in sepsis and identify tobacco-related biomarkers of lung injury. Methods: We studied a prospective cohort of 592 patients with sepsis from 2009 to 2017. Plasma cotinine and urine NNAL [urine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol] were measured to categorize smoking status. Plasma biomarkers of inflammation and lung injury were measured, including in a smaller cohort of trauma patients with ARDS to increase generalizability. Measurements and Main Results: Passive and active smoking were associated with increased odds of developing ARDS in patients with sepsis. Among patients with sepsis and ARDS, active cigarette smokers were younger and had lower severity of illness than nonsmokers. Patients with ARDS with cigarette smoke exposure had lower plasma levels of IL-8 (P = 0.01) and sTNFR-1 (soluble tumor necrosis factor 1; P = 0.01) compared with those without exposure. Similar biomarker patterns were observed in blunt trauma patients with ARDS. Conclusions: Passive and active smoking are associated with an increased risk of developing ARDS in patients with pulmonary and nonpulmonary sepsis. Among patients with ARDS, those with cigarette smoke exposure have less systemic inflammation, while active smokers also have lower severity of illness compared with nonsmokers, suggesting that smoking contributes to biological heterogeneity in ARDS.
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Affiliation(s)
- Farzad Moazed
- Department of Medicine,,Center for Tobacco Control Research and Education,,Department of Medicine, Highland Hospital, Oakland, California
| | | | | | - Jeffrey Gotts
- Department of Medicine,,Center for Tobacco Control Research and Education
| | - Amanda Conroy
- Department of Surgery, Zuckerberg San Francisco General Hospital, San Francisco, California; and
| | - Kevin Delucchi
- Center for Tobacco Control Research and Education,,Department of Psychiatry
| | | | - Mikhaela Arambulo
- Department of Anesthesia, University of California San Francisco, San Francisco, California
| | | | | | | | | | | | | | - Mitchell J. Cohen
- Department of Surgery, University of Colorado Denver, Denver, Colorado
| | | | | | | | - Lucy Kornblith
- Department of Surgery, Zuckerberg San Francisco General Hospital, San Francisco, California; and
| | - Michael Matthay
- Department of Medicine,,Cardiovascular Research Institute, and,Department of Anesthesia, University of California San Francisco, San Francisco, California
| | - Neal Benowitz
- Department of Medicine,,Center for Tobacco Control Research and Education
| | | | - Carolyn S. Calfee
- Department of Medicine,,Center for Tobacco Control Research and Education,,Cardiovascular Research Institute, and,Department of Anesthesia, University of California San Francisco, San Francisco, California
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21
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Biffl WL, Ball CG, Moore EE, Lees J, Todd SR, Wydo S, Privette A, Weaver JL, Koenig SM, Meagher A, Dultz L, Udekwu PO, Harrell K, Chen AK, Callcut R, Kornblith L, Jurkovich GJ, Castelo M, Schaffer KB. Don't mess with the pancreas! A multicenter analysis of the management of low-grade pancreatic injuries. J Trauma Acute Care Surg 2021; 91:820-828. [PMID: 34039927 DOI: 10.1097/ta.0000000000003293] [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: 12/11/2022]
Abstract
INTRODUCTION Current guidelines recommend nonoperative management (NOM) of low-grade (American Association for the Surgery of Trauma-Organ Injury Scale Grade I-II) pancreatic injuries (LGPIs), and drainage rather than resection for those undergoing operative management, but they are based on low-quality evidence. The purpose of this study was to review the contemporary management and outcomes of LGPIs and identify risk factors for morbidity. METHODS Multicenter retrospective review of diagnosis, management, and outcomes of adult pancreatic injuries from 2010 to 2018. The primary outcome was pancreas-related complications (PRCs). Predictors of PRCs were analyzed using multivariate logistic regression. RESULTS Twenty-nine centers submitted data on 728 patients with LGPI (76% men; mean age, 38 years; 37% penetrating; 51% Grade I; median Injury Severity Score, 24). Among 24-hour survivors, definitive management was NOM in 31%, surgical drainage alone in 54%, resection in 10%, and pancreatic debridement or suturing in 5%. The incidence of PRCs was 21% overall and was 42% after resection, 26% after drainage, and 4% after NOM. On multivariate analysis, independent risk factors for PRC were other intra-abdominal injury (odds ratio [OR], 2.30; 95% confidence interval [95% CI], 1.16-15.28), low volume (OR, 2.88; 1.65, 5.06), and penetrating injury (OR, 3.42; 95% CI, 1.80-6.58). Resection was very close to significance (OR, 2.06; 95% CI, 0.97-4.34) (p = 0.0584). CONCLUSION The incidence of PRCs is significant after LGPIs. Patients who undergo pancreatic resection have PRC rates equivalent to patients resected for high-grade pancreatic injuries. Those who underwent surgical drainage had slightly lower PRC rate, but only 4% of those who underwent NOM had PRCs. In patients with LGPIs, resection should be avoided. The NOM strategy should be used whenever possible and studied prospectively, particularly in penetrating trauma. LEVEL OF EVIDENCE Therapeutic Study, level IV.
