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  1. Article ; Online: Increasing Globalization and the Movement of Antimicrobial Resistance between Countries.

    Berndtson, Allison E

    Surgical infections

    2020  Volume 21, Issue 7, Page(s) 579–585

    Abstract: Background: ...

    Abstract Background:
    MeSH term(s) Antimicrobial Stewardship/organization & administration ; Antimicrobial Stewardship/standards ; Developing Countries ; Drug Resistance, Bacterial ; Emigration and Immigration ; Global Health ; Humans ; Infection Control/organization & administration ; Infection Control/standards ; Internationality ; Medical Tourism ; Travel
    Language English
    Publishing date 2020-05-20
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1440120-4
    ISSN 1557-8674 ; 1096-2964
    ISSN (online) 1557-8674
    ISSN 1096-2964
    DOI 10.1089/sur.2020.145
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    Zs.A 5617: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (2.OG)
    ab Jg. 2022: Lesesaal (EG)

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  2. Article ; Online: Who is informed of trauma informed care? Patients' primary language and comprehensiveness of initial trauma assessment.

    Kundu, Souma / Costantini, Todd W / Doucet, Jay J / Berndtson, Allison E

    The journal of trauma and acute care surgery

    2022  Volume 94, Issue 1, Page(s) 45–52

    Abstract: Background: For patients with limited English proficiency, language poses a unique challenge in patient-provider communication. Using certified medical interpretation (CMI) can be difficult in time- and resource-limited settings including trauma. We ... ...

    Abstract Background: For patients with limited English proficiency, language poses a unique challenge in patient-provider communication. Using certified medical interpretation (CMI) can be difficult in time- and resource-limited settings including trauma. We hypothesized that there would be limited use of CMI during major trauma resuscitations, less comprehensive assessments, and less empathetic communication for Spanish-speaking patients (SSPs) with limited English proficiency compared with English-speaking patients (ESPs).
    Methods: We analyzed video-recorded encounters of trauma initial assessments at a Level 1 trauma center. Each encounter was evaluated from patient arrival until completion of the secondary survey per Advanced Trauma Life Support protocol. A standard checklist of provider actions was used to assess comprehensiveness of the primary and secondary surveys and communication events such as provider introduction, reassurances, and communicating next steps to patients. We compared the SSP and ESP cohorts for significant differences in completion of checklist items.
    Results: Fifty patients with Glasgow Coma Scale scores of 14 and 15 were included (25 SSPs, 25 ESPs). The median age was 34 years (interquartile range, 25-65 years) for SSPs and 40 years (interquartile range, 29-54 years) for ESPs. In SSPs, 72% were male; in ESPs, 60% were male. Spanish-speaking patients received less comprehensive motor (48% complete SSPs vs. 96% ESPs, p < 0.001) and sensory (4% complete SSPs vs. 68% ESPs, p < 0.001) examinations, and less often had providers explain next steps (32% SSPs vs. 96% ESPs, p < 0.001) or reassure them (44% SSPs vs. 88% ESPs, p = 0.001). No patients were asked their primary language. Two SSP encounters (8%) used CMI; most (80%) used ad hoc interpretation, and 12% used English.
    Conclusion: We found significant differences in the initial care provided to trauma patients based on primary language. Inclusion of an interpreter as part of the trauma team may improve the quality of care provided to trauma patients with limited English proficiency.
    Level of evidence: Therapeutic/Care Management; Level IV.
    MeSH term(s) Humans ; Male ; Adult ; Female ; Communication Barriers ; Language ; Communication ; Surveys and Questionnaires ; Trauma Centers
    Language English
    Publishing date 2022-10-17
    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.0000000000003815
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    Zs.A 127: Show issues Location:
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  3. Article ; Online: Two-center analysis of cannabis on venous thromboembolism risk after traumatic injury: A matched analysis.

    Erwin, Casey R / Costantini, Todd W / Krzyzaniak, Andrea / Martin, Matthew J / Badiee, Jayraan / Rooney, Alexandra S / Haines, Laura N / Berndtson, Allison E / Bansal, Vishal / Sise, C Beth / Calvo, Richard Y / Sise, Michael J

    American journal of surgery

    2024  

    Abstract: Background: Conflicting evidence exists evaluating associations between cannabis (THC) and post-traumatic DVT.: Methods: Retrospective analysis (2014-2023) of patients ≥15yrs from two Level I trauma centers with robust VTE surveillance and ... ...

