Eric J Ley

Cedars-Sinai Medical Center, Los Angeles, California, United States

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Publications (74)122.81 Total impact

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    ABSTRACT: A physician-centered approach to systems design is fundamental to ameliorating the causes of many errors, inefficiencies, and reliability problems.
    JAMA surgery. 08/2014;
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    ABSTRACT: The purpose of this study is to determine the effect of postoperative fluid balance (FB) on subsequent outcomes in acute care surgery (ACS) patients admitted to the surgical intensive care unit (ICU).
    Journal of critical care. 07/2014;
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    ABSTRACT: Vancomycin-resistant Enterococcus (VRE) screening is routine practice in many intensive care units despite the question of its clinical significance. The value of VRE screening at predicting subsequent VRE or other hospital-acquired infection (HAI) is unknown. The purpose of this investigation was to examine the rate of subsequent VRE HAI in patients undergoing VRE screening. This study was conducted in a 24-bed surgical intensive care unit (SICU) at a Level I trauma center. Patients admitted to the SICU between February and August 2011 who had rectal swab for VRE screening within 72 hours were followed prospectively for the development of VRE and other HAIs. Demographics, clinical characteristics, and infection rates were compared between VRE-positive and VRE-negative patients. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of VRE screening for predicting subsequent VRE HAI were calculated. A total of 341 patients had VRE screening within 72 hours of SICU admission, with 32 VRE-positive (9%) and 309 VRE-negative (91%) patients. VRE-positive patients had a higher incidence of any HAI (78% vs. 35%, p < 0.001). Eight VRE-positive patients (25%) developed VRE HAI compared with only 3 VRE-negative patients (1%) (p < 0.001). VRE screening had a 73% sensitivity, 93% specificity, 25% PPV, and 99% NPV for determining subsequent VRE HAI. VRE colonization was present in 9% of SICU patients at admission. Negative VRE screen result had a high specificity and NPV for the development of subsequent VRE HAI. Empiric treatment of VRE infection may be unnecessary in VRE-negative patients. Prognostic/epidemiologic study, level III. Therapeutic study, level IV.
    The journal of trauma and acute care surgery. 05/2014; 76(5):1192-200.
  • The American surgeon 03/2014; 80(3):310-2. · 0.92 Impact Factor
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    ABSTRACT: Background Inflammatory bowel disease is associated with a higher risk for venous thromboembolism (VTE). Whether C. difficile infection similarly increases this risk is unknown. Methods This was a retrospective analysis of patients admitted to the surgical intensive care unit (ICU) at the Cedars-Sinai Medical Center from 02/2011 until 07/2013. The two groups were compared using standard statistical methodology. Results During the 30-month study period, a total of 1,728 patients were admitted to the surgical ICU. A total of 64 patients (3.7%) tested positive for C. difficile. The use of chemical prophylaxis for VTE was significantly higher in the C. difficile group (64.1% vs. 46.2%, p=0.005). Nonetheless, C. difficile patients had a higher risk for development of a VTE (23.4% vs. 11.0%, AOR [95% CI]: 1.87 [1.01, 3.48], p=0.048). In a forward logistic regression model, C. difficile was found to be independently associated with development of VTE (AOR [95% CI]: 1.87 [1.00, 3.47], p=0.049). Conclusion Clostridium difficile infection increases the risk for venous thromboembolism in surgical patients admitted to the intensive care unit.
