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  1. Article: Creating a comprehensive bicycle safety program.

    Elwell, Sean / Kulp, Heather / McCue, Jennifer

    Journal of trauma nursing : the official journal of the Society of Trauma Nurses

    2014  Volume 21, Issue 6, Page(s) 309–313

    Abstract: Trauma centers must play a role in injury prevention. Pediatric trauma centers have the ability to create injury prevention programs targeting all children. After analyzing our trauma registry data, we determined that bicycle injuries are a significant ... ...

    Abstract Trauma centers must play a role in injury prevention. Pediatric trauma centers have the ability to create injury prevention programs targeting all children. After analyzing our trauma registry data, we determined that bicycle injuries are a significant mechanism of injury in children and developed strategies aimed at preventing such injuries. Along with support from Kohl's Cares, we are able to achieve our mission of keeping children in our community healthy and safe. Our comprehensive bicycle safety program is targeted to various ages and learning styles and aims to increase bicycle safety and helmet use among children in our region.
    MeSH term(s) Accident Prevention/methods ; Adolescent ; Bicycling/injuries ; Child ; Child, Preschool ; Craniocerebral Trauma/prevention & control ; Delaware ; Female ; Hospitalization/statistics & numerical data ; Hospitals, Pediatric/organization & administration ; Hospitals, Teaching/organization & administration ; Humans ; Male ; Program Evaluation ; Safety Management/organization & administration ; Trauma Centers/organization & administration
    Language English
    Publishing date 2014-11
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1281159-2
    ISSN 1078-7496
    ISSN 1078-7496
    DOI 10.1097/JTN.0000000000000082
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    Zs.A 4339: Show issues Location:
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  2. Article ; Online: Life after near death: long-term outcomes of emergency department thoracotomy survivors.

    Keller, Deborah / Kulp, Heather / Maher, Zoe / Santora, Thomas A / Goldberg, Amy J / Seamon, Mark J

    The journal of trauma and acute care surgery

    2013  Volume 74, Issue 5, Page(s) 1315–1320

    Abstract: Background: Predictors of hospital survival after emergency department thoracotomy (EDT) are well established, but little is known of long-term outcomes after hospital survival. Our primary study objective was to analyze the long-term social, cognitive, ...

    Abstract Background: Predictors of hospital survival after emergency department thoracotomy (EDT) are well established, but little is known of long-term outcomes after hospital survival. Our primary study objective was to analyze the long-term social, cognitive, functional, and psychological outcomes in EDT survivors.
    Methods: Review of our Level I trauma center registry (2000-2010) revealed that 37 of 448 patients survived hospitalization after EDT. Demographics and clinical characteristics were analyzed. After attempts to contact survivors, 21 patients or caretakers were invited to an outpatient study evaluation; 16 were unreachable (none of whom were present in the Social Security Death Index). Study evaluation included demographic and social data and an outpatient multidisciplinary assessment with validated scoring instruments (Mini-Mental Status Exam, Glasgow Outcome Scores, Timed Get-Up and Go Test, Functional Independence Measure Scoring, SF-36 Health Survey, and civilian posttraumatic stress disorder checklist).
    Results: After extended hospitalization (43 ± 41 days), disposition varied (home, 62%; rehabilitation, 32%; skilled nursing facility, 6%), but readmission was common (33%) in the 37 EDT hospital survivors. Of the 21 contacted, 16 completed the study evaluation, 2 had died, 1 remained in a comatose state, and 2 were available by telephone only. While unemployment (75%), daily alcohol (50%), and drug use (38%) were common, of the 16 patients who underwent the comprehensive, multidisciplinary outpatient assessment after a median of 59 months following EDT, 75% had normal cognition and returned to normal activities, 81% were freely mobile and functional, and 75% had no evidence of posttraumatic stress disorder upon outpatient screening.
    Conclusion: Despite the common belief that EDT survivors often live with severe neurologic or functional impairment, we have found that most of our sampled EDT survivors had no evidence of long-term impairment. It is our hope that these results are considered by physicians making life or death decisions regarding the "futility" of EDT in our most severely injured patients.
    MeSH term(s) Activities of Daily Living/psychology ; Adult ; Female ; Glasgow Outcome Scale ; Health Status ; Humans ; Male ; Neuropsychological Tests ; Registries ; Survivors/psychology ; Survivors/statistics & numerical data ; Thoracotomy/adverse effects ; Thoracotomy/psychology ; Thoracotomy/statistics & numerical data ; Trauma Centers/statistics & numerical data ; Treatment Outcome ; Wounds and Injuries/psychology ; Wounds and Injuries/surgery
    Language English
    Publishing date 2013-05
    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.0b013e31828c3db4
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    Zs.A 127: Show issues Location:
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  3. Article ; Online: The effects of intraoperative hypothermia on surgical site infection: an analysis of 524 trauma laparotomies.

