Objectives: To compare outcomes in patients with rib fractures (RFX) who underwent surgical stabi... more Objectives: To compare outcomes in patients with rib fractures (RFX) who underwent surgical stabilization of rib fractures (SSRF) to those treated nonoperatively.
The role of laparoscopy in the evaluation of abdominal trauma continues to evolve. It has been su... more The role of laparoscopy in the evaluation of abdominal trauma continues to evolve. It has been successfully used in blunt and penetrating trauma. We report our experience with diagnostic laparoscopy in 28 patients with abdominal gunshot wounds. We found a 100% accuracy and a 0% morbidity in patients with negative laparoscopy. We report a case in which laparoscopy was used to demonstrate an isolated nonbleeding liver injury due to a gunshot wound to the abdomen. Nontherapeutic laparotomy was avoided.
Background: The open abdomen technique for the treatment of diffuse peritonitis has gained accept... more Background: The open abdomen technique for the treatment of diffuse peritonitis has gained acceptance. Our approach has been to use the zipper technique with daily irrigations. Once the abdominal problem has resolved, the mesh and zipper are removed. Surgeons are reluctant to reoperate on patients with such prior treatment because of the anticipation of a hostile abdomen. Our study is a retrospective review of 12 patients who were treated with the open abdomen technique. At a later date, they underwent elective reoperation. Study design: The charts of 12 patients were reviewed. After initial injury, the patients were in the surgical intensive care unit. Reoperations were performed nine months (mean) after discharge from this facility. The reasons for reoperation were closure of enteric fistula (five patients) and closure of an ostomy (seven patients). The abdominal wall was reconstructed in nine patients. In the other three patients, the abdomen was entered through a lateral incision and the bowel was reanastomosed. Results: All of the patients survived. There were five complications. Two patients had ischemic skin grafts successfully treated by hyperbaric oxygen therapy (HBO). Two patients had ischemic skin flaps that were covering mesh. They responded to HBO with minimal slough of superficial tissue. One patient had a low output fistula that closed after two weeks of total parenteral nutrition. Conclusions: A history of an open abdomen is not a contraindication to later operation. Bowel continuity can be restored and abdominal wall reconstruction can be performed safely. This can be done as early as three to four months after recovery from the original injury.
Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology, Aug 1, 2008
Material and Methods: A survey constructed from five definitions of centric relation (CR) as prov... more Material and Methods: A survey constructed from five definitions of centric relation (CR) as provided from the glossary of prosthodontic terms was sent to the chairmen of every oral and maxillofacial surgery and orthodontic program in the U.S. Only full time faculty from each program were asked to respond to the survey. The different responses were analyzed statistically by chi square analysis. Results: Seventy-three responses were obtained from the oral and maxillofacial surgeons and 64 from the orthodontists. There were 69 different programs represented in this survey. Orthodontists and surgeons had a significantly different response regarding the definition of centric relation (chi-squareϭ 28, dfϭ 4, p-valueϽ 0.0001). There was no difference between the two groups on the need for mounting models in centric relation for use in orthognathic surgery (chi-squareϭ 1, p-valueϾ 0.6). Regarding the definition of centric occlusion, there was a significant difference between orthodontists and surgeons (chi-squareϭ 9.9, dfϭ 1, p-valueϭ 0.0070). The fourth and fifth questions had to do with CR/CO slide and the direction of movement. There was a significant difference between the two groups regarding mandibular movement (chisquareϭ 28, dfϭ 2, p-valueϽ 0.0001). Surgeons were nearly unanimous in their opinion that the mandible would move anteriorly (88%), whereas there was more discordance among orthodontists. Within the orthodontic group, 50% indicated anterior movement and 47% indicated that either an anterior or posterior movement could occur. The surgeons were asked one additional question which the orthodontists were not. Forty-nine percent of the surgeons indicated that during a BSSO the proximal segment should be seated vertically and posteriorly prior to rigid fixation. Conclusion: The results of this study show there is a statistical lack of consistency amongst practitioners regarding an absolute definition of centric relation as it relates to orthognathic surgery. The inconsistency exists between specialties and within practitioners in each specialty.
