Lourdes Castanon

Interests

Research

Burn care, wound management, wound reconstruction and outcomes.

Teaching

Simulation, Animal Lab, Cadaver Lab and Mock Prep

Courses

Scholarly Contributions

Journals/Publications

• Castanon, L. (2008). Invading Basal Cell Carcinoma of the Scalp with Dura Involvement. Surgical Rounds.
• Henry, S., Mapula, S., Grevious, M., Foster, K. N., Phelan, H., Shupp, J., Chan, R., Harrington, D., Mashruwala, N., Brown, D. A., Mir, H., Singer, G., Cordova, A., Rae, L., Chin, T., Castanon, L., Bell, D., Hughes, W., & Molnar, J. A. (2024). Maximizing wound coverage in full-thickness skin defects: A randomized-controlled trial of autologous skin cell suspension and widely meshed autograft versus standard autografting. The journal of trauma and acute care surgery, 96(1), 85-93.
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  Traumatic insults, infection, and surgical procedures can leave skin defects that are not amenable to primary closure. Split-thickness skin grafting (STSG) is frequently used to achieve closure of these wounds. Although effective, STSG can be associated with donor site morbidity, compounding the burden of illness in patients undergoing soft tissue reconstruction procedures. With an expansion ratio of 1:80, autologous skin cell suspension (ASCS) has been demonstrated to significantly decrease donor skin requirements compared with traditional STSG in burn injuries. We hypothesized that the clinical performance of ASCS would be similar for soft tissue reconstruction of nonburn wounds.
• Hosseinpour, H., Anand, T., Bhogadi, S. K., Nelson, A., Hejazi, O., Castanon, L., Ghaedi, A., Khurshid, M. H., Magnotti, L. J., Joseph, B., & , A. F. (2024). The implications of poor nutritional status on outcomes of geriatric trauma patients. Surgery, 176(4), 1281-1288.
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  Malnutrition is shown to be associated with worse outcomes among surgical patients, yet its postdischarge outcomes in trauma patients are not clear. This study aimed to evaluate both index admission and postdischarge outcomes of geriatric trauma patients who are at risk of poor nutritional status.
• Safdar, M., Colosimo, C., Khurshid, M. H., Spencer, A. L., Hejazi, O., Castanon, L., Hosseinpour, H., Magnotti, L. J., Bhogadi, S. K., & Joseph, B. (2024). Drugs, Delirium, and Trauma: Substance Use and Incidence of Delirium After Traumatic Brain Injury. The Journal of surgical research, 301, 45-53.
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  There is a paucity of data on the effect of preinjury substance (alcohol, drugs) abuse on the risk of delirium in patients with traumatic brain injury (TBI). This study aimed to assess the incidence of delirium among patients with blunt TBI in association with different substances.
• Terrani, K. F., Bhogadi, S. K., Hosseinpour, H., Spencer, A. L., Alizai, Q., Colosimo, C., Nelson, A., Castanon, L., Magnotti, L. J., & Joseph, B. (2024). What Is Going on in Our Schools? Review of Injuries Among School Children Across the United States. The Journal of surgical research, 295, 310-317.
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  Children spend most of their time at school and participate in many activities that have the potential for causing injury. This study aims to describe the nationwide epidemiology of pediatric trauma sustained in school settings in the United States.
• 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(Supplement_6), 407-411.
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  Prophylactic local antibiotic therapy (LAbT) to prevent infection in open long bone fracture (OLBF) patients has been in use for many decades despite lack of definitive evidence confirming a beneficial effect. We aimed to evaluate the effect of LAbT on outcomes of OLBF patients on a nationwide scale.
• Castanon, L., Bhogadi, S. K., Anand, T., Hosseinpour, H., Nelson, A., Colosimo, C., Spencer, A. L., Gries, L., Ditillo, M., & Joseph, B. (2023). The Association Between the Timing of Initiation of Pharmacologic Venous Thromboembolism Prophylaxis with Outcomes in Burns Patients. Journal of burn care & research : official publication of the American Burn Association, 44(6), 1311-1315.
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  Hospitalized burn patients are at increased risk for venous thromboembolism (VTE). Guidelines regarding thromboprophylaxis in burn patients are unclear. This study aims to compare the outcomes of early versus late thromboprophylaxis initiation in burn patients. In this 3-year analysis of 2017-2019 ACS-TQIP, adult(18-64years) burn patients were identified after applying inclusion/exclusion criteria and stratified based on timing of initiation of VTE prophylaxis: Early(24 hours). Outcomes were deep venous thrombosis(DVT), pulmonary embolism(PE), unplanned return to operating room (OR), unplanned intensive care unit (ICU) admission, post-prophylaxis packed red blood cells (PRBC) transfusion, and mortality. Nine thousand two hundred and seventy-two patients were identified. Overall, median age was 41years, 71.5% were male, and median[IQR] injury severity score was 3[1-8]. 53% had second-degree burns, and 80% had less than 40% of total body surface area affected. Median time to thromboprophylaxis initiation was 11[6-20.6]hours. Overall VTE rate was 0.9% (DVT-0.7%, PE-0.2%). On univariable analysis, early prophylaxis group had lower rates of DVT(0.6% vs 1.1%, P = .025), and PE(0.1% vs 0.6%, P < .001). On multivariable regression, late prophylaxis was associated with 1.8 times higher odds of DVT (aOR = 1.8, 95% CI = 1.04-3.11, P = .03), 4.8 times higher odds of PE(aOR = 4.8, 95% CI = 1.9-11.9, P 
• 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.
• 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.
• Anand, T., Bible, L., Castanon, L., Ditillo, M., Douglas, M., Gries, L., Joseph, B., Nelson, A., Obaid, O., & Reina, R. (2022).

