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Article ; Online: Response to letter to the editor.

Santorelli, Jarrett E / Chau, Harrison / Godat, Laura / Casola, Giovanna / Doucet, Jay J / Costantini, Todd W

The journal of trauma and acute care surgery

2022 Volume 93, Issue 1, Page(s) e44–e45

Language	English
Publishing date	2022-03-14
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	2651070-4
ISSN	2163-0763 ; 2163-0755
ISSN (online)	2163-0763
ISSN	2163-0755
DOI	10.1097/TA.0000000000003601
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Author reply: Not so FAST-chest ultrasound underdiagnoses traumatic pneumothorax.

Santorelli, Jarrett E / Chau, Harrison / Godat, Laura / Casola, Giovanna / Doucet, Jay J / Costantini, Todd W

The journal of trauma and acute care surgery

2022 Volume 93, Issue 1, Page(s) e43

MeSH term(s)	Humans ; Pneumothorax/diagnostic imaging ; Thoracic Injuries/complications ; Thoracic Injuries/diagnostic imaging ; Ultrasonography
Language	English
Publishing date	2022-04-01
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	2651070-4
ISSN	2163-0763 ; 2163-0755
ISSN (online)	2163-0763
ISSN	2163-0755
DOI	10.1097/TA.0000000000003617
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Article ; Online: Response to Letter to the Editor: Not so FAST-chest ultrasound underdiagnoses traumatic pneumothorax.

Santorelli, Jarrett E / Chau, Harrison / Godat, Laura / Casola, Giovanna / Doucet, Jay J / Costantini, Todd W

The journal of trauma and acute care surgery

2022 Volume 93, Issue 1, Page(s) e41

MeSH term(s)	Humans ; Pneumothorax/diagnostic imaging ; Thoracic Injuries/complications ; Thoracic Injuries/diagnostic imaging ; Ultrasonography
Language	English
Publishing date	2022-04-01
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	2651070-4
ISSN	2163-0763 ; 2163-0755
ISSN (online)	2163-0763
ISSN	2163-0755
DOI	10.1097/TA.0000000000003600
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Zs.A 127: Show issues

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Article ; Online: Response to letter to the editor original article: Not so FAST-chest ultrasound underdiagnoses traumatic pneumothorax.

Santorelli, Jarrett E / Chau, Harrison / Godat, Laura / Casola, Giovanna / Doucet, Jay J / Costantini, Todd W

The journal of trauma and acute care surgery

2022 Volume 93, Issue 6, Page(s) e187–e188

MeSH term(s)	Humans ; Pneumothorax/diagnostic imaging ; Thoracic Injuries/complications ; Thoracic Injuries/diagnostic imaging ; Ultrasonography
Language	English
Publishing date	2022-08-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	2651070-4
ISSN	2163-0763 ; 2163-0755
ISSN (online)	2163-0763
ISSN	2163-0755
DOI	10.1097/TA.0000000000003761
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Zs.A 127: Show issues

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Article ; Online: Patient-centered outcomes research and the injured patient: a summary of application.

Godat, Laura N / Jensen, Aaron R / Stein, Deborah M

Trauma surgery & acute care open

2020 Volume 5, Issue 1, Page(s) e000422

Abstract: As trauma surgeons, we focus on the immediate care and needs of the injured patient every day. Historically, trauma and injury research has focused on outcomes such as mortality, complications, and length of stay; and process metrics such as time to CT ... ...

Abstract	As trauma surgeons, we focus on the immediate care and needs of the injured patient every day. Historically, trauma and injury research has focused on outcomes such as mortality, complications, and length of stay; and process metrics such as time to CT scan, resuscitation checklist frequencies, or venous thromboembolism prophylaxis rates. These outcomes are perceived by healthcare providers to be important, but patients likely have different perceptions of what outcomes are most important to measure and improve. True patient-centered outcomes research involves the healthcare providers, and the entire team of stakeholders including patients and the community. Understanding the process of stakeholder engagement and the barriers trauma researchers must overcome to effectively enter this field of research is important. This summary aims to inform the trauma research community on the basics of patient-centered outcomes research, priorities for funding from the Patient-Centered Outcomes Research Institute, resources for collaboration around patient-centered outcomes research, and a unique career development and training opportunity for early career trauma surgeons to develop a skill set in patient-centered outcomes research.
Language	English
Publishing date	2020-02-04
Publishing country	England
Document type	Journal Article ; Review
ISSN	2397-5776
ISSN (online)	2397-5776
DOI	10.1136/tsaco-2019-000422
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Emergency General Surgery and the Gallbladder: The Affordable Care Act's Impact on Practice Patterns.

