Adam Campman Nelson

Interests

No activities entered.

Courses

Scholarly Contributions

Chapters

• Nelson, A. (2023).

  Nelson A, Joseph B. (2023) The Use of REBOA in Resuscitation of the Trauma Patient. Current Surgery Therapy, 14^th Edition. 

  . In Current Surgery Therapy, 14th Edition..

Journals/Publications

• Akl, M., El-Qawaqzeh, K., Anand, T., Hosseinpour, H., Colosimo, C., Nelson, A., Alizai, Q., Ditillo, M., Magnotti, L., & Joseph, B. (2024). Trauma Laparotomy for the Cirrhotic Patient: An Outcome-Based Analysis. Journal of Surgical Research, 294. doi:10.1016/j.jss.2023.09.008
  More info

  Introduction: There is a lack of large-scale data on outcomes of cirrhotic patients undergoing trauma laparotomy. We aimed to compare outcomes of cirrhotic versus noncirrhotic trauma patients undergoing laparotomy. Methods: We analyzed 2018 American College of Surgeons Trauma Quality Improvement Program. We included blunt trauma patients (≥18 y) who underwent a laparotomy. Patients who were transferred, dead on arrival, or had penetrating injuries were excluded. Patients were matched in a 1:2 ratio (cirrhotic and noncirrhotic). Outcomes included mortality, complications, failure to rescue, transfusion requirements, and hospital and intensive care unit (ICU) lengths of stay. Multivariable backward stepwise regression analysis was performed. Results: Four hundred and seventy-one patients (cirrhotic, 157; noncirrhotic, 314) were matched. Mean age was 57 ± 15 y, 78% were male, and median injury severity score was 24. Cirrhotic patients had higher rates of mortality (60% versus 30%, P value
• Akl, M., Hejazi, O., Nelson, A., Khurshid, M. H., Stewart, C., Hosseinpour, H., Okosun, S., Magnotti, L. J., Bhogadi, S. K., & Joseph, B. (2024). From Procedure to Prognosis: The Association Between Obesity and Outcomes of Iliac Artery Injuries. The Journal of surgical research, 302, 621-627.
  More info

  The management of injuries to the iliac artery presents a challenging clinical scenario due to the impeded anatomical access. Obesity is a common comorbid condition known to affect the outcomes of trauma patients; however, there is a paucity of data on the association of obesity with the treatment and outcomes of iliac artery injuries. The aim of this study was to assess the association between body mass index (BMI) on the management and outcomes of patients with iliac artery injuries.
• Alexander, H. D., Bhogadi, S. K., Hejazi, O., Nelson, A., Khurshid, M. H., Stewart, C., Hosseinpour, H., Colosimo, C., Magnotti, L. J., & Joseph, B. (2024). The Synergy Factor: Trauma and Cancer. The Journal of surgical research, 302, 393-397.
  More info

  Trauma and cancer are the leading causes of death in the US. There is a paucity of data describing the impact of cancer on trauma patients. We aimed to determine the influence of cancer on outcomes of trauma patients.
• Alizai, Q., Arif, M., Colosimo, C., Hosseinpour, H., Spencer, A., Bhogadi, S., Nelson, A., Anand, T., Ditillo, M., & Joseph, B. (2024). Beyond the short-term relief: Outcomes of geriatric rib fracture patients receiving paravertebral nerve blocks and epidural analgesia. Injury, 55(1). doi:10.1016/j.injury.2023.111184
  More info

  Background: Adequate pain control is a critical component of rib fracture management. Our study aimed to evaluate the in-hospital and post-discharge outcomes of geriatric rib fracture patients who received paravertebral nerve block (PVNB) versus epidural analgesia (EA) on a national level. Methods: We performed a 5-year (2011–15) retrospective analysis of the Nationwide Readmission database. We included all the geriatric (≥65 years) blunt trauma patients with rib fractures who received a paravertebral nerve block (PVNB) or Epidural analgesia (EA) for chest injuries. We excluded patients who were dead on arrival, those with head AIS≥3, spine AIS >0, and those with cognitive impairment. Patients were stratified into two groups (PVNB and EA). A propensity score matching (1:2) was performed, and the two groups were compared. Our outcomes included delirium, hospital length of stay (LOS), 90-day readmissions, 90-day mechanical ventilation, and initial and 90-day mortality. Results: A total of 2,855 geriatric rib fracture patients were identified, out of which 352 (12 %) received PVNB and 2,503 (87 %) received EA. The mean (SD) age was 78 (8) years and 53 % were female. A total of 1,041 patients were matched (PVNB=347, EA=694 patients). The median [IQR] Injury severity score was 9 [3–15], median chest AIS was 3 [2–4], and 70 % had ≥3 rib fractures. The total mortality during index admission was 6 %, 13 % experienced delirium, and the median hospital LOS was 6 [4–10] days. There was no difference in the primary outcomes of the two groups including rates of index admission mortality (PVNB: 5.2% vs. EA:6.3 %, p = 0.548) and delirium (PVNB: 12.4% vs. EA:12.9 %, p = 0.862). We also found no statistically significant difference between these groups in terms of 90-day respiratory complications (p = 1.000), 90-day readmission (p = 0.111), 90-day mortality (p = 0.718), and 90-day need for mechanical ventilation (p = 1.000). Conclusion: The use of PVNB in geriatric trauma patients with multiple rib fractures is associated with comparable in-hospital and post-discharge outcomes relative to EA. PVNB is relatively easy to perform and has a better side effect profile. The use of PVNB as part of rib fracture management protocols warrants further consideration. Level of evidence: III Study type: Therapeutic/Care Management
• Anand, T., Hejazi, O., Conant, M., Joule, D., Lundy, M., Colosimo, C., Spencer, A., Nelson, A., Magnotti, L., & Joseph, B. (2024). Impact of resuscitation adjuncts on postintubation hypotension in patients with isolated traumatic brain injury. Journal of Trauma and Acute Care Surgery, 97(1). doi:10.1097/TA.0000000000004306
  More info

  INTRODUCTION Postintubation hypotension (PIH) is a risk factor of endotracheal intubation (ETI) after injury. For those with traumatic brain injury (TBI), one episode of hypotension can potentiate that injury. This study aimed to identify the resuscitation adjuncts that may decrease the incidence of PIH in this patient population. METHODS This is a 4-year (2019-2022) prospective observational study at a level I trauma center. Adult (18 years or older) patients with isolated TBI requiring ETI in the trauma bay were included. Blood pressures were measured 15 minutes preintubation and postintubation. Primary outcome was PIH, defined as a decrease in systolic blood pressure of ≥20% from baseline or to ≤80 mm Hg, or any decrease in mean arterial pressure to ≤60 mm Hg. Multivariable logistic regression was performed to identify the associations of preintubation vasopressor, hypertonic saline (HTS), packed red blood cell, and crystalloids on PIH incidence. RESULTS Of the 490 enrolled patients, 16% had mild (head AIS, ≤2), 35% had moderate (head AIS, 3-4), and 49% had severe TBI (head AIS, ≥5). The mean ± SD age was 42 ± 22 years, and 71% were male. The median ISS, head AIS, and Glasgow Coma Scale were 26 (19-38), 4 (3-5), and 6 (3-11), respectively. The mean ± SD systolic blood pressure 15 minutes preintubation and postintubation were 118 ± 46 and 106 ± 45, respectively. Before intubation, 31% received HTS; 10%, vasopressors; 20%, crystalloids; and 14%, at least 1 U of packed red blood cell (median, 2 [1-2] U). Overall, 304 patients (62%) developed PIH. On multivariable regression analysis, preintubation use of vasopressors and HTS was associated with significantly decreased odds of PIH independent of TBI severity, 0.310 (0.102-0.944, p = 0.039) and 0.393 (0.219-0.70, p = 0.002), respectively. CONCLUSION Nearly two thirds of isolated TBI patients developed PIH. Preintubation vasopressors and HTS are associated with a decreased incidence of PIH. Such adjuncts should be considered prior to ETI in patients with suspected TBI.
• Anand, T., Hejazi, O., Nelson, A., Litmanovich, B., Spencer, A. L., Khurshid, M. H., Ghaedi, A., Hosseinpour, H., Magnotti, L. J., & Joseph, B. (2024). Early Vasopressor Requirement Among Hypotensive Trauma Patients: Does It Cause More Harm Than Good?. The American surgeon, 31348241269425.
  More info

  Optimal utilization of vasopressors during early post-injury resuscitation remains unclear. Our study aims to describe the relationship between the timing of vasopressor administration and outcomes among hypotensive trauma patients.
• Bhogadi, S. K., Ditillo, M., Khurshid, M. H., Stewart, C., Hejazi, O., Spencer, A. L., Anand, T., Nelson, A., Magnotti, L. J., & Joseph, B. (2024). Development and Validation of Futility of Resuscitation Measure in Older Adult Trauma Patients. The Journal of surgical research, 301, 591-598.
  More info

  This study aimed to develop and validate Futility of Resuscitation Measure (FoRM) for predicting the futility of resuscitation among older adult trauma patients.
• Bhogadi, S. K., Stewart, C., Hosseinpour, H., Nelson, A., Ditillo, M., Matthews, M. R., Magnotti, L. J., & Joseph, B. (2024). Outcomes of Patients With Traumatic Brain Injury Transferred to Trauma Centers. JAMA surgery.
  More info

  Wide variations exist in traumatic brain injury (TBI) management strategies and transfer guidelines across the country.
• Bhogadi, S., El-Qawaqzeh, K., Colosimo, C., Hosseinpour, H., Magnotti, L., Spencer, A., Anand, T., Ditillo, M., Alizai, Q., Nelson, A., & Joseph, B. (2024). Pediatric Acute Compartment Syndrome in Long Bone Fractures: Who is at Risk?. Journal of Surgical Research, 298. doi:10.1016/j.jss.2024.01.032
  More info

  Introduction: There is a paucity of large-scale data on the factors that suggest an impending or underlying extremity pediatric acute compartment syndrome (ACS). In addition, literature regarding the timing of operative fixation and the risk of ACS is mixed. We aimed to describe the factors associated with pediatric ACS. Methods: Analysis of 2017-2019 Trauma Quality Improvement Program. We included patients aged
• Colosimo, C., Bhogadi, S. K., Hejazi, O., Nelson, A., Hosseinpour, H., Stewart, C., Spencer, A. L., Ditillo, M., Magnotti, L. J., & Joseph, B. (2024). When Every Minute Counts: REBOA Before Surgery Is Independently Associated With a 15-Minute Delay in Time to Definitive Hemorrhage Control. Military medicine, 189(Supplement_3), 262-267.
  More info

  Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a temporizing hemorrhage control intervention, but its inevitable effect on time to operating room (OR) has not been assessed. The aim of our study is to assess the impact of undergoing REBOA before surgery (RBS) on time to definitive hemorrhage control surgery.
• Colosimo, C., Otaibi, B., Bhogadi, S. K., Nelson, A., Spencer, A. L., Anand, T., Stewart, C., Magnotti, L. J., & Joseph, B. (2024). Obesity is a predictor of abdominal computed tomography imaging in pediatric trauma patients. The journal of trauma and acute care surgery.
  More info

  Computed tomography (CT) has helped to reduce the morbidity due to missed injuries. However, CT imaging is associated with radiation exposure and thus has limited indications in pediatric patients. In this study, we aimed to identify the association between obesity and abdominal CT imaging in pediatric trauma patients.
• El-Qawaqzeh, K., Magnotti, L., Hosseinpour, H., Nelson, A., Spencer, A., Anand, T., Bhogadi, S., Alizai, Q., Ditillo, M., & Joseph, B. (2024). Geriatric trauma, frailty, and ACS trauma center verification level: Are there any correlations with outcomes? Outcomes of Geriatric Patients in Trauma Centers. Injury, 55(1). doi:10.1016/j.injury.2023.110972
  More info

  Introduction: It remains unclear whether geriatrics benefit from care at higher-level trauma centers (TCs). We aimed to assess the impact of the TC verification level on frail geriatric trauma patients’ outcomes. We hypothesized that frail patients cared for at higher-level TCs would have improved outcomes. Study Design: Patients ≥65 years were identified from the Trauma Quality Improvement Program (TQIP) database (2017–2019). Patients transferred, discharged from emergency department (ED), and those with head abbreviated injury scale >3 were excluded. 11-factor modified frailty index was utilized. Propensity score matching (1:1) was performed. Outcomes included discharge to skilled nursing facility or rehab (SNF/rehab), withdrawal of life-supporting treatment (WLST), mortality, complications, failure-to-rescue, intensive care unit (ICU) admission, hospital length of stay (LOS), and ventilator days. Results: 110,680 patients were matched (Frail:55,340, Non-Frail:55,340). Mean age was 79 (7), 90% presented following falls, and median ISS was 5 [2–9]. Level-I/II TCs had lower rates of discharge to SNF/rehab (52.6% vs. 55.8% vs. 60.9%; p < 0.001), failure-to-rescue (0.5% vs. 0.4% vs. 0.6%;p = 0.005), and higher rates of WLST (2.4% vs. 2.1% vs. 0.3%; p < 0.001) compared to level-III regardless of injury severity and frailty. Compared to Level-III centers, Level-I/II centers had higher complications among moderate-to-severely injured patients (4.1% vs. 3.3% vs. 2.7%; p < 0.001), and lower mortality only among frail patients regardless of injury severity (1.8% vs. 1.5% vs. 2.6%; p < 0.001). Patients at Level-I TCs were more likely to be admitted to ICU, and had longer hospital LOS and ventilator days compared to Level-II and III TCs (p < 0.05). Conclusion: Frailty may play an important role when triaging geriatric trauma patients. In fact, the benefit of care at higher-level TCs is particularly evident for patients who are frail. Level III centers may be underperforming in providing access to palliative and end-of-life care.
• Fleming, S., Scott, A. P., Coutsouvelis, J., Fraser, C., Bajel, A., Nelson, A., Conyers, R., McEwan, A., Yeung, D., Campion, V., Teague, L., McGuire, M., Morris, E., Gabriel, M., Wayte, R., Douglas, G., Chien, N., & Hamad, N. (2024). ANZTCT practice statement: sinusoidal obstruction syndrome/veno-occlusive disease diagnosis and management. Internal medicine journal, 54(9), 1548-1556.
  More info

  Sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD) is a life-threatening complication which can develop after haemopoietic stem cell transplantation (HSCT) and some antibody-drug conjugates. Several SOS/VOD diagnostic and management guidelines exist, with the most recent and refined being the European Society for Blood and Marrow Transplantation adult and paediatric guidelines. Timely diagnosis and effective management (including the availability of therapeutic options) significantly contribute to improved patient outcomes. In Australia and New Zealand, there is variability in clinical practice and access to SOS/VOD therapies. This review aims to summarise the current evidence for SOS/VOD diagnosis, prevention and treatment and to provide recommendations for SOS/VOD in the context of contemporary Australasian HSCT clinical practice.
• Hage, K., Nelson, A., Khurshid, M. H., Stewart, C., Hosseinpour, H., Okosun, S., Hejazi, O., Magnotti, L. J., Bhogadi, S. K., & Joseph, B. (2024). Diagnostic Laparoscopy in Trauma Patients: Do We Need to Open and See if We Can See Without Opening?. The Journal of surgical research, 303, 14-21.
  More info

  Diagnostic laparoscopy (DL) has been advocated to reduce the incidence of nontherapeutic laparotomies (NL) among stable trauma patients. This study aimed to compare the outcomes of hemodynamically stable trauma patients undergoing DL versus NL.
• Hejazi, O., Ghaedi, A., Stewart, C., Khurshid, M. H., Spencer, A. L., Hosseinpour, H., Nelson, A., Bhogadi, S. K., Magnotti, L. J., & Joseph, B. (2024). The Harsh Reality: Outcomes of Patients With Operatively Managed Lung Injuries. The Journal of surgical research, 302, 656-661.
  More info

  Most traumatic lung injuries are managed non-operatively. There is a paucity of recent data on the outcomes of operatively managed lung injuries. The aim of our study is to determine the survival rates of operatively managed traumatic lung injury patients on a nationwide scale.
• Hejazi, O., Spencer, A. L., Khurshid, M. H., Nelson, A., Hosseinpour, H., Anand, T., Bhogadi, S. K., Matthews, M. R., Magnotti, L. J., & Joseph, B. (2024). Failure to Rescue in Geriatric Ground-Level Falls: The Role of Frailty on Not-So-Minor Injuries. The Journal of surgical research, 302, 891-896.
  More info

  The measure of mortality following a major complication (failure to rescue [FTR]) provides a quantifiable assessment of the level of care provided by trauma centers. However, there is a lack of data on the effects of patient-related factors on FTR incidence. The aim of this study was to identify the role of frailty on FTR incidence among geriatric trauma patients with ground-level falls (GLFs).
• Hosseinpour, H., Anand, T., Bhogadi, S. K., Nelson, A., Hejazi, O., Castanon, L., Ghaedi, A., Khurshid, M. H., Magnotti, L. J., Joseph, B., & , A. F. (2024). The implications of poor nutritional status on outcomes of geriatric trauma patients. Surgery, 176(4), 1281-1288.
  More info

  Malnutrition is shown to be associated with worse outcomes among surgical patients, yet its postdischarge outcomes in trauma patients are not clear. This study aimed to evaluate both index admission and postdischarge outcomes of geriatric trauma patients who are at risk of poor nutritional status.
• Hosseinpour, H., Anand, T., Hejazi, O., Colosimo, C., Bhogadi, S., Spencer, A., Nelson, A., Ditillo, M., Magnotti, L., & Joseph, B. (2024). The Role of Whole Blood Hemostatic Resuscitation in Bleeding Geriatric Trauma Patients. Journal of Surgical Research, 299. doi:10.1016/j.jss.2024.03.050
  More info

  Introduction: Whole blood (WB) has recently gained increased popularity as an adjunct to the resuscitation of hemorrhaging civilian trauma patients. We aimed to assess the nationwide outcomes of using WB as an adjunct to component therapy (CT) versus CT alone in resuscitating geriatric trauma patients. Methods: We performed a 5-y (2017-2021) retrospective analysis of the Trauma Quality Improvement Program. We included geriatric (age, ≥65 y) trauma patients presenting with hemorrhagic shock (shock index >1) and requiring at least 4 units of packed red blood cells in 4 h. Patients with severe head injuries (head Abbreviated Injury Scale ≥3) and transferred patients were excluded. Patients were stratified into WB-CT versus CT only. Primary outcomes were 6-h, 24-h, and in-hospital mortality. Secondary outcomes were major complications. Multivariable regression analysis was performed, adjusting for potential confounding factors. Results: A total of 1194 patients were identified, of which 141 (12%) received WB. The mean ± standard deviation age was 74 ± 7 y, 67.5% were male, and 83.4% had penetrating injuries. The median [interquartile range] Injury Severity Score was 19 [13-29], with no difference among study groups (P = 0.059). Overall, 6-h, 24-h, and in-hospital mortality were 16%, 23.1%, and 43.6%, respectively. On multivariable regression analysis, WB was independently associated with reduced 24-h (odds ratio, 0.62 [0.41-0.94]; P = 0.024), and in-hospital mortality (odds ratio, 0.60 [0.40-0.90]; P = 0.013), but not with major complications (odds ratio, 0.78 [0.53-1.15]; P = 0.207). Conclusions: Transfusion of WB as an adjunct to CT is associated with improved early and overall mortality in geriatric trauma patients presenting with severe hemorrhage. The findings from this study are clinically important, as this is an essential first step in prioritizing the selection of WB resuscitation for geriatric trauma patients presenting with hemorrhagic shock.
• Hosseinpour, H., Nelson, A., Bhogadi, S., Magnotti, L., Alizai, Q., Colosimo, C., Hage, K., Ditillo, M., Anand, T., & Joseph, B. (2024). Should We Keep or Transfer Our Severely Injured Geriatric Patients to Higher Levels of Care?. Journal of Surgical Research, 300. doi:10.1016/j.jss.2024.03.049
  More info

  Introduction: Interfacility transfer to higher levels of care is becoming increasingly common. This study aims to evaluate the association between transfer to higher levels of care and prolonged transfer times with outcomes of severely injured geriatric trauma patients compared to those who are managed definitively at lower-level trauma centers. Methods: Severely injured (Injury Severity Score >15) geriatric (≥60 y) trauma patients in the 2017-2018 American College of Surgeons Trauma Quality Improvement Program database managing at an American College of Surgeons/State Level III trauma center or transferring to a level I or II trauma center were included. Outcome measures were 24-h and in-hospital mortality and major complications. Results: Forty thousand seven hundred nineteen patients were identified. Mean age was 75 ± 8 y, 54% were male, 98% had a blunt mechanism of injury, and the median Injury Severity Score was 17 [16-21]. Median transfer time was 112 [79-154] min, and the most common transport mode was ground ambulance (82.3%). Transfer to higher levels of care within 90 min was associated with lower 24-h mortality (adjusted odds ratio [aOR]: 0.493, P < 0.001) and similar odds of in-hospital mortality as those managed at level III centers. However, every 30-min delay in transfer time beyond 90 min was progressively associated with increased odds of 24-h (aOR: 1.058, P < 0.001) and in-hospital (aOR: 1.114, P < 0.001) mortality and major complications (aOR: 1.127, P < 0.001). Conclusions: Every 30-min delay in interfacility transfer time beyond 90 min is associated with 6% and 11% higher risk-adjusted odds of 24-h and in-hospital mortality, respectively. Estimated interfacility transfer time should be considered while deciding about transferring severely injured geriatric trauma patients to a higher level of care.
• Hosseinpour, H., Stewart, C., Hejazi, O., Okosun, S., Khurshid, M., Nelson, A., Bhogadi, S., Ditillo, M., Magnotti, L., Joseph, B., Hosseinpour, H., Stewart, C., Hejazi, O., Okosun, S., Khurshid, M., Nelson, A., Bhogadi, S., Ditillo, M., Magnotti, L., & Joseph, B. (2024). FINDING THE SWEET SPOT: THE ASSOCIATION BETWEEN WHOLE BLOOD TO RED BLOOD CELLS RATIO AND OUTCOMES OF HEMORRHAGING CIVILIAN TRAUMA PATIENTS. Shock, 62(3). doi:10.1097/SHK.0000000000002405
  More info

  Purpose: To evaluate the dose-dependent effect of whole blood (WB) on the outcomes of civilian trauma patients with hemorrhagic shock. Methods: We performed a 2-year (2020–2021) retrospective analysis of the ACS-TQIP dataset. Adult (≥18) trauma patients with a shock index (SI) >1 who received at least 5 units of PRBC and one unit of WB within the first 4 h of admission were included. Primary outcomes were 6-h, 24-h, and in-hospital mortality. Secondary outcomes were major complications and hospital and intensive care unit length of stay. Results: A total of 830 trauma patients with a mean (SD) age of 38 (16) were identified. The median [IQR] 4-h WB and PRBC requirements were 2 [2–4] U and 10 [7–15] U, respectively, with a median WB:RBC ratio of 0.2 [0.1–0.3]. Every 0.1 increase in WB:RBC ratio was associated with decreased odds of 24-h mortality (aOR: 0.916, P = 0.035) and in-hospital mortality (aOR: 0.878, P < 0.001). Youden’s index identified 0.25 (1 U of WB for every 4 U of PRBC) as the optimal WB:PRBC ratio to reduce 24-h mortality. High ratio (≥0.25) group had lower adjusted odds of 24-h mortality (aOR: 0.678, P = 0.021) and in-hospital mortality (aOR: 0.618, P < 0.001) compared to the low ratio group. Conclusions: A higher WB:PRBC ratio was associated with improved early and late mortality in trauma patients with hemorrhagic shock. Given the availability of WB in trauma centers across the United States, at least one unit of WB for every 4 units of packed red blood cells may be administered to improve the survival of hemorrhaging civilian trauma patients.
• Joseph, B., Hosseinpour, H., Sakran, J., Anand, T., Colosimo, C., Nelson, A., Stewart, C., Spencer, A., Zhang, B., & Magnotti, L. (2024). Defining the Problem: 53 Years of Firearm Violence Afflicting America's Schools. Journal of the American College of Surgeons, 238(4). doi:10.1097/XCS.0000000000000955
  More info

  BACKGROUND: Firearm violence and school shootings remain a significant public health problem. This study aimed to examine how publicly available data from all 50 states might improve our understanding of the situation, firearm type, and demographics surrounding school shootings. STUDY DESIGN: School shootings occurring in the US for 53 years ending in May 2022 were analyzed, using primary data files that were obtained from the Center for Homeland Defense and Security. Data analyzed included situation, injury, firearm type, and demographics of victims and shooters. We compared the ratio of fatalities per wounded after stratifying by type of weapon. Rates (among children) of school shooting victims, wounded, and fatalities per 1 million population were stratified by year and compared over time. RESULTS: A total of 2,056 school shooting incidents involving 3,083 victims were analyzed: 2,033 children, 5 to 17 years, and 1,050 adults, 18 to 74 years. Most victims (77%) and shooters (96%) were male individuals with a mean age of 18 and 19 years, respectively. Of the weapons identified, handguns, rifles, and shotguns accounted for 84%, 7%, and 4%, respectively. Rifles had a higher fatality-to-wounded ratio (0.45) compared with shooters using multiple weapons (0.41), handguns (0.35), and shotguns (0.30). Linear regression analysis identified a significant increase in the rate of school shooting victims (β = 0.02, p = 0.0003), wounded (β = 0.01, p = 0.026), and fatalities (β = 0.01, p = 0.0003) among children over time. CONCLUSIONS: Despite heightened public awareness, the incidence of school shooting victims, wounded, and fatalities among children has steadily and significantly increased over the past 53 years. Understanding the epidemic represents the first step in preventing continued firearm violence in our schools.
• Khurshid, M., Hejazi, O., Spencer, A., Nelson, A., Stewart, C., Colosimo, C., Ditillo, M., Matthews, M., Magnotti, L., & Joseph, B. (2024). A little goes a long way: A comparison of enterolithotomy versus single-stage cholecystectomy in the management of gallstone ileus. Journal of Trauma and Acute Care Surgery. doi:10.1097/TA.0000000000004497
  More info

  INTRODUCTION Gallstone ileus is an infrequent complication of cholelithiasis with no specific guidelines for its management. This study aims to compare the outcomes of patients with gallstone ileus managed with both enterolithotomy with cholecystectomy (EL-CCY) versus those managed with enterolithotomy (EL) only. METHODS In this retrospective analysis of 2011-2017 Nationwide Readmissions Database, all patients with an index admission diagnosis of gallstone ileus were included. Patients were stratified based on the type of intervention received for gallstone ileus into those who underwent EL-CCY and those who underwent EL alone and compared. Primary outcomes were in-hospital complications (surgical site infections, sepsis, pneumonia, cardiac arrest, deep vein thrombosis, intestinal obstruction) and mortality. Secondary outcomes were hospital length of stay, hospital costs, and readmissions rate and cause of readmissions. Multivariable logistic regression analysis was performed. RESULTS A total of 1,960 patients were identified. The mean age was 67 years and 67% were female. Two hundred eighty-nine patients (14.7%) were managed with EL-CCY, whereas 1,671 patients (85.3%) underwent EL only. Overall, the readmission rate was 4.8%, whereas mortality was 4.2%. There was no significant difference between groups in terms of index-admission complications (24.8% vs. 21.7%, p = 0.415), mortality (6.2% vs. 3.9%, p = 0.068), rates of readmission (3.5% vs. 5.1%, p = 0.22), and cause of readmission (p > 0.05). Enterolithotomy and cholecystectomy group had significantly longer hospital length of stay (10 vs. 8 days, p < 0.001) and median hospital costs ($70,959 vs. $52,147, p < 0.001). On multivariable logistic regression analysis, female sex was a predictor of undergoing EL-CCY, whereas increasing age and higher grade of all-patient redefined diagnosis-related groups risk of mortality were independently associated with lower odds of undergoing EL-CCY. CONCLUSION Our findings suggest no difference between EL compared with EL-CCY in terms of complications, readmissions, and mortality. However, patients managed with EL-CCY had a longer hospital stay and higher hospital costs compared with EL. Further prospective studies are needed to validate these findings and develop management protocols for gallstone ileus.
• Litmanovich, B., Alizai, Q., Stewart, C., Hosseinpour, H., Nelson, A., Bhogadi, S., Colosimo, C., Spencer, A., Ditillo, M., & Joseph, B. (2024). Outcomes of Geriatric Burn Patients Presenting to the Trauma Service: How Does Frailty Factor in?. Journal of Surgical Research, 293. doi:10.1016/j.jss.2023.08.049
  More info

