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Article ; Online: Prehospital Transport Time and Outcomes for Pediatric Trauma: A National Study.

Burdick, Kendall J / Perez Coulter, Aixa / Tirabassi, Michael

2023 Volume 292, Page(s) 144–149

Abstract: Introduction: Historically, emergency medical services have aimed to deliver trauma patients to definitive care within the 60 min (min) "Golden Hour" to optimize survival. There is little evidence to support or refute this for pediatric trauma. The ... ...

Abstract	Introduction: Historically, emergency medical services have aimed to deliver trauma patients to definitive care within the 60 min (min) "Golden Hour" to optimize survival. There is little evidence to support or refute this for pediatric trauma. The objective of this investigation was to describe national trends in prehospital transport time, in relation to the "Golden Hour," and pediatric trauma outcomes. Methods: Retrospective cohort study of patients (<15 y old) receiving emergency medical services trauma transport between 2017 and 2019. Transport time (less than or greater than 60 min) was the exposure variable, and analyses were adjusted for injury severity score (ISS). Continuous variables with a normal distribution were compared by t-test was and skewed variables were compared by Mann-Whitney U-test. Categorical variables were compared by Chi-Square test. Results: 54,489 patients met our criteria: 49,628 blunt and 4861 penetrating. Most patients (62.2%) had transport times less than 60 min: 30,389 (61.2%) blunt and 3479 (71.6%) penetrating. The overall mortality rate was 1.6%, 1.2% for blunt and 5.5% for penetrating. For blunt trauma, mortality was higher for transport times less than 60 min (1.5%). For penetrating trauma, mortality was lower for transport times less than 60 min (0.7%). Mean ISS was greater for blunt (7.9) compared to penetrating trauma (7.1), and greater for both trauma types with transport times less than 60 min. For both trauma types, mean length of stay was significantly longer for transport times greater than 60 min, when adjusting for ISS (P < 0.001). Conclusions: We did not find evidence that prehospital transport within the "Golden Hour" had a substantial association with survival, though it may be associated with length of stay. There are many factors contributing to trauma outcomes, so efforts should continue to expand access and pediatric readiness.
Language	English
Publishing date	2023-08-22
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.2023.07.041
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Article ; Online: Auditory roughness: a delicate balance.

Burdick, Kendall J / Yang, Sean / Lopez, Andres E / Wessel, Connor / Schutz, Michael / Schlesinger, Joseph J

British journal of anaesthesia

2023 Volume 131, Issue 4, Page(s) 649–652

Abstract: Auditory roughness in medical alarm sounds is an important design attribute, and has been shown to impact user performance and perception. While roughness can assist in decreased signal-to-noise ratios (perceived loudness) and communicate urgency, it ... ...

Abstract	Auditory roughness in medical alarm sounds is an important design attribute, and has been shown to impact user performance and perception. While roughness can assist in decreased signal-to-noise ratios (perceived loudness) and communicate urgency, it might also impact patient recovery. Therefore, considerations of neuroscience correlates, music theory, and patient impact are critical aspects to investigate in order to optimise alarm design.
MeSH term(s)	Humans ; Sound ; Clinical Alarms ; Monitoring, Physiologic
Language	English
Publishing date	2023-08-01
Publishing country	England
Document type	Editorial
ZDB-ID	80074-0
ISSN	1471-6771 ; 0007-0912
ISSN (online)	1471-6771
ISSN	0007-0912
DOI	10.1016/j.bja.2023.07.003
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Article ; Online: Historical Redlining and Present-Day Nonsuicide Firearm Fatalities.

Dholakia, Ayesha / Burdick, Kendall J / Kreatsoulas, Catherine / Monuteaux, Michael C / Tsai, Jennifer / Subramanian, S V / Fleegler, Eric W

Annals of internal medicine

2024

Abstract: Background: Redlining began in the 1930s with the Home Owners' Loan Corporation (HOLC); this discriminatory practice limited mortgage availability and reinforced concentrated poverty that still exists today. It is important to understand the potential ... ...

