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Vella MA, Zone A, Succar B, Cheng M, Maiga AW, Appelbaum RD, Notario L, Pannell D, Holena DN, Dumas RP. Teamwork matters: The association between nontechnical skills and cardiac arrest in trauma patients presenting with hypotension. Surgery 2024; 175:1595-1599. [PMID: 38472080 DOI: 10.1016/j.surg.2024.02.004] [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] [Received: 09/01/2023] [Revised: 01/20/2024] [Accepted: 02/08/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND The impact of trauma team dynamics on outcomes in injured patients is not completely understood. We sought to evaluate the association between trauma team function, as measured by a modified Trauma Non-Technical Skills assessment, and cardiac arrest in hypotensive trauma patients. We hypothesized that better team function is associated with a decreased probability of developing cardiac arrest. METHODS Trauma video review was used to collect data from resuscitations of adult hypotensive trauma patients at 19 centers. Hypotension at emergency department presentation was defined as an initial systolic blood pressure <90 mm Hg or an initial systolic blood pressure ≥90 mm Hg followed by a systolic blood pressure <90 mm Hg within the first 5 minutes. Team dynamics were scored using a modified Trauma Non-Technical Skills assessment composed of 5 domains with combined scores ranging from 5 (best) to 15 (worst). Scores were compared between cardiac arrest/noncardiac arrest cases in the trauma bay. Logistic regression was used to evaluate the independent association between the Trauma Non-Technical Skills assessment and cardiac arrest. RESULTS A total of 430 patients were included (median age 43 years [interquartile range: 29-61]; 71.8% male; 36% penetrating mechanism; median Injury Severity Score 20 [10-33]; 11% experienced cardiac arrest in trauma bay). The median total Trauma Non-Technical Skills assessment score was 7 (6-9), higher in patients who experienced cardiac arrest in the trauma bay (9 [6-10] vs 7 [6-9]; P = .016). This association persisted after controlling for age, sex, mechanism, injury severity, initial systolic blood pressure, and initial Glasgow Coma Scale score (adjusted odds ratio: 1.28; 95% confidence interval:1.11-1.48; P < .001), indicating a ∼3% higher predicted probability of cardiac arrest per Trauma Non-Technical Skills point. CONCLUSION Better team function is independently associated with a decreased probability of cardiac arrest in trauma patients presenting with hypotension. This suggests that trauma team training may improve outcomes in peri-arrest patients.
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Affiliation(s)
- Michael A Vella
- University of Rochester Medical Center Division of Acute Care Surgery, Rochester, NY. http://www.twitter.com/MichealVella32
| | - Alea Zone
- UT Southwestern Medical Center, Division of Burn Trauma Acute and Critical Care Surgery, Dallas, TX
| | - Bahaa Succar
- UT Southwestern Medical Center, Division of Burn Trauma Acute and Critical Care Surgery, Dallas, TX. http://www.twitter.com/B_Succar
| | - Mingyuan Cheng
- UT Southwestern Medical Center, Division of Burn Trauma Acute and Critical Care Surgery, Dallas, TX
| | - Amelia W Maiga
- Vanderbilt University Medical Center, Division of Acute Care Surgery, Nashville, TN. http://www.twitter.com/AmeliaMaiga
| | - Rachel D Appelbaum
- Vanderbilt University Medical Center, Division of Acute Care Surgery, Nashville, TN. http://www.twitter.com/AppelbaumMD
| | | | | | - Daniel N Holena
- Medical College of Wisconsin Division of Trauma and Acute Care Surgery Milwaukee, WI. http://www.twitter.com/Daniel_Holena
| | - Ryan P Dumas
- UT Southwestern Medical Center, Division of Burn Trauma Acute and Critical Care Surgery, Dallas, TX.
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McLauchlan N, Ali A, Beyer CA, Brinson MM, Joergensen SM, Yelon J, Dumas RP, Vella MA, Cannon JW. Percutaneous thoracostomy with thoracic lavage for traumatic hemothorax: a performance improvement initiative. Trauma Surg Acute Care Open 2024; 9:e001298. [PMID: 38440095 PMCID: PMC10910477 DOI: 10.1136/tsaco-2023-001298] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/16/2024] [Indexed: 03/06/2024] Open
Abstract
Objectives Percutaneously placed small-bore (14 Fr) catheters and pleural lavage have emerged independently as innovative approaches to hemothorax management. This report describes techniques for combining percutaneous thoracostomy with pleural lavage and presents results from a performance improvement series of patients managed with percutaneous thoracostomy with immediate lavage. Methods This was a prospective performance improvement series of patients treated at a level 1 trauma center with percutaneous thoracostomy and immediate lavage between April 2021 and May 2023. Results Percutaneous thoracostomy with immediate lavage was used to treat nine hemodynamically normal patients with acute hemothorax. Injuries included both blunt and penetrating mechanisms. 56% of patients presented immediately after injury, and 44% presented in a delayed fashion ranging from 2 to 26 days after injury. Median length of stay was 6 days (IQR 6, 9). Seven patients were discharged home in stable condition, one was discharged to an acute rehabilitation facility, and one was discharged to a skilled nursing facility. Conclusions Percutaneous thoracostomy with pleural lavage is clinically feasible and effective and warrants further evaluation with a multicenter clinical trial. Level of evidence Therapeutic/care management, level V.
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Affiliation(s)
- Nathaniel McLauchlan
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ali Ali
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Carl A Beyer
- Department of Acute Care Surgery, University of South Florida, Tampa, Florida, USA
| | - Martha M Brinson
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Sarah M Joergensen
- Penn Acute Research Collaboration (PARC), University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jay Yelon
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ryan Peter Dumas
- Deparment of Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Michael A Vella
- Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Jeremy W Cannon
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Surgery, F. Edward Hébert School of Medicine at the Uniformed Services University, Bethesda, Maryland, USA
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Succar B, Vella MA, Holena DN, Dumas RP. Navigating the challenges of vascular access in hypotensive injured patients. Surgery 2024; 175:559-560. [PMID: 37980201 DOI: 10.1016/j.surg.2023.10.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 10/17/2023] [Indexed: 11/20/2023]
Affiliation(s)
- Bahaa Succar
- UT Southwestern Medical Center, Division of Burn Trauma Acute and Critical Care Surgery, Dallas, TX. https://twitter.com/B_Succar
| | - Michael A Vella
- University of Rochester Medical Center, Division of Acute Care Surgery, Rochester, NY. https://twitter.com/MichaelVella32
| | - Daniel N Holena
- Medical College of Wisconsin, Division of Trauma and Acute Care Surgery, Milwaukee, WI
| | - Ryan P Dumas
- UT Southwestern Medical Center, Division of Burn Trauma Acute and Critical Care Surgery, Dallas, TX.