    The American Journal of Surgery. 01/2014;
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    ABSTRACT: IMPORTANCE The growing demand for organs continues to outpace supply. This gap is most pronounced in minority populations, who constitute more than 40% of the organ waiting list. Hispanic Americans are particularly less likely to donate compared with other minorities for reasons that remain poorly understood and difficult to change. OBJECTIVE To determine whether outreach interventions that target Hispanic Americans improve organ donation outcomes. DESIGN, SETTING, AND PARTICIPANTS Prospective before-after study of 4 southern California neighborhoods with a high percentage of Hispanic American residents. We conducted cross-sectional telephone surveys before and 2 years after outreach interventions. Respondents 18 years or older were drawn randomly from lists of Hispanic surnames. Awareness, perceptions, and beliefs regarding organ donation and intent to donate were measured and compared before and after interventions. INTERVENTION Television and radio commercials about organ donation and educational programs at 5 high schools and 4 Catholic churches. MAIN OUTCOMES AND MEASURES Number of survey participants who specify intent to donate. RESULTS A total of 402 preintervention and 654 postintervention individuals participated in the surveys. We observed a significant increase in awareness of and knowledge about organ donation and a significant increase in the intent to donate (17.7% vs 12.1%; adjusted odds ratio, 1.55 [95% CI, 1.06-2.26; P = .02]). CONCLUSIONS AND RELEVANCE Focused donor outreach programs sustain awareness and knowledge and can significantly improve intent to donate organs in the Hispanic American population. These programs should continue to be evaluated and implemented to influence donor registration.
    JAMA surgery. 11/2013;
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    ABSTRACT: Flow disruptions (FDs) are deviations from the progression of care that compromise safety or efficiency. The frequency and specific causes of FDs remain poorly documented in trauma care. We undertook this study to identify and quantify the rate of FDs during various phases of trauma care. Seven trained observers studied a Level I trauma center over 2 months. Observers recorded details on FDs using a validated Tablet-PC data collection tool during various phases of care-trauma bay, imaging, operating room (OR)-and recorded work-system variables including breakdowns in communication and coordination, environmental distractions, equipment issues, and patient factors. Researchers observed 86 trauma cases including 72 low-level and 14 high-level activations. Altogether, 1,759 FDs were recorded (20.4/case). High-level trauma comprised a significantly higher number (p = 0.0003) and rate of FDs (p = 0.0158) than low-level trauma. Across the three phases of trauma care, there was a significant effect on FD number (p < 0.0001) and FD rate (p = 0.0005), with the highest in the OR, followed by computed tomography. The highest rates of FD per case and per hour were related to breakdowns in coordination. This study is the largest direct observational study of the trauma process conducted to date. Complexities associated with the critical patient who arrives in the trauma bay lead to a high prevalence of disruptions related to breakdowns in coordination, communication, equipment issues, and environmental factors. Prospective observation allows individual hospitals to identify and analyze these systemic deficiencies. Appropriate interventions can then be evaluated to streamline the care provided to trauma patients.
    World Journal of Surgery 11/2013; · 2.23 Impact Factor
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    ABSTRACT: Gender may influence outcomes following traumatic brain injury (TBI) although the mechanism is unknown. Animal TBI studies suggest that gender differences in endogenous hormone production may be the source. Limited retrospective clinical studies on gender present varied conclusions. Pediatric patients represent a unique population as pubescent children experience up-regulation of endogenous hormones that varies dramatically by gender. Younger children do not have these hormonal differences. The aim of this study was to compare pubescent and prepubescent females with males after isolated TBI to identify independent predictors of mortality. We performed a retrospective review of the National Trauma Data Bank Research Data Sets from 2007 and 2008 looking at all blunt trauma patients 18 years or younger who required hospital admission after isolated, moderate-to-severe TBI, defined as head Abbreviated Injury Scale (AIS) score 3 or greater. We excluded all individuals with AIS score of 3 or greater for any other region to limit the confounding effect of comorbidities. Based on the median age of menarche, we defined two age groups as follows: prepubescent (0-12 years) and pubescent (>12 years). Analysis was performed to compare trauma profiles and outcomes between groups. Our primary outcome measure was in-hospital mortality. A total of 20,280 patients met inclusion criteria; 10,135 were prepubescent, and 10,145 were pubescent. Overall mortality was 6.9%, and lower mortality was noted among prepubescent patients compared with pubescent (5.2% vs. 8.6%, p < 0.0001). Although female gender did not predict reduced mortality in the prepubescent cohort (adjusted odds ratio, 1.05; 95% confidence interval, 0.85-1.30; p = 0.63), female gender was associated with reduced mortality in the pubescent (adjusted odds ratio, 0.78; 95% confidence interval, 0.65-0.93; p = 0.007). In contrast to prepubescent female gender, pubescent female gender predicts reduced mortality following isolated, moderate-to-severe TBI. Endogenous hormonal differences may be a contributing factor and require further investigation. Prognostic study, level III.
