A5070489762- Trauma and Emergency Care Studies
- Venous Thromboembolism Diagnosis and Management
- Emergency and Acute Care Studies
- Cardiac, Anesthesia and Surgical Outcomes
- Abdominal Trauma and Injuries
- Pelvic and Acetabular Injuries
- Trauma Management and Diagnosis
- Healthcare Policy and Management
- Acute Myocardial Infarction Research
- Cardiac Arrest and Resuscitation
- Hip and Femur Fractures
- Injury Epidemiology and Prevention
- Airway Management and Intubation Techniques
- Trauma, Hemostasis, Coagulopathy, Resuscitation
- Clinical practice guidelines implementation
- Central Venous Catheters and Hemodialysis
- Healthcare cost, quality, practices
- Hospital Admissions and Outcomes
- Ultrasound in Clinical Applications
- Tracheal and airway disorders
- Atrial Fibrillation Management and Outcomes
- Esophageal and GI Pathology
- Patient Satisfaction in Healthcare
- Health Systems, Economic Evaluations, Quality of Life
- Primary Care and Health Outcomes
Johns Hopkins University
2016-2025
Johns Hopkins Medicine
2016-2025
National Patient Safety Foundation
2015-2024
University of British Columbia
2024
Johns Hopkins Children's Center
2024
Johns Hopkins Hospital
2013-2023
UC San Diego Health System
2023
National Institutes of Health
2011-2023
National Center for Advancing Translational Sciences
2020-2023
Maryland Department of Health
2023
Helicopter emergency medical services and their possible effect on outcomes for traumatically injured patients remain a subject of debate. Because helicopter are limited expensive resource, methodologically rigorous investigation its effectiveness compared with ground is warranted.
Within the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework, we performed a systematic review developed evidence-based recommendations to answer following PICO (Population, Intervention, Comparator, Outcomes) question: should patients who present pulseless after critical injuries (with without signs life penetrating thoracic, extrathoracic, or blunt injuries) undergo emergency department thoracotomy (EDT) (vs. resuscitation EDT) improve survival...
Studies involving physicians suggest that unconscious bias may be related to clinical decision making and predict poor patient-physician interaction. The presence of race social class its association with assessments or among medical students is unknown.
BACKGROUND Rib fractures are identified in 10% of all injury victims and associated with significant morbidity (33%) mortality (12%). Significant progress has been made the management rib over past few decades, including operative reduction internal fixation (rib ORIF); however, subset patients that would benefit most from this procedure remains ill-defined. The aim project was to develop evidence-based recommendations. METHODS Population, intervention, comparison, outcome (PICO) questions...
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STATEMENT OF THE PROBLEM Thoracic trauma is a notable cause of morbidity and mortality in American centers, where 25% traumatic deaths are related to injuries sustained within the thoracic cage.1 Chest occur ∼60% polytrauma cases; therefore, rough estimate occurrence hemothorax United States approaches 300,000 cases per year.2 The management pneumothorax has been complex problem since it was first described over 200 years ago. Although majority chest can be managed nonoperatively, there...
Significant health inequities persist among minority and socially disadvantaged patients. Better understanding of how unconscious biases affect clinical decision making may help to illuminate clinicians' roles in propagating disparities.To determine whether race and/or social class correlate with patient management decisions.We conducted a web-based survey 230 physicians from surgery related specialties at an academic, level I trauma center December 1, 2011, through January 31, 2012.We...
Clinical guidelines recommend low-molecular-weight heparin for thromboprophylaxis in patients with fractures, but trials of its effectiveness as compared aspirin are lacking.
Whole-blood (WB) resuscitation has gained renewed interest among civilian trauma centers. However, there remains insufficient evidence that WB as an adjunct to component therapy-based massive transfusion protocol (WB-MTP) is associated with a survival advantage over MTP alone in adult patients presenting severe hemorrhage.
Background: The purpose of this study is to describe practice patterns and outcomes posttraumatic retrievable inferior vena caval filters (R-IVCF). Methods: A retrospective review R-IVCFs placed during 2004 at 21 participating centers with follow up July 1, 2005 was performed. Primary included major complications (migration, pulmonary embolism [PE], symptomatic occlusion) reasons for failure retrieve. Results: Of 446 patients (69% male, 92% blunt trauma) receiving R-IVCFs, 76% prophylactic...
