Randall S Friese

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Courses

Scholarly Contributions

Chapters

• Friese, R. S. (2013). Electrolyte Disorders. In: JL Cameron and AM Cameron. In Current Surgical Therapy, 11th ed. Philadelphia: Mosby/Elsevier, 2013.
• Friese, R. S. (2012). Statistics. In: Moore, Rhee, Tisherman, and Fulda. In Surgical Critical Care and Emergency Surgery.
• Friese, R. S., & Okeeffe, T. S. (2012). Diagnostic Imagining, ultrasound, and interventional radiology. In Surgical Critical Care and Emergency Surgery.
• Friese, R. S. (2010). Acute Respiratory Failure. In: Rabinovici, Frankel, and Kirton. In Trauma, Critical Care and Surgical Emergencies.
• Friese, R. S. (2009). Cation-Binding Properties of Crown Ethers, Lariat Ethers, Bibracchial Lariat Ethers, and Poly(ethylene glycols) as Potential Phase-Transfer Catalysts. In American Chemical Society(pp 24–37). doi:10.1021/bk-1987-0326.ch004
• Shearer, v., & Friese, R. S. (2007). Penetrating Neck Trauma. In Trauma: Emergency Resuscitation, Perioperative Anesthesia and Surgical Management.
• Thal, E., & Friese, R. S. (2007). Traumatic Rupture of the Diaphragm. In Mastery of Surgery, 5th ed.
• Friese, R. S. (1996). Gastric Ulcers and Gastric Cancer. In Surgical Secrets, 3rd edition.

Journals/Publications

• Bhogadi, S. K., Magnotti, L. J., Hosseinpour, H., Anand, T., El-Qawaqzeh, K., Nelson, A., Colosimo, C., Spencer, A. L., Friese, R., Joseph, B., Bhogadi, S. K., Magnotti, L. J., Hosseinpour, H., Anand, T., El-Qawaqzeh, K., Nelson, A., Colosimo, C., Spencer, A. L., Friese, R., , Joseph, B., et al. (2023). The final decision among the injured elderly, to stop or to continue? Predictors of withdrawal of life supporting treatment. The journal of trauma and acute care surgery, 94(6), 778-783.
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  There is a paucity of data on factors that influence the decision regarding withdrawal of life supporting treatment (WLST) in geriatric trauma patients. We aimed to identify predictors of WLST in geriatric trauma patients.
• El-Qawaqzeh, K., Anand, T., Richards, J., Hosseinpour, H., Nelson, A., Akl, M., Obaid, O., Ditillo, M., Friese, R., & Joseph, B. (2023). Predictors of Mortality in Blunt Cardiac Injury: A Nationwide Analysis. Journal of Surgical Research, 281. doi:10.1016/j.jss.2022.07.047
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  Introduction: Blunt thoracic injury (BTI) is one of the most common causes of trauma admission in the United States and is uncommonly associated with cardiac injuries. Blunt cardiac injury (BCI) after blunt thoracic trauma is infrequent but carries a substantial risk of morbidity and sudden mortality. Our study aims to identify predictors of concomitant cardiac contusion among BTI patients and the predictors of mortality among patients presenting with BCI on a national level. Materials and Methods: We performed a 1-y (2017) analysis of the American College of Surgeons Trauma Quality Improvement Program. We included all adults (aged ≥ 18 y) with the diagnosis of BTI. We excluded patients who were transferred, had a penetrating mechanism of injury, and who were dead on arrival. Our primary outcomes were the independent predictors of concomitant cardiac contusions among BTI patients and the predictors of mortality among BCI patients. Our secondary outcome measures were in-hospital complications, differences in injury patterns, and injury severity between the survivors and nonsurvivors of BCI. Results: A total of 125,696 patients with BTI were identified, of which 2368 patients had BCI. Mean age was 52 ± 20 y, 67% were male, and median injury severity score was 14 [9-21]. The most common type of cardiac injury was cardiac contusion (43%). Age ≥ 65 y, higher 4-h packed red blood cell requirements, motor vehicle collision mechanism of injury, and concomitant thoracic injuries (hemothorax, flail chest, lung contusion, sternal fracture, diaphragmatic injury, and thoracic aortic injuries) were independently associated with concomitant cardiac contusion among BTI patients (P value < 0.05). Age ≥ 65 y, thoracic aortic injury, diaphragmatic injury, hemothorax, and a history of congestive heart failure were independently associated with mortality in BCI patients (P value < 0.05). Conclusions: Predictors of concomitant cardiac contusion among BTI patients and mortality among BCI patients were identified. Guidelines on the management of BCI should incorporate these predictors for timely identification of high-risk patients.
• Friese, R. S., O'keeffe, T., Mobily, M., Wynne, J. L., Branco, B. C., Joseph, B., Kulvatunyou, N., Rhee, P., & Tang, A. L. (2019). Does Money Matter? Relationship between Household Income and Mortality after Trauma. Panamerican Journal of Trauma, Critical Care & Emergency Surgery, 8(2), 91-95. doi:10.5005/jp-journals-10030-1245
• 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.
• 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.
• 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.
• Bauman, Z. M., Kulvatunyou, N., Joseph, B., Jain, A., Friese, R. S., Gries, L., O’Keeffe, T., Tang, A. L., Vercruysse, G., & Rhee, P. (2017). 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. doi:10.1007/s00268-017-4168-3
• Joseph, B., Azim, A., O'Keeffe, T., Ibraheem, K., Kulvatunyou, N., Tang, A., Vercruysse, G., Friese, R., Latifi, R., & Rhee, P. (2017). ACS Level I trauma centers outcomes do not correlate with patients' perception of hospital experience. The journal of trauma and acute care surgery.
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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 (CMS) 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-1 trauma centers correlate with actual hospital performance.
• 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.
• Bellal, J., 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, 0.
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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 healthcare providers.
• Gunst, M., Matsushima, K., Sperry, J., Ghaemmaghami, V., Robinson, M., O'Keeffe, T., Friese, R., & Frankel, H. (2016). Focused bedside echocardiography in the surgical intensive care unit: comparison of 3 methods to estimate cardiac index. Journal of intensive care medicine, 26(4), 255-60.
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  We sought to determine which of 3 methods used to evaluate cardiac index (CI) is the most accurate using focused bedside echocardiography (ECHO). We hypothesized that the fractional shortening (FS) method would provide a more accurate estimate of CI than the left ventricular outflow tract/velocity-time integral (LVOT/VTI) or Simpson's methods. This was a prospective observational cohort study conducted in the surgical ICU of an urban level 1 trauma center utilizing all patients with a pulmonary artery catheter (PAC) in place. Three surgical intensive care unit (SICU) faculty and 3 fellows underwent focused cardiac ultrasound training. Focused ECHO exams-bedside echocardiographic assessment in trauma/critical care (BEAT)- were performed using the Sonosite portable ultrasound device (Bothall, Washington). Stroke volume (SV) measurements were prospectively obtained on all trauma/SICU patients, with a PAC in place, using FS, LVOT/VTI, and Simpson's methods. The investigators were blinded to the PAC data. From each measurement, CI was calculated and categorized as low, normal, or high, based on a normal range of 2.4 to 4.0 L/min per m(2). Each CI obtained from the PAC was similarly categorized. The association between the BEAT and PAC estimates of CI was evaluated for each method using chi-square goodness of fit. Eighty five BEAT exams were performed on consecutive SICU patients, 56% were on trauma and 44% on emergency general surgery patients. There was a statistically significant association between the CI estimate using the FS method (P = .012), but not the LVOT/VTI (P = .33) or Simpson's method (P = .74). Our data showed a significant association between the PAC estimate of CI and our estimate using the FS method. The other methods were difficult to obtain, subjective, and inaccurate. Fractional shortening was the method of choice to estimate CI for the BEAT exam performed by intensivists in SICU 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. (2016). 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.
• 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.
• Rhee, P., Vercruysse, G., Tang, A., Okeeffe, T. S., Green, D., Friese, R. S., Gries, L. M., Joseph, B. A., Kulvatunyou, N., & Michailidou, M. (2016). Blunt Bilateral diaphragmatic rupture- a right side can be easily missed. Trauma Case Reports.
• Safavi, A., Safavi, A., Safavi, A., Skarsgard, E., Skarsgard, E., Skarsgard, E., Rhee, P., Rhee, P., Rhee, P., Zangbar, B., Zangbar, B., Zangbar, B., Kulvatunyou, N., Kulvatunyou, N., Kulvatunyou, N., Tang, A., Tang, A., Tang, A., Friese, R. S., , Friese, R. S., et al. (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.
• 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.
• Stuke, L., Jennings, A., Gunst, M., Tyner, T., Friese, R., O'Keeffe, T., & Frankel, H. (2016). Universal consent practice in academic intensive care units (ICUs). Journal of intensive care medicine, 25(1), 46-52.
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  The purpose of this study was to determine national practice for obtaining consent in academic adult intensive care units (ICUs) for routine bedside procedures and to define universal consent rates by patient demographics within our own institution's ICUs.
• 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., 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.
• 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.
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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.
• Branco, B., De Vitis, J., Joseph, B. A., Kulvatunyou, N., Tang, A., Friese, R. S., Rhee, P., & Okeeffe, T. S. (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.
• Friese, R. S. (2015). Mild Traumatic Brain Injury Defined by Glasgow Come Scale: Is it Really Mild?. Brain Injury.
• Friese, R. S., Haider, A. A., Joseph, B., Khalil, M., Kulvatunyou, N., Latifi, R., O'keeffe, T., Rhee, P., Tang, A., & Zangbar, B. (2015). Association of Facial Trauma, Severity of Head Injury, and Helmets in Bicycle Riders: A National Trauma Data Bank Study. Journal of The American College of Surgeons, 221(4). doi:10.1016/j.jamcollsurg.2015.07.316
• Friese, R. S., Ibrahim-zada, I., Lencinas, A., Maskaykina, I. Y., & Rhee, P. M. (2015). BRCA1 as a Novel Biomarker of Beta1-Blockade in Sepsis. Journal of The American College of Surgeons, 221(4), S40. doi:10.1016/j.jamcollsurg.2015.07.082
• Haider, A. A., Rhee, P. M., Khalil, M., Kulvatunyou, N., Zangbar, B., O'keeffe, T., Tang, A. L., Latifi, R., Friese, R. S., & Joseph, B. (2015). Association of Facial Trauma, Severity of Head Injury, and Helmets in Bicycle Riders: A National Trauma Data Bank Study. Journal of The American College of Surgeons, 221(4), S134. doi:10.1016/j.jamcollsurg.2015.07.316
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  Haider, Ansab A. MD; Rhee, Peter M. MD, FACS; Khalil, Mazhar MD; Kulvatunyou, Narong MD, FACS; Zangbar, Bardiya MD; O’Keeffe, Terence MB, ChB, FACS; Tang, Andrew L. MD, FACS; Latifi, Rifat MD, FACS; Friese, Randall S. MD, FACS; Joseph, Bellal MD, FACS Author Information
• Hsu, C., He, Y., Li, Y., Long, Q., & Friese, R. (2015). Doubly robust multiple imputation using kernel-based techniques. Biometrical journal. Biometrische Zeitschrift.
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  We consider the problem of estimating the marginal mean of an incompletely observed variable and develop a multiple imputation approach. Using fully observed predictors, we first establish two working models: one predicts the missing outcome variable, and the other predicts the probability of missingness. The predictive scores from the two models are used to measure the similarity between the incomplete and observed cases. Based on the predictive scores, we construct a set of kernel weights for the observed cases, with higher weights indicating more similarity. Missing data are imputed by sampling from the observed cases with probability proportional to their kernel weights. The proposed approach can produce reasonable estimates for the marginal mean and has a double robustness property, provided that one of the two working models is correctly specified. It also shows some robustness against misspecification of both models. We demonstrate these patterns in a simulation study. In a real-data example, we analyze the total helicopter response time from injury in the Arizona emergency medical service data.
• 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., 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., 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., 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).
• 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.
• O'keeffe, T., Friese, R. S., Gries, L. M., Jokar, T. O., Joseph, B., Khalil, M., Kulvatunyou, N., Rhee, P. M., Tang, A. L., & Zangbar, B. (2015). Redefining the Association Between Old Age and Poor Outcomes after Trauma: The Impact of the Frailty Syndrome. Journal of The American College of Surgeons, 221(4), S83-S84. doi:10.1016/j.jamcollsurg.2015.07.190
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  Jokar, Tahereh O. MD; Rhee, Peter M. MD, FACS; Zangbar, Bardiya MD; Kulvatunyou, Narong MD, FACS; Khalil, Mazhar MD; O’Keeffe, Terence MB, ChB, FACS; Tang, Andrew L. MD, FACS; Friese, Randall S. MD, FACS; Gries, Lynn M. MD; Joseph, Bellal MD, FACS Author Information
• O'keeffe, T., Latifi, R., Friese, R. S., Jokar, T. O., Joseph, B., Khalil, M., Kulvatunyou, N., Pandit, V., Rhee, P. M., & Tang, A. L. (2015). Impact of admission hypothermia on outcomes in severe traumatic brain injury: not so cool!. Journal of The American College of Surgeons, 221(4), e23. doi:10.1016/j.jamcollsurg.2015.08.358
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  Pandit, Viraj MD; Joseph, Bellal MD, FACS; Khalil, Mazhar MD; Kulvatunyou, Narong MD, FACS; Jokar, Tahereh O. MD; O’Keeffe, Terence MB, ChB, FACS; Tang, Andrew L. MD, FACS; Latifi, Rifat MD, FACS; Friese, Randall S. MD, FACS; Rhee, Peter M. MD, FACS Author Information
• O'keeffe, T., Latifi, R., Friese, R. S., Joseph, B., Khalil, M., Kulvatunyou, N., Rhee, P. M., Sadoum, M., Tang, A. L., & Zangbar, B. (2015). NSQIP Surgical Risk Calculator and Frailty in Emergency General Surgery: A Measure of Surgical Resilience. Journal of The American College of Surgeons, 221(4), S130. doi:10.1016/j.jamcollsurg.2015.07.307
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  METHODS: Using the California Inpatient Database, we analyzed 110,857 patients who underwent 1 of 8 oncologic resections (lung, esophagus, stomach,pancreas, hepatobiliary, colon, rectum, andkidney) between 2004 and 2011 at 491 hospitals. Minority-serving hospitals were defined as hospitals that ranked in the top quartile for the proportion of black andHispanic patients served. Amultivariate logistic regression analysiswas used to assess associations betweenmajor cancer surgery at MSH and their 30-day, 90-day, and repeated readmission rates.
• Peng, Z., Hamiel, C. R., Banerjee, A., Wischmeyer, P. E., Friese, R. S., & Wischmeyer, P. (2006). Glutamine attenuation of cell death and inducible nitric oxide synthase expression following inflammatory cytokine-induced injury is dependent on heat shock factor-1 expression. JPEN. Journal of parenteral and enteral nutrition, 30(5), 400-6; discussion 406-7.
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  Glutamine (GLN) has been shown to improve outcome after experimental and clinical models of critical illness. Enhanced expression of heat shock protein (HSP) has been hypothesized to be responsible for this protection. The heat shock response has been shown to inhibit inducible nitric oxide synthase (iNOS) gene expression and nitric oxide (NO) production. This study tested the hypothesis that GLN-mediated activation of the HSP pathway is responsible for improved survival and attenuation of iNOS expression after an inflammatory cytokine-induced injury.
