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Tran Z, Reeves M, Cho NY, Lum S, Benharash P, Mukherjee K. Outcomes of Hospitalized Injured Suspects Sustaining Gunshot Wounds From Law Enforcement Action. Am Surg 2024:31348241230095. [PMID: 38290493 DOI: 10.1177/00031348241230095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
BACKGROUND Although firearms are implicated in the majority of law enforcement intervention (LEI)-related deaths, scientific research is lacking. The present study sought to characterize clinical and financial outcomes between injured suspects and other gunshot wound (GSW) patients. STUDY DESIGN The 2016-2020 National Inpatient Sample was queried for patients ≥16 years old admitted following GSW. Patients were categorized as injured suspects (ISs) if they were injured in LEI and non-IS otherwise. The primary outcome was in-hospital mortality with complications, hospitalization duration (LOS), and costs secondarily considered. Multivariable regression models were used to adjust for patient characteristics, injury burden using the Trauma Mortality Prediction Model (TMPM), and hospital factors. RESULTS Of 143,125 hospitalizations, 1575 (1.10%) were IS. Compared to non-IS, ISs were less frequently Black (24.4% vs 54.3%) but had a higher proportion of psychiatric conditions (19.4% vs 6.4%) (P < .05). Although having a similar requirement for major operations and TMPM score, ISs more frequently underwent thoracic (11.4% vs 4.1%) and gastrointestinal operations (33.0% vs 25.7%) (P < .05). After adjustment, IS was associated with similar odds of mortality but was associated with greater odds of cardiac complications, respiratory failure, and need for intensive care. While LOS was similar, IS was associated with greater costs (β: +$14,300, 95% CI: 6,200-22,400). CONCLUSIONS Suspects injured during law enforcement intervention have similar in-hospital mortality but greater complication rates and costs. Through the quantification of the clinical and financial burden of IS, our findings may help inform further policy discussions regarding use of potentially lethal force in law enforcement intervention.
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Affiliation(s)
- Zachary Tran
- Division of Acute Care Surgery, Department of Surgery, Loma Linda University Health, Loma Linda, CA, USA
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Matthew Reeves
- Division of Acute Care Surgery, Department of Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - Nam Yong Cho
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Sharon Lum
- Division of Surgical Oncology, Department of Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Kaushik Mukherjee
- Division of Acute Care Surgery, Department of Surgery, Loma Linda University Health, Loma Linda, CA, USA
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Gagliardi JP, Smith CM, Chang-Sing EJK, Cramer LD, Robinson L, Shah D, Jivalagian PA, Turner NA, Wong AH. Racial Inequities in Police Transport for Patients to the Emergency Department: A Multicenter Analysis. Am J Prev Med 2024; 66:154-158. [PMID: 37661074 PMCID: PMC10842350 DOI: 10.1016/j.amepre.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/25/2023] [Accepted: 08/27/2023] [Indexed: 09/05/2023]
Abstract
INTRODUCTION Police involvement in patient transport to emergency medical care has increased over time, yet studies assessing racial inequities in transport are limited. This study evaluated the relationship between race and police transport to the emergency department for adult patients. METHODS This cross-sectional study evaluated adult (aged ≥18 years) visits at 13 different emergency departments across two regional hospital systems in the Southeastern and Northeastern U.S. from 2015 to 2022. Data were extracted from electronic health records. This analysis evaluated the association between race and transport by police transport using generalized linear multivariable mixed model with a binary logistic link for presence of police transport. Data were nested by patient and adjusted for site, demographics, and diagnostic visit characteristics. RESULTS Of 4,291,809 adult emergency department visits, 25,901 (0.6%) involved transport by police. Of the 25,901 visits in police-involved encounters, 10,513 (40.6%) patients were Black, and 9,827 (37.9%) were White. The adjusted model showed that Black patients were at higher odds of transport by police than White patients (AOR=1.64; 95% CI=1.57-1.72). Male sex, younger age (18-35 years), history of behavioral health diagnosis, and emergency department psychiatric or substance use disorders were independently associated with increased odds of police transport. CONCLUSIONS This analysis revealed racial inequities in police-involved transport to emergency medical care, highlighting an urgent need to evaluate drivers of inequities and the ways in which police transport influences clinical outcomes.
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Affiliation(s)
- Jane P Gagliardi
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
| | - Colin M Smith
- Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina
| | | | - Laura D Cramer
- Yale National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut
| | - Leah Robinson
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Dhruvil Shah
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Pateel A Jivalagian
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Nicholas A Turner
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Ambrose H Wong
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
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Atkins K, Schneider A, Gallaher J, Charles A. The effect of transport mode on mortality following isolated penetrating torso Trauma. Am J Surg 2023; 226:542-547. [PMID: 37453802 PMCID: PMC10528673 DOI: 10.1016/j.amjsurg.2023.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/12/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Prehospital interventions may increase the time to definitive care. Compared to ground ambulance, we hypothesize improved mortality for patients with isolated, penetrating torso injuries transported via private vehicle. METHODS We reviewed the National Trauma Data Bank (2017-2021) for adults with isolated, penetrating torso injuries stratified by mechanism (stabbing vs. firearm) and transport mode (private vehicle vs. ground ambulance). We performed a multivariable logistic regression to estimate the effect of transport mode on mortality. RESULTS 48,444 patients met our inclusion criteria. Patients transported by ambulance, injured by stabbing (n = 26,633) and by firearm (n = 21,811) had adjusted odds ratios of 1.81 (95%CI 1.05-3.14, p = 0.03) and 1.66 (95%CI 1.32-2.09,p < 0.001) respectively for mortality compared to private vehicle transport. CONCLUSION Patients with penetrating torso injuries have nearly twice the odds of mortality when transported by ground ambulance than private vehicles, despite injury severity. The "scoop and run" strategy may confer a survival benefit in this population.
