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Does lower extremity fracture fixation technique influence neurologic outcomes in patients with traumatic brain injury? The EAST Brain vs. Bone multicenter trial

Ghneim, Mira; Kufera, Joseph; Zhang, Ashling; Penaloza-Villalobos, Liz; Swentek, Lourdes; Watras, Jill; Smith, Alison; Hahn, Alexandra; Rodriguez Mederos, Dalier; Dickhudt, Timothy John; Laverick, Paige; Cunningham, Kyle; Norwood, Scott; Fernandez, Luis; Jacobson, Lewis E; Williams, Jamie M; Lottenberg, Lawrence; Azar, Faris; Shillinglaw, William; Slivinski, Andrea; Nahmias, Jeffry; Donnelly, Megan; Bala, Miklosh; Egodage, Tanya; Zhu, Clara; Udekwu, Pascal O; Norton, Hannah; Dunn, Julie A; Baer, Robert; McBride, Katherine; Santos, Ariel P; Shrestha, Kripa; Metzner, Caleb J; Murphy, Jade M; Schroeppel, Thomas J; Stillman, Zachery; O'Connor, Rick; Johnson, Dirk; Berry, Cherisse; Ratner, Molly; Reynolds, Jessica K; Humphrey, Mackenzie; Scott, Mark; Hickman, Zachary L; Twelker, Kate; Legister, Candice; Glass, Nina E; Siebenburgen, Christa; Palmer, Brandi; Semon, Gregory R; Lieser, Mark; McDonald, Hannah; Bugaev, Nikolay; LeClair, Madison J; Stein, Deborah; ,
OBJECTIVE:This study aimed to determine whether lower extremity fracture fixation technique and timing (≤24 vs. >24 hours) impact neurologic outcomes in TBI patients. METHODS:A prospective observational study was conducted across 30 trauma centers. Inclusion criteria were age 18 years and older, head Abbreviated Injury Scale (AIS) score of >2, and a diaphyseal femur or tibia fracture requiring external fixation (Ex-Fix), intramedullary nailing (IMN), or open reduction and internal fixation (ORIF). The analysis was conducted using analysis of variamce, Kruskal-Wallis, and multivariable regression models. Neurologic outcomes were measured by discharge Ranchos Los Amigos Revised Scale (RLAS-R). RESULTS:Of the 520 patients enrolled, 358 underwent Ex-Fix, IMN, or ORIF as definitive management. Head AIS was similar among cohorts. The Ex-Fix group experienced more severe lower extremity injuries (AIS score, 4-5) compared with the IMN group (16% vs. 3%, p = 0.01) but not the ORIF group (16% vs. 6%, p = 0.1). Time to operative intervention varied between the cohorts with the longest time to intervention for the IMN group (median hours: Ex-Fix, 15 [8-24] vs. ORIF, 26 [12-85] vs. IMN, 31 [12-70]; p < 0.001). The discharge RLAS-R score distribution was similar across the groups. After adjusting for confounders, neither method nor timing of lower extremity fixation influenced the discharge RLAS-R. Instead, increasing age and head AIS score were associated with a lower discharge RLAS-R score (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.002-1.03 and OR, 2.37; 95% CI, 1.75-3.22), and a higher Glasgow Coma Scale motor score on admission (OR, 0.84; 95% CI, 0.73-0.97) was associated with higher RLAS-R score at discharge. CONCLUSION:Neurologic outcomes in TBI are impacted by severity of the head injury and not the fracture fixation technique or timing. Therefore, the strategy of definitive fixation of lower extremity fractures should be dictated by patient physiology and the anatomy of the injured extremity and not by the concern for worsening neurologic outcomes in TBI patients. LEVEL OF EVIDENCE:Prognostic and Epidemiological; Level III.
PMID: 37335182
ISSN: 2163-0763
CID: 5725092

A Call to Action to Train Underrepresented Minorities in Surgical Subspecialties and Fellowships

