2020
Spirometry not pain level predicts outcomes in geriatric patients with isolated rib fractures.
Schuster KM, Sanghvi M, O'Connor R, Becher R, Maung AA, Davis KA. Spirometry not pain level predicts outcomes in geriatric patients with isolated rib fractures. Journal Of Trauma And Acute Care Surgery 2020, 89: 947-954. PMID: 32467465, DOI: 10.1097/ta.0000000000002795.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overEmergency Service, HospitalFemaleHand StrengthHospitals, RehabilitationHumansIntensive Care UnitsLength of StayMalePainPain ManagementPain MeasurementPatient DischargePatient TransferPredictive Value of TestsProspective StudiesRib FracturesSpirometryTrauma CentersTreatment OutcomeConceptsLength of stayIsolated rib fracturesNegative inspiratory forceUnplanned ICU admissionRib fracturesPain levelsDay 1ICU admissionInspiratory forceGrip strengthMedian LOSHospital day 1Expiratory volume 1Complete spirometryPain controlDischarge dispositionPulmonary functionEarly dischargeGeriatric patientsVital capacityMean ageSpirometry measuresPulmonary capacityLevel IVFEV1Closing the gap in care of blunt solid organ injury in children.
Yung N, Solomon D, Schuster K, Christison-Lagay E. Closing the gap in care of blunt solid organ injury in children. Journal Of Trauma And Acute Care Surgery 2020, 89: 894-899. PMID: 32345899, DOI: 10.1097/ta.0000000000002757.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentChildChild, PreschoolClinical Decision-MakingConsensusConservative TreatmentFemaleHospitals, PediatricHumansInfantInfant, NewbornInjury Severity ScoreLength of StayLiverMalePatient DischargePractice Guidelines as TopicProfessional Practice GapsRetrospective StudiesSpleenSurgical Procedures, OperativeTrauma CentersWounds, NonpenetratingYoung AdultConceptsAdult trauma centersPediatric trauma centerSolid organ injuryBlunt solid organ injuryOperative interventionOrgan injuryTrauma centerInjury gradeNonoperative managementLiver injuryPediatric blunt solid organ injuryPediatric solid organ injuryPhysiologic parametersNational Trauma Data BankTrauma center typeGrade of injuryTrauma Data BankBlunt spleenMean LOSHigher ORsConsensus guidelinesIsolated spleenOperative rateGrade ILevel IV
2019
The EGS Grading Scale For Skin And Soft Tissue Infections Is Predictive Of Poor Outcomes
Savage SA, Li SW, Utter GH, Cox JA, Wydo SM, Cahill K, Sarani B, Holzmacher J, Duane TM, Gandhi RR, Zielinski MD, Ray-Zack M, Tierney J, Chapin T, Murphy PB, Vogt KN, Schroeppel TJ, Callaghan E, Kobayashi L, Coimbra R, Schuster KM, Gillaspie D, Timsina L, Louis A, Crandall M. The EGS Grading Scale For Skin And Soft Tissue Infections Is Predictive Of Poor Outcomes. Journal Of Trauma And Acute Care Surgery 2019, Publish Ahead of Print: &na;. PMID: 30601458, PMCID: PMC6433490, DOI: 10.1097/ta.0000000000002175.Peer-Reviewed Original ResearchConceptsSoft tissue infectionsLength of stayDisease processGrading scaleInter-rater reliabilityGrade IVEmergency general surgery (EGS) diseasesDisparate disease processesRetrospective multicenter trialLaboratory Risk IndicatorNecrotizing Fasciitis (LRINEC) scoreSurgery of TraumaMulti-institutional trialHigh gradeDifferent disease processesClinical disease processesOverall complicationsHospital lengthICU lengthFasciitis (LRINEC) scoreMulticenter trialTissue infectionsValidation studyPoor outcomeDisease characteristicsSymptomatic human immunodeficiency virus–infected patients have poorer outcomes following emergency general surgery