  After 9,000 Laparotomies for Blunt Trauma, Resuscitation Is Becoming More Balanced and Time to Intervention Shorter: Evidence in Action.

  . The journal of trauma and acute care surgery, Publish Ahead of Print. doi:10.1097/ta.0000000000003574
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  Several advancements in hemorrhage control have been advocated for in the past decade, including balanced transfusions and earlier times to intervention. The aim of this study is to examine the effect of these advancements on outcomes of blunt trauma patients undergoing emergency laparotomy..This is a 5-year (2013-2017) analysis of the Trauma Quality Improvement Program. Adult (age ≥ 18 years) blunt trauma patients with early (≤4 hours) PRBC and FFP transfusions and an emergency (≤4 hours) laparotomy for hemorrhage control were identified. Time-trend analysis of 24-hour mortality, PRBC/FFP ratio, and time to laparotomy was performed over the study period. The association between mortality and PRBC/FFP ratio, patient demographics, injury characteristics, transfusion volumes, and ACS verification level was examined by hierarchical regression analysis adjusting for inter-year variability..A total of 9,773 blunt trauma patients with emergency laparotomy were identified. Mean age was 44 ± 18 years, 67.5% were male, and median ISS was 34 [24-43]. Mean SBP at presentation was 73 ± 28 mm Hg, and median transfusion requirements were PRBC 9 [5-17] and FFP 6 [3-12]. During the 5-year analysis, time to laparotomy decreased from 1.87 hours to 1.37 hours (p < 0.001), PRBC/FFP ratio at 4 hours decreased from 1.93 to 1.71 (p < 0.001), and 24-hour mortality decreased from 23.0% to 19.3% (p = 0.014). (Figure) On multivariate analysis, decreased PRBC/FFP ratio was independently associated with decreased 24-hour mortality (OR 0.88; p < 0.001) and in-hospital mortality (OR 0.89; p < 0.001)..Resuscitation is becoming more balanced and time to emergency laparotomy shorter in blunt trauma patients, with a significant improvement in mortality. Future efforts should be directed towards incorporating transfusion practices and timely surgical interventions as markers of trauma center quality..Level III.
• Anand, T., Bible, L., Castanon, L., Ditillo, M., Gries, L., Joseph, B., Nelson, A., Northcutt, A., Obaid, O., & Reina, R. (2022).

  Prospective Validation of The Rib Injury Guidelines (RIG) For Traumatic Rib Fractures.