    Seamon, Mark J / Wobb, Jessica / Gaughan, John P / Kulp, Heather / Kamel, Ihab / Dempsey, Daniel T

    Annals of surgery

    2012  Volume 255, Issue 4, Page(s) 789–795

    Abstract: Objectives: Our primary study objective was to determine whether intraoperative hypothermia predisposes patients to postoperative surgical site infections (SSI) after trauma laparotomy.: Background: Although intraoperative normothermia is an ... ...

    Abstract Objectives: Our primary study objective was to determine whether intraoperative hypothermia predisposes patients to postoperative surgical site infections (SSI) after trauma laparotomy.
    Background: Although intraoperative normothermia is an important quality performance measure for patients undergoing colorectal surgery, the effects of intraoperative hypothermia on SSI remain unstudied in trauma.
    Methods: A review of all patients (July 2003-June 2008) who survived 4 days or more after urgent trauma laparotomy at a level I trauma center revealed 524 patients. Patient characteristics, along with preoperative and intraoperative care focusing on SSI risk factors, including the depth and duration of intraoperative hypothermia, were evaluated. The primary outcome measure was the diagnosis of SSI within 30 days of surgery. Cut-point analysis of the entire range of lowest intraoperative temperature measurements established the temperature nadir that best predicted SSI development. Single and multiple variable logistic regression determined SSI predictors.
    Results: The mean intraoperative temperature nadir of the study population (n = 524) was 35.2°C ± 1.1°C and 30.5% had at least 1 temperature measurement less than 35°C. Patients who developed SSI (36.1%) had a lower mean intraoperative temperature nadir (P = 0.009) and had a greater number of intraoperative temperature measurements <35°C (P < 0.001) than those who did not. Cut-point analysis revealed an intraoperative temperature of 35°C as the nadir temperature most predictive of SSI development. Multivariate analysis determined that a single intraoperative temperature measurement less than 35°C independently increased the site infection risk 221% per degree below 35°C (OR: 2.21; 95% CI: 1.24-3.92, P = 0.007).
    Conclusions: Just as intraoperative hypothermia is an SSI risk factor in patients undergoing elective colorectal procedures, intraoperative hypothermia less than 35°C adversely affects SSI rates after trauma laparotomy. Our results suggest that intraoperative normothermia should be strictly maintained in patients undergoing operative trauma procedures.
    MeSH term(s) Adult ; Body Temperature ; Female ; Humans ; Hypothermia/complications ; Intraoperative Complications ; Laparotomy ; Logistic Models ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Surgical Wound Infection/etiology ; Wounds, Gunshot/surgery ; Wounds, Nonpenetrating/surgery ; Wounds, Stab/surgery
    Language English
    Publishing date 2012-04
    Publishing country United States
    Document type Journal Article
    ZDB-ID 340-2
    ISSN 1528-1140 ; 0003-4932
    ISSN (online) 1528-1140
    ISSN 0003-4932
    DOI 10.1097/SLA.0b013e31824b7e35
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  4. Article ; Online: Just one drop: the significance of a single hypotensive blood pressure reading during trauma resuscitations.

    Seamon, Mark J / Feather, Cristina / Smith, Brian P / Kulp, Heather / Gaughan, John P / Goldberg, Amy J

    The Journal of trauma

    2010  Volume 68, Issue 6, Page(s) 1289–94; discussion 1294–1295

    Abstract: Background: Single, isolated hypotensive blood pressure (BP) measurements frequently are ignored or considered "erroneous." Although their clinical significance remains unknown, we hypothesized that single, isolated hypotensive BP readings during trauma ...

