Lynn M Gries

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Scholarly Contributions

Chapters

• Gries, L. M. (2013). Common Problems in Acute Care Surgery. In Upper Gatrointestinal Bleeding. Springer Science + Business Media New York. doi:10.1007/978-1-4614-6123-4
• Rhee, P. M., & Gries, L. M. (2013). Upper Gastrointestinal Bleeding. In Common Problems in Acute Care Surgery. Springer, New York, NY. doi:10.1007/978-1-4614-6123-4_19
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  Upper gastrointestinal bleeding (UGIB) is a common problem and frequently generates a consult for the acute care surgeon. Although very few patients with this complaint ultimately have any surgical intervention, surgeons have historically been intimately involved in the management of UGIB patients. With the discovery of Helicobacter pylori, effective H. pylori treatment and eradication regimens have greatly decreased the incidence of peptic ulcer disease as well as shifted the algorithm away from surgical treatment. Moreover, there appears to be a decreasing incidence and mortality of peptic ulcer disease as well as a decrease in acute UGIB related to peptic ulcer disease [1]. Recent data suggests that surgical intervention for any symptom or complication of peptic ulcer disease have declined more than 80 % [2]. Moreover, the fields of diagnostic and therapeutic endoscopy as well as interventional radiology have expanded in directions that have had a huge impact on the treatment options available for the patient with an UGIB. The role of the surgeon will often be to assist their colleagues in guiding the patient into an informed and evidence based plan of action.

