Narong Kulvatunyou

Interests

Research

Percutaneous Catheter for trauma;Biomechanism of traumatic injury;Small bowel obstruction;Acute appendicitis;Outcome research

Teaching

Medical students, surgical residents, and staffs bedside teaching, lectures, group discussion; accomplish rotation milestones; Surgical residents teaching in the operating room; fellow teaching.

Courses

No activities entered.

Scholarly Contributions

Chapters

• Kulvatunyou, N., Rhee, P. M., Moore, .., Tisherman, .., & Fulda, .. (2012). Liver and Spleen. In Surgical Critical Care and Emergency Surgery: Clinical Questions and Answers.
• Kulvatunyou, N., Rhee, P., Moore, .., Tisherman, .., & Fulda, .. (2012). Incarcerating Hernia. In Surgical Critical Care and Emergency Surgery: Clinical Questions and Answers.
• Kulvatunyou, N., Roberts, P. R., Farmer, J. C., & Wall, M. H. (2010). Gastrointestinal Hemorrhage. In Pocket ICU Management (2nd edition). New York.

Journals/Publications

• Kulvatunyou, N., & Bauman, Z. M. (2022). Response: Letter to the editor: The small (14F) percutaneous catheter (P-CAT) versus large (28-32F) open chest tube for traumatic hemothorax: A multicenter randomized clinical trial. The journal of trauma and acute care surgery, 93(3), e126-e127.
• Asmar, S., Bible, L., Chehab, M., Tang, A., Khurrum, M., Douglas, M., Castanon, L., Kulvatunyou, N., & Joseph, B. (2021). Resuscitative Endovascular Balloon Occlusion of the Aorta vs Pre-Peritoneal Packing in Patients with Pelvic Fracture. Journal of the American College of Surgeons, 232(1), 17-26.e2.
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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 aimed to compare the outcomes of REBOA and/or PP, as temporizing measures, in blunt pelvic fracture patients. We hypothesized that REBOA is associated with worsened outcomes.
• Bauman, Z. M., Kulvatunyou, N., Joseph, B., Gries, L., O'Keeffe, T., Tang, A. L., & Rhee, P. (2021). Randomized Clinical Trial of 14-French (14F) Pigtail Catheters versus 28-32F Chest Tubes in the Management of Patients with Traumatic Hemothorax and Hemopneumothorax. World journal of surgery, 45(3), 880-886.
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  Traditional management of traumatic hemothorax/hemopneumothorax (HTX/HPTX) has been insertion of large-bore 32-40 French (Fr) chest tubes (CTs). Retrospective studies have shown 14Fr percutaneous pigtail catheters (PCs) are equally effective as CTs. Our aim was to compare effectiveness between PCs and CTs by performing the first randomized controlled trial (RCT). We hypothesize PCs work equally as well as CTs in management of traumatic HTX/HPTX.
• 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).
• Kulvatunyou, N., Bauman, Z. M., Zein Edine, S. B., de Moya, M., Krause, C., Mukherjee, K., Gries, L., Tang, A. L., Joseph, B., & Rhee, P. (2021). The small (14 Fr) percutaneous catheter (P-CAT) versus large (28-32 Fr) open chest tube for traumatic hemothorax: A multicenter randomized clinical trial. The journal of trauma and acute care surgery, 91(5), 809-813.
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  The traditional treatment of traumatic hemothorax (HTX) has been an insertion of a large-bore 36- to 40-Fr chest tube. Our previous single-center randomized controlled trial (RCT) had shown that 14-Fr percutaneous catheters (PCs) (pigtail) were equally as effective as chest tube. We performed a multicenter RCT, hypothesizing that PCs are as equally effective as chest tubes in the management of patients with traumatic HTX (NCT03546764).
• Kulvatunyou, N., Zimmerman, S. A., Adhikhari, S., Joseph, B., Gries, L., Tang, A. L., & Rhee, P. (2021). The Impact of FASTPASS: A Collaboration With Emergency Department to Improve Management of Patients With Gallbladder Disease and Acute Appendicitis. The Journal of surgical research, 260, 293-299.
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  Efficient Emergency Department (ED) throughput depends on several factors, including collaboration and consultation with surgical services. The acute care surgery service (ACS) collaborated with ED to implement a new process termed "FASTPASS" (FP), which might improve patient-care for those with acute appendicitis and gallbladder disease. The aim of this study was to evaluate the 1-year outcome of FP.
• Tang, A., Chehab, M., Ditillo, M., Asmar, S., Khurrum, M., Douglas, M., Bible, L., Kulvatunyou, N., & Joseph, B. (2021). Regionalization of trauma care by operative experience: Does the volume of emergent laparotomy matter?. The journal of trauma and acute care surgery, 90(1), 11-20.
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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.
• 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., Kulvatunyou, N., Davis, K., & Joseph, B. (2020). Virtual interviews for surgical critical care fellowships and acute care fellowships amid the COVID-19 pandemic: The show must still go on. The journal of trauma and acute care surgery, 89(4), e92-e94.
• 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., 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., Haddadin, Z., Sakran, J., Zeeshan, M., Asmar, S., Kulvatunyou, N., Tang, A., Northcutt, A., & Joseph, B. (2020). Barriers to improving health care value in emergency general surgery: A nationwide analysis. The journal of trauma and acute care surgery, 89(2), 289-300.
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  There is a growing need to improve the quality of care while decreasing health care costs in emergency general surgery (EGS). Health care value includes costs and quality and is a targeted metric by improvement programs. The aim of our study was to evaluate the trend of health care value in EGS over time and to identify barriers to high-value surgical care.
• 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.
• Roussas, A., Masjedi, A., Hanna, K., Zeeshan, M., Kulvatunyou, N., Gries, L., Tang, A., & Joseph, B. (2020). Number and Type of Complications Associated With Failure to Rescue in Trauma Patients. The Journal of surgical research, 254, 41-48.
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  Failure to rescue (FTR) is becoming a ubiquitous metric of quality care. The aim of our study is to determine the type and number of complications associated with FTR after trauma.
• Saljuqi, A. T., Hanna, K., Asmar, S., Tang, A., Zeeshan, M., Gries, L., Ditillo, M., Kulvatunyou, N., Castanon, L., & Joseph, B. (2020). Prospective Evaluation of Delirium in Geriatric Patients Undergoing Emergency General Surgery. Journal of the American College of Surgeons, 230(5), 758-765.
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  The prevalence of delirium and its impact on outcomes after emergency general surgery (EGS) remain unexplored. The aims of our study were to assess the impact of frailty on delirium and the impact of delirium on outcomes in geriatric EGS patients.
• Hamidi, M., Haddadin, Z., Zeeshan, M., Saljuqi, A. T., Hanna, K., Tang, A., Northcutt, A., Kulvatunyou, N., Gries, L., & Joseph, B. (2019). Prospective evaluation and comparison of the predictive ability of different frailty scores to predict outcomes in geriatric trauma patients. The journal of trauma and acute care surgery, 87(5), 1172-1180.
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  Different frailty scores have been proposed to measure frailty. No study has compared their predictive ability to predict outcomes in trauma patients. The aim of our study was to compare the predictive ability of different frailty scores to predict complications, mortality, discharge disposition, and 30-day readmission in trauma patients.
• Hamidi, M., Ho, C., Zeeshan, M., O'Keeffe, T., Hamza, A., Kulvatunyou, N., Jehan, F., & Joseph, B. (2019). Can Sarcopenia Quantified by Computed Tomography Scan Predict Adverse Outcomes in Emergency General Surgery?. The Journal of surgical research, 235, 141-147.
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  Sarcopenia (a decline of skeletal muscle mass) has been identified as a predictor of poor postoperative outcomes. The impact of sarcopenia in emergency general surgery (EGS) remains undetermined. The aim of this study was to evaluate the association between sarcopenia and outcomes after EGS.
• Hamidi, M., Zeeshan, M., Kulvatunyou, N., Adun, E., O'Keeffe, T., Zakaria, E. R., Gries, L., & Joseph, B. (2019). Outcomes After Massive Transfusion in Trauma Patients: Variability Among Trauma Centers. The Journal of surgical research, 234, 110-115.
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  Exsanguinating trauma patients often require massive blood transfusion (defined as transfusion of 10 or more pRBC units within first 24 h). The aim of our study is to assess the outcomes of trauma patients receiving massive transfusion at different levels of trauma centers.
• Hamidi, M., Zeeshan, M., Kulvatunyou, N., Mitra, H. S., Hanna, K., Tang, A., Northcutt, A., O'Keeffe, T., & Joseph, B. (2019). Operative spinal trauma: Thromboprophylaxis with low molecular weight heparin or a direct oral anticoagulant. Journal of thrombosis and haemostasis : JTH.
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  Essentials Operative spine trauma patients are at increased risk of venous thromboembolism (VTE). Direct oral anticoagulants (DOACs) may have a favorable efficacy and safety in spine trauma. Patients on DOACs had lower rates of VTE in comparison to low molecular weight heparin. DOACs did not augment the risk of surgical bleeding (transfusion, decompressive procedures).
• Hamidi, M., Zeeshan, M., Leon-Risemberg, V., Nikolich-Zugich, J., Hanna, K., Kulvatunyou, N., Saljuqi, A. T., Fain, M., & Joseph, B. (2019). Frailty as a prognostic factor for the critically ill older adult trauma patients. American journal of surgery.
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  Frailty is highly prevalent in the elderly and confers high risk for adverse outcomes. We aimed to assess the impact of frailty on critically ill older adult trauma patients.
• Hanna, K., Hamidi, M., Anderson, K. T., Ditillo, M., Zeeshan, M., Tang, A., Henry, M., Kulvatunyou, N., & Joseph, B. (2019). Pediatric resuscitation: Weight-based packed red blood cell volume is a reliable predictor of mortality. The journal of trauma and acute care surgery, 87(2), 356-363.
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  The definition of massive transfusion (MT) in civilian pediatric trauma patients is not established. In combat-injured pediatric patients, the definition of MT is based on the volume of total blood products transfused. The aim of this study is to define MT in civilian pediatric trauma patients based on a packed red blood cell (PRBC) volume threshold and compare its predictive power to a total blood products volume threshold.
• Hanna, K., Khalid, A., Hamidi, M., Gries, L., Haddadin, Z., Kulvatunyou, N., Zeeshan, M., & Joseph, B. (2019). Chronic Alcohol Consumption and Risk of Deep Venous Thrombosis: A Propensity-Matched Analysis. The Journal of surgical research, 244, 251-256.
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  Alcoholism is associated with variable effects on the coagulation system. Therefore, the aim of our study was to analyze the currently unknown association between chronic alcohol consumption and the risk of venous thromboembolism, which includes deep vein thrombosis (DVT) and pulmonary embolism (PE).
• Hanna, K., Palmer, J., Castanon, L., Zeeshan, M., Hamidi, M., Kulvatunyou, N., Gries, L., & Joseph, B. (2019). Racial and Ethnic Differences in Limiting Life-Sustaining Treatment in Trauma Patients. The American journal of hospice & palliative care, 1049909119847970.
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  Differences in health care between racial and ethnic groups exist. The literature suggests that African Americans and Hispanics prefer more aggressive treatment at the end of life. The aim of this study is to assess racial and ethnic differences in limiting life-sustaining treatment (LLST) after trauma.
• Jehan, F., Khan, M., Kulvatunyou, N., Hamidi, M., Gries, L., Zeeshan, M., O'Keeffe, T., & Joseph, B. (2019). Day of Hospital Admission and Effect on Outcomes: The Weekend Effect in Acute Gallstone Pancreatitis. The Journal of surgical research, 233, 192-198.
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  The aim of our study was to evaluate outcomes in patients who are admitted on weekend compared with those admitted on a weekday for acute gallstone pancreatitis.
• Jehan, F., Zeeshan, M., Kulvatunyou, N., Khan, M., O'Keeffe, T., Tang, A., Gries, L., & Joseph, B. (2019). Is There a Need for Platelet Transfusion After Traumatic Brain Injury in Patients on P2Y12 Inhibitors?. The Journal of surgical research, 236, 224-229.
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  A significant portion of patients sustaining traumatic brain injury (TBI) are on antiplatelet medications. The reversal of P2Y12 agents after intracranial hemorrhage (ICH) remains unclear. The aim of our study is to evaluate outcomes after TBI in patients who are on preinjury P2Y12 inhibitors and received a platelet transfusion.
• Joseph, B., Zeeshan, M., Sakran, J. V., Hamidi, M., Kulvatunyou, N., Khan, M., O'Keeffe, T., & Rhee, P. (2019). Nationwide Analysis of Resuscitative Endovascular Balloon Occlusion of the Aorta in Civilian Trauma. JAMA surgery.
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  The need for improved methods of hemorrhage control and resuscitation has resulted in a reappraisal of resuscitative endovascular balloon occlusion of the aorta (REBOA). However, there is a paucity of data regarding the use of REBOA on a multi-institutional level in the United States.
• Khan, M., Jehan, F., Zeeshan, M., Kulvatunyou, N., Fain, M. J., Saljuqi, A. T., O'Keeffe, T., & Joseph, B. (2019). Failure to Rescue After Emergency General Surgery in Geriatric Patients: Does Frailty Matter?. The Journal of surgical research, 233, 397-402.
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  Failure to rescue (FTR) is considered as an index of quality of care provided by a hospital. However, the role of frailty in FTR remains unclear. We hypothesized that the FTR rate is higher for frail geriatric emergency general surgery (EGS) patients than nonfrail geriatric EGS patients.
• Kulvatunyou, N., Zimmerman, S. A., Joseph, B., Friese, R. S., Gries, L., O'Keeffe, T., Stroster, J. A., & Tang, A. L. (2019). Risk Factors for Perforated Appendicitis in the Acute Care Surgery Era-Minimizing the Patient's Delayed Presentation Factor. The Journal of surgical research, 238, 113-118.
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  Numerous factors contribute to advanced disease or increased complications in patients with acute appendicitis (AA). This study aimed to identify risk factors associated with AA perforation, including the effect of system time (ST) delay, after controlling for patient time (PT) delay. In this study, PT was controlled (to less than or equal to 24 h) to better understand the effect of ST delay on AA perforation.
• Palmer, J., Pandit, V., Zeeshan, M., Kulvatunyou, N., Hamidi, M., Hanna, K., Fain, M., Nikolich-Zugich, J., Zakaria, E. R., & Joseph, B. (2019). The Acute Inflammatory Response after Trauma is heightened by Frailty: A Prospective Evaluation of Inflammatory and Endocrine System Alterations in Frailty. The journal of trauma and acute care surgery.
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  Frailty is a geriatric syndrome characterized by decreased physiological reserves, increased inflammation, and decreased anabolic-endocrine response. The biomarkers associated with frailty are poorly understood in trauma. The aim of this study was to analyze the association between frailty and immune: IL-1β, IL-6, IL-2Rα, TNF-α and endocrine biomarkers: Insulin-like growth factor-1(IGF-1), and growth hormone(GH) in trauma patients.
• Santino, C., Zeeshan, M., Hamidi, M., Hanna, K., Saljuqi, A. T., Kulvatunyou, N., Haddadin, Z., Northcutt, A., & Joseph, B. (2019). Prospective evaluation of health-related quality of life in geriatric trauma patients. Surgery, 166(3), 403-407.
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  Frailty is an established predictor of adverse outcomes in geriatric patients. Health-related quality of life (HRQoL) is an important outcome measure among trauma patients. This prospective observational study examined the impact of frailty on health-related quality of life in geriatric trauma patients.
• Skarupa, D., Hanna, K., Zeeshan, M., Madbak, F., Hamidi, M., Haddadin, Z., Northcutt, A., Gries, L., Kulvatunyou, N., & Joseph, B. (2019). Is early chemical thromboprophylaxis in patients with solid organ injury a solid decision?. The journal of trauma and acute care surgery, 87(5), 1104-1112.
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  The optimal time to initiate chemical thromboprophylaxis (CTP) in patients who have undergone nonoperative management (NOM) of blunt solid organ injuries (SOI) remains controversial. The aim of our study was to assess the impact of early initiation of CTP in patients with blunt abdominal SOIs.
• Zeeshan, M., Hamidi, M., Feinstein, A. J., Gries, L., Jehan, F., Sakran, J., Northcutt, A., OʼKeeffe, T., Kulvatunyou, N., & Joseph, B. (2019). 4-Factor Prothrombin Complex Concentrate is associated with Improved Survival in Trauma Related Hemorrhage: A Nationwide Propensity Matched Analysis. The journal of trauma and acute care surgery.
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  Post-traumatic hemorrhage is the most common preventable cause of death in trauma. Numerous small single-center studies have shown the superiority of 4-factor prothrombin complex concentrate(4-PCC) along with fresh frozen plasma (FFP) over FFP-alone in resuscitation of trauma patients. The aim of our study was to evaluate outcomes of severely injured trauma patients who received 4-PCC+FFP compared to FPP-alone.