    The journal of trauma and acute care surgery. 10/2013; 75(4):682-6.
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    ABSTRACT: Thoracic duct injury is a rare but serious complication following surgery of the neck or chest that leads to uncontrolled chyle leak. Conventional management includes drainage, nutritional modification, or aggressive surgical interventions such as thoracic duct ligation, flap coverage, fibrin glue, or talc pleurodesis; few successful medical therapeutics are available. We report a case of a high-output chylothorax refractory to aggressive medical and surgical interventions. Chyle output decreased substantially after initiating midodrine, an α1-adrenergic agonist that causes vasoconstriction of the lymph system, reducing chyle flow. This case report suggests that midodrine may be a novel therapeutic for refractory chyle leaks.
    Chest 09/2013; 144(3):1055-7. · 5.85 Impact Factor
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    ABSTRACT: Increased emergency department (ED) length of stay (LOS) has been associated with increased mortality in trauma patients. In 2010, we implemented a 24/7 open trauma bed protocol in our designated trauma intensive care units (TICUs) to facilitate rapid admission from the ED. This required maintenance of a daily bump list and timely transferring of patients out of the TICU. We hypothesized that ED LOS and mortality would decrease after implementation. The following data from patients admitted directly from the ED to any ICU were retrospectively compared before (2009) and after (2011) the implementation of a trauma bed protocol at a Level I trauma center: age, sex, Glasgow Coma Scale (GCS) score, shock on admission (systolic blood pressure < 90 mm Hg), mechanism, injury severity scores (Injury Severity Score [ISS] and Abbreviated Injury Scale [AIS] score), ED LOS, ICU readmission rates, and mortality. Of the patients, 267 (17%) of 1,611 before and 262 (21%) of 1,266 (p < 0.01) after the protocol were admitted directly to the ICU, despite similar characteristics. ED LOS decreased from 4.2 ± 4.0 hours to 3.1 ± 2.1 hours (p < 0.01) in all patients as well as patients with an ISS of greater than 24 (3.1 ± 2.5 vs. 2.2 ± 1.6, p < 0.05) and a head AIS score of greater than 2 (4.2 ± 4.9 vs. 3.1 ± 2.0, p = 0.01). Mortality was unchanged for all patients (9% vs. 8%, p = 0.58) but trends toward improved mortality were found after protocol implementation inpatients with an ISS of greater than 24 (30% vs. 13%, p = 0.07) and in patients with a head AIS score of greater than 2 (12% vs. 6%, p = 0.08). A greater proportion of total patients were admitted to a designated TICU after implementation (83% vs. 93%, p < 0.01). ICU readmissions were unchanged (0.3% vs. 1.5%, p = 0.21). The implementation of a 24/7 open trauma bed protocol in the surgery ICU was associated with a decreased ED LOS and increased admissions to designated TICUs in all patients. Improved throughput was achieved without increases in ICU readmissions. Therapeutic study, level IV.
    The journal of trauma and acute care surgery. 07/2013; 75(1):97-101.
