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Chang YR, Kuo LW, Hsu TA, Tee YS, Fu CY, Bajani F, Mis J, Poulakidas S, Bokhari F. The Role of Open Cardiopulmonary Resuscitation in Chest Trauma Patients with No Sign of Life: A National Trauma Data Bank Study. World J Surg 2023; 47:3107-3113. [PMID: 37740005 DOI: 10.1007/s00268-023-07180-5] [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] [Accepted: 08/26/2023] [Indexed: 09/24/2023]
Abstract
PURPOSE The effectiveness of open cardiopulmonary resuscitation (OCPR) remains controversial for trauma patients. In this current study, the role of OCPR in managing chest trauma patients is evaluated using nationwide real-world data. METHODS From 2014 to 2015, the National Trauma Data Bank was retrospectively queried for chest trauma patients with out-of-hospital cardiac arrest status. The emergency department (ED) and overall survival of patients without signs of life were analyzed. Multivariate logistic regression (MLR) analysis was performed to evaluate independent factors of mortality for the target group. Furthermore, a subset group of patients who survived after the ED were studied, focusing on the duration of survival after leaving the ED. RESULTS A total of 911 patients were enrolled in this study (OCPR vs. non-OCPR: 161 patients vs. 750 patients). The average overall mortality rate was 98.6% (N = 898). Among penetrating chest trauma patients, non-survivors in the ED had significantly higher proportions of gunshot injuries (83.9% vs. 69.7%, p = 0.001) and lower proportions of OCPR (20.7% vs. 44.4%, p < 0.001). MLR analysis showed that gunshot injuries and non-OCPR were significantly related to ED mortality in penetrating trauma patients without signs of life (odds ratio = 2.039, p = 0.006 and odds ratio = 2.900, p < 0.001, respectively). However, the overall survival rate of patients after ED survival (n = 99) was 9.9%, and only 21.2% (n = 21) of them survived more than 1 day after leaving the ED. CONCLUSION OCPR could be considered in situations where appropriate indications exist. The survival benefit was observed in critically ill patients with penetrating chest trauma who show no signs of life. By enhancing ED survival, OCPR may also contribute to overall survival improvement.
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Affiliation(s)
- Yau-Ren Chang
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing Street, Kwei Shan Township, Taipei, Taoyuan, Taiwan
| | - Ling-Wei Kuo
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, Chicago, USA
| | - Ting-An Hsu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing Street, Kwei Shan Township, Taipei, Taoyuan, Taiwan
| | - Yu-San Tee
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing Street, Kwei Shan Township, Taipei, Taoyuan, Taiwan.
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, Chicago, USA.
| | - Chih-Yuan Fu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing Street, Kwei Shan Township, Taipei, Taoyuan, Taiwan
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, Chicago, USA
| | - Francesco Bajani
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, Chicago, USA
| | - Justin Mis
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, Chicago, USA
| | - Stathis Poulakidas
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, Chicago, USA
| | - Faran Bokhari
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, Chicago, USA
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Kuo YC, Chien CY, Li PH, Hsu TA, Fu CY, Bajani F, Mis J, Poulakidas S, Bokhari F. Validation of the Twenty-Four-Hour Threshold for Bladder Repair: Impact on Infection Rates Using the National Trauma Data Bank. World J Surg 2023; 47:3116-3123. [PMID: 37851065 DOI: 10.1007/s00268-023-07224-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE This study aimed to validate the previously reported association between delayed bladder repair and increased infection rates using the National Trauma Data Bank (NTDB). METHODS Bladder injury patients with bladder repair in the NTDB from 2013 to 2015 were included. Propensity score matching (PSM) was used to compare mortality, infection rates, and hospital length of stay (LOS) between patients who underwent bladder repair within 24 h and those who underwent repair after 24 h. Linear regression and multivariate logistic regression analyses were also performed. RESULTS A total of 1658 patients were included in the study. Patients who underwent bladder repair after 24 h had significantly higher infection rates (5.4% vs. 1.2%, p = 0.032) and longer hospital LOS (17.1 vs. 14.0 days, p = 0.032) compared to those who underwent repair within 24 h after a well-balanced 1:1 PSM (N = 166). Linear regression analysis showed a positive correlation between time to bladder repair and hospital LOS for patients who underwent repair after 24 h (B-value = 0.093, p = 0.034). Multivariate logistic regression analysis indicated that bladder repair after 24 h increased the risk of infection (odds = 3.162, p = 0.018). Subset analyses were performed on patients who underwent bladder repairs within 24 h and were used as a control group. These analyses showed that the time to bladder repair did not significantly worsen outcomes. CONCLUSIONS Delayed bladder repair beyond 24 h increases the risk of infection and prolongs hospital stays. Timely diagnosis and surgical intervention remain crucial for minimizing complications in bladder injury patients.
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Affiliation(s)
- Yu-Chi Kuo
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Branch, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Ying Chien
- Department of General Surgery, Chang Gung Memorial Hospital, Keelung Branch, Chang Gung University, Keelung, Taiwan
| | - Pei-Hua Li
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Branch, Chang Gung University, Taoyuan, Taiwan
| | - Ting-An Hsu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Branch, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Yuan Fu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou Branch, Chang Gung University, Taoyuan, Taiwan.
| | - Francesco Bajani
- Department of Trauma and Burn Surgery, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Justin Mis
- Department of Trauma and Burn Surgery, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Stathis Poulakidas
- Department of Trauma and Burn Surgery, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Faran Bokhari
- Emergency Surgical Services, St. Francis Hospital, OSF Healthcare System, Peoria, IL, USA
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Sebekos K, Guiab K, Stamelos G, Capron G, Brigode W, Poulakidas S, Bokhari F. Comparison of Outcomes in Below-Knee Amputation Between Vascular, General, and Orthopedic Surgeons. J Surg Res 2023; 290:247-256. [PMID: 37302212 DOI: 10.1016/j.jss.2023.04.022] [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: 08/12/2022] [Revised: 04/26/2023] [Accepted: 04/30/2023] [Indexed: 06/13/2023]
Abstract
INTRODUCTION General surgeons (GS), orthopedic surgeons (OS), and vascular surgeons (VS) can perform below-knee amputation (BKA) operations. We compared the outcomes of BKA patients among the three specialties. METHODS Adult patients who underwent a BKA were identified from the 2016-2018 National Surgical Quality Improvement Project database. Statistical data for orthopedic and vascular BKA cases were then compared with GS cases using logistic regression analysis. Outcomes included mortality, length of hospital stay, and complications. RESULTS There were 9619 BKA cases. VS had the highest volume of BKA with 58.9% of the cases, compared to GS at 22.9% and OS at 18.1%. 4.4% of general surgery patients had severe frailty compared to OS (3.3%) and VS (3.4%, P < 0.001). VS has the lowest rates of emergency cases (11.9% versus 16.1 for GS versus 15.8% versus OS) and the most favorable wound classification (38.3%, versus 48.7% for GS and VS). Peripheral vascular disease was notably highest in VS (34.0% versus. 20.6% for GS and 9.9% for OS, P < 0.001). Compared to GS, VS was more likely to have a prolonged length of stay (odds ratio) (OR)(1.409), 95% CI 1.265-1.570) while OS was less likely (OR 0.650, 95% CI 0.561-0.754). OS had a lower risk of complications (OR 0.781, 95% CI 0.674-0.904). Mortality was not significantly different among the three specialties. CONCLUSIONS The National Surgical Quality Improvement Project retrospective analysis of BKA cases suggested that mortality was not statistically different when performed by VS, GS, and OS. There were fewer overall complications when OS performed a BKA, but this is more likely a result of operating upon a generally healthier patient population with lower incidence of preoperative comorbid conditions.
