Molly Douglas

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Courses

Scholarly Contributions

Chapters

• Douglas, M. (2020). Cardiac Valvular Disease in the Surgical ICU. In The SCORE Portal.
• Watkins, A., & Douglas, M. (2019). Common Infections and Antibiotics. In Surgery Boot CampHandbook: A Multimedia Guide to Surgical Training. Chapter 5: Wolter Kluwer.

Journals/Publications

• Douglas, M. J., Callcut, R., Celi, L. A., & Merchant, N. (2023). Interpretation and Use of Applied/Operational Machine Learning and Artificial Intelligence in Surgery. The Surgical clinics of North America, 103(2), 317-333.
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  Applications for artificial intelligence (AI) and machine learning in surgery include image interpretation, data summarization, automated narrative construction, trajectory and risk prediction, and operative navigation and robotics. The pace of development has been exponential, and some AI applications are working well. However, demonstrations of clinical utility, validity, and equity have lagged algorithm development and limited widespread adoption of AI into clinical practice. Outdated computing infrastructure and regulatory challenges which promote data silos are key barriers. Multidisciplinary teams will be needed to address these challenges and to build AI systems that are relevant, equitable, and dynamic.
• Douglas, M. J., Bell, B. W., Kinney, A., Pungitore, S. A., & Toner, B. P. (2022). Early COVID-19 respiratory risk stratification using machine learning. Trauma surgery & acute care open, 7(1), e000892.
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  COVID-19 has strained healthcare systems globally. In this and future pandemics, providers with limited critical care experience must distinguish between moderately ill patients and those who will require aggressive care, particularly endotracheal intubation. We sought to develop a machine learning-informed Early COVID-19 Respiratory Risk Stratification (ECoRRS) score to assist in triage, by providing a prediction of intubation within the next 48 hours based on objective clinical parameters.
• Douglas, M., Obaid, O., Castanon, L., Reina, R., Ditillo, M., Nelson, A., Bible, L., Anand, T., Gries, L., & Joseph, B. (2022). After 9,000 laparotomies for blunt trauma, resuscitation is becoming more balanced and time to intervention shorter: Evidence in action. The journal of trauma and acute care surgery, 93(3), 307-315.
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  Several advancements in hemorrhage control have been advocated for in the past decade, including balanced transfusions and earlier times to intervention. The aim of this study was to examine the effect of these advancements on outcomes of blunt trauma patients undergoing emergency laparotomy.
• Obaid, O., Anand, T., Nelson, A., Reina, R., Ditillo, M., Stewart, C., Douglas, M., Friese, R., Gries, L., & Joseph, B. (2022). Fibrinogen supplementation for the trauma patient: Should you choose fibrinogen concentrate over cryoprecipitate?. The journal of trauma and acute care surgery, 93(4), 453-460.
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  Trauma-induced coagulopathy is frequently associated with hypofibrinogenemia. Cryoprecipitate (Cryo), and fibrinogen concentrate (FC) are both potential means of fibrinogen supplementation. The aim of this study was to compare the outcomes of traumatic hemorrhagic patients who received fibrinogen supplementation using FC versus Cryo.
• Anand, T., Khurrum, M., Chehab, M., Bible, L., Asmar, S., Douglas, M., Ditillo, M., Gries, L., & Joseph, B. (2021). Racial and Ethnic Disparities in Frail Geriatric Trauma Patients. World journal of surgery, 45(5), 1330-1339.
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  Frailty in geriatric trauma patients is commonly associated with adverse outcomes. Racial disparities in geriatric trauma patients are previously described in the literature. We aimed to assess whether race and ethnicity influence outcomes in frail geriatric trauma patients.
• Anand, T., Obaid, O., Nelson, A., Chehab, M., Ditillo, M., Hammad, A., Douglas, M., Bible, L., & Joseph, B. (2021). Whole blood hemostatic resuscitation in pediatric trauma: A nationwide propensity-matched analysis. The journal of trauma and acute care surgery, 91(4), 573-578.
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  Whole blood (WB) has shown promise in pediatric trauma resuscitation following its prominent role in the resuscitation of adult trauma patients. Although WB in children has been shown to be feasible, its effectiveness has yet to be explored. The aim of this study was to examine the outcomes of WB transfusion as an adjunct to component therapy (CT) compared with CT only as early resuscitation for pediatric trauma patients.
• Chehab, M., Ditillo, M., Khurrum, M., Gries, L., Asmar, S., Douglas, M., Bible, L., Kulvatunyou, N., & Joseph, B. (2021). Managing acute uncomplicated appendicitis in frail geriatric patients: A second hit may be too much. The journal of trauma and acute care surgery, 90(3), 501-506.
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  Studies have proposed the use of antibiotics only in cases of acute uncomplicated appendicitis (AUA). However, there remains a paucity of data evaluating this nonoperative approach in the vulnerable frail geriatric population. The aim of this study was to examine long-term outcomes of frail geriatric patients with AUA treated with appendectomy compared with initial nonoperative management (NOP).