Escobar, Natalie; Keshinro, Ajaratu; Hambrecht, Amanda; Frangos, Spiros; Berman, Russell S; DiMaggio, Charles; Joseph, Kathie-Ann; Bukur, Marko; Klein, Michael J; Ude-Welcome, Akuezunkpa; Berry, Cherisse
BACKGROUND:With each succession along the surgical career pathway, from medical school to faculty, the percentage of those who identify as underrepresented in medicine (URiM) decreases. We sought to evaluate the demographic trend of surgical fellowship applicants, matriculants, and graduates over time. STUDY DESIGN:The Electronic Residency Application Service and the Graduate Medical Education Survey for general surgery fellowships in colorectal surgery, surgical oncology, pediatric surgery, thoracic surgery, and vascular surgery were retrospectively analyzed (2005 to 2020). The data were stratified by race and gender, descriptive statistics were performed, and time series were evaluated. Race/ethnicity groups included White, Asian, other, and URiM, which is defined as Black/African American, Hispanic/Latino(a), Alaskan or Hawaiian Native, and Native American. RESULTS:From 2005 to 2020, there were 5,357 Electronic Residency Application Service applicants, 4,559 matriculants, and 4,178 graduates to surgery fellowships. Whites, followed by Asians, represented the highest percentage of applicants (62.7% and 22.3%, respectively), matriculants (65.4% and 23.8% respectively), and graduates (65.4% and 24.0%, respectively). For URiMs, the applicants (13.4%), matriculants (9.1%), and graduates (9.1%) remained significantly low (p < 0.001). When stratified by both race and gender, only 4.6% of the applicants, 2.7% of matriculants, and 2.4% of graduates identified as both URiM and female compared to White female applicants (20.0%), matriculants (17.9%), and graduates (16.5%, p < 0.001). CONCLUSIONS:Significant disparities exist for URiMs in general surgery subspecialty fellowships. These results serve as a call to action to re-examine and improve the existing processes to increase the number of URiMs in the surgery subspecialty fellowship training pathway.
PMID: 36946471
ISSN: 1879-1190
CID: 5525062

Prehospital Hemorrhage Control and Treatment by Clinicians: A Joint Position Statement

[Berry, Cherisse; Gallagher, John M; Goodloe, Jeffrey M; Dorlac, Warren C; Dodd, Jimm; Fischer, Peter E]
PMID: 37349075
ISSN: 1097-6760
CID: 5525052

Trauma

Chapter by: Gooding, Rose C.; Llera, Brent; Harris, Randi; El-Shafy, Ibrahim Abd; Berry, Cherisse; Joseph, D"â„¢Andrea
in: The ABSITE Blueprints by
[S.l.] : Springer International Publishing, 2023
pp. 433-493
ISBN: 9783031326424
CID: 5717732

Epidemiology of Injury in the Elderly: Use of DOACs

Chapter by: Hambrecht, Amanda; Escobar, Natalie; Berry, Cherisse
in: Acute Care Surgery in Geriatric Patients by
[S.l.] : Springer International Publishing, 2023
pp. 75-81
ISBN: 9783031306501
CID: 5718002

Liver injury

Chapter by: Berry, Cherisse; Parikh, Manish; Pachter, H. Leon
in: Current Therapy of Trauma and Surgical Critical Care by
[S.l.] : Elsevier, 2023
pp. 383-397.e9
ISBN: 9780323697873
CID: 5615702

Invited Commentary: Achieving Health Equity in Trauma and Acute Care Surgery: The Need to Implement an Intersectionality Framework in the Analysis of All Patient Outcomes

Berry, Cherisse
PMID: 36281972
ISSN: 1879-1190
CID: 5388982

Substance use and pre-hospital crash injury severity among U.S. older adults: A five-year national cross-sectional study