Journals/Publications

• Castanon, L., Bhogadi, S. K., Anand, T., Hosseinpour, H., Nelson, A., Colosimo, C., Spencer, A. L., Gries, L., Ditillo, M., & Joseph, B. (2023). The Association Between the Timing of Initiation of Pharmacologic Venous Thromboembolism Prophylaxis with Outcomes in Burns Patients. Journal of burn care & research : official publication of the American Burn Association, 44(6), 1311-1315.
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  Hospitalized burn patients are at increased risk for venous thromboembolism (VTE). Guidelines regarding thromboprophylaxis in burn patients are unclear. This study aims to compare the outcomes of early versus late thromboprophylaxis initiation in burn patients. In this 3-year analysis of 2017-2019 ACS-TQIP, adult(18-64years) burn patients were identified after applying inclusion/exclusion criteria and stratified based on timing of initiation of VTE prophylaxis: Early(24 hours). Outcomes were deep venous thrombosis(DVT), pulmonary embolism(PE), unplanned return to operating room (OR), unplanned intensive care unit (ICU) admission, post-prophylaxis packed red blood cells (PRBC) transfusion, and mortality. Nine thousand two hundred and seventy-two patients were identified. Overall, median age was 41years, 71.5% were male, and median[IQR] injury severity score was 3[1-8]. 53% had second-degree burns, and 80% had less than 40% of total body surface area affected. Median time to thromboprophylaxis initiation was 11[6-20.6]hours. Overall VTE rate was 0.9% (DVT-0.7%, PE-0.2%). On univariable analysis, early prophylaxis group had lower rates of DVT(0.6% vs 1.1%, P = .025), and PE(0.1% vs 0.6%, P < .001). On multivariable regression, late prophylaxis was associated with 1.8 times higher odds of DVT (aOR = 1.8, 95% CI = 1.04-3.11, P = .03), 4.8 times higher odds of PE(aOR = 4.8, 95% CI = 1.9-11.9, P 
• Collins, W., El-Qawaqzeh, K., Ditillo, M., Hosseinpour, H., Nelson, A., Bhogadi, S., Castanon, L., Gries, L., Anand, T., & Joseph, B. (2023). Minimally Invasive Surgery for Genitourinary Trauma: A Nationwide Outcomes-Based Analysis. Journal of Surgical Research, 282. doi:10.1016/j.jss.2022.09.015
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  Introduction: Bladder and ureteral injuries are uncommon in trauma patients but are associated with increased morbidity and mortality. Patients presenting with such injuries may undergo either open surgical repair or laparoscopic repair. We aimed to compare outcomes of open surgical approach and laparoscopy in trauma patients with isolated bladder and ureteral injury. We hypothesized that laparoscopy is associated with improved outcomes. Methods: We performed a 2017 review of American College of Surgeons Trauma Quality Improvement Program and identified trauma patients with bladder and ureteral injury who underwent open surgical repair or laparoscopy. A 1:1 propensity score matching was performed adjusting for demographics, emergency department vitals (systolic blood pressure, heart rate, Glasgow Coma Scale), mechanism of injury, Injury Severity Score, each body region Abbreviated Injury Scale score, and transfusion units. Outcomes were rates of in-hospital major complications and mortality. Results: Of the 1,004,440 trauma patients, 384 patients (open: 192 and laparoscopy: 192) were matched and included. The mean age was 36 ± 15 y, Injury Severity Score was 27 [27-48], 77% were males, and 56% of patients had a blunt mechanism of injury, and 44% had penetrating injuries. Overall mortality was 7.3%. On univariate analysis, mortality was lower in the open group as compared to the laparoscopy group (10.4% versus 4.2%, P = 0.019) and survivor-only hospital length of stay was longer in the open group (8 [8-9] versus 7 [5-11], P = 0.008). There was no difference in overall major complications (23% versus 21%, P = 0.621). On multivariate analysis, open surgical repair was independently associated with lower odds of mortality (adjusted odds ratio: 0.405, 95% confidence interval: [0.17-0.95], P-value = 0.038) Conclusions: In our analysis open surgical repair of bladder and ureteral injuries was associated with lower mortality with other outcomes being similar when compared to laparoscopy. Laparoscopic surgical repair may not have an advantage over the open surgical repair for bladder and ureteral injuries. Further prospective studies are needed to delineate the ideal surgical approach for these injuries.
• El-Qawaqzeh, K., Hosseinpour, H., Gries, L., Magnotti, L. J., Bhogadi, S. K., Anand, T., Ditillo, M., Stewart, C., Cooper, Z., & Joseph, B. (2023). Dealing with the elder abuse epidemic: Disparities in interventions against elder abuse in trauma centers. Journal of the American Geriatrics Society, 71(6), 1735-1748.
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  Elder abuse is a major cause of injury, morbidity, and death. We aimed to identify the factors associated with interventions against suspected physical abuse in older adults.
• Anand, T., El-Qawaqzeh, K., Nelson, A., Hosseinpour, H., Ditillo, M., Gries, L., Castanon, L., & Joseph, B. (2022). Association Between Hemorrhage Control Interventions and Mortality in US Trauma Patients With Hemodynamically Unstable Pelvic Fractures. JAMA surgery.
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  Management of hemodynamically unstable pelvic fractures remains a challenge. Hemostatic interventions are used alone or in combination. There is a paucity of data on the association between the pattern of hemorrhage control interventions and outcomes after a severe pelvic fracture.
• Collins, W. J., El-Qawaqzeh, K., Ditillo, M., Hosseinpour, H., Nelson, A., Bhogadi, S. K., Castanon, L., Gries, L., Anand, T., & Joseph, B. (2022). Minimally Invasive Surgery for Genitourinary Trauma: A Nationwide Outcomes-Based Analysis. The Journal of surgical research, 282, 129-136.
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  Bladder and ureteral injuries are uncommon in trauma patients but are associated with increased morbidity and mortality. Patients presenting with such injuries may undergo either open surgical repair or laparoscopic repair. We aimed to compare outcomes of open surgical approach and laparoscopy in trauma patients with isolated bladder and ureteral injury. We hypothesized that laparoscopy is associated with improved outcomes.
• Douglas, M., Obaid, O., Castanon, L., Reina, R., Ditillo, M., Nelson, A., Bible, L., Anand, T., Gries, L., & Joseph, B. (2022). After 9,000 laparotomies for blunt trauma, resuscitation is becoming more balanced and time to intervention shorter: Evidence in action. The journal of trauma and acute care surgery, 93(3), 307-315.
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  Several advancements in hemorrhage control have been advocated for in the past decade, including balanced transfusions and earlier times to intervention. The aim of this study was to examine the effect of these advancements on outcomes of blunt trauma patients undergoing emergency laparotomy.
• Obaid, O., Anand, T., Nelson, A., Reina, R., Ditillo, M., Stewart, C., Douglas, M., Friese, R., Gries, L., & Joseph, B. (2022). Fibrinogen supplementation for the trauma patient: Should you choose fibrinogen concentrate over cryoprecipitate?. The journal of trauma and acute care surgery, 93(4), 453-460.
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  Trauma-induced coagulopathy is frequently associated with hypofibrinogenemia. Cryoprecipitate (Cryo), and fibrinogen concentrate (FC) are both potential means of fibrinogen supplementation. The aim of this study was to compare the outcomes of traumatic hemorrhagic patients who received fibrinogen supplementation using FC versus Cryo.
• Reina, R., Obaid, O., Northcutt, A., Nelson, A., Joseph, B., Gries, L., Ditillo, M., Castanon, L., Bible, L., & Anand, T. (2022). Prospective Validation of The Rib Injury Guidelines (RIG) For Traumatic Rib Fractures.. The journal of trauma and acute care surgery, Publish Ahead of Print. doi:10.1097/ta.0000000000003535
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  The Rib Injury Guidelines (RIG) were developed to guide triage of traumatic rib fracture patients to home, regular floor, or ICU and standardize care. The RIG score is based on patient history, physical examination, and imaging findings. The aim of this study is to evaluate triage effectiveness and healthcare resources utilization following RIG implementation..This is a prospective analysis at a Level I trauma center from October 2017 to January 2020. Adult (age ≥ 18 years) blunt trauma patients with a diagnosis of at least one rib fracture on CT imaging were included. Patients before (PRE) and after (POST) implementation of RIG were compared. In the POST group, patients were divided into RIG 1, RIG 2, and RIG 3 based on their RIG score. Outcomes were readmission for RIG 1 patients, unplanned ICU admission for RIG 2 patients, and overall ICU admission. Secondary outcomes were hospital length of stay (LOS) and mortality..A total of 1100 patients were identified (PRE: 754; POST: 346). Mean age was 56 ± 19 years, 788 (71.6%) were male, and median ISS was 14 [10-22]. The most common mechanism of injury was motor vehicle collision (554; 50.3%), 253 (22.9%) patients had ≥5 rib fractures, and 53 (4.8%) patients had a flail chest. In the POST group, 74 patients (21.1%) were RIG 1, 121 (35.2%) RIG 2, and 151 (43.7%) RIG 3. No patient in RIG 1 was readmitted following initial discharge, and 2 (1.6%) patients in RIG 2 had an unplanned ICU admission (both for alcohol withdrawal syndrome). POST patients had shorter hospital LOS (3 [1-6] vs. 4 [1-7] days; p = 0.019) and no difference in mortality (5.8% vs. 7.7%; p = 0.252). On multivariate analysis, RIG implementation was associated with decreased ICU admission (aOR 0.55 [0.36-0.82]; p = 0.004)..RIG is safe and effectively defines triage of rib fracture patients with an overall reduction in ICU admissions, shorter hospital LOS, and no readmissions..Level III.
• Anand, T., Khurrum, M., Chehab, M., Bible, L., Asmar, S., Douglas, M., Ditillo, M., Gries, L., & Joseph, B. (2021). Racial and Ethnic Disparities in Frail Geriatric Trauma Patients. World journal of surgery, 45(5), 1330-1339.
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  Frailty in geriatric trauma patients is commonly associated with adverse outcomes. Racial disparities in geriatric trauma patients are previously described in the literature. We aimed to assess whether race and ethnicity influence outcomes in frail geriatric trauma patients.
• Bauman, Z. M., Kulvatunyou, N., Joseph, B., Gries, L., O'Keeffe, T., Tang, A. L., & Rhee, P. (2021). Randomized Clinical Trial of 14-French (14F) Pigtail Catheters versus 28-32F Chest Tubes in the Management of Patients with Traumatic Hemothorax and Hemopneumothorax. World journal of surgery, 45(3), 880-886.
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  Traditional management of traumatic hemothorax/hemopneumothorax (HTX/HPTX) has been insertion of large-bore 32-40 French (Fr) chest tubes (CTs). Retrospective studies have shown 14Fr percutaneous pigtail catheters (PCs) are equally effective as CTs. Our aim was to compare effectiveness between PCs and CTs by performing the first randomized controlled trial (RCT). We hypothesize PCs work equally as well as CTs in management of traumatic HTX/HPTX.
• Kulvatunyou, N., Bauman, Z. M., Zein Edine, S. B., de Moya, M., Krause, C., Mukherjee, K., Gries, L., Tang, A. L., Joseph, B., & Rhee, P. (2021). The small (14 Fr) percutaneous catheter (P-CAT) versus large (28-32 Fr) open chest tube for traumatic hemothorax: A multicenter randomized clinical trial. The journal of trauma and acute care surgery, 91(5), 809-813.
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  The traditional treatment of traumatic hemothorax (HTX) has been an insertion of a large-bore 36- to 40-Fr chest tube. Our previous single-center randomized controlled trial (RCT) had shown that 14-Fr percutaneous catheters (PCs) (pigtail) were equally as effective as chest tube. We performed a multicenter RCT, hypothesizing that PCs are as equally effective as chest tubes in the management of patients with traumatic HTX (NCT03546764).
