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  1. Article ; Online: Emergency Department Thoracotomy in Penetrating Chest Trauma Patients with No Signs of Life: A Worthwhile Endeavor.

    Hatchimonji, Justin S / Seamon, Mark J

    World journal of surgery

    2023  Volume 47, Issue 12, Page(s) 3114–3115

    MeSH term(s) Humans ; Thoracotomy ; Wounds, Penetrating/surgery ; Thoracic Injuries/surgery ; Emergency Service, Hospital ; Wounds, Nonpenetrating/surgery ; Retrospective Studies
    Language English
    Publishing date 2023-10-13
    Publishing country United States
    Document type Journal Article
    ZDB-ID 224043-9
    ISSN 1432-2323 ; 0364-2313
    ISSN (online) 1432-2323
    ISSN 0364-2313
    DOI 10.1007/s00268-023-07213-z
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    Zs.A 1336: Show issues Location:
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  2. Article ; Online: The Role of Emergency Department Thoracotomy in Patients with Cranial Gunshot Wounds.

    Hatchimonji, Justin S / Meredyth, Nicole A / Gummadi, Sriharsha / Kaufman, Elinore J / Yelon, Jay A / Cannon, Jeremy W / Martin, Niels D / Seamon, Mark J

    The journal of trauma and acute care surgery

    2024  

    Abstract: Background: Although several society guidelines exist regarding emergency department thoracotomy (EDT), there is a lack of data upon which to base guidance for multiple gunshot wound (GSW) patients whose injuries include a cranial GSW. We hypothesized ... ...

    Abstract Background: Although several society guidelines exist regarding emergency department thoracotomy (EDT), there is a lack of data upon which to base guidance for multiple gunshot wound (GSW) patients whose injuries include a cranial GSW. We hypothesized that survival in these patients would be exceedingly low.
    Methods: We used Pennsylvania Trauma Outcomes Study (PTOS) data, 2002-2021, and included EDTs for GSWs. We defined EDT by ICD codes for thoracotomy or procedures requiring one, with a location flagged as ED. We defined head injuries as any head abbreviated injury scale (AIS) ≥1 and severe head injuries as head AIS ≥ 4. Head injuries were "isolated" if all other body regions AIS < 2. Descriptive statistics were performed. Discharge functional status was measured in 5 domains.
    Results: Over 20 years in Pennsylvania, 3,546 EDTs were performed, 2,771 (78.1%) for penetrating injuries. Most penetrating EDTs (2,003, 72.3%) had suffered GSWs. Survival among patients with isolated head wounds (n = 25) was 0%. Survival was 5.3% for the non-head-injured (n = 94/1,787). In patients with combined head and other injuries, survival was driven by the severity of the head wound - 0% (0/81) with a severe head injury (p = 0.035 vs no severe head injury), and 4.5% (5/110) with a non-severe head injury. Of the 5 head-injured survivors, 2 were fully dependent for transfer mobility, and 3 were partially or fully dependent for locomotion. Of 211 patients with a cranial injury who expired, 2 (0.9%) went on to organ donation.
    Conclusions: Though there is clearly no role for EDT in patients with isolated head GSWs, EDT may be considered in patients with combined injuries, as most of these patients have minor head injuries and survival is not different from the non-head-injured. However, if a severe head injury is clinically apparent, even in the presence of other body cavity injuries, EDT should not be pursued.
    Level of evidence: Level II, retrospective observational cohort study.
    Language English
    Publishing date 2024-02-20
    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.0000000000004282
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    Zs.A 127: Show issues Location:
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  3. Article ; Online: The open abdomen in mesenteric ischemia: A tool for patients undergoing revascularization.

    Hatchimonji, Justin S / Bakillah, Emna / Kaufman, Elinore J / Dowzicky, Phillip M / Braslow, Benjamin M / Kalapatapu, Venkat R / Reilly, Patrick M / Sharoky, Catherine E

    World journal of surgery

    2024  Volume 48, Issue 2, Page(s) 331–340

    Abstract: Background: We examined outcomes in Acute Mesenteric Ischemia (AMI) with the hypothesis that Open Abdomen (OA) is associated with decreased mortality.: Methods: We performed a cohort study reviewing NSQIP emergency laparotomy patients, 2016-2020, ... ...

