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Supported by the Lancaster General Health Research Institute, Emergency Medicine and Trauma research has been presented at regional and national conferences including the American Association for the Surgery of Trauma, the Society of Critical Care Medicine, and the American College of Surgeons.

Read Summaries of Emergency Medicine and Trauma Peer-Reviewed Publications Below

Our active clinical research program includes participation from trauma surgeons, nurses, advanced practitioners, liaisons from other specialties, and a research coordinator.

Summaries of Peer-Reviewed (Accepted) Publications of 2018

Preliminary Results of a Novel Hay-Hole Fall Prevention Initiative

Hay-hole falls are a prevalent source of trauma among Anabaptists - particularly Anabaptist youth. We sought to decrease hay-hole falls in South Central Pennsylvania through the development and distribution of all-weather hay-hole covers to members of the at-risk Anabaptist community.

Improved Outcomes in Elderly Trauma Patients with the Implementation of Two Innovative Geriatric-Specific Protocols - Final Report

Elderly trauma care is challenging due to the unique physiology and comorbidities prevalent in this population. Two practice management guidelines were implemented (HRGP and ACT Alert) to improve the care of these patients. A significant decrease in mortality was observed with combined implementation of both protocols compared to mortality prior to introduction of these guidelines.

Development of a Trauma System and Optimal Placement of Trauma Centers Using Geospatial Mapping

While the care of patients at individual trauma centers has been carefully optimized, the placement of TCs within the trauma systems could use improvement. PTSF and PHC4 databases were queried for adult trauma admissions from 2003-2015. ArcGIS Desktop was used to generate models to determine optimal locations of trauma centers across the state of Pennsylvania.

Undertriage in Trauma: Does an Organized Trauma Network Capture the Major Trauma Victim? A Statewide Analysis

Proper triage of critical trauma patients is essential for survival and patient outcomes. We sought to determine the percentage and distribution of patients meeting trauma criteria who received care at non-trauma centers within the state of Pennsylvania. We determined nearly a third of trauma patients are inappropriately triaged to non-trauma centers and that pockets of undertriage are scattered across the state.

Summaries of Peer-Reviewed Publications of 2017

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 trauma patients is debated. We sought to determine whether outcome differences existed for adolescent severe traumatic brain injury (sTBI) patients treated at pediatric versus adult trauma centers. Results of this study suggest 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 specialties. 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 Nursing 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, anti-inflammatory 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.

Summaries of Peer-Reviewed Publications of 2016

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 individuals afflicted by traumatic brain injury.

An Analysis of Beta Blocker Administration Pre- and Post-Traumatic Brain Injury with Subanalyses 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 purpose 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.

Internship Opportunities

The Lancaster General Research Institute offers summer internship opportunities to students interested in gaining research experience. The number of internships available varies from year to year.

Student interns perform a variety of tasks including data collection, data entry, and statistical analysis. We also encourage interns to shadow physicians in specialties of their choice.

Submit your application today!

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