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1. Screening and intervention for intimate partner violence at trauma centers and emergency departments: an evidence-based systematic review from the Eastern Association for the Surgery of Trauma

Author

Hee Soo Jung, Rishi Rattan, Anna Goldenberg, Erin Chang, Stephanie Bonne, D'Andrea Joseph, Amanda L Teichman, Patrick B Murphy, Courtney Edwards, Christina Colosimo, Anna Liveris, Emily Lawson, Kathleen Fox, Jennifer J Freeman, Krista L Haines, Linda Dultz, Farheen A Qurashi, Nathan Polite, Rachel L Choron, Sandra Arabian, Andrew T Schramm, Hassan Naser A Mashbari, and Randi N Smith

Subjects
Surgery, RD1-811, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Background Intimate partner violence (IPV) is a serious public health issue with a substantial burden on society. Screening and intervention practices vary widely and there are no standard guidelines. Our objective was to review research on current practices for IPV prevention in emergency departments and trauma centers in the USA and provide evidenced-based recommendations.Methods An evidence-based systematic review of the literature was conducted to address screening and intervention for IPV in adult trauma and emergency department patients. The Grading of Recommendations, Assessment, Development and Evaluations methodology was used to determine the quality of evidence. Studies were included if they addressed our prespecified population, intervention, control, and outcomes questions. Case reports, editorials, and abstracts were excluded from review.Results Seven studies met inclusion criteria. All seven were centered around screening for IPV; none addressed interventions when abuse was identified. Screening instruments varied across studies. Although it is unclear if one tool is more accurate than others, significantly more victims were identified when screening protocols were implemented compared with non-standardized approaches to identifying IPV victims.Conclusion Overall, there were very limited data addressing the topic of IPV screening and intervention in emergency medical settings, and the quality of the evidence was low. With likely low risk and a significant potential benefit, we conditionally recommend implementation of a screening protocol to identify victims of IPV in adults treated in the emergency department and trauma centers. Although the purpose of screening would ultimately be to provide resources for victims, no studies that assessed distinct interventions met our inclusion criteria. Therefore, we cannot make specific recommendations related to IPV interventions.PROSPERO registration number CRD42020219517.

Published
2023
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2. Creation of standardized tools to evaluate reporting in health research: Population Reporting Of Gender, Race, Ethnicity & Sex (PROGRES).

Author

Anne M Stey, Mira Ghneim, Onaona Gurney, Ariel P Santos, Rishi Rattan, Egide Abahuje, Archit Baskaran, Jeffry Nahmias, Joseph Richardson, Tanya L Zakrison, Zinzi D Baily, Elliott R Haut, Mihir Chaudhary, Bellal Joseph, Ben Zarzaur, and Kimberly Hendershot

Subjects
Public aspects of medicine, RA1-1270
Abstract

Despite increasing diversity in research recruitment, research finding reporting by gender, race, ethnicity, and sex has remained up to the discretion of authors. This study developped and piloted tools to standardize the inclusive reporting of gender, race, ethnicity, and sex in health research. A modified Delphi approach was used to develop standardized tools for the inclusive reporting of gender, race, ethnicity, and sex in health research. Health research, social epidemiology, sociology, and medical anthropology experts from 11 different universities participated in the Delphi process. The tools were pilot tested on 85 health research manuscripts in top health research journals to determine inter-rater reliability of the tools. The tools each spanned five dimensions for both sex and gender as well as race and ethnicity: Author inclusiveness, Participant inclusiveness, Nomenclature reporting, Descriptive reporting, and Outcomes reporting for each subpopulation. The sex and gender tool had a median score of 6 and a range of 1-15 out of 16 possible points. The percent agreement between reviewers piloting the sex and gender tool was 82%. The interrater reliability or average Cohen's Kappa was 0.54 with a standard deviation of 0.33 demonstrating moderate agreement. The race and ethnicity tool had a median score of 1 and a range of 0-15 out of 16 possible points. Race and ethnicity were both reported in only 25.8% of studies evaluated. Most studies that reported race reported only the largest subgroups; White, Black, and Latinx. The percent agreement between reviewers piloting the race and ethnicity tool was 84 and average Cohen's Kappa was 0.61 with a standard deviation of 0.38 demonstrating substantial agreement. While the overall dimension scores were low (indicating low inclusivity), the interrater reliability measures indicated moderate to substantial agreement for the respective tools. Efforts in recruitment alone will not provide more inclusive literature without improving reporting.

Published
2023
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3. PREVENTion of CLots in Orthopaedic Trauma (PREVENT CLOT): a randomised pragmatic trial protocol comparing aspirin versus low-molecular-weight heparin for blood clot prevention in orthopaedic trauma patients

Author

Deborah M Stein, Gregory J Jurkovich, Elliott R Haut, Rishi Rattan, Bellal Joseph, Theodore T Manson, Yasmin Degani, Debra Marvel, Heather A Vallier, Paul S. Whiting, Robert V O'Toole, Samuel Z Goldhaber, Joseph Cuschieri, Katherine P Frey, Nathan N O'Hara, Daniel O Scharfstein, Gerard P Slobogean, Tara J Taylor, Bryce E Haac, Anthony R Carlini, Kuladeep Sudini, Stephen T Wegener, Reza Firoozabadi, Michael J Bosse, Rachel B Seymour, Martha B Holden, Ida Leah Gitajn, Alexander L Eastman, Joshua L Gary, Conor P Kleweno, Renan C Castillo, Gregory T. Altman, A Britton Christmas, Robert A. Hymes, Greg E. Gaski, Roman M. Natoli, George C. Velmahos, Michael J. Weaver, Bryan A. Cotton, Herman Johal, Niv Sne, Roman Hayda, Andrew R. Evans, Patrick M. Osborn, Jessica C. Rivera, Christina L. Boulton, Prism S. Schneider, Patrick F. Bergin, Matthew E. Kutcher, Martin A. Croce, John C. Weinlein, William Obremskey, Oscar D. Guillamondegui, Eben A. Carroll, and Preston R. Miller

Subjects
Medicine
Abstract

Introduction Patients who sustain orthopaedic trauma are at an increased risk of venous thromboembolism (VTE), including fatal pulmonary embolism (PE). Current guidelines recommend low-molecular-weight heparin (LMWH) for VTE prophylaxis in orthopaedic trauma patients. However, emerging literature in total joint arthroplasty patients suggests the potential clinical benefits of VTE prophylaxis with aspirin. The primary aim of this trial is to compare aspirin with LMWH as a thromboprophylaxis in fracture patients.Methods and analysis PREVENT CLOT is a multicentre, randomised, pragmatic trial that aims to enrol 12 200 adult patients admitted to 1 of 21 participating centres with an operative extremity fracture, or any pelvis or acetabular fracture. The primary outcome is all-cause mortality. We will evaluate non-inferiority by testing whether the intention-to-treat difference in the probability of dying within 90 days of randomisation between aspirin and LMWH is less than our non-inferiority margin of 0.75%. Secondary efficacy outcomes include cause-specific mortality, non-fatal PE and deep vein thrombosis. Safety outcomes include bleeding complications, wound complications and deep surgical site infections.Ethics and dissemination The PREVENT CLOT trial has been approved by the ethics board at the coordinating centre (Johns Hopkins Bloomberg School of Public Health) and all participating sites. Recruitment began in April 2017 and will continue through 2021. As both study medications are currently in clinical use for VTE prophylaxis for orthopaedic trauma patients, the findings of this trial can be easily adopted into clinical practice. The results of this large, patient-centred pragmatic trial will help guide treatment choices to prevent VTE in fracture patients.Trial registration number NCT02984384.

Published
2021
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4. Outcomes in patients with gunshot wounds to the brain

Author

Rishi Rattan, Jeffry Nahmias, Areg Grigorian, Brandon Bruns, Paul J Chestovich, Jose L Pascual, Patrick Bosarge, Rindi Uhlich, Parker Hu, Allison G McNickle, Grace Chang, Todd W Costantini, Lawrence Lottenberg, John Berne, Chance Spalding, Leigh Anna Robinson, Lauren M Turco, Bryce Robinson, Joshua G Corsa, Michael Mount, Amy V Hamrick, Dalier R Mederos, Jason Weinberger, Jane K Lee, Kevin L Chow, Erik J Olson, Rachele Solomon, Danielle A Pigneri, Husayn A Ladhani, Joanne Fraifogl, Jeffrey Claridge, Terry Curry, Manasnun Kongwibulwut, Haytham Kaafarani, Janika San Roman, Craig Schreiber, Anna Goldenberg-Sandau, Nicole Lunardi, Farooq Usmani, Joseph Victor Sakran, Jessica M Babcock, Juan Carlos Quispe, Donna Cabral, Jhoanna Gulmatico, Jonathan J Parks, Jennifer Massetti, Onaona Gurney, Alison A Smith, Chrissy Guidry, Matthew E Kutcher, Melissa S Logan, Michelle Y Kincaid, Matthew Noorbaksh, Frances H Philp, Benjamin Cragun, and Robert D Winfield

Subjects
Surgery, RD1-811, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Introduction Gunshot wounds to the brain (GSWB) confer high lethality and uncertain recovery. It is unclear which patients benefit from aggressive resuscitation, and furthermore whether patients with GSWB undergoing cardiopulmonary resuscitation (CPR) have potential for survival or organ donation. Therefore, we sought to determine the rates of survival and organ donation, as well as identify factors associated with both outcomes in patients with GSWB undergoing CPR.Methods We performed a retrospective, multicenter study at 25 US trauma centers including dates between June 1, 2011 and December 31, 2017. Patients were included if they suffered isolated GSWB and required CPR at a referring hospital, in the field, or in the trauma resuscitation room. Patients were excluded for significant torso or extremity injuries, or if pregnant. Binomial regression models were used to determine predictors of survival/organ donation.Results 825 patients met study criteria; the majority were male (87.6%) with a mean age of 36.5 years. Most (67%) underwent CPR in the field and 2.1% (n=17) survived to discharge. Of the non-survivors, 17.5% (n=141) were considered eligible donors, with a donation rate of 58.9% (n=83) in this group. Regression models found several predictors of survival. Hormone replacement was predictive of both survival and organ donation.Conclusion We found that GSWB requiring CPR during trauma resuscitation was associated with a 2.1% survival rate and overall organ donation rate of 10.3%. Several factors appear to be favorably associated with survival, although predictions are uncertain due to the low number of survivors in this patient population. Hormone replacement was predictive of both survival and organ donation. These results are a starting point for determining appropriate treatment algorithms for this devastating clinical condition.Level of evidence Level II.

Published
2019
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5. Intraoperative identification of adrenal-renal fusion

Author

Griffin Boll, Rishi Rattan, Osman Yilmaz, and Michael E Tarnoff

Subjects
Adrenal, kidney, fusion, Surgery, RD1-811, Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Adrenal - renal fusion is a rare entity defined as incomplete encapsulation of the adrenal gland and kidney with histologically adjacent functional tissue. This report describes the first published intraoperative identification of this anomaly during laparoscopic adrenalectomy. The patient was a 59-year-old man with chronic hypertension refractory to multiple antihypertensives found to be caused by a right-sided aldosterone-producing adrenal adenoma in the setting of bilateral adrenal hyperplasia. During laparoscopic adrenalectomy, the normal avascular plane between the kidney and adrenal gland was absent. Pathologic evaluation confirmed adrenal - renal fusion without adrenal heterotopia. Identified intraoperatively, this may be misdiagnosed as invasive malignancy, and thus awareness of this anomaly may help prevent unnecessarily morbid resection.

Published
2015
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7. Association Between Child Access Prevention and State Firearm Laws With Pediatric Firearm-Related Deaths

Author

Majid Chammas, Saskya Byerly, Jennifer Lynde, Alejandro Mantero, Rebecca Saberi, Gareth Gilna, Gerd Daniel Pust, Rishi Rattan, Nicholas Namias, Marie Crandall, and D. Dante Yeh

Subjects
Suicide Prevention, Firearms, Humans, Wounds, Gunshot, Surgery, Centers for Disease Control and Prevention, U.S, Child, Homicide, United States
Abstract

We aim to study the association between state child access prevention (CAP) and overall firearm laws with pediatric firearm-related mortality.The Centers for Disease Control and Prevention Web-based Injury Statistics Query and Reporting System was queried for pediatric (aged18 y) all-intent (accidental, suicide, and homicide) firearm-related crude death rates (CDRs) among the 50 states from 1999 to 2019. States were into three groups: Always CAP (throughout the 20-year period), Never CAP, and New CAP (enacted CAP during study period). We used the Giffords Law Center Annual Gun Law Scorecard (A, B, C, D, F) to group states into strict (A, B) and lenient (C, D, F) firearm laws. A scatter plot was constructed to display state CDR based on CAP laws by year. The top 10 states by CDR per year were tabulated based on CAP law status. Wilcoxon rank-sum was used to compare CDR between strict and lenient scorecard states in 2019.There were 12 Always CAP, 21 Never CAP, and 17 New CAP states from 1999 to 2019. No states changed from CAP laws to no CAP laws. Never CAP and New CAP states dominated the high outliers in CDR compared to Always CAP. The top 10 states with the highest CDR per year were most commonly Never CAP. Strict firearm laws states had lower median CDR in 2019 than lenient states (0.79 [0-1.67] versus 2.59 [1.66-3.53], P = 0.007).Stricter overall gun laws are associated with three-fold lower all-intent pediatric firearm-related deaths. For 2 decades, the 10 states with the highest CDR were almost universally those without CAP laws. Our findings support the RAND Gun Policy in America initiative's claims on the importance of CAP laws in reducing suicide, unintentional deaths, and violent crime among children, but more research is needed.

Published
2023

8. Adding to the story, did penetrating trauma really increase? changes in trauma patterns during the COVID-19 pandemic: A multi-institutional, multi-region investigation

Author

Ava K Mokhtari, Lydia R Maurer, Michael Dezube, Kimberly Langeveld, Yee M. Wong, Claire Hardman, Shabnam Hafiz, Mark Sharrah, Hahn Soe-Lin, Kristina M Chapple, Rafael Peralta, Rishi Rattan, Caroline Butler, Jonathan J Parks, April E Mendoza, George C. Velmahos, and Noelle N. Saillant

Subjects
Trauma Centers, SARS-CoV-2, COVID-19, Humans, General Earth and Planetary Sciences, Wounds, Penetrating, Pandemics, United States, Retrospective Studies, General Environmental Science
Abstract

Results from single-region studies suggest that stay at home orders (SAHOs) had unforeseen consequences on the volume and patterns of traumatic injury during the initial months of the Coronavirus disease 2019 (COVID-19). The aim of this study was to describe, using a multi-regional approach, the effects of COVID-19 SAHOs on trauma volume and patterns of traumatic injury in the US.A retrospective cohort study was performed at four verified Level I trauma centers spanning three geographical regions across the United States (US). The study period spanned from April 1, 2020 - July 31, 2020 including a month-matched 2019 cohort. Patients were categorized into pre-COVID-19 (PCOV19) and first COVID-19 surge (FCOV19S) cohorts. Patient demographic, injury, and outcome data were collected via Trauma Registry queries. Univariate and multivariate analyses were performed.A total 5,616 patients presented to participating study centers during the PCOV19 (2,916) and FCOV19S (2,700) study periods. Blunt injury volume decreased (p = 0.006) due to a significant reduction in the number of motor vehicle collisions (MVCs) (p = 0.003). Penetrating trauma experienced a significant increase, 8% (246/2916) in 2019 to 11% (285/2,700) in 2020 (p = 0.007), which was associated with study site (p = 0.002), not SAHOs. Finally, study site was significantly associated with changes in nearly all injury mechanisms, whereas SAHOs accounted for observed decreases in calculated weekly averages of blunt injuries (p0.02) and MVCs (p = 0.003).Results of this study suggest that COVID-19 and initial SAHOs had variable consequences on patterns of traumatic injury, and that region-specific shifts in traumatic injury ensued during initial SAHOs. These results suggest that other factors, potentially socioeconomic or cultural, confound trauma volumes and types arising from SAHOs. Future analyses must consider how regional changes may be obscured with pooled cohorts, and focus on characterizing community-level changes to aid municipal preparation for future similar events.

