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Allsbrook A, To JQ, Pulido OR, Morgan ME, Perea LL, Shin H, Muller A, Ong A, Butts CA, Braverman MA. Body Mass Index Does Not Predict Injury Pattern or Outcome After Motorcycle Crash. J Surg Res 2024; 296:88-92. [PMID: 38241772 DOI: 10.1016/j.jss.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 03/01/2023] [Revised: 11/11/2023] [Accepted: 12/17/2023] [Indexed: 01/21/2024]
Abstract
INTRODUCTION The obesity epidemic plagues the United States, affecting approximately 42% of the population. The relationship of obesity with injury severity and outcomes has been poorly studied among motorcycle collisions (MCC). This study aimed to compare injury severity, mortality, injury regions, and hospital and intensive care unit length of stay (LOS) between obese and normal-weight MCC patients. METHODS Trauma registries from three Pennsylvania Level 1 trauma centers were queried for adult MCC patients (January 1, 2016, and December 31, 2020). Obesity was defined as adult patients with body mass index ≥ 30 kg/m2 and normal weight was defined as body mass index < 30 kg/m2 but > 18.5 kg/m2. Demographics and injury characteristics including injury severity score (ISS), abbreviated injury score, mortality, transfusions and LOS were compared. P ≤ 0.05 was considered significant. RESULTS One thousand one hundred sixty-four patients met the inclusion criteria: 40% obese (n = 463) and 60% nonobese (n = 701). Comparison of ISS demonstrated no statistically significant difference between obese and normal-weight patients with median ISS (interquartile range) 9 (5-14) versus 9 (5-14), respectively (P = 0.29). Obese patients were older with median age 45 (32-55) y versus 38 (26-54) y, respectively (P < 0.01). Comorbidities were equally distributed among both groups except for the incidence of hypertension (30 versus 13.8%, P < 0.01) and diabetes (11 versus 4.4%, P < 0.01). There was no statistically significant difference in Trauma Injury Severity Score or abbreviated injury score. Hospital LOS, intensive care unit LOS, and 30-day mortality among both groups were similar. CONCLUSIONS Obese patients experiencing MCC had no differences in distribution of injury, mortality, or injury severity, mortality, injury regions, and hospital compared to normal-weight adults. Our study differs from current data that obese motorcycle drivers may have different injury characteristics and increased LOS.
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Affiliation(s)
- Anthony Allsbrook
- Division of Acute Care Surgical Services, Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Jennifer Q To
- Division of Acute Care Surgical Services, Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Odessa R Pulido
- Department of Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Madison E Morgan
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Lindsey L Perea
- Division of Trauma and Acute Care Surgery, Department of Surgery, Penn Medicine Lancaster General Health, Lancaster, Pennsylvania
| | - Hannah Shin
- Department of Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Alison Muller
- Division of Trauma, Department of Surgery, Acute Care Surgery & Surgical Critical Care, Reading Hospital- Tower Health, West Reading, Pennsylvania
| | - Adrian Ong
- Division of Trauma, Department of Surgery, Acute Care Surgery & Surgical Critical Care, Reading Hospital- Tower Health, West Reading, Pennsylvania
| | - Christopher A Butts
- Division of Trauma, Department of Surgery, Acute Care Surgery & Surgical Critical Care, Reading Hospital- Tower Health, West Reading, Pennsylvania
| | - Maxwell A Braverman
- Division of Acute Care Surgical Services, Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania.
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Shin H, Pulido OR, Sullivan MC, Perea LL, Dammann K, To JQ, Braverman M, Wasser T, Muller A, Ong A, Butts CA. Geriatric Motorcycle-Related Outcomes: A Pennsylvania Multicenter Study. J Surg Res 2024; 296:249-255. [PMID: 38295712 DOI: 10.1016/j.jss.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 03/01/2023] [Revised: 11/30/2023] [Accepted: 12/27/2023] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Geriatric patients (GeP) often experience increased morbidity and mortality following traumatic insult and as a result, require more specialized care due to lower physiologic reserve and underlying medical comorbidities. Motorcycle injuries (MCCI) occur across all age groups; however, no large-scale studies evaluating outcomes of GeP exist for this particular subset of patients. Data thus far are limited to elderly participation in recreational activities such as water and alpine skiing, snowboarding, equestrian, snowmobiles, bicycles, and all-terrain vehicles. We hypothesized that GeP with MCCI will have a higher rate of mortality when compared with their younger counterparts despite increased helmet usage. METHODS We performed a multicenter retrospective review of MCCI patients at three Pennsylvania level I trauma centers from January 2016 to December 2020. Data were extracted from each institution's electronic medical records and trauma registry. GeP were defined as patients aged more than or equal to 65 y. The primary outcome was mortality. Secondary outcomes included ventilator days; hospital, intensive care unit, and intermediate unit length of stays; complications; and helmet use. 3:1 nongeriatric patients (NGeP) to GeP propensity score matching (PSM) was based on sex, abbreviated injury scale (AIS), and injury severity score (ISS). P ≤ 0.05 was considered significant. RESULTS One thousand five hundred thirty eight patients were included (GeP: 7% [n = 113]; NGP: 93% [n = 1425]). Prior to PSM, GeP had higher median Charlson Comorbidity Index (GeP: 3.0 versus NGeP: 0.0; P ≤ 0.001) and greater helmet usage (GeP: 73.5% versus NGeP: 54.6%; P = 0.001). There was a statistically significant difference between age cohorts in terms of ISS (GeP: 10.0 versus NGeP: 6.0, P = 0.43). There was no significant difference for any AIS body region. Mortality rates were similar between groups (GeP: 1.7% versus NGeP: 2.6%; P = 0.99). After PSM matching for sex, AIS, and ISS, GeP had significantly more comorbidities than NGeP (P ≤ 0.05). There was no difference in trauma bay interventions or complications between cohorts. Mortality rates were similar (GeP: 1.8% versus NGeP: 3.2%; P = 0.417). Differences in ventilator days as well as intensive care unit length of stay, intermediate unit length of stay, and hospital length of stay were negligible. Helmet usage between groups were similar (GeP: 64.5% versus NGeP: 66.8%; P = 0.649). CONCLUSIONS After matching for sex, ISS, and AIS, age more than 65 y was not associated with increased mortality following MCCI. There was also no significant difference in helmet use between groups. Further studies are needed to investigate the effects of other potential risk factors in the aging patient, such as frailty and anticoagulation use, before any recommendations regarding management of motorcycle-related injuries in GeP can be made.
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Affiliation(s)
- Hannah Shin
- Department of Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Odessa R Pulido
- Department of Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Megan C Sullivan
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Lindsey L Perea
- Division of Trauma and Acute Care Surgery, Department of Surgery, Penn Medicine Lancaster General Health, Lancaster, Pennsylvania
| | - Kyle Dammann
- Division of Acute Care Surgical Services, Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Jennifer Q To
- Division of Acute Care Surgical Services, Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Maxwell Braverman
- Division of Acute Care Surgical Services, Department of Surgery, St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Tom Wasser
- Division of Trauma, Acute Care Surgery & Surgical Critical Care, Department of Surgery, Reading Hospital- Tower Health, West Reading, Pennsylvania
| | - Alison Muller
- Division of Trauma, Acute Care Surgery & Surgical Critical Care, Department of Surgery, Reading Hospital- Tower Health, West Reading, Pennsylvania
| | - Adrian Ong
- Division of Trauma, Acute Care Surgery & Surgical Critical Care, Department of Surgery, Reading Hospital- Tower Health, West Reading, Pennsylvania
| | - Christopher A Butts
- Division of Trauma, Acute Care Surgery & Surgical Critical Care, Department of Surgery, Reading Hospital- Tower Health, West Reading, Pennsylvania.
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Butts CA, Byerly S, Nahmias J, Gelbard R, Ziesmann M, Bruns B, Davidson GH, Di Saverio S, Esposito TJ, Fischkoff K, Joseph B, Kaafarani H, Mentula P, Podda M, Sakran JV, Salminen P, Sammalkorpi H, Sawyer RG, Skeete D, Tesoriero R, Yeh DD. A core outcome set for appendicitis: A consensus approach utilizing modified Delphi methodology. J Trauma Acute Care Surg 2024; 96:487-492. [PMID: 37751156 DOI: 10.1097/ta.0000000000004144] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
BACKGROUND Appendicitis is one of the most common pathologies encountered by general and acute care surgeons. The current literature is inconsistent, as it is fraught with outcome heterogeneity, especially in the area of nonoperative management. We sought to develop a core outcome set (COS) for future appendicitis studies to facilitate outcome standardization and future data pooling. METHODS A modified Delphi study was conducted after identification of content experts in the field of appendicitis using both the Eastern Association for the Surgery of Trauma (EAST) landmark appendicitis articles and consensus from the EAST ad hoc COS taskforce on appendicitis. The study incorporated three rounds. Round 1 utilized free text outcome suggestions, then in rounds 2 and 3 the suggests were scored using a Likert scale of 1 to 9 with 1 to 3 denoting a less important outcome, 4 to 6 denoting an important but noncritical outcome, and 7 to 9 denoting a critically important outcome. Core outcome status consensus was defined a priori as >70% of scores 7 to 9 and <15% of scores 1 to 3. RESULTS Seventeen panelists initially agreed to participate in the study with 16 completing the process (94%). Thirty-two unique potential outcomes were initially suggested in round 1 and 10 (31%) met consensus with one outcome meeting exclusion at the end of round 2. At completion of round 3, a total of 17 (53%) outcomes achieved COS consensus. CONCLUSION An international panel of 16 appendicitis experts achieved consensus on 17 core outcomes that should be incorporated into future appendicitis studies as a minimum set of standardized outcomes to help frame future cohort-based studies on appendicitis. LEVEL OF EVIDENCE Diagnostic Test or Criteria; Level V.