• Zeeshan, M., Hamidi, M., O'Keeffe, T., Hanna, K., Kulvatunyou, N., Tang, A., & Joseph, B. (2019). Pediatric Liver Injury: Physical Examination, Fast and Serum Transaminases Can Serve as a Guide. The Journal of surgical research, 242, 151-156.
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  The aim of our study was to determine if the combination of physical examination (PE), serum transaminases along with Focused Assessment with Sonography in Trauma (FAST) would effectively rule out major hepatic injuries (HIs) after blunt abdominal trauma (BAT) in hemodynamically stable pediatric patients.
• Zeeshan, M., Hamidi, M., OʼKeeffe, T., Bae, E. H., Hanna, K., Friese, R. S., Kulvatunyou, N., Zakaria, E. R., Gries, L., Tang, A., & Joseph, B. (2019). Propranolol attenuates cognitive, learning, and memory deficits in a murine model of traumatic brain injury. The journal of trauma and acute care surgery, 87(5), 1140-1147.
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  β-blockers have been shown to improve survival after traumatic brain injury (TBI); however, the impact of continuous dosage of β-blockers on cognitive function has not been elucidated. We hypothesized that a daily dose of propranolol can improve memory, learning, and cognitive function following TBI.
• Bauman, Z. M., & Kulvatunyou, N. (2018). 14-French Pigtail Catheters for Traumatic Hemothorax/Hemopneumothorax: Size Does Not Matter: Reply. World journal of surgery.
• Burlew, C. C., Sumislawski, J. J., Behnfield, C. D., McNutt, M. K., McCarthy, J., Sharpe, J. P., Croce, M. A., Bala, M., Kashuk, J., Spalding, M. C., Beery, P. R., John, S., Hunt, D. J., Harmon, L., Stein, D. M., Callcut, R., Wybourn, C., Sperry, J., Anto, V., , Dunn, J., et al. (2018). TIME TO STROKE: A WESTERN TRAUMA ASSOCIATION MULTI-CENTER STUDY OF BLUNT CEREBROVASCULAR INJURIES. The journal of trauma and acute care surgery.
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  Screening for blunt cerebrovascular injuries (BCVI) in asymptomatic high-risk patients has become routine. To date, the length of this asymptomatic period has not been defined. Determining the time to stroke could impact therapy including earlier initiation of antithrombotics in multiply injured patients. The purpose of this study is to determine the time to stroke in patients with a BCVI-related stroke. We hypothesized the majority of patients suffer stroke between 24-72 hours after injury.
• Hamidi, M., Zeeshan, M., O'Keeffe, T., Nisbet, B., Northcutt, A., Nikolich-Zugich, J., Khan, M., Kulvatunyou, N., Fain, M., & Joseph, B. (2018). Prospective evaluation of frailty and functional independence in older adult trauma patients. American journal of surgery.
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  The aim of our study was to assess the association between frailty and functional status in geriatric trauma patients.
• Hamidi, M., Zeeshan, M., Sakran, J. V., Kulvatunyou, N., O'Keeffe, T., Northcutt, A., Zakaria, E. R., Tang, A., & Joseph, B. (2018). Direct Oral Anticoagulants vs Low-Molecular-Weight Heparin for Thromboprophylaxis in Nonoperative Pelvic Fractures. Journal of the American College of Surgeons.
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  Patients with pelvic fractures are prone to venous-thromboembolic(VTE) complications. Recent literature shows superiority of direct-oral-anticoagulants(DOACs) over low-molecular-weight-heparin (LMWH) for thromboprophylaxis in patients undergoing orthopedic surgeries. The aim of our study was to compare in-hospital outcomes for DOACs vs. LMWH in patients with non-operative pelvic fractures.
• Ibraheem, K., Khan, M., Rhee, P., Azim, A., O'Keeffe, T., Tang, A., Kulvatunyou, N., & Joseph, B. (2018). "No zone" approach in penetrating neck trauma reduces unnecessary computed tomography angiography and negative explorations. The Journal of surgical research, 221, 113-120.
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  The most recent management guidelines advocate computed tomography angiography (CTA) for any suspected vascular or aero-digestive injuries in all zones and give zone II injuries special consideration. We hypothesized that physical examination can safely guide CTA use in a "no zone" approach.
• Jehan, F., Aziz, H., O'Keeffe, T., Khan, M., Zakaria, E. R., Hamidi, M., Zeeshan, M., Kulvatunyou, N., & Joseph, B. (2018). THE ROLE OF 4-FACTOR PROTHROMBIN COMPLEX CONCENTRATE (4-PCC) IN COAGULOPATHY OF TRAUMA: A PROPENSITY MATCHED ANALYSIS. The journal of trauma and acute care surgery.
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  Coagulopathy is a common complication after severe trauma. The efficacy of 4-factor Prothrombin Complex Concentrate (4-PCC) as an adjunct to FFP in reversal of coagulopathy of trauma has not been studied. The aim of our study is to compare 4-PCC+FFP vs. FPP alone for the treatment of COT.
• Joseph, B., Jehan, F., Dacey, M., Kulvatunyou, N., Khan, M., Zeeshan, M., Gries, L., O'Keeffe, T., & Riall, T. S. (2018). Evaluating the Relevance of the 2013 Tokyo Guidelines for the Diagnosis and Management of Cholecystitis. Journal of the American College of Surgeons.
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  The 2013 Tokyo Guidelines (TG13) are used to diagnose, grade severity, and guide management of acute cholecystitis (AC). The aim of our study was to verify the diagnostic criteria, severity assessment, and management protocols based on the TG13.
• Joseph, B., Khan, M., Truitt, M., Jehan, F., Kulvatunyou, N., Azim, A., Jain, A., Zeeshan, M., Tang, A., & O'Keeffe, T. (2018). Massive Transfusion: The Revised Assessment of Bleeding and Transfusion (RABT) Score. World journal of surgery.
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  Massive transfusion (MT) is a lifesaving treatment for trauma patients with hemorrhagic shock, assessed by Assessment of Blood Consumption (ABC) Score based on mechanism of injury, systolic blood pressure (SBP), tachycardia, and FAST exam. The aim of this study was to assess the performance of ABC score by replacing hypotension and tachycardia; with Shock Index (SI) > 1.0 and including pelvic fractures.
• Khan, M., Jehan, F., O'Keeffe, T., Hamidi, M., Kulvatunyou, N., Tang, A., Gries, L., & Joseph, B. (2018). Oral Xa Inhibitors Versus Low Molecular Weight Heparin for Thromboprophylaxis After Nonoperative Spine Trauma. The Journal of surgical research, 232, 82-87.
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  Thromboprophylaxis with oral Xa inhibitors (Xa-Inh) are recommended after major orthopedic operation; however, its role in spine trauma is not well-defined. The aim of our study was to assess the impact of Xa-Inh in spinal trauma patients managed nonoperatively.
• Kulvatunyou, N., Zimmerman, S. A., Sadoun, M., Joseph, B. A., Friese, R. S., Gries, L. M., O'Keeffe, T., & Tang, A. L. (2018). Comparing Outcomes Between "Pull" Versus "Push" Percutaneous Endoscopic Gastrostomy in Acute Care Surgery: Under-Reported Pull Percutaneous Endoscopic Gastrostomy Incidence of Tube Dislodgement. The Journal of surgical research, 232, 56-62.
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  Percutaneous endoscopic gastrostomy (PEG) complications are often under-reported in the literature, especially regarding the incidence of tube dislodgement (TD). TD can cause significant morbidity depending on its timing. We compared outcomes between "push" and "pull" PEGs. We hypothesized that push PEGs, because of its T-fasteners and balloon tip, would have a lower incidence of TD and complications compared with pull PEGs.
• Mathew, P. J., Jehan, F., Kulvatunyou, N., Khan, M., O'Keeffe, T., Tang, A., Gries, L., Hamidi, M., Zakaria, E. R., & Joseph, B. (2018). The burden of excess length of stay in trauma patients. American journal of surgery, 216(5), 881-885.
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  Disposition of trauma patients frequently results in excessive hospital-stay. The aim of this study was to assess the risk of developing complications due to excessive stay in the hospital.
• Mccusker, A., Khan, M., Kulvatunyou, N., Zeeshan, M., Sakran, J. V., Hayek, H., O'Keeffe, T., Hamidi, M., Tang, A., & Joseph, B. (2018). Sarcopenia defined by a computed tomography estimate of the psoas muscle area does not predict frailty in geriatric trauma patients. American journal of surgery.
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  The aim of our study was to assess the correlation between frailty & sarcopenia and impact of each condition on outcomes in geriatric trauma patients.
• Swartz, T., Jehan, F., Tang, A., Gries, L., Zeeshan, M., Kulvatunyou, N., Hamidi, M., O'Keeffe, T., & Joseph, B. (2018). PROSPECTIVE EVALUATION OF LOW-HEALTH LITERACY AND ITS IMPACT ON OUTCOMES IN TRAUMA PATIENTS. The journal of trauma and acute care surgery.
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  Health-literacy is emerging focus of interest in public health and is evolving as an important component of national health policy. Low-health-literacy (LHL) is associated with poor outcomes. We aimed to identify factors associated with LHL and its relationship with health outcomes in trauma patients.
• Zeeshan, M., Hamidi, M., Kulvatunyou, N., Jehan, F., O'Keeffe, T., Khan, M., Rashdan, L., Tang, A., Zakaria, E. R., & Joseph, B. (2018). 3-Factor Vs. 4-Factor PCC in Coagulopathy of Trauma: Four is Better Than Three. Shock (Augusta, Ga.).
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  Coagulopathy of trauma(COT) is common and highly lethal. Prothrombin complex concentrate(PCC) has been advocated for correction of COT. However, the difference in efficacy between 3-factor PCC(3-PCC) vs. 4-factor PCC(4-PCC) remains unclear. The aim of our study was to compare efficacy of 3-PCC vs. 4-PCC in COT.
• Zeeshan, M., Jehan, F., O'Keeffe, T., Khan, M., Zakaria, E. R., Hamidi, M., Gries, L., Kulvatunyou, N., & Joseph, B. (2018). The Novel Oral Anticoagulants (NOACs) have Worse Outcomes Compared to Warfarin in Patients with Intracranial Hemorrhage after TBI. The journal of trauma and acute care surgery.
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  Novel-oral-anticoagulants(NOACs) use is increasing in trauma patients. The reversal of these agents after hemorrhage is still evolving. The aim of our study was to evaluate outcomes after traumatic brain injury in patients on NOACs.
• Zeeshan, M., Khan, M., O'Keeffe, T., Pollack, N., Hamidi, M., Kulvatunyou, N., Sakran, J. V., Gries, L., & Joseph, B. (2018). OPTIMAL TIMING OF INITIATION OF THROMBOPROPHYLAXIS IN SPINE TRAUMA MANAGED OPERATIVELY: A NATIONWIDE PROPENSITY MATCHED ANALYSIS OF TRAUMA QUALITY IMPROVEMENT PROGRAM. The journal of trauma and acute care surgery.
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  Patients with spinal trauma are at high-risk for venous-thromboembolism(VTE). Guidelines recommend prophylactic anticoagulation but they are unclear on timing of initiation of thromboprophylaxis. The aim of our study was to assess the impact of early vs late initiation of venous thromboprophylaxis in patients with spinal trauma who underwent operative intervention.
• Azim, A., Jehan, F. S., Rhee, P., O'Keeffe, T., Tang, A., Vercruysse, G., Kulvatunyou, N., Latifi, R., & Joseph, B. (2017). Big for small: Validating brain injury guidelines in pediatric traumatic brain injury. The journal of trauma and acute care surgery, 83(6), 1200-1204.
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  Brain injury guidelines (BIG) were developed to reduce overutilization of neurosurgical consultation (NC) as well as computed tomography (CT) imaging. Currently, BIG have been successfully applied to adult populations, but the value of implementing these guidelines among pediatric patients remains unassessed. Therefore, the aim of this study was to evaluate the established BIG (BIG-1 category) for managing pediatric traumatic brain injury (TBI) patients with intracranial hemorrhage (ICH) without NC (no-NC).
• Bauman, Z. M., Kulvatunyou, N., Joseph, B., Jain, A., Friese, R. S., Gries, L., O'Keeffe, T., Tang, A. L., Vercruysse, G., & Rhee, P. (2017). A Prospective Study of 7-Year Experience Using Percutaneous 14-French Pigtail Catheters for Traumatic Hemothorax/Hemopneumothorax at a Level-1 Trauma Center: Size Still Does Not Matter. World journal of surgery.
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  The effectiveness of 14-French (14F) pigtail catheters (PCs) compared to 32-40F chest tubes (CTs) in patients with traumatic hemothorax (HTX) and hemopneumothorax (HPTX) is becoming more well known but still lacking. The aim of our study was to analyze our cumulative experience and outcomes with PCs in patients with traumatic HTX/HPTX. We hypothesized that PCs would be as effective as CTs.
• Hassan, A., Jokar, T. O., Rhee, P., Ibraheem, K., Kulvatunyou, N., Anderson, K. T., Gries, L., Roward, Z. T., & Joseph, B. (2017). More Helmets Fewer Deaths: Motorcycle Helmet Legislation Impacts Traumatic Brain Injury-Related Mortality in Young Adults. The American surgeon, 83(6), 541-546.
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  The aim of our study was to assess the impact of helmet legislations on the incidence and the mortality rate of motorcycle collision (MCC)-related traumatic brain injury (TBI) in young adult trauma patients. A 1-year (2011) retrospective analysis was performed of all patients under 21 years old with trauma-related hospitalization using the Nationwide Inpatient Sample database (representing 20% of all in-patient admissions). Patients with MCC were identified using E-codes. States were classified into three groups based on helmet legislations: universal age helmet legislation,
• Jehan, F., Azim, A., Rhee, P., Khan, M., Gries, L., OʼKeeffe, T., Kulvatunyou, N., Tang, A., & Joseph, B. (2017). Decompressive craniectomy versus craniotomy only for intracranial hemorrhage evacuation: A propensity matched study. The journal of trauma and acute care surgery, 83(6), 1148-1153.
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  Decompressive craniectomy (DC) is often performed in conjunction with evacuation of intracranial hemorrhage (ICH) to control intracranial pressure (ICP) in patients with a traumatic brain injury (TBI). The efficacy of DC in lowering ICP is well established; however, its effect on clinical outcomes remains controversial. The aim of our study is to assess outcomes in TBI patients undergoing DC versus craniotomy only (CO) for the evacuation of ICH.
• Jehan, F., Khan, M., Sakran, J. V., Khreiss, M., O'Keeffe, T., Chi, A., Kulvatunyou, N., Jain, A., Zakaria, E. R., & Joseph, B. (2017). Perioperative Glycemic Control and Postoperative Complications in Patients Undergoing Emergency General Surgery: What is the role of HbA1c?. The journal of trauma and acute care surgery.
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  Plasma Hemoglobin A1c (HbA1c) reflects quality of glucose control in diabetic patients. Literature reports that patients undergoing surgery with an elevated HbA1c level are associated with increased postoperative morbidity and mortality. The aim of our study was to evaluate the impact of HbA1c level on outcomes after emergency general surgery (EGS).
• Jehan, F., O'Keeffe, T., Khan, M., Chi, A., Tang, A., Kulvatunyou, N., Gries, L., & Joseph, B. (2017). Early thromboprophylaxis with low-molecular-weight heparin is safe in patients with pelvic fracture managed nonoperatively. The Journal of surgical research, 219, 360-365.
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  Early initiation of thromboprophylaxis is highly desired in pelvic fracture patients, but it is often delayed due to the fear of hemorrhage. Aim of our study was to assess the safety of early initiation of venous thromboprophylaxis in patients with pelvic trauma managed nonoperatively.
• Jehan, F., Pandit, V., O'Keeffe, T., Azim, A., Jain, A., Tai, S. A., Tang, A., Khan, M., Kulvatunyou, N., Gries, L., & Joseph, B. (2017). The burden of firearm violence in the United States: stricter laws result in safer states. Journal of injury & violence research, 10(1).
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  Increasing firearm violence has resulted in a strong drive for stricter firearm legislations. Aim of this study was to determine the relationship between firearm legislations and firearm-related injuries across states in the United States.
• Joseph, B., Azim, A., O'Keeffe, T., Ibraheem, K., Kulvatunyou, N., Tang, A., Vercruysse, G., Friese, R., Latifi, R., & Rhee, P. (2017). American College of Surgeons Level I trauma centers outcomes do not correlate with patients' perception of hospital experience. The journal of trauma and acute care surgery, 82(4), 722-727.
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  The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is a data collection methodology for measuring a patient's perception of his/her hospital experience, and it has been selected by the Centers of Medicare and Medicaid Services as the validated and transparent national survey tool with publicly available results. Since 2012, hospital reimbursements rates have been linked to HCAHPS data based on patient satisfaction scores. The aim of this study was, therefore, to assess whether HCAHPS scores of Level I trauma centers correlate with actual hospital performance.
• Joseph, B., Azim, A., Zangbar, B., Bauman, Z., OʼKeeffe, T., Ibraheem, K., Kulvatunyou, N., Tang, A., Latifi, R., & Rhee, P. (2017). Improving mortality in trauma laparotomy through the evolution of damage control resuscitation: Analysis of 1,030 consecutive trauma laparotomies. The journal of trauma and acute care surgery, 82(2), 328-333.
