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Article ; Online: Blunt cerebrovascular injury: contribution of Timothy C Fabian MD and investigators from the University of Tennessee at Memphis to our understanding of the injury.

Miller, Preston R

Trauma surgery & acute care open

2023 Volume 8, Issue Suppl 1, Page(s) e001112

Abstract: Our understanding of blunt cerebrovascular injury (BCVI) has evolved considerably over recent decades. It was once seen as a rare injury that was difficult or impossible to predict and had no useful prevention or treatment measures available. In the late ...

Abstract	Our understanding of blunt cerebrovascular injury (BCVI) has evolved considerably over recent decades. It was once seen as a rare injury that was difficult or impossible to predict and had no useful prevention or treatment measures available. In the late 20th century, work by physicians caring for these injuries began to show that this was not the case. There were distinct risk factors for the injury and the often seen interval between injury and stroke provided an opportunity for stroke prevention. Timothy Fabian and the investigators at Memphis have been one of the groups at the forefront of this type of inquiry for >30 years. The contributions of this group has advanced the care of BCVI immensely. This review examines some of the work done by Dr Fabian and his colleagues and its importance in the care of injured patients.
Language	English
Publishing date	2023-04-06
Publishing country	England
Document type	Journal Article ; Review
ISSN	2397-5776
ISSN (online)	2397-5776
DOI	10.1136/tsaco-2023-001112
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Article ; Online: Preventing outliers: circumventing non-operative management failure.

Painter, Matthew / Miller, Preston R

Trauma surgery & acute care open

2024 Volume 9, Issue 1, Page(s) e001351

Language	English
Publishing date	2024-03-07
Publishing country	England
Document type	Journal Article
ISSN	2397-5776
ISSN (online)	2397-5776
DOI	10.1136/tsaco-2023-001351
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Article ; Online: Defining burden and severity of disease for emergency general surgery.

Miller, Preston R

Trauma surgery & acute care open

2017 Volume 2, Issue 1, Page(s) e000089

Abstract: As general surgery trainees continue to enter specialty practice at a high rate, fewer and fewer are caring for emergency general surgery (EGS) patients. Thus EGS has become one of the cornerstones of the practice of acute care surgery. With the ... ...

Abstract	As general surgery trainees continue to enter specialty practice at a high rate, fewer and fewer are caring for emergency general surgery (EGS) patients. Thus EGS has become one of the cornerstones of the practice of acute care surgery. With the centralization of this area of surgical care in many areas of the country, a clear understanding of the issues associated with this becomes vital. Understanding the public health implications with respect to burden of care and cost will allow for appropriate planning and resource allocation in the future. In addition, the development of validated severity modeling will help with risk stratification in future study of these diseases.
Language	English
Publishing date	2017-08-28
Publishing country	England
Document type	Journal Article ; Review
ISSN	2397-5776
ISSN (online)	2397-5776
DOI	10.1136/tsaco-2017-000089
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Article ; Online: Timing is everything: Early versus late palliative care consults in trauma.

Spencer, Audrey L / Miller, Preston R / Russell, Gregory B / Cornea, Isabella / Marterre, Buddy

The journal of trauma and acute care surgery

2022 Volume 94, Issue 5, Page(s) 652–658

Abstract: Background: The incorporation of dedicated palliative care (PC) services in the care of the critically injured trauma patient is not yet universal. Preexisting data demonstrate both economic and clinical value of PC consults, yet patient selection and ... ...

