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Article ; Online: What is the Role of Whole Blood Transfusions on Trauma Patients?

Porter, John M / Hazelton, Joshua P

2023 Volume 57, Issue 1, Page(s) 257–266

Abstract: Whole blood use in trauma has historically been limited to military use, but in recent years, there has been increasing data for use in civilian trauma. Emerging clinical data demonstrate an associated survival benefit, while some authors have also ... ...

Abstract	Whole blood use in trauma has historically been limited to military use, but in recent years, there has been increasing data for use in civilian trauma. Emerging clinical data demonstrate an associated survival benefit, while some authors have also identified decreased use of an overall number of blood products and decreased complications. Use of whole blood is gradually moving toward becoming the standard of care in the hemorrhaging trauma patient.
MeSH term(s)	Humans ; Resuscitation/adverse effects ; Blood Transfusion ; Shock, Hemorrhagic/etiology ; Wounds and Injuries/complications ; Wounds and Injuries/therapy
Language	English
Publishing date	2023-05-17
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	411889-3
ISSN	1878-0555 ; 0065-3411
ISSN (online)	1878-0555
ISSN	0065-3411
DOI	10.1016/j.yasu.2023.04.006
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Article ; Online: Pre-COVID-19 Physician Awareness of Mental Health Resources During and After Natural and Human-Made Disasters.

Sood, Natasha / Hazelton, Joshua P / Boehmer, Sue / Olympia, Robert P

Disaster medicine and public health preparedness

2022 Volume 17, Page(s) e282

Abstract: Objective: Physician mental health is critical during the recovery of natural and human-made disasters (NHDs), yet the accessibility of mental health resources to physicians has not been characterized. This study examined emergency medicine and trauma ... ...

Abstract	Objective: Physician mental health is critical during the recovery of natural and human-made disasters (NHDs), yet the accessibility of mental health resources to physicians has not been characterized. This study examined emergency medicine and trauma physician knowledge of and access to mental health resources in NHD settings. Methods: The survey was electronically disseminated to the American College of Emergency Physicians and the American Association of the Surgery of Trauma between February 4, 2020, and March 9, 2020. The 17-question survey assessed physician awareness and access to emergency preparedness resources at their institutions. Results: Of the responders, 86% (n = 229) were aware of written emergency response plans for their facility. While 31% were aware of the hospital's mental health policies and resources outside of the emergency response plan, only 25% knew how to access these resources during and after NHDs. Finally, 10% reported the incorporation of mental health resources during institutional practice drills. Conclusions: Physicians reported knowledge of emergency preparedness policies; however, significant gaps remain in physician knowledge and access to mental health resources NHD settings. As NHDs increase on a global scale, it is critical for health systems to ensure accessible infrastructure to support the mental well-being of health professionals.
MeSH term(s)	Humans ; Disaster Planning ; Mental Health ; COVID-19 ; Disasters ; Physicians ; Health Resources
Language	English
Publishing date	2022-11-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	2375268-3
ISSN	1938-744X ; 1935-7893
ISSN (online)	1938-744X
ISSN	1935-7893
DOI	10.1017/dmp.2022.256
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Article ; Online: Association of Acute Care Surgeon Experience With Emergency Surgery Patient Outcomes and Mortality.

Schuster, Kevin M / Hazelton, Joshua P / Rattigan, Deviney / Perez, Javier Martin / Bhattacharya, Bishwajit

JAMA surgery

2021 Volume 156, Issue 5, Page(s) 472–478

Abstract: Importance: Previous studies comparing emergency surgery outcomes with surgeon experience have been small or used administrative databases without controlling for patient physiology or operative complexity.: Objective: To evaluate the association of ... ...