• Kulvatunyou, N., Kulvatunyou, N., Khurrum, M., Joseph, B., Gries, L., Douglas, M., Ditillo, M., Chehab, M., Bible, L., & Asmar, S. (2021). Managing acute uncomplicated appendicitis in frail geriatric patients: A second hit may be too much.. The journal of trauma and acute care surgery, 90(3), 501-506. doi:10.1097/ta.0000000000003028
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  Studies have proposed the use of antibiotics only in cases of acute uncomplicated appendicitis (AUA). However, there remains a paucity of data evaluating this nonoperative approach in the vulnerable frail geriatric population. The aim of this study was to examine long-term outcomes of frail geriatric patients with AUA treated with appendectomy compared with initial nonoperative management (NOP)..We conducted a 1-year (2017) analysis of the Nationwide Readmissions Database and included all frail geriatric patients(age, ≥65 years) with a diagnosis of AUA. Frailty was assessed using the five-factor modified frailty index. Patients were stratified into those undergoing appendectomy at index admission (operative management) versus those receiving antibiotics only without operative intervention (NOP). Propensity score matching in a 1:1 ratio was performed adjusting for patient- and hospital-related factors..A total of 5,562 frail geriatric patients with AUA were identified from which a matched cohort of 1,320 patients in each group was obtained. Patients in the NOP and operative management were comparable in terms of age (75.5 ± 7.7 vs. 75.5 ± 7.4 years; p = 0.882) and modified frailty index (0.4 [0.4-0.6] vs. 0.4 [0.4-0.6]; p = 0.526). Failure of NOP management was reported in 18% of patients, 95% of which eventually underwent appendectomy. Over the 6-month follow-up period, patients in the NOP group had significantly higher rates of Clostridium difficile enterocolitis (3% vs. 1%; p < 0.001), greater number of overall hospitalized days (5 [3-9] vs. 4 [2-7] days; p < 0.001), and higher overall costs (US $16,000 [12,000-25,000] vs. US $11,000 [8,000-19,000]; p < 0.001). Patients undergoing appendectomy after failed NOP had significantly higher rates of complications (20% vs. 11%; p < 0.001), mortality (4% vs. 2%; p = 0.019), and appendiceal neoplasm (3% vs. 1%; p = 0.027)..One in six patients failed NOP within 6 months and required appendectomy with subsequent more complications and higher mortality. Appendectomy may offer better outcomes in managing AUA in the frail geriatric population..Therapeutic, level IV.
• Kulvatunyou, N., Zimmerman, S. A., Tang, A. L., Rhee, P., Kulvatunyou, N., Joseph, B., Gries, L., & Adhikhari, S. (2021). The Impact of FASTPASS: A Collaboration With Emergency Department to Improve Management of Patients With Gallbladder Disease and Acute Appendicitis.. The Journal of surgical research, 260, 293-299. doi:10.1016/j.jss.2020.11.018
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  Efficient Emergency Department (ED) throughput depends on several factors, including collaboration and consultation with surgical services. The acute care surgery service (ACS) collaborated with ED to implement a new process termed "FASTPASS" (FP), which might improve patient-care for those with acute appendicitis and gallbladder disease. The aim of this study was to evaluate the 1-year outcome of FP..FASTPASS is a joint collaboration between ACS and ED. ED physicians were provided with a simple check-list for diagnosing young males (
• O'keeffe, T., Kulvatunyou, N., Tang, A., Rhee, P., O'keeffe, T., Kulvatunyou, N., Joseph, B., Gries, L., & Bauman, Z. M. (2021). Randomized Clinical Trial of 14-French (14F) Pigtail Catheters versus 28–32F Chest Tubes in the Management of Patients with Traumatic Hemothorax and Hemopneumothorax. World Journal of Surgery, 45(3), 880-886. doi:10.1007/s00268-020-05852-0
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  Traditional management of traumatic hemothorax/hemopneumothorax (HTX/HPTX) has been insertion of large-bore 32–40 French (Fr) chest tubes (CTs). Retrospective studies have shown 14Fr percutaneous pigtail catheters (PCs) are equally effective as CTs. Our aim was to compare effectiveness between PCs and CTs by performing the first randomized controlled trial (RCT). We hypothesize PCs work equally as well as CTs in management of traumatic HTX/HPTX. Prospective RCT comparing 14Fr PCs to 28–32Fr CTs for management of traumatic HTX/HPTX from 07/2015 to 01/2018. We excluded patients requiring emergency tube placement or who refused. Primary outcome was failure rate defined as retained HTX or recurrent PTX requiring additional intervention. Secondary outcomes included initial output (IO), tube days and insertion perception experience (IPE) score on a scale of 1–5 (1 = tolerable experience, 5 = worst experience). Unpaired Student’s t-test, chi-square and Wilcoxon rank-sum test were utilized with significance set at P < 0.05. Forty-three patients were enrolled. Baseline characteristics between PC patients (N = 20) and CT patients (N = 23) were similar. Failure rates (10% PCs vs. 17% CTs, P = 0.49) between cohorts were similar. IO (median, 650 milliliters[ml]; interquartile range[IR], 375–1087; for PCs vs. 400 ml; IR, 240–700; for CTs, P = 0.06), and tube duration was similar, but PC patients reported lower IPE scores (median, 1, “I can tolerate it”; IR, 1–2) than CT patients (median, 3, “It was a bad experience”; IR, 3–4, P = 0.001). In patients with traumatic HTX/HPTX, 14Fr PCs were equally as effective as 28–32Fr CTs with no significant difference in failure rates. PC patients, however, reported a better insertion experience. www.ClinicalTrials.gov Registration ID: NCT02553434
• Tang, A. L., Rhee, P., Mukherjee, K., Moya, M. D., Kulvatunyou, N., Krause, C., Joseph, B., Gries, L., Edine, S. B., & Bauman, Z. M. (2021). The Small 14-French (Fr) Percutaneous Catheter vs. Large (28-32Fr) Open Chest Tube for Traumatic Hemothorax (P-CAT): A Multi-center Randomized Clinical Trial.. The journal of trauma and acute care surgery. doi:10.1097/ta.0000000000003180
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  The traditional treatment of traumatic hemothorax (HTX) has been an insertion of a large-bore 36-40 French (FR) chest tube (CT). Our previous single-center randomized controlled trial (RCT) had shown that 14Fr percutaneous catheters (PCs) (pigtail) were equally as effective as CTs. We performed a multi-center RCT, hypothesizing that PCs are as equally effective as CTs in the management of patients with traumatic HTX. (NCT03546764)..We performed a multi-institution prospective RCT comparing 14Fr PCs to 28-32Fr CTs in the management of patients with traumatic HTX from July, 2015 to September, 2020. We excluded patients who were in extremis and required emergent tube placement, and those who refused to participate. The primary outcome was failure rate, defined as a retained HTX requiring a second intervention. Secondary outcomes included daily drainage output, tube days, intensive care unit and hospital length of stay, and insertion perception experience (IPE) score on a scale of 1 to 5 (1=tolerable experience, 5=worst experience). Unpaired Student's t-test, chi-square and Wilcoxon rank-sum test was utilized with significance set at P < 0.05..After exclusion, 119 patients participated in the trial, 56 randomized to PCs and 63 to CTs. Baseline characteristics between the two groups were similar. The primary outcome, failure rate, was similar between the 2 groups (11% PCs vs. 13% CTs, P = 0.74). All other secondary outcomes were also similar, except PC patients reported lower IPE scores (median, 1, "I can tolerate it"; IR, 1-2) than CT patients (median, 3, "It was a bad experience"; IR, 2-5, P
• Tang, A. L., Rhee, P., O'keeffe, T., Kulvatunyou, N., Joseph, B., Gries, L., & Bauman, Z. M. (2021). Randomized Clinical Trial of 14-French (14F) Pigtail Catheters versus 28-32F Chest Tubes in the Management of Patients with Traumatic Hemothorax and Hemopneumothorax.. World journal of surgery, 45(3), 880-886.
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  Traditional management of traumatic hemothorax/hemopneumothorax (HTX/HPTX) has been insertion of large-bore 32-40 French (Fr) chest tubes (CTs). Retrospective studies have shown 14Fr percutaneous pigtail catheters (PCs) are equally effective as CTs. Our aim was to compare effectiveness between PCs and CTs by performing the first randomized controlled trial (RCT). We hypothesize PCs work equally as well as CTs in management of traumatic HTX/HPTX..Prospective RCT comparing 14Fr PCs to 28-32Fr CTs for management of traumatic HTX/HPTX from 07/2015 to 01/2018. We excluded patients requiring emergency tube placement or who refused. Primary outcome was failure rate defined as retained HTX or recurrent PTX requiring additional intervention. Secondary outcomes included initial output (IO), tube days and insertion perception experience (IPE) score on a scale of 1-5 (1 = tolerable experience, 5 = worst experience). Unpaired Student's t-test, chi-square and Wilcoxon rank-sum test were utilized with significance set at P < 0.05..Forty-three patients were enrolled. Baseline characteristics between PC patients (N = 20) and CT patients (N = 23) were similar. Failure rates (10% PCs vs. 17% CTs, P = 0.49) between cohorts were similar. IO (median, 650 milliliters[ml]; interquartile range[IR], 375-1087; for PCs vs. 400 ml; IR, 240-700; for CTs, P = 0.06), and tube duration was similar, but PC patients reported lower IPE scores (median, 1, "I can tolerate it"; IR, 1-2) than CT patients (median, 3, "It was a bad experience"; IR, 3-4, P = 0.001)..In patients with traumatic HTX/HPTX, 14Fr PCs were equally as effective as 28-32Fr CTs with no significant difference in failure rates. PC patients, however, reported a better insertion experience. www.ClinicalTrials.gov Registration ID: NCT02553434.
• Anand, T., Hanna, K., Kulvatunyou, N., Zeeshan, M., Ditillo, M., Castanon, L., Tang, A., Gries, L., & Joseph, B. (2020). Time to tracheostomy impacts overall outcomes in patients with cervical spinal cord injury. The journal of trauma and acute care surgery, 89(2), 358-364.
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  The morbidity associated with cervical spine injury increases in the setting of concomitant cervical spinal cord injury (CSCI). A significant proportion of these patients require placement of a tracheostomy. However, it remains unclear if timing to tracheostomy following traumatic CSCI can impact outcomes. The aim of our study was to characterize outcomes associated with tracheostomy timing following traumatic CSCI.
• Ditillo, M., Hanna, K., Castanon, L., Zeeshan, M., Kulvatunyou, N., Tang, A., Sakran, J., Gries, L., & Joseph, B. (2020). The Role of Cryoprecipitate in Massively Transfused Patients: Results from the TQIP Database May Change Your Mind. The journal of trauma and acute care surgery.
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  Cryoprecipitate was developed for the treatment of inherited and acquired coagulopathies. The role of cryoprecipitate in hemorrhaging trauma patients is still speculative. The aim of our study was to assess the role of cryoprecipitate as an adjunct to transfusion in trauma patients.
• Khurrum, M., Asmar, S., Henry, M., Ditillo, M., Chehab, M., Tang, A., Bible, L., Gries, L., & Joseph, B. (2020). The survival benefit of low molecular weight heparin over unfractionated heparin in pediatric trauma patients. Journal of pediatric surgery.
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  Venous thromboembolism (VTE) prophylaxis in pediatric patients is controversial and is mainly dependent on protocols derived from adult practices. Our study aimed to compare outcomes among pediatric trauma patients who received low molecular weight heparin (LMWH) compared to those who received unfractionated heparin (UFH).
• Kulvatunyou, N., Zimmerman, S. A., Adhikhari, S., Joseph, B., Gries, L., Tang, A. L., & Rhee, P. (2020). The Impact of FASTPASS: A Collaboration With Emergency Department to Improve Management of Patients With Gallbladder Disease and Acute Appendicitis. The Journal of surgical research, 260, 293-299.
  More info