Godat, Laura N / Costantini, Todd W / Doucet, Jay J

The Journal of surgical research

2020 Volume 257, Page(s) 356–362

Abstract: Background: Gallbladder disease frequently requires emergency general surgery (EGS). The Affordable Care Act (ACA) mandated health insurance coverage for all with the intent to improve access to care and decrease morbidity, mortality, and costs. We ... ...

Abstract	Background: Gallbladder disease frequently requires emergency general surgery (EGS). The Affordable Care Act (ACA) mandated health insurance coverage for all with the intent to improve access to care and decrease morbidity, mortality, and costs. We hypothesize that after the ACA open-enrollment in 2014 the number of EGS cholecystectomies decreased as access to care improved with a shift in EGS cholecystectomies to teaching institutions. Methods: A retrospective review of the National Inpatient Sample Database from 2012 to quarter 3 of 2015 was performed. Patients age 18-64, with a nonelective admission for gallbladder disease based on ICD-9 codes, were collected. Outcomes measured included cholecystectomy, complications, mortality, and wage index-adjusted costs. The effect of the ACA was determined by comparing preACA to postACA years. Results: 189,023 patients were identified. In the postACA period the payer distribution for admissions decreased for Self-pay (19.3% to 13.6%, P < 0.001), Medicaid increased (26.3% to 34.0%, P < 0.001) and Private insurance was unchanged (48.6% to 48.7%, P = 0.946). PostACA, admissions to teaching hospitals increased across all payer types, EGS cholecystectomies decreased, while complications increased, and mortality was unchanged. Median costs increased significantly for Medicaid and Private insurance while Self-pay was unchanged. Based on adjusted DID analyses for Insured compared to Self-pay patients, EGS cholecystectomies decreased (-2.7% versus -1.21%, P = 0.033) and median cost increased more rapidly (+$625 versus +$166, P = 0.017). Conclusions: The ACA has changed EGS, shifting the majority of patients to teaching institutions despite insurance type and decreasing the need for EGS cholecystectomy. The trend toward higher complication rate with increased overall cost requires attention.
MeSH term(s)	Adult ; Cholecystectomy/statistics & numerical data ; Emergency Treatment/statistics & numerical data ; Female ; Hospitals, Teaching/statistics & numerical data ; Humans ; Male ; Middle Aged ; Patient Protection and Affordable Care Act ; Postoperative Complications/epidemiology ; Practice Patterns, Physicians'/statistics & numerical data ; United States/epidemiology
Language	English
Publishing date	2020-09-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	80170-7
ISSN	1095-8673 ; 0022-4804
ISSN (online)	1095-8673
ISSN	0022-4804
DOI	10.1016/j.jss.2020.08.013
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Zs.A 178: Show issues

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Article ; Online: Predictors of Readmission Following Treatment for Traumatic Hemothorax.

Kirchberg, Tyler N / Costantini, Todd W / Santorelli, Jarrett / Doucet, Jay J / Godat, Laura N

The Journal of surgical research

2022 Volume 277, Page(s) 365–371

Abstract: Introduction: Retained-hemothorax after trauma can be associated with prolonged hospitalization, empyema, pneumonia, readmission, and the need for additional intervention. The purpose of this study is to reduce patient morbidity associated with retained- ...