  Introduction: Frailty has been known to negatively affect the outcomes of geriatric trauma patients. However, there is a lack of data on the effect of frailty on the outcomes of geriatric trauma patients with concomitant burn injuries. The aim of our study was to compare the outcomes of frail versus nonfrail geriatric trauma patients with concomitant burn injuries. Methods: We performed a retrospective analysis of American College of Surgeons Trauma Quality Improvement Program (2018). We included geriatric (≥65 y) trauma patients who sustained a concomitant burn injury with ≥10% Total Body Surface Area affected. Patients with body region-specific AIS ≥4 were excluded. Patients were stratified into Frail and Nonfrail, using 5-factor modified Frailty Index. Primary outcomes measured were mortality. Secondary outcomes measured were complications, and hospital and intensive care unit (ICU) length of stay (LOS). Multivariable logistic regression was performed to identify independent predictors of mortality. Results: A total of 574 patients were identified, of which 172(30%) were Frail. Mean age was 74 ± 7 y and median [interquartile range] ISS was 3[1-10]. Overall, the rate of mortality was 23% and median hospital LOS was 14[3-31]. After controlling for potential confounding factors, frailty was not identified as an independent predictor of mortality (adjusted odds ratio:1.059, P = 0.93) and complications (adjusted odds ratio:1.10, P = 0.73). However, frail patients had longer hospital (β: 5.01, P = 0.002) and ICU LOS (β: 2.12, P < 0.001). Conclusions: Among geriatric trauma patients with concomitant burn injuries, frailty is associated with longer hospital and ICU LOS, and higher rates of thrombotic complications, but not higher mortality or overall complications. Future research should investigate the impact of early assessment of frailty as well as tailored interventions on outcomes in this population.
• O'Connor, D., Hejazi, O., Colosimo, C., Stewart, C., Hosseinpour, H., Khurshid, M., Nelson, A. C., Joseph, B., Bhogadi, S. K., Anand, T., Spencer, A. L., & Magnotti, L. J. (2024). Role of endovascular management on outcomes in patients with traumatic inferior vena cava injuries. American journal of surgery, 238, 115836.
  More info

  The aim of this study was to examine the association between the injury mechanism and repair type with outcomes in patients with traumatic inferior vena cava injuries.
• Otaibi, B. W., Bhogadi, S. K., Khurshid, M. H., Stewart, C., Hosseinpour, H., Spencer, A. L., Hejazi, O., Nelson, A., Magnotti, L. J., & Joseph, B. (2024). Endovascular Versus Open Repair in Adolescent Patients With Difficult-to-Access Vascular Injuries. The Journal of surgical research, 302, 385-392.
  More info

  Management of subclavian artery injuries (SAI) and iliac artery injuries (IAI) in adolescent trauma patients poses a considerable challenge due to their complex anatomical locations. The aim of our study was to determine the association between the injury mechanism and type of repair with the outcomes of patients with traumatic SAI and IAI.
• Terrani, K., Bhogadi, S., Hosseinpour, H., Spencer, A., Alizai, Q., Colosimo, C., Nelson, A., Castanon, L., Magnotti, L., & Joseph, B. (2024). What Is Going on in Our Schools? Review of Injuries Among School Children Across the United States. Journal of Surgical Research, 295. doi:10.1016/j.jss.2023.11.019
  More info

  Introduction: Children spend most of their time at school and participate in many activities that have the potential for causing injury. This study aims to describe the nationwide epidemiology of pediatric trauma sustained in school settings in the United States. Methods: In the 3-y analysis of 2017-2019 American College of Surgeons-Trauma Quality Program, all pediatric trauma patients (≤18 y) injured in a school setting were included and stratified based on place of injury, into elementary, middle, and high school (HS) groups. Descriptive statistics and multivariable logistic regression analysis were performed to identify the independent predictors of intentional injuries. Results: 23,215 pediatric patients were identified, of which 15,264 patients were injured at elementary (57.6%), middle (17.5%), and high (25%) schools. The mean age was 9.5 y, 66.9% were male, 63.9% were white, the median injury severity score was 2 [1-4], and 95.6% had a blunt injury. Elementary school students were more likely to sustain falls (85%) and humerus fractures (43%) whereas HS students were more likely to be injured by assaults (17%). Overall, 7% of the students sustained intentional injuries. On multivariable logistic regression, male gender (odds ratio [OR] 1.54), Black race (OR 2.94), American Indian race (OR 1.88), Hispanic ethnicity (OR 1.77), positive drug screen (OR 4.9), middle (OR 5.2), and HSs (OR 10.6) were identified as independent predictors of intentional injury (all P < 0.01). Conclusions: Injury patterns vary across elementary, middle, and HSs. Racial factors appear to influence intentional injuries along with substance abuse. Further studies to understand these risk factors and efforts to reduce school injuries are warranted to provide a safe learning environment for children.
• Zambetti, B. R., Nelson, A. C., Hosseinpour, H., Anand, T., Colosimo, C., Spencer, A. L., Stewart, C., Bhogadi, S. K., Hejazi, O., Joseph, B., & Magnotti, L. J. (2024). The optimal management of blunt aortic injury in the young. American journal of surgery, 237, 115943.
  More info

  Blunt aortic injury (BAI) is relatively uncommon in the pediatric population. The goal of this study was to examine the management of BAI in both children and adolescents, using a large national dataset.
• Zomer, E., Zhou, J., Nelson, A. J., Sumithran, P., Nanayakkara, S., Ball, J., Kaye, D., Liew, D., Nicholls, S. J., Stub, D., & Zoungas, S. (2024). The cost-effectiveness of semaglutide in reducing cardiovascular risk among people with overweight and obesity and existing cardiovascular disease, but without diabetes. European heart journal. Quality of care & clinical outcomes.
  More info

  The Semaglutide Effects on Cardiovascular Outcomes in People with Overweight or Obesity (SELECT) trial demonstrated significant reductions in cardiovascular outcomes in people with cardiovascular disease (CVD) and overweight or obesity (but without diabetes). However, the cost of the medication has raised concerns about its financial viability and accessibility within healthcare systems. This study explored whether use of semaglutide for the secondary prevention of CVD in overweight or obesity is cost-effective from the Australian healthcare perspective.
• Alizai, Q., Anand, T., Bhogadi, S., Nelson, A., Hosseinpour, H., Stewart, C., Spencer, A., Colosimo, C., Ditillo, M., & Joseph, B. (2023). From surveillance to surgery: The delayed implications of non-operative and operative management of pancreatic injuries. American Journal of Surgery, 226(5). doi:10.1016/j.amjsurg.2023.07.027
  More info

  Background: Our study compares the delayed outcomes of operative versus nonoperative management of pancreatic injuries. Methods: We analyzed the 2017 Nationwide Readmissions Database on adult (≥18 years) trauma patients with pancreatic injuries. Patients who died on index admission were excluded. Patients were stratified into operative (OP) and non-operative (NOP) groups and compared for outcomes within 90 days of discharge. Multivariable regression analyses were performed. Results: We identified 1553 patients (NOP ​= ​1092; OP ​= ​461). The Mean (SD) age was 39 (17.0) years, 31% of patients were female, and 77% had blunt injuries. Median ISS was 17 [9–25] and 74% had concomitant non-pancreatic intraabdominal injuries. On multivariable analysis, operative management was independently associated with increased odds of 90-day readmissions (aOR ​= ​1.47; p ​= ​0.03), intraabdominal abscesses (aOR ​= ​2.7; p ​< ​0.01), pancreatic pseudocyst (aOR ​= ​2.4; p ​= ​0.04), and need for percutaneous or endoscopic management (aOR ​= ​5.8; p ​< ​0.001). Conclusion: Operative management of pancreatic injuries is associated with higher rates of delayed complications compared to non-operative management. Surgically treated pancreatic trauma patients may need close surveillance even after discharge.
• Anand, T., El-Qawaqzeh, K., Nelson, A., Hosseinpour, H., Ditillo, M., Gries, L., Castanon, L., & Joseph, B. (2023). Association Between Hemorrhage Control Interventions and Mortality in US Trauma Patients With Hemodynamically Unstable Pelvic Fractures. JAMA Surgery, 158(1), 63. doi:10.1001/jamasurg.2022.5772
• Avila, M., Bhogadi, S., Nelson, A., Hosseinpour, H., Ditillo, M., Akl, M., Anand, T., Spencer, A., Magnotti, L., & Joseph, B. (2023). The long-term risks of venous thromboembolism among non-operatively managed spinal fracture patients: A nationwide analysis. American Journal of Surgery, 225(6). doi:10.1016/j.amjsurg.2022.11.031
  More info

  Introduction: Long-term readmission data for venous thromboembolism (VTE) after spinal fractures is limited. We aimed to evaluate the 1-month and 6-month VTE readmission rates in non-operatively managed traumatic spinal fractures. Methods: Analysis of the 2017 NRD. Adults (≥18 years) with a primary diagnosis of spinal fracture who were managed non-operatively were included. Patients that died on index admission, were on pre-injury anticoagulants, and those with spinal cord injuries were excluded. Outcomes were rates of DVT, PE, and VTE during index admission, and at 1-month and 6-months after discharge. Multivariate regression analysis was performed to identify independent predictors of 6-month readmission with VTE. Results: 41,337 patients were identified. Mean age was 61 ± 22 years, and the median ISS was 17[9–22]. Vertebral fractures were: 11% sacrococcygeal; 29% lumbar; 19% thoracic; 20% cervical; and 21% multiple levels. During the index admission, 392(0.9%) patients developed DVT, 281(0.7%) developed PE, and 601(1.5%) VTE. Within 1-month of discharge, 177(0.4%) patients were readmitted with DVT, 142(0.3%) with PE, and 268(0.6%) with VTE. Within 6-months of discharge, 352(0.9%) patients were readmitted with DVT, 250(0.6%) with PE, and 513(1.2%) with VTE. Among those who were readmitted within 6-months with VTE, mortality was 6.7%. On multivariate analysis, older age(OR = 1.01,p < 0.01), higher ISS(OR = 1.03,p < 0.001), thoracic level of spinal fracture(OR = 1.37,p = 0.04), and discharge to skilled nursing facility, rehabilitation center, or care facility(OR = 1.73,p < 0.001) were independently associated with 6-month readmission due to VTE. Conclusions: VTE risk and associated mortality remains high for 6-months after non-operatively managed traumatic spinal fracture. Further studies regarding optimal duration and choice of thromboprophylactic agents are warranted.
• Bhogadi, S., Alizai, Q., Colosimo, C., Spencer, A., Stewart, C., Nelson, A., Ditillo, M., Castanon, L., Magnotti, L., Joseph, B., Dultz, L., Black, G., Campbell, M., Berndtson, A., Costantini, T., Kerwin, A., Skarupa, D., Burruss, S., Delgado, L., , Gomez, M., et al. (2023). Not all traumatic brain injury patients on preinjury anticoagulation are the same. American Journal of Surgery, 226(6). doi:10.1016/j.amjsurg.2023.05.034
  More info

  Background: Prognostic significance of different anticoagulants in TBI patients remains unanswered. We aimed to compare effects of different anticoagulants on outcomes of TBI patients. Methods: A secondary analysis of AAST BIG MIT. Blunt TBI patients ≥50 years using anticoagulants presenting ICH were identified. Outcomes were progression of ICH and need for neurosurgical intervention (NSI). Results: 393 patients were identified. Mean age was 74 and most common anticoagulant was aspirin (30%), followed by Plavix (28%), and coumadin (20%). 20% had progression of ICH and 10% underwent NSI. On multivariate regression for ICH progression, warfarin, SDH, IPH, SAH, alcohol intoxication and neurologic exam deterioration were associated with increased odds. Warfarin, abnormal neurologic exam on presentation, and SDH were independent predictors of NSI. Conclusions: Our findings reflect a dynamic interaction between type of anticoagulants, bleeding pattern & outcomes. Future modifications of BIG may need to take the type of anticoagulant into consideration.
• Bhogadi, S., Nelson, A., El-Qawaqzeh, K., Spencer, A., Hosseinpour, H., Castanon, L., Anand, T., Ditillo, M., Magnotti, L., & Joseph, B. (2023). Does preinjury anticoagulation worsen outcomes among traumatic hemothorax patients? A nationwide retrospective analysis. Injury, 54(9). doi:10.1016/j.injury.2023.110850
  More info

  Introduction: Up to a quarter of all traumatic deaths are due to thoracic injuries. Current guidelines recommend consideration of evacuation of all hemothoraces with tube thoracostomy. The aim of our study was to determine the impact of pre-injury anticoagulation on outcomes of traumatic hemothorax patients. Materials and Methods: We performed a 4-year (2017 – 2020) analysis of the ACS-TQIP database. We included all adult trauma patients (age ≥18 years) presenting with hemothorax and no other severe injuries (other body regions once), overall complications, hospital length of stay (LOS), and mortality. Results: A matched cohort of 6,962 patients (AC, 3,481; No-AC, 3,481) was analyzed. The median age was 75 years, and the median ISS was 10. The AC and No-AC groups were similar in terms of baseline characteristics. Compared to the No-AC group, AC group had higher rates of chest tube placement (46% vs 43%, p = 0.018), overall complications (8% vs 7%, p = 0.046), and longer hospital LOS (7[4–12] vs 6[3–10] days, p ≤ 0.001). Reintervention and mortality rates were similar between the groups (p>0.05). Conclusion: The use of preinjury anticoagulants in hemothorax patients negatively impacts patient outcomes. Increased surveillance is required while dealing with hemothorax patients on pre-injury anticoagulants, and consideration should be given to earlier interventions for such patients.
• Castanon, L., Anand, T., Bhogadi, S. K., Colosimo, C., Ditillo, M., El-Qawaqzeh, K., Gries, L., Hosseinpour, H., Joseph, B., Nelson, A., & Spencer, A. (2023). 289 The Timing of Pharmacologic Venous Thromboembolism Prophylaxis Initiation for Burn Patients with Concomitant Trauma. Journal of Burn Care & Research, 44(Supplement_2), S185-S185. doi:10.1093/jbcr/irad045.264
• Castanon, L., Bhogadi, S., Krishna Bhogadi, S., Anand, T., Hosseinpour, H., Nelson, A., Colosimo, C., Spencer, A., Gries, L., Ditillo, M., & Joseph, B. (2023). The Association Between the Timing of Initiation of Pharmacologic Venous Thromboembolism Prophylaxis with Outcomes in Burns Patients. Journal of Burn Care and Research, 44(6). doi:10.1093/jbcr/irad074
  More info

