A5000334641- Trauma and Emergency Care Studies
- Venous Thromboembolism Diagnosis and Management
- Emergency and Acute Care Studies
- Traumatic Brain Injury and Neurovascular Disturbances
- Injury Epidemiology and Prevention
- Acute Myocardial Infarction Research
- Trauma Management and Diagnosis
- COVID-19 and healthcare impacts
- Cardiac, Anesthesia and Surgical Outcomes
- Burn Injury Management and Outcomes
- Cardiac Arrest and Resuscitation
- Abdominal Trauma and Injuries
- Global Health and Surgery
- Atrial Fibrillation Management and Outcomes
- Acute Ischemic Stroke Management
- Ultrasound in Clinical Applications
- Pancreatic and Hepatic Oncology Research
- Trauma, Hemostasis, Coagulopathy, Resuscitation
- Gallbladder and Bile Duct Disorders
- Sepsis Diagnosis and Treatment
- Surgical site infection prevention
- Pelvic and Acetabular Injuries
- Pancreatitis Pathology and Treatment
- Infection Control in Healthcare
- Vascular Procedures and Complications
University of California, San Diego
2014-2024
University of California San Diego Medical Center
2023-2024
UC San Diego Health System
2018-2024
University of Arizona
2023
University of California System
2023
London Health Sciences Centre
2023
Association Clinique et Thérapeutique Infantile du Val de Marne
2023
American College of Surgeons
2016-2022
Via Christi Hospital
2022
St. Anthony Hospital
2022
Trauma patients are at increased risk of venous thromboembolism (VTE), which includes both deep vein thrombosis and pulmonary embolism. Pharmacologic VTE prophylaxis is a critical component optimal trauma care that significantly decreases risk. Optimal protocols must manage the with competing hemorrhage in following significant trauma. Currently, there variability across centers. In an attempt to optimize for injured patient, stakeholders from American Association Surgery College...
Empiric enoxaparin dosing is inadequate for most trauma patients, leading to below target initial anti-Xa levels and requiring dose adjustment optimal venous thromboembolism prophylaxis. We hypothesize that patient factors affecting can be identified based on drug pharmacokinetics, allowing creation of a new protocol will provide higher percentage in-target (0.2-0.4 IU/mL) patients at level assessment.Records 318 were evaluated, NONMEM PSN software used analyze 11 variables their effects...
Screening for blunt cerebrovascular injuries (BCVIs) in asymptomatic high-risk patients has become routine. To date, the length of this period not been defined. Determining time to stroke could impact therapy including earlier initiation antithrombotics multiply injured patients. The purpose study was determine with a BCVI-related stroke. We hypothesized that majority suffer between 24 hours and 72 after injury.Patients from January 2007 2017 37 trauma centers were reviewed.During 10-year...
Brain Injury Guidelines (BIG) was developed to effectively use health care resources including repeat head computed tomography (RHCT) scan and neurosurgical consultation in traumatic brain injury (TBI) patients. The aim of this study prospectively validate BIG at a multi-institutional level.This is prospective, observational, trial across nine Levels I II trauma centers. Adult (16 years or older) blunt TBI patients with positive initial (CT) were identified categorized into 1, 2, 3 based on...
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BACKGROUND Given the high mortality and morbidity of emergency general surgery (EGS), designing implementing effective quality assessment tools is imperative. Currently accepted EGS risk scores are limited by need for manual extraction, which time-intensive costly. We developed an automated institutional electronic health record (EHR)–linked registry that calculates a modified Emergency Surgery Score (mESS) Predictive OpTimal Trees in Risk (POTTER) score demonstrated their use benchmarking...
INTRODUCTION Pancreatic trauma results in high morbidity and mortality, part caused by the delay diagnosis subsequent organ dysfunction. Optimal operative management strategies remain unclear. We therefore sought to determine CT accuracy diagnosing pancreatic injury mortality associated with varying strategies. METHODS created a multicenter, registry from 18 Level 1 2 centers. Adult, blunt or penetrating injured patients 2005 2012 were analyzed. Sensitivity specificity of scan identification...
