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Trauma & Acute Care Surgery > Peer-Reviewed Publications 2017

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 national trauma meetings, including the American Association 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 practitioners, who work in Trauma Service, as well as several of our liaisons from other specialties. This activity has been supported through the administration of Lancaster General Hospital. Trauma Service has received numerous accolades for some of the research projects that we have accomplished. 


Summaries of Peer-Reviewed Publications of 2017

Click on summary titles for the corresponding PDF full reports. 

Vena Cava Filter Use in Trauma and Rates of Pulmonary Embolism

Vena cava filter (VCF) placement for pulmonary embolism (PE) prophylaxis in trauma is controversial. Limited research exists detailing trends in VCF use and occurrence of PE over time. We analyzed state and nationwide trends in VCF placement and PE occurrence from 2003 to 2015 and discovered that despite a precipitous decline of VCF use in trauma, PE rates remained unchanged during this period.
 

A Novel Approach to Optimal Placement of New Trauma Centers within an Existing Trauma System Using Geospatial Mapping

Trauma system expansion is a complex process often governed by financial and health care system imperatives.We sought to propose a new, informed approach to trauma system expansion through the use of geospatial mapping. Our study suggests that geospatial mapping set to specific parameters can effectively identify optimal locations for future TCs within an existing trauma network.
 

Outcome Differences in Adolescent Blunt Severe Polytrauma Patients Managed at Pediatric versus Adult Trauma Centers
The appropriate managing facility for adolescent trauma patients is debatable. We hypothesized that no differences in adjusted outcomes would be observed between pediatric trauma centers and adult trauma centers for this population. Despite similar rates of mortality and complications, these patients have improved functional status at discharge.

Gunshot Wounds Resulting in Hospitalization in the United States: 2004-2013

The United States (US) leads all high income countries in gunshot wound (GSW) deaths. However, as a result of two decades of reduced federal support, study of GSW has been largely neglected. During the study period, the annual rate of hospitalizations for GSW remained stable at 80 per 100,000 hospital admissions with decreased adjusted odds for mortality over the study duration. 


Big Children or Little Adults? A Statewide Analysis of Adolescent Isolated Severe Traumatic Brain Injury Outcomes at Pediatric versus Adult Trauma Centers
The appropriate managing center for adolescent truama patients is debated. We sought to determine whether outcome differences existed for adolescent severe traumatic brain injury (sTBI) patients treated at pediatric versus adult truama centers. Results of this study sugget outcomes for adolescent TBI patients are similar at both pediatric and adult centers.

An Overview of Nonoperative Blunt Splenic Injury Management with associated Splenic Artery Pseudoaneurysm 
The delayed development of splenic artery pseudoaneurysm (SAP) can complicate the non-operative management of splenic injuries. The study sought to determine the utility of repeat imaging in diagnosing SAP in patients managed non-operatively without angioembolization. Results of this investigation suggest patients with splenic injuries greater than Grade III managed non-operatively without angioembolization may benefit from repeat imaging within 48 hours.

An Epidemiological Overview of 13 Years of Firearm Hospitalizations in Pennsylvania

Gun violence is a controversial public health issue. We sought to provide a 13-y overview of firearm hospitalizations in Pennsylvania, analyzing trends in mode, intent, and outcome. All admissions to the Pennsylvania Trauma Outcome Study database from 2003 to 2015 were queried and GSWs were identified by external cause-of-injury codes. 4.2% of the patients presenting to Pennsylvania trauma centers were GSWs with handguns as the most common weapon of injury. Temporal trends in outcomes suggest rates of firearm hospitalizations are declining in Pennsylvania; however, outcomes remain unchanged.


An Analysis of Compassion Fatigue in a Surgeon Population: Are Female Surgeons at Heightened Risk?
Compassion fatigue (CF) is a prevalent issue for today’s healthcare provider. We sought to characterize levels of CF within a surgeon population, particularly comparing trauma surgery with other surgical specialities. Levels of CS were significantly lower in the trauma surgeon subgroup compared to other surgical specialties. Female surgeons from all specialties exhibited significantly higher levels of burnout and compassion fatigue compared with male surgeons. 


The Effect of Time to International Normalized Ratio Reversal on Intracranial Hemorrhage Evolution in Patients with Traumatic Brain Injury

The incidence of geriatric traumatic brain injury (TBI) is increasing throughout the United States, with many of these patients taking anticoagulation medication. This investigation attempted to determine the effect of time to international normalized ratio (INR) reversal on intracranial hemorrhage evolution in TBI patients taking prehospital AC medication. Reversal of INR of less than 5 hr was not associated with intracranial hemorrhage evolution; however, reversal of less than 10 hr was found to be associated with a decreased odds ratio for intracranial hemorrhage evolution.


A Preliminary Analysis of Compassion Satisfaction and Compassion Fatigue with Considerations for Nrursing Unit Specialization and Demographic Factors

Compassion fatigue (CF) is a state of physical/emotional distress that results from caring for those experiencing pain. We sought to characterize levels of CF in intensive care unit (ICU) and oncology nursing populations with subanalyses comparing specific personal and/or professional demographic factors. Levels of compassion satisfaction were significantly lower and levels of burnout were significantly higher in ICU nurses than in oncology nurses. Intensive care unit nurses and female nurses from both ICU and oncology specialties may be at increased risk for developing a poorer overall ProQOL and CF.


Omega-3 Fatty Acid Supplementation and Warfarin: A Lethal Combination in Traumatic Brain Injury

Polyunsaturated fatty acids such as omega-3 eicosapentaenoic acid and omega-6 docosahexaenoic acid, found in over-the-counter fish oil supplements, are often consumed for their beneficial, prophylactic, antiinflammatory effects. Unfortunately, the risks of omega-3 fatty acid supplementation are often underappreciated, particularly its ability to inhibit platelet aggregation and promote bleeding in patients taking anticoagulant medications. This study details the clinical case of an elderly patient taking warfarin and fish oil supplementation whose warfarin-induced coagulopathy could not be reversed after suffering blunt head trauma.

Emergency Operations Program is an Excellent Platform to Deal with In-Hospital Operation Disaster
This study describes utilization of the hospital's Emergency Operations Plan and incident command structure to mitigate damage caused by the sudden loss of the heating, ventilation, and air conditioning system within the entire operating room suite. After thorough investigation and identification of the issues that contributed to the malfunction, redundancies were built into the system to ensure that a similar incident did not occur again.


 
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