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Affiliation(s)
- Christopher A Butts
- From the Division of Trauma, Acute Care Surgery & Surgical Critical Care (C.A.B.), Department of Surgery, Reading Hospital-Tower Health, West Reading, Pennsylvania; Department of Surgery, University of Tennessee Health Science Center (S.B.), Memphis, Tennessee; UC Irvine Healthcare, Orange (J.N.), California; Department of Surgery, University of Alabama at Birmingham (R.G.), Birmingham, Alabama; University of Manitoba, Winnipeg (M.Z.), Manitoba, Canada; Department of Surgery, University of Texas Southwestern, Dallas (B.B.), Texas; Department of Surgery, University of Washington, Seattle (G.H.D.), Washington; AST5 ASR Marche, Hospital Madonna del Soccorso (S.D.S.), San Benedetto del Tronto, Italy; Department of Medicine, University of Illinois School of Medicine (T.J.E.), Peoria, Illinois; Department of Surgery, Columbia University Irving Medical Center (K.F.), New York, New York; Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery (B.J.), College of Medicine, University of Arizona, Tuscon, Arizona; Trauma, Emergency Surgery, and Surgical Critical Care (H.K.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Gastroenterological Surgery (P.M., H.S.), Helsinki University Hospital, Helsinki, Finland; Department of General and Emergency Surgery (M.P.), Cagliari University Hospital, Cagliari, Italy; Division of Acute Care Surgery, Department of Surgery (J.V.S.), Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Surgery (P.S.), University of Turku, Turku, Finland; Department of Surgery, Western Michigan University School of Medicine: Western Michigan University Homer Stryker MD School of Medicine (R.G.S.), Kalamazoo, Michigan; Roy J. and Lucille A. Carver College of Medicine (D.S.), University of Iowa, Iowa City, Iowa; Division of General Surgery, Trauma and Surgical Critical Care, Acute Care Surgery (R.T.), Zuckerberg San Francisco General Hospital, San Francisco, California; and Ernest E Moore Shock Trauma Center at Denver Health (D.D.Y.), University of Colorado, Denver, Colorado
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Luck T, Zaki PG, Slotkin EM, Michels R, Ong A, Butts CA. Age-Adjusted Modified Frailty Index: Association With Hip Fracture Discharge Functional Dependence. J Surg Res 2024; 295:214-221. [PMID: 38039726 DOI: 10.1016/j.jss.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 03/01/2023] [Revised: 09/20/2023] [Accepted: 10/28/2023] [Indexed: 12/03/2023]
Abstract
INTRODUCTION Hip fractures are a common traumatic injury that carry significant morbidity and mortality, and prognostication of functional outcome is becoming increasingly salient. Across multiple surgical specialties, the five-item and 11-item Modified Frailty Index (mFI-5 and mFI-11) have been found to be convenient, quick, and sensitive tools for identifying patients at risk for perioperative complications. A prior study described the superiority of an Age-Adjusted Modified Frailty Index (aamFI) for predicting perioperative complications compared to the mFI-5 in an elective hip surgery. We sought to externally validate the aamFI in a multicenter hip fracture cohort and hypothesize that these risk scores would not only predict functional dependence (FD) at discharge, but that the aamFI would outperform the mFI-5 and mFI-11. METHODS The Pennsylvania Trauma Systems Foundation registry was queried from 2010 to 2020 for CPT codes, ICD-9 and ICD-10 codes pertaining to hip fracture patients. Patients with missing locomotion and transfer mobility data were excluded. FD status was determined by discharge locomotion and transfer mobility scores per existing methodology. Univariable and Multivariable analysis as well as receiver operator characteristic curves were used to evaluate and compare the three indices for prediction of functional status at discharge. P value < 0.05 was considered significant. RESULTS Twelve thousand seven hundred and forty patients met inclusion criteria (FD: 8183; functional independent 4557). On univariable logistic regression analysis, the mFI-11 (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.47-1.58, P < 0.05), mFI-5 (OR 1.57, 95% CI 1.51-1.63), and aamFI (OR 1.57, 95% CI 1.52-1.62, P < 0.05) were associated with FD. On multivariable logistic regression analysis for predictors of FD, when controlling for age (for the mFI-11 and mFI-5), sex, injury severity score, and admission vitals (systolic blood pressure and respiratory rate), higher mFI-11 and mFI-5 scores independently predicted FD at discharge (OR 1.23, 95% CI 1.18-1.28, P < 0.05 and OR 1.23, 95% CI 1.18-1.29P < 0.05 respectively). Higher aaMFI scores had superior association with functional dependence (OR 1.59, 95% CI 1.54-1.64, P < 0.05). Receiver operator characteristic curves for the mFI-11, mFI-5, and aaMFI showed comparable diagnostic strength (area under curve [AUC] = 0.63 95% CI 0.62-0.64, P < 0.05; AUC = 0.63 95% CI 0.62-0.64, P < 0.05; and AUC = 0.67 95% CI 0.65-0.67, P < 0.05 respectively). CONCLUSIONS The mFI-11, mFI-5, and aamFI are predictive of functional outcome following hip fracture. By including age, the aamFI retains the ease of use of the mFI-5 while improving its prognostic utility for functional outcome.
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Affiliation(s)
- Trevor Luck
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Peter G Zaki
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Eric M Slotkin
- Division of Orthopedic Surgery, Department of Surgery, Reading Hospital, West Reading, Pennsylvania
| | - Ryan Michels
- Division of Orthopedic Surgery, Department of Surgery, Reading Hospital, West Reading, Pennsylvania
| | - Adrian Ong
- Division of Trauma, Department of Surgery, Acute Care Surgery, and Surgical Critical Care, Reading Hospital-Tower Health, West Reading, Pennsylvania
| | - Christopher A Butts
- Division of Trauma, Department of Surgery, Acute Care Surgery, and Surgical Critical Care, Reading Hospital-Tower Health, West Reading, Pennsylvania.
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Ra JH, Rattan R, Patel NJ, Bhattacharya B, Butts CA, Gupta S, Asfaw SH, Como JJ, Sahr SM, Bugaev N. Duration of antimicrobial treatment for complicated intra-abdominal infections after definitive source control: A systematic review, meta-analysis, and practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg 2023; 95:603-612. [PMID: 37316989 DOI: 10.1097/ta.0000000000003998] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Recent studies have evaluated outcomes associated with duration of antimicrobial treatment for complicated intra-abdominal infections (cIAI). The goal of this guideline was to help clinicians better define appropriate antimicrobial duration in patients who have undergone definitive source control for cIAI. METHODS A working group of Eastern Association for the Surgery of Trauma (EAST) performed a systematic review and meta-analyses of the available data pertaining to the duration of antibiotics after definitive source control of cIAI in adult patients. Only studies that compared patients treated with short vs. long duration antibiotic regimens were included. The critical outcomes of interest were selected by the group. Noninferiority of short compared with long duration of antimicrobial treatment was defined as an indicator for a potential recommendation in favor of shorter antibiotics course. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to assess the quality of the evidence and to formulate recommendations. RESULTS Sixteen studies were included. The short duration ranged from 1 dose to ≤10 days, with an average of 4 days, and the long duration ranged >1 day to 28 days, with an average of 8 days. There were no differences between short and long duration of antibiotics in terms of mortality (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.56-1.44), rate of surgical site infection (OR, 0.88; 95% CI, 0.56-1.38); persistent/recurrent abscess (OR, 0.76; 95% CI, 0.45-1.29); unplanned interventions (OR, 0.53; 95% CI, 0.12-2.26); hospital length of stay (mean difference, -2.62 days; CI, -7.08 to 1.83 days); or readmissions (OR, 0.92; 95% CI, 0.50-1.69). The level of evidence was assessed as very low. CONCLUSION The group made a recommendation for shorter (four or less days) versus longer duration (eight or more days) of antimicrobial treatment in adult patients with cIAIs who had definitive source control. LEVEL OF EVIDENCE Systematic Review and Meta-Analysis; Level III.
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Affiliation(s)
- Jin H Ra
- Department of Surgery, UNC-Chapel Hill (J.H.R.), Chapel Hill, North Carolina; DeWitt Daughtry Family Department of Surgery (R.R.), University of Miami Miller School of Medicine, Miami, Florida; Department of Surgery MetroHealth Medical Center (N.J.P.), Case Western Reserve University, Cleveland, Ohio; Department of Surgery, Yale School of Medicine (B.B.), New Haven, Connecticut; Department of Surgery Rutgers Robert Wood Johnson Medical School (C.A.B.), New Brunswick, New Jersey; Department of Surgery (S.G.), School of Medicine, University of Maryland, College Park, Maryland; Department of Surgery, Cleveland Clinic, Digestive Disease and Surgical Institute (S.H.A.); Department of Surgery, MetroHealth Medical Center (J.J.C.), Cleveland, Ohio; Sanford Medical Center (S.M.S.), Fargo, North Dakota; and Department of Surgery, Tufts Medical Center, Tufts School of Medicine (N.B.), Boston, Massachusetts
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Swarup A, Amro C, Choron RL, Cong A, Park J, Butts CA, Goswami J, Teichman AL. UTILITY OF COMPUTED TOMOGRAPHY RECONSTRUCTED THORACOLUMBAR SPINAL IMAGING IN BLUNT TRAUMA. J Trauma Acute Care Surg 2023:01586154-990000000-00323. [PMID: 37012636 DOI: 10.1097/ta.0000000000003983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
OBJECTIVES Fractures of the thoracolumbar(TL) spine are common and may cause neurologic damage, pain, and reduced quality of life. CT TL reconstructions from CT chest/abdomen/pelvis(CAP) are used to identify TL fractures, however their benefit over CAP imaging is unclear. We hypothesized that reformatted TL images do not identify additional clinically significant injuries or change outcomes. METHODS Retrospective data were collected 2016-2021 from trauma patients at a level-1 trauma center. All patients ≥18 years old, with TL fractures on CT CAP with/without CT TL reformats were included. Clinically significant TL fractures were defined as requiring operative fixation, brace, or spinal rehabilitation. A binary classification model was created to assess the diagnostic utility of CTCAP compared to CTTL in predicting clinically significant fractures in patients who underwent CT CAP/TL. RESULTS There were 828 patients with TL fractures, 634 had both CT CAP/CT TL (CAPTL) and 194CTCAP only (CAP). There were 134(16%) clinically significant TL fractures (14(7.2%) CT CAP vs120(18.9%) CT CAPTL,p < 0.001). There were no differences among unstable fractures, fractures on MRI only, mortality, or neurologic deficits on discharge between CAPTL and CAP(p > 0.05). Among clinically significant fractures, CAPTL was not associated with increased MRI utilization, surgery, spinal brace, or spinal cord rehabilitation(p > 0.05). Among clinically insignificant fractures, CAPTL was associated with increased MRIs, LOS, and ICU LOS (p < 0.05). CAPTL was also an independent predictor of increased MRIs (OR5.79,CI2.29-14.65,p < 0.01) and spine consultation (OR2.39,CI1.64-3.67,p < 0.01). More CTCAP/TL were performed in those with clinically significant fractures; however, CTCAP was equivalent to CTTL for detection of fractures(p > 0.05). CONCLUSION CTCAP alone is sufficient to identify clinically significant TL fractures. While the addition of TL reformatted imaging minimizes missed injuries, it is associated with increased hospital length of stay and MRI resource utilization. Therefore, careful consideration is needed for appropriate CT TL patient selection. STUDY TYPE Original Research. LEVEL OF EVIDENCE Level IV/Diagnostic Test.
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Affiliation(s)
- Abhishek Swarup
- Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Chris Amro
- Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Rachel L Choron
- Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Alexander Cong
- Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - John Park
- Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Christopher A Butts
- Division of Trauma/Acute Care Surgery, Reading Hospital, Tower Health, West Reading, PA
| | - Julie Goswami
- Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Amanda L Teichman
- Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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Williamson S, Muller A, Butts CA, Geng TA, Ong AW. Acute Colonic Pseudo-Obstruction: Colonoscopy versus Neostigmine First? J Surg Res 2023; 288:38-42. [PMID: 36948031 DOI: 10.1016/j.jss.2023.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/29/2022] [Revised: 02/10/2023] [Accepted: 02/19/2023] [Indexed: 03/22/2023]
Abstract
INTRODUCTION Neostigmine (NEO) and decompressive colonoscopy (COL) are two efficacious treatment modalities for acute colonic pseudo-obstruction (ACPO). We hypothesize that a COL first strategy is associated with better outcomes compared to a NEO first strategy. METHODS A single-center retrospective analysis was performed from 2013 to 2020. Patients ≥18 y with a diagnosis of ACPO were included. The outcome was a composite measure of acute operative intervention, 30-day readmission with ACPO, and 30-day ACPO-related mortality. A P-value of ≤ 0.05 indicated statistical significance. RESULTS Of 910 encounters in 849 patients, 50 (5.5%) episodes of ACPO in 39 patients were identified after exclusion of one patient with colon perforation on presentation. The median (interquartile range) age was 68 (62-84) y. NEO and COL were administered in 21 and 25 episodes, respectively. In 16 (32%) episodes, no NEO or COL was administered. When patients were given NEO first, COL or additional NEO was required in 12/18 (67%) compared with a COL first strategy where a second COL and/or NEO was given in 5/16 (32%) (P = 0.05). Both strategies had similar outcomes (NEO, 4/18 versus COL, 4/16, P = 0.85). Twenty-two (44%) episodes had an early intervention (≤48 h) with NEO and/or COL. There was no difference in outcome between those that received an early intervention and those who did not (5/22 versus 5/28, P = 0.71). CONCLUSIONS For patients failing conservative measures, a COL first approach was associated with fewer subsequent interventions, but with similar composite outcomes compared to a NEO first approach. Early (≤48 h) intervention with NEO and/or COL was not associated with improved outcomes.