Background: Rib fractures are a common injury in trauma patients and account for significant morbidity mortality within this population. Local anesthetic-based nerve blocks have been demonstrated to provide pain relief reduce complications. However, the analgesia provided by these is limited hours single injection or days continuous infusions, while duration of often lasts weeks. Case: This case series describes five with rib whose was successfully treated cryoneurolysis. Conclusions:...
OBJECTIVES San Diego County’s geographic location lends a unique demographic of migrant patients injured by falls at the United States-Mexico border. To prevent crossings, 2017 Executive Order allocated funds to increase southern California border wall height from 10 ft 30 ft, which was completed in December 2019. We hypothesized that elevated is associated with increased major trauma, resource utilization, and health care costs. METHODS Retrospective trauma registry review performed two...
Pharmacological venous thromboembolism (VTE) prophylaxis is recommended in the vast majority of trauma patients. The purpose this study was to characterize current dosing practices and timing initiation pharmacological VTE chemoprophylaxis at centers.This an international, cross-sectional survey providers. sponsored by American Association for Surgery Trauma (AAST) distributed AAST members. included 38 questions about practitioner demographics, experience, level location center,...
Death from noncompressible torso hemorrhage (NCTH) may be preventable with improved prehospital care and shorter in-hospital times to control. We hypothesized that surgical intervention for control would decrease mortality in hypotensive patients NCTH.This was an AAST-sponsored multicenter, prospective analysis of aged 15+ years who presented NCTH May 2018 December 2020. Hypotension defined as initial systolic blood pressure (SBP) ≤ 90 mm Hg. Primary outcomes interest were time...
The strong ion difference (SID) (apparent [SIDa] and effective [SIDe]) gap (SIG) provide a comprehensive method of evaluating acid-base status in critically ill patients. SID is the between cations anions plasma, while SIG demonstrates presence unmeasured ions. This approach accounts for changes patient's protein status, which particularly important those with burn injuries. We hypothesized that SIDa, SIDe, during first 72 hours after admission would be predictive mortality patients.This...
Patient outcome prediction models are underused in clinical practice because of lack integration with real-time patient data. The electronic health record (EHR) has the ability to use machine learning (ML) develop predictive models. While an EHR ML model been developed predict deterioration, it yet be validated for trauma. We hypothesized that Epic Deterioration Index (EDI) would mortality and unplanned intensive care unit (ICU) admission trauma patients.A retrospective analysis a registry...
As the population ages, more trauma patients are admitted with coagulopathy. Fresh frozen plasma is effective in reversing coagulopathy caused by warfarin; however, it not appropriate for all patients. Prothrombin complex concentrates (PCCs) an alternative who require emergent reversal, minimal-volume administration and have a supratherapeutic international normalized ratio (INR). A four-factor PCC initially approved Europe now available United States. We sought to review our experience...
Sex is associated with disparate risk of venous thromboembolism (VTE) in nontrauma patients, increased seen during pregnancy and women on hormone-containing medications. effects VTE after trauma are unclear. Some studies have demonstrated no effect whereas others instead shown a higher incidence among men. We hypothesized that male sex would increase the across all age groups patients undergoing standardized duplex screening.All admissions to Level I academic center 2000 2014 were reviewed....
BACKGROUND Retained hemothorax (rHTX) requiring intervention occurs in up to 20% of patients who undergo chest tube (TT) placement for a (HTX). Thoracic irrigation at the time TT decreases need secondary this patient group but those findings are limited because single-center design. A multicenter study was conducted evaluate effectiveness thoracic irrigation. METHODS multicenter, prospective, observational between June 2018 and July 2023. Eleven sites contributed patients. Patients were...
Severe burn injury produces significant tissue damage, resulting in metabolic acidosis. Current methods of acid-base evaluation are based on dependent variables that may not be accurate after injury. The strong ion method is independent and accurately predict outcomes severely burn-injured patients. authors hypothesize an increased gap present admission will associated with mortality pediatric A retrospective chart review was performed patients a TBSA 20% or greater. Data collected included...