Abstract	Importance: Previous studies comparing emergency surgery outcomes with surgeon experience have been small or used administrative databases without controlling for patient physiology or operative complexity. Objective: To evaluate the association of acute care surgeon experience with patient morbidity and mortality after emergency surgical procedures. Design, setting, and participants: This cohort study evaluated the association of surgeon experience with emergency surgery outcomes at 5 US academic level 1 trauma centers where the same surgeons provided emergency general surgical care. A total of 772 patients who presented with a traumatic injury and required an emergency surgical procedure or who presented with or developed a condition requiring an emergency general surgical intervention were operated on by 1 of 56 acute care surgeons. Surgeon groups were divided by experience of less than 6 years (early career), 6 to 10 years (early midcareer), 11 to 30 years (late midcareer), and 30 years or more (late career) from the end of training. Surgeons with less than 3 years of experience were also compared with the entire cohort. Hierarchical logistic regression models were constructed controlling for Emergency Surgery Score, case complexity, preoperative transfusion, and trauma or emergency general surgery. Data were collected from May 2015 to July 2017 and analyzed from February to May 2020. Main outcomes and measures: Mortality, complications, length of stay, blood loss, and unplanned return to the operating room. Results: Of 772 included patients, 469 (60.8%) were male, and the mean (SD) age was 50.1 (20.0) years. Of 772 operations, 618 were by surgeons with less than 10 years of experience. Early- and late-midcareer surgeons generally operated on older patients and patients with more septic shock, acute kidney failure, and higher Emergency Surgery Scores. Patient mortality, complications, postoperative transfusion, organ-space surgical site infection, and length of stay were similar between surgeon groups. Patients operated on by early-career surgeons had higher rates of unplanned return to the operating room compared with those operated on by early-midcareer surgeons (odds ratio [OR], 0.66; 95% CI, 0.40-1.09), late-midcareer surgeons (OR, 0.34; 95% CI, 0.13-0.90), and late-career surgeons (OR, 1.11; 95% CI, 0.45-2.75). Patients operated on by surgeons with less than 3 years of experience had similar mortality compared with the rest of the cohort (OR, 1.97; 95% CI, 0.85-4.57) but higher rates of complications (OR, 2.07; 95% CI, 1.05-4.07). Conclusions and relevance: In this study, experienced surgeons generally operated on older patients with more septic shock and kidney failure without affecting risk-adjusted mortality. Increased complications and unplanned return to the operating room may improve with experience. Early-career surgeons' outcomes may be improved if they are supported while experience is garnered.
MeSH term(s)	Acute Kidney Injury/complications ; Adult ; Aged ; Blood Transfusion ; Clinical Competence ; Emergencies ; Female ; Humans ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Postoperative Hemorrhage/etiology ; Postoperative Period ; Reoperation/statistics & numerical data ; Risk Factors ; Shock, Septic/complications ; Surgeons/standards ; Surgical Wound Infection/etiology ; Survival Rate ; Time Factors ; Trauma Centers/statistics & numerical data ; Treatment Outcome ; United States ; Wounds and Injuries/complications ; Wounds and Injuries/mortality ; Wounds and Injuries/surgery ; Young Adult
Language	English
Publishing date	2021-03-10
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.2021.0041
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Article ; Online: Repeat Imaging in Blunt Hepatic Injuries Can Wait for Clinical Change.

Fletcher, Kelsey L / Perea, Lindsey L / Morgan, Madison E / Otaibi, Banan W / Hazelton, Joshua P

The Journal of surgical research

2021 Volume 268, Page(s) 119–124

Abstract: Background: There is variability regarding the utilization and timing of repeat imaging in adult patients with blunt hepatic injury who are managed nonoperatively. This study examines the rate of delayed complications and interventions in patients with ... ...

Abstract	Background: There is variability regarding the utilization and timing of repeat imaging in adult patients with blunt hepatic injury who are managed nonoperatively. This study examines the rate of delayed complications and interventions in patients with blunt hepatic injuries who undergo repeat imaging prompted either by clinical change (CC) or non-clinical change (NCC). Methods: A nine-year, retrospective, dual-institution study was performed of adult patients with blunt hepatic injuries. Patients were identified based on whether repeat imaging was performed and reason for reimaging: CC or NCC. The incidence of delayed complications and interventions was examined for each type of scan. Results: Of 365 patients, 122 (33.4%) underwent repeat imaging [CC, n = 72 (59%); NCC, n=50 (41%)]. Mean time to repeat imaging was shorter in the NCC group [CC = 7.6 ± 8 days; NCC = 4.7 ± 6.3 days, P = 0.034]. Delayed complications were found in 30 (25%) patients reimaged, [CC, n = 20; NCC, n = 10, P = 0.395]. Interventions were performed in 12 (40%) patients [CC, n = 10; NCC, n = 2, P = 0.120]. Conclusions: Repeat imaging due to NCC occurred earlier than imaging performed by CC. One quarter of patients reimaged demonstrated a delayed complication, with nearly half undergoing intervention. There was no difference in incidence of delayed complications or interventions between groups, suggesting repeat imaging can be prompted by clinical change in blunt hepatic injuries.
MeSH term(s)	Abdominal Injuries/complications ; Adult ; Diagnostic Imaging ; Humans ; Incidence ; Liver/diagnostic imaging ; Liver/injuries ; Retrospective Studies ; Wounds, Nonpenetrating/complications ; Wounds, Nonpenetrating/diagnostic imaging ; Wounds, Nonpenetrating/therapy
Language	English
Publishing date	2021-07-22
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.2021.06.049
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Article ; Online: Medical Student Attitudes Toward Blood Donation in Times of Increased Need.