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  The aim of this study was to evaluate the related change in outcomes (mortality, complications) in patients undergoing trauma laparotomy (TL) with the implementation of damage control resuscitation (DCR). We hypothesized that the implementation of DCR in patients undergoing TL is associated with better outcomes.
• Joseph, B., Khalil, M., Hashmi, A., Hecker, L., Kulvatunyou, N., Tang, A., Friese, R. S., & Rhee, P. (2017). Survival benefits of remote ischemic conditioning in sepsis. The Journal of surgical research, 213, 131-137.
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  Sepsis remains the leading cause of death in the surgical intensive care unit. Prior studies have demonstrated a survival benefit of remote ischemic conditioning (RIC) in many disease states. The aim of this study was to determine the effects of RIC on survival in sepsis in an animal model and to assess alterations in inflammatory biochemical profiles. We hypothesized that RIC alters inflammatory biochemical profiles resulting in decreased mortality in a septic mouse model.
• Joseph, B., Orouji Jokar, T., Hassan, A., Azim, A., Mohler, M. J., Kulvatunyou, N., Siddiqi, S., Phelan, H., Fain, M., & Rhee, P. (2017). Redefining the association between old age and poor outcomes after trauma: The impact of frailty syndrome. The journal of trauma and acute care surgery, 82(3), 575-581.
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  Frailty syndrome (FS) is a well-established predictor of outcomes in geriatric patients. The aim of this study was to quantify the prevalence of FS in geriatric trauma patients and to determine its association with trauma readmissions, repeat falls, and mortality at 6 months.
• Khan, M., Azim, A., O'Keeffe, T., Jehan, F., Kulvatunyou, N., Santino, C., Tang, A., Vercruysse, G., Gries, L., & Joseph, B. (2017). Geriatric rescue after surgery (GRAS) score to predict failure-to-rescue in geriatric emergency general surgery patients. American journal of surgery.
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  Geriatric-patients(GP) undergoing emergency-general-surgery(EGS) are vulnerable to develop adverse-outcomes. Impact of patient-level-factors on Failure-to-Rescue(FTR) in EGS-GP remains unclear. Aim of our study was to determine factors associated with FTR(death from major-complication) and devise simple-bedside-score that predicts FTR in EGS-GP.
• Khan, M., Jehan, F., O'Keeffe, T., Pandit, V., Kulvatunyou, N., Tang, A., Gries, L., & Joseph, B. (2017). Primary repair for pediatric colonic injury: Are there differences among adult and pediatric trauma centers?. The Journal of surgical research, 220, 176-181.
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  Management of colonic injuries (colostomy [CO] versus primary anastomosis [PA]) among pediatric patients remains controversial. The aim of this study was to assess outcomes in pediatric trauma patient with colonic injury undergoing operative intervention.
• Khan, M., O'Keeffe, T., Jehan, F., Kulvatunyou, N., Kattaa, A., Gries, L., Tang, A., & Joseph, B. (2017). The impact of Glasgow Coma Scale-age prognosis score on geriatric traumatic brain injury outcomes. The Journal of surgical research, 216, 109-114.
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  As the population ages, increasing number of geriatric patients sustain traumatic brain injury (TBI). Communication of accurate prognostic information is crucial for making informed decisions on behalf of such patients. Therefore, the aim of our study was to develop a simple and clinically applicable tool that accurately predicts the prognosis in geriatric TBI patients.
• Kulvatunyou, N. (2017). FAST Ultrasound Examination as a Predictor of Outcomes After Resuscitative Throacotomy: A Prospective Evaluation. Annals of surgery, 266(6), e76.
• Singer, M., Azim, A., O'Keeffe, T., Khan, M., Jain, A., Kulvatunyou, N., Gries, L., Jehan, F., Tang, A., & Joseph, B. (2017). How does marijuana affect outcomes after trauma in ICU patients? A propensity-matched analysis. The journal of trauma and acute care surgery, 83(5), 846-849.
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  In the United States, marijuana abuse and dependence are becoming more prevalent among adult and adolescent trauma patients. Unlike several studies that focus on the effects of marijuana on the outcomes of diseases, our aim was to assess the relationship between a positive toxicology screen for marijuana and mortality in such patients.
• Azim, A., Haider, A. A., Rhee, P., Verma, K., Windell, E., Jokar, T. O., Kulvatunyou, N., Meer, M., Latifi, R., & Joseph, B. (2016). Early feeds not force feeds: Enteral nutrition in traumatic brain injury. The journal of trauma and acute care surgery, 81(3), 520-4.
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  Brain Trauma Foundation guidelines recommend the early use of enteral nutrition to optimize recovery following traumatic brain injury (TBI). Our aim was to examine the effect of early feeds (≤24 hours) on clinical outcomes after TBI.
• Hadeed, G. J., Smith, J., O'Keeffe, T., Kulvatunyou, N., Wynne, J. L., Joseph, B., Friese, R. S., Wachtel, T. L., Rhee, P. M., El-Menyar, A., & Latifi, R. (2016). Early surgical intervention and its impact on patients presenting with necrotizing soft tissue infections: A single academic center experience. Journal of emergencies, trauma, and shock, 9(1), 22-7.
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  Early diagnosis and emergent surgical debridement of necrotizing soft tissue infections (NSTIs) remains the cornerstone of care. We aimed to study the effect of early surgery on patients' outcomes and, in particular, on hospital length of stay (LOS) and Intensive Care Unit (ICU) LOS.
• Haider, A. A., Azim, A., Rhee, P., Kulvatunyou, N., Ibraheem, K., Tang, A., O'Keeffe, T., Iftikhar, H., Vercruysse, G., & Joseph, B. (2016). Substituting systolic blood pressure with shock index in the National Trauma Triage Protocol. The journal of trauma and acute care surgery, 81(6), 1136-1141.
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  The National Trauma Triage Protocol (NTTP) is an algorithm that guides emergency medical services providers through four decision steps to identify the patients that would benefit from trauma center care. The NTTP defines a systolic blood pressure (SBP) of less than 90 mm Hg as one of the criteria for trauma center need. The aim of our study was to determine the impact of substituting SBP of less than 90 mm Hg with shock index (SI) on triage performance.
• Jokar, T. O., Khalil, M., Rhee, P., Kulvatunyou, N., Pandit, V., O'Keeffe, T., Tang, A., & Joseph, B. (2016). Ratio-based Resuscitation in Trauma Patients with Traumatic Brain Injury: Is There a Similar Effect?. The American surgeon, 82(3), 271-7.
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  The use of 1:1:1 (packed red blood cells: fresh frozen plasma: platelets) transfusion ratio has been shown to improve survival in severely injured trauma patients. The aim of this study was to assess the outcomes in patients with traumatic brain injury (TBI) receiving 1:1:1 ratio-based blood product transfusion (RBT). We hypothesized that RBT improves survival in patients with TBI as only major injury. We performed a 3-year retrospective analysis of all patients with TBI as only major injury presenting to our Level I trauma center. Patients receiving blood transfusion were included. Patients were stratified into two groups: those who received RBT and those who did not receive RBT (No-RBT). The outcome measure was inhospital mortality. Multivariate logistic regression analysis was performed. A total of 189 patients were included of which 29 per cent (n = 55) received RBT. The mean age was 48 ± 24 years, median (range) Glasgow Coma Scale score was 12 (3-15), and median head abbreviated injury severity scale was 3 (3-5). The overall mortality rate was 28.5 per cent. Patients in the RBT group had a higher survival rate compared with the patients in the No-RBT group (83.6% vs 66.5%, P = 0.02). In conclusion, the survival benefit of RBT exists even in patients with TBI as major injury. Guidelines for the initial management of TBI patients should focus on the use of RBT. The beneficial effect of platelets in RBT among TBI patients requires further evaluation.
• Jokar, t., Khalil, M., Rhee, P., Kulvatunyou, N., Pandit, v., Okeeffe, T. S., Tang, A., & Joseph, B. A. (2016). Ratio-based resuscitation in trauma patients with traumatic brain injury: Is there a similar effect. American Surgeon, 82(3), 271-277.
• Joseph, B., Azim, A., Haider, A. A., Kulvatunyou, N., O'Keeffe, T., Hassan, A., Gries, L., Tran, E., Latifi, R., & Rhee, P. (2016). Bicycle helmets work when it matters the most. American journal of surgery.
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  Helmets are known to reduce the incidence of traumatic brain injury (TBI) after bicycle-related accidents. The aim of this study was to assess the association of helmets with severity of TBI and facial fractures after bicycle-related accidents.
• Joseph, B., Hadeed, S., Haider, A. A., Ditillo, M., Joseph, A., Pandit, V., Kulvatunyou, N., Tang, A., Latifi, R., & Rhee, P. (2016). Obesity and trauma mortality: Sizing up the risks in motor vehicle crashes. Obesity research & clinical practice.
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  Protective effects of safety devices in obese motorists in motor vehicle collisions (MVC) remain unclear. Aim of our study is to assess the association between morbid obesity and mortality in MVC, and to determine the efficacy of protective devices. We hypothesised that patients with morbid obesity will be at greater risk of death after MVC.
• Joseph, B., Haider, A. A., Azim, A., Kulvatunyou, N., Tang, A., OʼKeeffe, T., Latifi, R., Green, D. J., Friese, R. S., & Rhee, P. (2016). The impact of patient protection and Affordable Care Act on trauma care: A step in the right direction. The journal of trauma and acute care surgery, 81(3), 427-34.
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  The Patient Protection and Affordable Care Act (ACA) was implemented to guarantee financial coverage for health care for all Americans. The implementation of ACA is likely to influence the insurance status of Americans and reimbursement rates of trauma centers. The aim of this study was to assess the impact of ACA on the patient insurance status, hospital reimbursements, and clinical outcomes at a Level I trauma center. We hypothesized that there would be a significant decrease in the proportion of uninsured trauma patients visiting our Level I trauma center following the ACA, and this is associated with improved reimbursement.
• Joseph, B., Haider, A., Hassan, A., Kulvatunyou, N., Bains, S., Tang, A., Zangbar, B., OʼKeeffe, T., Vercruysse, G., Gries, L., & Rhee, P. (2016). Injury prevention programs against distracted driving among students. The journal of trauma and acute care surgery, 81(1), 144-8.
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  Motor vehicle crashes are the leading cause of death and nonfatal injury among young adults. The aims of this study were to assess the magnitude of distracted driving (DD) among students and to examine the effectiveness of awareness campaign against DD. We hypothesized that DD is prevalent among students and educational efforts such as DD awareness campaign can effectively reduce it.
• Joseph, B., Haider, A., Ibraheem, K., Kulvatunyou, N., Tang, A., Azim, A., O'Keeffe, T., Gries, L., Vercruysse, G., & Rhee, P. (2016). Revitalizing Vital Signs: The Role of Delta Shock Index. Shock (Augusta, Ga.), 46(3 Suppl 1), 50-4.
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  Although variability in vital parameters has been shown to predict outcomes, the role of change in shock index (delta SI) as a predictive tool remains unknown.
• Joseph, B., Ibraheem, K., Haider, A. A., Kulvatunyou, N., Tang, A., O'Keeffe, T., Bauman, Z. M., Green, D. J., Latifi, R., & Rhee, P. (2016). Identifying potential utility of REBOA: An autopsy study. The journal of trauma and acute care surgery.
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  Resuscitative thoracotomy (RT) has been the standard therapy in patients with acute arrest due to hemorrhagic shock. However; with the development of resuscitative endovascular balloon occlusion of the aorta (REBOA), its role as a potential adjunct to a highly morbid intervention like RT is being discussed. The aim of this study was to identify patients that most likely would have potentially benefitted from REBOA use based on autopsy findings.
• Joseph, B., Ibraheem, K., Haider, A. A., Kulvatunyou, N., Tang, A., O'Keeffe, T., Bauman, Z. M., Green, D. J., Latifi, R., & Rhee, P. (2016). Identifying potential utility of resuscitative endovascular balloon occlusion of the aorta: An autopsy study. The journal of trauma and acute care surgery, 81(5 Suppl 2 Proceedings of the 2015 Military Health System Research Symposium), S128-S132.
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  Resuscitative thoracotomy (RT) has been the standard therapy in patients with acute arrest due to hemorrhagic shock. However, with the development of resuscitative endovascular balloon occlusion of the aorta (REBOA), its role as a potential adjunct to a highly morbid intervention such as RT is being discussed. The aim of this study was to identify patients who most likely would have potentially benefited from REBOA use based on autopsy findings.
• Joseph, B., Jokar, T. O., Khalil, M., Haider, A. A., Kulvatunyou, N., Zangbar, B., Tang, A., Zeeshan, M., O'Keeffe, T., Abbas, D., Latifi, R., & Rhee, P. (2016). Identifying the broken heart: predictors of mortality and morbidity in suspected blunt cardiac injury. American journal of surgery, 211(6), 982-8.
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  Blunt cardiac injury (BCI) is an infrequent but potentially fatal finding in thoracic trauma. Its clinical presentation is highly variable and patient characteristics and injury pattern have never been described in trauma patients. The aim of this study was to identify predictors of mortality in BCI patients.
• Joseph, B., Khalil, M., Harrison, C., Swartz, T., Kulvatunyou, N., Haider, A. A., Jokar, T. O., Burk, D., Mahmoud, A., Latifi, R., & Rhee, P. (2016). Assessing the Efficacy of Prothrombin Complex Concentrate in Multiply Injured Patients With High-Energy Pelvic and Extremity Fractures. Journal of orthopaedic trauma, 30(12), 653-658.
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  Prothrombin complex concentrate (PCC) is being increasingly used for reversing induced coagulopathy of trauma. However, the use of PCC for reversing coagulopathy in multiply injured patients with pelvic and/or lower extremity fractures remains unclear. The aim of our study was to assess the efficacy of PCC for reversing coagulopathy in this group of patients.
• Joseph, B., Parvaneh, S., Swartz, T., Haider, A. A., Hassan, A., Kulvatunyou, N., Tang, A., Latifi, R., Najafi, B., & Rhee, P. (2016). Stress among surgical attending physicians and trainees: A quantitative assessment during trauma activation and emergency surgeries. The journal of trauma and acute care surgery, 81(4), 723-8.
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  The adverse effects of stress on the wellness of trauma team members are well established; however, the level of stress has never been quantitatively assessed. The aim of our study was to assess the level of stress using subjective data and objective heart rate variability (HRV) among attending surgeons (ASs), junior residents (JRs) (PGY2/PGY3), and senior residents (SRs) (PGY5/PGY6) during trauma activation and emergency surgery.
• Joseph, B., Phelan, H., Hassan, A., Jokar, T. O., O'Keeffe, T., Azim, A., Gries, L., Kulvatunyou, N., Latifi, R., & Rhee, P. (2016). The impact of frailty on failure-to-rescue in geriatric trauma patients: A prospective study. The journal of trauma and acute care surgery.
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  Failure-to-rescue (FTR) (defined as death from a major complication) is considered as an index of hospital quality in trauma patients. However, the role of frailty in FTR events remains unclear. We hypothesized that FTR rate is higher in elderly frail trauma patients.
• Joseph, B., Zangbar, B., Bains, S., Kulvatunyou, N., Khalil, M., Mahmoud, D., Friese, R. S., O'Keeffe, T., Pandit, V., & Rhee, P. (2016). Injury prevention programs against distracted driving: Are they effective?. Traffic injury prevention, 17(5), 460-4.
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  Distracted driving (talking and/or texting) is a growing public safety problem, with increasing incidence among adult drivers. The aim of this study was to identify the incidence of distracted driving (DD) among health care providers and to create awareness against DD. We hypothesized that distracted driving is prevalent among health care providers and a preventive campaign against distracted driving would effectively decrease distracted driving among health care providers.
• Joseph, B., Zangbar, B., Pandit, V., Fain, M., Mohler, M. J., Kulvatunyou, N., Jokar, T. O., O'Keeffe, T., Friese, R. S., & Rhee, P. (2016). Emergency General Surgery in the Elderly: Too Old or Too Frail?. Journal of the American College of Surgeons, 222(5), 805-13.
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  Assessment of operative risk in geriatric patients undergoing emergency general surgery (EGS) is challenging. Frailty is an established measure for risk assessment in elective surgical cases. Emerging literature suggests the superiority of frailty measurements to chronological age in predicting outcomes. The aim of this study was to assess the outcomes in elderly patients undergoing EGS using an established Rockwood frailty index.