  . The journal of trauma and acute care surgery, Publish Ahead of Print. doi:10.1097/ta.0000000000003535
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  The Rib Injury Guidelines (RIG) were developed to guide triage of traumatic rib fracture patients to home, regular floor, or ICU and standardize care. The RIG score is based on patient history, physical examination, and imaging findings. The aim of this study is to evaluate triage effectiveness and healthcare resources utilization following RIG implementation..This is a prospective analysis at a Level I trauma center from October 2017 to January 2020. Adult (age ≥ 18 years) blunt trauma patients with a diagnosis of at least one rib fracture on CT imaging were included. Patients before (PRE) and after (POST) implementation of RIG were compared. In the POST group, patients were divided into RIG 1, RIG 2, and RIG 3 based on their RIG score. Outcomes were readmission for RIG 1 patients, unplanned ICU admission for RIG 2 patients, and overall ICU admission. Secondary outcomes were hospital length of stay (LOS) and mortality..A total of 1100 patients were identified (PRE: 754; POST: 346). Mean age was 56 ± 19 years, 788 (71.6%) were male, and median ISS was 14 [10-22]. The most common mechanism of injury was motor vehicle collision (554; 50.3%), 253 (22.9%) patients had ≥5 rib fractures, and 53 (4.8%) patients had a flail chest. In the POST group, 74 patients (21.1%) were RIG 1, 121 (35.2%) RIG 2, and 151 (43.7%) RIG 3. No patient in RIG 1 was readmitted following initial discharge, and 2 (1.6%) patients in RIG 2 had an unplanned ICU admission (both for alcohol withdrawal syndrome). POST patients had shorter hospital LOS (3 [1-6] vs. 4 [1-7] days; p = 0.019) and no difference in mortality (5.8% vs. 7.7%; p = 0.252). On multivariate analysis, RIG implementation was associated with decreased ICU admission (aOR 0.55 [0.36-0.82]; p = 0.004)..RIG is safe and effectively defines triage of rib fracture patients with an overall reduction in ICU admissions, shorter hospital LOS, and no readmissions..Level III.
• Anand, T., El-Qawaqzeh, K., Nelson, A., Hosseinpour, H., Ditillo, M., Gries, L., Castanon, L., & Joseph, B. (2022). Association Between Hemorrhage Control Interventions and Mortality in US Trauma Patients With Hemodynamically Unstable Pelvic Fractures. JAMA surgery.
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  Management of hemodynamically unstable pelvic fractures remains a challenge. Hemostatic interventions are used alone or in combination. There is a paucity of data on the association between the pattern of hemorrhage control interventions and outcomes after a severe pelvic fracture.
• Collins, W. J., El-Qawaqzeh, K., Ditillo, M., Hosseinpour, H., Nelson, A., Bhogadi, S. K., Castanon, L., Gries, L., Anand, T., & Joseph, B. (2022). Minimally Invasive Surgery for Genitourinary Trauma: A Nationwide Outcomes-Based Analysis. The Journal of surgical research, 282, 129-136.
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  Bladder and ureteral injuries are uncommon in trauma patients but are associated with increased morbidity and mortality. Patients presenting with such injuries may undergo either open surgical repair or laparoscopic repair. We aimed to compare outcomes of open surgical approach and laparoscopy in trauma patients with isolated bladder and ureteral injury. We hypothesized that laparoscopy is associated with improved outcomes.
• Culbert, M. H., Nelson, A., Obaid, O., Castanon, L., Hosseinpour, H., Anand, T., El-Qawaqzeh, K., Stewart, C., Reina, R., & Joseph, B. (2022). Failure-to-rescue and mortality after emergent pediatric trauma laparotomy: How are the children doing?. Journal of pediatric surgery.
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  Emergent trauma laparotomy is associated with mortality rates of up to 40%. There is a paucity of data on the outcomes of emergent trauma laparotomies performed in the pediatric population. The aim of our study was to describe the outcomes, including mortality and FTR, among pediatric trauma patients undergoing emergent laparotomy and identify factors associated with failure-to-rescue (FTR).
• Douglas, M., Obaid, O., Castanon, L., Reina, R., Ditillo, M., Nelson, A., Bible, L., Anand, T., Gries, L., & Joseph, B. (2022). After 9,000 laparotomies for blunt trauma, resuscitation is becoming more balanced and time to intervention shorter: Evidence in action. The journal of trauma and acute care surgery, 93(3), 307-315.
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  Several advancements in hemorrhage control have been advocated for in the past decade, including balanced transfusions and earlier times to intervention. The aim of this study was to examine the effect of these advancements on outcomes of blunt trauma patients undergoing emergency laparotomy.
• Nelson, A., Reina, R., Northcutt, A., Obaid, O., Castanon, L., Ditillo, M., Gries, L., Bible, L., Anand, T., & Joseph, B. (2022). Prospective validation of the Rib Injury Guidelines for traumatic rib fractures. The journal of trauma and acute care surgery, 92(6), 967-973.
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  The Rib Injury Guidelines (RIG) were developed to guide triage of traumatic rib fracture patients to home, regular floor, or intensive care unit (ICU) and standardize care. The RIG score is based on patient history, physical examination, and imaging findings. The aim of this study was to evaluate triage effectiveness and health care resources utilization following RIG implementation.
• Reina, R., Anand, T., Bhogadi, S. K., Nelson, A., Hosseinpour, H., Ditillo, M., El-Qawaqzeh, K., Castanon, L., Stewart, C., & Joseph, B. (2022). Nonoperative management of blunt abdominal solid organ injury: Are we paying enough attention to patients on preinjury anticoagulation?. American journal of surgery.
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  This study aims to assess the impact of pre-injury anticoagulant use on outcomes of isolated blunt abdominal SOI patients who underwent NOM.
• Anand, T., Bible, L., Castanon, L., Ditillo, M. F., Douglas, M., Joseph, B., Khurrum, M., Nelson, A., Obaid, O., & Saljuqi, A. T. (2021).

  The Impact of Cannabinoid Consumption on Outcomes of Geriatric Rib Fracture Patients: A Nationwide Propensity-Matched Analysis

  . Journal of the American College of Surgeons, 233(5), S283. doi:10.1016/j.jamcollsurg.2021.07.585
• Anand, T., Bible, L., Castanon, L., Ditillo, M., Douglas, M., Hammad, A., Joseph, B., Nelson, A., & Obaid, O. (2021).

  Open Versus Laparoscopic Repair of Traumatic Diaphragmatic Injury: A Nationwide Propensity-Matched Analysis.

