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Schauer SG, April MD, Fisher AD, Wright FL, Winkle JM, Wright AR, Rizzo JA, Getz TM, Nicholson SE, Yazer MH, Braverman MA. A survey of low titer O whole blood use within the trauma quality improvement program registry. Transfusion 2024; 64 Suppl 2:S85-S92. [PMID: 38351716 DOI: 10.1111/trf.17746] [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: 01/24/2024] [Accepted: 01/27/2024] [Indexed: 05/12/2024]
Abstract
INTRODUCTION The use of low titer O whole blood (LTOWB) has expanded although it remains unclear how many civilian trauma centers are using LTOWB. METHODS We analyzed data on civilian LTOWB recipients in the American College of Surgeons Trauma Quality Improvement Program (TQIP) database 2020-2021. Unique facility keys were used to determine the number of centers that used LTOWB in that period. RESULTS A total of 16,603 patients received LTOWB in the TQIP database between 2020 and 2021; 6600 in 2020, and 10,003 in 2021. The total number of facilities that reported LTOWB use went from 287/779 (37%) in 2020 to 302/795 (38%) in 2021. Between 2020 and 2021, among all level 1-3 designated trauma facilities that report to TQIP LTOWB use increased at level-1 centers (118 to 129), and level-2 centers (81 to 86), but decreased in level-3 facilities (9 to 4). Among pediatric and dual pediatric-adult designated hospitals there was a decrease in the number of pediatric level-1 centers (29 to 28) capable of administering LTOWB. Among centers with either single or dual level-1 trauma center designation with adult centers, the number that administered LTOWB to injured pediatric patients also decreased from 17 to 10, respectively. CONCLUSIONS There was an increase in the number of facilities transfusing LTOWB between 2020 and 2021. The use of LTOWB is underutilized in children at centers that have it available. These findings inform the expansion of LTOWB use in trauma.
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Affiliation(s)
- Steven G Schauer
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Center for Combat and Battlefield (COMBAT) Research, University of Colorado School of Medicine, Aurora, Colorado, USA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Michael D April
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- 14th Field Hospital, Fort Stewart, Georgia, USA
| | - Andrew D Fisher
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Franklin L Wright
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Julie M Winkle
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Angela R Wright
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Julie A Rizzo
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Brooke Army Medical Center, JBSA Fort Sam Houston, Texas, USA
| | - Todd M Getz
- Center for Combat and Battlefield (COMBAT) Research, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Mark H Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Maxwell A Braverman
- University of Texas Health at San Antonio, San Antonio, Texas, USA
- St. Lukes University Health Network, Bethlehem, PA, USA
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Allsbrook A, To JQ, Pulido OR, Morgan ME, Perea LL, Shin H, Muller A, Ong A, Butts CA, Braverman MA. Body Mass Index Does Not Predict Injury Pattern or Outcome After Motorcycle Crash. J Surg Res 2024; 296:88-92. [PMID: 38241772 DOI: 10.1016/j.jss.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 11/11/2023] [Accepted: 12/17/2023] [Indexed: 01/21/2024]
Abstract
INTRODUCTION The obesity epidemic plagues the United States, affecting approximately 42% of the population. The relationship of obesity with injury severity and outcomes has been poorly studied among motorcycle collisions (MCC). This study aimed to compare injury severity, mortality, injury regions, and hospital and intensive care unit length of stay (LOS) between obese and normal-weight MCC patients. METHODS Trauma registries from three Pennsylvania Level 1 trauma centers were queried for adult MCC patients (January 1, 2016, and December 31, 2020). Obesity was defined as adult patients with body mass index ≥ 30 kg/m2 and normal weight was defined as body mass index < 30 kg/m2 but > 18.5 kg/m2. Demographics and injury characteristics including injury severity score (ISS), abbreviated injury score, mortality, transfusions and LOS were compared. P ≤ 0.05 was considered significant. RESULTS One thousand one hundred sixty-four patients met the inclusion criteria: 40% obese (n = 463) and 60% nonobese (n = 701). Comparison of ISS demonstrated no statistically significant difference between obese and normal-weight patients with median ISS (interquartile range) 9 (5-14) versus 9 (5-14), respectively (P = 0.29). Obese patients were older with median age 45 (32-55) y versus 38 (26-54) y, respectively (P < 0.01). Comorbidities were equally distributed among both groups except for the incidence of hypertension (30 versus 13.8%, P < 0.01) and diabetes (11 versus 4.4%, P < 0.01). There was no statistically significant difference in Trauma Injury Severity Score or abbreviated injury score. Hospital LOS, intensive care unit LOS, and 30-day mortality among both groups were similar. CONCLUSIONS Obese patients experiencing MCC had no differences in distribution of injury, mortality, or injury severity, mortality, injury regions, and hospital compared to normal-weight adults. Our study differs from current data that obese motorcycle drivers may have different injury characteristics and increased LOS.
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Affiliation(s)
- Anthony Allsbrook
- Division of Acute Care Surgical Services, Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Jennifer Q To
- Division of Acute Care Surgical Services, Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Odessa R Pulido
- Department of Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Madison E Morgan
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Lindsey L Perea
- Division of Trauma and Acute Care Surgery, Department of Surgery, Penn Medicine Lancaster General Health, Lancaster, Pennsylvania
| | - Hannah Shin
- Department of Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Alison Muller
- Division of Trauma, Department of Surgery, Acute Care Surgery & Surgical Critical Care, Reading Hospital- Tower Health, West Reading, Pennsylvania
| | - Adrian Ong
- Division of Trauma, Department of Surgery, Acute Care Surgery & Surgical Critical Care, Reading Hospital- Tower Health, West Reading, Pennsylvania
| | - Christopher A Butts
- Division of Trauma, Department of Surgery, Acute Care Surgery & Surgical Critical Care, Reading Hospital- Tower Health, West Reading, Pennsylvania
| | - Maxwell A Braverman
- Division of Acute Care Surgical Services, Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania.
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Smith AA, Cone JT, McNickle AG, Mitchao DP, Kostka R, Martinez B, Schroeppel T, Cavalea A, Shahan CP, Axtman B, Braverman MA. MultiCenter Study of Intra-Abdominal Abscess Formation After Major Operative Hepatic Trauma. J Surg Res 2024; 295:746-752. [PMID: 38147760 DOI: 10.1016/j.jss.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/10/2023] [Accepted: 11/09/2023] [Indexed: 12/28/2023]
Abstract
INTRODUCTION One of the significant complications of operative liver trauma is intra-abdominal abscesses (IAA). The objective of this study was to determine risk factors associated with postoperative IAA in surgical patients with major operative liver trauma. METHODS A retrospective multi-institutional study was performed at 13 Level 1 and Level 2 trauma centers from 2012 to 2021. Adult patients with major liver trauma (grade 3 and higher) requiring operative management were enrolled. Univariate and multivariate analyses were performed. RESULTS Three hundred seventy-two patients were included with 21.2% (n = 79/372) developing an IAA. No difference was found for age, gender, injury severity score, liver injury grade, and liver resections in patients between the groups (P > 0.05). Penetrating mechanism of injury (odds ratio (OR) 3.42, 95% confidence interval (CI) 1.54-7.57, P = 0.02), intraoperative massive transfusion protocol (OR 2.43, 95% CI 1.23-4.79, P = 0.01), biloma/bile leak (OR 2.14, 95% CI 1.01-4.53, P = 0.04), hospital length of stay (OR 1.04, 95% CI 1.02-1.06, P < 0.001), and additional intra-abdominal injuries (OR 2.27, 95% CI 1.09-4.72, P = 0.03) were independent risk factors for IAA. Intra-abdominal drains, damage control laparotomy, total units of packed red blood cells, number of days with an open abdomen, total abdominal surgeries, and blood loss during surgery were not found to be associated with a higher risk of IAA. CONCLUSIONS Patients with penetrating trauma, massive transfusion protocol activation, longer hospital length of stay, and injuries to other intra-abdominal organs were at higher risk for the development of an IAA following operative liver trauma. Results from this study could help to refine existing guidelines for managing complex operative traumatic liver injuries.
