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Haider AA, Safaya A, Mateo RB, Andrzej Laskowski I, Latifi R, Babu SC. Comparing Outcomes of Carotid Artery Stenting with Carotid Endarterectomy: Is There a Right Cohort for Stenting? J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.08.703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Jehan FS, Prabhakaran K, Haider AA, Khan MN, Zeeshan M, Rhee PM, Latifi R. Gallstone-Related Complications after Untreated Biliary Colic: A 6-Month Readmissions Study. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.07.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Khan MN, Mateo RB, Jehan FS, Zeeshan M, Pandit V, Haider AA, Azim A, Andrzej Laskowski I, Babu SC. Patients with Critical Limb Ischemia Requiring Intervention: Occurrence and Risk Factors for Reintervention. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.07.713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Zangbar B, Serack B, Rhee P, Joseph B, Pandit V, Friese RS, Haider AA, Tang AL. Outcomes in Trauma Patients with Isolated Epidural Hemorrhage: A Single-Institution Retrospective Cohort Study. Am Surg 2016; 82:1209-1214. [PMID: 28234186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The type, location, and size of intracranial hemorrhage are known to be associated with variable outcomes in patients with traumatic brain injury (TBI). The aim of our study was to assess the outcomes in patients with isolated epidural hemorrhage (EDH) based on the location of EDH. We performed a 3-year (2010-2012) retrospective chart review of the patients with TBI in our level 1 trauma center. Patients with an isolated EDH on initial head CT scan were included. Patients were divided into four groups based on the location of EDH: frontal, parietal, temporal, and occipital. Differences in demographics and outcomes between the four groups were assessed. Outcome measures were progression on repeat head CT and neurosurgical intervention (NI). A total of 76 patients were included in this study. The mean age was 20.6 ± 15.2 years, 68.4 per cent were male, median Glasgow Coma Scale (GCS) score 15 (13-15), and median head Abbreviated Injury Scale score was 3 (2-4). About 32.9 per cent patients (n = 25) had frontal EDH, 26.3 per cent (n = 20) had temporal EDH, 10.5 per cent (n = 8) had occipital EDH, while the remaining 30.3 per cent (n = 23) had parietal EDH. The overall progression rate was 21.1 per cent (n = 12) and NI rate was 29 per cent (n = 22). There was no difference in the outcome of patients based on location of EDH. Patients with NI had a longer hospital length of stay (P = 0.02) and longer intensive care unit length of stay (P = 0.05). The incidence of isolated EDH is low in patients with blunt TBI. Patients with isolated EDH undergoing NI have longer hospital stays compared to patients without NI. Further investigation is warranted to identify factors associated with need for NI and adverse outcomes in the cohort of patients with isolated EDH.
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MESH Headings
- Abbreviated Injury Scale
- Adult
- Brain Injuries/complications
- Brain Injuries/epidemiology
- Brain Injuries/surgery
- Disease Progression
- Female
- Glasgow Coma Scale
- Hematoma, Epidural, Cranial/epidemiology
- Hematoma, Epidural, Cranial/etiology
- Hematoma, Epidural, Cranial/pathology
- Hematoma, Epidural, Cranial/surgery
- Humans
- Intensive Care Units
- Length of Stay
- Male
- Neurosurgical Procedures/statistics & numerical data
- Outcome Assessment, Health Care
- Retrospective Studies
- Wounds, Nonpenetrating/complications
- Young Adult
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Affiliation(s)
- Bardiya Zangbar
- Division of Trauma, Department of Surgery, University of Arizona, Tucson, Arizona, USA
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Zangbar B, Serack B, Rhee P, Joseph B, Pandit V, Friese RS, Haider AA, Tang AL. Outcomes in Trauma Patients with Isolated Epidural Hemorrhage: A Single-Institution Retrospective Cohort Study. Am Surg 2016. [DOI: 10.1177/000313481608201228] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The type, location, and size of intracranial hemorrhage are known to be associated with variable outcomes in patients with traumatic brain injury (TBI). The aim of our study was to assess the outcomes in patients with isolated epidural hemorrhage (EDH) based on the location of EDH. We performed a 3-year (2010–2012) retrospective chart review of the patients with TBI in our level 1 trauma center. Patients with an isolated EDH on initial head CT scan were included. Patients were divided into four groups based on the location of EDH: frontal, parietal, temporal, and occipital. Differences in demographics and outcomes between the four groups were assessed. Outcome measures were progression on repeat head CT and neurosurgical intervention (NI). A total of 76 patients were included in this study. The mean age was 20.6 ± 15.2 years, 68.4 per cent were male, median Glasgow Coma Scale (GCS) score 15 (13–15), and median head Abbreviated Injury Scale score was 3 (2–4). About 32.9 per cent patients (n = 25) had frontal EDH, 26.3 per cent (n = 20) had temporal EDH, 10.5 per cent (n = 8) had occipital EDH, while the remaining 30.3 per cent (n = 23) had parietal EDH. The overall progression rate was 21.1 per cent (n = 12) and NI rate was 29 per cent (n = 22). There was no difference in the outcome of patients based on location of EDH. Patients with NI had a longer hospital length of stay ( P = 0.02) and longer intensive care unit length of stay ( P = 0.05). The incidence of isolated EDH is low in patients with blunt TBI. Patients with isolated EDH undergoing NI have longer hospital stays compared to patients without NI. Further investigation is warranted to identify factors associated with need for NI and adverse outcomes in the cohort of patients with isolated EDH.
