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Race and Insurance Status are Associated With Different Management Strategies After Thoracic Trauma

Rebollo Salazar, Daniela; Velez-Rosborough, Anna; DiMaggio, Charles; Krowsoski, Leandra; Klein, Michael; Berry, Cherisse; Tandon, Manish; Frangos, Spiros; Bukur, Marko
INTRODUCTION/BACKGROUND:Health-care disparities based on race and socioeconomic status among trauma patients are well-documented. However, the influence of these factors on the management of rib fractures following thoracic trauma is unknown. The aim of this study is to describe the association of race and insurance status on management and outcomes in patients who sustain rib fractures. METHODS:The Trauma Quality Improvement Program database was used to identify adult patients who presented with rib fractures between 2015 and 2016. Patient demographics, injury severity, procedures performed, and outcomes were evaluated. Multivariate logistic regression analysis was used to determine the effect of race and insurance status on mortality and the likelihood of rib fixation surgery and epidural analgesia for pain management. RESULTS:A total of 95,227 patients were identified. Of these, 2923 (3.1%) underwent rib fixation. Compared to White patients, Asians (AOR: 0.57, P = 0.001), Blacks or African-Americans (AA) (AOR: 0.70, P < 0.001), and Hispanics/Latinos (HL) (AOR: 0.78, P < 0.001) were less likely to undergo rib fixation surgery. AA patients (AOR: 0.67, P = 0.004), other non-Whites (ONW) (AOR: 0.61, P = 0.001), and HL (AOR 0.65, P = 0.006) were less likely to receive epidural analgesia. Compared to privately insured patients, mortality was higher in uninsured patients (AOR: 1.72, P < 0.001), Medicare patients (AOR: 1.80, P < 0.001), and patients with other non-private insurance (AOR: 1.23, P < 0.001). CONCLUSIONS:Non-White race is associated with a decreased likelihood of rib fixation and/or epidural placement, while underinsurance is associated with higher mortality in patients with thoracic trauma. Prospective efforts to examine the socioeconomic disparities within this population are warranted.
PMID: 33401122
ISSN: 1095-8673
CID: 4738802

Intimate Partner Homicide: Current Understandings of Identifying Risk and Providing Patient Empowerment

Rosenberg, David; Berry, Cherisse
Purpose of Review: Intimate partner homicide (IPH), the lethal consequence of intimate partner violence (IPV), continues to account for a significant proportion of homicides worldwide. This review will highlight known risk factors of IPH, the state of risk assessment in healthcare settings, and examples of public policies that have impacted IPH risk. Recent Findings: Studies have identified risk factors unique to IPH, which include female and transgender identities, a larger age gap between victim and perpetrator, race and ethnic minority identities, IPV during pregnancy, migration to the USA, socioeconomic instability, and a previous history of IPV. There are a variety of risk assessment tools used in healthcare settings, each developed within specific contexts of providers, participants, and settings. Finally, policies restricting firearm access to previous perpetrators of IPV has been associated with decreased rates in IPH. Summary: While there are discrete risk factors and vulnerabilities for IPH, further work is needed to better understand risk within historically marginalized communities. The variation in risk assessment tools suggests that the administrator should select the one that best meets the patient"™s specific situation. Finally, the association between firearm control and IPH rates is an encouraging example for future directions of impacting IPH. While there are still challenges to identifying and intervening on IPH, there are promising opportunities to innovate new methods of providing safety and empowerment.
ISSN: 2198-6096
CID: 5060622

Rehabilitation Concerns in the Geriatric Critically Ill and Injured - Part 2

Nowak, Brittany; Berry, Cherisse
As life expectancy increases and birth rates decline, the geriatric population continues to grow faster than any other age group. Aging is characterized by a progressive physiologic decline that promotes the onset of functional limitation and disability. With the increasing geriatric population, more elderly patients are presenting to emergency departments after trauma, and intensive care units are being met with increasing demand. Rehabilitation is critical in improving quality of life by maximizing physical, cognitive, and psychological recovery from injury or disease.
PMID: 33190772
ISSN: 1557-8232
CID: 4672202

Lofty goals and strategic plans are not enough to achieve and maintain a diverse workforce: an American Association for the Surgery of Trauma Diversity, Equity, and Inclusion Committee conversation [Editorial]

Brasel, Karen; Berry, Cherisse; Williams, Brian H; Henry, Sharon M; Upperman, Jeffrey; West, Michaela A
The American Association for the Surgery of Trauma Diversity, Equity, and Inclusion (DEI) Ad Hoc Committee organized a luncheon symposium with a distinguished panel of experts to discuss how to ensure a diverse surgical workforce. The panelists discussed the current state of DEI efforts within surgical departments and societal demographic changes that inform and necessitate surgical workforce adaptations. Concrete recommendations included the following: obtain internal data, establish DEI committee, include bias training, review hiring and compensation practices, support the department members doing the DEI work, commit adequate funding, be intentional with DEI efforts, and develop and support alternate pathways for promotion and tenure.
PMID: 34805547
ISSN: 2397-5776
CID: 5063262

The American Association for the Surgery of Trauma Diversity, Equity and Inclusion Committee Essay Contest: Voices of the Future [Comment]

Berry, Cherisse
PMID: 35018307
ISSN: 2397-5776
CID: 5118682

Single Center Experience With Veno-Venous Extracorporeal Membrane Oxygenation in Patients With Traumatic Brain Injury