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Affiliation(s)
- Sigrid Williamson
- Division of Trauma and Critical Care, Department of Surgery, Reading Hospital, Tower Health System, Reading, Pennsylvania.
| | - Alison Muller
- Division of Trauma and Critical Care, Department of Surgery, Reading Hospital, Tower Health System, Reading, Pennsylvania
| | - Christopher A Butts
- Division of Trauma and Critical Care, Department of Surgery, Reading Hospital, Tower Health System, Reading, Pennsylvania
| | - Thomas A Geng
- Division of Trauma and Critical Care, Department of Surgery, Reading Hospital, Tower Health System, Reading, Pennsylvania
| | - Adrian W Ong
- Division of Trauma and Critical Care, Department of Surgery, Reading Hospital, Tower Health System, Reading, Pennsylvania
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Amro C, Parekh AT, Diamond K, Lissauer ME, Butts CA. Traumatic Popliteal Artery Occlusion Following Lower Extremity Crush Injury Presenting With Isolated Patellar Dislocation. Am Surg 2023:31348231160846. [PMID: 36871965 DOI: 10.1177/00031348231160846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
While traumatic popliteal artery injury historically has a low incidence, failure to acutely recognize the vascular insult poses a significant risk of limb loss and functional impairment. A 71-year-old male presented with left lower extremity pain in setting of a crush injury working underneath a vehicle resulting in an isolated lateral dislocation of his patella and complete occlusion of the distal popliteal artery. He was taken to the operating room for an in-situ bypass and four-compartment fasciotomy. His hospital stay included three staged washouts/debridements with eventual closure. He was discharged after 38 days to a rehabilitation facility with ability to self-ambulate with assistance within one month. This patient's presentation is unique for his isolated patellar dislocation without associated injuries characteristically associated with a traumatic vascular injury of the popliteal artery and serves to remind the importance of complete examination in the setting of blunt trauma.
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Affiliation(s)
- Chris Amro
- Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Akshat T Parekh
- Department of Orthopedic Surgery, 8395Walter Reed Army Medical Center, Bethesda, MD, USA
| | - Keith Diamond
- Department of Orthopedic Surgery, 2042Maimonides Medical Center, Brooklyn, NY, USA
| | - Matthew E Lissauer
- Department of Surgery, 12227University of Connecticut School of Medicine, Hartford, CT, USA
| | - Christopher A Butts
- Department of Surgery, Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Amro C, Pepe RJ, Parekh AT, Butts CA. Non-Small Cell Lung Cancer Causing Atraumatic Splenic Rupture Without Splenic Metastasis. Am Surg 2023:31348231161697. [PMID: 36871964 DOI: 10.1177/00031348231161697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Atraumatic splenic rupture (ASR) is a rare occurrence but an important clinical entity. Although trauma is the most common cause of splenic rupture, there is limited literature on ASR. This case report discusses a 59-year-old woman presenting with tension hydrothorax and ASR in the setting of non-small cell lung carcinoma requiring emergent chest tube insertion and emergent splenectomy. Her hospital course was complicated by pulmonary embolism and thrombosis of the inferior vena cava. The patient expired three months after her initial presentation. This patient's presentation represents only the second documented case of atraumatic splenic rupture secondary to metastatic lung carcinoma without pathological evidence of splenic metastasis. Atraumatic splenic rupture secondary to metastatic NSCLC is a rare occurrence; though failure to detect, it may be fatal. Pathologic ASR may be an occult presentation of lung malignancy and in the presence of confirmed NSCLC may portend a poor prognosis.
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Affiliation(s)
- Chris Amro
- Department of Surgery, 43982Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Russel J Pepe
- Department of Surgery, 43982Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Akshat T Parekh
- Department of Orthopedic Surgery, 8395Walter Reed Army Medical Center, Bethesda, MD, USA
| | - Christopher A Butts
- Department of Surgery, Division of Acute Care Surgery, 43982Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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10
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Kim EJ, Michels R, Schiffer H, Musso M, Ong A, Geng T, Butts CA. Traumatic Amputation From a Rollover Farming Incident in a 16-Year-Old. Am Surg 2023. [PMID: 36867081 DOI: 10.1177/00031348231161698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
There is very little literature on the overall management of adolescent traumatic amputation, specifically of the lower extremity. We present a case involving an adolescent patient involved in an industrial farm tractor rollover with substantial crush and degloving injuries requiring bilateral lower extremity amputations. The patient was initially assessed and acutely managed in the field before arriving at an adult level 1 trauma center having two right lower extremity tourniquets already applied and a pelvic binder in place. During his hospitalization, he was revised to bilateral above-knee amputations that required multiple debridements prior to being transferred to a pediatric trauma center due to the extent of the soft tissue injury and need for flap coverage. Our adolescent patient presented with an uncommon injury mechanism resulting in significantly mangled lower extremities highlighting the importance of a multidisciplinary approach in all aspects of the patient's prehospital, intrahospital, and posthospital care.
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Affiliation(s)
- Esther J Kim
- Department of Surgery, 6823Reading Hospital, West Reading, PA, USA
| | - Ryan Michels
- Division of Orthopedic Surgery, Department of Surgery, 6823Reading Hospital, West Reading, PA, USA
| | - Herbert Schiffer
- Department of Emergency Medicine, 6823Reading Hospital, West Reading, PA, USA
| | - Michael Musso
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, 6823Reading Hospital, West Reading, PA, USA
| | - Adrian Ong
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, 6823Reading Hospital, West Reading, PA, USA
| | - Thomas Geng
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, 6823Reading Hospital, West Reading, PA, USA
| | - Christopher A Butts
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, 6823Reading Hospital, West Reading, PA, USA
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11
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Sigal A, Butts CA, Deaner T, Wasser T, Bailey B, Bindra M, Muller A, Martin AP, Ong A. Potentially Inappropriate Medications are Associated With Geriatric Trauma Recidivism. J Surg Res 2023; 283:581-585. [PMID: 36442257 DOI: 10.1016/j.jss.2022.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/12/2022] [Revised: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The American Geriatric Society has identified polypharmacy and categories of potentially inappropriate medication (PIM) that should be avoided in the elderly. These medications can potentially cause an increased risk of falls and traumatic events. MATERIALS AND METHODS We conducted a retrospective study on elderly patients with traumatic injuries at a Level 1 trauma center. We compared patients having only one traumatic event and those with one or more traumatic events with the presence of prescriptions for PIMs. RESULTS Identified high risk categories of anticoagulant and antiplatelet agents (odds ratio [OR] 1.18, 95% confidence interval [CI] 1.08-1.28), psychiatric and neurologic agents (OR 1.32, 95% CI 1.22-1.43), as well as medication with anticholinergic properties (OR 1.14, 95% CI 1.03-1.27) were associated with an increased risk of recurrent trauma. CONCLUSIONS We can quantify the risk of recurrent trauma with certain categories of PIM. Medication reconciliation and shared decision-making regarding the continued use of these medications may positively impact trauma recidivism.
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Affiliation(s)
- Adam Sigal
- Department of Emergency Medicine, Reading Hospital, West Reading, Pennsylvania.
| | - Christopher A Butts
- Division of Trauma, Acute Care and Surgical Critical Care, Department of Surgery, Reading Hospital, West Reading, Pennsylvania
| | - Traci Deaner
- Department of Emergency Medicine, Reading Hospital, West Reading, Pennsylvania
| | - Tom Wasser
- Department of Emergency Medicine, Reading Hospital, West Reading, Pennsylvania
| | - Blake Bailey
- Department of Emergency Medicine, Reading Hospital, West Reading, Pennsylvania
| | - Monisha Bindra
- Department of Emergency Medicine, Reading Hospital, West Reading, Pennsylvania
| | - Alison Muller
- Division of Trauma, Acute Care and Surgical Critical Care, Department of Surgery, Reading Hospital, West Reading, Pennsylvania
| | - Anthony P Martin
- Division of Trauma, Acute Care and Surgical Critical Care, Department of Surgery, Reading Hospital, West Reading, Pennsylvania
| | - Adrian Ong
- Division of Trauma, Acute Care and Surgical Critical Care, Department of Surgery, Reading Hospital, West Reading, Pennsylvania
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12
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Heidorn E, Costa M, Coots A, Ong A, Butts CA. Large Traumatic Lumbar Hernia: A Difficult and Uncommon Problem. Am Surg 2023:31348231157835. [PMID: 36803138 DOI: 10.1177/00031348231157835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Lumbar hernias are congenital or acquired posterolateral abdominal wall hernias and are located in the superior or inferior lumbar triangle. Traumatic lumbar hernias are rare, and the optimal method to repair these is not well-defined. We present the case of a 59-year-old obese female who presented after a motor vehicle collision with an 8.8 cm traumatic right-sided inferior lumbar hernia and overlying complex abdominal wall laceration. The patient underwent an open repair with retro rectus polypropylene mesh and biologic mesh underlay several months after the abdominal wall wound healed, and the patient lost 60 pounds. The patient recovered well without complications or recurrence at the one-year follow-up. This case demonstrates a complex, open surgical approach to repair a large traumatic lumbar hernia not amenable to laparoscopic repair.
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Affiliation(s)
- Elise Heidorn
- Department of Surgery, 6823Reading Hospital, West Reading, PA, USA
| | - Margaret Costa
- Department of Surgery, 6823Reading Hospital, West Reading, PA, USA
| | - Abigail Coots
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, 6823Reading Hospital, West Reading, PA, USA
| | - Adrian Ong
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, 6823Reading Hospital, West Reading, PA, USA
| | - Christopher A Butts
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, 6823Reading Hospital, West Reading, PA, USA
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13
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Yoo R, Gaziano MD, Cortes V, Chauhan N, Bamberger PK, Reilly EF, Geng T, Butts CA, Ong A. Distal Pancreatic Necrosis After Splenic Angioembolization. Am Surg 2023:31348231157839. [PMID: 36803024 DOI: 10.1177/00031348231157839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Pancreatic ischemia with necrosis is an extremely rare complication of splenic angioembolization (SAE). A 48-year-old male with a grade IV blunt splenic injury underwent angiography which demonstrated no active bleeding or pseudoaneurysm. Proximal SAE was performed. One week later, he developed severe sepsis. Repeat CT imaging showed nonperfusion of the distal pancreas, and laparotomy found necrosis of approximately 40% of the pancreas. Distal pancreatectomy and splenectomy were performed. He endured a prolonged hospital course with multiple complications. Clinicians should have a high index of suspicion for ischemic complications after SAE when sepsis develops.