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Succar B, Vella MA, Holena DN, Dumas RP. Response to "Letter To The Editor" on "Moving the needle on time to resuscitation: An EAST prospective multicenter study of vascular access in hypotensive injured patients using trauma video review". J Trauma Acute Care Surg 2024; 96:e17-e18. [PMID: 37936274 DOI: 10.1097/ta.0000000000004178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
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Maiga AW, Vella MA, Appelbaum RD, Irlmeier R, Ye F, Holena DN, Dumas RP. Getting out of the bay faster: Assessing trauma team performance using trauma video review. J Trauma Acute Care Surg 2024; 96:76-84. [PMID: 37880840 DOI: 10.1097/ta.0000000000004168] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
BACKGROUND Minutes matter for trauma patients in hemorrhagic shock. How trauma team function impacts time to the next phase of care has not been rigorously evaluated. We hypothesized better team performance scores to be associated with decreased time to the next phase of trauma care. METHODS This retrospective secondary analysis of a prospective multicenter observational study included hypotensive trauma patients at 19 centers. Using trauma video review, we analyzed team performance with the validated Non-Technical Skills for Trauma scale: leadership, cooperation and resource management, communication, assessment/decision making, and situational awareness. The primary outcome was minutes from patient arrival to next phase of care; deaths in the bay were excluded. Secondary outcomes included time to initiation and completion of first unit of blood and inpatient mortality. Associations between team dynamics and outcomes were assessed with a linear mixed-effects model adjusting for Injury Severity Score, mechanism, initial blood pressure and heart rate, number of team members, and trauma team lead training level and sex. RESULTS A total of 441 patients were included. The median Injury Severity Score was 22 (interquartile range, 10-34), and most (61%) sustained blunt trauma. The median time to next phase of care was 23.5 minutes (interquartile range, 17-35 minutes). Better leadership, communication, assessment/decision making, and situational awareness scores were associated with faster times to next phase of care (all p < 0.05). Each 1-point worsening in the Non-Technical Skills for Trauma scale score (scale, 5-15) was associated with 1.6 minutes more in the bay. The median resuscitation team size was 12 (interquartile range, 10-15), and larger teams were slower ( p < 0.05). Better situational awareness was associated with faster completion of first unit of blood by 4 to 5 minutes ( p < 0.05). CONCLUSION Better team performance is associated with faster transitions to next phase of care in hypotensive trauma patients, and larger teams are slower. Trauma team training should focus on optimizing team performance to facilitate faster hemorrhage control. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
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Affiliation(s)
- Amelia W Maiga
- From the Division of Acute Care Surgery, Department of Surgery (A.W.M., R.D.A.), Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee; Critical Illness, Brain dysfunction, and Survivorship Center (A.W.M.), Vanderbilt University Medical Center, Nashville, Tennessee; Division of Acute Care Surgery and Trauma (M.A.V.), University of Rochester Medical Center, Rochester, New York; Department of Biostatistics (R.I.), Vanderbilt University Medical Center, Nashville, Tennessee; Department of Medicine (F.Y.), Vanderbilt University Medical Center, Nashville, Tennessee; Division of Trauma and Acute Care Surgery (D.N.H.), Medical College of Wisconsin, Milwaukee, Wisconin; and Division of Burn Trauma Acute and Critical Care Surgery (R.P.D.), UT Southwestern Medical Center, Dallas, Texas
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Rogers EJ, Reidlinger T, Loria A, Oplinger A, Raza SS, Gestring ML, Vella MA. Medical Information During Trauma Resuscitations: Are Smartphones the Contemporary Medical ID Bracelet? J Surg Res 2023; 291:313-320. [PMID: 37506430 DOI: 10.1016/j.jss.2023.06.024] [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: 02/26/2023] [Revised: 05/17/2023] [Accepted: 06/12/2023] [Indexed: 07/30/2023]
Abstract
INTRODUCTION Smartphone emergency medical identification (SEMID) applications are built-in health information-storing functions that are accessible without a passcode. The utility of these applications in the real-time resuscitation of trauma patients is unknown. METHODS We prospectively evaluated all trauma activation patients ≥16 y and unable to provide a medical history for any reason for the presence of a smartphone at our urban level I center between October 2020 and September 2021. Available smartphones were queried for SEMID utilization, categories of information contained, and real-time clinical relevance. RESULTS One hundred and forty three patients with a median age of 39 y [interquartile range 28-59] and Injury Severity Score of 16 [2-29] were included. 30 (21%) patients arrived with a smartphone, 27 (90%) of which were accessible. 8 (30%) of those individuals utilized a SEMID application, and SEMID information was relevant for patient care in 6 cases (75%). The extracted information included: identifiers (75%), emergency contacts (50%), height/weight (38%), allergies (38%), age (38%), medications (25%), medical history (13%), and blood type (13%). CONCLUSIONS Approximately one in five altered trauma patients have smartphones present at arrival, some of which contain medical information pertinent for immediate care. There is a pressing need for education and our institution has developed a publicly-facing campaign with shareable materials to improve SEMID awareness and utilization. Other centers are likely to find similar benefit.
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Affiliation(s)
- Eli J Rogers
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Timothy Reidlinger
- Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Anthony Loria
- Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Adam Oplinger
- Kessler Trauma Center, University of Rochester Medical Center, Rochester, New York
| | - Shariq S Raza
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mark L Gestring
- Division of Acute Care Surgery and Trauma, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Michael A Vella
- Division of Acute Care Surgery and Trauma, University of Rochester School of Medicine and Dentistry, Rochester, New York.
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Niziolek GM, Keating J, Bailey J, Klingensmith NJ, Moren AM, Skarupa DJ, Loria A, Vella MA, Maher Z, Moore SA, Smith MC, Leung A, Shuster KM, Seamon MJ. Rethinking protocolized completion angiography following extremity vascular trauma: A prospective observational multicenter trial. J Trauma Acute Care Surg 2023; 95:105-110. [PMID: 37038254 DOI: 10.1097/ta.0000000000003925] [Citation(s) in RCA: 1] [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: 04/12/2023]
Abstract
BACKGROUND Completion angiography (CA) is commonly used following repair of extremity vascular injury and is recommended by the Eastern Association for the Surgery of Trauma practice management guidelines for extremity trauma. However, it remains unclear which patients benefit from CA because only level 3 evidence exists. METHODS This prospective observational multicenter (18LI, 2LII) analysis included patients 15 years or older with extremity vascular injuries requiring operative management. Clinical variables and outcomes were analyzed with respect to with our primary study endpoint, which is need for secondary vascular intervention. RESULTS Of 438 patients, 296 patients required arterial repair, and 90 patients (30.4%) underwent CA following arterial repair. Institutional protocol (70.9%) was cited as the most common reason to perform CA compared with concern for inadequate repair (29.1%). No patients required a redo extremity vascular surgery if a CA was performed per institutional protocol; however, 26.7% required redo vascular surgery if the CA was performed because of a concern for inadequate repair. No differences were observed in hospital mortality, length of stay, extremity ischemia, or need for amputation between those who did and did not undergo CA. CONCLUSION Completion angiogram following major extremity injury should be considered in a case-by-case basis. Limiting completion angiograms to those patients with concern for an inadequate vascular repair may limit unnecessary surgery and morbidity. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
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Affiliation(s)
- Grace M Niziolek
- From the Division of Trauma, Critical Care, and Emergency General Surgery, Department of Surgery (G.M.N., N.J.K., M.J.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Surgery (J.K.), Hartford Hospital, New Haven, Connecticut; Department of Surgery (J.B.), Rutgers New Jersey Medical School, Newark, New Jersey; Department of Surgery (N.J.K.), Emory University, Atlanta, Georgia; Salem Health Surgical Clinic - General Surgery (A.M.M.), Salem Hospital, Salem, Oregon; Department of Surgery (D.J.S.), University of Florida College of Medicine - Jacksonville, Jacksonville, Florida; Department of Surgery (A.L., M.A.V.), University of Rochester, Rochester, New York; Department of Surgery (Z.M.), Temple University, Philadelphia, Pennsylvania; Department of Surgery (S.A.M.), University of New Mexico, Albuquerque, New Mexico; Department of Surgery (M.C.S.), Vanderbilt University, Nashville, Tennessee; School of Medicine (A.L.), University of California - Irvine, Irvine, California; and Department of Surgery (K.M.S.), Yale University, New Haven, Connecticut
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8
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Bankhead BK, Bichard SL, Seltzer T, Thompson LA, Chambers B, Davis B, Knowlton LM, Tatebe LC, Vella MA, Dumas RP. Bias in the trauma bay: A multicenter qualitative study on team communication. J Trauma Acute Care Surg 2023; 94:771-777. [PMID: 36880706 DOI: 10.1097/ta.0000000000003897] [Citation(s) in RCA: 1] [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: 03/08/2023]
Abstract
BACKGROUND Team communication and bias in and out of the operating room have been shown to impact patient outcomes. Limited data exist regarding the impact of communication bias during trauma resuscitation and multidisciplinary team performance on patient outcomes. We sought to characterize bias in communication among health care clinicians during trauma resuscitations. METHODS Participation from multidisciplinary trauma team members (emergency medicine and surgery faculty, residents, nurses, medical students, emergency medical services personnel) was solicited from verified level 1 trauma centers. Comprehensive semistructured interviews were conducted and recorded for analysis; sample size was determined by saturation. Interviews were led by a team of doctorate communications experts. Central themes regarding bias were identified using Leximancer analytic software (Leximancer Pty Ltd., Brisbane, Australia). RESULTS Interviews with 40 team members (54% female, 82% White) from 5 geographically diverse Level 1 trauma centers were conducted. More than 14,000 words were analyzed. Statements regarding bias were analyzed and revealed a consensus that multiple forms of communication bias are present in the trauma bay. The presence of bias is primarily related to sex but was also influenced by race, experience, and occasionally the leader's age, weight, and height. The most commonly described targets of bias were females and non-White providers unfamiliar to the rest of the trauma team. Most common sources of bias were White male surgeons, female nurses, and nonhospital staff. Participants perceived bias being unconscious but affecting patient care. CONCLUSION Bias in the trauma bay is a barrier to effective team communication. Identification of common targets and sources of biases may lead to more effective communication and workflow in the trauma bay. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level IV.