Published
2022

10. Endovascular Intervention in Internal Carotid Artery Blunt Cerebrovascular Injury: An EAST Multicenter Study

Author

Margaret Lauerman, Emily Esposito, Chance Spalding, Joshua Simpson, Julie A. Dunn, Linda Zier, Sigrid Burruss, Paul Kim, Lewis E. Jacobson, Jamie Williams, Jeffry Nahmias, Areg Grigorian, Laura Harmon, Anna Gergen, Matthew Chatoor, Rishi Rattan, Andrew J. Young, Jose L. Pascual, Jason Murry, Adrian W. Ong, Alison Muller, Rovinder S. Sandhu, Rachel Appelbaum, Nikolay Bugaev, Antony Tatar, Khaled Zreik, Mark J. Lieser, Thomas M. Scalea, and Deborah M. Stein

Subjects
Stroke, Humans, Cerebrovascular Trauma, Prospective Studies, General Medicine, Carotid Artery Injuries, Wounds, Nonpenetrating, Aneurysm, False, Carotid Artery, Internal, Retrospective Studies
Abstract

Background Use of endovascular intervention (EI) for blunt cerebrovascular injury (BCVI) is without consensus guidelines. Rates of EI use and radiographic characteristics of BCVI undergoing EI nationally are unknown. Methods A post-hoc analysis of a prospective, observational study at 16 U.S. trauma centers from 2018 to 2020 was conducted. Internal carotid artery (ICA) BCVI was included. The primary outcome was EI use. Multivariable logistic regression was performed for predictors of EI use. Results From 332 ICA BCVI included, 21 (6.3%) underwent EI. 0/145 (0%) grade 1, 8/101 (7.9%) grade 2, 12/51 (23.5%) grade 3, and 1/20 (5.0%) grade 4 ICA BCVI underwent EI. Stroke occurred in 6/21 (28.6%) ICA BCVI undergoing EI and in 33/311 (10.6%) not undergoing EI ( P = .03), with all strokes with EI use occurring prior to or at the same time as EI. Percentage of luminal stenosis (37.75 vs 20.29%, P = .01) and median pseudoaneurysm size (9.00 mm vs 3.00 mm, P = .01) were greater in ICA BCVI undergoing EI. On logistic regression, only pseudoaneurysm size was associated with EI (odds ratio 1.205, 95% CI 1.035-1.404, P = .02). Of the 8 grade 2 ICA BCVI undergoing EI, 3/8 were grade 2 and 5/8 were grade 3 prior to EI. Of the 12 grade 3 ICA BCVI undergoing EI, 11/12 were grade 3 and 1/12 was a grade 2 ICA BCVI prior to EI. Discussion Pseudoaneurysm size is associated with use of EI for ICA BCVI. Stroke is more common in ICA BCVI with EI but did not occur after EI use.

Published
2022

11. Appendectomy versus nonoperative management of simple appendicitis: A post hoc analysis of an Eastern Association for the Surgery of Trauma multicenter study using a hierarchical ordinal scale

Author

D. Dante Yeh, Georgia Vasileiou, Sinong Qian, Hang Zhang, Khaled Abdul Jawad, Chris Dodgion, Ryan Lawless, Rishi Rattan, G. Daniel Pust, and Nicholas Namias

Subjects
Treatment Outcome, Appendectomy, Drainage, Humans, Surgical Wound Infection, Surgery, Appendicitis, Critical Care and Intensive Care Medicine, Anti-Bacterial Agents
Abstract

Controversy exists about the preferred initial treatment of appendicitis. We sought to compare the two treatments for initial management of simple appendicitis.In this post hoc analysis of the Multicenter Study for the Treatment of Appendicitis in America: Acute, Perforated, and Gangrenous database, subjects were divided into appendectomy or nonoperative management (NOM; antibiotics only or percutaneous drainage) cohorts. A novel topic-specific hierarchical ordinal scale was created with eight mutually exclusive categories: mortality, reoperation, other secondary interventions, readmission, emergency department visit, wound complication, surgical site infection, and no complication. Pairwise comparisons of American Association for the Surgery of Trauma Imaging Severity Grade 1 (simple appendicitis) patients were compared using win-lose-tie scoring and the sums of appendectomy/NOM groups were compared.A total 3,591 subjects were included: 3,262 appendectomy and 329 NOM, with significant differences in baseline characteristics between groups. Across 28 sites, the rate of NOM ranged from 0% to 48%, and the loss to follow-up rate was significantly higher for NOM compared with appendectomy (16.5% vs. 8.7%, p = 0.024). In the simple appendicitis hierarchical ordinal scale analysis, 2,319 subjects resulted in 8,714,304 pairwise comparisons; 75% of comparisons resulted in ties. The median (interquartile range) sums for the two groups are as follows: surgical, 400 (400-400), and NOM, 400 (-2,427 to 400) (p0.001). A larger proportion of appendectomy subjects (88.1%) had an outcome that was equivalent (or better) than at least half of the subjects compared with NOM subjects (NOM, 70.5%; OR [95% confidence interval], 0.3 [0.2-0.4]).In contemporary American practice, appendectomy (compared with NOM) for simple appendicitis is associated with lower odds of developing clinically important unfavorable outcomes in the first year after illness.Therapeutic/Care Management; Level III.

Published
2022

12. Microbial Epidemiology of Acute and Perforated Appendicitis: A Post-Hoc Analysis of an EAST Multicenter Study

Author

Khaled Abdul Jawad, Christopher M. Dodgion, Haytham M.A. Kaafarani, Georgia Vasileiou, Nicholas Namias, Martin D. Zielinski, Sinong Qian, D. Dante Yeh, Andreas Larentzakis, and Rishi Rattan

Subjects
Adult, medicine.medical_specialty, Percutaneous, Adolescent, medicine.drug_class, Antibiotics, Narrow spectrum, Antimicrobial Stewardship, Internal medicine, Post-hoc analysis, Epidemiology, Escherichia coli, Appendectomy, Humans, Medicine, Retrospective Studies, Perforated Appendicitis, business.industry, Appendicitis, medicine.disease, United States, Anti-Bacterial Agents, Multicenter study, Drainage, Surgery, business
Abstract

There are significant practice variations in antibiotic treatment for appendicitis, ranging from short-course narrow spectrum to long-course broad-spectrum. We sought to describe the modern microbial epidemiology of acute and perforated appendicitis in adults to help inform appropriate empiric coverage and support antibiotic stewardship initiatives.This is a post-hoc secondary analysis of the Multicenter Study of the Treatment of Appendicitis in America: Acute, Perforated, and Gangrenous (MUSTANG) which prospectively enrolled adult patients (age ≥ 18 years) diagnosed with appendicitis between January 2017 and June 2018 across 28 centers in the United States. We included all subjects with positive microbiologic cultures during primary or secondary (rescue after medical failure) appendectomy or percutaneous drainage. Culture yield was compared between low- and high-grade appendicitis as per the AAST classification.A total of 3,471 patients were included: 230 (7%) had cultures performed, and 179/230 (78%) had positive results. Cultures were less likely to be positive in grade 1 compared to grades 3, 4, or 5 appendicitis with 2/18 (11%) vs 61/70 (87%) (p.001). Only 1 subject had grade 2 appendicitis and culture results were negative. E. coli was the most common pathogen and cultured in 29 (46%) of primary appendectomy samples, 16 (50%) of secondary, and 44 (52%) of percutaneous drainage samples.Culturing low-grade appendicitis is low yield. E. coli is the most commonly cultured microbe in acute and perforated appendicitis. This data helps inform empiric coverage for both antibiotics alone and as an adjunct to operative or percutaneous intervention.

Published
2022

13. Factors associated with stroke formation in blunt cerebrovascular injury: An EAST multicenter study

Author

Deborah M. Stein, Margaret H. Lauerman, Rovinder Sandhu, Rachel Appelbaum, Linda Zier, Jason Murry, Thomas M. Scalea, Anna Gergen, Leah Hustad, Julie A. Dunn, Joshua Simpson, Sigrid Burruss, M Chance Spalding, Rishi Rattan, Andrew J. Young, Paul S. Kim, Laura Harmon, Mark Lieser, Matthew Chatoor, Emily C. Esposito, Adrian W. Ong, Areg Grigorian, Lewis E. Jacobson, Jeffry Nahmias, Khaled Zreik, Alison Muller, Joseph A. Kufera, Jamie Williams, Nikolay Bugaev, Jose L. Pascual, Timothy W. Wolff, and Antony Tatar

Subjects
Adult, Male, medicine.medical_specialty, Vertebral artery, Wounds, Nonpenetrating, Critical Care and Intensive Care Medicine, Lesion, Blunt, Risk Factors, medicine.artery, Internal medicine, Epidemiology, medicine, Humans, Cerebrovascular Trauma, Prospective Studies, cardiovascular diseases, Stroke, Vertebral Artery, business.industry, Anticoagulants, Middle Aged, medicine.disease, United States, Stenosis, Multicenter study, Cardiology, Female, Surgery, Internal carotid artery, medicine.symptom, Carotid Artery Injuries, business
Abstract

BACKGROUND Stroke risk factors after blunt cerebrovascular injury (BCVI) are ill-defined. We hypothesized that factors associated with stroke for BCVI would include medical therapy (ie: Aspirin®), radiographic features, and protocolization of care. METHODS An EAST-sponsored, 16 center, prospective, observational trial was undertaken. Stroke risk factors were analyzed individually for vertebral artery (VA) and internal carotid artery (ICA) BCVI. BCVI were graded on the standard 1-5 scale. Data was from the initial hospitalization only. RESULTS 777 BCVIs were included. Stroke rate was 8.9% for all BCVI, with an 11.7% rate of stroke for ICA BCVI and a 6.7% rate for VA BCVI. Use of a management protocol (p = 0.01), management by the trauma service (p = 0.04), antiplatelet therapy over the hospital stay (p < 0.001), and Aspirin® therapy specifically over the hospital stay (p < 0.001) were more common in ICA BCVI without stroke compared with those with stroke. Antiplatelet therapy over the hospital stay (p < 0.001) and Aspirin® therapy over the hospital stay (p < 0.001) were more common in VA BCVI without stroke than with stroke. Percentage luminal stenosis was higher in both ICA BCVI (p = 0.002) and VA BCVI (p < 0.001) with stroke. Decrease in percentage luminal stenosis (p < 0.001), resolution of intraluminal thrombus (p = 0.003), and new intraluminal thrombus (p = 0.001) were more common in ICA BCVI with stroke than without, while resolution of intraluminal thrombus (p = 0.03) and new intraluminal thrombus (p = 0.01) were more common in VA BCVI with stroke than without. CONCLUSIONS Protocol driven management by the trauma service, antiplatelet therapy (specifically Aspirin®), and lower percentage luminal stenosis were associated with lower stroke rates, while resolution and development of intraluminal thrombus were associated with higher stroke rates. Further research will be needed to incorporate these risk factors into lesion specific BCVI management.Study Type/Level of EvidenceOriginal article, prognostic and epidemiological, Level III.

Published
2021

14. Discordance in Appendicitis Grading and the Association with Outcomes: A Post-Hoc Analysis of an EAST Multicenter Study

Author

Eva M. Urrechaga, D. Dante Yeh, Gerd D. Pust, Rishi Rattan, Hang Zhang, Saskya Byerly, Khaled Abdul Jawad, Nicholas Namias, and Alessia C. Cioci

Subjects
Adult, Male, medicine.medical_specialty, Concordance, Severity of Illness Index, 03 medical and health sciences, symbols.namesake, 0302 clinical medicine, Statistical significance, Radiologists, medicine, Humans, Surgeons, business.industry, Incidence (epidemiology), Gold standard, Emergency department, Middle Aged, Appendicitis, medicine.disease, Surgery, Pathologists, Bonferroni correction, 030220 oncology & carcinogenesis, symbols, Female, 030211 gastroenterology & hepatology, Complication, business
Abstract

The American Association for the Surgery of Trauma (AAST) appendicitis severity grading criteria use independent subscales for radiologists (Rad), surgeons (Surg), and pathologists (Path). We reviewed the EAST Multicenter Study of the Treatment of Appendicitis in America: Acute, Perforated, and Gangrenous (MUSTANG) database to determine rates of discordance and clinical consequences of inaccuracy.A confusion matrix was constructed for pairs among Rad, Surg, and Path. Accuracy was reported using chronologically latest diagnosis as gold standard. "Concordance" (C) was achieved when both agreed on the severity grade and "Discordance"(D) when they disagreed. A composite endpoint("COMP"= 30-d incidence of surgical site infection, abscess, wound complication, Clavien-Dindo complication, secondary intervention, ED[Emergency Department] visit, hospital readmission, and mortality) was compared between C versus D groups via χFor each pair and diagnosis, subjects were categorized as C or D and compared for the incidence of COMP. Incidence of COMP for Surg and/or Path in C versus D: 16% versus. 26% (p = 0.006, NS by Bonferroni) for acute (A), 39% versus 33% (p = 0.39) for gangrenous (G), and 48% versus 37% (p = 0.035, NS by Bonferroni) for perforated (P). For Rad and/or Path in C versus. D: 17% versus 42% (p0.001) for A, 27% versus 31% (p = 0.95) for G, and 56% versus 48% (p = 0.48) for P. For C versus D: 17% versus 40% (p0.001) for A, 36% versus 26% (p = 0.43) for G, and 51% versus 39% (p = 0.29) for P.In appendicitis treated by appendectomy, surgeons are most accurate at diagnosing acute appendicitis and least accurate at diagnosing gangrenous. Radiologists are less accurate for all categories. When the surgeon is wrong, clinical outcomes are not significantly worse. However, when the radiologist is wrong about acute appendicitis, patients have worse clinical outcomes.