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Affiliation(s)
- Kathryn Atkins
- Department of Surgery, University of North Carolina at Chapel Hill, United States
| | - Andrew Schneider
- Department of Surgery, University of North Carolina at Chapel Hill, United States
| | - Jared Gallaher
- Department of Surgery, University of North Carolina at Chapel Hill, United States
| | - Anthony Charles
- Department of Surgery, University of North Carolina at Chapel Hill, United States.
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Renberg M, Dahlberg M, Gellerfors M, Rostami A, Günther M, Rostami E. Prehospital transportation of severe penetrating trauma victims in Sweden during the past decade: a police business? Scand J Trauma Resusc Emerg Med 2023; 31:45. [PMID: 37684674 PMCID: PMC10492387 DOI: 10.1186/s13049-023-01112-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/03/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION Sweden is facing a surge of gun violence that mandates optimized prehospital transport approaches, and a survey of current practice is fundamental for such optimization. Management of severe, penetrating trauma is time sensitive, and there may be a survival benefit in limiting prehospital interventions. An important aspect is unregulated transportation by police or private vehicles to the hospital, which may decrease time but may also be associated with adverse outcomes. It is not known whether transport of patients with penetrating trauma occurs outside the emergency medical services (EMS) in Sweden and whether it affects outcome. METHOD This was a retrospective, descriptive nationwide study of all patients with penetrating trauma and injury severity scores (ISSs) ≥ 15 registered in the Swedish national trauma registry (SweTrau) between June 13, 2011, and December 31, 2019. We hypothesized that transport by police and private vehicles occurred and that it affected mortality. RESULT A total of 657 patients were included. EMS transported 612 patients (93.2%), police 10 patients (1.5%), and private vehicles 27 patients (4.1%). Gunshot wounds (GSWs) were more common in police transport, 80% (n = 8), compared with private vehicles, 59% (n = 16), and EMS, 32% (n = 198). The Glasgow coma scale score (GCS) in the emergency department (ED) was lower for patients transported by police, 11.5 (interquartile range [IQR] 3, 15), in relation to EMS, 15 (IQR 14, 15) and private vehicles 15 (IQR 12.5, 15). The 30-day mortality for EMS was 30% (n = 184), 50% (n = 5) for police transport, and 22% (n = 6) for private vehicles. Transport by private vehicle, odds ratio (OR) 0.65, (confidence interval [CI] 0.24, 1.55, p = 0.4) and police OR 2.28 (CI 0.63, 8.3, p = 0.2) were not associated with increased mortality in relation to EMS. CONCLUSION Non-EMS transports did occur, however with a low incidence and did not affect mortality. GSWs were more common in police transport, and victims had lower GCS scorescores when arriving at the ED, which warrants further investigations of the operational management of shooting victims in Sweden.
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Affiliation(s)
- Mattias Renberg
- Department of Anesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden
| | - Martin Dahlberg
- Department of Surgery, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Gellerfors
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Rapid Response Car, Capio, Stockholm, Sweden
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
- Swedish Air Ambulance (SLA), Mora, Sweden
| | - Amir Rostami
- Department for Social Work and Criminology, University of Gävle, Gävle, Sweden
| | - Mattias Günther
- Department of Anesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden.
- Experimental Traumatology Unit, Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- Department of Clinical Science and Education, Section for Anesthesiology and Intensive Care, Södersjukhuset, Karolinska Institutet, Sjukhusbacken 10, S1, 118 83, Stockholm, Sweden.
| | - Elham Rostami
- Experimental Traumatology Unit, Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University Hospital , Uppsala, Sweden
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Wardrop R, Ranse J, Chaboyer W, Crilly J. Characteristics and outcomes of patient presentations to the emergency department via police: A scoping review. Australas Emerg Care 2023; 26:239-248. [PMID: 36792389 DOI: 10.1016/j.auec.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 01/16/2023] [Accepted: 01/29/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND As emergency department (ED) presentations continue to rise, understanding the complexities of vulnerable populations such as people brought in by police (BIBP) is crucial. This review aimed to map and describe the research about people BIBP to the ED. DESIGN AND METHOD A scoping review, guided by the Joanna Briggs Institute process, was undertaken. The databases CINAHL, Embase and PubMed were searched between November 2017 and July 2022. The Patterns, Advances, Gaps, Evidence for practice, Research recommendations (PAGER) framework was used to guide the analysis. RESULTS A total of 21 studies were included in the review, originating mainly from westernised countries. Examination of patterns across studies revealed four themes: routinely collected data is used to describe people BIBP to the ED; a focus on mental health care; the relationship between care delivery and outcomes; and the role of police in providing emergency care. CONCLUSION There is some understanding of the demographic characteristics, clinical characteristics, and outcomes of people BIBP to the ED. Knowledge gaps surrounding sociodemographic factors, prehospital and ED care delivery for people BIBP require further investigation to optimise outcomes for this vulnerable cohort of presenters.