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Affiliation(s)
- Brittany K Bankhead
- From the Division of Trauma, Burns, and Critical Care, Department of Surgery (B.K.B.), Texas Tech University Health Sciences Center, Lubbock, Texas; College of Media and Communication (S.L.B., T.S., L.A.T., B.C.), Texas Tech University, Lubbock, Texas; Department of Public Relations and Strategic Communication Management, Texas Tech University Health Sciences Center (B.D.), Lubbock, Texas; Department of Surgery (L.M.K.), Stanford University Medical Center, Palo Alto, California; Department of Surgery (L.C.T.), Northwestern University, Chicago, Illinois; Department of Surgery (M.A.V.), University of Rochester Medical Center, Rochester, New York; and Department of Surgery (R.P.D.), UT Southwestern Medical Center, Dallas, Texas
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Scrushy MG, Nagaraj M, Burke K, Kuhlenschmidt K, Jeter S, Johnson D, Brown K, Edwards C, Marinica A, Vella MA, Holena DN, Park C, Dumas RP. Under the Lens: Team Perception of Trauma Video Review. J Trauma Nurs 2023; 30:171-176. [PMID: 37144808 DOI: 10.1097/jtn.0000000000000723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Video-based assessment and review are becoming increasingly common, and trauma video review (TVR) has been shown to be an effective educational, quality improvement, and research tool. Yet, trauma team perception of TVR remains incompletely understood. OBJECTIVE We evaluated positive and negative perceptions of TVR across multiple team member groups. We hypothesized that members of the trauma team would find TVR educational and that anxiety would be low across all groups. METHODS An anonymous electronic survey was provided to nurses, trainees, and faculty during weekly multidisciplinary trauma performance improvement conference following each TVR activity. Surveys assessed perception of performance improvement and anxiety or apprehension (Likert scale: 1 "strongly disagree" to 5 "strongly agree"). We report individual and normalized cumulative scores (average of responses for each positive [n = 6] and negative [n = 4] question stem). RESULTS We analyzed 146 surveys over 8 months, with 100% completion rate. Respondents were trainees (58%), faculty (29%), and nurses (13%). Of the trainees, 73% were postgraduate year (PGY) 1-3 and 27% were PGY 4-9. Of all respondents, 84% had participated previously in a TVR conference. Respondents reported an improved perception of resuscitation education quality and personal leadership skills development. Participants found TVR to be more educational than punitive overall. Analysis of team member types showed lower scores for faculty for all positive stemmed questions. Trainees were more likely to agree with negative stemmed questions if they were a lower PGY, and nurses were least likely to agree with negative stemmed questions. CONCLUSIONS TVR improves trauma resuscitation education in a conference setting, with trainees and nurses reporting the greatest benefit. Nurses were noted to be the least apprehensive about TVR.
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Affiliation(s)
- Marinda G Scrushy
- Division of Burn, Trauma Acute and Critical Care Surgery (Drs Park and Dumas), Department of Surgery (Drs Scrushy, Nagaraj, Burke, Kuhlenschmidt, and Marinica), University of Texas at Southwestern, Dallas; Parkland Memorial Hospital, Dallas, Texas (Mss Jeter and Johnson and Drs Brown and Edwards); Department of Acute Care Surgery, University of Rochester Medical Center, New York (Dr Vella); and Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee (Dr Holena)
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Dumas RP, Vella MA, Maiga AW, Erickson CR, Dennis BM, da Luz LT, Pannell D, Quigley E, Velopulos CG, Hendzlik P, Marinica A, Bruce N, Margolick J, Butler DF, Estroff J, Zebley JA, Alexander A, Mitchell S, Grossman Verner HM, Truitt M, Berry S, Middlekauff J, Luce S, Leshikar D, Krowsoski L, Bukur M, Polite NM, McMann AH, Staszak R, Armen SB, Horrigan T, Moore FO, Bjordahl P, Guido J, Mathew S, Diaz BF, Mooney J, Hebeler K, Holena DN. MOVING THE NEEDLE ON TIME TO RESUSCITATION: AN EAST PROSPECTIVE MULTICENTER STUDY OF VASCULAR ACCESS IN HYPOTENSIVE INJURED PATIENTS USING TRAUMA VIDEO REVIEW. J Trauma Acute Care Surg 2023:01586154-990000000-00324. [PMID: 37012624 DOI: 10.1097/ta.0000000000003958] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
INTRODUCTION Vascular access in hypotensive trauma patients is challenging. Little evidence exists on the time required and success rates of vascular access types. We hypothesized that intraosseous (IO) access would be faster and more successful than peripheral IV (PIV) and central venous catheter (CVC) access in hypotensive patients. METHODS An EAST prospective multicenter trial was performed; 19 centers provided data. Trauma video review (TVR) was used to evaluate the resuscitations of hypotensive (systolic blood pressure ≤ 90 mmHg) trauma patients. Highly granular data from video recordings were abstracted. Data collected included vascular access attempt type, location, success rate, and procedural time. Demographic and injury-specific variables were obtained from the medical record. Success rates, procedural durations, and time to resuscitation were compared among access strategies (IO vs PIV vs CVC). RESULTS 1,410 access attempts occurred in 581 patients with a median age of 40[27-59] years and an ISS of 22[10-34]. 932 PIV, 204 IO and 249 CVC were attempted. 70% of access attempts were successful but were significantly less likely to be successful in females (64% vs. 71%, p = 0.01). Median time to any access was 5.0[3.2-8.0] minutes. IO had higher success rates than PIV or CVC (93% vs. 67% vs. 59%, p < 0.001) and remained higher after subsequent failures (second attempt 85% vs. 59% vs. 69%, p = 0.08; third attempt 100% vs 33% vs. 67%, p = 0.002). Duration varied by access type (IO 36[23-60]sec; PIV 44[31-61]sec; CVC 171[105-298]sec) and was significantly different between IO vs. CVC (p < 0.001) and PIV vs. CVC (p < 0.001) but not PIV vs. IO. Time to resuscitation initiation was shorter in patients whose initial access attempt was IO, 5.8 minutes vs. 6.7 minutes (p = 0.015). This was more pronounced in patients arriving to the hospital with no established access (5.7 minutes vs. 7.5 minutes, p = 0.001). CONCLUSIONS IO is as fast as PIV and more likely to be successful compared with other access strategies in hypotensive trauma patients. Patients whose initial access attempt was IO were resuscitated more expeditiously. IO access should be considered a first line therapy in hypotensive trauma patients. LEVEL OF EVIDENCE Level II Therapeutic/Care Management.