Published
2021

15. Analyzing pediatric bicycle injuries using geo-demographic data

Author

Gareth P. Gilna, Justin Stoler, Rebecca A. Saberi, Adriana C. Baez, Walter A. Ramsey, Carlos T. Huerta, Christopher F. O'Neil, Rishi Rattan, Eduardo A. Perez, Juan E. Sola, and Chad M. Thorson

Subjects
Male, Adolescent, Accidents, Traffic, General Medicine, Bicycling, Brain Injuries, Traumatic, Pediatrics, Perinatology and Child Health, Craniocerebral Trauma, Humans, Female, Head Protective Devices, Surgery, Child, Demography
Abstract

Bicycle accidents are potentially preventable, and helmets can mitigate the severity of injuries. The purpose of the study it to investigate geo-demographic areas to establish prevention policies and targeted programs.From October 2013 to March 2020 all bicycle injuries at a Level 1 trauma center were collected for ages ≤18 years. Demographics, injuries, and outcomes were analyzed. Incidents were aggregated to zip codes and the Local Indicators of Spatial Association (LISA) statistic was used to test for spatial clustering of injury rates per 10,000 children.Over the 8-year time period, 77 cases were identified with an average age of 13±4 years, 83% male and 48% non-Hispanic white. The majority of patients (98%) were not wearing a helmet. Loss of consciousness was reported in 44% and 21% sustained a traumatic brain injury. Twenty-eight percent required ICU care and 36% required operative interventions. There was only 1 mortality in the cohort (1%).Injuries were more common in lower household income zip codes (Figure 1). Six zip codes encompassing several interstate exits and the connected heavy-traffic roadways comprise a statistically significant cluster of pediatric bicycle accidents (Figure 1).Low-income neighborhoods and those near major roadways held the highest risk for pediatric bicycle accidents. Use of helmets was extremely low in the patient population, with high rates of traumatic brain injury. With this information, targeted programs to address high-risk intersections, helmet access, and safety education can be implemented locally.

Published
2022

16. Call to Action on the Categorization of Sex, Gender, Race, and Ethnicity in Surgical Research

Author

Kimberly M. Hendershot, Mark H. Hoofnagle, Anne M. Stey, Zinzi Bailey, Ariel P. Santos, Rishi Rattan, Tanya L. Zakrison, Ben L. Zarzaur, Elliott R. Haut, Joseph B. Richardson, Bellal Joseph, Onaona Gurney, Jeffry Nahmias, and Mira Ghneim

Subjects
Intersectionality, Surgical research, Biomedical Research, business.industry, Racial Groups, Sexism, Ethnic group, Gender studies, Health Status Disparities, Specialties, Surgical, Call to action, Race (biology), Racism, Sex Factors, Categorization, Research Design, Terminology as Topic, Sex gender, Ethnicity, Humans, Medicine, Surgery, business
Published
2021

17. The hidden burden of unplanned readmission after emergency general surgery

Author

D. Dante Yeh, Eva M. Urrechaga, Joshua Parreco, Rishi Rattan, Rebecca A. Saberi, Gareth P. Gilna, Alessia C. Cioci, Nicholas Namias, and Tanya L. Zakrison

Subjects
Adult, Male, medicine.medical_specialty, Time Factors, Adolescent, Critical Care and Intensive Care Medicine, Logistic regression, Patient Readmission, Risk Assessment, Young Adult, Postoperative Complications, Cost of Illness, Epidemiology, Unplanned readmission, Humans, Medicine, Emergency Treatment, Aged, Retrospective Studies, Hospital readmission, business.industry, General surgery, Odds ratio, Middle Aged, United States, Surgical Procedures, Operative, Female, Surgery, Level iii, Emergencies, Index hospitalization, business, Medicaid
Abstract

BACKGROUND There are no national studies of nonelective readmissions after emergency general surgery (EGS) diagnoses that track nonindex hospital readmission. We sought to determine the rate of overall and nonindex hospital readmissions at 30 and 90 days after discharge for EGS diagnoses, hypothesizing a significant portion would be to nonindex hospitals. METHODS The 2013 to 2014 Nationwide Readmissions Database was queried for all patients 16 years or older admitted with an EGS primary diagnosis and survived index hospitalization. Multivariable logistic regression identified risk factors for nonelective 30- and 90-day readmission to index and nonindex hospitals. RESULTS Of 4,171,983 patients, 13% experienced unplanned readmission at 30 days. Of these, 21% were admitted to a nonindex hospital. By 90 days, 22% experienced an unplanned readmission, of which 23% were to a nonindex hospital. The most common reason for readmission was infection. Publicly insured or uninsured patients accounted for 67% of admissions and 77% of readmissions. Readmission predictors at 30 days included leaving against medical advice (odds ratio [OR], 2.51 [2.47-2.56]), increased length of stay (4-7 days: OR, 1.42 [1.41-1.43]; >7 days: OR, 2.04 [2.02-2.06]), Charlson Comorbidity Index ≥2 (OR, 1.72 [1.71-1.73]), public insurance (Medicare: OR, 1.45 [1.44-1.46]; Medicaid: OR, 1.38 [1.37-1.40]), EGS patients who fell into the "Other" surgical category (OR, 1.42 [1.38-1.48]), and nonroutine discharge. Risk factors for readmission remained consistent at 90 days. CONCLUSION Given that nonindex hospital EGS readmission accounts for nearly a quarter of readmissions and often related to important benchmarks such as infection, current EGS quality metrics are inaccurate. This has implications for policy, benchmarking, and readmission reduction programs. LEVEL OF EVIDENCE Epidemiological study, level III.

Published
2021

18. Unplanned readmission after emergency laparotomy: A post hoc analysis of an EAST multicenter study

Author

Jennifer Rodriquez, Cory B. Emmert, Majed El Hechi, Vasileios Papadopoulos, Zachary Chadnick, Brittany Aicher, Mbaga S. Walusimbi, Daniel C. Cullinane, Daniel Steadman, Georgia Vasileiou, Claire Hardman, Rachel L. Choron, Simon Rodier, Javier Martin Perez, Georgios Tsoulfas, Lindsay O'Meara, Marta L. McCrum, Mirhee Kim, Anna Goldenberg-Sandau, David Turay, Haytham M.A. Kaafarani, Catherine G. Velopulos, Natalie Wall, Joseph V. Sakran, Napaporn Kongkaewpaisan, D. Dante Yeh, Heather Carmichael, Khaldoun Bekdache, Vasiliy Sim, Firas Madbak, Martin D. Zielinski, Thomas H. Shoultz, Maraya Camazine, Jeremy Badach, Jose J. Diaz, Rishi Rattan, George Black, Ursula J. Simonoski, Thomas J. Schroeppel, Leon Naar, and Cassandra Decker

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Perforation (oil well), Logistic regression, Patient Readmission, Risk Factors, Laparotomy, Post-hoc analysis, medicine, Humans, Prospective Studies, Emergency Treatment, Aged, business.industry, Emergency department, Odds ratio, Middle Aged, medicine.disease, Confidence interval, Bowel obstruction, Emergency medicine, Female, Surgery, Emergency Service, Hospital, business
Abstract

Hospital readmission is an important quality-of-care indicator. We sought to examine the rates and predictors of unplanned readmission for the high-risk non-trauma emergency laparotomy patient.This is a post hoc analysis of a multicenter prospective observational study. Between April 2018 and June 2019, a total of 19 centers enrolled all adult patients undergoing emergency laparotomies and systematically collected preoperative, operative, and 30-day postoperative variables. For the purpose of this study, we defined unplanned readmission as a readmission occurring within 30 days from discharge and one that was immediately preceded by an emergency department visit. Patients were excluded if they died during the index admission, were discharged to hospice, or were transferred to other hospitals. Predictors of unplanned readmission were evaluated using a multivariable logistic regression model, adjusting for patient demographics, comorbidities, laboratory variables, and preoperative acuity of disease variables.A total of 1,347 patients were included, of which 234 (17.4%) had an unplanned readmission. The median patient age was 60 y, 49.4% were male, and 71.4% were white. The most common diagnoses were hollow viscus perforation (28.1%) and small bowel obstruction (24.5%). Predictors of unplanned readmission included patient factors (eg, disseminated cancer [odds ratio: 2.22, confidence interval: 1.35-3.64, P = .002], weight loss10% in the past 6 months [odds ratio: 1.65, confidence interval: 1.07-2.54, P = .023], dyspnea at baseline [odds ratio: 1.62, confidence interval: 1.06-2.48, P = .026], wound complications [odds ratio: 2.23, confidence interval: 1.55-3.19, P.001], and discharge to nursing homes [odds ratio: 1.68, confidence interval: 1.02-2.80, P = .044]).Unplanned readmission after emergency laparotomies are common, especially for patients with wound complications or requiring nursing homes. These system factors are potential quality improvement targets to reduce readmissions.

Published
2021

19. Broad vs Narrow Spectrum Antibiotics in Common Bile Duct Stones: A Post Hoc Analysis of an Eastern Association for the Surgery of Trauma Multicenter Study

Author

Brett M, Tracy, Carrie L, Valdez, Cameron W, Paterson, Beth R, Hochman, Eugenia, Kwon, Carrie A, Sims, Rishi, Rattan, D, Dante Yeh, Rondi B, Gelbard, and Kiran, Venincasa

Subjects
Common Bile Duct, Cholecystectomy, Laparoscopic, Pancreatitis, Humans, Surgical Wound Infection, Surgery, Gallstones, Prospective Studies, Acute Kidney Injury, Anti-Bacterial Agents, Retrospective Studies
Abstract

Antimicrobial guidance for common bile duct stones during the perioperative period is limited. We sought to examine the effect of broad-spectrum (BS) vs narrow-spectrum (NS) antibiotics on surgical site infections (SSIs) in patients with common bile duct stones undergoing same-admission cholecystectomy.We performed a post hoc analysis of a prospective, observational, multicenter study of patients undergoing same-admission cholecystectomy for choledocholithiasis and/or acute biliary pancreatitis between 2016 and 2019. We excluded patients with cholangitis, perforated cholecystitis, and nonbiliary infections on admission. Patients were divided based on receipt of BS or NS antibiotics. Our primary outcome was the incidence of SSIs, and secondary outcomes included hospital length of stay, acute kidney injury (AKI), and 30-day readmission for SSI.The cohort had 891 patients: 51.7% (n= 461) received BS antibiotics and 48.3% (n = 430) received NS antibiotics. Overall antibiotic duration was longer in the BS group than in the NS group (6 vs 4 d, p = 0.01); however, there was no difference in rates of SSI (0.9% vs 0.5%, p = 0.7) or 30-day readmission for SSI (1.1% vs 1.2%, p = 1.0). Hospital length of stay was significantly longer in the BS group (p0.001) as were rates of AKI (5% vs 1.4%, p = 0.001). On multivariable regression, BS antibiotic use was a risk factor for AKI (adjusted odds ratio 2.8, 95% CI 1.16 to 7.82, p = 0.02).The incidence of SSI and 30-day readmission for SSI was similar between antibiotic groups. However, BS antibiotic use was associated with a longer hospitalization and greater likelihood of AKI.

Published
2022

21. Ethical Care of the Traumatized: Conceptual Introduction to Trauma-Informed Care for Surgeons and Surgical Residents

Author

John N Bliton, Tanya L Zakrison, Gerard Vong, Dwane A Johnson, Rishi Rattan, Dustin S Hanos, and Randi N Smith

Subjects
Surgeons, Health Personnel, Humans, Internship and Residency, Surgery, Morals
Abstract

Trauma-informed care (TIC) is a set of principles and practices designed to improve the ways professionals treat people who have been traumatized. This study reviews fundamental concepts of TIC and applies them to the work of surgeons. TIC is described in relation to fundamental medical ethical concepts, and evidence for TIC-based intervention is reviewed. Implementation of TIC in medical education is also described, and recommendations for practice changes are made.

Published
2022

22. EAST evidence-based statement on 'Stand Your Ground' laws

Author

Elinore J. Kaufman, Tanya L. Zakrison, Mark H. Hoofnagle, Leah C. Tatebe, Rishi Rattan, Patrick B. Murphy, Randi N. Smith, D’Andrea K. Joseph, D. Dante Yeh, Elliott R. Haut, John J. Como, A. Britton Christmas, Jeffrey A. Claridge, Deborah M. Stein, and Hee Soo Jung

Subjects
Firearms, Humans, Surgery, Wounds, Gunshot, Critical Care and Intensive Care Medicine
Published
2022

23. Grade 1 Internal Carotid Artery Blunt Cerebrovascular Injury Persistence Risks Stroke With Current Management: An EAST Multicenter Study

Author

Sarah Yang, Emily Esposito, Chance Spalding, Joshua Simpson, Julie A. Dunn, Linda Zier, Sigrid Burruss, Paul Kim, Lewis E. Jacobson, Jamie Williams, Jeffry Nahmias, Areg Grigorian, Laura Harmon, Anna Gergen, Matthew Chatoor, Rishi Rattan, Andrew J. Young, Jose L. Pascual, Jason Murry, Adrian W. Ong, Alison Muller, Rovinder S. Sandhu, Rachel Appelbaum, Nikolay Bugaev, Antony Tatar, Khaled Zreik, Mark J. Lieser, Thomas M. Scalea, Deborah M. Stein, and Margaret Lauerman

Subjects
General Medicine
Abstract

Background Higher blunt cerebrovascular injury (BCVI) grade and lack of medical therapy are associated with stroke. Knowledge of stroke risk factors specific to individual grades may help tailor BCVI therapy to specific injury characteristics. Methods A post-hoc analysis of a 16 center, prospective, observational trial (2018-2020) was performed including grade 1 internal carotid artery (ICA) BCVI. Repeat imaging was considered the second imaging occurrence only. Results From 145 grade 1 ICA BCVI included, 8 (5.5%) suffered a stroke. Grade 1 ICA BCVI with stroke were more commonly treated with mixed anticoagulation and antiplatelet therapy (75.0% vs 9.6%, P Discussion While the stroke rate for grade 1 ICA BCVI is low overall, injury persistence appears to heighten stroke risk. Some strokes occurred despite initiation of medical therapy. Repeat imaging is needed in grade 1 ICA BCVI to evaluate for injury progression or resolution.

Published
2022

24. Double-blinded manuscript review: Avoiding peer review bias

Author

Rishi Rattan, Tanya L. Zakrison, Ariel P. Santos, and David S. Morris

Subjects
medicine.medical_specialty, Text mining, business.industry, Double blinded, MEDLINE, Medicine, Surgery, Medical physics, Critical Care and Intensive Care Medicine, business
Published
2021

25. Screening and intervention for intimate partner violence at trauma centers and emergency departments: an evidence-based systematic review from the Eastern Association for the Surgery of Trauma

Author

Amanda L Teichman, Stephanie Bonne, Rishi Rattan, Linda Dultz, Farheen A Qurashi, Anna Goldenberg, Nathan Polite, Anna Liveris, Jennifer J Freeman, Christina Colosimo, Erin Chang, Rachel L Choron, Courtney Edwards, Sandra Arabian, Krista L Haines, D'Andrea Joseph, Patrick B Murphy, Andrew T Schramm, Hee Soo Jung, Emily Lawson, Kathleen Fox, Hassan Naser A Mashbari, and Randi N Smith

Subjects
Surgery, Critical Care and Intensive Care Medicine
Abstract

BackgroundIntimate partner violence (IPV) is a serious public health issue with a substantial burden on society. Screening and intervention practices vary widely and there are no standard guidelines. Our objective was to review research on current practices for IPV prevention in emergency departments and trauma centers in the USA and provide evidenced-based recommendations.MethodsAn evidence-based systematic review of the literature was conducted to address screening and intervention for IPV in adult trauma and emergency department patients. The Grading of Recommendations, Assessment, Development and Evaluations methodology was used to determine the quality of evidence. Studies were included if they addressed our prespecified population, intervention, control, and outcomes questions. Case reports, editorials, and abstracts were excluded from review.ResultsSeven studies met inclusion criteria. All seven were centered around screening for IPV; none addressed interventions when abuse was identified. Screening instruments varied across studies. Although it is unclear if one tool is more accurate than others, significantly more victims were identified when screening protocols were implemented compared with non-standardized approaches to identifying IPV victims.ConclusionOverall, there were very limited data addressing the topic of IPV screening and intervention in emergency medical settings, and the quality of the evidence was low. With likely low risk and a significant potential benefit, we conditionally recommend implementation of a screening protocol to identify victims of IPV in adults treated in the emergency department and trauma centers. Although the purpose of screening would ultimately be to provide resources for victims, no studies that assessed distinct interventions met our inclusion criteria. Therefore, we cannot make specific recommendations related to IPV interventions.PROSPERO registration numberCRD42020219517.