• Chehab, M., Ditillo, M., Obaid, O., Nelson, A., Poppe, B., Douglas, M., Anand, T., Bible, L., & Joseph, B. (2021). Never-frozen liquid plasma transfusion in civilian trauma: a nationwide propensity-matched analysis. The journal of trauma and acute care surgery, 91(1), 200-205.
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  Never-frozen liquid plasma (LQP) was found to reduce component waste, decrease health care expenses, and have a superior hemostatic profile compared with fresh frozen plasma (FFP). Although transfusing LQP in hemorrhaging patients has become more common, its clinical effectiveness remains to be explored. This study aims to examine outcomes of trauma patients transfused with LQP compared with thawed FFP.
• Kapadia, M., Obaid, O., Nelson, A., Hammad, A., Kitts, D. J., Anand, T., Ditillo, M., Douglas, M., & Joseph, B. (2022). Evaluation of Frailty Assessment Compliance in Acute Care Surgery: Changing Trends, Lessons Learned. The Journal of surgical research, 270, 236-244.
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  Routine frailty assessment has emerged recently in the surgical literature and is an important prognostication and risk stratification tool. The aim of our study was to review our 7-y experience with two frailty assessment tools and changing trends in their use.
• Khurrum, M., Chehab, M., Ditillo, M., Richards, J., Douglas, M., Bible, L., Spece, L., & Joseph, B. (2021). Trends in Geriatric Ground-Level Falls: Report from the National Trauma Data Bank. The Journal of surgical research, 266, 261-268.
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  Ground-level falls (GLF) are typically reported as a minor mechanism of injury; however, they represent a significant portion of hospitalized geriatric trauma patients as they can result in multisystem injury in this subset of the population. Our study aimed to analyze trends in geriatric trauma falls on the national level.
• Khurrum, M., Ditillo, M., Obaid, O., Anand, T., Nelson, A., Chehab, M., Kitts, D. J., Douglas, M., Bible, L., & Joseph, B. (2021). Four-factor prothrombin complex concentrate in adjunct to whole blood in trauma-related hemorrhage: Does whole blood replace the need for factors?. The journal of trauma and acute care surgery, 91(1), 34-39.
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  The use of whole blood (WB) for the treatment of hemorrhagic shock and coagulopathy is increasing in civilian trauma patients. Four-factor prothrombin complex concentrate (4-PCC) in adjunct to component therapy showed improved outcomes in trauma patients. Our study aims to evaluate the outcomes of trauma patients who received 4-PCC and WB (4-PCC-WB) compared with WB alone.
• 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.
• 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., 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.
• Hanna, K., Asmar, S., Ditillo, M., Chehab, M., Khurrum, M., Bible, L., Douglas, M., & Joseph, B. (2020). Readmission With Major Abdominal Complications After Penetrating Abdominal Trauma. The Journal of surgical research, 257, 69-78.
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  Despite improvements in operative techniques, major abdominal complications (MACs) continue to occur after penetrating abdominal trauma (PAT). This study aimed to evaluate the burden of MAC after PAT.
• Hanna, K., Bible, L., Chehab, M., Asmar, S., Douglas, M., Ditillo, M., Castanon, L., Tang, A., & Joseph, B. (2020). Nationwide analysis of whole blood hemostatic resuscitation in civilian trauma. The journal of trauma and acute care surgery, 89(2), 329-335.
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  Renewed interest in whole blood (WB) resuscitation in civilians has emerged following its military use. There is a paucity of data on its role in civilians where balanced component therapy (CT) resuscitation is the standard of care. The aim of this study was to assess nationwide outcomes of using WB as an adjunct to CT versus CT alone in resuscitating civilian trauma patients.
• Hanna, K., Chehab, M., Bible, L., 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.
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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.
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  Blunt cerebrovascular injury (BCVI) is associated with cerebrovascular accidents (CVA). Early therapy with antiplatelet agents or anticoagulants is recommended. There is 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.
• Siddiqui, S., Zhang, W. W., Platzbecker, K., Douglas, M. J., Rock, L. K., & Eikermann, M. (2020). Ethical, legal, and communication challenges in managing goals-of-care discussions in chronically critically ill patients. Journal of critical care.