Adeyemi, Oluwaseun; Bukur, Marko; Berry, Cherisse; DiMaggio, Charles; Grudzen, Corita R; Konda, Sanjit; Adenikinju, Abidemi; Cuthel, Allison; Bouillon-Minois, Jean-Baptiste; Akinsola, Omotola; Moore, Alison; McCormack, Ryan; Chodosh, Joshua
BACKGROUND:Alcohol and drug use (substance use) is a risk factor for crash involvement. OBJECTIVES:To assess the association between substance use and crash injury severity among older adults and how the relationship differs by rurality/urbanicity. METHODS:We pooled 2017-2021 cross-sectional data from the United States National Emergency Medical Service (EMS) Information System. We measured injury severity (low acuity, emergent, critical, and fatal) predicted by substance use, defined as self-reported or officer-reported alcohol and/or drug use. We controlled for age, sex, race/ethnicity, road user type, anatomical injured region, roadway crash, rurality/urbanicity, time of the day, and EMS response time. We performed a partial proportional ordinal logistic regression and reported the odds of worse injury outcomes (emergent, critical, and fatal injuries) compared to low acuity injuries, and the predicted probabilities by rurality/urbanicity. RESULTS:Our sample consisted of 252,790 older adults (65 years and older) road users. Approximately 67%, 25%, 6%, and 1% sustained low acuity, emergent, critical, and fatal injuries, respectively. Substance use was reported in approximately 3% of the population, and this proportion did not significantly differ by rurality/urbanicity. After controlling for patient, crash, and injury characteristics, substance use was associated with 36% increased odds of worse injury severity. Compared to urban areas, the predicted probabilities of emergent, critical, and fatal injuries were higher in rural and suburban areas. CONCLUSION:Substance use is associated with worse older adult crash injury severity and the injury severity is higher in rural and suburban areas compared to urban areas.
PMCID:10599556
PMID: 37878571
ISSN: 1932-6203
CID: 5606472

Prehospital Hemorrhage Control and Treatment by Clinicians: A Joint Position Statement

Berry, Cherisse; Gallagher, John M; Goodloe, Jeffrey M; Dorlac, Warren C; Dodd, Jimm; Fischer, Peter E
Exsanguination remains the leading cause of preventable death among victims of trauma. For adult and pediatric trauma patients in the prehospital phase of care, methods to control hemorrhage and hemostatic resuscitation are described in this joint consensus opinion by the American College of Surgeons Committee on Trauma, the American College of Emergency Physicians, and the National Association of EMS Physicians.
PMID: 36961935
ISSN: 1545-0066
CID: 5525072

Quality care is equitable care: a call to action to link quality to achieving health equity within acute care surgery [Editorial]

Knowlton, Lisa M; Zakrison, Tanya; Kao, Lillian S; McCrum, Marta L; Agarwal, Suresh; Bruns, Brandon; Joseph, Kathie-Ann; Berry, Cherisse
Health equity is defined as the sixth domain of healthcare quality. Understanding health disparities in acute care surgery (defined as trauma surgery, emergency general surgery and surgical critical care) is key to identifying targets that will improve outcomes and ensure delivery of high-quality care within healthcare organizations. Implementing a health equity framework within institutions such that local acute care surgeons can ensure equity is a component of quality is imperative. Recognizing this need, the AAST (American Association for the Surgery of Trauma) Diversity, Equity and Inclusion Committee convened an expert panel entitled 'Quality Care is Equitable Care' at the 81st annual meeting in September 2022 (Chicago, Illinois). Recommendations for introducing health equity metrics within health systems include: (1) capturing patient outcome data including patient experience data by race, ethnicity, language, sexual orientation, and gender identity; (2) ensuring cultural competency (eg, availability of language services; identifying sources of bias or inequities); (3) prioritizing health literacy; and (4) measuring disease-specific disparities such that targeted interventions are developed and implemented. A stepwise approach is outlined to include health equity as an organizational quality indicator.
PMCID:10186480
PMID: 37205273
ISSN: 2397-5776
CID: 5544372