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Ferrada P. Calling for Collaboration: Contributing to the Discourse on Circulation, Airway, Breathing vs Airway, Breathing, Circulation in Trauma Care: In Reply to Hachimi-Idrissi. J Am Coll Surg 2024; 238:981. [PMID: 38156777 DOI: 10.1097/xcs.0000000000000942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
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Ferrada P, García A, Duchesne J, Brenner M, Liu C, Ordóñez C, Menegozzo C, Salamea JC, Feliciano D. Comparing outcomes in patients with exsanguinating injuries: an Eastern Association for the Surgery of Trauma (EAST), multicenter, international trial evaluating prioritization of circulation over intubation (CAB over ABC). World J Emerg Surg 2024; 19:15. [PMID: 38664763 PMCID: PMC11044388 DOI: 10.1186/s13017-024-00545-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 04/21/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION Hemorrhage is a major cause of preventable trauma deaths, and the ABC approach is widely used during the primary survey. We hypothesize that prioritizing circulation over intubation (CAB) can improve outcomes in patients with exsanguinating injuries. METHODS A prospective observational study involving international trauma centers was conducted. Patients with systolic blood pressure below 90 who were intubated within 30 min of arrival were included. Prioritizing circulation (CAB) was defined as delaying intubation until blood products were started, and/or bleeding control was performed before securing the airway. Demographics, clinical data, and outcomes were recorded. RESULTS The study included 278 eligible patients, with 61.5% falling within the "CAB" cohort and 38.5% in the "ABC" cohort. Demographic and disease characteristics, including age, sex, ISS, use of blood products, and other relevant factors, exhibited comparable distributions between the two cohorts. The CAB group had a higher proportion of penetrating injuries and more patients receiving intubation in the operating room. Notably, patients in the CAB group demonstrated higher GCS scores, lower SBP values before intubation but higher after intubation, and a significantly lower incidence of cardiac arrest and post-intubation hypotension. Key outcomes revealed significantly lower 24-hour mortality in the CAB group (11.1% vs. 69.2%), a lower rate of renal failure, and a higher rate of ARDS. Multivariable logistic regression models showed a 91% reduction in the odds of mortality within 24 h and an 89% reduction at 30 days for the CAB cohort compared to the ABC cohort. These findings suggest that prioritizing circulation before intubation is associated with improved outcomes in patients with exsanguinating injuries. CONCLUSION Post-intubation hypotension is observed to be correlated with worse outcomes. The consideration of prioritizing circulation over intubation in patients with exsanguinating injuries, allowing for resuscitation, or bleeding control, appears to be associated with potential improvements in survival. Emphasizing the importance of circulation and resuscitation is crucial, and this approach might offer benefits for various bleeding-related conditions.
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Affiliation(s)
- Paula Ferrada
- Surgery Service line, Inova Healthcare System, Falls Church, VA, USA.
- Division and System Chief, Trauma and Acute Care Surgery, University of Virginia, Inova Healthcare System, 3300 Gallows Road, Falls Church, VA, 22042, USA.
| | - Alberto García
- Department of Surgery, Trauma and Critical Care, Fundación Valle del Lili, Cali, Colombia
| | - Juan Duchesne
- Department of Surgery, Tulane Health System, New Orleans, LA, USA
| | - Megan Brenner
- UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Chang Liu
- Surgery Service line, Inova Healthcare System, Falls Church, VA, USA
| | - Carlos Ordóñez
- Department of Surgery, Trauma and Critical Care, Fundación Valle del Lili, Cali, Colombia
| | - Carlos Menegozzo
- Division of General Surgery and Trauma, University of Sao Pablo, Sao Pablo, Brazil
| | | | - David Feliciano
- University of Maryland, Shock Trauma Center, Baltimore, MD, USA
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Ratnasekera AM, Seng SS, Kim D, Ji W, Jacovides CL, Kaufman EJ, Sadek HM, Perea LL, Poloni CM, Shnaydman I, Lee AJ, Sharp V, Miciura A, Trevizo E, Rosenthal MG, Lottenberg L, Zhao W, Keininger A, Hunt M, Cull J, Balentine C, Egodage T, Mohamed AT, Kincaid M, Doris S, Cotterman R, Seegert S, Jacobson LE, Williams J, Moncrief M, Palmer B, Mentzer C, Tackett N, Hranjec T, Dougherty T, Morrissey S, Donatelli-Seyler L, Rushing A, Tatebe LC, Nevill TJ, Aboutanos MB, Hamilton D, Redmond D, Cullinane DC, Falank C, McMellen M, Duran C, Daniels J, Ballow S, Schuster KM, Ferrada P. Propensity weighted analysis of chemical venous thromboembolism prophylaxis agents in isolated severe traumatic brain injury: An EAST sponsored multicenter study. Injury 2024:111523. [PMID: 38614835 DOI: 10.1016/j.injury.2024.111523] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 03/09/2024] [Accepted: 04/01/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND In patients with severe traumatic brain injury (TBI), clinicians must balance preventing venous thromboembolism (VTE) with the risk of intracranial hemorrhagic expansion (ICHE). We hypothesized that low molecular weight heparin (LMWH) would not increase risk of ICHE or VTE as compared to unfractionated heparin (UH) in patients with severe TBI. METHODS Patients ≥ 18 years of age with isolated severe TBI (AIS ≥ 3), admitted to 24 level I and II trauma centers between January 1, 2014 to December 31, 2020 and who received subcutaneous UH and LMWH injections for chemical venous thromboembolism prophylaxis (VTEP) were included. Primary outcomes were VTE and ICHE after VTEP initiation. Secondary outcomes were mortality and neurosurgical interventions. Entropy balancing (EBAL) weighted competing risk or logistic regression models were estimated for all outcomes with chemical VTEP agent as the predictor of interest. RESULTS 984 patients received chemical VTEP, 482 UH and 502 LMWH. Patients on LMWH more often had pre-existing conditions such as liver disease (UH vs LMWH 1.7 % vs. 4.4 %, p = 0.01), and coagulopathy (UH vs LMWH 0.4 % vs. 4.2 %, p < 0.001). There were no differences in VTE or ICHE after VTEP initiation. There were no differences in neurosurgical interventions performed. There were a total of 29 VTE events (3 %) in the cohort who received VTEP. A Cox proportional hazards model with a random effect for facility demonstrated no statistically significant differences in time to VTE across the two agents (p = 0.44). The LMWH group had a 43 % lower risk of overall ICHE compared to the UH group (HR = 0.57: 95 % CI = 0.32-1.03, p = 0.062), however was not statistically significant. CONCLUSION In this multi-center analysis, patients who received LMWH had a decreased risk of ICHE, with no differences in VTE, ICHE after VTEP initiation and neurosurgical interventions compared to those who received UH. There were no safety concerns when using LMWH compared to UH. LEVEL OF EVIDENCE Level III, Therapeutic Care Management.
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Affiliation(s)
- Asanthi M Ratnasekera
- Department of Surgery, Division of Trauma and Surgical Critical Care, Associate Professor of Surgery, Drexel College of Medicine, Philadelphia, PA, United States; Crozer Health Upland PA, Currently at Christianacare Health, Newark, DE, United States.
| | - Sirivan S Seng
- Department of Surgery, Crozer Health, Upland, PA, United States
| | - Daniel Kim
- Department of Surgery, Crozer Health, Upland, PA, United States
| | - Wenyan Ji
- Center for Biostatistics and Health Data Science, Department of Statistics, Virginia Polytechnic Institute and State University, Roanoke, VA, United States
| | - Christina L Jacovides
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, United States; Currently at Temple University, Philadelphia, PA, United States
| | - Elinore J Kaufman
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Hannah M Sadek
- Department of Surgery, Virginia Commonwealth University, Richmond, VA, United States
| | - Lindsey L Perea
- Department of Surgery, Penn Medicine Lancaster General Health, Lancaster, PA, United States
| | - Christina Monaco Poloni
- Department of Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, United States
| | - Ilya Shnaydman
- Department of Surgery, Medical Director, Surgical Intensive Care Unit, New York Medical College, West Chester Medical Center, Valhalla, NY, United States
| | | | - Victoria Sharp
- Department of Surgery, Trinity Health Ann Arbor, Ypsilanti, MI, United States
| | - Angela Miciura
- Department of Surgery, Trinity Health Ann Arbor, Ypsilanti, MI, United States
| | - Eric Trevizo
- Department of Surgery, Loma Linda University Medical Center, Loma Linda, CA, United States
| | - Martin G Rosenthal
- Department of Surgery, Loma Linda University Medical Center, Loma Linda, CA, United States
| | - Lawrence Lottenberg
- Department of Surgery, St. Mary's Medical Center, West Palm Beach, FL, United States; Florida Atlantic University, Boca Raton, FL, United States
| | - William Zhao
- Department of Surgery, St. Mary's Medical Center, West Palm Beach, FL, United States; Florida Atlantic University, Boca Raton, FL, United States
| | - Alicia Keininger
- Department of Surgery, Trinity Health Oakland, Pontiac, MI, United States
| | - Michele Hunt
- Department of Surgery, Trinity Health Oakland, Pontiac, MI, United States
| | - John Cull
- Department of Surgery, Prisma Health Upstate, Greenville, SC, United States
| | - Chassidy Balentine
- Department of Surgery, Prisma Health Upstate, Greenville, SC, United States
| | - Tanya Egodage
- Department of Surgery, Cooper University Hospital, Camden, NJ, United States
| | - Aleem T Mohamed
- Department of Surgery, Cooper University Hospital, Camden, NJ, United States
| | - Michelle Kincaid
- Department of Surgery, Ohio Health Grant Medical Center, Columbus, OH, United States
| | - Stephanie Doris
- Department of Surgery, Ohio Health Grant Medical Center, Columbus, OH, United States
| | - Robert Cotterman
- Department of Surgery, Promedica Toledo Hospital, Toledo, OH, United States
| | - Sara Seegert
- Department of Research, Promedica Toledo Hospital, Toledo, OH, United States
| | - Lewis E Jacobson
- Department of Surgery, Ascension St. Vincent Hospital, Indianapolis, IN, United States
| | - Jamie Williams
- Department of Surgery, Ascension St. Vincent Hospital, Indianapolis, IN, United States
| | - Melissa Moncrief
- Department of Trauma & Acute Care Surgery, Kettering Health Main Campus, Kettering, OH, United States
| | - Brandi Palmer
- Department of Trauma & Acute Care Surgery, Kettering Health Main Campus, Kettering, OH, United States
| | - Caleb Mentzer
- Department of Surgery, Spartanburg Medical Center, Spartanburg, SC, United States
| | - Nichole Tackett
- Department of Surgery, Spartanburg Medical Center, Spartanburg, SC, United States
| | - Tjasa Hranjec
- Department of Surgery, Memorial Healthcare System, Hollywood, FL, United States
| | - Thomas Dougherty
- Department of Surgery, Memorial Healthcare System, Hollywood, FL, United States
| | - Shawna Morrissey
- Department of Surgery, Conemaugh Memorial Medical Center, Johnstown, PA, United States
| | - Lauren Donatelli-Seyler
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Amy Rushing
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Leah C Tatebe
- Department of Surgery, Cook County Hospital, Chicago, IL, United States; Currently at Northwestern Memorial Hospital, Chicago, IL, United States
| | - Tiffany J Nevill
- Department of Surgery, Cook County Hospital, Chicago, IL, United States
| | - Michel B Aboutanos
- Department of Surgery, Virginia Commonwealth University, Richmond, VA, United States
| | - David Hamilton
- Department of Surgery, Penrose Hospital, Colorado Springs, CO, United States
| | - Diane Redmond
- Department of Surgery, Penrose Hospital, Colorado Springs, CO, United States
| | - Daniel C Cullinane
- Department of Surgery, Maine Medical Center, Portland, ME, United States
| | - Carolyne Falank
- Department of Surgery, Maine Medical Center, Portland, ME, United States
| | - Mark McMellen
- Department of Surgery, St. Anthony Hospital, Lakewood, CO, United States
| | - Chris Duran
- Department of Surgery, St. Anthony Hospital, Lakewood, CO, United States
| | - Jennifer Daniels
- Department of Surgery, University of California San Francisco, Fresno, CA, United States
| | - Shana Ballow
- Department of Surgery, University of California San Francisco, Fresno, CA, United States
| | - Kevin M Schuster
- Department of Surgery, Yale School of Medicine, New Haven, CT, United States
| | - Paula Ferrada
- Department of Surgery, INOVA Fairfax Health System, Fairfax, VA, United States
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Ferrada P. Enriching the discussion of shifting the ABCs of trauma to XABCs. Am J Surg 2024; 228:305-306. [PMID: 37833197 DOI: 10.1016/j.amjsurg.2023.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023]
Affiliation(s)
- Paula Ferrada
- Inova Healthcare System, 3300 Gallows Road, Falls Church, VA, 22042, USA.