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  Clinicians should expect controversial goals of care discussions in the surgical intensive care from time to time. Differing opinions about the likelihood of meaningful recovery in patients with chronic critical illness often exist between intensive care unit providers of different disciplines. Outcome predictions presented by health-care providers are often reflections of their own point of view that is influenced by provider experience, profession, and personal values, rather than the consequence of reliable scientific evaluation. In addition, family members of intensive care unit patients often develop acute cognitive, psychologic, and physical challenges. Providers in the surgical intensive care unit should approach goals-of-care discussions in a structured and interprofessional manner. This best practice paper highlights medical, legal and ethical implications of changing goals of care from prioritizing cure to prioritizing comfort and provides tools that help physicians become effective leaders in the multi-disciplinary management of patients with challenging prognostication.
• Stupinski, J., Bible, L., Asmar, S., Chehab, M., Douglas, M., Ditillo, M., Gries, L., Khurrum, M., & Joseph, B. (2020). Impact of Marijuana on Venous Thromboembolic Events: Cannabinoids Cause Clots in Trauma Patients. The journal of trauma and acute care surgery.
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  Tetra-hydro-cannabinoids (THC) can modulate the coagulation cascade resulting in hypercoagulability. However, the clinical relevance of these findings has not been investigated. The aim of our study was to evaluate the impact of pre-injury marijuana exposure on thromboembolic complications in trauma patients.
• Tang, A., Chehab, M., Ditillo, M., Asmar, S., Khurrum, M., Douglas, M., Bible, L., Kulvatunyou, N., & Joseph, B. (2020). Regionalization of Trauma Care by Operative Experience: Does the Volume of Emergent Laparotomy Matter?. The journal of trauma and acute care surgery.
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  The volume-outcome relationship led to the regionalization of trauma care. The relationship between trauma centers' injury-specific laparotomy volume and outcomes has not been explored. The aim of our study was to examine the relationship between a trauma center's injury-specific laparotomy volume and outcomes in blunt and penetrating trauma patients.
• Dauvin, A., Donado, C., Bachtiger, P., Huang, K. C., Sauer, C. M., Ramazzotti, D., Bonvini, M., Celi, L. A., & Douglas, M. J. (2019). Machine learning can accurately predict pre-admission baseline hemoglobin and creatinine in intensive care patients. NPJ digital medicine, 2, 116.
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  Patients admitted to the intensive care unit frequently have anemia and impaired renal function, but often lack historical blood results to contextualize the acuteness of these findings. Using data available within two hours of ICU admission, we developed machine learning models that accurately (AUC 0.86-0.89) classify an individual patient's baseline hemoglobin and creatinine levels. Compared to assuming the baseline to be the same as the admission lab value, machine learning performed significantly better at classifying acute kidney injury regardless of initial creatinine value, and significantly better at predicting baseline hemoglobin value in patients with admission hemoglobin of
• Douglas, M. J., & Ciraulo, D. (2017). Variability in Perioperative Fasting Practices Negatively Impacts Nutritional Support of Critically Ill Intubated Patients. The American surgeon, 83(8), 895-900.
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  The aim of the study was to quantify nutritional losses related to pre- and postoperative fasts in critically ill intubated patients and to explore whether shorter fasts are safe and appropriate in this population. A retrospective review of mechanically ventilated adults undergoing surgery more than 24 hours after admission to a Level I trauma center over 15 months was done, which yielded 132 procedures and 81 unique patients. Ninety per cent of preoperative periods and 43 per cent of postoperative periods were affected by nonmedical barriers to feeding. Eighty-two per cent of gastrically fed nonemergent cases were fasted for longer than the 6-hour American Society of Anesthesiologists guideline, whereas 91 per cent of emergent cases had shorter fasts. There were no anesthetic complications, placing an upper limit of 6 per cent on the rate of aspiration for fasts shorter than six hours (95% confidence). Forty-three per cent of cases did not resume tube feeds within 90 minutes postoperatively, and only 37 per cent had a documented justification for delay. Intubated patients were frequently fasted preoperatively for longer than recommended and postoperatively for longer than medically indicated. No complications were observed with shorter-than-guideline fasts. This strengthens the evidence that "standard" preoperative fasting is unnecessary and deleterious in many critically ill intubated patients. New protocols and national guidelines are needed to ensure adequate nutrition.
• Misercola, B., Sihler, K., Douglas, M., Ranney, S., & Dreifus, J. (2016). Transfer of acute care surgery patients in a rural state: a concerning trend. The Journal of surgical research, 206(1), 168-174.
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  Regionalized care of complex patients to larger hospitals is an increasingly common practice as the population ages and the physician shortage evolves. The Acute Care Surgery model is new, and there are limited data on the patients being transferred through this system. We hypothesized transfer patients would be older, more complex, and require additional resources.
• 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.