www.ccmjournal.org Critical Care Medicine • Volume 46 • Number 1 (Supplement) Learning Objectives... more www.ccmjournal.org Critical Care Medicine • Volume 46 • Number 1 (Supplement) Learning Objectives: Pain is common among trauma patients and has historically been managed with opioids. Opioid abuse and adverse effects have sparked interest in the use of non-opioid agents as an adjunct to opioids, but there is limited data to support this strategy in trauma. The purpose of this study was to assess the effectiveness and safety of combination gabapentin and methocarbamol as a component of multimodal pain therapy in the trauma population. Methods: Single center, retrospective study of patients admitted to the trauma service for > 72 hours between June 2012 and February 2017. Primary outcome was cumulative opioid use in morphine equivalents over the first 4 days of admission in patients receiving combination gabapentin and methocarbamol (MMPC) compared to opioid only regimens. Secondary outcomes included opioid use up to 7 days, adverse effects (constipation, nausea/ vomiting, or respiratory depression), and length of stay (LOS). A subgroup analysis including patients with rib fractures was also performed. Results: 1899 patients were screened with 200 included; 100 in both the MMPC and opioid only group. Groups were similar except for a higher injury severity score and more patients with rib fractures in the MMPC group. The MMPC also had lower use of IV APAP, but higher use of NSAIDs and scheduled opioids. The mean daily dose of gabapentin and methocarbamol in the MMPC group was 687 ± 310 mg and 2193 ± 574 mg, respectively. There was not a statistically significant difference found in the primary outcome of cumulative opioid use after 4 days (55 mg [29, 103] MMPC vs. 65 mg [41,110] opioid, p = 0.17). There were also no statistically significant differences in cumulative opioid use at 7 days (93 [34, 158] in MMPC versus 150 [70, 243] in opioid, p = 0.51), adverse effects, or LOS. In the rib fracture subgroup, there was significantly lower opioid use at 4 days (50 mg [22,95] vs. 78 mg [49,138], p < 0.01) and at 7 days in the MMPC group (93 mg [35, 15] vs. 150 mg [173, 119], p < 0.01). Conclusions: In this retrospective study, MMPC resulted in decreased opioid use although this did not reach statistical significance. Patients with rib fractures on MMPC had a significant decrease in opioid requirements. This and other subgroups warrant study to further evaluate the benefit of MMPC. 1623
JSLS : Journal of the Society of Laparoendoscopic Surgeons, 2001
Background: Distinguishing achalasia from pseudoachalasia can be difficult, as the clinical, radi... more Background: Distinguishing achalasia from pseudoachalasia can be difficult, as the clinical, radiological, and manometric findings can be similar to those seen in achalasia. The features that may differentiate achalasia from pseudoachalasia are reviewed and the pathogenesis of pseudoachalasia is discussed. Methods: A patient presented with a clinical scenario of achalasia that was documented by radiographic, endoscopic, and manometric studies. Her past medical history was significant for cervical cancer. Although brief improvement in symptoms was achieved with botulinum toxin injections and esophageal dilation, she had continued progression of symptoms. This direct involvement of the esophagus by a tumor was not demonstrated by any of the routine preoperative studies. Results: At the time of surgery, extensive involvement of the diaphragm, esophagus, and pericardium by a tumor was noted. Pathologic analysis of the tumor was consistent with metastatic cervical cancer Conclusion: Pseu...
The Journal of Trauma: Injury, Infection, and Critical Care, 2011
Injuries to pedestrians struck by motor vehicles represent a significant public health hazard in ... more Injuries to pedestrians struck by motor vehicles represent a significant public health hazard in large cities. The purpose of this study is to investigate the demographics of alcohol users who are struck by motor vehicles and to assess the effects of alcohol on pedestrian crossing patterns, medical management, and outcomes. Data were prospectively collected between December 2008 to September 2010 on all pedestrians who presented to a Level I trauma center after being struck by a motor vehicle. Variables were obtained by interviewing patients, scene witnesses, first responders, and medical records. Pedestrians who used alcohol were less likely to cross the street in the crosswalk with the signal (22.6% vs. 64.7%) and more likely to cross either in the crosswalk against the signal (22.6% vs. 12.4%) or midblock (54.8% vs. 22.8%). Alcohol use was associated with more initial computed tomography imaging studies compared with no alcohol involvement. Alcohol use was associated with a higher Injury Severity Score (8.82 vs. 4.85; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and hospital length of stay (3.89 days vs. 1.82 days; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) compared with those with no alcohol involvement. Patients who used alcohol had a lower average Glasgow Coma Scale score (13.80 vs. 14.76; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and a higher rate of head and neck, face, chest, abdomen, and extremity/pelvic girdle injuries (based on Abbreviated Injury Scale) than those with no alcohol involvement. Alcohol use is a significant risk factor for pedestrians who are struck by motor vehicles. These patients are more likely to cross the street in an unsafe manner and sustain more serious injuries. Traffic safety and injury prevention programs must address irresponsible alcohol use by pedestrians.