    Abstract Background: Single, isolated hypotensive blood pressure (BP) measurements frequently are ignored or considered "erroneous." Although their clinical significance remains unknown, we hypothesized that single, isolated hypotensive BP readings during trauma resuscitations signify the presence of severe injuries that often warrant immediate intervention.
    Methods: A prospective observational study was performed on all trauma patients admitted from June 2008 to January 2009. Patients with a single systolic blood pressure (SBP) reading <110 mm Hg during their trauma resuscitation were evaluated, and demographics, hemodynamics, resuscitation (fluids, blood products, and duration), injuries, and operative or endovascular management were analyzed. Single and multiple variable logistic regression analyses were performed. Cutpoint analysis of the entire range of lowest single SBP measurements determined which SBP value best predicted the need for immediate therapeutic intervention.
    Results: Patients (n = 145) were predominantly male (77.2%) but age (mean, 35.1 +/- 15.3 years) and injury mechanisms varied (penetrating, 46.2%; blunt, 53.8%). Cutpoint analysis determined that a single SBP reading <105 mm Hg best predicted the need for immediate therapeutic intervention. Although 38.1% patients with isolated SBP <105 mm Hg measurements underwent immediate therapeutic operative or endovascular procedures, only 10.4% (p < 0.001) with isolated SBP >or=105 mm Hg required these procedures. Patients were 12.4 times (confidence interval: 2.6-59.2; p = 0.002) more likely to undergo immediate therapeutic intervention than those with a single SBP >or=105 mm Hg.
    Conclusions: Single, isolated hypotensive BP measurements during trauma resuscitations should not be ignored or dismissed. Instead, our results suggest that a single SBP reading <105 mm Hg is associated with severe injuries that often require immediate operative or endovascular treatment and surgical intensive care unit admission.
    MeSH term(s) Adolescent ; Adult ; Aged ; Aged, 80 and over ; Blood Pressure Determination/methods ; Female ; Glasgow Coma Scale ; Hemodynamics ; Humans ; Hypotension/diagnosis ; Hypotension/physiopathology ; Injury Severity Score ; Lactates/blood ; Logistic Models ; Male ; Middle Aged ; Prospective Studies ; Resuscitation/methods ; Wounds and Injuries/physiopathology ; Wounds and Injuries/therapy
    Chemical Substances Lactates
    Language English
    Publishing date 2010-06
    Publishing country United States
    Document type Journal Article
    ZDB-ID 219302-4
    ISSN 1529-8809 ; 0022-5282 ; 1079-6061
    ISSN (online) 1529-8809
    ISSN 0022-5282 ; 1079-6061
    DOI 10.1097/TA.0b013e3181db05dc
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    Zs.A 127: Show issues Location:
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  5. Article ; Online: Do chronic liver disease scoring systems predict outcomes in trauma patients with liver disease? A comparison of MELD and CTP.

    Seamon, Mark J / Franco, Michael J / Stawicki, S Peter / Smith, Brian P / Kulp, Heather / Goldberg, Amy J / Santora, Thomas A / Gaughan, John P

    The Journal of trauma

    2010  Volume 69, Issue 3, Page(s) 568–573

    Abstract: Background: Although the Child-Turcotte-Pugh (CTP) score is an established outcome prediction tool for patients with liver disease, the Model for End-Stage Liver Disease (MELD) score has recently supplanted CTP for patients awaiting transplantation. ... ...