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Affiliation(s)
- Bardiya Zangbar
- From the Division of Trauma, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Bradley Serack
- From the Division of Trauma, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Peter Rhee
- From the Division of Trauma, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Bellal Joseph
- From the Division of Trauma, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Viraj Pandit
- From the Division of Trauma, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Randall S. Friese
- From the Division of Trauma, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Ansab A. Haider
- From the Division of Trauma, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Andrew L. Tang
- From the Division of Trauma, Department of Surgery, University of Arizona, Tucson, Arizona
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Joseph B, Haider AA, Azim A, Kulvatunyou N, Tang A, O'Keeffe T, Latifi R, Green DJ, Friese RS, Rhee P. The impact of patient protection and Affordable Care Act on trauma care. J Trauma Acute Care Surg 2016; 81:427-34. [DOI: 10.1097/ta.0000000000001082] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Joseph B, Azim A, Haider AA, Kulvatunyou N, O'Keeffe T, Hassan A, Gries L, Tran E, Latifi R, Rhee P. Bicycle helmets work when it matters the most. Am J Surg 2016; 213:413-417. [PMID: 27596799 DOI: 10.1016/j.amjsurg.2016.05.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 05/23/2016] [Accepted: 05/31/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Helmets are known to reduce the incidence of traumatic brain injury (TBI) after bicycle-related accidents. The aim of this study was to assess the association of helmets with severity of TBI and facial fractures after bicycle-related accidents. METHODS We performed an analysis of the 2012 National Trauma Data Bank abstracted information of all patients with an intracranial hemorrhage after bicycle-related accidents. Regression analysis was also performed. RESULTS A total of 6,267 patients were included. About 25.1% (n = 1,573) of bicycle riders were helmeted. Overall, 52.4% (n = 3,284) of the patients had severe TBI, and the mortality rate was 2.8% (n = 176). Helmeted bicycle riders had 51% reduced odds of severe TBI (odds ratio [OR] .49, 95% confidence interval [CI] .43 to .55, P < .001) and 44% reduced odds of mortality (OR .56, 95% CI .34 to .78, P = .010). Helmet use also reduced the odds of facial fractures by 31% (OR .69, 95% CI .58 to .81, P < .001). CONCLUSION Bicycle helmet use provides protection against severe TBI, reduces facial fractures, and saves lives even after sustaining an intracranial hemorrhage.
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Affiliation(s)
- Bellal Joseph
- Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA.