Published
2023

26. Outcomes of same admission cholecystectomy and endoscopic retrograde cholangiopancreatography for common bile duct stones: A post hoc analysis of an Eastern Association for the Surgery of Trauma multicenter study

Author

Rishi Rattan, Brett M. Tracy, Eli Mlaver, Eugenia Kwon, Apostolos Gaitanidis, D. Dante Yeh, April E. Mendoza, Michelle B. Mulder, Cameron W Paterson, and Rondi B. Gelbard

Subjects
Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Operative Time, Gallstones, Critical Care and Intensive Care Medicine, Cohort Studies, 03 medical and health sciences, Patient Admission, Postoperative Complications, 0302 clinical medicine, Post-hoc analysis, medicine, Humans, Cholecystectomy, Aged, Cholangiopancreatography, Endoscopic Retrograde, Endoscopic retrograde cholangiopancreatography, medicine.diagnostic_test, Common bile duct, business.industry, 030208 emergency & critical care medicine, Length of Stay, Middle Aged, Confidence interval, Surgery, Treatment Outcome, medicine.anatomical_structure, Multicenter study, Cohort, Female, Level iii, business
Abstract

BACKGROUND The optimal timing for cholecystectomy after endoscopic retrograde cholangiopancreatography (ERCP) for common bile duct (CBD) stones is unknown. We hypothesized that a delay between procedures would correlate with more biliary complications and longer hospitalizations. METHODS We prospectively identified patients who underwent same admission cholecystectomy after ERCP for CBD stones from 2016 to 2019 at 12 US medical centers. The cohort was stratified by time between ERCP and cholecystectomy: ≤24 hours (immediate), >24 to ≤72 hours (early), and >72 hours (late). Primary outcomes included operative duration, postoperative length of stay, (LOS), and hospital LOS. Secondary outcomes included rates of open conversion, CBD explorations, biliary complications, and in-hospital complications. RESULTS For the 349 patients comprising the study cohort, 33.8% (n = 118) were categorized as immediate, 50.4% (n = 176) as early, and 15.8% (n = 55) as late. Rates of CBD explorations were lower in the immediate group compared with the late group (0.9% vs. 9.1%, p = 0.01). Rates of open conversion were lower in the immediate group compared with the early group (0.9% vs. 10.8%, p < 0.01) and in the immediate group compared with the late group (0.9% vs. 10.9%, p < 0.001). On a mixed-model regression analysis, an immediate cholecystectomy was associated with a significant reduction in postoperative LOS (β = 0.79; 95% confidence interval, 0.65-0.96; p = 0.02) and hospital LOS (β = 0.68; 95% confidence interval, 0.62-0.75; p < 0.0001). CONCLUSION An immediate cholecystectomy following ERCP correlates with a shorter postoperative LOS and hospital LOS. Rates of CBD explorations and conversion to open appear more common after 24 hours. LEVEL OF EVIDENCE Therapeutic, level III.

Published
2021

27. Identifying Abuse and Neglect in Hospitalized Children With Burn Injuries

Author

Nima Khosravani, Juan E. Sola, Rishi Rattan, Louis R. Pizano, Eduardo A. Perez, Chad M. Thorson, Joshua Parreco, and Hallie J. Quiroz

Subjects
Male, Child abuse, medicine.medical_specialty, Adolescent, media_common.quotation_subject, Subgroup analysis, Logistic regression, Patient Readmission, Neglect, 03 medical and health sciences, 0302 clinical medicine, Secondary outcome, Primary outcome, Risk Factors, Humans, Medicine, Child Abuse, Child, media_common, Missed Diagnosis, business.industry, Infant, Newborn, Infant, Odds ratio, United States, Child, Preschool, 030220 oncology & carcinogenesis, Emergency medicine, Female, 030211 gastroenterology & hepatology, Surgery, Burns, business, Child, Hospitalized, Total body surface area
Abstract

The purpose of this study was to identify the pattern of injuries that relates to abuse and neglect in children with burn injuries.The Nationwide Readmissions Database for 2010-2014 was queried for all patients aged less than 18 y admitted with burn injuries. The primary outcome was child maltreatment identified at the index admission. The secondary outcome was readmission for maltreatment. A subgroup analysis was performed on patients without a diagnosis of maltreatment during the index admission. Multivariable logistic regression was performed for each outcome.There were 57,939 admissions identified and 1960 (3.4%) involved maltreatment at the index admission. Maltreatment was associated with total body surface area burned20% (odds ratio (OR) 2.79, P 0.001) and burn of the lower limbs (OR 1.37, P 0.001). Readmission for maltreatment was found in 120 (0.2%), and the strongest risk factor was maltreatment identified at the index admission (OR 5.11, P 0.001). After excluding the patients with maltreatment identified at the index admission, 96 (0.17%) children were found to have a readmission for maltreatment that may have been present on the index admission and subsequently missed. The strongest risk factor was burn of the eye or ocular adnexa (OR 3.79, P = 0.001).This study demonstrates that a portion of admissions for burn injuries in children could involve maltreatment that was undiagnosed. Identifying these at-risk individuals is critical to prevention efforts.

Published
2021

28. Full-face motorcycle helmets to reduce injury and death: A systematic review, meta-analysis, and practice management guideline from the Eastern Association for the Surgery of Trauma

Author

Eva M. Urréchaga, Lisa M. Kodadek, Nikolay Bugaev, Zachary M. Bauman, Kaushal H. Shah, Hiba Abdel Aziz, Marshall A. Beckman, John M. Reynolds, Hahn Soe-Lin, Marie L. Crandall, and Rishi Rattan

Subjects
Practice Management, Motorcycles, Skull Fractures, Brain Injuries, Traumatic, Practice Guidelines as Topic, Accidents, Traffic, Humans, Craniocerebral Trauma, Surgery, Head Protective Devices, General Medicine
Abstract

While motorcycle helmets reduce mortality and morbidity, no guidelines specify which is safest. We sought to determine if full-face helmets reduce injury and death.We searched for studies without exclusion based on: age, language, date, or randomization. Case reports, professional riders, and studies without original data were excluded. Pooled results were reported as OR (95% CI). Risk of bias and certainty was assessed. (PROSPERO #CRD42021226929).Of 4431 studies identified, 3074 were duplicates, leaving 1357 that were screened. Eighty-one full texts were assessed for eligibility, with 37 studies (n = 37,233) eventually included. Full-face helmets reduced traumatic brain injury (OR 0.40 [0.23-0.70]); injury severity for the head and neck (Abbreviated Injury Scale [AIS] mean difference -0.64 [-1.10 to -0.18]) and face (AIS mean difference -0.49 [-0.71 to -0.27]); and facial fracture (OR 0.26 [0.15-0.46]).Full-face motorcycle helmets are conditionally recommended to reduce traumatic brain injury, facial fractures, and injury severity.

Published
2022

29. Planning for the Next Pandemic: Trauma Injuries Require Pre-COVID-19 Levels of High-Intensity Resources

Author

Ava K. Mokhtari, Lydia R. Maurer, Yee M. Wong, Claire Hardman, Shabnam Hafiz, Mark Sharrah, Hahn Soe-Lin, Rafael Peralta, Jonathan J. Parks, Rishi Rattan, Caroline Butler, John O. Hwabejire, Jason Fawley, Peter J. Fagenholz, David R. King, Haytham Kaafarani, George C. Velmahos, Jarone Lee, April E. Mendoza, and Noelle N. Saillant

Subjects
Intensive Care Units, Trauma Centers, COVID-19, Humans, General Medicine, Emergency Service, Hospital, Pandemics, Retrospective Studies
Abstract

As hospital systems plan for health care utilization surges and stress, understanding the necessary resources of a trauma system is essential for planning capacity. We aimed to describe trends in high-intensity resource utilization (operating room [OR] usage and intensive care unit [ICU] admissions) for trauma care during the initial months of the COVID-19 pandemic. Trauma registry data (2019 pre-COVID-19 and 2020 COVID-19) were collected retrospectively from 4 level I trauma centers. Direct emergency department (ED) disposition to the OR or ICU was used as a proxy for high-intensity resource utilization. No change in the incidence of direct ED to ICU or ED to OR utilization was observed (2019: 24%, 2020 23%; P = .62 and 2019: 11%, 2020 10%; P = .71, respectively). These results suggest the need for continued access to ICU space and OR theaters for traumatic injury during national health emergencies, even when levels of trauma appear to be decreasing.

Published
2022

30. Does treatment delay for blunt cerebrovascular injury affect stroke rate?: An EAST multicenter study

Author

Rachel D Appelbaum, Emily Esposito, M Chance Spaulding, Joshua P Simpson, Julie Dunn, Linda B Zier, Sigrid Burruss, Paul P Kim, Lewis E Jacobson, Jamie M Williams, Jeffry Nahmias, Areg Grigorian, Laura Harmon, Anna K Gergen, Matthew Chatoor, Rishi Rattan, Andrew J Young, Jose L Pascual, Jason Murry, Adrian W Ong, Alison Muller, Rovinder S Sandhu, Nikolay Bugaev, Antony Tatar, Khaled Zreik, Mark J Lieser, Deborah M Stein, Thomas M Scalea, and Margaret H Lauerman

Subjects
Stroke, Injury Severity Score, General Earth and Planetary Sciences, Humans, Prospective Studies, Cerebrovascular Trauma, Wounds, Nonpenetrating, General Environmental Science, Time-to-Treatment, Retrospective Studies
Abstract

The purpose of this study was to analyze injury characteristics and stroke rates between blunt cerebrovascular injury (BCVI) with delayed vs non-delayed medical therapy. We hypothesized there would be increased stroke formation with delayed medical therapy.This is a sub-analysis of a 16 center, prospective, observational trial on BCVI. Delayed medial therapy was defined as initiation24 hours after admission. BCVI which did not receive medical therapy were excluded. Subgroups for injury presence were created using Abbreviated Injury Scale (AIS) score0 for AIS categories.636 BCVI were included. Median time to first medical therapy was 62 hours in the delayed group and 11 hours in the non-delayed group (p 0.001). The injury severity score (ISS) was greater in the delayed group (24.0 vs the non-delayed group 22.0, p 0.001) as was the median AIS head score (2.0 vs 1.0, p 0.001). The overall stroke rate was not different between the delayed vs non-delayed groups respectively (9.7% vs 9.5%, p = 1.00). Further evaluation of carotid vs vertebral artery injury showed no difference in stroke rate, 13.6% and 13.2%, p = 1.00 vs 7.3% and 6.5%, p = 0.84. Additionally, within all AIS categories there was no difference in stroke rate between delayed and non-delayed medical therapy (all N.S.), with AIS head0 13.8% vs 9.2%, p = 0.20 and AIS spine0 11.0% vs 9.3%, p = 0.63 respectively.Modern BCVI therapy is administered early. BCVI with delayed therapy were more severely injured. However, a higher stroke rate was not seen with delayed therapy, even for BCVI with head or spine injuries. This data suggests with competing injuries or other clinical concerns there is not an increased stroke rate with necessary delays of medical treatment for BCVI.