Khatun, Rahima / Otaibi, Banan W / Ssentongo, Anna / Hazelton, Joshua P / Cooper, AmandaB

The American surgeon

2021 Volume 88, Issue 9, Page(s) 2338–2344

Abstract: Background: In situations of increased need, such as mass casualty incidents (MCIs) and COVID-19, donated blood products are in shortage across the United States. Medical students are a potential pool for blood donors. The aim of this study was to ... ...

Abstract	Background: In situations of increased need, such as mass casualty incidents (MCIs) and COVID-19, donated blood products are in shortage across the United States. Medical students are a potential pool for blood donors. The aim of this study was to determine overall attitudes of medical students at a single academic institution toward blood donation during times of increased need. Methods: Three anonymous REDCap surveys were administered to all medical students at a rural academic institution. Surveys 1 and 2 were administered preceding and after an institution-wide MCI drill, in September and November 2019, respectively. Survey 3 was administered following a student-organized COVID-19 blood drive in June 2020. Multivariable analysis was performed to determine if factors, ie, experience with MCI drills and emergency medical services (EMS) training, were associated with willingness to donate blood. Furthermore, barriers to donation among those not willing to donate were assessed. Results: Overall response rate for MCI surveys (surveys 1 and 2) was 38% (mean age 25.2 years and 50% women). 91% (n = 210) of respondents were willing to donate blood. Previous participation in MCI drills and EMS training was not associated with higher willingness to donate blood. Response rate for survey 3 was 15.6% (59.4% women), and 30 (31.3%) respondents indicated they did not volunteer to donate blood during the COVID-19 drive. Most common reasons for not donating were "other," medical concerns, and being out-of-town. Conclusions: Majority of medical students are willing to donate blood during times of increased need and offer a possible solution to increase blood donor pool.
MeSH term(s)	Adult ; Blood Donors ; COVID-19/epidemiology ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Male ; Mass Casualty Incidents ; Students, Medical ; Surveys and Questionnaires ; Tissue and Organ Procurement
Language	English
Publishing date	2021-04-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
DOI	10.1177/00031348211011083
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Article ; Online: Added Value of Dedicated Spine CT to Detect Fracture in Patients with CT Chest, Abdomen, and Pelvis in the Trauma Setting.

Hardy, Caitlin / Hazelton, Joshua P / Gefen, Ron

Current problems in diagnostic radiology

2018 Volume 48, Issue 6, Page(s) 554–557

Abstract: Purpose: Fractures of the thoracolumbar spine account for up to 90% of spinal fractures, and are associated with significant disability. The advantage of acquiring dedicated spine CT imaging in addition to visceral CT studies of the chest, abdomen and ... ...

Abstract	Purpose: Fractures of the thoracolumbar spine account for up to 90% of spinal fractures, and are associated with significant disability. The advantage of acquiring dedicated spine CT imaging in addition to visceral CT studies of the chest, abdomen and pelvis for detection of spinal fractures has not been definitively established. This retrospective study seeks to determine the contribution of dedicated spine CT in the acute clinical setting. Methods: Patients who were diagnosed with fractures of the thoracic or lumbar spine at our institution between January 1, 2010 and June 30, 2014 were identified. Additional inclusion criteria included having a CT of the chest and/or abdomen and pelvis followed by a dedicated thoracic or lumbar spine CT within 30 days. Reports were reviewed for accuracy of fracture detection, and missed fractures were retrospectively analyzed on images for detectability. Results: A total of 102 patients met our inclusion criteria for a total of 312 fractures. Of the 312 fractures, 31 (10%) were missed on the initial visceral CT in 18 of the 102 patients. In all but two cases, at least one fracture was identified on the visceral spine CT. There were no cases in which the newly identified fractures changed patient management. Conclusion: All fractures requiring surgical intervention were identified on the visceral CT. A dedicated spine CT does detect additional spine fractures but does not clearly alter patient management.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Multiple Trauma/diagnostic imaging ; Pelvis/diagnostic imaging ; Pelvis/injuries ; Radiography, Abdominal ; Radiography, Thoracic ; Retrospective Studies ; Spinal Fractures/diagnostic imaging ; Tomography, X-Ray Computed/methods ; Wounds, Nonpenetrating/diagnostic imaging
Language	English
Publishing date	2018-08-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	198954-6
ISSN	1535-6302 ; 0363-0188
ISSN (online)	1535-6302
ISSN	0363-0188
DOI	10.1067/j.cpradiol.2018.08.002
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Article ; Online: Sutureless Repair of a Full-Thickness Cardiac Stab Wound Adjacent to the Right Coronary Artery Using Evarrest® Patch.