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Affiliation(s)
- Konstantinos Sebekos
- Department of Trauma and Burn - John H. Stroger Jr., Hospital of Cook County, Chicago, Illinois.
| | - Keren Guiab
- Department of Trauma and Burn - John H. Stroger Jr., Hospital of Cook County, Chicago, Illinois
| | - George Stamelos
- Department of Trauma and Burn - John H. Stroger Jr., Hospital of Cook County, Chicago, Illinois
| | - Gweniviere Capron
- Department of Trauma and Burn - John H. Stroger Jr., Hospital of Cook County, Chicago, Illinois
| | - William Brigode
- Department of Trauma and Burn - John H. Stroger Jr., Hospital of Cook County, Chicago, Illinois
| | - Stathis Poulakidas
- Department of Trauma and Burn - John H. Stroger Jr., Hospital of Cook County, Chicago, Illinois
| | - Faran Bokhari
- Department of Trauma and Burn - John H. Stroger Jr., Hospital of Cook County, Chicago, Illinois
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Kuo YC, Li PH, Hsu TA, Fu CY, Bajani F, Mis J, Poulakidas S, Bokhari F. Does a time threshold exist for bladder repair after which outcomes worsen? A Trauma Quality Improvement Program study. Surgery 2023; 173:1296-1302. [PMID: 36759210 DOI: 10.1016/j.surg.2022.12.025] [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: 08/18/2022] [Revised: 12/16/2022] [Accepted: 12/22/2022] [Indexed: 02/10/2023]
Abstract
BACKGROUND The appropriate timing of surgical intervention for bladder injuries is not well-defined. The effect of time to surgery on the outcomes of patients with a bladder injury was assessed using data from the Trauma Quality Improvement Program. METHODS Patients with dominant or isolated bladder injuries who underwent surgical repair from 2017 to 2019 were studied. Mortality, infection (surgical site infection or sepsis), acute kidney injury, overall length of stay, and length of stay after surgery were compared between patients who underwent bladder repair within and after 24 hours of arrival at the emergency department. The role of time to surgical repair in the outcomes of patients with a bladder injury was evaluated. RESULTS A total of 1,507 patients with a mean time to bladder repair of 14.0 hours were studied. In total, 233 (15.5%) patients with a bladder injury underwent bladder repair more than 1 day after emergency department arrival. These patients had significantly more infections (5.6% vs 2.5%, P = .011), more acute kidney injuries (7.8% vs 1.8%, P < .001), and a longer length of stay after surgery (16.0 vs 12.3 days, P = .001) than patients who underwent bladder repair within 1 day. A time to bladder repair longer than 24 hours after emergency department arrival did not significantly affect mortality (P = .075) but significantly increased the risk of infection/acute kidney injury (odds = 1.823, P = .040). However, the infection/acute kidney injury risk did not increase with increasing time to surgery in patients who underwent bladder repair within 24 hours (P = .120). CONCLUSION Patients with dominant or isolated bladder injuries may have a poor outcome (ie, increased infection rate, acute kidney injury, longer overall length of stay, and longer length of stay after bladder repair) if they undergo surgical repair more than 24 hours after arrival at the emergency department.
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Affiliation(s)
- Yu-Chi Kuo
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Pei-Hua Li
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Ting-An Hsu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Chih-Yuan Fu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan; Department of Trauma and Burn Surgery, John H. Stroger Jr Hospital of Cook County, Chicago, IL.
| | - Francesco Bajani
- Department of Trauma and Burn Surgery, John H. Stroger Jr Hospital of Cook County, Chicago, IL
| | - Justin Mis
- Department of Trauma and Burn Surgery, John H. Stroger Jr Hospital of Cook County, Chicago, IL
| | - Stathis Poulakidas
- Department of Trauma and Burn Surgery, John H. Stroger Jr Hospital of Cook County, Chicago, IL
| | - Faran Bokhari
- Department of Trauma and Burn Surgery, John H. Stroger Jr Hospital of Cook County, Chicago, IL
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Lu YC, Yu SY, Fu CY, Bajani F, Bokhari M, Mis J, Poulakidas S, Bokhari F. Increased Intra-abdominal Hemorrhage after Thoracic Endovascular Aortic Replacement in Patients with Concomitant Blunt Aortic Injuries and Abdominal Trauma: A National Trauma Data Bank Analysis. Eur J Cardiothorac Surg 2022; 62:6747958. [PMID: 36194000 DOI: 10.1093/ejcts/ezac494] [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: 06/07/2022] [Revised: 09/21/2022] [Accepted: 10/03/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The role of thoracic endovascular aortic replacement (TEVAR) in patients with concomitant blunt thoracic aortic injury (BTAI) and blunt abdomen trauma (BAT) was evaluated using nationwide real-world data. The risk of post-TEVAR abdominal hemorrhage was studied. METHODS Patients with BTAI and BAT in the National Trauma Data Bank were retrospectively studied. Propensity score matching (PSM) was used to evaluate the effect of TEVAR in delayed abdominal surgeries for hemostasis and the delayed need for blood transfusion. A multivariable logistic regression (MLR) analysis was used to evaluate the independent risk factors for delayed intra-abdominal hemorrhage in these patients. RESULTS A total of 928 concomitant BTAI and BAT patients were studied (TEVAR vs. non-TEVAR, 206 vs. 722). After a well-balanced PSM analysis, patients who received TEVAR had significantly more delayed abdominal surgeries for hemostasis [7.7% vs. 4.5%, standardized mean difference (SMD) = 0.316] and delayed need for blood transfusion (11.6% vs. 7.1%, SMD = 0.299) than those who did not. The MLR analysis showed that TEVAR increased the need for delayed abdominal surgeries (odds ratio = 2.026, p = 0.034). Among the patients who underwent TEVAR, the patients with delayed abdominal surgeries for hemostasis had a significantly higher proportion of severe abdominal injury (abdominal abbreviated injury scale (AIS) score of 4 or 5) than patients without delayed abdominal surgeries for hemostasis (31.6% vs. 15.5%, p = 0.038). CONCLUSIONS Patients with concomitant BTAI and BAT had a higher risk of intra-abdominal hemorrhage after TEVAR, especially patients with severe abdominal trauma.
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Affiliation(s)
- Yu-Chieh Lu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.,Department of Vascular and Endovascular Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Sheng-Yueh Yu
- Department of Vascular and Endovascular Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Chih-Yuan Fu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.,Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, Chicago, IL, USA
| | - Francesco Bajani
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, Chicago, IL, USA
| | - Marissa Bokhari
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, Chicago, IL, USA
| | - Justin Mis
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, Chicago, IL, USA
| | - Stathis Poulakidas
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, Chicago, IL, USA
| | - Faran Bokhari
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, Chicago, IL, USA
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Hsu CP, Cheng CT, Huang JF, Fu CY, Bajani F, Bokhari M, Mis J, Poulakidas S, Bokhari F. The effect of transarterial embolization versus nephrectomy on acute kidney injury in blunt renal trauma patients. World J Urol 2022; 40:1859-1865. [PMID: 35674789 DOI: 10.1007/s00345-022-04049-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/06/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The impact of transarterial embolization (TAE) and nephrectomy on acute kidney injury (AKI) in blunt renal trauma patients remains unclear, and we used the National Trauma Data Bank (NTDB) to investigate this issue. METHODS Adult patients from the NTDB between 2007 and 2015 who survived traumatic events with blunt injuries were eligible for inclusion. The exclusion criteria were those without outcome information, who required dialysis, or with chronic renal failure prior to the traumatic injury. Patients sustaining hepatic, splenic, or pelvic fractures or who had bilateral nephrectomy were also excluded. The patients were divided into three treatment groups, including conservative treatment, TAE, and nephrectomy. Two statistical models, logistic regression (LR) and inverse probability treatment weighting (IPTW), were used to clarify the AKI predictors. RESULTS The study included 10,096 patients. There were 9697 (96.0%), 202 (2.0%) and 197 (2.0%) patients in the conservative, TAE and nephrectomy groups, respectively. Nephrectomy was a statistically significant predictor of AKI in blunt renal trauma patients in the standard LR (odds ratio [OR], 4.58; 95% confidence interval [CI] 1.92-10.38; p < 0.001) and IPTW (OR, 5.16; 95% CI 1.07-24.85; p = 0.023) models. In addition, TAE was not a risk factor for AKI in blunt renal trauma patients (p > 0.05 in all models). CONCLUSION AKI is less likely affect patients with blunt renal trauma with TAE than those with nephrectomy. Nephrectomy is a risk factor for AKI in blunt renal trauma patients. TAE should be considered first when blunt renal trauma patients need a hemostatic procedure.