  Efficient Emergency Department (ED) throughput depends on several factors, including collaboration and consultation with surgical services. The acute care surgery service (ACS) collaborated with ED to implement a new process termed "FASTPASS" (FP), which might improve patient-care for those with acute appendicitis and gallbladder disease. The aim of this study was to evaluate the 1-year outcome of FP.
• Lokhandwala, A., Hanna, K., Gries, L., Zeeshan, M., Ditillo, M., Tang, A., Hamidi, M., & Joseph, B. (2020). Preinjury Statins Are Associated With Improved Survival in Patients With Traumatic Brain Injury. Journal of Surgical Research, 245. doi:10.1016/j.jss.2019.07.081
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  Background: Statins have been shown to improve outcomes in traumatic brain injury (TBI) in animal models. The aim of our study was to determine the effect of preinjury statins on outcomes in TBI patients. Methods: We performed a 4-y (2014-2017) review of our TBI database and included all patients aged ≥18 y with severe isolated TBI. Patients were stratified into those who were on statins and those who were not and were matched (1:2 ratio) using propensity score matching. The primary outcome was in-hospital mortality. The secondary outcomes were skilled nursing facility disposition, Glasgow Outcome Scale–extended score, and hospital and intensive care unit length of stay (LOS). Results: We identified 1359 patients, of which 270 were matched (statin: 90, no-statin: 180). Mean age was 55 ± 8y, median Glasgow Coma Scale was 10 (8-12), and median head–abbreviated injury scale was 3 (3-5). Matched groups were similar in age, mechanism of injury, Glasgow Coma Scale, Injury Severity Score, neurosurgical intervention, type and size of intracranial hemorrhage, and preinjury anticoagulant or antiplatelet use. The overall in-hospital mortality rate was 18%. Patients who received statins had lower rates of in-hospital mortality (11% versus 21%, P = 0.01), skilled nursing facility disposition (19% versus 28%; P = 0.04), and a higher median Glasgow Outcome Scale–extended (11 [9-13] versus 9 [8-10]; P = 0.04). No differences were found between the two groups in terms of hospital LOS (6 [4-9] versus 5 [3-8]; P = 0.34) and intensive care unit LOS (3 [3-6] versus 4 [3-5]; P = 0.09). Conclusions: Preinjury statin use in isolated traumatic brain injury patients is associated with improved outcomes. This finding warrants further investigations to evaluate the potential beneficial role of statins as a therapeutic drug in a TBI. Level of evidence: Level III Therapeutic.
• Roussas, A., Masjedi, A., Hanna, K., Zeeshan, M., Kulvatunyou, N., Gries, L., Tang, A., & Joseph, B. (2020). Number and Type of Complications Associated With Failure to Rescue in Trauma Patients. The Journal of surgical research, 254, 41-48.
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  Failure to rescue (FTR) is becoming a ubiquitous metric of quality care. The aim of our study is to determine the type and number of complications associated with FTR after trauma.
• Saljuqi, A. T., Hanna, K., Asmar, S., Tang, A., Zeeshan, M., Gries, L., Ditillo, M., Kulvatunyou, N., Castanon, L., & Joseph, B. (2020). Prospective Evaluation of Delirium in Geriatric Patients Undergoing Emergency General Surgery. Journal of the American College of Surgeons, 230(5), 758-765.
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  The prevalence of delirium and its impact on outcomes after emergency general surgery (EGS) remain unexplored. The aims of our study were to assess the impact of frailty on delirium and the impact of delirium on outcomes in geriatric EGS patients.
• Stupinski, J., Bible, L., Asmar, S., Chehab, M., Douglas, M., Ditillo, M., Gries, L., Khurrum, M., & Joseph, B. (2020). Impact of Marijuana on Venous Thromboembolic Events: Cannabinoids Cause Clots in Trauma Patients. The journal of trauma and acute care surgery.
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  Tetra-hydro-cannabinoids (THC) can modulate the coagulation cascade resulting in hypercoagulability. However, the clinical relevance of these findings has not been investigated. The aim of our study was to evaluate the impact of pre-injury marijuana exposure on thromboembolic complications in trauma patients.
• Gonzalez, M. G., Wei, R. M., Hatch, K. D., Gries, L. M., & Hill, M. G. (2019). A Novel Treatment for Massive Hemorrhage after Maternal Trauma in Pregnancy. AJP reports, 9(1), e27-e29.
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   Trauma in pregnancy can lead to life-threatening hemorrhage. Conventional treatments of hemorrhage include medical and surgical management. However, if these measures fail uterine compression is an option to control bleeding. We present a case where this management was employed.  A patient presented at 36 weeks of gestation with multiple injuries after a motor vehicle collision and experienced disseminated intravascular coagulation (DIC). The use of a Bakri balloon in combination with external compression with Coban, a sterile self-adherent bandage, after delivery temporized her bleeding and allowed her to become stable for further management.  When other measures fail and a hysterectomy is considered unsafe, the combination of internal and external uterine compression is an option.
• Hamidi, M., Haddadin, Z., Zeeshan, M., Saljuqi, A. T., Hanna, K., Tang, A., Northcutt, A., Kulvatunyou, N., Gries, L., & Joseph, B. (2019). Prospective evaluation and comparison of the predictive ability of different frailty scores to predict outcomes in geriatric trauma patients. The journal of trauma and acute care surgery, 87(5), 1172-1180.
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  Different frailty scores have been proposed to measure frailty. No study has compared their predictive ability to predict outcomes in trauma patients. The aim of our study was to compare the predictive ability of different frailty scores to predict complications, mortality, discharge disposition, and 30-day readmission in trauma patients.
• Hanna, K., Khalid, A., Hamidi, M., Gries, L., Haddadin, Z., Kulvatunyou, N., Zeeshan, M., & Joseph, B. (2019). Chronic Alcohol Consumption and Risk of Deep Venous Thrombosis: A Propensity-Matched Analysis. The Journal of surgical research, 244, 251-256.
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  Alcoholism is associated with variable effects on the coagulation system. Therefore, the aim of our study was to analyze the currently unknown association between chronic alcohol consumption and the risk of venous thromboembolism, which includes deep vein thrombosis (DVT) and pulmonary embolism (PE).
• Hanna, K., Palmer, J., Castanon, L., Zeeshan, M., Hamidi, M., Kulvatunyou, N., Gries, L., & Joseph, B. (2019). Racial and Ethnic Differences in Limiting Life-Sustaining Treatment in Trauma Patients. The American journal of hospice & palliative care, 36(11), 974-979.
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  Differences in health care between racial and ethnic groups exist. The literature suggests that African Americans and Hispanics prefer more aggressive treatment at the end of life. The aim of this study is to assess racial and ethnic differences in limiting life-sustaining treatment (LLST) after trauma.
• Jehan, F., Zeeshan, M., Kulvatunyou, N., Khan, M., O'Keeffe, T., Tang, A., Gries, L., & Joseph, B. (2019). Is There a Need for Platelet Transfusion After Traumatic Brain Injury in Patients on P2Y12 Inhibitors?. The Journal of surgical research, 236, 224-229.
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  A significant portion of patients sustaining traumatic brain injury (TBI) are on antiplatelet medications. The reversal of P2Y12 agents after intracranial hemorrhage (ICH) remains unclear. The aim of our study is to evaluate outcomes after TBI in patients who are on preinjury P2Y12 inhibitors and received a platelet transfusion.
• Joseph, B. A., Kulvatunyou, N., O'Keeffe, T., Northcutt, A., Sakran, J., Jehan, F., Gries, L. M., Feinstein, A., Hamidi, M., & Zeeshan, M. (2019). Four-factor prothrombin complex concentrate is associated with improved survival in trauma-related hemorrhage: A Nationwide Propensity Matched Analysis. Journal of Trauma and Acute Care Surgery, 87(2), 274-281. doi:doi: 10.1097/TA.0000000000002262
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  INTRODUCTION Post-traumatic hemorrhage is the most common preventable cause of death in trauma. Numerous small single-center studies have shown the superiority of four-factor prothrombin complex concentrate (4-PCC) along with fresh frozen plasma (FFP) over FFP alone in resuscitation of trauma patients. The aim of our study was to evaluate outcomes of severely injured trauma patients who received 4-PCC + FFP compared to FPP alone.METHODS Two-year (2015–2016) analysis of the American College of Surgeons-Trauma Quality Improvement Program database. All adult (age ≥18 years) trauma patients who received 4-PCC + FFP or FFP alone were included. We excluded patients who were on preinjury anticoagulants. Patients were stratified into two groups: 4-PCC + FFP versus FFP alone and were matched in a 1:1 ratio using propensity score matching for demographics, vitals, injury parameters, comorbidities, and level of trauma centers. Outcome measures were packed red blood cells, plasma and platelets transfused, complications, and mortality.RESULTS A total of 468 patients (4-PCC + FFP, 234; FFP alone, 234) were matched. Mean age was 50 ± 21 years; 70% were males; median injury severity score was 27 [20–36], and 86% had blunt injuries. Four-PCC + FFP was associated with a decreased requirement for packed red blood cells (6 units vs. 10 units; p = 0.02) and FFP (3 units vs. 6 units; p = 0.01) transfusion compared to FFP alone. Patients who received 4-PCC + FFP had a lower mortality (17.5% vs. 27.7%, p = 0.01) and lower rates of acute respiratory distress syndrome (1.3% vs. 4.7%, p = 0.04) and acute kidney injury (2.1% vs. 7.3%, p = 0.01). There was no difference in the rates of deep venous thrombosis (p = 0.11) and pulmonary embolism (p = 0.33), adverse discharge disposition (p = 0.21), and platelets transfusion (p = 0.72) between the two groups.CONCLUSIONS Our study demonstrates that the use of 4-PCC as an adjunct to FFP is associated with improved survival and reduction in transfusion requirements compared to FFP alone in resuscitation of severely injured trauma patients. Further studies are required to evaluate the role of addition of PCC to the massive transfusion protocol.LEVEL OF EVIDENCE Therapeutic studies, level III.
• Kulvatunyou, N., Saljuqi, A. T., Northcutt, A., Kulvatunyou, N., Kapadia, M., Joseph, B., Hanna, K., Hamidi, M. K., Gries, L. M., Ditillo, M., & Castanon, L. (2019). Prospective Evaluation of Frailty Assessment Compliance in Acute Care Surgery: Changing Trends, Lessons Learned. Journal of The American College of Surgeons, 229(4), S121. doi:10.1016/j.jamcollsurg.2019.08.271
• Kulvatunyou, N., Tang, A. L., Saljuqi, A. T., Northcutt, A., Kulvatunyou, N., Joseph, B., Hamidi, M. K., Haddadin, Z., Gries, L. M., Ditillo, M., & Anand, T. (2019). Association of Racial, Ethnic Disparities, and Frailty in Geriatric Trauma Patients. Journal of The American College of Surgeons, 229(4), S119. doi:10.1016/j.jamcollsurg.2019.08.265
• Kulvatunyou, N., Zeeshan, M., Tang, A., Kulvatunyou, N., Joseph, B., Hanna, K., Hamidi, M. K., Haddadin, Z., Gries, L. M., Ditillo, M., & Castanon, L. (2019). Evolution of Nonoperative Management of Abdominal Gunshot Wounds in the US: Analysis of 16,866 Abdominal Gunshot Wounds. Journal of The American College of Surgeons, 229(4), S295. doi:10.1016/j.jamcollsurg.2019.08.646
• Kulvatunyou, N., Zeeshan, M., Tang, A., Kulvatunyou, N., Joseph, B., Hanna, K., Hamidi, M. K., Haddadin, Z., Gries, L. M., Ditillo, M., & Castanon, L. (2019). Rib Plating the Non-Flail Chest May Not Be as Good as You Think. Journal of The American College of Surgeons, 229(4), e241-e242. doi:10.1016/j.jamcollsurg.2019.08.1396
• Kulvatunyou, N., Zeeshan, M., Vartanyan, P., Northcutt, A., Kulvatunyou, N., Joseph, B., Hanna, K., Hamidi, M. K., Gries, L. M., Ditillo, M., & Castanon, L. (2019). Chronic Alcoholism Is Bad for Broken Ribs: A Nationwide Analysis of 20,120 Patients with Rib Fractures. Journal of The American College of Surgeons, 229(4), S289-S290. doi:10.1016/j.jamcollsurg.2019.08.634
• 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.
• Lokhandwala, A., Hanna, K., Gries, L., Zeeshan, M., Ditillo, M., Tang, A., Hamidi, M., & Joseph, B. (2019). Preinjury Statins Are Associated With Improved Survival in Patients With Traumatic Brain Injury. The Journal of surgical research, 245, 367-372.
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  Statins have been shown to improve outcomes in traumatic brain injury (TBI) in animal models. The aim of our study was to determine the effect of preinjury statins on outcomes in TBI patients.
• O'keeffe, T., Kulvatunyou, N., Zeeshan, M., Tang, A. L., O'keeffe, T., Kulvatunyou, N., Joseph, B., Hanna, K., Hamidi, M. K., Gries, L. M., Gonzales, C., & Castanon, L. (2019). Trauma Centers Near the US-Mexico Border: What Are the Challenges?. Journal of The American College of Surgeons, 229(4), e243-e244. doi:10.1016/j.jamcollsurg.2019.08.1401
• O'keeffe, T., Kulvatunyou, N., Zeeshan, M., Tang, A. L., O'keeffe, T., Kulvatunyou, N., Joseph, B., Hanna, K., Hamidi, M. K., Haddadin, Z., Gries, L. M., & Astarabadi, M. (2019). Impact of Non-Neurologic Organ Dysfunction on Outcomes in Severe Isolated Traumatic Brain Injury. Journal of The American College of Surgeons, 229(4), S299. doi:10.1016/j.jamcollsurg.2019.08.655