• Khalil, M., Rhee, P., Jokar, T. O., Kulvatunyou, N., O'Keeffe, T., Tang, A., Hassan, A., Gries, L., Latifi, R., & Joseph, B. (2016). Antibiotics for appendicitis! Not so fast. The journal of trauma and acute care surgery, 80(6), 923-32.
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  Emerging literature in acute appendicitis favors the nonoperative management of acute appendicitis. However, the actual use of this practice on a national level is not assessed. The aim of this study was to assess the changing trends in nonoperative management of acute appendicitis and its effects on patient outcomes.
• Kulvatunyou, N. (2016). Metoprolol improves survival in severe traumatic brain injury dependent of heart rate control. American Journal of Surgery, 200(2), 586-592.
• Pandit, V., Michailidou, M., Rhee, P., Zangbar, B., Kulvatunyou, N., Khalil, M., O'Keeffe, T., Haider, A., Gries, L., & Joseph, B. (2016). The use of whole body computed tomography scans in pediatric trauma patients: Are there differences among adults and pediatric centers?. Journal of pediatric surgery, 51(4), 649-53.
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  Whole body CT (WBCT) scan is known to be associated with significant radiation risk especially in pediatric trauma patients. The aim of this study was to assess the use WBCT scan across trauma centers for the management of pediatric trauma patients.
• Safavi, A., Skarsgard, E. D., Rhee, P., Zangbar, B., Kulvatunyou, N., Tang, A., O'Keeffe, T., Friese, R. S., & Joseph, B. (2016). Trauma center variation in the management of pediatric patients with blunt abdominal solid organ injury: a national trauma data bank analysis. Journal of pediatric surgery, 51(3), 499-502.
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  Nonoperative management of hemodynamically stable children with Solid Organ Injury (SOI) has become standard of care. The aim of this study is to identify differences in management of children with SOI treated at Adult Trauma Centers (ATC) versus Pediatric Trauma Centers (PTC). We hypothesized that patients treated at ATC would undergo more procedures than PTC.
• Safavi, A., Skarsgard, E., Rhee, P., Zangbar, B., Kulvatunyou, N., Tang, A., Friese, R. S., Okeeffe, T. S., & Joseph, B. A. (2016). Trauma Center Variation in the Management of Pediatric Patients with Blunt Abdominal Solid Organ Injury: A National Trauma Data Bank Analysis. Journal of Pediatric surgery.
• Zangbar, B., Khalil, M., Gruessner, A., Joseph, B., Friese, R., Kulvatunyou, N., Wynne, J., Latifi, R., Rhee, P., & O'Keeffe, T. (2016). Levetiracetam Prophylaxis for Post-traumatic Brain Injury Seizures is Ineffective: A Propensity Score Analysis. World journal of surgery.
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  Early seizures after severe traumatic brain injury (TBI) have a reported incidence of up to 15 %. Prophylaxis for early seizures using 1 week of phenytoin is considered standard of care for seizure prevention. However, many centers have substituted the anticonvulsant levetiracetam without good data on the efficacy of this approach. Our hypothesis was that the treatment with levetiracetam is not effective in preventing early post-traumatic seizures.
• Zangbar, B., Khalil, M., Rhee, P., Joseph, B., Kulvatunyou, N., Tang, A., Friese, R. S., & O'Keeffe, T. (2016). Metoprolol improves survival in severe traumatic brain injury independent of heart rate control. The Journal of surgical research, 200(2), 586-92.
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  Multiple prior studies have suggested an association between survival and beta-blocker administration in patients with severe traumatic brain injury (TBI). However, it is unknown whether this benefit of beta-blockers is dependent on heart rate control. The aim of this study was to assess whether rate control affects survival in patients receiving metoprolol with severe TBI. Our hypothesis was that improved survival from beta-blockade would be associated with a reduction in heart rate.
• Aziz, H., Siordia, J. A., Rhee, P., Pandit, V., O'Keeffe, T., Kulvatunyou, N., & Joseph, B. (2015). Analyzing the effects of alcohol on adolescent trauma using the National Trauma Data Bank. The journal of trauma and acute care surgery, 79(3), 463-7.
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  Alcohol misuse is an important source of preventable injuries in the adolescent population. The aim of our study was to assess the effect of alcohol in adolescent trauma outcomes.
• Branco, B., Branco, B., De Vitis, J., De Vitis, J., Joseph, B. A., Joseph, B. A., Kulvatunyou, N., Kulvatunyou, N., Tang, A., Tang, A., Friese, R. S., Friese, R. S., Rhee, P., Rhee, P., Okeeffe, T. S., & Okeeffe, T. S. (2015). Financial implications of early tracheostomy in the healthcare cost containment era. Panamerican Journal of Trauma, Critical Care and Emergency Surgery, 4(3), 1-8.
• Branco, B., De Vitis, J., Joseph, B. A., Kulvatunyou, N., Tang, A., Friese, R. S., Rhee, P., & Okeeffe, T. S. (2015). Financial implications of early tracheostomy in the healthcare cost containment era. Panamerican Journal of Trauma, Critical Care and Emergency Surgery, 4(3), 1-8.
• Haider, A. A., Rhee, P., Orouji, T., Kulvatunyou, N., Hassanzadeh, T., Tang, A., Farman, A., O'Keeffe, T., Latifi, R., & Joseph, B. (2015). A second look at the utility of serial routine repeat computed tomographic scans in patients with traumatic brain injury. American journal of surgery, 210(6), 1088-93; discussion 1093-4.
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  The practice of a routine repeat head computed tomographic scans in patients with traumatic brain injury (TBI) is under question. The aim of our study was to evaluate the utility of a more than 1 repeat head computed tomography (M1CT) scans in patients with TBI.
• Joseph, B., Haider, A. A., Pandit, V., Kulvatunyou, N., Orouji, T., Khreiss, M., Tang, A., O'Keeffe, T., Friese, R., & Rhee, P. (2015). Impact of Hemorrhagic Shock on Pituitary Function. Journal of the American College of Surgeons, 221(2), 502-8.
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  Hypopituitarism after hypovolemic shock is well established in certain patient cohorts. However; the effects of hemorrhagic shock on pituitary function in trauma patients remains unknown. The aim of this study was to assess pituitary hormone variations in trauma patients with hemorrhagic shock.
• Joseph, B., Haider, A. A., Pandit, V., Tang, A., Kulvatunyou, N., OʼKeeffe, T., & Rhee, P. (2015). Changing paradigms in the management of 2184 patients with traumatic brain injury. Annals of surgery, 262(3), 440-8; discussion 446-8.
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  The aim of this study was to assess the change in trends in the management of traumatic brain injury (TBI) at a level I trauma center and the utilization of resources as a result of this change in management.
• Joseph, B., Khalil, M., Pandit, V., Kulvatunyou, N., Zangbar, B., O'Keeffe, T., Asif, A., Tang, A., Green, D. J., Gries, L., Friese, R. S., & Rhee, P. (2015). Adverse effects of admission blood alcohol on long-term cognitive function in patients with traumatic brain injury. The journal of trauma and acute care surgery, 78(2), 403-8.
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  Alcohol is known to be protective in patients with traumatic brain injury (TBI); however, its impact on the long-term cognitive function is unknown. We hypothesize that intoxication at the time of injury is associated with adverse long-term cognitive function in patients sustaining TBI.
• Joseph, B., Khalil, M., Pandit, V., Orouji Jokar, T., Cheaito, A., Kulvatunyou, N., Tang, A., O'Keeffe, T., Vercruysse, G., Green, D. J., Friese, R. S., & Rhee, P. (2015). Increasing organ donation after cardiac death in trauma patients. American journal of surgery, 210(3), 468-72.
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  Organ donation after cardiac death (DCD) is not optimal but still remains a valuable source of organ donation in trauma donors. The aim of this study was to assess national trends in DCD from trauma patients.
• Joseph, B., Khalil, M., Zangbar, B., Kulvatunyou, N., Orouji, T., Pandit, V., O'Keeffe, T., Tang, A., Gries, L., Friese, R. S., Rhee, P., & Davis, J. W. (2015). Prevalence of Domestic Violence Among Trauma Patients. JAMA surgery, 150(12), 1177-83.
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  Domestic violence is an extremely underreported crime and a growing social problem in the United States. However, the true burden of the problem remains unknown.
• Joseph, B., Pandit, V., Aziz, H., Kulvatunyou, N., Zangbar, B., Green, D. J., Haider, A., Tang, A., O'Keeffe, T., Gries, L., Friese, R. S., & Rhee, P. (2015). Mild traumatic brain injury defined by Glasgow Coma Scale: Is it really mild?. Brain injury, 29(1), 11-6.
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  Conventionally, a Glasgow Coma Scale (GCS) score of 13-15 defines mild traumatic brain injury (mTBI). The aim of this study was to identify the factors that predict progression on repeat head computed tomography (RHCT) and neurosurgical intervention (NSI) in patients categorized as mild TBI with intracranial injury (intracranial haemorrhage and/or skull fracture).
• Joseph, B., Pandit, V., Aziz, H., Kulvatunyou, N., Zangbar, B., Tang, A., O' Keeffe, T., Jehangir, Q., Snyder, K., & Rhee, P. (2015). Transforming hemoglobin measurement in trauma patients: noninvasive spot check hemoglobin. Journal of the American College of Surgeons, 220(1), 93-8.
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  Technological advances now allow for noninvasive Hbg measurements. Previous studies have reported on the efficacy of continuous noninvasive Hgb devices. Recently, a new device, Pronto-7, a spot check pulse CO-oximeter has become available. The aim of our study was to assess noninvasive Hgb measurement in trauma patients.
• Joseph, B., Pandit, V., Haider, A. A., Kulvatunyou, N., Zangbar, B., Tang, A., Aziz, H., Vercruysse, G., O'Keeffe, T., Freise, R. S., & Rhee, P. (2015). Improving Hospital Quality and Costs in Nonoperative Traumatic Brain Injury: The Role of Acute Care Surgeons. JAMA surgery, 150(9), 866-72.
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  The role of acute care surgeons is evolving; however, no guidelines exist for the selective treatment of patients with traumatic brain injury (TBI) exclusively by acute care surgeons. We implemented the Brain Injury Guidelines (BIG) for managing TBI at our institution on March 1, 2012.
• Joseph, B., Pandit, V., Harrison, C., Lubin, D., Kulvatunyou, N., Zangbar, B., Tang, A., O'Keeffe, T., Green, D. J., Gries, L., Friese, R. S., & Rhee, P. (2015). Early thromboembolic prophylaxis in patients with blunt solid abdominal organ injuries undergoing nonoperative management: is it safe?. American journal of surgery, 209(1), 194-8.
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  The aim of this study was to compare the safety of early (≤48 hours), intermediate (48 to 72 hours), and late (≥72 hours) venous thromboembolism prophylaxis in patients with blunt abdominal solid organ injury managed nonoperatively.
• Joseph, B., Pandit, V., Khalil, M., Kulvatunyou, N., Aziz, H., Tang, A., OʼKeeffe, T., Hays, D., Gries, L., Lemole, M., Friese, R. S., & Rhee, P. (2015). Use of prothrombin complex concentrate as an adjunct to fresh frozen plasma shortens time to craniotomy in traumatic brain injury patients. Neurosurgery, 76(5), 601-7; discussion 607.
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  The use of prothrombin complex concentrate (PCC) to reverse acquired (coagulopathy of trauma) and induced coagulopathy (preinjury warfarin use) is well defined.
• Joseph, B., Pandit, V., Khalil, M., Kulvatunyou, N., Zangbar, B., Friese, R. S., Mohler, M. J., Fain, M. J., & Rhee, P. (2015). Managing older adults with ground-level falls admitted to a trauma service: the effect of frailty. Journal of the American Geriatrics Society, 63(4), 745-9.
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  To determine whether frail elderly adults are at greater risk of fracture after a ground-level fall (GLF) than those who are not frail.
• Joseph, B., Pandit, V., Zangbar, B., Kulvatunyou, N., Khalil, M., Tang, A., O'Keeffe, T., Gries, L., Vercruysse, G., Friese, R. S., & Rhee, P. (2015). Secondary brain injury in trauma patients: the effects of remote ischemic conditioning. The journal of trauma and acute care surgery, 78(4), 698-703; discussion 703-5.
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  Management of traumatic brain injury (TBI) is focused on preventing secondary brain injury. Remote ischemic conditioning (RIC) is an established treatment modality that has been shown to improve patient outcomes secondary to inflammatory insults. The aim of our study was to assess whether RIC in trauma patients with severe TBI could reduce secondary brain injury.
• Joseph, B., Rawashdeh, B., Aziz, H., Kulvatunyou, N., Pandit, V., Jehangir, Q., O'Keeffe, T., Tang, A., Green, D. J., Friese, R. S., & Rhee, P. (2015). An acute care surgery dilemma: emergent laparoscopic cholecystectomy in patients on aspirin therapy. American journal of surgery, 209(4), 689-94.
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  The current literature regarding hemorrhagic complications in patients on long-term antiplatelet therapy undergoing emergent laparoscopic cholecystectomy is limited. The aim of our study was to describe hemorrhagic complications in patients on prehospital aspirin (ASP) therapy undergoing emergent cholecystectomy.
• Joseph, B., Zangbar, B., Khalil, M., Kulvatunyou, N., Haider, A. A., O'Keeffe, T., Tang, A., Vercruysse, G., Friese, R. S., & Rhee, P. (2015). Factors associated with failure-to-rescue in patients undergoing trauma laparotomy. Surgery, 158(2), 393-8.
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  Quality improvement initiatives have focused primarily on preventing in-hospital complications. Patients developing complications are at a greater risk of mortality; however, factors associated with failure-to-rescue (death after major complication) in trauma patients remain undefined. The aim of this study was to identify risk factors associated with failure-to-rescue in patients undergoing trauma laparotomy.
• Khalil, M., Pandit, V., Rhee, P., Kulvatunyou, N., Orouji, T., Tang, A., O'Keeffe, T., Gries, L., Vercruysse, G., Friese, R. S., & Joseph, B. (2015). Certified acute care surgery programs improve outcomes in patients undergoing emergency surgery: A nationwide analysis. The journal of trauma and acute care surgery, 79(1), 60-3; discussion 64.
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  Differences in outcomes among trauma centers (TCs) and non-TCs (NTCs) in patients undergoing emergency general surgery (EGS) are well established. However; the impact of development of certified acute care surgery (ACS) programs on patient outcomes remains unknown. The aim of this study was to evaluate outcomes in patients undergoing EGS across TCs, NTCs, and TCs with ACS (ACS-TC).
• Kulvatunyou, N. (2015). A second look at the utility of serial routine repeat computed tomographic scans in patients with traumatic brain injury. American Journal of Surgery, 210(6), 1088-1094.
• Kulvatunyou, N. (2015). Hips don't lie: Waist-to-hip ratio in trauma patients. Journal of Trauma & Acute Care Surgery, 79(6), 1055-1061.
• Kulvatunyou, N. (2015). Prevalence of Domestic Violence. JAMA Surgery, 150(12), 1177-83.
• Kulvatunyou, N. (2017). FAST Ultrasound Examination as a Predictor of Outcomes After Resuscitative Throacotomy: A Prospective Evaluation. Annals of surgery.
• Kulvatunyou, N., Pandit, V., Moutamn, S., Inaba, K., Chouliaras, K., DeMoya, M., Naraghi, L., Kalb, B., Arif, H., Sravanthi, R., Joseph, B., Gries, L., Tang, A. L., & Rhee, P. (2015). A multi-institution prospective observational study of small bowel obstruction: Clinical and computerized tomography predictors of which patients may require early surgery. The journal of trauma and acute care surgery, 79(3), 393-8.
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  For patients with adhesive small bowel obstruction (ASBO), early surgery after a failed trial of nonoperative treatment can improve outcome. However, deciding which patients require early surgery is difficult, given the lack of specific clinical or radiographic signs. The study goals were to identify clinical and computed tomography (CT) predictors of which patients may need early surgery and to evaluate the utility of the common CT findings.
• Michailidou, M., Kulvatunyou, N., Joseph, B., Gries, L., Friese, R. S., Green, D., O'Keeffe, T., Tang, A. L., Vercruysse, G., & Rhee, P. (2015). Blunt bilateral diaphragmatic rupture-A right side can be easily missed. Trauma case reports, 1(9-12), 84-87.
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  Blunt diaphragmatic rupture (BDR) is uncommon with a reported incidence range of 1%-2%. The true incidence is not known. Bilateral BDR is particularly rare. We presented a case of bilateral BDR and we think that the incidence is under-recognised thanks to an easily missed and difficult to diagnose right sided injury.
• Mobily, M., Branco, B. C., Joseph, B., Hernandez, N., Catalano, R. D., Judkins, D. G., Green, D. J., Kulvatunyou, N., Rhee, P., & Tang, A. L. (2015). Predictors of failure in the Advanced Trauma Life Support course. American journal of surgery, 210(5), 942-6.