Purpose of Review Surgical stabilization of rib fractures (aka rib plating) is underutilized, par... more Purpose of Review Surgical stabilization of rib fractures (aka rib plating) is underutilized, partly due to a perceived lack of evidence of benefit and unfamiliarity with the operation. The goal of this review is to identify and summarize the evidence surrounding surgical stabilization of chest wall injury in flail and non-flail injury patterns and highlight the limitations of our current knowledge. Recent Findings Recent meta-analyses and prior trials have provided evidence that rib fixation in flail chest injuries decreases the need for mechanical ventilation, decreases risk of pneumonia, and decreases mortality. Additionally, the Eastern Association for the Surgery of Trauma and the Rib Fracture Colloquium have provided statements supporting rib fixation in flail injuries. The role of rib plating for patients with non-flail rib fractures remains controversial and requires further study. Summary Surgical stabilization of rib fractures in flail injuries is supported by the evidence and should be utilized in these select patients. More evidence is needed in nonflail injuries before recommendations can be made for rib fixation. Keywords Surgical stabilization of rib fractures Á Rib plating Á Chest wall trauma Á Flail chest Á Open reduction and internal fixation This article is part of the Topical collection on Trauma Surgery.
We present a case report of laparoscopic gastrojejunostomy in a patient with gastric outlet obstr... more We present a case report of laparoscopic gastrojejunostomy in a patient with gastric outlet obstruction from unresectable cancer. We performed an intracorporeal gastrojejunostomy in a side-to-side fashion. The patient had no morbidity and minimal hospital stay.
Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology, Sep 1, 2010
Results: The governing mathematical equation for the osteobstruction in bone regeneration for the... more Results: The governing mathematical equation for the osteobstruction in bone regeneration for the S-GTR model is the partial differential equation, (ѨB ⁄ Ѩt) ϭ ٌ ⅐ (ϪD ٌ B) ϩ ((1 Ϫ 2) ⁄ (3))R(1 Ϫ (B ⁄ B ء))B where B is the bone cell concentration; the first term on the right hand side of equation (1) represents bone cell motility (migration) and the second term is the bone cell proliferation at graft site. The partial differential equation governing the D-GTR model is, (ѨB ⁄ Ѩt) ϭ ٌ ⅐ (D 2 ٌ B) ϩ R 2 (1 Ϫ (B ⁄ B ء))B ϩ ʦ ␥• where the last term on the right hand side of equation (2) represents the shock of resorption of membrane and some biochemical reactions. Conclusions: The mathematical model has been utilized to explain the events that lead to osteobstruction (a newly identified bone regeneration mechanism) in the S-GTR side of the experimental animal in comparison with the D-GTR side. It is suggested that the mathematical model be mandatory in the explanation of bone regeneration mechanisms.