  . The Journal of surgical research, 268, 452-458. doi:10.1016/j.jss.2021.07.022
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  Minimally invasive surgical techniques have become routinely applied in the evaluation and treatment of patients with isolated traumatic diaphragmatic injuries (TDI). However, there remains a paucity of data that compares the laparoscopic repair to the open repair approach. The aim of our study is to examine patient outcomes between TDI patients managed laparoscopically versus those managed using open repair..Adult (age ≥18 years) trauma patients presenting with TDI that required surgical repair were identified in the Trauma Quality Improvement Program database 2017. Patients were excluded if they underwent any other surgical procedure of the abdomen or chest. Patients were then stratified into 2 groups based on the surgical approach: laparoscopic repair of the diaphragm versus open repair. Propensity-score matching in a 1:2 ratio was performed. Primary outcome measures were in-hospital major complications and length of stay (LOS). Secondary outcome measure was in-hospital mortality..A total of 177 adult trauma patients who had a laparoscopic repair of their isolated diaphragmatic injury were matched to 354 patients who had an open repair. Mean age was 35 ± 16 years, 78% were male, and mean BMI was 27 ± 7 kg/m2. 67 percent of the patients had penetrating injuries, and the median ISS was 17 [9-21]. CT imaging was done in 67% of the patients, with 71% presenting with left-sided injury and 21% having visceral herniation. Conversion from laparoscopic to open was reported in 7.3% of the cases. Patients with a laparoscopic repair had significantly lower rates of major complications (5.6 versus 14.4%; P
• Asmar, S., Bible, L., Castanon, L., Chehab, M., Ditillo, M., Joseph, B., Khurrum, M., & Lokhandwala, A. M. (2021).

  Platelet Transfusion After Traumatic Intracranial Hemorrhage in Patients on Antiplatelet Agents.