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Affiliation(s)
- Chih-Po Hsu
- Division of Trauma and Emergency Surgery, Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Tung Cheng
- Division of Trauma and Emergency Surgery, Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Jen-Fu Huang
- Division of Trauma and Emergency Surgery, Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
| | - Chih-Yuan Fu
- Division of Trauma and Emergency Surgery, Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.,Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, Chicago, IL, USA
| | - Francesco Bajani
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, Chicago, IL, USA
| | - Marissa Bokhari
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, Chicago, IL, USA
| | - Justin Mis
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, Chicago, IL, USA
| | - Stathis Poulakidas
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, Chicago, IL, USA
| | - Faran Bokhari
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, Chicago, IL, USA
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Li PH, Hsu TA, Kuo YC, Fu CY, Bajani F, Bokhari M, Mis J, Poulakidas S, Bokhari F. The application of the WSES classification system for open pelvic fractures-validation and supplement from a nationwide data bank. World J Emerg Surg 2022; 17:29. [PMID: 35624457 PMCID: PMC9145531 DOI: 10.1186/s13017-022-00434-y] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Open pelvic fractures are rare but complex injuries. Concomitant external and internal hemorrhage and wound infection-related sepsis result in a high mortality rate and treatment challenges. Here, we validated the World Society Emergency Society (WSES) classification system for pelvic injuries in open pelvic fractures, which are quite different from closed fractures, using the National Trauma Data Bank (NTDB). Methods Open pelvic fracture patients in the NTDB 2015 dataset were retrospectively queried. The mortality rates associated with WSES minor, moderate and severe injuries were compared. A multivariate logistic regression model (MLR) was used to evaluate independent factors of mortality. Patients with and without sepsis were compared. The performance of the WSES classification in the prediction of mortality was evaluated by determining the discrimination and calibration. Results A total of 830 open pelvic fracture patients were studied. The mortality rates of the mild, moderate and severe WSES classes were 3.5%, 11.2% and 23.8%, respectively (p < 0.001). The MLR analysis showed that the presence of sepsis was an independent factor of mortality (odds of mortality 9.740, p < 0.001). Compared with patients without sepsis, those with sepsis had significantly higher mortality rates in all WSES classes (minor: 40.0% vs. 3.1%, p < 0.001; moderate: 50.0% vs. 9.1%, p < 0.001; severe: 66.7% vs. 22.2%, p < 0.001). The receiver operating characteristic (ROC) curve showed an acceptable discrimination of the WSES classification alone for evaluating the mortality of open pelvic fracture patients [area under curve (AUC) = 0.717]. Improved discrimination with an increased AUC was observed using the WSES classification plus sepsis (AUC = 0.767). Conclusions The WSES guidelines can be applied to evaluate patients with open pelvic fracture with accurate evaluation of outcomes. The presence of sepsis is recommended as a supplement to the WSES classification for open pelvic fractures.
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Affiliation(s)
- Pei-Hua Li
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Ting-An Hsu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Yu-Chi Kuo
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Chih-Yuan Fu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan. .,Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 8th floor, 1950 West Polk Street, Chicago, IL, 60612, USA.
| | - Francesco Bajani
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 8th floor, 1950 West Polk Street, Chicago, IL, 60612, USA
| | - Marissa Bokhari
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 8th floor, 1950 West Polk Street, Chicago, IL, 60612, USA
| | - Justin Mis
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 8th floor, 1950 West Polk Street, Chicago, IL, 60612, USA
| | - Stathis Poulakidas
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 8th floor, 1950 West Polk Street, Chicago, IL, 60612, USA
| | - Faran Bokhari
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 8th floor, 1950 West Polk Street, Chicago, IL, 60612, USA
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Fu CY, Bajani F, Bokhari M, Wang SH, Cheng CT, Mis J, Poulakidas S, Bokhari F. How long of a postponement in surgery can a blunt hollow viscus injury patient tolerate? A retrospective study from the National Trauma Data Bank. Surgery 2021; 171:526-532. [PMID: 34266649 DOI: 10.1016/j.surg.2021.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 06/02/2021] [Accepted: 06/15/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND In the management of patients with blunt abdominal trauma, delayed diagnosis and treatment of hollow viscus injury can occur. We assessed the effect of the time to surgery on the outcomes of blunt hollow viscus injury patients. METHODS The National Trauma Data Bank was queried from 2012 to 2015 to identify patients with blunt hollow viscus injury for inclusion. Patients with unstable hemodynamics, concomitant intra-abdominal organ injuries, or other severe extra-abdominal injuries were excluded. Inverse probability of treatment weighting and multivariate logistic regression were used to evaluate the effect of the time to surgery on the outcomes. RESULTS In total, 2,997 patients with blunt hollow viscus injury were studied; the mean time to abdominal surgery was 6.7 hours. Twenty-two hours was selected as a cutoff value for further analyses because of an observed transition zone at that time in the distribution of mortality and severe sepsis rates. After adjustment, patients who underwent surgery within 22 hours had a significantly lower mortality rate (1.2% vs 4.2%), lower sepsis rate (0.9% vs 4.5%), shorter hospital length of stay (8.7 vs 12.0 days), and shorter intensive care unit length of stay (1.4 vs 3.3 days). In patients who underwent surgery within 22 hours, neither mortality nor sepsis were affected significantly by the time to surgery. CONCLUSION In the management of patients with blunt hollow viscus injury, early surgical treatment is needed. Patients with isolated blunt hollow viscus injury may have a poor outcome if they undergo abdominal surgery more than 22 hours after arrival in the emergency department.
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Affiliation(s)
- Chih-Yuan Fu
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, Chicago, IL; Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan. https://twitter.com/PeterFu24437602
| | - Francesco Bajani
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, Chicago, IL
| | - Marissa Bokhari
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, Chicago, IL
| | - Szu-Han Wang
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Chi-Tung Cheng
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan; Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan.
| | - Justin Mis
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, Chicago, IL
| | - Stathis Poulakidas
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, Chicago, IL
| | - Faran Bokhari
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, Chicago, IL
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Fu CY, Bajani F, Bokhari M, Tatebe LC, Starr F, Messer T, Kaminsky M, Dennis A, Schlanser V, Mis J, Toor R, Poulakidas S, Bokhari F. Obesity is Associated with Worse Outcomes Among Abdominal Trauma Patients Undergoing Laparotomy: A Propensity-Matched Nationwide Cohort Study. World J Surg 2020; 44:755-763. [PMID: 31712846 PMCID: PMC7223826 DOI: 10.1007/s00268-019-05268-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Introduction Obesity is associated with increased morbidity and mortality in abdominal trauma patients. The characteristics of abdominal trauma patients with poor outcomes related to obesity require evaluation. We hypothesize that obesity is related to increased mortality and length of stay (LOS) among abdominal trauma patients undergoing laparotomies. Methods Abdominal trauma patients were identified from the National Trauma Data Bank between 2013 and 2015. Patients who received laparotomies were analyzed using propensity score matching (PSM) to evaluate the mortality rate and LOS between obese and non-obese patients. Patients without laparotomies were analyzed as a control group using PSM cohort analysis. Results A total of 33,798 abdominal trauma patients were evaluated, 10,987 of them received laparotomies. Of these patients, the proportion of obesity in deceased patients was significantly higher when compared to the survivors (33.1% vs. 26.2%, p < 0.001). Elevation of one kg/m2 of body mass index independently resulted in 2.5% increased odds of mortality. After a well-balanced PSM, obese patients undergoing laparotomies had significantly higher mortality rates [3.7% vs. 2.4%, standardized difference (SD) = 0.241], longer hospital LOS (11.1 vs. 9.6 days, SD = 0.135), and longer intensive care unit LOS (3.5 vs. 2.3 days, SD = 0.171) than non-obese patients undergoing laparotomies. Conclusions Obesity is associated with increased mortality in abdominal trauma patients who received laparotomies versus those who did not. Obesity requires a careful evaluation of alternatives to laparotomy in injured patients. Electronic supplementary material The online version of this article (10.1007/s00268-019-05268-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chih-Yuan Fu
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 1950 West Polk Street, 8th floor, Chicago, IL 60612 USA
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyüan, Taiwan
| | - Francesco Bajani
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 1950 West Polk Street, 8th floor, Chicago, IL 60612 USA
| | - Marissa Bokhari
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 1950 West Polk Street, 8th floor, Chicago, IL 60612 USA
| | - Leah C. Tatebe
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 1950 West Polk Street, 8th floor, Chicago, IL 60612 USA
| | - Frederick Starr
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 1950 West Polk Street, 8th floor, Chicago, IL 60612 USA
| | - Thomas Messer
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 1950 West Polk Street, 8th floor, Chicago, IL 60612 USA
| | - Matthew Kaminsky
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 1950 West Polk Street, 8th floor, Chicago, IL 60612 USA
| | - Andrew Dennis
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 1950 West Polk Street, 8th floor, Chicago, IL 60612 USA
| | - Victoria Schlanser
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 1950 West Polk Street, 8th floor, Chicago, IL 60612 USA
| | - Justin Mis
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 1950 West Polk Street, 8th floor, Chicago, IL 60612 USA
| | - Rubinder Toor
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 1950 West Polk Street, 8th floor, Chicago, IL 60612 USA
| | - Stathis Poulakidas
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 1950 West Polk Street, 8th floor, Chicago, IL 60612 USA
| | - Faran Bokhari
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 1950 West Polk Street, 8th floor, Chicago, IL 60612 USA
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Fu CY, Bajani F, Bokhari M, Butler C, Starr F, Messer T, Kaminsky M, Dennis A, Schlanser V, Poulakidas S, Mis J, Bokhari F. Association between Torso Gunshot Wound Volumes of Trauma Centers and Outcomes of Torso Gunshot Wound Patients. A Propensity-Matched Nationwide Cohort Study. PREHOSP EMERG CARE 2020; 25:731-739. [PMID: 33211620 DOI: 10.1080/10903127.2020.1852353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objective: The number and type of patients treated by trauma centers can vary widely because of a number of factors. There might be trauma centers with a high volume of torso GSWs that are not designated as high-level trauma centers. We proposed that, for torso gunshot wounds (GSWs), the treating hospital's trauma volume and not its trauma center level designation drives patient prognosis.Methods: The National Trauma Data Bank was queried for torso GSWs. The characteristics of torso GSWs in trauma centers with different volumes of torso GSWs were compared. The association between torso GSW volumes of trauma centers and the outcomes of torso GSWs were evaluated with propensity score matching (PSM) and multivariate logistic regression (MLR) analysis.Results: There were 618 trauma centers that treated 14,804 torso GSW patients in two years (2014-2015). In 191 level I trauma centers, 82 of them (42.9%, 82/191) treated <1 torso GSW per month. After well-balanced PSM, patients who were treated in higher volume trauma centers (≥9 torso GSWs/month) had a significantly lower mortality rate (7.9% vs. 9.7%). Patients treated in trauma centers with ≥9 torso GSWs/month had a 30.9% (odds ratio = 0.764) lower probability of death than if sent to trauma centers with <9 torso GSWs/month. Treatment in level I or II trauma centers did not significantly affect mortality.Conclusion: There is an uneven distribution of torso GSWs among trauma centers. Torso GSWs treated in trauma centers with ≥9 torso GSWs/month have significantly superior outcomes with regard to survival.
