Medicine and Health Sciences Commons^™

The Position Of The Eastern Association For The Surgery Of Trauma On The Future Of Trauma Surgery., Michael F Rotondo, Thomas J Esposito, Patrick M Reilly, Philip S Barie, J Wayne Meredith, Virginia A Eddy, Reuven Rabinovici, Lenworth M Jacobs, Paul R G Cunningham, Eric R Frykberg, Michael Rhodes, Michael D. Pasquale Md, Facs, Fccm, Blaine L Enderson, John J Locurto, Nabil A Atweh, Rao R Ivatury

Michael D Pasquale MD, FACS, FCCM

No abstract provided.

Utility Of Chest Radiographs After Guidewire Exchanges Of Central Venous Catheters., P Frassinelli, Michael D. Pasquale Md, Facs, Fccm, M D Cipolle, M Rhodes

Michael D Pasquale MD, FACS, FCCM

OBJECTIVE: To determine whether chest radiographs are warranted after uncomplicated guidewire exchanges of central venous catheters in patients admitted to a Level I trauma intensive care unit.

DESIGN: Prospective study performed in two phases.

SETTING: Intensive care unit in a Level I trauma center.

PATIENTS: Patients admitted to a Level I trauma center intensive care unit who required central venous catheter guidewire exchanges.

INTERVENTIONS: Criteria for uncomplicated guidewire exchanges were established and followed. A catheter exchange checklist was completed at each procedure, and a chest radiograph was performed after each guidewire exchange. The complications followed were catheter malposition, pneumothorax, hemothorax, …

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 …

Use Of Greenfield Filters In Renal Transplant Patients--Are They Safe?, Michael D. Pasquale Md, Facs, Fccm, J H Abrams, J S Najarian, F B Cerra

Michael D Pasquale MD, FACS, FCCM

No abstract provided.

Massive Hematochezia Secondary To Graft-Versus-Host Disease And Cytomegalovirus., M Shabahang, Michael D. Pasquale Md, Facs, Fccm, P Bitterman, E Cirenza, T Spitzer, S R Evans

Michael D Pasquale MD, FACS, FCCM

No abstract provided.

Multicenter Study Of Noninvasive Monitoring Systems As Alternatives To Invasive Monitoring Of Acutely Ill Emergency Patients., W C Shoemaker, H Belzberg, C C Wo, D P Milzman, Michael D. Pasquale Md, Facs, Fccm, L Baga, M A Fuss, G J Fulda, K Yarbrough, J P Van Dewater, P J Ferraro, D Thangathurai, P Roffey, G Velmahos, J A Murray, J A Asensio, K Eltawil, W R Dougherty, M J Sullivan, R S Patil, J Adibi, C B James, D Demetriades

Michael D Pasquale MD, FACS, FCCM

BACKGROUND: Recent reports showed lack of effectiveness of pulmonary artery catheterization in critically ill medical patients and relatively late-stage surgical patients with organ failure. Since invasive monitoring requires critical care environments, the early hemodynamic patterns may have been missed. Ideally, early noninvasive hemodynamic monitoring systems, if reliable, could be used as the "front end" of invasive monitoring to supply more complete descriptions of circulatory pathophysiology.

OBJECTIVES: To evaluate the accuracy and reliability of noninvasive hemodynamic monitoring consisting of a new bioimpedance method for estimating cardiac output combined with arterial BP, pulse oximetry, and transcutaneous PO2 and PCO2; we compared this …

Making The Case For A Paradigm Shift In Trauma Surgery., Thomas J Esposito, Michael Rotondo, Philip S Barie, Patrick Reilly, Michael D. Pasquale Md, Facs, Fccm

Michael D Pasquale MD, FACS, FCCM

No abstract provided.

Elective Colostomy Closure In An Aids Patient., Michael D. Pasquale Md, Facs, Fccm, J M Kenkel, R W Holt

Michael D Pasquale MD, FACS, FCCM

This article describes a 27-year-old patient with acquired immunodeficiency syndrome (AIDS) who underwent emergency sigmoid colostomy, Hartmann's pouch, and presacral drainage for rectal perforation. Three months later, he underwent uneventful elective colostomy closure, a procedure previously unreported in an AIDS patient. He remained without gastrointestinal symptoms for 14 months after colostomy closure until he died from central nervous system toxoplasmosis. A diagnosis of AIDS alone should not preclude colostomy closure in AIDS patients.