IMPORTANCE Civilian public mass shootings (CPMSs) in the US result in substantial injuries. Howev... more IMPORTANCE Civilian public mass shootings (CPMSs) in the US result in substantial injuries. However, the types and consequences of these injuries have not been systematically described. OBJECTIVE To describe the injury characteristics, outcomes, and health care burden associated with nonfatal injuries sustained during CPMSs and to better understand the consequences to patients, hospitals, and society at large. DESIGN, SETTING, AND PARTICIPANTS This retrospective case series of nonfatal injuries from 13 consecutive CPMSs (defined as Ն10 injured individuals) from 31 hospitals in the US from July 20, 2012, to August 31, 2019, used data from trauma logs and medical records to capture injuries, procedures, lengths of stay, functional impairment, disposition, and charges. A total of 403 individuals treated in hospitals within 24 hours of the CPMSs were included in the analysis. Data were analyzed from October 27 to December 5, 2021. EXPOSURES Nonfatal injuries sustained during CPMSs. MAIN OUTCOMES AND MEASURES Injuries and diagnoses, treating services, procedures, hospital care, and monetary charges. RESULTS Among the 403 individuals included in the study, the median age was 33.0 (IQR, 24.5-48.0 [range, 1 to >89]) years, and 209 (51.9%) were women. Among the 386 patients with race and ethnicity data available, 13 (3.4%) were Asian; 44 (11.4%), Black or African American; 59 (15.3), Hispanic/Latinx; and 270 (69.9%), White. Injuries included 252 gunshot wounds (62.5%) and 112 other injuries (27.8%), and 39 patients (9.7%) had no physical injuries. One hundred seventy-eight individuals (53.1%) arrived by ambulance. Of 494 body regions injured (mean [SD], 1.35 [0.68] per patient), most common included an extremity (282 [57.1%]), abdomen and/or pelvis (66 [13.4%]), head and/or neck (65 [13.2%]), and chest (50 [10.1%]). Overall, 147 individuals (36.5%) were admitted to a hospital, 95 (23.6%) underwent 1 surgical procedure, and 42 (10.4%) underwent multiple procedures (1.82 per patient). Among the 252 patients with gunshot wounds, the most common initial procedures were general and trauma surgery (41 [16.3%]) and orthopedic surgery (36 [14.3%]). In the emergency department, 148 of 364 injured individuals (40.7%) had 199 procedures (1.34 per patient). Median hospital length of stay was 4.0 (IQR, 2.0-7.5) days; for 50 patients in the intensive care unit, 3.0 (IQR, 2.0-8.0) days (13.7% of injuries and 34.0% of admissions). Among 364 injured patients, 160 (44.0%) had functional disability at discharge, with 19 (13.3%) sent to longterm care. The mean (SD) charges per patient were $64 976 ($160 083).
American journal of disaster medicine, Aug 1, 2019
Background: Civilian mass shooting events (CMSE) are occurring with increased frequency. Unfortun... more Background: Civilian mass shooting events (CMSE) are occurring with increased frequency. Unfortunately, our knowledge of how to respond to these events is largely based on military experience and medical examiner data. While this translational knowledge has improved our basic response to such events, it is critical that we have a better understanding of the wound patterns observed and the resources utilized in civilian mass shootings. This will allow us to better prepare our systems for future events.Methods: Patients from two consecutive CMSEs presented to the same level 1 trauma center in Fort Lauderdale, Florida. The patients received by this center were studied for their wound patterns as well as the care they received while in the hospital. This included wound patterns and severity, subspecialty interventions, and hospitalization requirements.Results: Both events produced a total of 19 victims who were brought to the center as trauma activations. The events had a combined fatality rate of 55 percent. Fifty-five percent of patients also had at least one wound to an extremity, two with major vascular injuries who had field tourniquets applied. Sixty-three percent required an orthopedic intervention and 32 percent required intensive care unit (ICU) admission, half of these with prolonged ventilator support.Conclusions: Given the number of extremity wounds in these events, we should continue the efforts championed by the stop the bleed campaign. The variety and quantity of specialties involved in the care of these patients also highlights the importance of a multidisciplinary approach to preparation and implementation of care in mass shooting events.