Abstract	Background: The incorporation of dedicated palliative care (PC) services in the care of the critically injured trauma patient is not yet universal. Preexisting data demonstrate both economic and clinical value of PC consults, yet patient selection and optimal timing of these consults are poorly defined, possibly leading to underutilization of PC services. Prior studies in geriatric patients have shown benefits of PC when PC clinicians are engaged earlier during hospitalization. We aim to compare hospitalization metrics of early versus late PC consultation in trauma patients. Methods: All patients 18 years or older admitted to the trauma service between January 1, 2019, and March 31, 2021, who received a PC consult were included. Patients were assigned to EARLY (PC consult ≤3 days after admission) and LATE (PC consult >3 days after admission) cohorts. Demographics, injury and underlying disease characteristics, outcomes, and financial data were compared. Length of stay (LOS) in the EARLY group is compared with LOS-3 in the LATE group. Results: A total of 154 patient records met the inclusion criteria (60 EARLY and 94 LATE). Injury Severity Score, head Abbreviated Injury Scale score, and medical comorbidities (congestive heart failure, dementia, previous stroke, chronic obstructive pulmonary disease, malignancy) were similar between the groups. The LATE group was younger (69.9 vs. 75.3, p = 0.04). Patients in the LATE group had significantly longer LOS (17.5 vs. 7.0 days, p < 0.01) and higher median hospital costs ($53,165 vs. $17,654, p < 0.01). Patients in the EARLY group had reduced ventilator days (2.4 vs. 7.0, p < 0.01) and reduced rates of tracheostomies and surgical feeding tubes (1.7% vs. 11.7%, p = 0.03). Conclusion: Trauma patients with early PC consultation had shorter LOS, reduced ventilator days, reduced rates of invasive procedures, and lower costs even after correcting for delay to consult in the late group. These findings suggest the need for mechanisms leading to earlier PC consult in critically injured patients. Level of evidence: Therapeutic/Care Management; Level IV.
MeSH term(s)	Humans ; Aged ; Palliative Care ; Hospitalization ; Length of Stay ; Injury Severity Score ; Referral and Consultation ; Retrospective Studies
Language	English
Publishing date	2022-12-25
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.0000000000003881
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Article ; Online: Diagnostic Inaccuracies Using Extended Focused Assessment With Sonography in Trauma for Traumatic Pneumothorax.

Butts, C Caleb / Cline, David / Pariyadath, Manoj / Avery, Martin D / Nunn, Andrew M / Miller, Preston R

The American surgeon

2022 Volume 89, Issue 6, Page(s) 2272–2275

Abstract: Background: Traumatic pneumothorax (PTX) can be deadly, and rapid diagnosis is vital. Ultrasound (US) is rapidly gaining acceptance as an accurate bedside diagnostic tool. While making the diagnosis is important, not all PTX require tube thoracostomy. ... ...

Abstract	Background: Traumatic pneumothorax (PTX) can be deadly, and rapid diagnosis is vital. Ultrasound (US) is rapidly gaining acceptance as an accurate bedside diagnostic tool. While making the diagnosis is important, not all PTX require tube thoracostomy. Our goal was to evaluate the predictive ability of ultrasound in identifying clinically significant PTX. Methods: Over 13 months, data was collected on patients undergoing evaluation for trauma. Patients were included if they underwent US, radiograph chest X-ray (CXR), and computed tomography of the chest. Predictive ability of ultrasound was evaluated in identifying clinically significant PTX. Results: Ninety-four patients received evaluation by all 3 modalities. Of these, 32% were diagnosed with PTX. Sixteen patients (17%) had a clinically significant PTX. Chest X-ray and US both had a sensitivity of 75%; however, US had more than twice as many false positives, resulting in a much lower positive predictive value (63% vs 80%). Conclusions: While US can reliably rule out PTX, it may be overly sensitive diagnosing clinically significant PTX. Ultrasound alone should not be used in determining the need for tube thoracostomy as many patients will not require acute intervention.
MeSH term(s)	Humans ; Pneumothorax/diagnostic imaging ; Pneumothorax/etiology ; Prospective Studies ; Thoracic Injuries/complications ; Thoracic Injuries/diagnostic imaging ; Chest Tubes ; Radiography ; Ultrasonography/methods ; Thoracostomy/methods
Language	English
Publishing date	2022-04-17
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	10.1177/00031348221087926
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Article ; Online: Win or lose, nighttime transcystic laparoscopic common bile duct exploration is a win.