Background: Several studies have described predictive models to identify trauma patients who require massive transfusion (MT). Early identification of lethal exsanguination may improve survival in this patient population. The purpose the current study was validate a simplified score predict MT at multiple Level I centers. Methods: All adult treated three centers from July 2006 June 2007 (1) were transported directly scene, (2) activations, and (3) received any blood transfusions during...
Postoperative venous thromboembolism (VTE) rates are widely reported quality metrics soon to be used in pay-for-performance programs. Surveillance bias occurs when some clinicians use imaging studies detect VTE more frequently than other clinicians. Because they look more, find events, paradoxically worsening their hospital's measure performance. A surveillance may influence measurement if (1) greater hospital prophylaxis adherence fails result lower measured rates, (2) hospitals with...
Background: Previous studies have suggested that prehospital spine immobilization provides minimal benefit to penetrating trauma patients but takes valuable time, potentially delaying definitive care. We hypothesized who are immobilized before transport higher mortality than nonimmobilized patients. Methods: performed a retrospective analysis of in the National Trauma Data Bank (version 6.2). Multiple logistic regression was used with as primary outcome measure. compared versus without...
Prehospital intravenous (IV) fluid administration is common in trauma patients, although little evidence supports this practice. We hypothesized that patients who received prehospital IV fluids have higher mortality than did not receive the setting.We performed a retrospective cohort study of from National Trauma Data Bank. Multiple logistic regression was used with as primary outcome measure. compared versus without administration, using patient demographics, mechanism, physiologic and...
Diagnosing blunt cardiac injury (BCI) can be difficult. Many patients with mechanism for BCI are admitted to the critical care setting based on associated injuries; however, debate surrounds those who hemodynamically stable and do not otherwise require a higher level of care. To allow safe discharge home or admission nonmonitored setting, should definitively ruled out in at risk.This Eastern Association Surgery Trauma (EAST) practice management guideline (PMG) updates original from 1998....
In 2012, Medicare began cutting reimbursement for hospitals with high readmission rates. We sought to define the incidence and risk factors associated after surgery.A total of 230,864 patients discharged general, upper gastrointestinal (GI), small large intestine, hepatopancreatobiliary (HPB), vascular, thoracic surgery were identified using 2011 American College Surgeons National Surgical Quality Improvement Program. Readmission rates patient characteristics analyzed. A predictive model was...
Blunt traumatic aortic injury (BTAI) is the second most common cause of death in trauma patients. Eighty percent patients with BTAI will die before reaching a center. The issues how to diagnose, treat, and manage were first addressed by Eastern Association for Surgery Trauma (EAST) practice management guidelines on this topic published 2000. Since that time, there have been advances BTAI. As result, EAST committee decided develop updated using Grading Recommendations, Assessment, Development...
BACKGROUND Identifying predictors of mortality and surgical complications has led to outcome improvements for a variety conditions. However, similar work yet be done factors affecting outcomes emergency general surgery (EGS). The objective this study was determine the in-hospital among EGS patients. METHODS Nationwide Inpatient Sample (2003–2011) queried patients with conditions encompassing as determined by American Association Surgery Trauma, categorizing them into predefined groups using...
Background: Recent studies suggest racial disparities in the treatment and outcomes of children with traumatic brain injury (TBI). This study aims to identify race-based clinical functional outcome differences among pediatric TBI patients a national database. Methods: A total 41,122 (ages 2–16 years) who were included National Pediatric Trauma Registry (from 1996–2001) studied. was categorized by Relative Head Injury Severity Score (RHISS) moderate severe included. Individual race groups...
Traumatic injury to the pancreas is rare but associated with significant morbidity and mortality, including fistula, sepsis, death. There are currently no practice management guidelines for medical surgical of traumatic pancreatic injuries. The overall objective this article provide evidence-based recommendations physician who presented pancreas.The MEDLINE database using PubMed was searched identify English language articles published from January 1965 December 2014 regarding adult patients...