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Affiliation(s)
- Walter L Biffl
- From the Scripps Memorial Hospital (W.L.B., M.C., K.B.S.), La Jolla, La Jolla, CA; University of Calgary, Calgary (C.G.B.), Alberta, Canada; Ernest E. Moore Shock Trauma Center at Denver Health (E.E.M.), Denver, CO; University of Oklahoma (J.L.), Oklahoma City, OK; Grady Memorial Hospital (S.R.T.), Atlanta, GA; Cooper University Hospital (SW), Camden, NJ; Medical University of South Carolina (A.P.), Charleston, SC; University of California-San Diego (J.L.W.), San Diego, CA; Virginia Tech Carilion School of Medicine (S.M.K.), Carilion Clinic, Roanoke VA; Indiana University School of Medicine- Methodist (A.M.), Indianapolis, IN; Parkland- UT Southwestern Medical Center (L.D.), Dallas, TX; WakeMed Health (P.O.U.), Raleigh, NC; University of Tennessee College of Medicine (K.H.), Chattanooga, TN; UCSF Fresno (A.K.C.), Fresno, CA; and San Francisco General Hospital (R.C., L.K.), San Francisco, CA; University of California-Davis (G.J.J.), Sacramento, CA
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22
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Barrett TJ, Cornwell M, Myndzar K, Rolling C, Xia Y, Drenkova K, Biebuyck A, Fields A, Tawil M, Luttrell-Williams E, Yuriditsky E, Smith G, Cotzia P, Neal MD, Kornblith L, Pittaluga S, Rapkiewicz A, Burgess H, Mohr I, Stapleford K, Voora D, Ruggles K, Hochman J, Berger JS. Abstract 109: Platelets Amplify Endotheliopathy In Covid-19. Arterioscler Thromb Vasc Biol 2021. [DOI: 10.1161/atvb.41.suppl_1.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In addition to their pivotal role in thrombosis and hemostasis, platelets participate in inflammatory responses and endothelial cell activation - hallmarks in the pathogenesis of coronavirus disease 2019 (COVID-19). Given the evidence for a hyperactive platelet phenotype in COVID-19, we investigated effector cell properties of COVID-19 platelets on endothelial cells (ECs). To explore this interaction, ECs were treated with platelet releasate from patients with and without COVID-19, and EC mRNA sequencing performed. We demonstrate that platelet released factors in COVID-19 promote an inflammatory hypercoagulable endotheliopathy. Investigation of the COVID-19 platelet transcriptome identified pathways related to organelle/granule release, metabolism, and immune effector function in addition to upregulation of
S100A8
and
S100A9
mRNA. Incubation of primary megakaryocytes with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) also induced upregulation of
S100A8
and
S100A9
mRNA. Consistent with increased gene expression, the heterodimer protein product of
S100A8
/
A9
, myeloid-related protein (MRP)8/14, was released to a greater extent by platelets from COVID-19 patients relative to controls. We demonstrate that platelet-derived MRP8/14 activates microvascular endothelial cells, promotes an inflammatory hypercoagulable phenotype, and is a significant contributor to thromboinflammation and poor clinical outcomes in COVID-19 patients. Finally, we present evidence that therapeutic targeting of platelet P2Y
12
represents a promising candidate to reduce proinflammatory and prothrombotic platelet-endothelial interactions. Altogether, these findings demonstrate a previously unappreciated role for platelets and their activation-induced endotheliopathy in COVID-19.