    Abstract Background: Conflicting evidence exists evaluating associations between cannabis (THC) and post-traumatic DVT.
    Methods: Retrospective analysis (2014-2023) of patients ≥15yrs from two Level I trauma centers with robust VTE surveillance and prophylaxis protocols. Multivariable hierarchical regression assessed the association between THC and DVT risk. THC ​+ ​patients were direct matched to other drug use categories on VTE risk markers and hospital length of stay.
    Results: Of 7365 patients, 3719 were drug-, 575 were THC ​+ ​only, 2583 were other drug+, and 488 were TCH+/other drug+. DVT rates by exposure group did not differ. TCH ​+ ​only patients had higher GCS scores, shorter hospital length of stay, and the lowest pelvic fracture and mortality rates. A total of 458 drug-, 453 other drug+, and 232 THC+/other drug ​+ ​patients were matched to 458, 453, and 232 THC ​+ ​only patients. There were no differences in DVT event rates in any paired sub-cohort set. Additionally, iteratively adjusted paired models did not show an association between THC and DVT.
    Conclusions: THC does not appear to be associated with increased DVT risk in patients with strict trauma chemoprophylaxis. Toxicology testing is useful for identifying substance abuse intervention opportunities, but not for DVT risk stratification in THC ​+ ​patients.
    Language English
    Publishing date 2024-03-26
    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.2024.03.023
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  4. Article ; Online: American Association for the Surgery of Trauma/American College of Surgeons Committee on trauma clinical protocol for post-discharge venous thromboembolism prophylaxis after trauma.

    Berndtson, Allison E / Cross, Alisa / Yorkgitis, Brian K / Kennedy, Ryan / Kochuba, Matthew P / Tignanelli, Christopher / Tominaga, Gail T / Jacobs, David G / Ashley, Dennis W / Ley, Eric J / Napolitano, Lena / Costantini, Todd W

    The journal of trauma and acute care surgery

    2024  

    Abstract: Abstract: Trauma patients are at an elevated risk for developing venous thromboembolism (VTE), which includes pulmonary embolism and deep vein thrombosis. In the inpatient setting, prompt pharmacologic prophylaxis is utilized to prevent VTE. For ... ...

    Abstract Abstract: Trauma patients are at an elevated risk for developing venous thromboembolism (VTE), which includes pulmonary embolism and deep vein thrombosis. In the inpatient setting, prompt pharmacologic prophylaxis is utilized to prevent VTE. For patients with lower extremity fractures or limited mobility, VTE risk does not return to baseline levels post-discharge. Currently, there are limited data to guide post-discharge VTE prophylaxis in trauma patients. The goal of these post-discharge VTE prophylaxis guidelines are to identify patients at the highest risk of developing VTE after discharge and to offer pharmacologic prophylaxis strategies to limit this risk.
    Language English
    Publishing date 2024-03-25
    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.0000000000004307
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    Zs.A 127: Show issues Location:
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  5. 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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    Uk I Zs.129: Show issues Location:
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  6. Article ; Online: Assessment of Surgical Care Provided in National Health Services Hospitals in Mozambique: The Importance of Subnational Metrics in Global Surgery.

    Cossa, Matchecane / Rose, John / Berndtson, Allison E / Noormahomed, Emilia / Bickler, Stephen W

    World journal of surgery

    2021  Volume 45, Issue 5, Page(s) 1306–1315

    Abstract: Introduction: Surgery plays a critical role in sustainable healthcare systems. Validated metrics exist to guide implementation of surgical services, but low-income countries (LIC) struggle to report recommended metrics and this poses a critical barrier ... ...

    Abstract Introduction: Surgery plays a critical role in sustainable healthcare systems. Validated metrics exist to guide implementation of surgical services, but low-income countries (LIC) struggle to report recommended metrics and this poses a critical barrier to addressing unmet need. We present a comprehensive national sample of surgical encounters from a LIC by assessing the National Health Services of Mozambique.
    Material and methods: A prospective cohort of all surgical encounters from Mozambique's National Health Service was gathered for all provinces between July and December 2015. Primary outcomes were timely access, provider densities for surgery, anesthesiology, and obstetrics (SAO) per 100,000 population, annualized surgical procedure volume per 100,000, and postoperative mortality (POMR). Secondary outcomes include operating room density and efficiency.
    Results: Fifty-four hospitals had surgical capacity in 11 provinces with 47,189 surgeries. 44.9% of Mozambique's population lives in Districts without access to surgical services. National SAO density was 1.2/100,000, ranging from 0.4/100,000 in Manica Province to 9.8/100,000 in Maputo City. Annualized national surgical case volume was 367 procedures/100,000 population, ranging from 180/100,000 in Zambezia Province to 1,897/100,000 in Maputo City. National POMR was 0.74% and ranged from 0.23% in Maputo Province to 1.78% in Niassa Province.
    Discussion: Surgical delivery in Mozambique falls short of international targets. Subnational deficiencies and variations between provinces pose targets for quality improvement in advancing national surgical plans. This serves as a template for LICs to follow in gathering surgical metrics for the WHO and the World Bank and offers short- and long-term targets for surgery as a component of health systems strengthening.
    MeSH term(s) Benchmarking ; Female ; Hospitals ; Humans ; Mozambique/epidemiology ; Pregnancy ; Prospective Studies ; State Medicine
    Language English
    Publishing date 2021-01-31
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 224043-9
    ISSN 1432-2323 ; 0364-2313
    ISSN (online) 1432-2323
    ISSN 0364-2313
    DOI 10.1007/s00268-020-05925-0
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    Zs.A 1336: Show issues Location:
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  7. Article ; Online: Management of choledocholithiasis in the elderly: Same-admission cholecystectomy remains the standard of care.