• O'keeffe, T., Kulvatunyou, N., Zeeshan, M., Tang, A. L., O'keeffe, T., Kulvatunyou, N., Joseph, B., Hanna, K., Hamidi, M. K., Haddadin, Z., Gries, L. M., & Ditillo, M. (2019). Readmission with Major Abdominal Complications after Penetrating Abdominal Trauma. Journal of The American College of Surgeons, 229(4), S307-S308. doi:10.1016/j.jamcollsurg.2019.08.671
• O'keeffe, T., Zeeshan, M., O'keeffe, T., Northcutt, A., Lokhandwala, A., Joseph, B., Hanna, K., Hamidi, M. K., Haddadin, Z., Gries, L. M., & Ditillo, M. (2019). Strict Resuscitation Strategies Improve Outcomes in Patients with Severe Traumatic Brain Injury. Journal of The American College of Surgeons, 229(4), S310-S311. doi:10.1016/j.jamcollsurg.2019.08.677
• O'keeffe, T., Zeeshan, M., Tang, A. L., O'keeffe, T., Northcutt, A., Joseph, B., Hanna, K., Hamidi, M. K., Haddadin, Z., Gries, L. M., & Ditillo, M. (2019). Early Initiation of Thromboprophylaxis in Operative Spine Trauma Does Not Increase the Risk of Bleeding Complication. Journal of The American College of Surgeons, 229(4), S194. doi:10.1016/j.jamcollsurg.2019.08.428
• Skarupa, D., Hanna, K., Zeeshan, M., Madbak, F., Hamidi, M., Haddadin, Z., Northcutt, A., Gries, L., Kulvatunyou, N., & Joseph, B. (2019). Is early chemical thromboprophylaxis in patients with solid organ injury a solid decision?. The journal of trauma and acute care surgery, 87(5), 1104-1112.
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  The optimal time to initiate chemical thromboprophylaxis (CTP) in patients who have undergone nonoperative management (NOM) of blunt solid organ injuries (SOI) remains controversial. The aim of our study was to assess the impact of early initiation of CTP in patients with blunt abdominal SOIs.
• Zakaria, E. R., Kulvatunyou, N., Zeeshan, M., Zakaria, E. R., Saljuqi, A. T., Kulvatunyou, N., Joseph, B., Hanna, K., Hamidi, M. K., Haddadin, Z., Gries, L. M., & Calabrese, E. C. (2019). Prospective Evaluation of Health Literacy and Its Impact on Outcomes after Emergency General Surgery. Journal of The American College of Surgeons, 229(4), S111-S112. doi:10.1016/j.jamcollsurg.2019.08.251
• Zeeshan, M., Hamidi, M., Feinstein, A. J., Gries, L., Jehan, F., Sakran, J., Northcutt, A., OʼKeeffe, T., Kulvatunyou, N., & Joseph, B. (2019). Four-factor prothrombin complex concentrate is associated with improved survival in trauma-related hemorrhage: A nationwide propensity-matched analysis. The journal of trauma and acute care surgery, 87(2), 274-281.
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  Post-traumatic hemorrhage is the most common preventable cause of death in trauma. Numerous small single-center studies have shown the superiority of four-factor prothrombin complex concentrate (4-PCC) along with fresh frozen plasma (FFP) over FFP alone in resuscitation of trauma patients. The aim of our study was to evaluate outcomes of severely injured trauma patients who received 4-PCC + FFP compared to FPP alone.
• Zeeshan, M., Hamidi, M., 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.
• Zeeshan, M., Tang, A. L., Richards, J., Northcutt, A., Joseph, B., Hanna, K., Hamidi, M. K., Gries, L. M., Ditillo, M., & Castanon, L. (2019). Prospective Evaluation of Factors Contributing to Racial Disparities in Outcomes after Trauma. Journal of The American College of Surgeons, 229(4), e239. doi:10.1016/j.jamcollsurg.2019.08.1389
• Joseph, B., Jehan, F., Dacey, M., Kulvatunyou, N., Khan, M., Zeeshan, M., Gries, L., O'Keeffe, T., & Riall, T. S. (2018). Evaluating the Relevance of the 2013 Tokyo Guidelines for the Diagnosis and Management of Cholecystitis. Journal of the American College of Surgeons.
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  The Tokyo Guidelines (TG13) is used to diagnose, grade severity, and guide management of acute cholecystitis (AC). Aim of our study was to verify the diagnostic criteria, severity assessment, and management protocols based on TG13.
• Khan, M., Jehan, F., O'Keeffe, T., Hamidi, M., Kulvatunyou, N., Tang, A., Gries, L., & Joseph, B. (2018). Oral Xa Inhibitors Versus Low Molecular Weight Heparin for Thromboprophylaxis After Nonoperative Spine Trauma. The Journal of surgical research, 232, 82-87.
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  Thromboprophylaxis with oral Xa inhibitors (Xa-Inh) are recommended after major orthopedic operation; however, its role in spine trauma is not well-defined. The aim of our study was to assess the impact of Xa-Inh in spinal trauma patients managed nonoperatively.
• Khan, M., Jehan, F., O'Keeffe, T., Hamidi, M., Truitt, M., Zeeshan, M., Gries, L., Tang, A., & Joseph, B. (2018). Optimal Timing of Initiation of Thromboprophylaxis after Nonoperative Blunt Spinal Trauma: A Propensity-Matched Analysis. Journal of the American College of Surgeons.
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  Patients with spinal trauma have the highest risk of a venous thromboembolism. Although anticoagulation is recommended, its optimal timing is not well-defined. We aimed to assess the impact of early initiation of thromboprophylaxis in spinal trauma patients who were managed nonoperatively.
• Kulvatunyou, N., Zakaria, E. R., O'keeffe, T., Zakaria, E. R., Wu, A., O'keeffe, T., Kulvatunyou, N., Khan, M. N., Joseph, B., Jehan, F., Hamidi, M., & Gries, L. M. (2018). Cannabinoids Use Is Associated with Improved Outcomes in Traumatic Brain Injury. Journal of The American College of Surgeons, 227(4), e230. doi:10.1016/j.jamcollsurg.2018.08.622
• 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.
• Mathew, P. J., Jehan, F., Kulvatunyou, N., Khan, M., O'Keeffe, T., Tang, A., Gries, L., Hamidi, M., Zakaria, E. R., & Joseph, B. (2018). The burden of excess length of stay in trauma patients. American journal of surgery, 216(5), 881-885.
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  Disposition of trauma patients frequently results in excessive hospital-stay. The aim of this study was to assess the risk of developing complications due to excessive stay in the hospital.
• Swartz, T., Jehan, F., Tang, A., Gries, L., Zeeshan, M., Kulvatunyou, N., Hamidi, M., O'Keeffe, T., & Joseph, B. (2018). PROSPECTIVE EVALUATION OF LOW-HEALTH LITERACY AND ITS IMPACT ON OUTCOMES IN TRAUMA PATIENTS. The journal of trauma and acute care surgery.
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  Health-literacy is emerging focus of interest in public health and is evolving as an important component of national health policy. Low-health-literacy (LHL) is associated with poor outcomes. We aimed to identify factors associated with LHL and its relationship with health outcomes in trauma patients.
• Zeeshan, M., Jehan, F., O'Keeffe, T., Khan, M., Zakaria, E. R., Hamidi, M., Gries, L., Kulvatunyou, N., & Joseph, B. (2018). The Novel Oral Anticoagulants (NOACs) have Worse Outcomes Compared to Warfarin in Patients with Intracranial Hemorrhage after TBI. The journal of trauma and acute care surgery.
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  Novel-oral-anticoagulants(NOACs) use is increasing in trauma patients. The reversal of these agents after hemorrhage is still evolving. The aim of our study was to evaluate outcomes after traumatic brain injury in patients on NOACs.
• Zeeshan, M., Khan, M., O'Keeffe, T., Pollack, N., Hamidi, M., Kulvatunyou, N., Sakran, J. V., Gries, L., & Joseph, B. (2018). OPTIMAL TIMING OF INITIATION OF THROMBOPROPHYLAXIS IN SPINE TRAUMA MANAGED OPERATIVELY: A NATIONWIDE PROPENSITY MATCHED ANALYSIS OF TRAUMA QUALITY IMPROVEMENT PROGRAM. The journal of trauma and acute care surgery.
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  Patients with spinal trauma are at high-risk for venous-thromboembolism(VTE). Guidelines recommend prophylactic anticoagulation but they are unclear on timing of initiation of thromboprophylaxis. The aim of our study was to assess the impact of early vs late initiation of venous thromboprophylaxis in patients with spinal trauma who underwent operative intervention.
• 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
• Hassan, A., Jokar, T. O., Rhee, P., Ibraheem, K., Kulvatunyou, N., Anderson, K. T., Gries, L., Roward, Z. T., & Joseph, B. (2017). More Helmets Fewer Deaths: Motorcycle Helmet Legislation Impacts Traumatic Brain Injury-Related Mortality in Young Adults. The American surgeon, 83(6), 541-546.
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  The aim of our study was to assess the impact of helmet legislations on the incidence and the mortality rate of motorcycle collision (MCC)-related traumatic brain injury (TBI) in young adult trauma patients. A 1-year (2011) retrospective analysis was performed of all patients under 21 years old with trauma-related hospitalization using the Nationwide Inpatient Sample database (representing 20% of all in-patient admissions). Patients with MCC were identified using E-codes. States were classified into three groups based on helmet legislations: universal age helmet legislation,
• Jehan, F., Azim, A., Rhee, P., Khan, M., Gries, L., OʼKeeffe, T., Kulvatunyou, N., Tang, A., & Joseph, B. (2017). Decompressive craniectomy versus craniotomy only for intracranial hemorrhage evacuation: A propensity matched study. The journal of trauma and acute care surgery, 83(6), 1148-1153.
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  Decompressive craniectomy (DC) is often performed in conjunction with evacuation of intracranial hemorrhage (ICH) to control intracranial pressure (ICP) in patients with a traumatic brain injury (TBI). The efficacy of DC in lowering ICP is well established; however, its effect on clinical outcomes remains controversial. The aim of our study is to assess outcomes in TBI patients undergoing DC versus craniotomy only (CO) for the evacuation of ICH.
• Jehan, F., O'Keeffe, T., Khan, M., Chi, A., Tang, A., Kulvatunyou, N., Gries, L., & Joseph, B. (2017). Early thromboprophylaxis with low-molecular-weight heparin is safe in patients with pelvic fracture managed nonoperatively. The Journal of surgical research, 219, 360-365.
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  Early initiation of thromboprophylaxis is highly desired in pelvic fracture patients, but it is often delayed due to the fear of hemorrhage. Aim of our study was to assess the safety of early initiation of venous thromboprophylaxis in patients with pelvic trauma managed nonoperatively.
• Joseph, B., Azim, A., Haider, A. A., Kulvatunyou, N., O'Keeffe, T., Hassan, A., Gries, L., Tran, E., Latifi, R., & Rhee, P. (2017). Bicycle helmets work when it matters the most. American journal of surgery, 213(2), 413-417.
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  Helmets are known to reduce the incidence of traumatic brain injury (TBI) after bicycle-related accidents. The aim of this study was to assess the association of helmets with severity of TBI and facial fractures after bicycle-related accidents.
• Khan, M., Jehan, F., O'Keeffe, T., Pandit, V., Kulvatunyou, N., Tang, A., Gries, L., & Joseph, B. (2017). Primary repair for pediatric colonic injury: Are there differences among adult and pediatric trauma centers?. The Journal of surgical research, 220, 176-181.
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  Management of colonic injuries (colostomy [CO] versus primary anastomosis [PA]) among pediatric patients remains controversial. The aim of this study was to assess outcomes in pediatric trauma patient with colonic injury undergoing operative intervention.
• Khan, M., O'Keeffe, T., Jehan, F., Kulvatunyou, N., Kattaa, A., Gries, L., Tang, A., & Joseph, B. (2017). The impact of Glasgow Coma Scale-age prognosis score on geriatric traumatic brain injury outcomes. The Journal of surgical research, 216, 109-114.
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  As the population ages, increasing number of geriatric patients sustain traumatic brain injury (TBI). Communication of accurate prognostic information is crucial for making informed decisions on behalf of such patients. Therefore, the aim of our study was to develop a simple and clinically applicable tool that accurately predicts the prognosis in geriatric TBI patients.
• Kulvatunyou, N., O'keeffe, T., Tang, A. L., O'keeffe, T., Kulvatunyou, N., Khan, M., Joseph, B., Gries, L. M., Azim, A., & Ahmed, F. S. (2017). Optimal Timing of Initiation Thromboprophylaxis in Spinal Trauma after Operative Intervention: A Propensity-Matched Analysis. Journal of The American College of Surgeons, 225(4), S58-S59. doi:10.1016/j.jamcollsurg.2017.07.116
• Kulvatunyou, N., Vercruysse, G. A., Vercruysse, G. A., Tang, A. L., Kulvatunyou, N., Khreiss, M., Joseph, B., Jehan, F., Gries, L. M., Aziz, H., & Azim, A. (2017). Pendulum of Peptic Ulcer Disease: An Overview of National Practice. Journal of The American College of Surgeons, 225(4), e96-e97. doi:10.1016/j.jamcollsurg.2017.07.786
• Mowery, N. T., Bruns, B. R., MacNew, H. G., Agarwal, S., Enniss, T. M., Khan, M., Guo, W. A., Cannon, J. W., Lissauer, M. E., Duane, T. M., Hildreth, A. N., Pappas, P. A., Gries, L. M., Kaiser, M., & Robinson, B. R. (2017). Surgical management of pancreatic necrosis: A practice management guideline from the Eastern Association for the Surgery of Trauma. The journal of trauma and acute care surgery, 83(2), 316-327.
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  Pancreatic or peripancreatic tissue necrosis confers substantial morbidity and mortality. New modalities have created a wide variation in approaches and timing of interventions for necrotizing pancreatitis. As acute care surgery evolves, its practitioners are increasingly being called upon to manage these complex patients.
• O'keeffe, T., Kulvatunyou, N., Tang, A. L., O'keeffe, T., Kulvatunyou, N., Khan, M., Joseph, B., Jain, A., Gries, L. M., & Ahmed, F. S. (2017). Urology Consultation Is Not Necessary in Patients with Low Grade Renal Trauma. Journal of The American College of Surgeons, 225(4), e190-e191. doi:10.1016/j.jamcollsurg.2017.07.1046