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Affiliation(s)
| | | | | | | | - Yuhe Xia
- NYU Langone Health, New York, NY
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23
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Biffl WL, Zhao FZ, Morse B, McNutt M, Lees J, Byerly S, Weaver J, Callcut R, Ball CG, Nahmias J, West M, Jurkovich GJ, Todd SR, Bala M, Spalding C, Kornblith L, Castelo M, Schaffer KB, Moore EE. A multicenter trial of current trends in the diagnosis and management of high-grade pancreatic injuries. J Trauma Acute Care Surg 2021; 90:776-786. [PMID: 33797499 DOI: 10.1097/ta.0000000000003080] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Outcomes following pancreatic trauma have not improved significantly over the past two decades. A 2013 Western Trauma Association algorithm highlighted emerging data that might improve the diagnosis and management of high-grade pancreatic injuries (HGPIs; grades III-V). We hypothesized that the use of magnetic resonance cholangiopancreatography, pancreatic duct stenting, operative drainage versus resection, and nonoperative management of HGPIs increased over time. METHODS Multicenter retrospective review of diagnosis, management, and outcomes of adult pancreatic injuries from 2010 to 2018 was performed. Data were analyzed by grade and time period (PRE, 2010-2013; POST, 2014-2018) using various statistical tests where appropriate. RESULTS Thirty-two centers reported data on 515 HGPI patients. A total of 270 (53%) had penetrating trauma, and 58% went directly to the operating room without imaging. Eighty-nine (17%) died within 24 hours. Management and outcomes of 426 24-hour survivors were evaluated. Agreement between computed tomography and operating room grading was 38%. Magnetic resonance cholangiopancreatography use doubled in grade IV/V injuries over time but was still low.Overall HGPI treatment and outcomes did not change over time. Resection was performed in 78% of grade III injuries and remained stable over time, while resection of grade IV/V injuries trended downward (56% to 39%, p = 0.11). Pancreas-related complications (PRCs) occurred more frequently in grade IV/V injuries managed with drainage versus resection (61% vs. 32%, p = 0.0051), but there was no difference in PRCs for grade III injuries between resection and drainage.Pancreatectomy closure had no impact on PRCs. Pancreatic duct stenting increased over time in grade IV/V injuries, with 76% used to treat PRCs. CONCLUSION Intraoperative and computed tomography grading are different in the majority of HGPI cases. Resection is still used for most patients with grade III injuries; however, drainage may be a noninferior alternative. Drainage trended upward for grade IV/V injuries, but the higher rate of PRCs calls for caution in this practice. LEVEL OF EVIDENCE Retrospective diagnostic/therapeutic study, level III.
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Affiliation(s)
- Walter L Biffl
- From the Scripps Memorial Hospital La Jolla (WLB, FZZ, MC, KBS), La Jolla, CA; Maine Medical Center (BM), Portland, ME; Memorial Hermann Hospital (MM), Houston, TX; University of Oklahoma (JL), Oklahoma City, OK; Ryder Trauma Center (SB), Miami, FL; University of California-San Diego (JW), San Diego, CA; San Francisco General Hospital (RC, LK), San Francisco, CA; University of Calgary (CCGB), Calgary, Alberta, Canada; University of California-Irvine (JN), Irvine, CA; North Memorial Health Hospital (MW), Robbinsdale, MN; University of California-Davis (GJJ), Sacramento, CA; Grady Memorial Hospital (SRT), Atlanta, GA; Hadassah- Hebrew University Medical Center (MB), Jerusalem, Israel; Grant Medical Center (CS), Columbus, OH; Ernest E. Moore Shock Trauma Center at Denver Health (EEM), Denver, CO
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