Bellal A Joseph

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Courses

Scholarly Contributions

Chapters

• Stewart, C., Chehab, M., & Joseph, B. A. (2020). Tracheal and Pulmonary Injury. In Management of Chest Trauma: A Practical Guide. Springer. doi:https://doi.org/10.1007/978-3-031-06959-8_17
• Joseph, B. A., & Hamidi, M. (2019). Changing Epidemiology of the American Population. In Clinics in geriatric medicine(pp 1-2).
• Joseph, B. A., & Hamidi, M. (2019). Emergency General Surgery in the Elderly. In Emergency General Surgery 2019(pp 451-463). Springer, Cham.
• Joseph, B. A., & Zeeshan, M. (2019). Trauma Room: "A Minute Man" Operating Room - Managing the Chaos Using Technologies. In The Modern Hospital(pp 231-245). Spring, Cham.
• Joseph, B. A. (2018). Trauma Systems: Standardization and Regionalization of Care Improve Quality of Care. In Current Trauma Reports(pp 39-47).
• Joseph, B. A., & Azim, A. (2018). traumatic Brain Injury advancements. In Surgical Critical Care Therapy 2018(pp 1-10). Springer.
• Joseph, B. A., & Hassan, A. (2017). Rehabilitation Concerns in Geriatric Trauma. In Geriatric Trauma and Critical Care(pp 423-429). New York: Springer.
• Joseph, B. A., & Rhee, P. (2017). Postinjury management. In Greenfield's Surgery: Scientific Principles and Practice(p. 35). Philadelphia: Wolters Kulwer.
• Rhee, P., & Joseph, B. A. (2017). Shock, Electrolytes, and Fluids. In Sabiston Textbook of Surgery(p. 54). Philadephlia: Elsevier.
• Joseph, B. A., & Rhee, P. (2015). Coagulopathy in the trauma patient. In Surgery: Evidence-Based Practice 2nd edition. PMPH.
• Rhee, P., & Joseph, B. A. (2015). Critical Care and Post injury management. In Greenfield's Surgery: Scientific Principals. Lippincott Williams and Wilkins.
• Joseph, B. A. (2014). Geriatric Trauma Patients. In Geriatric Trauma and Critical Care. Springer.
• Goldstein, S., Joseph, B. A., & Chi, A. (2013). Fluid and Electrolyte Therapy. In Current Surgical Therapy. Mosby Elsevier.
• Tang, A., Tang, A., Joseph, B. A., Joseph, B. A., Cox, C., Cox, C., Rhee, P., & Rhee, P. (2013). Pregnancy in Trauma. In Maternal Critical Care: A mutlidisciplinary Approach(pp 356-366). Cambridge University Press.
• Joseph, B. A. (2012). Liver Failure. In Surgical Critical Care and Emergency Surgery. Wiley-Blackwell.
• Joseph, B. A., Ditillo, M., & Chi, A. (2012). Nutritional lmanagement of gastro-intestinal fistulae. In Surgery of complex abdominal wall defects. Springer.
• Khreiss, M., & Joseph, B. A. (2011). Packing of Liver injuriy with damage control laparotomy. In Operative dictations in general and vascular surgery. Springer.

Journals/Publications

• Akl, M. N., Akl, M. N., Akl, M. N., Akl, M. N., El-Qawaqzeh, K., El-Qawaqzeh, K., El-Qawaqzeh, K., El-Qawaqzeh, K., Anand, T., Anand, T., Anand, T., Anand, T., Hosseinpour, H., Hosseinpour, H., Hosseinpour, H., Hosseinpour, H., Colosimo, C., Colosimo, C., Colosimo, C., , Colosimo, C., et al. (2023). Trauma Laparotomy for the Cirrhotic Patient: An Outcome-Based Analysis. The Journal of surgical research, 294, 128-136.
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  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.
• Alizai, Q., Alizai, Q., Alizai, Q., Anand, T., Anand, T., Anand, T., Bhogadi, S. K., Bhogadi, S. K., Bhogadi, S. K., Nelson, A., Nelson, A., Nelson, A., Hosseinpour, H., Hosseinpour, H., Hosseinpour, H., Stewart, C., Stewart, C., Stewart, C., Spencer, A. L., , Spencer, A. L., et al. (2023). From surveillance to surgery: The delayed implications of non-operative and operative management of pancreatic injuries. American journal of surgery, 226(5), 682-687.
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  Our study compares the delayed outcomes of operative versus nonoperative management of pancreatic injuries.
• Alizai, Q., Arif, M. S., Colosimo, C., Hosseinpour, H., Spencer, A. L., Bhogadi, S. K., Nelson, A., Anand, T., Ditillo, M., Joseph, B., Alizai, Q., Arif, M. S., Colosimo, C., Hosseinpour, H., Spencer, A. L., Bhogadi, S. K., Nelson, A., Anand, T., Ditillo, M., , Joseph, B., et al. (2023). Beyond the short-term relief: Outcomes of geriatric rib fracture patients receiving paravertebral nerve blocks and epidural analgesia. Injury, 111184.
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  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.
• Alizai, Q., Colosimo, C., Hosseinpour, H., Stewart, C., Bhogadi, S. K., Nelson, A., Spencer, A. L., Ditillo, M., Magnotti, L. J., Joseph, B., , A. F., Alizai, Q., Colosimo, C., Hosseinpour, H., Stewart, C., Bhogadi, S. K., Nelson, A., Spencer, A. L., Ditillo, M., , Magnotti, L. J., et al. (2023). It's Not All Black and White: The Effect of Increasing Severity of Frailty on Outcomes of Geriatric Trauma Patients. The journal of trauma and acute care surgery.
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  Frailty is associated with poor outcomes in trauma patients. However, the spectrum of physiologic deficits, once a patient is identified as frail, is unknown. The aim of this study was to assess the dynamic association between increasing frailty and outcomes among frail geriatric trauma patients.
• Anand, T., Anand, T., Anand, T., Anand, T., Anand, T., Anand, T., Anand, T., Anand, T., Anand, T., Crawford, A. E., Crawford, A. E., Crawford, A. E., Crawford, A. E., Crawford, A. E., Crawford, A. E., Crawford, A. E., Crawford, A. E., Crawford, A. E., Sjoquist, M., , Sjoquist, M., et al. (2023). Decreased Glycocalyx Shedding on Presentation in Hemorrhaging Geriatric Trauma Patients. The Journal of surgical research, 293, 709-716.
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  Plasma levels of syndecan-1 (Sdc-1), a biomarker of endothelial glycocalyx (EG) damage, correlate with worse outcomes in trauma patients. However, EG injury is not well characterized in injured older adults (OA). The aims of this study were to characterize Sdc-1 shedding in OA trauma patients relative to younger adults (YA) and determine associations with putative regulators of EG sheddases.
• Anand, T., Reyes, A. A., Sjoquist, M. C., Magnotti, L., Joseph, B., Anand, T., Reyes, A. A., Sjoquist, M. C., Magnotti, L., Joseph, B., Anand, T., Reyes, A. A., Sjoquist, M. C., Magnotti, L., Joseph, B., Anand, T., Reyes, A. A., Sjoquist, M. C., Magnotti, L., , Joseph, B., et al. (2023). Resuscitating the Endothelial Glycocalyx in Trauma and Hemorrhagic Shock. Annals of surgery open : perspectives of surgical history, education, and clinical approaches, 4(3), e298.
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  The endothelium is lined by a protective mesh of proteins and carbohydrates called the endothelial glycocalyx (EG). This layer creates a negatively charged gel-like barrier between the vascular environment and the surface of the endothelial cell. When intact the EG serves multiple functions, including mechanotransduction, cell signaling, regulation of permeability and fluid exchange across the microvasculature, and management of cell-cell interactions. In trauma and/or hemorrhagic shock, the glycocalyx is broken down, resulting in the shedding of its individual components. The shedding of the EG is associated with increased systemic inflammation, microvascular permeability, and flow-induced vasodilation, leading to further physiologic derangements. Animal and human studies have shown that the greater the severity of the injury, the greater the degree of shedding, which is associated with poor patient outcomes. Additional studies have shown that prioritizing certain resuscitation fluids, such as plasma, cryoprecipitate, and whole blood over crystalloid shows improved outcomes in hemorrhaging patients, potentially through a decrease in EG shedding impacting downstream signaling. The purpose of the following paragraphs is to briefly describe the EG, review the impact of EG shedding and hemorrhagic shock, and begin entertaining the notion of directed resuscitation. Directed resuscitation emphasizes transitioning from macroscopic 1:1 resuscitation to efforts that focus on minimizing EG shedding and maximizing its reconstitution.
• Barach, P., Barach, P., Ahmed, R., Ahmed, R., Agarwal, G., Agarwal, G., Olson, K., Olson, K., Welch, J., Welch, J., Chernoby, K., Chernoby, K., Hein, C. L., Hein, C. L., Anand, T., Anand, T., Joseph, B., Joseph, B., Rosenstein, D. L., , Rosenstein, D. L., et al. (2023). Navigating Personal Health Crises, Imposter Syndrome, Sexual Harassment, Clinical Mistakes, and Leadership Challenges: Lessons for Work-Life Wellness in Academic Medicine: Part 3 of 3. Kansas journal of medicine, 16, 165-171.
• Beiriger, J., Beiriger, J., Beiriger, J., Beiriger, J., Beiriger, J., Beiriger, J., Silver, D., Silver, D., Silver, D., Silver, D., Silver, D., Silver, D., Lu, L., Lu, L., Lu, L., Lu, L., Lu, L., Lu, L., Guyette, F. X., , Guyette, F. X., et al. (2023). The Geography of Injuries in Trauma Systems: Using Home as a Proxy for Incident Location. The Journal of surgical research, 290, 36-44.
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  Effective trauma system organization is crucial to timely access to care and requires accurate understanding of injury and resource locations. Many systems rely on home zip codes to evaluate geographic distribution of injury; however, few studies have evaluated the reliability of home as a proxy for incident location after injury.
• Bhogadi, S. K., Bhogadi, S. K., Bhogadi, S. K., Bhogadi, S. K., Bhogadi, S. K., Alizai, Q., Alizai, Q., Alizai, Q., Alizai, Q., Alizai, Q., Colosimo, C., Colosimo, C., Colosimo, C., Colosimo, C., Colosimo, C., Spencer, A. L., Spencer, A. L., Spencer, A. L., Spencer, A. L., , Spencer, A. L., et al. (2023). Not all traumatic brain injury patients on preinjury anticoagulation are the same. American journal of surgery.
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  Prognostic significance of different anticoagulants in TBI patients remains unanswered. We aimed to compare effects of different anticoagulants on outcomes of TBI patients.
• Bhogadi, S. K., Bhogadi, S. K., Bhogadi, S. K., Bhogadi, S. K., Bhogadi, S. K., Bhogadi, S. K., Bhogadi, S. K., Bhogadi, S. K., Bhogadi, S. K., Bhogadi, S. K., Stewart, C., Stewart, C., Stewart, C., Stewart, C., Stewart, C., Stewart, C., Stewart, C., Stewart, C., Stewart, C., , Stewart, C., et al. (2023). Local Antibiotic Therapy for Open Long Bone Fractures: Appropriate Prophylaxis or Unnecessary Exposure for the Orthopedic Trauma Patient?. Military medicine, 188(Supplement_6), 407-411.
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  Prophylactic local antibiotic therapy (LAbT) to prevent infection in open long bone fracture (OLBF) patients has been in use for many decades despite lack of definitive evidence confirming a beneficial effect. We aimed to evaluate the effect of LAbT on outcomes of OLBF patients on a nationwide scale.
• Bhogadi, S. K., Nelson, A., El-Qawaqzeh, K., Spencer, A. L., Hosseinpour, H., Castanon, L., Anand, T., Ditillo, M., Magnotti, L. J., Joseph, B., Bhogadi, S. K., Nelson, A., El-Qawaqzeh, K., Spencer, A. L., Hosseinpour, H., Castanon, L., Anand, T., Ditillo, M., Magnotti, L. J., , Joseph, B., et al. (2023). Does preinjury anticoagulation worsen outcomes among traumatic hemothorax patients? A nationwide retrospective analysis. Injury, 54(9), 110850.
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  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.
• Butts, C. A., Butts, C. A., Byerly, S., Byerly, S., Nahmias, J., Nahmias, J., Gelbard, R., Gelbard, R., Ziesmann, M., Ziesmann, M., Bruns, B., Bruns, B., Davidson, G. H., Davidson, G. H., Di Saverio, S., Di Saverio, S., Esposito, T. J., Esposito, T. J., Fischkoff, K., , Fischkoff, K., et al. (2023). A core outcome set for appendicitis: A consensus approach utilizing modified Delphi methodology. The journal of trauma and acute care surgery.
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  Appendicitis is one of the most common pathologies encountered by general and acute care surgeons. The current literature is inconsistent, as it is fraught with outcome heterogeneity, especially in the area of nonoperative management. We sought to develop a core outcome set (COS) for future appendicitis studies to facilitate outcome standardization and future data pooling.
• Cardenas, T. C., Cardenas, T. C., Cardenas, T. C., Cardenas, T. C., Trust, M. D., Trust, M. D., Trust, M. D., Trust, M. D., Davis, K. A., Davis, K. A., Davis, K. A., Davis, K. A., Joseph, B. A., Joseph, B. A., Joseph, B. A., Joseph, B. A., Jurkovich, G. J., Jurkovich, G. J., Jurkovich, G. J., , Jurkovich, G. J., et al. (2023). Effects of gender on work-life balance satisfaction among trauma surgeons: A survey study. American journal of surgery.
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  Physician burnout rates are rising. Because dissatisfaction with work-life balance (WLB) is associated with burnout, improving this balance is a key solution. This cross-sectional survey study aims to evaluate factors associated with WLB in trauma surgeons, stratified by gender.
• Castanon, L., Castanon, L., Bhogadi, S. K., Bhogadi, S. K., Anand, T., Anand, T., Hosseinpour, H., Hosseinpour, H., Nelson, A., Nelson, A., Colosimo, C., Colosimo, C., Spencer, A. L., Spencer, A. L., Gries, L., Gries, L., Ditillo, M., Ditillo, M., Joseph, B., , Joseph, B., et al. (2023). The Association Between the Timing of Initiation of Pharmacologic Venous Thromboembolism Prophylaxis with Outcomes in Burns Patients. Journal of burn care & research : official publication of the American Burn Association, 44(6), 1311-1315.
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  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 
• Cournoyer, E., Ferrell, J., Sharp, S., Ray, A., Jordan, M., Dandoy, C., Grimley, M., Roy, S., Lorsbach, R., Merrow, A. C., Nelson, A., Bartlett, A., Picarsic, J., Kumar, A., Cournoyer, E., Ferrell, J., Sharp, S., Ray, A., Jordan, M., , Dandoy, C., et al. (2023). Dabrafenib and trametinib in Langerhans cell histiocytosis and other histiocytic disorders. Haematologica.
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  Standard treatment for Langerhans Cell Histiocytosis (LCH) is chemotherapy, with high failure rates. Since MAP-kinase activating mutations are found in most cases, BRAF- and MEKinhibitors have been used successfully to treat patients with refractory or relapsed disease. However, data on long-term responses in children are limited and no data exist on their use as first-line therapy. We treated thirty-four patients (26 LCH, 2 Juvenile Xanthogranuloma, 2 Rosai-Dorfman Disease, 4 presumed single site-CNS histiocytosis) with either dabrafenib and/or trametinib, either as first line or after relapse or failure of chemotherapy. Sixteen patients aged 1.3-21 years, had disease that was recurrent or refractory to chemotherapy, 9 of whom had multisystem LCH with risk-organ involvement. With a median treatment duration of 4.3 years, 15 (94%) patients have sustained favorable responses. Eighteen patients aged 0.2-45 years received the inhibitor as first-line treatment. All of these have had sustained favorable responses, with a median treatment duration of 2.5 years. Three patients with presumed isolated CNS/pituitary-stalk histiocytosis demonstrated stabilization or improvement of disease. Overall, inhibitors were well tolerated. Five patients with single system LCH discontinued therapy and remain off therapy without recurrence. In contrast, all 4 patients with multisystem disease that discontinued therapy were restarted. Our data suggest that children suffering from histiocytoses can be treated safely, and effectively with dabrafenib or trametinib. Additional studies are needed however to determine the long term safety and optimal duration of therapy.
• El-Qawaqzeh, K., El-Qawaqzeh, K., El-Qawaqzeh, K., Anand, T., Anand, T., Anand, T., Alizai, Q., Alizai, Q., Alizai, Q., Colosimo, C., Colosimo, C., Colosimo, C., Hosseinpour, H., Hosseinpour, H., Hosseinpour, H., Spencer, A., Spencer, A., Spencer, A., Ditillo, M., , Ditillo, M., et al. (2023). Trauma in the Geriatric and the Super-Geriatric: Should They Be Treated the Same?. The Journal of surgical research, 293, 316-326.
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  There is paucity of studies comparing the characteristics of trauma in geriatrics and super-geriatrics. We aimed to explore the injury characteristics and outcomes of older adult trauma patients on a nationwide scale.
• El-Qawaqzeh, K., El-Qawaqzeh, K., El-Qawaqzeh, K., El-Qawaqzeh, K., El-Qawaqzeh, K., El-Qawaqzeh, K., Magnotti, L. J., Magnotti, L. J., Magnotti, L. J., Magnotti, L. J., Magnotti, L. J., Magnotti, L. J., Hosseinpour, H., Hosseinpour, H., Hosseinpour, H., Hosseinpour, H., Hosseinpour, H., Hosseinpour, H., Nelson, A., , Nelson, A., et al. (2023). Geriatric trauma, frailty, and ACS trauma center verification level: Are there any correlations with outcomes?. Injury, 110972.
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  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.
• Ferrada, P., Ferrada, R., Jacobs, L., Duchesne, J., Ghio, M., Joseph, B., Taghavi, S., Qasim, Z. A., Zakrison, T., Brenner, M., Dissanaike, S., Feliciano, D., Ferrada, P., Ferrada, R., Jacobs, L., Duchesne, J., Ghio, M., Joseph, B., Taghavi, S., , Qasim, Z. A., et al. (2023). Prioritizing Circulation to Improve Outcomes for Patients with Exsanguinating Injury: A Literature Review and Techniques to Help Clinicians Achieve Bleeding Control. Journal of the American College of Surgeons.
• Haggstrom, L. R., Haggstrom, L. R., Tucker, K., Tucker, K., Williams, R., Williams, R., Nelson, A., Nelson, A., Walsh, R., Walsh, R., Brungs, D., Brungs, D., Aghmesheh, M., Aghmesheh, M., Haggstrom, L. R., Tucker, K., Williams, R., Nelson, A., Walsh, R., , Brungs, D., et al. (2023). Exceptional Response to Olaparib: A Case Report of Metastatic Esophageal Squamous Cell Carcinoma in a Patient With Fanconi Anemia, Germline Mutation, and Somatic Mutations. JCO precision oncology, 7, e2300221.
• Hornor, M., Hornor, M., Khan, U., Khan, U., Cripps, M. W., Cripps, M. W., Cook Chapman, A., Cook Chapman, A., Knight-Davis, J., Knight-Davis, J., Puzio, T. J., Puzio, T. J., Joseph, B., Joseph, B., , A. G., , A. G., Hornor, M., Hornor, M., Khan, U., , Khan, U., et al. (2023). Futility in acute care surgery: first do no harm. Trauma surgery & acute care open, 8(1), e001167.
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  The consequences of the delivery of futile or potentially ineffective medical care and interventions are devastating on the healthcare system, our patients and their families, and healthcare providers. In emergency situations in particular, determining if escalating invasive interventions will benefit a frail and/or severely critically ill patient can be exceedingly difficult. In this review, our objective is to define the problem of potentially ineffective care within the specialty of acute care surgery and describe strategies for improving the care of our patients in these difficult situations.
• Hosseinpour, H., Hosseinpour, H., Hosseinpour, H., Hosseinpour, H., Hosseinpour, H., El-Qawaqzeh, K., El-Qawaqzeh, K., El-Qawaqzeh, K., El-Qawaqzeh, K., El-Qawaqzeh, K., Magnotti, L. J., Magnotti, L. J., Magnotti, L. J., Magnotti, L. J., Magnotti, L. J., Bhogadi, S. K., Bhogadi, S. K., Bhogadi, S. K., Bhogadi, S. K., , Bhogadi, S. K., et al. (2023). The unexpected paradox of geriatric traumatic brain injury outcomes: Uncovering racial and ethnic disparities. American journal of surgery, 226(2), 271-277.
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  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.
• Hosseinpour, H., Hosseinpour, H., Hosseinpour, H., Hosseinpour, H., Hosseinpour, H., Hosseinpour, H., Hosseinpour, H., Hosseinpour, H., Hosseinpour, H., Hosseinpour, H., Hosseinpour, H., Anand, T., Anand, T., Anand, T., Anand, T., Anand, T., Anand, T., Anand, T., Anand, T., , Anand, T., et al. (2023). Emergency Department Shock Index Outperforms Prehospital and Delta Shock Indices in Predicting Outcomes of Trauma Patients. The Journal of surgical research, 291, 204-212.
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  Multiple shock indices (SIs), including prehospital, emergency department (ED), and delta (ED SI - Prehospital SI) have been developed to predict outcomes among trauma patients. This study aims to compare the predictive abilities of these SIs for outcomes of polytrauma patients on a national level.
• Hosseinpour, H., Nelson, A., Bhogadi, S. K., Spencer, A. L., Alizai, Q., Colosimo, C., Anand, T., Ditillo, M., Magnotti, L. J., Joseph, B., Hosseinpour, H., Nelson, A., Bhogadi, S. K., Spencer, A. L., Alizai, Q., Colosimo, C., Anand, T., Ditillo, M., Magnotti, L. J., , Joseph, B., et al. (2023). Delayed versus early hepatic resection among patients with severe traumatic liver injuries undergoing damage control laparotomy. American journal of surgery.
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  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).
• Joseph, B., Tseng, E. S., Zielinski, M. D., Ramirez, C. L., Lynde, J., Galey, K. M., Bhogadi, S. K., El-Qawaqzeh, K., Hosseinpour, H., , E. E., Joseph, B., Tseng, E. S., Zielinski, M. D., Ramirez, C. L., Lynde, J., Galey, K. M., Bhogadi, S. K., El-Qawaqzeh, K., Hosseinpour, H., , , E. E., et al. (2023). Feeling like an imposter: are surgeons holding themselves back?. Trauma surgery & acute care open, 8(1), e001021.
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  Imposter syndrome is a psychological phenomenon where people doubt their achievements and have a persistent internalized fear of being exposed as a fraud, even when there is little evidence to support these thought processes. It typically occurs among high performers who are unable to internalize and accept their success. This phenomenon is not recognized as an official mental health diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; however, mental health professionals recognize it as a form of intellectual self-doubt. It has been reported that imposter syndrome is predominant in the high-stakes and evaluative culture of medicine, where healthcare workers are frequently agonized by feelings of worthlessness and incompetence. Imposter syndrome can lead to a variety of negative effects. These can include difficulty concentrating, decreased confidence, burnout, anxiety, stress, depression, and feelings of inadequacy. This article will discuss the prevalence of imposter syndrome among surgeons, its associated contributing factors, the effects it can have, and potential strategies for managing it. The recommended strategies to address imposter syndrome are based on the authors' opinions.
• Litmanovich, B., Alizai, Q., Stewart, C., Hosseinpour, H., Nelson, A., Bhogadi, S. K., Colosimo, C., Spencer, A. L., Ditillo, M., Joseph, B., Litmanovich, B., Alizai, Q., Stewart, C., Hosseinpour, H., Nelson, A., Bhogadi, S. K., Colosimo, C., Spencer, A. L., Ditillo, M., , Joseph, B., et al. (2023). Outcomes of Geriatric Burn Patients Presenting to the Trauma Service: How Does Frailty Factor in?. The Journal of surgical research, 293, 327-334.
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  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.
• Nelson, A. C., Bhogadi, S. K., Hosseinpour, H., Stewart, C., Anand, T., Spencer, A. L., Colosimo, C., Magnotti, L. J., Joseph, B., Nelson, A. C., Bhogadi, S. K., Hosseinpour, H., Stewart, C., Anand, T., Spencer, A. L., Colosimo, C., Magnotti, L. J., Joseph, B., Nelson, A. C., , Bhogadi, S. K., et al. (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), 712-718.
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  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).
• Nelson, A. G., Nelson, A. G., Nelson, A. G., Wang, H., Wang, H., Wang, H., Dewar, P. M., Dewar, P. M., Dewar, P. M., Eddy, E. M., Eddy, E. M., Eddy, E. M., Li, S., Li, S., Li, S., Lim, X. Y., Lim, X. Y., Lim, X. Y., Patton, T., , Patton, T., et al. (2023). Synthetic 5-amino-6-D-ribitylaminouracil paired with inflammatory stimuli facilitates MAIT cell expansion. Frontiers in immunology, 14, 1109759.
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  Mucosal-associated invariant T (MAIT) cells are a population of innate-like T cells, which mediate host immunity to microbial infection by recognizing metabolite antigens derived from microbial riboflavin synthesis presented by the MHC-I-related protein 1 (MR1). Namely, the potent MAIT cell antigens, 5-(2-oxopropylideneamino)-6-D-ribitylaminouracil (5-OP-RU) and 5-(2-oxoethylideneamino)-6-D-ribitylaminouracil (5-OE-RU), form via the condensation of the riboflavin precursor 5-amino-6-D-ribitylaminouracil (5-A-RU) with the reactive carbonyl species (RCS) methylglyoxal (MG) and glyoxal (G), respectively. Although MAIT cells are abundant in humans, they are rare in mice, and increasing their abundance using expansion protocols with antigen and adjuvant has been shown to facilitate their study in mouse models of infection and disease.
• Nelson, A. J., Nelson, A. J., Young, R., Young, R., Tarrar, I. H., Tarrar, I. H., Wojdyla, D., Wojdyla, D., Wang, T. Y., Wang, T. Y., Mehta, R. H., Mehta, R. H., Nelson, A. J., Nelson, A. J., Young, R., Young, R., Tarrar, I. H., Tarrar, I. H., Wojdyla, D., , Wojdyla, D., et al. (2023). Temporal Trends in Risk Factors of Periprocedural Stroke in Patients Undergoing Percutaneous Coronary Intervention: Insights from the ACC NCDR CathPCI Registry. The American journal of cardiology, 204, 284-286.
• Pagidipati, N. J., Granger, C. B., Nelson, A., Pagidipati, N. J., Granger, C. B., Nelson, A., Pagidipati, N. J., Granger, C. B., Nelson, A., Pagidipati, N. J., Granger, C. B., Nelson, A., Pagidipati, N. J., Granger, C. B., Nelson, A., Pagidipati, N. J., Granger, C. B., Nelson, A., Pagidipati, N. J., , Granger, C. B., et al. (2023). Coordinated Care for Optimization of Cardiovascular Preventive Therapies in Patients With Diabetes-Reply. JAMA, 330(8), 771-772.
• Raman, S. R., Raman, S. R., Qualls, L. G., Qualls, L. G., Hammill, B. G., Hammill, B. G., Nelson, A. J., Nelson, A. J., Nilles, E. K., Nilles, E. K., Marsolo, K., Marsolo, K., O'Brien, E. C., O'Brien, E. C., Raman, S. R., Raman, S. R., Qualls, L. G., Qualls, L. G., Hammill, B. G., , Hammill, B. G., et al. (2023). Optimizing data integration in trials that use EHR data: lessons learned from a multi-center randomized clinical trial. Trials, 24(1), 566.
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  Despite great promise, trials that ascertain patient clinical data from electronic health records (EHR), referred to here as "EHR-sourced" trials, are limited by uncertainty about how existing trial sites and infrastructure can be best used to operationalize study goals. Evidence is needed to support the practical use of EHRs in contemporary clinical trial settings.
• Silver, D. S., Silver, D. S., Sperry, J. L., Sperry, J. L., Beiriger, J., Beiriger, J., Lu, L., Lu, L., Guyette, F. X., Guyette, F. X., Wisniewski, S., Wisniewski, S., Moore, E. E., Moore, E. E., Schreiber, M., Schreiber, M., Joseph, B., Joseph, B., Wilson, C. T., , Wilson, C. T., et al. (2023). Association Between Emergency Medical Service Agency Volume and Mortality in Trauma Patients. Annals of surgery.
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  Evaluate the association of annual trauma patient volume on outcomes for emergency medical services (EMS) agencies.
• Stey, A. M., Ghneim, M., Gurney, O., Santos, A. P., Rattan, R., Abahuje, E., Baskaran, A., Nahmias, J., Richardson, J., Zakrison, T. L., Baily, Z. D., Haut, E. R., Chaudhary, M., Joseph, B., Zarzaur, B., Hendershot, K., Stey, A. M., Ghneim, M., Gurney, O., , Santos, A. P., et al. (2023). Creation of standardized tools to evaluate reporting in health research: Population Reporting Of Gender, Race, Ethnicity & Sex (PROGRES). PLOS global public health, 3(9), e0002227.
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  Despite increasing diversity in research recruitment, research finding reporting by gender, race, ethnicity, and sex has remained up to the discretion of authors. This study developped and piloted tools to standardize the inclusive reporting of gender, race, ethnicity, and sex in health research. A modified Delphi approach was used to develop standardized tools for the inclusive reporting of gender, race, ethnicity, and sex in health research. Health research, social epidemiology, sociology, and medical anthropology experts from 11 different universities participated in the Delphi process. The tools were pilot tested on 85 health research manuscripts in top health research journals to determine inter-rater reliability of the tools. The tools each spanned five dimensions for both sex and gender as well as race and ethnicity: Author inclusiveness, Participant inclusiveness, Nomenclature reporting, Descriptive reporting, and Outcomes reporting for each subpopulation. The sex and gender tool had a median score of 6 and a range of 1-15 out of 16 possible points. The percent agreement between reviewers piloting the sex and gender tool was 82%. The interrater reliability or average Cohen's Kappa was 0.54 with a standard deviation of 0.33 demonstrating moderate agreement. The race and ethnicity tool had a median score of 1 and a range of 0-15 out of 16 possible points. Race and ethnicity were both reported in only 25.8% of studies evaluated. Most studies that reported race reported only the largest subgroups; White, Black, and Latinx. The percent agreement between reviewers piloting the race and ethnicity tool was 84 and average Cohen's Kappa was 0.61 with a standard deviation of 0.38 demonstrating substantial agreement. While the overall dimension scores were low (indicating low inclusivity), the interrater reliability measures indicated moderate to substantial agreement for the respective tools. Efforts in recruitment alone will not provide more inclusive literature without improving reporting.
• Tabata-Kelly, M., Tabata-Kelly, M., Ruan, M., Ruan, M., Dey, T., Dey, T., Sheu, C., Sheu, C., Kerr, E., Kerr, E., Kaafarani, H., Kaafarani, H., Ornstein, K. A., Ornstein, K. A., Kelley, A., Kelley, A., Gray, T. F., Gray, T. F., Salim, A., , Salim, A., et al. (2023). Postdischarge Caregiver Burden Among Family Caregivers of Older Trauma Patients. JAMA surgery, 158(9), 945-952.
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  Caregiver burden, characterized by psychological distress and physical morbidity, affects more than 50 million family caregivers of older adults in the United States. Risk factors for caregiver burden among caregivers of older trauma patients have not been well characterized.
• 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.
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  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.
• Anand, T., & Joseph, B. (2022). Linguistic discordance: Factors go beyond language. American journal of surgery.
• 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.
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  Management of hemodynamically unstable pelvic fractures remains a challenge. Hemostatic interventions are used alone or in combination. There is a paucity of data on the association between the pattern of hemorrhage control interventions and outcomes after a severe pelvic fracture.
• Bruhns, R. P., Sulaiman, M. I., Gaub, M., Bae, E. H., Davidson Knapp, R. B., Larson, A. R., Smith, A., Coleman, D. L., Staatz, W. D., Sandweiss, A. J., Joseph, B., Hay, M., Largent-Milnes, T. M., & Vanderah, T. W. (2022). Angiotensin-(1-7) improves cognitive function and reduces inflammation in mice following mild traumatic brain injury. Frontiers in behavioral neuroscience, 16, 903980.
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  Traumatic brain injury (TBI) is a leading cause of disability in the US. Angiotensin 1-7 (Ang-1-7), an endogenous peptide, acts at the G protein coupled MAS1 receptors (MASR) to inhibit inflammatory mediators and decrease reactive oxygen species within the CNS. Few studies have identified whether Ang-(1-7) decreases cognitive impairment following closed TBI. This study examined the therapeutic effect of Ang-(1-7) on secondary injury observed in a murine model of mild TBI (mTBI) in a closed skull, single injury model.
• Chao, G. F., Zakrison, T. L., Oyetunji, S., Gaston-Hawkins, L., Sosa, J. A., Joseph, B., & Lindeman, B. (2022). Underrepresented in medicine: Making surgical training anti-racist. American journal of surgery, 224(1 Pt B), 302-306.
• Collins, W. J., El-Qawaqzeh, K., Ditillo, M., Hosseinpour, H., Nelson, A., Bhogadi, S. K., Castanon, L., Gries, L., Anand, T., & Joseph, B. (2022). Minimally Invasive Surgery for Genitourinary Trauma: A Nationwide Outcomes-Based Analysis. The Journal of surgical research, 282, 129-136.
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  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.
• Culbert, M. H., 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.
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  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).
• Deeb, A. P., Hoteit, L., Li, S., Guyette, F. X., Eastridge, B. J., Nirula, R., Vercruysse, G. A., O'Keeffe, T., Joseph, B., Neal, M. D., Sperry, J. L., & Brown, J. B. (2022). Prehospital synergy: Tranexamic acid and blood transfusion in patients at risk for hemorrhage. The journal of trauma and acute care surgery, 93(1), 52-58.
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  Growing evidence supports improved survival with prehospital blood products. Recent trials show a benefit of prehospital tranexamic acid (TXA) administration in select subgroups. Our objective was to determine if receiving prehospital packed red blood cells (pRBC) in addition to TXA improved survival in injured patients at risk of hemorrhage.
• 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. The journal of trauma and acute care surgery, 93(3), 307-315.
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  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.
• El-Qawaqzeh, K., Anand, T., Richards, J., Hosseinpour, H., Nelson, A., Akl, M. N., Obaid, O., Ditillo, M., Friese, R., & Joseph, B. (2022). Predictors of Mortality in Blunt Cardiac Injury: A Nationwide Analysis. The Journal of surgical research, 281, 22-32.
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  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.
• Florecki, K. L., Joseph, B. A., & Haut, E. R. (2022). A Comprehensive Multidisciplinary Approach-The Ideal Future State of Geriatric Trauma Care. JAMA surgery, 157(8), 683-684.
• Gebran, A., Bejjani, A., Badin, D., Sabbagh, H., Mahmoud, T., El Moheb, M., Nederpelt, C. J., Joseph, B., Nathens, A., & Kaafarani, H. M. (2022). Critically Appraising the Quality of Reporting of American College of Surgeons TQIP Studies in the Era of Large Data Research. Journal of the American College of Surgeons, 234(6), 989-998.
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  The American College of Surgeons-Trauma Quality Improvement Program (ACS-TQIP) database is one of the most widely used databases for trauma research. We aimed to critically appraise the quality of the methodological reporting of ACS-TQIP studies.
