Louis J Magnotti

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Journals/Publications

• Akl, M. N., El-Qawaqzeh, K., Anand, T., Hosseinpour, H., Colosimo, C., Nelson, A., Alizai, Q., Ditillo, M., Magnotti, L. J., & Joseph, B. (2024). Trauma Laparotomy for the Cirrhotic Patient: An Outcome-Based Analysis. The Journal of surgical research, 294, 128-136.
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  There is a lack of large-scale data on outcomes of cirrhotic patients undergoing trauma laparotomy. We aimed to compare outcomes of cirrhotic versus noncirrhotic trauma patients undergoing laparotomy.
• Alizai, Q., Colosimo, C., Hosseinpour, H., Stewart, C., Bhogadi, S. K., Nelson, A., Spencer, A. L., Ditillo, M., Magnotti, L. J., Joseph, B., & , A. F. (2023). It's Not All Black and White: The Effect of Increasing Severity of Frailty on Outcomes of Geriatric Trauma Patients. The journal of trauma and acute care surgery.
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  Frailty is associated with poor outcomes in trauma patients. However, the spectrum of physiologic deficits, once a patient is identified as frail, is unknown. The aim of this study was to assess the dynamic association between increasing frailty and outcomes among frail geriatric trauma patients.
• Anand, T., Reyes, A. A., Sjoquist, M. C., Magnotti, L., & Joseph, B. (2023). Resuscitating the Endothelial Glycocalyx in Trauma and Hemorrhagic Shock. Annals of surgery open : perspectives of surgical history, education, and clinical approaches, 4(3), e298.
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  The endothelium is lined by a protective mesh of proteins and carbohydrates called the endothelial glycocalyx (EG). This layer creates a negatively charged gel-like barrier between the vascular environment and the surface of the endothelial cell. When intact the EG serves multiple functions, including mechanotransduction, cell signaling, regulation of permeability and fluid exchange across the microvasculature, and management of cell-cell interactions. In trauma and/or hemorrhagic shock, the glycocalyx is broken down, resulting in the shedding of its individual components. The shedding of the EG is associated with increased systemic inflammation, microvascular permeability, and flow-induced vasodilation, leading to further physiologic derangements. Animal and human studies have shown that the greater the severity of the injury, the greater the degree of shedding, which is associated with poor patient outcomes. Additional studies have shown that prioritizing certain resuscitation fluids, such as plasma, cryoprecipitate, and whole blood over crystalloid shows improved outcomes in hemorrhaging patients, potentially through a decrease in EG shedding impacting downstream signaling. The purpose of the following paragraphs is to briefly describe the EG, review the impact of EG shedding and hemorrhagic shock, and begin entertaining the notion of directed resuscitation. Directed resuscitation emphasizes transitioning from macroscopic 1:1 resuscitation to efforts that focus on minimizing EG shedding and maximizing its reconstitution.
• Bhogadi, S. K., Alizai, Q., Colosimo, C., Spencer, A. L., Stewart, C., Nelson, A., Ditillo, M., Castanon, L., Magnotti, L. J., Joseph, B., , B. M., , A. A., Dultz, L., Black, G., Campbell, M., Berndtson, A. E., Costantini, T., Kerwin, A., Skarupa, D., , Burruss, S., et al. (2023). Not all traumatic brain injury patients on preinjury anticoagulation are the same. American journal of surgery.
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  Prognostic significance of different anticoagulants in TBI patients remains unanswered. We aimed to compare effects of different anticoagulants on outcomes of TBI patients.
• Bhogadi, S. K., Nelson, A., El-Qawaqzeh, K., Spencer, A. L., Hosseinpour, H., Castanon, L., Anand, T., Ditillo, M., Magnotti, L. J., & Joseph, B. (2023). Does preinjury anticoagulation worsen outcomes among traumatic hemothorax patients? A nationwide retrospective analysis. Injury, 54(9), 110850.
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  Up to a quarter of all traumatic deaths are due to thoracic injuries. Current guidelines recommend consideration of evacuation of all hemothoraces with tube thoracostomy. The aim of our study was to determine the impact of pre-injury anticoagulation on outcomes of traumatic hemothorax patients.
• Bhogadi, S. K., Stewart, C., El-Qawaqzeh, K., Colosimo, C., Hosseinpour, H., Nelson, A., Castanon, L., Spencer, A. L., Magnotti, L. J., & Joseph, B. (2023). Local Antibiotic Therapy for Open Long Bone Fractures: Appropriate Prophylaxis or Unnecessary Exposure for the Orthopedic Trauma Patient?. Military medicine, 188(Suppl 6), 407-411.
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  Prophylactic local antibiotic therapy (LAbT) to prevent infection in open long bone fracture (OLBF) patients has been in use for many decades despite lack of definitive evidence confirming a beneficial effect. We aimed to evaluate the effect of LAbT on outcomes of OLBF patients on a nationwide scale.
• El-Qawaqzeh, K., Anand, T., Alizai, Q., Colosimo, C., Hosseinpour, H., Spencer, A., Ditillo, M., Magnotti, L. J., Stewart, C., & Joseph, B. (2024). Trauma in the Geriatric and the Super-Geriatric: Should They Be Treated the Same?. The Journal of surgical research, 293, 316-326.
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  There is paucity of studies comparing the characteristics of trauma in geriatrics and super-geriatrics. We aimed to explore the injury characteristics and outcomes of older adult trauma patients on a nationwide scale.
• El-Qawaqzeh, K., Colosimo, C., Bhogadi, S. K., Magnotti, L. J., Hosseinpour, H., Castanon, L., Nelson, A., Ditillo, M., Anand, T., & Joseph, B. (2023). Unequal Treatment? Confronting Racial, Ethnic, and Socioeconomic Disparity in Management of Survivors of Violent Suicide Attempt. Journal of the American College of Surgeons, 237(1), 68-78.
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  Psychiatric inpatient hospitalization is nearly always indicated for patients with recent suicidal behavior. We aimed to assess the factors associated with receiving mental health services during hospitalization or on discharge among survivors of suicide attempts in trauma centers.
• El-Qawaqzeh, K., Magnotti, L. J., Hosseinpour, H., Nelson, A., Spencer, A. L., Anand, T., Bhogadi, S. K., Alizai, Q., Ditillo, M., & Joseph, B. (2023). Geriatric trauma, frailty, and ACS trauma center verification level: Are there any correlations with outcomes?. Injury, 110972.
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  It remains unclear whether geriatrics benefit from care at higher-level trauma centers (TCs). We aimed to assess the impact of the TC verification level on frail geriatric trauma patients' outcomes. We hypothesized that frail patients cared for at higher-level TCs would have improved outcomes.
• Hosseinpour, H., Anand, T., Bhogadi, S. K., Colosimo, C., El-Qawaqzeh, K., Spencer, A. L., Castanon, L., Ditillo, M., Magnotti, L. J., & Joseph, B. (2023). Emergency Department Shock Index Outperforms Prehospital and Delta Shock Indices in Predicting Outcomes of Trauma Patients. The Journal of surgical research, 291, 204-212.
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  Multiple shock indices (SIs), including prehospital, emergency department (ED), and delta (ED SI - Prehospital SI) have been developed to predict outcomes among trauma patients. This study aims to compare the predictive abilities of these SIs for outcomes of polytrauma patients on a national level.
• Hosseinpour, H., Nelson, A., Bhogadi, S. K., Spencer, A. L., Alizai, Q., Colosimo, C., Anand, T., Ditillo, M., Magnotti, L. J., & Joseph, B. (2023). Delayed versus early hepatic resection among patients with severe traumatic liver injuries undergoing damage control laparotomy. American journal of surgery, 226(6), 823-828.
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  We aimed to assess the effect of time to hepatic resection on the outcomes of patients with high-grade liver injuries who underwent damage control laparotomy (DCL).
• Nelson, A. C., Bhogadi, S. K., Hosseinpour, H., Stewart, C., Anand, T., Spencer, A. L., Colosimo, C., Magnotti, L. J., & Joseph, B. (2023). There Is No Such Thing as Too Soon: Long-Term Outcomes of Early Cholecystectomy for Frail Geriatric Patients with Acute Biliary Pancreatitis. Journal of the American College of Surgeons, 237(5), 712-718.
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  Early cholecystectomy (CCY) for acute biliary pancreatitis (ABP) is recommended but there is a paucity of data assessing this approach in frail geriatric patients. This study compares outcomes of frail geriatric ABP patients undergoing index admission CCY vs nonoperative management (NOM) with endoscopic retrograde cholangiopancreatography (ERCP).
• Patel, D. D., Zambetti, B. R., & Magnotti, L. J. (2024). Timing to Rib Fixation in Patients With Flail Chest. The Journal of surgical research, 294, 93-98.
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  Flail chest (FC) after blunt trauma is associated with significant morbidity and prolonged hospitalizations. The goal of this study was to examine the relationship between timing of rib fixation (ORIF) and pulmonary morbidity and mortality in patients with FC.
• Schmidt, J. C., Huang, D. D., Fleming, A. M., Brockman, V., Hennessy, E. A., Magnotti, L. J., Schroeppel, T., McFann, K., Hamilton, L. D., & Dunn, J. A. (2023). Missed blunt cerebrovascular injuries using current screening criteria - The time for liberalized screening is now. Injury, 54(5), 1342-1348.
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  Diagnostic Criteria Study BACKGROUND: The morbidity and mortality associated with ischemic stroke attributable to blunt cerebrovascular injury (BCVI) warrant aggressive screening. The Denver Criteria (DC) and Expanded Denver Criteria (eDC) have imprecise elements that can be difficult and subjective in application and can delay or prevent screening. We hypothesize these screening criteria lack adequate ability to consistently identify BCVI and that the use of a liberalized screening approach with CT angiography (CTA) is superior without increasing risk of acute kidney injury (AKI).
• Zambetti, B. R., Patel, D. D., Stuber, J. D., Zickler, W. P., Hosseinpour, H., Anand, T., Nelson, A. C., Stewart, C., Joseph, B., & Magnotti, L. J. (2023). Role of Endovascular Stenting in Patients with Traumatic Iliac Artery Injury. Journal of the American College of Surgeons, 236(4), 753-759.
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  Common and external iliac artery injuries (IAI) portend significant morbidity and mortality. The goal of this study was to examine the impact of mechanism of injury and type of repair on outcomes and identify the optimal repair for patients with traumatic IAI using a large, national dataset.
• Zambetti, B. R., Zickler, W. P., Byerly, S., Garrett, H. E., & Magnotti, L. J. (2023). Risk Factors for Acute Renal Failure After Endovascular Aneurysm Repair. The American surgeon, 31348231191181.