    Abstract Background: Although the Child-Turcotte-Pugh (CTP) score is an established outcome prediction tool for patients with liver disease, the Model for End-Stage Liver Disease (MELD) score has recently supplanted CTP for patients awaiting transplantation. Currently, data regarding the use of CTP in trauma is limited, whereas MELD remains unstudied. We compared MELD and CTP to determine which scoring system is a better clinical outcome predictor after trauma.
    Methods: A review of trauma admissions during 2003-2008 revealed 68 patients with chronic liver disease. Single and multiple variable analyses determined predictors of hepatic complications and survival. MELD and CTP were compared using odds ratios and area under the receiver operating curve (AUC) analyses. A p value ≤0.05 was significant.
    Results: The mean MELD and CTP scores of the population were 13.1 ± 6.0 and 8.3 ± 1.8, respectively (mean ± SD). Overall, 73.5% had one or more complications and 29.4% died. When survivors were compared with nonsurvivors, no difference in mean MELD scores was found, although mean CTP score (survivors, 7.7 ± 1.5; nonsurvivors, 9.4 ± 1.9; p = 0.001) and class ("C" survivors, 12.1%; "C" nonsurvivors, 56.3%; p = 0.002) were different, with survival relating to liver disease severity. Odds ratios and AUC determined that MELD was not predictive of hepatic complications or hospital survival (p > 0.05), although both CTP score and class were predictive (p < 0.05; AUC > 0.70).
    Conclusion: Trauma patients suffering from cirrhosis can be expected to have poorer than predicted outcomes using traditional trauma scoring systems, regardless of injury severity. Scoring systems for chronic liver disease offer a more effective alternative. We compared two scoring systems, MELD and CTP, and determined that CTP was the better predictor of hepatic complications and survival in our study population.
    MeSH term(s) Chronic Disease ; Confidence Intervals ; Female ; Humans ; Liver Diseases/classification ; Liver Diseases/complications ; Logistic Models ; Male ; Middle Aged ; Odds Ratio ; ROC Curve ; Retrospective Studies ; Severity of Illness Index ; Survival Analysis ; Wounds and Injuries/complications ; Wounds and Injuries/mortality
    Language English
    Publishing date 2010-09
    Publishing country United States
    Document type Comparative Study ; Journal Article
    ZDB-ID 219302-4
    ISSN 1529-8809 ; 0022-5282 ; 1079-6061
    ISSN (online) 1529-8809
    ISSN 0022-5282 ; 1079-6061
    DOI 10.1097/TA.0b013e3181ec0867
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  6. Article ; Online: An analysis of inner-city students' attitudes towards violence before and after participation in the "Cradle to Grave" programme.

    Goldberg, Amy J / Toto, Julia M / Kulp, Heather R / Lloyd, Michael E / Gaughan, John P / Seamon, Mark J / Charles, Scott P

    Injury

    2010  Volume 41, Issue 1, Page(s) 110–115

    Abstract: Background: Cradle to Grave (C2G), a hospital-based violence prevention programme, brings inner-city youth into an urban Level I trauma centre to follow the path of an adolescent gunshot victim from trauma bay to morgue. We hypothesised that C2G alters ... ...

    Abstract Background: Cradle to Grave (C2G), a hospital-based violence prevention programme, brings inner-city youth into an urban Level I trauma centre to follow the path of an adolescent gunshot victim from trauma bay to morgue. We hypothesised that C2G alters student attitudes towards gun violence.
    Methods: Eighty-eight adolescents were prospectively enrolled. With parental and student consent, students completed the Attitudes Towards Guns and Violence Questionnaire (AGVQ), a previously validated and reliable social science assessment tool. Two weeks later, the students participated in C2G. The survey was re-administered four weeks after C2G participation. AGVQ results are reported both as a total score and as a breakdown of the four component subscales. Higher AGVQ scores indicate proclivity towards violence. ANOVA compared scores with respect to demographics and type of school (public vs. charter).
    Results: C2G altered student's attitudes towards guns and violence. Of 43 public school students, total scores decreased following C2G (p=0.02). The greatest attitudinal change occurred in subscale 1, "Aggressive Response to Shame" (p<0.01). C2G failed to produce significant changes AGVQ scores in the 45 students attending a city charter school. The two groups were found to have baseline differences, with public school students showing higher baseline tendencies towards violence.
    Conclusions: Our hospital-based programme is capable of positively impacting adolescents' attitudes towards guns and violence. This effect is most pronounced in subjects who already display increased tendencies towards violence. These results suggest that hospitals offer a unique opportunity to address the public health crisis posed by inner-city firearm violence.
    MeSH term(s) Adolescent ; Adolescent Behavior/psychology ; Aggression ; Attitude ; Ethnic Groups ; Female ; Firearms ; Homicide/statistics & numerical data ; Humans ; Male ; Philadelphia ; Program Evaluation ; Role Playing ; Shame ; Students/psychology ; Surveys and Questionnaires ; Trauma Centers ; Urban Population ; Violence/prevention & control ; Violence/psychology ; Young Adult
    Language English
    Publishing date 2010-01
    Publishing country Netherlands
    Document type Evaluation Studies ; Journal Article
    ZDB-ID 218778-4
    ISSN 1879-0267 ; 0020-1383
    ISSN (online) 1879-0267
    ISSN 0020-1383
    DOI 10.1016/j.injury.2009.09.024
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    Zs.A 778: Show issues Location:
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    Zs.MO 10: Show issues

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  7. Article ; Online: Prehospital interventions for penetrating trauma victims: a prospective comparison between Advanced Life Support and Basic Life Support.