  Hospitalized burn patients are at increased risk for venous thromboembolism (VTE). Guidelines regarding thromboprophylaxis in burn patients are unclear. This study aims to compare the outcomes of early versus late thromboprophylaxis initiation in burn patients. In this 3-year analysis of 2017–2019 ACS-TQIP, adult(18–64years) burn patients were identified after applying inclusion/exclusion criteria and stratified based on timing of initiation of VTE prophylaxis: Early(24 hours). Outcomes were deep venous thrombosis(DVT), pulmonary embolism(PE), unplanned return to operating room (OR), unplanned intensive care unit (ICU) admission, post-prophylaxis packed red blood cells (PRBC) transfusion, and mortality. Nine thousand two hundred and seventy-two patients were identified. Overall, median age was 41years, 71.5% were male, and median[IQR] injury severity score was 3[1–8]. 53% had second-degree burns, and 80% had less than 40% of total body surface area affected. Median time to thromboprophylaxis initiation was 11[6–20.6] hours. Overall VTE rate was 0.9% (DVT−0.7%, PE−0.2%). On univariable analysis, early prophylaxis group had lower rates of DVT(0.6% vs 1.1%, P = .025), and PE(0.1% vs 0.6%, P < .001). On multivariable regression, late prophylaxis was associated with 1.8 times higher odds of DVT (aOR = 1.8, 95% CI = 1.04–3.11, P = .03), 4.8 times higher odds of PE(aOR = 4.8, 95% CI = 1.9–11.9, P < .001), and 2 times higher odds of unplanned ICU admission(aOR = 2.1, 95% CI = 1.4–3.1, P < .001). Furthermore, early thromboprophylaxis was not associated with increased odds of post-prophylaxis PRBC transfusion(aOR = 1.1, 95% CI = 0.8–1.4, P = .4), and mortality(aOR = 0.68, 95% CI = 0.4–1.1, P = .13). Early VTE prophylaxis in burn patients is associated with decreased rates of DVT and PE, without increasing the risk of bleeding and mortality. VTE prophylaxis may be initiated within 24 hours of admission to reduce VTE in this high-risk patient population.
• Collins, W., El-Qawaqzeh, K., Ditillo, M., Hosseinpour, H., Nelson, A., Bhogadi, S., Castanon, L., Gries, L., Anand, T., & Joseph, B. (2023). Minimally Invasive Surgery for Genitourinary Trauma: A Nationwide Outcomes-Based Analysis. Journal of Surgical Research, 282. doi:10.1016/j.jss.2022.09.015
  More info

  Introduction: Bladder and ureteral injuries are uncommon in trauma patients but are associated with increased morbidity and mortality. Patients presenting with such injuries may undergo either open surgical repair or laparoscopic repair. We aimed to compare outcomes of open surgical approach and laparoscopy in trauma patients with isolated bladder and ureteral injury. We hypothesized that laparoscopy is associated with improved outcomes. Methods: We performed a 2017 review of American College of Surgeons Trauma Quality Improvement Program and identified trauma patients with bladder and ureteral injury who underwent open surgical repair or laparoscopy. A 1:1 propensity score matching was performed adjusting for demographics, emergency department vitals (systolic blood pressure, heart rate, Glasgow Coma Scale), mechanism of injury, Injury Severity Score, each body region Abbreviated Injury Scale score, and transfusion units. Outcomes were rates of in-hospital major complications and mortality. Results: Of the 1,004,440 trauma patients, 384 patients (open: 192 and laparoscopy: 192) were matched and included. The mean age was 36 ± 15 y, Injury Severity Score was 27 [27-48], 77% were males, and 56% of patients had a blunt mechanism of injury, and 44% had penetrating injuries. Overall mortality was 7.3%. On univariate analysis, mortality was lower in the open group as compared to the laparoscopy group (10.4% versus 4.2%, P = 0.019) and survivor-only hospital length of stay was longer in the open group (8 [8-9] versus 7 [5-11], P = 0.008). There was no difference in overall major complications (23% versus 21%, P = 0.621). On multivariate analysis, open surgical repair was independently associated with lower odds of mortality (adjusted odds ratio: 0.405, 95% confidence interval: [0.17-0.95], P-value = 0.038) Conclusions: In our analysis open surgical repair of bladder and ureteral injuries was associated with lower mortality with other outcomes being similar when compared to laparoscopy. Laparoscopic surgical repair may not have an advantage over the open surgical repair for bladder and ureteral injuries. Further prospective studies are needed to delineate the ideal surgical approach for these injuries.
• Culbert, M., Nelson, A., Obaid, O., Castanon, L., Hosseinpour, H., Anand, T., El-Qawaqzeh, K., Stewart, C., Reina, R., & Joseph, B. (2023). Failure-to-rescue and mortality after emergent pediatric trauma laparotomy: How are the children doing? “Pediatric Emergent Trauma Laparotomy”. Journal of Pediatric Surgery, 58(3). doi:10.1016/j.jpedsurg.2022.08.017
  More info

  Introduction: Emergent trauma laparotomy is associated with mortality rates of up to 40%. There is a paucity of data on the outcomes of emergent trauma laparotomies performed in the pediatric population. The aim of our study was to describe the outcomes, including mortality and FTR, among pediatric trauma patients undergoing emergent laparotomy and identify factors associated with failure-to-rescue (FTR). Methods: We performed a one-year (2017) retrospective cohort analysis of the American College of Surgeons Trauma Quality Improvement Program dataset. All pediatric trauma patients (age
• El-Qawaqzeh, K., Anand, T., Richards, J., Hosseinpour, H., Nelson, A., Akl, M., Obaid, O., Ditillo, M., Friese, R., & Joseph, B. (2023). Predictors of Mortality in Blunt Cardiac Injury: A Nationwide Analysis. Journal of Surgical Research, 281. doi:10.1016/j.jss.2022.07.047
  More info

  Introduction: Blunt thoracic injury (BTI) is one of the most common causes of trauma admission in the United States and is uncommonly associated with cardiac injuries. Blunt cardiac injury (BCI) after blunt thoracic trauma is infrequent but carries a substantial risk of morbidity and sudden mortality. Our study aims to identify predictors of concomitant cardiac contusion among BTI patients and the predictors of mortality among patients presenting with BCI on a national level. Materials and Methods: We performed a 1-y (2017) analysis of the American College of Surgeons Trauma Quality Improvement Program. We included all adults (aged ≥ 18 y) with the diagnosis of BTI. We excluded patients who were transferred, had a penetrating mechanism of injury, and who were dead on arrival. Our primary outcomes were the independent predictors of concomitant cardiac contusions among BTI patients and the predictors of mortality among BCI patients. Our secondary outcome measures were in-hospital complications, differences in injury patterns, and injury severity between the survivors and nonsurvivors of BCI. Results: A total of 125,696 patients with BTI were identified, of which 2368 patients had BCI. Mean age was 52 ± 20 y, 67% were male, and median injury severity score was 14 [9-21]. The most common type of cardiac injury was cardiac contusion (43%). Age ≥ 65 y, higher 4-h packed red blood cell requirements, motor vehicle collision mechanism of injury, and concomitant thoracic injuries (hemothorax, flail chest, lung contusion, sternal fracture, diaphragmatic injury, and thoracic aortic injuries) were independently associated with concomitant cardiac contusion among BTI patients (P value < 0.05). Age ≥ 65 y, thoracic aortic injury, diaphragmatic injury, hemothorax, and a history of congestive heart failure were independently associated with mortality in BCI patients (P value < 0.05). Conclusions: Predictors of concomitant cardiac contusion among BTI patients and mortality among BCI patients were identified. Guidelines on the management of BCI should incorporate these predictors for timely identification of high-risk patients.
• El-Qawaqzeh, K., Colosimo, C., Bhogadi, S., Magnotti, L., Hosseinpour, H., Castanon, L., Nelson, A., Ditillo, M., Anand, T., & Joseph, B. (2023). Unequal Treatment? Confronting Racial, Ethnic, and Socioeconomic Disparity in Management of Survivors of Violent Suicide Attempt. Journal of the American College of Surgeons, 237(1). doi:10.1097/XCS.0000000000000716
  More info

  BACKGROUND: Psychiatric inpatient hospitalization is nearly always indicated for patients with recent suicidal behavior. We aimed to assess the factors associated with receiving mental health services during hospitalization or on discharge among survivors of suicide attempts in trauma centers. STUDY DESIGN: A 3-year analysis of the 2017 to 2019 American College of Surgeons TQIP. Adults (≥18 years) presenting after suicide attempts were included. Patients who died, those with emergency department discharge disposition, those with superficial lacerations, and those who were transferred to nonpsychiatric care facilities were excluded. Backward stepwise regression analyses were performed to identify predictors of receiving mental health services (inpatient psychiatric consultation/psychotherapy, discharge/transfer to a psychiatric hospital, or admission to a distinct psychiatric unit of a hospital). RESULTS: We identified 18,701 patients, and 56% received mental health services. The mean age was 40 ± 15 years, 72% were males, 73% were White, 57% had a preinjury psychiatric comorbidity, and 18% were uninsured. Of these 18,701 patients, 43% had moderate to severe injuries (Injury Severity Score > 8), and the most common injury was cut/stab (62%), followed by blunt mechanisms (falls, lying in front of a moving object, and intentional motor vehicle collisions) (18%) and firearm injuries (16%). On regression analyses, Black race, Hispanic ethnicity, male sex, younger age, and positive admission alcohol screen were associated with lower odds of receiving mental health services (p < 0.05). Increasing injury severity, being insured, having preinjury psychiatric diagnosis, and positive admission illicit drug screen were associated with higher odds of receiving mental health services (p < 0.05). CONCLUSIONS: Significant disparities exist in the management of survivors of suicide attempts. There is a desperate need for improved access to mental health services. Further studies should focus on delineating the cause of these disparities, identifying the barriers, and finding solutions.
• Hosseinpour, H., El-Qawaqzeh, K., Magnotti, L., Bhogadi, S., Ghneim, M., Nelson, A., Spencer, A., Colosimo, C., Anand, T., Ditillo, M., & Joseph, B. (2023). The unexpected paradox of geriatric traumatic brain injury outcomes: Uncovering racial and ethnic disparities. American Journal of Surgery, 226(2). doi:10.1016/j.amjsurg.2023.05.017
  More info

  Background: Healthcare disparities have always challenged surgical care in the US. We aimed to assess the influence of disparities on cerebral monitor placement and outcomes of geriatric TBI patients. Methods: Analysis of 2017–2019 ACS-TQIP. Included severe TBI patients ≥65 years. Patients who died within 24 h were excluded. Outcomes included mortality, cerebral monitors use, complications, and discharge disposition. Results: We included 208,495 patients (White = 175,941; Black = 12,194) (Hispanic = 195,769; Non-Hispanic = 12,258). On multivariable regression, White race was associated with higher mortality (aOR = 1.26; p < 0.001) and SNF/rehab discharge (aOR = 1.11; p < 0.001) and less likely to be discharged home (aOR = 0.90; p < 0.001) or to undergo cerebral monitoring (aOR = 0.77; p < 0.001) compared to Black. Non-Hispanics had higher mortality (aOR = 1.15; p = 0.013), complications (aOR = 1.26; p < 0.001), and SNF/Rehab discharge (aOR = 1.43; p < 0.001) and less likely to be discharged home (aOR = 0.69; p < 0.001) or to undergo cerebral monitoring (aOR = 0.84; p = 0.018) compared to Hispanics. Uninsured Hispanics had the lowest odds of SNF/rehab discharge (aOR = 0.18; p < 0.001). Conclusions: This study highlights the significant racial and ethnic disparities in the outcomes of geriatric TBI patients. Further studies are needed to address the reason behind these disparities and identify potentially modifiable risk factors in the geriatric trauma population.
• Hosseinpour, H., Magnotti, L., Bhogadi, S., Anand, T., El-Qawaqzeh, K., Ditillo, M., Colosimo, C., Spencer, A., Nelson, A., & Joseph, B. (2023). Time to Whole Blood Transfusion in Hemorrhaging Civilian Trauma Patients: There Is Always Room for Improvement. Journal of the American College of Surgeons, 237(1). doi:10.1097/XCS.0000000000000715
  More info

  BACKGROUND: Whole blood (WB) is becoming the preferred product for the resuscitation of hemorrhaging trauma patients. However, there is a lack of data on the optimum timing of receiving WB. We aimed to assess the effect of time to WB transfusion on the outcomes of trauma patients. STUDY DESIGN: The American College of Surgeons TQIP 2017 to 2019 database was analyzed. Adult trauma patients who received at least 1 unit of WB within the first 2 hours of admission were included. Patients were stratified by time to first unit of WB transfusion (first 30 minutes, second 30 minutes, and second hour). Primary outcomes were 24-hour and in-hospital mortality, adjusting for potential confounders. RESULTS: A total of 1,952 patients were identified. Mean age and systolic blood pressure were 42 ± 18 years and 101 ± 35 mmHg, respectively. Median Injury Severity Score was 17 [10 to 26], and all groups had comparable injury severities (p = 0.27). Overall, 24-hour and in-hospital mortality rates were 14% and 19%, respectively. Transfusion of WB after 30 minutes was progressively associated with increased adjusted odds of 24-hour mortality (second 30 minutes: Adjusted odds ratio [aOR] 2.07, p = 0.015; second hour: AOR 2.39, p = 0.010) and in-hospital mortality (second 30 minutes: AOR 1.79, p = 0.025; second hour: AOR 1.98, p = 0.018). On subanalysis of patients with an admission shock index >1, every 30-minute delay in WB transfusion was associated with higher odds of 24-hour (aOR 1.23, p = 0.019) and in-hospital (aOR 1.18, p = 0.033) mortality. CONCLUSIONS: Every minute delay in WB transfusion is associated with a 2% increase in odds of 24-hour and in-hospital mortality among hemorrhaging trauma patients. WB should be readily available and easily accessible in the trauma bay for the early resuscitation of hemorrhaging patients.
• Hosseinpour, H., Magnotti, L., Bhogadi, S., Colosimo, C., El-Qawaqzeh, K., Spencer, A., Anand, T., Ditillo, M., Nelson, A., & Joseph, B. (2023). Interfacility transfer of pediatric trauma patients to higher levels of care: The effect of transfer time and level of receiving trauma center. Journal of Trauma and Acute Care Surgery, 95(3). doi:10.1097/TA.0000000000003915
  More info

  BACKGROUND Interfacility transfer of pediatric trauma patients to pediatric trauma centers (PTCs) after evaluation in nontertiary centers is associated with improved outcomes. We aimed to assess the outcomes of transferred pediatric patients based on their severity of the injury, transfer time, and level of receiving PTCs. METHODS This is a 3-year (2017-2019) analysis of the American College of Surgeons Trauma Quality Improvement Program database. All children (younger than 15 years) who were transferred from other facilities to Level I or II PTC were included and stratified by level of receiving PTCs and injury severity. Outcome measures were in-hospital mortality and major complications. RESULTS A total of 67,726 transferred pediatric trauma patients were identified, of which 52,755 were transferred to Level I and 14,971 to Level II. The mean ± SD age and median Injury Severity Score were 7 ± 4 years and 4 (1-6), respectively. Eighty-five percent were transported by ground ambulance. The median transfer time for Levels I and II was 93 (70-129) and 90 (66-128) minutes, respectively (p < 0.001). On multivariable regression, interfacility transfers to Level I PTCs were associated with decreased risk-adjusted odds of in-hospital mortality among the mildly to moderately injured group (adjusted odds ratio, 0.59; p = 0.037) and severely injured group with a transfer time of less than 60 minutes (adjusted odds ratio, 0.27; p = 0.002). CONCLUSION Every minute increase in the interfacility transfer time is associated with a 2% increase in risk-adjusted odds of mortality among severely injured pediatric trauma patients. Factors other than the level of receiving PTCs, such as estimated transfer time and severity of injury, should be considered while deciding about transferring pediatric trauma patients to higher levels of care. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
• Hosseinpour, H., Nelson, A., Bhogadi, S., Spencer, A., Alizai, Q., Colosimo, C., Anand, T., Ditillo, M., Magnotti, L., & Joseph, B. (2023). Delayed versus early hepatic resection among patients with severe traumatic liver injuries undergoing damage control laparotomy. American Journal of Surgery, 226(6). doi:10.1016/j.amjsurg.2023.06.029
  More info

  Introduction: We aimed to assess the effect of time to hepatic resection on the outcomes of patients with high-grade liver injuries who underwent damage control laparotomy (DCL). Methods: This is a 4-year (2017–2020) analysis of the ACS-TQIP. Adult trauma patients with severe liver injuries (AAST-OIS grade ​≥ ​III) who underwent DCL and hepatic resection were included. We excluded patients with early mortality (
• Nelson, A. (2023).