• Hockett, D., Rabinowitz, J. B., Kwon, Y. K., Joseph, B., Kaafarani, H., & Aziz, H. (2022). Critical Appraisal of the Quality of Publications in Hepatobiliary and Pancreatic Surgery Research Using the American College of Surgeons NSQIP Database. Journal of the American College of Surgeons.
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  The use of the American College of Surgeons (ACS) NSQIP has increased in hepatobiliary and pancreatic surgery (HPB) research as it provides access to high-quality surgical outcome data on a national scale. Using the ACS-NSQIP database, this study examined the methodological reporting of HPB publications.
• Hosseinpour, H., El-Qawaqzeh, K., Stewart, C., Akl, M. N., Anand, T., Culbert, M. H., Nelson, A., Bhogadi, S. K., & Joseph, B. (2022). Emergency readmissions following geriatric ground-level falls: How does frailty factor in?. Injury, 53(11), 3723-3728.
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  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.
• Jehan, F. S., Pandit, V., Khreiss, M., Joseph, B., & Aziz, H. (2022). Frailty Predicts Loss of Independence After Liver Surgery. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 26(12), 2496-2502.
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  Loss of independence (LOI) is a significant concern in patients undergoing liver surgery. Although the risks of morbidity and mortality have been well studied, there is a dearth of data regarding the risk of LOI. Therefore, this study aimed to assess predictors of LOI after liver surgery.
• Joseph, B., Hosseinpour, H., & Bhogadi, S. K. (2022). Letter to editor re: A multicenter validation of the modified brain injury guidelines: Are they safe and effective?. The journal of trauma and acute care surgery, 93(5), e174.
• Joseph, B., Hosseinpour, H., & El-Qawaqzeh, K. (2022). Letter to Editor concerning "The feasibility and reliability of frailty assessment tools applicable in acute in-hospital trauma patients: A systematic review". The journal of trauma and acute care surgery, 93(4), e150-e151.
• Joseph, B., Obaid, O., Dultz, L., Black, G., Campbell, M., Berndtson, A. E., Costantini, T., Kerwin, A., Skarupa, D., Burruss, S., Delgado, L., Gomez, M., Mederos, D. R., Winfield, R., Cullinane, D., & , A. B. (2022). Validating the Brain Injury Guidelines: Results of an American Association for the Surgery of Trauma prospective multi-institutional trial. The journal of trauma and acute care surgery, 93(2), 157-165.
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  Brain Injury Guidelines (BIG) was developed to effectively use health care resources including repeat head computed tomography (RHCT) scan and neurosurgical consultation in traumatic brain injury (TBI) patients. The aim of this study was to prospectively validate BIG at a multi-institutional level.
• Joseph, B., Sakran, J. V., Obaid, O., Hosseinpour, H., Ditillo, M., Anand, T., & Zakrison, T. L. (2022). Nationwide Management of Trauma in Child Abuse: Exploring the Racial, Ethnic, and Socioeconomic Disparities. Annals of surgery, 276(3), 500-510.
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  Child abuse is a major cause of childhood injury, morbidity, and death. There is a paucity of data on the practice of abuse interventions among this vulnerable population. The aim of our study was to identify the factors associated with interventions for child abuse on a national scale.
• Joseph, B., Saljuqi, A. T., Amos, J. D., Teichman, A., Whitmill, M. L., Anand, T., Hosseinpour, H., Burruss, S. K., Dunn, J. A., Najafi, K., Godat, L. N., Enniss, T. M., Shoultz, T. H., Egodage, T., Bongiovanni, T., Hazelton, J. P., Colling, K. P., Costantini, T. W., Stein, D. M., , Schroeppel, T. J., et al. (2022). Prospective Validation and Application of the Trauma Specific Frailty Index (TSFI): Results of an AAST Multi-Institutional Observational Trial. The journal of trauma and acute care surgery.
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  The Frailty Index is a known predictor of adverse outcomes in geriatric patients. Trauma Specific Frailty Index (TSFI) was created and validated at a single center to accurately identify frailty and reliably predict worse outcomes among geriatric trauma patients. This study aims to prospectively validate the TSFI in a multi-institutional cohort of geriatric trauma patients.
• Joseph, B., Saljuqi, A. T., Phuong, J., Shipper, E., Braverman, M. A., Bixby, P. J., Price, M. A., Barraco, R. D., Cooper, Z., Jarman, M., Lack, W., Lueckel, S., Pivalizza, E., Bulger, E., & , G. T. (2022). Developing a National Trauma Research Action Plan: Results from the geriatric research gap Delphi survey. The journal of trauma and acute care surgery, 93(2), 209-219.
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  Treating older trauma patients requires a focus on the confluence of age-related physiological changes and the impact of the injury itself. Therefore, the primary way to improve the care of geriatric trauma patients is through the development of universal, systematic multidisciplinary research. To achieve this, the Coalition for National Trauma Research has developed the National Trauma Research Action Plan that has generated a comprehensive research agenda spanning the continuum of geriatric trauma care from prehospital to rehabilitation.
• Kapadia, M., Obaid, O., Nelson, A., Hammad, A., Kitts, D. J., Anand, T., Ditillo, M., Douglas, M., & Joseph, B. (2022). Evaluation of Frailty Assessment Compliance in Acute Care Surgery: Changing Trends, Lessons Learned. The Journal of surgical research, 270, 236-244.
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  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.
• 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. The journal of trauma and acute care surgery, 92(6), 967-973.
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  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.
• Obaid, O., Anand, T., Nelson, A., Reina, R., Ditillo, M., Stewart, C., Douglas, M., Friese, R., Gries, L., & Joseph, B. (2022). Fibrinogen supplementation for the trauma patient: Should you choose fibrinogen concentrate over cryoprecipitate?. The journal of trauma and acute care surgery, 93(4), 453-460.
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  Trauma-induced coagulopathy is frequently associated with hypofibrinogenemia. Cryoprecipitate (Cryo), and fibrinogen concentrate (FC) are both potential means of fibrinogen supplementation. The aim of this study was to compare the outcomes of traumatic hemorrhagic patients who received fibrinogen supplementation using FC versus Cryo.
• Reina, R., Anand, T., Bhogadi, S. K., 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.
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  This study aims to assess the impact of pre-injury anticoagulant use on outcomes of isolated blunt abdominal SOI patients who underwent NOM.
• Sherman, N. C., Williams, K. N., Hennemeyer, C. T., Devis, P., Chehab, M., Joseph, B., & Tang, A. L. (2022). Authors' response to "The diameter of the gelatin sponge affects the outcome of pelvic internal iliac artery embolization". The journal of trauma and acute care surgery, 92(5), e111.
• Sloane, P. D., Portelli Tremont, J. N., Brasel, K. J., Dhesi, J., Hewitt, J., Joseph, B. A., Ko, F. C., Kow, A. W., Lagoo-Deenadelayan, S. A., Levy, C. R., Louie, R. J., McConnell, E. S., Neuman, M. D., Partridge, J., & Rosenthal, R. A. (2022). Surgery and Geriatric Medicine: Toward Greater Integration and Collaboration. Journal of the American Medical Directors Association, 23(4), 525-527.
• Tseng, E. S., Williams, B. H., Santry, H. P., Martin, M. J., Bernard, A. C., & Joseph, B. A. (2022). History of Equity, Diversity, and Inclusion in Trauma Surgery: for Our Patients, for Our Profession, and for Ourselves. Current trauma reports, 1-13.
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  Disparities exist in outcome after injury, particularly related to race, ethnicity, socioeconomics, geography, and age. The mechanisms for this outcome disparity continue to be investigated. As trauma care providers, we are challenged to be mindful of and mitigate the impact of these disparities so that all patients realize the same opportunities for recovery. As surgeons, we also have varied professional experiences and opportunities for achievement and advancement depending upon our gender, ethnicity, race, religion, and sexual orientation. Even within a profession associated with relative affluence, socioeconomic status conveys different professional opportunities for surgeons.
• Zakaria, E. R., Yousufzai, W., Obaid, O., Asmar, S., Hsu, C. H., & Joseph, B. (2022). Cellular Cytosolic Energy Replenishment Increases Vascularized Composite Tissue Tolerance to Extended Cold Ischemia Time. Military medicine.
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  Vascularized composite allotransplantation (VCA) is a restorative surgical procedure to treat whole or partially disfiguring craniofacial or limb injuries. The routine clinical use of this VCA surgery is limited using compromised allografts from deceased donors and by the failure of the current hypothermic preservation protocols to extend the allograft's cold ischemia time beyond 4 h. We hypothesized that the active replenishment of the cellular cytosolic adenosine-5`-triphosphate (ATP) stores by means of energy delivery vehicles (ATPv) encapsulating high-energy ATP is a better strategy to improve allograft's tolerance to extended cold ischemia times.
• Anand, T., Khurrum, M., Chehab, M., Bible, L., Asmar, S., Douglas, M., Ditillo, M., Gries, L., & Joseph, B. (2021). Racial and Ethnic Disparities in Frail Geriatric Trauma Patients. World journal of surgery, 45(5), 1330-1339.
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  Frailty in geriatric trauma patients is commonly associated with adverse outcomes. Racial disparities in geriatric trauma patients are previously described in the literature. We aimed to assess whether race and ethnicity influence outcomes in frail geriatric trauma patients.
• 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, 91(4), 573-578.
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  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 was to examine the outcomes of WB transfusion as an adjunct to component therapy (CT) compared with CT only as early resuscitation for pediatric trauma patients.
• Asmar, S., Bible, L., Chehab, M., Obaid, O., Castanon, L., Yaghi, M., Ditillo, M., & Joseph, B. (2021). Traumatic Femoral Artery Injuries and Predictors of Compartment Syndrome: A Nationwide Analysis. The Journal of surgical research, 265, 159-167.
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  The femoral artery is commonly injured following lower extremity trauma. If not identified early and addressed properly, it can lead to compartment syndrome (CS) and limb amputation. The aim of this study is to examine traumatic femoral artery injuries and identify risk factors for the development of lower extremity CS.
• 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.
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  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.
• Asmar, S., Bible, L., Obaid, O., Tang, A., Khurrum, M., Castanon, L., Ditillo, M., & Joseph, B. (2021). Open vs Endovascular Treatment of Traumatic Peripheral Arterial Injury: Propensity Matched Analysis. Journal of the American College of Surgeons, 233(1), 131-138.e4.
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  Arterial injuries occur in the setting of blunt and penetrating trauma. Despite increasing use, there remains a paucity of data comparing long-term outcomes of endovascular vs open repair management of these injuries. The aim of our study was to compare outcomes and readmission rates of open vs endovascular repair of traumatic arterial injuries.
• Asmar, S., Bible, L., Vartanyan, P., Castanon, L., Masjedi, A., Richards, J., Ditillo, M., Tang, A., & Joseph, B. (2021). Firearm-Related Injuries: A Single Center Experience. The Journal of surgical research, 265, 289-296.
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  Firearm-related injuries (FRI) are an important public health crisis in the US. There is relatively less city level data examining the injury-related trends in Tucson, Arizona. Our study aims to examine FRI, in Southern Arizona's only Level I trauma center.
• Asmar, S., Nelson, A., Anand, T., Hammad, A., Obaid, O., Ditillo, M., Saljuqi, T., Tang, A., & Joseph, B. (2021). Marijuana and thromboembolic events in geriatric trauma patients: The cannabinoids clots correlation!. American journal of surgery.
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  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).
• Bauman, Z. M., Kulvatunyou, N., Joseph, B., Gries, L., O'Keeffe, T., Tang, A. L., & Rhee, P. (2021). Randomized Clinical Trial of 14-French (14F) Pigtail Catheters versus 28-32F Chest Tubes in the Management of Patients with Traumatic Hemothorax and Hemopneumothorax. World journal of surgery, 45(3), 880-886.
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  Traditional management of traumatic hemothorax/hemopneumothorax (HTX/HPTX) has been insertion of large-bore 32-40 French (Fr) chest tubes (CTs). Retrospective studies have shown 14Fr percutaneous pigtail catheters (PCs) are equally effective as CTs. Our aim was to compare effectiveness between PCs and CTs by performing the first randomized controlled trial (RCT). We hypothesize PCs work equally as well as CTs in management of traumatic HTX/HPTX.
• Bible, L., Obaid, O., Khurrum, M., Goh, M., Hammad, A., Kitts, D. J., Anand, T., Kapadia, M., & Joseph, B. (2021). Pre-Hospital Administration of Opioids in Trauma Patients: Is Dose Associated With Outcomes?. The Journal of surgical research, 268, 634-642.
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  Opioids are commonly used as an analgesic agent in the prehospital setting. Current efforts to prevent and control prescription opioid overuse are focused on the in-hospital and post-discharge phases. The aim of our study was to assess the associations between pre-hospital opioids use and in-hospital outcomes among trauma patients.
• Boeck, M. A., Juillard, C. J., Dicker, R. A., Joseph, B. A., & Sakran, J. V. (2021). Turning value into action: Healthcare workers using digital media advocacy to drive change. PloS one, 16(4), e0250875.
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  The standard method of sharing information in academia is the scientific journal. Yet health advocacy requires alternative methods to reach key stakeholders to drive change. The purpose of this study was to analyze the impact of social media and public narrative for advocacy in matters of firearm-related injury and death.
• Calabrese, E. C., Asmar, S., Bible, L., Khurrum, M., Chehab, M., Tang, A., Castanon, L., Ditillo, M., & Joseph, B. (2021). Prospective Evaluation of Health Literacy and Its Impact on Outcomes in Emergency General Surgery. The Journal of surgical research, 261, 343-350.
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  Health literacy (HL) is an important component of national health policy. The aim of our study was to assess the prevalence of low HL (LHL) and determine its impact on outcomes after emergency general surgery (EGS).
• Chehab, M., Ditillo, M., Obaid, O., Nelson, A., Poppe, B., Douglas, M., Anand, T., Bible, L., & Joseph, B. (2021). Never-frozen liquid plasma transfusion in civilian trauma: a nationwide propensity-matched analysis. The journal of trauma and acute care surgery, 91(1), 200-205.
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  Never-frozen liquid plasma (LQP) was found to reduce component waste, decrease health care expenses, and have a superior hemostatic profile compared with fresh frozen plasma (FFP). Although transfusing LQP in hemorrhaging patients has become more common, its clinical effectiveness remains to be explored. This study aims to examine outcomes of trauma patients transfused with LQP compared with thawed FFP.
• Dauch, J., Hamidi, M., Arrington, A. K., O'Grady, C. L., Hsu, C. H., Joseph, B., Riall, T. S., & Khreiss, M. (2021). The Impact of Frailty on Patients Undergoing Liver Resection for Colorectal Liver Metastasis. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract.
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  The aim of this study is to assess the impact of frailty on short-term outcomes after hepatectomy for colorectal liver metastasis (CRLM).
• DuBose, J. J., Burlew, C. C., Joseph, B., Keville, M., Harfouche, M., Morrison, J., Fox, C. J., Mooney, J., O'Toole, R., Slobogean, G., Marchand, L. S., Demetriades, D., Werner, N. L., Benjamin, E., & Costantini, T. (2021). Pelvic fracture-related hypotension: A review of contemporary adjuncts for hemorrhage control. The journal of trauma and acute care surgery, 91(4), e93-e103.
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  Major pelvic hemorrhage remains a considerable challenge of modern trauma care associated with mortality in over a third of patients. Efforts to improve outcomes demand continued research into the optimal employment of both traditional and newer hemostatic adjuncts across the full spectrum of emergent care environments. The purpose of this review is to provide a concise description of the rationale for and effective use of currently available adjuncts for the control of pelvic hemorrhage. In addition, the challenges of defining the optimal order and algorithm for employment of these adjuncts will be outlined.
• El Moheb, M., Han, K., Breen, K., El Hechi, M., Jia, Z., Mokhtari, A., Kongkaewpaisan, N., Kongwibulwut, M., Rodriguez, G., Ortega, C., Qin, H., Yang, J., Gao, R., Wang, Z., Gao, Z., Prichayudh, S., van der Wilden, G. M., Santin, S., Ribeiro, M. A., , Noppakunsomboom, N., et al. (2021). General Versus Neuraxial Anesthesia for Appendectomy: A Multicenter International Study. World journal of surgery, 45(11), 3295-3301.
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  In resource-limited countries, open appendectomy is still performed under general anesthesia (GA) or neuraxial anesthesia (NA). We sought to compare the postoperative outcomes of appendectomy under NA versus GA.
• Ghneim, M., Albrecht, J., Brasel, K., Knight, A., Liveris, A., Watras, J., Michetti, C. P., Haan, J., Lightwine, K., Winfield, R. D., Adams, S. D., Podbielski, J., Armen, S., Zacko, J. C., Nasrallah, F. S., Schaffer, K. B., Dunn, J. A., Smoot, B., Schroeppel, T. J., , Stillman, Z., et al. (2021). Factors associated with receipt of intracranial pressure monitoring in older adults with traumatic brain injury. Trauma surgery & acute care open, 6(1), e000733.
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  The Brain Trauma Foundation (BTF) Guidelines for the Management of Severe Traumatic Brain Injury (TBI) include intracranial pressure monitoring (ICPM), yet very little is known about ICPM in older adults. Our objectives were to characterize the utilization of ICPM in older adults and identify factors associated with ICPM in those who met the BTF guidelines.
• Hashmi, Z. G., Chehab, M., Nathens, A. B., Joseph, B., Bank, E. A., Jansen, J. O., & Holcomb, J. B. (2021). Whole truths but half the blood: Addressing the gap between the evidence and practice of pre-hospital and in-hospital blood product use for trauma resuscitation. Transfusion, 61 Suppl 1, S348-S353.
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  In recent years, several studies have demonstrated the efficacy of using pre-hospital blood product and in-hospital whole blood for trauma resuscitation. While some observations suggest an encouraging uptake of this evidence by emergency medical service (EMS) agencies and trauma centers, a nationwide characterization of blood product utilization for bleeding trauma patients remains unknown. The objective of this study is to determine nationwide estimates of pre-hospital blood product and in-hospital whole blood utilization for trauma resuscitation.
• Joseph, B., Chehab, M., & Asmar, S. (2021). Comment on Prospective Observational Evaluation of the ER-REBOA Catheter at 6 U.S. Trauma Centers. Annals of surgery.
• Kashkoush, A., Petitt, J. C., Ladhani, H., Ho, V. P., Kelly, M. L., & , A. A. (2021). Predictors of Mortality, Withdrawal of Life-Sustaining Measures, and Discharge Disposition in Octogenarians with Subdural Hematomas. World neurosurgery.
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  Risk factors for mortality in patients with subdural hematoma (SDH) include poor Glasgow Coma Scale (GCS) score, pupil nonreactivity, and hemodynamic instability on presentation. Little is published regarding prognosticators of SDH in the elderly. This study aims to examine risk factors for hospital mortality and withdrawal of life-sustaining measures in an octogenarian population presenting with SDH.
• Khurrum, M., Chehab, M., Ditillo, M., Richards, J., Douglas, M., Bible, L., Spece, L., & Joseph, B. (2021). Trends in Geriatric Ground-Level Falls: Report from the National Trauma Data Bank. The Journal of surgical research, 266, 261-268.
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  Ground-level falls (GLF) are typically reported as a minor mechanism of injury; however, they represent a significant portion of hospitalized geriatric trauma patients as they can result in multisystem injury in this subset of the population. Our study aimed to analyze trends in geriatric trauma falls on the national level.
• Khurrum, M., Ditillo, M., Obaid, O., Anand, T., Nelson, A., Chehab, M., Kitts, D. J., Douglas, M., Bible, L., & Joseph, B. (2021). Four-factor prothrombin complex concentrate in adjunct to whole blood in trauma-related hemorrhage: Does whole blood replace the need for factors?. The journal of trauma and acute care surgery, 91(1), 34-39.
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  The use of whole blood (WB) for the treatment of hemorrhagic shock and coagulopathy is increasing in civilian trauma patients. Four-factor prothrombin complex concentrate (4-PCC) in adjunct to component therapy showed improved outcomes in trauma patients. Our study aims to evaluate the outcomes of trauma patients who received 4-PCC and WB (4-PCC-WB) compared with WB alone.
• Kisat, M. T., Odenheimer-Bergman, A., Markus, H., Joseph, B., Srivatsan, S. N., Contente-Cuomo, T., Khalpey, Z., Keim, P., O'Keeffe, T., Askari, R., Salim, A., Rhee, P., & Murtaza, M. (2021). Plasma metagenomic sequencing to detect and quantify bacterial DNA in ICU patients suspected of sepsis: a proof-of-principle study. The journal of trauma and acute care surgery.
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  Timely recognition of sepsis and identification of pathogens can improve outcomes in critical care patients but microbial cultures have low accuracy and long turnaround times. In this proof-of-principle study, we describe metagenomic sequencing and analysis of non-human DNA in plasma. We hypothesized that quantitative analysis of bacterial DNA (bDNA) levels in plasma can enable detection and monitoring of pathogens.
• Kulvatunyou, N., Zimmerman, S. A., Adhikhari, S., Joseph, B., Gries, L., Tang, A. L., & Rhee, P. (2021). The Impact of FASTPASS: A Collaboration With Emergency Department to Improve Management of Patients With Gallbladder Disease and Acute Appendicitis. The Journal of surgical research, 260, 293-299.
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  Efficient Emergency Department (ED) throughput depends on several factors, including collaboration and consultation with surgical services. The acute care surgery service (ACS) collaborated with ED to implement a new process termed "FASTPASS" (FP), which might improve patient-care for those with acute appendicitis and gallbladder disease. The aim of this study was to evaluate the 1-year outcome of FP.
• Mohseni, S., Joseph, B., & Peden, C. J. (2021). Mitigating the stress response to improve outcomes for older patients undergoing emergency surgery with the addition of beta-adrenergic blockade. European journal of trauma and emergency surgery : official publication of the European Trauma Society.
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  As population age, healthcare systems and providers are likely to experience a substantial increase in the proportion of elderly patients requiring emergency surgery. Emergency surgery, compared with planned surgery, is strongly associated with increased risks of adverse postoperative outcomes due to the short time available for diagnosis, optimization, and intervention in patients presenting with physiological derangement. These patient populations, who are often frail and burdened with a variety of co-morbidities, have lower reserves to deal with the stress of the acute condition and the required emergency surgical intervention. In this review article, we discuss topical areas where mitigation of the physiological stress posed by the acute condition and asociated surgical intervention may be feasible. We consider the impact of the adrenergic response and use of beta blockers for these high-risk patients and discuss common risk factors such as frailty and delirium. A proactive multidisciplinary approach to peri-operative care aimed at mitigation of the stress response and proactive management of common conditions in the older emergency surgical patient could yield more favorable outcomes.
• Nahmias, J., Zakrison, T. L., Haut, E. R., Gurney, O., Joseph, B., Hendershot, K., Ghneim, M., Stey, A., Hoofnagle, M. H., Bailey, Z., Rattan, R., Richardson, J. B., Santos, A. P., & Zarzaur, B. (2021). Call to Action on the Categorization of Sex, Gender, Race, and Ethnicity in Surgical Research. Journal of the American College of Surgeons, 233(2), 316-319.
• O'Toole, R. V., Stein, D. M., Frey, K. P., O'Hara, N. N., Scharfstein, D. O., Slobogean, G. P., Taylor, T. J., Haac, B. E., Carlini, A. R., Manson, T. T., Sudini, K., Mullins, C. D., Wegener, S. T., Firoozabadi, R., Haut, E. R., Bosse, M. J., Seymour, R. B., Holden, M. B., Gitajn, I. L., , Goldhaber, S. Z., et al. (2021). PREVENTion of CLots in Orthopaedic Trauma (PREVENT CLOT): a randomised pragmatic trial protocol comparing aspirin versus low-molecular-weight heparin for blood clot prevention in orthopaedic trauma patients. BMJ open, 11(3), e041845.
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  Patients who sustain orthopaedic trauma are at an increased risk of venous thromboembolism (VTE), including fatal pulmonary embolism (PE). Current guidelines recommend low-molecular-weight heparin (LMWH) for VTE prophylaxis in orthopaedic trauma patients. However, emerging literature in total joint arthroplasty patients suggests the potential clinical benefits of VTE prophylaxis with aspirin. The primary aim of this trial is to compare aspirin with LMWH as a thromboprophylaxis in fracture patients.
• 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.
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  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.
• Qasim, Z., Butler, F. K., Holcomb, J. B., Kotora, J. G., Eastridge, B. J., Brohi, K., Scalea, T. M., Schwab, C. W., Drew, B., Gurney, J., Jansen, J. O., Kaplan, L. J., Martin, M. J., Rasmussen, T. E., Shackelford, S. A., Bank, E. A., Braude, D., Brenner, M., Guyette, F. X., , Joseph, B., et al. (2021). Complete Title: Selective Prehospital Advanced Resuscitative Care - Developing A Strategy to Prevent Prehospital Deaths From Noncompressible Torso Hemorrhage. Shock (Augusta, Ga.).
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  Hemorrhage, and particularly noncompressible torso hemorrhage (NCTH) remains a leading cause of potentially preventable prehospital death from trauma in the United States and globally. A subset of severely-injured patients either die in the field or develop irreversible hemorrhagic shock before they can receive hospital definitive care, resulting in poor outcomes. The focus of this opinion paper is to delineate (a) the need for existing trauma systems to adapt so that potentially life-saving advanced resuscitation and truncal hemorrhage control interventions can be delivered closer to the point-of-injury in select patients, and (b) a possible mechanism through which some trauma systems can train and incorporate select prehospital advanced resuscitative care teams to deliver those interventions.
• Qian, S., Vasileiou, G., Pust, G. D., Zakrison, T., Rattan, R., Zielinski, M., Ray-Zack, M., Zeeshan, M., Namias, N., Yeh, D. D., & , E. A. (2021). Prophylactic Drainage after Appendectomy for Perforated Appendicitis in Adults: A Post Hoc Analysis of an EAST Multi-Center Study. Surgical infections, 22(8), 780-786.
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  We sought to assess the efficacy of prophylactic abdominal drainage to prevent complications after appendectomy for perforated appendicitis. In this post hoc analysis of a prospective multi-center study of appendicitis in adults (≥ 18 years), we included patients with perforated appendicitis diagnosed intra-operatively. The 634 subjects were divided into groups on the basis of receipt of prophylactic drains. The demographics and outcomes analyzed were surgical site infection (SSI), intra-abdominal abscess (IAA), Clavien-Dindo complications, secondary interventions, and hospital length of stay (LOS). Multivariable logistic regression for the cumulative 30-day incidence of IAA was performed controlling for age, Charlson Comorbidity Index (CCI), antibiotic duration, presence of drains, and Operative American Association for the Surgery of Trauma (AAST) Grade. In comparing the Drain (n = 159) versus No-Drain (n = 475) groups, there was no difference in the frequency of male gender (61% versus 55%; p = 0.168), weight (87.9 ± 27.9 versus 83.8 ± 23.4 kg; p = 0.071), Alvarado score (7 [6-8] versus 7 [6-8]; p = 0.591), white blood cell (WBC) count (14.8 ± 4.8 versus 14.9 ± 4.5; p = 0.867), or CCI (1 [0-3] versus 1 [0-2]; p = 0.113). The Drain group was significantly older (51 ± 16 versus 48 ± 17 years; p = 0.017). Drain use increased as AAST EGS Appendicitis Operative Severity Grade increased: Grade 3 (62/311; 20%), Grade 4 (46/168; 27%), and Grade 5 (51/155; 33%); p = 0.007. For index hospitalization, the Drain group had a higher complication rate (43% versus 28%; p = 0.001) and longer LOS (4 [3-7] versus 3 [1-5] days; p 
• Ruiz, M., Peña, M., Cohen, A., Ehsani, H., Joseph, B., Fain, M., Mohler, J., & Toosizadeh, N. (2021). Physical and Cognitive Function Assessment to Predict Postoperative Outcomes of Abdominal Surgery. The Journal of surgical research, 267, 495-505.
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  Current evaluation methods to assess physical and cognitive function are limited and often not feasible in emergency settings. The upper-extremity function (UEF) test to assess physical and cognitive performance using wearable sensors. The purpose of this study was to examine the (1) relationship between preoperative UEF scores with in-hospital outcomes; and (2) association between postoperative UEF scores with 30-d adverse outcomes among adults undergoing emergent abdominal surgery.
• Sherman, N. C., Williams, K. N., Hennemeyer, C. T., Devis, P., Chehab, M., Joseph, B., & Tang, A. L. (2021). Effects of nonselective internal iliac artery angioembolization on pelvic venous flow in the swine model. The journal of trauma and acute care surgery, 91(2), 318-324.
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  Pelvic angioembolization (AE) is a mainstay in the treatment algorithm for pelvic hemorrhage from pelvic fractures. Nonselective AE refers to embolization of the bilateral internal iliac arteries (IIAs) proximally rather than embolization of their tributaries distally. The aim of this study was to quantify the effect of nonselective pelvic AE on pelvic venous flow in a swine model. We hypothesized that internal iliac vein (IIV) flow following IIA AE is reduced by half.
• Tseng, E. S., Weaver, J. L., Sangosanya, A. T., Gelbard, R. B., Martin, M. J., Tung, L., Santos, A. P., McCunn, M., Bonne, S., Joseph, B., Zakrison, T. L., & , E. A. (2021). And Miles to Go Before We Sleep: EAST Diversity and Inclusivity Progress and Remaining Challenges. Annals of surgery.
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  To examine the diversity, equity, and inclusion landscape in academic trauma surgery and the EAST organization.
• Abdul Jawad, K., Cioci, A., Urrechaga, E., Zhang, H., Byerly, S., Rattan, R., Pust, G. D., Namias, N., Yeh, D. D., & , E. A. (2020). Impact of Delay in Appendectomy on the Outcome of Appendicitis: A Post Hoc Analysis of an EAST Multicenter Study. Surgical infections.
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  Association between time-to-appendectomy and clinical outcomes is controversial with conflicting data regarding risk of perforation. The purpose of this study was to explore the associations between in-hospital delay in treatment of simple appendicitis with the incidence of complicated appendicitis discovered at appendectomy. The Eastern Association for the Surgery of Trauma (EAST) Multicenter Study of the Treatment of Appendicitis in America: Acute, Perforated, and Gangrenous (MUSTANG) database was queried and patients with acute appendicitis diagnosed on imaging were included. Upgrade was defined as gangrenous or perforated finding at appendectomy. Time intervals from emergency department (ED) triage to appendectomy were recorded in six-hour groups. Upgrade percentage for each group was presented and rates of a composite end point (30-day incidence of surgical site infection, abscess, wound complication, Clavien-Dindo complication, secondary intervention, ED visit, hospital re-admission, and mortality) were compared with Bonferroni correction to determine statistical significance (p = 0.05/9 = 0.005). Of 3,004 included subjects, 484 (16%) experienced upgrade at appendectomy. Upgrade rates (%, 95% confidence interval [CI]) were: group 0-6 hours, 17% (95% CI, 14-19); group 6-11 hours, 15% (95% CI, 13-17%); group 12-17 hours, 16% (95% CI, 13-19); group 18-23 hours, 17% (95% CI, 12-23); group 24-29 hours, 30% (95% CI, 20-43); and group 30+ hours, 24% (95% CI, 14-37) (p = 0.014, NS by Bonferroni). Of 484 subjects with upgrade, 200 (41%; 95% CI, 37-46) had a worse composite outcome compared with 518 (21%; CI, 19-22) of 2,520 subjects with no upgrade (p 
• Ahmed, F. S., Ali, L., Joseph, B. A., Ikram, A., Ul Mustafa, R., & Bukhari, S. A. (2020). A statistically rigorous deep neural network approach to predict mortality in trauma patients admitted to the intensive care unit. The journal of trauma and acute care surgery, 89(4), 736-742.
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  Trauma patients admitted to critical care are at high risk of mortality because of their injuries. Our aim was to develop a machine learning-based model to predict mortality using Fahad-Liaqat-Ahmad Intensive Machine (FLAIM) framework. We hypothesized machine learning could be applied to critically ill patients and would outperform currently used mortality scores.
• Alvikas, J., Myers, S. P., Wessel, C. B., Okonkwo, D. O., Joseph, B., Pelaez, C., Doberstein, C., Guillotte, A. R., Rosengart, M. R., & Neal, M. D. (2020). A systematic review and meta-analysis of traumatic intracranial hemorrhage in patients taking prehospital antiplatelet therapy: Is there a role for platelet transfusions?. The journal of trauma and acute care surgery, 88(6), 847-854.
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  Platelet transfusion has been utilized to reverse platelet dysfunction in patients on preinjury antiplatelets who have sustained a traumatic intracranial hemorrhage (tICH); however, there is little evidence to substantiate this practice. The objective of this study was to perform a systematic review on the impact of platelet transfusion on survival, hemorrhage progression and need for neurosurgical intervention in patients with tICH on prehospital antiplatelet medication.
• Anand, T., Hanna, K., Kulvatunyou, N., Zeeshan, M., Ditillo, M., Castanon, L., Tang, A., Gries, L., & Joseph, B. (2020). Time to tracheostomy impacts overall outcomes in patients with cervical spinal cord injury. The journal of trauma and acute care surgery, 89(2), 358-364.
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  The morbidity associated with cervical spine injury increases in the setting of concomitant cervical spinal cord injury (CSCI). A significant proportion of these patients require placement of a tracheostomy. However, it remains unclear if timing to tracheostomy following traumatic CSCI can impact outcomes. The aim of our study was to characterize outcomes associated with tracheostomy timing following traumatic CSCI.
• Asmar, S., Bible, L., Chehab, M., Tang, A., Khurrum, M., Douglas, M., Castanon, L., Kulvatunyou, N., & Joseph, B. (2020). Resuscitative Endovascular Balloon Occlusion of the Aorta vs Pre-Peritoneal Packing in Patients with Pelvic Fracture. Journal of the American College of Surgeons.
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  Pelvic hemorrhage is potentially lethal despite homeostatic interventions such as pre-peritoneal packing (PP), resuscitative endovascular balloon occlusion of the aorta (REBOA), surgery, and/or angioembolization. REBOA may be used as an alternative/adjunct to PP for temporizing bleeding in patients with pelvic fractures. Our study aimed to compare the outcomes of REBOA and/or PP, as temporizing measures, in blunt pelvic fracture patients. We hypothesized that REBOA is associated with worsened outcomes.
• Asmar, S., Chehab, M., Bible, L., Khurrum, M., Castanon, L., Ditillo, M., & Joseph, B. (2020). The ED Systolic Blood Pressure Relationship After Traumatic Brain Injury. The Journal of surgical research, 257, 493-500.
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  Blood pressure alterations in patients with traumatic brain injury (TBI) have been shown to be associated with increased mortality. However, there is paucity of data describing the optimal emergency department (ED) systolic blood pressure (SBP) target during the initial evaluation. The aim of our study was to assess the association between SBP on presentation and mortality in patients with TBI.
• Asmar, S., Kulvatunyou, N., Davis, K., & Joseph, B. (2020). Virtual interviews for surgical critical care fellowships and acute care fellowships amid the COVID-19 pandemic: The show must still go on. The journal of trauma and acute care surgery, 89(4), e92-e94.
• Asmar, S., Lokhandwala, A., & Joseph, B. (2020). Reply to: Response to: The neuroprotective effect of quetiapine in critically ill traumatic brain injury patients. The journal of trauma and acute care surgery, 89(6), e192-e193.
• Asmar, S., Lokhandwala, A., Richards, J., Bible, L., Avila, M., Castanon, L., Ditillo, M., Douglas, M., & Joseph, B. (2020). The neuroprotective effect of quetiapine in critically ill traumatic brain injury patients. The journal of trauma and acute care surgery, 89(4), 775-782.