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Keating M, Ferrada P, O'Halloran PJ, Perry W, Potter S, Reddy SS, Wilder FG, Reynolds IS. Tips for early career academic surgeons. Am J Surg 2024:S0002-9610(24)00031-X. [PMID: 38302367 DOI: 10.1016/j.amjsurg.2024.01.029] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 01/21/2024] [Accepted: 01/25/2024] [Indexed: 02/03/2024]
Affiliation(s)
- Muireann Keating
- Department of Plastic Surgery, St James's Hospital, Dublin 8, Ireland
| | - Paula Ferrada
- Division of Acute Care Surgery, Inova Health System, Falls Church, VA, USA
| | | | - William Perry
- Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - Shirley Potter
- Department of Plastic and Reconstructive Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Sanjay S Reddy
- Division of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Fatima G Wilder
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Ian S Reynolds
- Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
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Ferrada P, Ferrada R, Jacobs L, Duchesne J, Ghio M, Joseph B, Taghavi S, Qasim ZA, Zakrison T, Brenner M, Dissanaike S, Feliciano D. Prioritizing Circulation to Improve Outcomes for Patients with Exsanguinating Injury: A Literature Review and Techniques to Help Clinicians Achieve Bleeding Control. J Am Coll Surg 2024; 238:129-136. [PMID: 38014850 PMCID: PMC10718219 DOI: 10.1097/xcs.0000000000000889] [Citation(s) in RCA: 1] [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] [Received: 08/21/2023] [Revised: 09/13/2023] [Accepted: 09/13/2023] [Indexed: 11/29/2023]
Abstract
Prioritizing circulation in trauma care and delaying intubation in noncompressible cases improve outcomes. By prioritizing circulation, patient survival significantly improves, advocating evidence-based shifts in trauma care.
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Affiliation(s)
- Paula Ferrada
- From Inova Healthcare System, Division of Acute Care Surgery, Falls Church, VA (P Ferrada)
| | - Ricardo Ferrada
- Department of Surgery, Universidad del Valle, Cali, Colombia (R Ferrada)
| | - Lenworth Jacobs
- Department of Surgery, University of Connecticut, Harford, CT (Jacobs)
| | - Juan Duchesne
- Department of Surgery Tulane Health System, New Orleans, LA (Duchesne, Ghio, Taghavi)
| | - Michael Ghio
- Department of Surgery Tulane Health System, New Orleans, LA (Duchesne, Ghio, Taghavi)
| | - Bellal Joseph
- Department of Surgery the University of Arizona, Tucson, AZ (Joseph)
| | - Sharven Taghavi
- Department of Surgery Tulane Health System, New Orleans, LA (Duchesne, Ghio, Taghavi)
| | - Zaffer A Qasim
- Emergency Medicine Department, University of Pennsylvania, Philadelphia, PA (Qasim)
| | - Tanya Zakrison
- Department of Surgery, University of Chicago, Chicago, IL (Zakrison)
| | - Megan Brenner
- UCLA David Geffen School of Medicine, Los Angeles, CA (Brenner)
| | | | - David Feliciano
- University of Maryland, Shock Trauma Center, Baltimore, MD (Feliciano)
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7
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Ferrada P. The essential role of leadership training for physicians in the field of trauma. Rev Col Bras Cir 2023; 50:e20233686EDIT01. [PMID: 38088635 PMCID: PMC10668587 DOI: 10.1590/0100-6991e-20233686edit01-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 10/10/2023] [Indexed: 12/18/2023] Open
Affiliation(s)
- Paula Ferrada
- - University of Virginia, Trauma and Acute Care Surgery - Falls Church - VA - Estados Unidos
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Sartelli M, Coccolini F, Ansaloni L, Biffl WL, Blake DP, Boermeester MA, Coimbra R, Evans HL, Ferrada P, Gkiokas G, Jeschke MG, Hardcastle T, Hinson C, Labricciosa FM, Marwah S, Marttos AC, Quiodettis M, Rasa K, Ren J, Rubio-Perez I, Sawyer R, Shelat V, Upperman JS, Catena F. Declaration on infection prevention and management in global surgery. World J Emerg Surg 2023; 18:56. [PMID: 38057900 DOI: 10.1186/s13017-023-00526-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 11/25/2023] [Indexed: 12/08/2023] Open
Abstract
Surgeons in their daily practice are at the forefront in preventing and managing infections. However, among surgeons, appropriate measures of infection prevention and management are often disregarded. The lack of awareness of infection and prevention measures has marginalized surgeons from this battle. Together, the Global Alliance for Infections in Surgery (GAIS), the World Society of Emergency Surgery (WSES), the Surgical Infection Society (SIS), the Surgical Infection Society-Europe (SIS-E), the World Surgical Infection Society (WSIS), the American Association for the Surgery of Trauma (AAST), and the Panamerican Trauma Society (PTS) have jointly completed an international declaration, highlighting the threat posed by antimicrobial resistance globally and the need for preventing and managing infections appropriately across the surgical pathway. The authors representing these surgical societies call all surgeons around the world to participate in this global cause by pledging support for this declaration for maintaining the effectiveness of current and future antibiotics.
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Affiliation(s)
- Massimo Sartelli
- Department of Surgery, Macerata Hospital, Via Santa Lucia 2, 62100, Macerata, Italy.
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Luca Ansaloni
- Department General Surgery, Fondazione IRCCS San Matteo, Pavia, Italy
| | | | - David P Blake
- Division of Acute Care Surgery, Inova Health System, Falls Church, VA, USA
- University of Virginia School of Medicine, Charlottesville, VA, USA
- USUHS/F Edward Hebert School of Medicine, Bethesda, MD, USA
| | - Marja A Boermeester
- Department of Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Raul Coimbra
- Division of Trauma and Acute Care Surgery, Riverside University Health System Medical Center, Moreno Valley, CA, USA
| | - Heather L Evans
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Paula Ferrada
- Division of Acute Care Surgery, Inova Health System, Falls Church, VA, USA
| | - George Gkiokas
- Second Department of Surgery, Aretaieion University Hospital, National and Kapodistrian University of Athens, 10679, Athens, Greece
| | | | - Timothy Hardcastle
- Department of Health - KwaZulu-Natal, Surgery, University of KwaZulu-Natal and Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Chandler Hinson
- Frederick P. Whiddon College of Medicine, University of South Alabama, Mobile, AL, USA
| | | | - Sanjay Marwah
- Department of Surgery, BDS Post-Graduate Institute of Medical Sciences, Rohtak, India
| | - Antonio C Marttos
- Department of Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Martha Quiodettis
- Division of Trauma and Acute Care Surgery, Hospital Santo Tomas, Panama City, Panama
| | - Kemal Rasa
- Department of Surgery, Anadolu Medical Center, Kocaeli, Turkey
| | - Jianan Ren
- Research Institute of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Ines Rubio-Perez
- Unit of Colorectal Surgery, Department of General Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - Robert Sawyer
- Department of Surgery, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | - Vishal Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Jeffrey S Upperman
- Department of Pediatric Surgery, Vanderbilt Children's Medical Center, Nashville, TN, USA
| | - Fausto Catena
- General and Emergency Surgery, Bufalini Hospital, Cesena, Italy
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Ferrada P. Invited Commentary: The Power of Science: Randomized Controlled Trials in Trauma Surgery and the Need for Quality Data. J Am Coll Surg 2023; 237:737. [PMID: 37427848 DOI: 10.1097/xcs.0000000000000796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
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Abstract
This Surgical Innovation describes the advantages of prioritizing circulation in patients with compressible bleeding sources and in those with noncompressible torso injuries.
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Affiliation(s)
- Paula Ferrada
- University of Virginia School of Medicine, Charlottesville
- Division of Acute Care Surgery, Inova Health System, Falls Church, Virginia
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Ferrada P, Jacobs LM. "Resuscitation of the exsanguinating trauma patient: Prioritize circulation and stop the bleed". Am J Surg 2023; 226:294-295. [PMID: 37031043 DOI: 10.1016/j.amjsurg.2023.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 04/10/2023]
Affiliation(s)
- Paula Ferrada
- University of Virginia School of Medicine, System Chief Acute Care Surgery, Division of Acute Care Surgery, Inova Health System, Falls Church, VA, USA.
| | - Lenworth M Jacobs
- Hartford Hospital, Traumatology and Emergency Medicine at the University of Connecticut, USA
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12
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Ratnasekera AM, Kim D, Seng SS, Jacovides C, Kaufman EJ, Sadek HM, Perea LL, Monaco C, Shnaydman I, Jeongyoon Lee A, Sharp V, Miciura A, Trevizo E, Rosenthal M, Lottenberg L, Zhao W, Keininger A, Hunt M, Cull J, Balentine C, Egodage T, Mohamed A, Kincaid M, Doris S, Cotterman R, Seegert S, Jacobson LE, Williams J, Whitmill M, Palmer B, Mentzer C, Tackett N, Hranjec T, Dougherty T, Morrissey S, Donatelli-Seyler L, Rushing A, Tatebe LC, Nevill TJ, Aboutanos MB, Hamilton D, Redmond D, Cullinane DC, Falank C, McMellen M, Duran C, Daniels J, Ballow S, Schuster K, Ferrada P. Early VTE Prophylaxis in Severe Traumatic Brain Injury: A Propensity Score Weighted EAST Multi-Center Study. J Trauma Acute Care Surg 2023:01586154-990000000-00329. [PMID: 37017458 DOI: 10.1097/ta.0000000000003985] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
BACKGROUND Patients with TBI are at high risk of venous thromboembolism events (VTE). We hypothesized that early chemical VTE prophylaxis initiation (≤24 hours of a stable head CT) in severe TBI would reduce VTE without increasing risk of intracranial hemorrhage expansion (ICHE). METHODS A retrospective review of adult patients ≥18 years of age with isolated severe TBI (AIS ≥ 3) who were admitted to 24 level 1 and level 2 trauma centers from January 1, 2014 to December 31 2020 was conducted. Patients were divided into those who did not receive any VTE prophylaxis (NO VTEP), who received VTE prophylaxis ≤24 hours after stable head CT (VTEP ≤24) and who received VTE prophylaxis >24 hours after stable head CT (VTEP>24). Primary outcomes were VTE and ICHE. Covariate balancing propensity score weighting was utilized to balance demographic & clinical characteristics across three groups. Weighted univariate logistic regression models were estimated for VTE & ICHE with patient group as predictor of interest. RESULTS Of 3,936 patients, 1,784 met inclusion criteria. Incidences of VTE was significantly higher in the VTEP>24 group, with higher incidences of DVT in the group. Higher incidences of ICHE were observed in the VTEP≤24 and VTEP>24 groups. After propensity score weighting, there was a higher risk of VTE in patients in VTEP >24 compared to those in VTEP≤24 ( [OR] = 1.51; [95%CI] = 0.69-3.30; p = 0.307), however was not significant. Although, the No VTEP group had decreased odds of having ICHE compared to VTEP≤24 (OR = 0.75; 95%CI = 0.55-1.02, p = 0.070), the result was not statistically significant. CONCLUSIONS In this large multi-center analysis, there were no significant differences in VTE based on timing of initiation of VTE prophylaxis. Patients who never received VTE prophylaxis had decreased odds of ICHE. Further evaluation of VTE prophylaxis in larger randomized studies will be necessary for definitive conclusions. LEVEL OF EVIDENCE level III, Therapeutic Care Management.