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  Acute kidney injury (AKI) after endovascular aortic aneurysm repair (EVAR) is uncommon though carries significant morbidity. Procedural risk factors are not well established for acute renal failure (ARF) that requires initiation of dialysis. The goal of this study was to examine the impact of ARF on patients undergoing EVAR and identify risk factors for ARF using a large, national dataset.
• Zickler, W. P., Zambetti, B. R., Zickler, C. L., Zickler, M. K., Byerly, S., Garrett, H. E., & Magnotti, L. J. (2023). Impact of Patient and Procedural Factors on Outcomes Following Mesenteric Bypass. The American surgeon, 31348231198118.
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  Mesenteric bypass (MB) for patients with acute (AMI) and chronic mesenteric ischemia (CMI) is associated with cardiovascular (CV) and pulmonary morbidity.
• Berning, B. J., Magnotti, L. J., Lewis, R. H., Corley, C. E., Lim, G. H., Doty, J. B., Fabian, T. C., Croce, M. A., & Sharpe, J. P. (2022). Impact of Chemoprophylaxis on Thromboembolism Following Operative Fixation of Pelvic Fractures. The American surgeon, 88(1), 126-132.
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  Venous thromboembolism (VTE) is a common cause of serious morbidity and mortality. While chemoprophylaxis decreases VTE, there is the theoretical risk of increased hemorrhagic complications. The purpose of this study was to evaluate the impact of preoperative anticoagulation on VTE and bleeding complications in patients with blunt pelvic fractures requiring operative fixation.
• Byerly, S. E., Jones, M. D., Lenart, E. K., Seger, C. P., Filiberto, D. M., Lewis, R. H., Kerwin, A. J., & Magnotti, L. J. (2022). Serial CT for Nonoperatively Managed Splenic Injuries. The American surgeon, 88(7), 1504-1509.
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  The role of serial computed tomography (CT) in the nonoperative management of blunt splenic injuries (NOMSIs) remains unclear. The purpose of the study was to determine the utility of serial CT of Grade 2-5 NOMSI in the modern era.
• Filiberto, D. M., Jimenez, B. F., Lenart, E. K., Huang, D. D., Hare, M. E., Tolley, E. A., & Magnotti, L. J. (2022). Long-term functional outcomes after traumatic spine fractures. Surgery, 172(1), 460-465.
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  Traumatic spine fractures can result in chronic pain, disability, and prolonged rehabilitation. The purpose of this study is to determine the long-term effects of traumatic spine fractures on patients' functional outcomes after nonoperative and operative management.
• Filiberto, D. M., Toth, C., Afzal, M. O., Byerly, S., Lenart, E. K., Kerwin, A. J., Croce, M. A., & Magnotti, L. J. (2022). Radiographic and Clinical Predictors of Therapeutic Pelvic Angiography. The American surgeon, 88(7), 1432-1436.
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  Pelvic fractures are often complicated by hemorrhage contributing to morbidity and mortality. Management of these patients is multifaceted and computed tomography (CT) imaging plays an integral diagnostic role. The purpose of this study was to identify radiographic and clinical predictors of therapeutic angiography in patients with blunt pelvic fractures.
• Fleming, A. M., Shah, K. S., Byerly, S. E., Magnotti, L. J., Fischer, P. E., Seger, C. P., Kerwin, A. J., Croce, M. A., & Howley, I. W. (2022). Cryoprecipitate use during massive transfusion: A propensity score analysis. Injury, 53(6), 1972-1978.
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  Cryoprecipitate is frequently administered as an adjunct to balanced transfusion in the setting of traumatic hemorrhage. However, civilian studies have not demonstrated a clear survival advantage, and prior observational studies noted selection bias when analyzing cryoprecipitate use. Additionally, due to the logistics involved in cryoprecipitate administration, it is inconsistently implemented alongside standardized massive transfusion protocols. This study aims to evaluate the effects of early cryoprecipitate administration on inpatient mortality in the setting of massive transfusion for exsanguinating trauma and to use propensity score analysis to minimize selection bias.
• Huang, D. D., Manley, N. R., Lewis, R. H., Fischer, P. E., Lenart, E. K., Croce, M. A., & Magnotti, L. J. (2022). The sustained effect of a temporary measure: Urban firearm mortality following expiration of the Federal Assault Weapons Ban. American journal of surgery, 224(1 Pt A), 111-115.
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  The Federal Assault Weapons Ban (FAWB) was in effect from 1994 to 2004. We sought to examine its impact on firearm-related homicides.
• Huang, D. D., Manley, N. R., Lewis, R. H., Fischer, P. E., Magnotti, A., Davis, S., Croce, M. A., & Magnotti, L. J. (2022). Re-Sighting the Gun Debate: Defining Patterns of Firearm-Related Death to Help Focus Prevention Efforts. Journal of the American College of Surgeons, 234(4), 672-676.
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  Gun violence remains a significant public health problem. Although gun violence prevention efforts mostly target homicides, nationally, two-thirds of all firearm deaths are suicides. The purpose of this study was to define patterns of firearm-related deaths and examine the effect of population size.
• Lewis, R. H., Perkins, M., Fischer, P. E., Beebe, M. J., & Magnotti, L. J. (2022). Timing is everything: Impact of combined long bone fracture and major arterial injury on outcomes. The journal of trauma and acute care surgery, 92(1), 21-27.
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  Timing of extremity fracture fixation in patients with an associated major vascular injury remains controversial. Some favor temporary fracture fixation before definitive vascular repair to limit potential graft complications. Others advocate immediate revascularization to minimize ischemic time. The purpose of this study was to evaluate the timing of fracture fixation on outcomes in patients with concomitant long bone fracture and major arterial injury.
• Zambetti, B. R., Lewis, R. H., Chintalapani, S. R., Desai, N., Valaulikar, G. S., & Magnotti, L. J. (2022). Optimal time to thoracoscopy for trauma patients with retained hemothorax. Surgery, 172(4), 1265-1269.
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  Retained hemothorax remains a common problem after thoracic trauma with associated morbidity and prolonged hospitalizations. The goal of this study was to examine the impact of time to video assisted thoracoscopic surgery (VATS) on pulmonary morbidity using a large, national data set.
• Zambetti, B. R., Stuber, J. D., Patel, D. D., Lewis, R. H., Huang, D. D., Zickler, W. P., Fischer, P. E., Magnotti, A. L., Croce, M. A., & Magnotti, L. J. (2022). Impact of Endovascular Stenting on Outcomes in Patients with Traumatic Subclavian Artery Injury. Journal of the American College of Surgeons, 234(4), 444-449.
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  Traumatic subclavian artery injury (SAI) remains uncommon but can lead to significant morbidity and mortality. Although open and endovascular repair offer excellent limb salvage rates, their role in blunt and penetrating injuries is not well defined. The goal of this study was to examine the effect of mechanism of injury and type of repair on outcomes in patients with traumatic SAI.
• Zambetti, B. R., Zickler, W. P., Lewis, R. H., Pettigrew, B. D., Valaulikar, G. S., Afzal, M. O., Fischer, P. E., Croce, M. A., & Magnotti, L. J. (2022). Delayed Endovascular Repair With Procedural Anticoagulation: A Safe Strategy for Blunt Aortic Injury. Annals of vascular surgery, 84, 195-200.
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  Blunt aortic injury (BAI) and traumatic brain injury (TBI) are the leading causes of death after blunt trauma. The purposes of this study were to identify predictors of mortality for BAI and to examine the impact of procedural heparinization during thoracic endovascular aortic repair (TEVAR) on neurologic outcomes in patients with BAI/TBI.
• Zickler, W. P., Sharpe, J. P., Lewis, R. H., Zambetti, B. R., Jones, M. D., Zickler, M. K., Zickler, C. L., & Magnotti, L. J. (2022). In for a Penny, in for a Pound: Obesity weighs heavily on both cost and outcome in trauma. American journal of surgery, 224(1 Pt B), 590-594.
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  The current literature offers mixed conclusions regarding the effect of increased body mass index (BMI) on outcomes after trauma laparotomy. This study evaluated the impact of obesity on outcomes and cost for patients undergoing trauma laparotomy at a level 1 trauma center.
• Dooley, J. H., Dennis, B. M., Magnotti, L. J., Sharpe, J. P., Guillamondegui, O. D., Croce, M. A., & Fischer, P. E. (2021). Is NBATS-2 up to the Task? Actual vs. Predicted Patient Volume Shifts With the Addition of Another Trauma Center. The American surgeon, 87(4), 595-601.
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  Version 2 of the Needs-Based Assessment of Trauma Systems (NBATS) tool quantifies the impact of an additional trauma center on a region. This study applies NBATS-2 to a system where an additional trauma center was added to compare the tool's predictions to actual patient volumes.
• Filiberto, D. M., Afzal, M. O., Sharpe, J. P., Seger, C., Shankar, S., Croce, M. A., Fabian, T. C., & Magnotti, L. J. (2021). Radiographic predictors of therapeutic operative intervention after blunt abdominal trauma: the RAPTOR score. European journal of trauma and emergency surgery : official publication of the European Trauma Society, 47(6), 1813-1817.
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  Bowel and mesenteric injuries are rare in patients following blunt abdominal trauma. Computed tomography (CT) imaging has become a mainstay in the work-up of the stable trauma patient. The purpose of this study was to identify radiographic predictors of therapeutic operative intervention for mesenteric and/or bowel injuries in patients after blunt abdominal trauma.
• Lenart, E. K., Bee, T. K., Seger, C. P., Lewis, R. H., Filiberto, D. M., Huang, D. D., Fischer, P. E., Croce, M. A., Fabian, T. C., & Magnotti, L. J. (2021). Youth, poverty, and interpersonal violence: a recipe for PTSD. Trauma surgery & acute care open, 6(1), e000710.
• Manley, N. R., Huang, D. D., Lewis, R. H., Bee, T., Fischer, P. E., Croce, M. A., & Magnotti, L. J. (2021). Caught in the crossfire: 37 Years of firearm violence afflicting America's youth. The journal of trauma and acute care surgery, 90(4), 623-630.
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  Publicly available firearm data are difficult to access. Trauma registry data are excellent at documenting patterns of firearm-related injury. Law enforcement data excel at capturing national violence trends to include both circumstances and firearm involvement. The goal of this study was to use publicly available law enforcement data from all 50 states to better define patterns of firearm-related homicides in the young.
• Zambetti, B. R., Huang, D. D., Lewis, R. H., Fischer, P. E., Croce, M. A., & Magnotti, L. J. (2021). Use of Thoracic Endovascular Aortic Repair in Patients with Concomitant Blunt Aortic and Traumatic Brain Injury. Journal of the American College of Surgeons, 232(4), 416-422.