Sandler BJ, Davis KA, Schuster KM. Symptomatic human immunodeficiency virus–infected patients have poorer outcomes following emergency general surgery. Journal Of Trauma And Acute Care Surgery 2019, 86: 479-488. PMID: 30531208, DOI: 10.1097/ta.0000000000002161.Peer-Reviewed Original ResearchConceptsHIV/AIDS patientsHIV-negative patientsAsymptomatic HIV-positive patientsHIV-positive patientsActive antiretroviral therapyAIDS patientsAntiretroviral therapyHospital stayPostoperative complicationsHuman immunodeficiency virus-infected patientsEmergency general surgery proceduresHigher median total chargesImmune deficiency syndrome (AIDS) patientsHuman immunodeficiency virus (HIV) infectionEmergency general surgeryLonger hospital stayRetrospective cohort studyAcute renal failureHIV-negative controlsImmunodeficiency virus infectionVirus-infected patientsRecords of patientsUrinary tract infectionMedian total chargesNationwide Inpatient Sample
2018
Opioid dependency is independently associated with inferior clinical outcomes after trauma
Hsiang WR, McGeoch C, Lee S, Cheung W, Becher R, Davis KA, Schuster K. Opioid dependency is independently associated with inferior clinical outcomes after trauma. Injury 2018, 50: 192-196. PMID: 30342762, DOI: 10.1016/j.injury.2018.10.015.Peer-Reviewed Original ResearchConceptsNon-home dischargeOpioid-dependent patientsLength of stayInjury Severity ScoreOpioid dependencyVentilator daysMajor complicationsClinical outcomesPrescription abuseIllicit abuseLonger LOSChronic pain subgroupsMore ventilator daysOpioid-naïve patientsUse of opioidsAcademic Level IHigher readmission ratesInferior clinical outcomesChronic pain patientsOpioid subgroupsNaïve patientsAdult patientsPain subgroupsPatient demographicsReadmission ratesRelationship between duration of preoperative symptoms and postoperative ileus for small bowel obstruction
Brandt WS, Wood J, Bhattacharya B, Pei K, Davis KA, Schuster K. Relationship between duration of preoperative symptoms and postoperative ileus for small bowel obstruction. Journal Of Surgical Research 2018, 225: 40-44. PMID: 29605033, DOI: 10.1016/j.jss.2017.12.031.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAged, 80 and overAscitesEquipment and Supplies UtilizationFemaleFood IntoleranceHumansIleusIntensive Care UnitsIntestinal ObstructionIntestine, SmallLength of StayMaleMiddle AgedParenteral NutritionPostoperative ComplicationsPreoperative PeriodRetrospective StudiesRisk FactorsTime FactorsTime-to-TreatmentYoung AdultConceptsTolerance of dietSmall bowel obstructionPreoperative symptomsLength of stayPostoperative ileusUnivariable analysisTotal durationIntensive care unit admissionTotal parenteral nutrition useParenteral nutrition useCare unit admissionIntensive care unitPreoperative ascitesBowel obstructionPrimary endpointSecondary endpointsSymptom durationUnit admissionMedian durationOperative interventionPostoperative outcomesCare unitMultivariable analysisRetrospective reviewNutrition use
2014
The Use of Magnetic Resonance Imaging in the Diagnosis of Suspected Appendicitis in Pregnancy : Shortened Length of Stay Without Increase in Hospital Charges