    Seamon, Mark J / Doane, Stephen M / Gaughan, John P / Kulp, Heather / D'Andrea, Anthony P / Pathak, Abhijit S / Santora, Thomas A / Goldberg, Amy J / Wydro, Gerald C

    Injury

    2013  Volume 44, Issue 5, Page(s) 634–638

    Abstract: Background: Advanced Life Support (ALS) providers may perform more invasive prehospital procedures, while Basic Life Support (BLS) providers offer stabilisation care and often "scoop and run". We hypothesised that prehospital interventions by urban ALS ... ...

    Abstract Background: Advanced Life Support (ALS) providers may perform more invasive prehospital procedures, while Basic Life Support (BLS) providers offer stabilisation care and often "scoop and run". We hypothesised that prehospital interventions by urban ALS providers prolong prehospital time and decrease survival in penetrating trauma victims.
    Study design: We prospectively analysed 236 consecutive ambulance-transported, penetrating trauma patients an our urban Level-1 trauma centre (6/2008-12/2009). Inclusion criteria included ICU admission, length of stay >/=2 days, or in-hospital death. Demographics, clinical characteristics, and outcomes were compared between ALS and BLS patients. Single and multiple variable logistic regression analysis determined predictors of hospital survival.
    Results: Of 236 patients, 71% were transported by ALS and 29% by BLS. When ALS and BLS patients were compared, no differences in age, penetrating mechanism, scene GCS score, Injury Severity Score, or need for emergency surgery were detected (p>0.05). Patients transported by ALS units more often underwent prehospital interventions (97% vs. 17%; p<0.01), including endotracheal intubation, needle thoracostomy, cervical collar, IV placement, and crystalloid resuscitation. While ALS ambulance on-scene time was significantly longer than that of BLS (p<0.01), total prehospital time was not (p=0.98) despite these prehospital interventions (1.8 ± 1.0 per ALS patient vs. 0.2 ± 0.5 per BLS patient; p<0.01). Overall, 69.5% ALS patients and 88.4% of BLS patients (p<0.01) survived to hospital discharge.
    Conclusion: Prehospital resuscitative interventions by ALS units performed on penetrating trauma patients may lengthen on-scene time but do not significantly increase total prehospital time. Regardless, these interventions did not appear to benefit our rapidly transported, urban penetrating trauma patients.
    MeSH term(s) Adolescent ; Adult ; Advanced Trauma Life Support Care/organization & administration ; Ambulances ; Emergency Medical Services/organization & administration ; Female ; Humans ; Injury Severity Score ; Length of Stay/statistics & numerical data ; Life Support Care/methods ; Life Support Care/organization & administration ; Male ; Middle Aged ; Prospective Studies ; Time Factors ; Trauma Centers ; Treatment Outcome ; Triage/organization & administration ; United States/epidemiology ; Wounds, Penetrating/mortality ; Wounds, Penetrating/therapy
    Language English
    Publishing date 2013-05
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 218778-4
    ISSN 1879-0267 ; 0020-1383
    ISSN (online) 1879-0267
    ISSN 0020-1383
    DOI 10.1016/j.injury.2012.12.020
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  8. Article ; Online: Outcomes after emergency department thoracotomy for penetrating cardiac injuries: a new perspective.

    Molina, Ezequiel J / Gaughan, John P / Kulp, Heather / McClurken, James B / Goldberg, Amy J / Seamon, Mark J

    Interactive cardiovascular and thoracic surgery

    2008  Volume 7, Issue 5, Page(s) 845–848

    Abstract: Previous reports have described penetrating cardiac injuries as the anatomic injury with the greatest opportunity for emergency department thoracotomy (EDT) survival. We hypothesize that actual survival rates are lower than that initially reported. A ... ...