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  Blunt aortic injury (BAI) and traumatic brain injury (TBI) represent the 2 leading causes of death after blunt trauma. The goal of this study was to examine the impact of TBI and use of thoracic endovascular aortic repair (TEVAR) on patients with BAI, using a large, national dataset.
• Dooley, J. H., Ozdenerol, E., Sharpe, J. P., Magnotti, L. J., Croce, M. A., & Fischer, P. E. (2020). Location, location, location: Utilizing Needs-Based Assessment of Trauma Systems-2 in trauma system planning. The journal of trauma and acute care surgery, 88(1), 94-100.
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  In 2015, the American College of Surgeons Committee on Trauma introduced the Needs-Based Assessment of Trauma Systems (NBATS) tool to quantify the optimal number of trauma centers for a region. While useful, more focus was required on injury population, distribution, and transportation systems. Therefore, NBATS-2 was developed utilizing advanced geographical modeling. The purpose of this study was to evaluate NBATS-2 in a large regional trauma system.
• Huang, X., Magnotti, L. J., Fabian, T. C., Croce, M. A., & Sharpe, J. P. (2020). Does lack of thoracic trauma attenuate the severity of pulmonary failure? An 8-year analysis of critically injured patients. European journal of trauma and emergency surgery : official publication of the European Trauma Society, 46(1), 3-9.
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  Patients with thoracic trauma are presumed to be at higher risk for pulmonary dysfunction, but adult respiratory distress syndrome (ARDS) may develop in any patient, regardless of associated chest injury. This study evaluated the impact of thoracic trauma and pulmonary failure on outcomes in trauma patients admitted to the intensive-care unit (ICU).
• Lenart, E. K., Lewis, R. H., Sharpe, J. P., Fischer, P. E., Croce, M. A., & Magnotti, L. J. (2020). They only come out at night: Impact of time of day on outcomes after penetrating abdominal trauma. Surgery open science, 2(4), 1-4.
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  Patients who present at night following penetrating abdominal trauma are thought to have more severe injuries and increased risk for morbidity and mortality. The current literature is at odds regarding this belief. The purpose of this study was to evaluate time of day on outcomes following laparotomy for penetrating abdominal trauma.
• Lewis, R. H., Sharpe, J. P., Croce, M. A., Fabian, T. C., & Magnotti, L. J. (2020). How soon is too soon?: Optimal timing of split-thickness skin graft following polyglactin 910 mesh closure of the open abdomen. The journal of trauma and acute care surgery, 89(2), 377-381.
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  Various management strategies exist for the abdomen that will not close. At our institution, these patients are managed with polyglactin 910 mesh followed 14 days later (LATE) by split-thickness skin graft (STSG) or, in some cases, earlier (EARLY,
• Magnotti, L. J., Sharpe, J. P., Tolley, B., Thomas, F., Lewis, R. H., Filiberto, D. M., Evans, C., Kokorev, L., Fabian, T. C., & Croce, M. A. (2020). Long-term functional outcomes after traumatic popliteal artery injury: A 20-year experience. The journal of trauma and acute care surgery, 88(2), 197-206.
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  Traumatic popliteal arterial injury (TPAI) is associated with a risk of both limb loss and long-term morbidity due to prolonged ischemia and the often-associated musculoskeletal injuries. Long-term functional outcome following this injury has not been adequately studied. We evaluated patients with TPAI to determine if there was an improvement in functional outcome over time. We hypothesized that both the initial severity of ischemia and the associated injuries limited the ability of patients to improve functional outcome.
• Manley, N. R., Fischer, P. E., Sharpe, J. P., Stranch, E. W., Fabian, T. C., Croce, M. A., & Magnotti, L. J. (2020). Separating Truth from Alternative Facts: 37 Years of Guns, Murder, and Violence Across the US. Journal of the American College of Surgeons, 230(4), 475-481.
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  Gun violence remains a significant public health problem that is both understudied and underfunded, and plagued by inadequate or inaccessible data sources. Over the years, numerous trauma centers have attempted to use local registries to study single-institutional trends, however, this approach limits generalizability to our national epidemic. In fact, even easily accessible, health-centered data from the CDC lack national relevance because they are limited to those enrolled states only. We sought to examine how publicly available law enforcement data from all 50 states might complement our understanding of circumstances and demographics surrounding national firearm death and help forge the first step in partnering law enforcement with trauma centers.
• Lewis, R. H., Sharpe, J. P., Berning, B., Fabian, T. C., Croce, M. A., & Magnotti, L. J. (2019). Impact of a simplified management algorithm on outcome following exsanguinating pelvic fractures: A 10-year experience. The journal of trauma and acute care surgery, 86(4), 658-663.
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  Optimal management of exsanguinating pelvic fractures remains controversial. Our previous experience suggested that management decisions based on a defined algorithm were associated with a significant reduction in transfusion requirements and mortality. Based on these outcomes, a clinical pathway (PW) for the management of exsanguinating pelvic fractures was developed. The purpose of this study was to evaluate the impact of this PW on outcomes.
• Manley, N. R., Croce, M. A., Fischer, P. E., Crowe, D. E., Goines, J. H., Sharpe, J. P., Fabian, T. C., & Magnotti, L. J. (2019). Evolution of Firearm Violence over 20 Years: Integrating Law Enforcement and Clinical Data. Journal of the American College of Surgeons, 228(4), 427-434.
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  Data linking ballistics to injury are lacking. To address this data chasm, a partnership with law enforcement was developed to describe clinical outcomes from specific firearms.
• Manley, N. R., Sharpe, J. P., Lewis, R. H., Iltis, M. S., Chaudhuri, R., Fabian, T. C., Croce, M. A., & Magnotti, L. J. (2019). Analysis of over 2 decades of colon injuries identifies optimal method of diversion: Does an end justify the means?. The journal of trauma and acute care surgery, 86(2), 214-219.
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  Conflicting evidence exists regarding the definitive management of destructive colon injuries. Although diversion with an end ostomy can theoretically decrease initial complications, it mandates a more extensive reversal procedure. Conversely, anastomosis with proximal loop ostomy diversion, while simplifying the reversal, increases the number of suture lines and potential initial morbidity. Thus, the purpose of this study was to evaluate the impact of diversion technique on morbidity and mortality in patients with destructive colon injuries.
• Schroeppel, T. J., Sharpe, J. P., Shahan, C. P., Clement, L. P., Magnotti, L. J., Lee, M., Muhlbauer, M., Weinberg, J. A., Tolley, E. A., Croce, M. A., & Fabian, T. C. (2019). Beta-adrenergic blockade for attenuation of catecholamine surge after traumatic brain injury: a randomized pilot trial. Trauma surgery & acute care open, 4(1), e000307.
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  Beta-blockers have been proven in multiple studies to be beneficial in patients with traumatic brain injury. Few prospective studies have verified this and no randomized controlled trials. Additionally, most studies do not titrate the dose of beta-blockers to therapeutic effect. We hypothesize that propranolol titrated to effect will confer a survival benefit in patients with traumatic brain injury.
• Evans, C. R., Sharpe, J. P., Swanson, J. M., Wood, G. C., Fabian, T. C., Croce, M. A., & Magnotti, L. J. (2018). Keeping it Simple: Impact of a Restrictive Antibiotic Policy for Ventilator-Associated Pneumonia in Trauma Patients on Incidence and Sensitivities of Causative Pathogens. Surgical infections, 19(7), 672-678.
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  An integral part of ventilator-associated pneumonia (VAP) therapy is the appropriate choice of empiric antibiotics. Our previous experience demonstrated adherence to an empiric therapy pathway was associated with only modest changes in organisms causing VAP. The purpose of the current study was to evaluate the impact of a restrictive antibiotic policy for VAP in trauma patients on the incidence and sensitivities of causative pathogens since the previous study.
• Filiberto, D. M., Sharpe, J. P., Croce, M. A., Fabian, T. C., & Magnotti, L. J. (2018). Traumatic atlanto-occipital dissociation: No longer a death sentence. Surgery, 164(3), 500-503.
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  Traumatic atlanto-occipital dissociation is considered highly unstable and was once believed to be uniformly fatal. With recent advances in prehospital care, coupled with early diagnosis and stabilization, these injuries are potentially survivable. The aim of this study was to identify potentially modifiable risk factors associated with improved outcomes after a traumatic atlanto-occipital dissociation.
• Gibson, B. H., Sharpe, J. P., Lewis, R. H., Newell, J. S., Swanson, J. M., Wood, G. C., Fabian, T. C., Croce, M. A., & Magnotti, L. J. (2018). Use of Aerosolized Antibiotics in Gram-Negative Ventilator-Associated Pneumonia in Trauma Patients. The American surgeon, 84(12), 1906-1912.
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  Ventilator-associated pneumonia (VAP) is associated with significant morbidity (ventilator days, ICU days, and cost) and mortality increase in trauma patients. Multidrug-resistant strains of causative VAP pathogens are becoming increasingly common. Aerosolized antibiotics achieve high alveolar concentrations and provide valuable adjuncts in the treatment of VAP. This study examined the impact of aerosolized antibiotics in the treatment of VAP in trauma patients. Patients with either or VAP over 10 years treated with aerosolized antibiotics (cases) were stratified by age, severity of shock, and injury severity. A frequency-matched (by causative pathogen) control group treated without aerosolized antibiotics was used for comparison. Multivariable logistic regression was used to identify predictors for the use of aerosolized antibiotics. One hundred twenty VAP episodes were identified in 100 patients. Microbiologic resolution was achieved in all patients treated with aerosolized antibiotics. There was no difference in mortality (14.5% vs 15.7%, = 0.87) and no antibiotic-related complications in either group. Multivariable logistic regression identified VAP persistence and relapse as independent predictors for the use of aerosolized antibiotics. Combined with systemic therapy, aerosolized antibiotics broaden the spectrum of therapy. They are valuable adjuncts with minimal risk of antibiotic resistance and/or systemic complications.
• Lewis, R. H., Sharpe, J. P., Swanson, J. M., Fabian, T. C., Croce, M. A., & Magnotti, L. J. (2018). Reinventing the wheel: Impact of prolonged antibiotic exposure on multidrug-resistant ventilator-associated pneumonia in trauma patients. The journal of trauma and acute care surgery, 85(2), 256-262.
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  Multidrug-resistant (MDR) strains of both Acinetobacter baumannii (AB) and Pseudomonas aeruginosa (PA) as causative ventilator-associated pneumonia (VAP) pathogens are becoming increasingly common. Still, the risk factors associated with this increased resistance have yet to be elucidated. The purpose of this study was to examine the changing sensitivity patterns of these pathogens over time and determine which risk factors predict MDR in trauma patients with VAP.