| | - Asad Azim
- Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Ansab A Haider
- Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Narong Kulvatunyou
- Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Terence O'Keeffe
- Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Ahmed Hassan
- Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Lynn Gries
- Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Emily Tran
- Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Rifat Latifi
- Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Peter Rhee
- Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA
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Joseph B, Hadeed S, Haider AA, Ditillo M, Joseph A, Pandit V, Kulvatunyou N, Tang A, Latifi R, Rhee P. Obesity and trauma mortality: Sizing up the risks in motor vehicle crashes. Obes Res Clin Pract 2016; 11:72-78. [PMID: 26996285 DOI: 10.1016/j.orcp.2016.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 12/18/2015] [Accepted: 03/05/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Protective effects of safety devices in obese motorists in motor vehicle collisions (MVC) remain unclear. Aim of our study is to assess the association between morbid obesity and mortality in MVC, and to determine the efficacy of protective devices. We hypothesised that patients with morbid obesity will be at greater risk of death after MVC. METHODS A retrospective analysis of MVC patients (age ≥16 y.o.) was performed using the National Trauma Data Bank from 2007 to 2010. Patients with recorded comorbidity of morbid obesity (BMI≥40) were identified. Patients dead on arrival, with isolated traumatic brain injury, or incomplete data were excluded. The primary outcome was in-hospital mortality. Multivariate logistic regression was performed. RESULTS Our sample of 214,306 MVC occupants included 10,260 (4.8%) morbidly obese patients. Mortality risk was greatest among occupants with morbid obesity (ORcrude 1.74 [1.54-1.98]). After adjusting for patient demographics, safety device and physiological severity, odds of death was 1.52 [1.33-1.74] times greater in motorists with morbid obesity. Motorists with morbid obesity were at greater risk of death if no restraint (OR 1.84 [1.47-2.31]), seatbelt only (OR 1.48 [1.17-1.86]), or both seatbelt and airbag were present (OR 1.49 [1.13-1.97]). No significant differences in the odds of death exist between drivers with morbid obesity and non-morbidly obese drivers with only airbag deployment (OR 0.99 [0.65-1.51]). CONCLUSIONS Motorists with morbid obesity are at greater risk of MVC. Regardless of safety device use, occupants with morbid obesity remained at greater risk of death. Further research examining the effectiveness of vehicle restraints in drivers with morbid obesity is warranted.
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Affiliation(s)
- Bellal Joseph
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, United States.
| | - Steven Hadeed
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, United States
| | - Ansab A Haider
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, United States
| | - Michael Ditillo
- Department of Surgery, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, United States
| | - Aly Joseph
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, United States
| | - Viraj Pandit
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, United States
| | - Narong Kulvatunyou
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, United States
| | - Andrew Tang
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, United States
| | - Rifat Latifi
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, United States
| | - Peter Rhee
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, United States
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Inaba K, Aksoy H, Seamon MJ, Marks JA, Duchesne J, Schroll R, Fox CJ, Pieracci FM, Moore EE, Joseph B, Haider AA, Harvin JA, Lawless RA, Cannon J, Holland SR, Demetriades D. Multicenter evaluation of temporary intravascular shunt use in vascular trauma. J Trauma Acute Care Surg 2016; 80:359-64; discussion 364-5. [DOI: 10.1097/ta.0000000000000949] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Joseph B, Jokar TO, Khalil M, Haider AA, Kulvatunyou N, Zangbar B, Tang A, Zeeshan M, O'Keeffe T, Abbas D, Latifi R, Rhee P. Identifying the broken heart: predictors of mortality and morbidity in suspected blunt cardiac injury. Am J Surg 2016; 211:982-8. [PMID: 26879418 DOI: 10.1016/j.amjsurg.2015.10.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 10/21/2015] [Accepted: 10/28/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Blunt cardiac injury (BCI) is an infrequent but potentially fatal finding in thoracic trauma. Its clinical presentation is highly variable and patient characteristics and injury pattern have never been described in trauma patients. The aim of this study was to identify predictors of mortality in BCI patients. METHODS We performed an 8-year retrospective analysis of all trauma patients diagnosed with BCI at our Level 1 trauma center. Patients older than 18 years, blunt chest trauma, and a suspected diagnosis of BCI were included. BCI was diagnosed based on the presence of electrocardiography (EKG), echocardiography, biochemical cardiac markers, and/or radionuclide imaging studies. Elevated troponin I was defined as more than 2 recordings of greater than or equal to .2. Abnormal EKG findings were defined as the presence of bundle branch block, ST segment, and t-wave abnormalities. Univariate and multivariate regression analyses were performed. RESULTS A total of 117 patients with BCI were identified. The mean age was 51 ± 22 years, 65% were male, mean systolic blood pressure was 93 ± 65, and overall mortality rate was 44%. Patients who died were more likely to have a lactate greater than 2.5 (68% vs 31%, P = .02), hypotension (systolic blood pressure < 90) (86% vs 14%, P = .001), and elevated troponin I (86% vs 11%, P = .01). There was no difference in the rib fracture (58% vs 56%, P = .8), sternal fracture (11% vs 21%, P = .2), and abnormal EKG (89% vs 90%, P = .6) findings. Hypotension and lactate greater than 2.5 were the strongest predictors of mortality in BCI. CONCLUSIONS BCI remains an important diagnostic and management challenge. However, once diagnosed resuscitative therapy focused on correction of hypotension and lactate may prove beneficial. Although the role of troponin in diagnosing BCI remains controversial, elevated troponin may have prognostic significance.