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Affiliation(s)
- Rachel Wardrop
- School of Nursing and Midwifery, Griffith University, Parklands Dr, Southport, QLD 4222, Australia; Menzies Health Institute Queensland, Griffith University, Parklands Dr, Southport, QLD 4222, Australia.
| | - Jamie Ranse
- School of Nursing and Midwifery, Griffith University, Parklands Dr, Southport, QLD 4222, Australia; Menzies Health Institute Queensland, Griffith University, Parklands Dr, Southport, QLD 4222, Australia; Department of Emergency Medicine, Gold Coast Hospital and Health Service, 1 Hospital Blvd, Southport, QLD 4215, Australia.
| | - Wendy Chaboyer
- School of Nursing and Midwifery, Griffith University, Parklands Dr, Southport, QLD 4222, Australia; Menzies Health Institute Queensland, Griffith University, Parklands Dr, Southport, QLD 4222, Australia.
| | - Julia Crilly
- School of Nursing and Midwifery, Griffith University, Parklands Dr, Southport, QLD 4222, Australia; Menzies Health Institute Queensland, Griffith University, Parklands Dr, Southport, QLD 4222, Australia; Department of Emergency Medicine, Gold Coast Hospital and Health Service, 1 Hospital Blvd, Southport, QLD 4215, Australia.
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Epstein A, Lim R, Johannigman J, Fox CJ, Inaba K, Vercruysse GA, Thomas RW, Martin MJ, Konstantyn G, Schwaitzberg SD. Putting Medical Boots on the Ground: Lessons from the War in Ukraine and Applications for Future Conflict with Near-Peer Adversaries. J Am Coll Surg 2023; 237:364-373. [PMID: 37459197 PMCID: PMC10344429 DOI: 10.1097/xcs.0000000000000707] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 04/25/2023]
Abstract
In the past 20 years of the Global War on Terror, the US has seen substantial improvements in its system of medical delivery in combat. However, throughout that conflict, enemy forces did not have parity with the weaponry, capability, or personnel of the US and allied forces. War against countries like China and Russia, who are considered near-peer adversaries in terms of capabilities, will challenge battlefield medical care in many different ways. This article reviews the experience of a medical team, Global Surgical and Medical Support Group, that has been providing assistance, training, medical support, and surgical support to Ukraine since the Russian invasion began in February 2022. The team has extensive experience in medicine, surgery, austere environments, conflict zones, and building partner nation capacities. This article compares and contrasts the healthcare systems of this war against the systems used during the Global War on Terror. The lessons learned here could help the US anticipate challenges and successfully plan for the provision of medical care in a future conflict against an adversary with capabilities close to its own.
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Affiliation(s)
- Aaron Epstein
- From the Global Surgical and Medical Support Group (GSMSG), Washington, DC (Epstein)
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo - The State University of New York, Buffalo, NY (Epstein, Schwaitzberg)
- Department of Surgery, University of Oklahoma School of Medicine, Tulsa, OK (Lim)
- Department of Surgery, St Anthony Hospital, Lakewood, CO (Johannigman)
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD (Johannigman)
- Department of Radiology, Memorial Healthcare System, Hollywood, FL (Fox)
- Division of Trauma and Surgical Critical Care, Department of Surgery, University of Southern California, Los Angeles, CA (Inaba)
- Department of Surgery, University of Michigan School of Medicine, Ann Arbor, MI (Vercruysse)
- West Virginia University School of Medicine Eastern Division, Martinsburg, WV (Thomas)
- Department of Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA (Martin)
- Medical Service of the Armed Forces of Ukraine (Konstantyn)
- Department of General Surgery, Bohomolets National Medical University of Ukraine; Department of Military Surgery, Ukrainian Military Medical Academy, Kyiv, Ukraine (Konstantyn)
- Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo - The State University of New York, Buffalo, NY (Schwaitzberg)
| | - Robert Lim
- From the Global Surgical and Medical Support Group (GSMSG), Washington, DC (Epstein)
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo - The State University of New York, Buffalo, NY (Epstein, Schwaitzberg)
- Department of Surgery, University of Oklahoma School of Medicine, Tulsa, OK (Lim)
- Department of Surgery, St Anthony Hospital, Lakewood, CO (Johannigman)
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD (Johannigman)
- Department of Radiology, Memorial Healthcare System, Hollywood, FL (Fox)
- Division of Trauma and Surgical Critical Care, Department of Surgery, University of Southern California, Los Angeles, CA (Inaba)
- Department of Surgery, University of Michigan School of Medicine, Ann Arbor, MI (Vercruysse)
- West Virginia University School of Medicine Eastern Division, Martinsburg, WV (Thomas)
- Department of Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA (Martin)
- Medical Service of the Armed Forces of Ukraine (Konstantyn)
- Department of General Surgery, Bohomolets National Medical University of Ukraine; Department of Military Surgery, Ukrainian Military Medical Academy, Kyiv, Ukraine (Konstantyn)
- Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo - The State University of New York, Buffalo, NY (Schwaitzberg)
| | - Jay Johannigman
- From the Global Surgical and Medical Support Group (GSMSG), Washington, DC (Epstein)
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo - The State University of New York, Buffalo, NY (Epstein, Schwaitzberg)
- Department of Surgery, University of Oklahoma School of Medicine, Tulsa, OK (Lim)
- Department of Surgery, St Anthony Hospital, Lakewood, CO (Johannigman)
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD (Johannigman)