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Saadat GH, Toor R, Mazhar F, Bajani F, Tatebe L, Schlanser V, Kaminsky M, Messer T, Starr F, Dennis A, Poulakidas S, Bokhari F. Severe burn injury: Body Mass Index and the Baux score. Burns 2020; 47:72-77. [PMID: 33234365 DOI: 10.1016/j.burns.2020.10.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 10/23/2020] [Accepted: 10/29/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The revised Baux score (age total body surface area (TBSA) burned and inhalation injury)) is predictive of mortality in burn patients. Our study objective was to assess whether the addition of body mass index (BMI) to the revised Baux score would be of value. We posited that increasing BMI follows a pattern similar to age and TBSA in the revised Baux score after severe burn injury. METHODS Patient data from the burn registry was queried for patients admitted between 1/1/2013 to 8/31/2019. Patients 12 years or older with a TBSA of 20% or greater burn were included. Inpatient outcomes were analyzed based on BMI. RESULTS 56 of 1365 patients met inclusion criteria. Mean age of the study population was 48.25 years and 64.3% of patients were male. Median BMI was 25.8 and median TBSA was 26.5. Inhalation injury was present in 44.6% (25/56) of patients. Median hospital length of stay (LOS) and ICU LOS were 21.5 and 17 days respectively. On bivariate analysis, non-survivors had higher TBSA (41.5% vs 25.5%, p = 0.034), more inhalation injury (83.3%, 10/12 vs 34.8%, 15/43 p = 0.003) and higher complication rates (91.6%, 11/12 vs 59.1 %, 25/43, p = 0.043). Survivors also had higher BMI (28.2 vs 23, p = 0.003) and increased hospital LOS (24 vs 5.5, p = 0.003). Automatic model fit in binary logistic regression showed a negative relationship between BMI and mortality. CONCLUSION We found a negative relationship between BMI and mortality. Pre-obesity appears to have a protective role, but BMI was not found to be a useful addition to the revised Baux score. Larger sample sizes may be of benefit a for a for a more definitive understanding of the role of BMI with regards to burn survival.
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Affiliation(s)
- Ghulam H Saadat
- Department of Trauma and Burn Surgery, Cook County Health, 1950 W Polk St, 8th Floor, Chicago, IL, 60612, United States.
| | - Rubinder Toor
- Department of Trauma and Burn Surgery, Cook County Health, 1950 W Polk St, 8th Floor, Chicago, IL, 60612, United States.
| | - Faizan Mazhar
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, University of Milan, Milan, Italy.
| | - Francesco Bajani
- Department of Trauma and Burn Surgery, Cook County Health, 1950 W Polk St, 8th Floor, Chicago, IL, 60612, United States.
| | - Leah Tatebe
- Department of Trauma and Burn Surgery, Cook County Health, 1950 W Polk St, 8th Floor, Chicago, IL, 60612, United States.
| | - Victoria Schlanser
- Department of Trauma and Burn Surgery, Cook County Health, 1950 W Polk St, 8th Floor, Chicago, IL, 60612, United States.
| | - Matthew Kaminsky
- Department of Trauma and Burn Surgery, Cook County Health, 1950 W Polk St, 8th Floor, Chicago, IL, 60612, United States.
| | - Thomas Messer
- Department of Trauma and Burn Surgery, Cook County Health, 1950 W Polk St, 8th Floor, Chicago, IL, 60612, United States.
| | - Frederic Starr
- Department of Trauma and Burn Surgery, Cook County Health, 1950 W Polk St, 8th Floor, Chicago, IL, 60612, United States.
| | - Andrew Dennis
- Department of Trauma and Burn Surgery, Cook County Health, 1950 W Polk St, 8th Floor, Chicago, IL, 60612, United States.
| | - Stathis Poulakidas
- Department of Trauma and Burn Surgery, Cook County Health, 1950 W Polk St, 8th Floor, Chicago, IL, 60612, United States.
| | - Faran Bokhari
- Department of Trauma and Burn Surgery, Cook County Health, 1950 W Polk St, 8th Floor, Chicago, IL, 60612, United States.
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Colosimo C, Yon JR, Fredericks C, Kingsley S, Gupta S, Mentzer CJ, Bokhari F, Poulakidas S. Obesity is Not Associated With Need for Skin Grafting After Hidradenitis Excision. Am Surg 2020; 87:458-462. [PMID: 33047967 DOI: 10.1177/0003134820950686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a chronic, debilitating disease associated with inflammation, recurrent abscesses, and fistulae of skin containing apocrine sweat glands. We hypothesize that the need for skin grafting after vacuum-assisted closure was decreased with increasing body mass index (BMI). METHODS Seventy-one consecutive patients with excisions for HS were retrospectively evaluated for demographic data, number of excisions, the total area of excised skin, need for skin grafting, and BMI. Patients were stratified for BMI and underwent logistic regression to compare all other variables. RESULTS Average for BMI was 30.8 ± 7.72, age was 36.89 ±13.52, area excised was 743 cm2 ± 774 cm2, mean operating room trips were 2.62 ± 1.59, and skin grafting was 0.52 ± 0.55. Patients were 60% male. Forty out of 71 patients were obese. There was no correlation between age, BMI, sex, thenumber of excisions, amount of skin excised, or need for a skin graft. There was a statistically significant relationship between the amount of skin excised and the need for skin grafting (P = .006). CONCLUSIONS The amount of skin affected by HS appears to be independent of patient BMI. The need for skin grafting is solely dependent upon the amount of tissue excised. APPLICABILITY OF RESEARCH TO PRACTICE This knowledge will help preoperative planning for all patients with HS, regardless of BMI.
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Affiliation(s)
| | - James R Yon
- Department of Trauma and Acute Care Surgery, Swedish Medical Center, Englewood, CO, USA
| | - Charles Fredericks
- Division of Trauma, Acute Care, and General Surgery, UC Davis Medical Center, Sacramento, CA, USA
| | - Samuel Kingsley
- Department of Trauma and Burn, John H. Stroger, Jr, Hospital of Cook County, Chicago, IL, USA
| | - Sameer Gupta
- Department of Trauma and Burn, John H. Stroger, Jr, Hospital of Cook County, Chicago, IL, USA
| | - Caleb J Mentzer
- Division of Trauma, Critical Care & Acute Care Surgery, Spartanburg Medical Center, Spartanburg, SC, USA
| | - Faran Bokhari
- Department of Trauma and Burn, John H. Stroger, Jr, Hospital of Cook County, Chicago, IL, USA
| | - Stathis Poulakidas
- Department of Trauma and Burn, John H. Stroger, Jr, Hospital of Cook County, Chicago, IL, USA
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Colosimo C, Fredericks C, Yon JR, Kubasiak JC, Bokhari F, Poulakidas S. Damage control hip disarticulation: two-stage operation with index creation of a large medial flap for the septic hip. Trauma Surg Acute Care Open 2020; 5:e000502. [PMID: 32923682 PMCID: PMC7467553 DOI: 10.1136/tsaco-2020-000502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/11/2020] [Accepted: 08/05/2020] [Indexed: 01/09/2023] Open
Abstract
Background Although rarely performed, hip disarticulation (HD) is usually used for the patient with a non-viable leg who is also in extremis. HD was first used for trauma and infection; however, the technique was perfected during the age of hindquarter amputation for osteosarcomas. The operation performed by most surgeons today is still based on the oncological principles of high vessel control and ligation. When this approach has been used in the overwhelmingly infected or mangled extremity, it has resulted in high mortality rates. During the last 20 years, the concept of damage control operation has been embraced by emergency surgeons in all fields. We sought to extrapolate this concept and to apply it to the non-viable lower extremity. Methods We describe a new concept of damage control HD, review the technique and discuss our consecutive series of nine patients who underwent the procedure for trauma or necrotizing infection without flap dehiscence or mortality. Results All patients survived to hospital discharge. At time of discharge or at follow-up, six of the nine patients were able to transfer to a wheelchair. Discussion Proper disarticulations for infection need to address these two operative and postoperative issues: damage control debridement with creation of sufficient flap size and thorough postoperative wound care.Level IV.
