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  1. Article ; Online: Trauma and COVID-Induced Severe Rhabdomyolysis.

    Riccardi, Julia / Fredericks, Charles J / Callcut, Rachael A

    The American surgeon

    2021  Volume 88, Issue 5, Page(s) 1003–1005

    Abstract: The novel coronavirus COVID-19 has been implicated in a number of extra-pulmonary manifestations including rhabdomyolysis. It is hypothesized to be secondary to direct muscle damage from the virus. The usual treatment of rhabdomyolysis is resuscitation ... ...

    Abstract The novel coronavirus COVID-19 has been implicated in a number of extra-pulmonary manifestations including rhabdomyolysis. It is hypothesized to be secondary to direct muscle damage from the virus. The usual treatment of rhabdomyolysis is resuscitation with aggressive fluid management to prevent acute renal failure. However, the combination of blunt thoracic trauma and COVID pneumonia has posed additional challenges for critical care management. A 68-year-old male presented to our institution after being found down for an unknown duration of time. He was diagnosed symptomatic COVID pneumonia. His traumatic injuries included 4 rib fractures, a rectus sheath hematoma, and rhabdomyolysis with a creatinine kinase (CK) level of 16,716 U/L. He was initially treated with steroids, prone positioning, and aggressive fluid administration. Despite treatment his CK level peaked at 146,328 U/L. Here we present the case of trauma and COVID-induced rhabdomyolysis with an extremely elevated CK level.
    MeSH term(s) Acute Kidney Injury/prevention & control ; Aged ; COVID-19/complications ; Creatine Kinase ; Humans ; Male ; Rhabdomyolysis/etiology ; Rhabdomyolysis/therapy ; SARS-CoV-2
    Chemical Substances Creatine Kinase (EC 2.7.3.2)
    Language English
    Publishing date 2021-12-26
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 202465-2
    ISSN 1555-9823 ; 0003-1348
    ISSN (online) 1555-9823
    ISSN 0003-1348
    DOI 10.1177/00031348211063569
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  2. Article ; Online: Cell-Free Hemoglobin in the Pathophysiology of Trauma: A Scoping Review.

    Ross, James T / Robles, Anamaria J / Mazer, Monty B / Studer, Amy C / Remy, Kenneth E / Callcut, Rachael A

    Critical care explorations

    2024  Volume 6, Issue 2, Page(s) e1052

    Abstract: Objectives: Cell-free hemoglobin (CFH) is a potent mediator of endothelial dysfunction, organ injury, coagulopathy, and immunomodulation in hemolysis. These mechanisms have been demonstrated in patients with sepsis, hemoglobinopathies, and those ... ...

    Abstract Objectives: Cell-free hemoglobin (CFH) is a potent mediator of endothelial dysfunction, organ injury, coagulopathy, and immunomodulation in hemolysis. These mechanisms have been demonstrated in patients with sepsis, hemoglobinopathies, and those receiving transfusions. However, less is known about the role of CFH in the pathophysiology of trauma, despite the release of equivalent levels of free hemoglobin.
    Data sources: Ovid MEDLINE, Embase, Web of Science Core Collection, and BIOSIS Previews were searched up to January 21, 2023, using key terms related to free hemoglobin and trauma.
    Data extraction: Two independent reviewers selected studies focused on hemolysis in trauma patients, hemoglobin breakdown products, hemoglobin-mediated injury in trauma, transfusion, sepsis, or therapeutics.
    Data synthesis: Data from the selected studies and their references were synthesized into a narrative review.
    Conclusions: Free hemoglobin likely plays a role in endothelial dysfunction, organ injury, coagulopathy, and immune dysfunction in polytrauma. This is a compelling area of investigation as multiple existing therapeutics effectively block these pathways.
    Language English
    Publishing date 2024-02-12
    Publishing country United States
    Document type Journal Article ; Review
    ISSN 2639-8028
    ISSN (online) 2639-8028
    DOI 10.1097/CCE.0000000000001052
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  3. Article ; Online: Growing the next generation of trauma surgeon-scientists: Reflections on 20 years of research investment.

    Callcut, Rachael A / Dixon, Rachel / Smith, Jason W / Zarzaur, Ben

    The journal of trauma and acute care surgery

    2022  Volume 93, Issue 3, Page(s) 340–346

    Abstract: Introduction: The Eastern Association for the Surgery of Trauma mission includes fostering research and providing career development opportunities. Eastern Association for the Surgery of Trauma has awarded for 20 years a research scholarship to a ... ...