Journal of Trauma-injury Infection and Critical Care, Sep 1, 1995
The purpose of this study was to evaluate the sensitivity, specificity, and predictive value of d... more The purpose of this study was to evaluate the sensitivity, specificity, and predictive value of diagnostic laparoscopy (DL) in a large group of stable patients with abdominal gunshot wounds (ABGSWs). This study was a prospective case series developed by management protocol. In a 2 1/2-year period, DL was performed in 121 consecutive patients who were hemodynamically stable with ABGSWs and met protocol criteria. This represented 18% of all patients with ABGSWs seen in this period at the Ryder Trauma Center. The evaluation was conducted to determine peritoneal violation, the presence of intra-abdominal blood, and the need for exploration. There were 42 (35%) positive and 79 (65%) negative DLs. In patients with positive DL, 39 (92.8%) had exploratory laparotomy. In this group, 32 (82%) had therapeutic laparotomy, 6 (15.4%) had nontherapeutic laparotomy, and 1 (2.5%) had a negative laparotomy. In this patient, DL was felt to be inadequate by the attending surgeon, although no penetration or intraperitoneal blood were present, and a negative laparotomy was done. This represents a failure rate of 0.8%. There were 3 (7.2%) positive DLs, in whom laparotomy was not performed. These patients had isolated nonbleeding liver injuries, and nontherapeutic laparotomy was successfully avoided. The negative DL group was divided into 47 patients (60%) with isolated ABGSWs, and 32 patients (40%) with associated injuries, mostly orthopedic and thoracic. There were no false-negative DLs and no delayed laparotomies in these 121 patients. There was no mortality in this study group. The sensitivity for peritoneal penetration was 100%, and the specificity was 98.7%. The positive predictive value was 97.6%, and the negative predictive value was 100%. In deciding on need for laparotomy (i.e., injury requiring repair), DL had a positive predictive value of 82%; more importantly, the negative predictive value was 100%. In stable patients with ABGSWs and questionable intra-abdominal injury, DL can be safely used. It is highly sensitive and specific. It can effectively reduce the incidence of negative and nontherapeutic laparotomies, and the overall morbidity and hospital stay in this group of patients.
Journal of The American College of Surgeons, Oct 1, 2016
Statistically significant (p<0.05). CONCLUSIONS: The 4-7h post-admission time-window is critical ... more Statistically significant (p<0.05). CONCLUSIONS: The 4-7h post-admission time-window is critical for hemodynamically-unstable patients. It is during this time that relative mortality at TC2 vs TC1 raises, explaining the previously-observed results. Variations in available treatment modalities may account for this difference. However, further investigation is warranted to elucidate the specific cause(s) and, thereby, reduce in-hospital mortality among hemodynamically-unstable trauma patients.
Archives of Clinical Neuropsychology, Aug 28, 2014
Objective: This study evaluates the effects of early and intensive psychological intervention on ... more Objective: This study evaluates the effects of early and intensive psychological intervention on length of hospital stay (LOS) in patients with traumatic brain injury (TBI). Method: A retrospective analysis of prospectively collected data was performed at our Urban, Level 1 Trauma Center in 83 patients admitted following TBI. Data included demographics, time to psychological consultation, total follow-up visits, mechanism of injury, injury severity score (ISS), insurance status, need for and duration of mechanical ventilation, Glascow Coma Scale (GCS), disposition, and LOS. Patients were classified as early (7 days) consults after admission or liberation from mechanical ventilation, if needed. Statistical analysis included Multiple Logistic Regression to evaluate the effect of timing and intensity of psychological intervention on LOS. Results: No baseline differences in age, gender, ISS, and insurance status were identified. For non-ventilated patients early psychological consultation and total follow-ups predicted LOS (b ¼ .29, t(35) ¼ 2.81, p , .001; R 2 ¼ .84, F(3, 32) ¼ 61.46, p , .001). In ventilated patients, intensity of psychological intervention significantly predicted LOS (b ¼ .22, t(48) ¼ 2.88, p , .001; R 2 ¼ .73, F(2, 46) ¼ 61.30, p , .001). Conclusion(s): Psychological consultation and intervention was associated with significant reduction in LOS for patients with a TBI. Specifically, early consultation in non-ventilated patients was associated with reduced LOS; and intensity of psychological consultation positively predicted LOS in ventilated patients. These results suggest a beneficial role for psychological consultations and interventions during hospitalizations for patients with TBI.