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  Quetiapine is an atypical antipsychotic commonly used in critical care. Cellular and animal models demonstrated its novel anti-inflammatory properties in traumatic brain injury (TBI). Our study aimed to assess the effect of quetiapine on outcomes in critically ill TBI patients. We hypothesize that quetiapine improves neurological outcomes.
• Asmar, S., Zeeshan, M., Khurrum, M., Con, J., Chehab, M., Bible, L., Latifi, R., & Joseph, B. (2020). Delta Shock Index Predicts Outcomes in Pediatric Trauma Patients Regardless of Age. The Journal of surgical research, 259, 182-191.
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  Changes in the shock index (ΔSI) can be a predictive tool but is not established among pediatric trauma patients. The aim of our study was to assess the impact of ΔSI on mortality in pediatric trauma patients.
• Astarabadi, M., Khurrum, M., Asmar, S., Bible, L., Chehab, M., Castanon, L., Ditillo, M., Douglas, M., & Joseph, B. (2020). The impact of non-neurological organ dysfunction on outcomes in severe isolated traumatic brain injury. The journal of trauma and acute care surgery, 89(2), 405-410.
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  Organ dysfunction following traumatic brain injury (TBI) is common and has been associated with unpredictable outcomes. The aim of our study is to describe the incidence of non-neurological organ dysfunction (NNOD) and its impact on outcomes in patients with severe TBI admitted to our intensive care unit (ICU).
• Bernard, M., Martin, M. J., Corsa, J., Robinson, B., Zeeshan, M., Joseph, B., Morris, D., Shillinglaw, W., Schurr, M., Smith, T., Lara, S., Brown, C., Harrell, K., Maxwell, R., Berndtson, A. E., Curry, T., Kaups, K., Dirks, R., Rott, M., , Schroeppel, T., et al. (2020). Into the wild and on to the table: A Western Trauma Association multicenter analysis and comparison of wilderness falls in rock climbers and nonclimbers. The journal of trauma and acute care surgery, 89(3), 570-575.
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  Wilderness activities expose outdoor enthusiasts to austere environments with injury potential, including falls from height. The majority of published data on falls while climbing or hiking are from emergency departments. We sought to more accurately describe the injury pattern of wilderness falls that lead to serious injury requiring trauma center evaluation and to further distinguish climbing as a unique pattern of injury.
• Brown, C. V., Joseph, B. A., Davis, K., & Jurkovich, G. J. (2020). Modifiable Factors to Improve Work-Life Balance for Trauma Surgeons. The journal of trauma and acute care surgery.
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  A balance between work, and life outside of work, can be difficult for practicing physicians to achieve, especially for trauma surgeons. Work-life balance (WLB) has been associated with burnout as well as career changes. The specific aim of this study was to investigate factors associated with WLB for trauma surgeons. We hypothesized that trauma surgeons are dissatisfied with their WLB and there are modifiable factors that can be adjusted to improve and maintain WLB.
• Castanon, L., Asmar, S., Bible, L., Chehab, M., Ditillo, M., Khurrum, M., Hanna, K., Douglas, M., & Joseph, B. (2020). Early Enteral Nutrition in Geriatric Burn Patients: Is There a Benefit?. Journal of burn care & research : official publication of the American Burn Association, 41(5), 986-991.
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  Nutrition is a critical component of acute burn care and wound healing. There is no consensus over the appropriate timing of initiating enteral nutrition in geriatric burn patients. This study aimed to assess the impact of early enteral nutrition on outcomes in this patient population. We performed a 1-year (2017) analysis of the American College of Surgeons Trauma Quality Improvement Program and included all older adult (age ≥65 years) isolated thermal burn patients who were admitted for more than 24 hr and received enteral nutrition. Patients were stratified into two groups based on the timing of initiation of feeding: early (≤24 hr) vs late (>24 hr). Multivariate logistic regression was performed to control for potential confounding factors. Outcome measures were hospital and intensive care unit lengths of stay, in-hospital complications, and mortality. A total of 1,004,440 trauma patients were analyzed, of which 324 patients were included (early: 90 vs late: 234). The mean age was 73.9 years and mean TBSA burnt was 31%. Patients in the early enteral nutrition group had significantly lower rates of in-hospital complications and mortality (15.6% vs 26.1%; P = 0.044), and a shorter hospital length of stay (17 [11,23] days vs 20 [14,24] days; P = 0.042) and intensive care unit length of stay (13 [8,15] days vs 17 [9,21] days; P = 0.042). In our regression model of geriatric burn patients, early enteral nutrition was associated with improved outcomes. The cumulative benefits observed may warrant incorporating early enteral nutrition as part of intensive care protocols.
• Chehab, M., Afaneh, A., Bible, L., Castanon, L., Hanna, K., Ditillo, M., Khurrum, M., Asmar, S., & Joseph, B. (2020). Angioembolization in intra-abdominal solid organ injury: Does delay in angioembolization affect outcomes?. The journal of trauma and acute care surgery, 89(4), 723-729.
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  Angioembolization (AE) is an integral component in multidisciplinary algorithms for achieving hemostasis in patients with trauma. The American College of Surgeons Committee on Trauma recommends that interventional radiologists be available within 30 minutes to perform emergent AE. However, the impact of the timing of AE on patient outcomes is still not well known. We hypothesized that a delay in AE would be associated with increased mortality and higher blood transfusion requirements in patients with blunt intra-abdominal solid organ injury.
• Culbert, M. H., Hamidi, M., Zeeshan, M., Hanna, K., Romero, A., Joseph, B., & O'Keeffe, T. (2020). Retrospective Analysis of Low-Molecular-Weight Heparin and Unfractionated Heparin in Pediatric Trauma Patients: A Comparative Analysis. The Journal of surgical research, 249, 121-129.
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  Chemoprophylaxis with either unfractionated heparin (UFH) or Low-Molecular-Weight Heparin (LMWH) are recommended to prevent Venous Thromboembolism (VTE) after trauma. Experimental work has shown beneficial effects of LMWH in animal models, but it is unknown if similar effects exist in humans. We hypothesized that treatment with LMWH is associated with a survival benefit when compared to UFH.
• Ditillo, M., Hanna, K., Castanon, L., Zeeshan, M., Kulvatunyou, N., Tang, A., Sakran, J., Gries, L., & Joseph, B. (2020). The role of cryoprecipitate in massively transfused patients: Results from the Trauma Quality Improvement Program database may change your mind. The journal of trauma and acute care surgery, 89(2), 336-343.
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  Cryoprecipitate was developed for the treatment of inherited and acquired coagulopathies. The role of cryoprecipitate in hemorrhaging trauma patients is still speculative. The aim of our study was to assess the role of cryoprecipitate as an adjunct to transfusion in trauma patients.
• Duncan, T. K., Weaver, J. L., Zakrison, T. L., Joseph, B., Campbell, B. T., Christmas, A. B., Stewart, R. M., Kuhls, D. A., & Bulger, E. M. (2020). Domestic Violence and Safe Storage of Firearms in the COVID-19 Era. Annals of surgery, 272(2), e55-e57.
• El Moheb, M., Mokhtari, A., Han, K., van Erp, I., Kongkaewpaisan, N., Jia, Z., Rodriguez, G., Kongwibulwut, M., Kaafarani, H. M., & , I. P. (2020). Pain or No Pain, We Will Give You Opioids: Relationship Between Number of Opioid Pills Prescribed and Severity of Pain after Operation in US vs Non-US Patients. Journal of the American College of Surgeons, 231(6), 639-648.
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  Patients in the US receive disproportionally higher amounts of opioids after operations compared with their non-US counterparts. We aimed to assess the relationship between perceived pain severity after operation and the amount of opioid medications prescribed at discharge in US vs non-US patients.
• Godat, L. N., Jensen, A. R., Stein, D. M., & , C. f. (2020). Patient-centered outcomes research and the injured patient: a summary of application. Trauma surgery & acute care open, 5(1), e000422.
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  As trauma surgeons, we focus on the immediate care and needs of the injured patient every day. Historically, trauma and injury research has focused on outcomes such as mortality, complications, and length of stay; and process metrics such as time to CT scan, resuscitation checklist frequencies, or venous thromboembolism prophylaxis rates. These outcomes are perceived by healthcare providers to be important, but patients likely have different perceptions of what outcomes are most important to measure and improve. True patient-centered outcomes research involves the healthcare providers, and the entire team of stakeholders including patients and the community. Understanding the process of stakeholder engagement and the barriers trauma researchers must overcome to effectively enter this field of research is important. This summary aims to inform the trauma research community on the basics of patient-centered outcomes research, priorities for funding from the Patient-Centered Outcomes Research Institute, resources for collaboration around patient-centered outcomes research, and a unique career development and training opportunity for early career trauma surgeons to develop a skill set in patient-centered outcomes research.
• Guyette, F. X., Brown, J. B., Zenati, M. S., Early-Young, B. J., Adams, P. W., Eastridge, B. J., Nirula, R., Vercruysse, G. A., O'Keeffe, T., Joseph, B., Alarcon, L. H., Callaway, C. W., Zuckerbraun, B. S., Neal, M. D., Forsythe, R. M., Rosengart, M. R., Billiar, T. R., Yealy, D. M., Peitzman, A. B., , Sperry, J. L., et al. (2020). Tranexamic Acid During Prehospital Transport in Patients at Risk for Hemorrhage After Injury: A Double-blind, Placebo-Controlled, Randomized Clinical Trial. JAMA surgery.
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  In-hospital administration of tranexamic acid after injury improves outcomes in patients at risk for hemorrhage. Data demonstrating the benefit and safety of the pragmatic use of tranexamic acid in the prehospital phase of care are lacking for these patients.
• Hadeed, G. J., Smith, J., O'Keeffe, T., Kulvatunyou, N., Wynne, J. L., Joseph, B., Friese, R. S., Wachtel, T. L., Rhee, P. M., El-Menyar, A., & Latifi, R. (2020). Early surgical intervention and its impact on patients presenting with necrotizing soft tissue infections: A single academic center experience. Journal of emergencies, trauma, and shock, 9(1), 22-7.
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  Early diagnosis and emergent surgical debridement of necrotizing soft tissue infections (NSTIs) remains the cornerstone of care. We aimed to study the effect of early surgery on patients' outcomes and, in particular, on hospital length of stay (LOS) and Intensive Care Unit (ICU) LOS.
• Hamidi, M., Asmar, S., Bible, L., Hanna, K., Castanon, L., Avila, M., Ditillo, M., & Joseph, B. (2020). Early Thromboprophylaxis in Operative Spinal Trauma Does Not Increase Risk of Bleeding Complications. The Journal of surgical research, 258, 119-124.
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  Thromboprophylaxis in patients with spinal trauma is often delayed due to the risk of bleeding and expansion of the intraspinal hematoma (ISH). Our study aimed to assess the safety of early initiation of thromboprophylaxis in patients with operative spinal trauma (OST).
• Hanna, K., Asmar, S., Ditillo, M., Chehab, M., Khurrum, M., Bible, L., Douglas, M., & Joseph, B. (2020). Readmission With Major Abdominal Complications After Penetrating Abdominal Trauma. The Journal of surgical research, 257, 69-78.
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  Despite improvements in operative techniques, major abdominal complications (MACs) continue to occur after penetrating abdominal trauma (PAT). This study aimed to evaluate the burden of MAC after PAT.
• Hanna, K., Bible, L., Chehab, M., Asmar, S., Douglas, M., Ditillo, M., Castanon, L., Tang, A., & Joseph, B. (2020). Nationwide analysis of whole blood hemostatic resuscitation in civilian trauma. The journal of trauma and acute care surgery, 89(2), 329-335.
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  Renewed interest in whole blood (WB) resuscitation in civilians has emerged following its military use. There is a paucity of data on its role in civilians where balanced component therapy (CT) resuscitation is the standard of care. The aim of this study was to assess nationwide outcomes of using WB as an adjunct to CT versus CT alone in resuscitating civilian trauma patients.
• Hanna, K., Chehab, M., Bible, L., Asmar, S., Ditillo, M., Castanon, L., Tang, A., & Joseph, B. (2020). Failure to Rescue in Emergency General Surgery: Impact of Fragmentation of Care. Annals of surgery.
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  Compare emergency general surgery (EGS) patient outcomes following index and non-index hospital readmissions, and explore predictive factors for non-index readmission.
• Hanna, K., Chehab, M., Bible, L., Castanon, L., Douglas, M., Asmar, S., Ditillo, M., Tang, A., & Joseph, B. (2020). Nationwide analysis of cryopreserved packed red blood cell transfusion in civilian trauma. The journal of trauma and acute care surgery, 89(5), 861-866.
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  Liquid packed red blood cells (LPRBCs) have a limited shelf life and worsening quality with age. Cryopreserved packed red blood cells (CPRBCs) can be stored up to 10 years with no quality deterioration. The effect of CPRBCs on outcomes in civilian trauma is less explored. This study aims to evaluate the safety and efficacy of CPRBCs in civilian trauma patients.
• Hanna, K., Douglas, M., Asmar, S., Khurrum, M., Bible, L., Castanon, L., Ditillo, M., Kulvatunyou, N., & Joseph, B. (2020). Treatment of blunt cerebrovascular injuries: Anticoagulants or antiplatelet agents?. The journal of trauma and acute care surgery, 89(1), 74-79.
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  Blunt cerebrovascular injury (BCVI) is associated with cerebrovascular accidents (CVA). Early therapy with antiplatelet agents or anticoagulants is recommended. There are limited data comparing the effectiveness of these treatments. The aim of our study was to compare outcomes between BCVI patients who received anticoagulants versus those who received antiplatelet agents.
• Hanna, K., Haddadin, Z., Sakran, J., Zeeshan, M., Asmar, S., Kulvatunyou, N., Tang, A., Northcutt, A., & Joseph, B. (2020). Barriers to improving health care value in emergency general surgery: A nationwide analysis. The journal of trauma and acute care surgery, 89(2), 289-300.
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  There is a growing need to improve the quality of care while decreasing health care costs in emergency general surgery (EGS). Health care value includes costs and quality and is a targeted metric by improvement programs. The aim of our study was to evaluate the trend of health care value in EGS over time and to identify barriers to high-value surgical care.
• Hanna, K., Hamidi, M., Vartanyan, P., Henry, M., Castanon, L., Tang, A., Zeeshan, M., Kulvatunyou, N., & Joseph, B. (2020). Non-neurologic organ dysfunction plays a major role in predicting outcomes in pediatric traumatic brain injury. Journal of pediatric surgery, 55(8), 1590-1595.
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  Nonneurological organ dysfunction (NNOD) occurs after traumatic brain injury (TBI) and is associated with mortality. The aim of our study was to evaluate the prevalence of NNOD and its association with outcomes in pediatric patients with TBI. We hypothesized that NNOD is associated with worse outcomes in pediatric patients with severe TBI.
• Hanna, K., Harris, C., Trust, M. D., Bernard, A., Brown, C., Hamidi, M., & Joseph, B. (2020). Multicenter Validation of the Revised Assessment of Bleeding and Transfusion (RABT) Score for Predicting Massive Transfusion. World journal of surgery, 44(6), 1807-1816.
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  Massive transfusion (MT) is a lifesaving treatment for hemorrhaging patients. Predicting the need for MT is crucial to improve survival. The aim of our study was to validate the Revised Assessment of Bleeding and Transfusion (RABT) score to predict MT in a multicenter cohort of trauma patients.
• Hanna, K., Khan, M., Ditillo, M., Hamidi, M., Tang, A., Zeeshan, M., Saljuqi, A. T., & Joseph, B. (2020). Prospective evaluation of preoperative cognitive impairment and postoperative morbidity in geriatric patients undergoing emergency general surgery. American journal of surgery, 220(4), 1064-1070.
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  Cognitive impairment (CI) is common in geriatric patients. We aimed to evaluate the prevalence and impact of CI on outcomes in geriatric patients undergoing emergency general surgery (EGS).
• Hanna, K., Khurrum, M., & Joseph, B. (2020). Aspirin Resistance and Blunt Cerebrovascular Injuries Among Female Patients. The journal of trauma and acute care surgery.
• Hanna, K., Saljuqi, A. T., & Joseph, B. (2020). Delirium in Geriatric Patients Undergoing Emergency General Surgery: A Call to Action: In Reply to Cheng and Colleagues. Journal of the American College of Surgeons, 231(1), 189-190.
• Herrera-Escobar, J. P., Castillo-Angeles, M. A., Osman, S. Y., Orlas, C. P., Janjua, M. B., Abdullah-Arain, M., Reidy, E., Jarman, M. P., Price, M. A., Bulger, E. M., Nehra, D., Haider, A. H., & , N. T. (2020). Long-term patient-reported outcome measures after injury: National Trauma Research Action Plan (NTRAP) scoping review protocol. Trauma surgery & acute care open, 5(1), e000512.
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  A significant proportion of patients who survive traumatic injury continue to suffer impaired functional status and increased mortality long after discharge. However, despite the need to improve long-term outcomes, trauma registries in the USA do not collect data on outcomes or care processes after discharge. One of the main barriers is the lack of consensus regarding the optimal outcome metrics.
• Hoofnagle, M. H., Mubang, R. N., Joseph, D. K., Joseph, B. A., Christmas, A. B., Zakrison, T. L., & , t. E. (2020). Eastern Association for the Surgery of Trauma Statement on Structural Racism, and the Deaths of George Floyd, Ahmaud Arbery, and Breonna Taylor. Annals of surgery, 272(6), 911-914.
• Kaafarani, H. M., Han, K., El Moheb, M., Kongkaewpaisan, N., Jia, Z., El Hechi, M. W., van Wijck, S., Breen, K., Eid, A., Rodriguez, G., Kongwibulwut, M., Nordestgaard, A. T., Sakran, J. V., Ezzeddine, H., Joseph, B., Hamidi, M., Ortega, C., Flores, S. L., Gutierrez-Sougarret, B. J., , Qin, H., et al. (2020). Opioids After Surgery in the United States Versus the Rest of the World: The International Patterns of Opioid Prescribing (iPOP) Multicenter Study. Annals of surgery, 272(6), 879-886.
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  The International Patterns of Opioid Prescribing study compares postoperative opioid prescribing patterns in the United States (US) versus the rest of the world.
• Khalili, H., Ahl, R., Paydar, S., Sjolin, G., Cao, Y., Abdolrahimzadeh Fard, H., Niakan, A., Hanna, K., Joseph, B., & Mohseni, S. (2020). Beta-Blocker Therapy in Severe Traumatic Brain Injury: A Prospective Randomized Controlled Trial. World journal of surgery, 44(6), 1844-1853.
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  Observational studies have demonstrated improved outcomes in TBI patients receiving in-hospital beta-blockers. The aim of this study is to conduct a randomized controlled trial examining the effect of beta-blockers on outcomes in TBI patients.
• Khurrum, M., Asmar, S., & Joseph, B. (2020). Telemedicine in the ICU: Innovation in the Critical Care Process. Journal of intensive care medicine, 885066620968518.
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  Tele-ICU is a technology-based model designed to deliver effective critical care in the intensive care unit (ICU). The tele-ICU system has been developed to address the increasing demand for intensive care services and the shortage of intensivists. A finite number of intensivists from remote locations provide real-time services to multiple ICUs and assist in the treatment of critically ill patients. Risk prediction algorithms, smart alarm systems, and machine learning tools augment conventional coverage and can potentially improve the quality of care. Tele-ICU is associated with substantial improvements in mortality, reduced hospital and ICU length of stay, and decreased health care costs. Although multiple studies show improved outcomes following the implementation of tele-ICU, results are not consistent. Several factors, including the heterogeneity of tele-ICU infrastructure deployed in different facilities and the reluctance of health care workers to accept tele-ICU, could be associated with these varied results. Considerably high installation and ongoing operational costs might also be limiting the widespread utilization of this innovative service. While we believe that the implementation of tele-ICU offers potential advantages and makes critical care delivery more efficient, further research on the impact of this technology in critical care settings is warranted.
• Khurrum, M., Asmar, S., Henry, M., Ditillo, M., Chehab, M., Tang, A., Bible, L., Gries, L., & Joseph, B. (2020). The survival benefit of low molecular weight heparin over unfractionated heparin in pediatric trauma patients. Journal of pediatric surgery.
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  Venous thromboembolism (VTE) prophylaxis in pediatric patients is controversial and is mainly dependent on protocols derived from adult practices. Our study aimed to compare outcomes among pediatric trauma patients who received low molecular weight heparin (LMWH) compared to those who received unfractionated heparin (UFH).
• Khurrum, M., Chehab, M., & Joseph, B. (2020). Authors' response: Nonneurological organ dysfunction in severe isolated traumatic brain injury. The journal of trauma and acute care surgery, 89(4), e118-e119.
• Khurrum, M., Chehab, M., & Joseph, B. (2020). Non-Neurological Organ Dysfunction in Severe Isolated Traumatic Brain Injury. The journal of trauma and acute care surgery.
• Latifi, R., Samson, D. J., Gogna, S., & Joseph, B. A. (2020). Perioperative complications of complex abdominal wall reconstruction with biologic mesh: A pooled retrospective cohort analysis of 220 patients from two academic centers. International journal of surgery (London, England), 74, 94-99.
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  Perioperative outcomes in patients who undergo complex abdominal wall reconstruction (CAWR) may be associated with severe complications, mainly when these procedures are done urgently or emergently. This study aims to identify perioperative predictors of outcomes after CAWR with biologic mesh (BM).
• Lawless, R. A., Cralley, A., Qian, S., Vasileiou, G., Yeh, D. D., & , E. A. (2020). Antibiotics after Simple (Acute) Appendicitis Are Not Associated with Better Clinical Outcomes: A Post-Hoc Analysis of an EAST Multi-Center Study. Surgical infections.
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  The post-operative management of simple (acute) appendicitis differs throughout the United States. Guidelines regarding post-operative antibiotic usage remain unclear, and treatment generally is dictated by surgeon preference. We hypothesize that post-operative antibiotic use for simple appendicitis is not associated with lower post-operative complication rates. In a post-hoc analysis in a large multi-center observational study, only patients with an intra-operative diagnosis of AAST EGS Grade I were included. Subjects were classified into those receiving post-operative antibiotics (POST) and those given pre-operative antibiotics only (NONE). Clinical outcomes examined were length of stay (LOS), 30-day emergency department (ED) visits and hospital re-admissions, secondary interventions, surgical site infection (SSI), and intra-abdominal abscess (IAA). A total of 2,191 subjects were included, of whom 612 (28%) received post-operative antibiotics. Compared with the NONE group, POST patients were older (age 37 [range 26-50] versus 33 [26-46] years; p 
• Lokhandwala, A. M., Asmar, S., Khurrum, M., Chehab, M., Bible, L., Castanon, L., Ditillo, M., & Joseph, B. (2020). Platelet Transfusion After Traumatic Intracranial Hemorrhage in Patients on Antiplatelet Agents. The Journal of surgical research, 257, 239-245.
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  With an aging population, the number of patients on antiplatelet medications and traumatic brain injury (TBI) is increasing. Our study aimed to evaluate the role of platelet transfusion on outcomes after traumatic intracranial bleeding (IB) in these patients.
• Masjedi, A., Asmar, S., Bible, L., Khurrum, M., Chehab, M., Castanon, L., Ditillo, M., & Joseph, B. (2020). The Evolution of Nonoperative Management of Abdominal Gunshot Wounds in the United States. The Journal of surgical research, 253, 224-231.
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  Surgical exploration for gunshot wounds to the abdomen has been a surgical standard for the greater part of the past century. Recently, nonoperative management (NOM) has been deemed as a safe option for abdominal gunshot wounds (AGWs). The aim of this analysis was to review the utilization of NOM and mortality after AGWs.
• Naar, L., Kim, P., Byerly, S., Vasileiou, G., Zhang, H., Yeh, D. D., Kaafarani, H. M., & , E. A. (2020). Increased risk of malignancy for patients older than 40 years with appendicitis and an appendix wider than 10 mm on computed tomography scan: A post hoc analysis of an EAST multicenter study. Surgery, 168(4), 701-706.
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  The incidence of underlying malignancy in appendicitis ranges between 0.5% and 1.7%. We sought to identify the subset of patients with appendicitis who are at increased risk of appendiceal malignancy.
• P Ho, V., A Dicker, R., Haut, E. R., & , C. f. (2020). Dissemination, implementation, and de-implementation: the trauma perspective. Trauma surgery & acute care open, 5(1), e000423.
• Price, M. A., A Kozar, R., Bulger, E. M., Jurkovich, G. J., & , C. f. (2020). Building the future for national trauma research. Trauma surgery & acute care open, 5(1), e000421.
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  This paper describes the current funding, infrastructure growth and future state of trauma research. It also introduces a group of review articles generated from The Future of Trauma Research: Innovations in Research Methodology conference hosted by the American College of Surgeons Committee on Trauma in July 2019.
• Roussas, A., Masjedi, A., Hanna, K., Zeeshan, M., Kulvatunyou, N., Gries, L., Tang, A., & Joseph, B. (2020). Number and Type of Complications Associated With Failure to Rescue in Trauma Patients. The Journal of surgical research, 254, 41-48.
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  Failure to rescue (FTR) is becoming a ubiquitous metric of quality care. The aim of our study is to determine the type and number of complications associated with FTR after trauma.
• Sakran, J. V., Ezzeddine, H., Schwab, C. W., Bonne, S., Brasel, K. J., Burd, R. S., Cuschieri, J., Ficke, J., Gaines, B. A., Giacino, J. T., Gibran, N. S., Haider, A., Hall, E. C., Herrera-Escobar, J. P., Joseph, B., Kao, L., Kurowski, B. G., Livingston, D., Mandell, S. P., , Nehra, D., et al. (2020). Proceedings from the Consensus Conference on Trauma Patient-Reported Outcome Measures. Journal of the American College of Surgeons, 230(5), 819-835.
• Sakran, J. V., Nance, M., Riall, T., Asmar, S., Chehab, M., & Joseph, B. (2020). Pediatric Firearm Injuries and Fatalities: Do Racial Disparities Exist?. Annals of surgery, 272(4), 556-561.
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  To evaluate racial disparities among White and Black pediatric firearm injury patients on a national level.
• Saljuqi, A. T., Asmar, S., & Joseph, B. (2020). Delirium in Geriatric Patients Undergoing Emergency General Surgery: A Call to Action: Reply to Shin. Journal of the American College of Surgeons, 231(2), 306-307.
• Saljuqi, A. T., Hanna, K., Asmar, S., Tang, A., Zeeshan, M., Gries, L., Ditillo, M., Kulvatunyou, N., Castanon, L., & Joseph, B. (2020). Prospective Evaluation of Delirium in Geriatric Patients Undergoing Emergency General Surgery. Journal of the American College of Surgeons, 230(5), 758-765.
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  The prevalence of delirium and its impact on outcomes after emergency general surgery (EGS) remain unexplored. The aims of our study were to assess the impact of frailty on delirium and the impact of delirium on outcomes in geriatric EGS patients.
• Schwartz, J., Crandall, M., Hsu, A., Tepas, J. J., Joseph, B., & Yorkgitis, B. K. (2020). Applying Pediatric Brain Injury Guidelines at a Level I Adult/Pediatric Safety-Net Trauma Center. The Journal of surgical research, 255, 106-110.
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  Pediatric brain injuries are common, but current management of patients with mild traumatic intracranial hemorrhage (T-ICH) is suboptimal, often including unnecessary repeat head CT (RHCT) and neurosurgical consultation (NSC). Brain Injury Guidelines (BIG) have been developed to standardize the management of TBI, and recent work suggests they may be applied to children. The aim of this study was to apply BIG to a low-risk pediatric TBI population to further determine whether the framework can be safely applied to children in a way that reduces overutilization of RHCTs and NSC.
• Stupinski, J., Bible, L., Asmar, S., Chehab, M., Douglas, M., Ditillo, M., Gries, L., Khurrum, M., & Joseph, B. (2020). Impact of marijuana on venous thromboembolic events: Cannabinoids cause clots in trauma patients. The journal of trauma and acute care surgery, 89(1), 125-131.
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  Tetrahydrocannabinoids (THC) can modulate the coagulation cascade resulting in hypercoagulability. However, the clinical relevance of these findings has not been investigated. The aim of our study was to evaluate the impact of preinjury marijuana exposure on thromboembolic complications (TEC) in trauma patients.
• Tang, A., Chehab, M., Ditillo, M., Asmar, S., Khurrum, M., Douglas, M., Bible, L., Kulvatunyou, N., & Joseph, B. (2020). Regionalization of Trauma Care by Operative Experience: Does the Volume of Emergent Laparotomy Matter?. The journal of trauma and acute care surgery.
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  The volume-outcome relationship led to the regionalization of trauma care. The relationship between trauma centers' injury-specific laparotomy volume and outcomes has not been explored. The aim of our study was to examine the relationship between a trauma center's injury-specific laparotomy volume and outcomes in blunt and penetrating trauma patients.
• Tung, L., Long, A. M., Bonne, S., Tseng, E. S., Bruns, B., Joseph, B., Williams, B. H., Stein, D., Freischlag, J. A., Goulet, N., Khandelwal, C., Kiselak, E., Hoofnagle, M., Gelbard, R., Rattan, R., Joseph, D., Bernard, A., Zakrison, T. L., & , E. Q. (2020). Equity on the Frontlines of Trauma Surgery: An #EAST4ALL Roundtable. The journal of trauma and acute care surgery.
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  Inequity exists in surgical training and the workplace. The Eastern Association for the Surgery of Trauma Equity, Quality and Inclusion in Trauma Surgery Ad Hoc Task Force (EAST4ALL) sought to raise awareness and provide resources to combat these inequities.
• Vartan, P., Asmar, S., Bible, L., Chehab, M., Khurrum, M., Castanon, L., Ditillo, M., & Joseph, B. (2020). Alcohol Use Disorder Is Bad for Broken Ribs: A Nationwide Analysis of 19,638 Patients With Rib Fractures. The Journal of surgical research, 255, 556-564.
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  Alcohol use disorder (AUD) has deleterious effects on many organ systems. The aim of our study was to assess the impact of AUD on outcomes in patients with rib fractures. We hypothesized that AUD is associated with increased risk adverse outcomes.
• Zakrison, T. L., Martin, M., Seamon, M., Matthews, J., Joseph, B., Rattan, R., Mendoza, A., Bernard, A., Gelbard, R., Crandall, M., Punch, L., Joseph, D., Bonne, S., Mubang, R., McCunn, M., Rogers, S., Turner, P., Claridge, J., Henry, S., , de Moya, M., et al. (2020). COVID-19, Ethics and Equity-What Is Our Role as Surgeons?. Annals of surgery, 272(1), e14-e17.
• Bonne, S., Williams, B. H., Martin, M., Kaafarani, H., Weaver, W. L., Rattan, R., Byers, P. M., Joseph, D. K., Ferrada, P., Joseph, B., Santos, A., Winfield, R. D., DiBrito, S., Bernard, A., & Zakrison, T. L. (2019). #EAST4ALL: An introduction to the EAST equity, quality, and inclusion task force. The journal of trauma and acute care surgery, 87(1), 225-233.
• Bulger, E. M., Perina, D. G., Qasim, Z., Beldowicz, B., Brenner, M., Guyette, F., Rowe, D., Kang, C. S., Gurney, J., DuBose, J., Joseph, B., Lyon, R., Kaups, K., Friedman, V. E., Eastridge, B., & Stewart, R. (2019). Clinical use of resuscitative endovascular balloon occlusion of the aorta (REBOA) in civilian trauma systems in the USA, 2019: a joint statement from the American College of Surgeons Committee on Trauma, the American College of Emergency Physicians, the National Association of Emergency Medical Services Physicians and the National Association of Emergency Medical Technicians. Trauma surgery & acute care open, 4(1), e000376.
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  This is a joint statement from the American College of Surgeons Committee on Trauma, the American College of Emergency Physicians, the National Association of Emergency Medical Services Physicians and the National Association of Emergency Medical Technicians regarding the clinical use of resuscitative endovascular balloon occlusion of the aorta (REBOA) in civilian trauma systems in the USA. This statement addresses the system of care needed to manage trauma patients requiring the use of REBOA, in light of the current evidence available in this patient population. This statement was developed by an expert panel following a comprehensive review of the literature with representation from all sponsoring organizations and the US Military. This is an update to the previous statement published in 2018. It has been formally endorsed by the four sponsoring organizations.
• Cunningham, H. B., Scielzo, S. A., Nakonezny, P. A., Bruns, B. R., Brasel, K. J., Inaba, K., Brakenridge, S. C., Kerby, J. D., Joseph, B. A., Mohler, M. J., Cuschieri, J., Paulk, M. E., Ekeh, A. P., Madni, T. D., Taveras, L. R., Imran, J. B., Wolf, S. E., & Phelan, H. A. (2019). Trauma Surgeon and Palliative Care Physician Attitudes Regarding Goals-of-Care Delineation for Injured Geriatric Patients. The American journal of hospice & palliative care, 36(8), 669-674.
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  The value of defining goals of care (GoC) for geriatric patients is well known to the palliative care community but is a newer concept for many trauma surgeons. Palliative care specialists and trauma surgeons were surveyed to elicit the specialties' attitudes regarding (1) importance of GoC conversations for injured seniors; (2) confidence in their own specialty's ability to conduct these conversations; and (3) confidence in the ability of the other specialty to do so.
• Gondal, A. B., Hsu, C. H., Zeeshan, M., Hamidi, M., Joseph, B., & Ghaderi, I. (2019). A frailty index and the impact of frailty on postoperative outcomes in older patients after bariatric surgery. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery, 15(9), 1582-1588.
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  The prognostic value of frailty in the elderly surgical population has been well studied across surgical specialties. However, no studies have yet explored the effects of frailty across the full spectrum of adverse events after bariatric surgery.
• Hamidi, M., & Joseph, B. (2019). Changing Epidemiology of the American Population. Clinics in geriatric medicine, 35(1), 1-12.
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  The changing epidemiology of the geriatric population in the United States has diverse social, medical, and financial implications that will continue to expand over the next few decades. According to the US Census Bureau, 20% of the US population will be 65 years or older by 2030 and more than 50% will eventually belong to a minority group. These changes are expected to be accompanied by several effects on the geriatric population's demographics, injury characteristics, surgical interventions, and the cost of caring for the geriatric population, which will ultimately broaden the financial burden.
• Hamidi, M., Haddadin, Z., Zeeshan, M., Saljuqi, A. T., Hanna, K., Tang, A., Northcutt, A., Kulvatunyou, N., Gries, L., & Joseph, B. (2019). Prospective evaluation and comparison of the predictive ability of different frailty scores to predict outcomes in geriatric trauma patients. The journal of trauma and acute care surgery, 87(5), 1172-1180.
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  Different frailty scores have been proposed to measure frailty. No study has compared their predictive ability to predict outcomes in trauma patients. The aim of our study was to compare the predictive ability of different frailty scores to predict complications, mortality, discharge disposition, and 30-day readmission in trauma patients.
• Hamidi, M., Hanna, K., Omesiete, P., Cruz, A., Ewongwo, A., Pandit, V., Joseph, B., & Nfonsam, V. (2019). Does it matter where you get your surgery for colorectal cancer?. International journal of colorectal disease, 34(12), 2121-2127.
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  The influence of hospital-related factors on outcomes following colorectal surgery is not well-established. The aim of our study was to evaluate the relationship between hospital factors on outcomes in surgically managed colorectal cancer patients.