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    ABSTRACT: BACKGROUND: Trauma care is often delivered to unstable patients with incomplete medical histories, under time pressure, and with a need for multidisciplinary collaboration. Trauma patient flow through radiology is particularly prone to deviations from optimal care. A better understanding of this process could reduce errors and improve quality, flow, and patient outcomes. STUDY DESIGN: Disruptions to the flow of trauma care during trauma activations were observed over a 10-week period at a level I trauma center. Using a validated data collection tool, the type, nature, and impact of disruptions to the care process were recorded. Two physicians unaffiliated with the study conducted a post hoc, blinded review of the flow disruptions and assigned a clinical impact score to each. RESULTS: There were 581 flow disruptions observed during the radiologic care of 76 trauma patients. An average of 30.5 minutes (95% CI, 27-34; median, 29; interquartile range, 20-38) was spent in the CT scanner, with a mean of 14.5 flow disruptions per hour (95% CI, 11.8-17.2). Coordination problems (34%), communication failures (19%), interruptions (13%), patient-related factors (12%), and equipment issues (8%) were the most frequent disruption types. Flow disruptions with the highest clinical impact were generally related to patient movements while in the scanner, problems with ordering systems, equipment unavailability, and ineffective teamwork. CONCLUSIONS: Although flow disruptions cannot be eliminated completely, specific targeted interventions are available to address the issues identified.
    Journal of the American College of Surgeons 05/2013; · 4.50 Impact Factor
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    ABSTRACT: INTRODUCTION: High-dose vancomycin is increasingly prescribed for critically ill trauma patients at risk for methicillin-resistant Staphylococcus aureus pneumonia. Although trauma patients have multiple known risk factors for acute kidney injury (AKI), a link between vancomycin and AKI or mortality has not been established. We hypothesize that high vancomycin trough concentration (VT) after trauma is associated with AKI and increased mortality. METHODS: This was a retrospective analysis from a single institution Level I trauma center. Data were reviewed for all adult trauma patients who were admitted between 2006 and 2010. Patients were included if they received intravenous vancomycin, had serum creatinine levels before and after vancomycin administration, and had at least one recorded VT. Patients were stratified by VT into four groups: VT1 = 0-10 mg/L, VT2 = 10.1-15 mg/L, VT3 = 15.1-20 mg/L, VT4 >20 mg/L. Multivariable logistic regression was performed to determine the association between VT, AKI, and mortality. RESULTS: Of the 6781 trauma patients reviewed, 263 (3.9%) fit inclusion criteria. Ninety-seven (36.9%) patients developed AKI and 25 (9.5%) died. AKI and mortality increased progressively with VT. Ninety-one patients (34.6%) had troughs >20 mg/L and VT4 was independently associated with AKI (AOR 4.7, P < 0.01) and mortality (AOR 4.8, P = 0.05). CONCLUSION: AKI is common in trauma patients who receive intravenous vancomycin. A supratherapeutic trough level of >20 mg/L is an independent predictor of AKI and mortality in trauma patients.
    Journal of Surgical Research 05/2013; · 2.02 Impact Factor
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    ABSTRACT: BACKGROUND: In adult trauma, mortality varies with race and insurance status. In the elderly, insurance type has little impact on mortality after trauma and the influence of race is reduced. How race and insurance affect pediatric trauma requires further attention. We hypothesized that mortality after pediatric trauma is influenced by insurance type and not race. METHODS: We reviewed all cases of blunt trauma in children ≤13 y requiring admission, using the National Trauma Data Bank Research Data Sets for 2007 and 2008. Exclusions included an Abbreviated Injury Score of 6 for any body region, dead on arrival, and missing data. Our primary outcome measure was in-hospital mortality. RESULTS: We identified 831 Asian (1.2%), 10,592 black (15.5%), 45,173 white (66.2%), and 8498 Hispanic (12.5%) children, and 3161 children (4.6%) classified as other race. Mean age was 7.4 ± 4.5 y, 11.9% were uninsured, and overall in-hospital mortality was 1.4%. Multivariable modeling indicated that race was not associated with increased mortality (Asian versus white, adjusted odds ratio [AOR] 1.05, P = 0.88; black versus white, AOR 0.92, P = 0.42; Hispanic versus white, AOR 0.87, P = 0.26; and other race versus white, AOR 1.01, P = 0.96). In contrast, insurance status (any insurance versus no insurance, AOR 0.6, P < 0.01) and insurance type (private insurance versus no insurance, AOR 0.47, P < 0.01; Medicaid versus no insurance, 0.67, P < 0.01) predicted reduced mortality. CONCLUSIONS: Insurance status and insurance type are important predictors of mortality after pediatric trauma while, in contrast, race is not.