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Affiliation(s)
- Bellal Joseph
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA.
| | - Tahereh O Jokar
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Mazhar Khalil
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Ansab A Haider
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Narong Kulvatunyou
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Bardiya Zangbar
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Andrew Tang
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Muhammad Zeeshan
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Terence O'Keeffe
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Daniyal Abbas
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Rifat Latifi
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Peter Rhee
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ, USA
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Joseph B, Pandit V, Haider AA, Kulvatunyou N, Zangbar B, Tang A, Aziz H, Vercruysse G, O’Keeffe T, Freise RS, Rhee P. Improving Hospital Quality and Costs in Nonoperative Traumatic Brain Injury. JAMA Surg 2015; 150:866-72. [DOI: 10.1001/jamasurg.2015.1134] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Bellal Joseph
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arizona Medical Center, Tucson
| | - Viraj Pandit
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arizona Medical Center, Tucson
| | - Ansab A. Haider
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arizona Medical Center, Tucson
| | - Narong Kulvatunyou
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arizona Medical Center, Tucson
| | - Bardiya Zangbar
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arizona Medical Center, Tucson
| | - Andrew Tang
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arizona Medical Center, Tucson
| | - Hassan Aziz
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arizona Medical Center, Tucson
| | - Gary Vercruysse
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arizona Medical Center, Tucson
| | - Terence O’Keeffe
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arizona Medical Center, Tucson
| | - Randall S. Freise
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arizona Medical Center, Tucson
| | - Peter Rhee
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arizona Medical Center, Tucson
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Joseph B, Zangbar B, Khalil M, Kulvatunyou N, Haider AA, O'Keeffe T, Tang A, Vercruysse G, Friese RS, Rhee P. Factors associated with failure-to-rescue in patients undergoing trauma laparotomy. Surgery 2015; 158:393-8. [PMID: 26013985 DOI: 10.1016/j.surg.2015.03.047] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 03/02/2015] [Accepted: 03/04/2015] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Quality improvement initiatives have focused primarily on preventing in-hospital complications. Patients developing complications are at a greater risk of mortality; however, factors associated with failure-to-rescue (death after major complication) in trauma patients remain undefined. The aim of this study was to identify risk factors associated with failure-to-rescue in patients undergoing trauma laparotomy. METHODS An -8-year, retrospective analysis of patients undergoing trauma laparotomy was performed. Patients who developed major in-hospital complications were included. Major complications were defined as respiratory, infectious, cardiac, renal, or development of compartment syndrome. Regression analysis was performed to identify independent factors associated with failure-to-rescue after we adjusted for demographics, mechanism of injury, abdominal abbreviated injury scale, initial vital signs, damage control laparotomy, and volume of crystalloids and blood products administered. RESULTS A total of 1,029 patients were reviewed, of which 21% (n = 217) patients who developed major complications were included. The mean age was 39 ± 18 years, 82% were male, 61% had blunt trauma, and median abdominal abbreviated injury scale was 25 [16-34, interquartile range]. Respiratory complications (n = 77) followed by infectious complications (n = 75) were the most common complications. The failure-to-rescue rate was 15.7% (n = 34/217). Age, blunt trauma, severe head injury, uninsured status, and blood products administered on the second day were independent predictor for failure-to-rescue. CONCLUSION When major complications develop, age, uninsured status, severity of head injury, and prolonged resuscitation are associated independently with failure-to-rescue, whereas initial resuscitation, coagulopathy, and acidosis did not predict failure to rescue. Quality-of-care programs focus in patient level should be on improving the patient's insurance status, preventing secondary brain injury, and further development of resuscitation guidelines.
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Affiliation(s)
- Bellal Joseph
- Division of Trauma, Department of Surgery, University of Arizona, Tucson, AZ.
