Medicine and Health Sciences Commons^™

Outcome After Decompressive Craniectomy For The Treatment Of Severe Traumatic Brain Injury., Jerry Lee Howard, Mark D Cipolle, Meredith Anderson, Victoria Sabella, Daniele Shollenberger, P Mark Li, Michael D. Pasquale Md, Facs, Fccm

Michael D Pasquale MD, FACS, FCCM

BACKGROUND: Using decompressive craniectomy as part of the treatment regimen for severe traumatic brain injury (STBI) has become more common at our Level I trauma center. This study was designed to examine this practice with particular attention to long-term functional outcome.

METHODS: A retrospective review of prospectively collected data was performed for patients with STBI admitted from January 1, 2003 to December 31, 2005. Our institution manages patients using the Brain Trauma Foundation Guidelines. Data collected from patients undergoing decompressive craniectomy included: age, Injury Severity Score, admission and follow-up Glasgow Coma Score, timing of, and indication for decompressive craniectomy, and …

Defining "Dead On Arrival": Impact On A Level I Trauma Center., Michael D. Pasquale Md, Facs, Fccm, M Rhodes, M D Cipolle, T Hanley, T Wasser

Michael D Pasquale MD, FACS, FCCM

OBJECTIVE: To determine the potential impact of defining criteria for "dead on arrival" (DOA) on a Level I trauma center.

METHODS: From 1990 to 1994, trauma patients having cardiopulmonary resuscitation (CPR) performed by certified prehospital personnel were reviewed for time of CPR, outcome, and costs to determine whether any benefit would have been realized had DOA criteria been followed.

RESULTS: A total of 106 patients had prehospital CPR; 20 did not meet DOA criteria and underwent resuscitation, three survived (15%). Eighty-six patients met DOA criteria; 16 were pronounced dead without further resuscitative efforts (in-hospital costs of $200/patient), while 70 (81%) …

Clinical Clearance Of The Cervical Spine In Blunt Trauma Patients Younger Than 3 Years: A Multi-Center Study Of The American Association For The Surgery Of Trauma., Rafael Pieretti-Vanmarcke, George C Velmahos, Michael L Nance, Saleem Islam, Richard A Falcone, Paul W Wales, Rebeccah L Brown, Barbara A Gaines, Christine Mckenna, Forrest O Moore, Pamela W Goslar, Kenji Inaba, Galinos Barmparas, Eric R Scaife, Ryan R Metzger, Douglas L Brockmeyer, Jeffrey S Upperman, Joaquin Estrada, David A Lanning, Sara K Rasmussen, Paul D Danielson, Michael P Hirsh, Heitor F X Consani, Steven Stylianos, Candace Pineda, Scott H Norwood, Steven W Bruch, Robert Drongowski, Robert Barraco, Michael Pasquale, Farheen Hussain, Erwin F Hirsch, P Daniel Mcneely, Mary E Fallat, David S Foley, Joseph A Iocono, Heather M Bennett, Kenneth Waxman, Kelly Kam, Lisa Bakhos, Laurie Petrovick, Yuchiao Chang, Peter T Masiakos

Michael D Pasquale MD, FACS, FCCM

BACKGROUND: Cervical spine clearance in the very young child is challenging. Radiographic imaging to diagnose cervical spine injuries (CSI) even in the absence of clinical findings is common, raising concerns about radiation exposure and imaging-related complications. We examined whether simple clinical criteria can be used to safely rule out CSI in patients younger than 3 years. METHODS: The trauma registries from 22 level I or II trauma centers were reviewed for the 10-year period (January 1995 to January 2005). Blunt trauma patients younger than 3 years were identified. The measured outcome was CSI. Independent predictors of CSI were identified by …

Impact Of Age And Anticoagulation: Need For Neurosurgical Intervention In Trauma Patients With Mild Traumatic Brain Injury, Margaret Moore, Michael Pasquale, Michael Badellino

Michael D Pasquale MD, FACS, FCCM

BACKGROUND: Of the 500,000 brain injuries in the United States annually, 80% are considered mild (mild traumatic brain injury). Unfortunately, 2% to 3% of them will subsequently deteriorate and result in severe neurologic dysfunction. Intracerebral changes in the elderly, chronic oral anticoagulation, and platelet inhibition may contribute to the development of intracranial bleeding after minor head injury. We sought to investigate the association of age and the use of anticoagulation and antiplatelet therapy with neurologic deterioration and the need for neurosurgical intervention in patients presenting with mild traumatic brain injury. METHODS: A retrospective review of all adult (>14 years) …

Hepatic Angioembolization In Trauma Patients: Indications And Complications., Tim Misselbeck, Erik Teicher, Mark Cipolle, Michael Pasquale, Kamalesh Shah, Dale Dangleben, Michael Badellino

Michael D Pasquale MD, FACS, FCCM

BACKGROUND: Hepatic angiography (HA) and hepatic angioembolization (HAE) are increasingly used to diagnose and treat intrahepatic arterial injuries. This study was performed to review indications, outcomes, and complications of HA/HAE in blunt trauma patients who underwent HAE as adjunct management of hepatic injury.

METHODS: A retrospective review of consecutive cases of HA/HAE at a Level I trauma center during an 8-year period. Data include demographics, physiologic condition, liver injury grade, HA/HAE indications, outcomes, morbidity, and mortality.

RESULTS: Seventy-nine patients underwent diagnostic HA; 31 (39%) had subsequent HAE. Fifty-eight hemodynamically stable patients had computerized axial tomographic (CT) scan followed by HA. …

Odontoid Fractures In The Elderly: Should We Operate?, Alice Fagin, Mark Cipolle, Robert Barraco, Sherrine Eid, James Reed, P. Mark Li, Michael Pasquale

Michael D Pasquale MD, FACS, FCCM

BACKGROUND: : Treatment of odontoid fractures remains controversial. There are conflicting data in the literature with regard to timing of operative fixation (OP), as well as whether OP should be performed. Within our own institution, treatment is variable depending largely on surgeon preference. This study was undertaken in an attempt to develop management consensus by examining outcomes in elderly patients with odontoid fractures and comparing OP to a nonoperative (non-OP) approach.

METHODS: : The trauma registry of our level I trauma center was queried for elderly (age > or = 60) patients with odontoid fractures from January 2000 to May 2006. …

Hips Can Lie: Impact Of Excluding Isolated Hip Fractures On External Benchmarking Of Trauma Center Performance, David Gomez, Barbara Haas, Mark Hemmila, Michael Pasquale, Sandra Goble, Melanie Neal, N Mann, Wayne Meredith, Henry Cryer, Shahid Shafi, Avery Nathens

Michael D Pasquale MD, FACS, FCCM

BACKGROUND: Trauma centers (TCs) vary in the inclusion of patients with isolated hip fractures (IHFs) in their registries. This inconsistent case ascertainment may have significant implications on the assessment of TC performance and external benchmarking efforts. METHODS: Data were derived from the National Trauma Data Bank (2007-8.1). We included patients (aged 16 years or older) with Injury Severity Score value ≥ 9 who were admitted to Level I and II TCs. To ensure data quality, we limited the study to TC that routinely reported comorbidities and Abbreviated Injury Scale codes. IHF were defined as patients, aged 65 years or older, …