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García A, Sanchez AI, Ferrada P, Wolfe L, Duchesne J, Fraga GP, Benjamin E, Campbell A, Morales C, Pereira BM, Ribeiro M, Quiodettis M, Peck G, Salamea JC, Kruger VF, Ivatury R, Scalea T. Risk factors for the leakage of the repair of duodenal wounds: a secondary analysis of the Panamerican Trauma Society multicenter retrospective review. World J Emerg Surg 2023; 18:28. [PMID: 37016441 PMCID: PMC10074841 DOI: 10.1186/s13017-023-00494-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/19/2023] [Indexed: 04/06/2023] Open
Affiliation(s)
- Alberto García
- Division of Trauma and Acute Care Surgery, Department of Surgery, Department of Intensive Care, Fundación Valle del Lili, Cra 98 No. 18-49, 760032, Cali, Colombia.
- Division of Trauma and Acute Care Surgery, Department of Surgery, Universidad del Valle, Cali, Colombia.
- Department of Surgery, Universidad Icesi, Cali, Colombia.
| | - Alvaro I Sanchez
- Division of Thoracic Surgery, Department of Surgery, Fundación Valle del Lili, Cali, Colombia
| | - Paula Ferrada
- Division of Trauma and Acute Care Surgery, Innova Fairfax Hospital, Falls Church, VA, USA
| | - Luke Wolfe
- Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Juan Duchesne
- Department of Surgery, Tulane University, LA, New Orleans, USA
| | - Gustavo P Fraga
- Department of Trauma and Acute Care Surgery, University of Campinas, Campinas, Brazil
| | | | - Andre Campbell
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Carlos Morales
- Department of Surgery, Universidad de Antioquia, Medellín, Colombia
| | - Bruno M Pereira
- University of Vassouras, Rio De Janeiro, Brazil
- Santa Casa de Campinas, Campinas, Brazil
| | - Marcelo Ribeiro
- Consultant General and Trauma Surgeon, Chair Division of Trauma, Burns, Critical Care and Acute Care Surgery, Sheikh Shakhbout Medical City Mayo Clinic, Abu Dhabi, United Arab Emirates
| | - Martha Quiodettis
- Division of Trauma and Acute Care Surgery, Hospital Santo Tomas, Panama City, Panama
| | - Gregory Peck
- Department of Surgery, Robert Wood Johnson Place, New Brunswick, NJ, USA
| | - Juan C Salamea
- Department of Surgery, Hospital Vicente Corral Moscoso, Cuenca, Ecuador
| | - Vitor F Kruger
- Department of Trauma and Acute Care Surgery, University of Campinas, Campinas, Brazil
| | - Rao Ivatury
- Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Thomas Scalea
- Department of Surgery, Shock Trauma Center, University of Maryland, MD, College Park, USA
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14
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Bolaji T, Ratnasekera A, Ferrada P. Management of the complex duodenal injury. Am J Surg 2023; 225:639-644. [PMID: 36588016 DOI: 10.1016/j.amjsurg.2022.12.016] [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: 11/20/2022] [Revised: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Complex duodenal trauma is a rare injury with an incidence of 1-4.7% of all abdominal trauma. Historically, varied approaches have been used in the management of these complex injuries and the prevention of complications. This is a review of the current management methodology of complex duodenal injury. METHODS A review of the medical literature to include the past and current management of duodenal trauma was performed. Google scholar (1970-2022) and PubMed (1970-2022) were searched using the keywords: complex duodenal trauma, surgical management, and duodenal complications. DISCUSSION Complex duodenal trauma can be classified using the AAST grading scale as those encompassing grades III-V. Multiple studies and review articles characterize the difficulty in managing complex duodenal injuries. The tenets of operative management of duodenal trauma include the decision for damage control, resection of non-viable tissue, restoring gastrointestinal continuity, diversion of gastrointestinal contents, bile and pancreatic enzymes, allowing the repair to heal, and providing feeding access. The variety of both historic and current approaches attempt to address these tenets. The incidence of complications are as high as 65% with the most common complications including abscess formation, suture line dehiscence and fistula formation. The overall mortality ranges from 5 to 30%. CONCLUSIONS Many different approaches and strategies have been proposed to repair complex duodenal injuries, all of which address important tenets of its management. The risk of complications remains high, therefore, it is vital to have a thoughtful and multidisciplinary approach when treating these injuries.
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Affiliation(s)
- Toba Bolaji
- ChristianaCare, 4755 OgletownStanton Rd, Newark, DE, 19718, United States.
| | | | - Paula Ferrada
- Inova Fairfax Hospital, 3300 Gallows Rd, Falls Church, VA, 22042, United States
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15
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Ferrada P. The phrase "We've Always Done It This Way" should be not get in the way of advancing science and the care of our patients. Let's question the A,B,Cs of trauma. Is prioritizing circulation better when treating trauma patients that are exsanguinating? Am J Surg 2023; 225:1117-1118. [PMID: 36801134 DOI: 10.1016/j.amjsurg.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/09/2023] [Accepted: 02/14/2023] [Indexed: 02/17/2023]
Affiliation(s)
- Paula Ferrada
- Medical Education, University of Virginia School of Medicine, System Chief Acute Care Surgery, Division of Acute Care Surgery, Inova Health System, Falls Church, VA, USA.
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16
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Ferrada P, Cannon JW, Kozar RA, Bulger EM, Sugrue M, Napolitano LM, Tisherman SA, Coopersmith CM, Efron PA, Dries DJ, Dunn TB, Kaplan LJ. Surgical Science and the Evolution of Critical Care Medicine. Crit Care Med 2023; 51:182-211. [PMID: 36661448 DOI: 10.1097/ccm.0000000000005708] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Surgical science has driven innovation and inquiry across adult and pediatric disciplines that provide critical care regardless of location. Surgically originated but broadly applicable knowledge has been globally shared within the pages Critical Care Medicine over the last 50 years.
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Affiliation(s)
- Paula Ferrada
- Division of Trauma and Acute Care Surgery, Department of Surgery, Inova Fairfax Hospital, Falls Church, VA
| | - Jeremy W Cannon
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rosemary A Kozar
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Eileen M Bulger
- Division of Trauma, Burn and Critical Care Surgery, Department of Surgery, University of Washington at Seattle, Harborview, Seattle, WA
| | - Michael Sugrue
- Department of Surgery, Letterkenny University Hospital, County of Donegal, Ireland
| | - Lena M Napolitano
- Division of Acute Care Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Samuel A Tisherman
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Craig M Coopersmith
- Division of General Surgery, Department of Surgery, Emory University, Emory Critical Care Center, Atlanta, GA
| | - Phil A Efron
- Department of Surgery, Division of Critical Care, University of Florida, Gainesville, FL
| | - David J Dries
- Department of Surgery, University of Minnesota, Regions Healthcare, St. Paul, MN
| | - Ty B Dunn
- Division of Transplant Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Lewis J Kaplan
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Corporal Michael J. Crescenz VA Medical Center, Section of Surgical Critical Care, Surgical Services, Philadelphia, PA
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17
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Nunez-Ordonez N, Cabrera-Vargas LF, Ferrada P, Vervoort D. Narrowing the global surgical perspective: The big city bias. Am J Surg 2022; 224:1329-1331. [PMID: 36030099 DOI: 10.1016/j.amjsurg.2022.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Nicolas Nunez-Ordonez
- Pontificia Universidad Javeriana, Bogotá, Colombia; Faculty of Medicine, Universidad de los Andes, Bogotá, Colombia.
| | - Luis Felipe Cabrera-Vargas
- Department of Surgery, Hospital Universitario San Ignacio, Colombia; Department of Surgery, Universidad El Bosque, Colombia; Vascular Surgery Fellow, Universidad Militar Nueva Granada, Bogotá, Colombia.
| | - Paula Ferrada
- Trauma and Acute Care Surgery, Inova Health System, USA; Department of Surgery, Virginia Commonwealth University Medical Center, 16th Floor, West Hospital, 1200 E. Broad Street, Richmond, VA.
| | - Dominique Vervoort
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
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18
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Kauvar D, Cotton B, Khan M, Perreira B, Brenner M, Ferrada P, Horer T, Kirkpatrick A, Ordoñez C, Pirouzram A, Roberts D, Duchesne J. Challenges and Opportunities for Endovascular Treatment of Hemorrhage in Combat Casualty Care. Shock 2021; 56:46-51. [PMID: 34797786 DOI: 10.1097/shk.0000000000001514] [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: 11/26/2022]
Abstract
ABSTRACT The care of the hemorrhaging patient continues to evolve. The use of endovascular techniques to treat hemorrhage has increased significantly in civilian trauma care over the past 15 years and is identified as a major national trauma care research priority. Endovascular techniques are being increasingly employed to treat major thoracoabdominal arterial injuries and resuscitative endovascular balloon occlusion of the aorta is being adopted at trauma centers as a supportive adjunct to resuscitation in the exsanguinating patient. Emerging endovascular technology offers the opportunity to provide temporary or permanent control of non-compressible torso hemorrhage, which remains a vexing problem in combat casualty care. Endovascular advances have not been translated to the care of combat casualties to any significant degree, however. This review provides a summary and analysis of the gap between civilian endovascular hemorrhage control and combat casualty care practice to better align future research and development efforts.
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Affiliation(s)
- David Kauvar
- San Antonio Military Medical Center, San Antonio, TX
- Uniformed Services University, Bethesda, MD
| | - Bryan Cotton
- University of Texas Health Science Center at Houston, Houston, TX
| | - Mansoor Khan
- Imperial College London Department of Life Sciences, London, United Kingdom
| | | | - Megan Brenner
- Riverside University Health System, Moreno Valley, CA
| | | | | | | | - Carlos Ordoñez
- Division of Trauma and Acute Care Surgery, Department of Surgery. Fundacion Valle del Lili. Universidad del Valle, Cali, Colombia
| | | | | | - Juan Duchesne
- Tulane University School of Medicine, New Orleans, LA
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19
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Ordoñz CA, Khan M, Cotton B, Perreira B, Brenner M, Ferrada P, Horer T, Kauvar D, Kirkpatrick A, Priouzram A, Roberts D, Duchesne J. The Colombian Experience in Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA): The Progression From a Large Caliber to a Low-Profile Device at a Level I Trauma Center. Shock 2021; 56:42-45. [PMID: 31977958 DOI: 10.1097/shk.0000000000001515] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 11/26/2022]
Abstract
PURPOSE Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is now performed in many trauma centers, it is used at more than 250 hospitals in the United States and there is an increase rate of publications with the experience in these centers, but there is a gap of knowledge regarding the use of REBOA in Latin-America. This paper endeavors to describe the utilization of REBOA at a high level Latin-American Trauma Center and the transition from a large caliber to a low-profile device with the concomitant reduction in the groin access complications. METHODS A prospective, observational, single-center study was conducted. We included all trauma patients who underwent REBOA. We recorded data from admission parameters, complications, and clinical outcomes. RESULTS Fifty patients were included. Most of the REBOA catheters were inserted in the operating room [47 (94%)], and the arterial access was done by surgical cutdown [40 (80%)]. All the complications were associated with the catheter of 11 Fr Sheath used in 36 patients [n = 8/36 (22%) vs. n = 0/14 (0%); P = 0.05]. CONCLUSION REBOA can be used safely in blunt or penetrating thoracic, abdominal, and pelvic trauma. The insertion of a 7 Fr Sheath was associated with lower complications, so its use should be preferred over larger calibers.