  Nelson AC, Bhogadi SK, Hosseinpour H, Stewart C, Anand T, Spencer AL, Colosimo C, Magnotti LJ, Joseph B. There Is No Such Thing as Too Soon: Long-Term Outcomes of Early Cholecystectomy for Frail Geriatric Patients with Acute Biliary Pancreatitis.

  J Am Coll Surg. 2023 Nov 1;237(5):712-718. doi: 10.1097/XCS.0000000000000790. Epub 2023 Jun 23.

  . J Am Coll Surg.
• Nelson, A. (2023).

  Akl MN, El-Qawaqzeh K, Anand T, Hosseinpour H, Colosimo C, Nelson A, Alizai Q, Ditillo M, Magnotti LJ, Joseph B. Trauma Laparotomy for the Cirrhotic Patient: An Outcome-Based Analysis. J Surg Res. 2024 Feb;294:128-136. doi: 10.1016/j.jss.2023.09.008. Epub 2023 Oct 21.

  . J Surg Res.
• Nelson, A. (2023).

  Alizai Q, Anand T, Bhogadi SK, Nelson A, Hosseinpour H, Stewart C, Spencer AL, Colosimo C, Ditillo M, Joseph B. From surveillance to surgery: The delayed implications of non-operative and operative management of pancreatic injuries. Am J Surg. 2023 Nov;226(5):682-687. doi: 10.1016/j.amjsurg.2023.07.027. Epub 2023 Jul 21.

  . Am J Surg.
• Nelson, A. (2023).

  Alizai Q, Arif MS, Colosimo C, Hosseinpour H, Spencer AL, Bhogadi SK, Nelson A, Anand T, Ditillo M, Joseph B. Beyond the short-term relief: Outcomes of geriatric rib fracture patients receiving paravertebral nerve blocks and epidural analgesia. Injury. 2024 Jan;55(1):111184. doi: 10.1016/j.injury.2023.111184. Epub 2023 Nov 10.

  . Injury.
• Nelson, A. (2023).

  Alizai Q, Colosimo C, Hosseinpour H, Stewart C, Bhogadi SK, Nelson A, Spencer AL, Ditillo M, Magnotti LJ, Joseph B; AAST Frailty MIT Study Group. It's Not All Black and White: The Effect of Increasing Severity of Frailty on Outcomes of Geriatric Trauma Patients.

  J Trauma Acute Care Surg. 2023 Nov 22. doi: 10.1097/TA.0000000000004217. Online ahead of print.

  . J Trauma Acute Care Surgery.
• Nelson, A. (2023).

  Bhogadi SK, Nelson A, El-Qawaqzeh K, Spencer AL, Hosseinpour H, Castanon L, Anand T, Ditillo M, Magnotti LJ, Joseph B. Does preinjury anticoagulation worsen outcomes among traumatic hemothorax patients? A nationwide retrospective analysis. Injury. 2023 Sep;54(9):110850. doi: 10.1016/j.injury.2023.110850. Epub 2023 Jun 4.

  . Injury.
• Nelson, A. (2023).

  Bhogadi SK, Alizai Q, Colosimo C, Spencer AL, Stewart C, Nelson A, Ditillo M, Castanon L, Magnotti LJ, Joseph B; BIG Multi-institutional Study Group; American Association for the Surgery of Trauma Brain Injury Guidelines Multi-institutional Study Group; Dultz L, Black G, Campbell M, Berndtson AE, Costantini T, Kerwin A, Skarupa D, Burruss S, Delgado L, Gomez M, Mederos DR, Winfield R, Cullinane D, Hosseinpour H. Not all traumatic brain injury patients on preinjury anticoagulation are the same. Am J Surg. 2023 Dec;226(6):785-789. doi: 10.1016/j.amjsurg.2023.05.034. Epub 2023 Jun 3.

  . Am J Surg.
• Nelson, A. (2023).

  Bhogadi SK, Colosimo C, Hosseinpour H, Nelson A, Rose MI, Calvillo AR, Anand T, Ditillo M, Magnotti LJ, Joseph B. The undisclosed disclosures: The dollar-outcome relationship in resuscitative endovascular balloon occlusion of the aorta. J Trauma Acute Care Surg. 2023 Nov 1;95(5):726-730. doi: 10.1097/TA.0000000000004080. Epub 2023 Jun 15.

  . J Trauma Acute Care Surg.
• Nelson, A. (2023).

  Bhogadi SK, Magnotti LJ, Hosseinpour H, Anand T, El-Qawaqzeh K, Nelson A, Colosimo C, Spencer AL, Friese R, Joseph B. The final decision among the injured elderly, to stop or to continue? Predictors of withdrawal of life supporting treatment. J Trauma Acute Care Surg. 2023 Jun 1;94(6):778-783. doi: 10.1097/TA.0000000000003924. Epub 2023 Mar 11.

  . J Trauma Acute Care Surg.
• Nelson, A. (2023).

  Bhogadi SK, Stewart C, El-Qawaqzeh K, Colosimo C, Hosseinpour H, Nelson A, Castanon L, Spencer AL, Magnotti LJ, Joseph B. Local Antibiotic Therapy for Open Long Bone Fractures: Appropriate Prophylaxis or Unnecessary Exposure for the Orthopedic Trauma Patient?

  Mil Med. 2023 Nov 8;188(Suppl 6):407-411. doi: 10.1093/milmed/usad174.

  . Military Medicine.
• Nelson, A. (2023).

  Castanon L, Bhogadi SK, Anand T, Hosseinpour H, Nelson A, Colosimo C, Spencer AL, Gries L, Ditillo M, Joseph B.The Association Between the Timing of Initiation of Pharmacologic Venous Thromboembolism Prophylaxis with Outcomes in Burns Patients. J Burn Care Res. 2023 Nov 2;44(6):1311-1315. doi: 10.1093/jbcr/irad074.

  . J Burn REs.
• Nelson, A. (2023).

  El-Qawaqzeh K, Colosimo C, Bhogadi SK, Magnotti LJ, Hosseinpour H, Castanon L, Nelson A, Ditillo M, Anand T, Joseph B. Unequal Treatment? Confronting Racial, Ethnic, and Socioeconomic Disparity in Management of Survivors of Violent Suicide Attempt. J Am Coll Surg. 2023 Jul 1;237(1):68-78. doi: 10.1097/XCS.0000000000000716. Epub 2023 Apr 14.

  . J AM Coll Surg.
• Nelson, A. (2023).

  El-Qawaqzeh K, Magnotti LJ, Hosseinpour H, Nelson A, Spencer AL, Anand T, Bhogadi SK, Alizai Q, Ditillo M, Joseph B. Geriatric trauma, frailty, and ACS trauma center verification level: Are there any correlations with outcomes? Injury. 2024 Jan;55(1):110972. doi: 10.1016/j.injury.2023.110972. Epub 2023 Aug 7.

  . Injury.
• Nelson, A. (2023).

  Hosseinpour H, Nelson A, Bhogadi SK, Spencer AL, Alizai Q, Colosimo C, Anand T, Ditillo M, Magnotti LJ, Joseph B. Delayed versus early hepatic resection among patients with severe traumatic liver injuries undergoing damage control laparotomy. Am J Surg. 2023 Dec;226(6):823-828. doi: 10.1016/j.amjsurg.2023.06.029. Epub 2023 Jul 17.

  . Am J Surg.
• Nelson, A. (2023).

  Hosseinpour H, El-Qawaqzeh K, Magnotti LJ, Bhogadi SK, Ghneim M, Nelson A, Spencer AL, Colosimo C, Anand T, Ditillo M, Joseph B. The unexpected paradox of geriatric traumatic brain injury outcomes: Uncovering racial and ethnic disparities. Am J Surg. 2023 Aug;226(2):271-277. doi: 10.1016/j.amjsurg.2023.05.017. Epub 2023 May 18.

  . Am J Surg.
• Nelson, A. (2023).

  Hosseinpour H, Magnotti LJ, Bhogadi SK, Anand T, El-Qawaqzeh K, Ditillo M, Colosimo C, Spencer A, Nelson A, Joseph B. Time to Whole Blood Transfusion in Hemorrhaging Civilian Trauma Patients: There Is Always Room for Improvement. J Am Coll Surg. 2023 Jul 1;237(1):24-34. doi: 10.1097/XCS.0000000000000715. Epub 2023 Apr 18.

  . J Am Coll Surg.
• Nelson, A. (2023).

  Hosseinpour H, Magnotti LJ, Bhogadi SK, Colosimo C, El-Qawaqzeh K, Spencer AL, Anand T, Ditillo M, Nelson A, Joseph B. (2023) Interfacility transfer of pediatric trauma patients to higher levels of care: The effect of transfer time and level of receiving trauma center. J Trauma Acute Care Surg. 2023 Sep 1;95(3):383-390. doi: 10.1097/TA.0000000000003915.

  . J trauma Acute Care Surg.
• Nelson, A. (2023).

  Litmanovich B, Alizai Q, Stewart C, Hosseinpour H, Nelson A, Bhogadi SK, Colosimo C, Spencer AL, Ditillo M, Joseph B. Outcomes of Geriatric Burn Patients Presenting to the Trauma Service: How Does Frailty Factor in? J Surg Res. 2024 Jan;293:327-334. doi: 10.1016/j.jss.2023.08.049. Epub 2023 Oct 6.

  . J Surg Res.
• Nelson, A. (2023).

  Zambetti BR, Patel DD, Stuber JD, Zickler WP, Hosseinpour H, Anand T, Nelson AC, Stewart C, Joseph B, Magnotti LJ. (2023) Role of Endovascular Stenting in Patients with Traumatic Iliac Artery Injury. J Am Coll Surg. 2023 Apr 1;236(4):753-759. doi: 10.1097/XCS.0000000000000540.

  . J Am Coll Surg.
• Nelson, A. C. (2023). Role of Endovascular Stenting in Patients with Traumatic Iliac Artery Injury. Journal of the American College of Surgeons, 236(4), 753-759. doi:10.1097/xcs.0000000000000540
• Nelson, A., Bhogadi, S., Hosseinpour, H., Stewart, C., Anand, T., Spencer, A., Colosimo, C., Magnotti, L., & Joseph, B. (2023). There Is No Such Thing as Too Soon: Long-Term Outcomes of Early Cholecystectomy for Frail Geriatric Patients with Acute Biliary Pancreatitis. Journal of the American College of Surgeons, 237(5). doi:10.1097/XCS.0000000000000790
  More info

  BACKGROUND: Early cholecystectomy (CCY) for acute biliary pancreatitis (ABP) is recommended but there is a paucity of data assessing this approach in frail geriatric patients. This study compares outcomes of frail geriatric ABP patients undergoing index admission CCY vs nonoperative management (NOM) with endoscopic retrograde cholangiopancreatography (ERCP). STUDY DESIGN: Retrospective analysis of the Nationwide Readmissions Database (2017). All frail geriatric (65 years or older) patients with ABP were included. Patients were grouped by treatment at index admission: CCY vs NOM with endoscopic retrograde cholangiopancreatography. Propensity score matching was performed in a 1:2 ratio. Primary outcomes were 6-month readmissions, mortality, and length of stay. Secondary outcomes were 6-month failure of NOM defined as readmission for recurrent ABP, unplanned pancreas-related procedures, or unplanned CCY. Subanalysis was performed to compare outcomes of unplanned CCY vs early CCY. RESULTS: A total of 29,130 frail geriatric patients with ABP were identified and 7,941 were matched (CCY 5,294; NOM 2,647). Patients in the CCY group had lower 6-month rates of readmission for pancreas-related complications, unplanned readmissions for pancreas-related procedures, overall readmissions, and mortality, as well as fewer hospitalized days (p < 0.05). NOM failed in 12% of patients and 7% of NOM patients were readmitted within 6 months to undergo CCY, of which 56% were unplanned. Patients who underwent unplanned CCY had higher complication rates and hospital costs, longer hospital lengths of stay, and increased mortality compared with early CCY (p < 0.05). CONCLUSIONS: For frail geriatric patients with ABP, early CCY was associated with lower 6-month rates of complications, readmissions, mortality, and fewer hospitalized days. NOM was unsuccessful in nearly 1 of 7 within 6 months; of these, one-third required unplanned CCY. Early CCY should be prioritized for frail geriatric ABP patients when feasible. (J Am Coll Surg 2023;237:712–718.
• Akl, M., Anand, T., Reina, R., El-Qawaqzeh, K., Ditillo, M., Hosseinpour, H., Nelson, A., Obaid, O., Friese, R., & Joseph, B. (2022). Balanced hemostatic resuscitation for bleeding pediatric trauma patients: A nationwide quantitative analysis of outcomes. Journal of Pediatric Surgery, 57(12). doi:10.1016/j.jpedsurg.2022.07.005
  More info