  . The Journal of surgical research, 257, 239-245. doi:10.1016/j.jss.2020.07.076
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  With an aging population, the number of patients on antiplatelet medications and traumatic brain injury (TBI) is increasing. Our study aimed to evaluate the role of platelet transfusion on outcomes after traumatic intracranial bleeding (IB) in these patients..We analyzed our prospectively maintained TBI database from 2014 to 2016. We included all isolated TBI patients with an IB, who were on preinjury antiplatelet agents and excluded patients taking anticoagulants. Outcome measures included the progression of IB, neurosurgical intervention, and mortality. Regression analysis was performed..A total of 343 patients met the inclusion criteria. Mean age was 58 ± 11 y, 58% were men, and median injury severity score was 15 (10-24). Distribution of antiplatelet agents was as follows: aspirin (60%) and clopidogrel (35%). Overall, 74% patients received platelet transfusion after admission with a median number of two platelet units. After controlling for confounders, patients who received one unit of pooled platelets had no difference in progression of IB (odds ratio [OR]: 0.98, [0.6-1.9], P = 0.41), need for neurosurgical intervention (OR: 1.09, [0.7-2.5], P = 0.53), and mortality (OR: 0.84, [0.6-1.8], P = 0.51). However, patients who received two units of pooled platelets had lower rate of progression of IB (OR: 0.69, [0.4-0.8], P = 0.02), the need for neurosurgical intervention (OR: 0.81, [0.3-0.9], P = 0.03), and mortality (OR: 0.84, [0.5-0.9], P = 0.04). Both groups were compared with those who did not receive platelet transfusion..The use of two units of platelet may decrease the risk of IB progression, neurosurgical intervention, and mortality in patients on preinjury antiplatelet agents and TBI. Further studies should focus on developing protocols for platelet transfusion to improve outcomes in these patients..Level III prognostic.
• Asmar, S., Bible, L., Chehab, M., Obaid, O., Castanon, L., Yaghi, M., Ditillo, M., & Joseph, B. (2021). Traumatic Femoral Artery Injuries and Predictors of Compartment Syndrome: A Nationwide Analysis. The Journal of surgical research, 265, 159-167.
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  The femoral artery is commonly injured following lower extremity trauma. If not identified early and addressed properly, it can lead to compartment syndrome (CS) and limb amputation. The aim of this study is to examine traumatic femoral artery injuries and identify risk factors for the development of lower extremity CS.
• Asmar, S., Bible, L., Obaid, O., Anand, T., Chehab, M., Ditillo, M., Castanon, L., Nelson, A., & Joseph, B. (2021). Frail geriatric patients with acute calculous cholecystitis: Operative versus nonoperative management?. The journal of trauma and acute care surgery, 91(1), 219-225.
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  Nonoperative management of acute calculous cholecystitis (ACC) in the frail geriatric population is underexplored. The aim of our study was to examine long-term outcomes of frail geriatric patients with ACC treated with cholecystectomy compared with initial nonoperative management.
• Asmar, S., Bible, L., Obaid, O., Tang, A., Khurrum, M., Castanon, L., Ditillo, M., & Joseph, B. (2021). Open vs Endovascular Treatment of Traumatic Peripheral Arterial Injury: Propensity Matched Analysis. Journal of the American College of Surgeons, 233(1), 131-138.e4.
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  Arterial injuries occur in the setting of blunt and penetrating trauma. Despite increasing use, there remains a paucity of data comparing long-term outcomes of endovascular vs open repair management of these injuries. The aim of our study was to compare outcomes and readmission rates of open vs endovascular repair of traumatic arterial injuries.
• Asmar, S., Bible, L., Vartanyan, P., Castanon, L., Masjedi, A., Richards, J., Ditillo, M., Tang, A., & Joseph, B. (2021). Firearm-Related Injuries: A Single Center Experience. The Journal of surgical research, 265, 289-296.
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  Firearm-related injuries (FRI) are an important public health crisis in the US. There is relatively less city level data examining the injury-related trends in Tucson, Arizona. Our study aims to examine FRI, in Southern Arizona's only Level I trauma center.
• Calabrese, E. C., Asmar, S., Bible, L., Khurrum, M., Chehab, M., Tang, A., Castanon, L., Ditillo, M., & Joseph, B. (2021). Prospective Evaluation of Health Literacy and Its Impact on Outcomes in Emergency General Surgery. The Journal of surgical research, 261, 343-350.
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  Health literacy (HL) is an important component of national health policy. The aim of our study was to assess the prevalence of low HL (LHL) and determine its impact on outcomes after emergency general surgery (EGS).
• Hamidi, M., Asmar, S., Bible, L., Hanna, K., Castanon, L., Avila, M., Ditillo, M., & Joseph, B. (2021). Early Thromboprophylaxis in Operative Spinal Trauma Does Not Increase Risk of Bleeding Complications. The Journal of surgical research, 258, 119-124.
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  Thromboprophylaxis in patients with spinal trauma is often delayed due to the risk of bleeding and expansion of the intraspinal hematoma (ISH). Our study aimed to assess the safety of early initiation of thromboprophylaxis in patients with operative spinal trauma (OST).
• Obaid, O., Hammad, A., Bible, L., Ditillo, M., Castanon, L., Douglas, M., Anand, T., Nelson, A., & Joseph, B. (2021). Open Versus Laparoscopic Repair of Traumatic Diaphragmatic Injury: A Nationwide Propensity-Matched Analysis. The Journal of surgical research, 268, 452-458.
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  Minimally invasive surgical techniques have become routinely applied in the evaluation and treatment of patients with isolated traumatic diaphragmatic injuries (TDI). However, there remains a paucity of data that compares the laparoscopic repair to the open repair approach. The aim of our study is to examine patient outcomes between TDI patients managed laparoscopically versus those managed using open repair.