Abstract	Introduction: Retained-hemothorax after trauma can be associated with prolonged hospitalization, empyema, pneumonia, readmission, and the need for additional intervention. The purpose of this study is to reduce patient morbidity associated with retained-hemothorax by defining readmission rates and identifying predictors of readmission after traumatic hemothorax. Methods: The Nationwide Readmission Database for 2017 was queried for patients with an index admission for traumatic hemothorax during the first 9 mo of the year. Deaths during the index admission were excluded. Data collected includes demographics, injury mechanism, outcomes and interventions including chest tube, video-assisted thoracoscopic surgery, and thoracotomy. Chest-related readmissions (CRR) were defined as hemothorax, pleural effusion, pyothorax, and lung abscess. Univariate and multivariate analysis were used to identify predictors of readmission. Results: There were 13,903 patients admitted during the study period with a mean age of 53 ± 21, 75.2% were admitted after blunt versus 18.3% penetrating injury. The overall 90-day readmission rate was 20.8% (n = 2896). The 90-day CRR rate was 5.7% (n = 794), with 80.5% of these occurring within 30 d. Of all CRR, 62.3% (n = 495) required an intervention (chest tube 72.7%, Thoracotomy 26.9%, video-assisted thoracoscopic surgery 0.4%). Mortality for CRR was 6.2%. Predictors for CRR were age >50, pyothorax or pleural effusion during the index admission and discharge to another healthcare facility or skilled nursing facility. Conclusions: Majority of CRR after traumatic hemothorax occur within 30 d of discharge and frequently require invasive intervention. These findings can be used to improve post discharge follow-up and monitoring.
MeSH term(s)	Aftercare ; Empyema, Pleural/complications ; Hemothorax/epidemiology ; Hemothorax/etiology ; Hemothorax/therapy ; Humans ; Patient Discharge ; Patient Readmission ; Pleural Effusion/epidemiology ; Pleural Effusion/etiology ; Pleural Effusion/therapy ; Retrospective Studies ; Thoracic Injuries/surgery ; Thoracic Injuries/therapy
Language	English
Publishing date	2022-05-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	80170-7
ISSN	1095-8673 ; 0022-4804
ISSN (online)	1095-8673
ISSN	0022-4804
DOI	10.1016/j.jss.2022.04.031
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Zs.A 178: Show issues

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Article ; Online: Venous thromboembolism risk after spinal cord injury: A secondary analysis of the CLOTT study.

Godat, Laura N / Haut, Elliott R / Moore, Ernest E / Knudson, M Margaret / Costantini, Todd W

The journal of trauma and acute care surgery

2022 Volume 94, Issue 1, Page(s) 23–29

Abstract: Introduction: Patients with spinal cord injury (SCI) are at high risk of venous thromboembolism (VTE). Pharmacologic VTE prophylaxis (VTEppx) is frequently delayed in patients with SCI because of concerns for bleeding risk. Here, we hypothesized that ... ...

Abstract	Introduction: Patients with spinal cord injury (SCI) are at high risk of venous thromboembolism (VTE). Pharmacologic VTE prophylaxis (VTEppx) is frequently delayed in patients with SCI because of concerns for bleeding risk. Here, we hypothesized that delaying VTEppx until >48 hours would be associated with increased risk of thrombotic events. Methods: This is a secondary analysis of the 2018 to 2020 prospective, observational, cohort Consortium of Leaders in the Study of Traumatic Thromboembolism (CLOTT) study of patients aged 18 to 40 years, at 17 US level 1 trauma centers. Patients admitted for >48 hours with documented SCI were evaluated. Timing of initiation of VTEppx, rates of thrombotic events (deep vein thrombosis [DVT] and pulmonary embolism [PE]), and missed VTEppx doses were analyzed. The primary outcome was VTE (DVT + PE). Results: There were 343 patients with SCI. The mean ± SD age was 29.0 ± 6.6 years, 77.3% were male, and 78.7% sustained blunt mechanism. Thrombotic events occurred in 33 patients (9.6%): 30 DVTs (8.7%) and 3 PEs (0.9%). Venous thromboembolism prophylaxis started at ≤24 hours in 21.3% of patients and 49.3% at ≤48 hours. The rate of VTE for patients started on VTEppx ≤48 hours was 7.1% versus 12.1% if started after 48 hours ( p = 0.119). After adjusting for differences in risk factors between cohorts, starting ≤48 hours was independently associated with fewer VTEs (odds ratio, 0.45; 95% confidence interval, 0.101-0.978; p = 0.044). Unfractionated heparin was associated with a VTE rate of 21.0% versus 7.5% in those receiving enoxaparin as prophylaxis ( p = 0.003). Missed doses of VTEppx were common (29.7%) and associated with increased thrombotic events, although this was not significant on multivariate analysis. Conclusion: Rates of thrombotic events in patients with SCI are high. Prompt initiation of VTEppx with enoxaparin and efforts aimed at avoiding missed doses are critical to limit thrombotic events in these high-risk patients. Level of evidence: Prognostic and Epidemiological; Level IV.
MeSH term(s)	Humans ; Male ; Female ; Venous Thromboembolism/epidemiology ; Venous Thromboembolism/etiology ; Venous Thromboembolism/prevention & control ; Heparin/therapeutic use ; Enoxaparin/therapeutic use ; Prospective Studies ; Anticoagulants/therapeutic use ; Spinal Cord Injuries/complications ; Pulmonary Embolism/epidemiology ; Pulmonary Embolism/etiology ; Pulmonary Embolism/prevention & control ; Risk Factors
Chemical Substances	Heparin (9005-49-6) ; Enoxaparin ; Anticoagulants
Language	English
Publishing date	2022-10-07
Publishing country	United States
Document type	Observational Study ; Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	2651070-4
ISSN	2163-0763 ; 2163-0755
ISSN (online)	2163-0763
ISSN	2163-0755
DOI	10.1097/TA.0000000000003807
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Article ; Online: Association of 30-ft US-Mexico Border Wall in San Diego With Increased Migrant Deaths, Trauma Center Admissions, and Injury Severity.