Published
2022

31. Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study

Author

Dmitri Nepogodiev, Joana Ff Simoes, Elizabeth Li, Maria Picciochi, James C Glasbey, Glauco Baiocchi, Ruth Blanco-Colino, Daoud Chaudhry, Ehab AlAmeer, Kariem El-Boghdadly, Funmilola Wuraola, Dhruva Ghosh, Rohan R Gujjuri, Ewen M Harrison, Herman Lule, Haytham Kaafarani, Mohammad Khosravi, Irmgard Kronberger, Sezai Leventoğlu, Harvinder Mann, Kenneth A Mclean, Mengistu Gebreyohanes Mengesha, Maria Marta Modolo, Faustin Ntirenganya, Lisa Norman, Oumaima Outani, Riinu Pius, Peter Pockney, Ahmad Uzair Qureshi, April Camilla Roslani, Sohei Satoi, Catherine Shaw, Aneel Bhangu, Omar M Omar, Waheed-Ul-Rahman Ahmed, Leah Argus, Alasdair Ball, Edward P Bywater, Amanpreet Brar, Brett E Dawson, Irani Duran, Muhammed Elhadi, Conor S Jones, Sivesh K Kamarajah, James M Keatley, Samuel Lawday, Ella J Marson, Riinu Ots, Irène Santos, Elliott H Taylor, Isobel M Trout, Chris Varghese, Mary L Venn, William Xu, Irida Dajti, Arben Gjata, Salah Eddine Oussama Kacimi, Luis Boccalatte, Daniel Cox, Philip Townend, Felix Aigner, Irmgard Elisabeth Kronberger, Elgun Samadov, Amer Alderazi, Kamral Hossain, Greg Padmore, Gabrielle van Ramshorst, Ismaïl Lawani, Anis Cerovac, Samir Delibegovic, Gustavo Mendonça Ataíde Gomes, Igor Lima Buarque, Muhammad Gohar, Mihail Slavchev, Chukwuemeka Nwegbu, Arnav Agarwal, Janet Martin, Joshua Ng-Kamstra, Maricarmen Olivos, Wenhui Lou, Dong-Lin Ren, Jose Andres Calvache, Carlos J Perez Rivera, Ana Danic Hadzibegovic, Tomislav Kopjar, Jakov Mihanovic, Pablo Mijahil Avilés Jiménez, Nikolaos Gouvas, Jaroslav Klat, René Novysedlák, Nicolas Amisi, Peter Christensen, Alaa El-Hussuna, Sylvia Batista, Eddy Lincango-Naranjo, Sameh Emile, Danilo Alfonso Arévalo Sandoval, Hailu Dhufera, Samuel Hailu, Mengistu G Mengesha, Joonas H Kauppila, Alexis P Arnaud, Zaza Demetrashvili, Markus Albertsmeier, Hans Lederhuber, Markus W Löffler, Daniel Kwesi Acquah, Bernard Ofori, Stephen Tabiri, Symeon Metallidis, Georgios Tsoulfas, Maria-Lorena Aguilera-Arevalo, Gustavo Recinos, Tamás Mersich, Dániel Wettstein, Gabriele Kembuan, Peiman Brouki Milan, Mohammad Hossein Khosravi, Masoud Mozafari, Ahmed Hilmi, Helen Mohan, Oded Zmora, Gaetano Gallo, Francesco Pata, Gianluca Pellino, Yuki Fujimoto, Naoto Kuroda, Mohamad K Abou Chaar, Faris Ayasra, Ildar Fakhradiyev, Intisar Hisham Said Hamdun, Jang Jin-Young, Mohammad Jamal, Lina Karout, Aiste Gulla, Fanjandrainy Rasoaherinomenjanahary, Luc Hervé Samison, Iran Irani Durán Sánchez, Diana Samantha Gonzalez, Laura Martinez, María José Martínez, Alejandra Nayen, Antonio Ramos-De la Medina, Jade Nunez, Pueya Rashid Nashidengo, Rakesh Shah, Ashish Lal Shrestha, Pascal Jonker, Schelto Kruijff, Milou Noltes, Pieter Steinkamp, Deborah Wright, Lukman Abdur-Rahman, Adesoji Ademuyiwa, Adewale Adisa, Babatunde Osinaike, Justina Seyi-Olajide, Omolara Williams, Emmanuel Williams, Sofija Pejkova, Zainab Al Balushi, Raza Sayyed, Mustafa Abo Mohsen, Sadi A Abukhalaf, Moises Cukier, Hugo Gomez-Fernandez, Sebastian Shu Yip, Ximena Paola Vasquez Ojeda, Marie Dione Sacdalan, Piotr Major, José Azevedo, Miguel F Cunha, Ahmad Zarour, Eduard-Alexandru Bonci, Ionut Negoi, Sergey Efetov, Viktor Kochetkov, Andrey Litvin, Jc Allen Ingabire, Georges Bucyibaruta, Ntirenganya Faustin, Sosthene Habumuremyi, Alphonsine Imanishimwe, Haragirimana Jean de Dieu, Emmanuel Munyaneza, Isaie Ncogoza, Ehab Alameer, Abdourahmane Ndong, Dejan Radenkovic, Min Hoe Chew, Frederick Koh, James Ngu, Arpád Panyko, Uros Bele, Jurij Aleš Košir, Hassan Daoud, Ana Maria Minaya Bravo, Umesh Jayarajah, Dakshitha Wickramasinghe, Mohammed Elmujtba Adam Essa Adam, Martin Rutegård, Malin Sund, Michel Adamina, Eleftherios Gialamas, Karoline Horisberger, Muhammad Alshaar, Abel Huang, Varut Lohsiriwat, Shane Charles, Haithem Jlassi, Arda Isik, Hervé Monka Lekuya, Slava Kopetskyi, Hayder Alsaadi, Sattar Alshryda, Osaid Alser, Brittany Bankhead-Kendall, Kerry Breen, Hassan Mashbari, Fernando Bonilla Cal, Hamza Al-Naggar, Mayaba Maimbo, Dennis Mazingi, Tom 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Ugarte Oscco, Gian Mendiola, Yahaira Tatiana Carpio Colmenares, Carlos Shiraishi Zapata, Maria Rosa Ortiz, Marie Dione Sacdalan, Piotr Major, Filipe Castro Borges, Octavio Viveiros, Pedro Serralheiro, Paulo Santos-Costa, Filipa Mendes, Miguel Rocha Melo, Paulo Cardoso, Ana Soares, José Azevedo, Rita Gonçalves Pereira, Nelson Silva, André Caiado, Maria Luís Sacras, Pedro Azevedo, Rui Almeida-Reis, Miguel F Cunha, João Oliveira, Jorge Nogueiro, Mafalda Sampaio-Alves, Luciana Cidade Costa, Catarina Baía, Ana Cláudia Deus, Rita Branquinho, André Marçal, André Tojal, Ahmad Zarour, Ahmad Zarour, Silviu Tiberiu Makkai-Popa, Aurel Mironescu, Florin Grama, Elena Adelina Toma, Ionut Negoi, Daniela Filipescu, Nicolae Bacalbasa, Natalia Motas, Sebastian Ionescu, Octav Ginghina, Radu Costea, Narcis Octavian Zarnescu, Radu Drasovean, Eduard-Alexandru Bonci, Mihail-Gabriel Dimofte, Vlad Porumb, Mikhail Kirov, Yegor Molitvin, Andrey Litvin, Vadim Pykhteev, Marianna Raevskaya, Sergey Efetov, Aleksandr Butyrskii, Mushabab Alshahrani, Azah Althumairi, Nasser Alzerwi, Ahmed Al Ameer, Ahmed Al Ameer, Tariq Madkhali, Abddulrahman Saleh Almulhim, Salman Ghazwani, Abdu Ayoub, Othman Iskander, Mohammed Ghunaim, Mohammed Alharthi, Turki M Alzaidi, Azah Althumairi, Mohammad Alyami, Abdulrahman Al Amri, Azah Althumairi, Abdullah AlFakhri, Amal Alhefdhi, Sharfuddin Chowdhury, Thamer Nouh, Ameen Alshehri, Abdulrahman Alzahrani, Yousef Alalawi, Selmy Awad, Ibrahima Konate, Abdourahmane Ndong, Jacques Tendeng, Nan Zun Teo, Frederick Koh, Jurij Aleš Košir, Uros Bele, Sabra Aqil, Cristina Barrena López, Ana Sánchez Mozo, Antonio Rodriguez Infante, Patricia Caja Vivancos, Mikel Prieto, Igor Alberdi San Roman, Laura Gomez Fernandez, Josep Maria Muñoz Vives, Anna Carreras-Castañer, Berta Díaz-Feijoo, Ramon Sieira-Gil, Victor Turrado-Rodriguez, Anna Sánchez López, Santiago Sánchez-Cabús, Marta Jimenez Toscano, MªPilar Canals Sin, Saura García Laura, Oriol Martin Sole, Pedro Palazon Bellver, Sonia Pérez-Bertólez, Jordi Prat-Ortells, Mireia Riba Martínez, Josep Rubio-Palau, Xavier Tarrado, Jorge Nuñez, Veronica Alonso Mendoza, Coro Bescós, Eloy Espin-Basany, Martin Espinosa-Bravo, Daniel Gil-Sala, Susana González-Suárez, Nuria Montferrer Estruch, Jorge Nuñez, Lucia Porteiro Mariño, Ana Rodríguez-Tesouro, Fabian Rojas Portilla, M Pilar Tormos Pérez, Inmaculada Vives, Unai Garcia De Cortazar, Kiara Tudela, Aitor Landaluce-Olavarria, Mercedes Estaire Gómez, Jorge Almoguera, Bakarne Ugarte-Sierra, Virginia Jimenez, Marta Bertrand, Laura Cárdenas Puiggrós, Olga Delisau-Puig, Jorge Garcia-Adamez, David Julià Bergkvist, Eloy Maldonado-Marcos, Lucia Diego García, Marta Roldón Golet, Iván Soto-Darias, Aida Cristina Rahy-Martín, Diego Enjuto, Adolfo Ramos-Luengo, Juan Delgado Fernandez, Carolina Lugo Duarte, Cristina Ojeda Thies, Lucila Marquez, Diana Crego Vita, Jana Dziakova, Ana Maria Minaya Bravo, Jorge Caño Velasco, Olga Mateo-Sierra, Begoña Quintana-Villamandos, Cristina Rey Valcarcel, Javier Rio, Laura Román García de León, Marcello Di Martino, Jorge Prada, Javier Serrano González, Manuel Losada, Jose Tomas Castell Gomez, Ramon Corripio-Sanchez, Alexander Forero-Torres, José Manuel Morales-Puebla, Hanna Perez-Chrzanowska, Santiago Valderrabano Gonzalez, Alvaro Yebes, Ignacio Zapardiel, Manuel Diez Alonso, Nelson Morales Palacios, Alberto Cabañero Sánchez, Fátima Sánchez Fernández, Alfredo Abad Gurumeta, Ane Abad-Motos, Fernando Corella, Javier Ripollés-Melchor, Rosa Sanz-Gonzalez, Marta Alcaraz Fuentes, Maria Teresa Fernández Martín, Pablo Calvo Espino, Milagros Carrasco Prats, Antonio-José Fernández-López, Damián García Escudero, Vanesa Garcia Soria, Jesús Aarón Martínez Alonso, Miguel Ruiz-Marín, Beatriz Gómez Pérez, Joaquin Moya-Angeler, Daniel Fernández Martínez, Heura Llaquet Bayo, Enrique Colás-Ruiz, Susana Bella Romera, M Teresa Gavaldà Pellicé, Misericòrdia Jordà Solé, Enrique Jose Ruiz Velasquez, Bernardo Núñez, Raul Jimenez, Jon Zabaleta, Maria Jose González-Gimeno, Irene Ortega Vázquez, Antonio Perez Ferrer, Rubén Martín-Láez, Marcelo Moreno Suarez, Miguel Angel Freiria Eiras, Irene Ramallo-Solís, Juan-Carlos Gomez-Rosado, Jose Ramon Oliver Guillen, Mar Achalandabaso Boira, Juan Carlos Catalá Bauset, Julio Domenech, Rafael Badenes, Juan Carlos Bernal-Sprekelsen, Jorge Sancho-Muriel, Beatriz De Andrés-Asenjo, Francisco J Tejero-Pintor, Marc Vallve-Bernal, Alba Vazquez Melero, Laura Sánchez Blasco, Jorge Escartin, Victoria Duque Mallén, Selvaratnam Srishankar, Umesh Jayarajah, Charitha Sooriyabandara, Oshan Basnayake, Nalaka Gunawansa, Dakshitha Wickramasinghe, Prabuth Dulanjan Weeraddana, Thanusan Vimalakanthan, Shanthamoorthy Gishanthan, Pramodh Chandrasinghe, Eleftherios Gialamas, Marc-Olivier Sauvain, Ahmad Ghazal, Yusra Al-Sabbagh, Turki Alhassoun, Sara Maa Albared, Antoine Naem, Hareth Alnahr, Ghassan Jisry, Ali Hammed, Arda Isik, Okedi Francis Xaviour, Gaston Turinawe, Isaac Mubezi, Franck K Sikakulya, Andrew Kakeeto, Wilberforce M Kabweru, Hervé Monka Lekuya, Ronald Kiweewa, Herman Lule, Paul Matovu, Otolia Isaac, Mohamed Mashhour, Amin El Helw, Sattar Alshryda, Safeena Kherani, Awadelkarim Mohamed, Ferial Mohamed Ali Abbas, Diary Mohammed, Ehab Aldlyami, Rakesh Kundra, Mohamed Mashhour, Mohamed Mashhour, Antony Louis Rex Michael, Hayder Alsaadi, Kareem S Khalil, Rachel Dbeis, Shafaque Shaikh, Jenny Ferry, Aiman Jamal, Haleema Siddique, Rishi Das, Nikhil Ponugoti, Sivesh K Kamarajah, Pornjittra Rattanasirivilai, Asma Sultana, Frances Mosley, Matthew Chan, Antony Bateman, Gareth Davies-Jones, Fanourios Georgiades, Grant D Stewart, Navid Ahmadi, Aman Coonar, Mariam Baig, Chetan Khatri, Arthika Surendran, Julian Sonksen, Robert Sinnerton, Caitlin Brennan, Gemma Faulkner, Michael Greenhalgh, Hannah Emerson, Kiran Singisetti, Joshua Totty, Michael Wilson, Terence Lo, Harriet Corbett, Ijeoma Okonkwo, Gill Arbane, Kariem El-Boghdadly, Cyrus Kerawala, Chetan Parmar, Tom Abbott, Michael Bath, Funlayo Odejinmi, Jayesh Sagar, Rishi Talwar, Samuel Newman, John Hammond, John Moir, Natalie Duric, Tamas Szakmany, Ahmar Iftikhar Talib, Mina Youssef, Christopher Lewis-Lloyd, Christopher Lewis-Lloyd, Mariam Lami, Khurram Ayub, Benjamin Dean, Supriya Balasubramanya, Sathya Lakpriya, Luke Rogers, Paul Turner, Mark Maher, Kohila Sigamoney, John Edwards, Jihène El Kafsi, John Hardie, David Johnson, Christin Henein, Marianne Hollyman, Ketan Agarwal, Simon Powell, Govind Singh Chauhan, Rakesh Patel, Joel Gagnier, Heather Carmichael, Aurora, Kristofor A Olson, Eric Etchill, Joseph Incorvia, Sameer Hirji, Matthew Naunheim, Frederick Drake, Haytham Kaafarani, Caroline Reinke, Anna Alecci, Dennis Vaysburg, Jennifer Rodriquez, Emily Shih, Vin Shen Ban, Julia Coleman, Henry E Rice, Krista Kaups-Fresno, Emmanouil Giorgakis, Maggie DiNome, Neal Bhutiani, Omar Alnachoukati, Brittany Bankhead-Kendall, Taylor Aiken, Thomas Diehl, Ankush Gosain, Rishi Rattan, Muhammad Owais Abdul Ghani, Nensi Melissa Ruzgar, Anna Liveris, Nina Glass, Charu Paranjape, Theresa Chin, Antonio Meola, Kristina Nicholson, John Squiers, Stephanie Lueckel, Janani Reisenauer, Rachael Callcut, Ahmed Mansour, Allison Berndtson, Lucy Kornblith, Sara Seegert, Paulo Martins, Hamza Al-Naggar, Mohammed Al-Shehari, Ibrahim Al-Raimi, Allan Ngulube, Maphios Siamuchembu, Willard Mushiwokufa, Busisiwe Mlambo, Simbarashe Chinyowa, Ervis Agastra, Enton Bollano, Kostandin Gjyli, Dariel Thereska, Irida Dajti, Jola Kerpaci, Enxhi Vrapi, Lorena Zijaj, Bahraoui Djahida, Belabbes Fatima Zohra, Kouidri Khadidja, Oussama Bali, Nassim Benallel, Ismahene Lalmi, Meriem Abdoun, Nesrine Aouabed, Souad Bouaoud, Kamel Bouchenak, Assia Haif, Zineddine Soualili, Joaquin Bastet, Agustín Bianco, Daniel Capitaine, Jorge Centeno Lozada, Carlos Esquivel, Rodrigo Figueroa, Manuel Garcia, Pablo Martín García, José Ignacio Gerchunoff, Fernando Martinez Iascano, Jose Mondino, María Emilia Muriel, Carmignani Pablo, Martin Passadore, Alejandra Tornini, Rogelio Traverso, Lara Vargas, Gerardo Zanoni, Norberto Berber, Estefanía Cotta, Marcela Di Vincenzo, Esteban Sebastian Gallino, Cecilia Gigena, Bianca Grassano, Veronica Laudani, Ignacio Lugones, Constanza Madrid, Maximiliano Maricic, Antonio Alberto Martinez, Andres Rosso, Pablo Scher, Sofia Tachella, Damaris Idara Anabel Zezular, Carla Abuawad, Agustin Albani Forneris, Carola Allemand, Laura Gisela Alvarez Calzaretta, Luis Boccalatte, Jorge G Boretto, Rocio Boudou, Rodrigo Brandariz, Martin Buljubasich, Arturo Burchakchi, Martin Buttaro, Juan Pablo Campana, Virginia Cano Busnelli, Tomas Carminatti, Agustina Florencia Castro Lalín, Julian Cereghini, María Sol Crespi Amor, Roberto Sebastián Croattini, Maria Sol Fernandez, Marcelo Figari, Uriel Fraidenraij, Diego Gallegos, Agustín Maria García-Mansilla, Marcos Gonzalez, Matias Ignacio Gonzalez, Esteban Gonzalez Salazar, Jeremias Goransky, Guillermo Hernandez Gauna, Felipe Higuera, Fernando Holc, Esteban Gabriel Jauregui, Juan Larrañaga, Juan Liyo, Lionel Llano, Pablo Lobos, Emilia Luzzi, Gustavo Mastroianni, Santiago Miguel Mata-Suarez, Horacio F Mayer, Santiago Mc Loughlin, Efrain Mendoza, Ricardo Esteban Mentz, Pedro Mercado, Pablo Moyano, Florencia Noll, Diego Odetto, Agustina Rene Oliva, Rafael Perez Vidal, Catalina Poggi, Eduardo Jorge Premoli, María Lourdes Ramos, Patricio Rosas, Luciano Rossi, Gustavo Rossi, Jose Saadi, Jordán Scherñuk, Pablo Slullitel, María Verona Stang, María Victoria Taboada, Sebastian Tirapegui, Constanza Uffelmann, Carlos Vaccaro, Roberto Vagni, Ana Clara Valerio, Celeste Soledad Zarratea, Carina Chwat, Silvina Montal, Brian Morris, Pedro Valdez, Fernando Diaz-Couselo,Ricci C, Casadei R, Fruscio, R, Ornaghi, S, Felice Pecoraro, Emanuele Cammarata, Sofia Campanella, Daniela Canzonieri, Adriana Cordova, Federico De Michele, Ettore Dinoto, Mara Franza, Leo Licari, Daniele Matta, Domenico Mirabella, Roberto Pirrello, Pierfrancesco Pugliese, Fernando Rosatti, Giuseppe Salamone, Francesca Toia, Massimiliano Tripoli, Vito Chiantera, Mariano Catello Di Donna, Collaborative, Covidsurg, Collaborative, Globalsurg, Palmisano, Silvia, de Manzini, Nicolo', Simoes, J, Rosati, R, on behalf of COVIDSurg Collaborative, GlobalSurg Collaborative, Aldrighetti, L, Mortini, P, Olmi, S, Medical Oncology, Assoc Surg Training ASiT, European Soc Coloproctology ESCP, EuroSurg, G4 Alliance, GlobalPaedSurg, GICS, ItSURG, ISRC, Italian Soc Colorectal Surg SICCR, PTSurg, S-ECCO, South African Soc, and SpainSurg