- Department of Radiology, Memorial Healthcare System, Hollywood, FL (Fox)
- Division of Trauma and Surgical Critical Care, Department of Surgery, University of Southern California, Los Angeles, CA (Inaba)
- Department of Surgery, University of Michigan School of Medicine, Ann Arbor, MI (Vercruysse)
- West Virginia University School of Medicine Eastern Division, Martinsburg, WV (Thomas)
- Department of Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA (Martin)
- Medical Service of the Armed Forces of Ukraine (Konstantyn)
- Department of General Surgery, Bohomolets National Medical University of Ukraine; Department of Military Surgery, Ukrainian Military Medical Academy, Kyiv, Ukraine (Konstantyn)
- Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo - The State University of New York, Buffalo, NY (Schwaitzberg)
| | - Charles J Fox
- From the Global Surgical and Medical Support Group (GSMSG), Washington, DC (Epstein)
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo - The State University of New York, Buffalo, NY (Epstein, Schwaitzberg)
- Department of Surgery, University of Oklahoma School of Medicine, Tulsa, OK (Lim)
- Department of Surgery, St Anthony Hospital, Lakewood, CO (Johannigman)
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD (Johannigman)
- Department of Radiology, Memorial Healthcare System, Hollywood, FL (Fox)
- Division of Trauma and Surgical Critical Care, Department of Surgery, University of Southern California, Los Angeles, CA (Inaba)
- Department of Surgery, University of Michigan School of Medicine, Ann Arbor, MI (Vercruysse)
- West Virginia University School of Medicine Eastern Division, Martinsburg, WV (Thomas)
- Department of Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA (Martin)
- Medical Service of the Armed Forces of Ukraine (Konstantyn)
- Department of General Surgery, Bohomolets National Medical University of Ukraine; Department of Military Surgery, Ukrainian Military Medical Academy, Kyiv, Ukraine (Konstantyn)
- Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo - The State University of New York, Buffalo, NY (Schwaitzberg)
| | - Kenji Inaba
- From the Global Surgical and Medical Support Group (GSMSG), Washington, DC (Epstein)
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo - The State University of New York, Buffalo, NY (Epstein, Schwaitzberg)
- Department of Surgery, University of Oklahoma School of Medicine, Tulsa, OK (Lim)
- Department of Surgery, St Anthony Hospital, Lakewood, CO (Johannigman)
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD (Johannigman)
- Department of Radiology, Memorial Healthcare System, Hollywood, FL (Fox)
- Division of Trauma and Surgical Critical Care, Department of Surgery, University of Southern California, Los Angeles, CA (Inaba)
- Department of Surgery, University of Michigan School of Medicine, Ann Arbor, MI (Vercruysse)
- West Virginia University School of Medicine Eastern Division, Martinsburg, WV (Thomas)
- Department of Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA (Martin)
- Medical Service of the Armed Forces of Ukraine (Konstantyn)
- Department of General Surgery, Bohomolets National Medical University of Ukraine; Department of Military Surgery, Ukrainian Military Medical Academy, Kyiv, Ukraine (Konstantyn)
- Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo - The State University of New York, Buffalo, NY (Schwaitzberg)
| | - Gary A Vercruysse
- From the Global Surgical and Medical Support Group (GSMSG), Washington, DC (Epstein)
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo - The State University of New York, Buffalo, NY (Epstein, Schwaitzberg)
- Department of Surgery, University of Oklahoma School of Medicine, Tulsa, OK (Lim)
- Department of Surgery, St Anthony Hospital, Lakewood, CO (Johannigman)
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD (Johannigman)
- Department of Radiology, Memorial Healthcare System, Hollywood, FL (Fox)
- Division of Trauma and Surgical Critical Care, Department of Surgery, University of Southern California, Los Angeles, CA (Inaba)
- Department of Surgery, University of Michigan School of Medicine, Ann Arbor, MI (Vercruysse)
- West Virginia University School of Medicine Eastern Division, Martinsburg, WV (Thomas)
- Department of Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA (Martin)
- Medical Service of the Armed Forces of Ukraine (Konstantyn)
- Department of General Surgery, Bohomolets National Medical University of Ukraine; Department of Military Surgery, Ukrainian Military Medical Academy, Kyiv, Ukraine (Konstantyn)
- Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo - The State University of New York, Buffalo, NY (Schwaitzberg)
| | - Richard W Thomas
- From the Global Surgical and Medical Support Group (GSMSG), Washington, DC (Epstein)
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo - The State University of New York, Buffalo, NY (Epstein, Schwaitzberg)
- Department of Surgery, University of Oklahoma School of Medicine, Tulsa, OK (Lim)
- Department of Surgery, St Anthony Hospital, Lakewood, CO (Johannigman)
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD (Johannigman)
- Department of Radiology, Memorial Healthcare System, Hollywood, FL (Fox)
- Division of Trauma and Surgical Critical Care, Department of Surgery, University of Southern California, Los Angeles, CA (Inaba)
- Department of Surgery, University of Michigan School of Medicine, Ann Arbor, MI (Vercruysse)
- West Virginia University School of Medicine Eastern Division, Martinsburg, WV (Thomas)
- Department of Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA (Martin)
- Medical Service of the Armed Forces of Ukraine (Konstantyn)
- Department of General Surgery, Bohomolets National Medical University of Ukraine; Department of Military Surgery, Ukrainian Military Medical Academy, Kyiv, Ukraine (Konstantyn)
- Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo - The State University of New York, Buffalo, NY (Schwaitzberg)