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  Over 1 million healthcare providers have participated in the Advanced Trauma Life Support course. No studies have evaluated factors that predict course performance. This study aims to identify these predictors.
• Rhee, P., Inaba, K., Pandit, V., Khalil, M., Siboni, S., Vercruysse, G., Kulvatunyou, N., Tang, A., Asif, A., O'Keeffe, T., & Joseph, B. (2015). Early autologous fresh whole blood transfusion leads to less allogeneic transfusions and is safe. The journal of trauma and acute care surgery, 78(4), 729-34.
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  The practice of transfusing ones' own shed whole blood has obvious benefits such as reducing the need for allogeneic transfusions and decreasing the need for other fluids that are typically used for resuscitation in trauma. It is not widely adopted in the trauma setting because of the concern of worsening coagulopathy and the inflammatory process. The aim of this study was to assess outcomes in trauma patients receiving whole blood autotransfusion (AT) from hemothorax.
• Tang, A. L., Diven, C., Zangbar, B., Lubin, D., Joseph, B., Green, D. J., Kulvatunyou, N., Vercruysse, G., Friese, R. S., O'Keeffe, T., & Rhee, P. (2015). The elimination of anastomosis in open trauma vascular reconstruction: A novel technique using an animal model. The journal of trauma and acute care surgery, 79(6), 937-42.
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  The standard approach to vascular trauma involves arterial exposure and reconstruction using either a vein or polytetrafluoroethylene graft. We have developed a novel technique to repairing arterial injuries by deploying commercially available vascular stents through an open approach, thus eliminating the need for suture anastomosis. The objective of this study was to evaluate the feasibility, stent deployment time (SDT), and stent patency of this technique in a ewe vascular injury model.
• Vercruysse, G. A., Friese, R. S., Khalil, M., Ibrahim-Zada, I., Zangbar, B., Hashmi, A., Tang, A., O'Keeffe, T., Kulvatunyou, N., Green, D. J., Gries, L., Joseph, B., & Rhee, P. M. (2015). Overuse of helicopter transport in the minimally injured: A health care system problem that should be corrected. The journal of trauma and acute care surgery, 78(3), 510-5.
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  Mortality benefit has been demonstrated for trauma patients transported via helicopter but at great cost. This study identified patients who did not benefit from helicopter transport to our facility and demonstrates potential cost savings when transported instead by ground.
• Zangbar, B., Pandit, V., Kulvatunyou, N., Khalil, M., Rhee, P., O'Keeffe, T., Tang, A., Gries, L., Green, D. J., Friese, R. S., & Joseph, B. (2015). Clinical outcomes in patients on preinjury ibuprofen with traumatic brain injury. American journal of surgery, 209(6), 921-6.
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  The aim of our study was to evaluate the clinical outcomes in patients on preinjury Ibuprofen with traumatic brain injury.
• Zangbar, B., Wynne, J., Joseph, B., Pandit, V., Meyer, D., Kulvatunyou, N., Khalil, M., O'Keeffe, T., Tang, A., Lemole, M., Friese, R. S., & Rhee, P. (2015). Traumatic intracranial aneurysm in blunt trauma. Brain injury, 29(5), 601-6.
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  Computed Tomography Angiography (CTA) is being used to identify traumatic intracranial aneurysms (TICA) in patients with findings such as skull fracture and intracranial haemorrhage on initial Computed Tomography (CT) scans after blunt traumatic brain injury (TBI). However, the incidence of TICA in patients with blunt TBI is unknown. The aim of this study is to report the incidence of TICA in patients with blunt TBI and to assess the utility of CTA in detecting these lesions.
• Ginwalla, R., Rhee, P., Friese, R., Green, D. J., Gries, L., Joseph, B., Kulvatunyou, N., Lubin, D., O'Keeffe, T., Vercruysse, G., Wynne, J., & Tang, A. (2014). Repeal of the concealed weapons law and its impact on gun-related injuries and deaths. The journal of trauma and acute care surgery, 76(3), 569-74; discussion 574-5.
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  Senate Bill 1108 (SB-1108) allows adult citizens to carry concealed weapons without a permit and without completion of a training course. It is unclear whether the law creates a "deterrent factor" to criminals or whether it escalates gun-related violence. We hypothesized that the enactment of SB-1108 resulted in an increase in gun-related injuries and deaths (GRIDs) in southern Arizona.
• Joseph, B., Aziz, H., Pandit, V., Hays, D., Kulvatunyou, N., Tang, A., Wynne, J., O' Keeffe, T., Green, D. J., Friese, R. S., Gruessner, R., & Rhee, P. (2014). Prothrombin complex concentrate use in coagulopathy of lethal brain injuries increases organ donation. The American surgeon, 80(4), 335-8.
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  Coagulopathy is a defined barrier for organ donation in patients with lethal traumatic brain injuries. The purpose of this study was to document our experience with the use of prothrombin complex concentrate (PCC) to facilitate organ donation in patients with lethal traumatic brain injuries. We performed a 4-year retrospective analysis of all patients with devastating gunshot wounds to the brain. The data were analyzed for demographics, change in international normalized ratio (INR), and subsequent organ donation. The primary end point was organ donation. Eighty-eight patients with lethal traumatic brain injury were identified from the trauma registry of whom 13 were coagulopathic at the time of admission (mean INR 2.2 ± 0.8). Of these 13 patients, 10 patients received PCC in an effort to reverse their coagulopathy. Mean INR before PCC administration was 2.01 ± 0.7 and 1.1 ± 0.7 after administration (P < 0.006). Correction of coagulopathy was attained in 70 per cent (seven of 10) patients. Of these seven patients, consent for donation was obtained in six patients and resulted in 19 solid organs being procured. The cost of PCC per patient was $1022 ± 544. PCC effectively reveres coagulopathy associated with lethal traumatic brain injury and enabled patients to proceed to organ donation. Although various methodologies exist for the treatment of coagulopathy to facilitate organ donation, PCC provides a rapid and cost-effective therapy for reversal of coagulopathy in patients with lethal traumatic brain injuries.
• Joseph, B., Aziz, H., Pandit, V., Hays, D., Kulvatunyou, N., Yousuf, Z., Tang, A., O'Keeffe, T., Green, D., Friese, R. S., & Rhee, P. (2014). Prothrombin complex concentrate versus fresh-frozen plasma for reversal of coagulopathy of trauma: is there a difference?. World journal of surgery, 38(8), 1875-81.
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  The development of coagulopathy of trauma is multifactorial associated with hypoperfusion and consumption of coagulation factors. Previous studies have compared the role of factor replacement versus FPP for reversal of trauma coagulopathy. The purpose of our study was to determine the time to correction of coagulopathy and blood product requirement in patients who received PCC+FFP compared with patients who received FFP alone.
• Joseph, B., Aziz, H., Pandit, V., Kulvatunyou, N., Hashmi, A., Tang, A., Sadoun, M., O'Keeffe, T., Vercruysse, G., Green, D. J., Friese, R. S., & Rhee, P. (2014). A three-year prospective study of repeat head computed tomography in patients with traumatic brain injury. Journal of the American College of Surgeons, 219(1), 45-51.
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  A definitive consensus on the standardization of practice of a routine repeat head CT (RHCT) scan in patients with traumatic intracranial hemorrhage is lacking. We hypothesized that in examinable patients without neurologic deterioration, RHCT scan does not lead to neurosurgical intervention (craniotomy/craniectomy).
• Joseph, B., Aziz, H., Pandit, V., Kulvatunyou, N., O'Keeffe, T., Tang, A., Wynne, J., Hashmi, A., Vercruysse, G., Friese, R. S., & Rhee, P. (2014). Low-dose aspirin therapy is not a reason for repeating head computed tomographic scans in traumatic brain injury: a prospective study. The Journal of surgical research, 186(1), 287-91.
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  Most studies have categorized all antiplatelet drugs into one category. The aim of our study was to evaluate the utility of repeat head computed tomography (RHCT) and outcomes in patients on low-dose aspirin (acetylsalicylic acid; ASA) therapy.
• Joseph, B., Aziz, H., Pandit, V., Kulvatunyou, N., O'Keeffe, T., Wynne, J., Tang, A., Friese, R. S., & Rhee, P. (2014). Improving survival rates after civilian gunshot wounds to the brain. Journal of the American College of Surgeons, 218(1), 58-65.
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  Gunshot wounds to the brain are the most lethal of all firearm injuries, with reported survival rates of 10% to 15%. The aim of this study was to determine outcomes in patients with gunshot wounds to the brain, presenting to our institution over time. We hypothesized that aggressive management can increase survival and the rate of organ donation in patients with gunshot wounds to the brain.
• Joseph, B., Aziz, H., Pandit, V., Kulvatunyou, N., Sadoun, M., Tang, A., O'Keeffe, T., Green, D. J., Friese, R. S., & Rhee, P. (2014). Levothyroxine therapy before brain death declaration increases the number of solid organ donations. The journal of trauma and acute care surgery, 76(5), 1301-5.
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  Protocols call for the start of hormonal therapy with levothyroxine after the declaration of brain death. As the hormonal perturbations occur during the process of brain death, the role of the early initiation of levothyroxine therapy (LT) to salvage organs is not well defined. The aim of this study was to evaluate the impact of early LT (before the declaration of brain death) on the number of solid organs procured per donor.
• Joseph, B., Aziz, H., Pandit, V., Kulvatunyou, N., Sadoun, M., Tang, A., O'Keeffe, T., Gries, L., Green, D. J., Friese, R. S., Lemole, M. G., & Rhee, P. (2014). Prospective validation of the brain injury guidelines: managing traumatic brain injury without neurosurgical consultation. The journal of trauma and acute care surgery, 77(6), 984-8.
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  To optimize neurosurgical resources, guidelines were developed at our institution, allowing the acute care surgeons to independently manage traumatic intracranial hemorrhage less than or equal to 4 mm. The aim of our study was to evaluate our established Brain Injury Guidelines (BIG 1 category) for managing patients with traumatic brain injury (TBI) without neurosurgical consultation.
• Joseph, B., Aziz, H., Sadoun, M., Kulvatunyou, N., Pandit, V., Tang, A., Wynne, J., O' Keeffe, T., Friese, R. S., Gruessner, R. W., & Rhee, P. (2014). Fatal gunshot wound to the head: the impact of aggressive management. American journal of surgery, 207(1), 89-94.
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  Patients with fatal gunshot wounds (GSWs) to the head often have poor outcomes but are ideal candidates for organ donation. The purpose of this study was to evaluate the effects of aggressive management on organ donation in patient with fatal GSWs to the head.
• Joseph, B., Aziz, H., Snell, M., Pandit, V., Hays, D., Kulvatunyou, N., Tang, A., O'Keeffe, T., Wynne, J., Friese, R. S., & Rhee, P. (2014). The physiological effects of hyperosmolar resuscitation: 5% vs 3% hypertonic saline. American journal of surgery, 208(5), 697-702.
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  Use of 5% normal saline (NS) is gaining renewed interest. The primary aim of our study was to compare the physiological effects after the administration of different concentrations of hypertonic saline (3% vs 5%NS) in the initial resuscitation of trauma.
• Joseph, B., Aziz, H., Zangbar, B., Kulvatunyou, N., Pandit, V., O'Keeffe, T., Tang, A., Wynne, J., Friese, R. S., & Rhee, P. (2014). Acquired coagulopathy of traumatic brain injury defined by routine laboratory tests: which laboratory values matter?. The journal of trauma and acute care surgery, 76(1), 121-5.
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  Coagulopathy is a major determinant of disability and death in patients with traumatic intracranial hemorrhage. However, the correlation between coagulopathy defined by routine coagulation tests and clinical outcomes in traumatic brain injury (TBI) is not well defined. The aim of our study was to determine the effect of coagulopathy diagnosed by routine laboratory tests on outcomes in TBI patients.
• Joseph, B., Friese, R. S., Sadoun, M., Aziz, H., Kulvatunyou, N., Pandit, V., Wynne, J., Tang, A., O'Keeffe, T., & Rhee, P. (2014). The BIG (brain injury guidelines) project: defining the management of traumatic brain injury by acute care surgeons. The journal of trauma and acute care surgery, 76(4), 965-9.
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  It is becoming a standard practice that any "positive" identification of a radiographic intracranial injury requires transfer of the patient to a trauma center for observation and repeat head computed tomography (RHCT). The purpose of this study was to define guidelines-based on each patient's history, physical examination, and initial head CT findings-regarding which patients require a period of observation, RHCT, or neurosurgical consultation.
• Joseph, B., Khalil, M., Pandit, V., Kulvatunyou, N., Zangbar, B., Tang, A., O'Keeffe, T., Snyder, K., Green, D. J., Gries, L., Friese, R. S., & Rhee, P. (2014). Hypothermia in organ donation: a friend or foe?. The journal of trauma and acute care surgery, 77(4), 559-63.
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  Hypothermia is a known predictor of mortality in trauma patients; however, its impact on organ procurement has not been defined. The aim of this study was to assess the effect of hypothermia on organ procurement. We hypothesized that admission hypothermia impedes successful organ procurement.
• Joseph, B., Pandit, V., Aziz, H., Kulvatunyou, N., Hashmi, A., Tang, A., O'Keeffe, T., Wynne, J., Vercruysse, G., Friese, R. S., & Rhee, P. (2014). Clinical outcomes in traumatic brain injury patients on preinjury clopidogrel: a prospective analysis. The journal of trauma and acute care surgery, 76(3), 817-20.
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  Patients receiving antiplatelet medications are considered to be at an increased risk for traumatic intracranial hemorrhage after blunt head trauma. However, most studies have categorized all antiplatelet drugs into one category. The aim of our study was to evaluate clinical outcomes and the requirement of a repeat head computed tomography (RHCT) in patients on preinjury clopidogrel therapy.
• Joseph, B., Pandit, V., Hadeed, G., Kulvatunyou, N., Zangbar, B., Tang, A., O'Keeffe, T., Wynne, J., Green, D. J., Friese, R. S., & Rhee, P. (2014). Unveiling posttraumatic stress disorder in trauma surgeons: a national survey. The journal of trauma and acute care surgery, 77(1), 148-54; discussion 154.
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  The significance of posttraumatic stress disorder (PTSD) in trauma patients is well recognized. The impact trauma surgeons endure in managing critical trauma cases is unknown. The aim of our study was to assess the incidence of PTSD among trauma surgeons and identify risk factors associated with the development of PTSD.
• Joseph, B., Pandit, V., Meyer, D., Butvidas, L., Kulvatunyou, N., Khalil, M., Tang, A., Zangbar, B., O'Keeffe, T., Gries, L., Friese, R. S., & Rhee, P. (2014). The significance of platelet count in traumatic brain injury patients on antiplatelet therapy. The journal of trauma and acute care surgery, 77(3), 417-21.
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  Platelet dysfunction has been attributed to progression of initial intracranial hemorrhage (ICH) on repeat head computed tomographic (RHCT) scans in patients on prehospital antiplatelet therapy. However, there is little emphasis on the effect of platelet count and progression of ICH in patients with traumatic brain injury. The aim of this study was to determine the platelet count cutoff for progression on RHCT and neurosurgical intervention in patients on antiplatelet therapy.
• Joseph, B., Pandit, V., Rhee, P., Aziz, H., Sadoun, M., Wynne, J., Tang, A., Kulvatunyou, N., O'Keeffe, T., Fain, M. J., & Friese, R. S. (2014). Predicting hospital discharge disposition in geriatric trauma patients: is frailty the answer?. The journal of trauma and acute care surgery, 76(1), 196-200.
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  The frailty index (FI) has been shown to predict outcomes in geriatric patients. However, FI has never been applied as a prognostic measure after trauma. The aim of our study was to identify hospital admission factors predicting discharge disposition in geriatric trauma patients.
• Joseph, B., Pandit, V., Wynne, J., Aziz, H., Tang, A., Kulvatunyou, N., Webster, A., O'Keeffe, T., Ziemba, M., Friese, R. S., Weinstein, R. S., & Rhee, P. (2014). Telephotography in trauma: a 2-year clinical experience. Telemedicine journal and e-health : the official journal of the American Telemedicine Association, 20(4), 342-5.
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  Smartphones can be used to record and transmit high-quality clinical photographs. The aim of this study was to describe our experience with smartphone telephotography in the care of trauma patients. We hypothesized that smartphone telephotography can be safely and effectively implemented on a trauma service.