Subjects
Lung Diseases, Male, Internationality, SARS-Cov-2, COVID-19, surgery, pathways, pre-operative isolation, Settore MED/18 - CHIRURGIA GENERALE, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Lung Disease, ESTUDOS PROSPECTIVOS, Cohort Studies, Patient Isolation, Postoperative Complications, 80 and over, Prospective Studies, Prospective cohort study, 610 Medicine & health, Aged, 80 and over, Incidence (epidemiology), Treatment Outcome, Elective Surgical Procedures, Female, Elective Surgical Procedure, Cohort study, Human, medicine.medical_specialty, Isolation (health care), Preoperative care, NO, Anesthesiology, Preoperative Care, medicine, Humans, Elective surgery, LS7_4, Aged, business.industry, pathway, Surgery, Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], Prospective Studie, Anesthesiology and Pain Medicine, Human medicine, Postoperative Complication, Cohort Studie, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p=0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3days, with an OR (95%CI) at 4–7days or ≥8days of 1.25 (1.04–1.48), p=0.015 and 1.31 (1.11–1.55), p=0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p=0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3days, with an OR (95%CI) at 4–7days or ≥8days of 1.25 (1.04–1.48), p=0.015 and 1.31 (1.11–1.55), p=0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care.

Published
2021

32. The Emergency Surgery Score accurately predicts the need for postdischarge respiratory and renal support after emergent laparotomies: A prospective EAST multicenter study

Author

Zachary Chadnick, Jennifer Rodriquez, Daniel Cullinane, George E. Black, Georgia Vasileiou, José A. Díaz, Catherine G. Velopulos, Rachel L. Choron, Javier Martin Perez, Leon Naar, Haytham M.A. Kaafarani, Mirhee Kim, Heather Carmichael, Jeremy Badach, Georgios Tsoulfas, David Turay, Khaldoun Bekdache, Thomas Schroeppel, Napaporn Kongkaewpaisan, D. Dante Yeh, Marta L. McCrum, Cassandra Decker, Claire Hardman, Martin D. Zielinski, Firas Madbak, Majed El Hechi, Rishi Rattan, Brittany Aicher, Joseph V. Sakran, Daniel Steadman, Cory B. Emmert, Vasiliy Sim, Mbaga S. Walusimbi, Simon Rodier, Natalie Wall, Anna Goldenberg-Sandau, Thomas H. Shoultz, Lindsay O'Meara, Vasileios Papadopoulos, Maraya Camazine, and Ursula J. Simonoski

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Critical Care and Intensive Care Medicine, Risk Assessment, Cohort Studies, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Predictive Value of Tests, Renal Dialysis, Epidemiology, Post-hoc analysis, Humans, Medicine, Medical diagnosis, Respiratory system, Dialysis, Aged, Laparotomy, business.industry, 030208 emergency & critical care medicine, Evidence-based medicine, Middle Aged, medicine.disease, Respiration, Artificial, Hospitalization, Bowel obstruction, Emergency medicine, Female, Surgery, Observational study, Emergency Service, Hospital, business, Needs Assessment
Abstract

Background The Emergency Surgery Score (ESS) was recently validated as an accurate mortality risk calculator for emergency general surgery. We sought to prospectively evaluate whether ESS can predict the need for respiratory and/or renal support (RRS) at discharge after emergent laparotomies (EL). Methods This is a post hoc analysis of a 19-center prospective observational study. Between April 2018 and June 2019, all adult patients undergoing EL were enrolled. Preoperative, intraoperative, and postoperative variables were systematically collected. In this analysis, patients were excluded if they died during the index hospitalization, were discharged to hospice, or transferred to other hospitals. A composite variable, the need for RRS, was defined as the need for one or more of the following at hospital discharge: tracheostomy, ventilator dependence, or dialysis. Emergency Surgery Score was calculated for all patients, and the correlation between ESS and RRS was examined using the c-statistics method. Results From a total of 1,649 patients, 1,347 were included. Median age was 60 years, 49.4% were men, and 70.9% were White. The most common diagnoses were hollow viscus organ perforation (28.1%) and small bowel obstruction (24.5%); 87 patients (6.5%) had a need for RRS (4.7% tracheostomy, 2.7% dialysis, and 1.3% ventilator dependence). Emergency Surgery Score predicted the need for RRS in a stepwise fashion; for example, 0.7%, 26.2%, and 85.7% of patients required RRS at an ESS of 2, 12, and 16, respectively. The c-statistics for the need for RRS, the need for tracheostomy, ventilator dependence, or dialysis at discharge were 0.84, 0.82, 0.79, and 0.88, respectively. Conclusion Emergency Surgery Score accurately predicts the need for RRS at discharge in EL patients and could be used for preoperative patient counseling and for quality of care benchmarking. Level of evidence Prognostic and epidemiological, level III.

Published
2020

33. Equity on the frontlines of trauma surgery: An #EAST4ALL roundtable

Author

Elizabeth Kiselak, Rondi B. Gelbard, Deborah M. Stein, Brandon R. Bruns, Esther S. Tseng, Rishi Rattan, Julie A. Freischlag, D’Andrea K. Joseph, Andrew C. Bernard, Bellal Joseph, Mark H. Hoofnagle, Brian Williams, Tanya L. Zakrison, Andrea M. Long, Cathleen Khandelwal, Lily Tung, Stephanie Bonne, and Nicole Goulet

Subjects
Adult, Male, Sexism, MEDLINE, Critical Care and Intensive Care Medicine, 03 medical and health sciences, Racism, 0302 clinical medicine, Surveys and Questionnaires, Humans, Medicine, Acute care surgery, Societies, Medical, Medical education, Task force, business.industry, 030208 emergency & critical care medicine, Social Discrimination, Middle Aged, Surgical training, United States, Traumatology, Harassment, Female, Surgery, Homophobia, Implicit bias, business, Trauma surgery, Gender pay gap
Abstract

Background Inequity exists in surgical training and the workplace. The Eastern Association for the Surgery of Trauma (EAST) Equity, Quality, and Inclusion in Trauma Surgery Ad Hoc Task Force (EAST4ALL) sought to raise awareness and provide resources to combat these inequities. Methods A study was conducted of EAST members to ascertain areas of inequity and lack of inclusion. Specific problems and barriers were identified that hindered inclusion. Toolkits were developed as resources for individuals and institutions to address and overcome these barriers. Results Four key areas were identified: (1) harassment and discrimination, (2) gender pay gap or parity, (3) implicit bias and microaggressions, and (4) call-out culture. A diverse panel of seven surgeons with experience in overcoming these barriers either on a personal level or as a chief or chair of surgery was formed. Four scenarios based on these key areas were proposed to the panelists, who then modeled responses as allies. Conclusion Despite perceived progress in addressing discrimination and inequity, residents and faculty continue to encounter barriers at the workplace at levels today similar to those decades ago. Action is needed to address inequities and lack of inclusion in acute care surgery. The EAST is working on fostering a culture that minimizes bias and recognizes and addresses systemic inequities, and has provided toolkits to support these goals. Together, we can create a better future for all of us.

Published
2020

34. Multi-Center Outcomes of Chlorhexidine Oral Decontamination in Intensive Care Units

Author

Ning Lu, Gabriel Ruiz, Hahn Soe-Lin, Joshua Parreco, Rishi Rattan, Saskya Byerly, Nicholas Namias, and D. Dante Yeh

Subjects
Male, Microbiology (medical), medicine.medical_specialty, Mouthwashes, Severity of Illness Index, law.invention, Sepsis, 03 medical and health sciences, Sex Factors, 0302 clinical medicine, law, Intensive care, medicine, Humans, Hospital Mortality, 030212 general & internal medicine, Decontamination, Aged, Retrospective Studies, Aged, 80 and over, 0303 health sciences, 030306 microbiology, business.industry, Chlorhexidine, Racial Groups, Age Factors, Pneumonia, Human decontamination, Middle Aged, medicine.disease, Intensive care unit, Intensive Care Units, Logistic Models, Infectious Diseases, Emergency medicine, Female, Surgery, business, medicine.drug
Abstract

Background: The efficacy of oral chlorhexidine (oCHG) for decontamination in intensive care unit (ICU) patients is controversial. The purpose of this study was to evaluate the effect of oCHG decont...

Published
2020

35. Hidden Readmissions after Carotid Endarterectomy and Stenting

Author

Rishi Rattan, Nicholas Namias, Punam P. Parikh, Joshua Parreco, Omaida C. Velazquez, Hallie J. Quiroz, and R. Martinez

Subjects
Male, medicine.medical_specialty, Time Factors, Databases, Factual, medicine.medical_treatment, Carotid arteries, Myocardial Infarction, MEDLINE, Carotid endarterectomy, 030204 cardiovascular system & hematology, Patient Readmission, Risk Assessment, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Humans, Surgical Wound Infection, Medicine, Carotid Stenosis, Myocardial infarction, Risk factor, Stroke, Aged, Retrospective Studies, Endarterectomy, Carotid, business.industry, Endovascular Procedures, General Medicine, Odds ratio, Middle Aged, medicine.disease, Readmission rate, United States, Treatment Outcome, Emergency medicine, Female, Stents, Surgery, Cardiology and Cardiovascular Medicine, business
Abstract

Historically, carotid procedures incur a readmission rate of approximately 6%; however, these studies are not nationally representative and are limited to tracking only the index hospitals. We sought to evaluate a nationally representative database for readmission rates (including different hospitals) after both carotid endarterectomy (CEA) and carotid artery stenting (CAS) and determine risk factors for poor outcomes including postoperative mortality and myocardial infarction.This study was a retrospective analysis utilizing the 2010-2014 Nationwide Readmissions Database to query patients aged18 years undergoing CEA or CAS. Outcomes included initial admission mortality, and 30-day readmission, including mortality and myocardial infarction (MI). Univariable analysis of 39 demographic, clinical, and hospital variables was conducted with significance set at P 0.05. Significant variables were included in a multivariable logistic regression to identify independent risk factors for readmission. Results were weighted for national estimates.There were 527,622 patients undergoing carotid procedures and 13% (n = 69,187) underwent CAS. The 30-day readmission rate was 7% (n = 35,782), and of those, 25% (n = 8,862) were readmitted to a different hospital. When controlling for other factors, CAS was a risk factor for mortality at both index admission (odds ratio [OR] 2.29 [2.11-2.49]) and 30-day readmission (OR 1.48 [1.3-1.69]) and 30-day readmissions at both index hospital (OR 1.11 [1.07-1.14]) and different hospital (OR 1.38 [1.29-1.48]). Readmission to a different hospital increased mortality risk (OR 1.45 [1.29-1.63]) but did not have an effect on MI. Postoperative infections comprised 15% of readmissions while 6% of all readmissions were for stroke.Previously unreported, one in 4 readmissions after carotid procedures occur at a different hospital and this fragmentation of care could increase mortality risk after carotid procedures particularly for CAS which was also an independent risk factor for postoperative mortality and readmissions. Further validation is required to decrease unnecessary hospital after carotid procedures.

Published
2020

36. COVID-19 Pandemic Acute-care Surgery Practice Survey Results from the Panamerican Trauma Society International Trauma Tele-Grand Rounds

Author

Gerd D. Pust, C Rodrigo Olvera, Shevonne S. Satahoo, Nicholas Namias, Patricia Byers, Rishi Rattan, Gabriel Ruiz, D. Dante Yeh, Enrique Ginzburg, and Antonio Marttos

Subjects
Coronavirus disease 2019 (COVID-19), Emergency surgery, business.industry, Pandemic, medicine, Survey result, Acute care surgery, General Medicine, Medical emergency, medicine.disease, business
Published
2020

37. Risk factors for complications after cholecystectomy for common bile duct stones: An EAST multicenter study

Author

Brett M. Tracy, Cameron W. Paterson, Denise M. Torres, Katelyn Young, Beth R. Hochman, Martin D. Zielinski, Sigrid K. Burruss, Michelle B. Mulder, Daniel Dante Yeh, Rondi B. Gelbard, Beth Hochman, Natasha Coleman, Anna Goldenberg-Sandau, Jennifer Schweinsburg, Rondi Gelbard, Cameron Paterson, Brett Tracy, Denise Torres, David Morris, Ashley Boyer, Sigrid Burruss, Xian Luo-Owen, Daniel Cullinane, Laura Cullinane, April Mendoza, Apostolos Gaitanidis, Martin Zielinski, Maraya Camazine, Shaneeta Johnson, Michelle Mulder, Rishi Rattan, D. Dante Yeh, Jonathan Saxe, Daniel Kinstedt, Amanda Celii, and Kiran Venincasa

Subjects
Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Gallstones, 030230 surgery, Patient Readmission, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Risk Factors, Humans, Medicine, Prospective Studies, Aged, Endoscopic retrograde cholangiopancreatography, medicine.diagnostic_test, Common bile duct, business.industry, Odds ratio, Middle Aged, Jaundice, medicine.disease, United States, Confidence interval, Surgery, medicine.anatomical_structure, Cholecystectomy, Laparoscopic, 030220 oncology & carcinogenesis, Cohort, Pancreatitis, Female, Cholecystectomy, medicine.symptom, business
Abstract

Background We sought to prospectively identify risk factors for biliary complications and 30-day readmission after cholecystectomy for choledocholithiasis and gallstone pancreatitis across multiple US hospitals. Methods We performed a prospective, observational study of patients who underwent same admission cholecystectomy for choledocholithiasis and gallstone pancreatitis between 2016 and 2019 at 12 US centers. Patients with prior history of endoscopic retrograde cholangiopancreatography or diagnosis of cholangitis were excluded. We used logistic regression to determine associations between preoperative demographics, labs, and imaging on primary outcomes: postoperative biliary complications and 30-day readmission. Results There were 989 patients in the cohort. There were 16 (1.6%) patients with postoperative biliary complications, including intra-abdominal abscesses, endoscopic retrograde cholangiopancreatography-induced pancreatitis, and biliary leaks. Increasing operative time (odds ratio 1.01, 95% confidence interval 1.00–1.01, P = .02), worsening leukocytosis (odds ratio 1.16, 95% confidence interval 1.07–1.25, P = .0002), and jaundice (odds ratio 3.25, 95% confidence interval 1.01–10.42, P = .04) were associated with postoperative biliary complications. There were 36 (3.6%) patients readmitted within 30 days owing to a surgical complication. A prior postoperative biliary complication (odds ratio 7.8, 95% confidence interval 1.63–37.27, P = .01), male sex (odds ratio 2.42, 95% confidence interval 1.2–4.87, P = .01), and index operative duration (odds ratio 1.01, 95% confidence interval 1.00–1.01, P = .03) were associated with 30-day readmission. Conclusion Among patients undergoing cholecystectomy for common bile duct stones, jaundice, worsening leukocytosis, and longer operations are associated with postoperative biliary complications. A prior biliary complication is also predictive of a 30-day readmission. Surgeons should recognize these factors and avoid prematurely discharging at-risk patients given their propensity to develop complications and require readmission.