Stettler, Gregory R / Ganapathy, Aravindh S / Bosley, Maggie E / Spencer, Audrey L / Neff, Lucas P / Nunn, Andrew M / Miller, Preston R

Trauma surgery & acute care open

2023 Volume 8, Issue 1, Page(s) e001045

Abstract: Objectives: Although controversial, recent data suggest nighttime versus daytime laparoscopic cholecystectomy (LC) have comparable outcomes. Laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis decreases length of stay (LOS) as ... ...

Abstract	Objectives: Although controversial, recent data suggest nighttime versus daytime laparoscopic cholecystectomy (LC) have comparable outcomes. Laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis decreases length of stay (LOS) as compared with LC with endoscopic retrograde cholangiopancreatography (ERCP) but increases case complexity/time. The influence of time of day on LCBDE outcomes has not been evaluated. Our aim was to examine outcomes and LOS for nighttime (PM) compared with daytime LC+LCBDE (DAY). Methods: Consecutive patients who underwent LCBDE were reviewed. Demographics, operative duration, success of LCBDE, time to postoperative ERCP (if required), LOS, and complications were compared. PM procedures were defined as beginning 19:00-07:00 hours. Results: Between 2018 and 2022, sixty patients underwent LCBDE (PM 42%). Groups had equivalent age/sex and preoperative liver function tests (LFTs). LCBDE success was 69% PM versus 71% DAY (p=0.78). Operative duration did not differ (2.8 IQR: 2.2-3.3 hours vs. 2.8 IQR: 2.3-3.2 hours, p=0.9). LOS was compared, and PM LOS was shorter (p=0.03). Time to ERCP after a failed LCBDE at night was compared with daytime (13.8 IQR: 10.6-29.5 hours vs. 19.9 IQR: 18.7-54.4 hours, p=0.07). LOS for Conclusion: PM LCBDE cases are equivalent in safety and success rate to DAY cases but have reduced LOS. Widespread adoption of acute care surgery-driven management of choledocholithiasis via LCBDE during cholecystectomy may decrease LOS, especially in PM cases. Level of evidence: Level IV.
Language	English
Publishing date	2023-01-25
Publishing country	England
Document type	Journal Article
ISSN	2397-5776
ISSN (online)	2397-5776
DOI	10.1136/tsaco-2022-001045
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Article ; Online: Geographic Variation in Operative Management of Adhesive Small Bowel Obstruction.

Carmichael, Samuel P / Kline, David M / Mowery, Nathan T / Miller, Preston R / Meredith, J Wayne / Hanchate, Amresh D

The Journal of surgical research

2023 Volume 286, Page(s) 57–64

Abstract: Introduction: Variation in surgical management exists nationally. We hypothesize that geographic variation exists in adhesive small bowel obstruction (aSBO) management.: Materials and methods: A retrospective analysis of a national commercial ... ...