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Affiliation(s)
- Christina Colosimo
- Department of Trauma, Sky Ridge Medical Center, Lone Tree, Colorado, USA
| | - Charles Fredericks
- Department of General Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - James R Yon
- Department of Trauma and Acute Care Surgery, Swedish Medical Center, Englewood, Colorado, USA
| | - John C Kubasiak
- Department of General Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Faran Bokhari
- Department of Trauma And Burn, John H Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Stathis Poulakidas
- Department of Trauma And Burn, John H Stroger Hospital of Cook County, Chicago, Illinois, USA
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Yon JR, Fredericks C, Mentzer C, Kubasiak JC, Poulakidas S. The end of the assembly line: Shifting patterns of automotive burns. Burns 2020; 47:728-732. [PMID: 33153813 DOI: 10.1016/j.burns.2020.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 08/15/2020] [Accepted: 08/31/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION As recently as 2006, carburetor flash burns comprised as much as 27% of admissions for car-related burns, despite the fact carburetors were last installed in pre-1990 automobiles. The prevalence of this injury pattern is related to the estimated 14 million cars on the road today that were manufactured prior to that year. The aim of this study was to investigate modern sources of automotive burns and describe any new trends in automotive burn-related epidemiology. MATERIALS AND METHODS A retrospective review was conducted of all burn admissions from the years 2009-2013 to identify patients who suffered automotive-related burns. Pediatric patients (<18 years old) were excluded. Demographic information including age, gender, mechanism of injury, occupation, TBSA, number of operations, and length of hospital stay were recorded. RESULTS From 2009-2013, the burn center saw 83 admissions for automotive-related burns. 14.5% of patients were mechanics. The most common injury pattern was from radiator burns (47%), followed by gasoline related burns (30%). There were only two carburetor burns (2.4%). 67.4% of patients were treated for less than two hospital days and there was one death (1.2% mortality). CONCLUSION Despite the removal of carburetors from engines and a decrease in this specific mechanism, a significant morbidity remains with gasoline-inflicted burns. More public awareness is needed for the safe removal of radiator caps and handling of chemicals in overheating engines.
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Affiliation(s)
- James R Yon
- Department of Trauma and Acute Care Surgery, Swedish Medical Center, Englewood, CO, United States.
| | - Charles Fredericks
- Division of Trauma, Acute Care, and General Surgery, UC Davis Medical Center, Sacramento, CA, United States
| | - Caleb Mentzer
- Division of Trauma, Critical Care & Acute Care Surgery, Spartanburg Medical Center, Spartanburg, SC, United States
| | - John C Kubasiak
- Department of Burn, Trauma and Surgical Critical Care, Brigham and Women's Hospital, Boston, MA, United States
| | - Stathis Poulakidas
- Department of Trauma and Burn, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, United States
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Chang J, Hejna E, Fu CY, Bajani F, Tatabe L, Schlanser V, Kaminsky M, Dennis A, Starr F, Messer T, Poulakidas S, Bokhari F. Patients With Combined Thermal and Intraabdominal Injuries: More Salvageable Than Not. J Burn Care Res 2020; 41:835-840. [PMID: 32266403 DOI: 10.1093/jbcr/iraa052] [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: 11/13/2022]
Abstract
This study aims to better characterize the course and outcome of the uncommon subset of trauma patients with combined thermal and intraabdominal organ injuries. The National Trauma Data Bank was queried for burn patients with intraabdominal injury treated in all U.S. trauma centers from July 1, 2011 to June 30, 2015. General demographics, Glasgow coma scale (GCS), shock index (SI), Abbreviated Injury Scale (AIS) for burn, Injury Severity Score (ISS), blood transfusions, and abdominal surgery were evaluated. During the 5-year study period, there were 334 burn patients with intraabdominal injury, 39 (13.2%) of which received abdominal surgery. Burn patients who underwent operations had more severe injuries reflected by higher SI, AIS, ISS, blood transfusion, and worse outcomes including higher mortality, longer hospital and ICU length of stay, and more ventilator days compared to patients who did not undergo an operation. Nonsurvivors also exhibited more severe injuries, and a higher proportion received abdominal operation compared to survivors. Multivariate logistic regression analysis revealed that GCS on arrival, SI, AIS, ISS, blood transfusion, and abdominal operation to be independent risk factors for mortality. Propensity score matching to control covariables (mean age, systolic blood pressure on arrival, GCS on arrival, SI, ISS, time to operation, blood transfusion, and comorbidities) showed that of trauma patients who received abdominal operation, those with concomitant burn injury exhibited a higher rate of complications but no significant difference in mortality compared to those without burns, suggesting that patients with concomitant burns are not less salvageable than nonburned trauma patients.
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Affiliation(s)
- Jaimie Chang
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois
| | - Emily Hejna
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois
| | - Chih-Yuan Fu
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois.,Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taiwan
| | - Francesco Bajani
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois
| | - Leah Tatabe
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois
| | - Victoria Schlanser
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois
| | - Matthew Kaminsky
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois
| | - Andrew Dennis
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois
| | - Frederick Starr
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois
| | - Thomas Messer
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois
| | - Stathis Poulakidas
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois
| | - Faran Bokhari
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois
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Fu CY, Bajani F, Bokhari M, Tatebe LC, Starr F, Messer T, Kaminsky M, Dennis A, Schlanser V, Mis J, Toor R, Poulakidas S, Bokhari F. Authors' Reply: Obesity is Associated with Worse Outcomes Among Abdominal Trauma Patients Undergoing Laparotomy: A Propensity-Matched Nationwide Cohort Study. World J Surg 2020; 44:2828-2831. [PMID: 32458020 DOI: 10.1007/s00268-020-05576-1] [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: 11/29/2022]
Affiliation(s)
- Chih-Yuan Fu
- Department of Trauma and Burn, Cook County Health, 1950 W Polk St., Chicago, IL, 60612, USA
| | - Francesco Bajani
- Department of Trauma and Burn, Cook County Health, 1950 W Polk St., Chicago, IL, 60612, USA
| | - Marissa Bokhari
- Department of Trauma and Burn, Cook County Health, 1950 W Polk St., Chicago, IL, 60612, USA
| | - Leah C Tatebe
- Department of Trauma and Burn, Cook County Health, 1950 W Polk St., Chicago, IL, 60612, USA
| | - Frederic Starr
- Department of Trauma and Burn, Cook County Health, 1950 W Polk St., Chicago, IL, 60612, USA
| | - Thomas Messer
- Department of Trauma and Burn, Cook County Health, 1950 W Polk St., Chicago, IL, 60612, USA
| | - Matthew Kaminsky
- Department of Trauma and Burn, Cook County Health, 1950 W Polk St., Chicago, IL, 60612, USA
| | - Andrew Dennis
- Department of Trauma and Burn, Cook County Health, 1950 W Polk St., Chicago, IL, 60612, USA
| | - Victoria Schlanser
- Department of Trauma and Burn, Cook County Health, 1950 W Polk St., Chicago, IL, 60612, USA
| | - Justin Mis
- Department of Trauma and Burn, Cook County Health, 1950 W Polk St., Chicago, IL, 60612, USA
| | - Rubinder Toor
- Department of Trauma and Burn, Cook County Health, 1950 W Polk St., Chicago, IL, 60612, USA
| | - Stathis Poulakidas
- Department of Trauma and Burn, Cook County Health, 1950 W Polk St., Chicago, IL, 60612, USA
| | - Faran Bokhari
- Department of Trauma and Burn, Cook County Health, 1950 W Polk St., Chicago, IL, 60612, USA.