Objectives: To compare outcomes in patients with rib fractures (RFX) who underwent surgical stabi... more Objectives: To compare outcomes in patients with rib fractures (RFX) who underwent surgical stabilization of rib fractures (SSRF) to those treated nonoperatively.
The role of laparoscopy in the evaluation of abdominal trauma continues to evolve. It has been su... more The role of laparoscopy in the evaluation of abdominal trauma continues to evolve. It has been successfully used in blunt and penetrating trauma. We report our experience with diagnostic laparoscopy in 28 patients with abdominal gunshot wounds. We found a 100% accuracy and a 0% morbidity in patients with negative laparoscopy. We report a case in which laparoscopy was used to demonstrate an isolated nonbleeding liver injury due to a gunshot wound to the abdomen. Nontherapeutic laparotomy was avoided.
Background: The open abdomen technique for the treatment of diffuse peritonitis has gained accept... more Background: The open abdomen technique for the treatment of diffuse peritonitis has gained acceptance. Our approach has been to use the zipper technique with daily irrigations. Once the abdominal problem has resolved, the mesh and zipper are removed. Surgeons are reluctant to reoperate on patients with such prior treatment because of the anticipation of a hostile abdomen. Our study is a retrospective review of 12 patients who were treated with the open abdomen technique. At a later date, they underwent elective reoperation. Study design: The charts of 12 patients were reviewed. After initial injury, the patients were in the surgical intensive care unit. Reoperations were performed nine months (mean) after discharge from this facility. The reasons for reoperation were closure of enteric fistula (five patients) and closure of an ostomy (seven patients). The abdominal wall was reconstructed in nine patients. In the other three patients, the abdomen was entered through a lateral incision and the bowel was reanastomosed. Results: All of the patients survived. There were five complications. Two patients had ischemic skin grafts successfully treated by hyperbaric oxygen therapy (HBO). Two patients had ischemic skin flaps that were covering mesh. They responded to HBO with minimal slough of superficial tissue. One patient had a low output fistula that closed after two weeks of total parenteral nutrition. Conclusions: A history of an open abdomen is not a contraindication to later operation. Bowel continuity can be restored and abdominal wall reconstruction can be performed safely. This can be done as early as three to four months after recovery from the original injury.
Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology, Aug 1, 2008
Material and Methods: A survey constructed from five definitions of centric relation (CR) as prov... more Material and Methods: A survey constructed from five definitions of centric relation (CR) as provided from the glossary of prosthodontic terms was sent to the chairmen of every oral and maxillofacial surgery and orthodontic program in the U.S. Only full time faculty from each program were asked to respond to the survey. The different responses were analyzed statistically by chi square analysis. Results: Seventy-three responses were obtained from the oral and maxillofacial surgeons and 64 from the orthodontists. There were 69 different programs represented in this survey. Orthodontists and surgeons had a significantly different response regarding the definition of centric relation (chi-squareϭ 28, dfϭ 4, p-valueϽ 0.0001). There was no difference between the two groups on the need for mounting models in centric relation for use in orthognathic surgery (chi-squareϭ 1, p-valueϾ 0.6). Regarding the definition of centric occlusion, there was a significant difference between orthodontists and surgeons (chi-squareϭ 9.9, dfϭ 1, p-valueϭ 0.0070). The fourth and fifth questions had to do with CR/CO slide and the direction of movement. There was a significant difference between the two groups regarding mandibular movement (chisquareϭ 28, dfϭ 2, p-valueϽ 0.0001). Surgeons were nearly unanimous in their opinion that the mandible would move anteriorly (88%), whereas there was more discordance among orthodontists. Within the orthodontic group, 50% indicated anterior movement and 47% indicated that either an anterior or posterior movement could occur. The surgeons were asked one additional question which the orthodontists were not. Forty-nine percent of the surgeons indicated that during a BSSO the proximal segment should be seated vertically and posteriorly prior to rigid fixation. Conclusion: The results of this study show there is a statistical lack of consistency amongst practitioners regarding an absolute definition of centric relation as it relates to orthognathic surgery. The inconsistency exists between specialties and within practitioners in each specialty.