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Affiliation(s)
- Alison A Smith
- Surgery Department, Louisiana State University Health Sciences Center New Orleans, New Orleans, Louisiana.
| | - Jennifer T Cone
- Surgery Department, University of Chicago School of Medicine, Chicago, Illinois
| | - Allison G McNickle
- Surgery Department, University of Nevada- Las Vegas School of Medicine, Las Vegas, Nevada
| | - Delbrynth P Mitchao
- Surgery Department, LAC+USC Medical Center, University of Southern California, Los Angeles, California
| | - Ryan Kostka
- Surgery Department, Baylor Scott and White Health, Dallas, Texas
| | - Benjamin Martinez
- Trauma Surgery Division, Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana
| | - Thomas Schroeppel
- Surgery Department, University of Colorado Health, Colorado Springs, Colorado
| | - Alexander Cavalea
- Surgery Department, University of Tennessee Knoxville Medical Center, Knoxville, Tennessee
| | | | - Benjamin Axtman
- Trauma Division, Sanford Health Bismarck, Bismarck, North Dakota
| | - Maxwell A Braverman
- Surgery Department, St. Luke University Healthcare Network, Bethlehem, Pennsylvania
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Bauerle WB, Reese V, Stoltzfus J, Benton A, Knipe J, Wilde-Onia R, Castillo R, Thomas P, Cipolla J, Braverman MA. Effect of Standardized Reminder Calls on Trauma Patient No-Show Rate. J Am Coll Surg 2024; 238:236-241. [PMID: 37861231 DOI: 10.1097/xcs.0000000000000898] [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: 10/21/2023]
Abstract
BACKGROUND Most patients who sustain a traumatic injury require outpatient follow-up. A common barrier to outpatient postadmission care is patient failure to follow-up. One of the most significant factors resulting in failure to follow-up is age more than 35 years. Recent work has shown that follow-up telephone calls reduce readmission rates. Our aim was to decrease no-show appointments by 10% in 12 months. STUDY DESIGN The electronic medical records at our level I and II trauma centers were queried for all outpatient appointments for trauma between July 1, 2020, and June 9, 2021, and whether the patient attended their follow-up appointment. Patients with visits scheduled after August 1, 2021, received 24- and 48-hour previsit reminder calls. Patients with visits scheduled between July 1, 2020, and August 1, 2021, did not receive previsit calls. Both groups were compared using multivariable direct logistic regression models. RESULTS A total of 1,822 follow-up opportunities were included in the study. During the pre-implementation phase, there was a no-show rate of 30.9% (329 of 1,064 visits). Postintervention, a 12.2% reduction in overall no-show rate occurred. A statistically significant 11.2% decrease (p < 0.001) was seen in elderly patients. Multivariate analysis showed standardized calls resulted in significantly decreased odds of failing to keep an appointment (adjusted odds ratio = 0.610, p < 0.001). CONCLUSIONS Reminder calls led to a 12.2% reduction in no-show rate and were an independent predictor of a patient's likelihood of attending their appointment. Other predictors of attendance included insurance status and abdominal injury.
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Affiliation(s)
- Wayne B Bauerle
- From the Department of Surgery (Bauerle), St. Luke's University Health Network, Bethlehem, PA
| | - Vanessa Reese
- Department of Research and Innovation (Reese), St. Luke's University Health Network, Bethlehem, PA
| | - Jill Stoltzfus
- Department of Graduate Medical Education (Stoltzfus), St. Luke's University Health Network, Bethlehem, PA
| | - Adam Benton
- Department of Surgery, Division of Trauma and Acute Care Surgery (Benton, Knipe, Wilde-Onia, Castilllo, Thomas, Cipolla, Braverman), St. Luke's University Health Network, Bethlehem, PA
| | - Joshua Knipe
- Department of Surgery, Division of Trauma and Acute Care Surgery (Benton, Knipe, Wilde-Onia, Castilllo, Thomas, Cipolla, Braverman), St. Luke's University Health Network, Bethlehem, PA
- Department of Trauma Surgery (Knipe, Wilde-Onia, Castillo, Thomas, Cipolla, Braverman), St. Luke's University Health Network, Bethlehem, PA
| | - Rebecca Wilde-Onia
- Department of Surgery, Division of Trauma and Acute Care Surgery (Benton, Knipe, Wilde-Onia, Castilllo, Thomas, Cipolla, Braverman), St. Luke's University Health Network, Bethlehem, PA
- Department of Trauma Surgery (Knipe, Wilde-Onia, Castillo, Thomas, Cipolla, Braverman), St. Luke's University Health Network, Bethlehem, PA
| | - Roberto Castillo
- Department of Surgery, Division of Trauma and Acute Care Surgery (Benton, Knipe, Wilde-Onia, Castilllo, Thomas, Cipolla, Braverman), St. Luke's University Health Network, Bethlehem, PA
- Department of Trauma Surgery (Knipe, Wilde-Onia, Castillo, Thomas, Cipolla, Braverman), St. Luke's University Health Network, Bethlehem, PA
| | - Peter Thomas
- Department of Surgery, Division of Trauma and Acute Care Surgery (Benton, Knipe, Wilde-Onia, Castilllo, Thomas, Cipolla, Braverman), St. Luke's University Health Network, Bethlehem, PA
- Department of Trauma Surgery (Knipe, Wilde-Onia, Castillo, Thomas, Cipolla, Braverman), St. Luke's University Health Network, Bethlehem, PA
| | - James Cipolla
- Department of Surgery, Division of Trauma and Acute Care Surgery (Benton, Knipe, Wilde-Onia, Castilllo, Thomas, Cipolla, Braverman), St. Luke's University Health Network, Bethlehem, PA
- Department of Trauma Surgery (Knipe, Wilde-Onia, Castillo, Thomas, Cipolla, Braverman), St. Luke's University Health Network, Bethlehem, PA
| | - Maxwell A Braverman
- Department of Surgery, Division of Trauma and Acute Care Surgery (Benton, Knipe, Wilde-Onia, Castilllo, Thomas, Cipolla, Braverman), St. Luke's University Health Network, Bethlehem, PA
- Department of Trauma Surgery (Knipe, Wilde-Onia, Castillo, Thomas, Cipolla, Braverman), St. Luke's University Health Network, Bethlehem, PA
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5
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Braverman MA, Schauer SG, Ciaraglia A, Brigmon E, Smith AA, Barry L, Bynum J, Cap AD, Corral H, Fisher AD, Epley E, Jonas RB, Shiels M, Waltman E, Winckler C, Eastridge BJ, Stewart RM, Nicholson SE, Jenkins DH. The impact of prehospital whole blood on hemorrhaging trauma patients: A multi-center retrospective study. J Trauma Acute Care Surg 2023; 95:191-196. [PMID: 37012617 DOI: 10.1097/ta.0000000000003908] [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: 04/05/2023]
Abstract
BACKGROUND Whole blood (WB) use has become increasingly common in trauma centers across the United States for both in-hospital and prehospital resuscitation. We hypothesize that prehospital WB (pWB) use in trauma patients with suspected hemorrhage will result in improved hemodynamic status and reduced in-hospital blood product requirements. METHODS The institutional trauma registries of two academic level I trauma centers were queried for all patients from 2015-2019 who underwent transfusion upon arrival to the trauma bay. Patients who were dead on arrival or had isolated head injuries were excluded. Demographics, injury and shock characteristics, transfusion requirements, including massive transfusion protocol (MTP) (>10 U in 24 hours) and rapid transfusion (CAT3+) and outcomes were compared between pWB and non-pWB patients. Significantly different demographic, injury characteristics and pWB were included in univariate followed by stepwise logistic regression analysis to determine the relationship with shock index (SI). Our primary objective was to determine the relationship between pWB and improved hemodynamics or reduction in blood product utilization. RESULTS A total of 171 pWB and 1391 non-pWB patients met inclusion criteria. Prehospital WB patients had a lower median Injury Severity Score (17 vs. 21, p < 0.001) but higher prehospital SI showing greater physiologic disarray. Prehospital WB was associated with improvement in SI (-0.04 vs. 0.05, p = 0.002). Mortality and (LOS) were similar. Prehospital WB patients received fewer packed red blood cells, fresh frozen plasma, and platelets units across their LOS but total units and volumes were similar. Prehospital WB patients had fewer MTPs (22.6% vs. 32.4%, p = 0.01) despite a similar requirement of CAT3+ transfusion upon arrival. CONCLUSION Prehospital WB administration is associated with a greater improvement in SI and a reduction in MTP. This study is limited by its lack of power to detect a mortality difference. Prospective randomized controlled trials will be required to determine the true impact of pWB on trauma patients. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level IV.