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Affiliation(s)
- Ryan P Dumas
- UT Southwestern Medical Center, Division of Burn Trauma Acute and Critical Care Surgery, Dallas TX
| | - Michael A Vella
- University of Rochester Medical Center Division of Acute Care Surgery, Rochester, NY
| | - Amelia W Maiga
- Vanderbilt University Medical Center, Division of Acute Care Surgery, Nashville, TN
| | - Caroline R Erickson
- Vanderbilt University Medical Center, Division of Acute Care Surgery, Nashville, TN
| | - Brad M Dennis
- Vanderbilt University Medical Center, Division of Acute Care Surgery, Nashville, TN
| | | | | | - Emily Quigley
- University of Colorado, Section of Trauma, Acute Care Surgery and Critical Care, Aurora, CO
| | - Catherine G Velopulos
- University of Colorado, Section of Trauma, Acute Care Surgery and Critical Care, Aurora, CO
| | - Peter Hendzlik
- University of Rochester Medical Center Division of Acute Care Surgery, Rochester, NY
| | - Alexander Marinica
- UT Southwestern Medical Center, Division of Burn Trauma Acute and Critical Care Surgery, Dallas TX
| | - Nolan Bruce
- University of Arkansas for Medical Sciences, Trauma and Acute Care Surgery, Little Rock, AR
| | - Joseph Margolick
- University of Arkansas for Medical Sciences, Trauma and Acute Care Surgery, Little Rock, AR
| | - Dale F Butler
- University of Pennsylvania, Traumatology, Surgical Critical Care and Emergency Surgery, Philadelphia, PA
| | - Jordan Estroff
- George Washington University, Center for Trauma and Critical Care, Washington DC
| | - James A Zebley
- George Washington University, Center for Trauma and Critical Care, Washington DC
| | | | | | | | | | - Stepheny Berry
- University of Kansas, Acute Care Surgery, Trauma, and Surgical Critical Care, Kansas City, KS
| | - Jennifer Middlekauff
- University of Kansas, Acute Care Surgery, Trauma, and Surgical Critical Care, Kansas City, KS
| | - Siobhan Luce
- UC Davis Medical Center - Trauma, Acute Care Surgery and Surgical Critical Care, Sacramento, CA
| | - David Leshikar
- UC Davis Medical Center - Trauma, Acute Care Surgery and Surgical Critical Care, Sacramento, CA
| | | | | | | | | | - Ryan Staszak
- Penn State Health Medical Center, Division of Trauma, Acute Care and Critical Care Surgery, Hershey PA
| | - Scott B Armen
- Penn State Health Medical Center, Division of Trauma, Acute Care and Critical Care Surgery, Hershey PA
| | | | | | | | | | | | | | | | | | - Daniel N Holena
- Medical College of Wisconsin Division of Trauma and Acute Care Surgery Milwaukee, WI
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11
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Marinica AL, Nagaraj MB, Elson M, Vella MA, Holena DN, Dumas RP. Evaluating emergency department tube thoracostomy: A single-center use of trauma video review to assess efficiency and technique. Surgery 2023; 173:1086-1092. [PMID: 36740501 DOI: 10.1016/j.surg.2022.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/01/2022] [Accepted: 12/22/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Emergency department tube thoracostomy is a common procedure; however, assessing procedural skills is difficult. We sought to describe procedural variability and technical complications of emergency department tube thoracostomy using trauma video review. We hypothesized that factors such as hemodynamic abnormality lead to increased technical difficulty and malpositioning. METHODS Using trauma video review, we reviewed all emergency department tube thoracostomy from 2020 to 2022. Patients were stratified into hemodynamically abnormal (systolic blood pressure <90 or heart rate >120) and hemodynamically normal (systolic blood pressure ≥90 or heart rate ≤120). Emergency department tube thoracostomies outside of video-capable rooms, with incomplete visualization, or in patients undergoing cardiopulmonary resuscitation or resuscitative thoracotomy were excluded. The primary outcome was a procedure score modified from the validated tool ranging from 0 to 11 (higher score indicating better performance). Also measured were procedural times to (1) decision to place, (2) pleural entry, and (3) procedure completion. Postprocedure x-ray and chart review were used to determine accuracy. RESULTS In total, 51 videos met the inclusion criteria. The median age was 34 [interquartile range 24-40] years, body mass index 25.8 [interquartile range 21.8-30.7], predominately male (75%), blunt injury (57%), with Injury Severity Score of 22 [14.5-41]. The median procedure score was 9 [7-10]. Emergency department tube thoracostomies in patients with abnormal hemodynamics had significantly lower procedure scores (8 vs 10, P < .05). Hemodynamically abnormal patients had significantly shorter times from decision to proceed to pleural entry (4.05 vs 8.25 minutes, P < .001), and to completion (6.31 vs 14.23 minutes, P < .001). The most common complication was malpositioning (35.1%), with no significant difference noted when comparing hemodynamically normal and abnormal patients (P = .41). CONCLUSION Using trauma video review we identified significant procedural variability in emergency department tube thoracostomy, mainly that hemodynamic abnormality led to lower proficiency scores and increased malpositioning. Efforts are needed to define procedural benchmarks and evaluation in the context of patient outcomes. Using this technology and methodology can help establish procedural norms.
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Affiliation(s)
| | - Madhuri B Nagaraj
- University of Texas Southwestern Medical Center, Division of Burn, Trauma, Acute, and Critical Care Surgery, Dallas, TX. https://twitter.com/nagaraj_madhuri
| | - Matthew Elson
- University of Texas Southwestern Medical Center, Division of Burn, Trauma, Acute, and Critical Care Surgery, Dallas, TX. https://twitter.com/mElsonMD
| | - Michael A Vella
- University of Rochester Medical Center, Division of Acute Care Surgery and Trauma, NY. https://twitter.com/MichaelVella32
| | - Daniel N Holena
- Medical College of Wisconsin, Division of Acute Care Surgery, Milwaukee, WI. https://twitter.com/Daniel_Holena
| | - Ryan P Dumas
- University of Texas Southwestern Medical Center, Division of Burn, Trauma, Acute, and Critical Care Surgery, Dallas, TX. https://twitter.com/RPDUmasMD
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12
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Ganpo-Nkwenkwa NS, Wakeman DS, Pierson L, Vella MA, Wilson NA. Long-term functional, psychological, emotional, and social outcomes in pediatric victims of violence. J Pediatr Surg 2023; 58:774-781. [PMID: 35961819 DOI: 10.1016/j.jpedsurg.2022.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/12/2022] [Accepted: 07/25/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND To evaluate the long-term functional, psychological, and emotional outcomes in individuals who survived violence-related injuries as children. METHODS We retrospectively identified all pediatric patients (age <18y at time of injury) treated for a violent traumatic injury (gun-shot wound, stab, or assault) at our institution (1/2011-12/2020). We then prospectively attempted to contact and survey, via telephone, all patients that had reached adulthood (age ≥18y at time of study) using 7 Patient-Reported Outcomes Measurement Information System (PROMIS) instruments and the Primary Care Post Traumatic Stress Disorder (PTSD) screen. RESULTS Of the 270 patients identified, we attempted to contact 218, successfully contacted 68, and 24 participated in the study. Of participants, 15 (62.5%) sustained gunshot wounds, 8 (33.3%) were stabbed, and 1 (4.2%) was assaulted with a median time from injury of 6.7(3.4) years. Based on PROMIS metrics, Global Physical Health (55.0 vs. 50.0, p = 0.013) and Emotional Support (55.4 vs. 50.0, p = 0.004) were better in participants compared to reference populations. However, a disproportionate number of participants reported substance use in the past 30 days (45.8 vs 13.0%; p < 0.001), 41.7% screened positive for PTSD, and 62.5% requested resources and/or referral for medical care. CONCLUSIONS Many individuals who survive violent injuries as children continued to experience negative physical and mental outcomes extending into adulthood that required ongoing medical and psychological support. Further resources are needed to better understand the long-term effects of violent injury and to care for the complex needs of this population.
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Affiliation(s)
| | - Derek S Wakeman
- Division of Pediatric Surgery, Department of Surgery, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, United States
| | - Lauren Pierson
- Division of Pediatric Surgery, Department of Surgery, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, United States
| | - Michael A Vella
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of Rochester Medical Center, 601 Elmwood Avenue, Box SURG, Rochester, NY 14642, United States
| | - Nicole A Wilson
- Division of Pediatric Surgery, Department of Surgery, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, United States; Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States.
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13
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Gupta GK, Henrichs K, Nilsson K, Wagner S, Brown B, Masel D, Gestring ML, Vella MA, Refaai MA, Blumberg N. Reduction of anti-A and anti-B isoagglutinin titers of group O whole blood units employing an ABO antibody immune adsorption column. Transfus Apher Sci 2023:103686. [PMID: 36894466 DOI: 10.1016/j.transci.2023.103686] [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: 11/10/2022] [Revised: 02/17/2023] [Accepted: 02/27/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Massive hemorrhage is a leading cause of death from trauma. There is growing interest in group O whole blood transfusions to mitigate coagulopathy and hemorrhagic shock. Insufficient availability of low-titer group O whole blood is a barrier to routine use. We tested the efficacy of the Glycosorb® ABO immunoadsorption column to reduce anti-A/B titers in group O whole blood. METHODS Six group O whole blood units were collected from healthy volunteers, and centrifuged to separate platelet poor plasma. Platelet-poor plasma was filtered through a Glycosorb® ABO antibody immunoabsorption column, then reconstituted to prepare post-filtration whole blood. Anti-A/B titers, CBC, free hemoglobin, and thromboelastography (TEG) assays were performed on pre-and post-filtration whole blood. RESULTS Mean( ± SEM) anti-A (224 ± 65 pre vs 13 ± 4 post) and anti-B (138 ± 38 pre vs 11 ± 4 post) titers were significantly reduced (p = 0.004) in post-filtration whole blood. No significant changes were detected in CBC, free hemoglobin, and TEG parameters on day 0. Free hemoglobin increased throughout storage (48 mg/dl ± 24 Day 0 vs 73 ± 35 Day 7 vs 96 ± 44 Day 14; p = 0.14). CONCLUSIONS The Glycosorb® ABO column can significantly reduce anti-A/B isoagglutinin titers of group O whole blood units. Glycosorb® ABO could be employed to provide whole blood with lower risk of hemolysis and other consequences of infusing ABO incompatible plasma. Preparation of group O whole blood with substantially reduced anti-A/B would also increase the supply of low-titer group O whole blood for transfusion.
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Affiliation(s)
- Gaurav K Gupta
- Transfusion Medicine/Blood Bank, Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY, USA.
| | - Kelly Henrichs
- Transfusion Medicine/Blood Bank, Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY, USA.
| | - Kurt Nilsson
- Glycorex Transplantation AB, Section of Hematology, Lund, Sweden.
| | - Stephen Wagner
- American Red Cross Holland Laboratory, Rockville, MD, USA.
| | - Bethany Brown
- American Red Cross Holland Laboratory, Rockville, MD, USA.
| | - Debra Masel
- Transfusion Medicine/Blood Bank, Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY, USA.
| | - Mark L Gestring
- Acute Care Surgery and Trauma, Department of Surgery, University of Rochester, Rochester, NY, USA.
| | - Michael A Vella
- Acute Care Surgery and Trauma, Department of Surgery, University of Rochester, Rochester, NY, USA.
| | - Majed A Refaai
- Transfusion Medicine/Blood Bank, Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY, USA.
| | - Neil Blumberg
- Transfusion Medicine/Blood Bank, Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY, USA.