Jsls Journal of the Society of Laparoendoscopic Surgeons Society of Laparoendoscopic Surgeons, 2001
BACKGROUND: Distinguishing achalasia from pseudoachalasia can be difficult, as the clinical, radi... more BACKGROUND: Distinguishing achalasia from pseudoachalasia can be difficult, as the clinical, radiological, and manometric findings can be similar to those seen in achalasia. The features that may differentiate achalasia from pseudoachalasia are reviewed and the pathogenesis of pseudoachalasia is discussed.METHODS: A patient presented with a clinical scenario of achalasia that was documented by radiographic, endoscopic, and manometric studies. Her past medical history was significant for cervical cancer. Although brief improvement in symptoms was achieved with botulinum toxin injections and esophageal dilation, she had continued progression of symptoms. This direct involvement of the esophagus by a tumor was not demonstrated by any of the routine preoperative studies.RESULTS: At the time of surgery, extensive involvement of the diaphragm, esophagus, and pericardium by a tumor was noted. Pathologic analysis of the tumor was consistent with metastatic cervical cancerCONCLUSION: Pseudoachalasia has been known to occur in response to both benign and malignant causes. Differentiating between pseudoachalasia and achalasia is often difficult because of the similarities. As in this case, the diagnosis of pseudoachalasia may be made by surgical exploration.
The Journal of Trauma Injury Infection and Critical Care, Aug 1, 2009
Nearly 100,000 people await an organ transplant in the U.S. Improved utilization of potential org... more Nearly 100,000 people await an organ transplant in the U.S. Improved utilization of potential organ donors may reduce the organ shortage. Physician attitudes toward organ donation may influence donation rates; however, the attitudes of U.S. physicians have not been formally evaluated. Anonymous questionnaires were distributed to surgical attendings, surgical residents, and medical students at two academic medical centers. Willingness to donate one&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s own organs and family member&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s organs was examined, as well as experience with transplant procedures and religious views regarding organ donation. A total of 106 surveys were returned. Sixty-four percent of responders were willing to donate their own organs, and 49% had signed an organ donor card. Willingness to donate inversely correlated with professional experience. Eighty-four percent of those surveyed would agree to donate the organs of a family member, including 55% of those who refused to donate their own organs. Experience on the transplant service influenced 16% of those refusing donation, with the procurement procedure cited by 83% of this group. Sixteen percent refused organ donation on the basis of religious beliefs. The surveyed U.S. physicians are less willing to donate their organs compared with the general public. Despite understanding the critical need for organs, less than half of physicians surveyed had signed organ donor cards. Previous experiences with the procurement procedure influenced several responders to refuse organ donation. As the lay public traditionally looks to physicians for guidance, efforts must be made to improve physician attitudes toward organ donation with the hope of increasing donation rates.