Butts, Christopher A / Hagaman, Ashleigh / Porter, John / Hazelton, Joshua P

The American surgeon

2019 Volume 85, Issue 8, Page(s) e419–e420

MeSH term(s)	Adult ; Coronary Vessels ; Electrocardiography ; Heart Injuries/surgery ; Humans ; Sternotomy ; Suicide, Attempted ; Sutureless Surgical Procedures/instrumentation ; Wounds, Stab/surgery
Language	English
Publishing date	2019-09-27
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
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Article ; Online: Low-density Isolated Intraperitoneal Free Fluid in Pediatric Blunt Trauma Is Not Associated With Abdominal Injury.

Perea, Lindsey L / San Roman, Janika / Gaughan, John P / Gefen, Ron / Hazelton, Joshua P

Pediatric emergency care

2020 Volume 38, Issue 1, Page(s) e143–e146

Abstract: Objectives: Isolated intraperitoneal free fluid (IIFF) is defined as intraperitoneal fluid seen on computed tomography (CT) without identifiable injury. In a hemodynamically stable patient, this finding creates a challenge for physicians regarding the ... ...

Abstract	Objectives: Isolated intraperitoneal free fluid (IIFF) is defined as intraperitoneal fluid seen on computed tomography (CT) without identifiable injury. In a hemodynamically stable patient, this finding creates a challenge for physicians regarding the next steps in management because the clinical significance of this fluid is not completely understood. We hypothesized that pediatric blunt trauma patients with a finding of simple IIFF on CT would not have clinically significant intraabdominal injury. Methods: A retrospective review (2009-2018) was conducted of all pediatric blunt trauma patients who underwent CT scan of the abdomen/pelvis at our institution. All patients with scans performed at our institution with the finding of IIFF were included. Scans were reviewed to measure the Hounsfield Units (HU) of the intraabdominal fluid. Groups were stratified into HU > 25 and HU ≤ 25, below accepted cutoffs for acute blood, and clinical outcomes were reviewed. Results: A total of 413 patients had free fluid on CT abdomen/pelvis with 279 (68%) having only the finding of IIFF. The HU was 25 or less in 236 (85%) patients. No patients in the HU ≤ 25 group required operative exploration or had examination findings to indicate they had intraabdominal injury. Four (9%) patients in the HU > 25 required laparotomy (P < 0.0001). No patients in the HU ≤ 25 group required further workup or hospital admission over concern for intraabdominal injury. Conclusions: Pediatric blunt trauma patients with HU of 25 or less IIFF and a nonperitonitic physical examination did not require operative exploration or further workup for intraabdominal injury. In the absence of other injuries, it is safe to discharge these patients without further workup.
MeSH term(s)	Abdominal Injuries/diagnostic imaging ; Abdominal Injuries/surgery ; Child ; Humans ; Laparotomy ; Retrospective Studies ; Tomography, X-Ray Computed ; Wounds, Nonpenetrating/diagnostic imaging ; Wounds, Nonpenetrating/surgery
Language	English
Publishing date	2020-11-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	632588-9
ISSN	1535-1815 ; 0749-5161
ISSN (online)	1535-1815
ISSN	0749-5161
DOI	10.1097/PEC.0000000000002189
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Article ; Online: Patient Outcomes in Mesenteric Venous Thrombosis Treated With Empiric Antibiotics.

Lewcun, Joseph A / Khatun, Rahima / Allen, Steven / Hazelton, Joshua P / Cooper, Amanda

The American surgeon

2020 Volume 87, Issue 4, Page(s) 658–663

Abstract: Background: Mesenteric venous thrombosis (MVT) is typically associated with poor prognosis. Although prophylactic antibiotics are sometimes given with the intent of limiting bacterial luminal load and translocation in patients with MVT, this approach ... ...