    Journal of Surgical Research 04/2013; · 2.02 Impact Factor
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    ABSTRACT: INTRODUCTION: Studies on blood product transfusions after trauma recommend targeting specific ratios to reduce mortality. Although crystalloid volumes as little as 1.5 L predict increased mortality after trauma, little data is available regarding the threshold of red blood cell (RBC) transfusion volume that predicts increased mortality. MATERIALS AND METHODS: Data from a level I trauma center between January 2000 and December 2008 were reviewed. Trauma patients who received at least 100 mL RBC in the emergency department (ED) were included. Each unit of RBC was defined as 300 mL. Demographics, RBC transfusion volume, and mortality were analyzed in the nonelderly (<70 y) and elderly (≥70 y). Multivariate logistic regression was performed at various volume cutoffs to determine whether there was a threshold transfusion volume that independently predicted mortality. RESULTS: A total of 560 patients received ≥100 mL RBC in the ED. Overall mortality was 24.3%, with 22.5% (104 deaths) in the nonelderly and 32.7% (32 deaths) in the elderly. Multivariate logistic regression demonstrated that RBC transfusion of ≥900 mL was associated with increased mortality in both the nonelderly (adjusted odds ratio 2.06, P = 0.008) and elderly (adjusted odds ratio 5.08, P = 0.006). CONCLUSIONS: Although transfusion of greater than 2 units in the ED was an independent predictor of mortality, transfusion of 2 units or less was not. Interestingly, unlike crystalloid volume, stepwise increases in blood volume were not associated with stepwise increases in mortality. The underlying etiology for mortality discrepancies, such as transfusion ratios, hypothermia, or immunosuppression, needs to be better delineated.
    Journal of Surgical Research 04/2013; · 2.02 Impact Factor
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    ABSTRACT: Cirrhosis is known to be a significant risk factor for morbidity and mortality following trauma such that its presence is a requirement for trauma center transfer. The impact of trauma center level on post-injury survival in cirrhotic patients has not been well studied. The National Trauma Databank (version 7) was used to identify patients admitted with cirrhosis as a preexisting comorbidity. Patients who were dead on arrival, died in the emergency department, or had missing trauma center information were excluded. Our primary outcome measure was overall mortality stratified by admission trauma center level. Logistic regression analysis was used to derive adjusted mortality results. A total of 3,395 patients met inclusion criteria (0.16% of all National Trauma Databank patients). Patients admitted to a Level I center were more likely to be younger and minorities, experience penetrating injuries, and require immediate operative intervention despite similar Injury Severity Scores (ISS). Overall mortality was lower at Level I centers compared with other centers (10.3% vs. 14.0%, p = 0.001). After logistic regression, Level I centers were associated with significantly lower mortality compared with non-Level I centers (adjusted odds ratio, 0.70; 95% confidence interval, 0.53-0.89; p = 0.004). The mortality for cirrhotic patients admitted to a Level I trauma center was significantly less compared with those admitted to non-Level I centers. The etiology of this improved outcome needs to be identified and transmitted to non-Level I centers. Epidemiologic study, level III.
    The journal of trauma and acute care surgery. 04/2013; 74(4):1133-7.