Liepert, Amy E / Berndtson, Allison E / Hill, Linda L / Weaver, Jessica L / Godat, Laura N / Costantini, Todd W / Doucet, Jay J

JAMA surgery

2022 Volume 157, Issue 7, Page(s) 633–635

MeSH term(s)	California ; Humans ; Mexico/epidemiology ; Substance Abuse, Intravenous ; Transients and Migrants ; Trauma Centers
Language	English
Publishing date	2022-04-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	2701841-6
ISSN	2168-6262 ; 2168-6254
ISSN (online)	2168-6262
ISSN	2168-6254
DOI	10.1001/jamasurg.2022.1885
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Article ; Online: Repeat head computed tomography for anticoagulated patients with an initial negative scan is not cost-effective.

Borst, Johanna / Godat, Laura N / Berndtson, Allison E / Kobayashi, Leslie / Doucet, Jay J / Costantini, Todd W

Surgery

2021 Volume 170, Issue 2, Page(s) 623–627

Abstract: Background: Patients on antithrombotic medications presenting with blunt trauma are at risk for delayed intracranial hemorrhage. We hypothesized that clinically significant delayed intracranial hemorrhage is rare in patients presenting on antithrombotic ...

Abstract	Background: Patients on antithrombotic medications presenting with blunt trauma are at risk for delayed intracranial hemorrhage. We hypothesized that clinically significant delayed intracranial hemorrhage is rare in patients presenting on antithrombotic medications and therefore routine, repeat head computed tomography imaging is not a cost-effective practice to monitor for delayed intracranial hemorrhage. Methods: Patients presenting to our institution on antithrombotic (anticoagulant and antiplatelet) medications during a 5-y period from January 2014 through March 2019 who underwent a head computed tomography for blunt trauma were identified in our trauma registry. Patients with an initial negative head computed tomography underwent repeat imaging 6 h after their initial head computed tomography. Patient demographics, antithrombotic medication, international normalized ratio, Glasgow Coma Score, clinical change in neurologic status, and need for neurosurgical intervention were collected. Results: Our institution evaluated 1,676 patients on antithrombotic therapy with blunt trauma. The initial head computed tomography was negative in 1,377 patients (82.0%). Of those with an initial negative head computed tomography, 12 patients (0.9%) developed an intracranial hemorrhage that was identified on the second head computed tomography. Delayed intracranial hemorrhage included 6 patients with intraventricular hemorrhage, 3 with subdural hematoma, 2 with subarachnoid hemorrhage, and 1 with an intraparenchymal hemorrhage. None of the patients with delayed intracranial hemorrhage developed a change in neurologic status, required an intracranial pressure monitor, or underwent neurosurgical intervention. The estimated total direct cost of the negative head computed tomography scans was $926,247. Conclusion: Clinically significant delayed intracranial hemorrhage is rare in trauma patients on antithrombotic therapy, with an initial negative head computed tomography. Routine repeat head computed tomography imaging in patients with a negative scan on admission is not cost-effective.
MeSH term(s)	Aged ; Aged, 80 and over ; Anticoagulants/therapeutic use ; Cost-Benefit Analysis ; Female ; Head Injuries, Closed/complications ; Head Injuries, Closed/diagnostic imaging ; Humans ; Intracranial Hemorrhages/diagnostic imaging ; Intracranial Hemorrhages/epidemiology ; Male ; Middle Aged ; Platelet Aggregation Inhibitors/therapeutic use ; Retrospective Studies ; Time Factors ; Tomography, X-Ray Computed/economics
Chemical Substances	Anticoagulants ; Platelet Aggregation Inhibitors
Language	English
Publishing date	2021-03-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	202467-6
ISSN	1532-7361 ; 0039-6060
ISSN (online)	1532-7361
ISSN	0039-6060
DOI	10.1016/j.surg.2021.02.024
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