| | - Bardiya Zangbar
- Division of Trauma, Department of Surgery, University of Arizona, Tucson, AZ
| | - Mazhar Khalil
- Division of Trauma, Department of Surgery, University of Arizona, Tucson, AZ
| | - Narong Kulvatunyou
- Division of Trauma, Department of Surgery, University of Arizona, Tucson, AZ
| | - Ansab A Haider
- Division of Trauma, Department of Surgery, University of Arizona, Tucson, AZ
| | - Terence O'Keeffe
- Division of Trauma, Department of Surgery, University of Arizona, Tucson, AZ
| | - Andrew Tang
- Division of Trauma, Department of Surgery, University of Arizona, Tucson, AZ
| | - Gary Vercruysse
- Division of Trauma, Department of Surgery, University of Arizona, Tucson, AZ
| | - Randall S Friese
- Division of Trauma, Department of Surgery, University of Arizona, Tucson, AZ
| | - Peter Rhee
- Division of Trauma, Department of Surgery, University of Arizona, Tucson, AZ
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Joseph B, Haider AA, Pandit V, Kulvatunyou N, Orouji T, Khreiss M, Tang A, O'Keeffe T, Friese R, Rhee P. Impact of Hemorrhagic Shock on Pituitary Function. J Am Coll Surg 2015. [PMID: 26206647 DOI: 10.1016/j.jamcollsurg.2015.02.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Hypopituitarism after hypovolemic shock is well established in certain patient cohorts. However; the effects of hemorrhagic shock on pituitary function in trauma patients remains unknown. The aim of this study was to assess pituitary hormone variations in trauma patients with hemorrhagic shock. STUDY DESIGN Patients with acute traumatic hemorrhagic shock presenting to our level 1 trauma center were prospectively enrolled. Hemorrhagic shock was defined as systolic blood pressure (SBP) ≤ 90 mmHg on arrival or within 10 minutes of arrival in the emergency department, and requirement of ≥2 units of packed red blood cell transfusion. Serum cortisol and serum pituitary hormones (vasopressin [ADH], adrenocorticotrophic hormone [ACTH], thyroid stimulating hormone [TSH], follicular stimulating hormone [FSH], and luteinizing hormone [LH]) were measured in each patient on admission and at 24, 48, 72, and 96 hours after admission. Outcome measure was variation in pituitary hormones. RESULTS A total of 42 patients were prospectively enrolled; mean age was 37 ± 12 years, mean SBP 85.4 ± 64.5 mmHg, and median Injury Severity Score was 26 (range 18 to 38). There was an increase in the levels of cortisol (p < 0.001), a decrease in the levels of ACTH (p < 0.001) and ADH (p < 0.001), but no change in the levels of LH (p = 0.30), FSH (p = 0.07), and TSH (p = 0.89) over 96 hours. Ten patients died during their hospital stay. Patients who died had higher mean admission ADH levels (p = 0.03), higher mean admission ACTH levels (p < 0.001), and lower mean admission cortisol levels (p = 0.04) compared with patients who survived. CONCLUSIONS Acute hypopituitarism does not occur in trauma patients with acute hemorrhagic shock. In patients who died, there was a decrease in cortisol levels, which appears to be adrenal in origin.
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Affiliation(s)
- Bellal Joseph
- Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona Medical Center, Tucson, AZ.
| | - Ansab A Haider
- Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona Medical Center, Tucson, AZ
| | - Viraj Pandit
- Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona Medical Center, Tucson, AZ
| | - Narong Kulvatunyou
- Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona Medical Center, Tucson, AZ
| | - Tahereh Orouji
- Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona Medical Center, Tucson, AZ
| | - Mohammad Khreiss
- Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona Medical Center, Tucson, AZ
| | - Andrew Tang
- Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona Medical Center, Tucson, AZ
| | - Terence O'Keeffe
- Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona Medical Center, Tucson, AZ
| | - Randall Friese
- Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona Medical Center, Tucson, AZ
| | - Peter Rhee
- Division of Trauma, Emergency Surgery, Critical Care, and Burns, Department of Surgery, University of Arizona Medical Center, Tucson, AZ
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Affiliation(s)
- Bardiya Zangbar
- Division of Trauma, Critical Care, Emergency Surgery, and Burns Department of Surgery University of Arizona Tucson, Arizona
| | - Viraj Pandit
- Division of Trauma, Critical Care, Emergency Surgery, and Burns Department of Surgery University of Arizona Tucson, Arizona
| | - Peter Rhee
- Division of Trauma, Critical Care, Emergency Surgery, and Burns Department of Surgery University of Arizona Tucson, Arizona
| | - Ansab A. Haider
- Division of Trauma, Critical Care, Emergency Surgery, and Burns Department of Surgery University of Arizona Tucson, Arizona
| | - Mazhar Khalil
- Division of Trauma, Critical Care, Emergency Surgery, and Burns Department of Surgery University of Arizona Tucson, Arizona
| | - Bellal Joseph
- Division of Trauma, Critical Care, Emergency Surgery, and Burns Department of Surgery University of Arizona Tucson, Arizona
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15
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Zangbar B, Pandit V, Rhee P, Haider AA, Khalil M, Joseph B. Beauty parlor stroke syndrome: a rare entity in a trauma patient. Am Surg 2015; 81:E120-E122. [PMID: 25760188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Bardiya Zangbar
- Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, Arizona, USA
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