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Fu CY, Bajani F, Bokhari M, Butler C, Starr F, Messer T, Kaminsky M, Tatebe LC, Dennis A, Schlanser V, Poulakidas S, Cheng CT, Toor R, Mis J, Bokhari F. Obesity May Require a Higher Level of Trauma Care: A Propensity-Matched Nationwide Cohort Study. PREHOSP EMERG CARE 2020; 25:361-369. [PMID: 32286928 DOI: 10.1080/10903127.2020.1755754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Stable patients with less severe injuries are not necessarily triaged to high-level trauma centers according to current guidelines. Obese patients are prone to comorbidities and complications. We hypothesized that stable obese patients with low-energy trauma have lower mortality and fewer complications if treated at Level-I/II trauma centers. Methods: Blunt abdominal trauma (BAT) patients with systolic blood pressures ≥90mmHg, Glasgow coma scale ≥14, and respiratory rates at 10-29 were derived from the National Trauma Data Bank between 2013-2015. Per current triage guidelines, these patients are not necessarily triaged to high-level trauma centers. The relationship between obesity and mortality of stable BAT patients was analyzed. A subset analysis of patients with injury severity scores (ISS) <16 was performed with propensity score matching (PSM) to evaluate outcomes between Level-I/II and Level-III/IV trauma centers. Outcomes of obese patients were compared between Level-I/II and Level-III/IV trauma centers. Non-obese patients were analyzed as a control group using a similar PSM cohort analysis. Results: 48,043 stable BAT patients in 707 trauma centers were evaluated. Non-survivors had a significantly higher body mass index (BMI) (28.7 vs. 26.9, p < 0.001) and higher proportion of obesity (35.6% vs. 26.5%, p < 0.001) than survivors. After a PSM (1,502 obese patients: 751 in Level-I/II trauma centers and 751 in Level-III/IV trauma centers), obese patients treated in Level-I/II trauma centers had significantly lower complication rates than obese patients treated in other trauma centers (20.2% vs. 26.6%, standardized difference = 0.151). The complication rate of obese patients treated at Level-I/II trauma centers was 20.6% lower than obese patients treated at other trauma centers. Conclusion: Obesity plays a role in the mortality of stable BAT patients. Obese patients with ISS < 16 have lower complication rates at Level-I/II trauma centers compared to obese patients treated at other trauma centers. Obesity may be a consideration for triaging to Level-I/II trauma centers.
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Abstract
Abstract
Despite the fact that obesity is a known risk factor for comorbidities and complications, there is evidence suggesting a survival advantage for patients classified by body mass index (BMI) as overweight or obese. Investigated in various clinical areas, this “Obesity Paradox” has yet to be explored in the burn patient population. We sought to clarify whether this paradigm exists in burn patients. Data collected on 519 adult patients admitted to an American Burn Association Verified Burn Center between 2009 and 2017 was utilized. Univariable and multivariable logistic regression were used to determine the association between in-hospital mortality and BMI classifications (underweight <18.5 kg/m2, normal 18.5 to 24.9 kg/m2, overweight 25–29.9 kg/m2, obesity class I 30 to 34.9 kg/m2, obesity class II 35 to 39.9 kg/m2, and extreme obesity >40 kg/m2). For every kg/m2 increase in BMI, the odds of death decreased, with an adjusted odds ratio of 0.856 (95% confidence interval [CI] 0.767 to 0.956). When adjusted for total BSA (TBSA), being obesity class I was associated with an adjusted odds ratio of mortality of 0.0166 (95% CI 0.000332 to 0.833). The adjusted odds ratio for mortality for underweight patients was 4.13 (95% CI 0.416 to 41.055). There was no statistically significant difference in odds of mortality between the normal and overweight BMI categories. In conclusion, the obesity paradox exists in burn care: further investigation is needed to elucidate what specific phenotypic aspects confer this benefit and how these can enhance the care of burn patients.
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Xu TQ, Esmaeeli S, Kramer KZ, Wiegmann AL, Koeck E, Garcia MS, Tsai J, Bokhari F, Severin PN, Poulakidas S. Use of Ketamine for Moderate and Deep Sedation in Pediatric Burn Patients. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fu CY, Bajani F, Butler C, Welsh S, Messer T, Kaminsky M, Starr F, Dennis A, Schlanser V, Mis J, Poulakidas S, Bokhari F. Morbid Obesity's Silver Lining: An Armor for Hollow Viscus in Blunt Abdominal Trauma. World J Surg 2019; 43:1007-1013. [PMID: 30478685 DOI: 10.1007/s00268-018-4872-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Morbid obesity is usually accompanied by both subcutaneous and visceral fat accumulation. Fat can mimic an air bag, absorbing the force of a collision. We hypothesized that morbid obesity is mechanically protective for hollow viscus organs in blunt abdominal trauma (BAT). METHODS The National Trauma Data Bank (NTDB) was queried for BAT patients from 2013 to 2015. We looked at the rate of gastrointestinal (GI) tract injuries in all BAT patients with different BMIs. A subset analysis of BAT patients with operative GI tract injuries was performed to evaluate the need for abdominal operation. Multivariate analyses were carried out to identify factors independently associated with increased GI tract injuries and associated abdominal operations. RESULTS A total of 100,459 BAT patients were evaluated in the NTDB. Patients with GI tract injury had a lower proportion of morbidly obese patients [body weight index (BMI) ≥ 40 kg/m2)] (3.7% vs. 4.2%, p = 0.015) and instead had more underweight patients (BMI < 18.5) (5.9% vs. 5.0%, p < 0.001). The risk of GI tract injury decreased 11.6% independently in morbidly obese patients and increased 15.7% in underweight patients. Of the patients with GI tract injuries (N = 11,467), patients who needed a GI operation had a significantly lower proportion of morbidly obese patients (3.2% vs. 5.3%, p < 0.001). The risk of abdominal operation for GI tract injury decreased 57.3% independently in morbidly obese patients. Compared with underweight patients, morbidly obese patients had significantly less GI tract injury (6.0% vs. 13.3%, p < 0.001) and associated abdominal operation rates (65.2% vs. 73.3%, p < 0.001). CONCLUSION Obesity is protective in BAT. This translates into lower rates of GI tract injury and operation in morbidly obese patients. In contrast, underweight patients appear to suffer a higher rate of GI tract injury and associated GI operations.
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Affiliation(s)
- Chih-Yuan Fu
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Cook County Health and Hospital System and Rush University, 1950 West Polk Street, 8th floor, Chicago, IL, 60612, USA.,Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Francesco Bajani
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Cook County Health and Hospital System and Rush University, 1950 West Polk Street, 8th floor, Chicago, IL, 60612, USA
| | - Caroline Butler
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Cook County Health and Hospital System and Rush University, 1950 West Polk Street, 8th floor, Chicago, IL, 60612, USA
| | - Stanley Welsh
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Cook County Health and Hospital System and Rush University, 1950 West Polk Street, 8th floor, Chicago, IL, 60612, USA
| | - Thomas Messer
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Cook County Health and Hospital System and Rush University, 1950 West Polk Street, 8th floor, Chicago, IL, 60612, USA
| | - Matthew Kaminsky
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Cook County Health and Hospital System and Rush University, 1950 West Polk Street, 8th floor, Chicago, IL, 60612, USA
| | - Frederick Starr
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Cook County Health and Hospital System and Rush University, 1950 West Polk Street, 8th floor, Chicago, IL, 60612, USA
| | - Andrew Dennis
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Cook County Health and Hospital System and Rush University, 1950 West Polk Street, 8th floor, Chicago, IL, 60612, USA
| | - Victoria Schlanser
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Cook County Health and Hospital System and Rush University, 1950 West Polk Street, 8th floor, Chicago, IL, 60612, USA
| | - Justin Mis
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Cook County Health and Hospital System and Rush University, 1950 West Polk Street, 8th floor, Chicago, IL, 60612, USA
| | - Stathis Poulakidas
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Cook County Health and Hospital System and Rush University, 1950 West Polk Street, 8th floor, Chicago, IL, 60612, USA
| | - Faran Bokhari
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Cook County Health and Hospital System and Rush University, 1950 West Polk Street, 8th floor, Chicago, IL, 60612, USA.
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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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Fu CY, Bajani F, Tatebe L, Butler C, Starr F, Dennis A, Kaminsky M, Messer T, Schlanser V, Kramer K, Poulakidas S, Cheng CT, Mis J, Bokhari F. Right hospital, right patients: Penetrating injury patients treated at high-volume penetrating trauma centers have lower mortality. J Trauma Acute Care Surg 2019; 86:961-966. [PMID: 31124893 DOI: 10.1097/ta.0000000000002245] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 11/27/2022]
Abstract
BACKGROUND The recognition of the relationship between volume and outcomes led to the regionalization of trauma care. The relationship between trauma mechanism-subtype and outcomes has yet to be explored. We hypothesized that trauma centers with a high volume of penetrating trauma patients might be associated with a higher survival rate for penetrating trauma patients. METHODS A retrospective cohort analysis of penetrating trauma patients presenting between 2011 and 2015 was conducted using the National Trauma Database and the trauma registry at the Stroger Cook County Hospital. Linear regression was used to determine the relationship between mortality and the annual volume of penetrating trauma seen by the treating hospital. RESULTS Nationally, penetrating injuries account for 9.5% of the trauma cases treated. Patients treated within the top quartile penetrating-volume hospitals (≥167 penetrating cases per annum) are more severely injured (Injury Severity Score: 8.9 vs. 7.7) than those treated at the lowest quartile penetrating volume centers (<36.6 patients per annum). There was a lower mortality rate at institutions that treated high numbers of penetrating trauma patients per annum. A penetrating trauma mortality risk adjustment model showed that the volume of penetrating trauma patients was an independent factor associated with survival rate. CONCLUSION Trauma centers with high penetrating trauma patient volumes are associated with improved survival of these patients. This association with improved survival does not hold true for the total trauma volume at a center but is specific to the volume of the penetrating trauma subtype. LEVEL OF EVIDENCE Prognostic/Epidemiology Study, Level-III; Therapeutic/Care Management, Level IV.