Proceedings of the First Joint BMES/EMBS Conference. 1999 IEEE Engineering in Medicine and Biology 21st Annual Conference and the 1999 Annual Fall Meeting of the Biomedical Engineering Society (Cat. No.99CH37015), 1999
ABSTRACT In this study, a system was developed to assess quality of movement, as applied to lapar... more ABSTRACT In this study, a system was developed to assess quality of movement, as applied to laparoscopic instruments. An instrument is fitted with a variable inductor as part of a Colpitts oscillator. Output frequency is demodulated, sampled, and processed using LabView. In initial studies, this system is used to evaluate velocity and positioning accuracy during insertion and retraction tasks. Data show no significant difference between dominant and non-dominant hands, but velocity for extraction was higher than that of insertion, and marked improvement was seen over a three-day period
Journal of correctional health care : the official journal of the National Commission on Correctional Health Care, 2015
Bellevue Hospital's prison ward cares for male prisoners requiring medical attention that exc... more Bellevue Hospital's prison ward cares for male prisoners requiring medical attention that exceeds the capabilities of New York City Department of Correction (NYC-DOC) infirmaries. This study evaluated the injury patterns that occur in this patient population. Data were collected on consecutive prisoners transferred from NYC-DOC for traumatic injuries from June 1, 2003, to June 1, 2006, and analyzed by retrospective chart review. Overall, 251 patients were evaluated for traumatic injuries. Injury mechanisms were violent (75.7%), nonviolent (23.5%), and self-inflicted (0.8%). Of the 241 (96%) patients admitted, 213 (84.9%) required operative intervention. The most common injuries were mandible fractures (46.5%) and facial fractures (14.9%).
Studies in health technology and informatics, 1999
The applications of Minimally Invasive Surgery (MIS) and Laparoscopy are rapidly expanding. Despi... more The applications of Minimally Invasive Surgery (MIS) and Laparoscopy are rapidly expanding. Despite this expansion, the technology related to our understanding of the importance of haptic feedback related to laparoscopic surgery remains in its infancy. While many surgeons feel that the use of minimally invasive techniques eliminates force feedback and tactile sensation, the importance of haptics in MIS has not been fully evaluated. Moreover, there is considerable interest in the development of haptic simulators for MIS even though the importance of force feedback remains poorly understood. This study was designed to determine the ability of novice surgeons to interpret haptic feedback with respect to texture, shape and consistency of an object. Subjects were presented objects in a random order and participants were blinded as to their identity. Inspection by direct palpation, palpation with conventional instruments, and palpation with laparoscopic instruments was performed on all ob...
Proceedings of the IEEE 27th Annual Northeast Bioengineering Conference (Cat. No.01CH37201), 2001
ABSTRACT A laparoscopic test fixture was implemented to quantify motion and control with a surgic... more ABSTRACT A laparoscopic test fixture was implemented to quantify motion and control with a surgical instrument, assess tracking skill acquisition, and provide a basis to compare precision and consistency across a variety of test subjects and conditions. A conventional laparoscopic dissector was fitted with a depth sensor, whose analog output is sampled, processed, and stored using a LabView program on a personal computer. Novice users were tested in simple target approach exercises, using both dominant and non-dominant hands over a seven-day period. Analysis of test data indicated no significant difference in overall precision, but significant differences in approach trajectory, especially during retraction. Data also showed significant improvement in time to complete tasks from day one to day seven. The test fixture was seen to be effective in evaluating a variety of facets of instrument movement and control
Road safety constitutes a crisis with important health and economic impacts. In 2010, 11,000 pede... more Road safety constitutes a crisis with important health and economic impacts. In 2010, 11,000 pedestrians and 3500 bicyclists were injured by motor vehicles in New York City (NYC). Motor vehicle injuries represent the second leading cause of injury-related deaths in NYC children aged 5 to 14 years. To better target injury prevention strategies, we evaluated demographics, behaviors, environmental factors, injuries, and outcomes of pediatric pedestrians and bicyclists struck by motor vehicles in NYC. Pediatric data were extracted from a prospectively collected database of pedestrians and bicyclists struck by motor vehicles and treated at a level I regional trauma center between December 2008 and June 2011. Patients, guardians, and first responders were interviewed and medical records were reviewed. Institutional review board approval was granted and verbal consent was obtained. Of the 1457 patients, 168 (12%) were younger than 18 years. Compared with injured adults, children were more likely to be in male sex (69% vs 53%), to have minor injuries (83% vs 73% for injury severity scores of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;9), and to be discharged without admission (69% vs 67%). Midblock crossings were more common in children pedestrians than in adults (37% vs 19%), often despite supervision (48%). Electronic device use among teenagers aged 13 to 17 years was nearly 3 times that of adults (28% vs 11%). Risky behaviors are common among pediatric pedestrians and bicyclists injured by motor vehicles. Road safety education and prevention strategies must stress compliance with traffic laws, readdress the importance of supervision, and reinforce avoidance of common distractors including electronic devices.