  Background: The administration of balanced component therapy has been associated with improvements in outcomes in adult trauma. There is little to no specific data to guide transfusion ratios in children. The aim of our study is to compare outcomes among different transfusion strategies in pediatric trauma patients. Methods: We conducted a (2014–2016) retrospective analysis of the Trauma Quality Improvement Program. We selected all pediatric (age < 18) trauma patients who received at least one unit of packed red blood cells (PRBC) and fresh frozen plasma (FFP) within 4 h of admission. Patients were stratified based on their FFP:PRBC transfusion ratio in the first 4 h into: 1:1, 1:2, 1:3, and 1:3+. Primary outcomes were 24-mortality, in-hospital mortality. Secondary outcomes were complications and 24 h PRBC transfusion requirements. Multivariable logistic regression analysis was performed. Results: A total of 1,233 patients were identified of which 637 received transfusion ratio of 1:1, 365 1:2, 116 1:3, and 115 1:3+. Mean age was 11 ± 6y, 70% were male, ISS was 27 [20–38], and 62% sustained penetrating injuries. Patients in the 1:1 group had the lowest 24 h mortality (14% vs. 18% vs. 22% vs. 24%; p = 0.01) and in-hospital mortality (32% vs. 36% vs. 40% vs. 44%; p = 0.01). No difference was found between the groups in terms of complications (22% vs. 21% vs. 23% vs. 22%; p = 0.96) such as acute respiratory distress syndrome (3.3% vs. 3.6% vs. 0.9% vs. 0%; p = 0.10), and acute kidney injury (3% vs. 2.2% vs. 0.9% vs. 0.9%; p = 0.46). Additionally the 1:1 group had the lowest PRBC transfusion requirements (3[2–7] vs. 5[2–10] vs. 6[3–8] vs. 6[4–10]; p < 0.01). On regression analysis a progressive increase in the mortality adjusted odds ratio was observed as the FFP:PRBC transfusion ratio decreased. Conclusion: FFP:PRBC ratios closest to 1 were associated with increased survival in children. The resuscitation of pediatric patients should target a 1:1 ratio of FFP:PRBC. Further studies are needed for the development of massive transfusion protocols for this age group. Level of evidence: Level IV Study type: Therapeutic/Care Management
• Anand, T., Asmar, S., Ditillo, M., Hammad, A., Joseph, B., Nelson, A., Obaid, O., Saljuqi, T., & Tang, A. (2022). Marijuana and thromboembolic events in geriatric trauma patients: The cannabinoids clots correlation!. American journal of surgery, 223(4), 798-803. doi:10.1016/j.amjsurg.2021.07.036
  More info

  Tetrahydrocannabinol (THC) can alter the coagulation cascade resulting in hypercoagulability. The aim of our study is to evaluate the impact of THC use on thromboembolic complications (TEC) in geriatric trauma patients (GTP)..This is a 2017 analysis of the TQIP database including all GTP (age ≥65 years). Patients were stratified based on THC use. Propensity score matching (1:2 ratio) was performed..A total of 2,835 patients were matched (THC+: 945 and THC-: 1,890). Mean age was 70 ± 6 years, 94% sustained blunt injuries, and median ISS was 22[12-27]. Sixty-two percent of patients received thromboprophylaxis, with median time to initiation of 27 h from admission. Overall, the rate of TEC was 2.1% and mortality was 6.0%. THC + patients had significantly higher rates of TEC compared to THC- patients (3.0% vs. 1.7%; p = 0.01). Rates of DVT (2.2% vs 0.6%, p < 0.01) and PE (1.4% vs 0.4%, p < 0.01) were higher in the THC + group..THC exposure increases the risk of TEC in GTP. Incorporation of THC use into risk assessment protocols merits serious consideration in GTP.
• Douglas, M., Obaid, O., Castanon, L., Reina, R., Ditillo, M., Nelson, A., Bible, L., Anand, T., Gries, L., & Joseph, B. (2022). After 9,000 laparotomies for blunt trauma, resuscitation is becoming more balanced and time to intervention shorter: Evidence in action. Journal of Trauma and Acute Care Surgery, 93(3). doi:10.1097/TA.0000000000003574
  More info

  BACKGROUND Several advancements in hemorrhage control have been advocated for in the past decade, including balanced transfusions and earlier times to intervention. The aim of this study was to examine the effect of these advancements on outcomes of blunt trauma patients undergoing emergency laparotomy. METHODS This is a 5-year (2013-2017) analysis of the Trauma Quality Improvement Program. Adult (18 years or older) blunt trauma patients with early (≤4 hours) packed red blood cell (PRBC) and fresh frozen plasma (FFP) transfusions and an emergency (≤4 hours) laparotomy for hemorrhage control were identified. Time-trend analysis of 24-hour mortality, PRBC/FFP ratio, and time to laparotomy was performed over the study period. The association between mortality and PRBC/FFP ratio, patient demographics, injury characteristics, transfusion volumes, and American College of Surgeons verification level was examined by hierarchical regression analysis adjusting for interyear variability. RESULTS A total of 9,773 blunt trauma patients with emergency laparotomy were identified. The mean ± SD age was 44 ± 18 years, 67.5% were male, and median Injury Severity Score was 34 (range, 24-43). The mean ± SD systolic blood pressure at presentation was 73 ± 28 mm Hg, and the median transfusion requirements were PRBC 9 (range, 5-17) and FFP 6 (range, 3-12). During the 5-year analysis, time to laparotomy decreased from 1.87 hours to 1.37 hours (p < 0.001), PRBC/FFP ratio at 4 hours decreased from 1.93 to 1.71 (p < 0.001), and 24-hour mortality decreased from 23.0% to 19.3% (p = 0.014). On multivariate analysis, decreased PRBC/FFP ratio was independently associated with decreased 24-hour mortality (odds ratio, 0.88; p < 0.001) and in-hospital mortality (odds ratio, 0.89; p < 0.001). CONCLUSION Resuscitation is becoming more balanced and time to emergency laparotomy shorter in blunt trauma patients, with a significant improvement in mortality. Future efforts should be directed toward incorporating transfusion practices and timely surgical interventions as markers of trauma center quality. LEVEL OF EVIDENCE Therapeutic/care management, level III.
• Hosseinpour, H., El-Qawaqzeh, K., Stewart, C., Akl, M., Anand, T., Culbert, M., Nelson, A., Bhogadi, S., & Joseph, B. (2022). Emergency readmissions following geriatric ground-level falls: How does frailty factor in? “Ground-Level Falls among Frail Patients”. Injury, 53(11). doi:10.1016/j.injury.2022.08.048
  More info

  Background: Ground-level falls (GLFs) in older adults are increasing as life expectancy increases, and more patients are being discharged to skilled nursing facilities (SNFs) for continuity of care. However, GLF patients are not a homogenous cohort, and the role of frailty remains to be assessed. Thus, the aim of this study is to examine the impact of frailty on the in-hospital and 30-day outcomes of GLF patients. Materials and Methods: This is a cohort analysis from the Nationwide Readmissions Database 2017. Geriatric (age ≥65 years) trauma patients presenting following GLFs were identified and grouped based on their frailty status. The associations between frailty and 30-day mortality and emergency readmission were examined by multivariate regression analyses adjusting for patient demographics and injury characteristics. Results: A total of 100,850 geriatric GLF patients were identified (frail: 41% vs. non-frail: 59%). Frail GLF patients were younger (81[74–87] vs. 83[76–89] years; p
• Kapadia, M., Obaid, O., Nelson, A., Hammad, A., Kitts, D., Anand, T., Ditillo, M., Douglas, M., & Joseph, B. (2022). Evaluation of Frailty Assessment Compliance in Acute Care Surgery: Changing Trends, Lessons Learned. Journal of Surgical Research, 270. doi:10.1016/j.jss.2021.09.019
  More info

  Background: Routine frailty assessment has emerged recently in the surgical literature and is an important prognostication and risk stratification tool. The aim of our study was to review our 7-y experience with two frailty assessment tools and changing trends in their use. Methods: We performed a 7-y (2011-2017) analysis of our prospectively maintained frailty database. Frail patients were identified using the emergency general surgery and trauma specific frailty indices. Outcome measures were rates of compliance with frailty assessment, overall complications, discharge to skilled nursing facility (SNF)/rehab, and mortality over the study period. Multivariate logistic regression and Cochran-Armitage trend analyses were performed. Results: We evaluated a total of 1045 geriatric patients (Trauma: 587, EGS: 458). Mean age was 74.5 ± 7.9 y, 74% were males, and 81% were white. Overall, 34% of the patients were frail. Compared to non-frail patients, frail patients had higher adjusted rates of complications (OR 2.4 [1.9-2.9]), mortality (OR 1.8 [1.4-2.3]), and rehab/SNF disposition (OR 3.7 [3.1-4.3]). The compliance rate of measuring frailty increased from 12% in 2011 to 78% in 2017, P < 0.001 (Figure). The complication rate decreased (33% versus 21%, P < 0.001), while the rate of discharge disposition to SNF/Rehab increased (41% versus 58%, P < 0.001). There was no difference in mortality (11% versus 9.8%, P = 0.48) over the study period. Conclusions: Adherence to frailty measurement increased over the study period. This was accompanied by a significant decline in overall in-hospital complications. Frailty indices can be utilized to identify high-risk patients and develop post-operative strategies to improve outcomes in acute care surgery.
• Nelson, A. (2022). Nelson A, Reina R, Northcutt A, Obaid O, Castanon L, Ditillo M, Gries L, Bible L, Anand T, Joseph B. (2022) Prospective Validation of The Rib Injury Guidelines (RIG) for Traumatic Rib Fractures. Journal of Trauma and Acute Care Surgery. DOI: 10.1097/TA.0000000000003535. Journal of Trauma and Acute Care Surgery.. doi:DOI: 10.1097/TA.0000000000003535
• Nelson, A. (2022). Akl M, Anand T, Reina R, El-Qawaqzeh K, Ditillo M, Hosseinpour H, Nelson A, Obaid O, Freise R, Joseph B. (2022) Balanced Hemostatic Resuscitation for Bleeding Pediatric Trauma Patients: A Nationwide Quantitative Analysis of Outcomes. Journal of Pediatric Surgery. DOI: 10.1016/j.jpedsurg.2022.07.005. Journal of Pediatric Surgery. doi:DOI: 10.1016/j.jpedsurg.2022.07.005
• Nelson, A. (2022). Anand T, Nelson A, Obaid O, Ditillo M, El-Qawaqzeh K, Stewart C, Reina R, Hosseinpour H, Nguyen L, Joseph B. (2022) Futility of Resuscitation among Geriatric Trauma Patients: Do We Need to Define When to Withdraw Care? Journal of American College of Surgeons. DOI: 10.1097/01.XCS.0000896516.60590.12. Journal American College of Surgeons. doi:DOI: 10.1097/01.XCS.0000896516.60590.12
• Nelson, A. (2022). Anand T, El-Qawaqzeh K, Nelson A, Hosseinpour H, Ditillo M, Gries L, Castanon L, Joseph B. (2022) Association Between Hemorrhage Control Interventions and Mortality in US Trauma Patients With Hemodynamically Unstable Pelvic Fractures. JAMA Surgery. DOI: 10.1001/jamasurg.2022.5772. JAMA Surgery. doi:DOI: 10.1001/jamasurg.2022.5772
• Nelson, A. (2022). Avila M, Bhoghadi S, Nelson A, Hosseinpour H, Ditillo M, Akl M, Anand T, Spencer A, Magnotti L, Joseph B. (2022) The Long-Term Risks of Venous Thromboembolism among Non-Operatively Managed Spinal Fracture Patients: A Nationwide Analysis. American Journal of Surgery. DOI: 10.1016/j.amjsurg.2022.11.031. American Journal of Surgery.. doi:DOI: 10.1016/j.amjsurg.2022.11.031
• Nelson, A. (2022). Collins WJ, El-Qawaqzeh K, Ditillo M, Hosseinpour H, Nelson A, Bhogadi SK, Castanon L, Anand T, Joseph B. (2023) Minimally Invasive Surgery For Genitourinary Trauma: A Nationwide Outcomes-Based Analysis. Journal of Surgical Research. DOI: 10.1016/j.jss.2022.09.015. Journal of Surgical Research. doi:DOI: 10.1016/j.jss.2022.09.015
• Nelson, A. (2022). Culbert M, Nelson A, Obaid O, Castanon L, Hosseinpour H, Anand T, El-Qawaqzeh K, Stewart C, Reina R, Joseph B. (2022) Failure-to-Rescue and Mortality After Emergent Pediatric Trauma Laparotomy: How are the Children Doing? Journal of Pediatric Surgery. DOI: 10.1016/j.jpedsurg.2022.08.017. Journal of Pediatric Surgery. doi:DOI: 10.1016/j.jpedsurg.2022.08.017
• Nelson, A. (2022). Douglas M, Obaid O, Castanon L, Reina R, Ditillo M, Nelson A, Bible L, Anand T, Gries L, Joseph B. (2022) After 9.000 Laparotomies for Blunt Trauma, Resuscitation is Becoming More Balanced and Time to Intervention Shorter: Evidence in Action. Journal of Trauma and Acute Care Surgery. doi: 10.1097/TA.0000000000003574. . Journal of Trauma and Acute Care Surgery. doi:doi: 10.1097/TA.0000000000003574.
• Nelson, A. (2022). El-Qawaqzeh K, Anand T, Richards J, Hosseinpour H, Nelson A, Akl MN, Obaid O, Ditillo M, Friese R, Joseph B. (2023) Predictors of Mortality in Blunt Cardiac Injury: A Nationwide Analysis. Journal of Surgical Research. DOI: 10.1016/j.jss.2022.07.047  . Journal of Surgical Research. doi:DOI: 10.1016/j.jss.2022.07.047
• Nelson, A. (2022). Hosseinpour H, El-Qawaqzeh K, Stewart C, Akl MN, Anand T, Culbert MH, Nelson A, Bhogadi SK, Joseph B. (2022) Emergency Readmissions Following Geriatric Ground-Level Falls: How Does Frailty Factor In? Injury. DOI: 10.1016/j.injury.2022.08.048. . Injury. doi:DOI: 10.1016/j.injury.2022.08.048.
• Nelson, A. (2022). Obaid O, Anand T, Nelson A, Reina R, Ditillo M, Stewart C, Douglas M, Freise R, Gries L, Joseph B. (2022) Fibrinogen Supplementation for the Trauma Patient: Should You Choose Fibrinogen Concentrate Over Cryoprecipitate? Journal of Trauma and Acute Care Surgery. DOI: 10.1097/TA.0000000000003728. Journal of Trauma and Acute Care Surgery. doi:DOI: 10.1097/TA.0000000000003728
• Nelson, A. (2022). Reina R, Anand T, Bhogadi S, Nelson A, Hosseinpour H, Ditillo M, El-Qawaqzeh K, Castanon L, Stewart C, Joseph B. (2022) Nonoperative management of blunt abdominal solid organ injury: are we paying close enough attention to patients on preinjury anticoagulation? American Journal of Surgery. DOI: 10.1016/j.amjsurg.2022.06.019. American Journal of Surgery.. doi:DOI: 10.1016/j.amjsurg.2022.06.019
• Nelson, A. C. (2022). Nationwide Analysis of Outcomes after Resuscitative Endovascular Balloon Occlusion of the Aorta: Is There a Need for Age-Specific Considerations?. Journal of the American College of Surgeons, 235(5), S288-S289. doi:10.1097/01.xcs.0000895276.04948.e7
• Reina, R., Anand, T., Bhogadi, S., Nelson, A., Hosseinpour, H., Ditillo, M., El-Qawaqzeh, K., Castanon, L., Stewart, C., & Joseph, B. (2022). Nonoperative management of blunt abdominal solid organ injury: Are we paying enough attention to patients on preinjury anticoagulation?. American Journal of Surgery, 224(5). doi:10.1016/j.amjsurg.2022.06.019
  More info