• Hamidi, M., Ho, C., Zeeshan, M., O'Keeffe, T., Hamza, A., Kulvatunyou, N., Jehan, F., & Joseph, B. (2019). Can Sarcopenia Quantified by Computed Tomography Scan Predict Adverse Outcomes in Emergency General Surgery?. The Journal of surgical research, 235, 141-147.
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  Sarcopenia (a decline of skeletal muscle mass) has been identified as a predictor of poor postoperative outcomes. The impact of sarcopenia in emergency general surgery (EGS) remains undetermined. The aim of this study was to evaluate the association between sarcopenia and outcomes after EGS.
• Hamidi, M., Zeeshan, M., Kulvatunyou, N., Adun, E., O'Keeffe, T., Zakaria, E. R., Gries, L., & Joseph, B. (2019). Outcomes After Massive Transfusion in Trauma Patients: Variability Among Trauma Centers. The Journal of surgical research, 234, 110-115.
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  Exsanguinating trauma patients often require massive blood transfusion (defined as transfusion of 10 or more pRBC units within first 24 h). The aim of our study is to assess the outcomes of trauma patients receiving massive transfusion at different levels of trauma centers.
• Hamidi, M., Zeeshan, M., Kulvatunyou, N., Mitra, H. S., Hanna, K., Tang, A., Northcutt, A., O'Keeffe, T., & Joseph, B. (2019). Operative spinal trauma: Thromboprophylaxis with low molecular weight heparin or a direct oral anticoagulant. Journal of thrombosis and haemostasis : JTH, 17(6), 925-933.
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  Essentials Operative spine trauma patients are at increased risk of venous thromboembolism (VTE). Direct oral anticoagulants (DOACs) may have a favorable efficacy and safety in spine trauma. Patients on DOACs had lower rates of VTE in comparison to low molecular weight heparin. DOACs did not augment the risk of surgical bleeding (transfusion, decompressive procedures).
• Hamidi, M., Zeeshan, M., Leon-Risemberg, V., Nikolich-Zugich, J., Hanna, K., Kulvatunyou, N., Saljuqi, A. T., Fain, M., & Joseph, B. (2019). Frailty as a prognostic factor for the critically ill older adult trauma patients. American journal of surgery, 218(3), 484-489.
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  Frailty is highly prevalent in the elderly and confers high risk for adverse outcomes. We aimed to assess the impact of frailty on critically ill older adult trauma patients.
• Hamidi, M., Zeeshan, M., Sakran, J. V., Kulvatunyou, N., O'Keeffe, T., Northcutt, A., Zakaria, E. R., Tang, A., & Joseph, B. (2019). Direct Oral Anticoagulants vs Low-Molecular-Weight Heparin for Thromboprophylaxis in Nonoperative Pelvic Fractures. Journal of the American College of Surgeons, 228(1), 89-97.
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  Patients with pelvic fractures are prone to venous thromboembolic (VTE) complications. Recent literature shows superiority of direct oral anticoagulants (DOACs) over low-molecular-weight heparin (LMWH) for thromboprophylaxis in patients undergoing orthopaedic operations. The aim of our study was to compare in-hospital outcomes for DOACs vs LMWH in patients with nonoperative pelvic fractures.
• Hanna, K., Ditillo, M., & Joseph, B. (2019). The role of frailty and prehabilitation in surgery. Current opinion in critical care, 25(6), 717-722.
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  The aging surgical population constitutes a unique challenge to clinicians across the spectrum of care. Frailty is a valuable tool for preoperative risk stratification and may guide targeted interventions, such as prehabilitation. The aim of this review is to revise the recent literature on the role of frailty and prehabilitation to optimize geriatric patients undergoing surgery.
• Hanna, K., Hamidi, M., Anderson, K. T., Ditillo, M., Zeeshan, M., Tang, A., Henry, M., Kulvatunyou, N., & Joseph, B. (2019). Pediatric resuscitation: Weight-based packed red blood cell volume is a reliable predictor of mortality. The journal of trauma and acute care surgery, 87(2), 356-363.
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  The definition of massive transfusion (MT) in civilian pediatric trauma patients is not established. In combat-injured pediatric patients, the definition of MT is based on the volume of total blood products transfused. The aim of this study is to define MT in civilian pediatric trauma patients based on a packed red blood cell (PRBC) volume threshold and compare its predictive power to a total blood products volume threshold.
• Hanna, K., Khalid, A., Hamidi, M., Gries, L., Haddadin, Z., Kulvatunyou, N., Zeeshan, M., & Joseph, B. (2019). Chronic Alcohol Consumption and Risk of Deep Venous Thrombosis: A Propensity-Matched Analysis. The Journal of surgical research, 244, 251-256.
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  Alcoholism is associated with variable effects on the coagulation system. Therefore, the aim of our study was to analyze the currently unknown association between chronic alcohol consumption and the risk of venous thromboembolism, which includes deep vein thrombosis (DVT) and pulmonary embolism (PE).
• Hanna, K., Palmer, J., Castanon, L., Zeeshan, M., Hamidi, M., Kulvatunyou, N., Gries, L., & Joseph, B. (2019). Racial and Ethnic Differences in Limiting Life-Sustaining Treatment in Trauma Patients. The American journal of hospice & palliative care, 36(11), 974-979.
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  Differences in health care between racial and ethnic groups exist. The literature suggests that African Americans and Hispanics prefer more aggressive treatment at the end of life. The aim of this study is to assess racial and ethnic differences in limiting life-sustaining treatment (LLST) after trauma.
• Hanna, K., Zeeshan, M., Hamidi, M., Pandit, V., Omesiete, P., Cruz, A., Ewongwo, A., Joseph, B., & Nfonsam, V. (2019). Colon cancer in the young: contributing factors and short-term surgical outcomes. International journal of colorectal disease, 34(11), 1879-1885.
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  The incidence in young patients has increased significantly over the last few decades. The aim of this study is to evaluate demographic and tumor characteristics of young patients and analyze the short-term surgical outcomes of patients undergoing surgery.
• Jehan, F., & Joseph, B. (2019). Perioperative glycemic control and postoperative complications in patients undergoing emergency general surgery: What is the role of HbA1c?. The journal of trauma and acute care surgery, 86(2), 379.
• Jehan, F., Khan, M., Kulvatunyou, N., Hamidi, M., Gries, L., Zeeshan, M., O'Keeffe, T., & Joseph, B. (2019). Day of Hospital Admission and Effect on Outcomes: The Weekend Effect in Acute Gallstone Pancreatitis. The Journal of surgical research, 233, 192-198.
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  The aim of our study was to evaluate outcomes in patients who are admitted on weekend compared with those admitted on a weekday for acute gallstone pancreatitis.
• Jehan, F., Zeeshan, M., Kulvatunyou, N., Khan, M., O'Keeffe, T., Tang, A., Gries, L., & Joseph, B. (2019). Is There a Need for Platelet Transfusion After Traumatic Brain Injury in Patients on P2Y12 Inhibitors?. The Journal of surgical research, 236, 224-229.
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  A significant portion of patients sustaining traumatic brain injury (TBI) are on antiplatelet medications. The reversal of P2Y12 agents after intracranial hemorrhage (ICH) remains unclear. The aim of our study is to evaluate outcomes after TBI in patients who are on preinjury P2Y12 inhibitors and received a platelet transfusion.
• Joseph, B. A., Anand, T., & Tang, A. (2019). Penetrating Neck Trauma: A Review. Current Trauma Reports.
• Joseph, B. A., Kulvatunyou, N., O'Keeffe, T., Northcutt, A., Sakran, J., Jehan, F., Gries, L. M., Feinstein, A., Hamidi, M., & Zeeshan, M. (2019). Four-factor prothrombin complex concentrate is associated with improved survival in trauma-related hemorrhage: A Nationwide Propensity Matched Analysis. Journal of Trauma and Acute Care Surgery, 87(2), 274-281. doi:doi: 10.1097/TA.0000000000002262
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  INTRODUCTION Post-traumatic hemorrhage is the most common preventable cause of death in trauma. Numerous small single-center studies have shown the superiority of four-factor prothrombin complex concentrate (4-PCC) along with fresh frozen plasma (FFP) over FFP alone in resuscitation of trauma patients. The aim of our study was to evaluate outcomes of severely injured trauma patients who received 4-PCC + FFP compared to FPP alone.METHODS Two-year (2015–2016) analysis of the American College of Surgeons-Trauma Quality Improvement Program database. All adult (age ≥18 years) trauma patients who received 4-PCC + FFP or FFP alone were included. We excluded patients who were on preinjury anticoagulants. Patients were stratified into two groups: 4-PCC + FFP versus FFP alone and were matched in a 1:1 ratio using propensity score matching for demographics, vitals, injury parameters, comorbidities, and level of trauma centers. Outcome measures were packed red blood cells, plasma and platelets transfused, complications, and mortality.RESULTS A total of 468 patients (4-PCC + FFP, 234; FFP alone, 234) were matched. Mean age was 50 ± 21 years; 70% were males; median injury severity score was 27 [20–36], and 86% had blunt injuries. Four-PCC + FFP was associated with a decreased requirement for packed red blood cells (6 units vs. 10 units; p = 0.02) and FFP (3 units vs. 6 units; p = 0.01) transfusion compared to FFP alone. Patients who received 4-PCC + FFP had a lower mortality (17.5% vs. 27.7%, p = 0.01) and lower rates of acute respiratory distress syndrome (1.3% vs. 4.7%, p = 0.04) and acute kidney injury (2.1% vs. 7.3%, p = 0.01). There was no difference in the rates of deep venous thrombosis (p = 0.11) and pulmonary embolism (p = 0.33), adverse discharge disposition (p = 0.21), and platelets transfusion (p = 0.72) between the two groups.CONCLUSIONS Our study demonstrates that the use of 4-PCC as an adjunct to FFP is associated with improved survival and reduction in transfusion requirements compared to FFP alone in resuscitation of severely injured trauma patients. Further studies are required to evaluate the role of addition of PCC to the massive transfusion protocol.LEVEL OF EVIDENCE Therapeutic studies, level III.
• Joseph, B. A., Romagnoli, A. N., Zeeshan, M., & Brenner, M. l. (2019). Utilization of endovascular and open surgical repair in the United States: A 10-year analysis of the National Trauma Databank (NTDB). Am J Surg, 1128-1133.
• Joseph, B., & Hanna, K. (2019). Reassessing the Safety of Bicycle Helmets-Finding Vulnerability in Strength. JAMA otolaryngology-- head & neck surgery, 145(4), 305-306.
• Joseph, B., & Scalea, T. (2019). The Consequences of Aging on the Response to Injury and Critical Illness. Shock (Augusta, Ga.).
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  Changing demographic trends have led to an increase in the overall geriatric trauma patient volume. Furthermore, the intersection of aging and injury can be problematic because geriatric patients have multiple comorbidities, geriatric-specific syndromes, and reduced physiological reserve. Despite mounting evidence that frail geriatric patients have inferior outcomes following trauma, very few studies have examined the effect of aging on the biological response to injury. In the present article, we review the current literature and explore the pathophysiological rationale underlying observed data, available evidence, and future directions on this topic.
• Joseph, B., Hanna, K., Callcut, R. A., Coleman, J. J., Sakran, J. V., & Neumayer, L. A. (2019). The Hidden Burden of Mental Health Outcomes Following Firearm-related Injures. Annals of surgery, 270(4), 593-601.
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  Examine the effect of different types of firearms on readmission due to acute stress disorder (ASD) and/or post-traumatic stress disorder (PTSD) in firearm-injury victims.
• Joseph, B., Zeeshan, M., & Rhee, P. (2019). Addressing Limitations in Case-Control Study of Patients Undergoing Resuscitative Endovascular Balloon Occlusion of the Aorta-Reply. JAMA surgery.
• Joseph, B., Zeeshan, M., Sakran, J. V., Hamidi, M., Kulvatunyou, N., Khan, M., O'Keeffe, T., & Rhee, P. (2019). Nationwide Analysis of Resuscitative Endovascular Balloon Occlusion of the Aorta in Civilian Trauma. JAMA surgery, 154(6), 500-508.
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  The need for improved methods of hemorrhage control and resuscitation has resulted in a reappraisal of resuscitative endovascular balloon occlusion of the aorta (REBOA). However, there is a paucity of data regarding the use of REBOA on a multi-institutional level in the United States.
• Khan, M., Jehan, F., Zeeshan, M., Kulvatunyou, N., Fain, M. J., Saljuqi, A. T., O'Keeffe, T., & Joseph, B. (2019). Failure to Rescue After Emergency General Surgery in Geriatric Patients: Does Frailty Matter?. The Journal of surgical research, 233, 397-402.
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  Failure to rescue (FTR) is considered as an index of quality of care provided by a hospital. However, the role of frailty in FTR remains unclear. We hypothesized that the FTR rate is higher for frail geriatric emergency general surgery (EGS) patients than nonfrail geriatric EGS patients.
• Kulvatunyou, N., Zimmerman, S. A., Joseph, B., Friese, R. S., Gries, L., O'Keeffe, T., Stroster, J. A., & Tang, A. L. (2019). Risk Factors for Perforated Appendicitis in the Acute Care Surgery Era-Minimizing the Patient's Delayed Presentation Factor. The Journal of surgical research, 238, 113-118.
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  Numerous factors contribute to advanced disease or increased complications in patients with acute appendicitis (AA). This study aimed to identify risk factors associated with AA perforation, including the effect of system time (ST) delay, after controlling for patient time (PT) delay. In this study, PT was controlled (to less than or equal to 24 h) to better understand the effect of ST delay on AA perforation.
• Lunardi, N., Mehta, A., Ezzeddine, H., Canner, J. K., Hamidi, M., Jehan, F., Joseph, B. A., Nathens, A. B., Efron, D. T., Diaz, J., & Sakran, J. V. (2019). Recurring emergency general surgery: Characterizing a vulnerable population. The journal of trauma and acute care surgery, 86(3), 464-470.
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  Limited data exist for long-term outcomes after emergency general surgeries (EGSs) in the United States. This study aimed to characterize the incidence of inpatient readmissions and additional operations within 6 months of an EGS procedure.
• Lunardi, N., Mehta, A., Ezzeddine, H., Varma, S., Winfield, R. D., Kent, A., Canner, J. K., Nathens, A. B., Joseph, B. A., Efron, D. T., & Sakran, J. V. (2019). Unplanned readmission after traumatic injury: A long-term nationwide analysis. The journal of trauma and acute care surgery, 87(1), 188-194.
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  Long-term outcomes after trauma admissions remain understudied. We analyzed the characteristics of inpatient readmissions within 6 months of an index hospitalization for traumatic injury.
• Mehta, A., Lunardi, N., Efron, D. T., Joseph, B. A., Steven, K. A., Manukyan, M., Fakhry, S. M., & Sakran, J. V. (2019). Characterizing the underlying diagnoses for exploratory laparotomies to improve risk-adjustment models of postoperative mortality. The journal of trauma and acute care surgery, 86(4), 664-669.
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  Surgeons perform emergent exploratory laparotomies (ex-laps) for a myriad of surgical diagnoses. We characterized common diagnoses for which emergent ex-laps were performed and leveraged these groups to improve risk-adjustment models for postoperative mortality.
• Mehta, A., Varma, S., Efron, D. T., Joseph, B. A., Lunardi, N., Haut, E. R., Cooper, Z., & Sakran, J. V. (2019). Emergency general surgery in geriatric patients: How should we evaluate hospital experience?. The journal of trauma and acute care surgery, 86(2), 189-195.
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  As the aging American population poses unique challenges to acute care services, we determined if either hospital proportion or annual volume of geriatric patients undergoing emergency general surgery (EGS) procedures is associated with outcomes.
• Palmer, J., Pandit, V., Zeeshan, M., Kulvatunyou, N., Hamidi, M., Hanna, K., Fain, M., Nikolich-Zugich, J., Zakaria, E. R., & Joseph, B. (2019). The acute inflammatory response after trauma is heightened by frailty: A prospective evaluation of inflammatory and endocrine system alterations in frailty. The journal of trauma and acute care surgery, 87(1), 54-60.
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  Frailty is a geriatric syndrome characterized by decreased physiological reserves, increased inflammation, and decreased anabolic-endocrine response. The biomarkers associated with frailty are poorly understood in trauma. The aim of this study was to analyze the association between frailty and immune: IL-1β, IL-6, IL-2Rα, tumor necrosis factor (TNF)-α, and endocrine biomarkers: insulin-like growth factor-1 and growth hormone in trauma patients.
• Sakran, J. V., Ezzeddine, H., Haut, E. R., Lunardi, N., Mehta, A., Choron, R. L., Reid, J., Zeeshan, M., Hamidi, M., & Joseph, B. A. (2019). Prolonged operating room time in emergency general surgery is associated with venous thromboembolic complications. American journal of surgery, 218(5), 836-841.
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  We evaluated the association between operating room time and developing a deep vein thrombosis (DVT) or pulmonary embolus (PE) after emergency general surgery (EGS).
• Santino, C., Zeeshan, M., Hamidi, M., Hanna, K., Saljuqi, A. T., Kulvatunyou, N., Haddadin, Z., Northcutt, A., & Joseph, B. (2019). Prospective evaluation of health-related quality of life in geriatric trauma patients. Surgery, 166(3), 403-407.
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  Frailty is an established predictor of adverse outcomes in geriatric patients. Health-related quality of life (HRQoL) is an important outcome measure among trauma patients. This prospective observational study examined the impact of frailty on health-related quality of life in geriatric trauma patients.
• Skarupa, D. J., Khan, M., Hsu, A., Madbak, F. G., Ebler, D. J., Yorkgitis, B., Rahmathulla, G., Alcindor, D., & Joseph, B. (2019). Trends in civilian penetrating brain injury: A review of 26,871 patients. American journal of surgery, 218(2), 255-260.
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  The aim of our study is to analyze the 5 years' trends, mortality rate, and factors that influence mortality after civilian penetrating traumatic brain injury (pTBI).
• Skarupa, D., Hanna, K., Zeeshan, M., Madbak, F., Hamidi, M., Haddadin, Z., Northcutt, A., Gries, L., Kulvatunyou, N., & Joseph, B. (2019). Is early chemical thromboprophylaxis in patients with solid organ injury a solid decision?. The journal of trauma and acute care surgery, 87(5), 1104-1112.
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  The optimal time to initiate chemical thromboprophylaxis (CTP) in patients who have undergone nonoperative management (NOM) of blunt solid organ injuries (SOI) remains controversial. The aim of our study was to assess the impact of early initiation of CTP in patients with blunt abdominal SOIs.
• Vasileiou, G., Eid, A. I., Qian, S., Pust, G. D., Rattan, R., Namias, N., Larentzakis, A., Kaafarani, H. M., & Yeh, D. D. (2019). Appendicitis in Pregnancy: A Post-Hoc Analysis of an EAST Multicenter Study. Surgical infections.
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  To compare the presentation, management, and outcomes of appendicitis in pregnant and non-pregnant females of childbearing age (18-45 years). This was a post-hoc analysis of a prospectively collected database (January 2017-June 2018) from 28 centers in America. We compared pregnant and non-pregnant females' demographics, clinical presentation, laboratory data, imaging findings, management, and clinical outcomes. Of the 3,597 subjects, 1,010 (28%) were of childbearing age, and 41 were pregnant: The mean age of the pregnant subjects was 30 ± 8 years at a median gestational age of 15 (range 10-23) weeks. The two groups had similar demographics and clinical presentation, but there were differences in management and outcomes. For example, in pregnant subjects, abdominal ultrasound scans (US) plus magnetic resonance imaging (MRI) was the most frequently used imaging method (41%) followed by MRI alone (29%), US alone (22%), computed tomography (CT) (5%), and no imaging (2%). Despite similar American Association for the Surgery of Trauma Emergency General Surgery Clinical and Imaging Grade at presentation, pregnant subjects were more likely to be treated with antibiotics alone (15% versus 4%; p = 0.008). Pregnant subjects were less likely to have simple appendicitis and were more likely to have complicated (perforated or gangrenous) appendicitis or a normal appendix. With the exception of index hospital length of stay, there were no significant differences between the groups in clinical outcomes at index hospitalization or at 30 days. Almost 1 in 20 women of childbearing age presenting with appendicitis is pregnant. Appendicitis most commonly affects women in early to mid-pregnancy. Compared with non-pregnant women of childbearing age, pregnant women presenting with appendicitis undergo non-operative management more often and are less likely to have simple appendicitis. Compared with non-pregnant patients, they have similar clinical outcomes at both index hospitalization and 30 days after discharge.
• Zakaria, E. R., Joseph, B., Hamidi, M., Zeeshan, M., Algamal, A., Sartaj, F., Althani, M., Fadl, T., & Madan, D. (2019). Glycine improves peritoneal vasoreactivity to dialysis solutions in the elderly. Qatar medical journal, 2019(3), 19.
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  Peritoneal dialysis solution (PDS) dilates peritoneal microvessels predominantly by the activation of the endothelial nitric oxide (NO) pathway. We made an incidental observation of decreased PDS-induced, NO-dependent peritoneal microvascular vasoreactivity in elderly rats naïve to PDS exposure. We hypothesized that this subordinate NO-mediated peritoneal microvascular vasoreactivity is caused by increased oxidative stress in the aged endothelium, which compromises NO bioavailability in the elderly, and that peritoneal microvascular vasoreactivity can be improved by the supplementation of antioxidant glycine to PDS. We studied PDS-mediated vasoreactivity of four intestinal visceral arterioles of different orders by intravital microscopy in weaned, adult, and elderly rats to (i) confirm subordinate vasoreactivity to PDS in elderly rats; (ii) restore vasoreactivity by glycine supplementation; and (iii) establish age as an independent risk factor for endothelial cell dysfunction. In a crossover series, peritoneal microvascular vasoreactivity to PDS exposure was remarkably decreased in elderly rats. This subordinate vasoreactivity was completely restored by the supplementation of glycine to PDS. In a separate series, we assessed endothelial cell function in weaned and adult rats using the cumulative acetylcholine concentration-response curves. Unlike the adults, the weaned rats demonstrated remarkable sensitivity and reactivity to cumulative acetylcholine concentrations, suggesting the dependency of endothelial cell function on age. Aging is an independent risk factor for peritoneal microvascular endothelial cell dysfunction. Endothelial function in the elderly can be recovered by reinforcing the bioavailability of endothelial-derived NO through glycine. Dietary glycine supplementation is a potential therapeutic strategy to decrease the burden of oxidative stress on the aged endothelium.
• Zeeshan, M., Hamidi, M., Feinstein, A. J., Gries, L., Jehan, F., Sakran, J., Northcutt, A., OʼKeeffe, T., Kulvatunyou, N., & Joseph, B. (2019). Four-factor prothrombin complex concentrate is associated with improved survival in trauma-related hemorrhage: A nationwide propensity-matched analysis. The journal of trauma and acute care surgery, 87(2), 274-281.
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  Post-traumatic hemorrhage is the most common preventable cause of death in trauma. Numerous small single-center studies have shown the superiority of four-factor prothrombin complex concentrate (4-PCC) along with fresh frozen plasma (FFP) over FFP alone in resuscitation of trauma patients. The aim of our study was to evaluate outcomes of severely injured trauma patients who received 4-PCC + FFP compared to FPP alone.
• Zeeshan, M., Hamidi, M., O'Keeffe, T., Hanna, K., Kulvatunyou, N., Tang, A., & Joseph, B. (2019). Pediatric Liver Injury: Physical Examination, Fast and Serum Transaminases Can Serve as a Guide. The Journal of surgical research, 242, 151-156.
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  The aim of our study was to determine if the combination of physical examination (PE), serum transaminases along with Focused Assessment with Sonography in Trauma (FAST) would effectively rule out major hepatic injuries (HIs) after blunt abdominal trauma (BAT) in hemodynamically stable pediatric patients.
• Zeeshan, M., Hamidi, M., OʼKeeffe, T., Bae, E. H., Hanna, K., Friese, R. S., Kulvatunyou, N., Zakaria, E. R., Gries, L., Tang, A., & Joseph, B. (2019). Propranolol attenuates cognitive, learning, and memory deficits in a murine model of traumatic brain injury. The journal of trauma and acute care surgery, 87(5), 1140-1147.
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  β-blockers have been shown to improve survival after traumatic brain injury (TBI); however, the impact of continuous dosage of β-blockers on cognitive function has not been elucidated. We hypothesized that a daily dose of propranolol can improve memory, learning, and cognitive function following TBI.
• Zerhouni, Y. A., Scott, J. W., Ta, C., Hsu, P. C., Crandall, M., Gale, S. C., Schoenfeld, A. J., Bottiggi, A. J., Cornwell, E. E., Eastman, A., Davis, J. K., Joseph, B., Robinson, B. R., Shafi, S., White, C. Q., Williams, B. H., Haut, E. R., & Haider, A. H. (2019). Impact of the Affordable Care Act on trauma and emergency general surgery: An Eastern Association for the Surgery of Trauma systematic review and meta-analysis. The journal of trauma and acute care surgery, 87(2), 491-501.
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  Trauma and emergency general surgery (EGS) patients who are uninsured have worse outcomes as compared with insured patients. Partially modeled after the 2006 Massachusetts Healthcare Reform (MHR), the Patient Protection and Affordable Care Act was passed in 2010 with the goal of expanding health insurance coverage, primarily through state-based Medicaid expansion (ME). We evaluated the impact of ME and MHR on outcomes for trauma patients, EGS patients, and trauma systems.
• Cunningham, H. B., Scielzo, S. A., Nakonezny, P. A., Bruns, B. R., Brasel, K. J., Inaba, K., Brakenridge, S. C., Kerby, J. D., Joseph, B. A., Mohler, M. J., Cuschieri, J., Paulk, M. E., Ekeh, A. P., Madni, T. D., Taveras, L. R., Imran, J. B., Wolf, S. E., & Phelan, H. A. (2018). Burn Surgeon and Palliative Care Physician Attitudes Regarding Goals of Care Delineation for Burned Geriatric Patients. Journal of burn care & research : official publication of the American Burn Association, 39(6), 1000-1005.
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  Palliative care specialists (PCS) and burn surgeons (BS) were surveyed regarding: 1) importance of goals of care (GoC) conversations for burned seniors; 2) confidence in their own specialty's ability to conduct these conversations; and 3) confidence in the ability of the other specialty to do so. A 13-item survey was developed by the steering committee of a multicenter consortium dedicated to palliative care in the injured geriatric patient and beta-tested by BS and PCS unaffiliated with the consortium. The finalized instrument was electronically circulated to active physician members of the American Burn Association and American Academy for Hospice and Palliative Medicine. Forty-five BS (7.3%) and 244 PCS (5.7%) responded. Palliative physicians rated being more familiar with GoC, were more comfortable having a discussion with laypeople, were more likely to have reported high-quality training in performing conversations, believed more palliative specialists were needed in intensive care units, and had more interest in conducting conversations relative to BS. Both groups believed themselves to perform GoC discussions better than the other specialty perceived them to do so. BS favored leading team discussions, whereas palliative specialists preferred jointly led discussions. Both groups agreed that discussions should occur within 72 hours of admission. Both groups believe themselves to conduct GoC discussions for burned seniors better than the other specialty perceived them to do so, which led to disparate views on perceptions for the optimal leadership of these discussions.
• Hamidi, M., Zeeshan, M., O'Keeffe, T., Nisbet, B., Northcutt, A., Nikolich-Zugich, J., Khan, M., Kulvatunyou, N., Fain, M., & Joseph, B. (2018). Prospective evaluation of frailty and functional independence in older adult trauma patients. American journal of surgery, 216(6), 1070-1075.
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  The aim of our study was to assess the association between frailty and functional status in geriatric trauma patients.
• Jehan, F., Aziz, H., OʼKeeffe, T., Khan, M., Zakaria, E. R., Hamidi, M., Zeeshan, M., Kulvatunyou, N., & Joseph, B. (2018). The role of four-factor prothrombin complex concentrate in coagulopathy of trauma: A propensity matched analysis. The journal of trauma and acute care surgery, 85(1), 18-24.
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  Coagulopathy is a common complication after severe trauma. The efficacy of 4-factor prothrombin complex concentrate (4-PCC) as an adjunct to fresh frozen plasma (FFP) in reversal of coagulopathy of trauma (COT) has not been studied. The aim of our study is to compare 4-PCC + FFP versus FFP alone for the treatment of COT.
• Joseph, B. A. (2018). Attitudes Among Burn Surgeons and Palliative Care Physicians Regarding Goals of Care for Geriatric Burn Patients. Journal of Burn Care & Research, 132.
• Joseph, B. A. (2018). Characterizing the Underlying Diagnoses for Exploratory Laparotomies to Improve Risk-Adjustment Models of Postoperative Mortality. Journal of Trauma and Acute Care Surgery.
• Joseph, B. A. (2018). Continuous Remote Ischemic Conditioning Attenuates Cognitive and Motor Deficits From Moderate Traumatic Brain Injury. The Journal of Trauma and Acute Care Surgery.
• Joseph, B. A. (2018). Day of Hospital Admission and Effect on Outcomes: The Weekend Effect in Acute Gallstone Pancreatitis. Journal of Surgical Research, 233, 192-198.
• Joseph, B. A. (2018). Emergency General Surgery in Geriatric Patients: A Statewide Analysis of Surgeon and Hospital Volumes with Outcomes. The Journal of Trauma and Acute Care Surgery.
• Joseph, B. A. (2018). Evaluating the Relevance of of the 2013 Tokyo Guidelines for the Diagnosis and Management of Cholecystitis. Journal of the American college of Surgeons.
• Joseph, B. A. (2018). Failure to Rescue After Emergency General Surgery in Geriatric Patients: Does Frailty Matter?. Journal of Surgical Research, 233, 397-402.
• Joseph, B. A. (2018). Geriatric Traumatic Brain Injury: What we Know and What we Don't. Journal of Trauma and Acute Care Surgery.
• Joseph, B. A. (2018). Improving Survival After an Emergency Resuscitative Thoracotomy: A 5-Year Review of the TraumaQuality Improvement program. Trauma Surgery and Acute Care Open, 3(1), 201.
• Joseph, B. A. (2018). Mortality after Emergency Bowel Resections: The Role of Failure-to-Rescue. The Journal of Trauma and Acute Care Surgery.
• Joseph, B. A. (2018). Nationwide Trends in Mortality Following Penetrating trauma: Are we up for the Challenge?. Journal of Trauma and Acute Care Surgery, 1907.
• Joseph, B. A. (2018). Optimal Timing of Initiation of Thromboprophylaxis in Spine Trauma Managed Operatively: A Nationwide Propensity Matched Analysis of Trauma Quality Improvement Program. Journal of the American College of Surgeons.
• Joseph, B. A. (2018). Optimal Timing of Initiation of Thromboprophylaxis in Spine Trauma Managed Operatively: A Nationwide Propensity Matched Analysis of Trauma Quality Improvement Program. The Journal of Trauma and Acute Care Surgery.
• Joseph, B. A. (2018). Safety and Efficacy of Brain Injury Gudelines at a Level III Trauma Center. The Journal of Trauma and Acute Care Surgery.
• Joseph, B. A. (2018). The Novel Oral Anticoagulants (NOACs) have Worse Outcomes Compared to Warfarin in Patients with Intracranial Hemorrhage after TBI. The Journal of Trauma and Acute Care Surgery.
• Joseph, B. A. (2018). Validation of a Geriatric Trauma Prognosis Calculator: A PAL Li. ATE Consortium Study. Journal of the American Geriatrics Society, 65, 2302-2307.
• Joseph, B. A., Acar, M., D, E., N, L., ER, H., Z, C., & JV, S. (2018). Emergency Surgery in Geriatric Patients: How Should We Evaluate Hospital Experience?. Journal of Trauma and Acute Care Surgery.
• Joseph, B., Jehan, F., & Riall, T. S. (2018). Evaluating the Diagnostic Accuracy and Management Protocols: In Reply to Strasberg. Journal of the American College of Surgeons, 227(6), 624-626.
• Joseph, B., Jehan, F., Dacey, M., Kulvatunyou, N., Khan, M., Zeeshan, M., Gries, L., O'Keeffe, T., & Riall, T. S. (2018). Evaluating the Relevance of the 2013 Tokyo Guidelines for the Diagnosis and Management of Cholecystitis. Journal of the American College of Surgeons, 227(1), 38-43.e1.
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  The 2013 Tokyo Guidelines (TG13) are used to diagnose, grade severity, and guide management of acute cholecystitis (AC). The aim of our study was to verify the diagnostic criteria, severity assessment, and management protocols based on the TG13.
• Joseph, B., Khan, M., Jehan, F., Latifi, R., & Rhee, P. (2018). Improving survival after an emergency resuscitative thoracotomy: a 5-year review of the Trauma Quality Improvement Program. Trauma surgery & acute care open, 3(1), e000201.
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  Advancement in trauma care has led to the evolution of emergency resuscitative thoracotomy (ERT) for the revival of trauma patients. We now have more precise understanding of selecting suitable patients for achieving optimal outcomes. The aim of our study was to analyze the utilization and survival trends during the past 5 years, as well as factors that influence survival after ERT.
• Joseph, B., Khan, M., Truitt, M., Jehan, F., Kulvatunyou, N., Azim, A., Jain, A., Zeeshan, M., Tang, A., & O'Keeffe, T. (2018). Massive Transfusion: The Revised Assessment of Bleeding and Transfusion (RABT) Score. World journal of surgery, 42(11), 3560-3567.
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  Massive transfusion (MT) is a lifesaving treatment for trauma patients with hemorrhagic shock, assessed by Assessment of Blood Consumption (ABC) Score based on mechanism of injury, systolic blood pressure (SBP), tachycardia, and FAST exam. The aim of this study was to assess the performance of ABC score by replacing hypotension and tachycardia; with Shock Index (SI) > 1.0 and including pelvic fractures.
• Khan, M., Jehan, F., Bulger, E. M., OʼKeeffe, T., Holcomb, J. B., Wade, C. E., Schreiber, M. A., Joseph, B., & , P. S. (2018). Severely injured trauma patients with admission hyperfibrinolysis: Is there a role of tranexamic acid? Findings from the PROPPR trial. The journal of trauma and acute care surgery, 85(5), 851-857.
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  Administration of tranexamic acid (TXA) in coagulopathy of trauma gained popularity after the CRASH-2 trial. The aim of our analysis was to analyze the role of TXA in severely injured trauma patients with admission hyperfibrinolysis.
• Khan, M., Jehan, F., O'Keeffe, T., Hamidi, M., Kulvatunyou, N., Tang, A., Gries, L., & Joseph, B. (2018). Oral Xa Inhibitors Versus Low Molecular Weight Heparin for Thromboprophylaxis After Nonoperative Spine Trauma. The Journal of surgical research, 232, 82-87.
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  Thromboprophylaxis with oral Xa inhibitors (Xa-Inh) are recommended after major orthopedic operation; however, its role in spine trauma is not well-defined. The aim of our study was to assess the impact of Xa-Inh in spinal trauma patients managed nonoperatively.
• Khan, M., Jehan, F., O'Keeffe, T., Hamidi, M., Truitt, M., Zeeshan, M., Gries, L., Tang, A., & Joseph, B. (2018). Optimal Timing of Initiation of Thromboprophylaxis after Nonoperative Blunt Spinal Trauma: A Propensity-Matched Analysis. Journal of the American College of Surgeons, 226(5), 760-768.
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  Patients with spinal trauma have the highest risk of a venous thromboembolism. Although anticoagulation is recommended, its optimal timing is not well-defined. We aimed to assess the impact of early initiation of thromboprophylaxis in spinal trauma patients who were managed nonoperatively.