This study was designed to examine the characteristics of pedestrian and bicyclist collisions wit... more This study was designed to examine the characteristics of pedestrian and bicyclist collisions with motor vehicles within New York City&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s high-density hub. The primary objectives were to map crash locations and to identify hot spots within these injury clusters. The secondary objective was to quantify differences in injury severity based on road type and user behaviors. Between December 2008 and June 2011, data were prospectively collected from pedestrians and bicyclists struck by motor vehicles and brought to Bellevue Hospital, a Level 1 trauma center in New York City. Behaviors by cohort (i.e., crossing patterns for pedestrians, riding patterns for bicyclists), Injury Severity Score (ISS), and collision locations were extracted from the database. Analyses of mean ISS were performed using a Student&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s t test with a p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05 considered significant. Geomaps were created to identify clusters or &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;hot spots,&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; where higher volumes of crashes occurred over time. Spatial analysis was performed to demonstrate whether these were random events. A total of 1,457 patients (1,075 pedestrians and 382 bicyclists) were enrolled. Collision locations were known for 97.5%. Of the injured pedestrians, those crossing avenues (n = 277) had higher ISSs than those crossing streets (n = 522) (p = 0.01) and were more likely to die (p = 0.002). Pedestrians crossing midblock (n = 185) had higher mean ISSs than those crossing with the signal in the crosswalk (n = 320) (8.12 vs. 5.01, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Based on density mapping, hot spots of pedestrian collisions were detected in midtown Manhattan, while hot spots for bicyclists were detected at bridge and tunnel portals. Spatial analysis indicates that these are not random events (p…
While the efficacy of helmet use in the prevention of head injury is well described, helmet use a... more While the efficacy of helmet use in the prevention of head injury is well described, helmet use as it relates to bicyclists&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; behaviors and hospital resource use following injury is less defined. The objective of this study was to compare the demographics, behaviors, hospital workups, and outcomes of bicyclists based on helmet use. This study was a subset analysis of a 2.5-year prospective cohort study of vulnerable roadway users conducted at Bellevue Hospital Center, a New York City Level 1 trauma center. All bicyclists with known helmet status were included. Demographics, insurance type, traffic law compliance, alcohol use, Glasgow Coma Scale (GCS) score, initial imaging studies, Abbreviated Injury Scale (AIS) score, Injury Severity Score (ISS), admission status, length of stay, disposition, and mortality were assessed. Information was obtained primarily from patients; witnesses and first responders provided additional information. Of 374 patients, 113 (30.2%) were wearing helmets. White bicyclists were more likely to wear helmets; black bicyclists were less likely (p = 0.037). Patients with private insurance were more likely to wear helmets, those with Medicaid or no insurance were less likely (p = 0.027). Helmeted bicyclists were more likely to ride with the flow of traffic (97.2%) and within bike lanes (83.7%) (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001 and p = 0.013, respectively). Nonhelmeted bicyclists were more likely to ride against traffic flow (p = 0.003). There were no statistically significant differences in mean GCS score, AIS score, and mean ISS for helmeted versus nonhelmeted bicyclists. Nonhelmeted patients were more likely to have head computed tomographic scans (p = 0.049) and to be admitted (p = 0.030). Helmet use is an indicator of safe riding practices, although most injured bicyclists do not wear them. In this study, helmet use was associated with lower likelihood of head CTs and admission, leading to less hospital resource use. Injured riders failing to wear helmets should be targeted for educational programs. Epidemiologic study, level III.
The Journal of Trauma: Injury, Infection, and Critical Care, 2009
... Szerlip, Nicholas J. MD; Bholat, Omar MD; McCunn, Maureen M. MD, MIPP; Aarabi, Bizhan MD, FAC... more ... Szerlip, Nicholas J. MD; Bholat, Omar MD; McCunn, Maureen M. MD, MIPP; Aarabi, Bizhan MD, FACS, FRCSC; Scalea, Thomas M. MD. Article Outline. Collapse Box Author Information. ... 10.Wittenstein B, Ng C, Ravn H, Goldman A. Recombinant factor VII for severe bleeding ...