• Manley, N. R., Fabian, T. C., Sharpe, J. P., Magnotti, L. J., & Croce, M. A. (2018). Good news, bad news: An analysis of 11,294 gunshot wounds (GSWs) over two decades in a single center. The journal of trauma and acute care surgery, 84(1), 58-65.
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  Gun violence is a substantial public health problem accounting for significant physical, psychological, and financial costs. Although aggregate data sources demonstrate decreasing rates of firearm violence, analyses from individual trauma centers have shown that mortality and injury severity from gunshot wounds (GSWs) are increasing. To evaluate the evolving characteristics of gun violence in our region, we studied all GSWs admitted to our trauma center over a 20-year period.
• Manley, N. R., Magnotti, L. J., Fabian, T. C., Croce, M. A., & Sharpe, J. P. (2018). Impact of venorrhaphy and vein ligation in isolated lower-extremity venous injuries on venous thromboembolism and edema. The journal of trauma and acute care surgery, 84(2), 325-329.
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  Following venous injury, venorrhaphy can restore outflow, although it risks thrombosis and venous thromboembolism (VTE). Vein ligation is a faster option, although it potentially risks extremity edema. The purpose of this study was to evaluate the management of venous injury on VTE and extremity edema in patients with isolated lower-extremity venous injuries.
• Manley, N. R., Magnotti, L. J., Fabian, T. C., Cutshall, M. B., Croce, M. A., & Sharpe, J. P. (2018). Factors Contributing to Morbidity after Combined Arterial and Venous Lower Extremity Trauma. The American surgeon, 84(7), 1217-1222.
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  The purpose of this study was to evaluate the impact of management of venous injury on clinical outcomes in patients with combined lower extremity arterial and venous trauma. Patients with common and external iliac, common and superficial femoral, and popliteal artery injuries were identified. Patients who underwent vein repair and those who received vein ligation were compared. The analysis was repeated for those patients who required secondary intervention for their arterial injury and those who did not require secondary intervention. Seventy patients were identified with both arterial and venous injuries: 40 underwent vein ligation and 30 received vein repair. There was no difference in ischemic time between patients undergoing vein repair compared with ligation. Vein ligation did not produce a higher incidence of muscle debridement (10% vs 15%, P = 0.72), necessity for secondary intervention (10% vs 7.5%, P = 0.99), or amputation (3.3% vs 7.5%, P = 0.63). Patients who required secondary intervention had a greater degree of shock on presentation (packed red blood cells (PRBC), 13 units vs 6 units, P = 0.02) and were more likely to require muscle debridement (50% vs 9%, P = 0.02) and amputation (33% vs 3%, P = 0.03). Vein ligation did not impact muscle ischemia or success of arterial repair in patients with combined venous and arterial trauma in the lower extremities. Patient morbidity after extremity vascular trauma is most related to degree of shock.
• Nunn, A., Prakash, P., Inaba, K., Escalante, A., Maher, Z., Yamaguchi, S., Kim, D. Y., Maciel, J., Chiu, W. C., Drumheller, B., Hazelton, J. P., Mukherjee, K., Luo-Owen, X., Nygaard, R. M., Marek, A. P., Morse, B. C., Fitzgerald, C. A., Bosarge, P. L., Jawa, R. S., , Rowell, S. E., et al. (2018). Occupational exposure during emergency department thoracotomy: A prospective, multi-institution study. The journal of trauma and acute care surgery, 85(1), 78-84.
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  Occupational exposure is an important consideration during emergency department thoracotomy (EDT). While human immunodeficiency virus/hepatitis prevalence in trauma patients (0-16.8%) and occupational exposure rates during operative trauma procedures (1.9-18.0%) have been reported, exposure risk during EDT is unknown. We hypothesized that occupational exposure risk during EDT would be greater than other operative trauma procedures.
• Schroeppel, T. J., Clement, L. P., Barnard, D. L., Guererro, W., Ferguson, M. D., Sharpe, J. P., Magnotti, L. J., Croce, M. A., & Fabian, T. C. (2018). Propofol Infusion Syndrome: Efficacy of a Prospective Screening Protocol. The American surgeon, 84(8), 1333-1338.
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  Propofol infusion syndrome (PIS) is a potentially lethal complication of propofol marked by rhabdomyolysis, metabolic acidosis, and cardiac arrhythmias or collapse. The objective of this study was to determine the effectiveness of a prospective screening protocol to prevent PIS. All trauma patients admitted who received propofol as a continuous infusion were prospectively screened from November 1, 2013 to December 31, 2015. Variables studied included demographics, injury severity, laboratory values, infusion rates, and mortality. Serum creatine phosphokinase (CPK) and lactate were drawn daily. Propofol was stopped for a positive screen defined as an increase in CPK to greater than 5000 IU/L or lactate greater than 4 mmol/L. Positive and negative cohorts were compared. Two hundred and twenty-five patients met the inclusion criteria and 12 patients (5.3%) had propofol stopped because of elevated CPK. No differences were identified in demographics, transfusions, injury severity, hospital length of stay, or propofol dose. The positive screened group had longer intensive care unit length of stay (20 vs 13 days; P = 0.002) and increased vent days (14.5 vs 10 days; P = 0.008). Max serum osmolality (334 vs 305 mosm/kg; P = 0.049) and max serum CPK (6782 vs 1058 IU/L; P < 0.0001) were higher in the positive cohort. No cases of PIS occurred, and mortality (16.7 vs 15.5%; P = 0.999) was not different between the cohorts. The screening protocol was effective in eliminating PIS. Serial CPK evaluations provided an effective screening tool and serum lactate can be dropped from screening.
• Shahan, C. P., Sharpe, J. P., Stickley, S. M., Manley, N. R., Filiberto, D. M., Fabian, T. C., Croce, M. A., & Magnotti, L. J. (2018). The changing role of endovascular stenting for blunt cerebrovascular injuries. The journal of trauma and acute care surgery, 84(2), 308-311.
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  Few injuries have produced as much debate with respect to management as have blunt cerebrovascular injuries (BCVIs). Without question, early anticoagulation is the mainstay of therapy for these injuries. However, the role of endovascular stenting for BCVI remains controversial. Our purpose was to examine the use of endovascular stents for BCVI and outcomes and describe which injuries are being treated with stents.
• Shahan, C. P., Stavely, T. C., Croce, M. A., Fabian, T. C., & Magnotti, L. J. (2018). Long-Term Functional Outcomes after Blunt Cerebrovascular Injury: A 20-Year Experience. The American surgeon, 84(4), 551-556.
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  Since blunt cerebrovascular injury (BCVI) became increasingly recognized more than 20 years ago, significant improvements have been made in both diagnosis and treatment. Little is known regarding long-term functional outcomes in BCVI. The purpose of this study was to evaluate the impact of BCVI on those long-term outcomes. All patients with BCVI from 1996 to 2014 were identified from the trauma registry. Functional outcome was measured using the Boston University Activity Measure for Post-Acute Care. Multiple regression analysis was performed to identify potential predictors of outcomes. A total of 509 patients were identified. Overall mortality was 18 per cent (BCVI-related = 1%). Of the 415 survivors, follow-up was obtained in 77 (19%). Mean follow-up was five years, with a maximum of 19 years. Mean age and injury severity score were 47 and 25, respectively. Six (8%) patients suffered strokes. Mean Activity Measure for Post-Acute Care scores were 59 (mobility), 58 (activity), and 44 (cognitive function), each indicating significant impairment compared with normal. Multiple regression models identified 1) age as a predictor of decreased mobility, 2) injury severity score as a predictor of decreased mobility, activity, and cognitive function, and 3) stroke as a predictor of decreased activity, cognitive function, and likely mobility. Development of stroke and increased injury severity resulted in worse long-term functional outcomes after BCVI. Thus, stroke prevention with optimal diagnostic and treatment algorithms remains critical in the successful treatment of BCVI because it has significant impact on long-term functional outcomes and is the only modifiable predictor of outcomes in patients after BCVI.
• Sharpe, J. P., Fabian, T. C., Croce, M. A., & Magnotti, L. J. (2018). Re: Chemoprophylaxis for VTE prevention in spine surgery patients. The journal of trauma and acute care surgery, 85(6), 1133-1134.
• Savage, S. A., Zarzaur, B. L., Brewer, B. L., Lim, G. H., Martin, A. C., Magnotti, L. J., Croce, M. A., & Pohlman, T. H. (2017). 1: 1 Transfusion strategies are right for the wrong reasons. The journal of trauma and acute care surgery, 82(5), 845-852.
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  Early assessment of clot function identifies coagulopathies after injury. Abnormalities include a hypercoagulable state from excess thrombin generation, as well as an acquired coagulopathy. Efforts to address coagulopathy have resulted in earlier, aggressive use of plasma emphasizing 1:1 resuscitation. The purpose of this study was to describe coagulopathies in varying hemorrhagic profiles from a cohort of injured patients.
• Savage, S. A., Zarzaur, B. L., Pohlman, T. H., Brewer, B. L., Magnotti, L. J., Croce, M. A., Lim, G. H., & Martin, A. C. (2017). Clot dynamics and mortality: The MA-R ratio. The journal of trauma and acute care surgery, 83(4), 628-634.
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  The coagulopathy of trauma, illustrated by a short R-time, is common and well understood. The physiology behind this may be early thrombin burst with rapid clot formation. Rapid consumption of fibrinogen, however, may result in weak clot and substrate depletion, resulting in low MA. While these characteristics are interesting, utilizing thromboelastography (TEG) to identify those at risk of subsequent bleeding diathesis, especially in those who do not demonstrate early signs of physiologic derangement, is challenging. We have developed a novel ratio utilizing TEG values to describe patients at specific risk of traumatic coagulopathy. The purpose of this study was to create a single TEG value, which would reflect both the hypercoagulability and hypocoagulability of TIC. We hypothesized that this ratio, at admission, would be indicative of TIC and predictive of both blood product transfusion volumes and subsequent mortality.
• Shahan, C. P., Croce, M. A., Fabian, T. C., & Magnotti, L. J. (2017). Impact of Continuous Evaluation of Technology and Therapy: 30 Years of Research Reduces Stroke and Mortality from Blunt Cerebrovascular Injury. Journal of the American College of Surgeons, 224(4), 595-599.
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  Blunt cerebrovascular injury (BCVI) was underdiagnosed until the 1990s when blunt carotid injuries were found to be more common than historically described. Technological advancements and regionalization of trauma care have resulted in increased screening and improved diagnosis of BCVI. The aim of this study was to demonstrate that systematic evaluation of the screening and diagnosis of BCVI, combined with early and aggressive treatment, have led to reductions in BCVI-related stroke and mortality.