  Background: This study aims to assess the impact of pre-injury anticoagulant use on outcomes of isolated blunt abdominal SOI patients who underwent NOM. Methods: A 1-year(2017) analysis of the ACS-TQIP. We included all ≥18yrs trauma patients with isolated blunt abdominal-SOI who underwent NOM. Patients were stratified into two groups based on their history of pre-injury anticoagulant use. Propensity score matching was performed. Results: A matched cohort of 2709 patients (AC, 903; No-AC,1806) was analyzed. Compared to the No-AC group, the AC group had higher rates of failure of NOM(2.6% vs. 4.5%, p = 0.03), cardiac arrest (1.2%vs. 3.1%, p = 0.02), acute kidney injury (2.4% vs. 4.2%, p < 0.01), myocardial infarction (0.6% vs. 1.4%,p = 0.03), and mortality (5.1%vs. 7.6%,p = 0.01), and longer hospital LOS (17[10–24]vs.17[12–26]days,p = 0.04) and ICU LOS (11[6–17]vs.11[7–18]days,p = 0.01). Conclusion: Among nonoperatively managed blunt abdominal SOI patients, preinjury use of anticoagulants negatively impacts outcomes. Extra surveillance is required while managing patients with blunt abdominal SOI on pre-injury anticoagulants. Level of evidence: Level III. Study type: Therapeutic/care management.
• Anand, T., Obaid, O., Nelson, A., Chehab, M., Ditillo, M., Hammad, A., Douglas, M., Bible, L., & Joseph, B. (2021). Whole Blood Hemostatic Resuscitation in Pediatric Trauma: A Nationwide Propensity-Matched Analysis. The journal of trauma and acute care surgery.
  More info

  Whole blood (WB) has shown promise in pediatric trauma resuscitation following its prominent role in the resuscitation of adult trauma patients. Although WB in children has been shown to be feasible, its effectiveness has yet to be explored. The aim of this study is to examine the outcomes of WB transfusion as an adjunct to component therapy (CT) compared to CT only as early resuscitation for pediatric trauma patients.
• Asmar, S., Bible, L., Obaid, O., Anand, T., Chehab, M., Ditillo, M., Castanon, L., Nelson, A., & Joseph, B. (2021). Frail geriatric patients with acute calculous cholecystitis: Operative versus nonoperative management?. The journal of trauma and acute care surgery, 91(1), 219-225.
  More info

  Nonoperative management of acute calculous cholecystitis (ACC) in the frail geriatric population is underexplored. The aim of our study was to examine long-term outcomes of frail geriatric patients with ACC treated with cholecystectomy compared with initial nonoperative management.
• Butts, C. C., Miller, P., Nunn, A., Nelson, A., Rosenberg, M., Yanmis, O., & Avery, M. (2021). RIB fracture triage pathway decreases ICU utilization, pulmonary complications and hospital length of stay. Injury, 52(2), 231-234.
  More info

  Rib fractures are one of the most frequent causes of morbidity following blunt injury to the chest. Many of these patients require ICU care and often develop pulmonary complications. Prior studies have attempted to identify changes in predicted lung volumes or utilized the number of rib fractures to guide clinical decisions. A rib fracture triage pathway was developed to identify which patients will benefit from ICU level of care and shorten hospital length of stay for patients that do not require ICU care.
• Obaid, O., Hammad, A., Bible, L., Ditillo, M., Castanon, L., Douglas, M., Anand, T., Nelson, A., & Joseph, B. (2021). Open versus laparoscopic repair of traumatic diaphragmatic injury: A nationwide propensity-matched analysis. The Journal of surgical research, 268, 452-458.
  More info

  Minimally invasive surgical techniques have become routinely applied in the evaluation and treatment of patients with isolated traumatic diaphragmatic injuries (TDI). However, there remains a paucity of data that compares the laparoscopic repair to the open repair approach. The aim of our study is to examine patient outcomes between TDI patients managed laparoscopically versus those managed using open repair.
• Mowery, N. T., Terzian, W. T., & Nelson, A. C. (2020). Acute lung injury. Current problems in surgery, 57(5), 100777.

Proceedings Publications

• Nelson, A., Reina, R., Northcutt, A., Obaid, O., Castanon, L., Ditillo, M., Gries, L., Bible, L., Anand, T., & Joseph, B. (2022). Prospective validation of the Rib Injury Guidelines for traumatic rib fractures. In JACS.
  More info

  INTRODUCTION The Rib Injury Guidelines (RIG) were developed to guide triage of traumatic rib fracture patients to home, regular floor, or intensive care unit (ICU) and standardize care. The RIG score is based on patient history, physical examination, and imaging findings. The aim of this study was to evaluate triage effectiveness and health care resources utilization following RIG implementation. METHODS This is a prospective analysis at a level I trauma center from October 2017 to January 2020. Adult (18 years or older) blunt trauma patients with a diagnosis of at least one rib fracture on computed tomography imaging were included. Patients before (PRE) and after (POST) implementation of RIG were compared. In the POST group, patients were divided into RIG 1, RIG 2, and RIG 3 based on their RIG score. Outcomes were readmission for RIG 1 patients, unplanned ICU admission for RIG 2 patients, and overall ICU admission. Secondary outcomes were hospital length of stay (LOS) and mortality. RESULTS A total of 1,100 patients were identified (PRE, 754; POST, 346). Mean ± SD age was 56 ± 19 years, 788 (71.6%) were male, and median Injury Severity Score was 14 (range, 10-22). The most common mechanism of injury was motor vehicle collision (554 [50.3%]), 253 patients (22.9%) had ≥5 rib fractures, and 53 patients (4.8%) had a flail chest. In the POST group, 74 patients (21.1%) were RIG 1; 121 (35.2%), RIG 2; and 151 (43.7%), RIG 3. No patient in RIG 1 was readmitted following initial discharge, and two patients (1.6%) in RIG 2 had an unplanned ICU admission (both for alcohol withdrawal syndrome). Patients after implementation of RIG had shorter hospital LOS (3 [1-6] vs. 4 [1-7] days; p = 0.019) and no difference in mortality (5.8% vs. 7.7%; p = 0.252). On multivariate analysis, RIG implementation was associated with decreased ICU admission (adjusted odds ratio, 0.55 [0.36-0.82]; p = 0.004). CONCLUSION Rib Injury Guidelines are safe and effectively define triage of rib fracture patients with an overall reduction in ICU admissions, shorter hospital LOS, and no readmissions. LEVEL OF EVIDENCE Therapeutic/care management, level III.

Presentations

• Nelson, A. (2023).

  Nelson A, Worrell S, Ghaderi I, Boggs D, Magnotti L, Joseph B, Ditillo M. Work Based Assessments of Intraoperative Feedback Improve Satisfaction with Resident Feedback. ASE – Annual Meeting. 4/14/2023.

  . ASE.
• Nelson, A. (2023).

  Akl M, El-Qawaqzeh K, Magnotti L, Bhogadi S, Friese F, Hosseinpour H, Tang A, Nelson A, Anand T, Joseph B. Trauma Laparotomy for the Cirrhotic Patients: An Outcome-Based Analysis. ASC – Annual Meeting. 2/9/23.

  . ASC.
• Nelson, A. (2023).

  Astarabadi M, El-Qawaqzeh K, Nelson A, Hosseinpour H, Magnotti L, Bhogadi S, Anand T, Ditillo M, Castanon L, Joseph B. Surgical Stabilization for Flail Chest with Pulmonary Contusions: The Benefits May Outweigh the Risks. ASC – Annual Meeting. 2/9/23.

  . ASC.
• Nelson, A. (2023).

  Bhogadi S, Colosimo C, Alizai Q, Spencer A, Hosseinpour H, Nelson A, El-Qawaqzeh K, Castanon L, Magnotti L, Joseph B. Low-Volume Pediatric Trauma Centers Achieve Better Outcomes Than High-Volume Adult Trauma Centers in Treating Injured Children. AAST – Annual Meeting. 9/21/23.

  . AAST.
• Nelson, A. (2023).

  Bhogadi S, Nelson A, El-Qawaqzeh K, Stewart C, Hosseinpour H, Ditillo M, Magnotti L, Anand T, Tang A, Joseph B. Hold Your Horses: Non-Operative Management Versus Negative Laparotomy in Severe Abdominal Trauma. ASC – Annual Meeting. 2/9/23.

  . ASC.
• Nelson, A. (2023).

  Culbert M, Bhogadi S, Nelson A, El-Qawaqzeh K, Stewart C, Hosseinpour H, Gries L, Ditillo M, Magnotti L, Joseph B. Factors Affecting Rehabilitative Care in Trauma Patients with Positive Drug Screen. Quickshot. ASC – Annual Meeting. 2/8/23.

  . ASC.
• Nelson, A. (2023).

  El-Qawaqzeh K, Stewart C, Bhogadi S, Magnotti L, Hosseinpour H, Nelson A, Anand T, Friese R, Ditillo M, Joseph B. Trauma in the Geriatric and Super-Geriatric: Should They Be Treated the Same? ASC – Annual Meeting. 2/9/23.

  . ASC.
• Nelson, A. (2023).

  Hamidreza H, El-Qawaqzeh K, Magnotti L, Bhogadi S, Nelson A, Qaidar A, Anand T, Colosimo C, Ditillo M, Joseph B. The Silent Killer in Trauma: The Implications of Malnutrition on Outcomes of Older Adults. AAST – Annual Meeting. 9/20/2023.

  . AAST.
• Nelson, A. (2023).

  Hosseinpour H, Nelson A, El-Qawaqzeh K, Anand T, Bhogadi S, Ditillo M, Castanon L, Magnotti L, Stewart C, Joseph B. ED Shock Index (SI) Surpasses Prehospital and Delta SI in Predicting Outcomes of Trauma Patients. ASC – Annual Meeting. 2/8/23.

  . ASC.
• Nelson, A. (2023).

  Qaidar A, Spencer A, Hosseinpour H, Colosimo C, Bhogadi S, Nelson A, Stewart C, El-Qawaqzeh K, Magnotti L, Joseph B. The Frailty Spectrum: Changing the Binary Classification of Frailty. Quickshot. AAST – Annual Meeting. 9/23/23.

  . AAST.
• Nelson, A. (2023).

  Safdar H, Bhogadi S, Anand A, Hosseinpour H, Nelson A, El-Qawaqzeh K, Tang A, Magnotti L, Ditillo M, Joseph B. Injury Patterns, Interventions, and Outcomes of Traumatic Brain Injuries Across the United States. Quickshot. ASC – Annual Meeting. 2/9/23.

  . ASC.
• Nelson, A. (2023).

  Terrani KF, Bhogadi SK, Hosseinpour H, Spencer AL, Alizai Q, Colosimo C, Nelson A, Castanon L, Magnotti LJ, Joseph B. What Is Going on in Our Schools? Review of Injuries Among School Children Across the United States. J Surg Res. 2023 Dec 5;295:310-317. doi: 10.1016/j.jss.2023.11.019. Online ahead of print.

  . J Surg Res.
• Nelson, A. (2022). 03/21/22                       Resuscitative Thoracotomy: Who? When? Why? To What End? #155

  EAST Traumacast

  Podcast Only. EAST Traumacast.

• Nelson, A. (2022). 08/10/22                       Rib Injury Guidelines

                                      National Journal Club

                                      Chest Wall Injury Society. National Journal Club, Chest Wall Injury Society.

• Nelson, A. (2022). 09/14/22                       How to Transplant a Cactus

                                      Surgeons as Educators, Didactics Development

                                      American College of Surgeons. Surgeons as Educators, Didactics Development.

• Nelson, A. (2022). 10/14/22                       Pigtail Thoracostomy Tube Insertion Simulation

  Stormont Vail Trauma & Critical Care Symposium

  Topeka, KS. Stormont Vail Trauma & Critical Care Symposium.

• Nelson, A. (2022). 10/14/22                       Size Doesn’t Matter: Pigtails in Trauma

  Stormont Vail Trauma & Critical Care Symposium

  Topeka, KS. Stormont Vail Trauma & Critical Care Symposium.

• Nelson, A. (2022). 10/14/22                       Trauma in the Elderly: The Deception of Simplicity

  Stormont Vail Trauma & Critical Care Symposium

  Topeka, KS. Stormont Vail Trauma & Critical Care Symposium.

• Nelson, A. (2022). 11/17/22                       DVT Prophylaxis for Trauma: Current Guidelines and Future Directions

                                      Southwest Trauma and Acute Care Symposium

                                      Scottsdale, AZ. Southwest Trauma and Acute Care Symposium.

• Nelson, A. (2022). 6/15/22                         Overview of Geriatric Rib Fractures

  International Conference of Emergency Medicine

  Melbourne, Australia (Virtual). International Conference of Emergency Medicine Melbourne, Australia (Virtual).

• Nelson, A. (2022). 6/28/22                         Traumatic Brain Injury and Older Patients on Oral Blood Thinners

                                      AAST Geriatric Trauma Committee 
  Electronic presentation. AAST Geriatric Trauma Committee.