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Affiliation(s)
- Carlos A Ordoñz
- Fundación Valle del Lili, Division of Trauma and Acute Care Surgery, Department of Surgery, Universidad del Valle, Cali, Colombia
| | - Mansoor Khan
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, UK
| | - Bryan Cotton
- Department of Surgery, University of Texas Health Science Center, Houston, Texas
| | - Bruno Perreira
- Department of Surgery and Surgical Critical Care, University of Campinas, Campinas, Brazil
| | - Megan Brenner
- Department of Surgery, University of California Riverside, Riverside, California
| | - Paula Ferrada
- VCU Surgery Trauma, Critical Care and Emergency Surgery, Richmond, Virginia
| | - Tal Horer
- Department of Cardiothoracic and Vascular Surgery, Faculty of Life Science Orebro University Hospital and University, Orebro, Sweden
| | - David Kauvar
- Vascular Surgery Service, San Antonio Military Medical Center, San Antonio, Texas
| | - Andrew Kirkpatrick
- Regional Trauma Services, Foothills Medical Centre, Calgary, Alberta, Canada
- Departments of Surgery, Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
- Canadian Forces Health Services, Canada
| | - Artai Priouzram
- Department of Cardiothoracic and Vascular Surgery, Linkoping University Hospital, Linkoping, Sweden
| | - Derek Roberts
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, Civic Campus, Ottawa, Ontario, Canada
| | - Juan Duchesne
- Department of Surgery Tulane, New Orleans, Louisiana
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20
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Williams J, Gustafson M, Bai Y, Prater S, Wade CE, Guillamondegui OD, Khan M, Brenner M, Ferrada P, Roberts D, Horer T, Kauvar D, Kirkpatrick A, Ordonez C, Perreira B, Priouzram A, Duchesne J, Cotton BA. Limitations of Available Blood Products for Massive Transfusion During Mass Casualty Events at US Level 1 Trauma Centers. Shock 2021; 56:62-69. [PMID: 33470606 PMCID: PMC8601667 DOI: 10.1097/shk.0000000000001719] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 12/26/2019] [Accepted: 01/04/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Exsanguination remains a leading cause of preventable death in traumatically injured patients. To better treat hemorrhagic shock, hospitals have adopted massive transfusion protocols (MTPs) which accelerate the delivery of blood products to patients. There has been an increase in mass casualty events (MCE) worldwide over the past two decades. These events can overwhelm a responding hospital's supply of blood products. Using a computerized model, this study investigated the ability of US trauma centers (TCs) to meet the blood product requirements of MCEs. METHODS Cross-sectional survey data of on-hand blood products were collected from 16 US level-1 TCs. A discrete event simulation model of a TC was developed based on historic data of blood product consumption during MCEs. Each hospital's blood bank was evaluated across increasingly more demanding MCEs using modern MTPs to guide resuscitation efforts in massive transfusion (MT) patients. RESULTS A total of 9,000 simulations were performed on each TC's data. Under the least demanding MCE scenario, the median size MCE in which TCs failed to adequately meet blood product demand was 50 patients (IQR 20-90), considering platelets. Ten TCs exhaust their supply of platelets prior to red blood cells (RBCs) or plasma. Disregarding platelets, five TCs exhausted their supply of O- packed RBCs, six exhausted their AB plasma supply, and five had a mixed exhaustion picture. CONCLUSION Assuming a TC's ability to treat patients is limited only by their supply of blood products, US level-1 TCs lack the on-hand blood products required to adequately treat patients following a MCE. Use of non-traditional blood products, which have a longer shelf life, may allow TCs to better meet the blood product requirement needs of patients following larger MCEs.
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Affiliation(s)
- James Williams
- The Center for Translational Injury Research, The McGovern Medical School at the University of Texas Health Science Center, Houston, Texas
- Department of Surgery, The McGovern Medical School at the University of Texas Health Science Center, Houston, Texas
| | - Michael Gustafson
- Duke University Pratt School of Engineering, The McGovern Medical School at the University of Texas Health Science Center, Houston, Texas
| | - Yu Bai
- Pathology and Laboratory Medicine, The McGovern Medical School at the University of Texas Health Science Center, Houston, Texas
- Department of Emergency Medicine, The McGovern Medical School at the University of Texas Health Science Center, Houston, Texas
| | - Samuel Prater
- Department of Emergency Medicine, The McGovern Medical School at the University of Texas Health Science Center, Houston, Texas
- Department of Surgery, The Red Duke Trauma Institute at Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - Charles E. Wade
- The Center for Translational Injury Research, The McGovern Medical School at the University of Texas Health Science Center, Houston, Texas
- Department of Surgery, The McGovern Medical School at the University of Texas Health Science Center, Houston, Texas
| | | | - Mansoor Khan
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, UK
| | - Megan Brenner
- Department of Surgery, University of California Riverside, Riverside, California
| | - Paula Ferrada
- VCU Surgery Trauma, Critical Care and Emergency Surgery, Richmond, Virginia
| | - Derek Roberts
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Tal Horer
- Department of Cardiothoracic and Vascular Surgery, Faculty of Life Science Örebro University Hospital and University, Örebro, Sweden
| | - David Kauvar
- Vascular Surgery Service, San Antonio Military Medical Center, San Antonio, Texas
| | - Andrew Kirkpatrick
- Regional Trauma Services Foothills Medical Centre, Calgary, Alberta, Canada
- Departments of Surgery, Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
- Canadian Forces Health Services, Calgary, Alberta, Canada
| | - Carlos Ordonez
- Fundación Valle del Lili, Division of Trauma and Acute Care Surgery, Department of Surgery, Universidad del Valle, Cali, Valle del Cauca, Colombia
| | - Bruno Perreira
- Department of Surgery and Surgical Critical Care, University of Campinas, Campinas, Brazil
| | - Artai Priouzram
- Department of Cardiothoracic and Vascular Surgery, Linköping University Hospital, Linköping, Sweden
| | - Juan Duchesne
- Division Chief Acute Care Surgery, Department of Surgery Tulane, New Orleans, Louisiana
| | - Bryan A. Cotton
- The Center for Translational Injury Research, The McGovern Medical School at the University of Texas Health Science Center, Houston, Texas
- Department of Surgery, The McGovern Medical School at the University of Texas Health Science Center, Houston, Texas
- Department of Surgery, The Red Duke Trauma Institute at Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
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21
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Hörer TM, Pirouzram A, Khan M, Brenner M, Cotton B, Duchesne J, Ferrada P, Kauvar D, Kirkpatrick A, Ordonez C, Perreira B, Roberts D. Endovascular Resuscitation and Trauma Management (EVTM)-Practical Aspects and Implementation. Shock 2021; 56:37-41. [PMID: 32080064 DOI: 10.1097/shk.0000000000001529] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT In recent years there has been a tremendous increase in hemorrhage control by endovascular methods. Traumatic and non-traumatic hemorrhage is being more frequently managed with endografts, embolization agents, and minimal invasive methods. These methods initially were used in hemodynamically stable patients only, whereas now these are being implemented in acute settings and hemodynamically unstable patients. The strategy of using endovascular and combined open-endo methods approach for hemodynamic instability in trauma and non-trauma patients has been named EVTM- EndoVascular resuscitation and Trauma Management. The EVTM concept will be presented in this article, describing how it is developed and used, as well as its limitations and future aspects.
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Affiliation(s)
- Tal M Hörer
- Department of Cardiothoracic and Vascular Surgery, Faculty of Life Science, Örebro University Hospital and University, Orebro, Sweden
| | - Artai Pirouzram
- Department of Cardiothoracic and Vascular Surgery, Linköping University Hospital, Linkoping, Sweden
| | - Mansoor Khan
- Department of Digestive Diseases, Brighton and Sussex University Hospitals, Brighton, UK
| | - Megan Brenner
- Department of Surgery, University of California Riverside, Riverside, California
| | - Bryan Cotton
- Department of Surgery, University of Texas Health Science Center, Houston, Texas
| | - Juan Duchesne
- Division Chief Acute Care Surgery, Department of Surgery Tulane, New Orleans, Louisiana
| | - Paula Ferrada
- VCU Surgery Trauma, Critical Care and Emergency Surgery, Richmond, Virginia
| | - David Kauvar
- Vascular Surgery Service, San Antonio Military Medical Center, San Antonio, Texas
| | - Andrew Kirkpatrick
- Regional Trauma Services Foothills Medical Centre, Calgary, Alberta, Canada
- Departments of Surgery, Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
- Canadian Forces Health Services, Calgary, Alberta, Canada
| | - Carlos Ordonez
- Fundación Valle del Lili, Division of Trauma and Acute Care Surgery, Department of Surgery, Universidad del Valle, Colombia
| | - Bruno Perreira
- Department of Surgery and Surgical Critical Care, University of Campinas, Campinas, Brazil
| | - Derek Roberts
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, Civic Campus, Ottawa, Ontario, Canada
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Duchesne J, Taghavi S, Khan M, Perreira B, Cotton B, Brenner M, Ferrada P, Horer T, Kauvar D, Kirkpatrick A, Ordoñez C, Priouzram A, Roberts D. Circulatory Trauma: A Paradigm for Understanding the Role of Endovascular Therapy in Hemorrhage Control. Shock 2021; 56:22-29. [PMID: 34797785 DOI: 10.1097/shk.0000000000001513] [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: 11/25/2022]
Abstract
ABSTRACT The pathophysiology of traumatic hemorrhage is a phenomenon of vascular disruption and the symptom of bleeding represents one or more vascular injuries. In the Circulatory Trauma paradigm traumatic hemorrhage is viewed as injury to the circulatory system and suggests the underlying basis for endovascular hemorrhage control techniques. The question "Where is the patient bleeding?" is replaced by "Which blood vessels are disrupted?" and stopping bleeding becomes a matter of selective vessel access and vascular flow control. Control of traumatic hemorrhage has traditionally been performed via external access to the end organ that is bleeding followed by the application of direct pressure, packing, or clamping and repair of directly affected blood vessels. In the circulatory trauma paradigm, bleeding is seen as disruption to vessels which may be accessed internally, from within the vascular system. A variety of endovascular treatments such as balloon occlusion, embolization, or stent grafting can be used to control hemorrhage throughout the body. This narrative review presents a brief overview of the current role of endovascular therapy in the management of circulatory trauma. The authors draw on their personal experience combined with the last decade of published experiences with the use of endovascular techniques in trauma and present general recommendations for their evolving use. The focus of the review is on the use of endovascular techniques as specific vascular treatments using the circulatory trauma paradigm.
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Affiliation(s)
- Juan Duchesne
- Division Chief Acute Care Surgery, Department of Surgery Tulane, New Orleans, Louisiana, USA
| | - Sharven Taghavi
- Division Chief Acute Care Surgery, Department of Surgery Tulane, New Orleans, Louisiana, USA
| | - Mansoor Khan
- Department of Digestive Diseases, Brighton and Sussex University Hospitals, Brighton, UK
| | - Bruno Perreira
- Department of Surgery and Surgical Critical Care, University of Campinas, Campinas, Brazil
| | - Bryan Cotton
- Department of Surgery, University of Texas Health Science Center, Houston, Texas, USA
| | - Megan Brenner
- Department of Surgery, University of California Riverside, Riverside, California, USA
| | - Paula Ferrada
- VCU Surgery Trauma, Critical Care and Emergency Surgery, Richmond, Virginia, USA
| | - Tal Horer
- Department of Cardiothoracic and Vascular Surgery, Faculty of Life Science Örebro University Hospital and University, Örebro, Sweden
| | - David Kauvar
- Vascular Surgery Service, San Antonio Military Medical Center, San Antonio, Texas, USA
| | - Andrew Kirkpatrick
- Regional Trauma Services Foothills Medical Centre, Departments of Surgery, Critical Care Medicine, University of Calgary, Calgary, Alberta, Canadian Forces Health Services
| | - Carlos Ordoñez
- Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Universidad del Valle, Cali , Colombia
| | - Artai Priouzram
- Department of Cardiothoracic and Vascular Surgery, Linköping University Hospital, Linköping, Sweden
| | - Derek Roberts
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, Civic Campus, Ottawa, Ontario, Canada
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23
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Brill JB, Brenner M, Duchesne J, Roberts D, Ferrada P, Horer T, Kauvar D, Khan M, Kirkpatrick A, Ordonez C, Perreira B, Priouzram A, Cotton BA. The Role of TEG and ROTEM in Damage Control Resuscitation. Shock 2021; 56:52-61. [PMID: 33769424 PMCID: PMC8601668 DOI: 10.1097/shk.0000000000001686] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/05/2019] [Accepted: 10/20/2020] [Indexed: 11/26/2022]
Abstract
ABSTRACT Trauma-induced coagulopathy is associated with very high mortality, and hemorrhage remains the leading preventable cause of death after injury. Directed methods to combat coagulopathy and attain hemostasis are needed. The available literature regarding viscoelastic testing, including thrombelastography (TEG) and rotational thromboelastometry (ROTEM), was reviewed to provide clinically relevant guidance for emergency resuscitation. These tests predict massive transfusion and developing coagulopathy earlier than conventional coagulation testing, within 15 min using rapid testing. They can guide resuscitation after trauma, as well. TEG and ROTEM direct early transfusion of fresh frozen plasma when clinical gestalt has not activated a massive transfusion protocol. Reaction time and clotting time via these tests can also detect clinically significant levels of direct oral anticoagulants. Slowed clot kinetics suggest the need for transfusion of fibrinogen via concentrates or cryoprecipitate. Lowered clot strength can be corrected with platelets and fibrinogen. Finally, viscoelastic tests identify fibrinolysis, a finding associated with significantly increased mortality yet one that no conventional coagulation test can reliably detect. Using these parameters, guided resuscitation begins within minutes of a patient's arrival. A growing body of evidence suggests this approach may improve survival while reducing volumes of blood products transfused.