www.ccmjournal.org Critical Care Medicine • Volume 46 • Number 1 (Supplement) Learning Objectives... more www.ccmjournal.org Critical Care Medicine • Volume 46 • Number 1 (Supplement) Learning Objectives: Pain is common among trauma patients and has historically been managed with opioids. Opioid abuse and adverse effects have sparked interest in the use of non-opioid agents as an adjunct to opioids, but there is limited data to support this strategy in trauma. The purpose of this study was to assess the effectiveness and safety of combination gabapentin and methocarbamol as a component of multimodal pain therapy in the trauma population. Methods: Single center, retrospective study of patients admitted to the trauma service for > 72 hours between June 2012 and February 2017. Primary outcome was cumulative opioid use in morphine equivalents over the first 4 days of admission in patients receiving combination gabapentin and methocarbamol (MMPC) compared to opioid only regimens. Secondary outcomes included opioid use up to 7 days, adverse effects (constipation, nausea/ vomiting, or respiratory depression), and length of stay (LOS). A subgroup analysis including patients with rib fractures was also performed. Results: 1899 patients were screened with 200 included; 100 in both the MMPC and opioid only group. Groups were similar except for a higher injury severity score and more patients with rib fractures in the MMPC group. The MMPC also had lower use of IV APAP, but higher use of NSAIDs and scheduled opioids. The mean daily dose of gabapentin and methocarbamol in the MMPC group was 687 ± 310 mg and 2193 ± 574 mg, respectively. There was not a statistically significant difference found in the primary outcome of cumulative opioid use after 4 days (55 mg [29, 103] MMPC vs. 65 mg [41,110] opioid, p = 0.17). There were also no statistically significant differences in cumulative opioid use at 7 days (93 [34, 158] in MMPC versus 150 [70, 243] in opioid, p = 0.51), adverse effects, or LOS. In the rib fracture subgroup, there was significantly lower opioid use at 4 days (50 mg [22,95] vs. 78 mg [49,138], p < 0.01) and at 7 days in the MMPC group (93 mg [35, 15] vs. 150 mg [173, 119], p < 0.01). Conclusions: In this retrospective study, MMPC resulted in decreased opioid use although this did not reach statistical significance. Patients with rib fractures on MMPC had a significant decrease in opioid requirements. This and other subgroups warrant study to further evaluate the benefit of MMPC. 1623
JSLS : Journal of the Society of Laparoendoscopic Surgeons, 2001
Background: Distinguishing achalasia from pseudoachalasia can be difficult, as the clinical, radi... more Background: Distinguishing achalasia from pseudoachalasia can be difficult, as the clinical, radiological, and manometric findings can be similar to those seen in achalasia. The features that may differentiate achalasia from pseudoachalasia are reviewed and the pathogenesis of pseudoachalasia is discussed. Methods: A patient presented with a clinical scenario of achalasia that was documented by radiographic, endoscopic, and manometric studies. Her past medical history was significant for cervical cancer. Although brief improvement in symptoms was achieved with botulinum toxin injections and esophageal dilation, she had continued progression of symptoms. This direct involvement of the esophagus by a tumor was not demonstrated by any of the routine preoperative studies. Results: At the time of surgery, extensive involvement of the diaphragm, esophagus, and pericardium by a tumor was noted. Pathologic analysis of the tumor was consistent with metastatic cervical cancer Conclusion: Pseu...
The Journal of Trauma: Injury, Infection, and Critical Care, 2011
Injuries to pedestrians struck by motor vehicles represent a significant public health hazard in ... more Injuries to pedestrians struck by motor vehicles represent a significant public health hazard in large cities. The purpose of this study is to investigate the demographics of alcohol users who are struck by motor vehicles and to assess the effects of alcohol on pedestrian crossing patterns, medical management, and outcomes. Data were prospectively collected between December 2008 to September 2010 on all pedestrians who presented to a Level I trauma center after being struck by a motor vehicle. Variables were obtained by interviewing patients, scene witnesses, first responders, and medical records. Pedestrians who used alcohol were less likely to cross the street in the crosswalk with the signal (22.6% vs. 64.7%) and more likely to cross either in the crosswalk against the signal (22.6% vs. 12.4%) or midblock (54.8% vs. 22.8%). Alcohol use was associated with more initial computed tomography imaging studies compared with no alcohol involvement. Alcohol use was associated with a higher Injury Severity Score (8.82 vs. 4.85; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and hospital length of stay (3.89 days vs. 1.82 days; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) compared with those with no alcohol involvement. Patients who used alcohol had a lower average Glasgow Coma Scale score (13.80 vs. 14.76; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and a higher rate of head and neck, face, chest, abdomen, and extremity/pelvic girdle injuries (based on Abbreviated Injury Scale) than those with no alcohol involvement. Alcohol use is a significant risk factor for pedestrians who are struck by motor vehicles. These patients are more likely to cross the street in an unsafe manner and sustain more serious injuries. Traffic safety and injury prevention programs must address irresponsible alcohol use by pedestrians.