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14
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McLauchlan NR, Igra NM, Fisher LT, Byrne JP, Beyer CA, Geng Z, Schmulevich D, Brinson MM, Dumas RP, Holena DN, Hynes AM, Rosen CB, Shah AN, Vella MA, Cannon JW. Open versus percutaneous tube thoracostomy with and without thoracic lavage for traumatic hemothorax: a novel randomized controlled simulation trial. Trauma Surg Acute Care Open 2023; 8:e001050. [PMID: 36967862 PMCID: PMC10030794 DOI: 10.1136/tsaco-2022-001050] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/25/2023] [Indexed: 03/29/2023] Open
Abstract
Objective To quantify and assess the relative performance parameters of thoracic lavage and percutaneous thoracostomy (PT) using a novel, basic science 2×2 randomized controlled simulation trial. Summary background data Treatment of traumatic hemothorax (HTX) with open tube thoracostomy (TT) is painful and retained HTX is common. PT is potentially less painful whereas thoracic lavage may reduce retained HTX. Yet, procedural time and the feasibility of combining PT with lavage remain undefined. Methods A simulated partially clotted HTX (2%-gelatin-saline mixture) was loaded into a TT trainer and then evacuated after randomization to one of four protocols: TT+/-lavage or PT+/-lavage. Standardized inserts with fixed 28-Fr TT or 14-Fr PT positioning were used to minimize tube positioning variability. Lavage consisted of two 500 mL aliquots of warm saline after initial HTX evacuation. The primary outcome was HTX volume evacuated. The secondary outcome was additional procedural time required for the addition of the lavage. Results A total of 40 simulated HTX trials were randomized. TT alone evacuated a median of 1236 mL (IQR 1168, 1294) leaving a residual volume of 265 mL (IQR 206, 333). PT alone resulted in a significantly greater median residual volume of 588 mL (IQR 497, 646) (p=0.002). Adding lavage resulted in similar residual volumes for TT compared with TT alone but significantly less for PT compared with PT alone (p=0.002). Lavage increased procedural time for TT by a median of 7.0 min (IQR 6.5, 8.0) vs 11.7 min (IQR 10.2, 12.0) for PT (p<0.001). Conclusion This simulation trial characterized HTX evacuation in a standardized fashion. Adding lavage to thoracostomy placement may improve evacuation, particularly for small-diameter tubes, with little added procedural time. Further prospective clinical study is warranted. Level of evidence NA.
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Affiliation(s)
- Nathaniel R McLauchlan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Noah M Igra
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lydia T Fisher
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James P Byrne
- Johns Hopkins Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Carl A Beyer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zhi Geng
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniela Schmulevich
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Martha M Brinson
- Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | - Allyson M Hynes
- University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Claire B Rosen
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Michael A Vella
- Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Jeremy W Cannon
- Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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15
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Dumas RP, Cook C, Holena DN, Qi Y, Tabone N, Studwell SL, Miglani A, Vella MA. Roll the Tape: Implementing and Harnessing the Power of Trauma Video Review. J Surg Educ 2022; 79:e248-e256. [PMID: 36096880 DOI: 10.1016/j.jsurg.2022.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/07/2022] [Accepted: 08/15/2022] [Indexed: 06/15/2023]
Abstract
Trauma video review (TVR) is a powerful technology with a rapidly expanding role in trauma performance improvement, education, and research. Video review is particularly well suited for evaluating elements not found in the medical record such as rapid changes in patient condition, medical decision making, resuscitation tempo, and team leadership. As such, TVR is an ideal tool for general surgery trainee education and as a means to evaluate multiple ACGME Core Competencies and entrustable professional activities. This article describes the development of a TVR program and the novel way in which we have integrated TVR into our resident trauma curriculum.
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Affiliation(s)
- Ryan P Dumas
- Department of Surgery, University of Texas Southwestern Medical Center/Parkland Memorial Hospital, Dallas, Texas
| | - Caitlin Cook
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Daniel N Holena
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Yanjie Qi
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Nora Tabone
- Privacy Office, University of Rochester Medical Center, Rochester, New York
| | - Spencer L Studwell
- Office of Counsel, Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York
| | - Aekta Miglani
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York
| | - Michael A Vella
- Department of Surgery, University of Rochester Medical Center, Rochester, New York.
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16
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Rees JR, Maher Z, Dumas RP, Vella MA, Schroeder ME, Milia DJ, Zone AI, Cannon JW, Holena DN. Trauma video review outperforms prospective real-time data collection for study of resuscitative thoracotomy. Surgery 2022; 172:1563-1568. [PMID: 35927077 DOI: 10.1016/j.surg.2022.06.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/20/2022] [Accepted: 06/23/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND A major challenge in the study of high-impact, low-frequency procedures in trauma is the lack of accurate data for time-sensitive processes of care. Trauma video review offers a possible solution, allowing investigators to collect extremely granular time-stamped data. Using resuscitative thoracotomy as a model, we compared data collected using review of audiovisual recordings to data prospectively collected in real time with the hypothesis that data collected using video review would be subject to less missingness and bias. METHODS We conducted a prospective cohort study of patients undergoing resuscitative thoracotomy at a single urban academic level 1 trauma center. Key data on the timing and completion of procedural milestones of resuscitative thoracotomy were collected using video review and prospective collection. We used McNemar's test to compare proportions of missing data between the 2 methods and calculated bias in time measurements for prospective collection with respect to video review. Statistical analyses were performed using Stata v. 15.0 (College Station, TX). RESULTS We included 51 subjects (88% Black, 82% male, 90% injured by gunshot wounds) over the study period. Missingness in resuscitative thoracotomy procedural milestone time measurements ranged from 34% to 63% for prospective collection and 0 to 8% for video review and was less missing for video review for all key variables (P < .001). When not missing, bias in data collected by prospective collection was 10% to 43% compared with data collected by video review. CONCLUSIONS The data collected using video review have less missingness and bias than prospective collection data collected by trained research assistants. Audiovisual recording should be the gold standard for data collection for the study of time-sensitive processes of care in resuscitation.
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Affiliation(s)
- John R Rees
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Zoe Maher
- Division of Trauma and Surgical Critical Care, Lewis Katz School of Medicine at Temple University, Philadelphia, PA. https://twitter.com/zoe_maher
| | - Ryan P Dumas
- Division of Burn, Trauma, Acute, and Critical Care Surgery, University of Texas Southwestern, Dallas, TX. https://twitter.com/RPDumasMD
| | - Michael A Vella
- Division of Acute Care Surgery and Trauma, University of Rochester Medical Centre, Rochester, NY. https://twitter.com/MichaelVella32
| | - Mary E Schroeder
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - David J Milia
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Alea I Zone
- Penn Acute Research Collaboration, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Jeremy W Cannon
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Penn Acute Research Collaboration, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Department of Surgery, Uniformed Services University F. Edward Hébert School of Medicine, Bethesda, MD
| | - Daniel N Holena
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, WI.