Purpose of Review Surgical stabilization of rib fractures (aka rib plating) is underutilized, par... more Purpose of Review Surgical stabilization of rib fractures (aka rib plating) is underutilized, partly due to a perceived lack of evidence of benefit and unfamiliarity with the operation. The goal of this review is to identify and summarize the evidence surrounding surgical stabilization of chest wall injury in flail and non-flail injury patterns and highlight the limitations of our current knowledge. Recent Findings Recent meta-analyses and prior trials have provided evidence that rib fixation in flail chest injuries decreases the need for mechanical ventilation, decreases risk of pneumonia, and decreases mortality. Additionally, the Eastern Association for the Surgery of Trauma and the Rib Fracture Colloquium have provided statements supporting rib fixation in flail injuries. The role of rib plating for patients with non-flail rib fractures remains controversial and requires further study. Summary Surgical stabilization of rib fractures in flail injuries is supported by the evidence and should be utilized in these select patients. More evidence is needed in nonflail injuries before recommendations can be made for rib fixation. Keywords Surgical stabilization of rib fractures Á Rib plating Á Chest wall trauma Á Flail chest Á Open reduction and internal fixation This article is part of the Topical collection on Trauma Surgery.
We present a case report of laparoscopic gastrojejunostomy in a patient with gastric outlet obstr... more We present a case report of laparoscopic gastrojejunostomy in a patient with gastric outlet obstruction from unresectable cancer. We performed an intracorporeal gastrojejunostomy in a side-to-side fashion. The patient had no morbidity and minimal hospital stay.
Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology, Sep 1, 2010
Results: The governing mathematical equation for the osteobstruction in bone regeneration for the... more Results: The governing mathematical equation for the osteobstruction in bone regeneration for the S-GTR model is the partial differential equation, (ѨB ⁄ Ѩt) ϭ ٌ ⅐ (ϪD ٌ B) ϩ ((1 Ϫ 2) ⁄ (3))R(1 Ϫ (B ⁄ B ء))B where B is the bone cell concentration; the first term on the right hand side of equation (1) represents bone cell motility (migration) and the second term is the bone cell proliferation at graft site. The partial differential equation governing the D-GTR model is, (ѨB ⁄ Ѩt) ϭ ٌ ⅐ (D 2 ٌ B) ϩ R 2 (1 Ϫ (B ⁄ B ء))B ϩ ʦ ␥• where the last term on the right hand side of equation (2) represents the shock of resorption of membrane and some biochemical reactions. Conclusions: The mathematical model has been utilized to explain the events that lead to osteobstruction (a newly identified bone regeneration mechanism) in the S-GTR side of the experimental animal in comparison with the D-GTR side. It is suggested that the mathematical model be mandatory in the explanation of bone regeneration mechanisms.