Jsls Journal of the Society of Laparoendoscopic Surgeons Society of Laparoendoscopic Surgeons, 2001
BACKGROUND: Distinguishing achalasia from pseudoachalasia can be difficult, as the clinical, radi... more BACKGROUND: Distinguishing achalasia from pseudoachalasia can be difficult, as the clinical, radiological, and manometric findings can be similar to those seen in achalasia. The features that may differentiate achalasia from pseudoachalasia are reviewed and the pathogenesis of pseudoachalasia is discussed.METHODS: A patient presented with a clinical scenario of achalasia that was documented by radiographic, endoscopic, and manometric studies. Her past medical history was significant for cervical cancer. Although brief improvement in symptoms was achieved with botulinum toxin injections and esophageal dilation, she had continued progression of symptoms. This direct involvement of the esophagus by a tumor was not demonstrated by any of the routine preoperative studies.RESULTS: At the time of surgery, extensive involvement of the diaphragm, esophagus, and pericardium by a tumor was noted. Pathologic analysis of the tumor was consistent with metastatic cervical cancerCONCLUSION: Pseudoachalasia has been known to occur in response to both benign and malignant causes. Differentiating between pseudoachalasia and achalasia is often difficult because of the similarities. As in this case, the diagnosis of pseudoachalasia may be made by surgical exploration.
The Journal of Trauma Injury Infection and Critical Care, Aug 1, 2009
Nearly 100,000 people await an organ transplant in the U.S. Improved utilization of potential org... more Nearly 100,000 people await an organ transplant in the U.S. Improved utilization of potential organ donors may reduce the organ shortage. Physician attitudes toward organ donation may influence donation rates; however, the attitudes of U.S. physicians have not been formally evaluated. Anonymous questionnaires were distributed to surgical attendings, surgical residents, and medical students at two academic medical centers. Willingness to donate one&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s own organs and family member&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s organs was examined, as well as experience with transplant procedures and religious views regarding organ donation. A total of 106 surveys were returned. Sixty-four percent of responders were willing to donate their own organs, and 49% had signed an organ donor card. Willingness to donate inversely correlated with professional experience. Eighty-four percent of those surveyed would agree to donate the organs of a family member, including 55% of those who refused to donate their own organs. Experience on the transplant service influenced 16% of those refusing donation, with the procurement procedure cited by 83% of this group. Sixteen percent refused organ donation on the basis of religious beliefs. The surveyed U.S. physicians are less willing to donate their organs compared with the general public. Despite understanding the critical need for organs, less than half of physicians surveyed had signed organ donor cards. Previous experiences with the procurement procedure influenced several responders to refuse organ donation. As the lay public traditionally looks to physicians for guidance, efforts must be made to improve physician attitudes toward organ donation with the hope of increasing donation rates.