• Kulvatunyou, N., Zimmerman, S. A., Sadoun, M., Joseph, B. A., Friese, R. S., Gries, L. M., O'Keeffe, T., & Tang, A. L. (2018). Comparing Outcomes Between "Pull" Versus "Push" Percutaneous Endoscopic Gastrostomy in Acute Care Surgery: Under-Reported Pull Percutaneous Endoscopic Gastrostomy Incidence of Tube Dislodgement. The Journal of surgical research, 232, 56-62.
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  Percutaneous endoscopic gastrostomy (PEG) complications are often under-reported in the literature, especially regarding the incidence of tube dislodgement (TD). TD can cause significant morbidity depending on its timing. We compared outcomes between "push" and "pull" PEGs. We hypothesized that push PEGs, because of its T-fasteners and balloon tip, would have a lower incidence of TD and complications compared with pull PEGs.
• Martin, G. E., Carroll, C. P., Plummer, Z. J., Millar, D. A., Pritts, T. A., Makley, A. T., Joseph, B. A., Ngwenya, L. B., & Goodman, M. D. (2018). Safety and efficacy of brain injury guidelines at a Level III trauma center. The journal of trauma and acute care surgery, 84(3), 483-489.
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  Patients with mild to moderate traumatic brain injury (TBI) are often primarily managed by emergency medicine and trauma/acute care physicians. The Brain Injury Guidelines (BIG) were developed at an American College of Surgeons-accredited Level 1 trauma center to triage mild to moderate TBI patients and help identify patients who warrant neurosurgical consultation. The BIG have not been validated at a Level III trauma center. We hypothesized that BIG criteria can be safely adapted to an American College of Surgeons-accredited Level III trauma center to guide transfers to a higher echelon of care.
• Mathew, P. J., Jehan, F., Kulvatunyou, N., Khan, M., O'Keeffe, T., Tang, A., Gries, L., Hamidi, M., Zakaria, E. R., & Joseph, B. (2018). The burden of excess length of stay in trauma patients. American journal of surgery, 216(5), 881-885.
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  Disposition of trauma patients frequently results in excessive hospital-stay. The aim of this study was to assess the risk of developing complications due to excessive stay in the hospital.
• Mccusker, A., Khan, M., Kulvatunyou, N., Zeeshan, M., Sakran, J. V., Hayek, H., O'Keeffe, T., Hamidi, M., Tang, A., & Joseph, B. (2018). Sarcopenia defined by a computed tomography estimate of the psoas muscle area does not predict frailty in geriatric trauma patients. American journal of surgery.
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  The aim of our study was to assess the correlation between frailty & sarcopenia and impact of each condition on outcomes in geriatric trauma patients.
• Mehta, A., Dultz, L. A., Joseph, B., Canner, J. K., Stevens, K., Jones, C., Haut, E. R., Efron, D. T., & Sakran, J. V. (2018). Emergency general surgery in geriatric patients: A statewide analysis of surgeon and hospital volume with outcomes. The journal of trauma and acute care surgery, 84(6), 864-875.
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  Geriatric patients undergoing emergency general surgery (EGS) face significant morbidity and mortality. We assessed how surgeon and hospital volumes affected these outcomes.
• Mehta, A., Efron, D. T., Stevens, K., Manukyan, M. C., Joseph, B., & Sakran, J. V. (2018). Hospital variation in mortality after emergent bowel resections: The role of failure-to-rescue. The journal of trauma and acute care surgery, 84(5), 702-710.
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  Hospital variation in failure-to-rescue (FTR) rates has partially explained nationwide differences in mortality after elective surgeries. To examine the role of FTR among emergency general surgery, we compared nationwide risk-adjusted mortality, complications, and FTR rates after emergent bowel resections.
• Pandit, V., Khan, M., Zakaria, E. R., Largent-Milnes, T. M., Hamidi, M., O'Keeffe, T., Vanderah, T. W., & Joseph, B. (2018). Continuous remote ischemic conditioning attenuates cognitive and motor deficits from moderate traumatic brain injury. The journal of trauma and acute care surgery, 85(1), 48-53.
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  While studies show that single-dose remote ischemic conditioning (RIC) improves outcomes, the effect of continuous (daily) RIC is unknown. Thus, we aimed to investigate the role of continuous RIC on cognitive and motor function following traumatic brain injury (TBI).
• Riall, T. s., Jehan, F., & Joseph, B. A. (2018). Evaluating the Diagnostic Accuracy and Management Protocols: In Reply to Strasberg. Journal of the American College of Surgeons, 227(6), 624-626. doi:10.1016/j.jamcollsurg.2018.09.006
• Sakran, J. V., Mehta, A., Fransman, R., Nathens, A. B., Joseph, B., Kent, A., Haut, E. R., & Efron, D. T. (2018). Nationwide trends in mortality following penetrating trauma: Are we up for the challenge?. The journal of trauma and acute care surgery, 85(1), 160-166.
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  Despite a focus on improved prehospital care, penetrating injuries contribute substantially to trauma mortality in the United States. We therefore analyzed contemporary trends in prehospital mortality from penetrating trauma in the past decade.
• Stein, D. M., Kozar, R. A., Livingston, D. H., Luchette, F., Adams, S. D., Agrawal, V., Arbabi, S., Ballou, J., Barraco, R. D., Bernard, A. C., Biffl, W. L., Bosarge, P. L., Brasel, K. J., Cooper, Z., Efron, P. A., Fakhry, S. M., Hartline, C. A., Hwang, F., Joseph, B. A., , Kurek, S. J., et al. (2018). Geriatric traumatic brain injury-What we know and what we don't. The journal of trauma and acute care surgery, 85(4), 788-798.
• Swartz, T., Jehan, F., Tang, A., Gries, L., Zeeshan, M., Kulvatunyou, N., Hamidi, M., O'Keeffe, T., & Joseph, B. (2018). Prospective evaluation of low health literacy and its impact on outcomes in trauma patients. The journal of trauma and acute care surgery, 85(1), 187-192.
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  Health literacy is an emerging focus of interest in public health and is evolving as an important component of national health policy. Low health literacy (LHL) is associated with poor outcomes. We aimed to identify factors associated with LHL and its relationship with health outcomes in trauma patients.
• Zeeshan, M., Hamidi, M., Kulvatunyou, N., Jehan, F., O'Keeffe, T., Khan, M., Rashdan, L., Tang, A., Zakaria, E. R., & Joseph, B. (2018). 3-Factor Vs. 4-Factor PCC in Coagulopathy of Trauma: Four is Better Than Three. Shock (Augusta, Ga.).
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  Coagulopathy of trauma(COT) is common and highly lethal. Prothrombin complex concentrate(PCC) has been advocated for correction of COT. However, the difference in efficacy between 3-factor PCC(3-PCC) vs. 4-factor PCC(4-PCC) remains unclear. The aim of our study was to compare efficacy of 3-PCC vs. 4-PCC in COT.
• Zeeshan, M., Jehan, F., O'Keeffe, T., Khan, M., Zakaria, E. R., Hamidi, M., Gries, L., Kulvatunyou, N., & Joseph, B. (2018). The novel oral anticoagulants (NOACs) have worse outcomes compared with warfarin in patients with intracranial hemorrhage after TBI. The journal of trauma and acute care surgery, 85(5), 915-920.
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  Novel oral anticoagulant (NOAC) use is increasing in trauma patients. The reversal of these agents after hemorrhage is still evolving. The aim of our study was to evaluate outcomes after traumatic brain injury in patients on NOACs.
• Zeeshan, M., Khan, M., O'Keeffe, T., Pollack, N., Hamidi, M., Kulvatunyou, N., Sakran, J. V., Gries, L., & Joseph, B. (2018). Optimal timing of initiation of thromboprophylaxis in spine trauma managed operatively: A nationwide propensity-matched analysis of trauma quality improvement program. The journal of trauma and acute care surgery, 85(2), 387-392.
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  Patients with spinal trauma are at high risk for venous thromboembolic events (VTE). Guidelines recommend prophylactic anticoagulation but they are unclear on timing of initiation of thromboprophylaxis. The aim of our study was to assess the impact of early versus late initiation of venous thromboprophylaxis in patients with spinal trauma who underwent operative intervention.
• Azim, A., & Joseph, B. (2017). Re: Enteral nutrition in traumatic brain injury. The journal of trauma and acute care surgery, 82(3), 650-651.
• Azim, A., Jehan, F. S., Rhee, P., O'Keeffe, T., Tang, A., Vercruysse, G., Kulvatunyou, N., Latifi, R., & Joseph, B. (2017). Big for small: Validating brain injury guidelines in pediatric traumatic brain injury. The journal of trauma and acute care surgery, 83(6), 1200-1204.
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  Brain injury guidelines (BIG) were developed to reduce overutilization of neurosurgical consultation (NC) as well as computed tomography (CT) imaging. Currently, BIG have been successfully applied to adult populations, but the value of implementing these guidelines among pediatric patients remains unassessed. Therefore, the aim of this study was to evaluate the established BIG (BIG-1 category) for managing pediatric traumatic brain injury (TBI) patients with intracranial hemorrhage (ICH) without NC (no-NC).
• Boghossian, J. A., Joseph, B., Slepian, M. J., & Armstrong, D. G. (2017). Remote Ischemic ConditioningPromising Potential in Wound Repair in Diabetes?. Journal of the American Podiatric Medical Association, 107(4), 313-317.
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  Remote ischemic conditioning involves the use of a blood pressure cuff or similar device to induce brief (3-5 min) episodes of limb ischemia. This, in turn, seems to activate a group of distress signals that has shown the potential ability to improve healing of the heart muscle and other organ systems. Until recently, this has not been tested in people with diabetic foot ulcers. The purpose of this review was to provide background on remote ischemic conditioning and recent data to potentially support its use as an adjunct to healing diabetic foot ulcers and other types of tissue loss. We believe that this inexpensive therapy has the potential to be deployed and incorporated into a variety of other therapies to prime patients for healing and to reduce morbidity in patients with this common, complex, and costly complication.
• Cook, A. C., Joseph, B., Mohler, M. J., Inaba, K., Bruns, B. R., Nakonezny, P. A., Kerby, J. D., Brasel, K. J., Wolf, S. E., Cuschieri, J., Paulk, M. E., Rhodes, R. L., Brakenridge, S. C., Ekeh, A. P., & Phelan, H. A. (2017). Validation of a Geriatric Trauma Prognosis Calculator: A P.A.L.Li.A.T.E. Consortium Study. Journal of the American Geriatrics Society, 65(10), 2302-2307.
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  The P.A.L.Li.A.T.E. (prognostic assessment of life and limitations after trauma in the elderly) consortium has previously created a prognosis calculator for mortality after geriatric injury based on age, injury severity, and transfusion requirement called the geriatric trauma outcome score (GTOS). Here, we sought to create and validate a prognosis calculator called the geriatric trauma outcome score ii (GTOS II) estimating probability of unfavorable discharge.
• Cooper, Z., Maxwell, C. A., Fakhry, S. M., Joseph, B., Lundebjberg, N., Burke, P., & Baracco, R. (2017). A position paper: The convergence of aging and injury and the need for a Geriatric Trauma Coalition (GeriTraC). The journal of trauma and acute care surgery, 82(2), 419-422.
• Hassan, A., Jokar, T. O., Rhee, P., Ibraheem, K., Kulvatunyou, N., Anderson, K. T., Gries, L., Roward, Z. T., & Joseph, B. (2017). More Helmets Fewer Deaths: Motorcycle Helmet Legislation Impacts Traumatic Brain Injury-Related Mortality in Young Adults. The American surgeon, 83(6), 541-546.
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  The aim of our study was to assess the impact of helmet legislations on the incidence and the mortality rate of motorcycle collision (MCC)-related traumatic brain injury (TBI) in young adult trauma patients. A 1-year (2011) retrospective analysis was performed of all patients under 21 years old with trauma-related hospitalization using the Nationwide Inpatient Sample database (representing 20% of all in-patient admissions). Patients with MCC were identified using E-codes. States were classified into three groups based on helmet legislations: universal age helmet legislation,
• Jehan, F., Azim, A., Rhee, P., Khan, M., Gries, L., OʼKeeffe, T., Kulvatunyou, N., Tang, A., & Joseph, B. (2017). Decompressive craniectomy versus craniotomy only for intracranial hemorrhage evacuation: A propensity matched study. The journal of trauma and acute care surgery, 83(6), 1148-1153.
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  Decompressive craniectomy (DC) is often performed in conjunction with evacuation of intracranial hemorrhage (ICH) to control intracranial pressure (ICP) in patients with a traumatic brain injury (TBI). The efficacy of DC in lowering ICP is well established; however, its effect on clinical outcomes remains controversial. The aim of our study is to assess outcomes in TBI patients undergoing DC versus craniotomy only (CO) for the evacuation of ICH.
• Jehan, F., O'Keeffe, T., Khan, M., Chi, A., Tang, A., Kulvatunyou, N., Gries, L., & Joseph, B. (2017). Early thromboprophylaxis with low-molecular-weight heparin is safe in patients with pelvic fracture managed nonoperatively. The Journal of surgical research, 219, 360-365.
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  Early initiation of thromboprophylaxis is highly desired in pelvic fracture patients, but it is often delayed due to the fear of hemorrhage. Aim of our study was to assess the safety of early initiation of venous thromboprophylaxis in patients with pelvic trauma managed nonoperatively.
• Joseph, B. A. (2017). How does Marijuana Affect Outcomes After trauma in ICU Patients? A Propensity Matched Analysis. Journal of Trauma and Acute Care Surgery.
• Joseph, B., & Jehan, F. S. (2017). The Mobility and Impact of Frailty in the Intensive Care Unit. The Surgical clinics of North America, 97(6), 1199-1213.
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  Prevalence of pre-existing frailty in patients admitted to the intensive care unit (ICU) is increasing. Critical illness leads to a catabolic state that further diminishes body reserves and contributes to frailty independent of age and prehospital functional status. Because early mobilization of patients in the ICU results in accelerated recovery and improvement in functional status and quality of life, frailty can severely affect the mobility of patients in ICU ultimately prolonging recovery. Understanding the concept of frailty and the association of frailty and its impact on mobility in the ICU, identifying patients, and timely resource allocation helps in optimum care and improves clinical outcomes.
• Joseph, B., Azim, A., O'Keeffe, T., Ibraheem, K., Kulvatunyou, N., Tang, A., Vercruysse, G., Friese, R., Latifi, R., & Rhee, P. (2017). American College of Surgeons Level I trauma centers outcomes do not correlate with patients' perception of hospital experience. The journal of trauma and acute care surgery, 82(4), 722-727.
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  The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is a data collection methodology for measuring a patient's perception of his/her hospital experience, and it has been selected by the Centers of Medicare and Medicaid Services as the validated and transparent national survey tool with publicly available results. Since 2012, hospital reimbursements rates have been linked to HCAHPS data based on patient satisfaction scores. The aim of this study was, therefore, to assess whether HCAHPS scores of Level I trauma centers correlate with actual hospital performance.
• Joseph, B., Azim, A., Zangbar, B., Bauman, Z., OʼKeeffe, T., Ibraheem, K., Kulvatunyou, N., Tang, A., Latifi, R., & Rhee, P. (2017). Improving mortality in trauma laparotomy through the evolution of damage control resuscitation: Analysis of 1,030 consecutive trauma laparotomies. The journal of trauma and acute care surgery, 82(2), 328-333.
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  The aim of this study was to evaluate the related change in outcomes (mortality, complications) in patients undergoing trauma laparotomy (TL) with the implementation of damage control resuscitation (DCR). We hypothesized that the implementation of DCR in patients undergoing TL is associated with better outcomes.
• Joseph, B., Khalil, M., Hashmi, A., Hecker, L., Kulvatunyou, N., Tang, A., Friese, R. S., & Rhee, P. (2017). Survival benefits of remote ischemic conditioning in sepsis. The Journal of surgical research, 213, 131-137.
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  Sepsis remains the leading cause of death in the surgical intensive care unit. Prior studies have demonstrated a survival benefit of remote ischemic conditioning (RIC) in many disease states. The aim of this study was to determine the effects of RIC on survival in sepsis in an animal model and to assess alterations in inflammatory biochemical profiles. We hypothesized that RIC alters inflammatory biochemical profiles resulting in decreased mortality in a septic mouse model.
• Joseph, B., Orouji Jokar, T., Hassan, A., Azim, A., Mohler, M. J., Kulvatunyou, N., Siddiqi, S., Phelan, H., Fain, M., & Rhee, P. (2017). Redefining the association between old age and poor outcomes after trauma: The impact of frailty syndrome. The journal of trauma and acute care surgery, 82(3), 575-581.
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  Frailty syndrome (FS) is a well-established predictor of outcomes in geriatric patients. The aim of this study was to quantify the prevalence of FS in geriatric trauma patients and to determine its association with trauma readmissions, repeat falls, and mortality at 6 months.
• Joseph, B., Rhee, P., & Zangbar, B. (2017). Reply: Seasonal Variation in Emergency General Surgery: Why is February Underrepresented?. Annals of surgery, 266(6), e75.
• Joseph, B., Toosizadeh, N., Orouji Jokar, T., Heusser, M. R., Mohler, J., & Najafi, B. (2017). Upper-Extremity Function Predicts Adverse Health Outcomes among Older Adults Hospitalized for Ground-Level Falls. Gerontology, 63(4), 299-307.
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  Despite National Surgical Quality Improvement guidelines to integrate frailty into surgical elder assessments, a quick, accurate, and simple frailty assessment tool suitable for busy clinical settings is still not available. Recently, we have demonstrated that a simple upper-extremity function (UEF) test based on wearable sensors could identify frailty with high agreement with conventional assessments by testing 20-s repetitive elbow flexion and extension.
• Jurkovich, G. J., Davis, K. A., Burlew, C. C., Dente, C. J., Galante, J. M., Goodwin, J. S., Joseph, B., de Moya, M., Becher, R. D., & Pandit, V. (2017). Acute care surgery: An evolving paradigm. Current problems in surgery, 54(7), 364-395.
• Khan, M., Jehan, F., O'Keeffe, T., Pandit, V., Kulvatunyou, N., Tang, A., Gries, L., & Joseph, B. (2017). Primary repair for pediatric colonic injury: Are there differences among adult and pediatric trauma centers?. The Journal of surgical research, 220, 176-181.
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  Management of colonic injuries (colostomy [CO] versus primary anastomosis [PA]) among pediatric patients remains controversial. The aim of this study was to assess outcomes in pediatric trauma patient with colonic injury undergoing operative intervention.
• Khan, M., O'Keeffe, T., Jehan, F., Kulvatunyou, N., Kattaa, A., Gries, L., Tang, A., & Joseph, B. (2017). The impact of Glasgow Coma Scale-age prognosis score on geriatric traumatic brain injury outcomes. The Journal of surgical research, 216, 109-114.
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  As the population ages, increasing number of geriatric patients sustain traumatic brain injury (TBI). Communication of accurate prognostic information is crucial for making informed decisions on behalf of such patients. Therefore, the aim of our study was to develop a simple and clinically applicable tool that accurately predicts the prognosis in geriatric TBI patients.
• Khan, S. J., Desmarais, A. M., Joseph, B., & Amini, R. (2017). A Rare Case of Adult Onset Intussusception Complicated By Narcotic Dependence. Cureus, 9(1), e964.
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  This report describes a rare case of adult intussusception in a patient with a history of a Roux-en-Y gastric bypass procedure; complicated by a history of narcotic abuse, methadone dependence, and methamphetamine abuse. Adult patients who have undergone a Roux-en-Y gastric bypass procedure may be at an increased risk of developing intussusception, and clinicians involved in their care should be aware of this potential complication.
• Latifi, R., Samson, D., Haider, A., Azim, A., Iftikhar, H., Joseph, B., Tilley, E., Con, J., Gashi, S., & El-Menyar, A. (2017). Risk-adjusted adverse outcomes in complex abdominal wall hernia repair with biologic mesh: A case series of 140 patients. International journal of surgery (London, England), 43, 26-32.
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  Biologic mesh is preferred for repair of complex abdominal wall hernias (CAWHs) in patients at high risk of wound infection. We aimed to identify predictors of adverse outcomes after complex abdominal wall hernia repair (CAWR) using biologic mesh with different placement techniques and under different surgical settings.
• Lee, H., Joseph, B., Enriquez, A., & Najafi, B. (2017). Toward Using a Smartwatch to Monitor Frailty in a Hospital Setting: Using a Single Wrist-Wearable Sensor to Assess Frailty in Bedbound Inpatients. Gerontology.
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  While various objective tools have been validated for assessing physical frailty in the geriatric population, these are often unsuitable for busy clinics and mobility-impaired patients. Recently, we have developed a frailty meter (FM) using two wearable sensors, which allows capturing key frailty phenotypes (weakness, slowness, and exhaustion), by testing 20-s rapid elbow flexion-extension test.
• Madni, T. D., Ekeh, A. P., Brakenridge, S. C., Brasel, K. J., Joseph, B., Inaba, K., Bruns, B. R., Kerby, J. D., Cuschieri, J., Mohler, M. J., Nakonezny, P. A., Clark, A., Imran, J., Wolf, S. E., Paulk, M. E., Rhodes, R. L., & Phelan, H. A. (2017). A comparison of prognosis calculators for geriatric trauma: A Prognostic Assessment of Life and Limitations After Trauma in the Elderly consortium study. The journal of trauma and acute care surgery, 83(1), 90-96.
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  The nine-center Prognostic Assessment of Life and Limitations After Trauma in the Elderly consortium has validated the Geriatric Trauma Outcome Score (GTOS) as a prognosis calculator for injured elders. We compared GTOS' performance to that of the Trauma Injury Severity Score (TRISS) in a multicenter sample.
• Madni, T. D., Nakonezny, P. A., Wolf, S. E., Joseph, B., Mohler, M. J., Imran, J. B., Clark, A., Arnoldo, B. A., & Phelan, H. A. (2017). The Relationship Between Frailty and the Subjective Decision to Conduct a Goals of Care Discussion With Burned Elders. Journal of burn care & research : official publication of the American Burn Association.
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  Best practices are to conduct an early discussion of goals of care (GoC) after injury in the elderly, but this intervention is inconsistently applied. We hypothesized that a frail appearance was a factor in the decision to conduct a GoC discussion after thermal injury. A retrospective review was performed of all burn survivors aged ≥ 65 years at our ABA-verified level 1 burn center between April 02, 2009, and December 30, 2014. Demographic information included age, gender, mechanism of injury, percentage TBSA burned, revised Baux score, patient/physician racial discordance, documented GoC discussion (as defined within the electronic medical record), length of stay (LOS), and disposition. One rater retrospectively assigned clinical frailty scores to patients using the Canadian Study of Health and Aging Criteria, which ranged from 1 (very fit) to 7 (severely frail). Ordinal logistic regression was performed. Demographics for the cohort of 126 subjects were (mean ± SD): age = 75.5 ± 7.7 years, %TBSA burned = 11.9% ± 7.2, revised Baux = 87.8 ± 10.2, hospital LOS (days) = 14.9 ± 13.7, ICU LOS (days) = 6.2 ± 1.2, frailty score = 4.1 ± 1.1. Overall, 72% of geriatric survivors had a favorable discharge disposition. GoC discussions occurred in 25% of patients. GoC discussion (OR, 3.42; 95% CI, 1.54-7.60) and an unfavorable disposition (OR, 9.01; 95% CI, 3.91-20.78) were associated with greater predicted odds of receiving a higher ordered frailty score. Our results suggest that, even in the absence of a formal diagnosis, a frail appearance may influence a provider's decision to perform GoC discussions after severe thermal injury.
• Sandweiss, A. J., Azim, A., Ibraheem, K., Largent-Milnes, T. M., Rhee, P., Vanderah, T. W., & Joseph, B. (2017). Remote ischemic conditioning preserves cognition and motor coordination in a mouse model of traumatic brain injury. The journal of trauma and acute care surgery, 83(6), 1074-1081.
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  Management of traumatic brain injury (TBI) is focused on minimizing or preventing secondary brain injury. Remote ischemic conditioning (RIC) is an established treatment modality that has been shown to improve patient outcomes in different clinical settings by influencing inflammatory insults. In a clinical trial, RIC showed amelioration of SB100 and neuron-specific enolase. The aim of our study was to further elucidate the mechanisms and outcome when applying RIC in a mouse model of traumatic brain injury.
• Singer, M., Azim, A., O'Keeffe, T., Khan, M., Jain, A., Kulvatunyou, N., Gries, L., Jehan, F., Tang, A., & Joseph, B. (2017). How does marijuana affect outcomes after trauma in ICU patients? A propensity-matched analysis. The journal of trauma and acute care surgery, 83(5), 846-849.
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  In the United States, marijuana abuse and dependence are becoming more prevalent among adult and adolescent trauma patients. Unlike several studies that focus on the effects of marijuana on the outcomes of diseases, our aim was to assess the relationship between a positive toxicology screen for marijuana and mortality in such patients.
• Tignanelli, C. J., Joseph, B., Jakubus, J. L., Iskander, G. A., Napolitano, L. M., & Hemmila, M. R. (2017). Variability in Management of Blunt Liver Trauma and Contribution of Level of ACS-COT Verification Status on Mortality. The journal of trauma and acute care surgery.
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  Patients who sustain blunt liver trauma and are treated at an ACS-COT verified level 1 trauma center have an overall lower risk of mortality compared with patients admitted to a level 2 trauma center. However, elements contributing to these differences are unknown. We hypothesize that practice variation exists between trauma centers in management of blunt liver injury. Our objective is to identify practice variations and their effect on clinical outcomes.
• Azim, A., Haider, A. A., Rhee, P., Verma, K., Windell, E., Orouji Jokar, T., Kulvatunyou, N., Meer, M., Latifi, R., & Joseph, B. (2016). Early feeds not force feeds: enteral nutrition in traumatic brain injury. The journal of trauma and acute care surgery.
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  Brain Trauma Foundation guidelines recommend the early use of enteral nutrition to optimize recovery following traumatic brain injury (TBI). Our aim was to examine the effect of early feeds (≤24 hours) on clinical outcomes after TBI.
• Cook, A. C., Joseph, B., Inaba, K., Nakonezny, P. A., Bruns, B. R., Kerby, J. D., Brasel, K. J., Wolf, S. E., Cuschieri, J., Paulk, M. E., Rhodes, R. L., Brakenridge, S. C., & Phelan, H. A. (2016). Multicenter external validation of the Geriatric Trauma Outcome Score: A study by the Prognostic Assessment of Life and Limitations After Trauma in the Elderly (PALLIATE) consortium. The journal of trauma and acute care surgery, 80(2), 204-9.
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  A prognostic tool for geriatric mortality after injury called the Geriatric Trauma Outcome Score (GTOS), where GTOS = [age] + [ISS × 2.5] + [22 if transfused any PRBCs by 24 hours after admission], was previously developed based on 13 years of data from geriatric trauma patients admitted to Parkland Hospital. We sought to validate this model.
• Fortuna, G., DuBose, J. J., Mendelsberg, R., Inaba, K., Haider, A., Joseph, B., Skarupa, D., Selleck, M. J., OʼCallaghan, T. A., & Charlton-Ouw, K. (2016). Contemporary outcomes of lower extremity vascular repairs extending below the knee: A multicenter retrospective study. The journal of trauma and acute care surgery, 81(1), 63-70.
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  To determine the outcomes of vascular injury interventions extending below the knee.
• Galvagno, S. M., Smith, C. E., Varon, A. J., Hasenboehler, E. A., Sultan, S., Shaefer, G., To, K. B., Fox, A., Alley, D. E., Ditillo, M., Joseph, B. A., Robinson, B. R., & Haut, E. (2016). Pain management for blunt thoracic trauma: A joint practice management guideline from the eastern association for the surgery of trauma and trauma anesthesiology society. The journal of trauma and acute care surgery.
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  Thoracic trauma is the second most prevalent non-intentional injury in the United States, and is associated with significant morbidity. Analgesia for blunt thoracic trauma was first addressed by the Eastern Association for the Surgery of Trauma (EAST) with a practice management guideline published in 2005. Since that time, it was hypothesized that there have been advances in the analgesic management for blunt thoracic trauma. As a result, updated guidelines for this topic using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework recently adopted by EAST are presented.
• Hadeed, G., Smith, J., Okeeffe, T., Kulvatunyou, N., Wynne, J., Joseph, B. A., Friese, R., Wachtel, T., Rhee, P., Menyar, A., & Latifi, R. (2016). Early surgical intervention and its impact on patients presenting with necrotizing soft tissue infections: a single academic experience. Journal of Emergencies, Trauma and Shock, 1, 22-27.
• Haider, A. A., Azim, A., Rhee, P., Kulvatunyou, N., Ibraheem, K., Tang, A., O'Keeffe, T., Iftikhar, H., Vercruysse, G., & Joseph, B. (2016). Substituting systolic blood pressure with shock index in the National Trauma Triage Protocol. The journal of trauma and acute care surgery, 81(6), 1136-1141.
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  The National Trauma Triage Protocol (NTTP) is an algorithm that guides emergency medical services providers through four decision steps to identify the patients that would benefit from trauma center care. The NTTP defines a systolic blood pressure (SBP) of less than 90 mm Hg as one of the criteria for trauma center need. The aim of our study was to determine the impact of substituting SBP of less than 90 mm Hg with shock index (SI) on triage performance.
• Hodgman, E. I., Joseph, B., Mohler, J., Wolf, S. E., Paulk, M. E., Rhodes, R. L., Nakonezny, P. A., & Phelan, H. A. (2016). Creation of a decision aid for goal setting after geriatric burns: a study from the prognostic assessment of life and limitations after trauma in the elderly [PALLIATE] consortium. The journal of trauma and acute care surgery, 81(1), 168-72.
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  We hypothesized that a decision-support aid to predict index admission mortality and discharge disposition for geriatric burns could be constructed using the well-accepted Baux score (age +total body surface area burned) in a geriatric-specific cohort.
• Ibraheem, K., & Joseph, B. (2016). Role of computed tomography angiography in the management of Zone II penetrating neck trauma in patients with clinical hard signs. The journal of trauma and acute care surgery, 81(2), 400.
• Inaba, K., Aksoy, H., Seamon, M. J., Marks, J. A., Duchesne, J., Schroll, R., Fox, C. J., Pieracci, F. M., Moore, E. E., Joseph, B., Haider, A. A., Harvin, J. A., Lawless, R. A., Cannon, J., Holland, S. R., & Demetriades, D. (2016). Multicenter evaluation of temporary intravascular shunt use in vascular trauma. The journal of trauma and acute care surgery, 80(3), 359-64; discussion 364-5.
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  The indications and outcomes associated with temporary intravascular shunting (TIVS) for vascular trauma in the civilian sector are poorly understood. The objective of this study was to perform a contemporary multicenter review of TIVS use and outcomes.
• Inaba, K., Byerly, S., Bush, L. D., Martin, M. J., Martin, D., Peck, K. A., Barmparas, G., Bradley, M. J., Hazelton, J. P., Coimbra, R., Choudhry, A. J., Brown, C. V., Ball, C. G., Cherry-Bukowiec, J. R., Burlew, C. C., Joseph, B., Dunn, J., Minshall, C. T., Carrick, M. M., , Berg, G. M., et al. (2016). Cervical Spinal Clearance: A Prospective Western Trauma Association Multi-Institutional Trial. The journal of trauma and acute care surgery.
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  For blunt trauma patients who have failed the NEXUS low-risk criteria, the adequacy of CT as the definitive imaging modality for clearance remains controversial. The purpose of this study was to prospectively evaluate the accuracy of CT for the detection of clinically significant C-spine injury.
• Jie, T., Riall, T. S., Evan, O., Joseph, B. A., Mazhar, K., & Hassan, A. (2016). Comparative Analysis of Outcomes of Distal Pancreatectomy with or without Splenectomy Using the National Inpatient Sample. Journal of the Pancreas, 17(3), 241-246.
• Jokar, T. O., Khalil, M., Rhee, P., Kulvatunyou, N., Pandit, V., O'Keeffe, T., Tang, A., & Joseph, B. (2016). Ratio-based Resuscitation in Trauma Patients with Traumatic Brain Injury: Is There a Similar Effect?. The American surgeon, 82(3), 271-7.
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  The use of 1:1:1 (packed red blood cells: fresh frozen plasma: platelets) transfusion ratio has been shown to improve survival in severely injured trauma patients. The aim of this study was to assess the outcomes in patients with traumatic brain injury (TBI) receiving 1:1:1 ratio-based blood product transfusion (RBT). We hypothesized that RBT improves survival in patients with TBI as only major injury. We performed a 3-year retrospective analysis of all patients with TBI as only major injury presenting to our Level I trauma center. Patients receiving blood transfusion were included. Patients were stratified into two groups: those who received RBT and those who did not receive RBT (No-RBT). The outcome measure was inhospital mortality. Multivariate logistic regression analysis was performed. A total of 189 patients were included of which 29 per cent (n = 55) received RBT. The mean age was 48 ± 24 years, median (range) Glasgow Coma Scale score was 12 (3-15), and median head abbreviated injury severity scale was 3 (3-5). The overall mortality rate was 28.5 per cent. Patients in the RBT group had a higher survival rate compared with the patients in the No-RBT group (83.6% vs 66.5%, P = 0.02). In conclusion, the survival benefit of RBT exists even in patients with TBI as major injury. Guidelines for the initial management of TBI patients should focus on the use of RBT. The beneficial effect of platelets in RBT among TBI patients requires further evaluation.
• Jokar, t., Khalil, M., Rhee, P., Kulvatunyou, N., Pandit, v., Okeeffe, T. S., Tang, A., & Joseph, B. A. (2016). Ratio-based resuscitation in trauma patients with traumatic brain injury: Is there a similar effect. American Surgeon, 82(3), 271-277.
• Jokar, t., Khalil, M., Rhee, P., Kulvatunyou, N., Pandit, v., Okeeffe, T. S., Tang, A., & Joseph, B. A. (2016). Ratio-based resuscitation in trauma patients with traumatic brain injury: Is there a similiar effect. American Surgeon, 82(3), 271-277.
• Joseph, B. A., & Armstrong, D. G. (2016). Potential Perils of Peri-Pokémon Perambulation: The Dark Reality of Augmented Reality?. Oxford Medical Case Reports, 10, 265-266. doi:10.1093/omcr/omw080
• Joseph, B., & Armstrong, D. G. (2016). Potential perils of peri-Pokémon perambulation: the dark reality of augmented reality?. Oxford medical case reports, 2016(10), omw080.
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  Recently, the layering of augmented reality information on top of smartphone applications has created unprecedented user engagement and popularity. One augmented reality-based entertainment application, Pokémon Go (Pokémon Company, Tokyo, Japan) has become the most rapidly downloaded in history. This technology holds tremendous promise to promote ambulatory activity. However, there exists the obvious potential for distraction-related morbidity. We report two cases, presenting simultaneously to our trauma center, with injuries sustained secondary to gameplay with this augmented reality-based application.
• Joseph, B., Azim, A., Haider, A. A., Kulvatunyou, N., O'Keeffe, T., Hassan, A., Gries, L., Tran, E., Latifi, R., & Rhee, P. (2016). Bicycle helmets work when it matters the most. American journal of surgery.
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  Helmets are known to reduce the incidence of traumatic brain injury (TBI) after bicycle-related accidents. The aim of this study was to assess the association of helmets with severity of TBI and facial fractures after bicycle-related accidents.
• Joseph, B., Hadeed, G., Sadoun, M., Rhee, P. M., & Weinstein, R. S. (2016). Video consultation for trauma and emergency surgical patients. Critical care nursing quarterly, 35(4), 341-5.
