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  1. Article ; Online: Increased Lengths of Stay, ICU, and Ventilator Days in Trauma Patients with Asymptomatic COVID-19 Infection.

    Klutts, Garrett N / Squires, Austin / Bowman, Stephen M / Bhavaraju, Avi / Kalkwarf, Kyle J

    The American surgeon

    2022  Volume 88, Issue 7, Page(s) 1522–1525

    Abstract: Background: The SARS-Cov-2 coronavirus has varying clinical effects-from asymptomatic patients to life-threatening illness and death. At the only Level 1 Trauma Center in a rural state, outcomes appeared worse in trauma patients who tested positive for ... ...

    Abstract Background: The SARS-Cov-2 coronavirus has varying clinical effects-from asymptomatic patients to life-threatening illness and death. At the only Level 1 Trauma Center in a rural state, outcomes appeared worse in trauma patients who tested positive for COVID despite these patients presumably being asymptomatic or only mildly affected before their traumatic event. This study compares all trauma admissions that were COVID-positive to those who were not.
    Methods: The institutional database was queried for all level 1 and 2 trauma activations from March 2020-July 2021. The analysis consisted of a multivariate regression between COVID-negative and the COVID-positive group controlling for age, injury severity score (ISS), and Glasgow Coma Score (GCS). Outcomes compared were hospital length-of-stay (LOS), ICU LOS, ventilator days, days to discharge to a facility, and in-hospital mortality.
    Results: Hospital LOS was 2.7 days longer in the COVID-positive group (
    Conclusion: Trauma patients presenting positive for COVID-19 are presumed to be asymptomatic before their traumatic event. Despite this, the physiologic toll of trauma combined with the COVID infection causes significantly worse clinical outcomes, including increasing hospital days in this patient population, which continues to tax the already burdened healthcare system.
    MeSH term(s) COVID-19/therapy ; Humans ; Intensive Care Units ; Length of Stay ; Retrospective Studies ; SARS-CoV-2 ; Trauma Centers ; Ventilators, Mechanical
    Language English
    Publishing date 2022-04-13
    Publishing country United States
    Document type Journal Article
    ZDB-ID 202465-2
    ISSN 1555-9823 ; 0003-1348
    ISSN (online) 1555-9823
    ISSN 0003-1348
    DOI 10.1177/00031348221082290
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Are Chest Radiographs or Ultrasound More Accurate in Predicting a Pneumothorax or Need for a Thoracostomy Tube in Trauma Patients?

    DeLoach, Joseph P / Reif, Rebecca J / Smedley, Westin A / Klutts, Garrett N / Bhavaraju, Avi / Collins, Terry H / Kalkwarf, Kyle J

    The American surgeon

    2023  Volume 89, Issue 9, Page(s) 3751–3756

    Abstract: Background: Historically, chest radiographs (CXR) have been used to quickly diagnose pneumothorax (PTX) and hemothorax in trauma patients. Over the last 2 decades, chest ultrasound (CUS) as part of Extended Focused Assessment with Sonography in Trauma ( ... ...