• Shahan, C. P., Magnotti, L. J., & Fabian, T. C. (2017). Re: Screening for pediatric blunt cerebrovascular injury. The journal of trauma and acute care surgery, 82(1), 227-228.
• Sharpe, J. P., Gobbell, W. C., Carter, A. M., Pahlkotter, M. K., Muhlbauer, M. S., Camillo, F. X., Fabian, T. C., Croce, M. A., & Magnotti, L. J. (2017). Impact of venous thromboembolism chemoprophylaxis on postoperative hemorrhage following operative stabilization of spine fractures. The journal of trauma and acute care surgery, 83(6), 1108-1113.
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  Prophylactic anticoagulation may decrease the risk of venous thromboembolism (VTE) in patients with spine fractures following blunt trauma but comes with the threat of postoperative bleeding in patients requiring stabilization of these fractures. The purpose of this study was to evaluate the impact of preoperative anticoagulation on VTE and bleeding complications in patients with blunt spine fractures requiring operative stabilization.
• Sharpe, J. P., Khan, N. R., Chatterjee, A. R., Huang, J., Magnotti, L. J., Croce, M. A., & Fabian, T. C. (2017). Investigating Cyclooxygenase Inhibition in a Rat Pulmonary Contusion Model: A Laboratory Study Finding No Improvement with Ibuprofen. The American surgeon, 83(6), 666-672.
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  Minimal advances have been made in the management of pulmonary contusions (PCs). The purpose of this study was to evaluate the impact of cyclooxygenase inhibition on outcomes following PC in a rat model. PC was induced in anesthetized adult rats. Ibuprofen was given to the treatment group (TG) and water was given to the control group (CG). Lung injury was assessed with pulse oximetry, arterial blood gases, CT, and histopathologic examination. Inflammation was measured with both serum and bronchoalveolar lavage (BAL) levels of tumor necrosis factor α and interleukin-6. Rats in the TG did not differ from rats in the CG with respect to oxygenation. Pathologic examination demonstrated a trend toward more inflammatory infiltrate in the CG, yet the sizes of the contusions were larger in the TG. The CG trended toward decreased levels of interleukin-6 in the serum and BAL at both three and seven days. While BAL levels of tumor necrosis factor α were increased in the TG at three days compared to the CG, they trended toward a reduced amount at seven days. Our data do not support cyclooxygenase inhibition for treatment to decrease the respiratory compromise associated with PC in this model of rat PCs.
• Sharpe, J. P., Magnotti, L. J., Fabian, T. C., & Croce, M. A. (2017). Evolution of the operative management of colon trauma. Trauma surgery & acute care open, 2(1), e000092.
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  For any trauma surgeon, colon wounds remain a relatively common, yet sometimes challenging, clinical problem. Evolution in operative technique and improvements in antimicrobial therapy during the past two centuries have brought remarkable improvements in both morbidity and mortality after injury to the colon. Much of the early progress in management and patient survival after colon trauma evolved from wartime experience. Multiple evidence-based studies during the last several decades have allowed for more aggressive management, with most wounds undergoing primary repair or resection and anastomosis with an acceptably low suture line failure rate. Despite the abundance of quality evidence regarding management of colon trauma obtained from both military and civilian experience, there remains some debate among institutions regarding management of specific injuries. This is especially true with respect to destructive wounds, injuries to the left colon, blunt colon trauma and those wounds requiring colonic discontinuity during an abbreviated laparotomy. Some programs have developed data-driven protocols that have simplified management of destructive colon wounds, clearly identifying those high-risk patients who should undergo diversion, regardless of mechanism or anatomic location. This update will describe the progression in the approach to colon injuries through history while providing a current review of the literature regarding management of the more controversial wounds.
• Sharpe, J. P., Magnotti, L. J., Gobbell, W. C., Huang, X., Perez, E. A., Fabian, T. C., & Croce, M. A. (2017). Impact of early operative pelvic fixation on long-term self-reported outcome following severe pelvic fracture. The journal of trauma and acute care surgery, 82(3), 444-450.
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  Traumatic disruption of the pelvic ring is a significant cause of life-threatening hemorrhage. For those patients who survive the initial injury, these fractures are associated with long periods of immobilization and intense rehabilitation. There is little published information available regarding long-term functional outcomes in these patients. This study evaluated the impact of severe pelvic fractures on those long-term outcomes.
• Hendrick, L. E., Schroeppel, T. J., Sharpe, J. P., Alsbrook, D., Magnotti, L. J., Weinberg, J. A., Johnson, B. P., Lewis, R. H., Clement, L. P., Croce, M. A., & Fabian, T. C. (2016). Impact of Beta-Blockers on Nonhead Injured Trauma Patients. The American surgeon, 82(7), 575-9.
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  Catecholamine surge after traumatic injury may lead to dysautonomia with increased morbidity. Small retrospective studies have shown potential benefit of beta-blockers (BB) in trauma patients with and without traumatic brain injury (TBI). This study evaluates a large multiply injured cohort without TBI that received BB. Patients were identified from the trauma registry from January 1, 2003 to December 31, 2011. Patients who received >1 dose of BB were compared to controls. Patients with TBI, length of stay (LOS) < 2 days, and prehospital BB were excluded. Outcomes were mortality, intensive care unit (ICU) LOS, and LOS. Stepwise multivariable regression was used to identify variables significantly associated with mortality. During the study period, 19,151 eligible patients were admitted. The mean age was 39 years. Most were male (74%) and most sustained blunt mechanism (75%). A total of 1854 (11%) patients received BB. BB patients had longer LOS (16 vs 6 days), ICU LOS (7 vs 1 days), and higher mortality (2.8 vs 0.5%) (all P < 0.001). Multivariable regression demonstrated no benefit to BB after adjusting for potential confounding characteristics [odds ratio (OR) 0.952; confidence interval (CI) 0.620-1.461]. In conclusion, in this largest study to date, patients receiving BB were older, more severely injured, and had a higher mortality. Unlike TBI patients, multivariable regression showed no benefit from BB in this population.
• Newgard, C. D., Sanchez, B. J., Bulger, E. M., Brasel, K. J., Byers, A., Buick, J. E., Sheehan, K. L., Guyette, F. X., King, R. V., Mena-Munoz, J., Minei, J. P., Schmicker, R. H., & , R. I. (2016). A Geospatial Analysis of Severe Firearm Injuries Compared to Other Injury Mechanisms: Event Characteristics, Location, Timing, and Outcomes. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 23(5), 554-65.
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  Relatively little is known about the context and location of firearm injury events. Using a prospective cohort of trauma patients, we describe and compare severe firearm injury events to other violent and nonviolent injury mechanisms regarding incident location, proximity to home, time of day, spatial clustering, and outcomes.
• Schroeppel, T. J., Saleem, K., Sharpe, J. P., Magnotti, L. J., Weinberg, J. A., Fischer, P. E., Croce, M. A., & Fabian, T. C. (2016). Penetrating duodenal trauma: A 19-year experience. The journal of trauma and acute care surgery, 80(3), 461-5.
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  Multiple techniques are used for repair in duodenal injury ranging from simple suture repair for low-grade injuries to pancreaticoduodenectomy for complicated high-grade injuries. Drains, both intraluminal and extraluminal, are placed variably depending on associated injuries and confidence with the repair. It is our contention that a simplified approach to repair will limit complications and mortality. The major complication of duodenal leak (DL) was the outcome used to assess methods of repair in this study.
• Shahan, C. P., Magnotti, L. J., McBeth, P. B., Weinberg, J. A., Croce, M. A., & Fabian, T. C. (2016). Early antithrombotic therapy is safe and effective in patients with blunt cerebrovascular injury and solid organ injury or traumatic brain injury. The journal of trauma and acute care surgery, 81(1), 173-7.
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  Early antithrombotic therapy (AT) is the mainstay of treatment in the management of blunt cerebrovascular injury (BCVI). Despite this, optimal timing of initiation of AT in patients with BCVI in the presence of concomitant traumatic brain injury (TBI) or solid organ injury (SOI) remains controversial. The purpose of this study was to evaluate the impact of early initiation of AT on outcomes in patients with BCVI and TBI and/or SOI.
• Shahan, C. P., Magnotti, L. J., Stickley, S. M., Weinberg, J. A., Hendrick, L. E., Uhlmann, R. A., Schroeppel, T. J., Hoit, D. A., Croce, M. A., & Fabian, T. C. (2016). A safe and effective management strategy for blunt cerebrovascular injury: Avoiding unnecessary anticoagulation and eliminating stroke. The journal of trauma and acute care surgery, 80(6), 915-22.
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  Few injuries have produced as much debate with respect to management as have blunt cerebrovascular injuries (BCVIs). Recent work (American Association for the Surgery of Trauma 2013) from our institution suggested that 64-channel multidetector computed tomographic angiography (CTA) could be the primary screening tool for BCVI. Consequently, our screening algorithm changed from digital subtraction angiography (DSA) to CTA, with DSA reserved for definitive diagnosis of BCVI following CTA-positive study results or unexplained neurologic findings. The current study was performed to evaluate outcomes, including the potential for missed clinically significant BCVI, since this new management algorithm was adopted.
• Shahan, C. P., Weinberg, J. A., Magnotti, L. J., Fabian, T. C., & Croce, M. A. (2016). Trauma health literacy: In need of remediation. The journal of trauma and acute care surgery, 81(6), 1167-1170.
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  Little is known regarding health literacy among trauma patients. Anecdotal experience at our institution has suggested that a profound lack of understanding of basic health care information exists at some level in our patients after hospital discharge. The purpose of this study was to report the results of a pilot quality improvement project to determine trauma patient injury comprehension and how this affects their overall satisfaction with care received.
• Sharpe, J. P., Magnotti, L. J., Weinberg, J. A., Schroeppel, T. J., Fabian, T. C., & Croce, M. A. (2016). The old man and the C-spine fracture: Impact of halo vest stabilization in patients with blunt cervical spine fractures. The journal of trauma and acute care surgery, 80(1), 76-80.
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  Placement of a halo vest for cervical spine fractures is presumed to be less morbid than operative fixation. However, restrictions imposed by the halo vest can be detrimental, especially in older patients. The purpose of this study was to evaluate the impact of halo vest placement on outcomes by age in patients with cervical spine fractures without spinal cord injury.