    Abstract Background: We examined outcomes in Acute Mesenteric Ischemia (AMI) with the hypothesis that Open Abdomen (OA) is associated with decreased mortality.
    Methods: We performed a cohort study reviewing NSQIP emergency laparotomy patients, 2016-2020, with a postoperative diagnosis of mesenteric ischemia. OA was defined using flags for patients without fascial closure. Logistic regression was used with outcomes of 30-day mortality and several secondary outcomes.
    Results: Out of 5514 cases, 4624 (83.9%) underwent resection and 387 (7.0%) underwent revascularization. The OA rate was 32.6%. 10.8% of patients who were closed required reoperation. After adjustment for demographics, transfer status, comorbidities, preoperative variables including creatinine, white blood cell count, and anemia, as well as operative time, OA was associated with OR 1.58 for mortality (95% CI [1.38, 1.81], p < 0.001). Among revascularizations, there was no such association (p = 0.528). OA was associated with ventilator support >48 h (OR 4.04, 95% CI [3.55, 4.62], and p < 0.001).
    Conclusion: OA in AMI was associated with increased mortality and prolonged ventilation. This is not so in revascularization patients, and 1 in 10 patients who underwent primary closure required reoperation. OA should be considered in specific cases of AMI.
    Level of evidence: Retrospective cohort, Level III.
    MeSH term(s) Humans ; Mesenteric Ischemia/surgery ; Mesenteric Ischemia/mortality ; Mesenteric Ischemia/diagnosis ; Male ; Female ; Aged ; Middle Aged ; Retrospective Studies ; Open Abdomen Techniques/methods ; Vascular Surgical Procedures/methods ; Reoperation/statistics & numerical data ; Laparotomy/methods ; Cohort Studies ; Postoperative Complications/epidemiology ; Aged, 80 and over
    Language English
    Publishing date 2024-01-03
    Publishing country United States
    Document type Journal Article
    ZDB-ID 224043-9
    ISSN 1432-2323 ; 0364-2313
    ISSN (online) 1432-2323
    ISSN 0364-2313
    DOI 10.1002/wjs.12056
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    Zs.A 1336: Show issues Location:
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  4. Article ; Online: Hemodynamic Deterioration of Trauma Patients Undergoing Interhospital Transfer.

    Michos, Lia / Whitehorn, Gregory L / Seamon, Mark / Cannon, Jeremy W / Yelon, Jay / Kim, Patrick / Hatchimonji, Justin S / Song, Jamie / Kaufman, Elinore J

    The Journal of surgical research

    2024  Volume 298, Page(s) 119–127

    Abstract: Introduction: Organized trauma systems reduce morbidity and mortality after serious injury. Rapid transport to high-level trauma centers is ideal, but not always feasible. Thus, interhospital transfers are an important component of trauma systems. ... ...

    Abstract Introduction: Organized trauma systems reduce morbidity and mortality after serious injury. Rapid transport to high-level trauma centers is ideal, but not always feasible. Thus, interhospital transfers are an important component of trauma systems. However, transferring a seriously injured patient carries the risk of worsening condition before reaching definitive care. In this study, we evaluated characteristics and outcomes of patients whose hemodynamic status worsened during the transfer process.
    Methods: We conducted a retrospective cohort study using data from the Pennsylvania Trauma Outcomes Study database from 2011 to 2018. Patients were included if they had a heart rate ≤ 100 and systolic blood pressure ≥ 100 at presentation to the referring hospital and were transferred within 24 h. We defined hemodynamic deterioration (HDD) as admitting heart rate > 100 or systolic blood pressure < 100 at the receiving center. We compared demographics, mechanism of injury, injury severity, management, and outcomes between patients with and without HDD using descriptive statistics and multivariable regression analysis.
    Results: Of 52,919 included patients, 5331 (10.1%) had HDD. HDD patients were more often moderately-severely injured (injury severity score 9-15; 40.4% versus 39.4%, P < 0.001) and injured via motor vehicle collision (23.2% versus 16.6%, P < 0.001) or gunshot wound (2.1% versus 1.3%, P < 0.001). HDD patients more often had extremity or torso injuries and after transfer were more likely to be transferred to the intensive care unit (35% versus 28.5%, P < 0.001), go directly to surgery (8.4% versus 5.9%, P < 0.001), or interventional radiology (0.8% versus 0.3%, P < 0.001). Overall mortality in the HDD group was 4.9% versus 2.1% in the group who remained stable. These results were confirmed using multivariable analysis.
    Conclusions: Interhospital transfers are essential in trauma, but one in 10 transferred patients deteriorated hemodynamically in that process. This high-risk component of the trauma system requires close attention to the important aspects of transfer such as patient selection, pretransfer management/stabilization, and communication between facilities.
    Language English
    Publishing date 2024-04-10
    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.2024.03.007
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    Zs.A 178: Show issues Location:
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  5. Article ; Online: A tale of two cities: Policing and firearm homicides in Boston and Philadelphia.

