Faculty Bibliography

BACKGROUND:Current evaluation of rib fractures focuses almost exclusively on flail chest with little attention on bicortically displaced fractures. Chest trauma severe enough to cause fractures, leads to worse outcomes. An association between bicortically displaced rib fractures and pulmonary outcomes would potentially change patient care in the setting of trauma. We tested the hypothesis that bicortically displaced fractures were an important clinical marker for pulmonary outcomes in patients with non-flail rib fractures. METHODS:This nine center AAST multi-institutional study analyzed adults with two or more rib fractures. Admission CT scans were independently reviewed. The location, degree of rib fractures and pulmonary contusions were categorized. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of pneumonia, ARDS and tracheostomy. Analyses were performed in non-flail patients and also while controlling for flail chest to determine if bicortically displaced fractures were independently associated with outcomes. RESULTS:Of the 1110 patients 103 (9.3%) developed pneumonia, 78 (7.0%) required tracheostomy, and 30 (2.7%) developed ARDS. Bicortically displaced fractures were present in 277 (25%) of patients and in 206 (20.3%) of patients without flail chest. After adjusting for patient demographics, injury and admission physiology, negative pulmonary outcomes occurred over twice as frequently in those with bicortically displaced fractures without flail chest (n = 206) when compared to those without bicortically displaced fractures - pneumonia (OR 2.0, 95% CI 1.1-3.6), ARDS (OR 2.6, 95% CI 1.0-6.8) and tracheostomy (OR 2.7, 95% CI 1.4-5.2). When adjusting for the presence of flail chest, bicortically displaced fractures remained an independent predictor of pneumonia, tracheostomy and ARDS. CONCLUSIONS:Patients with bicortically displaced rib fractures are more likely to develop pneumonia, ARDS and need for tracheostomy even when controlling for flail chest. Future studies should investigate the utility of flail chest management algorithms in patients with bicortically displaced fractures. LEVEL OF EVIDENCE/METHODS:Prognostic and Epidemiological Study - Level IIIRetrospective Cohort Study.

Introduction: Gentrification is a worldwide issue that has many socio economic ramifications in the pursuit of "urban restructuring." Arguably, lower crime rates have been shown in gentrifying certain cities and communities. As New York gentrifies, we have used lower penetrating trauma rates as a surrogate to lower crime rates in the Northwestern side of Queens. As a result we have seen a drop in penetrating trauma rates in our affected area and trauma center.
Method(s): This is a population based retrospective study of 21,504 patients over a 10 year period of time (2007 - 2017) from our Level one trauma registry at Elmhurst Hospital. We stratified according to sex, age, ISS, mortality, GCS, BP, HR, insurance and race. Then we took 10 years of penetrating trauma injuries in comparison to all trauma patients seen by the trauma service. With the results we used Pearson Chi square to find statistical significance (Figure 1).
Result(s): In demographics, we have shown statistical significance in sex, age, insurance, HR and race. From 2007 to 2017 we have have shown a decreasing penetrating trauma rates from 13% to 6.4% (p < .001).
Conclusion(s): With statistical significance, we have shown a decrease in penetrating injury rates in Northwestern Queens that can be associated with gentrification of New York. As the process continues, trauma operative development may have to be adjusted to allow a fulfilling trauma education to our surgical residents and trauma fellows. Over the last 10 years, the rate of penetrating injuries dropped significantly by about half, from around 13.0% in the beginning of this time period to 6.47% in 2017 (p < .001). (Table Presented)

Background/UNASSIGNED:Nonagenarians represent a rapidly growing age group who often have functional limitations and multiple comorbidities, predisposing them to trauma. Aims/UNASSIGNED:The purpose of this study was to identify patient characteristics, hospital complications, and comorbidities that predict in-hospital mortality in the nonagenarian population following trauma. We also sought to create a scoring system using these variables. Settings and Design/UNASSIGNED:This study was a retrospective chart review. Methods/UNASSIGNED:We reviewed the medical records of 548 nonagenarian trauma patients admitted to two Level I trauma centers from 2006 to 2015. Statistical analysis was performed using logistic regression and a machine learning model, which calculated significant variables and computed a scoring system. Results/UNASSIGNED:= 39). Significant predictors of mortality were cardiac comorbidity, neuro-concussion, New Injury Severity Score (ISS) 16+, striking an object, ISS 25-75, and pulmonary and cardiac complications. Significant variables were assigned a numeric value. A score of 5+ carried a 41.1% mortality risk, 79% sensitivity, and 91% specificity. A score of 10+ had an associated 81.8% mortality risk with 31% specificity and 99% sensitivity. Conclusions/UNASSIGNED:Our findings identified reliable predictors of mortality in nonagenarian population posttrauma. The scoring system performs with good specificity and sensitivity and incrementally correlates with mortality risk.

We sought to determine patterns of injury in our Latino trauma community targeting alcohol (EtOH) intoxication as an influential variable. With the information gained in our culturally specific and culturally sensitive trauma community, we can use the information to fine-tune our trauma preventive medicine programs. Trauma injuries are the third largest contributor to racial disparities in the United States. Alcohol is involved in approximately half of all trauma admissions to trauma centers around the country. Some investigators have shown that Latinos have higher rates of high-risk drinking, and this factor is independently associated with mortality after trauma. This study is a retrospective review of 524 Latino blunt and penetrating trauma admissions for years (2012-2014). Electronic medical records with the hospital trauma registry charts were evaluated. The trauma registry database included age, gender, EtOH, mechanism of injury, location, insurance, and disposition. Statistical significance was used with chi-square test. Our results show a predominantly male population with falls being the primary mechanism of injury. Intoxicated injuries occurred mostly at bars/clubs, but a substantial amount occurred at the workplace. Despite having a majority of the injuries occurring with patients that have Medicaid or Charity Care insurance, a certain amount of the alcohol-related injuries had private insurance. Many of our Latino trauma patients are still suffering from trauma-related EtOH intoxication. With the information obtained from our project, we will be able to fine-tune and target our trauma preventive medicine program to provide education for our inner-city Latino community of EtOH intoxication-related trauma injuries.

INTRODUCTION: Body mass index (BMI) has commonly been used as a parameter to assess obesity in trauma patients. However, the variability of height and weight data in trauma patients limits the use of BMI as an accurate assessment tool in the trauma population. Quantitative radiologic measurements of visceral adiposity is an accurate method for assessing obesity in patients but requires further analysis before it can be accepted as a measurement tool for trauma patients. METHODS: A retrospective review of trauma cases with pre-operative CT scan from 2008 to 2015 produced 57 patients for evaluation. Preoperative BMI was calculated using measured height (m2) and weight (kg). Radiologic measurements of adiposity were obtained from preoperative CT scans using OsiriX DICOM viewer software. Visceral fat areas (VFA) and subcutaneous fat areas (SFA) were measured from a single axial slice at the level of L4-L5 intervertebral space. RESULTS: No statistically significant results were found relating visceral fat:subcutaneous fat ratios to length of stay or post-operative complications. Initial clinical observations noting an increased incidence of complications among patients with a V/S >/= 0.4 demonstrates a possible link between obesity and poor outcomes in trauma patients. A statistically significant correlation was noted between length of stay, peri-nephric fat and injury severity score. DISCUSSION AND CONCLUSION: Our pilot study should be viewed as the foundation for a larger prospective study, utilizing quantitative measurements of visceral adiposity to assess outcomes in trauma patients.