• O'keeffe, T., Kulvatunyou, N., Tang, A. L., O'keeffe, T., Kulvatunyou, N., Khan, M., Joseph, B., Jehan, F., Gries, L. M., & Azim, A. (2017). Functional Independence and Long-Term Recovery after Traumatic Brain Injury (TBI). Journal of The American College of Surgeons, 225(4), e179. doi:10.1016/j.jamcollsurg.2017.07.1014
• O'keeffe, T., Kulvatunyou, N., Tang, A. L., O'keeffe, T., Mccusker, A., Kulvatunyou, N., Khan, M., Joseph, B., Gries, L. M., & Ahmed, F. S. (2017). Sarcopenia Defined by Computed Tomography (CT) Psoas Muscle Area Does Not Predict Frailty in Trauma Patients. Journal of The American College of Surgeons, 225(4), S61. doi:10.1016/j.jamcollsurg.2017.07.123
• Singer, M., Azim, A., O'Keeffe, T., Khan, M., Jain, A., Kulvatunyou, N., Gries, L., Jehan, F., Tang, A., & Joseph, B. (2017). How does marijuana affect outcomes after trauma in ICU patients? A propensity-matched analysis. The journal of trauma and acute care surgery, 83(5), 846-849.
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  In the United States, marijuana abuse and dependence are becoming more prevalent among adult and adolescent trauma patients. Unlike several studies that focus on the effects of marijuana on the outcomes of diseases, our aim was to assess the relationship between a positive toxicology screen for marijuana and mortality in such patients.
• Tang, A. L., Swartz, T., Keeffe, T. O., Joseph, B., Jehan, F., Jain, A., Gries, L. M., & Ahmed, F. S. (2017). Predictors of Acute Kidney Injury after Exploratory Laparotomy in Trauma Patients. Journal of The American College of Surgeons, 225(4), e184. doi:10.1016/j.jamcollsurg.2017.07.1028
• Vercruysse, G. A., Vercruysse, G. A., Tang, A. L., Khan, M., Joseph, B., Jehan, F., Jain, A., Gries, L. M., & Azim, A. (2017). Trimodal Distribution of Trauma Deaths Is No More. Journal of The American College of Surgeons, 225(4), S64-S65. doi:10.1016/j.jamcollsurg.2017.07.132
• Joseph, B., Haider, A., Hassan, A., Kulvatunyou, N., Bains, S., Tang, A., Zangbar, B., OʼKeeffe, T., Vercruysse, G., Gries, L., & Rhee, P. (2016). Injury prevention programs against distracted driving among students. The journal of trauma and acute care surgery, 81(1), 144-8.
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  Motor vehicle crashes are the leading cause of death and nonfatal injury among young adults. The aims of this study were to assess the magnitude of distracted driving (DD) among students and to examine the effectiveness of awareness campaign against DD. We hypothesized that DD is prevalent among students and educational efforts such as DD awareness campaign can effectively reduce it.
• Joseph, B., Haider, A., Ibraheem, K., Kulvatunyou, N., Tang, A., Azim, A., O'Keeffe, T., Gries, L., Vercruysse, G., & Rhee, P. (2016). Revitalizing Vital Signs: The Role of Delta Shock Index. Shock (Augusta, Ga.), 46(3 Suppl 1), 50-4.
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  Although variability in vital parameters has been shown to predict outcomes, the role of change in shock index (delta SI) as a predictive tool remains unknown.
• Joseph, B., Phelan, H., Hassan, A., Orouji Jokar, T., O'Keeffe, T., Azim, A., Gries, L., Kulvatunyou, N., Latifi, R., & Rhee, P. (2016). The impact of frailty on failure-to-rescue in geriatric trauma patients: A prospective study. The journal of trauma and acute care surgery, 81(6), 1150-1155.
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  Failure-to-rescue (FTR) (defined as death from a major complication) is considered as an index of hospital quality in trauma patients. However, the role of frailty in FTR events remains unclear. We hypothesized that FTR rate is higher in elderly frail trauma patients.
• Khalil, M., Rhee, P., Jokar, T. O., Kulvatunyou, N., O'Keeffe, T., Tang, A., Hassan, A., Gries, L., Latifi, R., & Joseph, B. (2016). Antibiotics for appendicitis! Not so fast. The journal of trauma and acute care surgery, 80(6), 923-32.
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  Emerging literature in acute appendicitis favors the nonoperative management of acute appendicitis. However, the actual use of this practice on a national level is not assessed. The aim of this study was to assess the changing trends in nonoperative management of acute appendicitis and its effects on patient outcomes.
• Petkovska, I., Martin, D. R., Covington, M. F., Urbina, S., Duke, E., Daye, Z. J., Stolz, L. A., Keim, S. M., Costello, J. R., Chundru, S., Arif-Tiwari, H., Gilbertson-Dahdal, D., Gries, L., & Kalb, B. (2016). Accuracy of Unenhanced MR Imaging in the Detection of Acute Appendicitis: Single-Institution Clinical Performance Review. Radiology, 150468.
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  Purpose To determine the accuracy of unenhanced magnetic resonance (MR) imaging in the detection of acute appendicitis in patients younger than 50 years who present to the emergency department with right lower quadrant (RLQ) pain. Materials and Methods The institutional review board approved this retrospective study of 403 patients from August 1, 2012, to July 30, 2014, and waived the informed consent requirement. A cross-department strategy was instituted to use MR imaging as the primary diagnostic modality in patients aged 3-49 years who presented to the emergency department with RLQ pain. All MR examinations were performed with a 1.5- or 3.0-T system. Images were acquired without breath holding by using multiplanar half-Fourier single-shot T2-weighted imaging without and with spectral adiabatic inversion recovery fat suppression without oral or intravenous contrast material. MR imaging room time was measured for each patient. Prospective image interpretations from clinical records were reviewed to document acute appendicitis or other causes of abdominal pain. Final clinical outcomes were determined by using (a) surgical results (n = 77), (b) telephone follow-up combined with review of the patient's medical records (n = 291), or (c) consensus expert panel assessment if no follow-up data were available (n = 35). Logistic regression analysis was performed to evaluate the sensitivity and specificity of MR imaging in the detection of acute appendicitis, and corresponding 95% confidence intervals were determined. Results Of the 403 patients, 67 had MR imaging findings that were positive for acute appendicitis, and 336 had negative findings. MR imaging had a sensitivity of 97.0% (65 of 67) and a specificity of 99.4% (334 of 336). The mean total room time was 14 minutes (range, 8-62 minutes). An alternate diagnosis was offered in 173 (51.5%) of 336 patients. Conclusion MR imaging is a highly sensitive and specific test in the evaluation of patients younger than 50 years with acute RLQ pain that uses a rapid imaging protocol performed without intravenous or oral contrast material. (©) RSNA, 2016 Online supplemental material is available for this article.
• Rhee, P. M., Kulvatunyou, N., O'keeffe, T., Vercruysse, G. A., Vercruysse, G. A., Tang, A. L., Rhee, P. M., O'keeffe, T., Kulvatunyou, N., Joseph, B., Jokar, T. O., Hassan, A., Haider, A. A., & Gries, L. M. (2016). Suprapubic Catheter Placement in Lower Genitourinary Tract Injury: Friend or Foe?. Journal of The American College of Surgeons, 223(4), S162. doi:10.1016/j.jamcollsurg.2016.06.354
• Rhee, P. M., Kulvatunyou, N., Toosizadeh, N., Rhee, P. M., Najafi, B., Mohler, J., Kulvatunyou, N., Joseph, B., Jokar, T. O., Heusser, M. R., Hassan, A., & Gries, L. M. (2016). Motion Sensors Estimated Upper Extremity Frailty Score: A Practical Method to Identify 30-Day Recurrent Fall and Hospital Readmission in Elderly Trauma Patients. Journal of The American College of Surgeons, 223(4), S42. doi:10.1016/j.jamcollsurg.2016.06.105
• Rhee, P. M., O'keeffe, T., Kulvatunyou, N., Tang, A. L., Rhee, P. M., Raney, E., O'keeffe, T., Kulvatunyou, N., Joseph, B., Jokar, T. O., Ibraheem, K., Hannallah, J., & Gries, L. M. (2016). Computed Tomography-Measured Waist to Hip Ratio: A Reliable Predictor af Outcomes after Trauma. Journal of The American College of Surgeons, 223(4), S151-S152. doi:10.1016/j.jamcollsurg.2016.06.327
• Rhee, P. M., O'keeffe, T., Vercruysse, G. A., Kulvatunyou, N., Vercruysse, G. A., Tang, A. L., Rhee, P. M., O'keeffe, T., Kulvatunyou, N., Joseph, B., Haider, A. A., Gries, L. M., Azim, A., & Afzal, H. (2016). Score to Predict Failure-to-Rescue in Geriatric Emergency General Surgery Patients. Journal of The American College of Surgeons, 223(4), S54. doi:10.1016/j.jamcollsurg.2016.06.363
• Rhee, P. M., O'keeffe, T., Vercruysse, G. A., Kulvatunyou, N., Vercruysse, G. A., Tang, A. L., Rhee, P. M., O'keeffe, T., Kulvatunyou, N., Joseph, B., Hassan, A., Haider, A. A., Gries, L. M., & Azim, A. (2016). Trends in National Outcomes for Traumatic Brain Injury. Journal of The American College of Surgeons, 223(4), e211. doi:10.1016/j.jamcollsurg.2016.08.529
• Rhee, P. M., O'keeffe, T., Vercruysse, G. A., Vercruysse, G. A., Tang, A. L., Rhee, P. M., Pandit, V., O'keeffe, T., Joseph, B., Jokar, T. O., Ibraheem, K., & Gries, L. M. (2016). Assessing Variability Among Pediatric and Adult Trauma Centers in Managing Colonic Injury. Journal of The American College of Surgeons, 223(4), e196. doi:10.1016/j.jamcollsurg.2016.08.495
• 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.
• Aziz, H., Rhee, P., Pandit, V., Tang, A., Gries, L., & Joseph, B. (2015). The current concepts in management of animal (dog, cat, snake, scorpion) and human bite wounds. The journal of trauma and acute care surgery, 78(3), 641-8.
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  Animal and human bite wounds represent a significant global health issue. In the United States, animal and human bites are a very common health issue, causing significant morbidity and even, in rare scenarios, mortality. Most animal bite wounds in the United States are caused by dogs, with cat bites being a distant second. Human bite wounds constitute a dominant subset of all bite wounds. Several studies of bite wounds have reported improved outcomes with early diagnosis and immediate treatment. However, the available literature on the initial treatment provides a plethora of conflicting opinions and results. In this review, our aim was to identify and assess the current evidence on the management of animal (dog, cat, insects, scorpions, and snakes) and human bite wounds.
• 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.
• Hamidi, M., Zeeshan, M., Kulvatunyou, N., Adun, E., O'Keeffe, T., Zakaria, E. R., Gries, L., & Joseph, B. (2019). Outcomes After Massive Transfusion in Trauma Patients: Variability Among Trauma Centers. The Journal of surgical research, 234, 110-115.
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  Exsanguinating trauma patients often require massive blood transfusion (defined as transfusion of 10 or more pRBC units within first 24 h). The aim of our study is to assess the outcomes of trauma patients receiving massive transfusion at different levels of trauma centers.
• Jehan, F., Khan, M., Kulvatunyou, N., Hamidi, M., Gries, L., Zeeshan, M., O'Keeffe, T., & Joseph, B. (2019). Day of Hospital Admission and Effect on Outcomes: The Weekend Effect in Acute Gallstone Pancreatitis. The Journal of surgical research, 233, 192-198.
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  The aim of our study was to evaluate outcomes in patients who are admitted on weekend compared with those admitted on a weekday for acute gallstone pancreatitis.
• Jehan, F., Pandit, V., O'Keeffe, T., Azim, A., Jain, A., Tai, S. A., Tang, A., Khan, M., Kulvatunyou, N., Gries, L., & Joseph, B. (2018). The burden of firearm violence in the United States: stricter laws result in safer states. Journal of injury & violence research, 10(1).
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  Increasing firearm violence has resulted in a strong drive for stricter firearm legislations. Aim of this study was to determine the relationship between firearm legislations and firearm-related injuries across states in the United States.
• 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., 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., 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.
• Khalil, M., Pandit, V., Rhee, P., Kulvatunyou, N., Orouji, T., Tang, A., O'Keeffe, T., Gries, L., Vercruysse, G., Friese, R. S., & Joseph, B. (2015). Certified acute care surgery programs improve outcomes in patients undergoing emergency surgery: A nationwide analysis. The journal of trauma and acute care surgery, 79(1), 60-3; discussion 64.
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  Differences in outcomes among trauma centers (TCs) and non-TCs (NTCs) in patients undergoing emergency general surgery (EGS) are well established. However; the impact of development of certified acute care surgery (ACS) programs on patient outcomes remains unknown. The aim of this study was to evaluate outcomes in patients undergoing EGS across TCs, NTCs, and TCs with ACS (ACS-TC).
• Khan, M., Azim, A., O'Keeffe, T., Jehan, F., Kulvatunyou, N., Santino, C., Tang, A., Vercruysse, G., Gries, L., & Joseph, B. (2018). Geriatric rescue after surgery (GRAS) score to predict failure-to-rescue in geriatric emergency general surgery patients. American journal of surgery.
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  Geriatric-patients(GP) undergoing emergency-general-surgery(EGS) are vulnerable to develop adverse-outcomes. Impact of patient-level-factors on Failure-to-Rescue(FTR) in EGS-GP remains unclear. Aim of our study was to determine factors associated with FTR(death from major-complication) and devise simple-bedside-score that predicts FTR in EGS-GP.