Abstract	Introduction: Variation in surgical management exists nationally. We hypothesize that geographic variation exists in adhesive small bowel obstruction (aSBO) management. Materials and methods: A retrospective analysis of a national commercial insurance claims database (MarketScan) sample (2017-2019) was performed in adults with hospital admission due to aSBO. Geographic variation in rates of surgical intervention for aSBO was evaluated by state and compared to a risk-adjusted national baseline using a Bayesian spatial rates Poisson regression model. For individual-level analysis, patients were identified in 2018, with 365-d look back and follow-up periods. Logistic regression was performed for individual-level predictors of operative intervention for aSBO. Results: Two thousand one hundred forty-five patients were included. State-level analysis revealed rates of operative intervention for aSBO were significantly higher in Missouri and lower in Florida. On individual-level analysis, age (P < 0.01) and male sex (P < 0.03) but not comorbidity profile or prior aSBO, were negatively associated with undergoing operative management for aSBO. Patients presenting in 2018 with a history of admission for aSBO the year prior experienced a five-fold increase in odds of representation (odds ratio: 5.4, 95% confidence interval: 3.1-9.6) in 2019. Patients who received an operation for aSBO in 2018 reduced the odds of readmission in the next year by 77% (odds ratio: 0.23, 95% confidence interval: 0.1-0.5). The volume of operations performed within a state did not influence readmission. Conclusions: Surgical management of aSBO varies across the continental USA. Operative intervention is associated with decreased rates of representation in the following year. These data highlight a critical need for standardized guidelines for emergency general surgery patients.
MeSH term(s)	Adult ; Humans ; Male ; Tissue Adhesions/surgery ; Tissue Adhesions/complications ; Retrospective Studies ; Bayes Theorem ; Intestinal Obstruction/surgery ; Intestinal Obstruction/complications ; Hospitalization ; Treatment Outcome
Language	English
Publishing date	2023-02-06
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.2022.12.040
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Article ; Online: Reply to letter to the editor: Eliminating the benzos: A benzodiazepine-sparing approach to preventing and treating alcohol withdrawal syndrome.

Martin, Tamriage / Rebo, Kristin A / Stettler, Gregory R / Martin, Robert Shayn / Shilling, Elizabeth H / Hoth, James J / Nunn, Andrew M / McCullough, Mary Alyce / Miller, Preston R

The journal of trauma and acute care surgery

2024 Volume 96, Issue 5, Page(s) e43–e44

MeSH term(s)	Humans ; Substance Withdrawal Syndrome/prevention & control ; Benzodiazepines/therapeutic use ; Benzodiazepines/administration & dosage ; Ethanol/administration & dosage ; Alcoholism/complications
Chemical Substances	Benzodiazepines (12794-10-4) ; Ethanol (3K9958V90M)
Language	English
Publishing date	2024-02-19
Publishing country	United States
Document type	Letter ; Journal Article
ZDB-ID	2651070-4
ISSN	2163-0763 ; 2163-0755
ISSN (online)	2163-0763
ISSN	2163-0755
DOI	10.1097/TA.0000000000004286
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Article ; Online: The value of compassion: Healthcare savings of palliative care consults in trauma.

Spencer, Audrey L / Nunn, Andrew M / Miller, Preston R / Russell, Gregory B / Carmichael, Samuel P / Neri, Kristina E / Marterre, Buddy

Injury

2022

Abstract: Background: The effects of palliative care (PC) consultation on patient costs and hospitalization metrics in the adult trauma population are unclear.: Study design: We interrogated our Level I trauma center databases from 1/1/19 to 3/31/21 for ... ...

Abstract	Background: The effects of palliative care (PC) consultation on patient costs and hospitalization metrics in the adult trauma population are unclear. Study design: We interrogated our Level I trauma center databases from 1/1/19 to 3/31/21 for patients age ≥18 admitted to the trauma service. Patients undergoing PC consult were matched using propensity scoring to those without PC consultation based on age, admission Glasgow Coma Scale score, Injury Severity Score and Head Abbreviated Injury Scale. Total costs, total cost per day, hospital length of stay (LOS), ICU LOS, intubation days, discharge disposition, and rates of nephrology consultation and tracheostomy/feeding tube placements were compared. Results: 140 unique patients underwent PC consultation and were matched to a group not receiving PC consult during the same period. Median total costs in the PC cohort were $39,532 compared to $70,330 in the controls (p<0.01). Median costs per day in the PC cohort were $3,495 vs $17,970 in the controls (p<0.01). Median costs per ICU day in the PC cohort were $3,774 vs $17,127 in the controls (p<0.01). Mean hospital LOS (15.7 vs 7 days), ICU LOS (7.9 vs 2.9 days), and ventilator days (5.1 vs 1.5) were significantly higher in the PC cohort (all p<0.01). Rates of nephrology consultation (8.6 vs 2.1%, p = 0.03) and tracheostomy/feeding tube placements (12.1 vs 1.4%, p<0.01) were also higher in the PC group. Patients were more likely to discharge to hospice if they received a PC consult (33.6 vs 2.1%, p<0.01). Mean time to PC consult was 7.2 days (range 1 hour to 45 days). LOS post-consult correlated positively with time to PC consultation (r = 0.27, p<0.01). Conclusion: Expert PC services are known to alleviate suffering and avert patient goal- and value-incongruent care. While trauma patients demand significant resources, PC consultation offered in concordance with life-sustaining interventions is associated with significant savings to patients and the healthcare system. Given the correlation between LOS following PC consult and time to PC consult, savings may be amplified by earlier PC consultation in appropriate patients.
Language	English
Publishing date	2022-10-20
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.2022.10.021
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Zs.A 778: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Reclaiming the management of common duct stones in acute care surgery.