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  The saying goes that a picture is worth a thousand words, but what then is the value of video? For the care of trauma and emergency surgical patients, the use of video consultation between medical providers may be worth its weight in gold. Telemedicine has become an important tool in reducing the disparity among the haves and the have not's, in this case facilities with a trauma service and those without. This article presents the use of live video for trauma consultations between the only level 1 trauma center in Southern Arizona and several smaller rural hospitals. We also expand on what we believe the future and direction of telesurgery in the fields of critical care and trauma surgery.
• Joseph, B., Hadeed, S., Haider, A. A., Ditillo, M., Joseph, A., Pandit, V., Kulvatunyou, N., Tang, A., Latifi, R., & Rhee, P. (2016). Obesity and trauma mortality: Sizing up the risks in motor vehicle crashes. Obesity research & clinical practice.
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  Protective effects of safety devices in obese motorists in motor vehicle collisions (MVC) remain unclear. Aim of our study is to assess the association between morbid obesity and mortality in MVC, and to determine the efficacy of protective devices. We hypothesised that patients with morbid obesity will be at greater risk of death after MVC.
• Joseph, B., Haider, A. A., Azim, A., Kulvatunyou, N., Tang, A., OʼKeeffe, T., Latifi, R., Green, D. J., Friese, R. S., & Rhee, P. (2016). THE IMPACT OF PATIENT PROTECTION AND AFFORDABLE CARE ACT ON TRAUMA CARE: A STEP IN THE RIGHT DIRECTION. The journal of trauma and acute care surgery.
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  The Patient Protection and Affordable Care Act (ACA) was implemented to guarantee financial coverage for health care for all Americans. The implementation of ACA is likely to influence the insurance status of Americans and reimbursement rates of trauma centers. The aim of this study was to assess the impact of ACA on the patient insurance status, hospital reimbursements and clinical outcomes at a Level I trauma center. We hypothesized that there would be a significant decrease in the proportion of uninsured trauma patients visiting our level I trauma center following the ACA and this is associated with improved reimbursement.
• Joseph, B., Haider, A., Hassan, A., Kulvatunyou, N., Bains, S., Tang, A., Zangbar, B., OʼKeeffe, T., Vercruysse, G., Gries, L., & Rhee, P. (2016). Injury prevention programs against distracted driving among students. The journal of trauma and acute care surgery, 81(1), 144-8.
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  Motor vehicle crashes are the leading cause of death and nonfatal injury among young adults. The aims of this study were to assess the magnitude of distracted driving (DD) among students and to examine the effectiveness of awareness campaign against DD. We hypothesized that DD is prevalent among students and educational efforts such as DD awareness campaign can effectively reduce it.
• Joseph, B., Haider, A., Ibraheem, K., Kulvatunyou, N., Tang, A., Azim, A., O'Keeffe, T., Gries, L., Vercruysse, G., & Rhee, P. (2016). Revitalizing Vital Signs: The Role of Delta Shock Index. Shock (Augusta, Ga.), 46(3 Suppl 1), 50-4.
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  Although variability in vital parameters has been shown to predict outcomes, the role of change in shock index (delta SI) as a predictive tool remains unknown.
• Joseph, B., Hassan, A., & Pandit, V. (2016). Frailty in trauma: A systematic review of the surgical literature for clinical assessment tools. The journal of trauma and acute care surgery, 81(4), 805.
• Joseph, B., Ibraheem, K., Haider, A. A., Kulvatunyou, N., Tang, A., O'Keeffe, T., Bauman, Z. M., Green, D. J., Latifi, R., & Rhee, P. (2016). Identifying potential utility of REBOA: An autopsy study. The journal of trauma and acute care surgery.
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  Resuscitative thoracotomy (RT) has been the standard therapy in patients with acute arrest due to hemorrhagic shock. However; with the development of resuscitative endovascular balloon occlusion of the aorta (REBOA), its role as a potential adjunct to a highly morbid intervention like RT is being discussed. The aim of this study was to identify patients that most likely would have potentially benefitted from REBOA use based on autopsy findings.
• Joseph, B., Ibraheem, K., Haider, A. A., Kulvatunyou, N., Tang, A., O'Keeffe, T., Bauman, Z. M., Green, D. J., Latifi, R., & Rhee, P. (2016). Identifying potential utility of resuscitative endovascular balloon occlusion of the aorta: An autopsy study. The journal of trauma and acute care surgery, 81(5 Suppl 2 Proceedings of the 2015 Military Health System Research Symposium), S128-S132.
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  Resuscitative thoracotomy (RT) has been the standard therapy in patients with acute arrest due to hemorrhagic shock. However, with the development of resuscitative endovascular balloon occlusion of the aorta (REBOA), its role as a potential adjunct to a highly morbid intervention such as RT is being discussed. The aim of this study was to identify patients who most likely would have potentially benefited from REBOA use based on autopsy findings.
• Joseph, B., Jokar, T. O., Khalil, M., Haider, A. A., Kulvatunyou, N., Zangbar, B., Tang, A., Zeeshan, M., O'Keeffe, T., Abbas, D., Latifi, R., & Rhee, P. (2016). Identifying the broken heart: predictors of mortality and morbidity in suspected blunt cardiac injury. American journal of surgery, 211(6), 982-8.
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  Blunt cardiac injury (BCI) is an infrequent but potentially fatal finding in thoracic trauma. Its clinical presentation is highly variable and patient characteristics and injury pattern have never been described in trauma patients. The aim of this study was to identify predictors of mortality in BCI patients.
• Joseph, B., Khalil, M., Harrison, C., Swartz, T., Kulvatunyou, N., Haider, A. A., Jokar, T. O., Burk, D., Mahmoud, A., Latifi, R., & Rhee, P. (2016). Assessing the Efficacy of Prothrombin Complex Concentrate in Multiply Injured Patients With High-Energy Pelvic and Extremity Fractures. Journal of orthopaedic trauma, 30(12), 653-658.
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  Prothrombin complex concentrate (PCC) is being increasingly used for reversing induced coagulopathy of trauma. However, the use of PCC for reversing coagulopathy in multiply injured patients with pelvic and/or lower extremity fractures remains unclear. The aim of our study was to assess the efficacy of PCC for reversing coagulopathy in this group of patients.
• Joseph, B., Pandit, V., & Aziz, H. (2016). Neurosurgeons' Critical Role in Managing Traumatic Brain Injury--Reply. JAMA surgery, 151(2), 200.
• Joseph, B., Parvaneh, S., Swartz, T., Haider, A., Hassan, A., Kulavatunyou, N., Tang, A., Latifi, R., Najafi, B., & Rhee, P. (2016). Stress among surgical attendings and trainees: A quantitative assessment during trauma activation and emergency surgeries. The journal of trauma and acute care surgery.
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  The adverse effects of stress on the wellness of trauma team members is well established, however, the level of stress has never been quantitatively assessed. The aim of our study was to assess the level of stress using subjective data and objective heart rate variability (HRV) among attending surgeons (AS), junior (JR) (PGY2/PGY3), and senior (SR) (PGY5/PGY6) residents during trauma activation and emergency surgery.
• Joseph, B., Phelan, H., Hassan, A., Jokar, T. O., O'Keeffe, T., Azim, A., Gries, L., Kulvatunyou, N., Latifi, R., & Rhee, P. (2016). The impact of frailty on failure-to-rescue in geriatric trauma patients: A prospective study. The journal of trauma and acute care surgery.
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  Failure-to-rescue (FTR) (defined as death from a major complication) is considered as an index of hospital quality in trauma patients. However, the role of frailty in FTR events remains unclear. We hypothesized that FTR rate is higher in elderly frail trauma patients.
• Joseph, B., Rhee, P., & Zangbar, B. (2016). Reply: Seasonal Variation in Emergency General Surgery: Why is February Underrepresented?. Annals of surgery.
• Joseph, B., Zangbar, B., Bains, S., Kulvatunyou, N., Khalil, M., Mahmoud, D., Friese, R. S., O'Keeffe, T., Pandit, V., & Rhee, P. (2016). Injury prevention programs against distracted driving: Are they effective?. Traffic injury prevention, 17(5), 460-4.
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  Distracted driving (talking and/or texting) is a growing public safety problem, with increasing incidence among adult drivers. The aim of this study was to identify the incidence of distracted driving (DD) among health care providers and to create awareness against DD. We hypothesized that distracted driving is prevalent among health care providers and a preventive campaign against distracted driving would effectively decrease distracted driving among health care providers.
• Joseph, B., Zangbar, B., Pandit, V., Fain, M., Mohler, M. J., Kulvatunyou, N., Jokar, T. O., O'Keeffe, T., Friese, R. S., & Rhee, P. (2016). Emergency General Surgery in the Elderly: Too Old or Too Frail?. Journal of the American College of Surgeons, 222(5), 805-13.
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  Assessment of operative risk in geriatric patients undergoing emergency general surgery (EGS) is challenging. Frailty is an established measure for risk assessment in elective surgical cases. Emerging literature suggests the superiority of frailty measurements to chronological age in predicting outcomes. The aim of this study was to assess the outcomes in elderly patients undergoing EGS using an established Rockwood frailty index.
• Khalil, M., Rhee, P., Jokar, T. O., Kulvatunyou, N., O'Keeffe, T., Tang, A., Hassan, A., Gries, L., Latifi, R., & Joseph, B. (2016). Antibiotics for appendicitis! Not so fast. The journal of trauma and acute care surgery, 80(6), 923-32.
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  Emerging literature in acute appendicitis favors the nonoperative management of acute appendicitis. However, the actual use of this practice on a national level is not assessed. The aim of this study was to assess the changing trends in nonoperative management of acute appendicitis and its effects on patient outcomes.
• Michailidou, M., Kulvatunyou, N., Joseph, B. A., Gries, L. M., Friese, R. S., Green, D., Okeeffe, T. S., Tang, A., Vercruysse, G., & Rhee, P. (2016). Blunt Bilateral diaphragmatic rupture- a right side can be easily missed. Trauma Case Reports.
• Mohammed Ilyas, M. I., Zangbar, B., Nfonsam, V. N., Maegawa, F. A., Joseph, B. A., Patel, J. A., & Wexner, S. D. (2016). Are there differences in outcome after elective sigmoidectomy for diverticular disease and for cancer? A national inpatient study. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland.
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  the postoperative outcome after elective sigmoidectomy for diverticulitis has not been compared to that for cancer. The study aimed to evaluate the differences in the postoperative outcome after sigmoidectomy for diverticular disease and cancer.
• Nfonsam, V., Aziz, H., Pandit, V., Khalil, M., Jandova, J., & Joseph, B. (2016). Analyzing clinical outcomes in laparoscopic right vs. left colectomy in colon cancer patients using the NSQIP database. Cancer treatment communications, 8, 1-4.
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  Optimization of surgical outcomes after colectomy continues to be actively studied, but most studies group right-sided and left-sided colectomies together. The aim of our study was to determine whether the complication rate differs between right-sided and left-sided colectomies for cancer.
• Orouji Jokar, T., Ibraheem, K., Rhee, P., Kulavatunyou, N., Haider, A., Phelan, H. A., Fain, M., Mohler, M. J., & Joseph, B. (2016). Emergency general surgery specific frailty index: A validation study. The journal of trauma and acute care surgery, 81(2), 254-60.
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  Assessment of operative risk in geriatric patients undergoing emergency general surgery (EGS) is challenging. Frailty is an established measure for risk assessment in surgical cases. The aim of our study was to validate a modified 15-variable EGS-specific frailty index (EGSFI).
• Pandit, V., Khalil, M., Joseph, B., Jandova, J., Jokar, T. O., Haider, A. A., Zangbar, B., Asim, A., Hassan, A., & Nfonsam, V. (2016). Disparities in Mangement of Patients with Benign Colorectal Disease: Impact of Urbanization and Specialized Care. The American surgeon, 82(11), 1046-1051.
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  Disparities in the management of patients with various medical conditions are well established. Colorectal diseases continue to remain one of the most common causes for surgical intervention. The aim of this study was to assess disparities (rural versus urban) in the surgical management of patients with noncancerous benign colorectal diseases. We hypothesized that there is no difference among rural versus urban centers (UC) in the surgical management for noncancerous benign colorectal diseases. The national estimates of surgical procedures for benign colorectal diseases from the National Inpatient Sample database 2011 representing 20 per cent of all in-patient admissions were abstracted. Patients undergoing procedures (abscess drainage, hemmoroidectomy, fistulectomy, and bowel resections) were included. Patients with colon cancer and those who underwent emergency surgery were excluded. The population was divided into two groups: urban and rural, based on the location of treatment. Outcome measures were in-hospital complications, mortality, and hospital costs. Subanalysis of UC was preformed: centers with colorectal surgeons and centers without colorectal surgeons. Regression analysis was performed. A total of 20,617 patients who underwent surgical intervention for benign colorectal diseases across 496 (urban: 342, rural: 154) centers, were included. Of the UC, 38.3 per cent centers had colorectal surgeons. Patients managed in UC had lower complication rate (7.6% vs 10.2%, P < 0.001), shorter hospital length of stay (4.7 ± 3.1 vs 5.9 ± 3.6 days, P < 0.001), and higher hospital costs ($56,820 ± $27,691 vs $49,341 ± $2,598, P < 0.001) compared with rural centers. On subanalysis, patients managed in UC with colorectal surgeons had 11 per cent lower incidence of in-hospital complications [odds ratio: 0.89 (95% confidence interval: 0.76-0.94)] and a shorter hospital length of stay [Beta: -0.72 (95% confidence interval: -0.81 to -0.65)] when compared with patients managed in UC without colorectal specialization. Disparities exit in outcomes of the patients with noncancerous benign colorectal diseases managed surgically in urban versus rural centers. Specialized care with colorectal surgeons at UC helps reduce adverse patient outcomes. Steps to provide effective and safe surgical care in a cost-effective manner across rural as well as UC are warranted.
• Rhee, P. M., Moore, E. E., Joseph, B., Tang, A., Pandit, V., & Vercruysse, G. (2016). Gunshot wounds: A review of ballistics, bullets, weapons, and myths. The journal of trauma and acute care surgery, 80(6), 853-67.
• Rhee, P., Moore, E. E., Joseph, B., Tang, A., & Vercruysse, G. (2016). Re: The term 'shrapnel' is perfectly appropriate in modern usage. The journal of trauma and acute care surgery.
• Safavi, A., Skarsgard, E. D., Rhee, P., Zangbar, B., Kulvatunyou, N., Tang, A., O'Keeffe, T., Friese, R. S., & Joseph, B. (2016). Trauma center variation in the management of pediatric patients with blunt abdominal solid organ injury: a national trauma data bank analysis. Journal of pediatric surgery, 51(3), 499-502.
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  Nonoperative management of hemodynamically stable children with Solid Organ Injury (SOI) has become standard of care. The aim of this study is to identify differences in management of children with SOI treated at Adult Trauma Centers (ATC) versus Pediatric Trauma Centers (PTC). We hypothesized that patients treated at ATC would undergo more procedures than PTC.
• Safavi, A., Skarsgard, E., Rhee, P., Zangbar, B., Kulvatunyou, N., Tang, A., Friese, R. S., Okeeffe, T. S., Joseph, B. A., Safavi, A., Skarsgard, E., Rhee, P., Zangbar, B., Kulvatunyou, N., Tang, A., Friese, R. S., Okeeffe, T. S., & Joseph, B. A. (2016). Trauma Center Variation in the Management of Pediatric Patients with Blunt Abdominal Solid Organ Injury: A National Trauma Data Bank Analysis. Journal of Pediatric surgery.
• Toosizadeh, N., Joseph, B., Heusser, M. R., Orouji Jokar, T., Mohler, J., Phelan, H. A., & Najafi, B. (2016). Assessing Upper-Extremity Motion: An Innovative, Objective Method to Identify Frailty in Older Bed-Bound Trauma Patients. Journal of the American College of Surgeons, 223(2), 240-8.
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  Despite increasing evidence that assessing frailty facilitates medical decision-making, a quick and clinically simple frailty assessment tool is not available for trauma settings.
• Zangbar, B., Khalil, M., Gruessner, A., Joseph, B., Friese, R., Kulvatunyou, N., Wynne, J., Latifi, R., Rhee, P., & O'Keeffe, T. (2016). Levetiracetam Prophylaxis for Post-traumatic Brain Injury Seizures is Ineffective: A Propensity Score Analysis. World journal of surgery.
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  Early seizures after severe traumatic brain injury (TBI) have a reported incidence of up to 15 %. Prophylaxis for early seizures using 1 week of phenytoin is considered standard of care for seizure prevention. However, many centers have substituted the anticonvulsant levetiracetam without good data on the efficacy of this approach. Our hypothesis was that the treatment with levetiracetam is not effective in preventing early post-traumatic seizures.
• Zangbar, B., Khalil, M., Rhee, P., Joseph, B., Kulvatunyou, N., Tang, A., Friese, R. S., & O'Keeffe, T. (2016). Metoprolol improves survival in severe traumatic brain injury independent of heart rate control. The Journal of surgical research, 200(2), 586-92.
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  Multiple prior studies have suggested an association between survival and beta-blocker administration in patients with severe traumatic brain injury (TBI). However, it is unknown whether this benefit of beta-blockers is dependent on heart rate control. The aim of this study was to assess whether rate control affects survival in patients receiving metoprolol with severe TBI. Our hypothesis was that improved survival from beta-blockade would be associated with a reduction in heart rate.
• Zangbar, B., Rhee, P., Pandit, V., Hsu, C., Khalil, M., Okeefe, T., Neumayer, L., & Joseph, B. (2016). Seasonal Variation in Emergency General Surgery. Annals of surgery, 263(1), 76-81.
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  The aim of this study was to assess the seasonal variation in emergency general surgery (EGS) admissions.
• Zangbar, B., Serack, B., Rhee, P., Joseph, B., Pandit, V., Friese, R. S., Haider, A. A., & Tang, A. L. (2016). Outcomes in Trauma Patients with Isolated Epidural Hemorrhage: A Single-Institution Retrospective Cohort Study. The American surgeon, 82(12), 1209-1214.
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  The type, location, and size of intracranial hemorrhage are known to be associated with variable outcomes in patients with traumatic brain injury (TBI). The aim of our study was to assess the outcomes in patients with isolated epidural hemorrhage (EDH) based on the location of EDH. We performed a 3-year (2010-2012) retrospective chart review of the patients with TBI in our level 1 trauma center. Patients with an isolated EDH on initial head CT scan were included. Patients were divided into four groups based on the location of EDH: frontal, parietal, temporal, and occipital. Differences in demographics and outcomes between the four groups were assessed. Outcome measures were progression on repeat head CT and neurosurgical intervention (NI). A total of 76 patients were included in this study. The mean age was 20.6 ± 15.2 years, 68.4 per cent were male, median Glasgow Coma Scale (GCS) score 15 (13-15), and median head Abbreviated Injury Scale score was 3 (2-4). About 32.9 per cent patients (n = 25) had frontal EDH, 26.3 per cent (n = 20) had temporal EDH, 10.5 per cent (n = 8) had occipital EDH, while the remaining 30.3 per cent (n = 23) had parietal EDH. The overall progression rate was 21.1 per cent (n = 12) and NI rate was 29 per cent (n = 22). There was no difference in the outcome of patients based on location of EDH. Patients with NI had a longer hospital length of stay (P = 0.02) and longer intensive care unit length of stay (P = 0.05). The incidence of isolated EDH is low in patients with blunt TBI. Patients with isolated EDH undergoing NI have longer hospital stays compared to patients without NI. Further investigation is warranted to identify factors associated with need for NI and adverse outcomes in the cohort of patients with isolated EDH.
• Asmar, S., Bible, L., Chehab, M., Tang, A., Khurrum, M., Castanon, L., Ditillo, M., Douglas, M., & Joseph, B. (2021). Traumatic brain injury induced temperature dysregulation: What is the role of β blockers?. The journal of trauma and acute care surgery, 90(1), 177-184.
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  Traumatic brain injury (TBI) is associated with sympathetic discharge that leads to posttraumatic hyperthermia (PTH). Beta blockers (ββ) are known to counteract overactive sympathetic discharge. The aim of our study was to evaluate the effect of ββ on PTH in critically-ill TBI patients.
• Aziz, H., Pandit, V., Joseph, B., Jie, T., & Ong, E. (2015). Age and Obesity are Independent Predictors of Bile Duct Injuries in Patients Undergoing Laparoscopic Cholecystectomy. World journal of surgery, 39(7), 1804-8.
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  Iatrogenic bile duct injury is a serious complication of cholecystectomy. The aim of this study was to assess predictors of bile duct injury using a national database.
• Aziz, H., Pandit, V., Joseph, B., Jie, T., & Ong, E. (2015). Erratum to: Age and Obesity are Independent Predictors of Bile Duct Injuries in Patients Undergoing Laparoscopic Cholecystectomy. World journal of surgery, 39(7), 1809.
• Aziz, H., Rhee, P., Pandit, V., Tang, A., Gries, L., & Joseph, B. (2015). The current concepts in management of animal (dog, cat, snake, scorpion) and human bite wounds. The journal of trauma and acute care surgery, 78(3), 641-8.
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  Animal and human bite wounds represent a significant global health issue. In the United States, animal and human bites are a very common health issue, causing significant morbidity and even, in rare scenarios, mortality. Most animal bite wounds in the United States are caused by dogs, with cat bites being a distant second. Human bite wounds constitute a dominant subset of all bite wounds. Several studies of bite wounds have reported improved outcomes with early diagnosis and immediate treatment. However, the available literature on the initial treatment provides a plethora of conflicting opinions and results. In this review, our aim was to identify and assess the current evidence on the management of animal (dog, cat, insects, scorpions, and snakes) and human bite wounds.
• Aziz, H., Siordia, J. A., Rhee, P., Pandit, V., O'Keeffe, T., Kulvatunyou, N., & Joseph, B. (2015). Analyzing the effects of alcohol on adolescent trauma using the National Trauma Data Bank. The journal of trauma and acute care surgery, 79(3), 463-7.
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  Alcohol misuse is an important source of preventable injuries in the adolescent population. The aim of our study was to assess the effect of alcohol in adolescent trauma outcomes.
• Bauman, Z. M., Kulvatunyou, N., Joseph, B., Jain, A., Friese, R. S., Gries, L., O'Keeffe, T., Tang, A. L., Vercruysse, G., & Rhee, P. (2018). A Prospective Study of 7-Year Experience Using Percutaneous 14-French Pigtail Catheters for Traumatic Hemothorax/Hemopneumothorax at a Level-1 Trauma Center: Size Still Does Not Matter. World journal of surgery, 42(1), 107-113.
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  The effectiveness of 14-French (14F) pigtail catheters (PCs) compared to 32-40F chest tubes (CTs) in patients with traumatic hemothorax (HTX) and hemopneumothorax (HPTX) is becoming more well known but still lacking. The aim of our study was to analyze our cumulative experience and outcomes with PCs in patients with traumatic HTX/HPTX. We hypothesized that PCs would be as effective as CTs.
• Branco, B., Branco, B., De Vitis, J., De Vitis, J., Joseph, B. A., Joseph, B. A., Kulvatunyou, N., Kulvatunyou, N., Tang, A., Tang, A., Friese, R. S., Friese, R. S., Rhee, P., Rhee, P., Okeeffe, T. S., Okeeffe, T. S., Branco, B., De Vitis, J., Joseph, B. A., , Kulvatunyou, N., et al. (2015). Financial implications of early tracheostomy in the healthcare cost containment era. Panamerican Journal of Trauma, Critical Care and Emergency Surgery, 4(3), 1-8.
• Haider, A. A., Rhee, P., Orouji, T., Kulvatunyou, N., Hassanzadeh, T., Tang, A., Farman, A., O'Keeffe, T., Latifi, R., & Joseph, B. (2015). A second look at the utility of serial routine repeat computed tomographic scans in patients with traumatic brain injury. American journal of surgery, 210(6), 1088-94.
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  The practice of a routine repeat head computed tomographic scans in patients with traumatic brain injury (TBI) is under question. The aim of our study was to evaluate the utility of a more than 1 repeat head computed tomography (M1CT) scans in patients with TBI.
• Ibraheem, K., Khan, M., Rhee, P., Azim, A., O'Keeffe, T., Tang, A., Kulvatunyou, N., & Joseph, B. (2018). "No zone" approach in penetrating neck trauma reduces unnecessary computed tomography angiography and negative explorations. The Journal of surgical research, 221, 113-120.
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  The most recent management guidelines advocate computed tomography angiography (CTA) for any suspected vascular or aero-digestive injuries in all zones and give zone II injuries special consideration. We hypothesized that physical examination can safely guide CTA use in a "no zone" approach.
• Jehan, F., Khan, M., Sakran, J. V., Khreiss, M., O'Keeffe, T., Chi, A., Kulvatunyou, N., Jain, A., Zakaria, E. R., & Joseph, B. (2018). Perioperative glycemic control and postoperative complications in patients undergoing emergency general surgery: What is the role of Plasma Hemoglobin A1c?. The journal of trauma and acute care surgery, 84(1), 112-117.
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  Plasma hemoglobin A1c (HbA1c) reflects quality of glucose control in diabetic patients. Literature reports that patients undergoing surgery with an elevated HbA1c level are associated with increased postoperative morbidity and mortality. The aim of our study was to evaluate the impact of HbA1c level on outcomes after emergency general surgery (EGS).
• Jehan, F., Pandit, V., O'Keeffe, T., Azim, A., Jain, A., Tai, S. A., Tang, A., Khan, M., Kulvatunyou, N., Gries, L., & Joseph, B. (2018). The burden of firearm violence in the United States: stricter laws result in safer states. Journal of injury & violence research, 10(1).
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  Increasing firearm violence has resulted in a strong drive for stricter firearm legislations. Aim of this study was to determine the relationship between firearm legislations and firearm-related injuries across states in the United States.
• Jehan, F., Zeeshan, M., Con, J., Hanna, K., Tang, A., Hamidi, M., Latifi, R., & Joseph, B. (2020). Metabolic Syndrome Exponentially Increases the Risk of Adverse Outcomes in Operative Diverticulitis. The Journal of surgical research, 245, 544-551.
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  Metabolic syndrome (MS) is defined as the cluster: hypertension, obesity, and diabetes. Operative diverticulitis in the setting of MS can be challenging to manage. The aim of our study was to evaluate the impact of MS on outcomes in operative acute diverticulitis patients.
• Joseph, B. A., Kahlil, M., & Rhee, P. (2015). Penetrating Injuries to the Spleen and Kidney: An Evolution of Progress. Current Trauma Reports.
• Joseph, B., Haider, A. A., Pandit, V., Kulvatunyou, N., Orouji, T., Khreiss, M., Tang, A., O'Keeffe, T., Friese, R., & Rhee, P. (2015). Impact of Hemorrhagic Shock on Pituitary Function. Journal of the American College of Surgeons, 221(2), 502-8.
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  Hypopituitarism after hypovolemic shock is well established in certain patient cohorts. However; the effects of hemorrhagic shock on pituitary function in trauma patients remains unknown. The aim of this study was to assess pituitary hormone variations in trauma patients with hemorrhagic shock.
• Joseph, B., Haider, A. A., Pandit, V., Tang, A., Kulvatunyou, N., OʼKeeffe, T., & Rhee, P. (2015). Changing paradigms in the management of 2184 patients with traumatic brain injury. Annals of surgery, 262(3), 440-8; discussion 446-8.
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  The aim of this study was to assess the change in trends in the management of traumatic brain injury (TBI) at a level I trauma center and the utilization of resources as a result of this change in management.
• Joseph, B., Haider, A., & Rhee, P. (2015). Traumatic brain injury advancements. Current opinion in critical care, 21(6), 506-11.
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  Traumatic brain injury (TBI) remains the leading cause of morbidity and mortality in the United States. Over the last decade, several advancements have been made in the field of TBI all aimed at improving outcomes.
• Joseph, B., Khalil, M., Pandit, V., Kulvatunyou, N., Zangbar, B., O'Keeffe, T., Asif, A., Tang, A., Green, D. J., Gries, L., Friese, R. S., & Rhee, P. (2015). Adverse effects of admission blood alcohol on long-term cognitive function in patients with traumatic brain injury. The journal of trauma and acute care surgery, 78(2), 403-8.
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  Alcohol is known to be protective in patients with traumatic brain injury (TBI); however, its impact on the long-term cognitive function is unknown. We hypothesize that intoxication at the time of injury is associated with adverse long-term cognitive function in patients sustaining TBI.
• Joseph, B., Khalil, M., Pandit, V., Orouji Jokar, T., Cheaito, A., Kulvatunyou, N., Tang, A., O'Keeffe, T., Vercruysse, G., Green, D. J., Friese, R. S., & Rhee, P. (2015). Increasing organ donation after cardiac death in trauma patients. American journal of surgery, 210(3), 468-72.
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  Organ donation after cardiac death (DCD) is not optimal but still remains a valuable source of organ donation in trauma donors. The aim of this study was to assess national trends in DCD from trauma patients.
• Joseph, B., Khalil, M., Zangbar, B., Kulvatunyou, N., Orouji, T., Pandit, V., O'Keeffe, T., Tang, A., Gries, L., Friese, R. S., Rhee, P., & Davis, J. W. (2015). Prevalence of Domestic Violence Among Trauma Patients. JAMA surgery, 150(12), 1177-83.
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  Domestic violence is an extremely underreported crime and a growing social problem in the United States. However, the true burden of the problem remains unknown.
• Joseph, B., Khan, M., & Rhee, P. (2018). Non-invasive diagnosis and treatment strategies for traumatic brain injury: an update. Journal of neuroscience research.
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  Traumatic Brain Injury (TBI) remains the leading cause of morbidity and mortality in U.S. Since the last decade, there have been several advances in the understanding and management of TBI that have shown the potential to improve outcomes. The aim of this review is to provide a useful overview of these potential diagnostic and treatment strategies that have yet to be proven, along with an assessment of their impact on outcomes after a TBI.
• Joseph, B., Pandit, V., Aziz, H., Kulvatunyou, N., Zangbar, B., Green, D. J., Haider, A., Tang, A., O'Keeffe, T., Gries, L., Friese, R. S., & Rhee, P. (2015). Mild traumatic brain injury defined by Glasgow Coma Scale: Is it really mild?. Brain injury, 29(1), 11-6.
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  Conventionally, a Glasgow Coma Scale (GCS) score of 13-15 defines mild traumatic brain injury (mTBI). The aim of this study was to identify the factors that predict progression on repeat head computed tomography (RHCT) and neurosurgical intervention (NSI) in patients categorized as mild TBI with intracranial injury (intracranial haemorrhage and/or skull fracture).
• Joseph, B., Pandit, V., Aziz, H., Kulvatunyou, N., Zangbar, B., Tang, A., O' Keeffe, T., Jehangir, Q., Snyder, K., & Rhee, P. (2015). Transforming hemoglobin measurement in trauma patients: noninvasive spot check hemoglobin. Journal of the American College of Surgeons, 220(1), 93-8.
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  Technological advances now allow for noninvasive Hbg measurements. Previous studies have reported on the efficacy of continuous noninvasive Hgb devices. Recently, a new device, Pronto-7, a spot check pulse CO-oximeter has become available. The aim of our study was to assess noninvasive Hgb measurement in trauma patients.
• Joseph, B., Pandit, V., Haider, A. A., Kulvatunyou, N., Zangbar, B., Tang, A., Aziz, H., Vercruysse, G., O'Keeffe, T., Freise, R. S., & Rhee, P. (2015). Improving Hospital Quality and Costs in Nonoperative Traumatic Brain Injury: The Role of Acute Care Surgeons. JAMA surgery, 150(9), 866-72.
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  The role of acute care surgeons is evolving; however, no guidelines exist for the selective treatment of patients with traumatic brain injury (TBI) exclusively by acute care surgeons. We implemented the Brain Injury Guidelines (BIG) for managing TBI at our institution on March 1, 2012.
• Joseph, B., Pandit, V., Harrison, C., Lubin, D., Kulvatunyou, N., Zangbar, B., Tang, A., O'Keeffe, T., Green, D. J., Gries, L., Friese, R. S., & Rhee, P. (2015). Early thromboembolic prophylaxis in patients with blunt solid abdominal organ injuries undergoing nonoperative management: is it safe?. American journal of surgery, 209(1), 194-8.
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  The aim of this study was to compare the safety of early (≤48 hours), intermediate (48 to 72 hours), and late (≥72 hours) venous thromboembolism prophylaxis in patients with blunt abdominal solid organ injury managed nonoperatively.
• Joseph, B., Pandit, V., Khalil, M., Kulvatunyou, N., Aziz, H., Tang, A., OʼKeeffe, T., Hays, D., Gries, L., Lemole, M., Friese, R. S., & Rhee, P. (2015). Use of prothrombin complex concentrate as an adjunct to fresh frozen plasma shortens time to craniotomy in traumatic brain injury patients. Neurosurgery, 76(5), 601-7; discussion 607.
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  The use of prothrombin complex concentrate (PCC) to reverse acquired (coagulopathy of trauma) and induced coagulopathy (preinjury warfarin use) is well defined.
• Joseph, B., Pandit, V., Khalil, M., Kulvatunyou, N., Zangbar, B., Friese, R. S., Mohler, M. J., Fain, M. J., & Rhee, P. (2015). Managing older adults with ground-level falls admitted to a trauma service: the effect of frailty. Journal of the American Geriatrics Society, 63(4), 745-9.
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  To determine whether frail elderly adults are at greater risk of fracture after a ground-level fall (GLF) than those who are not frail.
• Joseph, B., Pandit, V., Zangbar, B., Kulvatunyou, N., Khalil, M., Tang, A., O'Keeffe, T., Gries, L., Vercruysse, G., Friese, R. S., & Rhee, P. (2015). Secondary brain injury in trauma patients: the effects of remote ischemic conditioning. The journal of trauma and acute care surgery, 78(4), 698-703; discussion 703-5.
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  Management of traumatic brain injury (TBI) is focused on preventing secondary brain injury. Remote ischemic conditioning (RIC) is an established treatment modality that has been shown to improve patient outcomes secondary to inflammatory insults. The aim of our study was to assess whether RIC in trauma patients with severe TBI could reduce secondary brain injury.
• Joseph, B., Rawashdeh, B., Aziz, H., Kulvatunyou, N., Pandit, V., Jehangir, Q., O'Keeffe, T., Tang, A., Green, D. J., Friese, R. S., & Rhee, P. (2015). An acute care surgery dilemma: emergent laparoscopic cholecystectomy in patients on aspirin therapy. American journal of surgery, 209(4), 689-94.
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  The current literature regarding hemorrhagic complications in patients on long-term antiplatelet therapy undergoing emergent laparoscopic cholecystectomy is limited. The aim of our study was to describe hemorrhagic complications in patients on prehospital aspirin (ASP) therapy undergoing emergent cholecystectomy.
• Joseph, B., Zangbar, B., Haider, A. A., Kulvatunyou, N., Khalil, M., Tang, A., O'Keeffe, T., Friese, R. S., Orouji Jokar, T., Vercruysse, G., Latifi, R., & Rhee, P. (2015). Hips don't lie: Waist-to-hip ratio in trauma patients. The journal of trauma and acute care surgery, 79(6), 1055-61.
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  Obesity measured by body mass index (BMI) is known to be associated with worse outcomes in trauma patients. Recent studies have assessed the impact of distribution of body fat measured by waist-hip ratio (WHR) on outcomes in nontrauma patients. The aim of this study was to assess the impact of distribution of body fat (WHR) on outcomes in trauma patients.
