Alain C Corcos

University of Pittsburgh, Pittsburgh, Pennsylvania, United States

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Publications (9)18.5 Total impact

  • Journal of Trauma and Acute Care Surgery 09/2014; 77(3):516-517. DOI:10.1097/TA.0000000000000390 · 2.50 Impact Factor
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    ABSTRACT: Sex-based outcome differences have been previously studied after thermal injury, with a higher risk of mortality being demonstrated in women. This is opposite to what has been found after traumatic injury. Little is known about the mechanisms and time course of these sex outcome differences after burn injury. A secondary analysis was performed using data from a prospective observational study designed to characterize the genetic and inflammatory response after significant thermal injury (2003-2010). Clinical outcomes were compared across sex (female vs male), and the independent risks associated with sex were determined using logistic regression analysis after controlling for important confounders. Stratified analysis across age and burn severity was performed, whereas Cox hazard survival curves were constructed to determine the time course of any sex differences found. During the time period of the study, 548 patients met inclusion criteria for the cohort study. Men and women were found to be similar in age, TBSA%, inhalation injury, and Acute Physiology and Chronic Health score. Regression analysis revealed that female sex was independently associated with over a 2-fold higher mortality after controlling for important confounders (odds ratio, 2.2; P = .049; 95% confidence interval, 1.01-4.8). The higher independent mortality risk for women was exaggerated and remained significant only in pediatric patients and demonstrated a dose-response relationship with increasing burn size (%TBSA). Survival analysis demonstrated early separation of female and male curves, and a greater independent risk of multiple organ failure was demonstrated in the pediatric cohort. The current results suggest that sex-based outcome differences may be different after thermal injury compared with traumatic injury and that the sex dimorphism may be exaggerated in patients with higher burn size and in those in the pediatric age group, with female sex being associated with poor outcome. These sex-based mortality differences occur early and may be a result of a higher risk of organ failure and early differences in the inflammatory response after burn injury. Further investigation is required to thoroughly characterize the mechanisms responsible for these divergent outcomes.
    Journal of burn care & research: official publication of the American Burn Association 05/2014; DOI:10.1097/BCR.0000000000000018 · 1.55 Impact Factor
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    ABSTRACT: Abstract Objective. Hypothermia has been associated with increased mortality in burn patients. We sought to characterize the body temperature of burn patients transported directly to a burn center by emergency medical services (EMS) personnel and identify the factors independently associated with hypothermia. Methods. We utilized prospective data collected by a statewide trauma registry to carry out a nested case-control study of burn patients transported by EMS directly to an accredited burn center between 2000 and 2011. Temperature at hospital admission ≤36.5°C was defined as hypothermia. We utilized registry data abstracted from prehospital care reports and hospital records in building a multivariable regression model to identify the factors associated with hypothermia. Results. Forty-two percent of the sample was hypothermic. Burns of 20-39% total body surface area (TBSA) (OR 1.44; 1.17-1.79) and ≥40% TBSA (OR 2.39; 1.57-3.64) were associated with hypothermia. Hypothermia was also associated with age > 60 (OR 1.50; 1.30-1.74), polytrauma (OR 1.58; 1.19-2.09), prehospital Glasgow Coma Scale <8 (OR 2.01; 1.46-2.78), and extrication (OR 1.49; 1.30-1.71). Hypothermia was also more common in the winter months (OR 1.54; 1.33-1.79) and less prevalent in patients weighing over 90 kg (OR 0.63; 0.46-0.88). Conclusions. A substantial proportion of burn patients demonstrate hypothermia at hospital arrival. Risk factors for hypothermia are readily identifiable by prehospital providers. Maintenance of normothermia should be stressed during prehospital care.
    Prehospital Emergency Care 01/2014; 18(3). DOI:10.3109/10903127.2013.864354 · 1.86 Impact Factor
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    ABSTRACT: Routine, whole-body computed tomography imaging (PAN-SCAN) has been shown to identify unexpected injuries and alter the management of patients presenting with blunt trauma. We sought to characterize the changes in practice over time and the utility of PAN-SCAN imaging in elderly patients who fall and require admission to a trauma center. We performed a retrospective analysis by using data derived from a Pennsylvania state-wide trauma registry (2007-2010). All hemodynamically stable patients (>65 years) who had a ground-level fall and were admitted for >24 hours were selected. Patients who underwent a combination of all three scans within 2 hours of arrival were considered to have underwent PAN-SCAN imaging. Clinical outcomes were compared across PAN-SCAN patients relative to less diagnostic imaging. Regression analysis was used to determine whether PAN-SCAN imaging was an independent determinate of mortality and resource use. Over the period of study, 13,043 patients met inclusion criteria. The annual rate of PAN-SCAN imaging after ground-level falls increased over time. After we controlled for important confounders, PAN-SCAN imaging was not associated with mortality (odds ratio 0.97, P = .74, 95% confidence interval 0.80-1.18). Despite greater injury severity, PAN-SCAN imaging was independently associated with significantly lesser intensive care unit requirements, step-down days, and a lesser overall duration of stay. PAN-SCAN imaging has become more common over time in elderly patients having a ground-level fall. Although PAN-SCAN imaging during the initial trauma evaluation was not associated with an independent decrease in the risk of mortality, it was independently associated with lesser hospital resource use. These data suggest that whole-body computed tomography imaging may benefit trauma center resource use for patients with ground-level falls.