| | - Matthew J Martin
- From the Global Surgical and Medical Support Group (GSMSG), Washington, DC (Epstein)
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo - The State University of New York, Buffalo, NY (Epstein, Schwaitzberg)
- Department of Surgery, University of Oklahoma School of Medicine, Tulsa, OK (Lim)
- Department of Surgery, St Anthony Hospital, Lakewood, CO (Johannigman)
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD (Johannigman)
- Department of Radiology, Memorial Healthcare System, Hollywood, FL (Fox)
- Division of Trauma and Surgical Critical Care, Department of Surgery, University of Southern California, Los Angeles, CA (Inaba)
- Department of Surgery, University of Michigan School of Medicine, Ann Arbor, MI (Vercruysse)
- West Virginia University School of Medicine Eastern Division, Martinsburg, WV (Thomas)
- Department of Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA (Martin)
- Medical Service of the Armed Forces of Ukraine (Konstantyn)
- Department of General Surgery, Bohomolets National Medical University of Ukraine; Department of Military Surgery, Ukrainian Military Medical Academy, Kyiv, Ukraine (Konstantyn)
- Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo - The State University of New York, Buffalo, NY (Schwaitzberg)
| | - Gumeniuk Konstantyn
- From the Global Surgical and Medical Support Group (GSMSG), Washington, DC (Epstein)
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo - The State University of New York, Buffalo, NY (Epstein, Schwaitzberg)
- Department of Surgery, University of Oklahoma School of Medicine, Tulsa, OK (Lim)
- Department of Surgery, St Anthony Hospital, Lakewood, CO (Johannigman)
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD (Johannigman)
- Department of Radiology, Memorial Healthcare System, Hollywood, FL (Fox)
- Division of Trauma and Surgical Critical Care, Department of Surgery, University of Southern California, Los Angeles, CA (Inaba)
- Department of Surgery, University of Michigan School of Medicine, Ann Arbor, MI (Vercruysse)
- West Virginia University School of Medicine Eastern Division, Martinsburg, WV (Thomas)
- Department of Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA (Martin)
- Medical Service of the Armed Forces of Ukraine (Konstantyn)
- Department of General Surgery, Bohomolets National Medical University of Ukraine; Department of Military Surgery, Ukrainian Military Medical Academy, Kyiv, Ukraine (Konstantyn)
- Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo - The State University of New York, Buffalo, NY (Schwaitzberg)
| | - Steven D Schwaitzberg
- From the Global Surgical and Medical Support Group (GSMSG), Washington, DC (Epstein)
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo - The State University of New York, Buffalo, NY (Epstein, Schwaitzberg)
- Department of Surgery, University of Oklahoma School of Medicine, Tulsa, OK (Lim)
- Department of Surgery, St Anthony Hospital, Lakewood, CO (Johannigman)
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD (Johannigman)
- Department of Radiology, Memorial Healthcare System, Hollywood, FL (Fox)
- Division of Trauma and Surgical Critical Care, Department of Surgery, University of Southern California, Los Angeles, CA (Inaba)
- Department of Surgery, University of Michigan School of Medicine, Ann Arbor, MI (Vercruysse)
- West Virginia University School of Medicine Eastern Division, Martinsburg, WV (Thomas)
- Department of Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA (Martin)
- Medical Service of the Armed Forces of Ukraine (Konstantyn)
- Department of General Surgery, Bohomolets National Medical University of Ukraine; Department of Military Surgery, Ukrainian Military Medical Academy, Kyiv, Ukraine (Konstantyn)
- Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo - The State University of New York, Buffalo, NY (Schwaitzberg)
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Salhi RA, Iyengar S, da Silva Bhatia B, Smith GC, Heisler M. How do current police practices impact trauma care in the prehospital setting? A scoping review. J Am Coll Emerg Physicians Open 2023; 4:e12974. [PMID: 37229183 PMCID: PMC10204184 DOI: 10.1002/emp2.12974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 04/08/2023] [Accepted: 04/27/2023] [Indexed: 05/27/2023] Open
Abstract
Objective In the United States, police are often important co-responders to 911 calls with emergency medical services for medical emergencies. To date, there remains a lack of a comprehensive understanding of the mechanisms by which police response modifies time to in-hospital medical care for traumatically injured patients. Further, it remains unclear if differentials exist within or between communities. A scoping review was performed to identify studies evaluating prehospital transport of traumatically injured patients and the role or impact of police involvement. Methods PubMed, SCOPUS, and Criminal Justice Abstracts databases were utilized to identify articles. English-language, US-based, peer-reviewed articles published on or prior to March 30, 2022 were eligible for inclusion. Results Of 19,437 articles initially identified, 70 articles were selected for full review and 17 for final inclusion. Key findings included (1) current law enforcement practices involving scene clearance introduce the potential for delayed patient transport but to date there is little research quantifying delays; (2) police transport protocols may decrease transport times; and (3) there are no studies examining the potential impact of scene clearance practices at the patient or community level. Conclusions Our results highlight that police are often the first on scene when responding to traumatic injuries and have an active role via scene clearance or, in some systems, patient transport. Despite the significant potential for impact on patient well-being, there remains a paucity of data examining and driving current practices.