• Joseph, B., Zangbar, B., Khalil, M., Kulvatunyou, N., Haider, A. A., O'Keeffe, T., Tang, A., Vercruysse, G., Friese, R. S., & Rhee, P. (2015). Factors associated with failure-to-rescue in patients undergoing trauma laparotomy. Surgery, 158(2), 393-8.
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  Quality improvement initiatives have focused primarily on preventing in-hospital complications. Patients developing complications are at a greater risk of mortality; however, factors associated with failure-to-rescue (death after major complication) in trauma patients remain undefined. The aim of this study was to identify risk factors associated with failure-to-rescue in patients undergoing trauma laparotomy.
• Khalil, M., Pandit, V., Rhee, P., Kulvatunyou, N., Orouji, T., Tang, A., O'Keeffe, T., Gries, L., Vercruysse, G., Friese, R. S., & Joseph, B. (2015). Certified acute care surgery programs improve outcomes in patients undergoing emergency surgery: A nationwide analysis. The journal of trauma and acute care surgery, 79(1), 60-3; discussion 64.
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  Differences in outcomes among trauma centers (TCs) and non-TCs (NTCs) in patients undergoing emergency general surgery (EGS) are well established. However; the impact of development of certified acute care surgery (ACS) programs on patient outcomes remains unknown. The aim of this study was to evaluate outcomes in patients undergoing EGS across TCs, NTCs, and TCs with ACS (ACS-TC).
• Khan, M., Azim, A., O'Keeffe, T., Jehan, F., Kulvatunyou, N., Santino, C., Tang, A., Vercruysse, G., Gries, L., & Joseph, B. (2018). Geriatric rescue after surgery (GRAS) score to predict failure-to-rescue in geriatric emergency general surgery patients. American journal of surgery, 215(1), 53-57.
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  Geriatric-patients(GP) undergoing emergency-general-surgery(EGS) are vulnerable to develop adverse-outcomes. Impact of patient-level-factors on Failure-to-Rescue(FTR) in EGS-GP remains unclear. Aim of our study was to determine factors associated with FTR(death from major-complication) and devise simple-bedside-score that predicts FTR in EGS-GP.
• Kulvatunyou, N., Pandit, V., Moutamn, S., Inaba, K., Chouliaras, K., DeMoya, M., Naraghi, L., Kalb, B., Arif, H., Sravanthi, R., Joseph, B., Gries, L., Tang, A. L., & Rhee, P. (2015). A multi-institution prospective observational study of small bowel obstruction: Clinical and computerized tomography predictors of which patients may require early surgery. The journal of trauma and acute care surgery, 79(3), 393-8.
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  For patients with adhesive small bowel obstruction (ASBO), early surgery after a failed trial of nonoperative treatment can improve outcome. However, deciding which patients require early surgery is difficult, given the lack of specific clinical or radiographic signs. The study goals were to identify clinical and computed tomography (CT) predictors of which patients may need early surgery and to evaluate the utility of the common CT findings.
• Lokhandwala, A., Hanna, K., Gries, L., Zeeshan, M., Ditillo, M., Tang, A., Hamidi, M., & Joseph, B. (2020). Preinjury Statins Are Associated With Improved Survival in Patients With Traumatic Brain Injury. The Journal of surgical research, 245, 367-372.
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  Statins have been shown to improve outcomes in traumatic brain injury (TBI) in animal models. The aim of our study was to determine the effect of preinjury statins on outcomes in TBI patients.
• Michailidou, M., Kulvatunyou, N., Joseph, B., Gries, L., Friese, R. S., Green, D., O'Keeffe, T., Tang, A. L., Vercruysse, G., & Rhee, P. (2015). Blunt bilateral diaphragmatic rupture-A right side can be easily missed. Trauma case reports, 1(9-12), 84-87.
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  Blunt diaphragmatic rupture (BDR) is uncommon with a reported incidence range of 1%-2%. The true incidence is not known. Bilateral BDR is particularly rare. We presented a case of bilateral BDR and we think that the incidence is under-recognised thanks to an easily missed and difficult to diagnose right sided injury.
• Michailidou, M., O'Keeffe, T., Mosier, J. M., Friese, R. S., Joseph, B., Rhee, P., & Sakles, J. C. (2015). A comparison of video laryngoscopy to direct laryngoscopy for the emergency intubation of trauma patients. World journal of surgery, 39(3), 782-8.
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  Direct laryngoscopy (DL) has long been the gold standard for tracheal intubation in emergency and trauma patients. Video laryngoscopy (VL) is increasingly used in many settings and the purpose of this study was to compare its effectiveness to direct laryngoscopy in trauma patients. Our hypothesis was that the success rate of VL would be higher than that of DL.
• Mobily, M., Branco, B. C., Joseph, B., Hernandez, N., Catalano, R. D., Judkins, D. G., Green, D. J., Kulvatunyou, N., Rhee, P., & Tang, A. L. (2015). Predictors of failure in the Advanced Trauma Life Support course. American journal of surgery, 210(5), 942-6.
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  Over 1 million healthcare providers have participated in the Advanced Trauma Life Support course. No studies have evaluated factors that predict course performance. This study aims to identify these predictors.
• Pandit, V., Michailidou, M., Rhee, P., Zangbar, B., Kulvatunyou, N., Khalil, M., O'Keeffe, T., Haider, A., Gries, L., & Joseph, B. (2015). The use of whole body computed tomography scans in pediatric trauma patients: Are there differences among adults and pediatric centers?. Journal of pediatric surgery.
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  Whole body CT (WBCT) scan is known to be associated with significant radiation risk especially in pediatric trauma patients. The aim of this study was to assess the use WBCT scan across trauma centers for the management of pediatric trauma patients.
• Rhee, P., Inaba, K., Pandit, V., Khalil, M., Siboni, S., Vercruysse, G., Kulvatunyou, N., Tang, A., Asif, A., O'Keeffe, T., & Joseph, B. (2015). Early autologous fresh whole blood transfusion leads to less allogeneic transfusions and is safe. The journal of trauma and acute care surgery, 78(4), 729-34.
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  The practice of transfusing ones' own shed whole blood has obvious benefits such as reducing the need for allogeneic transfusions and decreasing the need for other fluids that are typically used for resuscitation in trauma. It is not widely adopted in the trauma setting because of the concern of worsening coagulopathy and the inflammatory process. The aim of this study was to assess outcomes in trauma patients receiving whole blood autotransfusion (AT) from hemothorax.
• Tang, A. L., Diven, C., Zangbar, B., Lubin, D., Joseph, B., Green, D. J., Kulvatunyou, N., Vercruysse, G., Friese, R. S., O'Keeffe, T., & Rhee, P. (2015). The elimination of anastomosis in open trauma vascular reconstruction: A novel technique using an animal model. The journal of trauma and acute care surgery, 79(6), 937-42.
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  The standard approach to vascular trauma involves arterial exposure and reconstruction using either a vein or polytetrafluoroethylene graft. We have developed a novel technique to repairing arterial injuries by deploying commercially available vascular stents through an open approach, thus eliminating the need for suture anastomosis. The objective of this study was to evaluate the feasibility, stent deployment time (SDT), and stent patency of this technique in a ewe vascular injury model.
• Tang, A., Pandit, V., Fennell, V., Jones, T., Joseph, B., O'Keeffe, T., Friese, R. S., & Rhee, P. (2015). Intracranial pressure monitor in patients with traumatic brain injury. The Journal of surgical research, 194(2), 565-70.
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  Brain Trauma Foundation (BTF) guidelines recommend intracranial pressure (ICP) monitoring for traumatic brain injury (TBI) patients with a Glasgow Coma Scale score of 8 or less with an abnormal head computed tomography, or a normal head computed tomography scan with systolic blood pressure ≤90 mm Hg, posturing, or in patients of age ≥40. The benefits of these guidelines on outcome remain unproven. We hypothesized that adherence to BTF guidelines for ICP monitoring does not improve outcomes in patients with TBI.
• Vercruysse, G. A., Friese, R. S., Khalil, M., Ibrahim-Zada, I., Zangbar, B., Hashmi, A., Tang, A., O'Keeffe, T., Kulvatunyou, N., Green, D. J., Gries, L., Joseph, B., & Rhee, P. M. (2015). Overuse of helicopter transport in the minimally injured: A health care system problem that should be corrected. The journal of trauma and acute care surgery, 78(3), 510-5.
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  Mortality benefit has been demonstrated for trauma patients transported via helicopter but at great cost. This study identified patients who did not benefit from helicopter transport to our facility and demonstrates potential cost savings when transported instead by ground.
• Zangbar, B., Pandit, V., Rhee, P., Haider, A. A., Khalil, M., & Joseph, B. (2015). Beauty parlor stroke syndrome: a rare entity in a trauma patient. The American surgeon, 81(3), E120-2.
• Zangbar, B., Pandit, V., Rhee, P., Khalil, M., Kulvatunyou, N., O'Keeffe, T., Tang, A., Gries, L., Green, D. J., Friese, R. S., & Joseph, B. (2015). Clinical outcomes in patients on preinjury ibuprofen with traumatic brain injury. American journal of surgery, 209(6), 921-6.
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  The aim of our study was to evaluate the clinical outcomes in patients on preinjury Ibuprofen with traumatic brain injury.
• Zangbar, B., Wynne, J., Joseph, B., Pandit, V., Meyer, D., Kulvatunyou, N., Khalil, M., O'Keeffe, T., Tang, A., Lemole, M., Friese, R. S., & Rhee, P. (2015). Traumatic intracranial aneurysm in blunt trauma. Brain injury, 29(5), 601-6.
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  Computed Tomography Angiography (CTA) is being used to identify traumatic intracranial aneurysms (TICA) in patients with findings such as skull fracture and intracranial haemorrhage on initial Computed Tomography (CT) scans after blunt traumatic brain injury (TBI). However, the incidence of TICA in patients with blunt TBI is unknown. The aim of this study is to report the incidence of TICA in patients with blunt TBI and to assess the utility of CTA in detecting these lesions.
• Bui, E., Joseph, B., Rhee, P., Diven, C., Pandit, V., & Brown, C. V. (2014). Contemporary management of radiation exposure and injury. The journal of trauma and acute care surgery, 77(3), 495-500.
• Con, J., Friese, R. S., Long, D. M., Zangbar, B., O'Keeffe, T., Joseph, B., Rhee, P., & Tang, A. L. (2014). Falls from ladders: age matters more than height. The Journal of surgical research, 191(2), 262-7.
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  Falls from ladders account for a significant number of hospital visits. However, the epidemiology, injury pattern, and how age affects such falls are poorly described in the literature.
• Ditillo, M., Pandit, V., Rhee, P., Aziz, H., Hadeed, S., Bhattacharya, B., Friese, R. S., Davis, K., & Joseph, B. (2014). Morbid obesity predisposes trauma patients to worse outcomes: a National Trauma Data Bank analysis. The journal of trauma and acute care surgery, 76(1), 176-9.
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  One third of US adults are obese. The impact of obesity on outcomes after blunt traumatic injury has been studied with discrepant results. The aim of our study was to evaluate outcomes in morbidly obese patients after blunt trauma. We hypothesized that morbidly obese patients have adverse outcomes as compared with nonobese patients after blunt traumatic injury.
• Friese, R. S., Friese, R. S., Friese, R. S., Wynne, J., Wynne, J., Wynne, J., Joseph, B. A., Joseph, B. A., Joseph, B. A., Diven, c., Diven, c., Diven, c., Hashmi, A., Hashmi, A., Hashmi, A., Pandit, v., Pandit, v., Pandit, v., Okeeffe, T., , Okeeffe, T., et al. (2014). Age and Mortality after injury: is the association linear?. European Journal of Trauma, 40(5), 567-572.
• Ginwalla, R., Rhee, P., Friese, R., Green, D. J., Gries, L., Joseph, B., Kulvatunyou, N., Lubin, D., O'Keeffe, T., Vercruysse, G., Wynne, J., & Tang, A. (2014). Repeal of the concealed weapons law and its impact on gun-related injuries and deaths. The journal of trauma and acute care surgery, 76(3), 569-74; discussion 574-5.
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  Senate Bill 1108 (SB-1108) allows adult citizens to carry concealed weapons without a permit and without completion of a training course. It is unclear whether the law creates a "deterrent factor" to criminals or whether it escalates gun-related violence. We hypothesized that the enactment of SB-1108 resulted in an increase in gun-related injuries and deaths (GRIDs) in southern Arizona.
• Hadjizacharia, P., Rhee, P., Pandit, V., Aziz, H., Green, D., & Joseph, B. (2014). Blunt assault: 'million dollar baby'. The American surgeon, 80(1), 72-5.
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  Contrasting reports exist in the literature regarding the management of patients with blunt assault to the head, neck, and face and more importantly for clearing the cervical spine. The purpose of our study was to determine the risk of cervical spine injuries after blunt assault to the head, neck, and face and its association with other injuries. We performed a retrospective case review of all blunt assault trauma admissions to the head, neck, and face at our Level I trauma center. We identified all patients who were assaulted with hands and feet and blunt instruments. A total of 3286 patients with blunt assault to the head, neck, and face were identified of whom 11 (0.003%) were found to have a cervical spine fracture or cervical spine subluxation. None of the patients had a cervical spinal cord injury. The 11 patients composed our study population with a mean age of 39 ± 7.8 years, 100 per cent were male, and the mean Injury Severity Score was 12 ± 7.9. Five (45%) patients required surgery for stabilization of the cervical spine. Mortality was reported in only one patient who had a C7 transverse process fracture. Cervical spine injury after blunt assault is rare but does occur and encompasses significant injuries requiring surgical intervention. However, these injuries are the result of direct blows to the cervical spine and we suggest that assaulted patients with no direct trauma to the neck do not require an exhaustive evaluation of the cervical spine.
• Hashmi, A., Ibrahim-Zada, I., Rhee, P., Aziz, H., Fain, M. J., Friese, R. S., & Joseph, B. (2014). Predictors of mortality in geriatric trauma patients: a systematic review and meta-analysis. The journal of trauma and acute care surgery, 76(3), 894-901.
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  The rate of mortality and factors predicting worst outcomes in the geriatric population presenting with trauma are not well established. This study aimed to examine mortality rates in severe and extremely severe injured individuals 65 years or older and to identify the predictors of mortality based on available evidence in the literature.
• Joseph, B. A., Pandit, V., Zangbar, B., Amman, M., Khalil, M., Okeeffe, T., Orouji, T., Asif, A., Katta, A., Judkins, D., & Friese, R. (2014). Rethinking bicycle helmets as a preventive tool: a 4 year review of bicycle injuries. European Journal of Trauma and Emergency Surgery, 40(6), 729-732.
• Joseph, B. A., Pandit, v., Aziz, H., Kulvatunyou, N., Hashmi, A., Tang, A., Okeeffe, T., Wynne, J., Vercruysse, G., Friese, R., & Rhee, P. (2014). Pre-Injury Clopidogrel warrants a repeat head computed tomographic scans in traumatic brain injury: a prospective study. Journal of Trauma and Acute Care Surgery, 76(3), 817-820.
• Joseph, B., Aziz, H., Pandit, V., Hays, D., Kulvatunyou, N., Tang, A., Wynne, J., O' Keeffe, T., Green, D. J., Friese, R. S., Gruessner, R., & Rhee, P. (2014). Prothrombin complex concentrate use in coagulopathy of lethal brain injuries increases organ donation. The American surgeon, 80(4), 335-8.
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  Coagulopathy is a defined barrier for organ donation in patients with lethal traumatic brain injuries. The purpose of this study was to document our experience with the use of prothrombin complex concentrate (PCC) to facilitate organ donation in patients with lethal traumatic brain injuries. We performed a 4-year retrospective analysis of all patients with devastating gunshot wounds to the brain. The data were analyzed for demographics, change in international normalized ratio (INR), and subsequent organ donation. The primary end point was organ donation. Eighty-eight patients with lethal traumatic brain injury were identified from the trauma registry of whom 13 were coagulopathic at the time of admission (mean INR 2.2 ± 0.8). Of these 13 patients, 10 patients received PCC in an effort to reverse their coagulopathy. Mean INR before PCC administration was 2.01 ± 0.7 and 1.1 ± 0.7 after administration (P < 0.006). Correction of coagulopathy was attained in 70 per cent (seven of 10) patients. Of these seven patients, consent for donation was obtained in six patients and resulted in 19 solid organs being procured. The cost of PCC per patient was $1022 ± 544. PCC effectively reveres coagulopathy associated with lethal traumatic brain injury and enabled patients to proceed to organ donation. Although various methodologies exist for the treatment of coagulopathy to facilitate organ donation, PCC provides a rapid and cost-effective therapy for reversal of coagulopathy in patients with lethal traumatic brain injuries.
• Joseph, B., Aziz, H., Pandit, V., Hays, D., Kulvatunyou, N., Yousuf, Z., Tang, A., O'Keeffe, T., Green, D., Friese, R. S., & Rhee, P. (2014). Prothrombin complex concentrate versus fresh-frozen plasma for reversal of coagulopathy of trauma: is there a difference?. World journal of surgery, 38(8), 1875-81.
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  The development of coagulopathy of trauma is multifactorial associated with hypoperfusion and consumption of coagulation factors. Previous studies have compared the role of factor replacement versus FPP for reversal of trauma coagulopathy. The purpose of our study was to determine the time to correction of coagulopathy and blood product requirement in patients who received PCC+FFP compared with patients who received FFP alone.
• Joseph, B., Aziz, H., Pandit, V., Kulvatunyou, N., Hashmi, A., Tang, A., Sadoun, M., O'Keeffe, T., Vercruysse, G., Green, D. J., Friese, R. S., & Rhee, P. (2014). A three-year prospective study of repeat head computed tomography in patients with traumatic brain injury. Journal of the American College of Surgeons, 219(1), 45-51.
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  A definitive consensus on the standardization of practice of a routine repeat head CT (RHCT) scan in patients with traumatic intracranial hemorrhage is lacking. We hypothesized that in examinable patients without neurologic deterioration, RHCT scan does not lead to neurosurgical intervention (craniotomy/craniectomy).
• Joseph, B., Aziz, H., Pandit, V., Kulvatunyou, N., O'Keeffe, T., Tang, A., Wynne, J., Hashmi, A., Vercruysse, G., Friese, R. S., & Rhee, P. (2014). Low-dose aspirin therapy is not a reason for repeating head computed tomographic scans in traumatic brain injury: a prospective study. The Journal of surgical research, 186(1), 287-91.
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  Most studies have categorized all antiplatelet drugs into one category. The aim of our study was to evaluate the utility of repeat head computed tomography (RHCT) and outcomes in patients on low-dose aspirin (acetylsalicylic acid; ASA) therapy.
• Joseph, B., Aziz, H., Pandit, V., Kulvatunyou, N., O'Keeffe, T., Wynne, J., Tang, A., Friese, R. S., & Rhee, P. (2014). Improving survival rates after civilian gunshot wounds to the brain. Journal of the American College of Surgeons, 218(1), 58-65.
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  Gunshot wounds to the brain are the most lethal of all firearm injuries, with reported survival rates of 10% to 15%. The aim of this study was to determine outcomes in patients with gunshot wounds to the brain, presenting to our institution over time. We hypothesized that aggressive management can increase survival and the rate of organ donation in patients with gunshot wounds to the brain.
• Joseph, B., Aziz, H., Pandit, V., Kulvatunyou, N., Sadoun, M., Tang, A., O'Keeffe, T., Green, D. J., Friese, R. S., & Rhee, P. (2014). Levothyroxine therapy before brain death declaration increases the number of solid organ donations. The journal of trauma and acute care surgery, 76(5), 1301-5.
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  Protocols call for the start of hormonal therapy with levothyroxine after the declaration of brain death. As the hormonal perturbations occur during the process of brain death, the role of the early initiation of levothyroxine therapy (LT) to salvage organs is not well defined. The aim of this study was to evaluate the impact of early LT (before the declaration of brain death) on the number of solid organs procured per donor.
• Joseph, B., Aziz, H., Pandit, V., Kulvatunyou, N., Sadoun, M., Tang, A., O'Keeffe, T., Gries, L., Green, D. J., Friese, R. S., Lemole, M. G., & Rhee, P. (2014). Prospective validation of the brain injury guidelines: managing traumatic brain injury without neurosurgical consultation. The journal of trauma and acute care surgery, 77(6), 984-8.
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  To optimize neurosurgical resources, guidelines were developed at our institution, allowing the acute care surgeons to independently manage traumatic intracranial hemorrhage less than or equal to 4 mm. The aim of our study was to evaluate our established Brain Injury Guidelines (BIG 1 category) for managing patients with traumatic brain injury (TBI) without neurosurgical consultation.
• Joseph, B., Aziz, H., Sadoun, M., Kulvatunyou, N., Pandit, V., Tang, A., Wynne, J., O' Keeffe, T., Friese, R. S., Gruessner, R. W., & Rhee, P. (2014). Fatal gunshot wound to the head: the impact of aggressive management. American journal of surgery, 207(1), 89-94.
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  Patients with fatal gunshot wounds (GSWs) to the head often have poor outcomes but are ideal candidates for organ donation. The purpose of this study was to evaluate the effects of aggressive management on organ donation in patient with fatal GSWs to the head.
• Joseph, B., Aziz, H., Snell, M., Pandit, V., Hays, D., Kulvatunyou, N., Tang, A., O'Keeffe, T., Wynne, J., Friese, R. S., & Rhee, P. (2014). The physiological effects of hyperosmolar resuscitation: 5% vs 3% hypertonic saline. American journal of surgery, 208(5), 697-702.
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  Use of 5% normal saline (NS) is gaining renewed interest. The primary aim of our study was to compare the physiological effects after the administration of different concentrations of hypertonic saline (3% vs 5%NS) in the initial resuscitation of trauma.
• Joseph, B., Aziz, H., Zangbar, B., Kulvatunyou, N., Pandit, V., O'Keeffe, T., Tang, A., Wynne, J., Friese, R. S., & Rhee, P. (2014). Acquired coagulopathy of traumatic brain injury defined by routine laboratory tests: which laboratory values matter?. The journal of trauma and acute care surgery, 76(1), 121-5.
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  Coagulopathy is a major determinant of disability and death in patients with traumatic intracranial hemorrhage. However, the correlation between coagulopathy defined by routine coagulation tests and clinical outcomes in traumatic brain injury (TBI) is not well defined. The aim of our study was to determine the effect of coagulopathy diagnosed by routine laboratory tests on outcomes in TBI patients.
• Joseph, B., Ditillo, M., Pandit, V., Aziz, H., Sadoun, M., Hays, D., Davis, K., Friese, R., & Rhee, P. (2014). Dabigatran therapy: minor trauma injuries are no longer minor. The American surgeon, 80(4), E116-8.
• Joseph, B., Friese, R. S., Sadoun, M., Aziz, H., Kulvatunyou, N., Pandit, V., Wynne, J., Tang, A., O'Keeffe, T., & Rhee, P. (2014). The BIG (brain injury guidelines) project: defining the management of traumatic brain injury by acute care surgeons. The journal of trauma and acute care surgery, 76(4), 965-9.
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  It is becoming a standard practice that any "positive" identification of a radiographic intracranial injury requires transfer of the patient to a trauma center for observation and repeat head computed tomography (RHCT). The purpose of this study was to define guidelines-based on each patient's history, physical examination, and initial head CT findings-regarding which patients require a period of observation, RHCT, or neurosurgical consultation.
• Joseph, B., Khalil, M., Pandit, V., Kulvatunyou, N., Zangbar, B., Tang, A., O'Keeffe, T., Snyder, K., Green, D. J., Gries, L., Friese, R. S., & Rhee, P. (2014). Hypothermia in organ donation: a friend or foe?. The journal of trauma and acute care surgery, 77(4), 559-63.
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  Hypothermia is a known predictor of mortality in trauma patients; however, its impact on organ procurement has not been defined. The aim of this study was to assess the effect of hypothermia on organ procurement. We hypothesized that admission hypothermia impedes successful organ procurement.
• Joseph, B., Pandit, V., Aziz, H., Kulvatunyou, N., Hashmi, A., Tang, A., O'Keeffe, T., Wynne, J., Vercruysse, G., Friese, R. S., & Rhee, P. (2014). Clinical outcomes in traumatic brain injury patients on preinjury clopidogrel: a prospective analysis. The journal of trauma and acute care surgery, 76(3), 817-20.
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  Patients receiving antiplatelet medications are considered to be at an increased risk for traumatic intracranial hemorrhage after blunt head trauma. However, most studies have categorized all antiplatelet drugs into one category. The aim of our study was to evaluate clinical outcomes and the requirement of a repeat head computed tomography (RHCT) in patients on preinjury clopidogrel therapy.
• Joseph, B., Pandit, V., Hadeed, G., Kulvatunyou, N., Zangbar, B., Tang, A., O'Keeffe, T., Wynne, J., Green, D. J., Friese, R. S., & Rhee, P. (2014). Unveiling posttraumatic stress disorder in trauma surgeons: a national survey. The journal of trauma and acute care surgery, 77(1), 148-54; discussion 154.
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  The significance of posttraumatic stress disorder (PTSD) in trauma patients is well recognized. The impact trauma surgeons endure in managing critical trauma cases is unknown. The aim of our study was to assess the incidence of PTSD among trauma surgeons and identify risk factors associated with the development of PTSD.
• Joseph, B., Pandit, V., Meyer, D., Butvidas, L., Kulvatunyou, N., Khalil, M., Tang, A., Zangbar, B., O'Keeffe, T., Gries, L., Friese, R. S., & Rhee, P. (2014). The significance of platelet count in traumatic brain injury patients on antiplatelet therapy. The journal of trauma and acute care surgery, 77(3), 417-21.
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  Platelet dysfunction has been attributed to progression of initial intracranial hemorrhage (ICH) on repeat head computed tomographic (RHCT) scans in patients on prehospital antiplatelet therapy. However, there is little emphasis on the effect of platelet count and progression of ICH in patients with traumatic brain injury. The aim of this study was to determine the platelet count cutoff for progression on RHCT and neurosurgical intervention in patients on antiplatelet therapy.
• Joseph, B., Pandit, V., Rhee, P., Aziz, H., Sadoun, M., Wynne, J., Tang, A., Kulvatunyou, N., O'Keeffe, T., Fain, M. J., & Friese, R. S. (2014). Predicting hospital discharge disposition in geriatric trauma patients: is frailty the answer?. The journal of trauma and acute care surgery, 76(1), 196-200.
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  The frailty index (FI) has been shown to predict outcomes in geriatric patients. However, FI has never been applied as a prognostic measure after trauma. The aim of our study was to identify hospital admission factors predicting discharge disposition in geriatric trauma patients.
• Joseph, B., Pandit, V., Sadoun, M., Zangbar, B., Fain, M. J., Friese, R. S., & Rhee, P. (2014). Frailty in surgery. The journal of trauma and acute care surgery, 76(4), 1151-6.
• Joseph, B., Pandit, V., Wynne, J., Aziz, H., Tang, A., Kulvatunyou, N., Webster, A., O'Keeffe, T., Ziemba, M., Friese, R. S., Weinstein, R. S., & Rhee, P. (2014). Telephotography in trauma: a 2-year clinical experience. Telemedicine journal and e-health : the official journal of the American Telemedicine Association, 20(4), 342-5.
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  Smartphones can be used to record and transmit high-quality clinical photographs. The aim of this study was to describe our experience with smartphone telephotography in the care of trauma patients. We hypothesized that smartphone telephotography can be safely and effectively implemented on a trauma service.
• Joseph, B., Pandit, V., Zangbar, B., Kulvatunyou, N., Hashmi, A., Green, D. J., O'Keeffe, T., Tang, A., Vercruysse, G., Fain, M. J., Friese, R. S., & Rhee, P. (2014). Superiority of frailty over age in predicting outcomes among geriatric trauma patients: a prospective analysis. JAMA surgery, 149(8), 766-72.
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  The Frailty Index (FI) is a known predictor of adverse outcomes in geriatric patients. The usefulness of the FI as an outcome measure in geriatric trauma patients is unknown.
• Joseph, B., Pandit, V., Zangbar, B., Kulvatunyou, N., Tang, A., O'Keeffe, T., Green, D. J., Vercruysse, G., Fain, M. J., Friese, R. S., & Rhee, P. (2014). Validating trauma-specific frailty index for geriatric trauma patients: a prospective analysis. Journal of the American College of Surgeons, 219(1), 10-17.e1.
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  The Frailty Index has been shown to predict discharge disposition in geriatric patients. The aim of this study was to validate the modified 15-variable Trauma-Specific Frailty Index (TSFI) to predict discharge disposition in geriatric trauma patients. We hypothesized that TSFI can predict discharge disposition in geriatric trauma patients.
• Joseph, B., Sadoun, M., Aziz, H., Tang, A., Wynne, J. L., Pandit, V., Kulvatunyou, N., O'Keeffe, T., Friese, R. S., & Rhee, P. (2014). Repeat head computed tomography in anticoagulated traumatic brain injury patients: still warranted. The American surgeon, 80(1), 43-7.
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  Anticoagulation agents are proven risk factors for intracranial hemorrhage (ICH) in traumatic brain injury (TBI). The aim of our study is to describe the epidemiology of prehospital coumadin, aspirin, and Plavix (CAP) patients with ICH and evaluate the use of repeat head computed tomography (CT) in this group. We performed a retrospective study from our trauma registry. All patients with intracranial hemorrhage on initial CT with prehospital CAP therapy were included. Demographics, CT scan findings, number of repeat CT scans, progressive findings, and neurosurgical intervention were abstracted. A comparison between prehospital CAP and no-CAP patients was done using χ(2) and Mann-Whitney U test. A total of 1606 patients with blunt TBI charts were reviewed of whom 508 patients had intracranial bleeding on initial CT scan and 72 were on prehospital CAP therapy. CAP patients were older (P < 0.001), had higher Injury Severity Score and head Abbreviated Injury Scores on admission (P < 0.001), were more likely to present with an abnormal neurologic examination (P = 0.004), and had higher hospital and intensive care unit lengths of stay (P < 0.005). Eighty-four per cent of patients were on antiplatelet therapy and 27 per cent were on warfarin. The CAP patients have a threefold increase in the rate of worsening repeat head CT (26 vs 9%, P < 0.05). Prehospital CAP therapy is high risk for progression of bleeding on repeat head CT. Routine repeat head CT remains an important component in this patient population and can provide useful information.
• Joseph, B., Zangbar, B., Pandit, V., Kulvatunyou, N., Haider, A., O'Keeffe, T., Khalil, M., Tang, A., Vercruysse, G., Gries, L., Friese, R. S., & Rhee, P. (2014). Mortality after trauma laparotomy in geriatric patients. The Journal of surgical research, 190(2), 662-6.
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  Geriatric patients are at higher risk for adverse outcomes after injury because of their altered physiological reserve. Mortality after trauma laparotomy remains high; however, outcomes in geriatric patients after trauma laparotomy have not been well established. The aim of our study was to identify factors predicting mortality in geriatric trauma patients undergoing laparotomy.
• Joseph, B., Zangbar, B., Pandit, V., Vercruysse, G., Aziz, H., Kulvatunyou, N., Wynne, J., O'Keeffe, T., Tang, A., Friese, R. S., & Rhee, P. (2014). The conjoint effect of reduced crystalloid administration and decreased damage-control laparotomy use in the development of abdominal compartment syndrome. The journal of trauma and acute care surgery, 76(2), 457-61.
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  Anticipation of abdominal compartment syndrome (ACS) is a factor for performing damage-control laparotomy (DCL). Recent years have seen changes in resuscitation patterns and a decline in the use of DCL. We hypothesized that reductions in both crystalloid resuscitation and the use of DCL is associated with a reduced rate of ACS in trauma patients.
• Kulvatunyou, N., Kulvatunyou, N., Kulvatunyou, N., Erickson, L., Erickson, L., Erickson, L., Vijayasekaran, A., Vijayasekaran, A., Vijayasekaran, A., Gries, L. M., Gries, L. M., Gries, L. M., Joseph, B. A., Joseph, B. A., Joseph, B. A., Friese, R. S., Friese, R. S., Friese, R. S., Okeeffe, T. S., , Okeeffe, T. S., et al. (2014). Randomized clinical trial of pigtail catheter versus chest tube in injured patients with uncomplicated traumatic pneumothorax. British Journal of Surgery, 101(2), 17-22.
• Kulvatunyou, N., Watt, J., Friese, R. S., Gries, L., Green, D. J., Joseph, B., O'Keeffe, T., Tang, A. L., Vercruysse, G., & Rhee, P. (2014). Management of acute mild gallstone pancreatitis under acute care surgery: should patients be admitted to the surgery or medicine service?. American journal of surgery, 208(6), 981-7; discussion 986-7.
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  We hypothesized that patients with acute mild gallstone pancreatitis (GSP) admitted to surgery (SUR; vs medicine [MED]) had a shorter time to surgery, shorter hospital length of stay (HLOS), and lower costs.
• Michailidou, M., Kulvatunyou, N., Friese, R. S., Gries, L., Green, D. J., Joseph, B., O'Keeffe, T., Tang, A. L., Vercruysse, G., & Rhee, P. (2014). Time and cost analysis of gallbladder surgery under the acute care surgery model. The journal of trauma and acute care surgery, 76(3), 710-4.
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  The acute care surgery (ACS) model has been shown to improve work flow efficiency and to reduce hospital stay. We hypothesized that, in patients with gallbladder (GB) disease who were admitted through our emergency department (ED) and then underwent surgery, the ACS model shortened the time to surgery, decreased the length of hospital stay, and reduced hospital costs.
• Pandit, V., Patel, N., Rhee, P., Kulvatunyou, N., Aziz, H., Green, D. J., O'Keeffe, T., Zangbar, B., Tang, A., Gries, L., Friese, R. S., & Joseph, B. (2014). Effect of alcohol in traumatic brain injury: is it really protective?. The Journal of surgical research, 190(2), 634-9.
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  Studies have proposed a neuroprotective role for alcohol (ETOH) in traumatic brain injury (TBI). We hypothesized that ETOH intoxication is associated with mortality in patients with severe TBI.
• Pandit, V., Rhee, P., Aziz, H., Jehangir, Q., Friese, R. S., & Joseph, B. (2014). Perforated appendicitis with gastrointestinal basidiobolomycosis: a rare finding. Surgical infections, 15(3), 339-42.
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  Background: Basidiobolomycosis is a rare fungal infection caused by the fungus Basidiobolus ranarum. Gastrointestinal basidiobolomycosis (GIB) is an unusual presentation of the fungal infection that is reported sparsely in the literature, but is an emerging infection in the southwestern United States. Lack of awareness of GIB has resulted in its delayed diagnosis and in extensive morbidity and mortality in patients with GIB.
• Pandit, V., Rhee, P., Hashmi, A., Kulvatunyou, N., Tang, A., Khalil, M., O'Keeffe, T., Green, D., Friese, R. S., & Joseph, B. (2014). Shock index predicts mortality in geriatric trauma patients: an analysis of the National Trauma Data Bank. The journal of trauma and acute care surgery, 76(4), 1111-5.
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  Heart rate and systolic blood pressure are unreliable in geriatric trauma patients. Shock index (SI) (heart rate/systolic blood pressure) is a simple marker of worse outcomes after injury. The aim of this study was to assess the utility of SI in predicting outcomes. We hypothesized that SI predicts mortality in geriatric trauma patients.