Published
2020

38. Nationwide Outcomes and Risk Factors for Reinjury After Penetrating Trauma

Author

Nicholas Namias, Matthew S. Sussman, David J. Ebler, Joshua Parreco, Marie Crandall, Eugenia Lee, and Rishi Rattan

Subjects
Adult, Male, medicine.medical_specialty, Time Factors, Adolescent, Databases, Factual, Wounds, Penetrating, Logistic regression, Patient Readmission, New diagnosis, Young Adult, 03 medical and health sciences, Injury Severity Score, 0302 clinical medicine, Blunt, Risk Factors, Injury prevention, medicine, Risk of mortality, Humans, Hospital Mortality, Aged, Retrospective Studies, Health Services Needs and Demand, Hospital readmission, business.industry, Odds ratio, Continuity of Patient Care, Middle Aged, medicine.disease, 030220 oncology & carcinogenesis, Emergency medicine, Female, 030211 gastroenterology & hepatology, Surgery, business, Penetrating trauma
Abstract

Previous studies have shown that a notable portion of patients who are readmitted for reinjury after penetrating trauma present to a different hospital. The purpose of this study was to identify the risk factors for reinjury after penetrating trauma including reinjury admissions to different hospitals.The 2010-2014 Nationwide Readmissions Database was queried for patients surviving penetrating trauma. E-codes identified patients subsequently admitted with a new diagnosis of blunt or penetrating trauma. Univariable analysis was performed using 44 injury, patient, and hospital characteristics. Multivariable logistic regression using significant variables identified risk factors for the outcomes of reinjury, different hospital readmission, and in-hospital mortality after reinjury.There were 443,113 patients identified. The reinjury rate was 3.5%. Patients presented to a different hospital in 30.0% of reinjuries. Self-inflicted injuries had a higher risk of reinjury (odds ratio [OR]: 2.66, P 0.05). Readmission to a different hospital increased risk of mortality (OR: 1.62, P 0.05). Firearm injury on index admission increased risk of mortality after reinjury (OR: 1.94, P 0.05).This study represents the first national finding that one in three patients present to a different hospital for reinjury after penetrating trauma and have a higher risk of mortality due to this fragmentation of care. These findings have implications for quality and cost improvements by identifying areas to improve continuity of care and the implementation of penetrating injury prevention programs.

Published
2020

39. Appendicitis in Pregnancy: A Post-Hoc Analysis of an EAST Multicenter Study

Author

Georgia, Vasileiou, Ahmed I, Eid, Sinong, Qian, Gerd D, Pust, Rishi, Rattan, Nicholas, Namias, Andreas, Larentzakis, Haytham M A, Kaafarani, D Dante, Yeh, and Matthew, Bradley

Subjects
Adult, Microbiology (medical), Pediatrics, medicine.medical_specialty, MEDLINE, Gestational Age, Appendix, Patient Readmission, Severity of Illness Index, Young Adult, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Pregnancy, Post-hoc analysis, medicine, Appendectomy, Humans, 030212 general & internal medicine, Pregnancy Complications, Infectious, reproductive and urinary physiology, Ultrasonography, 0303 health sciences, 030306 microbiology, business.industry, Length of Stay, Appendicitis, medicine.disease, Magnetic Resonance Imaging, Anti-Bacterial Agents, Infectious Diseases, Multicenter study, Intestinal Perforation, Case-Control Studies, Childbearing age, Drainage, Female, Surgery, Presentation (obstetrics), Tomography, X-Ray Computed, business
Abstract

Objective: To compare the presentation, management, and outcomes of appendicitis in pregnant and non-pregnant females of childbearing age (18–45 years). Methods: This was a post-hoc analysis of a p...

Published
2020

40. Different Surgeon, Different Duration: Lack of Consensus on the Appropriate Duration of Antimicrobial Prophylaxis and Therapy in Surgical Practice

Author

Patrick T, Delaplain, Haytham M A, Kaafarani, L Andrew O, Benedict, Christopher A, Guidry, Dennis, Kim, Michele M, Loor, David, Machado-Aranda, Tina S, Mele, April E, Mendoza, Gareth, Morris-Stiff, Rishi, Rattan, Jeffrey S, Upperman, Philip S, Barie, Sebastian D, Schubl, and Philip A, Efron

Subjects
Microbiology (medical), Surgeons, Infectious Diseases, Consensus, Anti-Infective Agents, Humans, Surgical Wound Infection, Surgery, Antibiotic Prophylaxis, Anti-Bacterial Agents
Published
2022

41. Role of Empiric Antifungal Therapy in Patients with Perforated Peptic Ulcers

Author

Majid Chammas, Khaled Abdul Jawad, Rebecca A. Saberi, Gareth Gilna, Eva M. Urrechaga, Alessia Cioci, Rishi Rattan, Gerd Daniel Pust, Nicholas Namias, and Daniel Dante Yeh

Subjects
Microbiology (medical), Infectious Diseases, Antifungal Agents, Logistic Models, Peptic Ulcer Perforation, Odds Ratio, Humans, Surgery, Propensity Score
Published
2022

42. Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study (vol 46, pg 2021, 2022)

Author

Pata, Francesco, Di Martino, Marcello, Podda, Mauro, Di Saverio, Salomone, Ielpo, Benedetto, Pellino, ACIE Appy Study Collaborative Abba Julio, Gianluca., Abdullah, Alshamrani, Abdullah, Alturkistani, Abdulrahman, Alghamdi, Abdulrahman, Almalki, Adam, Orengia, Adnan, Kuvvetli, Adolfo, Pisanu, Adrian, Smith, Adriana Michelle Treviño Figueroa, Aeris Jane Nacion, Ahmad, Alhazmi, Ahmad, Bouhuwaish, Ahmad, Khalid, Ahmed, Alsufyani, Ainhoa Valle Rubio, Akshay, Bavikatte, Kumar, Akshay, Al-Radjid, Jamiri, Alberto de San Ildefonso Pereira, Alberto, Porcu, Alberto, Sartori, Aldo, Rocca, Aleksandar, Sretenovic, Anselmo, Alessandro, Alessandro De Luca, Alexandros, Charalabopoulos, Alexios, Tzivanakis, Alfonso, Bandin, Alfonso, Nájar, Alice, Frontali, Alsulaimani, Faisal, Amaia Martínez Roldan, Amal, Hamid, Ana, André, Ana, Minaya-Bravo, Andre, Das, Andrea, Bondurri, Andrea, Costanzi, Lucchi, Andrea, Andrei, Mihailescu, Police, Andrea, Andres Mendoza Zuchini, Angela, Romano, Iossa, Angelo, Antonella, Chessa, Antonella, Tromba, Antonio, Castaldi, Antonio, Brillantino, Antonio, Ferronetti, Giuliani, Antonio, Antonio Ramos-De la Medina, Antonio, Tarasconi, Arcangelo, Picciariello, Argyrios, Ioannidis, Ari, Leppäniemi, Arshad, Rashid, Ashrarur Rahman Mitul, Asif, Mehraj, Asim, Laharwal, Atif, Iqbal, Athanasios, Liarakos, Athanasios, Marinis, Beatriz de Andrés-Asenjo, Belén, Matías-García, DE SIMONE, Belinda, Ben, Creavin, Ben, Stubbs, Brian, Goh, Branislav, Jovanovic, Bruno, Sensi, Carlo, Gazia, Carlos, Cerdán, Carlos Javier Gómez Díaz, Carlos Petrola Chacón, Carlos, Yánez, Carmelo Lo Faro, Caroline, Reinke, Casandra, Dominguez, Charudutt, Paranjape, Charlotte, Thomas, Chia Chi Fung, DE LUCIA, Chiara, Chiu Hiu Fung Jennifer, Christian, Ovalle-Chao, Claudio, Guerci, Cleo, Kenington, Corina, Gica, Cristina, Folliero, Cristopher, Varela, Daniel, Popowich, Daniele, Delogu, Daniele, Zigiotto, Danilo, Vinci, Dario, D'Antonio, David Alessio Merlini, David, Merlini, David, Moro-Valdezate, Deborah, Keller, Diana Cristiana Nicolaescu, Diego, Sasia, Edgar, Rodas, Dimitrios, Linardoutsos, Domenico, Russello, Pedro Alfonso Nájar-Castañeda, Habil Gregor Stavrou, Edoardo, Rosso, Edoardo, Saladino, Edoardo, Ricciardi, Eduardo, Smith-Singares, Efstratia, Baili, Eleftheria, Douka, Guaitoli, Eleonora, Elisa, Francone, Elisa Maria Vaterlini, Elisa Sefora Pierobon, Emilio, Morales, Emilio Peña Ros, Enrico, Benzoni, Enrico, Erdas, Enrico, Pinotti, Enrique, Colás-Ruiz, Ernesto, Laterza, Esteban, Foianini, Eugenia, Cardamone, Eugenio, Licardie, Fabio, Marino, Fahad, Alsofyani, Fahad, Qahtani, Farhan, Khan, Fatlum, Maraska, Fatmir, Saliu, Fausto, Madrid, Fausto, Rosa, Federico, Luvisetto, Felipe, Alconchel, Felipe, Pareja-Ciuro, Fernanda, Neves, Ferdinando, Agresta, Fernando, Cordera, Fernando, Pardo, Fernando, Mendoza-Moreno, Fernando, Munoz-Flores, Francesca Maria Silvestri, Francesca Paola Tropeano, Francesca, Pecchini, Francesca, Serio, Francesco, Colombo, Francesco Di Marzo, Francesco, Ferrara, Francesco, Lancellotti, Francesco, Litta, Francesco, Martini, Francesco, Roscio, Francisco, Blanco-Antona, Francisco Javier Quezada Barcenas, Francisco, Schlottmann, Gabriel, Herrera-Almario, Gabrielle van Ramshorst, Gallo, Gaetano, Gaetano, Luglio, Georgios, Kampouroglou, Georgios, Papadopoulos, Gerardo, Arredondo, Giacomo, Calini, Giampaolo, Formisano, Galiffa, Giampaolo, Gian Marco Palini, Gianluca, Colucci, Gianluca, Pagano, Gianluca, Vanni, Gianmaria Casoni Pattacini, Gianpiero, Gravante, Giorgio, Lisi, Giovanni, Bellanova, Giovanni De Nobili, Giovanni Sammy Necchi, Sinibaldi, Giovanni, Giulia, Bacchiocchi, Giulia, Bagaglini, Maggi, Giulia, Giuliano, Izzo, Giulio, Argenio, Giuseppe, Brisinda, Giuseppe, Esposito, Giuseppe, Frazzetta, Giuseppe Massimiliano De Luca, Nigri, Giuseppe, Giuseppe, Sica, MARTIN DE MERCADO, Gonzalo, Gustavo Armand Ugon, Gustavo, Martinez-Mier, Gustavo Miguel Machain Vega, Gustavo, Nari, Herald, Nikaj, Ignacio, Neri, Igor Alberdi San Roman, Iliya, Fidoshev, Iñaki, Martínez, Ionut, Negoi, Irene, Ortega, Irune Vicente Rodríguez, Isabel, Cornejo, Ismael, Mora-Guzmán, Issam, Al-Najami, Ivan, Romic, Izaskun, Balciscueta, James, Olivier, Jan, Lammel-Lindemann, Jana, Dziakova, Javier, Salinas, Jelena Pejanovic Jovanovic, Jeryl Anne Silvia Reyes, Joanne, Salas, Jose Antonio Diaz-Elizondo, Jose Gustavo Parreira, Juan, Bellido, Juan, Salamea, Juan Carlos Martín Del Olmo, Juliana María Ordoñez, Sofi, Junaid, Justin, Davies, Kapil, Sahnan, Kebebe, Bekele, Kelvin, Voon, Leandro, Siragusa, Lorenzo, Petagna, Ferrario, Luca, Luca, Giordano, Luca, Nespoli, Luca, Pio, Lucia, Moletta, Luciano, Curella, Lucio, Taglietti, Luigi, Bonavina, Luigi, Conti, Luis Eduardo Pérez-Sánchez, Luis Felipe Cabrera Vargas, Luis, Sánchez-Guillén, Luis, Tallon-Aguilar, Mansoor, Khan, Marcello Giuseppe Spampinato, Marcelo, Viola, Marcelo Viola Malet, Angrisani, Marco, Marco, Calussi, Marco, Catarci, Marco, Giordano, Marco, Materazzo, Marco, Milone, Marco, Pellicciaro, Marco Vito Marino, María Daniela Moreno Villamizar, Lolli, MARIA GIULIA, Bellini, MARIA IRENE, Maria, Lemma, Maria Michela Chiarello, Mario, Montes-Manrique, Mario, Rodriguez-Lopez, Mario, Serradilla-Martín, Mark, Peter, Marta, Paniagua-García-Señoráns, Martin, Rutegård, Martin, Salö, Massimiliano, Silveri, Massimiliano, Veroux, Matteo, Nardi, Matteo, Rottoli, Matti, Tolonen, Mauricio Pedraza Ciro, Mauricio, Zuluaga, Maurizio, Iacobone, Mauro, Montuori, Mazin, Ali, Melody García Domínguez, Menna Maria Paola, Micaela, Piccoli, Michela, Campanelli, Michele De Rosa, Manigrasso, Michele, Maruccia, Michele, Michele, Torre, Michele, Zuolo, Miguel, Pera, Mihiri, Weerasekera, Mikel, Prieto, Min Myat Thway, Mohamed, Shaat, Mohammad, Azfar, Mostafa, Shalaby, Muhammad Asif Raza, Muhammad Umar Younis, Muhammed, Elhadi, Mujahid, Ali, Musab, Althomali, Nadiah Al Amri, Nagendra, Dudi-Venkata, Nahar, Alselaim, Neil, Smart, Nelson, Trelles, Nicolò, Falco, Petrucciani, Niccolo', Nicola, Antonacci, Nicola, Cillara, Nicolae, Gica, Nicolò, Pecorelli, Nicolò, Tamini, Nikolaos, Machairas, Nura, Feituri, Nuria Ortega Torrecilla, Octavio Avila Mercado, Ohood, Alaamer, Oktay, Irkorucu, Omar, Alsherif, Oreste Claudio Buonomo, Orestes, Valles-Guerra, Orestis, Ioannidis, Oscar Isaac Hernández Palmas, Oscar Sanz Guadarrama, Osman, Bozbiyik, Pablo, Rodrigues, Pamela, Milito, Paolo, Panaccio, Panagiotis, Dorovinis, Paola, Prieto, Paolo, Baroffio, Patrizia, Marsanic, Pawel, Ajawin, Peng Soon Koh, Pietro, Anoldo, Piotr, Major, Qasem, Alharthi, Rashid, Lui, Riccardo, Caruso, Richard, Brady, Rishi, Rattan, Rishi, Singhal, Roberta, Angelico, Roberta Maria Isernia, Roberta, Tutino, Roberto, Peltrini, Rodrigo, Tejos, Roosevelt, Fajardo, Rossella, Elia, Salvador, Morales-Conde, Sami, Benli, Sara, Fuentes, Sara Gortázar de Las Casas, Sara Ortiz de Guzmán Aragón, Sara, Vertaldi, Selmy, Awad, Sergio, Gentilli, Sergio Alberto Weckmann Lujan, Serkan, Tayar, Shabab, Althobaiti, DI GIOVANNI, Silvia, Soliman, Ghedan, Sonia, Pérez-Bertólez, Sonja, Chiappetta, Spiros, Delis, Stefano, Scaringi, Süleyman, Çetinkünar, Stylianos, Kykalos, Syed Muhammad Ali, Sylvia, Krivan, Tak Lit Derek Fung, Tarik, Delko, Tatiana Nicolás López, Tercio De Campos, Teresa Calderón Duque, Teresa, Perra, Theodore, Liakakos, Theodoros, Daskalakis, Tijmen, Koëter, Tiku, Zalla, Tomás Elosua González, Tommaso, Campagnaro, Toure Alpha Oumar, Ugo, Grossi, Valentina, Sosa, Valentina, Testa, Valentina, Tomajer, Valeria, Andriola, Valeria, Tonini, Valerio, Celentano, Voglino, Valerio, Venkateswara Rao Katta, Víctor Hugo García Orozco, Victor, Turrado-Rodriguez, Victor, Visag-Castillo, Victoria, Graham, Viktor, Rachkov, Vincenzo, Papagni, Vincenzo, Vigorita, Virginia Jiménez Carneros, Bellato, Vittoria, Wolf, Bechstein, Yuksel, Altinel, and Zutoia, Balciscueta