• Pisani, M. A., Friese, R. S., Gehlbach, B. K., Schwab, R. J., Weinhouse, G. L., & Jones, S. F. (2015). Sleep in the intensive care unit. American journal of respiratory and critical care medicine, 191(7), 731-8.
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  Sleep is an important physiologic process, and lack of sleep is associated with a host of adverse outcomes. Basic and clinical research has documented the important role circadian rhythm plays in biologic function. Critical illness is a time of extreme vulnerability for patients, and the important role sleep may play in recovery for intensive care unit (ICU) patients is just beginning to be explored. This concise clinical review focuses on the current state of research examining sleep in critical illness. We discuss sleep and circadian rhythm abnormalities that occur in ICU patients and the challenges to measuring alterations in circadian rhythm in critical illness and review methods to measure sleep in the ICU, including polysomnography, actigraphy, and questionnaires. We discuss data on the impact of potentially modifiable disruptors to patient sleep, such as noise, light, and patient care activities, and report on potential methods to improve sleep in the setting of critical illness. Finally, we review the latest literature on sleep disturbances that persist or develop after critical illness.
• 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., 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.
• Aziz, H., Friese, R. S., Gruessner, R. W., Joseph, B., Kulvatunyou, N., O'Keeffe, T., Pandit, V., Rhee, P., Sadoun, M., Tang, A., Vercruysse, G., & Wynne, J. (2014). The Faltering Rates of Organ Donation in Trauma Patients: A Critical Analysis of United Network for Organ Sharing Database. Journal of Surgical Research. doi:10.1016/j.jss.2013.11.695
• Aziz, H., Friese, R. S., Joseph, B., Kulvatunyou, N., Lemole, M., Meyer, D. E., O'Keeffe, T., Pandit, V., Rhee, P., Tang, A., Wynne, J., & Zangbar, B. (2014). Incidence of Traumatic Intracranial Aneurysm in Blunt Trauma Patients: A 10-year Report. Journal of Surgical Research. doi:10.1016/j.jss.2013.11.1045
• Butvidas, L., Kim, S., & Friese, R. S. (2014). 1248: A RARE CASE OF A BAROTRAUMA INDUCED UPPER THORACIC ESOPHAGEAL PERFORATION MANNAGED NON-OPERATIVELY. Critical Care Medicine, 42, A1652. doi:10.1097/01.ccm.0000458715.64798.bd
• Castanon, L., Hadeed, S., Friese, R. S., Ditillo, M. F., Joseph, B., Pandit, V., Philip, A., Rhee, P. M., & Zangbar, B. (2014). Morbidly obese patients and motor vehicle collisions: are protective devices really protective?. Journal of The American College of Surgeons, 219(4), e150. doi:10.1016/j.jamcollsurg.2014.07.789
• 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.
• Friese, R. S., Ibrahim-zada, I., Maskaykina, I. Y., & Rhee, P. M. (2014). CAMP as a prognostic biomarker of survival due to beta1-blockade in sepsis. Journal of The American College of Surgeons, 219(4), e29-e30. doi:10.1016/j.jamcollsurg.2014.07.464
• Friese, R. S., Joseph, B., Khalil, M., Kulvatunyou, N., Meyer, D. E., O'keeffe, T., Pandit, V., Rhee, P. M., Tang, A. L., & Vercruysse, G. A. (2014). Early Use of Venous Thromboembolic Prophylaxis in Traumatic Brain Injury: A Safe Practice. Journal of The American College of Surgeons, 219(3), S69. doi:10.1016/j.jamcollsurg.2014.07.160
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  Meyer, David MD; Joseph, Bellal MD, FACS; Pandit, Viraj MD; Kulvatunyou, Narong MD, FACS; Khalil, Mazhar MD; O'Keeffe, Terence MBchB, FACS; Tang, Andrew L. MD, FACS; Vercruysse, Gary A. MD, FACS; Friese, Randall S. MD, FACS; Rhee, Peter M. MD, FACS Author Information
• Friese, R. S., Wynne, J., Gries, L., Hashmi, A., Joseph, B., Kulvatunyou, N., O'keeffe, T., Pandit, V., Rhee, P., Tang, A., Vercruysse, G. A., Vercruysse, G., & Zangbar, B. (2014). The Effect of Age on Mortality In Patients With Traumatic Brain Injury. Journal of Surgical Research, 186(2), 676. doi:10.1016/j.jss.2013.11.844
• 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.
• 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.
• Ibrahim-Zada, I., Rhee, P., Gomez, C. T., Weller, J., & Friese, R. S. (2014). Inhibition of sepsis-induced inflammatory response by β1-adrenergic antagonists. The journal of trauma and acute care surgery, 76(2), 320-7; discussion 327-8.
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  Although previous studies have described potential benefits of nonselective β-adrenergic antagonist therapy in sepsis, there is a paucity of data on the use of β1-selective antagonists (B1AA). The purposes of this study were to describe the effects of B1AA on survival in septic animals and to explore for molecular mechanisms of potential treatment benefit.
• 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., Amman, M., Khalil, M., Orouji, T., Asif, A., Katta, A., Judkins, D., Friese, R., Rhee, P., & O’Keeffe, T. (2014). Rethinking bicycle helmets as a preventive tool: a 4-year review of bicycle injuries. European Journal of Trauma and Emergency Surgery, 40(6). doi:10.1007/s00068-014-0453-0
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  Conclusion: Bicycle helmets may have a protective effect against external head injury but its protective role for intra-cranial hemorrhage is questionable. Further studies assessing the protective role of helmets for intra-cranial hemorrhage are warranted. Introduction: Traumatic brain injury is a leading cause of disability in bicycle riders. Preventive measures including bicycle helmet laws have been highlighted; however, its protective role has always been debated. The aim of this study was to determine the utility of bicycle helmets in prevention of intra-cranial hemorrhage. We hypothesized that bicycle helmets are protective and prevent the development of intra-cranial hemorrhage. Methods: We performed a 4-year (2009–2012) retrospective cohort analysis of all the patients who presented with traumatic brain injury due to bicycle injuries to our level 1 trauma center. We compared helmeted and non-helmeted bicycle riders for differences in the patterns of injury, need for intensive care unit admissions and mortality. Results: A total of 864 patients were reviewed of which, 709 patients (helmeted = 300, non-helmeted = 409) were included. Non-helmeted bicycle riders were more likely to be young (p < 0.001) males (p = 0.01). There was no difference in the median ISS between the two groups (p = 0.3). Non-helmeted riders were more likely to have a skull fracture (p = 0.01) and a scalp laceration (p = 0.01) compared to the helmeted riders. There was no difference in intra-cranial hemorrhage between the two groups (p = 0.1). Wearing a bicycle helmet was not independently associated (p = 0.1) with development of intra-cranial hemorrhage.
• Joseph, B., Pandit, V., Zangbar, B., Amman, M., Khalil, M., Orouji, T., Asif, A., Kattaa, A., Judkins, D., Friese, R., Rhee, P., & O’Keeffe, T. (2014). Erratum: Rethinking bicycle helmets as a preventive tool: a 4-year review of bicycle injuries [Eur J Trauma Emerg Surg, DOI 10.1007/s00068-014-0453-0]. European Journal of Trauma and Emergency Surgery, 40(6). doi:10.1007/s00068-014-0459-7
• 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., Kulvatunyou, N., Erickson, L., Erickson, L., Erickson, L., Erickson, L., Vijayasekaran, A., Vijayasekaran, A., Vijayasekaran, A., Vijayasekaran, A., Gries, L. M., Gries, L. M., Gries, L. M., Gries, L. M., Joseph, B. A., Joseph, B. A., Joseph, B. A., , Joseph, B. A., 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.
• McPhillips, S., Friese, R., & Vercruysse, G. (2014). Case report of rare chronic myelogenous leukemia related multibacterial splenic abscess presenting with scrotal swelling. International journal of surgery case reports, 5(12), 951-3.
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  Splenic abscesses associated with leukemia are rare. Most reported cases of splenic abscesses occur after chemotherapy and are related to the immunosuppressive effects of the chemotherapy. Their etiology is most frequently fungal.
• 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.
• Michailidou, M., O’Keeffe, T., Mosier, J. M., Friese, R. S., Joseph, B., Rhee, P., & Sakles, J. C. (2014). A Comparison of Video Laryngoscopy to Direct Laryngoscopy for the Emergency Intubation of Trauma Patients. World Journal of Surgery, 39(3), 782-788. doi:10.1007/s00268-014-2845-z
• O'keeffe, T., Friese, R. S., Amman, M., Asif, A., Joseph, B., Judkins, D., Katta, A., Khalil, M., Orouji, T., Pandit, V., Rhee, P., & Zangbar, B. (2014). Rethinking bicycle helmets as a preventive tool: a 4-year review of bicycle injuries.. European journal of trauma and emergency surgery : official publication of the European Trauma Society, 40(6), 729-32. doi:10.1007/s00068-014-0453-0
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  Traumatic brain injury is a leading cause of disability in bicycle riders. Preventive measures including bicycle helmet laws have been highlighted; however, its protective role has always been debated. The aim of this study was to determine the utility of bicycle helmets in prevention of intra-cranial hemorrhage. We hypothesized that bicycle helmets are protective and prevent the development of intra-cranial hemorrhage..We performed a 4-year (2009-2012) retrospective cohort analysis of all the patients who presented with traumatic brain injury due to bicycle injuries to our level 1 trauma center. We compared helmeted and non-helmeted bicycle riders for differences in the patterns of injury, need for intensive care unit admissions and mortality..A total of 864 patients were reviewed of which, 709 patients (helmeted = 300, non-helmeted = 409) were included. Non-helmeted bicycle riders were more likely to be young (p < 0.001) males (p = 0.01). There was no difference in the median ISS between the two groups (p = 0.3). Non-helmeted riders were more likely to have a skull fracture (p = 0.01) and a scalp laceration (p = 0.01) compared to the helmeted riders. There was no difference in intra-cranial hemorrhage between the two groups (p = 0.1). Wearing a bicycle helmet was not independently associated (p = 0.1) with development of intra-cranial hemorrhage..Bicycle helmets may have a protective effect against external head injury but its protective role for intra-cranial hemorrhage is questionable. Further studies assessing the protective role of helmets for intra-cranial hemorrhage are warranted.
• O'keeffe, T., Friese, R. S., Amman, M., Asif, A., Joseph, B., Judkins, D., Kattaa, A., Khalil, M., Orouji, T., Pandit, V., Rhee, P., & Zangbar, B. (2014). Erratum to: Rethinking bicycle helmets as a preventive tool: a 4-year review of bicycle injuries.. European journal of trauma and emergency surgery : official publication of the European Trauma Society, 40(6), 733. doi:10.1007/s00068-014-0459-7
• O'keeffe, T., Friese, R. S., Anderson, K. T., Joseph, B., Kulvatunyou, N., Pandit, V., Rhee, P. M., Tang, A. L., Vercruysse, G. A., & Zangbar, B. (2014). Children Are Safer in States with Universal Motorcycle Helmet Legislation: A National Study. Journal of The American College of Surgeons, 219(3), S79. doi:10.1016/j.jamcollsurg.2014.07.187
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  Anderson, Kathryn T. MD; Rhee, Peter M. MD, FACS; Pandit, Viraj MD; Kulvatunyou, Narong MD, FACS; Zangbar, Bardiya MD; O'Keeffe, Terence MBchB, FACS; Tang, Andrew L. MD, FACS; Vercruysse, Gary A. MD, FACS; Friese, Randall S. MD, FACS; Joseph, Bellal MD, FACS Author Information
• O'keeffe, T., Friese, R. S., Bains, S. S., Green, D. J., Joseph, B., Kulvatunyou, N., Pandit, V., Rhee, P. M., Tang, A. L., & Zangbar, B. (2014). Injury Prevention Programs against Distracted Driving: Are They Effective?. Journal of The American College of Surgeons, 219(3), S101. doi:10.1016/j.jamcollsurg.2014.07.241
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  Zangbar, Bardiya MD; Joseph, Bellal MD, FACS; Pandit, Viraj MD; Kulvatunyou, Narong MD, FACS; Bains, Sandeep S.; Tang, Andrew L. MD, FACS; O'Keeffe, Terence MBchB, FACS; Green, Donald J. MD, FACS; Friese, Randall S. MD, FACS; Rhee, Peter M. MD, FACS Author Information
• O'keeffe, T., Friese, R. S., Green, D. J., Gries, L., Joseph, B., Kulvatunyou, N., Pandit, V., Rhee, P. M., Tang, A. L., & Zangbar, B. (2014). The Burden of Firearm Violence in the United States: Stricter Laws Result in Safer States. Journal of The American College of Surgeons, 219(3), S49. doi:10.1016/j.jamcollsurg.2014.07.110
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  Pandit, Viraj MD; Rhee, Peter M. MD, FACS; Zangbar, Bardiya MD; Kulvatunyou, Narong MD, FACS; O'Keeffe, Terence MBChB FACS; Tang, Andrew L. MD, FACS; Green, Donald J. MD; Gries, Lynn MD; Friese, Randall S. MD, FACS; Joseph, Bellal MD, FACS Author Information
• O'keeffe, T., Friese, R. S., Ibrahim-zada, I., Munoz, L., & Rhee, P. (2014). 1028: DISPARITY IN TRAUMA AND CRITICAL CARE FOR TRAUMATIC BRAIN INJURY IN ARIZONA. Critical Care Medicine, 42, A1607. doi:10.1097/01.ccm.0000458525.68734.8c
• 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.
• Wright, D. W., Yeatts, S. D., Silbergleit, R., Palesch, Y. Y., Hertzberg, V. S., Frankel, M., Goldstein, F. C., Caveney, A. F., Howlett-Smith, H., Bengelink, E. M., Manley, G. T., Merck, L. H., Janis, L. S., & Barsan, W. G. (2014). Very early administration of progesterone for acute traumatic brain injury. The New England journal of medicine, 371(26), 2457-66.
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  Traumatic brain injury (TBI) is a major cause of death and disability worldwide. Progesterone has been shown to improve neurologic outcome in multiple experimental models and two early-phase trials involving patients with TBI.