    Abstract Background: Historically, chest radiographs (CXR) have been used to quickly diagnose pneumothorax (PTX) and hemothorax in trauma patients. Over the last 2 decades, chest ultrasound (CUS) as part of Extended Focused Assessment with Sonography in Trauma (eFAST) has also become accepted as a modality for the early diagnosis of PTX in trauma patients.
    Methods: We queried our institution's trauma databases for all trauma team activations from 2021 for patients with eFAST results. Demographics, injury variables, and the following were collected: initial eFAST CUS, CXR, computed tomography (CT) scan, and thoracostomy tube procedure notes. We then compared PTX detection rates on initial CXR and CUS to those on thoracic CT scans.
    Results: 580 patients were included in the analysis after excluding patients without a chest CT scan within 2 hours of arrival. Extended Focused Assessment with Sonography in Trauma was 68.4% sensitive and 87.5% specific for detecting a moderate-to-large PTX on chest CT, while CXR was 23.5% sensitive and 86.3% specific. Extended Focused Assessment with Sonography in Trauma was 69.8% sensitive for predicting the need for tube thoracostomy, while CXR was 40.0% sensitive.
    Discussion: At our institution, eFAST CUS was superior to CXR for diagnosing the presence of a PTX and predicting the need for a thoracostomy tube. However, neither test is accurate enough to diagnose a PTX nor predict if the patient will require a thoracostomy tube. Based on the specificity of both tests, a negative CXR or eFAST means there is a high probability that the patient does not have a PTX and will not need a chest tube.
    MeSH term(s) Humans ; Chest Tubes ; Pneumothorax/diagnostic imaging ; Pneumothorax/etiology ; Pneumothorax/surgery ; Thoracostomy ; Radiography ; Ultrasonography/methods ; Thoracic Injuries/complications ; Thoracic Injuries/diagnostic imaging ; Retrospective Studies
    Language English
    Publishing date 2023-05-12
    Publishing country United States
    Document type Journal Article
    ZDB-ID 202465-2
    ISSN 1555-9823 ; 0003-1348
    ISSN (online) 1555-9823
    ISSN 0003-1348
    DOI 10.1177/00031348231175105
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Geospatial Analysis of Prehospital Triage and Early Potential Preventable Traumatic Deaths.

    Klutts, Garrett N / Kalkwarf, Kyle J / Yang, Yijiong / Gill, Joseph P / Wade, Charles E / Persse, David / Wolf, Dwayne A / Deloach, Joe P / Smedley, Weston A / Corbin, Seana L / Schulz, Kevin / Tabor, Jeff / Bhavaraju, Avi / Drake, Stacy

    The American surgeon

    2023  Volume 89, Issue 7, Page(s) 3322–3324

    Abstract: Severely injured patients often depend on prompt prehospital triage for survival. This study aimed to examine the under-triage of preventable or potentially preventable traumatic deaths. A retrospective review of Harris County, TX, revealed 1848 deaths ... ...

    Abstract Severely injured patients often depend on prompt prehospital triage for survival. This study aimed to examine the under-triage of preventable or potentially preventable traumatic deaths. A retrospective review of Harris County, TX, revealed 1848 deaths within 24 hours of injury, with 186 being preventable or potentially preventable (P/PP). The analysis evaluated the geospatial relationship between each death and the receiving hospital. Out of the 186 P/PP deaths, these were more commonly male, minority, and penetrating mechanisms when compared with NP deaths. Of the 186 PP/P, 97 patients were transported to hospital care, 35 (36%) were transported to Level III, IV, or non-designated hospitals. Geospatial analysis revealed an association between the location of initial injury and proximity to receiving Level III, IV, and non-designated centers. Geospatial analysis supports proximity to the nearest hospital as one of the primary reasons for under-triage.
    MeSH term(s) Humans ; Male ; Triage ; Emergency Medical Services ; Trauma Centers ; Hospitals ; Retrospective Studies ; Wounds and Injuries/therapy
    Language English
    Publishing date 2023-02-17
    Publishing country United States
    Document type Journal Article
    ZDB-ID 202465-2
    ISSN 1555-9823 ; 0003-1348
    ISSN (online) 1555-9823
    ISSN 0003-1348
    DOI 10.1177/00031348231157910
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Increases in Violence and Changes in Trauma Admissions During the COVID Quarantine.

    Klutts, Garrett N / Deloach, Joe / McBain, Sacha A / Jensen, Hanna / Sexton, Kevin W / Kalkwarf, Kyle J / Karim, Saleema / Bhavaraju, Avi

    The American surgeon

    2021  Volume 88, Issue 3, Page(s) 356–359

    Abstract: Background: The COVID-19 pandemic caused an abrupt change to societal norms. We anecdotally noticed an increase in penetrating and violent trauma during the period of stay-at-home orders. Studying these changes will allow trauma centers to better ... ...