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Affiliation(s)
- Maxwell A Braverman
- From the Department of Surgery (M.A.B., A.C., E.B., E.S., A.A.S., L.B., H.C., R.B.J., B.J.E., R.M.S., S.E.N., D.H.J.), UT Health San Antonio; Department of Emergency Medicine (S.G.S.), Brooke Army Medical Center, United States Army Institute of Surgical Research (S.G.S., A.D.C., J.B.), JBSA Fort Sam Houston; Department of Surgery (A.D.F.), University of New Mexico School of Medicine, Albuquerque, New Mexico; Southwest Texas Regional Advisory Council (E.E.); Trauma Services (M.S.), University Hospital; South Texas Blood & Tissue Center (E.W.); and Department of Emergency Health Sciences (C.W.), UT Health, San Antonio, Texas
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Myers JC, Braverman MA, Ciaraglia A, Alkhateb R, Barry L, Brooke Z, Chang J, Wang H, Elenes R, Hepburn B, Ireland K, Jonas R, Nelson J, Pedraza S, Song J, Nicholson S, Eastridge B, Stewart R, Greebon L, Xenakis E, Jenkins D. Risk factors for massive transfusion in obstetrical hemorrhage and consideration of a whole blood program. Transfusion 2023; 63 Suppl 3:S112-S119. [PMID: 37067378 DOI: 10.1111/trf.17331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/18/2023] [Accepted: 02/18/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND Postpartum hemorrhage (PPH) is one of the leading causes of obstetric complications. The goal of this study was to identify risk factors for obstetric (OB) massive transfusion (MT) and determine the feasibility of developing a low-titer group O RhD-positive whole blood (LTO + WB) protocol for OB hemorrhage. STUDY DESIGN AND METHODS A retrospective study of OB patients who received transfusion within 24 h. MT patients were those who received >3 U of pRBC within 1 h or > 10 U in 24 h. Patient demographics, OB history, comorbidities, blood type, antibody status, and known risk factors for PPH and maternal-fetal outcomes were compared. Logistic regression was used for univariate and multivariate analyses. RESULTS Of the 610 transfused OB patients, 12.0% (n = 73) required MT. Groups were well matched for body mass index (BMI), maternal comorbidities, and history of spontaneous vaginal deliveries. The incidence of the previous cesarean section was higher in the MT group. Exactly 93.9% of patients were RhD-positive and 3.77% of all patients possessed an antibody on pretransfusion testing. Patients with MT had a longer length of stay (LOS), higher rate of intensive care unit (ICU) admission, fetal death, and hysterectomy. Multivariate analysis found age >35, PPH, placenta percreta, accreta, and increta to be significant (p < .05) risk factors for MT. DISCUSSION Patients over 35 years and those with abnormal placentation are at increased risk of requiring MT. With a time to delivery of 2 days, potential MT patients can be identified early, and with a 94% rate of RhD-positive+, they are eligible to receive low-titer O whole blood (LTOWB) providing hemostatic resuscitation with reduced donor exposure.
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Affiliation(s)
- John C Myers
- Department of Surgery, UT Health San Antonio, San Antonio, Texas, USA
| | | | - Angelo Ciaraglia
- Department of Surgery, UT Health San Antonio, San Antonio, Texas, USA
| | - Rahaf Alkhateb
- Department of Pathology, UT Health San Antonio, San Antonio, Texas, USA
| | - Lauran Barry
- Department of Surgery, UT Health San Antonio, San Antonio, Texas, USA
| | - Zachary Brooke
- Department of Surgery, UT Health San Antonio, San Antonio, Texas, USA
| | - Jeffrey Chang
- Department of Obstetrics and Gynecology, UT Health San Antonio, San Antonio, Texas, USA
| | - Hanzhang Wang
- Department of Urology, UT Health San Antonio, San Antonio, Texas, USA
| | - Rafael Elenes
- Department of Anesthesia, UT Health San Antonio, San Antonio, Texas, USA
| | - Byron Hepburn
- Military Health Institute, UT Health San Antonio, San Antonio, Texas, USA
| | - Kayla Ireland
- Department of Obstetrics and Gynecology, UT Health San Antonio, San Antonio, Texas, USA
| | - Rachelle Jonas
- Department of Surgery, UT Health San Antonio, San Antonio, Texas, USA
| | - Jeremy Nelson
- Military Health Institute, UT Health San Antonio, San Antonio, Texas, USA
| | - Santiago Pedraza
- Department of Surgery, UT Health San Antonio, San Antonio, Texas, USA
| | - Jun Song
- Department of Obstetrics and Gynecology, UT Health San Antonio, San Antonio, Texas, USA
| | | | - Brian Eastridge
- Department of Surgery, UT Health San Antonio, San Antonio, Texas, USA
| | - Ronald Stewart
- Department of Surgery, UT Health San Antonio, San Antonio, Texas, USA
| | - Leslie Greebon
- Department of Pathology, UT Health San Antonio, San Antonio, Texas, USA
| | - Elly Xenakis
- Department of Obstetrics and Gynecology, UT Health San Antonio, San Antonio, Texas, USA
| | - Donald Jenkins
- Department of Surgery, UT Health San Antonio, San Antonio, Texas, USA
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Thompson P, Ciaraglia A, Handspiker E, Bjerkvig C, Bynum JA, Glassberg E, Gurney JM, Hudson AJ, Jenkins DH, Nicholson SE, Strandenes G, Braverman MA. Risk of Harm in Needle Decompression for Tension Pneumothorax. J Spec Oper Med 2023:ZU1D-3DL9. [PMID: 37036785 DOI: 10.55460/zu1d-3dl9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
INTRODUCTION Tension pneumothorax (TPX) is the third most common cause of preventable death in trauma. Needle decompression at the fifth intercostal space at anterior axillary line (5th ICS AAL) is recommended by Tactical Combat Casualty Care (TCCC) with an 83-mm needle catheter unit (NCU). We sought to determine the risk of cardiac injury at this site. METHODS Institutional data sets from two trauma centers were queried for 200 patients with CT chest. Inclusion criteria include body mass index of =30 and age 18-40 years. Measurements were taken at 2nd ICS mid clavicular line (MCL), 5th ICS AAL and distance from the skin to pericardium at 5th ICS AAL. Groups were compared using Mann-Whitney U and chi-squared tests. RESULTS The median age was 27 years with median BMI of 23.8 kg/m2. The cohort was 69.5% male. Mean chest wall thickness at 2nd ICS MCL was 38-mm (interquartile range (IQR) 32-45). At 5th ICS AAL, the median chest wall thickness was 30-mm (IQR 21-40) and the distance from skin to pericardium was 66-mm (IQR 54-79). CONCLUSION The distance from skin to pericardium for 75% of patients falls within the length of the recommended needle catheter unit (83-mm). The current TCCC recommendation to "hub" the 83mm needle catheter unit has potential risk of cardiac injury.
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Hamlin S, Alexander R, Hayes K, Szoke A, Benton A, Wilde-Onia R, Castillo R, Thomas P, Cipolla J, Braverman MA. Impact of a High Observation Trauma Protocol on Patients with Isolated Traumatic Brain Injury. J Am Coll Surg 2023:00019464-990000000-00607. [PMID: 37026829 DOI: 10.1097/xcs.0000000000000703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
BACKGROUND Nationally, the volume of geriatric falls with intracranial hemorrhage (ICH) is increasing. Our institution began observing patients with ICH, a GCS ≥ 14, and no midline shift or intraventricular hemorrhage with hourly neurologic examination outside the ICU in a high observation trauma (HOT) protocol. We first excluded patients on anticoagulants/antiplatelets (HOT I), then included antiplatelets and warfarin (HOT II) and finally included direct oral anticoagulants (HOT III). Our hypothesis is that HOT protocol safely reduces ICU utilization and creates cost savings in this patient population. STUDY DESIGN Our institutional trauma registry was retrospectively queried for all patients on HOT protocol. Patients were stratified based on date of admission: HOT I (2008-2014), HOT II (2015-2018) and HOT III (2019-2021). Demographics, anticoagulant use, injury characteristics, lengths of stay (LOS), incidence of neuro-intervention, and mortality. RESULTS Over the study period, 2343 patients were admitted, including HOT I (n=939), HOT II (n=794), and HOT III (n=610). Of these patients, 331 (35%), 554 (70%), and 495 (81%) were admitted to the floor under HOT protocol. HOT patients required neurointervention in 3.0%, 0.5% and 0.4% of cases over HOT I, II, and III, respectively. Mortality among HOT protocol patients was found to be 0.6% in HOT I, 0.9% in HOT II and 0.2% in the HOT III cohort (p=0.33). CONCLUSION Across the study period, ICU utilization decreased without an increase in neurosurgical intervention or mortality indicating the efficacy of the HOT selection criteria in identifying appropriate candidates for stepdown admission and high observation trauma protocol.