• Nelson, A. (2022, Febraury). Reina R, Castanon L, Obaid O, Anand A, Nelson A, Stewart C, Ditillo M, Douglas M, Bible L, Joseph B. “Current State of Hemorrhage Control and Hemostatic Resuscitation in Trauma Centers Across the United States.” . Western Trauma Association.
• Nelson, A. (2022, February). Anand T, Obaid O, Castanon L, Nelson A, Douglas M, Ditillo M, Bible L, Gries L, Stewart C, Jospeh B. The Needle That Just Doesn’t Move: Pelvic Fracture Mortality Remains High Despite Advancements in Hemorrhage Control. . Western Trauma Association.
• Nelson, A. (2022, January). Bible L, Obaid O, Nelson A, Reina R, Anand T, Ditillo M, Douglas M, Castanon L, Joseph B. “The Long-Term Risks of Venous Thromboembolism After Non-Operatively Managed Spinal Fracture.” EAST – Annual Meeting. 1/14/22.. Eastern Association for the Surgery of Trauma.
• Nelson, A. (2022, January). Obaid O, Ditillo M, Reina R, Castanon L, Douglas M, Bible L, Anand T, Nelson A, Joseph B. “Fibrinogen Supplementation for Trauma Patients: Should You Choose Fibrinogen Concentrate Over Cryoprecipitate?” EAST – Annual Meeting. 1/12/22.. EAST.
• Nelson, A. (2022, January). Obaid O, Douglas M, Reina R, Bible L, Castanon L, Ditillo M, Anand T, Nelson A, Joseph B. Nonoperative Management of Blunt Abdominal Solid Organ Injury: Are We Paying Enough Attention to Patients on Preinjury Anticoagulation?” EAST – Annual Meeting. Quickshot. 1/13/22.. EAST.
• Nelson, A. (2022, May). Fernandez V, Nguyen L, Dischner J, Omar O, Hosseinpour H, Bhogadi S, El-Qawaqzeh K, Joseph B, Nelson A. “Characterization of Serial Rib Injury Guidelines (RIG) Scoring for Patients with Traumatic Rib Fractures.” University of Arizona Department of Surgery Research Symposium. 5/18/22 . University of Arizona Dept of Surgery Research Symposium.
• Nelson, A. (2022, October). Nelson A, Obaid O, Hosseinpour H, Ditillo M, El-Qawaqzeh K, Stewart C, Reina R, Nguyen L, Joseph. “There’s No Such Thing as Too Soon: Long-Term Outcomes of Early Cholecystectomy for Frail Geriatric Patients with Acute Biliary Pancreatitis.” . American College of Surgeons.
• Nelson, A. (2022, October). Anand T, Nelson A, Obaid O, Ditillo M, El-Qawaqzeh K, Stewart C, Reina R, Hosseinpour H, Nguyen L, Joseph B. “Futility of Resuscitation among Geriatric Trauma Patients: Do We Need to Define When to Withdraw Care?” ACS – Annual Meeting. 10/19/22.. American College of Surgeons.
• Nelson, A. (2022, October). El-Qawaqzeh K, Anand T, Hosseinpour H, Ditillo M, Obaid O, Nelson A, Stewart C, Nguyen L, Reina R, Joseph B. “Nationwide Analysis of Outcomes Following REBOA: Is There a Need for Age-Specific Considerations?” ACS – Annual Meeting. 10/18/22.. American College of Surgeons.
• Nelson, A. (2022, October). El-Qawaqzeh K, Reina R, Hosseinpour H, Ditillo M, Obaid O, Anand T, Stewart C, Nelson A, Nguyen L, Joseph B. Geriatric Trauma, Frailty, and American College of Surgeons Trauma Center Verification Level: Are There Any Correlations with Outcomes?” ACS – Annual Meeting. 10/19/22.. American College of Surgeons.
• Nelson, A. (2022, October). Hosseinpour H, Stewart C, Obaid O, Ditillo M, El-Qawaqzeh K, Nelson A, Reina R, Anand T, Nguyen L, Joseph B. “Increased Mortality for Transferred Trauma Patients: Should Transfer Time Become the Next Quality Care Indicator?” . American College of Surgeons.
• Nelson, A. (2022, October). Nguyen L, Ditillo M, Reina R, Anand T, Hosseinpour H, Nelson A, El-Qawaqzeh K, Stewart C, Obaid O, Joseph B. “Operative Management of Penetrating Colon Injuries: Gone Are the Days of Diverting Colostomy.” ACS – Annual Meeting. 10/17/22.. American College of Surgeons.
• Nelson, A. (2022, September). El-Qawaqzeh, Castanon L, Reina R, Stewart C, Hosseinpour H, Anand T, Ditillo M, Obaid O, Nelson A, Joseph B. “Dealing with the Growing Epidemic of Elder Abuse: Nationwide Disparities in Interventions for Abuse Among the Vulnerable Elderly.” AAST – Annual Meeting. 9/23/22.. American Association for the Surgery of Trauma.
• Nelson, A. (2021). After 9,000 Laparotomies for Blunt Trauma, Resuscitation is Becoming More Balanced and Time to Intervention Shorter: How Low Can We Go?. AAST - Annual Meeting. 9/2021.
  More info

  Douglas M, Hammad A, Nelson A, Obaid O, Bible L, Castañón L, Ditillo M, Chehab M, Tang A, Joseph B. After 9,000 Laparotomies for Blunt Trauma, Resuscitation is Becoming More Balanced and Time to Intervention Shorter: How Low Can We Go?” AAST - Annual Meeting. 9/2021.
• Nelson, A. (2021). Prospective Validation of the Rib Injury Guidelines (RIG) for Traumatic Rib Fractures. AAST - Annual Meeting. Quickshot. 9/2021.
  More info

  Nelson A, Hammad A, Northcutt A, Obaid O, Castañón L, Ditillo M, Bible L, Douglas M, Tang A, Joseph B. “Prospective Validation of the Rib Injury Guidelines (RIG) for Traumatic Rib Fractures.” AAST - Annual Meeting. Quickshot. 9/2021
• Nelson, A. (2020). Ready for Prime Time? PGY-5 Resident Autonomy and Performance in Emergency General Surgery Using SIMPL Case Evaluation Data. AAST - Annual Meeting. QuickShot. 9/2020.
  More info

  Nelson A, Hildreth A. “Ready for Prime Time? PGY-5 Resident Autonomy and Performance in Emergency General Surgery Using SIMPL Case Evaluation Data.” AAST - Annual Meeting. QuickShot. 9/2020
• Nelson, A. (2020). Reliable Identification of Rib Fracture Patients at Risk of Pulmonary Complications for Only Ten Bucks. American College of Surgeons Region 4 Committee on Trauma Paper Competition. 11/2019.
  More info

  Nelson A, Miller P, Butts C, Hoth J, Nunn A, Rosenberg M, Yannis O, Ruffo J, Avery M. “Reliable Identification of Rib Fracture Patients at Risk of Pulmonary Complications for Only Ten Bucks.” American College of Surgeons Region 4 Committee on Trauma Paper Competition. 11/2019
• Nelson, A. (2019). Reliable Identification of Rib Fracture Patients at Risk of Pulmonary Complications for Only Ten Bucks. American College of Surgeons North and South Carolina Committee on Trauma Paper Competition. 7/2019. Second Place - Clinical Research.
  More info

  Nelson A, Miller P, Butts C, Hoth J, Nunn A, Rosenberg M, Yannis O, Ruffo J, Avery M. “Reliable Identification of Rib Fracture Patients at Risk of Pulmonary Complications for Only Ten Bucks.” American College of Surgeons North and South Carolina Committee on Trauma Paper Competition. 7/2019. Second Place - Clinical Research
• Nelson, A. (2019). Rib Fracture Triage Pathway Decreases ICU Utilization, Pulmonary Complications and Hospital Length of Stay. American Association for the Surgery of Trauma - Annual Meeting. 9/2019.
  More info

  Butts C, Nelson A, Miller P, Nunn A, Rosenberg M, Yanmis O, Avery M. “Rib Fracture Triage Pathway Decreases ICU Utilization, Pulmonary Complications and Hospital Length of Stay.” American Association for the Surgery of Trauma - Annual Meeting. 9/2019

Poster Presentations

• Nelson, A. (2022). Anand T, El-Qawaqzeh K, Ditillo M, Reina R, Nelson A, Hosseinpour H, Stewart C, Obaid O, Gries L, Joseph B. “Earlier Vasopressor Requirement Among Hypotensive Patients Independently Associated with Poor Outcomes.” AAST – Annual Meeting. 9/21/22. AAST.
• Nelson, A. (2022). Ditillo M, Hosseinpour H, Douglas M, Obaid O, Gries L, El-Qawaqzeh K, Friese R, Reina R, Nelson A, Joseph B. “Decisions, Decisions: Futility of Resuscitation measure Identifies Elderly Trauma Patients Who May Not Benefit from Heroic Measures.” AAST – Annual Meeting. 9/21/22 . AAST.
• Nelson, A. (2022). El-Qawaqzeh K, Nelson A, Reina R, Stewart C, Hosseinpour H, Ditillo M, Gries L, Obaid O, Anand T, Joseph B. “The Final Decision Among the Injured Elderly, To Stop or Continue? A Nationwide Study of Predictors for Withdrawl of Care.” AAST – Annual Meeting. 9/21/22. AAST.
• Nelson, A. (2022). El-Qawaqzeh K, Castanon L, Obaid O, Gries L, Hosseinpour H, Nelson A, Stewart C, Reina R, Anand T, Joseph B. “Answering the Age-Old Question: Should We Keep or Should We Transfer Our Severely Injured Geriatric Patients to Higher Levels of Care?” AAST – Annual Meeting. 9/21/22 . AAST.
• Nelson, A. (2022). LaGrone L, Nelson A, Anderson A, Kwak M, Reinhart L, Knight A, Bongiovanni T, Barsan I, Buck C, Bandera V, Adams S, Joseph V, Stein D. “Geriatric Trauma Education: A Novel Protcol for Assessment of Equity and Reach of Traditional Dissemination Channels” AAST – Annual Meeting. 9/21/22 . AAST.
• Nelson, A. (2021). Four-factor prothrombin complex concentrate in adjunct to whole blood in traumarelated hemorrhage: Does whole blood replace the need for factors?. EAST - Annual Meeting. 1/2021.
  More info

  Khurrum M, Ditillo M, Obaid O, Anand T, Nelson A, Chehab M, Kitts D, Douglas M, Bible L, Joseph B. “Four-factor prothrombin complex concentrate in adjunct to whole blood in traumarelated hemorrhage: Does whole blood replace the need for factors?” EAST - Annual Meeting. 1/2021
• Nelson, A. (2021). Ground-Level Falls in Geriatrics are Low-Impact Injuries with High-Imapct Consequences: How Does Frailty Factor In?. AAST - Annual Meeting. 9/2021.
  More info

  Chehab M, Bible L, Hammad A, Douglas M, Obaid O, Nelson A, Castañón L, Ditillo M, Tang A, Joseph B. “Ground-Level Falls in Geriatrics are Low-Impact Injuries with High-Imapct Consequences: How Does Frailty Factor In?” AAST - Annual Meeting. 9/2021.
• Nelson, A. (2021). Paravertebral Nerve Block vs. Epidural Analgesia in Geriatric Rib Fractures: Are We Too Invasive?. AAST - Annual Meeting. 9/2021.
  More info

  Anand T, Hammad A, Obaid O, Douglas M, Bible L, Nelson A, Tang A, Ditillo M, Castañón L, Joseph B. “Paravertebral Nerve Block vs. Epidural Analgesia in Geriatric Rib Fractures: Are We Too Invasive?”. AAST - Annual Meeting. 9/2021
• Nelson, A. (2019). ACGME Case Log Data Do Not Adequately Describe General Surgery Resident Experience with Emergency General Surgery Cases. AAST - Annual Meeting. 9/2019.
  More info

  Nelson A, Miller P, Hildreth A. “ACGME Case Log Data Do Not Adequately Describe General Surgery Resident Experience with Emergency General Surgery Cases.” AAST - Annual Meeting. 9/2019
• Nelson, A. (2019). ACGME Case Log Data Do Not Adequately Describe General Surgery Resident Experience with Emergency General Surgery Cases. Wake Forest School of Medicine 27th Annual Surgical Residents’ and Fellows’ Research Day.
  More info

  Nelson A, Miller P, Hildreth A. “ACGME Case Log Data Do Not Adequately Describe General Surgery Resident Experience with Emergency General Surgery Cases.” Wake Forest School of Medicine 27th Annual Surgical Residents’ and Fellows’ Research Day. 11/2019.
• Nelson, A. (2019). Reliable Identification of Rib Fracture Patients at Risk of Pulmonary Complications for Only Ten Bucks. American College of Surgeons - Annual Meeting. 10/2019.
  More info

  Nelson A, Miller P, Butts C, Hoth J, Nunn A, Rosenberg M, Yannis O, Ruffo J, Avery M. “Reliable Identification of Rib Fracture Patients at Risk of Pulmonary Complications for Only Ten Bucks.” American College of Surgeons - Annual Meeting. 10/2019
• Nelson, A. (2019). Reliable Identification of Rib Fracture Patients at Risk of Pulmonary Complications for Only Ten Bucks. Wake Forest School of Medicine 27th Annual Surgical Residents’ and Fellows’ Research Day.
  More info

  Nelson A, Miller P, Butts C, Hoth J, Nunn A, Rosenberg M, Yannis O, Ruffo J, Avery M. “Reliable Identification of Rib Fracture Patients at Risk of Pulmonary Complications for Only Ten Bucks.” Wake Forest School of Medicine 27th Annual Surgical Residents’ and Fellows’ Research Day. 11/2019. First Place - Fellow, Clinical Research
• Nelson, A. (2012). Bad PRES for Bortezomib – case presentation of posterior reversible leukoencephalopathy syndrome due to bortezomib therapy for multiple myeloma. Brainstorm Neurosciences Conference. 4/2012.
  More info

  Nelson A, Gibson S, Warner J. “Bad PRES for Bortezomib – case presentation of posterior reversible leukoencephalopathy syndrome due to bortezomib therapy for multiple myeloma.” Brainstorm Neurosciences Conference. 4/2012

Others

• Nelson, A. (2022, January). Bryant MK. “Outcomes after emergency general surgery and trauma care in incarcerated

  individuals: an EAST multi-center study.” EAST – Annual Meeting. 1/12/22. .

  More info

  Invited discussant at EAST Annual Meeting