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Trauma & Acute Care Surgery

Trauma & Acute Care Surgery > Peer-Reviewed Publications 2016

Research

Lancaster General Hospital’s Trauma Service has a very active clinical research program. We have a Clinical Research Coordinator who organizes and sets up monthly research meetings with timelines for presentations at national meetings.

We are also supported by the Research Institute at Lancaster General Hospital, which provides strong statistical support for the numerous projects that we are involved with. At any one time, we have a number of ongoing projects, many of which have been presented for both podium and poster presentations at naional trauma meetings, inlcuding the American Assoication for the Surgery of Trauma, Society of Critical Care Medicine, American College of Surgeons, etc.

The participants in our research program include the trauma surgeons, nurses and advanced practioners, who work in Trauma Service, as well as several of our liasons from other specialties. This activity has been supported through the administratiom of Lancaster Genreal Hospital. Trauma Service has received numerous accolades for some of the research projects that we have accomplished. 


Summaries of Peer-Reviewed Publications of 2016

Click on summary titles for the corresponding PDF full reports. 

An Analysis of Neurosurgical Practice Patterns and Outcomes for Serious to Critical Traumatic Brain Injuries in a Mature Trauma State
Limited research exists detailing trends in neurosurgical practice patterns over time. This study sought to analyze trends in rates of craniotomy, craniectomy, and intracranial pressure monitor placement in the Commonwealth of Pennsylvania. While fluctuation in practice patterns was observed over time, no change in outcomes were found for individials afflicted by traumatic brain injury.

An Analysis of Beta Blocker Administration Pre- and Post-Traumatic Brain Injury with Sub-Analyses for Head Injury Severity and Myocardial Injury
A growing body of literature indicates that beta blocker administration following traumatic brain injury is cerebroprotective, limiting secondary injury. The effects of preinjury beta blocker status, however, remain poorly understood. This study sought to characterize the effects of pre- and post-injury beta blocker administration on mortality. Results of this study suggest preinjury beta blocker administration does not reduce odds of mortality.

A Bitter Pill to Swallow: Dysphagia in Cervical Spine Injury
Dysphagia is a common complication after cervical spine trauma with spinal cord injury. The pupose of this investigation was to determine whether geriatric patients with spinous injury not involving the spinal cord were also at increased risk. The results of this study suggest even those impacted by non-spinal cord involved injuries are at increased risk for developing dysphagia.

Improved Functional Discharge Status Despite Higher Complication Rates at Level I Trauma Centers 

We sought to compare outcome measures besides mortality between level I and level II trauma centers, including complication rates and functional status at discharge (FSD). We hypothesized level I trauma centers would have lower complication rates and higher FSD compared to level II counterparts. Unadjusted total complication rate was significantly higher at level I centers with the three most prevalent significantly higher complications: pneumonia, UTI and DVT. Despite a higher complication rate, severe trauma patients managed at level I centers had increased functional status at discharge.


Repetition, Repetition! Radiographic Re-Read Protocol Identifies Clinically Relevant Errors 

Radiographic reading errors, however, can lead to missed diagnoses and adverse outcomes, compromising patient care. In 2015, our level II trauma center implemented a protocol mandating re-reads of all radiographic studies completed on our highest level trauma activations (Code T) within 24 hours. We sought to determine the efficacy of this radiographic re-read protocol in identifying missed diagnoses in Code T patients. Clinically relevant errors, although a marginal amount, were discovered during radiographic re-reads for Code T trauma patients. 


Ventilator Autotriggering in a Patient Following Massive Intracerebral Hemorrhage and Brain Death 

Ventilator autotriggering may potentially occur following terminal brain stem herniation due to interaction between a hyperdynamic cardiovascular state consequent to massive catecholamine release and high stroke volume interacting with compliant lung tissue causing cyclic gas movement within the patient-ventilator system. Case report of a patient admitted with intracerebral hemorrhage and declining neurologic status is detailed in this study.


Early Hormonal Resuscitation After Nonsurvivable Brain Injury: Impact on Organ Recovery 

Cardiopulmonary instability following catastrophic brain injury is consequent to multisystem effects of brain herniation. Delaying hormonal resuscitation (HRT) pending brain death testing and consent for organ procurement causes significant delay between brainstem herniation and optimal mechanism-based care for organ function. This results in poor organ viability, less favorable transplant outcomes and puts at risk the option of organ donation for families. Our team demonstrates dramatically improved cardiopulmonary stability and effectiveness of early hormonal resuscitation in two patients following non-survivable brain injury.


 
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