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Affiliation(s)
- Rachel Yoo
- Department of Surgery, Division of Acute Care Surgery/Trauma, Reading Hospital, 419713Tower Health System, Reading, PA, USA
| | | | - Vicente Cortes
- Department of Surgery, Division of Acute Care Surgery/Trauma, Reading Hospital, 419713Tower Health System, Reading, PA, USA
| | - Nikunj Chauhan
- Department of Interventional Radiology, Reading Hospital, 419713Tower Health System, Reading, PA, USA
| | - Peter K Bamberger
- Department of Surgery, Division of Acute Care Surgery/Trauma, Reading Hospital, 419713Tower Health System, Reading, PA, USA
| | - Eugene F Reilly
- Department of Surgery, Division of Acute Care Surgery/Trauma, Reading Hospital, 419713Tower Health System, Reading, PA, USA
| | - Thomas Geng
- Department of Surgery, Division of Acute Care Surgery/Trauma, Reading Hospital, 419713Tower Health System, Reading, PA, USA
| | - Christopher A Butts
- Department of Surgery, Division of Acute Care Surgery/Trauma, Reading Hospital, 419713Tower Health System, Reading, PA, USA
| | - Adrian Ong
- Department of Surgery, Division of Acute Care Surgery/Trauma, Reading Hospital, 419713Tower Health System, Reading, PA, USA
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14
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Yoo R, Evanson D, Gaziano M, Muller A, Martin A, Chauhan N, Butts CA, Cortes V, Reilly EF, Bamberger PK, Geng T, Ong A. Negative Splenic Angiography in Blunt Trauma: Does Embolization Affect Splenic Salvage? Am Surg 2023:31348231157863. [PMID: 36794385 DOI: 10.1177/00031348231157863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Angioembolization in blunt splenic trauma is used to maximize splenic preservation. Superiority of prophylactic embolization over expectant management in patients with a negative splenic angiography (SA) is debated. We hypothesized that embolization in negative SA would be associated with splenic salvage. Of 83 patients undergoing SA, 30 (36%) had a negative SA. Embolization was performed in 23 (77%). Grade of injury, contrast extravasation (CE) on computed tomography (CT) or embolization were not associated with splenectomy. In 20 patients with either a high-grade injury or CE on CT, 17 (85%) underwent embolization with a failure rate of 24%. In the remaining 10 without high-risk features, 6 underwent embolization with a 0% splenectomy rate. Despite embolization, the failure rate of nonoperative management (NOM) remains significant in those with high-grade injury or CE on CT. A low threshold for early splenectomy after prophylactic embolization is needed.
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Affiliation(s)
- Rachel Yoo
- Division of Acute Care Surgery/Trauma, Department of Surgery, 6823Reading Hospital, Reading, PA, USA; 419713Tower Health System, Reading, PA, USA
| | - Davin Evanson
- 12312Drexel University College of Medicine, Philadelphia, PA, USA
| | - Michael Gaziano
- 12312Drexel University College of Medicine, Philadelphia, PA, USA
| | - Alison Muller
- Division of Acute Care Surgery/Trauma, Department of Surgery, 6823Reading Hospital, Reading, PA, USA; 419713Tower Health System, Reading, PA, USA
| | - Anthony Martin
- Division of Acute Care Surgery/Trauma, Department of Surgery, 6823Reading Hospital, Reading, PA, USA; 419713Tower Health System, Reading, PA, USA
| | - Nikunj Chauhan
- Department of Interventional Radiology, 6823Reading Hospital, Reading, PA, USA; 419713Tower Health System, Reading, PA, USA
| | - Christopher A Butts
- Division of Acute Care Surgery/Trauma, Department of Surgery, 6823Reading Hospital, Reading, PA, USA; 419713Tower Health System, Reading, PA, USA
| | - Vicente Cortes
- Division of Acute Care Surgery/Trauma, Department of Surgery, 6823Reading Hospital, Reading, PA, USA; 419713Tower Health System, Reading, PA, USA
| | - Eugene F Reilly
- Division of Acute Care Surgery/Trauma, Department of Surgery, 6823Reading Hospital, Reading, PA, USA; 419713Tower Health System, Reading, PA, USA
| | - Peter K Bamberger
- Division of Acute Care Surgery/Trauma, Department of Surgery, 6823Reading Hospital, Reading, PA, USA; 419713Tower Health System, Reading, PA, USA
| | - Thomas Geng
- Division of Acute Care Surgery/Trauma, Department of Surgery, 6823Reading Hospital, Reading, PA, USA; 419713Tower Health System, Reading, PA, USA
| | - Adrian Ong
- Division of Acute Care Surgery/Trauma, Department of Surgery, 6823Reading Hospital, Reading, PA, USA; 419713Tower Health System, Reading, PA, USA
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15
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Abstract
Coronavirus disease 2019 (COVID-19) typically manifests with respiratory symptoms and can ultimately progress to severe multiorgan failure. Viral myositis, systemic capillary leak syndrome, and arteriovenous thrombosis are atypical manifestations of COVID-19. We present a case of a 33-year-old woman, fully vaccinated against COVID-19, who developed myositis and shock. She ultimately required bilateral lower extremity fasciotomies secondary to compartment syndrome, presumably from COVID-19 myositis. Although compartment syndrome from COVID-19 myositis has been reported for ocular, hand, and thigh compartment syndromes, this is the first case report showing bilateral lower extremity compartment syndrome secondary to COVID-19 myositis in a fully vaccinated individual. As we learn more about COVID-19 and its extrapulmonary effects, it is imperative to consider all working diagnoses when working up patients. Providers must be aware of extrapulmonary effects of COVID-19, particularly in individuals who might deviate from traditional symptoms.
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Affiliation(s)
- Kate M Brod
- Department of Surgery, Division of Trauma Acute Care Surgery, and Surgical Critical Care, Reading Hospital, 419713Tower Health
| | - Jordan Wohl
- Department of Emergency Medicine, Reading Hospital, 419713Tower Health
| | - Christopher A Butts
- Department of Surgery, Division of Trauma Acute Care Surgery, and Surgical Critical Care, Reading Hospital, 419713Tower Health
| | - Eugene F Reilly
- Department of Surgery, Division of Trauma Acute Care Surgery, and Surgical Critical Care, Reading Hospital, 419713Tower Health
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16
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McCarley S, Yu B, Guay R, Ong A, Sacks D, Butts CA. Percutaneous Retrieval of Retained Gallstones. Am Surg 2022:31348221084944. [PMID: 35333657 DOI: 10.1177/00031348221084944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Laparoscopic cholecystectomy has become the gold standard for patients with gallbladder disease. However, spilled gallstones occur in up to 18% of laparoscopic cholecystectomies, which may result in retained gallstones. Though most do not cause issues, there may be abscess formation from 4 months to 10 years postoperatively. We present a 78-year-old patient who formed a subhepatic abscess 3 months postoperatively from his laparoscopic cholecystectomy secondary to a 1 cm retained gallstone. The abscess was percutaneously drained by interventional radiology (IR), and the stone was subsequently removed by IR using a percutaneous approach. Open and laparoscopic approaches have been previously described for abscess drainage and removal of gallstones. In this case, both the abscess and stone were drained and removed percutaneously by IR. Though this is an uncommon entity, percutaneous decompression can aid in preventing such patients from undergoing additional surgery.
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Affiliation(s)
- Saudia McCarley
- Department of Surgery, 6823Reading Hospital-Tower Health, West Reading, PA, USA
| | - Bernice Yu
- Department of Surgery, 6823Reading Hospital-Tower Health, West Reading, PA, USA
| | - Robert Guay
- Department of Interventional Radiology, 6823Reading Hospital-Tower Health, West Reading, PA, USA
| | - Adrian Ong
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, Department of Surgery, 6823Reading Hospital-Tower Health, West Reading, PA, USA
| | - David Sacks
- Department of Interventional Radiology, 6823Reading Hospital-Tower Health, West Reading, PA, USA
| | - Christopher A Butts
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, Department of Surgery, 6823Reading Hospital-Tower Health, West Reading, PA, USA
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17
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Panico R, Cai J, Butts CA, To JQ. Understanding the course of COVID-19-induced pneumomediastinum. JAAPA 2021; 34:31-33. [PMID: 34593717 PMCID: PMC8541892 DOI: 10.1097/01.jaa.0000794992.99292.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Since its discovery, COVID-19 has infected nearly 112 million people and caused about 2.5 millions deaths worldwide. Our understanding of the clinical presentation and complications of COVID-19 is still evolving. Bilateral pulmonary ground-glass opacities on imaging have become characteristic in the diagnosis of COVID-19, but pneumomediastinum has now also been reported in some patients with COVID-19. Reports on the overall prognosis for these patients are conflicting and little information exists regarding long-term complications. This article describes the clinical course of a patient who did not need mechanical ventilation but developed spontaneous pneumomediastinum.
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Affiliation(s)
- Rocco Panico
- Rocco Panico is lead critical care advanced practice provider at Robert Wood Johnson Barnabas Health-Somerset in Somerville, N.J. Jenny Cai is an assistant professor at Rutgers-Robert Wood Johnson Medical School in New Brunswick, N.J. Christopher A. Butts is an assistant professor of surgery at Drexel University School of Medicine's Reading, Pa., campus; a trauma/acute care surgeon at Reading Hospital; a clinical assistant professor of surgery at Rutgers-Robert Wood Johnson Medical School; and a clinical instructor in general surgery at Philadelphia (Pa.) College of Osteopathic Medicine. Jennifer Q. To is a clinical adjunct assistant professor of surgery at the Lewis Katz School of Medicine at Temple University in Philadelphia, Pa., and practices at St Luke's University Health Network in Bethlehem, Pa. The authors have disclosed no potential conflicts of interest, financial or otherwise
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18
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Arias FD, Brown ZJ, Prochilo G, Butts CA, To J. Follicular Cholecystitis: What a General Surgeon Should Know. Am Surg 2021; 88:554-556. [PMID: 34645334 DOI: 10.1177/00031348211047212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Fernando D Arias
- Department of Surgery, 12287Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Zachary J Brown
- Department of Surgery, 12287Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.,Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Gina Prochilo
- Department of Pathology, 12287Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Christopher A Butts
- Department of Surgery, Division of Acute Care Surgery, Rutgers Robert Wood Johnson New, Brunswick, NJ, USA
| | - Jennifer To
- Department of Surgery, Division of Acute Care Surgery, Rutgers Robert Wood Johnson New, Brunswick, NJ, USA.,Department of Surgery, Division of Trauma and Acute Care Surgical Services, 12287St Luke's University Health Network, Bethlehem, PA, USA
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19
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Teichman AL, Walls D, Choron RL, Butts CA, Krumrei N, Amro C, Swaminathan S, Arcomano N, Parekh A, Romeo P. The Utility of Lower Extremity Screening Duplex for The Detection of Deep Vein Thrombosis in Trauma. J Surg Res 2021; 269:151-157. [PMID: 34563841 DOI: 10.1016/j.jss.2021.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 02/05/2021] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Trauma patients are high-risk for venous thromboembolism (VTE). Lower extremity screening duplex ultrasonography (LESDUS) is controversial and not standardized for early VTE diagnosis. By implementing risk stratification and selective screening, we aim to optimize resource utilization. MATERIALS AND METHODS A retrospective review were conducted at a Level-1 Trauma Center, January 2015-October 2019. LESDUS was performed within 72-h of presentation, then weekly. Demographics, VTE data, and outcomes were collected from the trauma registry. Risk assessment profile (RAP) score was calculated based on collected data. RESULTS Of 5,645 patients included, 2,813 (49.8%) were screened for lower extremity deep vein thrombosis (LEDVT). Of 187 patients with LEDVT, 154 were diagnosed on LESDUS, 18 after negative LESDUS, and 15 in unscreened patients. Patients with VTE were older (61y versus 55, P < 0.01), more often male (70.9% versus 29.1%, P = 0.03), had higher ISS (16 versus 10, P < 0.01), longer hospital length of stay (LOS) (11.5 d versus 3, P < 0.01), longer ICU LOS (4.5 d versus 1, P < 0.01), and increased mortality (9.1% versus 4.3%, P = 0.01). RAP was higher in VTE patients versus those without (nine versus three, P < 0.01). RAP ≥8 was 62.5% sensitive and 70.4% specific for VTE. Chemoprophylaxis delay also correlated with increased VTE (OR = 1.48, 95% CI = 1.03-2.12). CONCLUSIONS VTE remains a significant complication in trauma patients. Despite a universal LESDUS protocol, only 50% of patients underwent screening and 20% of all LE DVTs were not identified on LESDUS. To optimize resource utilization and protocol adherence, LESDUS should only be performed if RAP ≥8 or if unable to administer timely chemoprophylaxis.