• Wynne, J., Friese, R. S., Aziz, H., Green, D. J., Joseph, B., Kulvatunyou, N., Nfonsam, V. N., O'keeffe, T., Pandit, V., Rhee, P., Tang, A., & Zangbar, B. (2014). Laparoscopic Colon Resections in Geriatric Patients: Improving Outcomes in Acute Diverticulitis. Journal of Surgical Research, 186(2), 496. doi:10.1016/j.jss.2013.11.042
• Wynne, J., Friese, R. S., Aziz, H., Gries, L., Hashmi, A., Joseph, B., Kulvatunyou, N., O'keeffe, T., Pandit, V., Rhee, P., Tang, A., Vercruysse, G. A., & Vercruysse, G. (2014). Magnetic Resonance Cholangio-pancreatography before an Endoscopic Retrograde Cholangio-pancreatography: Is it really required?. Journal of Surgical Research, 186(2), 495. doi:10.1016/j.jss.2013.11.059
• Wynne, J., Friese, R. S., Aziz, H., Jehangir, Q., Joseph, B., Kulvatunyou, N., O'keeffe, T., Pandit, V., Rawashdeh, B., Rhee, P., Tang, A., Vercruysse, G. A., & Vercruysse, G. (2014). An Acute Care Surgery Dilemma: Immediate Laparoscopic Cholecystectomy In Patients On Anti Platelet Therapy. Journal of Surgical Research, 186(2), 495. doi:10.1016/j.jss.2013.11.062
• Wynne, J., Friese, R. S., Green, D. J., Hashmi, A., Joseph, B., Kulvatunyou, N., O'keeffe, T., Pandit, V., Rhee, P., Serack, B., Tang, A., & Zangbar, B. (2014). Outcomes In Trauma Patients With Isolated Epidural Hemorrhage. Journal of Surgical Research, 186(2), 676. doi:10.1016/j.jss.2013.11.846
• 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., Friese, R. S., Joseph, B., Kulvatunyou, N., O'Keeffe, T., Rhee, P., Sadoun, M., Snell, M., Tang, A., & Wynne, J. (2013). Hyperosmolar Resuscitation: 5% Normal Saline Vs. 3% Normal Saline. Journal of Surgical Research. doi:10.1016/j.jss.2012.10.295
• 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).
• Echeverria, A., Friese, R. S., Holman, A., Joseph, B., Kulvatunyou, N., Mendes, K., O'Keeffe, T., Rhee, P., Tang, A., & Wynne, J. (2013). Cryoprecipitate Wastage: An Unintended Consequence of Introduction of A Massive Transfusion Protocol. Journal of Surgical Research. doi:10.1016/j.jss.2012.10.294
• Friese, R. S., Ginwalla, R., Green, D., Gries, L., Jones, T., Joseph, B., Kulvatunyou, N., Lubin, D., Martin, M. M., Means, R. R., O'Keeffe, T., Rhee, P., Tang, A., Vercruysse, G., & Wynne, J. (2013). Modified Veress needle decompression of tension pneumothorax. Journal of Trauma and Acute Care Surgery.
• Friese, R. S., Glazer, E. S., Green, D. J., Gries, L., Joseph, B., Kulvatunyou, N., O'Keeffe, T., Rhee, P., Tang, A., & Wynne, J. (2013). Complications After Percutaneous Endoscopic Gastrostomy Tube Placement in the Era of Acute Care Surgery. Journal of Surgical Research. doi:10.1016/j.jss.2012.10.891
• Friese, R. S., Gomez, C. T., Ibrahim-zada, I., & Rhee, P. M. (2013). Inhibition of sepsis-induced inflammatory response by beta1-adrenergic antagonists. Journal of The American College of Surgeons, 217(3), S45-S46. doi:10.1016/j.jamcollsurg.2013.07.092
• Friese, R. S., Hashmi, A., Ibrahim-zada, I., Joseph, B., Kulvatunyou, N., & Rhee, P. (2013). 178: SURVIVAL BENEFITS OF REMOTE ISCHEMIC POST-CONDITIONING IN SEPSIS. Critical Care Medicine, 41, A39. doi:10.1097/01.ccm.0000439327.20685.ef
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  Introduction: Sepsis remains the leading cause of death in surgical intensive care unit. Prior studies have demonstrated a survival benefit of remote ischemic post-conditioning (rIPC) in many diseases. However, the utility of rIPC for the treatment of sepsis remains unknown. The aim of the study was to describe effect and to determine the optimal timing of rIPC on survival in sepsis. Methods: 8–12 week C57BL/6 mice received intra-peritoneal injection of 12.5 mg/kg lipopolysaccharide (LPS). Septic animals in experimental group underwent rIPC at 15 minutes (early rIPC) or at two hours (late rIPC) after LPS injection under anesthesia. Animals in control group had a sham procedure. The femoral artery was dissected out surgically and six 4 minute-cycles of ischemic re-perfusion were performed with a micro-vascular clip in the experimental group. Primary outcome measure was survival at 5 days post-LPS injection. Kaplan-Meier survival analysis and log-rank test were utilized to assess differences in mortality. Results: There were 14 controls, 10 early and 10 late rIPC mice. 70% (7/10) of animals in late rIPC group, and 50% (5/10) in early rIPC group survived 5 days compared to only 21% (3/14) of animals in control group.There was no difference in survival in early rIPC group compared to the control (p=0.14). Late rIPC group had increased survival at 5 days post-LPS (p=0.0453) with hazard ratio of 0.296 (95% CI 0.09, 0.98). Conclusions: Our study demonstrated that late remote ischemic post-conditioning improved overall survival in septic mice and has potential for implementation in the clinical practice. Late rIPC has significant effect on survival. Further studies are necessary to refine understanding of the observed survival benefits, the optimum timing of the intervention, and its implication in sepsis management.
• Friese, R. S., O'keeffe, T., Wynne, J. L., Dehdashti, N., Gries, L., Joseph, B., Kulvatunyou, N., Rhee, P. M., Tang, A. L., & Vercruysse, G. A. (2013). Incidence and pattern of cervical spine injury in patients who fall: don't worry about how high, worry about how old. Journal of The American College of Surgeons, 217(3), S112. doi:10.1016/j.jamcollsurg.2013.07.259
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  RESULTS: The response rate was 53% (107/201), and the median follow-up was 7 years (range 1.8-18.9). The respondents were 53% male, median age 72 years (median age at surgery was 66). Pathology included: 19 ampullary adenocarcinomas, 17 pancreatic adenocarcinomas, 15 cystadenomas, 17 IPMNs, 6 neuroendocrine tumors, 6 duodenal adenocarcinomas, 3 cholangiocarcinomas, and 24 other lesions. The majority lost weight (median -9.5kg), 46 required pancreatic enzymes, and 25 developed diabetes. Before surgery, 85% reported satisfaction with life, versus 94% after surgery. Of
• 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., 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., 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.
• Kulvatunyou, N., Erickson, L., Vijayasekaran, A., Gries, L., Joseph, B., Friese, R. F., O'Keeffe, T., Tang, A. L., Wynne, J. L., & Rhee, P. (2013). Randomized clinical trial of pigtail catheter versus chest tube in injured patients with uncomplicated traumatic pneumothorax. British Journal of Surgery, 101(2), 17-22. doi:10.1002/bjs.9377
• 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.
• Mobily, M., Friese, R. S., Wynne, J., Branco, B. C., Catalano, R., Frantz, N., Green, D. J., Gries, L., Hernandez, N., Joseph, B., Judkins, D., Kulvatunyou, N., O'keeffe, T., Rhee, P., & Tang, A. (2013). Advanced Trauma Life Support Participant Course: A Critical Review. Journal of Surgical Research, 179(2), 344. doi:10.1016/j.jss.2012.10.869
• O'keeffe, T., Wynne, J. L., Friese, R. S., Green, D. J., Gries, L., Joseph, B., Kulvatunyou, N., Michailidou, M., Rhee, P. M., & Tang, A. L. (2013). Time and cost analysis of gallbladder surgery under acute care surgery model. Journal of The American College of Surgeons, 217(3), S114. doi:10.1016/j.jamcollsurg.2013.07.263
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  BACKGROUND: 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. METHODS: We retrospectively queried our GB surgery practice records for 2008 (before the establishment of the ACS model at our institution in 2009). We then performed time and cost comparison with our prospectively maintained GB surgery practice database for 2010. We excluded any inpatient GB surgeries and any GB surgeries that were performed for choledocholithiasis and acute pancreatitis. RESULTS: Our study was composed of 94 patients from the pre-ACS period (2008) and 234 patients from the ACS period (2010). Patients’ baseline characteristics were similar between the two periods, except for a higher percentage of females in the ACS period (77% vs. 66%, p = 0.04). Approximately one third of patients from both periods had acute cholecystitis. In the ACS period, the mean time to surgery, that is, from ED arrival to operating room arrival, was shorter (20.8 [13.8] hours vs. 25.7 [16.2] hours, p = 0.007); more patients underwent surgery within 24 hours after ED arrival (75% vs. 59%, p = 0.004); and more patients underwent surgery between 12:00 midnight and 7:00 AM (25% vs. 6.4%, pG 0.001). As a result, hospital length of stay was 1.4 days shorter in the ACS period, with cost saving per patient of approximately $1,000. CONCLUSION: We found that implementation of ACS model led to benefits for patients who came to our ED with GB disease, including shorter time to surgery, shorter hospital stay, and decreased hospital costs. The ACS model benefits the health care system. (J Trauma Acute Care Surg. 2014;76: 710Y714. Copyright * 2014 by Lippincott Williams & Wilkins) LEVEL OF EVIDENCE: Therapeutic study, level IV.
• O'Keeffe, T., Rhee, P., Shafi, S., Friese, R. S., & Gentilello, L. M. (2013). Alcohol use increases diagnostic testing, procedures, charges, and the risk of hospital admission: a population-based study of injured patients in the emergency department. American journal of surgery, 206(1), 16-22.
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  Alcohol use may alter mental status and vital signs in injured patients, leading to increased testing during emergency department (ED) evaluation. We hypothesized that alcohol use increases the hospital charges when caring for these injured patients.
• Wynne, J. L., Friese, R. S., Aziz, H., Hays, D. P., Joseph, B., Kulvatunyou, N., O'keeffe, T., Pandit, V., Rhee, P., & Tang, A. L. (2013). Prothrombin Complex Concentrate Effectively Treats Coagulopathy in Patients With Lethal Brain Injuries and Increases Organ Donation. Journal of Surgical Research, 179(2), 198. doi:10.1016/j.jss.2012.10.297
• Wynne, J. L., O'keeffe, T., Friese, R. S., Aziz, H., Hays, D. P., Joseph, B., Kulvatunyou, N., Pandit, V., Rhee, P. M., & Tang, A. L. (2013). Prothrombin complex concentrate in conjunction with fresh frozen plasma improves time to craniotomy in traumatic brain injury. Journal of The American College of Surgeons, 217(3), 113-114. doi:10.1016/j.jamcollsurg.2013.07.262
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  Joseph, Bellal MD, FACS; Aziz, Hassan MD; Pandit, Viraj MD; Hays, Daniel BS; Kulvatunyou, Narong MD, FACS; Tang, Andrew L. MD, FACS; Wynne, Julie L. MD, FACS; O'Keeffe, Terence MBChB, MSPH, FACS; Friese, Randall S. MD, FACS; Rhee, Peter M. MD, MPH, FACS Author Information
• Wynne, J. L., O'keeffe, T., Friese, R. S., Aziz, H., Joseph, B., Kulvatunyou, N., Pandit, V., Rhee, P. M., Tang, A. L., & Vercruysse, G. A. (2013). Frailty is superior to age in predicting outcomes in geriatric trauma patients: a prospective analysis. Journal of The American College of Surgeons, 217(3), S59. doi:10.1016/j.jamcollsurg.2013.07.123
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  Frailty is superior to age in predicting outcomes in geriatric trauma patients: a prospective analysis Viraj Pandit, MD*, Bellal Joseph, MD, FACS, Peter M Rhee, MD, MPH, FACS, Hassan Aziz, MD, Narong Kulvatunyou, MD, FACS, Julie L Wynne, MD, FACS, Andrew L Tang, MD, FACS, Terence O’Keeffe, MBChB, FACS, MSPH, Gary A Vercruysse, MD, FACS, Randall S Friese, MD, FACS The University of Arizona, Tucson, AZ
• Blecker, N., Rhee, P., Judkins, D. G., Wynne, J. L., Friese, R. S., Kulvatunyou, N., Latifi, R., & O'Keeffe, T. (2012). Pediatric all-terrain vehicle trauma: the epidemic continues unabated. Pediatric emergency care, 28(5), 443-7.
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  The popularity of all-terrain vehicles (ATVs) continues to increase, but this form of recreation is not as well regulated and can impact children disproportionately. This study examines the epidemiology of ATV injuries in Arizona with emphasis on pediatric injuries and compares ATV injuries to those associated with motorcycle (MCC) and motor vehicle crashes (MVC).
• Con, J., Friese, R. S., Joseph, B., Long, D. M., O'Keeffe, T., Rhee, P., Tang, A., & Zangbar, B. (2012). Falls from ladders: age matters more than height. Journal of Surgical Research. doi:10.1016/j.jss.2014.05.072
• Frankel, H. L., Butler, K. L., Cuschieri, J., Friese, R. S., Huynh, T., Mohr, A. M., Schinco, M. A., Napolitano, L. M., Britt, L. D., Coimbra, R., Croce, M. A., Davis, J. W., Jurkovich, G. J., Moore, E. E., Morris, J. A., Peitzman, A. B., Pruitt, B. A., Rozycki, G. S., Scalea, T. M., & Meredith, J. W. (2012). The role and value of surgical critical care, an essential component of Acute Care Surgery, in the Affordable Care Act: a report from the Critical Care Committee and Board of Managers of the American Association for the Surgery of Trauma. The journal of trauma and acute care surgery, 73(1), 20-6.
• Friese, R. S. (2012). Sleep, circadian rhythms, and critical illness. SLEEP.
• Friese, R. S. (2012). The Open Abdomen. Nutrition in Clinical Practice, 27(4), 492-498. doi:10.1177/0884533612446197
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  The use of the “open abdomen” as a technique in the management of the complex surgical patient stems from the concept of damage control. Damage control principles underscore the importance of an abbreviated laparotomy focused on control of hemorrhage and gastrointestinal contamination in patients presenting with significant physiologic compromise. Definitive repair of injuries is postponed and the abdomen is temporarily “closed” using one of a number of different techniques. The ultimate goal is formal abdominal fascial closure within 48–72 hours of the initial laparotomy. Frequently, daily trips to the operating room are required for incremental closure of the abdominal fascia. However, in some cases, fascial closure is not possible secondary to ongoing visceral edema and loss of the peritoneal domain. In these cases, the patient is left with an “open abdomen” until skin grafting over the exposed peritoneal organs can be performed. Patients with an open abdomen have peritoneal contents exposed to the atmosphere and require a complex dressing to maintain fascial domain and provide protection to exposed organs. These patients are typically critically ill and managed in the intensive care unit early in the disease process. The open abdomen has become an important tool for the management of physiologically unstable patients requiring emergent abdominal surgical procedures. These patients present unique challenges to the critical care and nutrition support teams. Careful attention to fluid and electrolyte management, meticulous wound care, prevention of enteroatmospheric fistula, and individualized nutrition support therapy are essential to successful recovery in this patient population.