Subjects
appendicitis, COVID19
Published
2022

43. Readmission and reinjury patterns in pediatric assault victims

Author

Rishi Rattan, Ellie A. Moeller, Joshua Parreco, John Kimball, Nicholas Cortolillo, and R. Martinez

Subjects
Male, medicine.medical_specialty, Adolescent, Databases, Factual, Poison control, Intensive Care Units, Pediatric, Patient Readmission, Suicide prevention, Occupational safety and health, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, 030225 pediatrics, Injury prevention, Pediatric surgery, Humans, Medicine, Hidden populations, Child, Crime Victims, Retrospective Studies, Recidivism, business.industry, Incidence, Human factors and ergonomics, social sciences, General Medicine, Prognosis, Patient Discharge, United States, Pediatrics, Perinatology and Child Health, Emergency medicine, Wounds and Injuries, Female, 030211 gastroenterology & hepatology, Surgery, business
Abstract

Repeated pediatric assault should be a never event. The purpose of this study was to evaluate the readmission and reinjury patterns in pediatric victims of assault including readmissions to different hospitals across the US.The 2010-2014 Nationwide Readmissions Database was queried for all nonelective admissions for patients under the age of 18 years. Primary outcomes were readmission or reinjury within 1 year. Results were weighted for national estimates.Assault-related injury occurred in 46,294 pediatric patients with 11.4% of patients being readmitted within 1 year. Of those readmitted, 35.2% presented to a different hospital. Reinjury within 1 year occurred in about 1% of patients, with 14.8% of those presenting to a different hospital. Age 13 years, firearm-injury, ISS 15, female gender, and leaving AMA were found to be independent prognostic indicators of readmission within 1 year among pediatric assault patients.Care of children who are admitted and discharged for assault injuries is more fragmented that previously thought. Quality metrics fail to capture this previously hidden population. Our results identify treatable factors which could improve the care of children after assault.

Published
2019

45. Surgical Infections and the Future of Research: Re-Defining the Research Agenda for the Surgical Infection Society

Author

Patrick T, Delaplain, Haytham M A, Kaafarani, L Andrew O, Benedict, Christopher A, Guidry, Dennis, Kim, Michele M, Loor, David, Machado-Aranda, Tina S, Mele, April E, Mendoza, Gareth, Morris-Stiff, Rishi, Rattan, Jeffrey S, Upperman, Philip S, Barie, Sebastian D, Schubl, and Philip, Efron

Subjects
Microbiology (medical), medicine.medical_specialty, Biomedical Research, Consensus, Delphi Technique, business.industry, macromolecular substances, Infectious Diseases, Surveys and Questionnaires, medicine, Humans, Surgical Wound Infection, Surgery, Intensive care medicine, business, Surgical Infections, Risk management
Abstract

Background: Infections represent a major component of surgical practice. Risk mitigation, seeking eradication and optimal patient outcomes, require a concerted, multifocal effort to understand dise...

Published
2021

46. Readmission Following Surgical Stabilization of Rib Fractures: Analysis of Incidence, Cost, and Risk Factors Utilizing the Nationwide Readmissions Database

Author

Jeffrey J Aalberg, Benjamin P Johnson, Rishi Rattan, Horacio Hojman, Eric J. Mahoney, Nikolay Bugaev, and Sandra S. Arabian

Subjects
medicine.medical_specialty, Multivariate analysis, Demographics, Adult patients, Database, business.industry, Incidence (epidemiology), Psychological intervention, MEDLINE, Critical Care and Intensive Care Medicine, computer.software_genre, Article, Epidemiology, Medicine, Surgery, Level iii, business, computer
Abstract

BACKGROUND Surgical stabilization of rib fractures (SSRF) has become increasingly common for the treatment of traumatic rib fractures; however, little is known about related postoperative readmissions. The aims of this study were to determine the rate and cost of readmissions and to identify patient, hospital, and injury characteristics that are associated with risk of readmission in patients who underwent SSRF. The null hypotheses were that readmissions following rib fixation were rare and unrelated to the SSRF complications. METHODS This is a retrospective analysis of the 2015 to 2017 Nationwide Readmission Database. Adult patients with rib fractures treated by SSRF were included. Univariate and multivariate analyses were used to compare patients readmitted within 30 days with those who were not, based on demographics, comorbidities, and hospital characteristics. Financial information examined included average visit costs and national extrapolations. RESULTS A total of 2,522 patients who underwent SSRF were included, of whom 276 (10.9%) were readmitted within 30 days. In 36.2% of patients, the reasons for readmissions were related to complications of rib fractures or SSRF. The rest of the patients (63.8%) were readmitted because of mostly nontrauma reasons (32.2%) and new traumatic injuries (21.1%) among other reasons. Multivariate analysis demonstrated that ventilator use, discharge other than home, hospital size, and medical comorbidities were significantly associated with risk of readmission. Nationally, an estimated 2,498 patients undergo SSRF each year, with costs of US $176 million for initial admissions and US $5.9 million for readmissions. CONCLUSION Readmissions after SSRF are rare and mostly attributed to the reasons not directly related to sequelae of rib fractures or SSRF complications. Interventions aimed at optimizing patients' preexisting medical conditions before discharge should be further investigated as a potential way to decrease rates of readmission after SSRF. LEVEL OF EVIDENCE Epidemiological study, level III.

Published
2021

47. Advanced Statistics: Multiple Logistic Regression, Cox Proportional Hazards, and Propensity Scores

Author

D. Dante Yeh, Alejandro Mantero, Joshua P. Parreco, Alessia C. Cioci, Anthony L. Cioci, and Rishi Rattan

Subjects
Microbiology (medical), business.industry, Proportional hazards model, Confounding, Statistics as Topic, Gold standard (test), Logistic regression, Causality, law.invention, Infectious Diseases, Logistic Models, Randomized controlled trial, Bias, law, Propensity score matching, Statistics, Medicine, Humans, Surgery, business, Propensity Score, Proportional Hazards Models
Abstract

Background: Randomized controlled trials (RCTs) are generally regarded as the gold standard for demonstrating causality because they effectively mitigate bias from both known and unknown confounder...

Published
2021

48. The role of direct peritoneal resuscitation in the treatment of hemorrhagic shock after trauma and in emergency acute care surgery: a systematic review

Author

Marcelo Augusto Fontenelle Ribeiro-Junior, Cássia Tiemi Kawase Costa, Samara de Souza Augusto, Paola Rezende Néder, Yasmin Garcia Batista Elia, Rishi, Rattan, Andressa Daniel Maurício, Giuliani, Antonio, Gallo, Gaetano, Mauro, Podda, Umberto, Bracale, Tiziana, Principi, Pata, Francesco, and Salomone Di Saverio

Subjects
Resuscitation, open abdomen, shock, Shock, Hemorrhagic, Critical Care and Intensive Care Medicine, Microcirculation, visceral ischemia, Rats, Sprague-Dawley, Edema, medicine, Animals, Humans, Orthopedics and Sports Medicine, primary fascial closure, Septic shock, business.industry, direct peritoneal resuscitation, Hypoxia (medical), medicine.disease, inflammation, haemorrhage, Rats, Blood pressure, medicine.anatomical_structure, Anesthesia, Shock (circulatory), Emergency Medicine, Abdomen, Fluid Therapy, Surgery, medicine.symptom, business
Abstract

Direct peritoneal resuscitation (DPR) has been used to help preserve microcirculation by reversing vasoconstriction and hypoperfusion associated with the pathophysiological process of shock, which can occur despite appropriate intravenous resuscitation. This approach depends on infusing a hyperosmolar solution intraperitoneally via a percutaneous catheter with the tip ending near the pelvis or the root of the mesentery. The abdomen is usually left open with a negative pressure abdominal dressing to continuously evacuate the infused dialysate. Hypertonicity of the solution triggers visceral vasodilation to help maintain blood flow, even during shock, and is also associated with reduced local inflammatory cytokines and other mediators, preservation of endothelial cell function, and mitigation of organ edema and necrosis. It also has a direct effect on liver perfusion and edema, more rapidly corrects electrolyte abnormalities compared to intravenous resuscitation alone, and may requireless intravenous fluid to stabilize blood pressure, all of which shortens the time required to close patients’ abdomen. An online query using the search term “direct peritoneal resuscitation” was carried out in PubMed, MEDLINE and SciELO, limited to publications indexed from January 2014 to June 2020. Of the 20 articles returned, full text was able to be obtained for 19. A manual review of included articles’ references was resulted in the addition of 1 article, for a total of 20 included articles. The 20 articles were comprised of 15 animal studies, 4 clinical studies,and 1 expert opinion. The benefits include both local and possibly systemic effects on perfusion, hypoxia, acidosis, and inflammation, and are associated with improved outcomes and reduced complications. DPR shows promise in patients with hemorrhagic shock, septic shock, and other conditions resulting in an open abdomen after damage control laparotomy.

Published
2021

49. The Long-term Risk of Venous Thromboembolism After Blunt Splenic Injury Managed by Embolization

Author

Rishi Rattan, Nicholas Namias, Eva M. Urrechaga, Michelle B. Mulder, Kenneth G. Proctor, Joshua Parreco, Sarah A. Eidelson, and Matthew S. Sussman

Subjects
Adult, Male, Risk, medicine.medical_specialty, business.industry, medicine.medical_treatment, MEDLINE, Venous Thromboembolism, Middle Aged, Wounds, Nonpenetrating, Embolization, Therapeutic, Patient Readmission, Surgery, Long term risk, Blunt, Risk Factors, Humans, Medicine, Female, Embolization, business, Venous thromboembolism, Spleen, Aged
Published
2020

50. Use of Predictive Equations for Energy Prescription Results in Inaccurate Estimation in Trauma Patients

Author

Rishi Rattan, Sinong Qian, D. Dante Yeh, Georgia Vasileiou, Michelle B. Mulder, Jonathan Parks, Gerd D. Pust, Rahul Iyengar, Patricia Byers, Lindsey M. Gass, and Edward B. Lineen

Subjects
Adult, Male, Critical Care, 030309 nutrition & dietetics, Critical Illness, Medicine (miscellaneous), Body weight, Energy requirement, Body Mass Index, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Humans, Medicine, Medical prescription, 0303 health sciences, Nutrition and Dietetics, Nutritional Support, Critically ill, business.industry, Body Weight, Nutritional Requirements, Calorimetry, Indirect, Middle Aged, Stress factor, Prescriptions, Health evaluation, Mechanism of injury, Anesthesia, Wounds and Injuries, Female, 030211 gastroenterology & hepatology, Energy Intake, Energy Metabolism, business, Body mass index
Abstract

Background Overfeeding and underfeeding are associated with poor clinical outcomes. In the absence of indirect calorimetry (IC), the Society of Critical Care Medicine/ASPEN recommend prescribing 25-30 kcal/kg. The Harris-Benedict equation (HBE) multiplied by a stress factor is commonly applied in critically ill patients. We describe the difference between estimated and actual energy needs in critically injured patients. Methods From March to November 2018, we collected demographics and energy needs determined by continuous IC (started within 4 days) in intubated adults. Ideal or adjusted body weight was used for 25-30 kcal/kg, and HBE was multiplied by a 1.3 stress factor (1.3HBE). Daily requirements up to 14 days, extubation, or death were calculated using all 3 methods and compared with IC. Results Fifty-five subjects were included. Median age was 38 [27-58] years, 38 (69%) were male, body mass index was 28 [25-33] kg/m2 , and Acute Physiology and Chronic Health Evaluation II score was 17 [14-24] Mechanism of injury was blunt (38, 69%), penetrating (9, 16%), and burn (8, 15%). By day 14, compared with measured energy requirements by IC, the other methods could result in a cumulative 1827-kcal (+7%) surplus (1.3HBE), a 1313-kcal (-5%) deficit (25 kcal/kg), or a 3950-kcal (+14%) surplus (30 kcal/kg) per patient over a median 9 days. Conclusion In critically injured patients, predictive equations for energy needs do not account for dynamic metabolic changes over time and could result in underfeeding or overfeeding. Adjusting daily prescription based on continuous IC may result in better individualized treatment.

Published
2019

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