IMPORTANCE Civilian public mass shootings (CPMSs) in the US result in substantial injuries. Howev... more IMPORTANCE Civilian public mass shootings (CPMSs) in the US result in substantial injuries. However, the types and consequences of these injuries have not been systematically described. OBJECTIVE To describe the injury characteristics, outcomes, and health care burden associated with nonfatal injuries sustained during CPMSs and to better understand the consequences to patients, hospitals, and society at large. DESIGN, SETTING, AND PARTICIPANTS This retrospective case series of nonfatal injuries from 13 consecutive CPMSs (defined as Ն10 injured individuals) from 31 hospitals in the US from July 20, 2012, to August 31, 2019, used data from trauma logs and medical records to capture injuries, procedures, lengths of stay, functional impairment, disposition, and charges. A total of 403 individuals treated in hospitals within 24 hours of the CPMSs were included in the analysis. Data were analyzed from October 27 to December 5, 2021. EXPOSURES Nonfatal injuries sustained during CPMSs. MAIN OUTCOMES AND MEASURES Injuries and diagnoses, treating services, procedures, hospital care, and monetary charges. RESULTS Among the 403 individuals included in the study, the median age was 33.0 (IQR, 24.5-48.0 [range, 1 to >89]) years, and 209 (51.9%) were women. Among the 386 patients with race and ethnicity data available, 13 (3.4%) were Asian; 44 (11.4%), Black or African American; 59 (15.3), Hispanic/Latinx; and 270 (69.9%), White. Injuries included 252 gunshot wounds (62.5%) and 112 other injuries (27.8%), and 39 patients (9.7%) had no physical injuries. One hundred seventy-eight individuals (53.1%) arrived by ambulance. Of 494 body regions injured (mean [SD], 1.35 [0.68] per patient), most common included an extremity (282 [57.1%]), abdomen and/or pelvis (66 [13.4%]), head and/or neck (65 [13.2%]), and chest (50 [10.1%]). Overall, 147 individuals (36.5%) were admitted to a hospital, 95 (23.6%) underwent 1 surgical procedure, and 42 (10.4%) underwent multiple procedures (1.82 per patient). Among the 252 patients with gunshot wounds, the most common initial procedures were general and trauma surgery (41 [16.3%]) and orthopedic surgery (36 [14.3%]). In the emergency department, 148 of 364 injured individuals (40.7%) had 199 procedures (1.34 per patient). Median hospital length of stay was 4.0 (IQR, 2.0-7.5) days; for 50 patients in the intensive care unit, 3.0 (IQR, 2.0-8.0) days (13.7% of injuries and 34.0% of admissions). Among 364 injured patients, 160 (44.0%) had functional disability at discharge, with 19 (13.3%) sent to longterm care. The mean (SD) charges per patient were $64 976 ($160 083).
American journal of disaster medicine, Aug 1, 2019
Background: Civilian mass shooting events (CMSE) are occurring with increased frequency. Unfortun... more Background: Civilian mass shooting events (CMSE) are occurring with increased frequency. Unfortunately, our knowledge of how to respond to these events is largely based on military experience and medical examiner data. While this translational knowledge has improved our basic response to such events, it is critical that we have a better understanding of the wound patterns observed and the resources utilized in civilian mass shootings. This will allow us to better prepare our systems for future events.Methods: Patients from two consecutive CMSEs presented to the same level 1 trauma center in Fort Lauderdale, Florida. The patients received by this center were studied for their wound patterns as well as the care they received while in the hospital. This included wound patterns and severity, subspecialty interventions, and hospitalization requirements.Results: Both events produced a total of 19 victims who were brought to the center as trauma activations. The events had a combined fatality rate of 55 percent. Fifty-five percent of patients also had at least one wound to an extremity, two with major vascular injuries who had field tourniquets applied. Sixty-three percent required an orthopedic intervention and 32 percent required intensive care unit (ICU) admission, half of these with prolonged ventilator support.Conclusions: Given the number of extremity wounds in these events, we should continue the efforts championed by the stop the bleed campaign. The variety and quantity of specialties involved in the care of these patients also highlights the importance of a multidisciplinary approach to preparation and implementation of care in mass shooting events.
