A5060430676- Trauma and Emergency Care Studies
- Cardiac Arrest and Resuscitation
- Abdominal Trauma and Injuries
- Trauma Management and Diagnosis
- Pelvic and Acetabular Injuries
- Sepsis Diagnosis and Treatment
- Cardiac, Anesthesia and Surgical Outcomes
- Emergency and Acute Care Studies
- Appendicitis Diagnosis and Management
- Respiratory Support and Mechanisms
- Nosocomial Infections in ICU
- Abdominal Surgery and Complications
- Spinal Fractures and Fixation Techniques
- Gallbladder and Bile Duct Disorders
- Hemodynamic Monitoring and Therapy
- Hernia repair and management
- Pleural and Pulmonary Diseases
- Trauma, Hemostasis, Coagulopathy, Resuscitation
- Substance Abuse Treatment and Outcomes
- Pneumonia and Respiratory Infections
- Traumatic Brain Injury and Neurovascular Disturbances
- Pediatric Hepatobiliary Diseases and Treatments
- Hip and Femur Fractures
- Intestinal and Peritoneal Adhesions
- Venous Thromboembolism Diagnosis and Management
Wake Forest University
2016-2025
Atrium Health Wake Forest Baptist
2015-2025
University Medical Center
2003-2024
St George's, University of London
2023
Lehigh Valley Hospital-Pocono
2021
Lehigh Valley Health Network
2021
Princeton University
2020
University of Puerto Rico at Carolina
2011-2017
Jacobson Holman (United States)
2016
Maine Farmland Trust
2016
The successful treatment of intraabdominal infection requires a combination anatomical source control and antibiotics. appropriate duration antimicrobial therapy remains unclear.We randomly assigned 518 patients with complicated adequate to receive antibiotics until 2 days after the resolution fever, leukocytosis, ileus, maximum 10 (control group), or fixed course (experimental group) for 4±1 calendar days. primary outcome was composite surgical-site infection, recurrent death within 30...
Recent randomized prospective data suggest that early hyperglycemia is associated with excess mortality in critically ill patients, and tight glucose control leads to improved outcome. This concept has not been carefully examined trauma the relationship of from sepsis this population unclear. The objective study was determine different levels blood elevation outcome a ICU population.The records all patients admitted over 2-year period at Level I center were reviewed for age, injury severity...
Objective To prospectively examine outcomes associated with an aggressive screening protocol for blunt cerebrovascular injury (BCVI), and to compare the accuracy of computed tomographic angiography (CTA) magnetic resonance (MRA) versus conventional respect BCVI diagnosis. Summary Background Data In past 5 years, (carotid vertebral arteries) has been recognized increasing frequency. Initial studies described carotid injuries their morbidity, while more recent reports have established...
To prospectively examine outcomes associated with an aggressive screening protocol for blunt cerebrovascular injury (BCVI), and to compare the accuracy of computed tomographic angiography (CTA) magnetic resonance (MRA) versus conventional respect BCVI diagnosis.In past 5 years, (carotid vertebral arteries) has been recognized increasing frequency. Initial studies described carotid injuries their morbidity, while more recent reports have established devastating potential injuries. It...
Background Bleeding pelvic fractures (BPF) carry mortality as high 60%, yet controversy remains over optimal initial management. Some base intervention on fracture pattern, with immediate external fixation (EX FIX) in amenable aimed at controlling venous bleeding. Others feel ongoing hemodynamic instability indicates arterial bleeding, and prefer early angiography (ANGIO) before EX-FIX. Our aim was to evaluate markers of bleeding patients BPF, thus identifying requiring ANGIO regardless...
Background Blunt cerebrovascular injuries (BCVIs), once thought to be rare, have been recognized with increasing frequency in recent years. An incidence of 0.33% for carotid artery injury (CAI) was noted from our institution, 24% stroke-related mortality. Vertebral (VAI) has both rare and questionable significance. Incidence, associated patterns, outcomes were examined during a period aggressive screening (four-vessel angiography). Methods Patients BCVI identified the registry Level I trauma...
In Brief Objective: The goal of this report is to examine the success vacuum-assisted fascial closure (VAFC) under a carefully applied protocol in abdominal after open abdomen. Summary Background Data: With development damage control techniques and understanding compartment syndrome, abdomen has become commonplace trauma patients. If not closed early postoperative period, combination adhesions retraction frequently make primary impossible creation planned ventral hernia required. We have...
The pathophysiology of pulmonary contusion (PC) is poorly understood, and only minimal advances have been made in management this entity over the past 20 years. Improvement understanding PC has hindered by fact that there no accurate way to quantitate amount injury. With project, we examine a method accurately measuring degree quantifying volume relative function outcome.Patients with from isolated chest trauma who had admission computed tomographic scan were identified registry Level I...
The use of open abdomen techniques in damage control laparotomy and abdominal compartment syndrome has led to development several methods temporary closure. All these require creation a planned hernia with later reconstruction patients unable undergo fascial closure the early postoperative period. We review method late primary closure, thus eliminating need for delayed some patients.The records all managed abdomens over 5-year period at Level I trauma center were reviewed injury...