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Affiliation(s)
- Chih-Yuan Fu
- From the Department of Trauma and Burn Surgery (C-Y.F., F.B., L.T., C.B., F.S., A.D., M.K., T.M., V.S., K.K., S.P. C-T.C., J.M., F.B.), Stroger Hospital of Cook County, Rush University, Chicago, Illinois; and Department of Trauma and Emergency Surgery (C-Y.F., C-T.C.), Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
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Alterie J, Dennis AJ, Baig A, Impens A, Ivkovic K, Joseph KT, Messer TA, Poulakidas S, Starr FL, Wiley DE, Bokhari F, Nagy KK. Does Pain Have a Role When It Comes to Tourniquet Training? J Spec Oper Med 2018; 18:71-74. [PMID: 30222841 DOI: 10.55460/yc9f-gmu1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/01/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND One of the greatest conundrums with tourniquet (TQ) education is the use of an appropriate surrogate of hemorrhage in the training setting to determine whether a TQ has been successfully used. At our facility, we currently use loss of audible Doppler signal or loss of palpable pulse to represent adequate occlusion of vasculature and thus successful TQ application. We set out to determine whether pain can be used to indicate successful TQ application in the training setting. METHODS Three tourniquet systems (a pneumatic tourniquet, Combat Application Tourniquet® [C-A-T], and Stretch Wrap and Tuck Tourniquet™ [SWAT-T]) were used to occlude the arterial vasculature of the left upper arm (LUA), right upper arm (RUA), left forearm (LFA), right forearm (RFA), right thigh (RTH), and right calf (RCA) of 41 volunteers. A 4MHz, handheld Doppler ultrasound was used to confirm loss of Doppler signal (LOS) at the radial or posterior tibial artery to denote successful TQ application. Once successful placement of the TQ was noted, subjects rated their pain from 0 to 10 on the visual analog scale. In addition, the circumference of each limb, the pressure with the pneumatic TQ, number of twists with the C-A-T, and length of TQ used for the SWAT-T to obtain LOS was recorded. RESULTS All 41 subjects had measurements at all anatomic sites with the pneumatic TQ, except one participant who was unable to complete the LUA. In total, pain was rated as 1 or less by 61% of subjects for LUA, 50% for LFA, 57.5% for RUA, 52.5% RFA, 15% for RTH, and 25% for RCA. Pain was rated 3 or 4 by 45% of subjects for RTH. For the C-A-T, data were collected from 40 participants. In total, pain was rated as 1 or less by 57.5% for the LUA, 70% for the LFA, 62.5% for the RUA, 75% for the RFA, 15% for the RTH, and 40% for the RCA. Pain was rated 3 or 4 by 42.5%. The SWAT-T group consisted of 37 participants for all anatomic locations. In total, pain was rated as 1 or less by 27% for LUA, 40.5% for the LFA, 27.0% for the RUA, 43.2 for the RFA, 18.9% for the RTH, and 16.2% for the RCA. Pain was rated 5 by 21.6% for RTH application, and 3 or 4 by 35%. CONCLUSION The unexpected low pain values recorded when loss of signal was reached make the use of pain too sensitive as an indicator to confirm adequate occlusion of vasculature and, thus, successful TQ application.
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Schlanser V, Dennis A, Ivkovic K, Joseph K, Kaminsky M, Messer T, Poulakidas S, Starr F, Bokhari F. Placenta to the Rescue: Limb Salvage Using Dehydrated Human Amnion/Chorion Membrane. J Burn Care Res 2017; 39:1048-1052. [DOI: 10.1093/jbcr/irx031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Victoria Schlanser
- Department of Trauma and Burn, Cook County Health and Hospital Systems, Chicago, Illinois
| | - Andrew Dennis
- Department of Trauma and Burn, Cook County Health and Hospital Systems, Chicago, Illinois
| | - Katarina Ivkovic
- Institute for Healthcare Innovation at Midwestern University, Downers Grove, Illinois
| | - Kimberly Joseph
- Department of Trauma and Burn, Cook County Health and Hospital Systems, Chicago, Illinois
| | - Matthew Kaminsky
- Department of Trauma and Burn, Cook County Health and Hospital Systems, Chicago, Illinois
| | - Thomas Messer
- Department of Trauma and Burn, Cook County Health and Hospital Systems, Chicago, Illinois
| | - Stathis Poulakidas
- Department of Trauma and Burn, Cook County Health and Hospital Systems, Chicago, Illinois
| | - Frederic Starr
- Department of Trauma and Burn, Cook County Health and Hospital Systems, Chicago, Illinois
| | - Faran Bokhari
- Department of Trauma and Burn, Cook County Health and Hospital Systems, Chicago, Illinois
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Fredericks C, Yon JR, Alex G, Morton M, Messer T, Bokhari F, Poulakidas S. Levamisole-induced Necrosis Syndrome: Presentation and Management. Wounds 2017; 29:71-76. [PMID: 28355139] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Levamisole is an antihelminthic drug with immunomod- ulatory properties. Recent estimates suggest the majority of the cocaine in the United States is adulterated with levamisole. Le- vamisole-induced necrosis syndrome (LINES) is characterized by vasculitis, neutropenia, and purpura that progresses to skin necro- sis. Diagnosis relies on physical examination ndings and history of previous cocaine use. The purpose of this case series is to describe the pathophysiology, diagnosis, and management of LINES. The au- thors' institutional database was reviewed from 2008 to 2015, and they found 3 patients with LINES. Subsequent management and outcomes data are discussed. Patients had a variety of outcomes ranging from local wound care to necrosis and amputation of pha- langes. Patients with LINES can have a wide variety of outcomes; thus, this syndrome must be aggressively managed. Psychotherapy should also be utilized to help patients with further cocaine use. Levamisole-induced necrosis syndrome incidence is expected to in- crease, and all providers should be aware of this patient population.
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Affiliation(s)
- Charles Fredericks
- Department of General Surgery, Rush University Medical Center, Chicago, IL
| | - James R Yon
- Department of Trauma and Burn, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | - Gillian Alex
- Department of General Surgery, Rush University Medical Center, Chicago, IL
| | - Molly Morton
- Department of General Surgery, Rush University Medical Center, Chicago, IL
| | - Thomas Messer
- Department of Trauma and Burn, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | - Faran Bokhari
- Department of Trauma and Burn, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | - Stathis Poulakidas
- Department of Trauma and Burn, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
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Dennis AJ, Salabat R, Kingsley S, Starr F, Joseph K, Wiley D, Messer T, Poulakidas S, Nagy KK, Bokhari F. Trans Abdominal Wall Traction as a universal solution to the management of giant ventral hernias. J Am Coll Surg 2014. [DOI: 10.1016/j.jamcollsurg.2014.07.909] [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: 11/24/2022]
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Saeed K, Best C, Sullivan CM, Poulakidas S, Dysico GL. Poster 59 Acupuncture Treatment for Scar Release After Traumatic Burn to the Lower Extremity: A Case Report. PM R 2014. [DOI: 10.1016/j.pmrj.2014.08.454] [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: 11/17/2022]
Affiliation(s)
- Kashif Saeed
- Rush University Medical Center, Chicago, IL, United States
| | - Craig Best
- Rush University Medical Center, Chicago, IL, United States
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Kowal-Vem A, Poulakidas S, Barnett B, Conway D, Culver D, Ferrari M, Potenza B, Koenig M, Mah J, Majewski M, Morris L, Powers J, Stokes E, Tan M, Salstrom SJ, Zaletel C, Ambutas S, Casey K, Stein J, DeSane M, Berry K, Konz EC, Riemer MR, Cullum ME. Fecal containment in bedridden patients: economic impact of 2 commercial bowel catheter systems. Am J Crit Care 2009; 18:S2-14: quiz S15. [PMID: 19623696 DOI: 10.4037/ajcc2009521] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [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: 11/01/2022]
Abstract
BACKGROUND Fecal contamination is a major challenge in patients in acute/critical care settings that is associated with increased cost of care and supplies and with development of pressure ulcers, incontinence dermatitis, skin and soft tissue infections, and urinary tract infections. OBJECTIVES To assess the economic impact of fecal containment in bedridden patients using 2 different indwelling bowel catheters and to compare infection rates between groups. METHODS A multicenter, observational study was done at 12 US sites (7 that use catheter A, 5 that use catheter B). Patients were followed from insertion of an indwelling bowel catheter system until the patient left the acute/critical care unit or until 29 days after enrollment, whichever came first. Demographic data, frequency of bedding/dressing changes, incidence of infection, and Braden scores (risk of pressure ulcers) were recorded. RESULTS The study included 146 bedridden patients (76 with catheter A, 70 with catheter B) who had similar Braden scores at enrollment. The rate of bedding/dressing changes per day differed significantly between groups (1.20 for catheter A vs 1.71 for catheter B; P = .004). According to a formula that accounted for personnel resources and laundry cycle costs, catheter A cost $13.94 less per patient per day to use than did catheter B. Catheter A was less likely than was catheter B to be removed during the observational period (P = .03). Observed infection rates were low. CONCLUSION Catheter A may be more cost-effective than catheter B because it requires fewer unscheduled linen changes per patient day.