    Abstract Previous reports have described penetrating cardiac injuries as the anatomic injury with the greatest opportunity for emergency department thoracotomy (EDT) survival. We hypothesize that actual survival rates are lower than that initially reported. A retrospective review of our EDT experience was performed. Data collected included injury mechanism and location, presence of measurable ED vital signs, initial ED cardiac rhythm, GCS, method of transportation, and survival. Logistic regression analysis identified predictors of survival. Ninety-four of 237 patients presented penetrating cardiac injuries after EDT. Eighty-nine patients (95%) were males. Measurable ED vital signs were present in 15 patients (16%). Cardiac injuries were caused by GSW in 82 patients (87%) and SW in 12 patients (13%). Fifteen patients (16%) survived EDT and were taken to the operating room, while eight patients (8%) survived their entire hospitalization. All survivors were neurologically intact. Survival rates were 5% for GSW and 33% for SW. Mechanism of injury (SW), prehospital transportation by police, higher GCS, sinus tachycardia, and measurable ED vital signs were associated with improved survival. In urban trauma centers where firearm injuries are much more common than stabbings, the presence of a penetrating cardiac injury may no longer be considered a predictor of survival after EDT.
    MeSH term(s) Adolescent ; Adult ; Emergency Service, Hospital/statistics & numerical data ; Female ; Heart Injuries/mortality ; Heart Injuries/surgery ; Humans ; Logistic Models ; Male ; Medical Futility ; Patient Selection ; Philadelphia/epidemiology ; Retrospective Studies ; Risk Assessment ; Thoracotomy/mortality ; Treatment Outcome ; Urban Health Services/statistics & numerical data ; Wounds, Penetrating/mortality ; Wounds, Penetrating/surgery
    Language English
    Publishing date 2008-10
    Publishing country England
    Document type Journal Article
    ZDB-ID 2095298-3
    ISSN 1569-9285 ; 1569-9293
    ISSN (online) 1569-9285
    ISSN 1569-9293
    DOI 10.1510/icvts.2008.183293
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  9. Article: Emergency department thoracotomy: survival of the least expected.

    Seamon, Mark J / Fisher, Carol A / Gaughan, John P / Kulp, Heather / Dempsey, Daniel T / Goldberg, Amy J

    World journal of surgery

    2008  Volume 32, Issue 4, Page(s) 604–612

    Abstract: Although emergency department thoracotomy (EDT) is often considered a controversial "last chance" method of resuscitation, we hypothesized that EDT performed in a busy urban Level I trauma center has significant salvage rates despite the absence of ... ...

    Abstract Although emergency department thoracotomy (EDT) is often considered a controversial "last chance" method of resuscitation, we hypothesized that EDT performed in a busy urban Level I trauma center has significant salvage rates despite the absence of traditional survival predictors. A retrospective review revealed that 180 patients underwent EDT after traumatic arrest for penetrating injury between 2000 and 2005. All were deemed nonsalvageable by other resuscitation methods. Injury mechanism and location, signs of life (SOLs), initial cardiac rhythm, and presence of vital signs were analyzed. In total, 23 patients survived hospitalization neurologically intact. Compared to nonsurvivors, survivors more often suffered multiple stab wounds (21.7% vs. 1.9%, p = 0.001), presented with field (95.7% vs. 72.6%, p = 0.016) and ED (87.0% vs. 60.5%, p = 0.014) SOLs, had sustainable cardiac rhythms (sinus tachycardia, 43.5% vs. 10.2%, p = 0.001; normal sinus rhythm, 17.4% vs. 4.5%, p = 0.037), and had measurable vital signs (65.2% vs. 25.5%; p = 0.001). However, only 3 of 23 (13.0%) survivors had all survival predictors, and one survivor had none. Frequent predictors in survivors were field SOLs (95.7%), ED SOLs (87.0%), salvageable initial cardiac rhythms (78.3%), and obtainable vital signs (65.2%). Stabbing mechanism (30.4%) and cardiac injury location (30.4%) were least common. Had a strict policy of EDT performance based solely on the presence of survival predictors been followed and EDT withheld, several patients who ultimately survived would have died. Our study suggests that EDT is a technique that should be utilized for patients with critical penetrating injuries even in the absence of many traditional survival predictors.
    MeSH term(s) Adolescent ; Adult ; Aged ; Emergencies ; Female ; Heart Arrest/etiology ; Heart Arrest/mortality ; Heart Arrest/surgery ; Heart Rate ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Odds Ratio ; Predictive Value of Tests ; Retrospective Studies ; Salvage Therapy/mortality ; Survival Analysis ; Survival Rate ; Thoracotomy/mortality ; Trauma Centers ; Trauma Severity Indices ; Treatment Outcome ; Wounds, Penetrating/mortality ; Wounds, Penetrating/surgery
    Language English
    Publishing date 2008-01-26
    Publishing country United States
    Document type Journal Article
    ZDB-ID 224043-9
    ISSN 1432-2323 ; 0364-2313
    ISSN (online) 1432-2323
    ISSN 0364-2313
    DOI 10.1007/s00268-007-9392-9
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  10. Article ; Online: HIV and hepatitis in an urban penetrating trauma population: unrecognized and untreated.