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Affiliation(s)
- Jason B. Brill
- Department of Surgery, University of Texas Health Science Center, Houston, Texas
| | - Megan Brenner
- Department of Surgery, University of California Riverside, Riverside, California
| | - Juan Duchesne
- Division Chief Acute Care Surgery, Department of Surgery Tulane, New Orleans, Louisiana
| | - Derek Roberts
- Division Chief Acute Care Surgery, Department of Surgery Tulane, New Orleans, Louisiana
| | - Paula Ferrada
- VCU Surgery Trauma, Critical Care and Emergency Surgery, Richmond, Virginia
| | - Tal Horer
- Department of Cardiothoracic and Vascular Surgery, Faculty of Life Science Örebro University Hospital and University, Örebro, Sweden
| | - David Kauvar
- Vascular Surgery Service, San Antonio Military Medical Center, San Antonio, Texas
| | - Mansoor Khan
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, UK
| | - Andrew Kirkpatrick
- Regional Trauma Services Foothills Medical Centre, Calgary, Alberta, Canada
- Departments of Surgery, Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
- Canadian Forces Health Services, Calgary, Alberta, Canada
| | - Carlos Ordonez
- Fundación Valle del Lili, Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Valle, Colombia
| | - Bruno Perreira
- Department of Surgery and Surgical Critical Care, University of Campinas, Campinas, Brazil
| | - Artai Priouzram
- Department of Cardiothoracic and Vascular Surgery, Linköping University Hospital, Linköping, Sweden
| | - Bryan A. Cotton
- Department of Surgery, University of Texas Health Science Center, Houston, Texas
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McCoy CC, Brenner M, Duchesne J, Roberts D, Ferrada P, Horer T, Kauvar D, Khan M, Kirkpatrick A, Ordonez C, Perreira B, Priouzram A, Cotton BA. Back to the Future: Whole Blood Resuscitation of the Severely Injured Trauma Patient. Shock 2021; 56:9-15. [PMID: 33122511 PMCID: PMC8601673 DOI: 10.1097/shk.0000000000001685] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/09/2019] [Accepted: 10/20/2020] [Indexed: 11/30/2022]
Abstract
ABSTRACT Following advances in blood typing and storage, whole blood transfusion became available for the treatment of casualties during World War I. While substantially utilized during World War II and the Korean War, whole blood transfusion declined during the Vietnam War as civilian centers transitioned to blood component therapies. Little evidence supported this shift, and recent conflicts in Iraq and Afghanistan have renewed interest in military and civilian applications of whole blood transfusion. Within the past two decades, civilian trauma centers have begun to study transfusion protocols based upon cold-stored, low anti-A/B titer type O whole blood for the treatment of severely injured civilian trauma patients. Early data suggests equivalent or improved resuscitation and hemostatic markers with whole blood transfusion when compared to balanced blood component therapy. Additional studies are taking place to define the optimal way to utilize low-titer type O whole blood in both prehospital and trauma center resuscitation of bleeding patients.
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Affiliation(s)
- Christopher Cameron McCoy
- Department of Surgery and the Center for Translational Injury Research, University of Texas Health Science Center, Houston, Texas
| | - Megan Brenner
- Department of Surgery, University of California Riverside, Riverside, California
| | - Juan Duchesne
- Division Chief Acute Care Surgery, Department of Surgery, Tulane, New Orleans, Louisiana
| | - Derek Roberts
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, Civic Campus, Ottawa, Ontario, Canada
| | - Paula Ferrada
- Department of Cardiothoracic and Vascular Surgery, Faculty of Life Science Örebro University Hospital and University, Örebro, Sweden
| | - Tal Horer
- VCU Surgery Trauma, Critical Care and Emergency Surgery, Richmond, Virginia
| | - David Kauvar
- Vascular Surgery Service, San Antonio Military Medical Center, San Antonio, Texas
| | - Mansoor Khan
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, UK
| | - Andrew Kirkpatrick
- Regional Trauma Services Foothills Medical Centre, Calgary, Alberta, Canada
- Canadian Forces Health Services, Calgary, Alberta, Canada
| | - Carlos Ordonez
- Departments of Surgery, Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
- Fundacioń Valle del Lili, Division of Trauma and Acute Care Surgery, Department of Surgery, Universidad del Valle, Valle, Columbia
| | - Bruno Perreira
- Department of Surgery and Surgical Critical Care, University of Campinas, Campinas, Brazil
| | - Artai Priouzram
- Department of Cardiothoracic and Vascular Surgery, Linköping University Hospital, Linköping, Sweden
| | - Bryan A. Cotton
- Department of Surgery and the Center for Translational Injury Research, University of Texas Health Science Center, Houston, Texas
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Stengel D, Leisterer J, Ferrada P, Ekkernkamp A, Mutze S, Hoenning A. Point-of-care ultrasonography for diagnosing thoracoabdominal injuries in patients with blunt trauma. Emergencias 2021; 32:280-281. [PMID: 32692006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Dirk Stengel
- Centre for Clinical Research, Department of Trauma and Orthopaedic Surgery, Unfallkrankenhaus Berlin, Berlín, Alemania
| | | | - Paula Ferrada
- Department of Surgery, Virginia Commonwealth University, Richmond, VA, Estados Unidos
| | - Axel Ekkernkamp
- Klinikum Department of Trauma and Reconstructive Surgery, University Hospital, Greifswald, Alemania
| | - Sven Mutze
- Department of Diagnostic and Interventional Radiology, Unfallkrankenhaus Berlin, Berlín, Alemania
| | - Alexander Hoenning
- Centre for Clinical Research, Department of Trauma and Orthopaedic Surgery, Unfallkrankenhaus Berlin, Berlín, Alemania
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Chen H, Ferrada P, Kennedy G, Lindeman B, Newman E, Solorzano C, Telem D, Wang T, Zenilman M. American Journal of Surgery editorial board statement. Am J Surg 2021; 221:1106. [PMID: 34024427 DOI: 10.1016/j.amjsurg.2021.04.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Cabrera Vargas LF, Pedraza M, Rincon FA, Pulido JA, Mendoza-Zuchini A, Gomez D, Moreno-Villamizar MD, Ferrada P, Lopez P, Di Saverio S. Fully therapeutic laparoscopy for penetrating abdominal trauma in stable patients. Am J Surg 2021; 223:206-207. [PMID: 34294385 DOI: 10.1016/j.amjsurg.2021.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/23/2021] [Accepted: 07/08/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Luis Felipe Cabrera Vargas
- Department of Surgery, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio de Bogotá, Colombia; Department of Vascular Surgery, Universidad Militar Nueva Granada, Bogotá, Colombia.
| | - Mauricio Pedraza
- Department of General Surgery, Universidad El Bosque, Bogotá, Colombia.
| | | | | | - Andres Mendoza-Zuchini
- Departamento General Surgery, Cobos Medical Center, Universidad El Bosque, Bogotá Colombia.
| | - Daniel Gomez
- Departamento General Surgery, Universidad Militar Nueva Granada, Bogotá, Colombia.
| | | | - Paula Ferrada
- Department of Surgery, Virginia Commonwealth University Medical Center, 16th Floor, West Hospital, 1200 E. Broad Street, Richmond, VA 23219, USA.
| | - Paula Lopez
- Departament of General Surgery, Universidad El Bosque, Avenida Cra 9 # 131a-20, Bogotá, Colombia.
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Roberts DJ, Cotton BA, Duchesne J, Ferrada P, Horer TM, Kauvar D, Khan M, Kirkpatrick AW, Ordoñez C, Perreira B, Priouzram A, Brenner ML. Endovascular Versus Open: Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta or Thoracotomy for Management of Post-Injury Noncompressible Torso Hemorrhage. JEVTM 2021. [DOI: 10.26676/jevtm.v40i(2).136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Non-compressible torso haemorrhage (NCTH) (i.e., bleeding from anatomical locations not amenable to control by direct pressure or tourniquet application) is a leading cause of potentially preventable death after injury. In select trauma patients with infra-diaphragmatic NCTH-related hemorrhagic shock or traumatic circulatory arrest, occlusion of the aorta proximal to the site of hemorrhage may sustain or restore spontaneous circulation. While the traditional method of achieving proximal aortic occlusion included Emergency Department thoracotomy (EDT) with descending thoracic aortic cross-clamping, resuscitative endovascular balloon occlusion of the aorta (REBOA) affords a less invasive option when thoracotomy is not required for other indications. In this manuscript, we review the innovation, pathophysiologic effects, indications for, and technique of EDT and partial, intermittent, and complete REBOA in injured patients, including recommended methods for reversing aortic occlusion. We also discuss advantages and disadvantages of each of these methods of proximal aortic occlusion and review studies comparing their effectiveness and safety for managing post-injury NCTH. We conclude the above by providing recommendations as to when each of these methods may be best when indicated to manage injured patients with NCTH.
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Ferrada P. Use of Thrombin Generation to Guide Therapy in Trauma Patients. J Am Coll Surg 2021; 232:716. [PMID: 33896477 DOI: 10.1016/j.jamcollsurg.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 02/05/2021] [Indexed: 10/21/2022]
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Sharp SP, Mackenzie DG, Ong DSY, Mountziaris PM, Logghe HJ, Ferrada P, Wexner SD. Factors Influencing the Dissemination of Tweets at the American College of Surgeons Clinical Congress 2018. Am Surg 2020; 87:520-526. [PMID: 33106021 DOI: 10.1177/0003134820950680] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 11/15/2022]
Abstract
BACKGROUND Social media is increasingly used in surgery, facilitating the dissemination of knowledge. Social media can potentially aid networking, education, and information exchange. This study explored the impact of tweet components and tweeter characteristics during a large surgical congress to inform recommendations for optimizing social media use at future surgical conferences. METHODS Twitter activity was monitored during the American College of Surgeons Clinical Congress 2018 using NodeXL to extract tweets containing the conference hashtag #ACSCC18 (or #ACSCC2018). Multivariable logistic regression analysis was performed to identify independent predictors of retweet activity, also testing for multicollinearity and interactions among variables. RESULTS There were 4386 tweets that contained #ACSCC18 (or #ACSCC2018) posted from 1023 Twitter accounts. A larger group of Twitter accounts just retweeted. Other Twitter accounts with a stake in the conference neither tweeted nor retweeted. In a multivariable analysis of original tweets, the following were all independently associated with retweets, in decreasing order of effect size: mention of other tweeters, multimedia, inclusion of other hashtags, and the number of followers. In contrast with other conferences, the inclusion of a weblink (URL)-for example, link to paper or blog-was not associated with retweets. DISCUSSION This study helps understand social media impact at surgical conferences. Engage by tweeting and retweeting. Mention other tweeters, add multimedia, include congress hashtags and topic-specific hashtags, and build your followers. Although not associated with retweet activity in this study, the inclusion of URLs can still contribute in substantiating the disseminated content based on findings at other conferences.