Multicenter, Randomized, Prospective Trial Of Early Tracheostomy., H J Sugerman, L Wolfe, Michael D. Pasquale Md, Facs, Fccm, F B Rogers, K F O'Malley, M Knudson, L Dinardo, M Gordon, S Schaffer

Michael D Pasquale MD, FACS, FCCM

OBJECTIVES: Determine the effect of early (days 3-5) or late (days 10-14) tracheostomy on intensive care unit length of stay (ICU LOS), frequency of pneumonia, and mortality, and evidence of short-term or long-term pharyngeal, laryngeal, or tracheal injury in head trauma, non-head trauma, and critically ill nontrauma patients.

STUDY DESIGN: Randomized, prospective.

SETTING: Five Level I trauma centers.

METHODS: Data were obtained prospectively and included Acute Physiology and Chronic Health Evaluation III score (AIII), Glasgow Coma Scale score, Emergency Room Trauma Score, Injury Severity Score, Acute Injury Score, type of endotracheal tube or tracheostomy, level of positive end-expiratory pressure, and …

Impact Of Cirrhosis On Outcomes In Trauma., Dale A Dangleben, Omid Jazaeri, Thomas Wasser, Mark Cipolle, Michael D. Pasquale Md, Facs, Fccm

Michael D Pasquale MD, FACS, FCCM

BACKGROUND: Cirrhosis as an independent predictor of poor outcomes in trauma patients was identified in 1990. We hypothesized that the degree of preinjury hepatic dysfunction is, by itself, an independent predictor of mortality.

STUDY DESIGN: The trauma registry at our Level I trauma center was queried for all ICD-9 codes for liver disease from 1999 to 2003, and patients were categorized as having Child-Turcotte-Pugh (CTP) class A, B, or C cirrhosis. Data analyzed included age, mechanism of injury, Abbreviated Injury Score (AIS), Injury Severity Score (ISS), Glasgow Coma Score (GCS), hospital length of stay, ventilator days, procedures performed, transfusion of …

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%) …

Bilateral Renal Artery Thrombosis Secondary To Blunt Trauma: Case Report And Review Of The Literature., P Frassinelli, Michael D. Pasquale Md, Facs, Fccm, C Reckard, J Goodreau, G Sherwin

Michael D Pasquale MD, FACS, FCCM

No abstract provided.

Value-Based Medicine: The Financial Impact Of A Pressure Ulcer Prevention Program On A Trauma Population, Jayme D. Lieberman Md, Patrick S. Duffy Md, Kai L. Bortz Rn, Rovinder S. Sandhu Md, Michael D. Pasquale Md, Facs, Fccm, Michael M. Badellino Md

Michael D Pasquale MD, FACS, FCCM

No abstract provided.

The Role Of Surveillance Duplex Scanning In Preventing Venous Thromboembolism In Trauma Patients., Mark D. Cipolle, Randolph Wojcik Md, Elizabeth Seislove, Thomas E. Wasser, Michael D. Pasquale Md, Facs, Fccm

Michael D Pasquale MD, FACS, FCCM

BACKGROUND: This study was performed to determine the role of duplex scanning in preventing pulmonary embolism (PE), the correlation of venous thromboembolism (VTE) risk score with the incidence of deep venous thrombosis (DVT), and patients who may benefit from surveillance duplex scanning.

METHODS: Age, sex, Injury Severity Score (ISS), VTE score, length of stay, diagnoses, and bleeding risk were recorded from the trauma registry in patients who had a duplex scan from 1995 to 2000.