    Abstract Introduction: The Eastern Association for the Surgery of Trauma mission includes fostering research and providing career development opportunities. Eastern Association for the Surgery of Trauma has awarded for 20 years a research scholarship to a promising young investigator. The research mentorship efforts were expanded 5 years ago with the INVEST-C Hack-a-thon. INVEST-C provides an intensive, short-term engagement to propel junior faculty toward establishing research independence. This study investigates the impact of these programs on academic productivity.
    Methods: Pubmed records, National Institutes of Health (NIH) Reporter data, and SCOPUS h-index were acquired for all scholarship (SCH) awardees from 2002 to 2021 (n = 20) and all INVEST-C (INV) participants (2017-2020, n = 19). Current type of practice, total number of funding awards, and timing of first award were ascertained. INVEST-C participants were also surveyed on an annual basis to track their progress. Medians (interquartile range [IQR]) are reported and compared (analysis of variance).
    Results: Median publications (PUBs) of SCH awardees were 56 (IQR, 33-88), h-index was 16 (IQR, 12-21), and 25% of awardees have ≥1 NIH grant since their SCH. Among the last 10 awardees with a minimum of 2 years from SCH, 40% have received an NIH award compared with a mean NIH funding rate of 18.5% over the same period. For those remaining in academics (90% SCH), PUBs were higher for those >5 years (66 [IQR, 51-115]) versus <5 years from their SCH (33 [22-59]; p = 0.05), but there was no difference in h-index (16 [IQR, 14-25] vs. 15 [9-19], p = NS). Comparing the most recent 5 years of SCH to INV group, there was no difference in academic productivity as measured by total PUBs (SCH, 33 [IQR, 22-59] vs. INV, 34 [IQR, 18-44]; p = 0.7) or h-index (INV, 9 [IQR, 5-14]; p = 0.1). However, no attendee held research funding before INV, but 31.6% (6 of 19 attendees) have subsequently acquired ≥1 funding award (11 non-NIH, 1 NIH) in the short interval since participation.
    Conclusion: Investments in research activities have translated to significant extramural funding. Those in the last 5 years have been particularly fruitful with INV participants already achieving equal median academic productivity to SCH recipients.
    Level of evidence: Prognostic and Epidemiologic; Level III.
    MeSH term(s) Awards and Prizes ; Biomedical Research ; Financing, Organized ; Humans ; National Institutes of Health (U.S.) ; Research Personnel ; Surgeons ; United States
    Language English
    Publishing date 2022-06-01
    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.0000000000003714
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  4. Article: What is the best position for preventing ventilator-associated pneumonia?

    Callcut, Rachael A

    Respiratory care

    2010  Volume 55, Issue 3, Page(s) 353–354

    MeSH term(s) Humans ; Intubation, Intratracheal/methods ; Patient Positioning/methods ; Pneumonia, Ventilator-Associated/prevention & control ; Respiration, Artificial ; Respiratory Aspiration/prevention & control ; Respiratory Function Tests ; Work of Breathing
    Language English
    Publishing date 2010-03
    Publishing country United States
    Document type Comment ; Editorial
    ZDB-ID 603252-7
    ISSN 0020-1324 ; 0098-9142
    ISSN 0020-1324 ; 0098-9142
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  5. Article ; Online: Banning open carry of unloaded handguns decreases firearm-related fatalities and hospital utilization.

    Callcut, Rachael A / Robles, Anamaria M Joyce / Mell, Matthew W

    Trauma surgery & acute care open

    2018  Volume 3, Issue 1, Page(s) e000196

    Abstract: Background: Since 1967, in California it has been illegal to openly carry a loaded firearm in public except when engaged in hunting or law enforcement. However, beginning January 1, 2012, public open carry of unloaded handguns also became illegal. Fatal ...