• Friese, R. S., Green, D. J., Gries, L., Joseph, B., Kulvatunyou, N., O'Keeffe, T., Rhee, P., Tang, A., & Wynne, J. (2012). Does the Added Workload of Emergency General Surgery Negatively Impact Trauma Outcomes. Journal of Surgical Research. doi:10.1016/j.jss.2011.11.957
• Friese, R. S., Wynne, J. L., O'keeffe, T. S., Hsu, P., Joseph, B., Kulvatunyou, N., Rhee, P., & Tang, A. (2012). Age and Mortality After Injury: Is the Association Linear?. Journal of Surgical Research, 172(2), 284-285. doi:10.1016/j.jss.2011.11.484
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  Introduction: In 2008, 39.6 million persons were aged 65 years or older. As demographic transition progresses this group of elderly Americans is expected to number 72.1 million by 2030. Injury is the ninth leading cause of death for Americans aged 65 or older. Additionally, multiple studies have demonstrated a linear association between advancing age and mortality after injury. An inflection point, or age at which outcomes begin to differ, has not been previously described. We hypothesized that the relationship between age and mortality after injury is non-linear and an inflection point exists. Methods: We performed a retrospective cohort analysis of the trauma registry at our urban level one center from 2007 through 2009. All patients aged 65 and older with the admission diagnosis of injury were included in the analysis. Nonparametric logistic regression was used to identify the functional form between mortality and age. Multivariate logistic regression controlling for injury mechanism, Injury Severity Score (ISS), initial blood pressure, Glasgow Coma Score, hospital length of stay, head abbreviated injury score (AIS), need for any operative procedure, and need for intensive care unit (ICU) admission was utilized to explore the association between age and mortality. Age 65 was used as reference. Significance was defined as p
• Friese, R., & Friese, R. S. (2012). The open abdomen: definitions, management principles, and nutrition support considerations. Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition, 27(4).
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  The use of the "open abdomen" as a technique in the management of the complex surgical patient stems from the concept of damage control. Damage control principles underscore the importance of an abbreviated laparotomy focused on control of hemorrhage and gastrointestinal contamination in patients presenting with significant physiologic compromise. Definitive repair of injuries is postponed and the abdomen is temporarily "closed" using one of a number of different techniques. The ultimate goal is formal abdominal fascial closure within 48-72 hours of the initial laparotomy. Frequently, daily trips to the operating room are required for incremental closure of the abdominal fascia. However, in some cases, fascial closure is not possible secondary to ongoing visceral edema and loss of the peritoneal domain. In these cases, the patient is left with an "open abdomen" until skin grafting over the exposed peritoneal organs can be performed. Patients with an open abdomen have peritoneal contents exposed to the atmosphere and require a complex dressing to maintain fascial domain and provide protection to exposed organs. These patients are typically critically ill and managed in the intensive care unit early in the disease process. The open abdomen has become an important tool for the management of physiologically unstable patients requiring emergent abdominal surgical procedures. These patients present unique challenges to the critical care and nutrition support teams. Careful attention to fluid and electrolyte management, meticulous wound care, prevention of enteroatmospheric fistula, and individualized nutrition support therapy are essential to successful recovery in this patient population.
• Joseph, B. A., Joseph, B. A., Kulvatunyou, N., Kulvatunyou, N., Okeeffe, T. S., Okeeffe, T. S., Tang, A., Tang, A., Friese, R. S., Friese, R. S., Joseph, B. A., Kulvatunyou, N., Okeeffe, T. S., Tang, A., Friese, R. S., Joseph, B. A., Kulvatunyou, N., Okeeffe, T. S., Tang, A., & Friese, R. S. (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. (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.
• Joseph, B., Hadjizacharia, P., Aziz, H., Snyder, K., Wynne, J., Kulvatunyou, N., Tang, A., O’Keeffe, T., Latifi, R., Friese, R., & Rhee, P. (2012). Continuous Noninvasive Hemoglobin Monitor from Pulse Ox: Ready for Prime Time?. World Journal of Surgery, 37(3), 525-529. doi:10.1007/s00268-012-1871-y
• 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., Wynne, J. L., O'keeffe, T., Friese, R. S., Joseph, B., Kulvatunyou, N., O'keeffe, T., Rhee, P. M., & Tang, A. (2012). Enterocutaneous fistulas and a hostile abdomen: reoperative surgical approaches.. World journal of surgery, 36(3), 516-23. doi:10.1007/s00268-011-1306-1
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  Damage-control surgery and open-abdomen is an acceptable—and often lifesaving—approach to the treatment of patients with severe trauma, abdominal compartment syndrome, necrotizing soft tissue catastrophes, and other abdominal disasters, when closing the abdomen is not possible, ill advised, or will have serious sequelae. However, common consequences of open-abdomen management include large abdominal wall defects, enterocutaneous fistulas (ECFs), and enteroatmospheric fistulas (EAFs). Furthermore, in such patients, a frozen and hostile abdomen (alone or combined with ECFs) is not uncommon. Adding biologic mesh to our surgical armamentarium has revolutionized hernia surgery.
• Latifi, r., Joseph, B. A., Kulvatunyou, N., Wynne, J., Okeeffe, T. S., Tang, A., Friese, R. S., & Rhee, P. (2012). Enterocutaneous Fistulae and the Hostile Abdomen: Re-operative Surgical Approaches. World Journal of Surgery, 36(3), 516-523.
• Le, A., Friese, R. S., Hsu, C., Wynne, J. L., Rhee, P., & O'Keeffe, T. (2012). Sleep disruptions and nocturnal nursing interactions in the intensive care unit. The Journal of surgical research, 177(2), 310-4.
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  Sleep deprivation, common in intensive care unit (ICU) patients, may be associated with increased morbidity and/or mortality. We previously demonstrated that significant numbers of nocturnal nursing interactions (NNIs) occur during the routine care of surgical ICU patients. For this study, we assessed the quantity and type of NNIs in different ICU types: medical, surgical, cardiothoracic, pediatric, and neonatal. We hypothesized that the number and type of NNIs vary among different ICU types.
• Phelan, H. A., Eastman, A. L., Aldy, K., Carroll, E. A., Nakonezny, P. A., Jan, T., Howard, J. L., Chen, Y., Friese, R. S., & Minei, J. P. (2012). Prestorage leukoreduction abrogates the detrimental effect of aging on packed red cells transfused after trauma: a prospective cohort study. American journal of surgery, 203(2), 198-204.
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  The aim of this study was to prospectively duplicate previous retrospective findings showing that prestorage leukoreduction blunts the detrimental effect of aging on banked packed red blood cells transfused after injury.
• Stassen, N. A., Bhullar, I., Cheng, J. D., Crandall, M. L., Friese, R. S., Guillamondegui, O. D., Jawa, R. S., Maung, A. A., Rohs, T. J., Sangosanya, A., Schuster, K. M., Seamon, M. J., Tchorz, K. M., Zarzuar, B. L., & Kerwin, A. J. (2012). Selective nonoperative management of blunt splenic injury: an Eastern Association for the Surgery of Trauma practice management guideline. The journal of trauma and acute care surgery, 73(5 Suppl 4), S294-300.
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  During the last century, the management of blunt force trauma to the spleen has changed from observation and expectant management in the early part of the 1900s to mainly operative intervention, to the current practice of selective operative and nonoperative management. These issues were first addressed by the Eastern Association for the Surgery of Trauma (EAST) in the Practice Management Guidelines for Non-operative Management of Blunt Injury to the Liver and Spleen published online in 2003. Since that time, a large volume of literature on these topics has been published requiring a reevaluation of the current EAST guideline.
• Stassen, N. A., Bhullar, I., Cheng, J. D., Crandall, M., Friese, R., Guillamondegui, O., Jawa, R., Maung, A., Rohs, T. J., Sangosanya, A., Schuster, K., Seamon, M., Tchorz, K. M., Zarzuar, B. L., & Kerwin, A. (2012). Nonoperative management of blunt hepatic injury: an Eastern Association for the Surgery of Trauma practice management guideline. The journal of trauma and acute care surgery, 73(5 Suppl 4), S288-93.
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  During the last century, the management of blunt force trauma to the liver has changed from observation and expectant management in the early part of the 1900s to mainly operative intervention, to the current practice of selective operative and nonoperative management. These issues were first addressed by the Eastern Association for the Surgery of Trauma in the Practice Management Guidelines for Nonoperative Management of Blunt Injury to the Liver and Spleen published online in 2003. Since that time, a large volume of literature on these topics has been published requiring a reevaluation of the previous Eastern Association for the Surgery of Trauma guideline.
• Watt, J., Amini, A., Mosier, J., Gustafson, M., Wynne, J. L., Friese, R., Gruessner, R. W., Rhee, P., & O'Keeffe, T. (2012). Treatment of severe hemolytic anemia caused by Clostridium perfringens sepsis in a liver transplant recipient. Surgical infections, 13(1), 60-2.
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  Clostridium perfringens bacteremia accompanied by extensive intravascular hemolysis is an almost inescapably fatal infection.
• Wynne, J. L., Friese, R. S., O'keeffe, T., Dineen, H. A., Joseph, B. A., Kulvatunyou, N., Rhee, P. M., Sadoun, M., Tang, A., & Villegas, C. V. (2012). Are all trauma centers equal: Analyzing pediatric outcomes. Journal of The American College of Surgeons, 215(3), S100. doi:10.1016/j.jamcollsurg.2012.06.266
• Wynne, J., O'keeffe, T., Friese, R. S., Joseph, B., Kaplan, S., Kulvatunyou, N., Rhee, P., & Tang, A. (2012). 685: OUTCOMES IN EVER VENTILATED SUPER ELDERLY TRAUMA PATIENTS. Critical Care Medicine, 40, 1-328. doi:10.1097/01.ccm.0000424901.71778.fb
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  Introduction: Outcomes from mechanical ventilation of groups of super elderly medical and surgical ICU patients have been described, but the specific group of super elderly trauma patients has not been examined. The purpose of this study is to describe the prevalence of intubation in the cohort of super elderly trauma patients in a Level I trauma center, and define outcomes. Hypothesis: We hypothesize that any intubation in the groups of octogenarian and nonagenarian trauma patients correlates strongly with mortality, and that this effect increases with age. Methods: A five year interval (2007-2012) of a trauma registry of an urban Level I trauma center was queried with regards to incidence and outcomes of mechanical ventilation for cohorts of octogenarian and nonagenarian trauma patients. Cohorts were compared over parameters within the registry. Results: 1,142 trauma patients between the ages of 80 and 99 were included in the analysis; of these, the 126 ever intubated patients comprised the group for analysis. 19 of 214 nonagenarians (8.9%) and 107 of 928 octogenarians (11.5%) required intubation. There was no statistically significant difference in ventilator or ICU days between the two age groups. Only 3 (15.7%) of the nonagenarians were successfully extubated, while 66 (61.7%) of the octogenarians were. In a multivariate model, nonagenarian status strongly predicted extubation failure (OR=11.6 [95%CI=2.8-48.3], p=0.001). 16 of 19 nonagenarians (84%) and 41 of 107 octogenarians (47%) died during the hospitalization, and this was statistically significant (p
• Wynne, J., O'keeffe, T., Friese, R. S., Joseph, B., Kulvatunyou, N., Meyer, D. E., Rhee, P., & Tang, A. (2012). 777: UTILITY OF HEAD CTA IN BLUNT TRAUMA PATIENTS. Critical Care Medicine, 40, 1-328. doi:10.1097/01.ccm.0000424992.08043.f3
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  Introduction: Indications for obtaining IV contrasted Head CT in the evaluation of critically ill blunt trauma patients remain undefined. The presence of subarachnoid hemorrhage may portend rupture of a pre-existing cerebral aneurysm; however, it may result from blunt trauma alone, or from rupture of traumatic cerebral pseudoaneurysm. Additionally, the association of skull base fractures with vascular injury may prompt clinicians to pursue contrasted Head imaging. The purpose of this study was to examine the utility of Head CTA in blunt trauma patients. Hypothesis: We hypothesized that the routine addition of IV contrasted Head CT to the evaluation of blunt trauma patients with traumatic brain injury results in an extremely low yield of new, clinically useful information. Methods: Data was collected retrospectively from the Trauma Registry and Radiology Database of our urban Level I Trauma Center. All blunt trauma patients evaluated on admission with a non-contrasted Head CT, and subsequently with a contrasted Head CT at any time during the admission, during a 48 month period (2008-2012), were entered in the study. Results: During the study period, 287 blunt trauma patients received both studies. Cerebral aneurysms were identified in 22 patients (7.7%). Of these, 12 (4%) were incidental findings, 7 (2.4%) were ruptures of pre-existing aneurysms, and 3 (1.0%) were traumatic pseudoaneurysms. Patients with pre-existing aneurysms differed from the group of patients with traumatic pseudoaneurysms with regard to age, mechanism, and Head AIS. Traumatic pseudoaneurysm occurred only in high mechanism patients (MCC, rollover MVC, and pedestrian struck). Conclusions: The use of contrasted Head CT in blunt trauma patients identifies a prevalence of cerebral aneurysm consistent with that of the general population. Traumatic cerebral pseudoaneurysm was found only in a very small subset of young, high mechanism patients. Routine exposure of the trauma patient to the additional cost, radiation and IV contrast exposure associated with CTA of the head is not warranted.
• Barmparas, G., Inaba, K., Georgiou, C., Hadjizacharia, P., Chan, L. S., Demetriades, D., Friese, R., & Rhee, P. (2011). Swan-Ganz catheter use in trauma patients can be reduced without negatively affecting outcomes. World journal of surgery, 35(8), 1809-17.
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  The use of pulmonary artery catheter (PAC) is controversial. The purpose of this study was to document the changing pattern of PAC use and to determine its effect on outcome.
• 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., 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.
• Frankel, H., Friese, R. S., Ghaemmaghami, V., Gunst, M., Matsushima, K., O'keeffe, T., Robinson, M., & Sperry, J. L. (2011). Focused bedside echocardiography in the surgical intensive care unit: comparison of 3 methods to estimate cardiac index.. Journal of intensive care medicine, 26(4), 255-60. doi:10.1177/0885066610389973
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  We sought to determine which of 3 methods used to evaluate cardiac index (CI) is the most accurate using focused bedside echocardiography (ECHO). We hypothesized that the fractional shortening (FS) method would provide a more accurate estimate of CI than the left ventricular outflow tract/velocity-time integral (LVOT/VTI) or Simpson's methods. This was a prospective observational cohort study conducted in the surgical ICU of an urban level 1 trauma center utilizing all patients with a pulmonary artery catheter (PAC) in place. Three surgical intensive care unit (SICU) faculty and 3 fellows underwent focused cardiac ultrasound training. Focused ECHO exams-bedside echocardiographic assessment in trauma/critical care (BEAT)- were performed using the Sonosite portable ultrasound device (Bothall, Washington). Stroke volume (SV) measurements were prospectively obtained on all trauma/SICU patients, with a PAC in place, using FS, LVOT/VTI, and Simpson's methods. The investigators were blinded to the PAC data. From each measurement, CI was calculated and categorized as low, normal, or high, based on a normal range of 2.4 to 4.0 L/min per m(2). Each CI obtained from the PAC was similarly categorized. The association between the BEAT and PAC estimates of CI was evaluated for each method using chi-square goodness of fit. Eighty five BEAT exams were performed on consecutive SICU patients, 56% were on trauma and 44% on emergency general surgery patients. There was a statistically significant association between the CI estimate using the FS method (P = .012), but not the LVOT/VTI (P = .33) or Simpson's method (P = .74). Our data showed a significant association between the PAC estimate of CI and our estimate using the FS method. The other methods were difficult to obtain, subjective, and inaccurate. Fractional shortening was the method of choice to estimate CI for the BEAT exam performed by intensivists in SICU patients.
• Friese, R. S. (2011). Gut access in critically ill and injured patients: Where have we gone thus far?. European Surgery.