• Joseph, B., Pandit, V., Zangbar, B., Kulvatunyou, N., Hashmi, A., Green, D. J., O'Keeffe, T., Tang, A., Vercruysse, G., Fain, M. J., Friese, R. S., & Rhee, P. (2014). Superiority of frailty over age in predicting outcomes among geriatric trauma patients: a prospective analysis. JAMA surgery, 149(8), 766-72.
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  The Frailty Index (FI) is a known predictor of adverse outcomes in geriatric patients. The usefulness of the FI as an outcome measure in geriatric trauma patients is unknown.
• Joseph, B., Pandit, V., Zangbar, B., Kulvatunyou, N., Tang, A., O'Keeffe, T., Green, D. J., Vercruysse, G., Fain, M. J., Friese, R. S., & Rhee, P. (2014). Validating trauma-specific frailty index for geriatric trauma patients: a prospective analysis. Journal of the American College of Surgeons, 219(1), 10-17.e1.
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  The Frailty Index has been shown to predict discharge disposition in geriatric patients. The aim of this study was to validate the modified 15-variable Trauma-Specific Frailty Index (TSFI) to predict discharge disposition in geriatric trauma patients. We hypothesized that TSFI can predict discharge disposition in geriatric trauma patients.
• Joseph, B., Sadoun, M., Aziz, H., Tang, A., Wynne, J. L., Pandit, V., Kulvatunyou, N., O'Keeffe, T., Friese, R. S., & Rhee, P. (2014). Repeat head computed tomography in anticoagulated traumatic brain injury patients: still warranted. The American surgeon, 80(1), 43-7.
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  Anticoagulation agents are proven risk factors for intracranial hemorrhage (ICH) in traumatic brain injury (TBI). The aim of our study is to describe the epidemiology of prehospital coumadin, aspirin, and Plavix (CAP) patients with ICH and evaluate the use of repeat head computed tomography (CT) in this group. We performed a retrospective study from our trauma registry. All patients with intracranial hemorrhage on initial CT with prehospital CAP therapy were included. Demographics, CT scan findings, number of repeat CT scans, progressive findings, and neurosurgical intervention were abstracted. A comparison between prehospital CAP and no-CAP patients was done using χ(2) and Mann-Whitney U test. A total of 1606 patients with blunt TBI charts were reviewed of whom 508 patients had intracranial bleeding on initial CT scan and 72 were on prehospital CAP therapy. CAP patients were older (P < 0.001), had higher Injury Severity Score and head Abbreviated Injury Scores on admission (P < 0.001), were more likely to present with an abnormal neurologic examination (P = 0.004), and had higher hospital and intensive care unit lengths of stay (P < 0.005). Eighty-four per cent of patients were on antiplatelet therapy and 27 per cent were on warfarin. The CAP patients have a threefold increase in the rate of worsening repeat head CT (26 vs 9%, P < 0.05). Prehospital CAP therapy is high risk for progression of bleeding on repeat head CT. Routine repeat head CT remains an important component in this patient population and can provide useful information.
• Joseph, B., Zangbar, B., Pandit, V., Kulvatunyou, N., Haider, A., O'Keeffe, T., Khalil, M., Tang, A., Vercruysse, G., Gries, L., Friese, R. S., & Rhee, P. (2014). Mortality after trauma laparotomy in geriatric patients. The Journal of surgical research, 190(2), 662-6.
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  Geriatric patients are at higher risk for adverse outcomes after injury because of their altered physiological reserve. Mortality after trauma laparotomy remains high; however, outcomes in geriatric patients after trauma laparotomy have not been well established. The aim of our study was to identify factors predicting mortality in geriatric trauma patients undergoing laparotomy.
• Joseph, B., Zangbar, B., Pandit, V., Vercruysse, G., Aziz, H., Kulvatunyou, N., Wynne, J., O'Keeffe, T., Tang, A., Friese, R. S., & Rhee, P. (2014). The conjoint effect of reduced crystalloid administration and decreased damage-control laparotomy use in the development of abdominal compartment syndrome. The journal of trauma and acute care surgery, 76(2), 457-61.
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  Anticipation of abdominal compartment syndrome (ACS) is a factor for performing damage-control laparotomy (DCL). Recent years have seen changes in resuscitation patterns and a decline in the use of DCL. We hypothesized that reductions in both crystalloid resuscitation and the use of DCL is associated with a reduced rate of ACS in trauma patients.
• Kulvatunyou, N. (2014). Age and mortality after injury: is the association linear?. European Journal of Trauma & Emergency Surgery, 40(5), 567-572.
• Kulvatunyou, N. (2014). Delayed hemorrhagic complications in the nonoperative management of blunt splenic trauma. The journal of trauma and acute care surgery, 77(5), 800.
• Kulvatunyou, N., Erickson, L., Vijayasekaran, A., Gries, L., Joseph, B., Friese, R. F., O'Keeffe, T., Tang, A. L., Wynne, J. L., & Rhee, P. (2014). Randomized clinical trial of pigtail catheter versus chest tube in injured patients with uncomplicated traumatic pneumothorax. The British journal of surgery, 101(2), 17-22.
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  Small pigtail catheters appear to work as well as the traditional large-bore chest tubes in patients with traumatic pneumothorax, but it is not known whether the smaller pigtail catheters are associated with less tube-site pain. This study was conducted to compare tube-site pain following pigtail catheter or chest tube insertion in patients with uncomplicated traumatic pneumothorax.
• Kulvatunyou, N., Watt, J., Friese, R. S., Gries, L., Green, D. J., Joseph, B., O'Keeffe, T., Tang, A. L., Vercruysse, G., & Rhee, P. (2014). Management of acute mild gallstone pancreatitis under acute care surgery: should patients be admitted to the surgery or medicine service?. American journal of surgery, 208(6), 981-7; discussion 986-7.
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  We hypothesized that patients with acute mild gallstone pancreatitis (GSP) admitted to surgery (SUR; vs medicine [MED]) had a shorter time to surgery, shorter hospital length of stay (HLOS), and lower costs.
• Michailidou, M., Kulvatunyou, N., Friese, R. S., Gries, L., Green, D. J., Joseph, B., O'Keeffe, T., Tang, A. L., Vercruysse, G., & Rhee, P. (2014). Time and cost analysis of gallbladder surgery under the acute care surgery model. The journal of trauma and acute care surgery, 76(3), 710-4.
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  The acute care surgery (ACS) model has been shown to improve work flow efficiency and to reduce hospital stay. We hypothesized that, in patients with gallbladder (GB) disease who were admitted through our emergency department (ED) and then underwent surgery, the ACS model shortened the time to surgery, decreased the length of hospital stay, and reduced hospital costs.
• Pandit, V., Patel, N., Rhee, P., Kulvatunyou, N., Aziz, H., Green, D. J., O'Keeffe, T., Zangbar, B., Tang, A., Gries, L., Friese, R. S., & Joseph, B. (2014). Effect of alcohol in traumatic brain injury: is it really protective?. The Journal of surgical research, 190(2), 634-9.
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  Studies have proposed a neuroprotective role for alcohol (ETOH) in traumatic brain injury (TBI). We hypothesized that ETOH intoxication is associated with mortality in patients with severe TBI.
• Pandit, V., Rhee, P., Hashmi, A., Kulvatunyou, N., Tang, A., Khalil, M., O'Keeffe, T., Green, D., Friese, R. S., & Joseph, B. (2014). Shock index predicts mortality in geriatric trauma patients: an analysis of the National Trauma Data Bank. The journal of trauma and acute care surgery, 76(4), 1111-5.
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  Heart rate and systolic blood pressure are unreliable in geriatric trauma patients. Shock index (SI) (heart rate/systolic blood pressure) is a simple marker of worse outcomes after injury. The aim of this study was to assess the utility of SI in predicting outcomes. We hypothesized that SI predicts mortality in geriatric trauma patients.
• Rhee, P., Joseph, B., Pandit, V., Aziz, H., Vercruysse, G., Kulvatunyou, N., & Friese, R. S. (2014). Increasing trauma deaths in the United States. Annals of surgery, 260(1), 13-21.
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  To determine the impact of the increasing aging population on trauma mortality relative to mortality from cancer and heart disease in the United States.
• Safavi, A., Rhee, P., Pandit, V., Kulvatunyou, N., Tang, A., Aziz, H., Green, D., O'Keeffe, T., Vercruysse, G., Friese, R. S., & Joseph, B. (2014). Children are safer in states with strict firearm laws: a National Inpatient Sample study. The journal of trauma and acute care surgery, 76(1), 146-50; discussion 150-1.
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  Firearm control laws vary across the United States and remain state specific. The aim of this study was to determine the relationship between variation in states' firearm control laws and the risk of firearm-related injuries in pediatric population. We hypothesized that strict firearm control laws impact the incidence of pediatric firearm injury.
• Tang, A., Hashmi, A., Narong, K., Joseph, B., Viraj, P., Vercruysse, G., Zangbar, B., Gries, L., O'Keeffe, T., Green, D., Friese, R., & Rhee, P. (2014). A critical analysis of secondary overtriage to a Level I trauma center. The journal of trauma and acute care surgery, 77(6), 969-73.
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  Trauma centers often receive transfers from lower-level trauma centers or nontrauma hospitals. The aim of this study was to analyze the incidence and pattern of secondary overtriage to our Level I trauma center.
• Aziz, H., Rhee, P., Pandit, V., Ibrahim-Zada, I., Kulvatunyou, N., Wynne, J., Zangbar, B., O'Keeffe, T., Tang, A., Friese, R. S., & Joseph, B. (2013). Mild and moderate pediatric traumatic brain injury: replace routine repeat head computed tomography with neurologic examination. The journal of trauma and acute care surgery, 75(4), 550-4.
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  Opinion is divided on the role of routine repeat head computed tomography (RHCT) for guiding clinical management in pediatric patients with blunt head trauma. We hypothesize that routine RHCT does not lead to change in management in mild and moderate traumatic brain injury (TBI).
• Glazer, E. S., Kulvatunyou, N., Green, D. J., Gries, L., Joseph, B., O'Keeffe, T., Tang, A. L., Wynne, J. L., Friese, R. S., & Rhee, P. M. (2013). Contemporary acute care surgery percutaneous endoscopic gastrostomy tube placement: an extreme bumper height and complications. The journal of trauma and acute care surgery, 75(5), 859-63.
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  As the role of acute care surgery (ACS) becomes more prevalent, clinicians in this specialty will be placing more percutaneous endoscopic gastrostomy (PEG) tubes. In this contemporary series of ACS PEG procedures, we hypothesized that technical aspects of PEG tube placement may play an important role.
• Joseph, B., Aziz, H., Sadoun, M., Kulvatunyou, N., Tang, A., O'Keeffe, T., Wynne, J., Gries, L., Green, D. J., Friese, R. S., & Rhee, P. (2013). The acute care surgery model: managing traumatic brain injury without an inpatient neurosurgical consultation. The journal of trauma and acute care surgery, 75(1), 102-5; discussion 105.
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  Neurosurgical services are a limited resource and effective use of them would improve the health care system. Acute care surgeons (ACS) are accustomed to treating mild traumatic brain injury (TBI) including those with minor radiographic intracranial injuries. We hypothesized that ACS safely manage mild TBI with intracranial hemorrhage (ICH) on head computed tomographic (CT) scan without neurosurgical consultation (NC).
• Joseph, B., Hadjizacharia, P., Aziz, H., Kulvatunyou, N., Tang, A., Pandit, V., Wynne, J., O'Keeffe, T., Friese, R. S., & Rhee, P. (2013). Prothrombin complex concentrate: an effective therapy in reversing the coagulopathy of traumatic brain injury. The journal of trauma and acute care surgery, 74(1), 248-53.
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  Coagulopathy in patients with traumatic brain injury (TBI) is a well-studied concept. Prothrombin complex concentrate (PCC) has been shown to be an effective treatment modality for correction of TBI coagulopathy. However, its use and effectiveness compared with recombinant factor VII (rFVIIa) in TBI has not been established. The purpose of this study was to compare PCC and rFVIIa for the correction of TBI coagulopathy.
• Joseph, B., Hadjizacharia, P., Aziz, H., Snyder, K., Wynne, J., Kulvatunyou, N., Tang, A., O'Keeffe, T., Latifi, R., Friese, R., & Rhee, P. (2013). Continuous noninvasive hemoglobin monitor from pulse ox: ready for prime time?. World journal of surgery, 37(3), 525-9.
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  Advances in technology have allowed for continuous noninvasive hemoglobin monitoring (SpHb), which may enable earlier detection of hemorrhage and more efficient surgical and/or blood transfusion management. The use of SpHb has not been described in the trauma population. The purpose of the present study was to evaluate the accuracy of a SpHb measurement device in severely injured trauma patients.
• Joseph, B., Pandit, V., Aziz, H., Tang, A., Kulvatunyou, N., Wynne, J., Hsu, P., O'Keeffe, T., Gries, L., Friese, R. S., & Rhee, P. (2013). Rehabilitation after trauma; does age matter?. The Journal of surgical research, 184(1), 541-5.
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  Variability exits in the ability to predict overall recovery after trauma and inpatient rehabilitation. The aim of this study was to identify factors predicting functional improvement in trauma patients undergoing inpatient rehabilitation.
• Joseph, B., Pandit, V., Khreiss, M., Aziz, H., Kulvatunyou, N., Tang, A., Wynne, J., O'Keeffe, T., Friese, R. S., Weinstein, R. S., & Rhee, P. (2013). Improving communication in level 1 trauma centers: replacing pagers with smartphones. Telemedicine journal and e-health : the official journal of the American Telemedicine Association, 19(3), 150-4.
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  Communication among healthcare providers continues to change, and 90% of healthcare providers are now carrying cellular phones. Compared with pagers, the rate and amount of information immediately available via cellular phones are far superior. Wireless devices such as smartphones are ideal in acute trauma settings as they can transfer patient information quickly in a coordinate manner to all the team members responsible for patient care.
• Joseph, B., Pandit, V., Sadoun, M., Larkins, C. G., Kulvatunyou, N., Tang, A., Mino, M., Friese, R. S., & Rhee, P. (2013). A prospective evaluation of platelet function in patients on antiplatelet therapy with traumatic intracranial hemorrhage. The journal of trauma and acute care surgery, 75(6), 990-4.
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  Platelet transfusion is increasingly used in patients with traumatic intracranial hemorrhage (ICH) on aspirin therapy to minimize the progression of ICH. We hypothesized (null) that platelet transfusion in this cohort of patients does not improve platelet function.
• Kulvatunyou, N. (2013). Association between side-impact airbag deployment and risk of injury: a matched cohort study using the CIREN and the NASS-CDS. The journal of trauma and acute care surgery, 74(5), 1378-9.
• Kulvatunyou, N. (2013). Validation of the ROPE index. The journal of trauma and acute care surgery, 74(3), 948.
• Kulvatunyou, N., Bender, J. S., & Albrecht, R. M. (2013). Traumatic abdominal wall hernia classification. The journal of trauma and acute care surgery, 75(3), 536.
• Lubin, D., Tang, A. L., Friese, R. S., Martin, M., Green, D. J., Jones, T., Means, R. R., Ginwalla, R., O'Keeffe, T. S., Joseph, B. A., Wynne, J. L., Kulvatunyou, N., Vercruysse, G., Gries, L., & Rhee, P. (2013). Modified Veress needle decompression of tension pneumothorax: a randomized crossover animal study. The journal of trauma and acute care surgery, 75(6), 1071-5.
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  The current prehospital standard of care using a large bore intravenous catheter for tension pneumothorax (tPTX) decompression is associated with a high failure rate. We developed a modified Veress needle (mVN) for this condition. The purpose of this study was to evaluate the effectiveness and safety of the mVN as compared with a 14-gauge needle thoracostomy (NT) in a swine tPTX model.
• Blecker, N., Rhee, P., Judkins, D. G., Wynne, J. L., Friese, R. S., Kulvatunyou, N., Latifi, R., & O'Keeffe, T. (2012). Pediatric all-terrain vehicle trauma: the epidemic continues unabated. Pediatric emergency care, 28(5), 443-7.
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  The popularity of all-terrain vehicles (ATVs) continues to increase, but this form of recreation is not as well regulated and can impact children disproportionately. This study examines the epidemiology of ATV injuries in Arizona with emphasis on pediatric injuries and compares ATV injuries to those associated with motorcycle (MCC) and motor vehicle crashes (MVC).
• DuBose, J., Inaba, K., Demetriades, D., Scalea, T. M., O'Connor, J., Menaker, J., Morales, C., Konstantinidis, A., Shiflett, A., Copwood, B., & , A. R. (2012). Management of post-traumatic retained hemothorax: a prospective, observational, multicenter AAST study. The journal of trauma and acute care surgery, 72(1), 11-22; discussion 22-4; quiz 316.