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Affiliation(s)
- Sean Hamlin
- St Lukes University Health Network, Department of Surgery, Division of Acute Care Surgery, Bethlehem, PA
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9
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Perea LL, Moore K, Docherty C, Nguyen U, Seamon MJ, Byrne JP, Jenkins DH, Braverman MA, Porter JM, Armento IG, Mentzer C, Leonard GC, Luis AJ, Noorbakhsh MR, Babowice JE, Kaafarani HMA, Mokhtari A, Martin MJ, Badiee J, Mains C, Madayag RM, Moore SA, Madden K, Hazelton JP. Whole Blood Resuscitation is Safe in Pediatric Trauma Patients: A Multicenter Study. Am Surg 2023:31348231157864. [PMID: 36792959 DOI: 10.1177/00031348231157864] [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: 02/17/2023]
Abstract
INTRODUCTION Whole blood (WB) resuscitation has been associated with a mortality benefit in trauma patients. Several small series report the safe use of WB in the pediatric trauma population. We performed a subgroup analysis of the pediatric patients from a large prospective multicenter trial comparing patients receiving WB or blood component therapy (BCT) during trauma resuscitation. We hypothesized that WB resuscitation would be safe compared to BCT resuscitation in pediatric trauma patients. METHODS This study included pediatric trauma patients (0-17 y), from ten level-I trauma centers, who received any blood transfusion during initial resuscitation. Patients were included in the WB group if they received at least one unit of WB during their resuscitation, and the BCT group was composed of patients receiving traditional blood product resuscitation. The primary outcome was in-hospital mortality with secondary outcomes being complications. Multivariate logistic regression was performed to assess for mortality and complications in those treated with WB vs BCT. RESULTS Ninety patients, with both penetrating and blunt mechanisms of injury (MOI), were enrolled in the study (WB: 62 (69%), BCT: 28 (21%)). Whole blood patients were more likely to be male. There were no differences in age, MOI, shock index, or injury severity score between groups. On logistic regression, there was no difference in complications. Mortality was not different between the groups (P = .983). CONCLUSION Our data suggest WB resuscitation is safe when compared to BCT resuscitation in the care of critically injured pediatric trauma patients.
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Affiliation(s)
- Lindsey L Perea
- Department of Surgery, Division of Trauma and Acute Care Surgery, 209639Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Kate Moore
- Department of Surgery, Division of Trauma and Acute Care Surgery, 209639Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | | | - Uyen Nguyen
- 12310Penn State College of Medicine, Hershey, PA, USA
| | - Mark J Seamon
- 14640Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - James P Byrne
- 14640Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Donald H Jenkins
- 14742University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Maxwell A Braverman
- 14742University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | | | - Caleb Mentzer
- 7442Spartanburg Regional Healthcare System, Spartanburg, SC, USA
| | - Guy C Leonard
- 7442Spartanburg Regional Healthcare System, Spartanburg, SC, USA
| | | | | | | | | | - Ava Mokhtari
- 548305Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | | | | | | | - Joshua P Hazelton
- 12311Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
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Bauerle WB, Braverman MA, Brown AM. A Systematic Approach to Beginning a Retrospective Research Study: A guide for surgical trainees. Surgery in Practice and Science 2022. [DOI: 10.1016/j.sipas.2022.100132] [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] [Indexed: 10/14/2022] Open
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Cooper Z, Herrera-Escobar JP, Phuong J, Braverman MA, Bonne S, Knudson MM, Rivara FP, Rowhani-Rahbar A, Price MA, Bulger EM. Developing a National Trauma Research Action Plan: Results from the injury prevention research gap Delphi survey. J Trauma Acute Care Surg 2022; 93:367-375. [PMID: 35545804 DOI: 10.1097/ta.0000000000003665] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In its 2016 report on trauma care, the National Academies of Sciences, Engineering, and Medicine called for the establishment of a National Trauma Research Action Plan to strengthen and guide future trauma research. To address this recommendation, the Department of Defense funded the Coalition for National Trauma Research to generate a comprehensive research agenda spanning the continuum of trauma and burn care. We describe the gap analysis and high priority research questions generated from the National Trauma Research Action Plan panel on injury prevention. METHODS Experts in injury prevention research were recruited to identify current gaps in injury prevention research, generate research questions and establish the priority of these questions using a consensus-driven Delphi survey approach from December 2019 through September 2020. Participants were identified using established Delphi recruitment guidelines to ensure heterogeneity and generalizability with both military and civilian representatives. Participants were encouraged, but not required, to use a Patient/Population, Intervention, Comparison, and Outcome format to generate research questions: Patient/Population; Intervention; Compare/Control; Outcome model. On subsequent surveys, participants were asked to rank the priority of each research question on a nine-point Likert scale, categorized to represent low-, medium-, and high-priority items. Consensus was defined as 60% or greater of panelists agreeing on the priority category. RESULTS Twenty-eight subject matter experts generated 394 questions in 12 topic areas. By round 3 of the Delphi, 367 (93.1%) questions reached consensus, of which 169 (46.1%) were determined to be high priority, 196 (53.4%) medium priority, and 2 (0.5%) low priority. Among the 169 high priority questions, suicide (29.6%), firearm violence (20.1%), and violence prevention (18.3%) were the most prevalent topic areas. CONCLUSION This Delphi gap analysis of injury prevention research identified 169 high priority research questions that will help guide investigators in future injury prevention research. Funding agencies and researchers should consider these gaps when they prioritize future research. LEVEL OF EVIDENCE Therepeutic/Care Management; Level IV.
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Affiliation(s)
- Zara Cooper
- From the Center for Surgery and Public Health (Z.C., J.P.H.-E.), Brigham and Women's Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Biomedical Informatics and Medical Education (J.P.), University of Washington, Seattle, Washington; Coalition for National Trauma Research (M.A.B., M.A.P.), San Antonio, Texas; Department of Surgery (S.B.), Rutgers University, Newark, New Jersey; Department of Surgery (M.M.K.), University of California, San Francisco, California; Department of Pediatrics (F.P.R.), Department of Epidemiology (A.R.-R.), and Department of Surgery (E.M.B.), University of Washington, Seattle, Washington
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Joseph B, Saljuqi AT, Phuong J, Shipper E, Braverman MA, Bixby PJ, Price MA, Barraco RD, Cooper Z, Jarman M, Lack W, Lueckel S, Pivalizza E, Bulger E. Developing a National Trauma Research Action Plan: Results from the geriatric research gap Delphi survey. J Trauma Acute Care Surg 2022; 93:209-219. [PMID: 35393380 DOI: 10.1097/ta.0000000000003626] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Treating older trauma patients requires a focus on the confluence of age-related physiological changes and the impact of the injury itself. Therefore, the primary way to improve the care of geriatric trauma patients is through the development of universal, systematic multidisciplinary research. To achieve this, the Coalition for National Trauma Research has developed the National Trauma Research Action Plan that has generated a comprehensive research agenda spanning the continuum of geriatric trauma care from prehospital to rehabilitation. METHODS Experts in geriatric trauma care and research were recruited to identify current gaps in clinical geriatric research, generate research questions, and establish the priority of these questions using a consensus-driven Delphi survey approach. Participants were identified using established Delphi recruitment guidelines ensuring heterogeneity and generalizability. On subsequent surveys, participants were asked to rank the priority of each research question on a nine-point Likert scale, categorized to represent low-, medium-, and high-priority items. The consensus was defined as more than 60% of panelists agreeing on the priority category. RESULTS A total of 24 subject matter experts generated questions in 109 key topic areas. After editing for duplication, 514 questions were included in the priority ranking. By round 3, 362 questions (70%) reached 60% consensus. Of these, 161 (44%) were high, 198 (55%) medium, and 3 (1%) low priority. CONCLUSION Among the questions prioritized as high priority, questions related to three types of injuries (i.e., rib fracture, traumatic brain injury, and lower extremity injury) occurred with the greatest frequency. Among the 25 highest priority questions, the key topics with the highest frequency were pain management, frailty, and anticoagulation-related interventions. The most common types of research proposed were interventional clinical trials and comparative effectiveness studies, outcome research, and health care systems research.