• Anand, T., Hanna, K., Kulvatunyou, N., Zeeshan, M., Ditillo, M., Castanon, L., Tang, A., Gries, L., & Joseph, B. (2020). Time to tracheostomy impacts overall outcomes in patients with cervical spinal cord injury. The journal of trauma and acute care surgery, 89(2), 358-364.
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  The morbidity associated with cervical spine injury increases in the setting of concomitant cervical spinal cord injury (CSCI). A significant proportion of these patients require placement of a tracheostomy. However, it remains unclear if timing to tracheostomy following traumatic CSCI can impact outcomes. The aim of our study was to characterize outcomes associated with tracheostomy timing following traumatic CSCI.
• Asmar, S., Bible, L., Chehab, M., Tang, A., Khurrum, M., Douglas, M., Castanon, L., Kulvatunyou, N., & Joseph, B. (2020). Resuscitative Endovascular Balloon Occlusion of the Aorta vs Pre-Peritoneal Packing in Patients with Pelvic Fracture. Journal of the American College of Surgeons.
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  Pelvic hemorrhage is potentially lethal despite homeostatic interventions such as pre-peritoneal packing (PP), resuscitative endovascular balloon occlusion of the aorta (REBOA), surgery, and/or angioembolization. REBOA may be used as an alternative/adjunct to PP for temporizing bleeding in patients with pelvic fractures. Our study aims to compare the outcomes of REBOA and/or PP, as temporizing measures, in blunt pelvic fracture patients. We hypothesize that REBOA is associated with worsened outcomes.
• Asmar, S., Chehab, M., Bible, L., Khurrum, M., Castanon, L., Ditillo, M., & Joseph, B. (2020). The ED Systolic Blood Pressure Relationship After Traumatic Brain Injury. The Journal of surgical research, 257, 493-500.
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  Blood pressure alterations in patients with traumatic brain injury (TBI) have been shown to be associated with increased mortality. However, there is paucity of data describing the optimal emergency department (ED) systolic blood pressure (SBP) target during the initial evaluation. The aim of our study was to assess the association between SBP on presentation and mortality in patients with TBI.
• Asmar, S., Lokhandwala, A., Richards, J., Bible, L., Avila, M., Castanon, L., Ditillo, M., Douglas, M., & Joseph, B. (2020). The neuroprotective effect of quetiapine in critically ill traumatic brain injury patients. The journal of trauma and acute care surgery, 89(4), 775-782.
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  Quetiapine is an atypical antipsychotic commonly used in critical care. Cellular and animal models demonstrated its novel anti-inflammatory properties in traumatic brain injury (TBI). Our study aimed to assess the effect of quetiapine on outcomes in critically ill TBI patients. We hypothesize that quetiapine improves neurological outcomes.
• Astarabadi, M., Khurrum, M., Asmar, S., Bible, L., Chehab, M., Castanon, L., Ditillo, M., Douglas, M., & Joseph, B. (2020). The impact of non-neurological organ dysfunction on outcomes in severe isolated traumatic brain injury. The journal of trauma and acute care surgery, 89(2), 405-410.
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  Organ dysfunction following traumatic brain injury (TBI) is common and has been associated with unpredictable outcomes. The aim of our study is to describe the incidence of non-neurological organ dysfunction (NNOD) and its impact on outcomes in patients with severe TBI admitted to our intensive care unit (ICU).
• Castanon, L., Asmar, S., Bible, L., Chehab, M., Ditillo, M., Khurrum, M., Hanna, K., Douglas, M., & Joseph, B. (2020). Early Enteral Nutrition in Geriatric Burn Patients: Is There a Benefit?. Journal of burn care & research : official publication of the American Burn Association, 41(5), 986-991.
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  Nutrition is a critical component of acute burn care and wound healing. There is no consensus over the appropriate timing of initiating enteral nutrition in geriatric burn patients. This study aimed to assess the impact of early enteral nutrition on outcomes in this patient population. We performed a 1-year (2017) analysis of the American College of Surgeons Trauma Quality Improvement Program and included all older adult (age ≥65 years) isolated thermal burn patients who were admitted for more than 24 hr and received enteral nutrition. Patients were stratified into two groups based on the timing of initiation of feeding: early (≤24 hr) vs late (>24 hr). Multivariate logistic regression was performed to control for potential confounding factors. Outcome measures were hospital and intensive care unit lengths of stay, in-hospital complications, and mortality. A total of 1,004,440 trauma patients were analyzed, of which 324 patients were included (early: 90 vs late: 234). The mean age was 73.9 years and mean TBSA burnt was 31%. Patients in the early enteral nutrition group had significantly lower rates of in-hospital complications and mortality (15.6% vs 26.1%; P = 0.044), and a shorter hospital length of stay (17 [11,23] days vs 20 [14,24] days; P = 0.042) and intensive care unit length of stay (13 [8,15] days vs 17 [9,21] days; P = 0.042). In our regression model of geriatric burn patients, early enteral nutrition was associated with improved outcomes. The cumulative benefits observed may warrant incorporating early enteral nutrition as part of intensive care protocols.
• Chehab, M., Afaneh, A., Bible, L., Castanon, L., Hanna, K., Ditillo, M., Khurrum, M., Asmar, S., & Joseph, B. (2020). Angioembolization in intra-abdominal solid organ injury: Does delay in angioembolization affect outcomes?. The journal of trauma and acute care surgery, 89(4), 723-729.
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  Angioembolization (AE) is an integral component in multidisciplinary algorithms for achieving hemostasis in patients with trauma. The American College of Surgeons Committee on Trauma recommends that interventional radiologists be available within 30 minutes to perform emergent AE. However, the impact of the timing of AE on patient outcomes is still not well known. We hypothesized that a delay in AE would be associated with increased mortality and higher blood transfusion requirements in patients with blunt intra-abdominal solid organ injury.