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17
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Burke K, Nagaraj M, Kuhlenschmidt K, Marinica AL, Lowe J, Park C, Vella MA, Holena DN, Cripps MW, Dumas RP. Under the Lens: Provider Perception of Trauma Video Review. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.08.468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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18
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Vella MA, Warshauer A, Tortorello G, Fernandez-Moure J, Giacolone J, Chen B, Cabulong A, Chreiman K, Sims C, Schwab CW, Reilly PM, Lane-Fall M, Seamon MJ. Long-term Functional, Psychological, Emotional, and Social Outcomes in Survivors of Firearm Injuries. JAMA Surg 2021; 155:51-59. [PMID: 31746949 DOI: 10.1001/jamasurg.2019.4533] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The outcomes of firearm injuries in the United States are devastating. Although firearm mortality and costs have been investigated, the long-term outcomes after surviving a gunshot wound (GSW) remain unstudied. Objective To determine the long-term functional, psychological, emotional, and social outcomes among survivors of firearm injuries. Design, Setting, and Participants This prospective cohort study assessed patient-reported outcomes among GSW survivors from January 1, 2008, through December 31, 2017, at a single urban level I trauma center. Attempts were made to contact all adult patients (aged ≥18 years) discharged alive during the study period. A total of 3088 patients were identified; 516 (16.7%) who died during hospitalization and 45 (1.5%) who died after discharge were excluded. Telephone contact was made with 263 (10.4%) of the remaining patients, and 80 (30.4%) declined study participation. The final study sample consisted of 183 participants. Data were analyzed from June 1, 2018, through June 20, 2019. Exposures A GSW sustained from January 1, 2008, through December 31, 2017. Main Outcomes and Measures Scores on 8 Patient-Reported Outcomes Measurement Information System (PROMIS) instruments (Global Physical Health, Global Mental Health, Physical Function, Emotional Support, Ability to Participate in Social Roles and Activities, Pain Intensity, Alcohol Use, and Severity of Substance Use) and the Primary Care PTSD (posttraumatic stress disorder) Screen for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Results Of the 263 patients who survived a GSW and were contacted, 183 (69.6%) participated. Participants were more likely to be admitted to the hospital compared with those who declined (150 [82.0%] vs 54 [67.5%]; P = .01). Participants had a median time from GSW of 5.9 years (range, 4.7-8.1 years) and were primarily young (median age, 27 years [range, 21-36 years]), black (168 [91.8%]), male (169 [92.3%]), and employed before GSW (pre-GSW, 139 [76.0%]; post-GSW, 113 [62.1%]; decrease, 14.3%; P = .004). Combined alcohol and substance use increased by 13.2% (pre-GSW use, 56 [30.8%]; post-GSW use, 80 [44.0%]). Participants had mean (SD) scores below population norms (50 [10]) for Global Physical Health (45 [11]; P < .001), Global Mental Health (48 [11]; P = .03), and Physical Function (45 [12]; P < .001) PROMIS metrics. Eighty-nine participants (48.6%) had a positive screen for probable PTSD. Patients who required intensive care unit admission (n = 64) had worse mean (SD) Physical Function scores (42 [13] vs 46 [11]; P = .045) than those not requiring the intensive care unit. Survivors no more than 5 years after injury had greater PTSD risk (38 of 63 [60.3%] vs 51 of 119 [42.9%]; P = .03) but better mean (SD) Global Physical Health scores (47 [11] vs 43 [11]; P = .04) than those more than 5 years after injury. Conclusions and Relevance This study's results suggest that the lasting effects of firearm injury reach far beyond mortality and economic burden. Survivors of GSWs may have negative outcomes for years after injury. These findings suggest that early identification and initiation of long-term longitudinal care is paramount.
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Affiliation(s)
- Michael A Vella
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.,currently affiliated with Division of Acute Care Surgery and Trauma, University of Rochester Medical Center, Rochester, New York
| | - Alexander Warshauer
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Gabriella Tortorello
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Joseph Fernandez-Moure
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Joseph Giacolone
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.,currently affiliated with Department of Surgery, Stanford University, Palo Alto, California
| | - Bofeng Chen
- medical student, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Alexander Cabulong
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Kristen Chreiman
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Carrie Sims
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - C William Schwab
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Patrick M Reilly
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Meghan Lane-Fall
- Department of Anesthesia and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Mark J Seamon
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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19
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Burchard PR, Poleshuck EL, Yates EH, Cerulli C, Gestring ML, Vella MA. A Different City's Experience with COVID-19 and Interpersonal Violence: Increased Support-Seeking but Decreased Service Use. J Am Coll Surg 2021; 232:1018-1019. [PMID: 33722462 DOI: 10.1016/j.jamcollsurg.2020.12.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 11/19/2022]
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20
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Hatchimonji JS, Sikoutris J, Smith BP, Vella MA, Dumas RP, Qasim ZA, Gallagher JJ, Reilly PM, Raza SS, Cannon JW. The REBOA Dissipation Curve: Training Starts to Wane at 6 Months in the Absence of Clinical REBOA Cases. J Surg Educ 2020; 77:1598-1604. [PMID: 32741695 DOI: 10.1016/j.jsurg.2020.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/27/2020] [Accepted: 05/03/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a low-frequency, high-acuity intervention. We hypothesized that REBOA-specific knowledge and comfort deteriorate significantly within 6 months of a formal training course if REBOA is not performed in the interim. METHODS A comprehensive REBOA course was developed including didactics and hands-on practical simulation training. Baseline knowledge and comfort were assessed with a precourse objective test and a subjective self-assessment. REBOA knowledge and comfort were then re-assessed immediately postcourse and again at 6 months and 1 year. Performance trends were measured using paired Student's t and Wilcoxon signed-rank tests. RESULTS Thirteen participants were evaluated including trauma faculty (n = 10) and fellows (n = 3). Test scores improved significantly from precourse (72% ± 10% correct) to postcourse (88% ± 8%, p < 0.001). At 6 months, scores remained no different from postcourse (p = 0.126); at 1 year, scores decreased back to baseline (p = 0.024 from postcourse; 0.285 from precourse). Subjective comfort with femoral arterial line placement and REBOA improved with training (p = 0.044 and 0.003, respectively). Femoral arterial line comfort remained unchanged from postcourse at 6 months (p = 0.898) and 1 year (p = 0.158). However, subjective comfort with REBOA decreased relative to postcourse levels at 6 months (p = 0.009), driven primarily by participants with no clinical REBOA cases in the interim. CONCLUSIONS A formal REBOA curriculum improves knowledge and comfort with critical aspects of this procedure. This knowledge persists at 6 months, though subjective comfort deteriorated among those without REBOA placement in the interim. REBOA refresher training should be considered at 6-month intervals in the absence of clinical REBOA cases. LEVEL OF EVIDENCE/STUDY TYPE Level III, prognostic.
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Affiliation(s)
- Justin S Hatchimonji
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Jennifer Sikoutris
- Undergraduate Nursing Department, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania
| | - Brian P Smith
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael A Vella
- Division of Acute Care Surgery and Trauma, Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Ryan P Dumas
- Division of General and Acute Care Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Zaffer A Qasim
- Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - John J Gallagher
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Patrick M Reilly
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shariq S Raza
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeremy W Cannon
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgery, Uniformed Services university of the Health Sciences, Bethesda, Maryland
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Vella MA, Li H, Reilly PM, Raza SS. Unlocked yet untapped: The ubiquitous smartphone and utilization of emergency medical identification technology in the care of the injured patient. Surg Open Sci 2020; 2:122-126. [PMID: 32754716 PMCID: PMC7391891 DOI: 10.1016/j.sopen.2020.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/23/2020] [Accepted: 03/25/2020] [Indexed: 11/18/2022] Open
Abstract
Background Smartphones allow users to store health and identification information that is accessible without a passcode—conceivably invaluable information for care of unresponsive trauma patients. We sought to characterize the use of smartphone emergency medical identification applications and hypothesized that these are infrequently used but positively perceived. Methods We surveyed a convenience sample of adult trauma patients/family members (nonproviders) and providers from an urban Level I trauma center during July 2018 on their demographics and smartphone emergency medical identification application usage. Descriptive and chi-square/Fisher exact analyses were performed to characterize the use of smartphone emergency medical identification applications and compare groups. Results 338 subjects participated; most were female (52%) with median age of 36 (29–48). 182 (54%) were providers and 306 (91%) owned smartphones. 157 (51%) owners were aware smartphone emergency medical identification existed, but only 94 (31%) used it. 123 providers encountered unresponsive patients with smartphones, but only 26 (21%) queried smartphone emergency medical identification, with 19 (73%) finding smartphone emergency medical identification helpful. All 8 (100%) nonproviders who reported to have had their smartphone emergency medical identification queried believed it was beneficial. There were no differences between groups in smartphone emergency medical identification awareness and utilization. Conclusion Smartphone emergency medical identification technology is underused despite its potential benefits. Future work should focus on improving education to use this technology in trauma care.