    Abstract Background: Since 1967, in California it has been illegal to openly carry a loaded firearm in public except when engaged in hunting or law enforcement. However, beginning January 1, 2012, public open carry of unloaded handguns also became illegal. Fatal and non-fatal (NF) firearm injuries were examined before and after adoption of the 2012 ban to quantify the effect of the new law on public health.
    Methods: State-level data were obtained directly from California and nine other US state inpatient and emergency department (ED) discharge databases, and the Centers for Disease Control Web-Based Injury Statistics Query and Reporting System. Case numbers of firearm fatalities, NF hospitalizations, NF ED visits, and state-level population estimates were extracted. Each incident was classified as unintentional, self-inflicted, or assault. Crude incidence rates were calculated. The strength of gun laws was quantified using the Brady grade. There were no changes to open carry in these nine states during the study. Using a difference-in-difference technique, the rate trends 3 years preban and postban were compared.
    Results: The 2012 open carry ban resulted in a significantly lower incident rate of both firearm-related fatalities and NF hospitalizations (p<0.001). The effect of the law remained significant when controlling for baseline state gun laws (p<0.001). Firearm incident rate drops in California were significant for male homicide (p=0.023), hospitalization for NF assault (p=0.021  male; p=0.025 female), and ED NF assault visits (p=0.04). No significant decreases were observed by sex for suicides or unintentional injury. Changing the law saved an estimated 337 lives (3.6% fewer deaths) and 1285 NF visits in California during the postban period.
    Discussion: Open carry ban decreases fatalities and healthcare utilization even in a state with baseline strict gun laws. The most significant impact is from decreasing firearm-related fatal and NF assaults.
    Level of evidence: III, epidemiology.
    Language English
    Publishing date 2018-10-24
    Publishing country England
    Document type Journal Article
    ISSN 2397-5776
    ISSN (online) 2397-5776
    DOI 10.1136/tsaco-2018-000196
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  6. Article ; Online: Is it time to measure complications from the National Trauma Data Bank? A longitudinal analysis of recent reporting trends.

    Robles, Anamaria J / Conroy, Amanda S / Cohen, Mitchell J / Callcut, Rachael A

    The journal of trauma and acute care surgery

    2019  Volume 86, Issue 2, Page(s) 282–288

    Abstract: Background: Payers have approached select complications as never events, yet there is rationale that achieving a zero incidence of these events is impractical. Prior 2005 National Trauma Data Bank (NTDB) analysis showed high rates (37%) of centers ... ...

    Abstract Background: Payers have approached select complications as never events, yet there is rationale that achieving a zero incidence of these events is impractical. Prior 2005 National Trauma Data Bank (NTDB) analysis showed high rates (37%) of centers reporting no complications data making national estimates for determining standardized complication rates difficult to ascertain.
    Methods: The 2008-2012 NTDB National Sample Program nationally weighted files were used to calculate yearly national estimates. Rates were compared in all centers and those reporting complications data. Hospital characteristics were compared using Student t test. In 2011, an other complication category was introduced; overall rates were calculated with and without this category. Yearly estimates were reported for patients receiving care within centers reporting complications data.
    Results: From 2008-2012 NTDB, there were raw data on 3,657,884 patients. A total of 594,894 patients (16.3%) experienced one or more complications (82.7% one complication; 17.3% two or more complications). Excluding the other complication category, the overall weighted rate was 8.4% to 9.2%. Pneumonia was the most common complication (2.7-3.0%), occurring at twice the 2005 rate. The number of centers reporting no complications data dropped to 8.1% in 2011 (2008, 14.5%; 2009, 18.2%; 2010, 15.9%; 2012, 8.9%). By 2012, nearly all level I centers reported complications, whereas 46.4% of level IVs reported none (I 0.5%, II 2.7%, III 8.5%, p = 0.04). Data were reported the least frequently in nonteaching hospitals (15.8%, p = 0.007), those in the South (19.6%, p = 0.007), and those with less than 200 beds (23.6%, p = 0.005).
    Conclusion: Overall rates of complications from 2008 to 2012 were nearly twofold higher than 2005 data. Reporting has increased, and NTDB may provide a valuable platform for establishing rational and achievable measures for specific complications.
    Level of evidence: Prognostic and epidemiological, level IV.
    MeSH term(s) Adolescent ; Adult ; Aged ; Aged, 80 and over ; Databases, Factual/statistics & numerical data ; Female ; Humans ; Male ; Middle Aged ; Risk Management/trends ; Trauma Centers/statistics & numerical data ; United States ; Wounds and Injuries/complications ; Young Adult
    Language English
    Publishing date 2019-01-08
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2651070-4
    ISSN 2163-0763 ; 2163-0755
    ISSN (online) 2163-0763
    ISSN 2163-0755
    DOI 10.1097/TA.0000000000002133
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  7. Article ; Online: Trauma Early Mortality Prediction Tool (TEMPT) for assessing 28-day mortality.

    Kunitake, Ryan C / Kornblith, Lucy Z / Cohen, Mitchell Jay / Callcut, Rachael A

    Trauma surgery & acute care open

    2018  Volume 3, Issue 1, Page(s) e000131

    Abstract: Background: Prior mortality prediction models have incorporated severity of anatomic injury quantified by Abbreviated Injury Severity Score (AIS). Using a prospective cohort, a new score independent of AIS was developed using clinical and laboratory ... ...