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Affiliation(s)
- Bellal Joseph
- From the Department of Surgery (B.J., A.T.S.), University of Arizona, College of Medicine, Tucson, Arizona; Department of Biomedical Informatics and Medical Education (J.P., E.S.), The University of Washington, Seattle, Washington; Coalition for National Trauma Research (M.A.B., P.J.B., M.A.P.), San Antonio, Texas; University of South Florida Morsani College of Medicine-Lehigh Valley Campus (R.D.B.), Allentown, Pennsylvania; Brigham & Women's Hospital (Z.C., M.J.), Boston, Massachusetts; Department of Surgery (W.L., E.B.), The Department of Surgery, Trauma and Surgical Critical Care Division (S.L.), Brown University, Providence, Rhode Island; Department of Anesthesiology (E.P.), UTHealth Houston McGovern Medical School, Houston, Texas; Department of Surgery, The Division of Trauma and Critical care (R.D.B.), Lehigh Valley Hospital and Health Network, University of South Florida Morsani College of Medicine (USF-MCOM), Lehigh Valley Campus, Allentown, PA
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13
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Costantini TW, Galante JM, Braverman MA, Phuong J, Price MA, Cuschieri J, Godat LN, Holcomb JB, Coimbra R, Bulger EM. Developing a National Trauma Research Action Plan: Results from the acute resuscitation, initial patient evaluation, imaging, and management research gap Delphi survey. J Trauma Acute Care Surg 2022; 93:200-208. [PMID: 35444148 DOI: 10.1097/ta.0000000000003648] [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: 11/25/2022]
Abstract
BACKGROUND Injury is the leading cause of death in patients aged 1 to 45 years and contributes to a significant public health burden for individuals of all ages. To achieve zero preventable deaths and disability after injury, the National Academies of Science, Engineering and Medicine called for the development of a National Trauma Research Action Plan to improve outcomes for military and civilian trauma patients. Because rapid resuscitation and prompt identification and treatment of injuries are critical in achieving optimal outcomes, a panel of experts was convened to generate high-priority research questions in the areas of acute resuscitation, initial evaluation, imaging, and definitive management on injury. METHODS Forty-three subject matter experts in trauma care and injury research were recruited to perform a gap analysis of current literature and prioritize unanswered research questions using a consensus-driven Delphi survey approach. Four Delphi rounds were conducted to generate research questions and prioritize them using a 9-point Likert scale. Research questions were stratified as low, medium, or high priority, with consensus defined as ≥60% of panelists agreeing on the priority category. Research questions were coded using a taxonomy of 118 research concepts that were standard across all National Trauma Research Action Plan panels. RESULTS There were 1,422 questions generated, of which 992 (69.8%) reached consensus. Of the questions reaching consensus, 327 (33.0%) were given high priority, 621 (62.6%) medium priority, and 44 (4.4%) low priority. Pharmaceutical intervention and fluid/blood product resuscitation were most frequently scored as high-priority intervention concepts. Research questions related to traumatic brain injury, vascular injury, pelvic fracture, and venous thromboembolism prophylaxis were highly prioritized. CONCLUSION This research gap analysis identified more than 300 high-priority research questions within the broad category of Acute Resuscitation, Initial Evaluation, Imaging, and Definitive Management. Research funding should be prioritized to address these high-priority topics in the future.
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Affiliation(s)
- Todd W Costantini
- From the Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California San Diego School of Medicine (T.W.C.), San Diego, CA; Division of Trauma, Acute Care Surgery and Surgical Critical Care, Department of Surgery, University of California Davis School of Medicine (J.M.G.), Sacramento, CA; Coalition for National Trauma Research, (M.A.B.), San Antonio, TX; Harborview Injury Prevention and Research Center, University of Washington (J.P.), Seattle, WA; Coalition for National Trauma Research, (M.A.P.), San Antonio, TX; Division of General Surgery, Zuckerberg San Francisco General Hospital, University of California San Francisco School of Medicine (J.C.), San Francisco, CA; Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California San Diego School of Medicine (L.N.G.); San Diego, CA; Division of Trauma and Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham School of Medicine (J.B.H.); Birmingham, AL; Riverside University Health System Medical Center, Loma Linda University School of Medicine (R.C.); Riverside, CA; and Division of Trauma, Burn and Critical Care Surgery, Department of Surgery, University of Washington School of Medicine (E.M.B.); Seattle, WA
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Braverman MA, Smith AA, Ciaraglia AV, Radowsky JS, Schauer SG, Sams VG, Greebon LJ, Shiels MD, Jonas RB, Ngamsuntikul S, Waltman E, Epley E, Rose T, Bynum JA, Cap AP, Eastridge BJ, Stewart RM, Jenkins DH, Nicholson SE. The regional whole blood program in San Antonio, TX: A 3-year update on prehospital and in-hospital transfusion practices for traumatic and non-traumatic hemorrhage. Transfusion 2022; 62 Suppl 1:S80-S89. [PMID: 35748675 DOI: 10.1111/trf.16964] [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: 02/06/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/30/2022]
Abstract
Low titer type O Rh-D + whole blood (LTO + WB) has become a first-line resuscitation medium for hemorrhagic shock in many centers around the World. Showing early effectiveness on the battlefield, LTO + WB is used in both the pre-hospital and in-hospital settings for traumatic and non-traumatic hemorrhage resuscitation. Starting in 2018, the San Antonio Whole Blood Collaborative has worked to provide LTO + WB across Southwest Texas, initially in the form of remote damage control resuscitation followed by in-hospital trauma resuscitation. This program has since expanded to include pediatric trauma resuscitation, obstetric hemorrhage, females of childbearing potential, and non-traumatic hemorrhage. The objective of this manuscript is to provide a three-year update on the successes and expansion of this system and outline resuscitation challenges in special populations.
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Affiliation(s)
| | - Allison A Smith
- Department of Surgery, UT Health San Antonio, San Antonio, Texas, USA
| | | | - Jason S Radowsky
- Department of Trauma and Acute Care Surgery, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - Steven G Schauer
- Department of Emergency Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, Texas, USA.,United States Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - Valerie G Sams
- Department of Trauma and Acute Care Surgery, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - Leslie J Greebon
- Department of Pathology, UT Health San Antonio, San Antonio, Texas, USA
| | | | | | | | | | - Eric Epley
- Southwest Texas Regional Advisory Council, San Antonio, Texas, USA
| | - Tracee Rose
- Southwest Texas Regional Advisory Council, San Antonio, Texas, USA
| | - James A Bynum
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - Andre P Cap
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - Brian J Eastridge
- Department of Surgery, UT Health San Antonio, San Antonio, Texas, USA
| | - Ronald M Stewart
- Department of Surgery, UT Health San Antonio, San Antonio, Texas, USA
| | - Donald H Jenkins
- Department of Surgery, UT Health San Antonio, San Antonio, Texas, USA
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Stein DM, Braverman MA, Phuong J, Shipper E, Price MA, Bixby PJ, Adelson PD, Ansel BM, Cifu DX, DeVine JG, Galvagno SM, Gelb DE, Harris O, Kang CS, Kitagawa RS, McQuillan KA, Patel MB, Robertson CS, Salim A, Shutter L, Valadka AB, Bulger EM. Developing a National Trauma Research Action Plan: Results from the Neurotrauma Research Panel Delphi Survey. J Trauma Acute Care Surg 2022; 92:906-915. [PMID: 35001020 DOI: 10.1097/ta.0000000000003527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In 2016, the National Academies of Science, Engineering and Medicine called for the development of a National Trauma Research Action Plan. The Department of Defense funded the Coalition for National Trauma Research to generate a comprehensive research agenda spanning the continuum of trauma and burn care. Given the public health burden of injuries to the central nervous system, neurotrauma was one of 11 panels formed to address this recommendation with a gap analysis and generation of high-priority research questions. METHODS We recruited interdisciplinary experts to identify gaps in the neurotrauma literature, generate research questions, and prioritize those questions using a consensus-driven Delphi survey approach. We conducted four Delphi rounds in which participants generated key research questions and then prioritized the importance of the questions on a 9-point Likert scale. Consensus was defined as 60% or greater of panelists agreeing on the priority category. We then coded research questions using an National Trauma Research Action Plan taxonomy of 118 research concepts, which were consistent across all 11 panels. RESULTS Twenty-eight neurotrauma experts generated 675 research questions. Of these, 364 (53.9%) reached consensus, and 56 were determined to be high priority (15.4%), 303 were deemed to be medium priority (83.2%), and 5 were low priority (1.4%). The research topics were stratified into three groups-severe traumatic brain injury (TBI), mild TBI (mTBI), and spinal cord injury. The number of high-priority questions for each subtopic was 46 for severe TBI (19.7%), 3 for mTBI (4.3%) and 7 for SCI (11.7%). CONCLUSION This Delphi gap analysis of neurotrauma research identified 56 high-priority research questions. There are clear areas of focus for severe TBI, mTBI, and spinal cord injury that will help guide investigators in future neurotrauma research. Funding agencies should consider these gaps when they prioritize future research. LEVEL OF EVIDENCE Diagnostic Test or Criteria, Level IV.