• Friese, R. S., Cervantes, L. A., Cucher, D. J., O'keeffe, T., Rhee, P., & Taylor, Z. (2011). Alcohol has No Effect on Failure Rates of Non-Operative Management of the Spleen. Journal of Surgical Research, 165(2), 182. doi:10.1016/j.jss.2010.11.685
• Friese, R. S., Joseph, B., Kulvatunyou, N., O'Keeffe, T., Rhee, P., Tang, A., & Wynne, J. (2011). Incidence and pattern of cervical spine injury in blunt assault. Journal of Trauma-injury Infection and Critical Care. doi:10.1097/ta.0b013e318238b7ca
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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.We queried the trauma registry at our Level I trauma center for patients admitted with the diagnosis of blunt assault over a 5-year period (2005-2009). Patients with CSI were identified by International Classification Diagnosis (Ninth Revision) codes of 805, 806, 839, or 952. We only included the patients who received the blow to the head and face. For eligible patients, we extracted data from trauma registry and inpatient chart review, including radiographic reports. A single author (N.K.) reviewed computed tomography (CT) scan of all individuals with CSI. We performed summary and Spearman rank correlation statistical analysis with p value
• Friese, R. S., Wynne, J., Latifi, R., Blecker, N., Joseph, B., Kulvatunyou, N., O'keeffe, T., O'neil, M., & Rhee, P. (2011). Timing Of Organ Donation After Injury: Implications For Early Resuscitation. Journal of Surgical Research, 165(2), 182. doi:10.1016/j.jss.2010.11.681
• Joseph, B. A., Joseph, B. A., Tang, A., Tang, A., Friese, R. S., Friese, R. S., Okeeffe, T. S., Okeeffe, T. S., Kulvatunyou, N., Kulvatunyou, N., Con, J., Con, J., Rhee, P., Rhee, P., Latifi, R., Latifi, R., Joseph, B. A., Tang, A., Friese, R. S., , Okeeffe, T. S., et al. (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., Joseph, B. A., Joseph, B. A., Tang, A., Tang, A., Okeeffe, T. S., Okeeffe, T. S., Wynne, J., Wynne, J., Friese, R. S., Friese, R. S., Latifi, R., Latifi, R., Rhee, P., & Rhee, P. (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.
• O'keeffe, T., Wynne, J. L., Friese, R. S., Latifi, R., Joseph, B., Kulvatunyou, N., Rhee, P., & Tang, A. (2011). Total parenteral nutrition in critically ill and injured patients. European Surgery-acta Chirurgica Austriaca, 43(1), 19-23. doi:10.1007/s10353-011-0589-7
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  BACKGROUND: Malnutrition is common in critically ill and severely injured patients. Many factors are responsible for the development of malnutrition in critically ill and injured patients, including the hypercatabolic states associated with trauma, sepsis, often repeated surgical intervention, long periods of inability to take nutrition by mouth and many other factors. While oral or enteral nutrition is the preferable technique of provision nutrition support, often this is impossible, impractical or ill advised. To this end, the total parenteral nutrition (TPN), in clinical practice since 1968, as developed by Dr. Stanley J. Dudrick, has been an instrumental technique in providing all needed nutrient substrates and calories intravenously to all those patients who cannot eat, will not eat or should not eat. METHODS: Review of literature. RESULTS: TPN is efficacious in patients who are malnourished and unable to receive adequate oral or enteral nutrients in particular in short gut syndromes, severe gut dysfunction, mesenteric vascular insufficiency, prolonged bowel obstruction, high volume fistulas, sepsis with hemodynamic instability, and many other conditions. CONCLUSIONS: TPN can remain the primary technique of providing all nutrient substrates and caloric needs until the GI tract can safely and effectively be used.
• O'Keeffe, T., Thekkumel, J. J., Friese, S., Shafi, S., & Josephs, S. C. (2011). A policy of dedicated follow-up improves the rate of removal of retrievable inferior Vena Cava Filters in trauma patients. The American surgeon, 77(1), 103-8.
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  Retrievable Inferior Vena Cava Filters (IVCF) for prophylaxis against pulmonary embolus have been associated with low rates of removal. Strategies for improving the rates of retrieval have not been described. We hypothesized that a policy of dedicated follow-up would achieve a higher rate of filter removal. Trauma and Nontrauma patients who had a retrievable IVCF placed during 2006 were identified. A protocol existed for trauma patients with chart stickers, arm bracelets, and dedicated follow-up by nurse practitioners from three trauma teams. No protocol existed for nontrauma patients. Statistical analysis was performed using χ(2) analysis or analysis of variance. One hundred sixty-seven retrievable IVCFs were placed over 12 months; 91 in trauma patients and 76 in nontrauma patients. Trauma patients were more likely to have their IVCF removed than nontrauma patients, 55 per cent versus 19 per cent, P < 0.001. There were differences between the three trauma teams, with removal rates of 44 per cent, 42 per cent, and 86 per cent respectively (P < 0.05). On multivariate analysis young age and trauma patient status were independent predictors of filter removal. A policy of dedicated follow-up of patients with IVCFs can achieve significantly higher rates of filter removal than have been previously reported. Similar policies should be adopted by all centers placing retrievable IVCFs to maximize retrieval rates.
• 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.
• Friese, R. S. (2010). Total parenteral nutrition in critically ill and injured patients. European Surgery.
• Friese, R. S., Wynne, J. L., Latifi, R., Kulvatunyou, N., O'keeffe, T., Piercecchi, C., Rhee, P., & Snyder, K. A. (2010). Initial Admission Core Body Temperature Is a Better Predictor of Survival in Trauma Patients than Time to Normothermia. Journal of Surgical Research, 158(2), 417. doi:10.1016/j.jss.2009.11.681
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  Hypothermia on arrival has been shown to be a predictor of morbidity and mortality in trauma patients. No studies to date have examined the effect on outcome of the length of time taken by a hypothermic patient to achieve a normal core body temperature. Our hypothesis was that the time required to achieve normothermia is a better predictor of mortality than the initial core body temperature. Methods: All trauma patients admitted to a surgical Intensive Care Unit (ICU) at a level I trauma center in 2008 were retrospectively analyzed to identify their presenting core body temperature in the Emergency Department (ED). For the purposes of this study we defined hypothermia as an initial temperature of less than 36 degrees Centigrade (°C). Time taken to achieve normothermia was calculated from data extracted from the electronic medical record. We compared crude mortality between hypothermic and normothermic patients using Chi-square analysis, and then used a multivariate logistic regression model to adjust for confounders such as age, sex, injury severity as well as time required to achieve normothermia. Results are presented as proportions or means±Standard Deviation. Results: Of the 763 patients admitted to the surgical ICU over this period, 179 were hypothermic on presentation to the ED. Hypothermic patients were more likely to be hypotensive in the ED (8.3% vs. 2.6%, p=0.01), have a lower GCS (11±5 vs. 12.7±4, P
• Friese, R., Friese, R. S., Vander Werf, B. D., Watt, J., Joseph, B., Wynne, J., Kulvatunyou, N., & O'Keeffe, T. (2010). Can plasma B-type natriuretic peptide levels predict need for mechanical ventilation after injury?. American journal of surgery, 200(6).
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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.
• Higa, G., Friese, R., O'Keeffe, T., Wynne, J., Bowlby, P., Ziemba, M., Latifi, R., Kulvatunyou, N., & Rhee, P. (2010). Damage control laparotomy: a vital tool once overused. The Journal of trauma, 69(1), 53-9.
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  Trauma surgery is in constant evolution as is the use of damage control laparotomy (DCL). The purpose of this study was to report the change in usage of DCL over time and its effect on outcome.
• Matsushima, K., Cook, A., Tyner, T., Tollack, L., Williams, R., Lemaire, S., Friese, R., & Frankel, H. (2010). Parenteral nutrition: a clear and present danger unabated by tight glucose control. American journal of surgery, 200(3), 386-90.
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  The infectious risks of parenteral nutrition (PN) in critical illness are well described, although most literature predates tight glucose control (TGC) practice. The authors hypothesized that PN-related complications are ameliorated by TGC and are equivalent to those in enteral nutrition (EN) patients.
• Napolitano, L. M., Fulda, G. J., Davis, K. A., Ashley, D. W., Friese, R., Van Way, C. W., Meredith, J. W., Fabian, T. C., Jurkovich, G. J., & Peitzman, A. B. (2010). Challenging issues in surgical critical care, trauma, and acute care surgery: a report from the Critical Care Committee of the American Association for the Surgery of Trauma. The Journal of trauma, 69(6), 1619-33.
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  Critical care workforce analyses estimate a 35% shortage of intensivists by 2020 as a result of the aging population and the growing demand for greater utilization of intensivists. Surgical critical care in the U.S. is particularly challenged by a significant shortfall of surgical intensivists, with only 2586 surgeons currently certified in surgical critical care by the American Board of Surgery, and even fewer surgeons (1204) recertified in surgical critical care as of 2009. Surgical critical care fellows (160 in 2009) represent only 7.6% of all critical care trainees (2109 in 2009), with the largest number of critical care fellowship positions in internal medicine (1472, 69.8%). Traditional trauma fellowships have now transitioned into Surgical Critical Care or Acute Care Surgery (trauma, surgical critical care, emergency surgery) fellowships. Since adult critical care services are a large, expensive part of U.S. healthcare and workforce shortages continue to impact our healthcare system, recommendations for regionalization of critical care services in the U.S. is considered. The Critical Care Committee of the AAST has compiled national data regarding these important issues that face us in surgical critical care, trauma and acute care surgery, and discuss potential solutions for these issues.
• Parthasarathy, S., Friese, R. S., & Ayas, N. T. (2010). Biological validity to sleep measurements during critical illness. Critical care medicine, 38(2), 705-6.
• Phelan, H. A., Gonzalez, R. P., Patel, H. D., Caudill, J. B., Traylor, R. K., Yancey, L. R., Sperry, J. L., Friese, R. S., & Nakonezny, P. A. (2010). Prestorage leukoreduction ameliorates the effects of aging on banked blood. The Journal of trauma, 69(2), 330-7.
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  Previous studies have demonstrated that the transfusion of older blood is independently associated with higher rates of infectious complications, multiple organ failure, and mortality. Putative mechanisms implicate leukocytes in stored blood that generate immunomodulatory mediators as the stored blood ages. The purpose of this retrospective cohort study was to describe the effect of prestorage leukoreduction (PS-LR) on the detrimental clinical effects of increasing age on blood products used in trauma patients.
• Stuke, L., Jennings, A., Gunst, M., Tyner, T., Friese, R., O'Keeffe, T., & Frankel, H. (2010). Universal consent practice in academic intensive care units (ICUs). Journal of Intensive Care Medicine, 25(1). doi:10.1177/0885066609350982
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  The purpose of this study was to determine national practice for obtaining consent in academic adult intensive care units (ICUs) for routine bedside procedures and to define universal consent rates by patient demographics within our own institutionĝ™s ICUs. Methods: A 10-question survey was sent to the program directors for all U.S. surgical and pulmonary critical care directors regarding consent practices. Further, the adoption of a universal consent protocol in an academic county hospital was studied. Results: Cross-sectional study: Thirty-seven percent of program directors completed the survey. Consent rates varied from 35% to 97% by procedure, with only 14% using a universal consent document. Providers in Medical ICUs obtained consent more often than in Surgical ICUs for both central line and pulmonary artery catheter placement (82.8% and 93.1% vs. 52.6% and 52.6%, respectively). Prospective cohort study: At our institution, 90% of 363 patients or their proxies signed universal consent for procedures, 4.4% consent with exemptions, while 5.2% refused. Insured patients were 2.7 times more likely to sign full universal consent for bedside ICU procedures than uninsured patients. Conclusion: There was a national variation in ICU consent practices with an interest in a wider usage of universal consent protocols. The latter was adopted differentially based on patient demographics. Universal consent was widely accepted at our institution.
• Stuke, L., Jennings, A., Gunst, M., Tyner, T., O'keeffe, T., Frankel, H. L., & Friese, R. S. (2010). Universal consent practice in academic intensive care units (ICUs).. Journal of intensive care medicine, 25(1), 46-52. doi:10.1177/0885066609350982
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  The purpose of this study was to determine national practice for obtaining consent in academic adult intensive care units (ICUs) for routine bedside procedures and to define universal consent rates by patient demographics within our own institution's ICUs..A 10-question survey was sent to the program directors for all U.S. surgical and pulmonary critical care directors regarding consent practices. Further, the adoption of a universal consent protocol in an academic county hospital was studied..Cross-sectional study: Thirty-seven percent of program directors completed the survey. Consent rates varied from 35% to 97% by procedure, with only 14% using a universal consent document. Providers in Medical ICUs obtained consent more often than in Surgical ICUs for both central line and pulmonary artery catheter placement (82.8% and 93.1% vs. 52.6% and 52.6%, respectively). Prospective cohort study: At our institution, 90% of 363 patients or their proxies signed universal consent for procedures, 4.4% consent with exemptions, while 5.2% refused. Insured patients were 2.7 times more likely to sign full universal consent for bedside ICU procedures than uninsured patients..There was a national variation in ICU consent practices with an interest in a wider usage of universal consent protocols. The latter was adopted differentially based on patient demographics. Universal consent was widely accepted at our institution.
• Friese, R. S., Bruns, B., & Sinton, C. M. (2009). Sleep deprivation after septic insult increases mortality independent of age. The Journal of trauma, 66(1), 50-4.
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  Sleep deprivation is a common problem in the intensive care unit. Animal models have demonstrated that sleep deprivation alone is associated with increased mortality. We have previously shown that septic insult with sleep deprivation results in increased mortality in a murine model. The aging process is known to reduce the restorative phases of sleep. The purpose of this study was to evaluate the effect of age on mortality with sleep deprivation during recovery from septic insult.
• Friese, R. S., Wallace, L., Mcbride, D., & O'keeffe, T. (2009). QS220. Nocturnal Care Interactions and Sleep Disruption in the Intensive Care Unit. Journal of Surgical Research, 151(2), 292. doi:10.1016/j.jss.2008.11.522
• Gunst, M., Ghaemmaghami, V., Sperry, J., O'Keeffe, T., Friese, R., & Frankel, H. (2009). Letters to the editor. Journal of Trauma - Injury, Infection and Critical Care, 66(2). doi:10.1097/TA.0b013e318196ad23
• Latifi, R., Hadeed, G. J., Rhee, P., O'Keeffe, T., Friese, R. S., Wynne, J. L., Ziemba, M. L., & Judkins, D. (2009). Initial experiences and outcomes of telepresence in the management of trauma and emergency surgical patients. American journal of surgery, 198(6), 905-10.
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  Teletrauma programs allow rural patients access to advanced trauma and emergency medical services that are often limited to urban areas.
• O'keeffe, T., Friese, R. S., & Shafi, S. (2009). QS393. Vaccination for Post-Traumatic Splenectomy: Are We Doing it Right?. Journal of Surgical Research, 151(2), 300. doi:10.1016/j.jss.2008.11.704
• Phelan, H. A., Velmahos, G. C., Jurkovich, G. J., Friese, R. S., Minei, J. P., Menaker, J. A., Philp, A., Evans, H. L., Gunn, M. L., Eastman, A. L., Rowell, S. E., Allison, C. E., Barbosa, R. L., Norwood, S. H., Tabbara, M., Dente, C. J., Carrick, M. M., Wall, M. J., Feeney, J., , O'Neill, P. J., et al. (2009). An evaluation of multidetector computed tomography in detecting pancreatic injury: results of a multicenter AAST study. The Journal of trauma, 66(3), 641-6; discussion 646-7.