• Ditillo, M., Hanna, K., Castanon, L., Zeeshan, M., Kulvatunyou, N., Tang, A., Sakran, J., Gries, L., & Joseph, B. (2020). The role of cryoprecipitate in massively transfused patients: Results from the Trauma Quality Improvement Program database may change your mind. The journal of trauma and acute care surgery, 89(2), 336-343.
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  Cryoprecipitate was developed for the treatment of inherited and acquired coagulopathies. The role of cryoprecipitate in hemorrhaging trauma patients is still speculative. The aim of our study was to assess the role of cryoprecipitate as an adjunct to transfusion in trauma patients.
• Hanna, K., Bible, L., Chehab, M., Asmar, S., Douglas, M., Ditillo, M., Castanon, L., Tang, A., & Joseph, B. (2020). Nationwide analysis of whole blood hemostatic resuscitation in civilian trauma. The journal of trauma and acute care surgery, 89(2), 329-335.
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  Renewed interest in whole blood (WB) resuscitation in civilians has emerged following its military use. There is a paucity of data on its role in civilians where balanced component therapy (CT) resuscitation is the standard of care. The aim of this study was to assess nationwide outcomes of using WB as an adjunct to CT versus CT alone in resuscitating civilian trauma patients.
• Hanna, K., Chehab, M., Bible, L., Asmar, S., Ditillo, M., Castanon, L., Tang, A., & Joseph, B. (2020). Failure to Rescue in Emergency General Surgery: Impact of Fragmentation of Care. Annals of surgery.
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  Compare emergency general surgery (EGS) patient outcomes following index and non-index hospital readmissions, and explore predictive factors for non-index readmission.
• Hanna, K., Chehab, M., Bible, L., Castanon, L., Douglas, M., Asmar, S., Ditillo, M., Tang, A., & Joseph, B. (2020). Nationwide analysis of cryopreserved packed red blood cell transfusion in civilian trauma. The journal of trauma and acute care surgery, 89(5), 861-866.
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  Liquid packed red blood cells (LPRBCs) have a limited shelf life and worsening quality with age. Cryopreserved packed red blood cells (CPRBCs) can be stored up to 10 years with no quality deterioration. The effect of CPRBCs on outcomes in civilian trauma is less explored. This study aims to evaluate the safety and efficacy of CPRBCs in civilian trauma patients.
• Hanna, K., Douglas, M., Asmar, S., Khurrum, M., Bible, L., Castanon, L., Ditillo, M., Kulvatunyou, N., & Joseph, B. (2020). Treatment of blunt cerebrovascular injuries: Anticoagulants or antiplatelet agents?. The journal of trauma and acute care surgery, 89(1), 74-79.
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  Blunt cerebrovascular injury (BCVI) is associated with cerebrovascular accidents (CVA). Early therapy with antiplatelet agents or anticoagulants is recommended. There are limited data comparing the effectiveness of these treatments. The aim of our study was to compare outcomes between BCVI patients who received anticoagulants versus those who received antiplatelet agents.
• Hanna, K., Hamidi, M., Vartanyan, P., Henry, M., Castanon, L., Tang, A., Zeeshan, M., Kulvatunyou, N., & Joseph, B. (2020). Non-neurologic organ dysfunction plays a major role in predicting outcomes in pediatric traumatic brain injury. Journal of pediatric surgery, 55(8), 1590-1595.
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  Nonneurological organ dysfunction (NNOD) occurs after traumatic brain injury (TBI) and is associated with mortality. The aim of our study was to evaluate the prevalence of NNOD and its association with outcomes in pediatric patients with TBI. We hypothesized that NNOD is associated with worse outcomes in pediatric patients with severe TBI.
• Lokhandwala, A. M., Asmar, S., Khurrum, M., Chehab, M., Bible, L., Castanon, L., Ditillo, M., & Joseph, B. (2020). Platelet Transfusion After Traumatic Intracranial Hemorrhage in Patients on Antiplatelet Agents. The Journal of surgical research, 257, 239-245.
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  With an aging population, the number of patients on antiplatelet medications and traumatic brain injury (TBI) is increasing. Our study aimed to evaluate the role of platelet transfusion on outcomes after traumatic intracranial bleeding (IB) in these patients.
• Masjedi, A., Asmar, S., Bible, L., Khurrum, M., Chehab, M., Castanon, L., Ditillo, M., & Joseph, B. (2020). The Evolution of Nonoperative Management of Abdominal Gunshot Wounds in the United States. The Journal of surgical research, 253, 224-231.
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  Surgical exploration for gunshot wounds to the abdomen has been a surgical standard for the greater part of the past century. Recently, nonoperative management (NOM) has been deemed as a safe option for abdominal gunshot wounds (AGWs). The aim of this analysis was to review the utilization of NOM and mortality after AGWs.
• Saljuqi, A. T., Hanna, K., Asmar, S., Tang, A., Zeeshan, M., Gries, L., Ditillo, M., Kulvatunyou, N., Castanon, L., & Joseph, B. (2020). Prospective Evaluation of Delirium in Geriatric Patients Undergoing Emergency General Surgery. Journal of the American College of Surgeons, 230(5), 758-765.
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  The prevalence of delirium and its impact on outcomes after emergency general surgery (EGS) remain unexplored. The aims of our study were to assess the impact of frailty on delirium and the impact of delirium on outcomes in geriatric EGS patients.
• Vartan, P., Asmar, S., Bible, L., Chehab, M., Khurrum, M., Castanon, L., Ditillo, M., & Joseph, B. (2020). Alcohol Use Disorder Is Bad for Broken Ribs: A Nationwide Analysis of 19,638 Patients With Rib Fractures. The Journal of surgical research, 255, 556-564.
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  Alcohol use disorder (AUD) has deleterious effects on many organ systems. The aim of our study was to assess the impact of AUD on outcomes in patients with rib fractures. We hypothesized that AUD is associated with increased risk adverse outcomes.