    Hatchimonji, Justin S / Bakillah, Emna / Hynes, Allyson M / Torres, Crisanto M / Sanchez, Sabrina E / Seamon, Mark J / Scantling, Dane R

    The journal of trauma and acute care surgery

    2023  Volume 95, Issue 5, Page(s) 713–718

    Abstract: Background: Recent political movements have raised questions about the effectiveness of police funding, but the impact of law enforcement budgets on firearm violence is unknown. We hypothesized that department funding and measures of police activity ... ...

    Abstract Background: Recent political movements have raised questions about the effectiveness of police funding, but the impact of law enforcement budgets on firearm violence is unknown. We hypothesized that department funding and measures of police activity would be associated with decreased shootings and firearm homicides (FHs) in two major cities with different police funding patterns.
    Methods: We collected data from the following sources: district attorney's offices, police departments, Federal Bureau of Investigation Uniform Crime Reporting program, the Centers for Disease Control, the Annual Survey of Public Employment and Payroll, and the American Community Survey. Data included demographics, police department budgets, number of officers, homicide clearance rates, firearms recovered, shootings, and FHs, 2015 to 2020. Totals were normalized to population and number of shootings. We used panel linear regression to measure associations between policing variables, shootings, and FHs while adjusting for covariates.
    Results: Firearm homicides significantly increased in Philadelphia. In Boston, the trend was less clear, although there was an increase in 2020. Police budget normalized to shootings trended toward a decrease in Philadelphia and an increase in Boston. The number of firearms recovered annually appeared to increase in Boston but peaked midstudy in Philadelphia. In multivariable analyses, police budget was associated with neither shootings nor FHs. However, increased firearm recovery was associated with lower shooting ( β = -0.0004, p = 0.022) and FH ( β = -0.00005, p = 0.004) rates.
    Conclusion: Philadelphia and Boston demonstrated differences in police funding, 2015 to 2020. While budget is not associated with shootings or FHs, firearm recovery is suggesting that removal of firearms from circulation remains key. The impact this has on vulnerable populations requires further investigation.
    Level of evidence: Prognostic and Epidemiological; Level IV.
    MeSH term(s) Humans ; United States/epidemiology ; Homicide ; Wounds, Gunshot/epidemiology ; Cities/epidemiology ; Boston ; Philadelphia/epidemiology ; Police ; Firearms
    Language English
    Publishing date 2023-06-15
    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.0000000000004008
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    Zs.A 127: Show issues Location:
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  6. Article ; Online: Funding the war in America: A look in the mirror.

    Hynes, Allyson M / Weaver, Jessica L / Hatchimonji, Justin S / Sperry, Jason L / Sanchez, Sabrina E / Seamon, Mark J / Kheirbek, Tareq / Scantling, Dane R

    The journal of trauma and acute care surgery

    2023  Volume 95, Issue 5, Page(s) 621–627

    Abstract: Background: Health care political action committees (HPACs) historically contribute more to candidates opposing firearm restrictions (FRs), clashing with their affiliated medical societies. These societies have increasingly emphasized the prevention of ... ...