• Weinberg, J. A., Moore, A. H., Magnotti, L. J., Teague, R. J., Ward, T. A., Wasmund, J. B., Lamb, E. M., Schroeppel, T. J., Savage, S. A., Minard, G., Maish, G. O., Croce, M. A., & Fabian, T. C. (2016). Contemporary management of civilian penetrating cervicothoracic arterial injuries. The journal of trauma and acute care surgery, 81(2), 302-6.
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  The management of arterial injury at the thoracic outlet has long hinged on the fundamental principles of extensile exposure and vascular anastomosis. Nonetheless, treatment options for such injuries have evolved to include both endovascular stent placement and temporary vascular shunts. The purpose of this study was to evaluate our recent experience with penetrating cervicothoracic arterial injuries in light of these developments in trauma care.
• Jarrell, A. S., Wood, G. C., Ponnapula, S., Magnotti, L. J., Croce, M. A., Swanson, J. M., Boucher, B. A., & Fabian, T. C. (2015). Short-duration treatment for catheter-associated urinary tract infections in critically ill trauma patients. The journal of trauma and acute care surgery, 79(4), 649-53.
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  The optimal treatment duration for catheter-associated urinary tract infection (CA-UTI) in critically ill patients is unclear. The Infectious Diseases Society of America recommends up to 14 days of therapy; however, short-duration therapy (SDT) for 3 days to 5 days is often used in trauma intensive care unit (ICU) patients at our center. The efficacy of SDT for CA-UTI has not been studied in this population. The objective was to evaluate the efficacy of SDT for CA-UTI in trauma ICU patients.
• Schroeppel, T. J., Sharpe, J. P., Magnotti, L. J., Weinberg, J. A., Croce, M. A., & Fabian, T. C. (2015). How to Further Decrease the Efficiency of Care at a Level I Trauma Center: Implement the Amended Resident Work Hours. The American surgeon, 81(7), 698-703.
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  Work-hour restrictions were amended in 2011 to limit interns to 16 continuous duty hours, essentially requiring a night float system of 12-hour shifts. We hypothesize that there has been no improvement in outcomes after implementation of the amended work-hour restrictions. Outcomes from trauma admissions were queried from the trauma registry from 2009 to 2011 (PRE) and 2011 to 2013 (POST). The primary outcome was mortality with secondary outcomes intensive care unit length of stay (LOS)and LOS. Patients were stratified based on age, mechanism, gender, blood pressure, heart rate, and injury severity (Injury Severity Score, Glasgow Coma Scale, Base Deficit). Outcomes were then compared from admissions PRE to POST. A total of 9178 patients were included in the study population. The mean age was 42 with most being male (72%) and blunt mechanism (81%). Patient populations were well matched except patients in the POST period were slightly older (43 vs 42 years; P = 0.01). Intensive care unit LOS and LOS were higher in the POST period. After adjusted analysis, admission in the POST period was not a predictor of mortality (odds ratio 0.857; confidence interval 0.655-1.12). The POST period was an independent predictor for LOS (β = 0.74; P = 0.002). This study adds to the mounting evidence that the implementation of the amended limits on work hours leads to furthermore decreased efficiency of care.
• Seamon, M. J., Haut, E. R., Van Arendonk, K., Barbosa, R. R., Chiu, W. C., Dente, C. J., Fox, N., Jawa, R. S., Khwaja, K., Lee, J. K., Magnotti, L. J., Mayglothling, J. A., McDonald, A. A., Rowell, S., To, K. B., Falck-Ytter, Y., & Rhee, P. (2015). An evidence-based approach to patient selection for emergency department thoracotomy: A practice management guideline from the Eastern Association for the Surgery of Trauma. The journal of trauma and acute care surgery, 79(1), 159-73.
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  Within the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework, we performed a systematic review and developed evidence-based recommendations to answer the following PICO (Population, Intervention, Comparator, Outcomes) question: should patients who present pulseless after critical injuries (with and without signs of life after penetrating thoracic, extrathoracic, or blunt injuries) undergo emergency department thoracotomy (EDT) (vs. resuscitation without EDT) to improve survival and neurologically intact survival?
• Sharpe, J. P., Magnotti, L. J., Weinberg, J. A., Swanson, J. M., Schroeppel, T. J., Clement, L. P., Wood, G. C., Fabian, T. C., & Croce, M. A. (2015). Adherence to an established diagnostic threshold for ventilator-associated pneumonia contributes to low false-negative rates in trauma patients. The journal of trauma and acute care surgery, 78(3), 468-73; discussion 473-4.
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  The diagnosis of ventilator-associated pneumonia (VAP) in our institution has followed an established diagnostic threshold (DT) of equal to or greater than 10 colony-forming units (CFU) per milliliter on bronchoalveolar lavage (BAL) based on our previous study (PS). Because mortality from VAP is related to treatment delay, some have advocated a lower DT. The purpose of the current study (CS) was to evaluate the impact of adherence to this DT for VAP on false-negative (FN) rates and mortality in trauma patients.
• Sharpe, J. P., Magnotti, L. J., Weinberg, J. A., Swanson, J. M., Wood, G. C., Fabian, T. C., & Croce, M. A. (2015). Impact of pathogen-directed antimicrobial therapy for ventilator-associated pneumonia in trauma patients on charges and recurrence. Journal of the American College of Surgeons, 220(4), 489-95.
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  Ventilator-associated pneumonia (VAP) represents one of the driving forces behind antibiotic use in the ICU. In a previous study, we established a defined algorithm for treatment of hospital-acquired VAP dictated by the causative pathogen. The purpose of the current study was to evaluate the impact of this algorithm for hospital-acquired VAP on recurrence and charges in trauma patients.
• Nirula, R., Millar, D., Greene, T., McFadden, M., Shah, L., Scalea, T. M., Stein, D. M., Magnotti, L. J., Jurkovich, G. J., Vercruysse, G., Demetriades, D., Scherer, L. A., Peitzman, A., Sperry, J., Beauchamp, K., Bell, S., Feiz-Erfan, I., O'Neill, P., & Coimbra, R. (2014). Decompressive craniectomy or medical management for refractory intracranial hypertension: an AAST-MIT propensity score analysis. The journal of trauma and acute care surgery, 76(4), 944-52; discussion 952-5.
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  Moderate/severe traumatic brain injury (TBI) management involves minimizing cerebral edema to maintain brain oxygen delivery. While medical therapy (MT) consisting of diuresis, hyperosmolar therapy, ventriculostomy, and barbiturate coma is the standard of care, decompressive craniectomy (DC) for refractory intracranial hypertension (ICH) has gained renewed interest. Since TBI treatment guidelines consider DC a second-tier intervention after MT failure, we sought to determine if early DC (
• Paulus, E. M., Weinberg, J. A., Magnotti, L. J., Sharpe, J. P., Schroeppel, T. J., Fabian, T. C., & Croce, M. A. (2014). Admission red cell distribution width: a novel predictor of massive transfusion after injury. The American surgeon, 80(7), 685-9.
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  Admission red cell distribution width (aRDW) has been shown to predict mortality in trauma patients by an unclear mechanism. It has been speculated that aRDW is a marker of chronic health status, but elevated RDW may also reflect recent hemorrhage. We hypothesized that aRDW is a predictor of major hemorrhage in trauma patients. Shock trauma patients at a Level I trauma center over 6.5 years were evaluated. Patients were stratified by aRDW quintile (Q1: less than 13%, Q2: 13.1 to 13.5%, Q3: 13.6 to 14.0%, Q4: 14.1 to 14.9%, Q5: 15.0% or greater). Massive transfusion (MT) was defined as 10 or more packed red blood cells in the first 24 hours. From multiple logistic regression, odds ratios with 95 per cent confidence intervals (CIs) were determined to evaluate the association between aRDW quintile and MT. Three thousand nine hundred ninety-four met study criteria. Overall MT incidence was 10 per cent and in-hospital mortality was 17 per cent. MT and mortality increased in a stepwise fashion by aRDW quintile (P < 0.0001). From logistic regression, a threefold increased odds of MT was associated with aRDW Q4 (CI, 1.81 to 4.92), and a 3.5-fold increased odds of MT was associated with aRDW Q5 (CI, 2.70 to 5.83). aRDW independently predicted MT, suggesting that elevated aRDW is an indicator of major hemorrhage in trauma patients. The association between aRDW and mortality in trauma patients may be explained by acute hemorrhage rather than chronic health status.
• Schroeppel, T. J., Fabian, T. C., Clement, L. P., Fischer, P. E., Magnotti, L. J., Sharpe, J. P., Lee, M., & Croce, M. A. (2014). Propofol infusion syndrome: a lethal condition in critically injured patients eliminated by a simple screening protocol. Injury, 45(1), 245-9.
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  Propofol infusion syndrome (PIS) is defined by arrhythmia, rhabdomyolysis, lactic acidosis, and unrecognized leads to death. We sought to determine the incidence of PIS in trauma patients and evaluate the efficacy of a prospective screening protocol in this patient population.
• Schroeppel, T. J., Sharpe, J. P., Magnotti, L. J., Weinberg, J. A., Clement, L. P., Croce, M. A., & Fabian, T. C. (2014). Traumatic brain injury and β-blockers: not all drugs are created equal. The journal of trauma and acute care surgery, 76(2), 504-9; discussion 509.
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  Dysautonomia in traumatic brain injury patients may contribute to secondary injury. We hypothesize that propranolol is the best β-blocker (BB) to block the excess catecholamines and improve mortality in this patient population.
• Schroeppel, T. J., Sharpe, J. P., Magnotti, L. J., Weinberg, J. A., Croce, M. A., & Fabian, T. C. (2014). How to increase the burden on trauma centers: implement the 80-hour work week. The American surgeon, 80(7), 659-63.
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  The 80-hour week was implemented in 2003 to improve outcomes and limit errors. We hypothesize that there has been no change in outcomes postimplementation of the restrictions. Outcomes were queried from the trauma registry from 1997 to 2002 (PRE) and 2004 to 2009 (POST). Primary outcomes were mortality, intensive care unit length of stay (ICU LOS), and length of stay (LOS). Patients were stratified based on demographics, blood pressure, heart rate, and injury severity (Injury Severity Score, Glasgow Coma Score, base deficit). Outcomes were then compared PRE with POST. A total of 41,770 patients were admitted during the study period. The mean age was 38 years with most being male (73%) and blunt mechanism (78%). Although patients admitted in the POST period had a slightly higher blood pressure, they were older and had higher injury severity. ICU LOS, LOS, self-pay, and mortality were higher in the POST period. After adjusted analysis, admission in the POST period was no longer a predictor of mortality (odds ratio, 1.02; confidence interval, 0.92 to 1.14). Whereas patients were more slightly more injured in the POST period, the adjusted analysis shows no difference in mortality and both a longer LOS and ICU LOS. Whether the increase is the result of more severe injury in the POST period or less efficient disposition remains to be elucidated. This study adds to the mounting evidence that the implementation of the limits on work hours does not lead to better outcomes.