• Gonzales, C., Hanna, K., Gries, L. M., Zeeshan, M., Castanon, L., O'Keeffe, T., Kulvatunyou, N., Hamidi, M. K., Tang, A. L., & Joseph, B. (2019). Trauma Centers Near the US-Mexico Border: What Are the Challenges?. JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 229(4), E243-E244.
• Haddadin, Z., Hanna, K., Castanon, L., Zeeshan, M., Ditillo, M., Tang, A., Gries, L. M., Hamidi, M. K., Kulvatunyou, N., & Joseph, B. (2019). Rib Plating the Non-Flail Chest May Not Be as Good as You Think. JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 229(4), E241-E242.
• Haddadin, Z., Hanna, K., Gries, L. M., Zeeshan, M., Tang, A., Ditillo, M., Castanon, L., Hamidi, M. K., Kulvatunyou, N., & Joseph, B. (2019). Evolution of Nonoperative Management of Abdominal Gunshot Wounds in the US: Analysis of 16,866 Abdominal Gunshot Wounds. JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 229(4), S295-S295.
• Hanna, K., Palmer, J., Castanon, L., Zeeshan, M., Hamidi, M., Kulvatunyou, N., Gries, L., & Joseph, B. (2019). Racial and Ethnic Differences in Limiting Life-Sustaining Treatment in Trauma Patients. AMERICAN JOURNAL OF HOSPICE & PALLIATIVE MEDICINE, 36(11), 974-979.
• Hanna, K., Palmer, J., Castanon, L., Zeeshan, M., Hamidi, M., Kulvatunyou, N., Gries, L., & Joseph, B. (2019). Racial and Ethnic Differences in Limiting Life-Sustaining Treatment in Trauma Patients. The American journal of hospice & palliative care, 36(11), 974-979.
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  Differences in health care between racial and ethnic groups exist. The literature suggests that African Americans and Hispanics prefer more aggressive treatment at the end of life. The aim of this study is to assess racial and ethnic differences in limiting life-sustaining treatment (LLST) after trauma.
• Kapadia, M., Hanna, K., Northcutt, A., Saljuqi, A., Ditillo, M., Gries, L. M., Kulvatunyou, N., Hamidi, M. K., Castanon, L., & Joseph, B. (2019). Prospective Evaluation of Frailty Assessment Compliance in Acute Care Surgery: Changing Trends, Lessons Learned. JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 229(4), S121-S121.
• Richards, J., Hanna, K., Gries, L. M., Zeeshan, M., Tang, A. L., Ditillo, M., Hamidi, M. K., Northcutt, A., Castanon, L., & Joseph, B. (2019). Prospective Evaluation of Factors Contributing to Racial Disparities in Outcomes after Trauma. JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 229(4), E239-E239.
• Vartanyan, P., Hanna, K., Zeeshan, M., Hamidi, M. K., Gries, L. M., Kulvatunyou, N., Northcutt, A., Castanon, L., Ditillo, M., & Joseph, B. (2019). Chronic Alcoholism Is Bad for Broken Ribs: A Nationwide Analysis of 20,120 Patients with Rib Fractures. JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 229(4), S289-S290.
• Hammad, A. Y., Ditillo, M., & Castanon, L. (2018). Pancreatitis. SURGICAL CLINICS OF NORTH AMERICA, 98(5), 895-913.
• Hammad, A. Y., Ditillo, M., & Castanon, L. (2018). Pancreatitis. The Surgical clinics of North America, 98(5), 895-913.
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  Acute pancreatitis is an inflammation of the glandular parenchyma of the retroperitoneal organ that leads to injury with or without subsequent destruction of the pancreatic acini. This inflammatory process can either result in a self-limited disease or involve life-threatening multiorgan complications. Chronic pancreatitis consists of endocrine and exocrine gland dysfunction that develops secondary to progressive inflammation and chronic fibrosis of the pancreatic acini with permanent structural damage. Recurrent attacks of acute pancreatitis can result in chronic pancreatitis; acute and chronic pancreatitis are different diseases with separate morphologic patterns. Acute pancreatitis has an increasing incidence but a decreasing mortality.
• Zeeshan, M., Khan, M., O'Keeffe, T., Pollack, N., Hamidi, M., Kulvatunyou, N., Sakran, J. V., Gries, L., & Joseph, B. (2018). Optimal timing of initiation of thromboprophylaxis in spine trauma managed operatively: A nationwide propensity-matched analysis of trauma quality improvement program. The journal of trauma and acute care surgery, 85(2), 387-392.
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  Patients with spinal trauma are at high risk for venous thromboembolic events (VTE). Guidelines recommend prophylactic anticoagulation but they are unclear on timing of initiation of thromboprophylaxis. The aim of our study was to assess the impact of early versus late initiation of venous thromboprophylaxis in patients with spinal trauma who underwent operative intervention.
• Duncan, C. L., Enlow, P. T., Szabo, M. M., Tolchin, E., Kelly, R. W., Castanon, L., & Aballay, A. M. (2016). A Pilot Study of the Efficacy of Active Leptospermum Honey for the Treatment of Partial-Thickness Facial Burns. ADVANCES IN SKIN & WOUND CARE, 29(8), 349-355.
• Duncan, C. L., Enlow, P. T., Szabo, M. M., Tolchin, E., Kelly, R. W., Castanon, L., & Aballay, A. M. (2016). A Pilot Study of the Efficacy of Active Leptospermum Honey for the Treatment of Partial-Thickness Facial Burns. Advances in skin & wound care, 29(8), 349-55.
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  Research suggests that active Leptospermum honey (ALH) improves outcomes in patients with partial-thickness burns by enhancing healing and reepithelialization rates, as well as by protecting against antibiotic-resistant microorganisms. This study assessed the effectiveness of ALH gel on healing time, bacterial growth, patient satisfaction, and cost of treatment.
• Asmar, S., Bible, L., Chehab, M., Tang, A., Khurrum, M., Castanon, L., Ditillo, M., Douglas, M., & Joseph, B. (2021). Traumatic brain injury induced temperature dysregulation: What is the role of β blockers?. The journal of trauma and acute care surgery, 90(1), 177-184.
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  Traumatic brain injury (TBI) is associated with sympathetic discharge that leads to posttraumatic hyperthermia (PTH). Beta blockers (ββ) are known to counteract overactive sympathetic discharge. The aim of our study was to evaluate the effect of ββ on PTH in critically-ill TBI patients.
• Ditillo, M. F., Joseph, B., Rhee, P. M., Pandit, V., Castanon, L., Hadeed, S., Zangbar, B., Friese, R. S., & Philip, A. (2014). Morbidly obese patients and motor vehicle collisions: are protective devices really protective?. JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 219(4), E150-E150.