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Affiliation(s)
- Michael A Vella
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Division of Acute Care Surgery and Trauma, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Howard Li
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Patrick M Reilly
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Shariq S Raza
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Vella MA, Dumas RP, Holena DN. Supporting the Educational, Research, and Clinical Care Goals of the Academic Trauma Center: Video Review for Trauma Resuscitation. JAMA Surg 2019; 154:257-258. [PMID: 30601875 DOI: 10.1001/jamasurg.2018.5077] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Michael A Vella
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ryan P Dumas
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Division of General and Acute Care Surgery, University of Texas Southwestern Medical School, Dallas
| | - Daniel N Holena
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Vella MA, Dumas RP, DuBose J, Morrison J, Scalea T, Moore L, Podbielski J, Inaba K, Piccinini A, Kauvar DS, Baggenstoss VL, Spalding C, Fox C, Moore EE, Cannon JW. Intraoperative REBOA: an analysis of the American Association for the Surgery of Trauma AORTA registry. Trauma Surg Acute Care Open 2019; 4:e000340. [PMID: 31799415 PMCID: PMC6861115 DOI: 10.1136/tsaco-2019-000340] [Citation(s) in RCA: 9] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/08/2019] [Accepted: 08/10/2019] [Indexed: 11/04/2022] Open
Abstract
Background Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a less-invasive technique for aortic occlusion (AO). Commonly performed in the emergency department (ED), the role of intraoperative placement is less defined. We hypothesized that operating room (OR) placement is associated with increased in-hospital mortality. Methods The American Association for the Surgery of Trauma AORTA registry was used to identify patients undergoing REBOA. Injury characteristics and outcomes data were compared between OR and ED groups. The primary outcome was in-hospital mortality; secondary outcomes included total AO time, transfusion requirements, and acute kidney injury. Results Location and timing of catheter insertion were available for 305 of 321 (95%) subjects. 58 patients underwent REBOA in the OR (19%). There were no differences with respect to sex, admission lactate, and Injury Severity Score. The OR group was younger (33 years vs. 41 years, p=0.01) and with more penetrating injuries (36% vs. 15%, p<0.001). There were significant differences with respect to admission physiology. Time from admission to AO was longer in the OR group (75 minutes vs. 23 minutes, p<0.001) as was time to definitive hemostasis (116 minutes vs. 79 minutes, p=0.01). Unadjusted mortality was lower in the OR group (36.2% vs. 68.8%, p<0.001). There were no differences in secondary outcomes. After controlling for covariates, there was no association between insertion location and in-hospital mortality (OR 1.8, 95% CI 0.30 to 11.50). Discussion OR REBOA placement is common and generally employed in patients with more stable admission physiology. OR placement was not associated with increased in-hospital mortality despite longer times to AO and definite hemostasis when compared with catheters placed in the ED. Level of evidence IV; therapeutic/care management.
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Affiliation(s)
- Michael A Vella
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ryan Peter Dumas
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of General and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Joseph DuBose
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Jonathan Morrison
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Thomas Scalea
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Laura Moore
- Division of Trauma and Surgical Critical Care, University of Texas, Houston, Texas, USA
| | - Jeanette Podbielski
- Division of Trauma and Surgical Critical Care, University of Texas, Houston, Texas, USA
| | - Kenji Inaba
- Division of Surgical Critical Care and Trauma, Los Angeles County + University of Southern California Hospital, Los Angeles, California, USA
| | - Alice Piccinini
- Division of Surgical Critical Care and Trauma, Los Angeles County + University of Southern California Hospital, Los Angeles, California, USA
| | - David S Kauvar
- Division of Trauma and Surgical Critical Care, San Antonio Military Medical Center/US Army Institute of Surgical Research, San Antonio, Texas, USA
| | - Valorie L Baggenstoss
- Division of Trauma and Surgical Critical Care, San Antonio Military Medical Center/US Army Institute of Surgical Research, San Antonio, Texas, USA
| | - Chance Spalding
- Department of Surgery, Grant Medical Center, Columbus, Ohio, USA
| | - Charles Fox
- Department of Surgery, Denver Health Medical Center, Denver, Colorado, USA
| | - Ernest E Moore
- Department of Surgery, Denver Health Medical Center, Denver, Colorado, USA
| | - Jeremy W Cannon
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Dumas RP, Vella MA, Chreiman KC, Smith BP, Subramanian M, Maher Z, Seamon MJ, Holena DN. Team Assessment and Decision Making Is Associated With Outcomes: A Trauma Video Review Analysis. J Surg Res 2019; 246:544-549. [PMID: 31635832 DOI: 10.1016/j.jss.2019.09.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 04/25/2019] [Revised: 07/24/2019] [Accepted: 09/18/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Teamwork is a critical element of trauma resuscitation. Assessment tools such as T-NOTECHS (Trauma NOn-TECHnical Skills) exist, but correlation with patient outcomes is unclear. Using emergency department thoracotomy (EDT), we sought to describe T-NOTECHS scores during resuscitations. We hypothesized that patients undergoing EDT whose resuscitations had better scores would be more likely to have return of spontaneous circulation (ROSC). METHODS Continuously recording video was used to review all captured EDTs over a 24-mo period. We used a modification of the validated T-NOTECHS instrument to measure five domains on a 3-point scale (1 = best, 2 = average, 3 = worst). A total T-NOTECHS score was calculated by one of three reviewers. The primary outcome was ROSC. ROSC was defined as an organized rhythm no longer requiring internal cardiac compressions. Associations between variables and ROSC were examined using univariate regression. RESULTS Sixty-one EDTs were captured. Nineteen patients had ROSC (31%) and 42 (69%) did not. The median T-NOTECHS score for all resuscitations was 8 [IQR 6-10]. As demographic and injury data (age, gender, mechanism, signs of life) were not associated with ROSC in univariate analysis, they were not considered for inclusion in a multivariable regression model. The association between overall T-NOTECHS score and ROSC did not reach statistical significance, but examination of the individual components of the T-NOTECHS score demonstrated that, compared to resuscitations that had "average" (2) or "worst" (3) scores on "Assessment and Decision Making," resuscitations with a "best" score were 5 times more likely to lead to ROSC. CONCLUSIONS Although the association between overall T-NOTECHS scores and ROSC did not reach statistical significance, better scores in the domain of assessment and decision making are associated with improved rates of ROSC in patients arriving in cardiac arrest who undergo EDT. LEVEL OF EVIDENCE Level IV Therapeutic/Care Management.
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Affiliation(s)
- Ryan P Dumas
- Division of General and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Michael A Vella
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kristen C Chreiman
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian P Smith
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Madhu Subramanian
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Zoe Maher
- Division of Trauma and Surgical Critical Care, Temple University, Philadelphia, Pennsylvania
| | - Mark J Seamon
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel N Holena
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
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Affiliation(s)
- Michael A Vella
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jose Pascual-Lopez
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Surgical Critical Care, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Lewis J Kaplan
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Surgical Critical Care, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
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Dumas RP, Vella MA, Hatchimonji JS, Ma L, Maher Z, Holena DN. Trauma video review utilization: A survey of practice in the United States. Am J Surg 2019; 219:49-53. [PMID: 31537325 DOI: 10.1016/j.amjsurg.2019.08.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/08/2019] [Accepted: 08/26/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Trauma video review (TVR) for quality improvement and education in the United States has been described for nearly three decades. The most recent information on this practice indicated a declining prevalence. We hypothesized that TVR utilization has increased since most recent estimates. METHODS We conducted a survey of TVR practices at level I and level II US trauma centers. We distributed an electronic survey covering past, current, and future TVR utilization to the Eastern Association for the Surgery of Trauma membership. RESULTS 45.0% of US level I and level II trauma centers completed surveys. 71/249 centers (28.5%) had active TVR programs. The use of TVR did not differ between level I and level II centers (28.8% vs. 27.8%, p = 0.87). Respondents using TVR were overwhelmingly positive about its perception (median score 8, [IQR 6-9]; 10 = 'best') at their institutions. CONCLUSIONS TVR use at Level I centers has increased over the past decade. Increased TVR utilization may form the basis for multicenter studies comparing processes of care during trauma resuscitation.
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Affiliation(s)
- R P Dumas
- Division of General and Acute Care Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - M A Vella
- Division of Acute Care Surgery and Trauma, University of Rochester School of Medicine and Dentistry, Rochester NY, USA.
| | - J S Hatchimonji
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, USA.
| | - L Ma
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, USA.
| | - Z Maher
- Division of Trauma and Surgical Critical Care, Temple University, Philadelphia, PA, USA.
| | - D N Holena
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, USA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA.
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Affiliation(s)
- M A Vella
- Department of Medicine, University College Hospital, London
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Abstract
Traumatic brain injury (TBI) is a leading cause of death and disability in patients with trauma. Management strategies must focus on preventing secondary injury by avoiding hypotension and hypoxia and maintaining appropriate cerebral perfusion pressure (CPP), which is a surrogate for cerebral blood flow. CPP can be maintained by increasing mean arterial pressure, decreasing intracranial pressure, or both. The goal should be euvolemia and avoidance of hypotension. Other factors that deserve important consideration in the acute management of patients with TBI are venous thromboembolism, stress ulcer, and seizure prophylaxis, as well as nutritional and metabolic optimization.