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Affiliation(s)
- Rama A. Salhi
- Department of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Sonia Iyengar
- University of Michigan Medical SchoolAnn ArborMichiganUSA
| | | | - Graham C. Smith
- Department of Emergency MedicineUniversity of MichiganAnn ArborMichiganUSA
- Washtenaw/Livingston Medical Control AuthorityAnn ArborMichiganUSA
| | - Michele Heisler
- Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
- Institute for Healthcare Policy and InnovationUniversity of MichiganAnn ArborMichiganUSA
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8
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Walter C, Miller M, Jones V, Ryan LM. Emergency Department-Attended Injuries Resulting from School-Based Violence in Baltimore Adolescents, 2019-2020. THE JOURNAL OF SCHOOL HEALTH 2023; 93:219-225. [PMID: 36426581 DOI: 10.1111/josh.13288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 09/29/2022] [Accepted: 11/02/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Our objective is to describe violence-related injuries to early adolescents that occurred at school, resulting in emergency department (ED) evaluation. METHODS This retrospective cohort study at an urban academic pediatric ED in Baltimore, MD, identified patients 10-15 years old who presented with an injury from intentional, interpersonal violence that occurred at school between January 2019-December 2020. Descriptive statistics were used to summarize patient and event characteristics. RESULTS Of 819 youth 10-15 years of age evaluated for a violence-related injury, school was the location in 115 cases (14.0%). All events occurred prior to the statewide stay at home order (March 30, 2020). School-injured youth had a mean age of 12.7 ± 1.7 years and were predominantly male (64.3%). Of the 115 cases, 75 (65.2%) involved an altercation with a peer, 26 (22.6%) involved a teacher or school staff, 6 (5.2%) involved a family member, 1 (0.9%) involved police, 6 (5.2%) involved an unknown party, and 1 (0.9%) involved an unrelated but known adult. All injured youth were discharged from the ED. CONCLUSIONS School-based violence is a well-recognized cause of traumatic injuries to adolescents and may involve peers, teachers, or school staff.
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Affiliation(s)
- Creason Walter
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mattea Miller
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Vanya Jones
- Health, Behavior, & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Leticia Manning Ryan
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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9
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Ferrada P, Cannon JW, Kozar RA, Bulger EM, Sugrue M, Napolitano LM, Tisherman SA, Coopersmith CM, Efron PA, Dries DJ, Dunn TB, Kaplan LJ. Surgical Science and the Evolution of Critical Care Medicine. Crit Care Med 2023; 51:182-211. [PMID: 36661448 DOI: 10.1097/ccm.0000000000005708] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Surgical science has driven innovation and inquiry across adult and pediatric disciplines that provide critical care regardless of location. Surgically originated but broadly applicable knowledge has been globally shared within the pages Critical Care Medicine over the last 50 years.
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Affiliation(s)
- Paula Ferrada
- Division of Trauma and Acute Care Surgery, Department of Surgery, Inova Fairfax Hospital, Falls Church, VA
| | - Jeremy W Cannon
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rosemary A Kozar
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Eileen M Bulger
- Division of Trauma, Burn and Critical Care Surgery, Department of Surgery, University of Washington at Seattle, Harborview, Seattle, WA
| | - Michael Sugrue
- Department of Surgery, Letterkenny University Hospital, County of Donegal, Ireland
| | - Lena M Napolitano
- Division of Acute Care Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Samuel A Tisherman
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Craig M Coopersmith
- Division of General Surgery, Department of Surgery, Emory University, Emory Critical Care Center, Atlanta, GA
| | - Phil A Efron
- Department of Surgery, Division of Critical Care, University of Florida, Gainesville, FL
| | - David J Dries
- Department of Surgery, University of Minnesota, Regions Healthcare, St. Paul, MN
| | - Ty B Dunn
- Division of Transplant Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Lewis J Kaplan
- Division of Trauma, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Corporal Michael J. Crescenz VA Medical Center, Section of Surgical Critical Care, Surgical Services, Philadelphia, PA
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10
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When it comes to urban penetrating trauma in America: "Start your engines". J Trauma Acute Care Surg 2023; 94:e23-e24. [PMID: 36694338 DOI: 10.1097/ta.0000000000003814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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11
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Coming in hot: Police transport and prehospital time after firearm injury. J Trauma Acute Care Surg 2022; 93:656-663. [DOI: 10.1097/ta.0000000000003689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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12
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Byrne JP, Kaufman E, Scantling D, Tam V, Martin N, Raza S, Cannon JW, Schwab CW, Reilly PM, Seamon MJ. Association Between Geospatial Access to Care and Firearm Injury Mortality in Philadelphia. JAMA Surg 2022; 157:942-949. [PMID: 36001304 PMCID: PMC9403855 DOI: 10.1001/jamasurg.2022.3677] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/30/2022] [Indexed: 11/14/2022]
Abstract
Importance The burden of firearm violence in US cities continues to rise. The role of access to trauma center care as a trauma system measure with implications for firearm injury mortality has not been comprehensively evaluated. Objective To evaluate the association between geospatial access to care and firearm injury mortality in an urban trauma system. Design, Setting, and Participants Retrospective cohort study of all people 15 years and older shot due to interpersonal violence in Philadelphia, Pennsylvania, between January 1, 2015, and August 9, 2021. Exposures Geospatial access to care, defined as the predicted ground transport time to the nearest trauma center for each person shot, derived by geospatial network analysis. Main Outcomes and Measures Risk-adjusted mortality estimated using hierarchical logistic regression. The population attributable fraction was used to estimate the proportion of fatalities attributable to disparities in geospatial access to care. Results During the study period, 10 105 people (910 [9%] female and 9195 [91%] male; median [IQR] age, 26 [21-28] years; 8441 [84%] Black, 1596 [16%] White, and 68 other [<1%], including Asian and unknown, consolidated owing to small numbers) were shot due to interpersonal violence in Philadelphia. Of these, 1999 (20%) died. The median (IQR) predicted transport time was 5.6 (3.8-7.2) minutes. After risk adjustment, each additional minute of predicted ground transport time was associated with an increase in odds of mortality (odds ratio [OR], 1.03 per minute; 95% CI, 1.01-1.05). Calculation of the population attributable fraction using mortality rate ratios for incremental 1-minute increases in predicted ground transport time estimated that 23% of shooting fatalities could be attributed to differences in access to care, equivalent to 455 deaths over the study period. Conclusions and Relevance These findings indicate that geospatial access to care may be an important trauma system measure, improvements to which may result in reduced deaths from gun violence in US cities.