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Affiliation(s)
- Stephen P Sharp
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Douglas G Mackenzie
- Department of General Practice, NHS Education for Scotland, Edinburgh, Midlothian, UK
| | - David S Y Ong
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Paschalia M Mountziaris
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Heather J Logghe
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Paula Ferrada
- 72054 Department of Surgery and Trauma, Virginia Commonwealth University, Richmond, VA, USA
| | - Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
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Palomino WM, Pendelton A, Ferrada R, Ferrada P. Safety and Feasibility of Minimally Invasive Approach for Trauma in a Low-Resource Income Environment. Am Surg 2020; 86:524-526. [PMID: 32684035 DOI: 10.1177/0003134820919742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- William Mejía Palomino
- 537694 Nuestra Señora de los Remedios-Clínica Palma Real, Cali-Palmira, Valle-Colombia, Colombia
| | | | - Ricardo Ferrada
- 537694 Nuestra Señora de los Remedios-Clínica Palma Real, Cali-Palmira, Valle-Colombia, Colombia
| | - Paula Ferrada
- 6889 Virginia Commonwealth University, Richmond, VA, USA
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Ferrada P, Vanguri P, Anand RJ, Whelan J, Duane T, Wolfe L, Ivatury R. Flat Inferior Vena Cava: Indicator of Poor Prognosis in Trauma and Acute Care Surgery Patients. Am Surg 2020; 78:1396-8. [DOI: 10.1177/000313481207801234] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Flat inferior vena cava (IVC) on ultrasound examination has been shown to correlate with hypovolemic status. We hypothesize that a flat IVC on limited echocardiogram (LTTE) performed in the emergency room (ER) correlates with poor prognosis in acutely ill surgical patients. We conducted a retrospective review of all patients undergoing LTTE in the ER from September 2010 until June 2011. IVC diameter was estimated by subxiphoid window. Flat IVC was defined as diameter less than 2 cm. Fat IVC was defined as diameter greater than 2 cm. Need for intensive care unit admission, blood transfusion requirement, mortality, and need for emergent operation between patients with flat versus Fat IVC were compared. One hundred one hypotensive patients had LTTE performed in the ER. Average age was 38 years. Admission diagnosis was blunt trauma (n = 80), penetrating trauma (n = 13), acute care surgery pathology (n = 7), and burn (n = 1). Seventy-four patients had flat IVC on initial LTTE. Compared with those with fat IVC, flat patients were found have higher rates of intensive care unit admission (51.3 vs 14.8%; P = 0.001), blood transfusion requirement (12.2 vs 3.7%), and mortality (13.5 vs 3.7%). This population also underwent emergent surgery on hospital Day 1 more often (16.2 vs 0%; P = 0.033). Initial flat IVC on LTTE is an indicator of hypovolemia and a predictor of poor outcome.
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Affiliation(s)
- Paula Ferrada
- Trauma, Critical Care and Emergency Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Poornima Vanguri
- Trauma, Critical Care and Emergency Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Rahul J. Anand
- Trauma, Critical Care and Emergency Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - James Whelan
- Trauma, Critical Care and Emergency Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Therese Duane
- Trauma, Critical Care and Emergency Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Luke Wolfe
- Trauma, Critical Care and Emergency Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Rao Ivatury
- Trauma, Critical Care and Emergency Medicine, Virginia Commonwealth University, Richmond, Virginia
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Cabrera LF, Ferrada P, Mayol J, Mendoza AC, Herrera G, Pedraza M, Sanchez S. Impact of social media on the continuous education of the general surgeon, a new experience, @Cirbosque: A Latin American example. Surgery 2020; 167:890-894. [PMID: 32359773 DOI: 10.1016/j.surg.2020.03.008] [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: 01/30/2020] [Accepted: 03/18/2020] [Indexed: 12/20/2022]
Abstract
Social media has gained widespread recognition for its importance in the medical field. Such platforms play an important role for learning and teaching, because knowledge can be transmitted instantly and massively, and specialists in different world-wide locations can discuss experiences instantaneously. The present article presents our experience of using social media to facilitate surgical learning while encouraging leadership and global mentoring. This retrospective descriptive study was initiated at the time of the creation of our social media handle on Twitter, February 22, 2019. Since that time, we have posted 10,587 academic tweets; the monthly growth rate has been 9% (393 new followers per month). Currently, we have 4,213 followers, 11,241,000 impressions, 121,105 visits, and 121,105 mentions. We have reviewed 59 topics of interest in general surgery and 132 clinical cases in trauma, as well as in hepatobiliary, gastrointestinal, thoracic, and acute-care surgery. We have made 13 image challenges using illustrations of diagnostic and intraoperative images. Although the evidence is uncertain to promote education performed entirely through social media, we show that @Cirbosque has been effective, and the impact of this initiative on Twitter is appreciated by many surgeons worldwide, including renowned teachers in each of the topics addressed. Furthermore, the number of participants in the discussions increased each day, as did all impact indicators according to Twitter Analytics. Thus, we conclude that the educational message of @Cirbosque is having a positive effect and reaching thousands of people worldwide, suggesting that others can develop similar outreach programs in education and communication.
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Affiliation(s)
- Luis Felipe Cabrera
- Department of General Surgery, Hospital Universitario Fundación Santa Fe de Bogotá, Bogota, Colombia; School of Medicine, Universidad de los Andes, Bogotá, Colombia
| | - Paula Ferrada
- Department of Acute Care Surgical Services, Virginia Commonwealth University, Richmond, VA
| | - Julio Mayol
- Department of Surgery, Hospital Clinico San Carlos de Madrid, Instituto de Investigacion Sanitaria San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Gabriel Herrera
- Department of General Surgery, Hospital Universitario Fundación Santa Fe de Bogotá, Bogota, Colombia; School of Medicine, Universidad de los Andes, Bogotá, Colombia
| | | | - Sebastian Sanchez
- Department of Surgery, Pontificia Universidad Javeriana, Bogota, Colombia
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Jayaraman S, DeAntonio JH, Leichtle SW, Han J, Liebrecht L, Contaifer D, Young C, Chou C, Staschen J, Doan D, Kumar NG, Wolfe L, Nguyen T, Chenault G, Anand RJ, Bennett JD, Ferrada P, Goldberg S, Procter LD, Rodas EB, Rossi AP, Whelan JF, Feeser VR, Vitto MJ, Broering B, Hobgood S, Mangino M, Aboutanos M, Bachmann L, Wijesinghe DS. Detecting direct oral anticoagulants in trauma patients using liquid chromatography-mass spectrometry: A novel approach to medication reconciliation. J Trauma Acute Care Surg 2020; 88:508-514. [PMID: 31688825 PMCID: PMC7802815 DOI: 10.1097/ta.0000000000002527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Accurate medication reconciliation in trauma patients is essential but difficult. Currently, there is no established clinical method of detecting direct oral anticoagulants (DOACs) in trauma patients. We hypothesized that a liquid chromatography-mass spectrometry (LCMS)-based assay can be used to accurately detect DOACs in trauma patients upon hospital arrival. METHODS Plasma samples were collected from 356 patients who provided informed consent including 10 healthy controls, 19 known positive or negative controls, and 327 trauma patients older than 65 years who were evaluated at our large, urban level 1 trauma center. The assay methodology was developed in healthy and known controls to detect apixaban, rivaroxaban, and dabigatran using LCMS and then applied to 327 samples from trauma patients. Standard medication reconciliation processes in the electronic medical record documenting DOAC usage were compared with LCMS results to determine overall accuracy, sensitivity, specificity, and positive and negative predictive values (PPV, NPV) of the assay. RESULTS Of 356 patients, 39 (10.96%) were on DOACs: 21 were on apixaban, 14 on rivaroxaban, and 4 on dabigatran. The overall accuracy of the assay for detecting any DOAC was 98.60%, with a sensitivity of 94.87% and specificity of 99.05% (PPV, 92.50%; NPV, 99.37%). The assay detected apixaban with a sensitivity of 90.48% and specificity of 99.10% (PPV, 86.36%; NPV 99.40%). There were three false-positive results and two false-negative LCMS results for apixaban. Dabigatran and rivaroxaban were detected with 100% sensitivity and specificity. CONCLUSION This LCMS-based assay was highly accurate in detecting DOACs in trauma patients. Further studies need to confirm the clinical efficacy of this LCMS assay and its value for medication reconciliation in trauma patients. LEVEL OF EVIDENCE Diagnostic Test, level III.
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Affiliation(s)
- Sudha Jayaraman
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine
| | - Jonathan H. DeAntonio
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine
| | - Stefan W. Leichtle
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine
| | - Jinfeng Han
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine
| | - Loren Liebrecht
- Department of Internal Medicine, Virginia Commonwealth University School of Medicine
| | - Daniel Contaifer
- Department of Pharmacotherapy and Outcomes Sciences, Virginia Commonwealth University School of Pharmacy
| | | | | | | | - David Doan
- Department of Pharmacotherapy and Outcomes Sciences, Virginia Commonwealth University School of Pharmacy
| | - Naren Gajenthra Kumar
- Department of Pharmacotherapy and Outcomes Sciences, Virginia Commonwealth University School of Pharmacy
| | - Luke Wolfe
- Department of Surgery Virginia Commonwealth University School of Medicine
| | - Tammy Nguyen
- Department of Emergency Medicine, Virginia Commonwealth University School of Medicine
| | | | - Rahul J. Anand
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine
| | - Jonathan D. Bennett
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine
| | - Paula Ferrada
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine
| | - Stephanie Goldberg
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine
| | - Levi D. Procter
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine
| | - Edgar B. Rodas
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine
| | - Alan P. Rossi
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine
| | - James F. Whelan
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine
| | - V. Ramana Feeser
- Department of Emergency Medicine, Virginia Commonwealth University School of Medicine
| | - Michael J. Vitto
- Department of Emergency Medicine, Virginia Commonwealth University School of Medicine
| | - Beth Broering
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine
| | - Sarah Hobgood
- Division of Geriatric Medicine, Department of Internal Medicine, Virginia Commonwealth University School of Medicine
| | - Martin Mangino
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine
| | - Michel Aboutanos
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine
| | | | - Dayanjan S Wijesinghe
- Department of Pharmacotherapy and Outcomes Sciences, Virginia Commonwealth University School of Pharmacy
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Affiliation(s)
- Paula Ferrada
- VCU Surgery Trauma, Critical Care and Emergency Surgery, PO Box 980454, West Hospital, 15th Floor, East Wing, 1200 E, Broad St, Richmond, VA, 23298-0454, USA.
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Abstract
Clostridium (reclassified as " Clostridioides ") difficile infection (CDI) occurs as a chronic or an acute illness with intensity varying from mild to severe. Although most cases of CDI can be managed with antibiotics and supportive care, when the patient presents with fulminant disease, the early decision to perform surgery is imperative for survival. The current standard of care is the subtotal colectomy. However, loop ileostomy with vancomycin enemas delivered into the colonic mucosa has been described as a viable option on selected patients.