Abstract	Background: Mesenteric venous thrombosis (MVT) is typically associated with poor prognosis. Although prophylactic antibiotics are sometimes given with the intent of limiting bacterial luminal load and translocation in patients with MVT, this approach has not been universally adopted. The aim of this study is to analyze whether utilizing antibiotics empirically in those with MVT improves patient outcomes and survival when compared to those who do not receive empiric antibiotics. Methods: A retrospective review of patients admitted with MVT between 2002 and 2019 at a single academic institution was performed. Demographics and rates of mortality need for bowel resection, readmission, and Results: Eighty-three patients (mean age 64.5 years and 55.4% male) who were admitted for MVT were included. Empiric antibiotics were utilized in 53% (n = 44) of MVT patients while 47% (n = 39) received supportive treatment without empiric antibiotics. Death occurred in 4 patients treated with antibiotics and 6 patients treated without antibiotics (9.1% vs. 15.3%, Conclusions: Empiric antibiotic usage may not improve rates of mortality or hospital readmission in patients with MVT and may unnecessarily expose patients to an increased risk of
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Bacterial Infections/etiology ; Bacterial Infections/mortality ; Bacterial Infections/prevention & control ; Clostridium Infections/etiology ; Clostridium Infections/mortality ; Clostridium Infections/prevention & control ; Female ; Humans ; Length of Stay/statistics & numerical data ; Male ; Mesenteric Veins ; Middle Aged ; Patient Readmission/statistics & numerical data ; Retrospective Studies ; Survival Rate ; Treatment Outcome ; Venous Thrombosis/complications ; Young Adult
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2020-11-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
DOI	10.1177/0003134820954850
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Article ; Online: Routine Repeat Imaging of Pediatric Blunt Solid Organ Injuries Is Not Necessary.

Fletcher, Kelsey L / Meagher, Mitchell / Spencer, Brianna L / Morgan, Madison E / Safford, Shawn D / Armen, Scott B / Hazelton, Joshua P / Perea, Lindsey L

The American surgeon

2021 Volume 89, Issue 4, Page(s) 691–698

Abstract: Introduction: Nonoperative management of hemodynamically stable patients with blunt splenic and/or hepatic injury has been widely accepted in the pediatric population. However, variability exists in the utilization and timing of repeat imaging to assess ...

Abstract	Introduction: Nonoperative management of hemodynamically stable patients with blunt splenic and/or hepatic injury has been widely accepted in the pediatric population. However, variability exists in the utilization and timing of repeat imaging to assess for delayed complications during index hospitalization. Recent level-IV evidence suggests that repeat imaging in children should be performed based on a patient's clinical status rather than on a routine basis. The aim of this study is to examine the rate of delayed complications and interventions in pediatric trauma patients with blunt splenic and/or hepatic injuries who undergo repeat imaging prompted either by a clinical change (CC) or non-clinical change (NCC). Methods: A 9-year (2011-2019), retrospective, dual-institution study was performed of children (0-17 years) with blunt splenic and/or hepatic injuries. Patients were grouped based on reason for repeat imaging: CC or NCC. The rate of organ-specific delayed complications and interventions was examined by reason for scan. Results: A total of 307 injuries were included in the study period (174 splenic, 113 hepatic, and 20 both). Of 194 splenic injuries, 30(15.5%) underwent repeat imaging (CC = 19; NCC = 11). Of 133 hepatic injuries, 27(20.3%) underwent repeat imaging (CC = 21; NCC = 6). There was no difference in the incidence of organ-specific delayed complications between the CC and NCC groups. Of the 4 patients with complications necessitating intervention, only one was identified based on NCC. Conclusions: Our data suggest routine repeat imaging is unnecessary in children with blunt splenic and/or hepatic injuries; therefore, practitioners may rely on a patient's clinical change.
MeSH term(s)	Humans ; Child ; Retrospective Studies ; Injury Severity Score ; Spleen/diagnostic imaging ; Spleen/injuries ; Liver/diagnostic imaging ; Liver/injuries ; Abdominal Injuries/diagnostic imaging ; Tomography, X-Ray Computed ; Wounds, Nonpenetrating/surgery
Language	English
Publishing date	2021-08-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
DOI	10.1177/00031348211038587
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