Fonseca AL, Schuster KM, Kaplan LJ, Maung AA, Lui FY, Davis KA. The Use of Magnetic Resonance Imaging in the Diagnosis of Suspected Appendicitis in Pregnancy : Shortened Length of Stay Without Increase in Hospital Charges. JAMA Surgery 2014, 149: 687-693. PMID: 24871698, DOI: 10.1001/jamasurg.2013.4658.Peer-Reviewed Original ResearchConceptsMR imaging groupHospital chargesNontherapeutic explorationsPregnant patientsImaging groupFetal outcomesShorter LOSEmergency departmentUniversity tertiary referral centerMean hospital chargesTertiary referral centerLength of stayMagnetic resonancePathology-confirmed appendicitisAbdominal painOperative interventionReferral centerClinical outcomesGestational ageMultivariable analysisRetrospective reviewFetal lossAppendicitisMAIN OUTCOMEPatientsPredictive factors for failure of nonoperative management in perforated appendicitis
Maxfield MW, Schuster KM, Bokhari J, McGillicuddy EA, Davis KA. Predictive factors for failure of nonoperative management in perforated appendicitis. Journal Of Trauma And Acute Care Surgery 2014, 76: 976-981. PMID: 24662860, DOI: 10.1097/ta.0000000000000187.Peer-Reviewed Original ResearchConceptsNonoperative managementAbdominal tendernessFailure groupIntensive care unit careUniversity tertiary care hospitalTertiary care hospitalLength of stayUnit careCare hospitalDefinitive treatmentLaboratory markersPerforated appendicitisNonsurgical treatmentClinical findingsPredictive factorsRadiographic findingsTomographic scanTherapeutic studiesAppendicitisEarly operationLevel IIIPatientsAbscessPhlegmonTachycardia
2013
Routine Nasogastric Decompression in Small Bowel Obstruction: Is it Really Necessary?
Fonseca AL, Schuster KM, Maung AA, Kaplan LJ, Davis KA. Routine Nasogastric Decompression in Small Bowel Obstruction: Is it Really Necessary? The American Surgeon 2013, 79: 422-428. PMID: 23574854, DOI: 10.1177/000313481307900433.Peer-Reviewed Original ResearchConceptsSmall bowel obstructionNasogastric decompressionHospital lengthNG decompressionBowel obstructionRespiratory failureDiagnosis of SBOYale-New Haven HospitalNasogastric tube useRisk of pneumoniaRoutine nasogastric decompressionDevelopment of pneumoniaRetrospective chart reviewNew Haven HospitalBowel restIntravenous hydrationChart reviewAdult patientsTube useNGT placementPatientsStayOutcome variablesDecompressionNGTWhen the ICU is the operating room
Piper GL, Maerz LL, Schuster KM, Maung AA, Luckianow GM, Davis KA, Kaplan LJ. When the ICU is the operating room. Journal Of Trauma And Acute Care Surgery 2013, 74: 871-875. PMID: 23425750, DOI: 10.1097/ta.0b013e31827e9c52.Peer-Reviewed Original ResearchConceptsSurgical intensive care unitOperating roomOperative locationICU casesEmergency general surgery patientsGeneral surgery patientsTotal operative casesType of anesthesiaIntensive care unitMode of ventilationT-testStudent's t-testSurgery patientsCare unitNeuromuscular blockadeAdverse outcomesDeep sedationProcedure typeOperative procedureSurgical proceduresEpidemiologic studiesICU databaseCase volumeLevel ITotal cases
2012
Compared to conventional ventilation, airway pressure release ventilation may increase ventilator days in trauma patients
Maung AA, Schuster KM, Kaplan LJ, Ditillo MF, Piper GL, Maerz LL, Lui FY, Johnson DC, Davis KA. Compared to conventional ventilation, airway pressure release ventilation may increase ventilator days in trauma patients. Journal Of Trauma And Acute Care Surgery 2012, 73: 507-510. PMID: 23019679, DOI: 10.1097/ta.0b013e31825ff653.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedContinuous Positive Airway PressureCritical CareDatabases, FactualFemaleFollow-Up StudiesHumansInjury Severity ScoreIntra-Abdominal HypertensionLength of StayLinear ModelsMaleMiddle AgedMultivariate AnalysisPulmonary Gas ExchangeRespiration, ArtificialRetrospective StudiesRisk AssessmentSurvival RateTime FactorsTrauma CentersTreatment OutcomeVentilator WeaningWounds and InjuriesConceptsAirway pressure release ventilationTotal ventilator daysVentilator daysHospital complicationsMechanical ventilationAIS scoreChest Abbreviated Injury Scale scoreAbbreviated Injury Scale scoreSpontaneous breathing trialAbdominal compartment syndromeAcute lung injuryAcute renal failureInjury Scale scoreStudy entry criteriaInjury Severity ScorePotential confounding factorsAPRV groupAPRV modeBreathing trialRescue therapyCompartment syndromeLung injuryRenal failureIndependent predictorsRetrospective review