• Kulvatunyou, N., O'keeffe, T., Latifi, R., Rhee, P. M., Zangbar, B., Tang, A. L., Rhee, P. M., O'keeffe, T., Mathew, P. J., Latifi, R., Kulvatunyou, N., Khalil, M., Joseph, B., & Gries, L. M. (2015). All pelvises are created equal: or are they? Sex differences in pelvic trauma. Journal of The American College of Surgeons, 221(4), e24. doi:10.1016/j.jamcollsurg.2015.08.361
• Kulvatunyou, N., Pandit, V., Moutamn, S., Inaba, K., Chouliaras, K., DeMoya, M., Naraghi, L., Kalb, B., Arif, H., Sravanthi, R., Joseph, B., Gries, L., Tang, A. L., & Rhee, P. (2015). A multi-institution prospective observational study of small bowel obstruction: Clinical and computerized tomography predictors of which patients may require early surgery. The journal of trauma and acute care surgery, 79(3), 393-8.
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  For patients with adhesive small bowel obstruction (ASBO), early surgery after a failed trial of nonoperative treatment can improve outcome. However, deciding which patients require early surgery is difficult, given the lack of specific clinical or radiographic signs. The study goals were to identify clinical and computed tomography (CT) predictors of which patients may need early surgery and to evaluate the utility of the common CT findings.
• 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.
• Pandit, V., Michailidou, M., Rhee, P., Zangbar, B., Kulvatunyou, N., Khalil, M., O'Keeffe, T., Haider, A., Gries, L., & Joseph, B. (2015). The use of whole body computed tomography scans in pediatric trauma patients: Are there differences among adults and pediatric centers?. Journal of pediatric surgery.
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  Whole body CT (WBCT) scan is known to be associated with significant radiation risk especially in pediatric trauma patients. The aim of this study was to assess the use WBCT scan across trauma centers for the management of pediatric trauma patients.
• Rhee, P. M., Kulvatunyou, N., O'keeffe, T., Friese, R. S., Zangbar, B., Tang, A. L., Rhee, P. M., O'keeffe, T., Kulvatunyou, N., Khalil, M., Joseph, B., Jokar, T. O., Gries, L. M., & Friese, R. S. (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
• Rhee, P. M., Kulvatunyou, N., O'keeffe, T., Latifi, R., Zangbar, B., Tang, A. L., Rhee, P. M., O'keeffe, T., Latifi, R., Kulvatunyou, N., Joseph, B., Jokar, T. O., Haider, A. A., & Gries, L. M. (2015). Unveiling Deterioration in Traumatic Brain Injury: The Role of Delta Shock Index. Journal of The American College of Surgeons, 221(4), S169-S170. doi:10.1016/j.jamcollsurg.2015.07.405
• Rhee, P. M., Kulvatunyou, N., O'keeffe, T., Latifi, R., Zangbar, B., Tang, A. L., Rhee, P. M., O'keeffe, T., Latifi, R., Kulvatunyou, N., Khalil, M., Joseph, B., Haider, A. A., & Gries, L. M. (2015). Take ’em Where They Belong: Outcome Differences in Pediatric Traumatic Brain Injury among Trauma Centers. Journal of The American College of Surgeons, 221(4), S108-S109. doi:10.1016/j.jamcollsurg.2015.07.252
• Rhee, P., Kulvatunyou, N., O'keeffe, T., Latifi, R., Tang, A., Rhee, P., O'keeffe, T., Latifi, R., Kulvatunyou, N., Khalil, M., Joseph, B., & Gries, L. (2015). The protective effect of remote ischemic conditioning in a septic mice model. Journal of Critical Care, 30(4), 848. doi:10.1016/j.jcrc.2015.04.084
• 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.
• Braun, B. M., Gries, L. M., Hildreth, A. N., & Miller, A. N. (2014). Moped collisions among patients with revoked drivers' licenses are a significant public health problem: a retrospective cohort study. The American surgeon, 80(8), 792-5.
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  Many states do not require a license to operate a moped, defined as a motor vehicle with less than 50-cc engine displacement. These vehicles may therefore serve as a mode of transportation for those who are driving without a license and who may have a history of prior high-risk behavior. We hypothesized that those involved in moped collisions were more likely to have previous convictions for driving while intoxicated (DWI) and other non-DWI offenses than those on conventional motorcycles. At a Level I trauma center, we queried the trauma registry from January 2005 to October 2010 for admissions after motorcycle or moped collisions. Classification of mechanism of injury was verified through chart review. Corrections databases from our state were then reviewed for previous convictions for DWI and other offenses. One thousand seventy-three patients over the study period were involved in motorcycle or moped collisions; 94 were from another state. Of the patients identified from our state, 249 had moped collisions and 730 had motorcycle collisions. Forty-nine per cent (121) of moped drivers had a history of DWI versus only 8 per cent (56) of motorcycle drivers (P ≤ 0.05). Sixty-four per cent (161) of moped drivers were previously convicted of a crime versus 20 per cent (146) of those on motorcycles (P ≤ 0.05). Moped drivers were significantly more likely to have a prior conviction of DWI as well as prior convictions of other crimes, establishing a pattern of disregard for the law. The use of these vehicles without a license likely presents a risk to public safety. Legislation to require licensing before moped operation should be considered.
• Friese, R. S., Wynne, J., Kulvatunyou, N., Rhee, P., Vercruysse, G. A., Vercruysse, G. A., Zangbar, B., Wynne, J., Vercruysse, G., Tang, A., Rhee, P., Pandit, V., O'keeffe, T., Kulvatunyou, N., Joseph, B., Hashmi, A., Gries, L., & Friese, R. S. (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.
• 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., 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., 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., 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.
• Kulvatunyou, N., Erickson, L., Vijayasekaran, A., Gries, L., Joseph, B., Friese, R. F., O'Keeffe, T., Tang, A. L., Wynne, J. L., & Rhee, P. (2014). Randomized clinical trial of pigtail catheter versus chest tube in injured patients with uncomplicated traumatic pneumothorax. The British journal of surgery, 101(2), 17-22.
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  Small pigtail catheters appear to work as well as the traditional large-bore chest tubes in patients with traumatic pneumothorax, but it is not known whether the smaller pigtail catheters are associated with less tube-site pain. This study was conducted to compare tube-site pain following pigtail catheter or chest tube insertion in patients with uncomplicated traumatic pneumothorax.
• 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.
• Kulvatunyou, N., Wynne, J., Friese, R. S., Rhee, P., Vercruysse, G. A., Vercruysse, G. A., Wynne, J., Vercruysse, G., Tang, A., Rhee, P., Pandit, V., O'keeffe, T., Kulvatunyou, N., Joseph, B., Hashmi, A., Gries, L., Friese, R. S., & Aziz, H. (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
• Michailidou, M., Kulvatunyou, N., Friese, R. S., Gries, L., Green, D. J., Joseph, B., O'Keeffe, T., Tang, A. L., Vercruysse, G., & Rhee, P. (2014). Time and cost analysis of gallbladder surgery under the acute care surgery model. The journal of trauma and acute care surgery, 76(3), 710-4.
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  The acute care surgery (ACS) model has been shown to improve work flow efficiency and to reduce hospital stay. We hypothesized that, in patients with gallbladder (GB) disease who were admitted through our emergency department (ED) and then underwent surgery, the ACS model shortened the time to surgery, decreased the length of hospital stay, and reduced hospital costs.
• Pandit, V., Patel, N., Rhee, P., Kulvatunyou, N., Aziz, H., Green, D. J., O'Keeffe, T., Zangbar, B., Tang, A., Gries, L., Friese, R. S., & Joseph, B. (2014). Effect of alcohol in traumatic brain injury: is it really protective?. The Journal of surgical research, 190(2), 634-9.
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  Studies have proposed a neuroprotective role for alcohol (ETOH) in traumatic brain injury (TBI). We hypothesized that ETOH intoxication is associated with mortality in patients with severe TBI.
• Rhee, P. M., Kulvatunyou, N., O'keeffe, T., Friese, R. S., Tang, A. L., Rhee, P. M., Pandit, V., O'keeffe, T., Kulvatunyou, N., Khalil, M., Joseph, B., Gries, L., Green, D. J., & Friese, R. S. (2014). The Bimodal Effect: Impact of Admission Systolic Blood Pressure on Mortality in Isolated Traumatic Brain Injury. Journal of The American College of Surgeons, 219(3), S67. doi:10.1016/j.jamcollsurg.2014.07.156
• Rhee, P. M., Kulvatunyou, N., O'keeffe, T., Friese, R. S., Zangbar, B., Tang, A. L., Rhee, P. M., Pandit, V., O'keeffe, T., Kulvatunyou, N., Joseph, B., Gries, L., Green, D. J., & Friese, R. S. (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
• Rhee, P., Kulvatunyou, N., O'keeffe, T., Wynne, J., Vercruysse, G. A., Vercruysse, G. A., Friese, R. S., Zangbar, B., Wynne, J., Vercruysse, G., Tang, A., Rhee, P., Pandit, V., O'keeffe, T., Kulvatunyou, N., Joseph, B., Hashmi, A., Gries, L., & Friese, R. S. (2014). Shock Index Predicts Mortality in Geriatric Trauma Patients: An Analysis of The National Trauma Data Bank. Journal of Surgical Research, 186(2), 687. doi:10.1016/j.jss.2013.11.998
• 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.
• 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.
• Gries, L. M. (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
• 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., 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.
• Kulvatunyou, N., Friese, R. S., O'keeffe, T., Wynne, J. L., Vercruysse, G. A., Rhee, P. M., Wynne, J. L., Vercruysse, G. A., Tang, A. L., Rhee, P. M., O'keeffe, T., Kulvatunyou, N., Joseph, B., Gries, L., Friese, R. S., & Dehdashti, N. (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
• Kulvatunyou, N., Joseph, B., Wynne, J. L., Friese, R. S., Rhee, P. M., Wynne, J. L., Tang, A. L., Rhee, P. M., O'keeffe, T., Kulvatunyou, N., Joseph, B., Gries, L., Green, D. J., Glazer, E. S., & Friese, R. S. (2013). Complications After Percutaneous Endoscopic Gastrostomy Tube Placement in the Era of Acute Care Surgery. Journal of Surgical Research, 179(2), 346. doi:10.1016/j.jss.2012.10.891
• Kulvatunyou, N., O'keeffe, T., Wynne, J. L., Friese, R. S., Rhee, P. M., Wynne, J. L., Tang, A. L., Rhee, P. M., O'keeffe, T., Michailidou, M., Kulvatunyou, N., Joseph, B., Gries, L., Green, D. J., & Friese, R. S. (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.
• 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., Kulvatunyou, N., Wynne, J., Rhee, P., Wynne, J., Tang, A., Rhee, P., O'keeffe, T., Mobily, M., Kulvatunyou, N., Judkins, D., Joseph, B., Hernandez, N., Gries, L., Green, D. J., Friese, R. S., Frantz, N., Catalano, R., & Branco, B. C. (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
• Joseph, B., Kulvatunyou, N., Wynne, J., Rhee, P., Friese, R. S., Wynne, J., Tang, A., Rhee, P., O'keeffe, T., Kulvatunyou, N., Joseph, B., Gries, L., Green, D. J., & Friese, R. S. (2012). Does the Added Workload of Emergency General Surgery Negatively Impact Trauma Outcomes. Journal of Surgical Research, 172(2), 347. doi:10.1016/j.jss.2011.11.957
• 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.
• Eckels, P. C., Banerjee, A., Moore, E. E., McLaughlin, N. J., Gries, L. M., Kelher, M. R., England, K. M., Gamboni-Robertson, F., Khan, S. Y., & Silliman, C. C. (2009). Amantadine inhibits platelet-activating factor induced clathrin-mediated endocytosis in human neutrophils. American journal of physiology. Cell physiology, 297(4), C886-97.
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  Receptor signaling is integral for adhesion, emigration, phagocytosis, and reactive oxygen species production in polymorphonuclear neutrophils (PMNs). Priming is an important part of PMN emigration, but it can also lead to PMN-mediated organ injury in the host. Platelet-activating factor (PAF) primes PMNs through activation of a specific G protein-coupled receptor. We hypothesize that PAF priming of PMNs requires clathrin-mediated endocytosis (CME) of the PAF receptor (PAFr), and, therefore, amantadine, known to inhibit CME, significantly antagonizes PAF signaling. PMNs were isolated by standard techniques to >98% purity and tested for viability. Amantadine (1 mM) significantly inhibited the PAF-mediated changes in the cellular distribution of clathrin and the physical colocalization [fluorescence resonance energy transfer positive (FRET+)] of early endosome antigen-1 and Rab5a, known components of CME and similar to hypertonic saline, a known inhibitor of CME. Furthermore, amantadine had no effect on the PAF-induced cytosolic calcium flux; however, phosphorylation of p38 MAPK was significantly decreased. Amantadine inhibited PAF-mediated changes in PMN physiology, including priming of the NADPH oxidase and shape change with lesser inhibition of increases in CD11b surface expression and elastase release. Furthermore, rimantadine, an amantadine analog, was a more potent inhibitor of PAF priming of the N-formyl-methionyl-leucyl-phenylalanine-activated oxidase. PAF priming of PMNs requires clathrin-mediated endocytosis that is inhibited when PMNs are pretreated with either amantadine or rimantadine. Thus, amantadine and rimantadine have the potential to ameliorate PMN-mediated tissue damage in humans.
• Moore, E. E., Silliman, C. C., Moore, E. E., Mclaughlin, N. J., Johnson, J. L., Gries, L., Eckels, P. C., Damle, S. S., & Banerjee, A. (2006). FMLP INDUCES C5A RECEPTOR ENDOCYTOSIS IN HUMAN NEUTROPHILS. Shock, 25(Supplement 1), 85. doi:10.1097/00024382-200606001-00255
• Silliman, C. C., Moore, E. E., Mclaughlin, N. J., Johnson, J. L., Gries, L., & Eckels, P. C. (2006). HYPERTONIC SALINE INHIBITS C5A PRIMING OF THE PMN VIA ARREST OF C5A RECEPTOR ENDOCYTOSIS. Shock, 25(Supplement 1), 19. doi:10.1097/00024382-200606001-00058