Journal of Trauma-injury Infection and Critical Care, Sep 1, 1995
The purpose of this study was to evaluate the sensitivity, specificity, and predictive value of d... more The purpose of this study was to evaluate the sensitivity, specificity, and predictive value of diagnostic laparoscopy (DL) in a large group of stable patients with abdominal gunshot wounds (ABGSWs). This study was a prospective case series developed by management protocol. In a 2 1/2-year period, DL was performed in 121 consecutive patients who were hemodynamically stable with ABGSWs and met protocol criteria. This represented 18% of all patients with ABGSWs seen in this period at the Ryder Trauma Center. The evaluation was conducted to determine peritoneal violation, the presence of intra-abdominal blood, and the need for exploration. There were 42 (35%) positive and 79 (65%) negative DLs. In patients with positive DL, 39 (92.8%) had exploratory laparotomy. In this group, 32 (82%) had therapeutic laparotomy, 6 (15.4%) had nontherapeutic laparotomy, and 1 (2.5%) had a negative laparotomy. In this patient, DL was felt to be inadequate by the attending surgeon, although no penetration or intraperitoneal blood were present, and a negative laparotomy was done. This represents a failure rate of 0.8%. There were 3 (7.2%) positive DLs, in whom laparotomy was not performed. These patients had isolated nonbleeding liver injuries, and nontherapeutic laparotomy was successfully avoided. The negative DL group was divided into 47 patients (60%) with isolated ABGSWs, and 32 patients (40%) with associated injuries, mostly orthopedic and thoracic. There were no false-negative DLs and no delayed laparotomies in these 121 patients. There was no mortality in this study group. The sensitivity for peritoneal penetration was 100%, and the specificity was 98.7%. The positive predictive value was 97.6%, and the negative predictive value was 100%. In deciding on need for laparotomy (i.e., injury requiring repair), DL had a positive predictive value of 82%; more importantly, the negative predictive value was 100%. In stable patients with ABGSWs and questionable intra-abdominal injury, DL can be safely used. It is highly sensitive and specific. It can effectively reduce the incidence of negative and nontherapeutic laparotomies, and the overall morbidity and hospital stay in this group of patients.
Journal of The American College of Surgeons, Oct 1, 2016
Statistically significant (p<0.05). CONCLUSIONS: The 4-7h post-admission time-window is critical ... more Statistically significant (p<0.05). CONCLUSIONS: The 4-7h post-admission time-window is critical for hemodynamically-unstable patients. It is during this time that relative mortality at TC2 vs TC1 raises, explaining the previously-observed results. Variations in available treatment modalities may account for this difference. However, further investigation is warranted to elucidate the specific cause(s) and, thereby, reduce in-hospital mortality among hemodynamically-unstable trauma patients.
Archives of Clinical Neuropsychology, Aug 28, 2014
Objective: This study evaluates the effects of early and intensive psychological intervention on ... more Objective: This study evaluates the effects of early and intensive psychological intervention on length of hospital stay (LOS) in patients with traumatic brain injury (TBI). Method: A retrospective analysis of prospectively collected data was performed at our Urban, Level 1 Trauma Center in 83 patients admitted following TBI. Data included demographics, time to psychological consultation, total follow-up visits, mechanism of injury, injury severity score (ISS), insurance status, need for and duration of mechanical ventilation, Glascow Coma Scale (GCS), disposition, and LOS. Patients were classified as early (7 days) consults after admission or liberation from mechanical ventilation, if needed. Statistical analysis included Multiple Logistic Regression to evaluate the effect of timing and intensity of psychological intervention on LOS. Results: No baseline differences in age, gender, ISS, and insurance status were identified. For non-ventilated patients early psychological consultation and total follow-ups predicted LOS (b ¼ .29, t(35) ¼ 2.81, p , .001; R 2 ¼ .84, F(3, 32) ¼ 61.46, p , .001). In ventilated patients, intensity of psychological intervention significantly predicted LOS (b ¼ .22, t(48) ¼ 2.88, p , .001; R 2 ¼ .73, F(2, 46) ¼ 61.30, p , .001). Conclusion(s): Psychological consultation and intervention was associated with significant reduction in LOS for patients with a TBI. Specifically, early consultation in non-ventilated patients was associated with reduced LOS; and intensity of psychological consultation positively predicted LOS in ventilated patients. These results suggest a beneficial role for psychological consultations and interventions during hospitalizations for patients with TBI.
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