• Sharpe, J. P., Magnotti, L. J., Croce, M. A., Paulus, E. M., Schroeppel, T. J., Fabian, T. C., & Weinberg, J. A. (2014). Crystalloid administration during trauma resuscitation: does less really equal more?. The journal of trauma and acute care surgery, 77(6), 828-32; discussion 832.
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  Current direction in trauma resuscitation includes emphasis on minimizing crystalloid, along with early transfusion of blood products. Although evidence suggests that higher crystalloid volume during the first 24 hours is associated with negative outcomes, the effect of crystalloid administration during initial resuscitation remains unclear. The purpose of this study was to evaluate the impact of the ratio of crystalloid to packed red blood cells (C/PRBCs) infused during initial emergency department resuscitation on pulmonary morbidity and mortality.
• Sharpe, J. P., Magnotti, L. J., Weinberg, J. A., Brocker, J. A., Schroeppel, T. J., Zarzaur, B. L., Fabian, T. C., & Croce, M. A. (2014). Gender disparity in ventilator-associated pneumonia following trauma: identifying risk factors for mortality. The journal of trauma and acute care surgery, 77(1), 161-5.
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  Gender alone offers no survival advantage in humans following trauma. However, male gender does predict increased morbidity, specifically ventilator-associated pneumonia (VAP). Previous work has shown that despite lower incidence of VAP, females with VAP have increased mortality. The purposes of this study were to evaluate the impact of VAP and gender on outcome and to determine which characteristics of severe VAP predict mortality in trauma patients.
• Sharpe, J. P., Magnotti, L. J., Weinberg, J. A., Shahan, C. P., Cullinan, D. R., Marino, K. A., Fabian, T. C., & Croce, M. A. (2014). Applicability of an established management algorithm for destructive colon injuries after abbreviated laparotomy: a 17-year experience. Journal of the American College of Surgeons, 218(4), 636-41.
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  For more than a decade, operative decisions (resection plus anastomosis vs diversion) for colon injuries, at our institution, have followed a defined management algorithm based on established risk factors (pre- or intraoperative transfusion requirements of more than 6 units packed RBCs and/or presence of significant comorbid diseases). However, this management algorithm was originally developed for patients managed with a single laparotomy. The purpose of this study was to evaluate the applicability of this algorithm to destructive colon injuries after abbreviated laparotomy (AL) and to determine whether additional risk factors should be considered.
• DiCocco, J. M., Fabian, T. C., Emmett, K. P., Magnotti, L. J., Zarzaur, B. L., Khan, N., Kelly, J. M., & Croce, M. A. (2013). Functional outcomes following blunt cerebrovascular injury. The journal of trauma and acute care surgery, 74(4), 955-60.
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  There has been much debate on whom to screen, how to screen, and how to treat blunt cerebrovascular injury (BCVI), but there has been little published on long-term functional outcomes following diagnosis and treatment of BCVI. This study was conducted to address those long-term outcomes.
• Hill, D. M., Schroeppel, T. J., Magnotti, L. J., Clement, L. P., Sharpe, J. P., Fischer, P. E., Weinberg, J. A., Croce, M. A., & Fabian, T. C. (2013). Methicillin-resistant Staphylococcus aureus in early ventilator-associated pneumonia: cause for concern?. Surgical infections, 14(6), 520-4.
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  Ventilator-associated pneumonia (VAP) accounts for almost 90% of infections in mechanically ventilated patients and more than one-quarter of all patients requiring intubation, with associated mortality rates as high as 70%. The rise in methicillin resistance within the community has led to a national increase in methicillin-resistant Staphylococcus aureus (MRSA) rates in early VAP and associated healthcare expenditure.
• McGwin, G., Melton, S., Kerby, J., Rue, L. W., Magnotti, L. J., Croce, M. A., Fabian, T. C., & Weinberg, J. A. (2013). Survival bias revisited. The journal of trauma and acute care surgery, 74(1), 345-6.
• Sharpe, J. P., Magnotti, L. J., Weinberg, J. A., Shahan, C. P., Cullinan, D. R., Fabian, T. C., & Croce, M. A. (2013). Applicability of an established management algorithm for colon injuries following blunt trauma. The journal of trauma and acute care surgery, 74(2), 419-24; discussion 424-5.
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  Operative management at our institution for all colon injuries have followed a defined algorithm (ALG) based on risk factors originally identified for penetrating injuries. The purpose of this study was to evaluate the applicability of the ALG to blunt colon injuries.
• Sharpe, J. P., Weinberg, J. A., Magnotti, L. J., Fabian, T. C., & Croce, M. A. (2013). Does plasma transfusion portend pulmonary dysfunction? A tale of two ratios. The journal of trauma and acute care surgery, 75(1), 32-6; discussion 36.
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  An unresolved concern regarding resuscitation in the setting of massive hemorrhage is potential lung injury from the transfusion of relatively more plasma-rich components. However, the association between plasma-to-packed red blood cell (PRBC) ratio and subsequent pulmonary dysfunction remains unclear. The purpose of this study was to evaluate the impact of plasma/PRBC on PaO2-to-FIO2 (P/F) ratio in the setting of massive transfusion (MT).
• Sharpe, J. P., Weinberg, J. A., Magnotti, L. J., Nouer, S. S., Yoo, W., Zarzaur, B. L., Cullinan, D. R., Hendrick, L. E., Fabian, T. C., & Croce, M. A. (2013). Outcomes of operations performed by attending surgeons after overnight trauma shifts. Journal of the American College of Surgeons, 216(4), 791-7; discussion 797-9.
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  To date, work-hour restrictions have not been imposed on attending surgeons in the United States. The purpose of this study was to investigate the impact of working an overnight trauma shift on outcomes of general surgery operations performed the next day by the post-call attending physician.
• Swanson, J. M., Connor, K. A., Magnotti, L. J., Croce, M. A., Johnson, J., Wood, G. C., & Fabian, T. C. (2013). Resolution of clinical and laboratory abnormalities after diagnosis of ventilator-associated pneumonia in trauma patients. Surgical infections, 14(1), 49-55.
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  Guidelines advise that patients with ventilator-associated pneumonia (VAP) should respond clinically by Day 3 of antibiotics. White blood cell (WBC) count, maximum temperature (Tmax), and PaO2:FIO2 ratio are all said to respond significantly by Day 6. Resolution of abnormalities has not been evaluated in trauma patients.
• Weinberg, J. A., MacLennan, P. A., Vandromme-Cusick, M. J., Magnotti, L. J., Kerby, J. D., Rue, L. W., Angotti, J. M., Garrett, C. A., Hendrick, L. E., Croce, M. A., Fabian, T. C., Barnum, S. R., & Patel, R. P. (2013). The deleterious effect of red blood cell storage on microvascular response to transfusion. The journal of trauma and acute care surgery, 75(5), 807-12.
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  The transfusion of relatively older red blood cells (RBCs) has been associated with both morbidity and mortality in trauma patients in observational studies. Although the mechanisms responsible for this phenomenon remain unclear, alterations in the microcirculation as a result of the transfusion of relatively older blood may be a causative factor. To assess this hypothesis, we evaluated microvascular perfusion in trauma patients during RBC transfusion.
• Wells, D. L., Swanson, J. M., Wood, G. C., Magnotti, L. J., Boucher, B. A., Croce, M. A., Harrison, C. G., Muhlbauer, M. S., & Fabian, T. C. (2013). Authors' response. Critical care (London, England), 17(1), 401.
• DiCocco, J. M., Fabian, T. C., Emmett, K. P., Magnotti, L. J., Goldberg, S. P., & Croce, M. A. (2012). Components separation for abdominal wall reconstruction: the Memphis modification. Surgery, 151(1), 118-25.
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  Since the advent of damage control surgery, more patients are left with an open abdomen. Surgeons are then left with the challenge of how to restore continuity of the abdominal wall. Many different techniques have been utilized for reconstruction with widely variable recurrence rates, mainly depending on the length of follow-up. A modification of the components separation technique was developed in Memphis, Tennessee at the Presley Memorial Trauma Center. This modification greatly increased the length gained in the midline. Additionally, many patients can be reconstructed without the use of prosthetics, reducing the infectious complications. The purpose of this manuscript is to describe in detail how to perform a modification of the components separation technique that has been shown to have one of the lowest recurrence rates in the literature.
• Dickerson, R. N., Pitts, S. L., Maish, G. O., Schroeppel, T. J., Magnotti, L. J., Croce, M. A., Minard, G., & Brown, R. O. (2012). A reappraisal of nitrogen requirements for patients with critical illness and trauma. The journal of trauma and acute care surgery, 73(3), 549-57.
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  Studies regarding protein requirements for patients with critical illness are inconclusive owing to small sample size and population heterogeneity. The primary objectives of this study were to determine the amount of protein required to achieve nitrogen equilibrium or a positive nitrogen balance (NB, -4 g/d or better) and ascertain whether patients with traumatic brain injury (TBI) exhibit greater protein catabolism than those without TBI.
• Hamilton, L. A., Christopher Wood, G., Magnotti, L. J., Croce, M. A., Martin, J. B., Swanson, J. M., Boucher, B. A., & Fabian, T. C. (2012). Treatment of methicillin-resistant Staphylococcus aureus ventilator-associated pneumonia with high-dose vancomycin or linezolid. The journal of trauma and acute care surgery, 72(6), 1478-83.
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  The purpose of this study was to determine the clinical cure rate of high-dose vancomycin for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) ventilator-associated pneumonia (VAP) in critically ill trauma patients. Recent trials suggest that a traditional dose of 1 g q12 hours results in unacceptable cure rates for MRSA VAP. Thus, more aggressive vancomycin dosing has the potential to improve efficacy. Based on pharmacokinetic principles, the goal initial dose at the study center has been 20 mg/kg q12 hours or q8 hours since the 1990s.
• Parks, N. A., Magnotti, L. J., Weinberg, J. A., Zarzaur, B. L., Schroeppel, T. J., Swanson, J. M., Fabian, T. C., & Croce, M. A. (2012). Use of the clinical pulmonary infection score to guide therapy for ventilator-associated pneumonia risks antibiotic overexposure in patients with trauma. The journal of trauma and acute care surgery, 73(1), 52-8; discussion 58-9.