    Berndtson, Allison E / Costantini, Todd W / Smith, Alan M / Edwards, Sara B / Kobayashi, Leslie / Doucet, Jay J / Godat, Laura N

    Surgery

    2022  Volume 172, Issue 4, Page(s) 1057–1064

    Abstract: Background: Current guidelines recommend that patients with choledocholithiasis undergo same-admission cholecystectomy. The compliance with this guideline is poor in elderly patients. We hypothesized that elderly patients treated with endoscopic ... ...

    Abstract Background: Current guidelines recommend that patients with choledocholithiasis undergo same-admission cholecystectomy. The compliance with this guideline is poor in elderly patients. We hypothesized that elderly patients treated with endoscopic retrograde cholangiopancreatography (ERCP) alone would have higher complication and readmission rates than the patients treated with cholecystectomy.
    Methods: The Nationwide Readmissions Database was queried for all patients aged ≥65 years with admission for choledocholithiasis January to June 2016. The patients were divided based on index treatment received: (1) no intervention; (2) ERCP alone; or (3) cholecystectomy. Multivariate analyses identified predictors of cholecystectomy during index admission and of readmissions.
    Results: A total of 16,121 patients with choledocholithiasis were admitted; 38.4% underwent cholecystectomy, 37.6% endoscopic retrograde cholangiopancreatography alone, and 24.0% no intervention. The patients not receiving a cholecystectomy were more likely to be older, female, have a higher Elixhauser score, do-not-resuscitate status, and at a teaching hospital (all P < .001). Emergency readmissions for recurrent biliary disease were lowest in patients undoing a cholecystectomy (2.2% vs 9.2% endoscopic retrograde cholangiopancreatography and 12.4% no intervention, P < .001), as were readmissions for complications (3.6% vs 5.5% and 7.8%, P < .001). Cholecystectomy reduced rates of readmissions for recurrent disease (odds ratio 0.168, P < .001), for complications (odds ratio 0.540, P < .001), and death during readmission (odds ratio 0.503, P = .007); endoscopic retrograde cholangiopancreatography alone reduced only rates of readmissions. Age was not a predictor of readmission or death.
    Conclusion: Index admission cholecystectomy is associated with a lower risk of readmission for biliary disease or complications, as well as death during readmission, in elderly patients. Age alone is not predictive of outcomes; surgical intervention should be guided by clinical condition, comorbidities, and patient preference.
    MeSH term(s) Aged ; Cholangiopancreatography, Endoscopic Retrograde/adverse effects ; Cholecystectomy/adverse effects ; Cholecystectomy, Laparoscopic/adverse effects ; Choledocholithiasis/surgery ; Female ; Gallbladder Diseases/surgery ; Hospitalization ; Humans ; Retrospective Studies ; Standard of Care
    Language English
    Publishing date 2022-08-18
    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.2022.06.008
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  8. 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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  9. Article ; Online: The TEAM (Trauma Evaluation and Management) course: medical student knowledge gains and retention in the USA versus Ghana.

    Berndtson, Allison E / Morna, Martin / Debrah, Samuel / Coimbra, Raul

    Trauma surgery & acute care open

    2019  Volume 4, Issue 1, Page(s) e000287

    Abstract: Introduction: Trauma and injury are significant contributors to the global burden of disease, with 5 million deaths and 250 million disability-adjusted life years lost in 2015. This burden is disproportionally borne by low- and middle-income countries ( ... ...