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Affiliation(s)
- Aela Vely
- Division of Acute Care Surgical Services, Virginia Commonwealth University, Richmond, Virginia
| | - Paula Ferrada
- Division of Acute Care Surgical Services, Virginia Commonwealth University, Richmond, Virginia
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Sharp S, Mountziaris P, Logghe H, MacKenzie DG, Ong D, Ferrada P, Wexner SD. Social Media Use during the 2018 American College of Surgeons Clinical Congress. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.785] [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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Leichtle SW, Torres B, Collins R, Jayaraman SP, Ferrada P, Aboutanos MB. Triage Protocol for Rib Fracture Patients: Clinical Function Is More Important Than Age and Anatomy. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.1404] [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: 10/25/2022]
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Affiliation(s)
- Emily B. Rivet
- Division of Bariatric and Gastrointestinal Surgery, Departments of Surgery and Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond
| | - Egidio Del Fabbro
- Division of Hematology, Department of Internal Medicine, Oncology and Palliative Care, Virginia Commonwealth University School of Medicine, Richmond
| | - Paula Ferrada
- Division of Acute Care Surgical Services, Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond
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Affiliation(s)
- Asanthi Ratnasekera
- Division of Trauma, Critical Care and Emergency Surgery, Department of Surgery, Virginia Commonwealth University, Richmond
| | - Paula Ferrada
- Division of Trauma, Critical Care and Emergency Surgery, Department of Surgery, Virginia Commonwealth University, Richmond
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Kim WC, Ferrada P, Rodas E, Levy M, Aboutanos MA, Anand RJ. Making the Diagnosis-Acute Primary Aortoduodenal Fistula Bleeding Presenting in a Blunt Trauma Patient. Am Surg 2019. [PMID: 31405434 DOI: 10.1177/000313481908500705] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Mador B, Fuselli P, Choudhary D, Bokhari F, Tanenbaum B, Tze N, Wong TH, Grant I, Sahi S, Tanenbaum B, Figueira S, Knight H, Grant I, Beno S, Moore L, Macpherson A, Laverty C, Watson I, Watson I, Laverty C, Bérubé M, Cowan S, Homer K, Bouderba S, Soltana K, Fransblow L, Fransblow L, Bérubé M, Gonthier C, Bryson A, Bokhari F, Rados A, Courval V, Masales C, Trust MD, Hogan J, Warriner Z, Lalande A, Chung D, Tanenbaun B, Kuper T, Mckee J, Bratu I, Makish A, Versolatto A, Ramagnano S, Mehrnoush V, Kang D, Moore L, Schellenberg M, LeBreton M, Javidan AP, Schwartz G, Doucet J, Cunningham A, Clarke R, Paradis T, Beamish I, Hilsden R, Raizman I, Green R, Green R, Green R, Esmail R, Moon J(J, Cheng V, Brisson A, Beno S, Heck C, Koeck E, Schneider P, Bal C, Ko YM(D, Martinez M, Kim D, Tierney J, Emigh B, Lie J, Tierney J, MacLean A, Milton L, Bradley N, Kim M, White J, Harris I, Tekian A, Babul S, Cowle S, Turcotte K, Dhillon R, Chadha K, Fu CY, Bajan F, Welsh S, Kaminsky M, Dennis A, Starr F, Butler C, Messer T, Poulakidas S, Ramagnano S, Grushka J, Beckett A, Filteau C, Larocque J, Nadkarni N, Chua WC, Loo L, Ang ASH, Iau PTC, Goo JTT, Chan KC, Adam TN, Seow DCC, Ng YS, Malhotra R, Chan AWM, Matchar DB, Van Nguyen H, Ong MEH, Lampron J, Bougie A, Brown C, Patel A, Edwards L, Spitz K, Ramagnano S, Lampron J, Nucete M, Lindsey S, Lampron J, Figueira S, Matar M, Michael D, Rosenfield D, Harvey G, Jessa K, Tardif PA, Mercier E, Berthelot S, Lecky F, Cameron P, Archambault P, Tien H, Beckett A, Nathens A, Luz LTD, Benjamin S, Chisholm A, Benjamin S, Chisholm A, Tien H, Beckett A, Nathens A, Luz LTD, Pasquotti T, Klassen B, Brisson A, Tze N, Fawcett V, Tsang B, Kabaroff A, Verhoeff K, Turner S, Kim M, Widder S, Fung C, Widder S, Kim M, Moore L, Lecky F, Lawrence T, Soltana K, Mansour T, Moore L, Bouderba S, Turgeon A, Krouchev R, Mercier E, Friedman D, Souranis A, Slapcoff L, Friedman D, Fakir MB, Turcotte V, Valiquette MP, Bernard F, Giroux M, Côté MÈ, Gagné A, Dollé S, Gélinas C, Belcaïd A, Truchon C, Moore L, Clément J, Pelletier LP, Ivkov V, Gamble K, Constable L, Haegert J, Bajani F, Fu CY, Welsh S, Kaminsky M, Dennis A, Starr F, Messer T, Butler C, Tatebe L, Poulakidas S, Thauvette D, Engels P, Klassen B, Coates A, De Silva S, Schellenberg M, Biswas S, Inaba K, Cheng V, Warriner Z, Love B, Demetriades D, Schellenberg M, Inaba K, Trust MD, Love B, Cheng V, Strumwasser A, Demetriades D, Joos E, Dawe P, Hameed M, Evans D, Garraway N, Gawaziuk J, Cristall N, Logsetty S, Ramagnano S, Federman N, Murphy P, Parry N, Leeper R, McBeth P, Wachs J, Hamilton D, Ball C, Gillman L, Kirkpatrick A, Dulai S, Falconer C, McLachlin M, Armstrong A, Parry N, Vogt K, Shi Q, Coates A, Engels P, Rice T, Nathens A, Naidu D, Brubacher J, Chan H, Erdelyi S, Kubasiak J, Bokhari F, Kaminsky M, Lauzier F, Tardif PA, Lamontagne F, Chassé M, Stelfox HT, Kortbeek J, Lessard-Bonaventure P, Truchon C, Turgeon A, Cheng V, Inaba K, Foran C, Warriner Z, Trust MD, Clark D, Demetriades D, Levesque K, Lampron J, Nathens A, Tien H, Luz LTD, Jing R, McFarlan A, Liu M, Sander B, Fowler R, Rizoli S, Ferrada P, Murthi S, Nirula R, Edwards S, Cantrell E, Han J, Haase D, Singleton A, Birkas Y, Casola G, Coimbra R, Condron M, Schreiber M, Azarow K, Hamilton N, Long W, Maxwell B, Jafri M, Whitman L, Wilson H, Wong H, Grushka J, Razek T, Fata P, Deckelbaum D, Kawaja K, Beckett A, Razek T, Deckelbaum D, Grushka J, Fata P, Beckett A, Lund M, Leeper R, Conn LG, Strauss R, Haas B, Beckett A, Nathens A, Tien H, Callum J, Luz LTD, Higgins S, Coles J, Erdogan M, Coles J, Higgins S, Erdogan M, Erdogan M, Kureshi N, Fenerty L, Thibault-Halman G, Walling S, Clarke DB, Vis C, Nosworthy S, Razek T, Boulanger N, Deckelbaum D, Grushka J, Fata P, Beckett A, Khwaja K, Schellenberg M, Inaba K, Warriner Z, Trust MD, Matsushima K, Lam L, Demetriades D, Lakha N, Wong H, McLauchlin L, Ashe CS, Logie SA, Lenton-Brym T, Rosenfield D, McDowall D, Wales P, Principi T, Mis J, Kaminsky M, Bokhari F, Rahbar E, Cotton B, Bryan P, MacGillivray S, Thompson G, Wishart I, Hameed M, Joos E, Evans D, Garraway N, Dawe P, Wild J, Widom K, Torres D, Blansfield J, Shabahang M, Dove J, Fluck M, Hameed M, Roux L, Nicol A, Schulenberg L, Fredericks C, Messer T, Starr F, Dennis A, Bokhari F, Kaminsky M, Teixeira P, Coopwood B, Aydelotte J, Cardenas T, Ali S, Brown C, Dawe P, Fredericks C, Matta LD, Messer T, Starr F, Dennis A, Kaminsky M, Bokhari F, Jiang HY, Yoon J, Kim M, Widder S, Hameed M, Wray C, Agarwal A, Harvin J. 2019 Trauma Association of Canada Annual Scientific Meeting Abstracts. Can J Surg 2019; 62:S3-S35. [PMID: 31091053 DOI: 10.1503/cjs.008619] [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: 11/01/2022] Open
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Fitzgerald CA, Smith RN, Luo-Owen X, Turay D, Ferrada P, Han J, Williams BH, Hussain M, Ekeh AP, Herzing K, Zakrison T, Gelbard R. Screening for Harassment, Abuse, and Discrimination among Surgery Residents: An EAST Multicenter Trial. Am Surg 2019. [DOI: 10.1177/000313481908500519] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Estimating the prevalence of harassment, verbal abuse, and discrimination among residents is difficult as events are often under-reported. The purpose of this study was to determine the prevalence of discrimination and abuse among surgical residents using the HITS (Hurt, Insulted, Threatened with harm or Screamed at) screening tool. A multicenter, cross-sectional, survey-based study was conducted at five academic teaching hospitals. Of 310 residents, 76 (24.5%) completed the survey. The HITS screening tool was positive in 3.9 per cent. The most common forms of abuse included sexual harassment (28.9%), discrimination based on gender (15.7%), and discrimination based on ethnicity (7.9%). There was a positive correlation between individuals who reported gender discrimination and racial discrimination (r = 0.778, n = 13, P = 0.002). Individuals who experienced insults were more likely to experience physical threats (r = 0.437, n = 79, P < 0.001) or verbal abuse (r = 0.690, n = 79, P < 0.001). Discrimination and harassment among surgical residents in academic teaching hospitals across the United States is not uncommon. Further research is needed to determine the impact of these findings on resident attrition.
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Affiliation(s)
| | | | - Xian Luo-Owen
- Loma Linda University and Medical Center, Loma Linda, California
| | - David Turay
- Loma Linda University and Medical Center, Loma Linda, California
| | - Paula Ferrada
- Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Jinfeng Han
- Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Brian H. Williams
- UT Southwestern Medical Center, Parkland Memorial Hospital, Dallas, Texas
| | - Munira Hussain
- West Virginia University Hospital, Morgantown, West Virginia
| | - A. Peter Ekeh
- Wright State University Boonshoft School of Medicine, Miami Valley Hospital, Dayton, Ohio; and
| | - Karen Herzing
- Wright State University Boonshoft School of Medicine, Miami Valley Hospital, Dayton, Ohio; and
| | - Tanyal Zakrison
- Ryder Trauma Center, University of Miami Miller School of Medicine, Miami, Florida
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Fitzgerald CA, Smith RN, Luo-Owen X, Turay D, Ferrada P, Han J, Williams BH, Hussain M, Ekeh AP, Herzing K, Zakrison TL, Gelbard RB. Screening for Harassment, Abuse, and Discrimination among Surgery Residents: An EAST Multicenter Trial. Am Surg 2019; 85:456-461. [PMID: 31126355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Estimating the prevalence of harassment, verbal abuse, and discrimination among residents is difficult as events are often under-reported. The purpose of this study was to determine the prevalence of discrimination and abuse among surgical residents using the HITS (Hurt, Insulted, Threatened with harm or Screamed at) screening tool. A multicenter, cross-sectional, survey-based study was conducted at five academic teaching hospitals. Of 310 residents, 76 (24.5%) completed the survey. The HITS screening tool was positive in 3.9 per cent. The most common forms of abuse included sexual harassment (28.9%), discrimination based on gender (15.7%), and discrimination based on ethnicity (7.9%). There was a positive correlation between individuals who reported gender discrimination and racial discrimination (r = 0.778, n = 13, P = 0.002). Individuals who experienced insults were more likely to experience physical threats (r = 0.437, n = 79, P < 0.001) or verbal abuse (r = 0.690, n = 79, P < 0.001). Discrimination and harassment among surgical residents in academic teaching hospitals across the United States is not uncommon. Further research is needed to determine the impact of these findings on resident attrition.
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DeAntonio JH, Nguyen T, Chenault G, Aboutanos MB, Anand RJ, Ferrada P, Goldberg S, Leichtle SW, Procter LD, Rodas EB, Rossi AP, Whelan JF, Feeser VR, Vitto MJ, Broering B, Hobgood S, Mangino M, Wijesinghe DS, Jayaraman S. Medications and patient safety in the trauma setting: a systematic review. World J Emerg Surg 2019; 14:5. [PMID: 30815027 PMCID: PMC6377727 DOI: 10.1186/s13017-019-0225-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 02/03/2019] [Indexed: 02/17/2023] Open
Abstract
Background Medication errors account for the most common adverse events and a significant cause of mortality in the USA. The Joint Commission has required medication reconciliation since 2006. We aimed to survey the literature and determine the challenges and effectiveness of medication reconciliation in the trauma patient population. Materials and methods We conducted a systematic review of the literature to determine the effectiveness of medication reconciliation in trauma patients. English language articles were retrieved from PubMed/Medline, CINAHL, and Cochrane Review databases with search terms "trauma OR injury, AND medication reconciliation OR med rec OR med rek, AND effectiveness OR errors OR intervention OR improvements." Results The search resulted in 82 articles. After screening for relevance and duplicates, the 43 remaining were further reviewed, and only four articles, which presented results on medication reconciliation in 3041 trauma patients, were included. Two were retrospective and two were prospective. Two showed only 4% accuracy at time of admission with 48% of medication reconciliations having at least one medication discrepancy. There were major differences across the studies prohibiting comparative statistical analysis. Conclusions Trauma medication reconciliation is important because of the potential for adverse outcomes given the emergent nature of the illness. The few articles published at this time on medication reconciliation in trauma suggest poor accuracy. Numerous strategies have been implemented in general medicine to improve its accuracy, but these have not yet been studied in trauma. This topic is an important but unrecognized area of research in this field.