Parker, Brandon M; Menaker, Jay; Berry, Cherisse D; Tesoreiero, Ronald B; O'Connor, James V; Stein, Deborah M; Scalea, Thomas M
Veno-venous extracorporeal membrane oxygenation (VV-ECMO) use in patients following traumatic injury continues to increase. Some consider traumatic brain injury (TBI) as an absolute contraindication for VV-ECMO because of the concern for systemic anticoagulation (A/C) worsening intracranial injury. We evaluated outcomes and complications in patients with TBI treated with VV-ECMO.
PMID: 33295187
ISSN: 1555-9823
CID: 4706242

Response Regarding: "Elderly Patients With Cervical Spine Fractures After Ground Level Falls are at Risk for Blunt Cerebrovascular Injury" [Letter]

Gorman, Elizabeth; DiMaggio, Charles; Frangos, Spiros; Klein, Michael; Berry, Cherisse; Bukur, Marko
PMID: 32838972
ISSN: 1095-8673
CID: 4574232

Benchmarking Accomplishments of Leaders in American Surgery and Justification for Enhancing Diversity and Inclusion

Butler, Paris D; Pugh, Carla M; Meer, Elana; Lett, Lanair A; Tilahun, Estifanos D; Sanfey, Hilary A; Berry, Cherisse; Stain, Steven C; DeMatteo, Ronald P; Vickers, Selwyn M; Britt, L D; Martin, Colin A
OBJECTIVE:To comprehensively assess the level of achievement and demographics of national surgical society presidents. BACKGROUND:Data on the accomplishments needed to rise to positions of national surgical leadership is scarce and merit alone does not always yield such opportunities. Recognizing the shortcomings of sex and ethnic diversity within academic surgical leadership, the American College of Surgeon (ACS), American Surgical Association (ASA), Association of Women Surgeons (AWS), and the Society of Black Academic Surgeons (SBAS) partnered to address these challenges by performing a comprehensive assessment of their presidents over the last 16 years. METHODS:ACS, ASA, AWS, and SBAS presidents' CVs, at the time of their presidential term, were assessed for demographics and scholastic achievements. Regression analyses controlling for age were performed to determine relative differences across societies. RESULTS:A total of 62 of the 64 presidents' CVs were received and assessed (97% response rate). There was a large discrepancy in the average age in years of ACS (70) and ASA (66) presidents compared to the AWS (51) and SBAS (53) presidents. For the ACS and ASA cohort, 87% were male and 83% were White, collectively. After controlling for age (52), the AWS and SBAS presidents' scholastic achievements were comparable to the ACS (and ASA) cohort in 9 and 12 of the 15 accessed metrics, respectively. CONCLUSION/CONCLUSIONS:The ACS and ASA presidents' CVs displayed unsurpassed scholastic achievement, and although not equivalent, both the AWS and the SBAS presidents had comparable attainment. These findings further substantiate that women and ethnic minority surgeons are deserving of additional national leadership consideration as organized medicine pursues a more diverse and reflective physician workforce.
PMID: 32649466
ISSN: 1528-1140
CID: 4581552

Increasing age is associated with worse outcomes in elderly patients with severe liver injury

Gorman, Elizabeth; Bukur, Marko; Frangos, Spiros; DiMaggio, Charles; Kozar, Rosemary; Klein, Michael; Pachter, H Leon; Berry, Cherisse
While the incidence of geriatric trauma continues to increase, outcomes following severe blunt liver injury (BLI) are unknown. We sought to investigate independent predictors of mortality among elderly trauma patients with severe BLI. A retrospective study of the NTDB (2014-15) identified patients with isolated, high-grade BLI. Patients were stratified into two groups, non-elderly (<65 years) and elderly (≥65 years), and then two management groups: operative within 24 h of admission and non-operative. Demographics and outcomes were compared. Multivariable logistic regression was used to estimate association with mortality. A total of 1133 patients met our inclusion criteria. 107 patients required surgery and 1011 patients were managed non-operatively. Age was independently associated with mortality (AOR 1.04, p < .001). For patients <65 years, need for operative intervention was associated with a 55 times greater likelihood of death (AOR 55.1, p < .001). In patients ≥65 years, operative intervention was associated with a 122 times greater likelihood of death (AOR 122.09, p = .005). Age is independently associated with mortality in patients with high grade BLI.
PMID: 32653089
ISSN: 1879-1883
CID: 4527632

Blacks/African American Communities are at Highest Risk of COVID-19: Spatial Modeling of New York City ZIP Code-Level Testing Results

DiMaggio, Charles; Klein, Michael; Berry, Cherisse; Frangos, Spiros
INTRODUCTION/BACKGROUND:The population and spatial characteristics of COVID-19 infections are poorly understood, but there is increasing evidence that in addition to individual clinical factors, demographic, socioeconomic and racial characteristics play an important role. METHODS:We analyzed positive COVID-19 testing results counts within New York City ZIP Code Tabulation Areas (ZCTA) with Bayesian hierarchical Poisson spatial models using integrated nested Laplace approximations. RESULTS:Spatial clustering accounted for approximately 32% of the variation in the data. There was a nearly five-fold increase in the risk of a positive COVID-19 test. (IDR = 4.8, 95% Cr I 2.4, 9.7) associated with the proportion of Black / African American residents. Increases in the proportion of residents older than 65 years, housing density and the proportion of residents with heart disease were each associated with an approximate doubling of risk. In a multivariable model including estimates for age, COPD, heart disease, housing density and Black/African American race, the only variables that remained associated with positive COVID-19 testing with a probability greater than chance were the proportion of Black/African American residents and proportion of older persons. CONCLUSIONS:Areas with large proportions of Black/African American residents are at markedly higher risk that is not fully explained by characteristics of the environment and pre-existing conditions in the population.
PMID: 32827672
ISSN: 1873-2585
CID: 4581562