    Abstract Background: The COVID-19 pandemic caused an abrupt change to societal norms. We anecdotally noticed an increase in penetrating and violent trauma during the period of stay-at-home orders. Studying these changes will allow trauma centers to better prepare for future waves of COVID-19 or other global catastrophes.
    Methods: We queried our institutional database for all level 1 and 2 trauma activations presenting from the scene within our local county from March 18 to May 21, 2020 and matched time periods from 2016 to 2019. Primary outcomes were overall trauma volume, rates of penetrating trauma, rates of violent trauma, and transfusion requirements.
    Results: The number of penetrating and violent traumas at our trauma center during the period of societal quarantine for the COVID-19 pandemic was more than any historical total. During the COVID-19 time period, we saw 39 penetrating traumas, while the mean value for the same time period from 2016 to 2019 was 26 (
    Discussion: Societal quarantine increased the number of penetrating and violent traumas, with a concurrent increased percentage of patients transfused. Despite this, there was no change in outcomes. Given the continuation of the COVID-19 pandemic, quarantine measures could be re-implemented. Data from this study can help guide expectations and utilization of hospital resources in the future.
    MeSH term(s) Adolescent ; Adult ; Age Distribution ; Aged ; Arkansas/epidemiology ; Blood Transfusion/statistics & numerical data ; COVID-19/epidemiology ; COVID-19/prevention & control ; Female ; Hospitalization ; Humans ; Male ; Middle Aged ; Pandemics ; Quarantine ; Sex Distribution ; Time Factors ; Trauma Centers/statistics & numerical data ; Violence/statistics & numerical data ; Wounds, Nonpenetrating/epidemiology ; Wounds, Penetrating/epidemiology ; Young Adult
    Language English
    Publishing date 2021-11-03
    Publishing country United States
    Document type Comparative Study ; Journal Article
    ZDB-ID 202465-2
    ISSN 1555-9823 ; 0003-1348
    ISSN (online) 1555-9823
    ISSN 0003-1348
    DOI 10.1177/00031348211050824
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Artificial Intelligence in Liver Transplantation.

    Khorsandi, Shirin Elizabeth / Hardgrave, Hailey J / Osborn, Tamara / Klutts, Garrett / Nigh, Joe / Spencer-Cole, Richard T / Kakos, Christos D / Anastasiou, Ioannis / Mavros, Michail N / Giorgakis, Emmanouil

    Transplantation proceedings

    2021  Volume 53, Issue 10, Page(s) 2939–2944

    Abstract: Background: Advancements based on artificial intelligence have emerged in all areas of medicine. Many decisions in organ transplantation can now potentially be addressed in a more precise manner with the aid of artificial intelligence.: Method/results! ...

    Abstract Background: Advancements based on artificial intelligence have emerged in all areas of medicine. Many decisions in organ transplantation can now potentially be addressed in a more precise manner with the aid of artificial intelligence.
    Method/results: All elements of liver transplantation consist of a set of input variables and a set of output variables. Artificial intelligence identifies relationships between the input variables; that is, how they select the data groups to train patterns and how they can predict the potential outcomes of the output variables. The most widely used classifiers to address the different aspects of liver transplantation are artificial neural networks, decision tree classifiers, random forest, and naïve Bayes classification models. Artificial intelligence applications are being evaluated in liver transplantation, especially in organ allocation, donor-recipient matching, survival prediction analysis, and transplant oncology.
    Conclusion: In the years to come, deep learning-based models will be used by liver transplant experts to support their decisions, especially in areas where securing equitability in the transplant process needs to be optimized.
    MeSH term(s) Artificial Intelligence ; Bayes Theorem ; Humans ; Liver Transplantation ; Neural Networks, Computer ; Tissue Donors
    Language English
    Publishing date 2021-11-02
    Publishing country United States
    Document type Journal Article
    ZDB-ID 82046-5
    ISSN 1873-2623 ; 0041-1345
    ISSN (online) 1873-2623
    ISSN 0041-1345
    DOI 10.1016/j.transproceed.2021.09.045
    Database MEDical Literature Analysis and Retrieval System OnLINE

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