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Affiliation(s)
- Amanda L Teichman
- Department of Surgery, Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
| | - David Walls
- Department of Surgery, Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Rachel L Choron
- Department of Surgery, Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Christopher A Butts
- Department of Surgery, Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Nicole Krumrei
- Department of Surgery, Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Christopher Amro
- Department of Surgery, Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Sneha Swaminathan
- Department of Surgery, Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Nicholas Arcomano
- Department of Surgery, Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Akshat Parekh
- Department of Surgery, Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Paul Romeo
- Department of Surgery, Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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20
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Iacono SA, Krumrei NJ, Niroomand A, Walls DO, Lissauer M, To J, Butts CA. Age Is But a Number: Damage Control Surgery Outcomes in Geriatric Emergency General Surgery. J Surg Res 2021; 267:452-457. [PMID: 34237630 DOI: 10.1016/j.jss.2021.05.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 02/15/2021] [Revised: 04/24/2021] [Accepted: 05/29/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Damage control surgery (DCS) with temporary abdominal closure (TAC) is increasingly utilized in emergency general surgery (EGS). As the population ages, more geriatric patients (GP) are undergoing EGS operations. Concern exists for GP's ability to tolerate DCS. We hypothesize that DCS in GP does not increase morbidity or mortality and has similar rates of primary closure compared to non-geriatric patients (NGP). METHODS A retrospective chart review from 2014-2020 was conducted on all non-trauma EGS patients who underwent DCS with TAC. Demographics, admission lab values, fluid amounts, length of stay (LOS), timing of closure, post-operative complications and mortality were collected. GP were compared to NGP and results were analyzed using Chi square and Wilcox signed rank test. RESULTS Ninety-eight patients (n = 50, <65 y; n = 48, ≥65 y) met inclusion criteria. There was no significant difference in median number of operations (3 versus 2), time to primary closure (2.5 versus 3 d), hospital LOS (19 versus 17.5 d), ICU LOS (11 versus 8 d), rate of primary closure (66% versus 56%), post op ileus (44% versus 48%), abscess (14% versus 10%), need for surgery after closure (32% versus 19%), anastomotic dehiscence (16% versus 6%), or mortality (34% versus 42%). Average time until take back after index procedure did not vary significantly between young and elderly group (45.8 versus 38.5 h; P = 0.89). GP were more likely to have hypertension (83% versus 50%; P ≤ 0.05), atrial fibrillation (25% versus 4%; P ≤ 0.05) and lower median heart rate compared to NGP (90 versus 103; P ≤ 0.05). CONCLUSIONS DCS with TAC in geriatric EGS patients achieves similar outcomes and mortality to younger patients. Indication, not age, should factor into the decision to perform DCS.
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Affiliation(s)
- Stephen A Iacono
- Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Nicole J Krumrei
- Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Anna Niroomand
- Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - David O Walls
- Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Matthew Lissauer
- Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Jennifer To
- St. Luke's University Health Network, Bethlehem, Pennsylvania
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21
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Choron RL, Butts CA, Bargoud C, Krumrei NJ, Teichman AL, Schroeder ME, Bover Manderski MT, Cai J, Song C, Rodricks MB, Lissauer M, Gupta R. Fever in the ICU: A Predictor of Mortality in Mechanically Ventilated COVID-19 Patients. J Intensive Care Med 2021; 36:484-493. [PMID: 33317374 PMCID: PMC7738811 DOI: 10.1177/0885066620979622] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE While fever may be a presenting symptom of COVID-19, fever at hospital admission has not been identified as a predictor of mortality. However, hyperthermia during critical illness among ventilated COVID-19 patients in the ICU has not yet been studied. We sought to determine mortality predictors among ventilated COVID-19 ICU patients and we hypothesized that fever in the ICU is predictive of mortality. MATERIALS AND METHODS We conducted a retrospective cohort study of 103 ventilated COVID-19 patients admitted to the ICU between March 14 and May 27, 2020. Final follow-up was June 5, 2020. Patients discharged from the ICU or who died were included. Patients still admitted to the ICU at final follow-up were excluded. RESULTS 103 patients were included, 40 survived and 63(61.1%) died. Deceased patients were older {66 years[IQR18] vs 62.5[IQR10], (p = 0.0237)}, more often male {48(68%) vs 22(55%), (p = 0.0247)}, had lower initial oxygen saturation {86.0%[IQR18] vs 91.5%[IQR11.5], (p = 0.0060)}, and had lower pH nadir than survivors {7.10[IQR0.2] vs 7.30[IQR0.2] (p < 0.0001)}. Patients had higher peak temperatures during ICU stay as compared to hospital presentation {103.3°F[IQR1.7] vs 100.0°F[IQR3.5], (p < 0.0001)}. Deceased patients had higher peak ICU temperatures than survivors {103.6°F[IQR2.0] vs 102.9°F[IQR1.4], (p = 0.0008)}. Increasing peak temperatures were linearly associated with mortality. Febrile patients who underwent targeted temperature management to achieve normothermia did not have different outcomes than those not actively cooled. Multivariable analysis revealed 60% and 75% higher risk of mortality with peak temperature greater than 103°F and 104°F respectively; it also confirmed hyperthermia, age, male sex, and acidosis to be predictors of mortality. CONCLUSIONS This is one of the first studies to identify ICU hyperthermia as predictive of mortality in ventilated COVID-19 patients. Additional predictors included male sex, age, and acidosis. With COVID-19 cases increasing, identification of ICU mortality predictors is crucial to improve risk stratification, resource management, and patient outcomes.
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Affiliation(s)
- Rachel L. Choron
- Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Christopher A. Butts
- Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Christopher Bargoud
- Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Nicole J. Krumrei
- Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Amanda L. Teichman
- Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Mary E. Schroeder
- Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Division of Acute Care Surgery, Froedtert Memorial Lutheran Hospital, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Jenny Cai
- Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Cherry Song
- Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Michael B. Rodricks
- Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Matthew Lissauer
- Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Rajan Gupta
- Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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22
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Tsai A, Teichman A, Butts CA, Cai JY, Peck GL, Adams CD, Hanna JS. Mesenteric venous thrombosis: A lethal complication of hyperglycemic crises. Am J Health Syst Pharm 2021; 78:105-107. [PMID: 33119766 DOI: 10.1093/ajhp/zxaa353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
PURPOSE Although hyperglycemic crises can lead to a hypercoagulable state, few instances of associated mesenteric venous thrombosis (MVT) have been reported. Worsening abdominal pain in the context of shock requiring vasopressor support should prompt urgent further investigation. SUMMARY A 44-year-old Hispanic male arrived at an emergency department with chief complaints of lethargy, polydipsia, and polyuria. His past medical history included type 2 diabetes, epilepsy, obesity, tobacco smoking, and noncompliance with his medications. On arrival the patient had a serum glucose concentration of >1,600 mg/dL, and hyperosmolar hyperglycemic syndrome (HHS) was diagnosed. The patient was admitted to the intensive care unit with respiratory failure and subsequently developed shock refractory to fluid resuscitation, necessitating vasopressor support. On hospital day 4, a computerized tomogram obtained for investigation of increasing abdominal tenderness revealed superior MVT and pneumatosis intestinalis. Despite an emergency laparotomy and enterectomy, the patient ultimately succumbed on hospital day 41 due to recurrent pneumonia complicated by acute respiratory distress syndrome and septic shock. CONCLUSION Shock that is refractory to aggressive fluid resuscitation, necessitating pressor support, in the setting of HHS or diabetic ketoacidosis should prompt investigation for the underlying source of shock. Other etiologies, including hypovolemic, cardiogenic, and obstructive shock, should be considered; however, infection is the leading trigger of hyperglycemic crises. Although rarely reported, MVT should be considered in the diagnostic algorithm in the absence of an identified infectious source. Prompt investigation should include use of diagnostic modalities such as computed tomography to assess for MVT.
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Affiliation(s)
- Andrew Tsai
- Robert Wood Johnson University Hospital Somerset, Somerville, NJ
| | - Amanda Teichman
- Robert Wood Johnson University Hospital Somerset, Somerville, NJ.,Division of Acute Care Surgery, Rutgers-Robert Wood Johnson School of Medicine, New Brunswick, NJ
| | | | - Jenny Y Cai
- Robert Wood Johnson University Hospital Somerset, Somerville, NJ
| | - Gregory L Peck
- Division of Acute Care Surgery, Rutgers-Robert Wood Johnson School of Medicine, New Brunswick, NJ.,Rutgers School of Public Health, Piscataway, NJ
| | - Christopher D Adams
- Robert Wood Johnson University Hospital Somerset, Somerville, NJ.,Rutgers School of Public Health, Piscataway, NJ
| | - Joseph S Hanna
- Robert Wood Johnson University Hospital Somerset, Somerville, NJ.,Division of Acute Care Surgery, Rutgers-Robert Wood Johnson School of Medicine, New Brunswick, NJ
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23
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Choron RL, Butts CA, Bargoud C, Krumrei N, Teichman AL, Schroeder M, Bover Manderski MT, To J, Moffa SM, Rodricks MB, Lissauer M, Gupta R. Surgeons in surge - the versatility of the acute care surgeon: outcomes of COVID-19 ICU patients in a community hospital where all ICU patients are managed by surgical intensivists. Trauma Surg Acute Care Open 2020; 5:e000557. [PMID: 34192160 PMCID: PMC7705423 DOI: 10.1136/tsaco-2020-000557] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/21/2020] [Accepted: 10/31/2020] [Indexed: 12/24/2022] Open
Abstract
Background Reported characteristics and outcomes of critically ill patients with COVID-19 admitted to the intensive care unit (ICU) are widely disparate with varying mortality rates. No literature describes outcomes in ICU patients with COVID-19 managed by an acute care surgery (ACS) division. Our ACS division manages all ICU patients at a community hospital in New Jersey. When that hospital was overwhelmed and in crisis secondary to COVID-19, we sought to describe outcomes for all patients with COVID-19 admitted to our closed ICU managed by the ACS division. Methods This was a prospective case series of the first 120 consecutive patients with COVID-19 admitted on March 14 to May 10, 2020. Final follow-up was May 27, 2020. Patients discharged from the ICU or who died were included. Patients still admitted to the ICU at final follow-up were excluded. Results One hundred and twenty patients were included (median age 64 years (range 25–89), 66.7% men). The most common comorbidities were hypertension (75; 62.5%), obesity (61; 50.8%), and diabetes (50; 41.7%). One hundred and thirteen (94%) developed acute respiratory distress syndrome, 89 (74.2%) had shock, and 76 (63.3%) experienced acute kidney injury. One hundred (83.3%) required invasive mechanical ventilation (IMV). Median ICU length of stay (LOS) was 8.5 days (IQR 9), hospital LOS was 14.5 days (IQR 13). Mortality for all ICU patients with COVID-19 was 53.3% and 62% for IMV patients. Conclusions This is the first report of patients with COVID-19 admitted to a community hospital ICU managed by an ACS division who also provided all surge care. Mortality of critically ill patients with COVID-19 admitted to an overwhelmed hospital in crisis may not be as high as initially thought based on prior reports. While COVID-19 is a non-surgical disease, ACS divisions have the capability of successfully caring for both surgical and medical critically ill patients, thus providing versatility in times of crisis. Level of evidence Level V.