Abstract	Background: Redlining began in the 1930s with the Home Owners' Loan Corporation (HOLC); this discriminatory practice limited mortgage availability and reinforced concentrated poverty that still exists today. It is important to understand the potential health implications of this federally sanctioned segregation. Objective: To examine the relationship between historical redlining policies and present-day nonsuicide firearm fatalities. Design: Maps from the HOLC were overlaid with incidence of nonsuicide firearm fatalities from 2014 to 2022. A multilevel negative binomial regression model tested the association between modern-day firearm fatalities and HOLC historical grading (A ["best"] to D ["hazardous"]), controlling for year, HOLC area-level demographics, and state-level factors as fixed effects and a random intercept for city. Incidence rates (IRs) per 100 000 persons, incidence rate ratios (IRRs), and adjusted IRRs (aIRRs) for each HOLC grade were estimated using A-rated areas as the reference. Setting: 202 cities with areas graded by the HOLC in the 1930s. Participants: Population of the 8597 areas assessed by the HOLC. Measurements: Nonsuicide firearm fatalities. Results: From 2014 to 2022, a total of 41 428 nonsuicide firearm fatalities occurred in HOLC-graded areas. The firearm fatality rate increased as the HOLC grade progressed from A to D. In A-graded areas, the IR was 3.78 (95% CI, 3.52 to 4.05) per 100 000 persons per year. In B-graded areas, the IR, IRR, and aIRR relative to A areas were 7.43 (CI, 7.24 to 7.62) per 100 000 persons per year, 2.12 (CI, 1.94 to 2.32), and 1.42 (CI, 1.30 to 1.54), respectively. In C-graded areas, these values were 11.24 (CI, 11.08 to 11.40) per 100 000 persons per year, 3.78 (CI, 3.47 to 4.12), and 1.90 (CI, 1.75 to 2.07), respectively. In D-graded areas, these values were 16.26 (CI, 16.01 to 16.52) per 100 000 persons per year, 5.51 (CI, 5.05 to 6.02), and 2.07 (CI, 1.90 to 2.25), respectively. Limitation: The Gun Violence Archive relies on media coverage and police reports. Conclusion: Discriminatory redlining policies from 80 years ago are associated with nonsuicide firearm fatalities today. Primary funding source: Fred Lovejoy Housestaff Research and Education Fund.
Language	English
Publishing date	2024-04-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	336-0
ISSN	1539-3704 ; 0003-4819
ISSN (online)	1539-3704
ISSN	0003-4819
DOI	10.7326/M23-2496
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Article ; Online: Racial & ethnic disparities in geographic access to critical care in the United States: A geographic information systems analysis.

Burdick, Kendall J / Rees, Chris A / Lee, Lois K / Monuteaux, Michael C / Mannix, Rebekah / Mills, David / Hirsh, Michael P / Fleegler, Eric W

PloS one

2023 Volume 18, Issue 11, Page(s) e0287720

Abstract: Objective: It is important to identify gaps in access and reduce health outcome disparities, understanding access to intensive care unit (ICU) beds, especially by race and ethnicity, is crucial. Our objective was to evaluate the race and ethnicity- ... ...