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    ABSTRACT: BACKGROUND: Effective handoffs of care are critical for maintaining patient safety and avoiding communication problems. Using the flow disruption observation technique, we examined transitions of care along the trauma pathway. We hypothesized that more transitions would lead to more disruptions, and that different pathways would have different numbers of disruptions. METHODS: We trained observers to identify flow disruptions, and then followed 181 patients from arrival in the emergency department (ED) to the completion of care using a specially formatted PC tablet. We mapped each patient's journey and recorded and classified flow disruptions during transition periods into seven categories. RESULTS: Mapping the transitions of care shows that approximately four of five patients were assessed in the ED, transferred to imaging for further diagnostics, and then returned to the ED. There was a mean of 2.2 ± 0.09 transitions per patient, a mean of 0.66 ± 0.15 flow disruptions per patient, and 0.31 ± 0.07 flow disruptions per transition. Most of these (53%) were related to coordination problems. Although disruptions did not rise with more transitions, patients who went directly to the operating room or needed direct admission to intensive care unit were significantly more likely (P=0.0028) to experience flow disruptions than those who took other, less expedited pathways. CONCLUSIONS: Transitions in trauma care are vulnerable to systems problems and human errors. Coordination problems predominate as the cause. Sicker, time-pressured, and more at-risk patients are more likely to experience problems. Safety practices used in motor racing and other industries might be applied to address these problems.
    Journal of Surgical Research 03/2013; · 2.02 Impact Factor
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    ABSTRACT: Traumatic brain injury (TBI) is an enormous public health problem, with 1.7 million new cases of TBI recorded annually by the Centers for Disease Control. However, TBI has proven to be an extremely challenging condition to treat. Here, we apply a nanoprodrug strategy in a mouse model of TBI. The novel nanoprodrug contains a derivative of the nonsteroidal anti-inflammatory drug (NSAID) ibuprofen in an emulsion with the antioxidant α-tocopherol. The ibuprofen derivative, Ibu2TEG, contains a tetra ethylene glycol (TEG) spacer consisting of biodegradable ester bonds. The biodegradable ester bonds ensure that the prodrug molecules break down hydrolytically or enzymatically. The drug is labeled with the fluorescent reporter Cy5.5 using nonbiodegradable bonds to 1-octadecanethiol, allowing us to reliably track its accumulation in the brain after TBI. We delivered a moderate injury using a highly reproducible mouse model of closed-skull controlled cortical impact to the parietal region of the cortex, followed by an injection of the nanoprodrug at a dose of 0.2 mg per mouse. The blood brain barrier is known to exhibit increased permeability at the site of injury. We tested for accumulation of the fluorescent drug particles at the site of injury using confocal and bioluminescence imaging of whole brains and brain slices 36 hours after administration. We demonstrated that the drug does accumulate preferentially in the region of injured tissue, likely due to an enhanced permeability and retention (EPR) phenomenon. The use of a nanoprodrug approach to deliver therapeutics in TBI represents a promising potential therapeutic modality.
    PLoS ONE 01/2013; 8(4):e61819. · 3.53 Impact Factor
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    ABSTRACT: High school students are an important target audience for organ donation education. A novel educational intervention focused on Hispanic American (HA) high school students might improve organ donation rates. A prospective observational study was conducted in five Los Angeles High Schools with a high percentage of HA students. A "culturally sensitive" educational program was administered to students in grades 9 to 12. Preintervention surveys that assessed awareness, knowledge, perception, and beliefs regarding donation as well as the intent to become an organ donor were compared to postintervention surveys. A total of 10,146 high school students participated in the study. After exclusions, 4876 preintervention and 3182 postintervention surveys were analyzed. A significant increase in the overall knowledge, awareness, and beliefs regarding donation was observed after the intervention, as evidenced by a significant increase in the percentage of correct answers on the survey (41% pre- versus 44% postintervention, P < .0001). When specifically examining HA students, there was a significant increase in the intent to donate organs (adjusted odds ratio 1.21, 95% confidence interval: 1.09, 1.34, P = .0003). This is the first study to demonstrate a significant increase in the intent to donate among HA high school students following an educational intervention.