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Affiliation(s)
- Rachel Leah Choron
- Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Christopher A Butts
- Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Christopher Bargoud
- Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Nicole Krumrei
- Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Amanda L Teichman
- Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Mary Schroeder
- Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.,Division of Acute Care Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michelle T Bover Manderski
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health New Brunswick Campus, Piscataway, New Jersey, USA
| | - Jennifer To
- Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Salvatore M Moffa
- Chief Medical Officer, Robert Wood Johnson University Hospital Somerset, Somerville, New Jersey, USA
| | - Michael B Rodricks
- Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Matthew Lissauer
- Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Rajan Gupta
- Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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24
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NeMoyer RE, Hanna JS, To J, LaFonte M, Butts CA. Cecal Volvulus Within a Left Inguinal Hernia : An Uncommon Problem Resulting in a Closed Loop Obstruction and Loss of Domain. Am Surg 2020; 86:1577-1579. [PMID: 32735450 DOI: 10.1177/0003134820940243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Rachel E NeMoyer
- Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Joseph S Hanna
- Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Jennifer To
- Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Marc LaFonte
- Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Christopher A Butts
- Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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25
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Fernandez FB, Ong A, Martin AP, Schwab CW, Wasser T, Butts CA, McNicholas AR, Muller AL, Barbera CF, Trupp R, Sigal AP. Success Of An Expedited Emergency Department Triage Evaluation System For Geriatric Trauma Patients Not Meeting Trauma Activation Criteria. Open Access Emerg Med 2019; 11:241-247. [PMID: 31754315 PMCID: PMC6825467 DOI: 10.2147/oaem.s212617] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 10/07/2019] [Indexed: 11/23/2022] Open
Abstract
Background Geriatric patients are at increased risk of injury following low-energy mechanisms and are less tolerant of injury. Current criteria for trauma team activation (TTA) often miss these injuries. We evaluated a novel triage process for an expedited Emergency Medicine Physician evaluation protocol (T3) for at-risk geriatric sub-populations not meeting trauma team activation (TTA) criteria. Methods Retrospective review of injured patients (≥65 years) from a Level II Trauma Center with an Injury Severity Score (ISS < 16), prior to (Pre-T3, Jan 2007-Oct 2009), and after (Post-T3, Jan 2010-Oct 2012), implementation of T3, as well as a contemporary period (CP, Jan 2013-Oct 2015). Demographics, physiologic variables, and timeliness of care were measured. Rates of ICU admission, operative procedures and lengths of stay and in-hospital mortality were compared for all periods. Logistic regression analysis determined variables independently associated with mortality. Results Post-T3, 49.2% of geriatric registry patients underwent T3 with a reduction in key time intervals. Median time to evaluation (42.1 mins vs 61.7 min, p<0.001), median time to CT (161.3 mins vs 212.9 mins, p<0.001) and EDLOS (364.6 mins vs 451.5 mins, p=0.023) were all reduced compared to non-expedited evaluations. There was no change in mortality after the implementation of the protocol. Conclusion The T3 protocol expedited patient evaluation of at-risk geriatric patients that would not otherwise meet TTA criteria. The new process met the goals of the American College of Surgeons Trauma Quality Improvement Program while conserving resources.
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Affiliation(s)
| | - Adrian Ong
- Trauma and Surgical Critical Care Reading Hospital, Reading, PA, USA
| | - Anthony P Martin
- Trauma and Surgical Critical Care Reading Hospital, Reading, PA, USA
| | - C William Schwab
- Trauma and Surgical Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Tom Wasser
- Complete Statistical Services, Macungie, PA, USA
| | | | | | - Alison L Muller
- Trauma and Surgical Critical Care Reading Hospital, Reading, PA, USA
| | - Charles F Barbera
- Department of Emergency Medicine, Reading Hospital, Reading, PA, USA
| | - Rachael Trupp
- Department of Emergency Medicine, Reading Hospital, Reading, PA, USA
| | - Adam P Sigal
- Department of Emergency Medicine, Reading Hospital, Reading, PA, USA
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26
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Butts CA, Speer JJ, Brady JJ, Stephenson RJ, Langenau E, DiTomasso R, Fresa K, Becker M, Sesso A. Introduction to Clerkship: Bridging the Gap Between Preclinical and Clinical Medical Education. J Osteopath Med 2019; 119:578-587. [PMID: 31449304 DOI: 10.7556/jaoa.2019.101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Despite a diverse range of curricular advancements to address the difficult transition from classroom learning to clinical training during medical education, hurdles persist. A 4-week course was designed at the Philadelphia College of Osteopathic Medicine (PCOM) to make this transition easier. Objectives To determine whether PCOM students' comfort and preparedness increased after taking a 4-week clinical transition course before third-year clinical clerkships, and to determine whether faculty perceptions of student preparedness and comfort were improved after participation in the course compared with previous third-year students. Methods Second-year osteopathic medical students at PCOM participated in a 4-week course, Introduction to Clinical Clerkship (I2C). The course included 16 small-group exercises, which all took place before students began their third-year clerkship rotations. The exercises in the course extended beyond the skills learned during their classroom years. Students were given a pre- and postcourse survey to evaluate their comfort level with 58 different aspects of clinical practice. Participating faculty were surveyed to evaluate their perception of student preparedness and comfort compared with previous third-year students who had not undergone the exercise. Results After completing the I2C course, third-year osteopathic medical students (n=232) reported increased comfort with 57 of the 58 learning objectives and each of the 5 coded clinical competency areas (patient assessment, effective communication, hospital logistics, procedural skills, and core knowledge) (P<.01). Preceptors reported that students who completed the I2C course were more prepared (54.5%) and more comfortable (63.4%) with clinical duties, as compared with their recollections of previous third-year osteopathic medical students. Conclusion Within the 5 competencies, students on average felt more comfortable and were perceived by faculty as better prepared than previous students who had not taken the I2C course. The establishment of a preclinical transition exercise appears to help bridge the gap between the preclinical and clinical years. This learning model allows medical students to feel both more comfortable and better prepared throughout the transition from classroom learning to clinical rotations.
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27
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Butts CA, Gonzalez R, Gaughan JP, San Roman J, Ross S, Porter J, Hazelton JP. Comparison of Urban Off-Road Vehicle and Motorcycle Injuries at a Level 1 Trauma Center. J Surg Res 2019; 245:373-376. [PMID: 31425878 DOI: 10.1016/j.jss.2019.07.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/01/2019] [Revised: 06/27/2019] [Accepted: 07/19/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Recently, there has been an increase in the usage of dirt bikes and all-terrain vehicles in urban environments. Previously, it has been shown that crashes involving these urban off-road vehicles (UORVs) resulted in different injury patterns from crashes that occurred in rural environments. The aim of this study was to compare injury patterns of patients involved in crashes while riding UORVs versus motorcycles (MCs). METHODS A retrospective review (2005-2016) of patients who presented to our urban level I trauma center as a result of any MC or UORV crash was performed. Patients who presented after 48 h from the time of accident were excluded. A P < 0.05 was considered significant. RESULTS We identified 1556 patients who were involved in an MC or UORV crash resulting in injury (MC: n = 1324 [85%]; UORVs: n = 232 [15%]). Patients in UORV crashes were younger (26.2 y versus 39.6 y), less likely to be helmeted (39.6% versus 90.2%), required fewer emergent trauma bay procedures (28.4% versus 36.7%), and needed fewer operative interventions (45.9% versus 54.2%) (all P < 0.05). Both groups had a similar Injury Severity Score (12.2 versus 12.6; P = 0.54) and Glasgow Coma Score (13.8 versus 13.5; P = 0.46). UORV patients had a lower mortality (0.9% versus 4.7%; P < 0.05) compared to MC crash patients despite similar injury patterns. CONCLUSIONS Our data demonstrate that patients sustaining UORV injuries were younger and less likely to be helmeted but have a lower mortality rate after a crash, despite sustaining similar injuries as motorcyclists. This study provides an overview of how crashes involving UORV usage is a unique phenomenon and not entirely comparable to MC crashes.
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Affiliation(s)
- Christopher A Butts
- Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
| | - Roberto Gonzalez
- Division of Trauma, Surgical Critical Care, & Acute Care Surgery, Cooper University Hospital, Camden, New Jersey
| | - John P Gaughan
- Department of Internal Medicine, Cooper University Hospital, Department of Internal Medicine, Camden, New Jersey
| | - Janika San Roman
- Division of Trauma, Surgical Critical Care, & Acute Care Surgery, Cooper University Hospital, Camden, New Jersey
| | - Steven Ross
- Division of Trauma, Surgical Critical Care, & Acute Care Surgery, Cooper University Hospital, Camden, New Jersey
| | - John Porter
- Division of Trauma, Surgical Critical Care, & Acute Care Surgery, Cooper University Hospital, Camden, New Jersey
| | - Joshua P Hazelton
- Division of Trauma, Acute Care, and Critical Care Surgery, Department of Surgery, Penn State University College of Medicine, Hershey, Pennsylvania
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28
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Butts CA, Hagaman A, Porter J, Hazelton JP. Sutureless Repair of a Full-Thickness Cardiac Stab Wound Adjacent to the Right Coronary Artery Using Evarrest® Patch. Am Surg 2019. [DOI: 10.1177/000313481908500820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Christopher A. Butts
- Division of Acute Care Surgery Department of Surgery Rutgers Robert Wood Johnson Medical School New Brunswick, New Jersey
| | - Ashleigh Hagaman
- Department of Trauma, Surgical Critical Care, & Acute Care Surgery Cooper University Hospital Camden, New Jersey
| | - John Porter
- Department of Trauma, Surgical Critical Care, & Acute Care Surgery Cooper University Hospital Camden, New Jersey
| | - Joshua P. Hazelton
- Division of Trauma, Acute Care, and Critical Care Surgery Department of Surgery Penn State University College of Medicine Hershey, Pennsylvania
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29
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Butts CA, Hagaman A, Porter J, Hazelton JP. Sutureless Repair of a Full-Thickness Cardiac Stab Wound Adjacent to the Right Coronary Artery Using Evarrest® Patch. Am Surg 2019; 85:e419-e420. [PMID: 31560334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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30
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Butts CA, Gonzalez R, Nguyen L, Gaughan JP, Ross S, Porter J, Hazelton JP. Twelve-Year Review of Urban Versus Rural Off-road Vehicle Injuries at a Level 1 Trauma Center. J Surg Res 2018; 233:331-334. [PMID: 30502267 DOI: 10.1016/j.jss.2018.07.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 03/01/2018] [Revised: 06/05/2018] [Accepted: 07/18/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Traditionally, all-terrain vehicles (ATVs) and dirt bikes (DBs) have been used in rural locations for recreation and work. Recently, there has been an increase in the use of these vehicles in an urban environment. The aim of this study is to compare the injury patterns of patients involved in crashes while riding off-road vehicles in both urban (UORV) and rural (RORV) environment. METHODS A retrospective review (2005-2016) of patients who presented to an urban level 1 trauma center as a result of any ATV or DB crash was performed. UORV was defined as any ATV or DB accident that occurred on paved inner city, suburban, or major roadways. RORV was defined as those accidents that occurred on secondary roadways or off-road. Patients who presented more than 48 h from time of accident were excluded. A P < 0.05 was considered significant. RESULTS Five hundred and twenty-eight patients were identified to have an ATV or DB injury (RORV n = 296 [56%]; UORV n = 232 [44%]). UORV accidents had a higher Injury Severity Score (12.2 versus 9.7; P < 0.05), lower presenting Glasgow Coma Scale (13.8 versus 14.3; P < 0.05), more likely to need emergent trauma bay procedures (28.5% versus 17.9%; P < 0.05), were less likely to have been helmeted (39.6% versus 71.2%; P < 0.05) with a higher unhelmeted Abbreviated Injury Scale head of ≥3 (13.5% versus 5%; <0.05), and more likely to have extremity injuries (53.5% versus 41.2%; P < 0.05). There were no significant differences in additional injury patterns or hospital outcomes including mortality for the two groups. CONCLUSIONS Our data suggest that UORV use was associated with decreased helmet use, higher mean Injury Severity Score, lower presenting Glasgow Coma Scale, an increased need for emergent trauma bay procedures, higher unhelmeted Abbreviated Injury Scale head scores, and higher rates of extremity injuries.