Abstract	Objective: It is important to identify gaps in access and reduce health outcome disparities, understanding access to intensive care unit (ICU) beds, especially by race and ethnicity, is crucial. Our objective was to evaluate the race and ethnicity-specific 60-minute drive time accessibility of ICU beds in the United States (US). Design: We conducted a cross-sectional study using road network analysis to determine the number of ICU beds within a 60-minute drive time, and calculated adult intensive care bed ratios per 100,000 adults. We evaluated the US population at the Census block group level and stratified our analysis by race and ethnicity and by urbanicity. We classified block groups into four access levels: no access (0 adult intensive care beds/100,000 adults), below average access (>0-19.5), average access (19.6-32.0), and above average access (>32.0). We calculated the proportion of adults in each racial and ethnic group within the four access levels. Setting: All 50 US states and the District of Columbia. Participants: Adults ≥15 years old. Main outcome measures: Adult intensive care beds/100,000 adults and percentage of adults national and state) within four access levels by race and ethnicity. Results: High variability existed in access to ICU beds by state, and substantial disparities by race and ethnicity. 1.8% (n = 5,038,797) of Americans had no access to an ICU bed, and 26.8% (n = 73,095,752) had below average access, within a 60-minute drive time. Racial and ethnic analysis showed high rates of disparities (no access/below average access): American Indians/Alaskan Native 12.6%/28.5%, Asian 0.7%/23.1%, Black or African American 0.6%/16.5%, Hispanic or Latino 1.4%/23.0%, Native Hawaiian and other Pacific Islander 5.2%/35.0%, and White 2.1%/29.0%. A higher percentage of rural block groups had no (5.2%) or below average access (41.2%), compared to urban block groups (0.2% no access, 26.8% below average access). Conclusion: ICU bed availability varied substantially by geography, race and ethnicity, and by urbanicity, creating significant disparities in critical care access. The variability in ICU bed access may indicate inequalities in healthcare access overall by limiting resources for the management of critically ill patients.
MeSH term(s)	Adult ; Humans ; United States ; Adolescent ; Cross-Sectional Studies ; Geographic Information Systems ; Health Services Accessibility ; Ethnicity ; Hawaii ; Healthcare Disparities
Language	English
Publishing date	2023-11-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0287720
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Article ; Online: Abortion Restrictiveness and Infant Mortality: An Ecologic Study, 2014-2018.

Burdick, Kendall J / Coughlin, Catherine G / D'Ambrosi, Gabrielle R / Monuteaux, Michael C / Economy, Katherine E / Mannix, Rebekah C / Lee, Lois K

American journal of preventive medicine

2023 Volume 66, Issue 3, Page(s) 418–426

Abstract: Introduction: The U.S. has the highest infant mortality rate among peer countries. Restrictive abortion laws may contribute to poor infant health outcomes. This ecological study investigated the association between county-level infant mortality and ... ...

Abstract	Introduction: The U.S. has the highest infant mortality rate among peer countries. Restrictive abortion laws may contribute to poor infant health outcomes. This ecological study investigated the association between county-level infant mortality and state-level abortion access legislation in the U.S. from 2014 to 2018. Methods: A multivariable regression analysis with the outcome of county-level infant mortality rates, controlling for the primary exposure of state-level abortion laws, and county-level factors, county-level distance to an abortion facility, and state Medicaid expansion status was performed. Incidence rate ratios and 95% CIs were reported. Analyses were conducted in 2022-2023. Results: There were 113,397 infant deaths among 19,559,660 live births (infant mortality rate=5.79 deaths/1,000 live births; 95% CI=5.75, 5.82). Black infant mortality rate (10.69/1,000) was more than twice the White infant mortality rate (4.87/1,000). In the multivariable model, increased infant mortality rates were seen in states with ≥8 restrictive laws, with the most restrictive (11-12 laws) having a 16% increased infant mortality level (adjusted incidence rate ratios=1.162; 95% CI=1.103, 1.224). Increased infant mortality rates were associated with increased county-level Black race individuals (adjusted incidence rate ratios=1.031; 95% CI=1.026, 1.037), high school education (adjusted incidence rate ratios=1.018; 95% CI=1.008, 1.029), maternal smoking (adjusted incidence rate ratios=1.025; 95% CI=1.018, 1.033), and inadequate prenatal care (adjusted incidence rate ratios=1.045; 95% CI=1.036, 1.055). Conclusions: State-level abortion law restrictiveness is associated with higher county-level infant mortality rates. The Supreme Court decision on Dobbs versus Jackson and changes in state laws limiting abortion may affect future infant mortality.
MeSH term(s)	Infant ; Female ; United States/epidemiology ; Pregnancy ; Humans ; Abortion, Induced ; Infant Mortality ; Regression Analysis ; Medicaid ; Smoking
Language	English
Publishing date	2023-10-14
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	632646-8
ISSN	1873-2607 ; 0749-3797
ISSN (online)	1873-2607
ISSN	0749-3797
DOI	10.1016/j.amepre.2023.10.010
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Article ; Online: Serial virus filtration: A case study evaluating the product-dependent impact of control strategies on process efficiency.