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  Efforts to determine the suitability of low-grade pancreatic injuries for nonoperative management have been hindered by the inaccuracy of older computed tomography (CT) technology for detecting pancreatic injury (PI). This retrospective, multicenter American Association for the Surgery of Trauma-sponsored trial examined the sensitivity of newer 16- and 64-multidetector CT (MDCT) for detecting PI, and sensitivity/specificity for the identification of pancreatic ductal injury (PDI).
• Shafi, S., Stewart, R. M., Nathens, A. B., Friese, R. S., Frankel, H., & Gentilello, L. M. (2009). Significant variations in mortality occur at similarly designated trauma centers. Archives of surgery (Chicago, Ill. : 1960), 144(1), 64-8.
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  Mortality rates vary across designated trauma centers (TC), even after controlling for injury severity.
• Sinton, C. M., Kovakkattu, D., & Friese, R. S. (2009). Validation of a novel method to interrupt sleep in the mouse. Journal of neuroscience methods, 184(1), 71-8.
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  Interrupted sleep, fragmented sleep or restricted sleep is a corollary of many psychiatric, neurological and respiratory disorders and also results from disruptive environments such as that of the intensive care unit (ICU). Recent rodent studies have revealed that sleep interruption (SI) can have more significant consequences for cognitive and neurophysiological variables than were expected and may even be equivalent to those of total sleep deprivation. Results from this research are therefore being increasingly recognized for their implications, which may include delayed recovery from critical illness in the ICU. Here we describe in detail a method for interrupting sleep in a murine model, which we had previously adopted to show an increase in mortality after septic insult. Interrupting sleep for 30s every 2 min over 48 h significantly decreased rapid eye movement (REM) and non-rapid eye movement (NREM) sleep. The technique, which is based on using a standard laboratory orbital shaker to oscillate the cage containing the mouse, can easily be adapted to use different parameters for SI. During recovery, mice exhibited a rebound in REM sleep time and an increase in the depth of NREM sleep as measured by delta (1-4 Hz) power in the electroencephalogram. The changes in sleep both during and after SI showed some differences from those previously observed in the rat using the same SI parameters. In conclusion, the mouse may provide a useful alternative model for studying the effects of SI.
• Eastman, A. L., Metzger, J. C., Pepe, P. E., Benitez, F. L., Decker, J., Rinnert, K. J., Field, C. A., & Friese, R. S. (2008). Conductive electrical devices: a prospective, population-based study of the medical safety of law enforcement use. The Journal of trauma, 64(6), 1567-72.
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  To examine police compliance with policies for the proper use of conductive electrical devices (CEDs) and, in turn, track any associated medical events following CED application.
• Friese, R. S. (2008). Good night, sleep tight: the time is ripe for critical care providers to wake up and focus on sleep. Critical care (London, England), 12(3), 146.
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  The role of sleep during recovery from acute illness has been overlooked for decades. Advances in the support of critically ill patients have been made in mechanical ventilation, specialized nutrition support, highly specific antibiotic therapy, and early rehabilitation. However, the promotion of sleep - a basic tenet for survival - has been actively ignored by critical care providers. Bourne and coworkers recently conducted a small clinical trial that describes improved sleep efficiency with oral melatonin use in critically ill patients.
• Friese, R. S. (2008). Sleep and recovery from critical illness and injury: a review of theory, current practice, and future directions. Critical care medicine, 36(3), 697-705.
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  The objectives of this article were to describe the deleterious effects of sleep deprivation, characterize sleep in patients cared for in an intensive care unit (ICU) environment, and propose an integrated strategy to improve sleep in critical care units.
• Friese, R. S., Barber, R., McBride, D., Bender, J., & Gentilello, L. M. (2008). Could Beta blockade improve outcome after injury by modulating inflammatory profiles?. The Journal of trauma, 64(4), 1061-8.
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  Cardioprotection with beta-receptor antagonists improves outcome in high risk patients undergoing elective surgery. Recent trials have demonstrated an association between beta blocker (BB) use and improved outcomes after injury. The mechanisms through which BB result in improved outcomes remain poorly elucidated. In vitro evidence supports that BB modulates the postinjury inflammatory response. The purpose of this study was to examine the effects of BB on inflammatory profiles in injured patients at increased risk for heart disease.
• Friese, R. S., Sperry, J. L., Phelan, H. A., & Gentilello, L. M. (2008). The use of leukoreduced red blood cell products is associated with fewer infectious complications in trauma patients. American journal of surgery, 196(1), 56-61.
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  Clinical studies suggest that leukocytes in banked blood may increase infectious complications after transfusion. However, these investigations included few injured patients. Therefore, the effect of the use of leukoreduced red blood cell (RBC) products in this patient population is unknown. In addition, large numbers of RBC transfusions are frequently required in the treatment of patients with hemorrhagic shock, which may have a more profound effect on infectious risk. The purpose of this study was to determine the effect of prestorage leukoreduction on infectious complications in injured patients.
• Gunst, M., Ghaemmaghami, V., Sperry, J., Robinson, M., O'Keeffe, T., Friese, R., & Frankel, H. (2008). Accuracy of cardiac function and volume status estimates using the bedside echocardiographic assessment in trauma/critical care. The Journal of trauma, 65(3), 509-16.
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  Critically ill patients often require invasive monitoring to evaluate and optimize cardiac function and preload. With questionable outcomes associated with pulmonary artery catheters (PACs), some have evaluated the role of less invasive monitors. We hypothesized that the Bedside Echocardiographic Assessment in Trauma (BEAT) examination would generate cardiac index (CI) and central venous pressure (CVP) estimates that correlate with that of a PAC.
• Gunst, M., Sperry, J., Ghaemmaghami, V., O'Keeffe, T., Friese, R., & Frankel, H. (2008). Bedside echocardiographic assessment for trauma/critical care: the BEAT exam. Journal of the American College of Surgeons, 207(3), e1-3.
• Parks, J. K., Klein, J., Frankel, H. L., Friese, R. S., & Shafi, S. (2008). Dissecting delays in trauma care using corporate lean six sigma methodology. The Journal of trauma, 65(5), 1098-104; discussion 1104-5.
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  The Institute of Medicine has identified trauma center overcrowding as a crisis. We applied corporate Lean Six Sigma methodology to reduce overcrowding by quantifying patient dwell times in trauma resuscitation units (TRU) and to identify opportunities for reducing them.
• Shafi, S., Friese, R., & Gentilello, L. M. (2008). Moving beyond personnel and process: a case for incorporating outcome measures in the trauma center designation process. Archives of surgery (Chicago, Ill. : 1960), 143(2), 115-9; discussion 120.
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  Similarly designated trauma centers do not achieve similar outcomes.
• Sperry, J. L., Friese, R. S., Frankel, H. L., West, M. A., Cuschieri, J., Moore, E. E., Harbrecht, B. G., Peitzman, A. B., Billiar, T. R., Maier, R. V., Remick, D. G., & Minei, J. P. (2008). Male gender is associated with excessive IL-6 expression following severe injury. The Journal of trauma, 64(3), 572-8; discussion 578-9.
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  An important and persistent laboratory finding has been that males and females respond differently after traumatic injury and hemorrhagic shock. We have previously presented clinical data showing that male gender is independently associated with a 40% higher rate of multiple organ failure (MOF) and a 25% higher rate of nosocomial infection (NI) after injury; however, the mechanism responsible for this dimorphic response after injury has not been adequately characterized clinically.
• Friese, R. S., Diaz-Arrastia, R., McBride, D., Frankel, H., & Gentilello, L. M. (2007). Quantity and quality of sleep in the surgical intensive care unit: are our patients sleeping?. The Journal of trauma, 63(6), 1210-4.
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  The lack of adequate sleep during intensive care unit (ICU) admission is a frequently overlooked complication. Disrupted sleep is associated with immune system dysfunction, impaired resistance to infection, as well as alterations in nitrogen balance and wound healing. The effects of surgical ICU admission on patients' sleep quality and architecture remain poorly defined. The purpose of this study was to describe the quantity and quality of sleep as well as sleep architecture, as defined by polysomnography (PSG), in patients cared for in the surgical ICU.
• Friese, R. S., Dineen, S., Jennings, A., Pruitt, J., McBride, D., Shafi, S., Frankel, H., & Gentilello, L. M. (2007). Serum B-type natriuretic peptide: a marker of fluid resuscitation after injury?. The Journal of trauma, 62(6), 1346-50; discussion 1350-1.
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  Excessive volume resuscitation after injury is associated with severe complications. B-type natriuretic peptide (BNP) is secreted from myocardium under increased wall stretch and is used in medical intensive care units (ICUs) as a noninvasive method to detect heart failure. However, the use of BNP as a marker of fluid overload during resuscitation from injury has not been previously described.
• Friese, R. S., Malekzadeh, S., Shafi, S., Gentilello, L. M., & Starr, A. (2007). Abdominal ultrasound is an unreliable modality for the detection of hemoperitoneum in patients with pelvic fracture. The Journal of trauma, 63(1), 97-102.
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  Detection of hemoperitoneum in patients with pelvic fracture and hemodynamic instability is important to determine the need for laparotomy versus pelvic angiography. The use of ultrasound (FAST [Focused Assessment with Sonography for Trauma]) for the evaluation of hemoperitoneum after blunt abdominal trauma has become widespread. However, its sensitivity and specificity in patients with pelvic fracture remain poorly defined. The purpose of this study was to determine the sensitivity and specificity of FAST for the detection of hemoperitoneum in patients with pelvic fracture and an increased risk for hemorrhage.
• Ghaemmaghami, V., Sperry, J., Gunst, M., Friese, R., Starr, A., Frankel, H., Gentilello, L. M., & Shafi, S. (2007). Effects of early use of external pelvic compression on transfusion requirements and mortality in pelvic fractures. American journal of surgery, 194(6), 720-3; discussion 723.
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  We hypothesized that early use of external mechanical compression (EMC) reduces hemorrhage and mortality associated with pelvic fractures.
• Gunst, M. A., Sperry, J. L., Ghaemmaghami, V., Gunst, R. F., Friese, R. S., Frankel, H. L., Gentilello, L. M., & Shafi, S. (2007). Increased risk of death associated with hypotension is not altered by the presence of brain injury in pediatric trauma patients. American journal of surgery, 194(6), 741-4; discussion 744-5.
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  Hypotension is a well-known predictor of mortality in pediatric trauma patients. However, it is unknown whether the mortality rate is higher in patients with traumatic brain injury (TBI) than in those without TBI. We hypothesized that systemic hypotension increases mortality in pediatric patients with TBI more than it does in pediatric patients with extracranial injuries only.
• Meyer, A., Friese, R., Hauser, C., Smith, P., Shapiro, B., & Pruitt, B. (2007). Discussion. Journal of Trauma - Injury, Infection and Critical Care, 62(6). doi:10.1097/TA.0b013e31804798c3
• Phelan, H. A., Sperry, J. L., & Friese, R. S. (2007). Leukoreduction before red blood cell transfusion has no impact on mortality in trauma patients. The Journal of surgical research, 138(1), 32-6.
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  Studies suggest that leukocytes in donated blood increase mortality and length of hospital stay (LOS) after transfusion. These studies included few trauma patients, however. Many institutions now mandate leukoreduction (LR) of transfusion products, which increases costs by approximately $30/unit. The purpose of this study was to examine the effect of LR on mortality and LOS in trauma patients.
• Brakenridge, S. C., Delagarza, J., Eastman, A. E., Foteh, K., Friese, R. S., Higgins, J., Holland, D., Olson, C., & Smith, B. (2006). Clinical surgery-American High-frequency percussive ventilation improves oxygenation in trauma patients with acute respiratory distress syndrome: a retrospective review. J Surg, N/A.
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  Background: High-frequency percussive ventilation (HFPV), a hybrid of conventional mechanical ventilation and high-frequency oscillatory ventilation, has been used to salvage patients with persistent hypoxemia on conventional mechanical ventilation. We hypothesized that oxygenation would improve in injured patients with severe hypoxemia who were converted to HFPV after initial management with conventional ventilation. Methods: Chart review identified patients with acute respiratory distress syndrome (ARDS) managed with HFPV. Oxygenation parameters (oxygenation index, OI; PaO2/FIO2 ratio, P/F) and mean airway pressures (mPaw) were recorded at baseline and at 1 to 4, 8 to 12, and 12 to 24 hours after initiation of HFPV. Values at baseline and each time point after conversion to HFPV were compared by using analysis of variance or Kruskal-Wallis tests. Results: Twelve patients, over 24 months, were reviewed. Baseline measurements were OI: 42.2 33, P/F: 70 31, (median interquartile range), and mPaw: 29 8 (mean standard deviation) cm H2O. After initiation of HFPV, mPaw did not differ from baseline. There was an improvement in OI (P .01) from baseline at 12 to 24 hours after initiation of HFPV and in P/F at 12 to 24 hours (P .002) and 8 to 12 hours (P .001) after initiation of HFPV. Conclusions: HFPV may improve oxygenation in patients with ARDS without a concomitant increase in mPaw. A randomized trial of HFPV versus conventional ventilation in trauma patients is needed. © 2006 Excerpta Medica Inc. All rights reserved.
• Brakenridge, S. C., Delagarza, J., Eastman, A. E., Foteh, K., Friese, R. S., Higgins, J., Holland, D., Olson, C., Smith, B., Brakenridge, S. C., Delagarza, J., Eastman, A. E., Foteh, K., Friese, R. S., Higgins, J., Holland, D., Olson, C., Smith, B., Brakenridge, S. C., , Delagarza, J., et al. (2006). Clinical surgery-American High-frequency percussive ventilation improves oxygenation in trauma patients with acute respiratory distress syndrome: a retrospective review. Am. J. Surg.
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  Background: High-frequency percussive ventilation (HFPV), a hybrid of conventional mechanical ventilation and high-frequency oscillatory ventilation, has been used to salvage patients with persistent hypoxemia on conventional mechanical ventilation. We hypothesized that oxygenation would improve in injured patients with severe hypoxemia who were converted to HFPV after initial management with conventional ventilation. Methods: Chart review identified patients with acute respiratory distress syndrome (ARDS) managed with HFPV. Oxygenation parameters (oxygenation index, OI; PaO2/FIO2 ratio, P/F) and mean airway pressures (mPaw) were recorded at baseline and at 1 to 4, 8 to 12, and 12 to 24 hours after initiation of HFPV. Values at baseline and each time point after conversion to HFPV were compared by using analysis of variance or Kruskal-Wallis tests. Results: Twelve patients, over 24 months, were reviewed. Baseline measurements were OI: 42.2 33, P/F: 70 31, (median interquartile range), and mPaw: 29 8 (mean standard deviation) cm H2O. After initiation of HFPV, mPaw did not differ from baseline. There was an improvement in OI (P .01) from baseline at 12 to 24 hours after initiation of HFPV and in P/F at 12 to 24 hours (P .002) and 8 to 12 hours (P .001) after initiation of HFPV. Conclusions: HFPV may improve oxygenation in patients with ARDS without a concomitant increase in mPaw. A randomized trial of HFPV versus conventional ventilation in trauma patients is needed. © 2006 Excerpta Medica Inc. All rights reserved.