Bosley, Maggie E / Ganapathy, Aravindh S / Sanin, Gloria D / Cambronero, Gabriel E / Neff, Lucas P / Syriani, Fadi A / Gaffley, Michaela W / Evangelista, Meagan E / Westcott, Carl J / Miller, Preston R / Nunn, Andrew M

The journal of trauma and acute care surgery

2023 Volume 95, Issue 4, Page(s) 524–528

Abstract: Background: Acute care surgery (ACS) is well positioned to manage choledocholithiasis at the time of laparoscopic cholecystectomy, but barriers to laparoscopic common bile duct exploration (LCBDE) include experience and the perceived need for ... ...

Abstract	Background: Acute care surgery (ACS) is well positioned to manage choledocholithiasis at the time of laparoscopic cholecystectomy, but barriers to laparoscopic common bile duct exploration (LCBDE) include experience and the perceived need for specialized equipment. The technical complexity of this pathway is generally seen as challenging. As such, LCBDE is historically relegated to the "enthusiast." However, a simplified, effective LCBDE technique as part of a "surgery first" strategy could drive wider adoption in the specialty most often managing these patients. To determine efficacy and safety, we sought to compare our initial ACS-driven experience with a simple, fluoroscopy-guided, catheter-based LCBDE approach during laparoscopic cholecystectomy (LC) to LC with endoscopic retrograde cholangiopancreatography (ERCP). Methods: We reviewed ACS patients who underwent LCBDE or LC + ERCP (pre-/postoperative) at a tertiary care center in the 4 years since starting this surgery first approach. Demographics, outcomes, and length of stay (LOS) were compared on an intention to treat basis. Laparoscopic common bile duct exploration was performed via using wire/catheter Seldinger techniques under fluoroscopic guidance with flushing or balloon dilation of the sphincter as needed. Our primary outcomes were LOS and successful duct clearance. Results: One hundred eighty patients were treated for choledocholithiasis with 71 undergoing LCBDE. The success rate of catheter-based LCBDE was 70.4%. Length of stay was significantly reduced for the LCBDE group compared with the LC + ERCP group (48.8 vs. 84.3 hours, p < 0.01). Of note, there were no intraoperative or postoperative complications in the LCBDE group. Conclusion: A simplified catheter-based approach to LCBDE is safe and associated with decreased LOS when compared with LC + ERCP. This simplified step-up approach may help facilitate wider LCBDE utilization by ACS providers who are well positioned for a timely surgery first approach in the management of uncomplicated choledocholithiasis. Level of evidence: Therapeutic/Care Management; Level IV.
MeSH term(s)	Humans ; Choledocholithiasis/surgery ; Gallstones/surgery ; Cholangiopancreatography, Endoscopic Retrograde/methods ; Cholecystectomy, Laparoscopic/methods ; Fluoroscopy ; Retrospective Studies ; Length of Stay
Language	English
Publishing date	2023-07-05
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	2651070-4
ISSN	2163-0763 ; 2163-0755
ISSN (online)	2163-0763
ISSN	2163-0755
DOI	10.1097/TA.0000000000004102
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