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Affiliation(s)
- Areta Kowal-Vem
- John H. Stroger Hospital, Cook County, Chicago, Illinois, USA
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Eckert MJ, Davis KA, Reed RL, Esposito TJ, Santaniello JM, Poulakidas S, Gamelli RL, Luchette FA. Ventilator-associated pneumonia, like real estate: location really matters. ACTA ACUST UNITED AC 2006; 60:104-10; discussion 110. [PMID: 16456443 DOI: 10.1097/01.ta.0000197376.98296.7c] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [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
INTRODUCTION Previous work has demonstrated an increased risk of ventilator-associated pneumonia (VAP) in trauma patients after prehospital (field) intubation as compared with emergency department (ED) intubations. However, this population was not compared with patients intubated as inpatients, making data interpretation difficult. We sought to further examine predictors for the development of VAP after trauma. METHODS A 10-year retrospective review of all patients mechanically ventilated greater than 24 hours after injury was performed. RESULTS In all, 1,628 patients were identified, of which 1,213 (75%) were intubated as inpatients and 415 were emergently intubated (353 ED, 62 field). Overall, those intubated emergently were younger (p = 0.03) and less injured as seen by higher Glasgow Coma Scale scores (p = 0.0002), lower Injury Severity Scores (p = 0.01) and higher Revised Trauma Scores (p < 0.0001). Despite a lower injury severity, those patients emergently intubated were more likely to develop pneumonia as 22% of ED intubations and 15% of field intubations developed pneumonia, as compared with the inpatient rate of 6.5%. Pneumonia after field intubation was more likely to be community-acquired (p < 0.0001) with a significantly lower percentage of infecting enteric gram-negative rods (p < 0.0001) as compared with the inpatient and ED groups. Forward logistic regression analysis (with VAP = 1) identified inpatient intubation as protective against VAP (odds ratio 0.28, 95% CI = 0.2-0.4). Backwards logistic regression analysis further identified both field airway (odds ratio 2.29, 95% CI = 1.1-4.9) and ED airway (odds ratio 3.61, 95% CI = 2.5-5.2) as predictive of VAP. CONCLUSIONS Compared with a population of trauma patients as inpatients, and excluding those patients mechanically ventilated less than 24 hours, patients intubated in the ED or field have a higher incidence of pneumonia, despite equivalent or lower injury severity.
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Affiliation(s)
- Matthew J Eckert
- Division of Trauma, Surgical Critical Care and Burns, Department of Surgery, Loyola University Medical Center, Stritch School of Medicine, 2160 S. First Avenue, Maywood, IL 60153, USA.
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Ahmad A, Hayek B, Poulakidas S, Gamelli R. Orbital cellulitis in a burned child. Burns 2005; 31:650-2. [PMID: 15993311 DOI: 10.1016/j.burns.2004.12.011] [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: 10/28/2004] [Accepted: 12/22/2004] [Indexed: 11/20/2022]
Affiliation(s)
- Amjad Ahmad
- Department of Ophthalmology, Surgical Critical Care and Burns, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
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Davis KA, Eckert MJ, Reed RL, Esposito TJ, Santaniello JM, Poulakidas S, Luchette FA. Ventilator-associated pneumonia in injured patients: do you trust your Gram's stain? ACTA ACUST UNITED AC 2005; 58:462-6; discussion 466-7. [PMID: 15761337 DOI: 10.1097/01.ta.0000153941.39697.aa] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The results of sputum or bronchoalveolar lavage (BAL) fluid Gram's stain have been used to guide presumptive antibiotic therapy for ventilator-associated pneumonia (VAP) in injured patients, despite reported variability in sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. Our aim was to evaluate the utility of Gram's stain of BAL fluid in the diagnosis of VAP. METHODS We conducted a retrospective chart review of all mechanically ventilated trauma patients who developed pneumonia over a 5-year period in whom Gram's stain and final culture data were available. RESULTS One hundred fifty-five records with complete data sets were reviewed. VAP was diagnosed by Centers for Disease Control and Prevention criteria and confirmed by BAL and quantitative culture in all patients. Overall accuracy of Gram's stain in diagnosing VAP for any organism was 88% (137 true-positives). When assessed for the ability to predict pneumonia caused by a specific organism, the accuracy decreased significantly, with only 63% of Gram-negative VAPs and 72% of Gram-positive VAPs accurately identified by Gram's stain. However, the absence of Gram-positive organism of Gram's stain excludes Gram-positive VAP in 80% of patients. CONCLUSION All trauma patients should be covered presumptively for gram-negative organisms, as they encompass 70% of infections, but are not reliably identified by Gram's stain. As 88% of VAP can be identified by the presence of any organism on Gram's stain, it may be useful in the early diagnosis of VAP but cannot reliably be used to guide presumptive therapy.
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Affiliation(s)
- Kimberly A Davis
- Department of Surgery, Division of Trauma, Surgical Critical Care and Burns, Loyola University Medical Center, Maywood, Illinois 60153, USA.
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Abstract
BACKGROUND Several risk factors, including emergent intubation, severe head injury, shock, blunt trauma, and high severity of injury, have been identified as risk factors for the development of pneumonia after trauma. This study assesses the contribution of emergent intubation to the development of pneumonia after injury. METHODS A retrospective review of all trauma patients requiring intubation or cricothyroidotomy in the Emergency Department (ED) or in the pre-hospital area (field) over a 41/2 year period. RESULTS 571 patients comprised the study population. Of these, 80% had airways established in the ED, while 20% were intubated in the field. Field intubation was associated with a lower Glasgow Coma Scale (GCS) score (p <0.0001) and more severe injury (p <0.0001), particularly to the chest and extremities.Twenty-five percent of the population developed pneumonia. Patients diagnosed with pneumonia were older (p=0.009), and had a higher ISS (p <0.0001), lower GCS score, (p <0.008), longer ICU and hospital length of stay (p < 0.0001). Injuries to the head, thorax and extremities were more common (p < 0.05) and more severe (p <0.05) in patients developing pneumonia. The incidence of pneumonia after field airway was significantly higher (35% versus 23%, p=0.048).Multiple logistic regression analysis identified field intubation, age, AIS-head, and AIS-extremity as independent risk factors for pneumonia. CONCLUSION Pre-hospital but not ED intubation is an independent risk factor for the development of post-traumatic pneumonia. Other predictors include the severity of injury, specifically head and extremity injuries.
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Affiliation(s)
- Matthew J Eckert
- Department of Surgery, Division of Trauma, Surgical Critical Care and Burns, Loyola University Medical Center, Maywood, Illinois 60153, USA
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Reed RL, Luchette F, Davis KA, Esposito TJ, Poulakidas S, Santaniello J, Silver G, Pyrz K, Gamelli R. Medicare???s Bundling of Trauma Care Codes Violates Relative Value Principles. ACTA ACUST UNITED AC 2004; 57:1164-72. [PMID: 15625445 DOI: 10.1097/01.ta.0000151259.21467.fb] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Physician payment by Medicare is based on a Resource-Based Relative Value Scale (RBRVS). The Correct Coding Initiative (CCI) was introduced to counter unbundling by pairing component procedures with more comprehensive procedures. We hypothesized that Medicare's rebundling process ignored relative value concepts. METHODS CCI tables were downloaded from Medicare's website. Each comprehensive code's Relative Value Units (RVUs) were compared with component RVUs. Trauma, Burn, and Critical Care (TBC) surgeon charges were analyzed to determine whether component services had higher RVUs than the comprehensive charge. RESULTS 2,990 component CPT codes had total RVUs exceeding the RVUs of their paired comprehensive codes. If the undervalued comprehensive codes had been valued at their highest component's value, the minimum additional revenue would have been $211,600.59 per surgeon per year. CONCLUSION A relative value scale depends upon equity in value units. Disregarding RVUs when bundling services and procedures results in severe physician underpayment.
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Affiliation(s)
- R Lawrence Reed
- Division of Trauma, Critical Care, and Burns, Department of Surgery, Loyola University Medical Center, Maywood IL, USA
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