Proceedings of the First Joint BMES/EMBS Conference. 1999 IEEE Engineering in Medicine and Biology 21st Annual Conference and the 1999 Annual Fall Meeting of the Biomedical Engineering Society (Cat. No.99CH37015), 1999
ABSTRACT In this study, a system was developed to assess quality of movement, as applied to lapar... more ABSTRACT In this study, a system was developed to assess quality of movement, as applied to laparoscopic instruments. An instrument is fitted with a variable inductor as part of a Colpitts oscillator. Output frequency is demodulated, sampled, and processed using LabView. In initial studies, this system is used to evaluate velocity and positioning accuracy during insertion and retraction tasks. Data show no significant difference between dominant and non-dominant hands, but velocity for extraction was higher than that of insertion, and marked improvement was seen over a three-day period
Journal of correctional health care : the official journal of the National Commission on Correctional Health Care, 2015
Bellevue Hospital's prison ward cares for male prisoners requiring medical attention that exc... more Bellevue Hospital's prison ward cares for male prisoners requiring medical attention that exceeds the capabilities of New York City Department of Correction (NYC-DOC) infirmaries. This study evaluated the injury patterns that occur in this patient population. Data were collected on consecutive prisoners transferred from NYC-DOC for traumatic injuries from June 1, 2003, to June 1, 2006, and analyzed by retrospective chart review. Overall, 251 patients were evaluated for traumatic injuries. Injury mechanisms were violent (75.7%), nonviolent (23.5%), and self-inflicted (0.8%). Of the 241 (96%) patients admitted, 213 (84.9%) required operative intervention. The most common injuries were mandible fractures (46.5%) and facial fractures (14.9%).
Studies in health technology and informatics, 1999
The applications of Minimally Invasive Surgery (MIS) and Laparoscopy are rapidly expanding. Despi... more The applications of Minimally Invasive Surgery (MIS) and Laparoscopy are rapidly expanding. Despite this expansion, the technology related to our understanding of the importance of haptic feedback related to laparoscopic surgery remains in its infancy. While many surgeons feel that the use of minimally invasive techniques eliminates force feedback and tactile sensation, the importance of haptics in MIS has not been fully evaluated. Moreover, there is considerable interest in the development of haptic simulators for MIS even though the importance of force feedback remains poorly understood. This study was designed to determine the ability of novice surgeons to interpret haptic feedback with respect to texture, shape and consistency of an object. Subjects were presented objects in a random order and participants were blinded as to their identity. Inspection by direct palpation, palpation with conventional instruments, and palpation with laparoscopic instruments was performed on all ob...
Proceedings of the IEEE 27th Annual Northeast Bioengineering Conference (Cat. No.01CH37201), 2001
ABSTRACT A laparoscopic test fixture was implemented to quantify motion and control with a surgic... more ABSTRACT A laparoscopic test fixture was implemented to quantify motion and control with a surgical instrument, assess tracking skill acquisition, and provide a basis to compare precision and consistency across a variety of test subjects and conditions. A conventional laparoscopic dissector was fitted with a depth sensor, whose analog output is sampled, processed, and stored using a LabView program on a personal computer. Novice users were tested in simple target approach exercises, using both dominant and non-dominant hands over a seven-day period. Analysis of test data indicated no significant difference in overall precision, but significant differences in approach trajectory, especially during retraction. Data also showed significant improvement in time to complete tasks from day one to day seven. The test fixture was seen to be effective in evaluating a variety of facets of instrument movement and control
Road safety constitutes a crisis with important health and economic impacts. In 2010, 11,000 pede... more Road safety constitutes a crisis with important health and economic impacts. In 2010, 11,000 pedestrians and 3500 bicyclists were injured by motor vehicles in New York City (NYC). Motor vehicle injuries represent the second leading cause of injury-related deaths in NYC children aged 5 to 14 years. To better target injury prevention strategies, we evaluated demographics, behaviors, environmental factors, injuries, and outcomes of pediatric pedestrians and bicyclists struck by motor vehicles in NYC. Pediatric data were extracted from a prospectively collected database of pedestrians and bicyclists struck by motor vehicles and treated at a level I regional trauma center between December 2008 and June 2011. Patients, guardians, and first responders were interviewed and medical records were reviewed. Institutional review board approval was granted and verbal consent was obtained. Of the 1457 patients, 168 (12%) were younger than 18 years. Compared with injured adults, children were more likely to be in male sex (69% vs 53%), to have minor injuries (83% vs 73% for injury severity scores of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;9), and to be discharged without admission (69% vs 67%). Midblock crossings were more common in children pedestrians than in adults (37% vs 19%), often despite supervision (48%). Electronic device use among teenagers aged 13 to 17 years was nearly 3 times that of adults (28% vs 11%). Risky behaviors are common among pediatric pedestrians and bicyclists injured by motor vehicles. Road safety education and prevention strategies must stress compliance with traffic laws, readdress the importance of supervision, and reinforce avoidance of common distractors including electronic devices.