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Affiliation(s)
- Jonathan H. DeAntonio
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
- Department of Surgery, VCU School of Medicine, VCU Health System, Virginia Commonwealth University, Richmond, Virginia USA
| | - Tammy Nguyen
- Department of Emergency Medicine, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Gregory Chenault
- VCU Health Department of Pharmacy Services, Critical Care, Richmond, Virginia USA
| | - Michel B. Aboutanos
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Rahul J. Anand
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Paula Ferrada
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Stephanie Goldberg
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Stefan W. Leichtle
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Levi D. Procter
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Edgar B. Rodas
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
- Program for Global Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Alan P. Rossi
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - James F. Whelan
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - V. Ramana Feeser
- Department of Emergency Medicine, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Michael J. Vitto
- Department of Emergency Medicine, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Beth Broering
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Sarah Hobgood
- Division of Geriatrics, Department of Internal Medicine, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Martin Mangino
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
| | - Dayanjan S. Wijesinghe
- Department of Pharmacotherapy and Outcomes Sciences and Laboratory of Pharmacometabolomics and Companion Diagnostics, Virginia Commonwealth University School of Pharmacy, VCU Health, Richmond, Virginia USA
| | - Sudha Jayaraman
- Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
- Program for Global Surgery, Department of Surgery, Virginia Commonwealth University, VCU Health, Richmond, Virginia USA
- VCU School of Medicine, Richmond, Virginia USA
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Ferrada P, Manzano-Nunez R, Lopez-Castilla V, Orlas C, García AF, Ordonez CA, Dubose JJ. Meta-Analysis of Post-Intubation Hypotension: A Plea to Consider Circulation First in Hypovolemic Patients. Am Surg 2019; 85:167-172. [PMID: 30819293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Hypovolemic patients can develop postintubation hypotension (PIH). Our objective is to review the literature regarding PIH and the association with mortality. We searched MEDLINE from inception to February 2018. A meta-analysis was performed to assess the effect of PIH on mortality. The results of the meta-analysis were reported in forest plots of the estimated effects of the included studies with a 95 per cent confidence interval. Heterogeneity was evaluated using the I² test, which corresponded to low (I² < 25%), medium (I² = 25-75%), and high (I² > 75%) heterogeneity. We identified 243 records. Four studies were included in the meta-analysis. The studies reported 2044 patients with 36.8 per cent (n = 753) developing PIH. Data indirectly reflecting the hemodynamic status were available in three studies (n = 1117 patients). Overall mortality was 24.6 per cent (n = 503) and was significantly higher in patients that developed PIH [mortality, n (%): PIH = 250/753 (33.2%) vs 253/1291 (19.6%), P < 0.001]. Patients that develop PIH have an increased mortality. Considering a targeted resuscitation in hypovolemic patients is pivotal to minimize PIH.
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Ferrada P, Manzano-Nunez R, Lopez-Castilla V, Orlas C, GarcÍA AF, Ordonez CA, Dubose JJ. Meta-Analysis of Post-Intubation Hypotension: A Plea to Consider Circulation First in Hypovolemic Patients. Am Surg 2019. [DOI: 10.1177/000313481908500223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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
Hypovolemic patients can develop postintubation hypotension (PIH). Our objective is to review the literature regarding PIH and the association with mortality. We searched MEDLINE from inception to February 2018. A meta-analysis was performed to assess the effect of PIH on mortality. The results of the meta-analysis were reported in forest plots of the estimated effects of the included studies with a 95 per cent confidence interval. Heterogeneity was evaluated using the I2 test, which corresponded to low (I2 < 25%), medium (I2 = 25–75%), and high (I2 > 75%) heterogeneity. We identified 243 records. Four studies were included in the meta-analysis. The studies reported 2044 patients with 36.8 per cent (n = 753) developing PIH. Data indirectly reflecting the hemodynamic status were available in three studies (n = 1117 patients). Overall mortality was 24.6 per cent (n = 503) and was significantly higher in patients that developed PIH [mortality, n (%): PIH = 250/753 (33.2%) vs 253/1291 (19.6%), P < 0.001]. Patients that develop PIH have an increased mortality. Considering a targeted resuscitation in hypovolemic patients is pivotal to minimize PIH.
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Affiliation(s)
- Paula Ferrada
- Virginia Commonwealth University, Richmond, Virginia
| | | | | | | | | | | | - Joseph J. Dubose
- Shock Trauma Centre, University of Maryland, College Park, Maryland
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Simões CA, Ribeiro MA, Portilho AS, Favaro M, Santin S, Ferrada P, Aparecido Dedivitis R, Cernea CR. Evaluation of a Training Model for Cervical Trauma Using Cadavers. Am Surg 2019. [DOI: 10.1177/000313481908500110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Cesar Augusto Simões
- Department of Surgery University of Santo Amaro School of Medicine São Paulo, Brazil
| | - Marcelo A.F. Ribeiro
- Department of Surgery University of Santo Amaro School of Medicine São Paulo, Brazil
| | | | - Murillo Favaro
- Department of Surgery University of Santo Amaro School of Medicine São Paulo, Brazil
| | - Stephanie Santin
- Department of Surgery University of Santo Amaro School of Medicine São Paulo, Brazil
| | - Paula Ferrada
- Department of Surgery Virginia Commonwealth University Richmond, Virginia
| | - Rogério Aparecido Dedivitis
- Department of Head and Neck Surgery Hospital das Clínicas University of São Paulo School of Medicine São Paulo, Brazil
| | - Cláudio Roberto Cernea
- Department of Head and Neck Surgery Hospital das Clínicas University of São Paulo School of Medicine São Paulo, Brazil
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Simões CA, Ribeiro MAF, Portilho AS, Favaro M, Santin S, Ferrada P, Dedivitis RA, Cernea CR. Evaluation of a Training Model for Cervical Trauma Using Cadavers. Am Surg 2019; 85:e21-e23. [PMID: 30760363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Stengel D, Leisterer J, Ferrada P, Ekkernkamp A, Mutze S, Hoenning A. Point-of-care ultrasonography for diagnosing thoracoabdominal injuries in patients with blunt trauma. Cochrane Database Syst Rev 2018; 12:CD012669. [PMID: 30548249 PMCID: PMC6517180 DOI: 10.1002/14651858.cd012669.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Point-of-care sonography (POCS) has emerged as the screening modality of choice for suspected body trauma in many emergency departments worldwide. Its best known application is FAST (focused abdominal sonography for trauma). The technology is almost ubiquitously available, can be performed during resuscitation, and does not expose patients or staff to radiation. While many authors have stressed the high specificity of POCS, its sensitivity varied markedly across studies. This review aimed to compile the current best evidence about the diagnostic accuracy of POCS imaging protocols in the setting of blunt thoracoabdominal trauma. OBJECTIVES To determine the diagnostic accuracy of POCS for detecting and excluding free fluid, organ injuries, vascular lesions, and other injuries (e.g. pneumothorax) compared to a diagnostic reference standard (i.e. computed tomography (CT), magnetic resonance imaging (MRI), thoracoscopy or thoracotomy, laparoscopy or laparotomy, autopsy, or any combination of these) in patients with blunt trauma. SEARCH METHODS We searched Ovid MEDLINE (1946 to July 2017) and Ovid Embase (1974 to July 2017), as well as PubMed (1947 to July 2017), employing a prospectively defined literature and data retrieval strategy. We also screened the Cochrane Library, Google Scholar, and BIOSIS for potentially relevant citations, and scanned the reference lists of full-text papers for articles missed by the electronic search. We performed a top-up search on 6 December 2018, and identified eight new studies which may be incorporated into the first update of this review. SELECTION CRITERIA We assessed studies for eligibility using predefined inclusion and exclusion criteria. We included either prospective or retrospective diagnostic cohort studies that enrolled patients of any age and gender who sustained any type of blunt injury in a civilian scenario. Eligible studies had to provide sufficient information to construct a 2 x 2 table of diagnostic accuracy to allow for calculating sensitivity, specificity, and other indices of diagnostic test accuracy. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles, abstracts, and full texts of reports using a prespecified data extraction form. Methodological quality of individual studies was rated by the QUADAS-2 instrument (the revised and updated version of the original Quality Assessment of Diagnostic Accuracy Studies list of items). We calculated sensitivity and specificity with 95% confidence intervals (CI), tabulated the pairs of sensitivity and specificity with CI, and depicted these estimates by coupled forest plots using Review Manager 5 (RevMan 5). For pooling summary estimates of sensitivity and specificity, and investigating heterogeneity across studies, we fitted a bivariate model using Stata 14.0. MAIN RESULTS We included 34 studies with 8635 participants in this review. Summary estimates of sensitivity and specificity were 0.74 (95% CI 0.65 to 0.81) and 0.96 (95% CI 0.94 to 0.98). Pooled positive and negative likelihood ratios were estimated at 18.5 (95% CI 10.8 to 40.5) and 0.27 (95% CI 0.19 to 0.37), respectively. There was substantial heterogeneity across studies, and the reported accuracy of POCS strongly depended on the population and affected body area. In children, pooled sensitivity of POCS was 0.63 (95% CI 0.46 to 0.77), as compared to 0.78 (95% CI 0.69 to 0.84) in an adult or mixed population. Associated specificity in children was 0.91 (95% CI 0.81 to 0.96) and in an adult or mixed population 0.97 (95% CI 0.96 to 0.99). For abdominal trauma, POCS had a sensitivity of 0.68 (95% CI 0.59 to 0.75) and a specificity of 0.95 (95% CI 0.92 to 0.97). For chest injuries, sensitivity and specificity were calculated at 0.96 (95% CI 0.88 to 0.99) and 0.99 (95% CI 0.97 to 1.00). If we consider the results of all 34 included studies in a virtual population of 1000 patients, based on the observed median prevalence (pretest probability) of thoracoabdominal trauma of 28%, POCS would miss 73 patients with injuries and falsely suggest the presence of injuries in another 29 patients. Furthermore, in a virtual population of 1000 children, based on the observed median prevalence (pretest probability) of thoracoabdominal trauma of 31%, POCS would miss 118 children with injuries and falsely suggest the presence of injuries in another 62 children. AUTHORS' CONCLUSIONS In patients with suspected blunt thoracoabdominal trauma, positive POCS findings are helpful for guiding treatment decisions. However, with regard to abdominal trauma, a negative POCS exam does not rule out injuries and must be verified by a reference test such as CT. This is of particular importance in paediatric trauma, where the sensitivity of POCS is poor. Based on a small number of studies in a mixed population, POCS may have a higher sensitivity in chest injuries. This warrants larger, confirmatory trials to affirm the accuracy of POCS for diagnosing thoracic trauma.
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Affiliation(s)
- Dirk Stengel
- Unfallkrankenhaus BerlinCentre for Clinical Research, Department of Trauma and Orthopaedic SurgeryBerlinGermany12683
| | | | - Paula Ferrada
- Virginia Commonwealth UniversityDepartment of SurgeryRichmondVAUSA
| | - Axel Ekkernkamp
- University HospitalDepartment of Trauma and Reconstructive SurgeryGreifswaldGermany17475
| | - Sven Mutze
- Unfallkrankenhaus BerlinDepartment of Diagnostic and Interventional RadiologyWarener Str 7BerlinGermany12683
| | - Alexander Hoenning
- Unfallkrankenhaus BerlinCentre for Clinical Research, Department of Trauma and Orthopaedic SurgeryBerlinGermany12683
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