Kozaili, Julie / Shah, Aesha / Robbins, Donna / Brinkman, Nathan / Burdick, Michael / Strauss, Daniel

Biotechnology journal

2023 Volume 18, Issue 9, Page(s) e2200599

Abstract: The production of biopharmaceutical products carries an inherent risk of contamination by adventitious viruses. Historically, these manufacturing processes have incorporated a dedicated virus filtration step to ensure product safety. However, challenging ...

Abstract	The production of biopharmaceutical products carries an inherent risk of contamination by adventitious viruses. Historically, these manufacturing processes have incorporated a dedicated virus filtration step to ensure product safety. However, challenging process conditions can lead to passage of small viruses to the permeate pool and an overall decrease in the desired virus logarithmic reduction value (LRV) for the process. The implementation of serial virus filtration has improved the robustness of such processes, albeit concerns about increased operating times and process complexity have limited its implementation. This work focused on optimizing a serial filtration process and identifying process control strategies to provide maximum efficiency while ensuring proper controls for process complexity. Constant TMP was identified as the optimal control strategy, which combined with the optimal filter ratio, resulted in a robust and faster virus filtration process. To demonstrate this hypothesis, data with two filters connected in series (1:1 filter ratio) are presented for a representative non-fouling molecule. Similarly, for a fouling product, the optimal setup was a combination of a filter connected in series to two filters operated in parallel (2:1 filter ratio). The optimized filter ratios bring cost- and time-savings benefits to the virus filtration step, thereby offering improved productivity. The results of risk and cost analyses performed as part of this study combined with the control strategy, offer companies a toolbox of strategies to accommodate products with different filterability profiles in their downstream processes. This work demonstrates that the safety advantages of performing filters in series can be achieved with minimal increases in time, cost, and risk.
MeSH term(s)	Filtration/methods ; Viruses ; Biological Products
Chemical Substances	Biological Products
Language	English
Publishing date	2023-06-15
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2221885-3
ISSN	1860-7314 ; 1860-6768
ISSN (online)	1860-7314
ISSN	1860-6768
DOI	10.1002/biot.202200599
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Article ; Online: Racial and Ethnic Disparities in Access to Pediatric Trauma Centers in the United States: A Geographic Information Systems Analysis.

Burdick, Kendall J / Lee, Lois K / Mannix, Rebekah / Monuteaux, Michael C / Hirsh, Michael P / Fleegler, Eric W

Annals of emergency medicine

2022 Volume 81, Issue 3, Page(s) 325–333

Abstract: Study objective: Injury is the leading cause of death and disability for children, making access to pediatric trauma centers crucial to pediatric trauma care. Our objective was to describe the pediatric population with timely access to a pediatric ... ...