• Eastman, A., Holland, D., Higgins, J., Smith, B., Delagarza, J., Olson, C., Brakenridge, S., Foteh, K., & Friese, R. (2006). High-frequency percussive ventilation improves oxygenation in trauma patients with acute respiratory distress syndrome: a retrospective review. American journal of surgery, 192(2), 191-5.
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  High-frequency percussive ventilation (HFPV), a hybrid of conventional mechanical ventilation and high-frequency oscillatory ventilation, has been used to salvage patients with persistent hypoxemia on conventional mechanical ventilation. We hypothesized that oxygenation would improve in injured patients with severe hypoxemia who were converted to HFPV after initial management with conventional ventilation.
• Friese, R. (2006). Discussant. Journal of Parenteral and Enteral Nutrition, 30(5).
• Friese, R. S., Phelan, H., & Sperry, J. L. (2006). Leukoreduction Before Red Blood Cell Transfusion Has No Impact on Mortality in Trauma Patients. Journal of Surgical Research. doi:10.1016/j.jss.2006.07.048
• Friese, R. S., Shafi, S., & Gentilello, L. M. (2006). Pulmonary artery catheter use is associated with reduced mortality in severely injured patients: a National Trauma Data Bank analysis of 53,312 patients. Critical care medicine, 34(6), 1597-601.
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  To evaluate the association between pulmonary artery catheter (PAC) use and mortality in a large cohort of injured patients. We hypothesized that PAC use is associated with improved survival in critically injured trauma patients.
• Landay, M., Oliver, Q., Estrera, A., Friese, R., Boonswang, N., & DiMaio, J. M. (2006). Lung penetration by thoracostomy tubes: imaging findings on CT. Journal of thoracic imaging, 21(3), 197-204.
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  We have analyzed the radiographic and computed tomographic (CT) appearance of thoracostomy (chest) tubes inadvertently placed into the lungs. We have studied the clinical sequela of such malpositioning and discussed treatment options. Cases were collected from chest CT log book reports between January 1998 and January 31, 2005 which indicated or suggested intrapulmonary thoracostomy tube placement. CT scans were reviewed by the authors. The chest radiographs and medical records--including thoracic surgical reports--of those patients whose scans demonstrated intrapulmonary tube placement or indeterminate tube location were reviewed. Fifty patients, in whom 51 thoracostomy tubes were placed into the lungs, are included in this series. None of these tubes were described as intrapulmonary on reports of chest radiographs done before CT scanning. In 13 patients (26%), thoracostomy tube placements produced immediate improvement in pleural abnormalities. Dramatic increase or development of chest wall emphysema or pneumothorax was noted in 4 (8%) patients after tube placement. Twenty-five patients (50%) demonstrated either abrupt or gradual increase in pulmonary or pleural opacity on postplacement chest radiographs. Twenty-one (42%) had no apparent clinical complications. Thirteen (26%) had either prolonged air leaks or recurrent pneumothorax. Ten (20%) developed pneumonia. Retained hemothorax or empyema occurred in 8 (16%). Twelve patients (24%) required subsequent thoracic surgery. Intrapulmonary placement of thoracostomy tubes is probably more common than previously reported. This possibility should be considered when radiographs and CT scans are evaluated.
• Shafi, S., Friese, R. S., & Gentilello, L. M. (2006). Moving beyond personnel and process: A case for incorporting outcome measures in trauma center designation process. Journal of Surgical Research, 130(2), 296-297. doi:10.1016/j.jss.2005.11.391
• Sperry, J. L., Gentilello, L. M., Minei, J. P., Diaz-Arrastia, R. R., Friese, R. S., & Shafi, S. (2006). Waiting for the patient to "sober up": Effect of alcohol intoxication on glasgow coma scale score of brain injured patients. The Journal of trauma, 61(6), 1305-11.
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  Between 35% to 50% of traumatic brain injury (TBI) patients are under the influence of alcohol. Alcohol intoxication may limit the ability of the Glasgow Coma Scale (GCS) to accurately assess severity of TBI. We hypothesized that alcohol intoxication significantly depresses GCS scores of TBI patients.
• Friese, R. S., Coln, C. E., & Gentilello, L. M. (2005). Laparoscopy is sufficient to exclude occult diaphragm injury after penetrating abdominal trauma. The Journal of trauma, 58(4), 789-92.
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  Occult diaphragm injury after penetrating thoracoabdominal injury can be difficult to diagnose and can remain occult for months to years. Delayed diagnosis is associated with the risk of hernia formation, strangulation, and high morbidity and mortality. Although laparoscopy has been proposed as a means of evaluating the diaphragm in these patients, prior studies did not include a confirmatory procedure or did not report long-term follow-up. Thus, true sensitivity and specificity remain unknown. The purpose of this study was to determine the sensitivity and specificity of laparoscopy for the detection of diaphragm injury after penetrating thoracoabdominal trauma. We hypothesized that laparoscopy alone is sufficient to exclude diaphragm injury after penetrating thoracoabdominal trauma.
• Friese, R. S., Philmon, W., Arnoldo, B. D., Hunt, J. P., & Purdue, G. F. (2005). PRE-OPERATIVE FASTING IS UNNECESSARY FOR ENDO-TRACHEALLY INTUBATED BURN PATIENTS.: 153-S. Critical Care Medicine, 33, A41. doi:10.1097/00003246-200512002-00150
• Rehring, T. F., Bender, P. R., Cairns, C. B., Joo, K., Friese, R. S., Shapiro, J. I., Cleveland, J. C., & Banerjee, A. (1997). Different preconditioning stimuli invoke disparate electromechanical and energetic responses to global ischemia in rat hearts. Canadian journal of physiology and pharmacology, 75(4), 335-42.
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  One hypothesized mechanism of the cardioprotection provided by preconditioning is decreased utilization of ATP during ischemia. Although ATP levels in preconditioned heart during ischemia have been previously studied, contractile activity during ischemia has not been investigated. Contractile activity accounts for significant ATP consumption during ischemia. We hypothesized that preconditioning stimuli may conserve energy during the ischemic period by decreasing myocardial contractile energy expenditure prior to asystolic cardiac arrest. We studied three preconditioning stimuli: (i) four cycles of 5-min periods of ischemia (4 x 5' CI), (ii) 2 min of alpha 1-adrenergic stimulation (phenylephrine; PE), and (iii) 2 min of P1-purinergic stimulation (adenosine). The effects of these stimuli on myocardial ATP, ventricular contractility, and the time to cessation of electromechanical function (asystole) during the sustained ischemic period were then examined. Preconditioning stimuli (4 x 5' CI, phenylephrine, and adenosine) improved postischemic functional recovery compared with nonpreconditioned controls. Myocardial ATP contents at the end of 20 min of global ischemia were higher for adenosine-treated (9.0 +/- 1.5 mumol/g dry weight; p < 0.05) and PE-treated (9.9 +/- 1.9 mumol/g dryweight; p < 0.05) hearts than for controls (6.6 +/- 1.2 mumol/g dry weight). The CI hearts began with lower myocardial ATP levels (9.9 +/- 1.2 mumol/g dry weight; p < 0.05) than other groups prior to the sustained ischemic period (control 13.4 +/- 1.0 mumol/g dry weight). As a result of a lower rate of ATP depletion, ATP levels in the CI group were similar to the untreated control after 20 min of sustained ischemia (5.5 +/- 0.7 mumol/g dry weight). Preconditioning with 4 x 5' CI or adenosine (but not PE) led to earlier ventricular arrest. Only adenosine-treated hearts demonstrated a more rapid decline in ventricular contractility during sustained ischemia than did nonpreconditioned control hearts. We conclude that while the final recovery of ventricular contractility after asystolic arrest and reperfusion is improved by preconditioning with different stimuli (4 x 5' CI, adenosine, or PE), each stimulus conferred a characteristic electromechanical and energy conservation strategy during sustained ischemia. Adenosine conserved myocardial ATP content and reduced total cardiac work (developed pressure and heart beats). CI conserved myocardial ATP and minimized the number of ischemic cardiac beats. PE preserved myocardial ATP during ischemia without changing contractile behavior. Thus, energy conservation strategies during ischemia could contribute to the protection afforded by preconditioning stimuli, but the mechanisms appear to differ among stimuli.
• Banerjee, A., Brew, E. C., Friese, R. S., Harken, A. H., & Rehring, T. F. (1996). RESEARCH REVIEW Clinically Accessible Cell Signaling: Second Messengers in Sepsis and Trauma. J Surg Res, N/A. doi:DOI: 10.1006/jsre.1996.0042
• Friese, R. S., Fullerton, D. A., McIntyre, R. C., Rehring, T. F., Agrafojo, J., Banerjee, A., & Harken, A. H. (1996). NO prevents neutrophil-mediated pulmonary vasomotor dysfunction in acute lung injury. The Journal of surgical research, 63(1), 23-8.
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  The purpose of this study was to examine the effect of administration of inhaled nitric oxide (NO) on lung neutrophil accumulation and pulmonary vascular endothelial cell function in endotoxin-induced acute lung injury. Mechanically ventilated rats were studied 4 hr after endotoxin (0.5 mg/kg IP). Inhaled NO (20 ppm) was administered for either the entire 4 hr after endotoxin (continuous group) or for only the first 2 of 4 hr after endotoxin (abbreviated group). Endothelial-dependent (acetylcholine, ACh) and -independent cGMP-mediated relaxation (nitroprusside, SNP) pulmonary vasorelaxation were studied in isolated pulmonary arterial rings. Lung neutrophil accumulation was determined by myeloperoxidase assay (MPO). Inhaled NO prevented endotoxin-induced lung neutrophil accumulation as well as pulmonary endothelial cell dysfunction. However, this protection required continuous administration of inhaled NO. We conclude that inhaled NO prevents neutrophil-mediated pulmonary vascular endothelial cell dysfunction in acute lung injury.
• Fullerton, D. A., Eisenach, J. H., Friese, R. S., Agrafojo, J., Sheridan, B. C., & McIntyre, R. C. (1996). Impairment of endothelial-dependent pulmonary vasorelaxation after mesenteric ischemia/reperfusion. Surgery, 120(5), 879-84.
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  A major hemodynamic feature of acute lung injury is pulmonary hypertension caused by pulmonary vasoconstriction. Impairment of the mechanisms of pulmonary vasorelaxation may contribute to this pulmonary vasoconstriction. This study examined the effect of mesenteric ischemia/reperfusion (I/R) on lung neutrophil accumulation and endothelial-dependent and -independent cyclic 3'-5' guanosine monophosphate-mediated pulmonary vasorelaxation in rats.
• Fullerton, D. A., Eisenach, J. H., McIntyre, R. C., Friese, R. S., Sheridan, B. C., Roe, G. B., Agrafojo, J., Banerjee, A., & Harken, A. H. (1996). Inhaled nitric oxide prevents pulmonary endothelial dysfunction after mesenteric ischemia-reperfusion. The American journal of physiology, 271(2 Pt 1), L326-31.
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  This study examined the effect of inhaled nitric oxide (NO) on lung neutrophil accumulation and endothelial-dependent and -independent guanosine 3',5'-cyclic monophosphate (cGMP)-mediated mechanisms of pulmonary vasorelaxation after mesenteric ischemia-reperfusion (I/R) in mechanically ventilated rats. Inhaled NO (20 ppm) was administered in two protocols: 1) throughout mesenteric I/R and 2) during mesenteric reperfusion alone. Concentration-response curves were generated (10(-9) to 10(-8) M) for acetylcho-line (ACh), A23187, and sodium nitroprusside (SNP) in isolated pulmonary arterial rings preconstricted with phenylephrine. Lung neutrophil accumulation [myeloperoxidase assay (MPO)] was significantly increased from 2.4 +/- 0.2 units/g lung wt in controls to 10.3 +/- 0.4 after 1 h of superior mesenteric artery occlusion and 2 h of reperfusion. Lung MPO activity was not different from controls in rats receiving inhaled NO either 1) during mesenteric I/R or during mesenteric reperfusion alone. The concentration-response curves demonstrated significant impairment of pulmonary vasorelaxation by endothelial-dependent mechanisms (response to ACh and A23187) but not endothelial-independent pulmonary vasorelaxation (response to SNP) after mesenteric I/R. This pulmonary vasomotor dysfunction was prevented by administration of inhaled NO during either mesenteric I/R or during mesenteric reperfusion alone. We conclude that inhaled NO prevents lung neutrophil accumulation and pulmonary vascular endothelial dysfunction after mesenteric I/R.
• Rehring, T. F., Brew, E. C., Friese, R. S., Banerjee, A., & Harken, A. H. (1996). Clinically accessible cell signaling: second messengers in sepsis and trauma. The Journal of surgical research, 60(1), 270-7.
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  Inflammatory mediators of trauma and sepsis transduce cellular events through cell surface receptors initiating intricate membrane and cytosolic reaction cascades that funnel through surprisingly few checkpoints in order to provoke a cellular response. As critical care surgeons, we can explore these cell signalling systems. The purpose of this article is to delineate the six known second messenger pathways relevant to surgical sepsis and trauma. Our comprehension of these signaling systems may offer us an opportunity to blunt post-traumatic cellular injury and promote a constructive response.
• Rehring, T. F., Brew, E. C., Friese, R. S., Banerjee, A., & Harken, A. H. (1995). Cardiac preconditioning protects against irreversible injury rather than attenuating stunning. The Journal of surgical research, 59(1), 111-4.
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  The purpose of this experiment was to determine if cardiac preconditioning (PC) mediates protection by attenuating stunning or preventing irreversible injury. Inherent in the definition of myocardial stunning is the ability to respond to catechol stimulation after ischemia/reperfusion (I/R). Irreversibly injured myocardium cannot respond to catechols. We hypothesized that alpha 1-adrenergic-stimulated PC is mediated through a functional protection against reversible injury. We investigated this hypothesis in the isolated, buffer-perfused rat heart subjected to global ischemia (20 min, 37.5 degrees C) and reperfusion (40 min). The PC group received an alpha 1-adrenergic stimulus (norepinephrine, 0.5-1.0 microM, 2 min) 10 min prior to ischemia. Control hearts were perfused normoxically for 80 min. Developed pressure (DP) and heart rate were recorded continuously. To determine maximal myocellular function, all hearts received a beta-adrenergic pathway stimulus (forskolin (FSK), 100 microM bolus) at end reperfusion. The ability to improve DP in response to FSK was indicative of reversible dysfunction (stunning). Failure to attain the maximal DP established in normoxic controls was utilized as a measure of irreversible dysfunction. Recovery was assessed as a percentage of initial DP. The results suggest that (1) PC protects against an I/R injury (recovery: I/R, 50.1%; PC + I/R, 76.0%; P < 0.05); (2) all groups exhibit reversible dysfunction (all increased DP in response to FSK); (3) when maximally stimulated, I/R hearts are unable to develop pressures similar to those of normoxic controls, suggesting irreversible injury; and (4) PC hearts, however, attained similar maximal pressures compared to controls. We conclude that alpha 1-adrenergic PC improves postischemic cardiac function by preventing irreversible injury.(ABSTRACT TRUNCATED AT 250 WORDS)
• Friese, R. S. (1994). Trauma Primes Cells: An Editorial Review. SHOCK, 59(1), 1-7.