    Abstract Introduction: Trauma and injury are significant contributors to the global burden of disease, with 5 million deaths and 250 million disability-adjusted life years lost in 2015. This burden is disproportionally borne by low- and middle-income countries (LMICs). Solutions are complex, but one area for improvement is basic trauma education. The American College of Surgeons has developed the Trauma Evaluation and Management (TEAM) course as an introduction to trauma care for medical students. We hypothesized that the TEAM course would be an effective educational program in LMICs and result in increased knowledge gains and retention similar to students in high-income countries (HICs).
    Methods: The TEAM course was taught and students evaluated at two sites, one LMIC (Ghana) and one HIC (USA), after obtaining approval from the HIC Institutional Review Board and medical schools at both sites. Participation was optional for all students and results were de-identified. The course was administered by a single educator for all sessions. Multiple-choice exams were given before and after the course, and again 6 months later.
    Results: A total of 62 LMIC and 64 HIC students participated in the course and completed initial testing. Demographics for the two groups were similar, as was participant attrition over time. LMIC students started with a relative knowledge deficit, scoring lower on both pre-course and post-course tests than HIC students, but gained more knowledge during the initial teaching session. After 6 months, the LMIC students continued to improve, whereas the HIC students' knowledge had regressed. Most students recommended course expansion.
    Conclusion: The TEAM course is a useful tool to provide the basic principles of trauma care to students in LMICs, and should be expanded. Further study is needed to determine the impact of TEAM education on patient care in LMICs.
    Level of evidence: Level III; Care Management.
    Language English
    Publishing date 2019-05-01
    Publishing country England
    Document type Journal Article
    ISSN 2397-5776
    ISSN (online) 2397-5776
    DOI 10.1136/tsaco-2018-000287
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  10. Article ; Online: Survey of venous thromboembolism prophylaxis in trauma patients: current prescribing practices and concordance with clinical practice guidelines.

    Alexander, Kaitlin M / Butts, Charles Caleb / Lee, Yan-Leei Larry / Kutcher, Matthew E / Polite, Nathan / Haut, Elliott R / Spain, David / Berndtson, Allison E / Costantini, Todd W / Simmons, Jon D

    Trauma surgery & acute care open

    2023  Volume 8, Issue 1, Page(s) e001070

    Abstract: Objectives: Pharmacological venous thromboembolism (VTE) prophylaxis is recommended in the vast majority of trauma patients. The purpose of this study was to characterize current dosing practices and timing of initiation of pharmacological VTE ... ...

    Abstract Objectives: Pharmacological venous thromboembolism (VTE) prophylaxis is recommended in the vast majority of trauma patients. The purpose of this study was to characterize current dosing practices and timing of initiation of pharmacological VTE chemoprophylaxis at trauma centers.
    Methods: This was an international, cross-sectional survey of trauma providers. The survey was sponsored by the American Association for the Surgery of Trauma (AAST) and distributed to AAST members. The survey included 38 questions about practitioner demographics, experience, level and location of trauma center, and individual/site-specific practices regarding the dosing, selection, and timing of initiation of pharmacological VTE chemoprophylaxis in trauma patients.
    Results: One hundred eighteen trauma providers responded (estimated response rate 6.9%). Most respondents were at level 1 trauma centers (100/118; 84.7%) and had >10 years of experience (73/118; 61.9%). While multiple dosing regimens were used, the most common dose reported was enoxaparin 30 mg every 12 hours (80/118; 67.8%). The majority of respondents (88/118; 74.6%) indicated adjusting the dose in patients with obesity. Seventy-eight (66.1%) routinely use antifactor Xa levels to guide dosing. Respondents at academic institutions were more likely to use guideline-directed dosing (based on the Eastern Association of the Surgery of Trauma and the Western Trauma Association guidelines) of VTE chemoprophylaxis compared with those at non-academic centers (86.2% vs 62.5%; p=0.0158) and guideline-directed dosing was reported more often if the trauma team included a clinical pharmacist (88.2% vs 69.0%; p=0.0142). Wide variability in initial timing of VTE chemoprophylaxis after traumatic brain injury, solid organ injury, and spinal cord injuries was found.
    Conclusions: A high degree of variability exists in prescribing and monitoring practices for the prevention of VTE in trauma patients. Clinical pharmacists may be helpful on trauma teams to optimize dosing and increase prescribing of guideline-concordant VTE chemoprophylaxis.
    Language English
    Publishing date 2023-05-12
    Publishing country England
    Document type Journal Article
    ISSN 2397-5776
    ISSN (online) 2397-5776
    DOI 10.1136/tsaco-2022-001070
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