Abstract	Study objective: Injury is the leading cause of death and disability for children, making access to pediatric trauma centers crucial to pediatric trauma care. Our objective was to describe the pediatric population with timely access to a pediatric trauma center by demographics and geography in the United States. Methods: Level 1, 2, and 3 pediatric trauma center locations were provided by the American Trauma Society. Geographic information systems road network and rotor wing analysis determined US Census Block Groups with the ground and/or air access to a pediatric trauma center within a 60-minute transport time. We then described, at the national and state levels, the 2020 pediatric population (< 15 years old) with and without pediatric trauma center access by ground and air, stratified by race, ethnicity, and urbanicity. Results: There were 157 pediatric trauma centers (82 Level 1, 64 Level 2, 11 Level 3). Of the 2020 US pediatric population, 33,352,872 (54.5%) had timely access to Level 1-3 pediatric trauma centers by ground and 45,431,026 (74.1%) by air. The percentage of children with access by race and ethnicity were (by ground, by air): American Indian/Alaskan Native (31.0%, 43.5%), White (48.7%, 71.3%), Native Hawaiian/Pacific Islander (59.3%, 61.0%), Hispanic (60.2%, 76.9%), Black (64.2%, 78.0%), and Asian (76.5%, 89.5%). Only 48.2% of children living in rural block groups had access, compared with 83.6% in urban block groups. Conclusion: Significant disparities in current access to pediatric trauma centers exist by race and ethnicity, and geography, leaving some children at risk for poor trauma outcomes.
MeSH term(s)	Adolescent ; Child ; Humans ; Ethnicity ; Geographic Information Systems ; Health Services Accessibility ; Trauma Centers ; United States ; Healthcare Disparities/ethnology ; Racial Groups
Language	English
Publishing date	2022-10-31
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	603080-4
ISSN	1097-6760 ; 0196-0644
ISSN (online)	1097-6760
ISSN	0196-0644
DOI	10.1016/j.annemergmed.2022.08.454
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Article ; Online: Perceived effectiveness of video interviews for orthopaedic surgery residency during COVID-19.

Warren, Jonathan R / Khalil, Lafi S / Pietroski, Alexander D / Burdick, Gabriel B / McIntosh, Michael J / Guthrie, Stuart T / Muh, Stephanie J

BMC medical education

2022 Volume 22, Issue 1, Page(s) 566

Abstract: Background: During the 2020-21 residency interview season, interviews were conducted through virtual platforms due to the COVID-19 pandemic. The purpose of this study is to assess the general perceptions of applicants, residents and attendings at a ... ...

Abstract	Background: During the 2020-21 residency interview season, interviews were conducted through virtual platforms due to the COVID-19 pandemic. The purpose of this study is to assess the general perceptions of applicants, residents and attendings at a single, large, metropolitan orthopaedic residency with regards to the video interview process before and after the interview season. Methods: Surveys were sent to all orthopaedic applicants, residents, and attendings before the interview season. Applicants who received interviews and responded to the first survey (46) and faculty who responded to the first survey (28) were sent a second survey after interviews to assess how their perceptions of video interviews changed. Results: Initially, 50% of applicants (360/722) and 50% of faculty and residents (28/56) responded before interview season. After interviews, 55% of interviewees (25/46) and 64% of faculty and residents (18/28) responded. Before interviews, 91% of applicants stated they would prefer in-person interviews and 71% were worried that video interviews would prevent them from finding the best program fit. Before interviews, 100% of faculty and residents stated they would rather conduct in-person interviews and 86% felt that residencies would be less likely to find applicants who best fit the program. Comparing responses before and after interviews, 16% fewer applicants (p = 0.01) perceived that in-person interviews provide a better sense of a residency program and faculty and residents' perceived ability to build rapport with interviewees improved in 11% of respondents (p = 0.01). However, in-person interviews were still heavily favored by interviewees (84%) and faculty and residents (88%) after the interview season. Conclusions: In-person interviews for Orthopaedic Surgery Residency are perceived as superior and are preferred among the overwhelming majority of applicants, residents, and interviewers. Nevertheless, perceptions toward video interviews improved in certain domains after interview season, identifying potential areas of improvement and alternative interview options for future applicants.
MeSH term(s)	COVID-19/epidemiology ; Humans ; Internship and Residency ; Orthopedic Procedures ; Orthopedics ; Pandemics
Language	English
Publishing date	2022-07-22
Publishing country	England
Document type	Journal Article
ZDB-ID	2044473-4
ISSN	1472-6920 ; 1472-6920
ISSN (online)	1472-6920
ISSN	1472-6920
DOI	10.1186/s12909-022-03623-0
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Article ; Online: Racial & ethnic disparities in geographic access to critical care in the United States