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  The natural history and optimal management of retained hemothorax (RH) after chest tube placement is unknown. The intent of our study was to determine practice patterns used and identify independent predictors of the need for thoracotomy.
• DuBose, J., Inaba, K., Okoye, O., Demetriades, D., Scalea, T., O'Connor, J., Menaker, J., Morales, C., Shiflett, T., Brown, C., Copwood, B., & , A. R. (2012). Development of posttraumatic empyema in patients with retained hemothorax: results of a prospective, observational AAST study. The journal of trauma and acute care surgery, 73(3), 752-7.
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  The natural history of retained hemothorax (RH), in particular factors contributing to the subsequent development of empyema, is not well known. The intent of our study was to establish the modern incidence of empyema among patients with trauma and RH and identify the independent predictors for development of this complication.
• Joseph, B. A., Joseph, B. A., Kulvatunyou, N., Kulvatunyou, N., Okeeffe, T. S., Okeeffe, T. S., Tang, A., Tang, A., Friese, R. S., & Friese, R. S. (2012). Does the added workload of emergency general surgery negatively impact trauma outcome. Journal of Surgical Research, 179(2), 347.
• Joseph, B. A., Joseph, B. A., Kulvatunyou, N., Kulvatunyou, N., Tang, A., Tang, A., Okeeffe, T. S., Okeeffe, T. S., Friese, R. S., & Friese, R. S. (2012). Are all trauma centers equal: analyzing pediatric outcomes. Journal of the American College of Surgeons, Volume: 215(Issue: 3), s100. doi:DOI: 10.1016/j.jamcollsurg.2012.06.266
• Joseph, B., Amini, A., Friese, R. S., Houdek, M., Hays, D., Kulvatunyou, N., Wynne, J., O'Keeffe, T., Latifi, R., & Rhee, P. (2012). Factor IX complex for the correction of traumatic coagulopathy. The journal of trauma and acute care surgery, 72(4), 828-34.
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  Damage control resuscitation advocates correction of coagulopathy; however, options are limited and expensive. The use of prothrombin complex concentrate (PCC), also known as factor IX complex, can quickly accelerate reversal of coagulopathy at relatively low cost. The purpose of this study is to describe our experience in the use of factor IX complex in coagulopathic trauma patients.
• Kulvatunyou, N., Friese, R. S., Joseph, B., O'Keeffe, T., Wynne, J. L., Tang, A. L., & Rhee, P. (2012). Incidence and pattern of cervical spine injury in blunt assault: it is not how they are hit, but how they fall. The journal of trauma and acute care surgery, 72(1), 271-5.
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  The injury mechanism of blunt cervical spine injury (CSI) involves two forces: (1) an acceleration-deceleration force or change in velocity (delta v) that causes significant head and neck movement, resulting in flexion-extension injury pattern and (2) a direct force to the head or face against an immovable object with force transmitted down the cervical spine. Combining those two forces creates what bioengineers call imparted energy (IE). In blunt assault to the head or face, IE is low; hence, the reported incidence of CSI is low. The goal of our study was to identify the incidence, pattern, and outcome of CSI in blunt assaulted patients.
• Kulvatunyou, N., Joseph, B., Friese, R. S., Green, D., Gries, L., O'Keeffe, T., Tang, A. L., Wynne, J. L., & Rhee, P. (2012). 14 French pigtail catheters placed by surgeons to drain blood on trauma patients: is 14-Fr too small?. The journal of trauma and acute care surgery, 73(6), 1423-7.
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  Small 14F pigtail catheters (PCs) have been shown to drain air quite well in patients with traumatic pneumothorax (PTX). But their effectiveness in draining blood in patients with traumatic hemothorax (HTX) or hemopneumothorax (HPTX) is unknown. We hypothesized that 14F PCs can drain blood as well as large-bore 32F to 40F chest tubes. We herein report our early case series experience with PCs in the management of traumatic HTX and HPTX.
• Kulvatunyou, N., Joseph, B., Gries, L., Friese, R. S., Green, D., O'Keeffe, T., Wynne, J. L., Tang, A. L., & Rhee, P. (2012). A prospective cohort study of 200 acute care gallbladder surgeries: the same disease but a different approach. The journal of trauma and acute care surgery, 73(5), 1039-45.
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  For patients who present to the emergency department (ED) with symptomatic cholelithiasis, surgery is indicated only if they are diagnosed of acute cholecystitis (AC). We hypothesized that, because preoperative signs and diagnostic tests are not sensitive enough to diagnose AC, coupled with the potential health care burden of non-AC gallbladder, surgery may be offered sooner.
• Latifi, R., Joseph, B., Kulvatunyou, N., Wynne, J. L., O'Keeffe, T., Tang, A., Friese, R., & Rhee, P. M. (2012). Enterocutaneous fistulas and a hostile abdomen: reoperative surgical approaches. World journal of surgery, 36(3), 516-23.
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  Damage-control surgery and open-abdomen is an acceptable—and often lifesaving—approach to the treatment of patients with severe trauma, abdominal compartment syndrome, necrotizing soft tissue catastrophes, and other abdominal disasters, when closing the abdomen is not possible, ill advised, or will have serious sequelae. However, common consequences of open-abdomen management include large abdominal wall defects, enterocutaneous fistulas (ECFs), and enteroatmospheric fistulas (EAFs). Furthermore, in such patients, a frozen and hostile abdomen (alone or combined with ECFs) is not uncommon. Adding biologic mesh to our surgical armamentarium has revolutionized hernia surgery.
• Diven, C., Joseph, B. A., Kulvatunyou, N., Friese, R. S., Tang, A., & Okeeffe, T. S. (2011). Albuterol and Ipratropium Are Associated With Increased Ventilator-Associated Pneumonia Rates in Intubated Trauma Patients. Critical Care Medicine, 39(12), 197.
• Joseph, B. A., Tang, A., Friese, R. S., Okeeffe, T. S., Kulvatunyou, N., Con, J., Rhee, P., & Latifi, R. (2011). Evidence based immune-modulating nutritional therapy in critically ill and injured patients. European Surgery, 91(3), 579-593.
• Kulvatunyou, N. (2011). National emergency x-radiography utilization study criteria is inadequate to rule out fracture after significant blunt trauma compared with computed tomography. The Journal of trauma, 71(4), 1093-4.
• Kulvatunyou, N., Albrecht, R. M., Bender, J. S., Friese, R. S., Joseph, B., Latifi, R., O'Keefe, T., Wynn, J. L., & Rhee, P. M. (2011). Seatbelt triad: severe abdominal wall disruption, hollow viscus injury, and major vascular injury. The American surgeon, 77(5), 534-8.
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  The triad of seatbelt-related severe abdominal wall disruption, hollow viscus injury, and distal abdominal aortic injury after a motor vehicle collision is uncommon. We present a small case series involving those three clinical features with the goal of preventing a future missed diagnosis of the distal abdominal aortic injury in particular.
• Kulvatunyou, N., Joseph, B. A., Tang, A., Okeeffe, T. S., Wynne, J., Friese, R. S., Latifi, R., & Rhee, P. (2011). Gut access in critically ill and injured patients: where have we gone thus far?. European Surgery, 43(1), 24-29.
• Kulvatunyou, N., Rhee, P. M., Carter, S. N., Roberts, P. M., Lees, J. S., Bender, J. S., & Albrecht, R. M. (2011). Defining incidence and outcome of contrast-induced nephropathy among trauma: is it overhyped?. The American surgeon, 77(6), 686-9.
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  Contrast-induced nephropathy (CIN) in trauma patients is uncommon and the incidence is unknown. We studied the incidence of CIN and its outcome. A retrospective chart review of trauma patients 16 years of age and older who were admitted to our Level I trauma center during 2005 was performed. Patients who received the intravenous contrast CT scan and had their serum creatinine (Cr) monitored at admission and at 48 to 72 hours were identified. CIN was defined as a 0.5-mg/dL rise of serum Cr or a 25 per cent increase from the baseline if the baseline Cr was abnormal. We excluded patients transferred from an outside facility, patients without repeated serum Cr measurements, patients who had cardiac arrest or persistent hypotension, and patients who had received N-acetylcysteine (Mucomyst) before their CT scan. We compared CIN and non-CIN groups. During 2005, 543 fit our study criteria, of whom 19 (3.5%) had CIN. CIN (vs non-CIN) had a higher baseline serum Cr (1.48 + 0.23 vs 1.06 + 0.02, P < 0.001), a longer intensive care unit stay (17 vs 5 days, P < 0.001), and a longer hospital stay (19 vs 8 days, P < 0.001); the mortality rate was not different (10 vs 4%, P = 0.2). We found elevated baseline serum Cr (OR, 1.92; 95% CI, 1.13 to 3.27; P = 0.016) to be associated with increased risk for CIN. All but two serum Cr levels peaked within 48 hours; all returned to baseline. One patient with an underlying congenital kidney disease required temporary dialysis. CIN incidence in trauma is low and the clinical course is benign.
• Kulvatunyou, N., Vijayasekaran, A., Hansen, A., Wynne, J. L., O'Keeffe, T., Friese, R. S., Joseph, B., Tang, A., & Rhee, P. (2011). Two-year experience of using pigtail catheters to treat traumatic pneumothorax: a changing trend. The Journal of trauma, 71(5), 1104-7; discussion 1107.
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  The traditional treatment of patients with traumatic hemopneumothorax has been an insertion of a chest tube (CT). But CT, because of its large caliber and significant trauma during an insertion, can cause pain, prevent full lung expansion, and worsen pulmonary outcome. Pigtail catheters (PCs) are smaller and less invasive; they have worked well in patients with nontraumatic pneumothorax (PTX). The purpose of this study was to review our early experience of PC use in trauma patients.
• Raoof, M., Joseph, B. A., Friese, R. S., Kulvatunyou, N., O'Keeffe, T., Tang, A., Wynne, J., Latifi, R., & Rhee, P. (2011). Organ donation after traumatic cardiopulmonary arrest. American journal of surgery, 202(6), 701-5; discussion 705-6.
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  The gap between demand of transplantable organs and their supply continues to widen. Trauma patients constitute a significant proportion of organ donors. The incidence of organ donation after traumatic cardiopulmonary arrest (TCPA), however, is not clear. The goals of this study were to determine the success rate of organ donation in patients undergoing cardiopulmonary resuscitation (CPR) after trauma and to determine if there are variables that may predict successful organ donation.
• Higa, G., Friese, R., O'Keeffe, T., Wynne, J., Bowlby, P., Ziemba, M., Latifi, R., Kulvatunyou, N., & Rhee, P. (2010). Damage control laparotomy: a vital tool once overused. The Journal of trauma, 69(1), 53-9.
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  Trauma surgery is in constant evolution as is the use of damage control laparotomy (DCL). The purpose of this study was to report the change in usage of DCL over time and its effect on outcome.
• Kulvatunyou, N. (2010). Clinical examination in complement with computed tomography scan: an effective method for identification of cervical spine injury. The Journal of trauma, 68(5), 1269.
• Kulvatunyou, N., Lees, J. S., Bender, J. B., Bright, B., & Albrecht, R. (2010). Decreased use of cervical spine clearance in blunt trauma: the implication of the injury mechanism and distracting injury. Accident; analysis and prevention, 42(4), 1151-5.
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  Cervical spine injury (CSI) can be ruled out based on clinical examination and no X-ray is required if patient is awake, alert, and examinable. This is known as a clinical clearance (CC). Clinicians have decreased the use and reliance of CC and relied more upon X-ray, especially now that computerized tomography (CT) is fast and readily available. The objective of this study was to identify clinical factors, in particular, the injury mechanism and the distracting injuries, which may be associated with CSI. The knowledge may help to improve the use of CC.
• Vander Werf, B. D., Watt, J., Joseph, B., Wynne, J., Kulvatunyou, N., O'Keeffe, T., & Friese, R. S. (2010). Can plasma B-type natriuretic peptide levels predict need for mechanical ventilation after injury?. American journal of surgery, 200(6), 845-50; discussion 850.
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  B-type natriuretic peptide (BNP) is a neurohormone released from cardiomyocytes in response to volume expansion and increased ventricular wall distension. Increased plasma BNP levels are associated with mortality in critically ill patients cared for in medical intensive care units (ICUs). Additionally, plasma BNP levels may serve as a biomarker for excessive fluid resuscitation after injury. The utility of plasma BNP levels as a prognosticator of outcomes after injury has not been previously described. The purpose of this study was to describe the change in plasma BNP levels over the first 48 hours after injury and determine if there was a correlation between plasma BNP levels and clinical outcomes.
• Dennis, R. W., Marshall, A., Deshmukh, H., Bender, J. S., Kulvatunyou, N., Lees, J. S., & Albrecht, R. M. (2009). Abdominal wall injuries occurring after blunt trauma: incidence and grading system. American journal of surgery, 197(3), 413-7.
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  Traumatic abdominal wall injuries (AWIs) are being increasingly recognized after blunt force injury.
• Kulvatunyou, N. (2009). Renal gunshot wound: clinical management and outcome. The Journal of trauma, 67(3), 677; author reply 677.
• Kulvatunyou, N., Albrecht, R. M., & Roberts, P. (2009). An unusual case of intensive care unit ileus: a case of a posttraumatic pericecal herniation. The American surgeon, 75(2), 179-81.
• Kulvatunyou, N. (2008). The impact of safety belt use on liver injuries in motor vehicle crashes. The Journal of trauma, 65(2), 493.
• Kulvatunyou, N., Boonbarwornrattanakul, A., Soonthornkit, Y., Kocharsanee, C., & Lertsithichai, P. (2007). Incidence of ventilator-associated pneumonia (VAP) after the institution of an educational program on VAP prevention. Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 90(1), 89-95.
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  Demonstrate if the institution of an educational program on VAP and its prevention is effective in helping reduce the incidence of VAP in a surgical ICU.
• Kulvatunyou, N. (2005). Blood transfusion. Journal of the American College of Surgeons, 201(4), 650-1.
• Kulvatunyou, N., & Heard, S. O. (2004). Care of the injured Jehovah's Witness patient: case report and review of the literature. Journal of clinical anesthesia, 16(7), 548-53.
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  Care for the Jehovah's Witness patient can be a challenge and often a dilemma to clinicians because of the patient's religious beliefs and teachings against receiving blood and blood products, especially in emergency or trauma settings. We present a case of a severely injured elderly Jehovah's Witness patient who survived. We also review the literature and offer an organized approach to care for such patients.
• Kulvatunyou, N., Groehler, K. E., Taylor, J. H., & Beilman, G. J. (2003). Mononuclear cell function and energetics in early traumatic injury. Surgical infections, 4(1), 3-10.
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  The reason for increased infectious complications after traumatic injury is complex and incompletely understood. We propose a relationship between the energetic state of circulating immune cells and immune cell function in traumatic injury. To examine this relationship, cellular adenosine triphosphate (ATP) concentration and cellular functions were measured in peripheral blood mononuclear cells from trauma patients and normal subjects.
• Kulvatunyou, N., Heard, S. O., & Bankey, P. E. (2002). A subclavian artery injury, secondary to internal jugular vein cannulation, is a predictable right-sided phenomenon. Anesthesia and analgesia, 95(3), 564-6, table of contents.
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  Internal jugular vein cannulation is a frequently performed procedure. We present a case with a review of the literatures of subclavian artery injury secondary to this procedure, recognizing that this complication may be a right-sided phenomenon secondary to its unique anatomical layout.
• Kulvatunyou, N., & Schein, M. (2001). Perforated subhepatic appendicitis in the laparoscopic era. Surgical endoscopy, 15(7), 769.
• Kulvatunyou, N., Rucinski, J., & Schein, M. (1997). Delayed complication of Port-A-Cath: perforation of the superior vena cava. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 15(2), 865.
• Singh, A. K., Kulvatunyou, N., Singh, I., & Stanley, W. S. (1989). In situ genetic complementation analysis of cells with generalized peroxisomal dysfunction. Human heredity, 39(5), 298-301.
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  Most patients with Zellweger syndrome, neonatal adrenoleukodystrophy, infantile Refsum disease and hyperpipecolic acidemia are characterized by a deficiency of peroxisomes. We have developed a simple cytological method for the in situ detection of genetic complementation among and between these patients who are clinically and biochemically defined as having generalized peroxisomal dysfunction. This technique should facilitate both complementation studies in these disorders and investigations into the biogenesis of peroxisomes.