    Abstract Background: Prior mortality prediction models have incorporated severity of anatomic injury quantified by Abbreviated Injury Severity Score (AIS). Using a prospective cohort, a new score independent of AIS was developed using clinical and laboratory markers present on emergency department presentation to predict 28-day mortality.
    Methods: All patients (n=1427) enrolled in an ongoing prospective cohort study were included. Demographic, laboratory, and clinical data were recorded on admission. True random number generator technique divided the cohort into derivation (n=707) and validation groups (n=720). Using Youden indices, threshold values were selected for each potential predictor in the derivation cohort. Logistic regression was used to identify independent predictors. Significant variables were equally weighted to create a new mortality prediction score, the Trauma Early Mortality Prediction Tool (TEMPT) score. Area under the curve (AUC) was tested in the validation group. Pairwise comparison of Trauma Injury Severity Score (TRISS), Revised Trauma Score, Glasgow Coma Scale, and Injury Severity Score were tested against the TEMPT score.
    Results: There was no difference between baseline characteristics between derivation and validation groups. In multiple logistic regression, a model with presence of traumatic brain injury, increased age, elevated systolic blood pressure, decreased base excess, prolonged partial thromboplastin time, increased international normalized ratio (INR), and decreased temperature accurately predicted mortality at 28 days (AUC 0.93, 95% CI 0.90 to 0.96, P<0.001). In the validation cohort, this score, termed TEMPT, predicted 28-day mortality with an AUC 0.94 (95% CI 0.92 to 0.97). The TEMPT score preformed similarly to the revised TRISS score for severely injured patients and was highly predictive in those having mild to moderate injury.
    Discussion: TEMPT is a simple AIS-independent mortality prediction tool applicable very early following injury. TEMPT provides an AIS-independent score that could be used for early identification of those at risk of doing poorly following even minor injury.
    Level of evidence: Level II.
    Language English
    Publishing date 2018-01-08
    Publishing country England
    Document type Journal Article
    ISSN 2397-5776
    ISSN (online) 2397-5776
    DOI 10.1136/tsaco-2017-000131
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  8. Article ; Online: Emergency Department Length of Stay and Mortality in Critically Injured Patients.

    Stey, Anne M / Kanzaria, Hemal K / Dudley, R Adams / Bilimoria, Karl Y / Knudson, M Margaret / Callcut, Rachael A

    Journal of intensive care medicine

    2021  Volume 37, Issue 2, Page(s) 278–287

    Abstract: Objective: Multicenter data from 2 decades ago demonstrated that critically ill and injured patients spending more than 6 hours in the emergency department (ED) before transfer to the intensive care unit (ICU) had higher mortality rates. A contemporary ... ...

    Abstract Objective: Multicenter data from 2 decades ago demonstrated that critically ill and injured patients spending more than 6 hours in the emergency department (ED) before transfer to the intensive care unit (ICU) had higher mortality rates. A contemporary analysis of ED length of stay in critically injured patients at American College of Surgeons' Trauma Quality Improvement Program (ACS-TQIP) centers was performed to test whether prolonged ED length of stay is still associated with mortality.
    Methods: This was an observational cohort study of critically injured patients admitted directly to ICU from the ED in ACS-TQIP centers from 2010-2015. Spending more than 6 hours in the ED was defined as prolonged ED length of stay. Patients with prolonged ED length of stay were matched to those with non-prolonged ED length of stay and mortality was compared.
    Main results: A total of 113,097 patients were directly admitted from the ED to the ICU following injury. The median ED length of stay was 167 minutes. Prolonged ED length of stay occurred in 15,279 (13.5%) of patients. Women accounted for 29.4% of patients with prolonged ED length of stay but only 25.8% of patients with non-prolonged ED length of stay,
    Conclusion: Prolonged ED length of stay is no longer associated with mortality among critically injured patients. Women are more likely to have prolonged ED length of stay and mortality.
    MeSH term(s) Critical Illness/therapy ; Emergency Service, Hospital ; Female ; Hospitalization ; Humans ; Intensive Care Units ; Length of Stay ; Male
    Language English
    Publishing date 2021-03-01
    Publishing country United States
    Document type Journal Article ; Multicenter Study ; Observational Study
    ZDB-ID 632828-3
    ISSN 1525-1489 ; 0885-0666
    ISSN (online) 1525-1489
    ISSN 0885-0666
    DOI 10.1177/0885066621995426
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  9. Article ; Online: Modern advances in vascular trauma.