RESULTS: There were 1,513 duplex scans obtained (10,141 trauma admissions), 253 (2.5%) cases of DVT (52% above-knee, 8% upper extremity), and 30 cases of PE …

Outcome Of Blunt Thoracic Aortic Injury In A Level I Trauma Center: An 8-Year Review., E J Frick, M D Cipolle, Michael D. Pasquale Md, Facs, Fccm, T E Wasser, M Rhodes, Raymond L. Singer Md, S A Nastasee

Michael D Pasquale MD, FACS, FCCM

BACKGROUND: The purpose of this study was to evaluate our experience with blunt thoracic aortic injury and identify factors predictive of outcome.

METHODS: Hospital charts, trauma registry data, and autopsies of 64 patients with blunt thoracic aortic injury from 1988 to 1995 were reviewed.

RESULTS: Patients were identified and segregated based on admission physiology. Group 1 patients (n = 19) arrived in arrest. Group 2 patients (n = 10) arrived in shock with systolic BP 90. Group 3 patients (n = 35) arrived with systolic BP>90. All patients in groups 1 and 2 expired. Injury Severity Scores for nonsurvivors …

2015 Annual Nsqip Conference Erin (Enhanced Recovery In Nsqip) Session, Michael D. Pasquale Md, Facs, Fccm, Pat Toselli Do, Richard Kolesky Md, Robert J. Sinnott Do, Cathleen Webber Rn, Mshs, Sharon Pustilnik Rn, Bs, Justina A. Momah Rn, Crnp

Michael D Pasquale MD, FACS, FCCM

No abstract provided.

Using Tqip Results In Your Trauma Center: Three Hospitals Experience, Michael Pasquale, Elizabeth Seislove

Michael D Pasquale MD, FACS, FCCM

No abstract provided.

Panel Discussion Using Tqip Results In Your Trauma Center: Tqip Participants Experiences., Michael Pasquale, Judith Schultz, Elizabeth Seislove

Michael D Pasquale MD, FACS, FCCM

No abstract provided.

Male Gender Is Associated With Increased Risk For Postinjury Pneumonia., Christopher J Gannon, Michael Pasquale, J Kathleen Tracy, Robert J Mccarter, Lena M Napolitano

Michael D Pasquale MD, FACS, FCCM

Nosocomial pneumonia in trauma patients is a significant source of resource utilization and mortality. We have previously described increased rates of pneumonia in male trauma patients in a single institution study. In that study, female trauma patients had a lower incidence of postinjury pneumonia but a higher relative risk for mortality when they did develop pneumonia. We sought to investigate the hypothesis that male trauma patients have an increased incidence of postinjury pneumonia in a separate population-based dataset. Prospective data were collected on 30,288 trauma patients (26,231 blunt injuries, 4057 penetrating injuries) admitted to all trauma centers (n = 26) …

The Trauma Quality Improvement Program (Tqip): Why We Need It And How We Utilize It., Elizabeth Seislove, M. Neal, Michael Pasquale

Michael D Pasquale MD, FACS, FCCM

No abstract provided.

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 …

Contribution Of Age And Gender To Outcome Of Blunt Splenic Injury In Adults: Multicenter Study Of The Eastern Association For The Surgery Of Trauma, Brian Harbrecht, Andrew Peitzman, Louis Rivera, Brian Heil, Martin Croce, John Morris, Blaine Enderson, Stanley Kurek, Michael Pasquale, Eric Frykberg, Joseph Minei, Wayne Meredith, Jospeh Young, G. Kealey, Steven Ross, Fred Luchette, Mary Mccarthy, Frank Davis, David Shatz, Glenn Tinkoff, Ernest Block, John Cone, Larry Jones, Thomas Chalifoux, Michael Federle, Keith Clancy, Juan Ochoa, Samir Fakhry, Richard Townsend, Richard Bell, Leonard Weireter, Michael Shapiro, Fred Rogers, Michael Dunham, Clyde Mcauley

Michael D Pasquale MD, FACS, FCCM

Background : The purpose of this study was to examine the contribution of age and gender to outcome after treatment of blunt splenic injury in adults.

Methods : Through the Multi-Institutional Trials Committee of the Eastern Association for the Surgery of Trauma (EAST), 1488 adult patients from 27 trauma centers who suffered blunt splenic injury in 1997 were examined retrospectively.