This study was designed to examine the characteristics of pedestrian and bicyclist collisions wit... more This study was designed to examine the characteristics of pedestrian and bicyclist collisions with motor vehicles within New York City&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s high-density hub. The primary objectives were to map crash locations and to identify hot spots within these injury clusters. The secondary objective was to quantify differences in injury severity based on road type and user behaviors. Between December 2008 and June 2011, data were prospectively collected from pedestrians and bicyclists struck by motor vehicles and brought to Bellevue Hospital, a Level 1 trauma center in New York City. Behaviors by cohort (i.e., crossing patterns for pedestrians, riding patterns for bicyclists), Injury Severity Score (ISS), and collision locations were extracted from the database. Analyses of mean ISS were performed using a Student&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s t test with a p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05 considered significant. Geomaps were created to identify clusters or &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;hot spots,&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; where higher volumes of crashes occurred over time. Spatial analysis was performed to demonstrate whether these were random events. A total of 1,457 patients (1,075 pedestrians and 382 bicyclists) were enrolled. Collision locations were known for 97.5%. Of the injured pedestrians, those crossing avenues (n = 277) had higher ISSs than those crossing streets (n = 522) (p = 0.01) and were more likely to die (p = 0.002). Pedestrians crossing midblock (n = 185) had higher mean ISSs than those crossing with the signal in the crosswalk (n = 320) (8.12 vs. 5.01, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Based on density mapping, hot spots of pedestrian collisions were detected in midtown Manhattan, while hot spots for bicyclists were detected at bridge and tunnel portals. Spatial analysis indicates that these are not random events (p…
While the efficacy of helmet use in the prevention of head injury is well described, helmet use a... more While the efficacy of helmet use in the prevention of head injury is well described, helmet use as it relates to bicyclists&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; behaviors and hospital resource use following injury is less defined. The objective of this study was to compare the demographics, behaviors, hospital workups, and outcomes of bicyclists based on helmet use. This study was a subset analysis of a 2.5-year prospective cohort study of vulnerable roadway users conducted at Bellevue Hospital Center, a New York City Level 1 trauma center. All bicyclists with known helmet status were included. Demographics, insurance type, traffic law compliance, alcohol use, Glasgow Coma Scale (GCS) score, initial imaging studies, Abbreviated Injury Scale (AIS) score, Injury Severity Score (ISS), admission status, length of stay, disposition, and mortality were assessed. Information was obtained primarily from patients; witnesses and first responders provided additional information. Of 374 patients, 113 (30.2%) were wearing helmets. White bicyclists were more likely to wear helmets; black bicyclists were less likely (p = 0.037). Patients with private insurance were more likely to wear helmets, those with Medicaid or no insurance were less likely (p = 0.027). Helmeted bicyclists were more likely to ride with the flow of traffic (97.2%) and within bike lanes (83.7%) (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001 and p = 0.013, respectively). Nonhelmeted bicyclists were more likely to ride against traffic flow (p = 0.003). There were no statistically significant differences in mean GCS score, AIS score, and mean ISS for helmeted versus nonhelmeted bicyclists. Nonhelmeted patients were more likely to have head computed tomographic scans (p = 0.049) and to be admitted (p = 0.030). Helmet use is an indicator of safe riding practices, although most injured bicyclists do not wear them. In this study, helmet use was associated with lower likelihood of head CTs and admission, leading to less hospital resource use. Injured riders failing to wear helmets should be targeted for educational programs. Epidemiologic study, level III.
The Journal of Trauma: Injury, Infection, and Critical Care, 2009
... Szerlip, Nicholas J. MD; Bholat, Omar MD; McCunn, Maureen M. MD, MIPP; Aarabi, Bizhan MD, FAC... more ... Szerlip, Nicholas J. MD; Bholat, Omar MD; McCunn, Maureen M. MD, MIPP; Aarabi, Bizhan MD, FACS, FRCSC; Scalea, Thomas M. MD. Article Outline. Collapse Box Author Information. ... 10.Wittenstein B, Ng C, Ravn H, Goldman A. Recombinant factor VII for severe bleeding ...
Uploads
Papers by Omar Bholat