Kendall J. Burdick / Chris A. Rees / Lois K. Lee / Michael C. Monuteaux / Rebekah Mannix / David Mills / Michael P. Hirsh / Eric W. Fleegler

PLoS ONE, Vol 18, Iss

A geographic information systems analysis

2023 Volume 11

Keywords	Medicine ; R ; Science ; Q
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
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Article ; Online: Association of Neighborhood Conditions and Resources for Children With Life Expectancy at Birth in the US.

Shanahan, Kristen H / Subramanian, S V / Burdick, Kendall J / Monuteaux, Michael C / Lee, Lois K / Fleegler, Eric W

JAMA network open

2022 Volume 5, Issue 10, Page(s) e2235912

Abstract: Importance: To address inequities in life expectancy, we must understand the associations of modifiable socioeconomic and structural factors with life expectancy. However, the association of limited neighborhood resources and deleterious physical ... ...

Abstract	Importance: To address inequities in life expectancy, we must understand the associations of modifiable socioeconomic and structural factors with life expectancy. However, the association of limited neighborhood resources and deleterious physical conditions with life expectancy is not well understood. Objective: To evaluate the association of community social and economic conditions and resources for children with life expectancy at birth. Design, setting, and participants: This cross-sectional study examined neighborhood child opportunity and life expectancy using data from residents of 65 662 US Census tracts in 2015. The analysis was conducted from July 6 to October 1, 2021. Exposures: Neighborhood conditions and resources for children in 2015. Main outcomes and measures: The primary outcome was life expectancy at birth at the Census tract level based on data from the US Small-Area Life Expectancy Estimates Project (January 1, 2010, to December 31, 2015). Neighborhood conditions and resources for children were quantified by Census tract Child Opportunity Index (COI) 2.0 scores for 2015. This index captures community conditions associated with children's health and long-term outcomes categorized into 5 levels, from very low to very high opportunity. It includes 29 indicators in 3 domains: education, health and environment, and social and economic factors. Mixed-effects and simple linear regression models were used to estimate the associations between standardized COI scores (composite and domain-specific) and life expectancy. Results: The study included residents from 65 662 of 73 057 US Census tracts (89.9%). Life expectancy at birth across Census tracts ranged from 56.3 years to 93.6 years (mean [SD], 78.2 [4.0] years). Life expectancy in Census tracts with very low COI scores was lower than life expectancy in Census tracts with very high COI scores (-7.06 years [95% CI, -7.13 to -6.99 years]). Stepwise associations were observed between COI scores and life expectancy. For each domain, life expectancy was shortest in Census tracts with very low compared with very high COI scores (education: β = -2.02 years [95% CI, -2.12 to -1.92 years]); health and environment: β = -2.30 years [95% CI, -2.41 to -2.20 years]; social and economic: β = -4.16 years [95% CI, -4.26 to -4.06 years]). The models accounted for 41% to 54% of variability in life expectancy at birth (R2 = 0.41-0.54). Conclusions and relevance: In this study, neighborhood conditions and resources for children were significantly associated with life expectancy at birth, accounting for substantial variability in life expectancy at the Census tract level. These findings suggest that community resources and conditions are important targets for antipoverty interventions and policies to improve life expectancy and address health inequities.
MeSH term(s)	Censuses ; Child ; Cross-Sectional Studies ; Humans ; Infant, Newborn ; Life Expectancy ; Residence Characteristics
Language	English
Publishing date	2022-10-03
Publishing country	United States
Document type	Journal Article
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2022.35912
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