    Seamon, Mark J / Ginwalla, Rashna / Kulp, Heather / Patel, Jigar / Pathak, Abhijit S / Santora, Thomas A / Gaughan, John P / Goldberg, Amy J / Tedaldi, Ellen M

    The Journal of trauma

    2011  Volume 71, Issue 2, Page(s) 306–10; discussion 311

    Abstract: Background: Despite limited prospective data, it is commonly believed that human immunodeficiency virus (HIV) and hepatitis infections are widespread in the penetrating trauma population, placing healthcare workers at risk for occupational exposure. Our ...

    Abstract Background: Despite limited prospective data, it is commonly believed that human immunodeficiency virus (HIV) and hepatitis infections are widespread in the penetrating trauma population, placing healthcare workers at risk for occupational exposure. Our primary study objective was to measure the prevalence of HIV (anti-HIV), hepatitis B (HB surface antigen [HBsAg]), and hepatitis C virus (anti-HCV) in our penetrating trauma population.
    Methods: We prospectively analyzed penetrating trauma patients admitted to Temple University Hospital between August 2008 and February 2010. Patients (n = 341) were tested with an oral swab for anti-HIV and serum evaluated for HBsAg and anti-HCV. Positives were confirmed with western blot, neutralization immunoassay, and reverse transcription polymerase chain reaction, respectively. Demographics, risk factors, and clinical characteristics were analyzed.
    Results: Of 341 patients, 4 patients (1.2%) tested positive for anti-HIV and 2 had a positive HBsAg (0.6%). Hepatitis C was the most prevalent measured infection as anti-HCV was detected in 26 (7.6%) patients. Overall, 32 (9.4%) patients were tested positive for anti-HIV, HBsAg, or anti-HCV. Twenty-eight (75%) of these patients who tested positive were undiagnosed before study enrollment. When potential risk factors were analyzed, age (odds ratio, 1.07, p = 0.031) and intravenous drug use (odds ratio 14.4, p < 0.001) independently increased the likelihood of anti-HIV, HBsAg, or anti-HCV-positive markers.
    Conclusions: Greater than 9% of our penetrating trauma study population tested positive for anti-HIV, HBsAg, or anti-HCV although patients were infrequently aware of their seropositive status. As penetrating trauma victims frequently require expedient, invasive procedures, universal precautions are essential. The prevalence of undiagnosed HIV and hepatitis in penetrating trauma victims provides an important opportunity for education, screening, and earlier treatment of this high-risk population.
    MeSH term(s) Adolescent ; Adult ; Aged ; Aged, 80 and over ; Comorbidity ; Female ; HIV Infections/epidemiology ; Hepatitis B/epidemiology ; Hepatitis B Surface Antigens/analysis ; Hepatitis C/epidemiology ; Humans ; Male ; Middle Aged ; Philadelphia/epidemiology ; Prevalence ; Prospective Studies ; Risk Factors ; Urban Population/statistics & numerical data ; Wounds, Penetrating/epidemiology ; Young Adult
    Chemical Substances Hepatitis B Surface Antigens
    Language English
    Publishing date 2011-08
    Publishing country United States
    Document type Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 219302-4
    ISSN 1529-8809 ; 0022-5282 ; 1079-6061
    ISSN (online) 1529-8809
    ISSN 0022-5282 ; 1079-6061
    DOI 10.1097/TA.0b013e31822178bd
    Database MEDical Literature Analysis and Retrieval System OnLINE

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