Results : Fifteen percent of patients were 55 years of age or older. A similar proportion of patients >= 55 went directly to the operating room compared with patients < 55 (41% vs. 38%) but the mortality for patients >= 55 was significantly greater than patients < 55 (43% vs. 23%). Patients >= 55 failed nonoperative …

Anxiety, Satisfaction With Needs Met And Well-Being In Family Members Present During Trauma Resuscitation: A Comparative Study., Michael Pasquale, S. Eid

Michael D Pasquale MD, FACS, FCCM

No abstract provided.

National Trauma Institute Prospective Evaluation Of The Ventilator Bundle In Trauma Patients: Does It Really Work?, Martin A. Croce Md, Karen J. Brasel Md, Mph, Raul Coimbra Md, Phd, Charles A. Adams Jr, Md, Preston R. Miller Md, Michael D. Pasquale Md, Facs, Fccm, Chanchai S. Mcdonald Phd, Somchan Vuthipadadon Phd, Timothy C. Fabian Md, Elizabeth A. Tolley Phd

Michael D Pasquale MD, FACS, FCCM

BACKGROUND: Since its introduction by the Institute for Healthcare Improvement, the ventilator bundle (VB) has been credited with a reduction in ventilator-associated pneumonia (VAP). The VB consists of stress ulcer prophylaxis, deep venous thrombosis prophylaxis, head-of-bed elevation, and daily sedation vacation with weaning assessment. While there is little compelling evidence that the VB is effective, it has been widely accepted. The Centers for Medical and Medicaid Services has suggested that VAP should be a "never event" and may reduce payment to providers. To provide evidence of its efficacy, the National Trauma Institute organized a prospective multi-institutional trial to evaluate the …

Antibiotics In Abdominal Wall Reconstruction, Joseph J. Stirparo Md, Michael D. Pasquale Md, Facs, Fccm

Michael D Pasquale MD, FACS, FCCM

No abstract provided.

Family Presence During Trauma Resuscitation: Ready For Primetime?, Mae Pasquale, Michael Pasquale, Leslie Baga, Sherrine Eid, Jane Leske

Michael D Pasquale MD, FACS, FCCM

BACKGROUND: The concept of family presence during trauma resuscitation (FPTR) remains controversial. Healthcare providers have expressed concern that resuscitation of severely injured trauma patients is inappropriate for family members as they may have psychologic distress, disrupt resuscitative efforts, or misinterpret provider actions, which can ultimately impact satisfaction with care. The minimal evidence that exists is descriptive or anecdotal.

METHODS: Using a previously developed FPTR protocol, a prospective, comparative study assessing 50 adult family members, who were present (n = 25) or not present (n = 25) with their severely injured adult family member during resuscitation, was conducted. Family member anxiety …

Health Care Reform At Trauma Centers--Mortality, Complications, And Length Of Stay, Shahid Shafi, Sunni Barnes, David Nicewander, David Ballard, Avery Nathens, Angela Ingraham, Mark Hemmila, Sandra Goble, Melanie Neal, Michael Pasquale, John Fildes, Larry Gentilello

Michael D Pasquale MD, FACS, FCCM

No abstract provided.

Family Presence During Trauma Resuscitation: Ready For Primetime?, Mae Pasquale, Michael Pasquale, Leslie Baga, Sherrine Eid, Jane Leske

Michael D Pasquale MD, FACS, FCCM

No abstract provided.

Health Care Reform At Trauma Centers: Mortality, Complications, And Length Of Stay (Presentation), Shahid Shafi, Sunni Barnes, David Nicewander, David Ballard, Avery Nathens, Angela Ingraham, Mark Hemmila, John Fildes, Michael Pasquale, Larry Gentilello

Michael D Pasquale MD, FACS, FCCM

No abstract provided.

Use Of Geocoding And Us Census Data To Assess Determinants Of Outcome In Trauma Patients, Krista M. Goodman Md, John J. Hong Md, Sherrine Eid Mph, Leslie Baga Bsn, Ccrc, Michael M. Badellino Md, Mph, Facs, Michael D. Pasquale Md, Facs

Michael D Pasquale MD, FACS, FCCM

No abstract provided.