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Affiliation(s)
- Christopher A Butts
- Department of Trauma, Surgical Critical Care, & Acute Care Surgery, Cooper University Hospital, Camden, New Jersey
| | - Roberto Gonzalez
- Department of Trauma, Surgical Critical Care, & Acute Care Surgery, Cooper University Hospital, Camden, New Jersey
| | - Linh Nguyen
- Department of Trauma, Surgical Critical Care, & Acute Care Surgery, Cooper University Hospital, Camden, New Jersey
| | - John P Gaughan
- Department of Trauma, Surgical Critical Care, & Acute Care Surgery, Cooper University Hospital, Camden, New Jersey
| | - Steven Ross
- Department of Trauma, Surgical Critical Care, & Acute Care Surgery, Cooper University Hospital, Camden, New Jersey
| | - John Porter
- Department of Trauma, Surgical Critical Care, & Acute Care Surgery, Cooper University Hospital, Camden, New Jersey
| | - Joshua P Hazelton
- Department of Trauma, Surgical Critical Care, & Acute Care Surgery, Cooper University Hospital, Camden, New Jersey.
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31
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Schwartz J, Madden NJ, Butts CA, Slotman GJ, Budeir MH. The Problem of Exposure for Damage Control in an Adolescent with Multiple Abdominal Gunshot Wounds Six Months after Surgery for a Previous Abdominal Gunshot. Am Surg 2018; 84:e314-e316. [PMID: 30454461] [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: 06/09/2023]
Affiliation(s)
- Jandie Schwartz
- Department of Surgery, Inspira Health Network, Vineland, New Jersey, USA
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32
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Schwartz J, Madden NJ, Butts CA, Slotman GJ, Budeir MH. The Problem of Exposure for Damage Control in an Adolescent with Multiple Abdominal Gunshot Wounds Six Months after Surgery for a Previous Abdominal Gunshot. Am Surg 2018. [DOI: 10.1177/000313481808400818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jandie Schwartz
- Department of Surgery Inspira Health Network Vineland, New Jersey
| | - Nicholas J. Madden
- Department of Surgery Chester-Crozer Medical Center Upland, Pennsylvania
| | | | - Gus J. Slotman
- Department of Surgery Inspira Health Network Vineland, New Jersey
| | - Mohammed H. Budeir
- Department of Surgery Chester-Crozer Medical Center Upland, Pennsylvania
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Abstract
For patients with advanced non-small-cell lung cancer (nsclc) lacking a targetable molecular driver, the mainstay of treatment has been cytotoxic chemotherapy. The survival benefit of chemotherapy in this setting is modest and comes with the potential for significant toxicity. The introduction of immunotherapeutic agents targeting the programmed cell death 1 protein (PD-1) and the programmed cell death ligand 1 (PD-L1) has drastically changed the treatment paradigms for these patients. Three agents-atezolizumab, nivolumab, and pembrolizumab-have been shown to be superior to chemotherapy in the second-line setting. For patients with tumours strongly expressing PD-L1, pembrolizumab has been associated with improved outcomes in the first-line setting. Demonstration of the significant benefits of immunotherapy in nsclc has focused attention on new questions. Combination checkpoint regimens, with acceptable toxicity and potentially enhanced efficacy, have been developed, as have combinations of immunotherapy with chemotherapy. In this review, we focus on the published trials that have changed the treatment landscape in advanced nsclc and on the ongoing clinical trials that offer hope to further improve outcomes for patients with advanced nsclc.
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Affiliation(s)
- A Pabani
- Division of Medical Oncology, Cross Cancer Institute, Edmonton, AB
| | - C A Butts
- Division of Medical Oncology, Cross Cancer Institute, Edmonton, AB
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34
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Butts CA, Brady JJ, Wilhelm S, Castor L, Sherwood A, McCall A, Patch J, Jones P, Cortes V, Ong AW. Do simple beside lung function tests predict morbidity after rib fractures? Am J Surg 2016; 213:473-477. [PMID: 27894507 DOI: 10.1016/j.amjsurg.2016.11.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 07/25/2016] [Revised: 11/13/2016] [Accepted: 11/18/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND We evaluated if incentive spirometry volume (ISV) and peak expiratory flow rate (PEFR) could predict acute respiratory failure (ARF) in patients with rib fractures. METHODS Normotensive, co-operative patients were enrolled prospectively. ISV and PEFR were measured on admission, at 24 h and at 48 h by taking the best of three readings each time. The primary outcome, ARF, was defined as requiring invasive or noninvasive positive pressure ventilation. RESULTS 99 patients were enrolled (median age, 77 years). ARF occurred in 9%. Of the lung function tests, only a low median ISV at admission was associated with ARF (500 ml vs 1250 ml, p = 0.04). Three of 69 patients with ISV of ≥1000 ml versus six of 30 with ISV <1000 ml developed ARF (p = 0.01). Other significant factors were: number of rib fractures, tube thoracostomy, any lower-third rib fracture, flail segment. CONCLUSION PEFR did not predict ARF. Admission ISV may have value in predicting ARF.
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Affiliation(s)
- Christopher A Butts
- Department of Surgery, Philadelphia College of Osteopathic Medicine, 4170 City Avenue, Philadelphia, PA 19131, United States
| | - John J Brady
- Department of Surgery, Philadelphia College of Osteopathic Medicine, 4170 City Avenue, Philadelphia, PA 19131, United States
| | - Sara Wilhelm
- Department of Surgery, Section of Trauma and Acute Care Surgery, Reading Health System, Sixth Avenue and Spruce Street, West Reading, PA 19611, United States
| | - Laura Castor
- Department of Surgery, Section of Trauma and Acute Care Surgery, Reading Health System, Sixth Avenue and Spruce Street, West Reading, PA 19611, United States
| | - Alicia Sherwood
- Department of Surgery, Section of Trauma and Acute Care Surgery, Reading Health System, Sixth Avenue and Spruce Street, West Reading, PA 19611, United States
| | - Abby McCall
- Department of Surgery, Section of Trauma and Acute Care Surgery, Reading Health System, Sixth Avenue and Spruce Street, West Reading, PA 19611, United States
| | - John Patch
- Department of Surgery, Section of Trauma and Acute Care Surgery, Reading Health System, Sixth Avenue and Spruce Street, West Reading, PA 19611, United States
| | - Pamela Jones
- Department of Surgery, Section of Trauma and Acute Care Surgery, Reading Health System, Sixth Avenue and Spruce Street, West Reading, PA 19611, United States
| | - Vicente Cortes
- Department of Surgery, Section of Trauma and Acute Care Surgery, Reading Health System, Sixth Avenue and Spruce Street, West Reading, PA 19611, United States
| | - Adrian W Ong
- Department of Surgery, Section of Trauma and Acute Care Surgery, Reading Health System, Sixth Avenue and Spruce Street, West Reading, PA 19611, United States.
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Butts CA, Behnam A, Fernandez FB, Ong AW. Facial Fractures with Oronasal Hemorrhage in the Elderly: Impact on Outcome. Am Surg 2015. [DOI: 10.1177/000313481508100805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Christopher A. Butts
- Department of Surgery Philadelphia College of Osteopathic Medicine 4170 City Avenue Philadelphia, Pennsylvania
| | - Amir Behnam
- Division of Plastic Surgery Reading Health System Sixth Avenue and Spruce Street West Reading, Pennsylvania
| | - Forrest B. Fernandez
- Division of General Surgery Reading Health System Sixth Avenue and Spruce Street West Reading, Pennsylvania
| | - Adrian W. Ong
- Division of General Surgery Reading Health System Sixth Avenue and Spruce Street West Reading, Pennsylvania
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Carrier M, Lazo-Langner A, Shivakumar S, Tagalakis V, Gross PL, Blais N, Butts CA, Crowther M. Clinical challenges in patients with cancer-associated thrombosis: Canadian expert consensus recommendations. ACTA ACUST UNITED AC 2015; 22:49-59. [PMID: 25684988 DOI: 10.3747/co.22.2392] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Venous thromboembolism is a common complication in cancer patients, and thromboembolism is the second most common cause of death after cancer progression. A number of clinical practice guidelines provide recommendations for the management of cancer-associated thrombosis. However, the guidelines lack recommendations covering commonly encountered clinical challenges (for example, thrombocytopenia, recurrent venous thromboembolism, etc.) for which little or no evidence exists. Accordingly, recommendations were developed to provide expert guidance to medical oncologists and other health care professionals caring for patients with cancer-associated thrombosis. The current expert consensus was developed by a team of 21 clinical experts. For each identified clinical challenge, the literature in medline, embase, and Evidence Based Medicine Reviews was systematically reviewed. The quality of the evidence was assessed, summarized, and graded. Consensus statements were generated, and the experts voted anonymously using a modified Delphi process on their level of agreement with the various statements. Statements were progressively revised through separate voting iterations and were then finalized. Clinicians using these recommendations and suggestions should tailor patient management according to the risks and benefits of the treatment options, patient values and preferences, and local cost and resource allocations.