• Friese, R. S. (1993). Use of Enteral Nutrition Following Severe Blunt Multisystem Trauma. Journal of Critical Care Nutrition, 1(1), 37-39.

Proceedings Publications

• 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. In American College of Surgeons.
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  Background 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. Methods Retrospective analysis of the latest publicly available HCAHPS data (2014-2015) was performed. American College of Surgeons (ACS) verified Level I trauma centers for each state were identified from the ACS registry and then the following data points were collected for each hospital: HCAHPS linear mean scores regarding cleanliness of the hospital, doctor and nurse communication with the patient, staff responsiveness, pain management, overall hospital rating, and patient willingness to recommend the hospital. Our outcome measure were serious complication scores, failure-to-rescue (FTR) scores and readmission-after-discharge scores. Spearman correlation analysis was performed. Results A total of 119 ACS verified Level I trauma centers across 46 states were included. The median [IQR] overall hospital rating score for Level I trauma centers was 89 (87-90). The mean ± SD score for serious complication was 0.96 ± 0.266, FTR was 123.06 ± 22.5, and readmission after discharge was 15.71 ± 1.07. The Spearman correlation analysis showed that overall HCAHP-based hospital rating scores did not correlate with serious complications (correlation coefficient = 0.14 p = 0.125), FTR (correlation coefficient = -0.15 p = 0.073), or readmission after discharge (correlation coefficient = -0.18 p = 0.053). Conclusion The findings of our study suggest that no correlation exists between HCAHPS patient satisfaction scores and hospital performance for Level I trauma centers. Consequently, the Centers of Medicare and Medicaid Services should reconsider hospital reimbursement decisions based on HCAHP patient satisfaction scores. Level of Evidence Prognostic/epidemiologic study, level III; therapeutic study, level IV.
• Joseph, B., Zangbar, B., Pandit, V., Fain, M., Mohler, M., Kulvatunyou, N., Jokar, T., O'Keeffe, T., Friese, R., & Rhee, P. (2016). Emergency General Surgery in the Elderly: Too Old or Too Frail? Presented orally at the Surgical Forum of the American College of Surgeons 100th Annual Clinical Congress, San Francisco, CA, October 2014.. In Surgical Forum of the American College of Surgeons.
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  Background 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. Study Design We prospectively measured preadmission frailty in all geriatric (aged 65 years and older) patients undergoing EGS at our institution during a 2-year period. Frailty index (FI) was calculated using the modified 50-variable Rockwood Preadmission FI. Frail patients were defined by FI ≥ 0.25. Outcomes measures were in-hospital complications, development of major complications, and mortality. Multivariate regression analysis was performed. Results A total of 220 patients were enrolled, of which 82 (37%) were frail. Frailty index score did not correlate with age (R = 0.64; R2 = 0.53; p = 0.1) and poorly correlated with American Society of Anesthesiologists score (R = 0.51; R2 = 0.44; p = 0.045). Thirty-five percent (n = 77) of patients had postoperative complications and 19% (n = 42) had major complications. Frailty index was an independent predictor for development of in-hospital complications (odds ratio = 2.13; 95% CI, 1.09-4.16; p = 0.02) and major complications (odds ratio = 3.87; 95% CI, 1.69-8.84; p = 0.001). Age and American Society of Anesthesiologists score were not predictive of postoperative and major complications. Our FI model had 80% sensitivity, 72% specificity, and area under the curve of 0.75 in predicting complications in geriatric patients undergoing EGS. The overall mortality rate was 3.2% (n = 7) and all patients who died were frail. Conclusions Frailty index independently predicts postoperative complications, major complications, and hospital length of stay in elderly patients undergoing emergency general surgery. Use of FI will provide insight into the hospital course of elderly patients, allowing for identification of patients in need and more efficient allocation of hospital resources.
• Zangbar, B., Serack, B., Rhee, P., Joseph, B., Pandit, V., Friese, R., Haider, A., & Tang, A. (2016, N/A). Outcomes in trauma patients with isolated epidural hemorrhage: A single-institution retrospective cohort study. In N/A.
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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.
• Latifi, R., Joseph, B., Kulvatunyou, N., Wynne, J., O'Keeffe, T., Tang, A., Friese, R., & Rhee, P. (2012). Enterocutaneous fistulas and a hostile abdomen: Reoperative surgical approaches. In ACS Conference.
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  Damage-control surgery and open-abdomen is an acceptable-and often lifesaving-approach to the treatment of patients with severe trauma, abdominal compartment syndrome, necrotizing soft tissue catastrophes, and other abdominal disasters, when closing the abdomen is not possible, ill advised, or will have serious sequelae. However, common consequences of open-abdomen management include large abdominal wall defects, enterocutaneous fistulas (ECFs), and enteroatmospheric fistulas (EAFs). Furthermore, in such patients, a frozen and hostile abdomen (alone or combined with ECFs) is not uncommon. Adding biologic mesh to our surgical armamentarium has revolutionized hernia surgery. © 2011 Société Internationale de Chirurgie.

Presentations

• Friese, R. S. (2012, July). Sleep and Critical Illness/Injury. Department of Surgery grand Rounds. Tucson, AZ: University of Arizona.
• Friese, R. S. (2012, October). Practical Applications of Ultrasound in the ICU: ECHO and Thoracic. American College of Surgeons 99th Annual Clinical Congress. Chicago, IL.
• Friese, R. S. (2012, September). Nutrition Support in the Brain Injured Patient. Neurosurgical Grand Rounds. Tucson, AZ: University of Arizona College of Medicine.
• Friese, R. S. (2011, February). Sleep Deprivation after Septic Insult Truncates Pro-Inflammatory Cytokine Release in a Murine Model. Western Trauma Association. Big Sky, Montana.
• Friese, R. S. (2011, October). Postoperative Care: Fluids, Electrolytes, and Infection. American College of Surgeons 97th Annual Clinical Congress. Washington, DC.
• Friese, R. S. (2011, October). Trauma: Resuscitation and Head/Neck Injuries. American College of Surgeons 95th Annual Clinical Congress. Chicago, Illinois.
• Friese, R. S. (2009, October). Postoperative Care: Fluids, Electrolytes, and Infection. American College of Surgeons 96th Annual Clinical Congress. Washington, DC.
• Friese, R. S. (2010, February). Rearranging GI Anatomy: Consequences Related to Nutrition. American Society for Parenteral and Enteral Nutrition/Clinical Nutrition Week. Las Vegas, Nevada.
• Friese, R. S. (2010, November). Research in Southern Arizona. Arizona Trauma and Acute Care Consortium (AzTrACC) Grand Rounds. Tucson, AZ: University of Arizona.
• Friese, R. S. (2010, October). FAST Ultrasound Skills: Pitfalls and Limitations. American College of Surgeons 96th Annual Clinical Congress. Washington, DC.
• Friese, R. S. (2010, October). Trauma: Resuscitation and Head/Neck Injuries. American College of Surgeons 96th Annual Clinical Congress.
• Friese, R. S. (2008, June). Does Sleep Deprivation After Septic Insult Influence Survival?. International Shock Congress 6th Congress of the International Federation of Shock Societies. Cologne, Germany: International Federation of Shock Societies.
• Friese, R. S. (2008, May). Clinical Trials: Design and Analysis. Surgical Grand Rounds University of Texas. Dallas, Texas: Southwestern Medical Center UTSW School of Medicine.
• Friese, R. S. (2008, October). Ultrasound in the Surgical ICU: Central Venous Catheter Insertion. American College of Surgeons 94th Annual Clinical Congress. San Francisco, California.
• Friese, R. S. (2007, January). The Use of Leukoreduced Red Cell Products is Associated with Fewer Infectious Complications in Trauma Infections. 20th Annual Meeting of the Eastern Association for the Surgery of Trauma. Fort Meyers, Florida.
• Friese, R. S. (2007, March). Management of Colon Injury Following Damage Control Surgery. Southwest Surgical Congress. Rancho Mirage, California.
• Friese, R. S. (2007, March). Quantity and Quality of Sleep in the Surgical Intensive Care Unit : Are Our Patients Sleeping?. Western Trauma Association. Steamboat Springs, Colorado.
• Friese, R. S. (2007, March). Sleep in the ICU: How Well Are Our Patients Sleeping. TSIS 2007 - 7th World Congress on Trauma, Shock, Inflammation and Sepsis. Munich, Germany.
• Friese, R. S. (2007, September). Sleep deprivation after septic insult in a murine model increases mortality independent of age. American Association for the Surgery of Trauma. Maui, Hawaii.
• Friese, R. S. (2006, April). Mediators and Modulators of the Inflammatory Response after Injury. Surgical Grand Rounds University of Texas Southwestern Medical Center. UTSW School of Medicine: Dallas, Texas.
• Friese, R. S. (2006, January). Abdominal Ultrasound (FAST) Is An Unreliable Modality For The Evaluation Of Hemoperitoneum In Patients With Pelvic Fracture After Blunt Mechanism. Eastern Association for the Surgery of Trauma. Orlando, FL.
• Friese, R. S. (2006, January). Pre-operative Fasting Is Unnecessary for Endotracheally Intubated Burn Patients. Society of Critical Care Medicine. San Francisco, CA.
• Friese, R. S. (2006, May). Advances in Nutrition Support for the General Surgeon. Current Topics in General Surgery. UTSW School of Medicine: Dallas, Texas.
• Friese, R. S. (2006, September). Serum B-Type Natriuretic Peptide: A Marker of Fluid Resuscitation After Injury?. American Association for the Surgery of Trauma 65th Meeting. New Orleans, Louisianna.
• Friese, R. S. (2005, April). Damage Control Surgery. Current Topics in General Surgery UTSW School of Medicine. Dallas, Texas: UTSW School of Medicine.
• Friese, R. S. (2005, April). High-Frequency Percussive Ventilation Improves Oxygenation in Trauma Patients with Acute Respiratory Distress Syndrome. Southwestern Surgical Congress. San Antonio, TX.
• Friese, R. S. (2005, September). Tachycardia on Admission to the Emergency Department after Injury is a Predictor of On-Going Hemorrhage Independent of Systolic Blood Pressure. American Association for the Surgery of Trauma. Atlanta, GA.
• Friese, R. S. (2004, February). Laparoscopy is Sufficient to Exclude Occult Diaphragm Injury after Penetrating Abdominal Trauma. Western Trauma Association For The Surgery of Trauma. Steamboat, CO.
• Friese, R. S. (2004, September). Pulmonary Artery Catheter Use is Associated with Reduced Mortality in Severely Injured Patients: A National Trauma Data Bank Analysis of 53,312 Patients. American Association For The Surgery of Trauma. Maui, Hawaii.
• Friese, R. S. (2003, September). Common Conundrums of Nutritional Support for the Critically Ill Surgical Patient. Current topics in Clinical Nutrition UTSW School of Medicine Dallas, Texas. Dallas, Texas: UTSW School of Medicine.
• Friese, R. S. (2003, September). Reduction of Pulse Pressure Variation is Correlated with Preload Recruitable Increases in Cardiac Index. American Association for the Surgery of Trauma. Minneapolis, Minnesota.
• Friese, R. S. (2002, December). Nutrition in the Surgical Patient. Surgical Ground Rounds. Dallas, TX: University of Texas Southwestern Medical Center UTSW School of Medicine.
• Friese, R. S. (2002, January). The Pulmonary Artery Catheter: Past, Present, and Is there a Future?. Surgical Grand Rounds. Dallas, Texas: University of Texas Southwestern Medical Center UTSW School of Medicine.
• Friese, R. S. (2002, September). The Basic Science of Wound Healing. Surgical Ground Rounds University of Texas. Dallas, Texas: Southwestern Medical Center UTSW School of Medicine.
• Friese, R. S. (2002, September). The Modified Multiple Organ Dysfunction Score is a Reliable Indicator of ICU Mortality. American Association for the Surgery of Trauma. Orlando, Florida.
• Friese, R. S. (2001, November). The Modified Multiple Organ Dysfunction Score is a reliable Indicator of ICU Mortality. Regional ACSCOT Resident/Fellow Abstract Competition. New Orleans, Louisiana: ACSCOT.
• Friese, R. S. (1995, February). Minimally Invasive Surgery: No Benefit in Hernia Repair. Horizons in General Surgery. Breckenridge, Colorado.
• Friese, R. S. (1995, November). NO Prevents Neutrophil-Mediated Pulmonary Vasomotor Dysfunction in Acute Lung Injury. Association for Academic Surgery. Dearborn, Michigan.
• Friese, R. S. (1994, April). Gastroesophageal Reflux: Medical Therapy Withstands the test of Time. Surgical Grand Rounds University of Colorado: Resident Debates. Denver, Colorado: VAMC.
• Friese, R. S. (1994, February). Deep Venous Thrombosis: Prophylaxis is Mandatory. Horizons in General Surgery. Breckenridge, Colorado.
• Friese, R. S. (1994, February). Neointimal Thickening in Arteriovenous Loop PTFE Grafts is Promoted by Increased Graft Porosity. Thirty-sixth Annual University Surgical Residents Conference. Jackson, Mississippi.
• Friese, R. S. (1994, May). Neointimal Thickening in Arteriovenous Loop PTFE Grafts is Promoted by Increased Graft Porosit. 1994 Annual Meeting of the Colorado Chapter of the American College of Surgeons. Colorado Springs, Colorado: Colorado Chapter of the American College of Surgeons.
• Friese, R. S. (1993, January). Rectal Carcinoma: Adjuvant Chemotherapy is Overrated. Surgical Grand Rounds University of Colorado: Resident Debates. Denver, Colorado: University Hospital.
• Friese, R. S. (1992, October). Use of Enteral Nutrition Following Severe Blunt Multisystem Trauma. The Fourth Clinical Meeting of Chief Surgical Residents. Metairie, Louisiana.
• Friese, R. S. (1992, September). Extensive Preoperative Cardiovascular Work Up is Unnecessary. Surgical Grand Rounds University of Colorado: Resident Debates. Denver, Colorado: University Hospital.
• Friese, R. S. (1991, August). The Swan Gantz Catheter is Over Used. Surgical Grand Rounds University of Colorado: Resident Debates. Denver, Colorado: University Hospital.

Others

• Friese, R. S. (2011, February). Citizen of the Year Gala. Oro Valley Rotary Club.
• Friese, R. S. (2011, February). National Day of Solidarity for Compassionate Patient Care.
• Friese, R. S. (2011, January). Post State of the Union Address interview. CBS Morning News.
• Friese, R. S. (2011, January). Tucson Incident interview. CNN Evening News.
• Friese, R. S. (2011, May). Saving Gaby Giffords. CNN Primetime Special.
• Friese, R. S. (2011, May). Seeking Sleep in the ICU. Arizona Public Media.
• Friese, R. S. (2008, February). Good Night, Sleep Tight, turn off hospital lights. USA Today.
• Friese, R. S. (2008, January). Does sleep deprivation after septic insult influence survival?.
• Friese, R. S. (2007, December). Healing: In ICU, Lack of Sleep Can Hurt Recovery. New York Times.
• Friese, R. S. (2007, January). Sleep in the Intensive Care Unit: How Well Do Our Patients Sleep.
• Friese, R. S. (2006, November). Pre-Operative Fasting is Unnecessary for Endotracheally Intubated Burn Patients.