Presentations

• Kulvatunyou, N. (2018, January/ Winter). "FASTPASS" gallbladder disease and acute appendicitis - a collaboration between acute care surgery and emergency department to improve patient care process. Academic Surgical Conference. Jacksonville, FL.
• Kulvatunyou, N. (2018, July/ Summer). Trauma Guidlines in Action: Capsule Comments: Resuscitation End-Point. 43rd Annual Scientific Program Royal College of Surgeons. Pattaya, Thailand.
• Kulvatunyou, N. (2018, July/Summer). Trauma Case Management: Global Perspectives Panelist. 43rd Annual Scientific Program Royal College of Surgeons of Thailand. Pattaya, Thailand.
• Kulvatunyou, N. (2016, March). Hypothermia: Friend or Foe. Trauma Program Managers' Workshop. Mount Graham Regional Medical Center.
• Kulvatunyou, N., & Moutamn, S. (2016, April, 2016). Comparing outcome between Push-PEG and Pull-PEG: the incidence of tube dislodgement in pull-PEG is underreported. Southwest Surgical Conference. Coronado, California: Southwest Surgical society.
• Kulvatunyou, N., & Singer, M. (2016, April 3-6, 2016). Incidence of unnecessary emergency department thoracotomy at a level one academic trauma center. Southwest Surgical Conference. Coronado, California: Southwest Surgical Society.
• Kulvatunyou, N. (2015, April). Can oral contract CT scan affect the clnical course of adhesive small bowel obstruction?. Southwest Surgical Congress. Monterey, Califorina.
• Kulvatunyou, N. (2015, April). Risk factors and influence of system time on incidence of acute appendicitis perforation given that patient's time delay is not a factor. Southwest Surgical Congress. Monterey, California.
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  Quick shot: Acute Care Surgery Session
• Kulvatunyou, N. (2014, April). Acute gallstone pancreatitis—Should patient be admitted to surgery or medicine?. Southwest Surgical Society. Scottsdale, AZ.
• Kulvatunyou, N. (2014, April). Blunt Liver injury—Should we still serial hemoglobin?. Trauma Association of Canada (TAC). Montreal, Canada.
• Kulvatunyou, N. (2014, April). Choledocholithiasis-identifying the predictor of stone passers. Southwest Surgical Society. Scottsdale, Arizona.
• Kulvatunyou, N. (2014, April). Quick-shot Presentation session-“Pull” vs “Push” percutaneous endoscopic gastrostomy (PEG), “Pull” PEG tube dislodgement may be under-appreciated. Southwest Surgical Society. Scottsdale, Arizona.
• Kulvatunyou, N. (2014, January). Characterization of “Aggressive” VS. “Dormant” acute appendicitis. EAST Society of Trauma (EAST). Naple, FL.
• Kulvatunyou, N. (2014, July). Forces of Nature: Pattern of Injuries. 25th Annual Southwest Regional Trauma Conference. Tucson, AZ.
• Kulvatunyou, N. (2014, November). A Multi-institution prospective observational study of small bowel obstruction: clinical and computerized tomography predictors of which patients may require early surgery. Western Surgical Society. Indian Wells, CA.
• Kulvatunyou, N. (2013, April). Cervical spine injury: More than you really want to know. Annual Trauma 2013 Update to Nurses, First Responders, and Emergency Medical Personnels. Tucson, AZ.
• Kulvatunyou, N. (2013, January). A prospective randomized study of pigtail versus chest tube for traumatic pneumothorax: tube site pain and efficacy. EAST Society of Trauma (EAST). Phoenix, Arizona.
• Kulvatunyou, N. (2013, October). Incidence and pattern of cervical spine injury in patients who fall: Don’t worry about how high, worry about how old. Annual American College of Surgery Meeting 2013. Washington, DC.
• Kulvatunyou, N. (2013, October). Time and cost analysis of gallbladder surgery under acute care surgery model. Annual American College of Surgery Meeting 2013. Washington, DC.
• Kulvatunyou, N. (2012, April). Extremity trauma. Southwest Emergency Medical Service CE lecture. Tucson, AZ.
• Kulvatunyou, N. (2012, April). Spine trauma. Southwest Emergency Medical Service CE lecture. Tucson, AZ.
• Kulvatunyou, N. (2012, August). 14 French Pigtail Catheter for Traumatic Chest Wall Trauma; Size does not matter. 23rd Annual Southwest Regional Trauma Conference. Tucson, AZ.
• Kulvatunyou, N. (2012, March). A prospective study of 200 patients with gallbladder disease seen in the emergency department under acute care surgery mode. Southwest Surgical Congress. Rancho Pablos Verdes, California.
• Kulvatunyou, N. (2012, March). Small 14-French pigtail catheter inserted by surgeon drain blood as well as chest tube. Western Trauma Association (WTA). Vail, Colorado.
• Kulvatunyou, N. (2012, September). Different type of acute appendicitis, Occlusive versus nonocclusive- a possible implication for early perforation. American Association Society of Trauma (AAST). Kauai, Hawii.
• Kulvatunyou, N. (2011, January). Pattern of cervical spine injury in blunt assault: it’s not how they’re hit, it’s how they fall. Society of Critical Care Medicine. San Diego, CA.
• Kulvatunyou, N. (2011, June). Tuscon Shootings. 11th Annual Arizona EMS Odyssey Conference. Phoenix, Arizona.
• Kulvatunyou, N. (2011, March). 2-year experience of pigtail catheter in the management of traumatic pneumothorax: a changing trend. Western Trauma Association (WTA). Sky Mountain, Montana.
• Kulvatunyou, N. (2010, March). Incidence, risk factors, and clinical outcome of contrast-induced nephropathy among trauma patients. Surgical Southwest Association Meeting. Tucson, AZ.
• Kulvatunyou, N. (2010, October). Gunshot wound. Santa Cruz County Emergency Medical Service. Patagonia Lake State Park, Arizona.
• Kulvatunyou, N. (2010, October). Horse Injury. Santa Cruz County Emergency Medical Services. Patagonia Lake State Park, Arizona.
• Kulvatunyou, N. (2009, Feb). Cervical spine clearance in awake and alert (GCS14-15) blunt trauma patient: the implications of mechanism of injury and distracting injury. Quick Shot oral presentation, 4th Annual Academic Surgical Congress. Fort Myers, FL.
• Kulvatunyou, N. (2009, November). Triad of severe abdominal wall disruption, hollow viscus injury, and distal abdominal aortic injury in blunt abdominal trauma. Poster presentation, Arizona Trauma and Acute Care Consortium (AZTrACC). Phoenix, Arizona.
• Kulvatunyou, N. (2008, February). Percutaneous Tracheostomy: why, when, and how?. Oklahoma Chapter of Respiratory Therapist. Oklahoma City, Oklahoma.
• Kulvatunyou, N. (2008, May). Percutaneous Tracheostomy: When, why, and how?. Grand Round, Department of Surgery, U of Michigan State. Sparrow, MI.
• Kulvatunyou, N. (2008, October). Mononuclear Cell Function and Energetics in Early Traumatic Injury. Thailand Surgical Association Meeting. Pataya, Thailand.
• Kulvatunyou, N. (2006, July). Facial Trauma and Airway Management. Oklahoma EMT Association Medic Update 2006. Ardmore, Oklahoma.
• Kulvatunyou, N. (2006, March). End-point Of Resuscitation: The World Inside My Little Box. Grand Round, Department of Surgery, Oklahoma University Health Science Center. Oklahoma City, Oklahoma.
• Kulvatunyou, N. (2006, October). What I have learned about trauma and critical care coding and billing. Moore AAPC Chapter, Norman Institution of Technology. Norman, Oklahoma.
• Kulvatunyou, N. (2005, April). Modern ICU and changing trend. Annual Nurse Conference, Department of nursing, Boorapa University. Sriracha, Chonburi.
• Kulvatunyou, N. (2004, April). Initial Evaluation and Resuscitation in an injured patient. Public Health Emergency Medicine nurses group. Bangkok, Thailand.
• Kulvatunyou, N. (2004, January). Critical Care and Trauma. Thai Critical Care nurses group. Bangkok, Thailand.
• Kulvatunyou, N. (2004, May). Infection in Trauma: diagnosis, treatment, and prevention. Thai Royal College of Surgeon Spring Annual Meeting. Bangkok, Thailand.
• Kulvatunyou, N. (2004, November). Acute Abdomen in ICU. Inter-hospital Conference. Bangkok, Thailand.
• Kulvatunyou, N. (2004, October). Update in Trauma: Basic Science. Thai Royal College of Surgeon Annual Fall Meeting. Bangkok, Thailand.

Poster Presentations

• Kulvatunyou, N. (2009, August). Infection in Trauma. Grand Round, Department of Surgery, University of Oklahoma Health Science Center. Oklahoma City, OK.

Reviews

• Cucher, D., Kulvatunyou, N., Green, D. J., Jie, T., & Ong, E. S. (2014. Gallstone pancreatitis: a review(pp 257-80).
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  Gallstone disease is the most common cause of acute pancreatitis in the Western world. In most cases, gallstone pancreatitis is a mild and self-limiting disease, and patients may proceed without complications to cholecystectomy to prevent future recurrence. Severe disease occurs in about 20% of cases and is associated with significant mortality; meticulous management is critical. A thorough understanding of the disease process, diagnosis, severity stratification, and principles of management is essential to the appropriate care of patients presenting with this disease. This article reviews these topics with a focus on surgical management, including appropriate timing and choice of interventions.

Others

• Kulvatunyou, N. (2013, January). Pigtail Catheters Less Painful than Chest tubes for Traumatic Pneumothorax. http://www.acssurgerynews.com/index.php?id=14883&cHash=071010&tx_ttnews[tt_news]=140033
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  Featured in American College of Surgery: Surgery News1/21/2013
• Kulvatunyou, N. (2011, April). Device Offers Benefits for Quadriplegics. http://www.wildcat.arizona.edu/article/2011/04/device_offers_benefits_for_quadriplegics
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  Featured in Arizona Daily Wildcat NewspaperApril 1, 2011Devices Offers Benefits for Quadriplegics
• Kulvatunyou, N. (2011, February). UA Trauma Surgeon First in Arizona to Implant Device that Frees Quadriplegic Patients from Ventilator. Media.
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  Featured in KGUN 9 News