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Affiliation(s)
- James P. Byrne
- Department of Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elinore Kaufman
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Dane Scantling
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Vicky Tam
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Niels Martin
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Shariq Raza
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Jeremy W. Cannon
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - C. William Schwab
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Patrick M. Reilly
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Mark J. Seamon
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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13
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An analysis of police transport in an Eastern Association for the Surgery of Trauma multicenter trial examining prehospital procedures in penetrating trauma patients. J Trauma Acute Care Surg 2022; 93:265-272. [PMID: 35121705 DOI: 10.1097/ta.0000000000003563] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Police transport (PT) of penetrating trauma patients in urban locations has become routine in certain metropolitan areas; however, whether it results in improved outcomes over prehospital Advanced life support (ALS) transport has not been determined in a multicenter study. We hypothesized that PT would not result in improved outcomes. METHODS This was a multicenter, prospective, observational study of adults (18+ years) with penetrating trauma to the torso and/or proximal extremity presenting at 25 urban trauma centers. Police transport and ALS patients were allocated via nearest neighbor, propensity matching. Transport mode also examined by Cox regression. RESULTS Of 1,618 total patients, 294 (18.2%) had PT and 1,324 (81.8%) were by ALS. After matching, 588 (294/cohort) remained. The patients were primarily Black (n = 497, 84.5%), males (n = 525, 89.3%, injured by gunshot wound (n = 494, 84.0%) with 34.5% (n = 203) having Injury Severity Score of 16 or higher. Overall mortality by propensity matching was not different between cohorts (15.6% ALS vs. 15.0% PT, p = 0.82). In severely injured patients (Injury Severity Score ≥16), mortality did not differ between PT and ALS transport (38.8% vs. 36.0%, respectively; p = 0.68). Cox regression analysis controlled for relevant factors revealed no association with a mortality benefit in patients transported by ALS. CONCLUSION Police transport of penetrating trauma patients in urban locations results in similar outcomes compared with ALS. Immediate transport to definitive trauma care should be emphasized in this patient population. LEVEL OF EVIDENCE Prognostic and Epidemiologic; Level III.
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14
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Glatts J, Weissenburger J, Mullen-Fortino M, Mazzone L, Cacchione PZ. Patient Extrication Process for Urban Emergency Departments. J Emerg Nurs 2022; 48:328-338. [DOI: 10.1016/j.jen.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 01/15/2022] [Accepted: 01/31/2022] [Indexed: 11/28/2022]
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Duchesne J, Slaughter K, Puente I, Berne JD, Yorkgitis B, Mull J, Sperry J, Tessmer M, Costantini T, Berndtson AE, Kai T, Rokvic G, Norwood S, Meadows K, Chang G, Lemon BM, Jacome T, Van Sant L, Paul J, Maher Z, Goldberg AJ, Madayag RM, Pinson G, Lieser MJ, Haan J, Marshall G, Carrick M, Tatum D. Impact of time to surgery on mortality in hypotensive patients with noncompressible torso hemorrhage: An AAST multicenter, prospective study. J Trauma Acute Care Surg 2022; 92:801-811. [PMID: 35468112 DOI: 10.1097/ta.0000000000003544] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Death from noncompressible torso hemorrhage (NCTH) may be preventable with improved prehospital care and shorter in-hospital times to hemorrhage control. We hypothesized that shorter times to surgical intervention for hemorrhage control would decrease mortality in hypotensive patients with NCTH. METHODS This was an AAST-sponsored multicenter, prospective analysis of hypotensive patients aged 15+ years who presented with NCTH from May 2018 to December 2020. Hypotension was defined as an initial systolic blood pressure (SBP) ≤ 90 mm Hg. Primary outcomes of interest were time to surgical intervention and in-hospital mortality. RESULTS There were 242 hypotensive patients, of which 48 died (19.8%). Nonsurvivors had higher mean age (47.3 vs. 38.8; p = 0.02), higher mean New Injury Severity Score (38 vs. 29; p < 0.001), lower admit systolic blood pressure (68 vs. 79 mm Hg; p < 0.01), higher incidence of vascular injury (41.7% vs. 21.1%; p = 0.02), and shorter median (interquartile range, 25-75) time from injury to operating room start (74 minutes [48-98 minutes] vs. 88 minutes [61-128 minutes]; p = 0.03) than did survivors. Multivariable Cox regression showed shorter time from emergency department arrival to operating room start was not associated with improved survival (p = 0.04). CONCLUSION Patients who died arrived to a trauma center in a similar time frame as did survivors but presented in greater physiological distress and had significantly shorter times to surgical hemorrhage intervention than did survivors. This suggests that even expediting a critically ill patient through the current trauma system is not sufficient time to save lives from NCTH. Civilian prehospital advance resuscitative care starting from the patient first contact needs special consideration. LEVEL OF EVIDENCE Prognostic/Epidemiologic, Level III.