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Affiliation(s)
- Michael A. Vella
- Chief Resident in General Surgery, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Medical Center North, CCC-4312, 1161 21st Avenue South, Nashville, TN 37232-2730,
| | - Marie Crandall
- Professor of Surgery, Division of Acute Care Surgery, Department of Surgery, University of Florida, Jacksonville, 655 West 8th Street, Jacksonville, FL 32209,
| | - Mayur B. Patel
- Assistant Professor of Surgery, Neurosurgery, Hearing & Speech Sciences, Division of Trauma, Surgical Critical Care, and Emergency General Surgery, Department of Surgery, Section of Surgical Sciences, Center for Health Services Research, Vanderbilt Brain Institute, Vanderbilt University Medical Center, 1211 21 Avenue South, Medical Arts Building, Suite 404, Nashville, TN 37212,
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Kummerow Broman K, Vella MA, Tarpley JL, Dittus RS, Roumie CL. Identification of postoperative care amenable to telehealth. Surgery 2016; 160:264-71. [DOI: 10.1016/j.surg.2016.02.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 01/27/2016] [Accepted: 02/13/2016] [Indexed: 11/27/2022]
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Affiliation(s)
- Michael A. Vella
- Section of Surgical Sciences, Tennessee Valley Healthcare System, Veterans Affairs Medical Center, Nashville2Department of Surgery, Vanderbilt University, Nashville, Tennessee
| | - Kristy Kummerow Broman
- Section of Surgical Sciences, Tennessee Valley Healthcare System, Veterans Affairs Medical Center, Nashville2Department of Surgery, Vanderbilt University, Nashville, Tennessee3Tennessee Valley Healthcare System, Veterans Affairs Medical Center, Geriatric
| | - John L. Tarpley
- Section of Surgical Sciences, Tennessee Valley Healthcare System, Veterans Affairs Medical Center, Nashville2Department of Surgery, Vanderbilt University, Nashville, Tennessee
| | - Robert S. Dittus
- Section of Surgical Sciences, Tennessee Valley Healthcare System, Veterans Affairs Medical Center, Nashville4Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Christianne L. Roumie
- Section of Surgical Sciences, Tennessee Valley Healthcare System, Veterans Affairs Medical Center, Nashville4Department of Medicine, Vanderbilt University, Nashville, Tennessee
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Kensinger CD, McMaster WG, Vella MA, Sexton KW, Snyder RA, Terhune KP. Residents as Educators: A Modern Model. J Surg Educ 2015; 72:949-956. [PMID: 26143515 PMCID: PMC4831619 DOI: 10.1016/j.jsurg.2015.04.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 03/31/2015] [Accepted: 04/06/2015] [Indexed: 06/01/2023]
Abstract
Education during surgical residency has changed significantly. As part of the shifting landscape, the importance of an organized and structured curriculum has increased. However, establishing this is often difficult secondary to clinical demands and pressure both on faculty and residents. We present a peer-assisted learning model for academic institutions without professional non-clinical educations. The "resident as educator" (RAE) model empowers residents to be the organizers of the education curriculum. RAE is built on a culture of commitment to education, skill development and team building, allowing the upper level residents to develop and execute the curriculum. Several modules designed to address junior level residents and medical students' educational needs have been implemented, including (1) intern boot camp, (2) summer school, (3) technical skill sessions, (4) trauma orientation, (5) weekly teaching conferences, and (4) a fourth year medical student surgical preparation course. Promoting residents as educators leads to an overall benefit for the program by being cost-effective and time-efficient, while simultaneously promoting professional development of residents and a culture of education.
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Affiliation(s)
- Clark D. Kensinger
- Vanderbilt University Medical Center, Department of General Surgery. 1161 21st Avenue South, D4313 MCN. Nashville, TN 37232, United States of America
| | - William G. McMaster
- Vanderbilt University Medical Center, Department of General Surgery. 1161 21st Avenue South, D4313 MCN. Nashville, TN 37232, United States of America
| | - Michael A. Vella
- Vanderbilt University Medical Center, Department of General Surgery. 1161 21st Avenue South, D4313 MCN. Nashville, TN 37232, United States of America
| | - Kevin W. Sexton
- Vanderbilt University Medical Center, Department of General Surgery. 1161 21st Avenue South, D4313 MCN. Nashville, TN 37232, United States of America
| | - Rebecca A. Snyder
- Vanderbilt University Medical Center, Department of General Surgery. 1161 21st Avenue South, D4313 MCN. Nashville, TN 37232, United States of America
| | - Kyla P. Terhune
- Vanderbilt University Medical Center, Department of General Surgery. 1161 21st Avenue South, D4313 MCN. Nashville, TN 37232, United States of America
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Boeshore KL, Ashurst JV, Vella MA, Greczek N, Belousov Y, Lucas R. Polyamine treatment increases initiation of neurite outgrowth from PC12 cells. Dev Biol 2006. [DOI: 10.1016/j.ydbio.2006.04.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Fifty elderly patients who had suffered cerebrovascular incidents from no obvious cause and 33 age-matched controls were investigated for the presence of a patent foramen ovale by contrast 2-dimensional echocardiography at rest and after the Valsalva manoeuvre. Right-to-left shunting was found in only one patient and in none of the controls. This finding is in contradistinction to young adult stroke patients in whom the prevalence of a haemodynamically significant patent foramina ovale is high. Paradoxical embolism is an uncommon cause of stroke in the elderly.
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Affiliation(s)
- M A Vella
- Department of Geriatrics and General Medicine, Guy's Hospital, London, UK
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Affiliation(s)
- M A Vella
- Department of Medicine, University College Hospital, London
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Williams LG, Jowett NI, Vella MA, Humphries S, Galton DJ. Allelic variation adjacent to the human insulin and apolipoprotein C-II genes in different ethnic groups. Hum Genet 1985; 71:227-30. [PMID: 2998971 DOI: 10.1007/bf00284580] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We have used DNA probes for the human insulin gene and apolipoprotein C-II (apo C-II) gene to determine the extent of allelic variation in different ethnic groups. The distribution of an apo C-II DNA polymorphism revealed by the restriction endonuclease Taq I showed no significant variation amongst racial groups; in contrast, an insulin gene-related DNA polymorphism showed marked variability. In Japanese, Chinese, and Asian Indian groups there was an increased frequency of homozygosity for the class 1 allele compared to Caucasian groups (P less than 0.001, P less than 0.01, and P less than 0.05, respectively). In Caucasian, Japanese, Chinese, and Asian Indian groups no class 2 allele was observed; but in the Negroid populations (African and West Indian) the class 2 allele frequencies were 0.23 and 0.25 respectively. Possible reasons for this variation in allele distribution are considered in relation to disease associations.
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Rees A, Stocks J, Sharpe CR, Vella MA, Shoulders CC, Katz J, Jowett NI, Baralle FE, Galton DJ. Deoxyribonucleic acid polymorphism in the apolipoprotein A-1-C-III gene cluster. Association with hypertriglyceridemia. J Clin Invest 1985; 76:1090-5. [PMID: 2995445 PMCID: PMC423995 DOI: 10.1172/jci112062] [Citation(s) in RCA: 143] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
A DNA sequence polymorphism, revealed by digestion of human DNA with the restriction endonuclease Sst-1 and hybridization with an apolipoprotein A-I complementary DNA clone, has been shown to be located in or close to the 3' noncoding region of the apolipoprotein C-III gene. This polymorphism is found in significantly increased prevalence (P less than 0.001) in Caucasian hypertriglyceridemic subjects compared with race-matched controls, and its distribution in normal individuals of differing racial origins is reported. Furthermore, no alteration of high density lipoprotein or apolipoprotein A-I and apolipoprotein C-III phenotypes was observed in individuals with or without the polymorphism.
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Jowett NI, Rees A, Williams LG, Stocks J, Vella MA, Hitman GA, Katz J, Galton DJ. Insulin and apolipoprotein A-1/C-III gene polymorphisms relating to hypertriglyceridaemia and diabetes mellitus. Diabetologia 1984; 27:180-3. [PMID: 6436127 DOI: 10.1007/bf00273802] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Two gene specific probes have been used to identify polymorphic DNA loci on chromosome 11 close to the insulin and apoprotein A-1 genes in a genetic analysis of hypertriglyceridaemic patients with and without co-existing diabetes. Of the 45 patients studied with both probes, 15 were diabetic of whom nine possessed class 3/3 insulin polymorphism genotypes, compared with none in the non-diabetic group (p less than 0.001; chi 2 test). In contrast, an uncommon apolipoprotein A-1 polymorphism was found to be equally distributed in the diabetic and the non-diabetic patients. No co-segregation of these two particular genetic polymorphisms was found in either patient group. The differing associations of the two disease-related polymorphism genotypes in patients with hypertriglyceridaemia with or without co-existing diabetes may possibly reflect differing aetiologies of the hyperlipidaemia.
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Vella MA, Lewis J, Hossain J, Jariwalla AG. Multiple hamartomas of the lung. Br J Clin Pract 1982; 36:206-8. [PMID: 7171441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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