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Affiliation(s)
- M Carrier
- Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
| | - A Lazo-Langner
- Departments of Medicine, Oncology, and Epidemiology and Biostatistics, University of Western Ontario, London, ON
| | - S Shivakumar
- Department of Medicine, QEII Health Sciences Centre, Dalhousie University, Halifax, NS
| | - V Tagalakis
- Department of Medicine, Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Montreal, QC
| | - P L Gross
- Thrombosis and Atherosclerosis Research Institute, Department of Medicine, McMaster University, Hamilton, ON
| | - N Blais
- Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, QC
| | - C A Butts
- Department of Oncology, University of Alberta, Edmonton, AB
| | - M Crowther
- St. Joseph's Hospital, and Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON
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Groen HJM, Socinski MA, Grossi F, Juhasz E, Gridelli C, Baas P, Butts CA, Chmielowska E, Usari T, Selaru P, Harmon C, Williams JA, Gao F, Tye L, Chao RC, Blumenschein GR. A randomized, double-blind, phase II study of erlotinib with or without sunitinib for the second-line treatment of metastatic non-small-cell lung cancer (NSCLC). Ann Oncol 2013; 24:2382-9. [PMID: 23788751 PMCID: PMC6267942 DOI: 10.1093/annonc/mdt212] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [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: 03/30/2013] [Revised: 04/29/2013] [Accepted: 04/29/2013] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Combined inhibition of vascular, platelet-derived, and epidermal growth factor receptor (EGFR) pathways may overcome refractoriness to single agents in platinum-pretreated non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS This randomized, double-blind, multicenter, phase II trial evaluated sunitinib 37.5 mg/day plus erlotinib 150 mg/day versus placebo plus erlotinib continuously in 4-week cycles. Eligible patients had histologically confirmed stage IIIB or IV NSCLC previously treated with one or two chemotherapy regimens, including one platinum-based regimen. The primary end point was progression-free survival (PFS) by an independent central review. RESULTS One hundred and thirty-two patients were randomly assigned, and the median duration of follow-up was 17.7 months. The median PFS was 2.8 versus 2.0 months for the combination versus erlotinib alone (HR 0.898, P = 0.321). The median overall survival (OS) was 8.2 versus 7.6 months (HR 1.066, P = 0.617). Objective response rates (ORRs) were 4.6% and 3.0%, respectively. Sunitinib plus erlotinib was fairly well tolerated although most treatment-related adverse events (AEs) were more frequent than with erlotinib alone: diarrhea (55% versus 33%), rash (41% versus 30%), fatigue (31% versus 25%), decreased appetite (30% versus 13%), nausea (28% versus 14%), and thrombocytopenia (13% versus 0%). CONCLUSIONS The addition of sunitinib to erlotinib did not significantly improve PFS in patients with advanced, platinum-pretreated NSCLC.
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Affiliation(s)
- H J M Groen
- Department of Pulmonary Diseases, University Medical Center Groningen, Groningen, The Netherlands.
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Swift J, Butts CA, Cheung-Lau J, Yerubandi V, Dmochowski IJ. Efficient self-assembly of Archaeoglobus fulgidus ferritin around metallic cores. Langmuir 2009; 25:5219-5225. [PMID: 19260687 DOI: 10.1021/la8040743] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Interfacing biological systems with inorganic nanoparticles is of great interest, as it offers means of particle stabilization and spatial control in electronic or biomedical applications. We report on the particle-directed assembly of hyperthermophile Archaeoglobus fulgidus ferritin subunits around negatively charged colloidal gold. An annealing process allows rapid assembly of the protein in near-native stoichiometry. Transmission electron microscopy suggests that greater than 95% of nanoparticles are encapsulated while the self-assembly process ensures that almost 100% of the assembled ferritin cavities are occupied.
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Affiliation(s)
- Joe Swift
- Department of Chemistry, University of Pennsylvania, 231 South 34th Street, Philadelphia, Pennsylvania 19104-6323, USA
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Butts CA, Swift J, Kang SG, Di Costanzo L, Christianson DW, Saven JG, Dmochowski IJ. Directing Noble Metal Ion Chemistry within a Designed Ferritin Protein,. Biochemistry 2008; 47:12729-39. [DOI: 10.1021/bi8016735] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Christopher A. Butts
- Department of Chemistry, University of Pennsylvania, 231 South 34th Street, Philadelphia, Pennsylvania 19104-6323
| | - Joe Swift
- Department of Chemistry, University of Pennsylvania, 231 South 34th Street, Philadelphia, Pennsylvania 19104-6323
| | - Seung-gu Kang
- Department of Chemistry, University of Pennsylvania, 231 South 34th Street, Philadelphia, Pennsylvania 19104-6323
| | - Luigi Di Costanzo
- Department of Chemistry, University of Pennsylvania, 231 South 34th Street, Philadelphia, Pennsylvania 19104-6323
| | - David W. Christianson
- Department of Chemistry, University of Pennsylvania, 231 South 34th Street, Philadelphia, Pennsylvania 19104-6323
| | - Jeffery G. Saven
- Department of Chemistry, University of Pennsylvania, 231 South 34th Street, Philadelphia, Pennsylvania 19104-6323
| | - Ivan J. Dmochowski
- Department of Chemistry, University of Pennsylvania, 231 South 34th Street, Philadelphia, Pennsylvania 19104-6323
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Zhang L, Swift J, Butts CA, Yerubandi V, Dmochowski IJ. Structure and activity of apoferritin-stabilized gold nanoparticles. J Inorg Biochem 2007; 101:1719-29. [PMID: 17723241 DOI: 10.1016/j.jinorgbio.2007.07.023] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2007] [Revised: 07/12/2007] [Accepted: 07/13/2007] [Indexed: 11/15/2022]
Abstract
A simple method for synthesizing gold nanoparticles stabilized by horse spleen apoferritin (HSAF) is reported using NaBH(4) or 3-(N-morpholino)propanesulfonic acid (MOPS) as the reducing agent. AuCl(4)(-) reduction by NaBH(4) was complete within a few seconds, whereas reduction by MOPS was much slower; in all cases, protein was required during reduction to keep the gold particles in aqueous solution. Transmission electron microscopy (TEM) showed that the gold nanoparticles were associated with the outer surface of the protein. The average particle diameters were 3.6 and 15.4 nm for NaBH(4)-reduced and MOPS-reduced Au-HSAF, respectively. A 5-nm difference in the UV-Vis absorption maximum was observed for NaBH(4)-reduced (530 nm) and MOPS-reduced Au-HSAF (535 nm), which was attributed to the greater size and aggregation of the MOPS-reduced gold sample. NaBH(4)-reduced Au-HSAF was much more effective than MOPS-reduced Au-HSAF in catalyzing the reduction of 4-nitrophenol by NaBH(4), based on the greater accessibility of the NaBH(4)-reduced gold particle to the substrate. Rapid reduction of AuCl(4)(-) by NaBH(4) was determined to result in less surface passivation by the protein. Methods for studying ferritin-gold nanoparticle assemblies may be readily applied to other protein-metal colloid systems.
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Affiliation(s)
- Lei Zhang
- Department of Chemistry, University of Pennsylvania, 231 South 34th Street, Philadelphia, PA 19104-6323, USA
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Dommels YEM, Butts CA, Zhu S, Davy M, Martell S, Hedderley D, Barnett MPG, McNabb WC, Roy NC. Characterization of intestinal inflammation and identification of related gene expression changes in mdr1a(-/-) mice. Genes Nutr 2007; 2:209-23. [PMID: 18850176 DOI: 10.1007/s12263-007-0051-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2006] [Accepted: 01/24/2007] [Indexed: 12/31/2022]
Abstract
Multidrug resistance targeted mutation (mdr1a (-/-) ) mice spontaneously develop intestinal inflammation. The aim of this study was to further characterize the intestinal inflammation in mdr1a (-/-) mice. Intestinal samples were collected to measure inflammation and gene expression changes over time. The first signs of inflammation occurred around 16 weeks of age and most mdr1a (-/-) mice developed inflammation between 16 and 27 weeks of age. The total histological injury score was the highest in the colon. The inflammatory lesions were transmural and discontinuous, revealing similarities to human inflammatory bowel diseases (IBD). Genes involved in inflammatory response pathways were up-regulated whereas genes involved in biotransformation and transport were down-regulated in colonic epithelial cell scrapings of inflamed mdra1 (-/-) mice at 25 weeks of age compared to non-inflamed FVB mice. These results show overlap to human IBD and strengthen the use of this in vivo model to study human IBD. The anti-inflammatory regenerating islet-derived genes were expressed at a lower level during inflammation initiation in non-inflamed colonic epithelial cell scrapings of mdr1a (-/-) mice at 12 weeks of age. This result suggests that an insufficiently suppressed immune response could be crucial to the initiation and development of intestinal inflammation in mdr1a (-/-) mice.
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Affiliation(s)
- Y E M Dommels
- Crop & Food Research, Private Bag 11600, Palmerston North, 4442, New Zealand
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Reiman T, Butts CA. Upper gastrointestinal bleeding as a metastatic manifestation of breast cancer: a case report and review of the literature. Can J Gastroenterol 2001; 15:67-71. [PMID: 11248910 DOI: 10.1155/2001/898434] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
CASE PRESENTATION A 64-year-old woman with known metastatic lobular breast cancer presented with fever, epigastric pain, hematemesis, and melena. A bleeding, ulcerated gastric metastasis was found and was treated with endoscopic therapy, omeprazole, and hormonal therapy. The patient was alive and well 13 months later. The bleeding was probably precipitated by necrosis of the lesion during chemotherapy. DISCUSSION Gastrointestinal tract metastases from primary breast carcinoma are present in 14% to 35% of cases in autopsy series, with gastric involvement in 6% to 18% of cases. Recognized much less commonly during life than in autopsy studies, they can occur anywhere in the gut and can mimic virtually any gastrointestinal disorder. Endoscopy and barium studies facilitate diagnosis. Gastric lesions that have been noted include "linitis plastica", nodules, polyps, and ulcers. They are usually due to lobular breast carcinoma and resemble primary gastric carcinoma on microscopy. Reported cases of bleeding gastric metastases have been treated successfully with various local and systemic modalities. The median survival time of reviewed cases was four months from presentation (with a range of zero to 24 months). CONCLUSIONS Gastrointestinal metastasis is an underdiagnosed complication of breast cancer. Gastrointestinal bleeding from metastatic breast cancer is an uncommon presentation that is readily diagnosed and that can be treated successfully by endoscopic hemostatic therapy.
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Affiliation(s)
- T Reiman
- Department of Medicine, Cross Cancer Institute, Edmonton, Canada
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Rusthoven JJ, Osoba D, Butts CA, Yelle L, Findlay H, Grenville A. The impact of postchemotherapy nausea and vomiting on quality of life after moderately emetogenic chemotherapy. Support Care Cancer 1998; 6:389-95. [PMID: 9695208 DOI: 10.1007/s005200050182] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The purpose of the study was to assess the impact of postchemotherapy nausea and vomiting (PCNV) after moderately emetogenic chemotherapy on health-related quality of life (HRQOL) in patients with cancer being treated in a routine clinical practice setting. The European Organization for Research and Treatment in Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30) was administered on day 2 and day 6 following moderately emetogenic chemotherapy to 119 patients with a variety of cancers. Patients kept daily diaries to record the occurrence and severity of nausea and vomiting. The QLQ-C30 questions were modified, for this study only, to assess the impact of nausea and vomiting on HRQOL in patients who experienced nausea and/or vomiting during the six days following chemotherapy. Those patients who experienced either nausea or vomiting experienced a decrease in HRQOL from prechemotherapy levels on six functioning and five symptom scales at day 2, and on four functioning and four symptom scales on day 6. Comparison of mean scores between the unmodified QLQ-30 and the nausea and vomiting versions demonstrated that the HRQOL rating attributed to nausea and vomiting accounted for much, but not all, of the deterioration in HRQOL scores in patients who experienced these symptoms. It can be concluded that patients who experience PCNV experience a significant negative impact on their HRQOL and that this impact can be attributed in large part to their experience of nausea and vomiting. However, since not all of the deterioration is attributable to these symptoms, other reasons for some of the decrease in HRQOL must also be identified in future studies.
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Affiliation(s)
- J J Rusthoven
- Department of Medical Oncology, Hamilton Regional Cancer Centre, Ont., Canada
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Nassar BA, Ludman MD, Costa MT, Welch JP, Butts CA, Love JR, Hogg H, Beis MJ. More on breast cancer guidelines. CMAJ 1998; 158:1429; author reply 1429-30. [PMID: 9629100 PMCID: PMC1229360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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