    Abstract Background: Health care political action committees (HPACs) historically contribute more to candidates opposing firearm restrictions (FRs), clashing with their affiliated medical societies. These societies have increasingly emphasized the prevention of firearm violence and it is not known if recent contributions by their HPACs have aligned with their stated goals. We hypothesized that such HPACs still contribute similar amounts toward legislators up for reelection opposing FR.
    Methods: We identified HPACs of medical societies endorsing one or both calls-to-action against firearm violence published in the Annals of Internal Medicine (2015, 2019). House of Representatives (HOR) votes on H.R.8, a background checks bill, were characterized from GovTrack. We compiled HPAC contributions between the H.R.8 vote and election to HOR members up for re-election from the National Institute on Money in Politics. Our primary outcome was total campaign contributions by H.R.8 stance. Secondary outcomes included percentage of politicians funded and total contributions.
    Results: Nineteen societies endorsed one or both call-to-action articles. Three hundred eighty-five of 430 HOR members ran for reelection in 2020. Those endorsing H.R.8 (n = 226, 59%) received $2.8 M for $4,750 (interquartile range [IQR], $1000-$15,500) per candidate. Those opposing (n = 159, 41%) received $1.5 M for $2,500 (IQR, $0-$11,000) per candidate ( p = 0.0057). Health care political action committees donated toward a median of 20% (IQR, 7-28) of candidates endorsing H.R.8 and 9% (IQR, 4-22) of candidates opposing H.R.8 ( p = 0.0014). Those endorsing H.R.8 received 1,585 total contributions for a median of 3 (IQR, 1-10) contributions per candidate, while those opposing received 834 total contributions for a median of 2 (IQR, 0-7) contributions per candidate ( p = 0.0029).
    Conclusion: Politicians voting against background checks received substantial contributions toward reelection from the HPACs of societies advocating for firearm restrictions. However, this is the first study to suggest that HPAC's contributions have become more congruent with their respective societies. Further alignment of medical society goals and their HPAC political contributions could have a profound impact on firearm violence.
    Level of evidence: Prognostic and Epidemiological; Level III.
    MeSH term(s) United States ; Politics ; Societies, Medical ; Firearms ; Violence
    Language English
    Publishing date 2023-04-04
    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.0000000000003982
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  7. Article ; Online: Trauma Does not Quarantine: Violence During the COVID-19 Pandemic.

    Hatchimonji, Justin S / Swendiman, Robert A / Seamon, Mark J / Nance, Michael L

    Annals of surgery

    2020  Volume 272, Issue 2, Page(s) e53–e54

    MeSH term(s) Betacoronavirus ; COVID-19 ; Coronavirus Infections/epidemiology ; Decision Making ; Humans ; Pandemics ; Personal Protective Equipment/supply & distribution ; Pneumonia, Viral/epidemiology ; SARS-CoV-2 ; Surgery Department, Hospital/organization & administration ; Triage ; United States/epidemiology ; Violence/statistics & numerical data ; Wounds and Injuries/epidemiology ; Wounds and Injuries/surgery ; Wounds, Gunshot/epidemiology ; Wounds, Gunshot/surgery
    Keywords covid19
    Language English
    Publishing date 2020-07-16
    Publishing country United States
    Document type Journal Article
    ZDB-ID 340-2
    ISSN 1528-1140 ; 0003-4932
    ISSN (online) 1528-1140
    ISSN 0003-4932
    DOI 10.1097/SLA.0000000000003996
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  8. Article: The traveling pelvic bullet: a case of retrograde ballistic migration through the venous system.

    Hatchimonji, Justin S / Raza, Shariq S / Martin, Niels D / Cannon, Jeremy W / Wang, Grace J / Glaser, Julia D

    Journal of vascular surgery cases and innovative techniques

    2022  Volume 8, Issue 4, Page(s) 587–591

    Abstract: Migration of a ballistic missile through the vasculature is rare but important to recognize. It can lead to diagnostic confusion and seemingly unexplainable bullet trajectories. We have described the case of a young man with a gunshot wound to the ... ...

    Abstract Migration of a ballistic missile through the vasculature is rare but important to recognize. It can lead to diagnostic confusion and seemingly unexplainable bullet trajectories. We have described the case of a young man with a gunshot wound to the axillary vein and initial embolus to the inferior vena cava. The bullet subsequently migrated to the right common iliac vein, allowing for straightforward retrieval.
    Language English
    Publishing date 2022-08-28
    Publishing country United States
    Document type Case Reports
    ISSN 2468-4287
    ISSN 2468-4287
    DOI 10.1016/j.jvscit.2022.08.016
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  9. Article ; Online: Efficient evaluation of center-level emergency surgery performance using a high-yield procedure set: A step towards an EGS registry.

    Hatchimonji, Justin S / Kaufman, Elinore J / Dowzicky, Phillip M / Scantling, Dane R / Holena, Daniel N

    American journal of surgery

    2021  Volume 222, Issue 3, Page(s) 625–630

    Abstract: Background: Emergency general surgery (EGS) lacks mechanisms to compare performance between institutions. Focusing on higher-risk procedures may efficiently identify outliers.: Methods: EGS patients were identified from the 2016 State Inpatient ... ...