• Rhee, P., Joseph, B., Pandit, V., Aziz, H., Vercruysse, G., Kulvatunyou, N., & Friese, R. S. (2014). Increasing trauma deaths in the United States. Annals of surgery, 260(1), 13-21.
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  To determine the impact of the increasing aging population on trauma mortality relative to mortality from cancer and heart disease in the United States.
• Safavi, A., Rhee, P., Pandit, V., Kulvatunyou, N., Tang, A., Aziz, H., Green, D., O'Keeffe, T., Vercruysse, G., Friese, R. S., & Joseph, B. (2014). Children are safer in states with strict firearm laws: a National Inpatient Sample study. The journal of trauma and acute care surgery, 76(1), 146-50; discussion 150-1.
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  Firearm control laws vary across the United States and remain state specific. The aim of this study was to determine the relationship between variation in states' firearm control laws and the risk of firearm-related injuries in pediatric population. We hypothesized that strict firearm control laws impact the incidence of pediatric firearm injury.
• Tang, A., Hashmi, A., Pandit, V., Joseph, B., Kulvatunyou, N., Vercruysse, G., Zangbar, B., Gries, L., O'Keeffe, T., Green, D., Friese, R., & Rhee, P. (2014). A critical analysis of secondary overtriage to a Level I trauma center. The journal of trauma and acute care surgery, 77(6), 969-73.
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  Trauma centers often receive transfers from lower-level trauma centers or nontrauma hospitals. The aim of this study was to analyze the incidence and pattern of secondary overtriage to our Level I trauma center.
• Weinstein, R. S., Lopez, A. M., Joseph, B. A., Erps, K. A., Holcomb, M., Barker, G. P., & Krupinski, E. A. (2014). Telemedicine, telehealth, and mobile health applications that work: opportunities and barriers. The American journal of medicine, 127(3), 183-7.
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  There has been a spike in interest and use of telehealth, catalyzed recently by the anticipated implementation of the Affordable Care Act, which rewards efficiency in healthcare delivery. Advances in telehealth services are in many areas, including gap service coverage (eg, night-time radiology coverage), urgent services (eg, telestroke services and teleburn services), mandated services (eg, the delivery of health care services to prison inmates), and the proliferation of video-enabled multisite group chart rounds (eg, Extension for Community Healthcare Outcomes programs). Progress has been made in confronting traditional barriers to the proliferation of telehealth. Reimbursement by third-party payers has been addressed in 19 states that passed parity legislation to guarantee payment for telehealth services. Medicare lags behind Medicaid, in some states, in reimbursement. Interstate medical licensure rules remain problematic. Mobile health is currently undergoing explosive growth and could be a disruptive innovation that will change the face of healthcare in the future.
• Zangbar, B., Pandit, V., Rhee, P., Aziz, H., Hashmi, A., Friese, R. S., Weinstein, R., & Joseph, B. (2014). Smartphone surgery: how technology can transform practice. Telemedicine journal and e-health : the official journal of the American Telemedicine Association, 20(6), 590-2.
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  Rural trauma care has been regarded as being the "challenge for the next decade." Trauma patients in rural areas face more struggles than their urban counterparts because of the absence of specialized trauma care, delay in providing immediate care to trauma victims, and longer transport times to reach a trauma center. Telemedicine is a promising tool for facilitating rural trauma care. This stellar tool creates a real-time link between a remotely located specialist and the local healthcare provider, especially during the initial management of the trauma patient, involving resuscitation and even intubation. However, the high cost of purchasing, setting up, and maintaining all the needed equipment has made telemedicine an expensive proposition for rural hospitals, which frequently have limited budgets. But recently, new improvements in communication technology have made smartphones an indispensable part of daily life, even in rural areas. These devices have great potential to improve patient care and enhance medical education because of their wide adoption and ease of use. In this article, we describe our initial teletrauma experience and the effect of smartphone implementation in patient care and medical education at the University of Arizona Medical Center in Tucson.
• Aziz, H., Rhee, P., Pandit, V., Ibrahim-Zada, I., Kulvatunyou, N., Wynne, J., Zangbar, B., O'Keeffe, T., Tang, A., Friese, R. S., & Joseph, B. (2013). Mild and moderate pediatric traumatic brain injury: replace routine repeat head computed tomography with neurologic examination. The journal of trauma and acute care surgery, 75(4), 550-4.
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  Opinion is divided on the role of routine repeat head computed tomography (RHCT) for guiding clinical management in pediatric patients with blunt head trauma. We hypothesize that routine RHCT does not lead to change in management in mild and moderate traumatic brain injury (TBI).
• Glazer, E. S., Kulvatunyou, N., Green, D. J., Gries, L., Joseph, B., O'Keeffe, T., Tang, A. L., Wynne, J. L., Friese, R. S., & Rhee, P. M. (2013). Contemporary acute care surgery percutaneous endoscopic gastrostomy tube placement: an extreme bumper height and complications. The journal of trauma and acute care surgery, 75(5), 859-63.
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  As the role of acute care surgery (ACS) becomes more prevalent, clinicians in this specialty will be placing more percutaneous endoscopic gastrostomy (PEG) tubes. In this contemporary series of ACS PEG procedures, we hypothesized that technical aspects of PEG tube placement may play an important role.
• Joseph, B. A. (2013). Lower Extremity Fractures in falls. European Journal of Trauma and Emergency Surgery.
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  DOI: 10.1007/s00068-013-0358-3
• Joseph, B., Aziz, H., Sadoun, M., Kulvatunyou, N., Tang, A., O'Keeffe, T., Wynne, J., Gries, L., Green, D. J., Friese, R. S., & Rhee, P. (2013). The acute care surgery model: managing traumatic brain injury without an inpatient neurosurgical consultation. The journal of trauma and acute care surgery, 75(1), 102-5; discussion 105.
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  Neurosurgical services are a limited resource and effective use of them would improve the health care system. Acute care surgeons (ACS) are accustomed to treating mild traumatic brain injury (TBI) including those with minor radiographic intracranial injuries. We hypothesized that ACS safely manage mild TBI with intracranial hemorrhage (ICH) on head computed tomographic (CT) scan without neurosurgical consultation (NC).
• Joseph, B., Brown, C. V., Diven, C., Bui, E., Aziz, H., & Rhee, P. (2013). Current concepts in the management of biologic and chemical warfare causalities. The journal of trauma and acute care surgery, 75(4), 582-9.
• Joseph, B., Hadjizacharia, P., Aziz, H., Kulvatunyou, N., Tang, A., Pandit, V., Wynne, J., O'Keeffe, T., Friese, R. S., & Rhee, P. (2013). Prothrombin complex concentrate: an effective therapy in reversing the coagulopathy of traumatic brain injury. The journal of trauma and acute care surgery, 74(1), 248-53.
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  Coagulopathy in patients with traumatic brain injury (TBI) is a well-studied concept. Prothrombin complex concentrate (PCC) has been shown to be an effective treatment modality for correction of TBI coagulopathy. However, its use and effectiveness compared with recombinant factor VII (rFVIIa) in TBI has not been established. The purpose of this study was to compare PCC and rFVIIa for the correction of TBI coagulopathy.
• Joseph, B., Hadjizacharia, P., Aziz, H., Snyder, K., Wynne, J., Kulvatunyou, N., Tang, A., O'Keeffe, T., Latifi, R., Friese, R., & Rhee, P. (2013). Continuous noninvasive hemoglobin monitor from pulse ox: ready for prime time?. World journal of surgery, 37(3), 525-9.
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  Advances in technology have allowed for continuous noninvasive hemoglobin monitoring (SpHb), which may enable earlier detection of hemorrhage and more efficient surgical and/or blood transfusion management. The use of SpHb has not been described in the trauma population. The purpose of the present study was to evaluate the accuracy of a SpHb measurement device in severely injured trauma patients.
• Joseph, B., Pandit, V., Aziz, H., Tang, A., Kulvatunyou, N., Wynne, J., Hsu, P., O'Keeffe, T., Gries, L., Friese, R. S., & Rhee, P. (2013). Rehabilitation after trauma; does age matter?. The Journal of surgical research, 184(1), 541-5.
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  Variability exits in the ability to predict overall recovery after trauma and inpatient rehabilitation. The aim of this study was to identify factors predicting functional improvement in trauma patients undergoing inpatient rehabilitation.
• Joseph, B., Pandit, V., Khreiss, M., Aziz, H., Kulvatunyou, N., Tang, A., Wynne, J., O'Keeffe, T., Friese, R. S., Weinstein, R. S., & Rhee, P. (2013). Improving communication in level 1 trauma centers: replacing pagers with smartphones. Telemedicine journal and e-health : the official journal of the American Telemedicine Association, 19(3), 150-4.
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  Communication among healthcare providers continues to change, and 90% of healthcare providers are now carrying cellular phones. Compared with pagers, the rate and amount of information immediately available via cellular phones are far superior. Wireless devices such as smartphones are ideal in acute trauma settings as they can transfer patient information quickly in a coordinate manner to all the team members responsible for patient care.
• Joseph, B., Pandit, V., Sadoun, M., Larkins, C. G., Kulvatunyou, N., Tang, A., Mino, M., Friese, R. S., & Rhee, P. (2013). A prospective evaluation of platelet function in patients on antiplatelet therapy with traumatic intracranial hemorrhage. The journal of trauma and acute care surgery, 75(6), 990-4.
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  Platelet transfusion is increasingly used in patients with traumatic intracranial hemorrhage (ICH) on aspirin therapy to minimize the progression of ICH. We hypothesized (null) that platelet transfusion in this cohort of patients does not improve platelet function.
• Lubin, D., Tang, A. L., Friese, R. S., Martin, M., Green, D. J., Jones, T., Means, R. R., Ginwalla, R., O'Keeffe, T. S., Joseph, B. A., Wynne, J. L., Kulvatunyou, N., Vercruysse, G., Gries, L., & Rhee, P. (2013). Modified Veress needle decompression of tension pneumothorax: a randomized crossover animal study. The journal of trauma and acute care surgery, 75(6), 1071-5.
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  The current prehospital standard of care using a large bore intravenous catheter for tension pneumothorax (tPTX) decompression is associated with a high failure rate. We developed a modified Veress needle (mVN) for this condition. The purpose of this study was to evaluate the effectiveness and safety of the mVN as compared with a 14-gauge needle thoracostomy (NT) in a swine tPTX model.
• Mosier, J., Joseph, B., & Sakles, J. C. (2013). Telebation: next-generation telemedicine in remote airway management using current wireless technologies. Telemedicine journal and e-health : the official journal of the American Telemedicine Association, 19(2), 95-8.
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  Since the first remote intubation with telemedicine guidance, wireless technology has advanced to enable more portable methods of telemedicine involvement in remote airway management.
• pandit, v., rhee, p., aziz, h., jehangir, q., friese, r., & Joseph, B. A. (2013). Perforated appendicitis with gastrointestinal basiobolomycosis: A rare finding. Journal of surgical infections.
• Joseph, B. A., Joseph, B. A., Joseph, B. A., Joseph, B. A., Kulvatunyou, N., Kulvatunyou, N., Kulvatunyou, N., Kulvatunyou, N., Okeeffe, T. S., Okeeffe, T. S., Okeeffe, T. S., Okeeffe, T. S., Tang, A., Tang, A., Tang, A., Tang, A., Friese, R. S., Friese, R. S., Friese, R. S., , Friese, R. S., et al. (2012). Does the added workload of emergency general surgery negatively impact trauma outcome. Journal of Surgical Research, 179(2), 347.
• Joseph, B. A., Joseph, B. A., Kulvatunyou, N., Kulvatunyou, N., Tang, A., Tang, A., Okeeffe, T. S., Okeeffe, T. S., Friese, R. S., Friese, R. S., Joseph, B. A., Joseph, B. A., Kulvatunyou, N., Kulvatunyou, N., Tang, A., Tang, A., Okeeffe, T. S., Okeeffe, T. S., Friese, R. S., , Friese, R. S., et al. (2012). Are all trauma centers equal: analyzing pediatric outcomes. Journal of the American College of Surgeons, Volume: 215(Issue: 3), s100. doi:DOI: 10.1016/j.jamcollsurg.2012.06.266
• Joseph, B., Amini, A., Friese, R. S., Houdek, M., Hays, D., Kulvatunyou, N., Wynne, J., O'Keeffe, T., Latifi, R., & Rhee, P. (2012). Factor IX complex for the correction of traumatic coagulopathy. The journal of trauma and acute care surgery, 72(4), 828-34.
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  Damage control resuscitation advocates correction of coagulopathy; however, options are limited and expensive. The use of prothrombin complex concentrate (PCC), also known as factor IX complex, can quickly accelerate reversal of coagulopathy at relatively low cost. The purpose of this study is to describe our experience in the use of factor IX complex in coagulopathic trauma patients.
• Kulvatunyou, N., Friese, R. S., Joseph, B., O'Keeffe, T., Wynne, J. L., Tang, A. L., & Rhee, P. (2012). Incidence and pattern of cervical spine injury in blunt assault: it is not how they are hit, but how they fall. The journal of trauma and acute care surgery, 72(1), 271-5.
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  The injury mechanism of blunt cervical spine injury (CSI) involves two forces: (1) an acceleration-deceleration force or change in velocity (delta v) that causes significant head and neck movement, resulting in flexion-extension injury pattern and (2) a direct force to the head or face against an immovable object with force transmitted down the cervical spine. Combining those two forces creates what bioengineers call imparted energy (IE). In blunt assault to the head or face, IE is low; hence, the reported incidence of CSI is low. The goal of our study was to identify the incidence, pattern, and outcome of CSI in blunt assaulted patients.
• Kulvatunyou, N., Joseph, B., Friese, R. S., Green, D., Gries, L., O'Keeffe, T., Tang, A. L., Wynne, J. L., & Rhee, P. (2012). 14 French pigtail catheters placed by surgeons to drain blood on trauma patients: is 14-Fr too small?. The journal of trauma and acute care surgery, 73(6), 1423-7.
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  Small 14F pigtail catheters (PCs) have been shown to drain air quite well in patients with traumatic pneumothorax (PTX). But their effectiveness in draining blood in patients with traumatic hemothorax (HTX) or hemopneumothorax (HPTX) is unknown. We hypothesized that 14F PCs can drain blood as well as large-bore 32F to 40F chest tubes. We herein report our early case series experience with PCs in the management of traumatic HTX and HPTX.
• Kulvatunyou, N., Joseph, B., Gries, L., Friese, R. S., Green, D., O'Keeffe, T., Wynne, J. L., Tang, A. L., & Rhee, P. (2012). A prospective cohort study of 200 acute care gallbladder surgeries: the same disease but a different approach. The journal of trauma and acute care surgery, 73(5), 1039-45.
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  For patients who present to the emergency department (ED) with symptomatic cholelithiasis, surgery is indicated only if they are diagnosed of acute cholecystitis (AC). We hypothesized that, because preoperative signs and diagnostic tests are not sensitive enough to diagnose AC, coupled with the potential health care burden of non-AC gallbladder, surgery may be offered sooner.
• Latifi, r., Latifi, r., Latifi, r., Joseph, B. A., Joseph, B. A., Joseph, B. A., Kulvatunyou, N., Kulvatunyou, N., Kulvatunyou, N., Wynne, J., Wynne, J., Wynne, J., Okeeffe, T. S., Okeeffe, T. S., Okeeffe, T. S., Tang, A., Tang, A., Tang, A., Friese, R. S., , Friese, R. S., et al. (2012). Enterocutaneous Fistulae and the Hostile Abdomen: Re-operative Surgical Approaches. World Journal of Surgery, 36(3), 516-523.
• Sixta, S., Moore, F. O., Ditillo, M. F., Fox, A. D., Garcia, A. J., Holena, D., Joseph, B., Tyrie, L., & Cotton, B. (2012). Screening for thoracolumbar spinal injuries in blunt trauma: an Eastern Association for the Surgery of Trauma practice management guideline. The journal of trauma and acute care surgery, 73(5 Suppl 4), S326-32.
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  Thoracolumbar spine (TLS) injuries have an incidence rate of 5% in blunt trauma patients. The Eastern Association for the Surgery of Trauma published Practice Management Guidelines for the Screening of Thoracolumbar Spine Fracture in 2007. The Practice Management Guidelines Committee was assembled to reevaluate the literature.
• Diven, C., Diven, C., Joseph, B. A., Joseph, B. A., Kulvatunyou, N., Kulvatunyou, N., Friese, R. S., Friese, R. S., Tang, A., Tang, A., Okeeffe, T. S., Okeeffe, T. S., Diven, C., Diven, C., Joseph, B. A., Joseph, B. A., Kulvatunyou, N., Kulvatunyou, N., Friese, R. S., , Friese, R. S., et al. (2011). Albuterol and Ipratropium Are Associated With Increased Ventilator-Associated Pneumonia Rates in Intubated Trauma Patients. Critical Care Medicine, 39(12), 197.
• Diven, C., Joseph, B. A., Kulvatunyou, N., Friese, R. S., Tang, A., Okeeffe, T. S., Diven, C., Joseph, B. A., Kulvatunyou, N., Friese, R. S., Tang, A., Okeeffe, T. S., Diven, C., Joseph, B. A., Kulvatunyou, N., Friese, R. S., Tang, A., & Okeeffe, T. S. (2011). Albuterol and Ipratropium Are Associated With Increased Ventilator-Associated Pneumonia Rates in Intubated Trauma Patients. Critical Care Medicine, 39(12), 197.
• Joseph, B. A., Joseph, B. A., Joseph, B. A., Tang, A., Tang, A., Tang, A., Friese, R. S., Friese, R. S., Friese, R. S., Okeeffe, T. S., Okeeffe, T. S., Okeeffe, T. S., Kulvatunyou, N., Kulvatunyou, N., Kulvatunyou, N., Con, J., Con, J., Con, J., Rhee, P., , Rhee, P., et al. (2011). Evidence based immune-modulating nutritional therapy in critically ill and injured patients. European Surgery, 91(3), 579-593.
• Joseph, B. A., Tang, A., Friese, R. S., Okeeffe, T. S., Kulvatunyou, N., Con, J., Rhee, P., & Latifi, R. (2011). Evidence based immune-modulating nutritional therapy in critically ill and injured patients. European Surgery, 91(3), 579-593.
• Kulvatunyou, N., Albrecht, R. M., Bender, J. S., Friese, R. S., Joseph, B., Latifi, R., O'Keefe, T., Wynn, J. L., & Rhee, P. M. (2011). Seatbelt triad: severe abdominal wall disruption, hollow viscus injury, and major vascular injury. The American surgeon, 77(5), 534-8.
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  The triad of seatbelt-related severe abdominal wall disruption, hollow viscus injury, and distal abdominal aortic injury after a motor vehicle collision is uncommon. We present a small case series involving those three clinical features with the goal of preventing a future missed diagnosis of the distal abdominal aortic injury in particular.
• Kulvatunyou, N., Kulvatunyou, N., Kulvatunyou, N., Kulvatunyou, N., Joseph, B. A., Joseph, B. A., Joseph, B. A., Joseph, B. A., Tang, A., Tang, A., Tang, A., Tang, A., Okeeffe, T. S., Okeeffe, T. S., Okeeffe, T. S., Okeeffe, T. S., Wynne, J., Wynne, J., Wynne, J., , Wynne, J., et al. (2011). Gut access in critically ill and injured patients: where have we gone thus far?. European Surgery, 43(1), 24-29.
• Kulvatunyou, N., Vijayasekaran, A., Hansen, A., Wynne, J. L., O'Keeffe, T., Friese, R. S., Joseph, B., Tang, A., & Rhee, P. (2011). Two-year experience of using pigtail catheters to treat traumatic pneumothorax: a changing trend. The Journal of trauma, 71(5), 1104-7; discussion 1107.
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  The traditional treatment of patients with traumatic hemopneumothorax has been an insertion of a chest tube (CT). But CT, because of its large caliber and significant trauma during an insertion, can cause pain, prevent full lung expansion, and worsen pulmonary outcome. Pigtail catheters (PCs) are smaller and less invasive; they have worked well in patients with nontraumatic pneumothorax (PTX). The purpose of this study was to review our early experience of PC use in trauma patients.
• Menaker, J., Joseph, B., Stein, D. M., & Scalea, T. M. (2011). Angiointervention: high rates of failure following blunt renal injuries. World journal of surgery, 35(3), 520-7.
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  Nonoperative management (NOM) of solid organ injury after blunt trauma is now standard. Recently, angioembolization (AE) has been used to extend NOM. Few data exist on evaluating NOM of blunt renal injuries (BRIs). We sought to determine the overall efficacy of NOM as well as the outcome of AE in patients with BRI.
• Menaker, K., Joseph, B. A., Stein, D., & Scalea, T. (2011). Angiointervention: High rates of failure following blunt renal injuries. World Journal of Surgery, 35(3), 520-527.
• Raoof, M., Joseph, B. A., Friese, R. S., Kulvatunyou, N., O'Keeffe, T., Tang, A., Wynne, J., Latifi, R., & Rhee, P. (2011). Organ donation after traumatic cardiopulmonary arrest. American journal of surgery, 202(6), 701-5; discussion 705-6.
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  The gap between demand of transplantable organs and their supply continues to widen. Trauma patients constitute a significant proportion of organ donors. The incidence of organ donation after traumatic cardiopulmonary arrest (TCPA), however, is not clear. The goals of this study were to determine the success rate of organ donation in patients undergoing cardiopulmonary resuscitation (CPR) after trauma and to determine if there are variables that may predict successful organ donation.
• Joseph, B., Wynne, J. L., Dudrick, S. J., & Latifi, R. (2010). Nutrition in Trauma and Critically Ill Patients. European journal of trauma and emergency surgery : official publication of the European Trauma Society, 36(1), 25-30.
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  Despite significant improvements in the practice of metabolic support of critically ill patients in recent years, malnutrition continues to be common among surgical patients, adding significantly to complications, infections, length of stay, costs, and increased mortality. Furthermore, hypercatabolism is the major metabolic response after major trauma and emergency surgery, making this patient population a unique subgroup of critically ill patients vulnerable to further decline in nutritional status. Many questions have already been answered, such as whether critically ill patients should be fed, when they should be fed, and how nutrients should be delivered. What is not entirely clear is what we should feed critically ill patients at different phases of specific diseases and disorders, as well as whether or not we should enhance and/or modulate patients' immunity.
• Vander Werf, B. D., Watt, J., Joseph, B., Wynne, J., Kulvatunyou, N., O'Keeffe, T., & Friese, R. S. (2010). Can plasma B-type natriuretic peptide levels predict need for mechanical ventilation after injury?. American journal of surgery, 200(6), 845-50; discussion 850.
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  B-type natriuretic peptide (BNP) is a neurohormone released from cardiomyocytes in response to volume expansion and increased ventricular wall distension. Increased plasma BNP levels are associated with mortality in critically ill patients cared for in medical intensive care units (ICUs). Additionally, plasma BNP levels may serve as a biomarker for excessive fluid resuscitation after injury. The utility of plasma BNP levels as a prognosticator of outcomes after injury has not been previously described. The purpose of this study was to describe the change in plasma BNP levels over the first 48 hours after injury and determine if there was a correlation between plasma BNP levels and clinical outcomes.
• Joseph, B., Morton, J. M., Hernandez-Boussard, T., Rubinfeld, I., Faraj, C., & Velanovich, V. (2009). Relationship between hospital volume, system clinical resources, and mortality in pancreatic resection. Journal of the American College of Surgeons, 208(4), 520-7.
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  The relationship between hospital volume and perioperative mortality in pancreaticoduodenectomy has been well established. We studied whether associations exist between hospital volume and hospital clinical resources and between both of these factors to mortality to help explain this relationship.
• Joseph, B. A., Genaw, j., Carlin, A., Jordan, J., Talley, J., & Rubenfield, I. (2007). Perioperative tight glycemic control: The challenges of bariatric surgery patients and the fear of hypoglycemic events. the Permanente Journal, 11(2), 36-39.
• Joseph, B., Genaw, J., Carlin, A., Jordan, J., Talley, J., & Rubinfeld, I. (2007). Perioperative tight glycemic control: the challenge of bariatric surgery patients and the fear of hypoglycemic events. The Permanente journal, 11(2), 36-9.
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  Tight glycemic control (TGC) is rapidly becoming a standard of care for all hospitalized patients. However, fear of hypoglycemia has proven a potent barrier to adoption of such initiatives by physicians and medical staff. Henry Ford Hospital has pursued aggressive glycemic control for all hospital patients. Because the initial standard TGC protocol (TGCP) was insufficient to improve glycemic control in our bariatric surgery patients, we hypothesized that a more intensive protocol would be necessary to improve glycemic control for this group.

Presentations

• Joseph, B. A. (2019, April). Is Plasma More Than Just Factors? Factor Concentrates versus Plasma-based Resuscitation. Trauma Critical Care & Acute Care Surgery. Las Vegas, NV.
• Joseph, B. A. (2019, April). Minimal TBI: Keep or Send?. Trauma Critical Care & Acute Care Surgery. Las Vegas, NV.
• Joseph, B. A. (2019, April). Social Media in Acute Care Surgery. Trauma Critical Care & Acute Care Surgery. Las Vegas, NV.
• Joseph, B. A. (2019, February). Correction of Coagulopathy: Factor-based vs. Plasma. The Eastern Association for the Surgery of Trauma Masters Webinar.
• Joseph, B. A. (2019, February). The Role of Frailty in Geriatric Surgery and Trauma. American Association for the Surgery of Trauma Virtual Grand Round.
• Joseph, B. A. (2019, February). The Role of Frailty in Trauma & Surgery. Phoenix Trauma Symposium St Joseph’s Hospital and Medical Center. Phoenix, AZ.
• Joseph, B. A. (2019, January). Time and Work Commitment. The Eastern Association for the Surgery of Trauma Annual Scientific Assembly. Austin, TX.
• Joseph, B. A. (2019, June). Breaking the AlphaBet Code. 30th Southwest Regional Conference. Tucson, AZ.
• Joseph, B. A. (2019, June). The Elephant in the Room: PTSD among Patients & Providers. 30th Southwest Regional Conference. Tucson, AZ.
• Joseph, B. A. (2019, May). Craniectomy for TBI is a Waste of Time and Money. Austin Trauma & Critical Care Conference. Austin, TX.
• Joseph, B. A. (2019, May). Frailty: Definition, Assessment, and Optimization. 50th Middle East Medical Assembly. American University of Beirut, Lebanon.
• Joseph, B. A. (2019, May). Implementing the Brain Injury Guidelines. Austin Trauma & Critical Care Conference. Austin, TX.
• Joseph, B. A. (2019, May). Management of Massive Intraoperative Bleeding. 50th Middle East Medical Assembly. American University of Beirut, Lebanon.
• Joseph, B. A. (2019, May). Management of Traumatic Brain Injury in a Bleeding Polytrauma Patient. 50th Middle East Medical Assembly. American University of Beirut, Lebanon.
• Joseph, B. A. (2019, May). Point of Care Coagulation Management. 50th Middle East Medical Assembly, American University of Beirut. American University of Beirut, Lebanon.
• Joseph, B. A., Neumayer, L. A., Hanna, K., Calcutt, R., Coleman, J., & Sakran, V. (2019, April). The Hidden Burden of Mental Health Outcomes Following Firearm Related Injuries. American Surgical Association. Dallas, Texas.
• Joseph, B. A. (2018, September/ Fall). Nationwide Analysis of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) In Civilian Trauma. The American Association for the Surgery of Trauma. San Diego, California.
• Joseph, B. A. (2013, October). Use of prothrombin complex concentrate as a adjunct to fresh frozen plasma shortens time to craniotomy in traumatic brain injury patients. Surgical Forum, American College of Surgeons. Washington, DC.
• Joseph, B. A. (2015, April). Changing paradigms in the management of 2,184 traumatic brain injury patients.. American Surgical Association- 135th annual meeting. San Diego, Ca.
• Joseph, B. A. (2015, Augusst). The Survival Benefit of remote ischemic conditioning in septic mouse model. World Federation of Societies of Intensive and Critical Care Medicine. Seoul, South Korea.
• Joseph, B. A. (2015, August). Damage control Laparotomy needs damage control: A second look in the era of damage control resuscitation. Military Health Research Symposium. Fort Lauderdale, Fl.
• Joseph, B. A. (2015, August). Identifying potential utility of REBOA: an autopsy study. Military Health System Research Symposium. Fort Lauderdale, FL.
• Joseph, B. A. (2015, January). Stress among surgical attendings and trainees: a quantitative assessment during trauma activations and emergency surgeries. Eastern Association for the Surgery of Trauma. San Antonio, Tx.
• Joseph, B. A. (2015, November). Improving mortality in trauma laparotomy through the evolution of damage control resuscitation: analysis of 1030 consecutive trauma laparotomies.. Western Surgical Association. Napa Valley, Ca.
• Joseph, B. A. (2014, Fall). Reducing secondary brain injury in trauma patients: The effect of remote ischemic conditioning. American Association for the Surger of Trauma. Philadelphia, Pa.
• Joseph, B. A. (2014, Fall). The survival benefit of remote ischemic conditioning in septic mouse model. Western Surgical Association. Indian Wells, Ca.
• Joseph, B. A. (2014, March). Prospective validation of the brain injury guidelines: Managing traumatic brain injury without neurosurgical intervention. Western Association for the Surgery of Trauma. Steamboat Springs, Co.
• Joseph, B. A. (2014, September). Early Whole blood auto-transfusion : An undefined practice in civiliam trauma. The American Association for the Surgery of Trauma. Philadelphia, Pa.
• Joseph, B. A. (2013, August). Prothrombin complex concentrate versus fresh frozen plasma for reversal of coagulopathy of trauma: Is there a difference. AAST/IATSC International Surgical Week, International Society of Surgery. Helsinki, Finland.
• Joseph, B. A. (2013, February). Predictors of Failure in ATLS. Academic Surgical Conference. New Orleans, LA.
• Joseph, B. A. (2013, March). Prospective evaluation of platelet function in patients with TBI on Aspirin therapy. Western Trauma Association. Aspen, Co.
• Joseph, B. A. (2013, March). Telephotography on the acute care surgery service: A 2 year experience. Southwestern Surgical Association. Santa Barbara, Ca.
• Joseph, B. A. (2013, November). A prospective three year study of repeat head computed tomography in traumatic brain injury. Western Surgical Association. Salt Lake City, Ut.
• Joseph, B. A. (2013, October). Aggressive management can improve survival rates after civilian gun shot wounds to the head. American Colllege of Surgeons. Washington, DC.
• Joseph, B. A. (2011, April). Predictors and prevalence of organ donation after traumatic cardiopulmonary arrest. Southwestern Surgical Congress. Ko Olina, Hawaii.
• Joseph, B. A. (2006, June). Perioperative tight glycemic control: the challenges of bariatric surgery patients and the fear of hypoglycemia. American Society for Bariatric Surgery. San Francisco, Ca.
• Joseph, B. A. (2006, October). Relationship between hospital volume and system support in pancreatic resections. Surgical Forums: American College of Surgeons. Chicago, Il.
• Joseph, B. A. (2005, May). Prevention of surgical site infections in bariatric surgery patients through implementing a process improvement approach. Michigan Chapter, American College of Surgeons. Detriot, Mi.

Poster Presentations

• Joseph, B. A. (2015, spring). Approach to the Geriatric Trauma Patient: Establishing Best Practices.. American Geriatric Society. National Harbor, MD.
• Joseph, B. A. (2014, fall). The Brain Injury Guidelines: A Prospective Analysis. The American Association for the Surgery of Trauma Annual Meeting. Philadelphia, Pa.
• Joseph, B. A. (2014, winter). Transforming Hemoglobin Measurement in Trauma Patients: Non-Invasive Spot Check Hemoglogin. Eastern Association for the Surgery of Trauma. Naples, Florida.
• Joseph, B. A. (2013, spring). Levothryoxine Therapy Prior to Brain Death Declaration Increases the Number of Solid Organ Donations. American Transplant Conference. Seattle Washington.
• Joseph, B. A. (2013, spring). Low Dose Aspirin Therapy is not a reason for RHCT in Patients with TBI. American Association of Neurosurgeons. New Orleans, LA.
• Joseph, B. A. (2013, winter). Prospective Evaluation of Non Invasive Hemoglobin Monitor for Trauma ICU Patients. Critical Care Congress. San Juan Puerto Rico.
• Joseph, B. A. (2011, fall). Prothrombin Complex Concentrate: An Effective Therapy in Reversing the Coagulopathy of Traumatic Brain Injury. American Association for the Surgery of Trauma. Chicago, IL.
• Joseph, B. A. (2011, summer). Continuous Noninvasive Hemoglobin Monitor from Pulse Ox: Ready for Prime Time. Applications for Combat Care. Ft. Lauderdale, FL.
• Joseph, B. A. (2011, summer). Prothrombin Complex Concentrate: An Effective Therapy in Reversing the Coagulopathy of Traumatic Brain Injury. Advanced Technology Applications for Combat Casualty Care.
• Joseph, B. A. (2011, summer). Pictures are worth a thousand words. Advanced Technology Applications for Combat Casualty Care. St. Petersburg, FL.
• Joseph, B. A. (2009, fall). Non operative management of blunt renal injuries: outcomes may not be as good as we think. American Association for the Surgery of Trauma. Pittsburgh, PA.
• Joseph, B. A. (2009, spring). The Challenges of Bariatric Surgey Patients and the Fear of Hypoglycemix Events. Michigan Chapter- American College of Surgeons. Detroit, MI.

Reviews

• Bhogadi, S. K., Colosimo, C., Hosseinpour, H., Nelson, A., Rose, M. I., Calvillo, A. R., Anand, T., Ditillo, M., Magnotti, L. J., Joseph, B., Bhogadi, S. K., Colosimo, C., Hosseinpour, H., Nelson, A., Rose, M. I., Calvillo, A. R., Anand, T., Ditillo, M., Magnotti, L. J., , Joseph, B., et al. (2023. The undisclosed disclosures: The dollar-outcome relationship in resuscitative endovascular balloon occlusion of the aorta(pp 726-730).
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  Despite its rapid evolution, resuscitative endovascular balloon occlusion of the aorta (REBOA) remains a controversial intervention that continues to generate active research. Proper conflict of interest (COI) disclosure helps to ensure that research is conducted objectively, without bias. We aimed to identify the accuracy of COI disclosures in REBOA research.
• Joseph, B., Haider, A., & Rhee, P. (2015. Non-invasive hemoglobin monitoring.
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  Technology has transformed the practice of medicine in general and surgery in particular over the last several decades. This change in practice has allowed to perform diagnostic and therapeutic tests less invasively. Hemoglobin monitoring remains one of the most commonly performed diagnostic tests in the United States. Recently, non-invasive hemoglobin monitoring technology has gained popularity. The aim of this article is to review the principles of how this technology works, pros and cons, and the implications of non-invasive hemoglobin technology particularly in trauma surgery.

Others

• Nfonsam, V. N., Joseph, B. A., Ewongwo, A., Cruz, A., Pandit, V., Hanna, K., Hamidi, M., Zeeshan, M., & Omesiete, P. (2019, Oct 2019). A National Analysis of Tumor Characteristic Treatment Patterns and Long term outcomes in Patients with Early Onset Colon Cancer. Journal of the American College of Surgeons.
• Joseph, B. A. (2015, October). Helmeted Bicycle Riders have significantly reduced severity of injury and lower death. ACS news. https://shar.es/1ubiOr
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  ACS new press release
• Joseph, B. A. (2010, october). UMC heart surgeos heading to ethiopia. KVOA : local news release. http://www.kvoa.com/new/umc-heart-surgeons-heading-to-ethiopia