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Affiliation(s)
- Deborah M Stein
- From the Program in Trauma, University of Maryland School of Medicine (D.M.S.), Baltimore, Maryland; Department of Biomedical Informatics and Medical Education (J.P.), University of Washington, Seattle, Washington; Coalition for National Trauma Research (M.A.B., E.S., M.A.P., P.J.B.), San Antonio, Texas; Department of Neurosurgery, Mayo Clinic (P.D.A.), Barrow Neurological Institute at Phoenix Children's Hospital; Division of Neurosurgery, Department of Child Health (P.D.A.), University of Arizona, Phoenix, Arizona; Department of Neurological Surgery (B.M.A.), Indiana University School of Medicine, Indianapolis, Indiana; Department of Physical Medicine and Rehabilitation (D.X.C.), Virginia Commonwealth University School of Medicine, Richmond, Virginia; Department of Orthopaedics, Augusta University Health (J.G.D.), Augusta, Georgia; Department of Anesthesiology (S.M.G.), Department of Orthopaedics (D.E.G.), University of Maryland School of Medicine, Baltimore, Maryland; Department of Neurosurgery (O.H.), Stanford University, Palo Alto, California; Department of Emergency Medicine (C.S.K.), Madigan Army Medicine Center, Tacoma, Washington; Department of Neurosurgery (R.S.K.), McGovern Medical School, Houston, Texas; R Adams Cowley Shock Trauma Center (K.A.M.), University of Maryland Medical Center, Baltimore, Maryland; Department of Surgery (M.B.P.), Vanderbilt University School of Medicine, Nashville, Tennessee; Department of Neurosurgery (C.S.R.), Baylor College of Medicine, Houston, Texas; Department of Surgery (A.S.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Critical Care Medicine (L.S.), Neurology & Neurosurgery, University of Pittsburg, Pittsburgh, Pennsylvania; Department of Neurosurgery (A.B.V.), Virginia Commonwealth University School of Medicine, Richmond, Virginia; Department of Surgery (E.M.B.), Harborview Medical Center, University of Washington, Seattle, Washington
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Newgard CD, Braverman MA, Phuong J, Shipper ES, Price MA, Bixby PJ, Goralnick E, Daya MR, Lerner EB, Guyette FX, Rowell S, Doucet J, Jenkins P, Mann NC, Staudenmayer K, Blake DP, Bulger E. Developing a National Trauma Research Action Plan: Results from the prehospital and mass casualty research Delphi survey. J Trauma Acute Care Surg 2022; 92:398-406. [PMID: 34789701 DOI: 10.1097/ta.0000000000003469] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The National Academies of Sciences, Engineering, and Medicine 2016 trauma system report recommended a National Trauma Research Action Plan to strengthen and guide future trauma research. To address this recommendation, 11 expert panels completed a Delphi survey process to create a comprehensive research agenda, spanning the continuum of trauma care. We describe the gap analysis and high-priority research questions generated from the National Trauma Research Action Plan panel on prehospital and mass casualty trauma care. METHODS We recruited interdisciplinary national experts to identify gaps in the prehospital and mass casualty trauma evidence base and generate prioritized research questions using a consensus-driven Delphi survey approach. We included military and civilian representatives. Panelists were encouraged to use the Patient/Population, Intervention, Compare/Control, and Outcome format to generate research questions. We conducted four Delphi rounds in which participants generated key research questions and then prioritized the questions on a 9-point Likert scale to low-, medium-, and high-priority items. We defined consensus as ≥60% agreement on the priority category and coded research questions using a taxonomy of 118 research concepts in 9 categories. RESULTS Thirty-one interdisciplinary subject matter experts generated 490 research questions, of which 433 (88%) reached consensus on priority. The rankings of the 433 questions were as follows: 81 (19%) high priority, 339 (78%) medium priority, and 13 (3%) low priority. Among the 81 high-priority questions, there were 46 taxonomy concepts, including health systems of care (36 questions), interventional clinical trials and comparative effectiveness (32 questions), mortality as an outcome (30 questions), prehospital time/transport mode/level of responder (24 questions), system benchmarks (17 questions), and fluid/blood product resuscitation (17 questions). CONCLUSION This Delphi gap analysis of prehospital and mass casualty care identified 81 high-priority research questions to guide investigators and funding agencies for future trauma research.
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Affiliation(s)
- Craig D Newgard
- From the Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine (C.D.N., M.R.D.), Oregon Health and Science University, Portland, Oregon; Coalition for National Trauma Research (M.A.B., E.S.S., M.A.P., P.J.B.), San Antonio, Texas; Department of Biomedical Informatics and Medical Education (J.P.), University of Washington, Seattle, Washington; Department of Emergency Medicine (E.G.), Brigham and Women's Hospital Harvard Medical School Boston, Massachusetts; Department of Emergency Medicine (E.B.L.), Jacobs School of Medicine and Biomedical Sciences University at Buffalo, Buffalo, New York; Department of Emergency Medicine (F.X.G.), University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Surgery (S.R.), University of Chicago Medicine and Biological Sciences, Chicago, Illinois; Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery (J.D.), University of California San Diego Health, San Diego, California; Department of Surgery (P.J.), Indiana University School of Medicine, Indianapolis, Indiana; Department of Pediatrics (N.C.M.), University of Utah School of Medicine, Salt Lake City, Utah; Department of Surgery (K.S.), Stanford University, Palo Alto, California; Department of Surgery (D.P.B.), Inova Medical Group/Inova Fairfax Medical Campus, Falls Church, Virginia; and Department of Surgery (E.B.), Harborview Medical Center University of Washington, Seattle, Washington
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Alexander RM, Hamlin S, Szoke A, Ramirez CL, Wilde-Onia R, Thomas P, Cipolla J, Castillo RC, Braverman MA. High Observation Trauma Protocol Is Safe in Anticoagulated Patients with Mild Traumatic Brain Injury. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.07.610] [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] [Indexed: 11/25/2022]
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Braverman MA, Smith A, Pokorny D, Axtman B, Shahan CP, Barry L, Corral H, Jonas RB, Shiels M, Schaefer R, Epley E, Winckler C, Waltman E, Eastridge BJ, Nicholson SE, Stewart RM, Jenkins DH. Prehospital whole blood reduces early mortality in patients with hemorrhagic shock. Transfusion 2021; 61 Suppl 1:S15-S21. [PMID: 34269467 DOI: 10.1111/trf.16528] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 12/31/2020] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Low titer O+ whole blood (LTOWB) is being increasingly used for resuscitation of hemorrhagic shock in military and civilian settings. The objective of this study was to identify the impact of prehospital LTOWB on survival for patients in shock receiving prehospital LTOWB transfusion. STUDY DESIGN AND METHODS A single institutional trauma registry was queried for patients undergoing prehospital transfusion between 2015 and 2019. Patients were stratified based on prehospital LTOWB transfusion (PHT) or no prehospital transfusion (NT). Outcomes measured included emergency department (ED), 6-h and hospital mortality, change in shock index (SI), and incidence of massive transfusion. Statistical analyses were performed. RESULTS A total of 538 patients met inclusion criteria. Patients undergoing PHT had worse shock physiology (median SI 1.25 vs. 0.95, p < .001) with greater reversal of shock upon arrival (-0.28 vs. -0.002, p < .001). In a propensity-matched group of 214 patients with prehospital shock, 58 patients underwent PHT and 156 did not. Demographics were similar between the groups. Mean improvement in SI between scene and ED was greatest for patients in the PHT group with a lower trauma bay mortality (0% vs. 7%, p = .04). No survival benefit for patients in prehospital cardiac arrest receiving LTOWB was found (p > .05). DISCUSSION This study demonstrated that trauma patients who received prehospital LTOWB transfusion had a greater improvement in SI and a reduction in early mortality. Patient with prehospital cardiac arrest did not have an improvement in survival. These findings support LTOWB use in the prehospital setting. Further multi-institutional prospective studies are needed.