Acute respiratory distress syndrome (ARDS) is a major contributor to morbidity and mortality in trauma patients. Although many injuries conditions are believed be associated with ARDS independent risk factors patients their relative importance development of the undefined. The aim this project identify for blunt examine contributions each factor development. Patients were identified from registry Level I center over 4.5-year period. Records reviewed demographics, injury characteristics,...
Severe injury and shock are frequently associated with abnormalities in patient body temperature. Substantial increases mortality have been profound hypothermia, especially below 35 degrees C. The purpose of this study was to further characterize the impact hypothermia a large dataset trauma patients. This retrospective analysis 2004 version National Trauma Data Bank (NTDB), which contains approximately 1.1 million patients from over 400 centers. Admission temperature analyzed respect...
Tominaga, Gail T. MD; Staudenmayer, Kristan L. Shafi, Shahid Schuster, Kevin M. Savage, Stephanie A. Ross, Steven Muskat, Peter Mowery, Nathan Miller, Preston Inaba, Kenji Cohen, Mitchell Jay Ciesla, David Brown, Carlos V.R. Agarwal, Suresh Aboutanos, Michel B. Utter, Garth H. Crandall, Marie MD American Association for the Surgery of Trauma Committee on Patient Assessment Author Information
Currently, there is no established system for assessing disease severity in emergency general surgery (EGS) patients. The purpose of this project was to develop a uniform grading measuring anatomic patient population.The Committee on Patient Assessment and Outcomes the American Association Surgery Trauma developed proposal by consensus experts EGS diseases. It then reviewed approved Board Managers Trauma.A described, with specific grades eight commonly encountered gastrointestinal...
Objective To evaluate the effect of timing spine fracture fixation on outcome in multiply injured patients. Summary Background Data There is little consensus regarding optimal after blunt trauma. Potential advantages early include earlier patient mobilization and fewer septic complications; disadvantages compounded complications from associated injuries inconvenience surgical scheduling. Methods Patients with fractures trauma admitted to an urban level 1 center during a 42-month period who...
During the past decade, nonoperative management (NOM) of hemodynamically stable blunt trauma patients with liver (L) or spleen (S) injury has become standard care. This trend led to concerns over missed associated intra-abdominal injuries concomitant morbidity. To better understand incidence and risk injury, patterns were examined in all injuries, reviewed undergoing NOM.Patients identified from registry a Level I center 3-year period. Records for demographics, characteristics, injuries....
Published contraindications to nonoperative management (NOM) of blunt splenic injury (BSI) include age > or = 55, Glasgow Coma Scale score < 13, admission blood pressure 100 mm Hg, major (grades 3-5) injuries, and large amounts hemoperitoneum. Recently reported NOM rates approximate 60%, with failure 10% 15%. This study evaluated our failures for BSI relative these clinical factors.All patients at a Level I trauma center over 46-month period ending September 1999 were reviewed. Failures...
Background: The early resuscitation occurs in the emergency department (ED) where intensive care unit protocols do not always extend and monitoring capabilities vary. Our hypothesis is that increased ED length of stay (LOS) leads to hospital mortality patients undergoing immediate surgical intervention. Methods: We examined all trauma activation admissions from January 2002 July 2009 admitted Trauma Service (n = 3,973). Exclusion criteria were as follows: taken operating room within first 2...
Background: Coagulopathy is present in 25% to 38% of trauma patients on arrival the hospital, and these are four times more likely die than without coagulopathy. Recently, a high ratio fresh frozen plasma (FFP) packed red blood cells (PRBCs) has been shown decrease mortality massively transfused patients. Therefore, we hypothesized that with elevated International Normalized Ratio (INR) hospital may benefit from transfusion FFP:PRBC those lower INR. Methods: Retrospective multicenter cohort...
Objective To compare patient-reported, health-related quality of life (QoL) for children with serious congenital heart defects (CHDs) and unaffected classmates to investigate the demographic clinical factors influencing QoL. Design Retrospective cohort study. Setting UK National Health Service. Patients UK-wide CHDs aged 10–14 years requiring cardiac intervention in first year one 17 paediatric surgical centres operating during 1992–1995. A comparison group similar age sex was recruited....
Venous thromboembolism (VTE) is a leading cause of death in multisystem trauma patients; the importance VTE prevention well recognized. Presently, standard dose enoxaparin (30 mg BID) used as chemical prophylaxis, regardless weight or physiologic status. However, evidence suggests decreased bioavailability critically ill patients. Therefore, we hypothesized that weight-based dosing regimen would provide more adequate prophylaxis (as indicated by antifactor Xa levels) for patients our...
The staged laparotomy in the operative management of emergency general surgery (EGS) patients is an extension trauma surgeons operating on this population. Indications for its application, however, are not well defined, and currently based lethal triad used physiologically-decompensated patients. This study sought to determine acute indications staged, rapid source control (RSCL) EGS patients.All undergoing emergent RSCL non-RSCL over 3 years were studied. Demographics, physiologic...
Objective Increased intra-abdominal pressure (IAP) compromises cardiopulmonary function and visceral perfusion. Our goal was to characterize acute changes in these subsystems associated with operative abdominal decompression. Patient Population A series of 11 consecutive injured patients monitored a pulmonary artery catheter nasogastric tonometer whom decompression performed. Indications for included oliguria or progressive acidosis despite aggressive resuscitation the presence elevated IAP...