    Transplantation Proceedings 01/2013; 45(1):13-9. · 0.95 Impact Factor
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    ABSTRACT: BACKGROUND: Little focus is on health care disparities in the elderly, a population largely covered by public insurance. We characterized insurance type and race in elderly trauma patients to determine if lack of insurance or minority status predict increased mortality. METHODS: The National Trauma Data Bank (version 7.0) was queried for all adult blunt trauma patients. We divided patients into two cohorts (15-64 or <65 years) based on age for universal Medicare eligibility. Our primary outcome measure was in-hospital mortality. Multiple logistic regression was used to control for confounding variables. RESULTS: A total of 541,471 patients met inclusion criteria. Among younger patients, the most common insurance type was private (41.0%), with 26.9% uninsured. In contrast, the most common insurance type among older patients was Medicare (64.6%), with 6.0% uninsured. Within the younger cohort, private insurance (adjusted odds ratio [AOR], 0.6; p < 0.01) and other insurance (AOR, 0.8; p < 0.01) predicted reduced mortality, while Medicare predicted similar mortality (AOR, 1.1; p = 0.18) compared with no insurance. Black race (AOR, 1.4; p < 0.01) and Hispanic ethnicity (AOR, 1.4; p < 0.01) predicted higher mortality compared with white race. Within the older cohort, no insurance predicted similar mortality as Medicare (AOR, 1.0; p = 0.43), private insurance (AOR, 1.0; p = 0.51), and other insurance (AOR, 1.0; p = 0.71). Hispanic ethnicity predicted increased mortality (AOR, 1.4; p < 0.01), while Asian race was protective (AOR, 0.7; p = 0.01) compared with white race. CONCLUSION: Elderly trauma patients present primarily with Medicare, while younger trauma patients are mostly privately insured; elderly patients are four times more likely to be insured. Disparities caused by lack of insurance and minority race are reduced in elderly trauma patients. LEVEL OF EVIDENCE: Epidemiologic/prognostic study, level III.
    The journal of trauma and acute care surgery. 11/2012;
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    ABSTRACT: Prehospital hypothermia (PH) is known to increase mortality following traumatic injury. PH relationship with transfusion requirements has not been documented. The purpose of this investigation was to analyze the impact of PH on blood product requirements and subsequent outcomes. The Los Angeles County Trauma System Database was queried for all patients admitted between 2005 and 2009. Demographics, physiologic parameters, and transfusion requirements were obtained and dichotomized by admission temperatures with a core temperature of less than 36.5°C considered hypothermic. Multivariate analysis was performed to determine factors contributing to transfusion requirements and to derive adjusted odds ratios (AORs) for mortality and rates of adult respiratory distress syndrome and pneumonia. A total of 21,023 patients were analyzed in our study with 44.6% presenting with PH. Hypothermic patients required 26% more fluid resuscitation (p < 0.001) in the emergency department and 17% more total blood products (p < 0.001) than those who were admitted with a normal temperature. There was a trend toward an increase in emergency department transfusion (8%, p = 0.06). PH was independently associated with the need for a transfusion (AOR, 1.1; p = 0.047), increased mortality (AOR, 2.0; p < 0.01), as well as incidence of adult respiratory distress syndrome (AOR, 1.8; p < 0.05) and pneumonia (AOR, 2.6; p < 0.01). PH is associated with increased transfusion and fluid requirements and subsequently worse outcomes. Interventions that correct hypothermia may decrease transfusion requirements and improve outcomes. Prospective studies investigating correction of hypothermia in trauma patients are warranted. Prognostic/epidemiologic study, level III.
    The journal of trauma and acute care surgery. 11/2012; 73(5):1195-201.

Publication Stats

241 Citations
122.81 Total Impact Points

Institutions

  • 2009–2014
    • Cedars-Sinai Medical Center
      • Cedars Sinai Medical Center
      Los Angeles, California, United States
  • 2010
    • University of California, Los Angeles
      • Department of Surgery
      Los Angeles, California, United States