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  The clinical pulmonary infection score (CPIS) has been advocated to guide both the diagnosis and duration of therapy in ventilator-associated pneumonia (VAP). However, the clinical, physiologic, and radiologic components of the CPIS may be difficult to differentiate from the systemic effects of injury and inflammation, unnecessarily prolonging VAP therapy. This study evaluates the use of CPIS in determining the appropriate duration of antimicrobial therapy for VAP in patients with critical illness and trauma.
• Sharpe, J. P., Magnotti, L. J., Weinberg, J. A., Parks, N. A., Maish, G. O., Shahan, C. P., Fabian, T. C., & Croce, M. A. (2012). Adherence to a simplified management algorithm reduces morbidity and mortality after penetrating colon injuries: a 15-year experience. Journal of the American College of Surgeons, 214(4), 591-7; discussion 597-8.
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  Our previous experience with colon injuries suggested that operative decisions based on a defined algorithm improve outcomes. The purpose of this study was to evaluate the validity of this algorithm in the face of an increased incidence of destructive injuries observed in recent years.
• Sharpe, J. P., Magnotti, L. J., Weinberg, J. A., Zarzaur, B. L., Shahan, C. P., Parks, N. A., Fabian, T. C., & Croce, M. A. (2012). Impact of location on outcome after penetrating colon injuries. The journal of trauma and acute care surgery, 73(6), 1428-32; discussion 1433.
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  Most studies examining suture line failure after penetrating colon injuries have focused on right- versus left-sided injuries. In our institution, operative decisions (resection plus anastomosis vs. diversion) are based on a defined management algorithm regardless of injury location. The purpose of this study was to evaluate the effect of injury location on outcomes after penetrating colon injuries.
• Sharpe, J. P., Magnotti, L. J., Weinberg, J. A., Zarzaur, B. L., Stickley, S. M., Scott, S. E., Fabian, T. C., & Croce, M. A. (2012). Impact of a defined management algorithm on outcome after traumatic pancreatic injury. The journal of trauma and acute care surgery, 72(1), 100-5.
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  The optimal management of pancreatic injuries, specifically with respect to defining ductal integrity, remains controversial. Our previous experience suggested that decisions based on probability of ductal injury might improve outcome. Consequently, a management algorithm (ALG) was developed and implemented. The purpose of this study was to evaluate the impact of this ALG on outcomes.
• Sharpe, J. P., Weinberg, J. A., Magnotti, L. J., Croce, M. A., & Fabian, T. C. (2012). Toward a better definition of massive transfusion: focus on the interval of hemorrhage control. The journal of trauma and acute care surgery, 73(6), 1553-7.
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  In clinical research, massive transfusion (MT) is commonly defined as transfusion of 10 or more red blood cell (RBC) units within 24 hours. However, the clinical relevance of this definition remains poorly understood. In this study, we evaluated whether patients who reach the MT threshold during hemorrhage control differ clinically from those who reach it after hemorrhage control (i.e., after intensive care unit [ICU] arrival) but before 24 hours.
• Sharpe, J. P., Weinberg, J. A., Magnotti, L. J., Maclennan, P. A., Schroeppel, T. J., Fabian, T. C., & Croce, M. A. (2012). Accounting for differences in transfusion volume: Are all massive transfusions created equal?. The journal of trauma and acute care surgery, 72(6), 1536-40.
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  Among patients subjected to massive transfusion (MT), some will require considerably more blood than others, depending on the rate and quantity of hemorrhage. In analyses concerning plasma to red blood cell (RBC) ratios and platelet to RBC ratios, this has yet to be examined. We sought to evaluate the effect of the number of RBC units transfused on both plasma:RBC and platelet:RBC and their association with mortality in MT patients.
• Weinberg, J. A., MacLennan, P. A., Vandromme-Cusick, M. J., Angotti, J. M., Magnotti, L. J., Kerby, J. D., Rue, L. W., Barnum, S. R., & Patel, R. P. (2012). Microvascular response to red blood cell transfusion in trauma patients. Shock (Augusta, Ga.), 37(3), 276-81.
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  Trauma patients are often transfused allogeneic red blood cells (RBCs) in an effort to augment tissue oxygen delivery. However, the effect of RBC transfusion on microvascular perfusion in this patient population is not well understood. To this end, we investigated the effect of RBC transfusion on sublingual microvascular perfusion in trauma patients. Sublingual microcirculation was imaged at bedside with a sidestream dark-field illumination microscope before and after transfusion of one RBC unit in hemodynamically stable, anemic trauma patients. The perfused proportion of capillaries (PPC) before and after transfusion was determined, and the percent change in capillary perfusion following transfusion (ΔPPC) calculated. Sublingual microcirculation was observed in 30 patients. Mean age was 47 (SD, 21) years, mean Injury Severity Score was 29 (SD, 16), and mean pretransfusion hemoglobin was 7.5 (SD, 0.9) g/dL. No patients had a mean arterial pressure of less than 65 mmHg (mean, 89 [SD, 17] mmHg) or lactate of greater than 2.5 mmol/L (mean, 1.1 [SD, 0.3] mmol/L). Following transfusion, ΔPPC ranged from +68% to -36% and was found to inversely correlate significantly with pretransfusion PPC (Spearman r = -0.63, P = 0.0002). Pretransfusion PPC may be selectively deranged in otherwise stable trauma patients. Patients with relatively altered baseline PPC tend to demonstrate improvement in perfusion following transfusion, whereas those with relatively normal perfusion at baseline tend to demonstrate either no change or, in fact, a decline in PPC. Bedside sublingual imaging may have the potential to detect subtle perfusion defects and ultimately inform clinical decision making with respect to transfusion.
• Wells, D. L., Swanson, J. M., Wood, G. C., Magnotti, L. J., Boucher, B. A., Croce, M. A., Harrison, C. G., Muhlbauer, M. S., & Fabian, T. C. (2012). The relationship between serum sodium and intracranial pressure when using hypertonic saline to target mild hypernatremia in patients with head trauma. Critical care (London, England), 16(5), R193.
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  Limited data suggest mild hypernatremia may be related to lower intracranial pressure (ICP) in patients with traumatic brain injury (TBI). The practice at the study center has been to use hypertonic saline (HTS) to generate a targeted serum sodium of 145 to 155 mEq/l in patients with TBI. The purpose of this study was to determine the relationship between serum sodium values and ICP, and to evaluate the acute effect of HTS on ICP.
• Czosnowski, Q. A., Wood, G. C., Magnotti, L. J., Croce, M. A., Swanson, J. M., Boucher, B. A., & Fabian, T. C. (2011). Clinical and microbiologic outcomes in trauma patients treated for Stenotrophomonas maltophilia ventilator-associated pneumonia. Pharmacotherapy, 31(4), 338-45.
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  To determine clinical and microbiologic plus clinical success rates in critically ill trauma patients who received treatment for Stenotrophomonas maltophilia ventilator-associated pneumonia (VAP).
• DiCocco, J. M., Fabian, T. C., Emmett, K. P., Magnotti, L. J., Zarzaur, B. L., Bate, B. G., Muhlbauer, M. S., Khan, N., Kelly, J. M., Williams, J. S., & Croce, M. A. (2011). Optimal outcomes for patients with blunt cerebrovascular injury (BCVI): tailoring treatment to the lesion. Journal of the American College of Surgeons, 212(4), 549-57; discussion 557-9.
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  Blunt cerebrovascular injuries (BCVI) once went unrecognized until cerebral ischemia or death occurred. We previously demonstrated that screening of high-risk asymptomatic patients and early treatment improved outcomes. However, major dissections, pseudoaneurysms, and fistulas rarely heal with antithrombotic therapy alone. Endovascular therapy in these lesions has increased without reports of outcomes. We sought to determine ischemic stroke and death rates after BCVI with and without endovascular treatment.
• Fischer, P. E., Zarzaur, B. L., Fabian, T. C., Magnotti, L. J., & Croce, M. A. (2011). Minor trauma is an unrecognized contributor to poor fetal outcomes: a population-based study of 78,552 pregnancies. The Journal of trauma, 71(1), 90-3.
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  Fetal outcomes after minor injury (MI) to pregnant women are difficult to study because these patients are discharged after emergency room evaluation and not entered in trauma registries. The purpose of this study was to determine the association of both minor and severe injury on fetal demise and prematurity/low birth weight (LBW) in a large population-based study using robust state databases.
• Magnotti, L. J., Bradburn, E. H., Webb, D. L., Berry, S. D., Fischer, P. E., Zarzaur, B. L., Schroeppel, T. J., Fabian, T. C., & Croce, M. A. (2011). Admission ionized calcium levels predict the need for multiple transfusions: a prospective study of 591 critically ill trauma patients. The Journal of trauma, 70(2), 391-5; discussion 395-7.
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  Deaths from uncontrolled exsanguinating hemorrhage occur rapidly postinjury. Any successful resuscitation strategy must also occur early, underscoring the importance of rapid identification of patients at risk for multiple transfusions. Previous studies have shown low ionized calcium (iCa) levels to be associated with hypotension and function as a predictor of mortality. We hypothesized that admission iCa levels could potentially predict the need for multiple transfusions in critically ill trauma patients.
• Magnotti, L. J., Croce, M. A., Zarzaur, B. L., Swanson, J. M., Wood, G. C., Weinberg, J. A., & Fabian, T. C. (2011). Causative pathogen dictates optimal duration of antimicrobial therapy for ventilator-associated pneumonia in trauma patients. Journal of the American College of Surgeons, 212(4), 476-84; discussion 484-6.
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  Recent ventilator-associated pneumonia (VAP) guidelines recommend considering abbreviated therapy in patients with non-Pseudomonas aeruginosa VAP if clinical signs resolve. However, using an arbitrary day cutoff or clinical signs can be suboptimal for some, especially multiply injured patients, resulting in relapse and/or antibiotic resistance. Previously, we showed that repeat bronchoalveolar lavage (BAL) could guide antimicrobial duration for community-acquired VAP in trauma patients. The purpose of this study was to determine the appropriate duration of antimicrobial therapy for VAP in trauma patients secondary to hospital-acquired pathogens.

Reviews

• Bhogadi, S. K., Colosimo, C., Hosseinpour, H., Nelson, A., Rose, M. I., Calvillo, A. R., Anand, T., Ditillo, M., Magnotti, L. J., & Joseph, B. (2023. The undisclosed disclosures: The dollar-outcome relationship in resuscitative endovascular balloon occlusion of the aorta(pp 726-730).
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  Despite its rapid evolution, resuscitative endovascular balloon occlusion of the aorta (REBOA) remains a controversial intervention that continues to generate active research. Proper conflict of interest (COI) disclosure helps to ensure that research is conducted objectively, without bias. We aimed to identify the accuracy of COI disclosures in REBOA research.