2010
Contrast-Induced Nephropathy in Elderly Trauma Patients
McGillicuddy EA, Schuster KM, Kaplan LJ, Maung AA, Lui FY, Maerz LL, Johnson DC, Davis KA. Contrast-Induced Nephropathy in Elderly Trauma Patients. Journal Of Trauma And Acute Care Surgery 2010, 68: 294-297. PMID: 20154540, DOI: 10.1097/ta.0b013e3181cf7e40.Peer-Reviewed Original ResearchConceptsAcute kidney injuryElderly trauma patientsTrauma patientsNoncontrast groupDevelopment of AKIRisk of AKILevel one trauma centerContrast-Induced NephropathyHours of admissionIndependent risk factorHours of presentationLength of stayAdministration of contrastHospital mortalityKidney injuryBaseline characteristicsElderly patientsOccult injuriesProlonged lengthRenal functionSerum creatinineTrauma centerIntravenous contrastMedical recordsRisk factors
2009
Factors Predicting Morbidity and Mortality in Emergency Colorectal Procedures in Elderly Patients
McGillicuddy EA, Schuster KM, Davis KA, Longo WE. Factors Predicting Morbidity and Mortality in Emergency Colorectal Procedures in Elderly Patients. JAMA Surgery 2009, 144: 1157-1162. PMID: 20026835, DOI: 10.1001/archsurg.2009.203.Peer-Reviewed Original ResearchConceptsEmergency colorectal proceduresEmergent colorectal proceduresColorectal proceduresHospital mortalityElderly patientsUniversity tertiary referral centerIntra-abdominal contaminationIntraoperative blood lossPatients 65 yearsAdvanced colorectal cancerCurrent Procedural Terminology codesModifiable risk factorsTertiary referral centerColorectal cancer screeningRecurrent respiratory failureProcedural Terminology codesPredicting MorbidityHospital morbidityPostoperative morbidityRenal insufficiencyRespiratory failureFrequent complicationReferral centerBlood lossRetrospective review
2008
Trauma Team Oversight Improves Efficiency of Care and Augments Clinical and Economic Outcomes
Davis KA, Cabbad NC, Schuster KM, Kaplan LJ, Carusone C, Leary T, Udelsman R. Trauma Team Oversight Improves Efficiency of Care and Augments Clinical and Economic Outcomes. Journal Of Trauma And Acute Care Surgery 2008, 65: 1236-1244. PMID: 19077607, DOI: 10.1097/ta.0b013e31818ba311.Peer-Reviewed Original ResearchMeSH KeywordsAbbreviated Injury ScaleConnecticutCost-Benefit AnalysisCross-Sectional StudiesEfficiency, OrganizationalFees, MedicalHospital CostsHumansInjury Severity ScoreLength of StayLinear ModelsMultiple TraumaOutcome and Process Assessment, Health CarePatient Care TeamPersonnel Administration, HospitalQuality Assurance, Health CareTrauma CentersUtilization ReviewConceptsInjury Severity ScoreEfficiency of careHospital lengthTrauma serviceFull-time trauma surgeonsMean Injury Severity ScoreMedian Injury Severity ScoreTrauma team activation criteriaLevel I trauma centerPercentage of patientsShorter hospital lengthI trauma centerLength of stayActual hospital costsMost patientsPatient demographicsTrauma activationsTrauma centerHospital contribution marginInjury patternsSeverity scoreHospital costsPatient managementTrauma surgeonsPatients