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Affiliation(s)
| | - Alison Smith
- Department of Surgery, UT Health San Antonio, San Antonio, Texas, USA
| | - Douglas Pokorny
- Department of Surgery, UT Health San Antonio, San Antonio, Texas, USA
| | - Benjamin Axtman
- Department of Surgery, UT Health San Antonio, San Antonio, Texas, USA
| | | | - Lauran Barry
- Department of Surgery, UT Health San Antonio, San Antonio, Texas, USA
| | - Hannah Corral
- Department of Surgery, UT Health San Antonio, San Antonio, Texas, USA
| | | | - Michael Shiels
- Trauma Services, University Hospital, San Antonio, Texas, USA
| | - Randall Schaefer
- Southwest Texas Regional Advisory Council, San Antonio, Texas, USA
| | - Eric Epley
- Southwest Texas Regional Advisory Council, San Antonio, Texas, USA
| | - Christopher Winckler
- Department of Emergency Health Services, UT Health San Antonio, San Antonio, Texas, USA
| | | | - Brian J Eastridge
- Department of Surgery, UT Health San Antonio, San Antonio, Texas, USA
| | | | - Ronald M Stewart
- Department of Surgery, UT Health San Antonio, San Antonio, Texas, USA
| | - Donald H Jenkins
- Department of Surgery, UT Health San Antonio, San Antonio, Texas, USA
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Munoz JL, Kimura AM, Xenakis E, Jenkins DH, Braverman MA, Ramsey PS, Ireland KE. Whole blood transfusion reduces overall component transfusion in cases of placenta accreta spectrum: a pilot program. J Matern Fetal Neonatal Med 2021; 35:6455-6460. [PMID: 33902384 DOI: 10.1080/14767058.2021.1915275] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 09/30/2022]
Abstract
OBJECTIVE Placenta accreta spectrum (PAS) is a group of placental invasion pathologies associated with significant morbidity to both mother and fetus. The majority of patients with PAS will require a blood transfusion at time of delivery and subsequent cesarean hysterectomy. The optimal approach to maternal acute blood loss resuscitation is currently unknown. METHODS Here, we present a cohort analysis of 34 patients with pathology-confirmed PAS treated with either whole blood (n = 16) or component therapy (n = 18) for initial intraoperative resuscitation. RESULTS We observed comparable results in post-operative outcomes with fewer overall transfusions and subsequently, lower volumes of resuscitation (p=.03) with whole blood initial resuscitation. CONCLUSIONS Whole blood transfusion may represent a viable option for initial resuscitation with lower resuscitation volumes and transfusion-associated complications without directly effecting post-operative outcomes in cases of PAS.
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Affiliation(s)
- Jessian L Munoz
- Division of Maternal Fetal Medicine,University of Texas Health Sciences Center at San Antonio, San Antonio, TX, USA.,Department of Obstetrics & Gynecology, University Health System, San Antonio, TX, USA
| | - Alison M Kimura
- Division of Maternal Fetal Medicine,University of Texas Health Sciences Center at San Antonio, San Antonio, TX, USA.,Department of Obstetrics & Gynecology, University Health System, San Antonio, TX, USA
| | - Elly Xenakis
- Division of Maternal Fetal Medicine,University of Texas Health Sciences Center at San Antonio, San Antonio, TX, USA.,Department of Obstetrics & Gynecology, University Health System, San Antonio, TX, USA
| | - Donald H Jenkins
- Division of Trauma and Emergency Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Maxwell A Braverman
- Division of Trauma and Emergency Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Patrick S Ramsey
- Division of Maternal Fetal Medicine,University of Texas Health Sciences Center at San Antonio, San Antonio, TX, USA.,Department of Obstetrics & Gynecology, University Health System, San Antonio, TX, USA
| | - Kayla E Ireland
- Division of Maternal Fetal Medicine,University of Texas Health Sciences Center at San Antonio, San Antonio, TX, USA.,Department of Obstetrics & Gynecology, University Health System, San Antonio, TX, USA
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Braverman MA, Smith A, Shahan CP, Axtman B, Epley E, Hitchman S, Waltman E, Winckler C, Nicholson SE, Eastridge BJ, Stewart RM, Jenkins DH. From battlefront to homefront: creation of a civilian walking blood bank. Transfusion 2020; 60 Suppl 3:S167-S172. [PMID: 32478857 DOI: 10.1111/trf.15694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/17/2020] [Accepted: 01/17/2020] [Indexed: 01/24/2023]
Abstract
Hemorrhagic shock remains the leading cause of preventable death on the battlefield, despite major advances in trauma care. Early initiation of balanced resuscitation has been shown to decrease mortality in the hemorrhaging patient. To address transfusion limitations in austere environments or in the event of multiple casualties, walking blood banks have been used in the combat setting with great success. Leveraging the success of the region-wide whole blood program in San Antonio, Texas, we report a novel plan that represents a model response to mass casualty incidents.
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Affiliation(s)
| | - Alison Smith
- Department of Surgery, UT Health San Antonio, San Antonio, Texas
| | | | - Benjamin Axtman
- Department of Surgery, UT Health San Antonio, San Antonio, Texas
| | - Eric Epley
- Southwest Texas Regional Advisory Council, San Antonio, Texas
| | - Scott Hitchman
- Southwest Texas Regional Advisory Council, San Antonio, Texas
| | | | - Christopher Winckler
- Department of Emergency Health Services, UT Health San Antonio, San Antonio, Texas
| | | | | | - Ronald M Stewart
- Department of Surgery, UT Health San Antonio, San Antonio, Texas
| | - Donald H Jenkins
- Department of Surgery, UT Health San Antonio, San Antonio, Texas
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21
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Morris DS, Braverman MA, Corean J, Myers JC, Xenakis E, Ireland K, Greebon L, Ilstrup S, Jenkins DH. Whole blood for postpartum hemorrhage: early experience at two institutions. Transfusion 2020; 60 Suppl 3:S31-S35. [PMID: 32478935 DOI: 10.1111/trf.15731] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/07/2020] [Accepted: 02/08/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Death from postpartum hemorrhage (PPH) remains a significant preventable problem worldwide. Cold-stored, low-titer, type-O whole blood (LTOWB) is increasingly being used for resuscitation of injured patients, but it is uncommon in PPH patients, and it is unclear what its role may be in this population. STUDY DESIGN AND METHODS Brief report of the early experience of WB use for PPH in two institutions, one university hospital and one private hospital. RESULTS Different approaches have been implemented at the two institutions, one designed for emergency release, uncrossmatched transfusion of LTOWB as part of a massive transfusion protocol (MTP) and one for high-risk obstetric patients with known placental abnormalities. A total of 7 PPH patients have received a total of 17 units of LTOWB between the two institutions. No severe adverse transfusion reactions were observed clinically in either institution and the clinical outcomes were favorable in all cases. CONCLUSION In our early experience, LTOWB can be implemented for two different PPH clinical scenarios. Larger studies are needed to compare outcomes between LTOWB and traditional component resuscitation strategies.
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Affiliation(s)
- David S Morris
- Division of Trauma, Intermountain Medical Center, Murray, Utah
| | - Maxwell A Braverman
- Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas
| | - Jessica Corean
- Division of Pathology, University of Utah, Salt Lake City, Utah
| | - John C Myers
- Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas
| | - Elly Xenakis
- Department of Obstetrics and Gynecology, University of Texas Health San Antonio, San Antonio, Texas
| | - Kayla Ireland
- Department of Obstetrics and Gynecology, University of Texas Health San Antonio, San Antonio, Texas
| | - Leslie Greebon
- Department of Obstetrics and Gynecology, University of Texas Health San Antonio, San Antonio, Texas
| | - Sarah Ilstrup
- Division of Transfusion Medicine, Intermountain Medical Center, Salt Lake City, Utah
| | - Donald H Jenkins
- Department of Surgery, University of Texas Health San Antonio, San Antonio, Texas
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22
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Thompson P, Hudson AJ, Convertino VA, Bjerkvig C, Eliassen HS, Eastridge BJ, Irvine-Smith T, Braverman MA, Hellander S, Jenkins DH, Rappold JF, Gurney JM, Glassberg E, Cap AP, Aussett S, Apelseth TO, Williams S, Ward KR, Shackelford SA, Stroberg P, Vikeness BH, Pepe PE, Winckler CJ, Woolley T, Enbuske S, De Pasquale M, Boffard KD, Austlid I, Fosse TK, Asbjornsen H, Spinella PC, Strandenes G. Risk of Harm Associated With Using Rapid Sequence Induction Intubation and Positive Pressure Ventilation in Patients With Hemorrhagic Shock. J Spec Oper Med 2020; 20:97-102. [PMID: 32969011 DOI: 10.55460/q4g3-feqr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/01/2020] [Indexed: 06/11/2023]
Abstract
Based on limited published evidence, physiological principles, clinical experience, and expertise, the author group has developed a consensus statement on the potential for iatrogenic harm with rapid sequence induction (RSI) intubation and positive-pressure ventilation (PPV) on patients in hemorrhagic shock. "In hemorrhagic shock, or any low flow (central hypovolemic) state, it should be noted that RSI and PPV are likely to cause iatrogenic harm by decreasing cardiac output." The use of RSI and PPV leads to an increased burden of shock due to a decreased cardiac output (CO)2 which is one of the primary determinants of oxygen delivery (DO2). The diminishing DO2 creates a state of systemic hypoxia, the severity of which will determine the magnitude of the shock (shock dose) and a growing deficit of oxygen, referred to as oxygen debt. Rapid accumulation of critical levels of oxygen debt results in coagulopathy and organ dysfunction and failure. Spontaneous respiration induced negative intrathoracic pressure (ITP) provides the pressure differential driving venous return. PPV subsequently increases ITP and thus right atrial pressure. The loss in pressure differential directly decreases CO and DO2 with a resultant increase in systemic hypoxia. If RSI and PPV are deemed necessary, prior or parallel resuscitation with blood products is required to mitigate post intervention reduction of DO2 and the potential for inducing cardiac arrest in the critically shocked patient.