    Abstract Background: Emergency general surgery (EGS) lacks mechanisms to compare performance between institutions. Focusing on higher-risk procedures may efficiently identify outliers.
    Methods: EGS patients were identified from the 2016 State Inpatient Databases of Florida, New York, and Kentucky. Risk-adjusted mortality was calculated as an O:E ratio, generating expected mortality from a model including demographic and procedural factors. Outliers were centers whose 90% confidence intervals excluded 1. This was repeated in several subsets, to determine if these yielded outliers similar to the overall dataset.
    Results: We identified 45,430 EGS patients. Overall, 3 high performing centers and 5 low performing centers were identified. Exclusion of appendectomies and cholecystectomies resulted in a remaining data set of 13,569 patients (29.9% of the overall data set), with 2 high performers and 5 low performers. One low performer in the limited data set was not identified in the overall set.
    Conclusion: Evaluation of 5 procedures, making up less than a third of EGS, identifies most outliers. A streamlined monitoring procedure may facilitate maintenance of an EGS registry.
    MeSH term(s) Appendectomy/mortality ; Benchmarking ; Cholecystectomy/mortality ; Confidence Intervals ; Databases, Factual ; Emergencies ; Emergency Treatment/mortality ; Florida ; General Surgery ; Hospital Mortality ; Hospitals/standards ; Humans ; Kentucky ; Laparotomy/mortality ; New York ; Odds Ratio ; Outliers, DRG ; Registries ; Surgical Procedures, Operative/mortality ; Treatment Outcome
    Language English
    Publishing date 2021-01-23
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2953-1
    ISSN 1879-1883 ; 0002-9610
    ISSN (online) 1879-1883
    ISSN 0002-9610
    DOI 10.1016/j.amjsurg.2021.01.025
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  10. Article ; Online: Beyond pain and disability: The lasting effects of trauma on life after injury.

    Hatchimonji, Justin S / Kaufman, Elinore J / Babalola, Deborah / Candido, Katelyn / Chreiman, Kristen / Jackson, Sunny / Reilly, Patrick M / Seamon, Mark J

    The journal of trauma and acute care surgery

    2022  Volume 93, Issue 3, Page(s) 332–339

    Abstract: Background: The impact of traumatic injury likely extends beyond direct physical consequences and lasts well beyond the acute injury phase. Data collection is sparse after hospital discharge, however. In this observational study, we hypothesized that ... ...

    Abstract Background: The impact of traumatic injury likely extends beyond direct physical consequences and lasts well beyond the acute injury phase. Data collection is sparse after hospital discharge, however. In this observational study, we hypothesized that sequelae of injury would last at least 6 months and sought to prospectively determine patient-reported physical, emotional, and social outcomes during this postinjury period.
    Methods: We surveyed patients admitted to our Level I trauma center (July 2019 to October 2020) regarding baseline functioning and quality of life after injury, using the Patient-Reported Outcomes Measurement Information System (PROMIS-29) instrument, a primary care posttraumatic stress disorder screen, and questions on substance use, employment, and living situation. Patients were re-surveyed at 6 months. PROMIS-29 scores are reported as t scores compared with the US population. Differences between groups were analyzed using χ 2 , signed-rank, and t tests, with paired tests used for changes over time.
    Results: Three hundred sixty-two patients completed the baseline, 130 of whom completed 6-month follow-up. Those completing the 6-month survey were similar ages (43.3 ± 17.8 vs. 44.4 ± 19.0, p = 0.57), mechanism (24.7% vs. 28.0% shot or stabbed, p = 0.61), and severities (median Injury Severity Score, 9 vs. 9; p = 0.15) as those who only completed the baseline. There were 55.0% reported being hospitalized for an injury previously. Patients reported decreases in ability to participate in social roles and activities (mean t score 51.4 vs. 55.3; p = 0.011) and increases in anxiety (53.8 vs. 50.5, p = 0.011) and depression (51.0 vs. 48.7, p = 0.025). There were 26.2% that screened positive for posttraumatic stress disorder at 6 months. Employment decreased at 6 months, with 63.9% reporting being "occasionally" employed or unemployed at 6 months versus 44.6% preinjury ( p < 0.001).
    Conclusion: The effects of injury extend beyond pain and disability, impacting several realms of life for at least 6 months following trauma. These data support the development of screening and intervention protocols for postinjury patients.
    Level of evidence: Prognostic and Epidemiologic; Level IV.
    MeSH term(s) Disabled Persons ; Humans ; Injury Severity Score ; Pain ; Quality of Life ; Stress Disorders, Post-Traumatic/psychology ; Trauma Centers
    Language English
    Publishing date 2022-05-12
    Publishing country United States
    Document type Journal Article ; Observational Study
    ZDB-ID 2651070-4
    ISSN 2163-0763 ; 2163-0755
    ISSN (online) 2163-0763
    ISSN 2163-0755
    DOI 10.1097/TA.0000000000003606
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