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Affiliation(s)
- Juan Duchesne
- From the Tulane University School of Medicine (J.D., K.S., D.T.), New Orleans, Louisiana; Broward Health Medical Center (I.P., J.D.B.), Fort Lauderdale; University of Florida-Jacksonville (B.Y., J.M.), Jacksonville, Florida; University of Pittsburgh (J.S., M.T.), Pittsburgh, Pennsylvania; UC San Diego Medical Center (T.C., A.E.B.), San Diego, California; University of Kentucky Chandler Medical Center (T.K., G.R.), Lexington, Kentucky; University of Texas Health Tyler (S.N., K.M.), Tyler, Texas; Mount Sinai Hospital (G.C., B.M.L.), Chicago, Illinois; Our Lady of the Lake Regional Medical Center (T.J.), Baton Rouge, Louisiana; University of New Mexico Hospital (L.V.S., J.P.), Albuquerque, New Mexico; Temple University Hospital (Z.M., A.J.G.), Philadelphia, Pennsylvania; St. Anthony Hospital (R.M.M., G.P.), Lakewood, Colorado; Research Medical Center (M.J.L.), Kansas City, Missouri; Ascension Via Christi Hospital St. Francis (J.H.), Wichita, Kansas; and Medical City Plano (G.M., M.C.), Plano, Texas
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16
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Neeki MM, Cheung C, Dong F, Pham N, Shafer D, Neeki A, Hajjafar K, Borger R, Woodward B, Tran L. Emergent needle thoracostomy in prehospital trauma patients: a review of procedural execution through computed tomography scans. Trauma Surg Acute Care Open 2021; 6:e000752. [PMID: 34527813 PMCID: PMC8404440 DOI: 10.1136/tsaco-2021-000752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/08/2021] [Indexed: 11/04/2022] Open
Abstract
Background Traumatic tension pneumothoraces (TPT) are among the most serious causes of death in traumatic injuries, requiring immediate treatment with a needle thoracostomy (NT). Improperly placed NT insertion into the pleural cavity may fail to treat a life-threatening TPT. This study aimed to assess the accuracy of prehospital NT placements by paramedics in adult trauma patients. Methods A retrospective chart review was performed on 84 consecutive trauma patients who had received NT by prehospital personnel. The primary outcome was the accuracy of NT placement by prehospital personnel. Comparisons of various variables were conducted between those who survived and those who died, and proper versus improper needle insertion separately. Results Proper NT placement into the pleural cavity was noted in 27.4% of adult trauma patients. In addition, more than 19% of the procedures performed by the prehospital providers appeared to have not been medically indicated. Discussion Long-term strategies may be needed to improve the capabilities and performance of prehospital providers' capabilities in this delicate life-saving procedure. Level of evidence IV.
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Affiliation(s)
- Michael M Neeki
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Colton, California, USA.,Department of Emergency Medicine, California University of Science and Medicine, San Bernardino, California, USA.,Department of General Surgery, Arrowhead Regional Medical Center, Colton, California, USA
| | - Christina Cheung
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Colton, California, USA
| | - Fanglong Dong
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Colton, California, USA
| | - Nam Pham
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Colton, California, USA
| | - Dylan Shafer
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Colton, California, USA
| | - Arianna Neeki
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Colton, California, USA
| | - Keeyon Hajjafar
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Colton, California, USA
| | - Rodney Borger
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Colton, California, USA.,Department of Emergency Medicine, California University of Science and Medicine, San Bernardino, California, USA
| | - Brandon Woodward
- Department of General Surgery, Arrowhead Regional Medical Center, Colton, California, USA.,Department of General Surgery, California University of Science and Medicine, San Bernardino, California, USA
| | - Louis Tran
- Department of Emergency Medicine, Arrowhead Regional Medical Center, Colton, California, USA.,Department of Emergency Medicine, California University of Science and Medicine, San Bernardino, California, USA
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Inaba K, Jurkovich GJ. Police Transport for Penetrating Trauma-Lessons From Patients in Philadelphia. JAMA Netw Open 2021; 4:e2035122. [PMID: 33492370 DOI: 10.1001/jamanetworkopen.2020.35122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Kenji Inaba
- Department of Surgery, University of Southern California, LAC+USC Medical Center, Los Angeles
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