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Pokorny DM, Braverman MA, Edmundson PM, Bittenbinder DM, Zhu CS, Winckler CJ, Schaefer R, McGinity AC, Epley E, Eastridge BJ, Nicholson SE, Stewart RM, Jenkins DH. The use of prehospital blood products in the resuscitation of trauma patients: a review of prehospital transfusion practices and a description of our regional whole blood program in San Antonio,
TX. ACTA ACUST UNITED AC 2019. [DOI: 10.1111/voxs.12498] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Douglas M. Pokorny
- The University of Texas Health Science Center San Antonio TX USA
- Department of Surgery The University of Texas Health Science Center San Antonio TX USA
| | - Maxwell A. Braverman
- The University of Texas Health Science Center San Antonio TX USA
- Department of Surgery The University of Texas Health Science Center San Antonio TX USA
| | - Philip M. Edmundson
- The University of Texas Health Science Center San Antonio TX USA
- Department of Surgery The University of Texas Health Science Center San Antonio TX USA
| | - David M. Bittenbinder
- The University of Texas Health Science Center San Antonio TX USA
- Department of Surgery The University of Texas Health Science Center San Antonio TX USA
| | - Caroline S. Zhu
- The University of Texas Health Science Center San Antonio TX USA
| | - Christopher J. Winckler
- The University of Texas Health Science Center San Antonio TX USA
- Department of Emergency Health Sciences The University of Texas Health Science Center San AntonioTX USA
- Department of Emergency Medicine The University of Texas Health Science Center, San AntonioTX USA
- Southwest Texas Regional Advisory Council San AntonioTX USA
| | - Randall Schaefer
- Department of Emergency Medicine The University of Texas Health Science Center, San AntonioTX USA
| | - Ashley C. McGinity
- The University of Texas Health Science Center San Antonio TX USA
- Department of Surgery The University of Texas Health Science Center San Antonio TX USA
| | - Eric Epley
- Southwest Texas Regional Advisory Council San AntonioTX USA
| | - Brian J. Eastridge
- The University of Texas Health Science Center San Antonio TX USA
- Department of Surgery The University of Texas Health Science Center San Antonio TX USA
- Southwest Texas Regional Advisory Council San AntonioTX USA
| | - Susannah E. Nicholson
- The University of Texas Health Science Center San Antonio TX USA
- Department of Surgery The University of Texas Health Science Center San Antonio TX USA
| | - Ronald M. Stewart
- The University of Texas Health Science Center San Antonio TX USA
- Department of Surgery The University of Texas Health Science Center San Antonio TX USA
- Southwest Texas Regional Advisory Council San AntonioTX USA
| | - Donald H. Jenkins
- The University of Texas Health Science Center San Antonio TX USA
- Department of Surgery The University of Texas Health Science Center San Antonio TX USA
- Southwest Texas Regional Advisory Council San AntonioTX USA
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Blake KM, Braverman MA, Nettleman JH, Sposato LK, LaDuca RL. Pendant arm length control of dimensionality in cobalt dipyridylamine coordination polymers containing meta-benzenedicarboxylate ligands. Inorganica Chim Acta 2010. [DOI: 10.1016/j.ica.2010.07.070] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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25
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Blake KM, Johnston LL, Braverman MA, Nettleman JH, Sposato LK, LaDuca RL. Divalent metal 1,3-phenylenediacetate coordination polymers with rigid or flexible dipyridyl tethers: Chains, layers, and interpenetrated networks. Inorganica Chim Acta 2010. [DOI: 10.1016/j.ica.2010.03.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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26
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Braverman MA, Szymanski PJ, Supkowski RM, LaDuca RL. Synthesis, structure and magnetic properties of a pair of copper dicarboxylate/dipyridylamine coordination polymers with a non-interpenetrated CdSO4 topology. Inorganica Chim Acta 2009. [DOI: 10.1016/j.ica.2009.04.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Shyu E, Braverman MA, Supkowski RM, LaDuca RL. Control of topology and dimensionality by aromatic dicarboxylate pendant arm position and length in cadmium coordination polymers incorporating a hydrogen-bonding capable kinked dipyridine ligand. Inorganica Chim Acta 2009. [DOI: 10.1016/j.ica.2008.10.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Braverman MA, Nettleman JH, Supkowski RM, LaDuca RL. Copper Phthalate Coordination Polymers Incorporating Kinked Dipyridyl Ligands: An Unprecedented 8-Connected Network and One-Dimensional Chiral Nanobarrels with Hydrophobic Channels Constructed from Septuple Helical Motifs. Inorg Chem 2009; 48:4918-26. [DOI: 10.1021/ic900331m] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Maxwell A. Braverman
- Lyman Briggs College and Department of Chemistry, Michigan State University, East Lansing, Michigan 48825
| | - Joseph H. Nettleman
- Lyman Briggs College and Department of Chemistry, Michigan State University, East Lansing, Michigan 48825
| | - Ronald M. Supkowski
- Department of Chemistry and Physics, King’s College, Wilkes-Barre, Pennsylvania 18711
| | - Robert L. LaDuca
- Lyman Briggs College and Department of Chemistry, Michigan State University, East Lansing, Michigan 48825
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Braverman MA, Laduca RL. Poly[4,4'-imino-dipyridinium [di-μ(4)-isophthalato-κO:O':O'':O''-di-μ(3)-iso-phthal-ato-κO:O':O'';κO:O':O'',O'''-trizinc(II)] dihydrate]. Acta Crystallogr Sect E Struct Rep Online 2008; 64:m1601. [PMID: 21581198 PMCID: PMC2960139 DOI: 10.1107/s1600536808038373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2008] [Accepted: 11/17/2008] [Indexed: 11/11/2022]
Abstract
In the title compound, {(C10H11N3)[Zn3(C8H4O4)4]·2H2O}n, divalent Zn atoms are linked into trinuclear units featuring tetrahedral, octahedral and distorted tetrahedral, octahedral and square-pyramidal coordination geometries. These trinuclear units are connected by isopthalate dianions into [Zn3(isophthalate)4]n2n− anionic layers, which aggregate into the three-dimensional structure via hydrogen-bonding pathways mediated by doubly protonated 4,4′-iminodipyridinium cations and water molecules of crystallization. One solvent water molecule was found to be disordered over two positions, each with a 50% site-occupancy factor.
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Affiliation(s)
- Maxwell A Braverman
- Lyman Briggs College, Department of Chemistry, Michigan State University, East Lansing, MI 48825, USA
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30
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Braverman MA, Supkowski RM, LaDuca RL. A mutually inclined interpenetrated cobalt benzenetricarboxylate/organodiimine layered coordination polymer containing “infinite” water chains and its irreversible crystal-to-crystal structural transformation upon dehydration. INORG CHEM COMMUN 2008. [DOI: 10.1016/j.inoche.2008.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Braverman MA, LaDuca RL. Hydrothermal synthesis of divalent metal pyromellitate/dipyridylamine complexes: From an unprecedented supramolecular three-dimensional topology to an anionic coordination polymer framework with large incipient cation-bearing voids. CrystEngComm 2008. [DOI: 10.1039/b712182b] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Braverman MA, Supkowski RM, LaDuca RL. Luminescent zinc and cadmium complexes incorporating 1,3,5-benzenetricarboxylate and a protonated kinked organodiimine: From a hydrogen-bonded layer motif to thermally robust two-dimensional coordination polymers. J SOLID STATE CHEM 2007. [DOI: 10.1016/j.jssc.2007.04.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Braverman MA, Supkowski RM, LaDuca RL. One-dimensional nickel and cobalt phthalate coordination polymers incorporating the kinked dipodal organodiimine 4,4′-dipyridylamine: Hydrothermal synthesis, structural characterization and thermal properties. Inorganica Chim Acta 2007. [DOI: 10.1016/j.ica.2006.12.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Knapp WR, Thomas JG, Martin DP, Braverman MA, Trovitch RJ, LaDuca RL. Divalent Nickel and Monovalent Copper Pseudohalide Coordination Polymers Incorporating the Kinked Organodiimine 4,4′-Dipyridylamine: From a (4,4)-Type Lamellar Motif to an Unprecedented Staircase Morphology. Z Anorg Allg Chem 2007. [DOI: 10.1002/zaac.200600337] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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