Proceedings Publications

• Anand, T., El-Qawaqzeh, K., Nelson, A., Hosseinpour, H., Ditillo, M., Gries, L., Castanon, L., & Joseph, B. (2023). Association between Hemorrhage Control Interventions and Mortality in US Trauma Patients with Hemodynamically Unstable Pelvic Fractures. In JAMA Surgery.
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  Importance: Management of hemodynamically unstable pelvic fractures remains a challenge. Hemostatic interventions are used alone or in combination. There is a paucity of data on the association between the pattern of hemorrhage control interventions and outcomes after a severe pelvic fracture. Objective: To characterize clinical outcomes and study the patterns of hemorrhage control interventions in hemodynamically unstable pelvic fractures. Design, Setting, and Participants: In this cohort study, a retrospective review was performed of data from the 2017 American College of Surgeons Trauma Quality Improvement Program database, a national multi-institutional database of trauma patients in the United States. Adult patients (aged ≥18 years) with pelvic fractures who received early transfusions (≥4 units of packed red blood cells in 4 hours) and underwent intervention for pelvic hemorrhage control were identified. Use and order of preperitoneal pelvic packing (PP), pelvic angioembolization (AE), and resuscitative endovascular balloon occlusion of the aorta (REBOA) in zone 3 were examined and compared against the primary outcome of mortality. The associations between intervention patterns and mortality, complications, and 24-hour transfusions were further examined by backward stepwise regression analyses. Data analyses were performed in September 2021. Main Outcomes and Measures: Primary outcomes were rates of 24-hour, emergency department, and in-hospital mortality. Secondary outcomes were major in-hospital complications. Results: A total of 1396 patients were identified. Mean (SD) age was 47 (19) years, 975 (70%) were male, and the mean (SD) lowest systolic blood pressure was 71 (25) mm Hg. The median (IQR) Injury Severity Score was 24 (14-34), with a 24-hour mortality of 217 patients (15.5%), ED mortality of 10 patients (0.7%), in-hospital mortality of 501 patients (36%), and complication rate of 574 patients (41%). Pelvic AE was the most used intervention (774 [55%]), followed by preperitoneal PP (659 [47%]) and REBOA zone 3 (126 [9%]). Among the cohort, 1236 patients (89%) had 1 intervention, 157 (11%) had 2 interventions, and 3 (0.2%) had 3 interventions. On regression analyses, only pelvic AE was associated with a mortality reduction (odds ratio [OR], 0.62; 95% CI, 0.47 to 0.82; P
• Stupinski, J., Bible, L., Asmar, S., Chehab, M., Douglas, M., Ditillo, M., Gries, L., Khurrum, M., & Joseph, B. (2020). Impact of marijuana on venous thromboembolic events: Cannabinoids cause clots in trauma patients. In Journal of Trauma and Acute Care Surgery.
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  BACKGROUND Tetrahydrocannabinoids (THC) can modulate the coagulation cascade resulting in hypercoagulability. However, the clinical relevance of these findings has not been investigated. The aim of our study was to evaluate the impact of preinjury marijuana exposure on thromboembolic complications (TEC) in trauma patients. METHODS We performed a 2-year (2015-2016) analysis of American College of Surgeons Trauma Quality and Improvement Program database and included all adult (≥18 year) trauma patients. Patients were stratified based on preinjury exposure to Marijuana: THC + ve and THC -ve groups. We performed propensity score matching to control for confounding variables: demographics, comorbidities, injury parameters, hospital course, and thromboprophylaxis use. Outcomes were TEC (deep venous thrombosis, pulmonary embolism, stroke, myocardial infarction) and mortality. RESULTS Of 593,818 trauma patients, 678 patients were matched (THC + ve: 226 vs. THC -ve: 452). Mean age was 34 ± 15 years, Injury Severity Score was 14 (10-21). There was no difference between the two groups regarding age (p = 0.75), sex (p = 0.99), Injury Severity Score (p = 0.54), spine Abbreviated Injury Scale (AIS) (p = 0.61), head AIS (p = 0.32), extremities AIS (p = 0.38), use of unfractionated heparin (p = 0.54), use of low molecular weight heparin (p = 0.54), and hospital length of stay (p = 0.87). Overall, the rate of TEC was 4.3% and mortality was 4%. Patients in THC + ve group had higher rates of TEC compared with those in THC -ve group (3.5% vs. 1.1%, p = 0.03). The rate of deep venous thrombosis (6.6% vs. 1.8%, p = 0.02) and PE (2.2% vs. 0.2%, p = 0.04) was higher in THC + ve group. However, there was no difference regarding the rate of stroke (p = 0.24), myocardial infarction (p = 0.35) and mortality (p = 0.28). CONCLUSION THC exposure increases the risk of TEC in patients with trauma. Early identification and treatment for TEC is required to improve outcomes in this high-risk subset of trauma patients. LEVEL OF EVIDENCE Prognostic study, level III.
• Zeeshan, M., Jehan, F., O'Keeffe, T., Khan, M., Zakaria, E., Hamidi, M., Gries, L., Kulvatunyou, N., & Joseph, B. (2018). The novel oral anticoagulants (NOACs) have worse outcomes compared with warfarin in patients with intracranial hemorrhage after TBI. In Journal of Trauma and Acute Care.
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  INTRODUCTION Novel oral anticoagulant (NOAC) use is increasing in trauma patients. The reversal of these agents after hemorrhage is still evolving. The aim of our study was to evaluate outcomes after traumatic brain injury in patients on NOACs. METHODS 3-year (2014-2016) analysis of our prospectively maintained traumatic brain injury (TBI) database. We included all TBI patients with intracranial hemorrhage (ICH) on anticoagulants. Patients were stratified into two groups, those on NOACs and on warfarin, and were matched in a 1:2 ratio using propensity score matching for demographics, injury and vital parameters, type, and size of ICH. Outcome measures were progression of ICH, mortality, skilled nursing facility (SNF) disposition, and hospital and intensive care unit (ICU) length of stay (LOS). RESULTS We analyzed 1,459 TBI patients, of which 210 patients were matched (NAOCs, 70; warfarin, 140). Matched groups were similar in age (p = 0.21), mechanism of injury (p = 0.61), Glasgow Coma Scale (GCS) score (p = 0.54), Injury Severity Score (p = 0.62), and type and size of ICH (p = 0.09). Patients on preinjury NOACs had higher rate of progression (p = 0.03), neurosurgical intervention (p = 0.04), mortality (p = 0.04), and longer ICU LOS (p = 0.04) compared with patients on warfarin. However, there was no difference in hospital LOS (p = 0.22) and SNF disposition (p = 0.14). On sub-Analysis of severe TBI patients (GCS ≤ 8), rate of progression (p = 0.59), neurosurgical intervention (p = 0.62), or mortality (p = 0.81) was similar in both groups. CONCLUSIONS The use of NOACs generally carries a high risk of bleeding and can be detrimental in head injuries with ICH. NOAC use is associated with increased risk of progression of ICH, neurosurgical intervention, and mortality after a mild and moderate TBI. Primary care physicians and cardiologists need to reconsider the data on the need for anticoagulation and the type of agent used and weigh it against the risk of bleeding. In addition, development of reversal agents for the NOACs and implementation of a strict protocol for the reversal of these agents may lead to improved outcomes. LEVEL OF EVIDENCE Therapeutic studies, level III.
• Zeeshan, M., Khan, M., O'Keeffe, T., Pollack, N., Hamidi, M., Kulvatunyou, N., Sakran, J., Gries, L., & Joseph, B. (2018). Optimal timing of initiation of thromboprophylaxis in spine trauma managed operatively: A nationwide propensity-matched analysis of trauma quality improvement program. In Journal of Trauma and Acute Care Surgery.
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  BACKGROUND Patients with spinal trauma are at high risk for venous thromboembolic events (VTE). Guidelines recommend prophylactic anticoagulation but they are unclear on timing of initiation of thromboprophylaxis. The aim of our study was to assess the impact of early versus late initiation of venous thromboprophylaxis in patients with spinal trauma who underwent operative intervention. METHODS We performed a 2-year (2013-2014) review of patients with isolated spine trauma (spine-Abbreviated Injury Scale score, ≥ 3 and no other injury in another body region with Abbreviated Injury Scale score, > 2) who underwent operative intervention and received thromboprophylaxis postoperatively. Patients were divided into two groups based on the timing of initiation of thromboprophylaxis: early(
• Hassan, A., Jokar, T., Rhee, P., Ibraheem, K., Kulvatunyou, N., Anderson, K., Gries, L., Roward, Z., & Joseph, B. (2017). More helmets fewer deaths: Motorcycle helmet legislation impacts traumatic brain injury-related mortality in young adults. In American SUrgeon.
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  The aim of our study was to assess the impact of helmet legislations on the incidence and the mortality rate of motorcycle collision (MCC)-related traumatic brain injury (TBI) in young adult trauma patients. A 1-year (2011) retrospective analysis was performed of all patients under 21 years old with trauma-related hospitalization using the Nationwide Inpatient Sample database (representing 20% of all in-patient admissions). Patients withMCC were identified using E-codes. States were classified into three groups based on helmet legislations: universal age helmet legislation,

Presentations

• Gries, L. M. (2015, 01/2015). Multidisciplinary Care of a Chronically Self-Harming Patient. Psychiatry Grand Rounds/M & M. University of Arizona: University of Arizona.
• Gries, L. M. (2014, 03/2014). Convention and Controversy in Acute Management of Traumatic Brain Injury. Neuroscience Grand Rounds. University of Arizona: University of Arizona.
• Gries, L. M. (2013, 04/24/2013). Border Crossers. 24th Annual Code Trauma Critical Care Symposium on Border Jumpers. Mission Bay, CA.
• Gries, L. M. (2013, 05/23/2013). Borderland Trauma: Cases from the Wall, The Desert, and the Overloaded Vehicle. Trauma Conference. Sierra Vista AZ.
• Gries, L. M. (2010, 03/2010). Management of Acute Mesenteric Ischemia. Acute Care Surgery Conference. Wake Forest/Baptist Medical Center: Wake Forest/Baptist Medical Center.
• Gries, L. M. (2010, 03/2010). Management of the Open Abdomen. Acute Care Surgery Conference. Wake Forest/Baptist Medical Center: Wake Forest/Baptist Medical Center.
• Gries, L. M. (2010, 04/2010). Envenomations: Spiders and Snakes. Critical Care Conference. Wake Forest/Baptist Medical Center: Wake Forest/Baptist Medical Center.
• Gries, L. M. (2010, 07/2010). Intern Bootcamp: Bronchoscopy in the ICU. Department of Surgery Grand Rounds. Wake Forest/Baptist Medical Center: Wake Forest/Baptist Medical Center.
• Gries, L. M. (2010, 11/2010). Preperitoneal Pelvic Packing in Trauma. Acute Care Surgery Conference. Wake Forest/Baptist Medical Center: Wake Forest/Baptist Medical Center.
• Gries, L. M. (2009, 01/2009). Liver Abscesses: Etiology and Microbiology. Gastroenterology/Surgery Case Conference. University of Colorado Health Sciences Center: University of Colorado.
• Gries, L. M. (2008, 12/2008). Case Presentation: Carcinoid Tumors. UCHSC Department of Surgery Grand Rounds. University of Colorado Health Sciences Center: University of Colorado.
• Gries, L. M. (2008, 12/2008). Causes of Small Bowel Obstruction in the Virgin Abdomen. Gastroenterology/Surgery Case Conference. University of Colorado Health Sciences Center: University of Colorado.
• Gries, L. M. (2007, 02/2007). Octreotide and Fibrin Glue in the Prevention of Pancreatic Fistula after Pancreatic Resection. UCHSC Department of Surgery Grand Rounds. University of Colorado Health Sciences Center: University of Colorado.
• Gries, L. M. (2007, 2007). Where is Waldo?: Localization of retained bullet after a GSW to the heart. Southwestern Surgical Society Annual Meeting 2007.
• Gries, L. M. (2006, 2006). Hypertonic Saline Inhibits GPCR Priming of the Neutrophil via Arrest of Receptor Endocytosis. ACS Committee on Trauma annual meeting, 2006.
• Gries, L. M. (2006, 2006). Hypertonic saline inhibits C5a priming of the PMN via arrest of a C5a receptor endocytosis. Shock Society Annual Meeting 2006.
• Gries, L. M. (2006, 2006). Sphingodinr kinase-dependent calcium flux is integral to C5a priming of the PMN. Society of University Surgeons Annual Meeting 2006.
• Gries, L. M. (2005, 03/2005). Screening for Blunt Cerebrovascular Injury. Horizons in Surgery Meeting, Breckenridge, Colorado.
• Gries, L. M. (2005, 2005). Complement Priming translocates P47phox to the Neutrophil Plasma Membrane. Poster session, Shock Society annual meeting, 2005.
• Gries, L. M. (2005, 2005). Sphingosine Kinase Mediates Complement Priming of PMNs. American College of Surgeons annual meeting, 2005.

Poster Presentations

• Kailey, T., Douglas, M., Mikal, A., Trimble, V., & Gries, L. M. (2024, November).

  Reducing Ventilator Associated Pneumonia rates through Improved Data Quality

  . ACS TQIP Annual Conference. Louisville, Kentucky.

Others

• Gries, L. M. (2016, 01). Banner Mobile App.
• Gries, L. M. (2013, 05). Border Wall Causes Serious Injuries, Tucson Doctors Say. ArizonaCentral.com.
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  Media ArizonaCentral.com