    Callcut, Rachael A / Mell, Matthew W

    The Surgical clinics of North America

    2013  Volume 93, Issue 4, Page(s) 941–61, ix

    Abstract: Early diagnosis and intervention are paramount for improving the likelihood of a favorable outcome for traumatic vascular injuries. As technology has rapidly diversified, the diagnostic and therapeutic approaches available for vascular injuries have ... ...

    Abstract Early diagnosis and intervention are paramount for improving the likelihood of a favorable outcome for traumatic vascular injuries. As technology has rapidly diversified, the diagnostic and therapeutic approaches available for vascular injuries have evolved. Mortality and morbidity from vascular injury have declined over the last decade. The use of vascular shunts and tourniquets has become standard of care in military medicine.
    MeSH term(s) Amputation ; Arteries/injuries ; Blood Vessel Prosthesis Implantation ; Cerebrovascular Trauma/diagnosis ; Cerebrovascular Trauma/surgery ; Diagnostic Imaging/methods ; Early Diagnosis ; Endovascular Procedures/trends ; Extremities/blood supply ; Humans ; Thoracic Injuries/diagnosis ; Thoracic Injuries/surgery ; Tourniquets ; Treatment Outcome ; Vascular System Injuries/diagnosis ; Vascular System Injuries/surgery ; Wounds, Nonpenetrating/diagnosis ; Wounds, Nonpenetrating/surgery
    Language English
    Publishing date 2013-08
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 215713-5
    ISSN 1558-3171 ; 0039-6109
    ISSN (online) 1558-3171
    ISSN 0039-6109
    DOI 10.1016/j.suc.2013.04.010
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  10. Article ; Online: A Parallel Pandemic: Increased Firearm Injuries at Five Northern California Trauma Centers During the COVID-19 Pandemic: An Interrupted Time-series Analysis.

    Matthay, Zachary A / Callcut, Rachael A / Kwok, Amy M / Aarabi, Shahram / Forrester, Joseph D / Kornblith, Lucy Z

    Annals of surgery

    2021  Volume 275, Issue 5, Page(s) e725–e727

    Abstract: Objective: This study aimed to characterize changes in firearm injuries at 5 level 1 trauma centers in Northern California in the 12 months following the start of the COVID-19 pandemic compared with the preceding 4 years, accounting for regional ... ...

    Abstract Objective: This study aimed to characterize changes in firearm injuries at 5 level 1 trauma centers in Northern California in the 12 months following the start of the COVID-19 pandemic compared with the preceding 4 years, accounting for regional variations and seasonal trends.
    Summary and background data: Increased firearm injuries have been reported during the early peaks of the COVID-19 pandemic despite shelter-in-place restrictions. However, these data are overwhelmingly from singlecenter studies, during the initial phase of the pandemic prior to lifting of shelter-in-place restrictions, or do not account for seasonal trends.
    Methods: An interrupted time-series analysis (ITSA) of all firearm injuries presenting to 5 adult level 1 trauma centers in Northern California was performed (January 2016to February 2021). ITSA modeled the association of the onset of the COVID-19 pandemic (March 2020) with monthly firearm injuries using the ordinary least-squares method, included month indicators to adjust for seasonality, and specified lags of up to 12 months to account for autocorrelation.
    Results: Prior to the start of COVID-19, firearm injuries averaged (±SD) of 86 (±16) and were decreasing by 0.5/month (P < 0.01). The start of COVID- 19 (March 2020) was associated with an alarming increase of 39 firearm injuries/month (P < 0.01) followed by an ongoing rise of 3.5/mo (P < 0.01). This resulted in an average of 130 (±26) firearm injuries/month during the COVID-19 period and included 8 of the 10 highest monthly firearm injury rates in the past 5 years.
    Conclusions: These data highlight an alarming escalation in firearm injuries in the 12 months following the onset of the COVID-19 pandemic in Northern California. Additional studies and resources are needed to better understand and address this parallel public health crisis.
    MeSH term(s) Adult ; COVID-19/epidemiology ; California/epidemiology ; Firearms ; Humans ; Pandemics ; Retrospective Studies ; Trauma Centers ; Wounds, Gunshot/epidemiology
    Language English
    Publishing date 2021-12-14
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 340-2
    ISSN 1528-1140 ; 0003-4932
    ISSN (online) 1528-1140
    ISSN 0003-4932
    DOI 10.1097/SLA.0000000000005334
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