    Surgery 10/2013; 154(4):816-22. DOI:10.1016/j.surg.2013.07.015 · 3.37 Impact Factor
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    ABSTRACT: It is commonly believed that hypothermia occurring during burn resuscitation is associated with poor outcome but there is little direct supporting evidence. The authors conducted an analysis of a statewide trauma registry to determine whether hypothermia (T ≤36.5°C) was associated with mortality when controlling for clinical confounders. They included all patients treated at an accredited burn center from 2000 to 2011 where the trauma registrar recorded the primary injury type as a burn. They excluded records with missing data and nonphysiologic temperature (<26°C or >42°C). The primary exposure of interest was hypothermia. The authors constructed a hierarchical, multivariable logistic regression model to examine the effect of hypothermia on survival, controlling for potentially confounding variables. Predictors of mortality are presented as odds ratio (95% confidence interval). Primary burn injury was coded 17,098 times during the study period. Of these, 3809 were not treated at a burn center and 1192 were excluded for missing data. Admission hypothermia was independently associated with mortality (1.91 [1.58-2.29]) when adjusting for age, sex, total second- and third-degree burn surface area (TBSA), comorbid conditions, injury severity score, direct transport vs referral, method of temperature measurement, year, and the hospital providing care. Increasing age, female sex, TBSA >40%, presence of multiple comorbid conditions, and increasing injury severity score were associated with mortality. Other variables in the model were not independently associated with outcome. There was a weak correlation between TBSA and admission temperature (r = .18). Hypothermia at hospital admission is independently associated with mortality in burn patients when controlling for clinical confounders. Future studies should address potential causes underlying this observation.
    Journal of burn care & research: official publication of the American Burn Association 08/2013; 34(5). DOI:10.1097/BCR.0b013e3182a231fb · 1.55 Impact Factor
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    ABSTRACT: Endovascular management of blunt aortic injury has dramatically reduced the morbidity and mortality associated with this specific injury. There remains a paucity of evidence quantifying the beneficial effects associated with endovascular (ENDO) techniques for other vascular injury types and little information regarding the impact ENDO techniques have had on the management of traumatic vascular injuries over time. We performed a retrospective analysis of data from the National Trauma Data Bank over 2002 to 2006 and 2008 time periods (NTDB 7.2 and RDS 2008). Injured patients undergoing any arterial vascular repair procedure using ENDO or standard open techniques were determined using ICD-9-CM procedure codes. Abbreviated Injury codes were used to select patients who suffered subclavian, carotid, or thoracic aortic injury. Logistic regression was used to determine whether EARLY ENDO procedures (first 24 hours after injury) were independently associated with a lower risk of mortality. The percentage of ENDO procedures significantly increased over time irrespective of mechanism of injury. When aortic (thoracic), subclavian, and carotid arterial injuries were analyzed, a significant decrease in mortality over time was found. The percentage of ENDO procedures for all arterial injury subtypes significantly increased in the RECENT (2008) period. Seventy-five percentage of ENDO procedures occurred early (initial 24 hours) with 20% of those patients being hypotensive upon arrival (systolic blood pressure <90 mm Hg). For patients who had vascular procedures in the RECENT period, regression analysis revealed that early ENDO procedures were independently associated with a 35% reduction in mortality risk (odds ratio, 0.65; 95% confidence interval, 0.5-0.8) after controlling for major confounders including mechanism of injury and presence of hypotension on arrival. ENDO procedures for arterial injury have increased over time while mortality for arterial injury subtypes has significantly decreased. Early ENDO procedures are common and are independently associated with a lower risk of mortality. These results suggest outcomes after vascular injury may benefit from ENDO expertise and that ENDO techniques should be incorporated into the early treatment algorithm of trauma patients with vascular injury, particularly those that require difficult operative exposure.
    01/2012; 72(1):41-6; discussion 46-7. DOI:10.1097/TA.0b013e31823d0f03
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    ABSTRACT: Platelet transfusion is utilized increasingly for traumatic brain injury (TBI) for the reversal of aspirin (ASA) therapy. Assessment of platelet inhibition and reversal by platelet transfusion after TBI has not been adequately characterized. A retrospective cohort analysis of TBI patients at a level I trauma center (January 2008-December 2009) was performed. The Aspirin Response Test (ART; VerifyNow) was used to assess platelet inhibition in TBI patients and guide platelet transfusion in patients with ASA-induced suppression. A follow-up ART was obtained after platelet administration. Primary endpoints were progression of intracranial hemorrhage on computed tomography, need for craniotomy, and mortality. We analyzed 84 patients (median age, 78 [interquartile range, 64-86)]; 54% male). ASA use was documented in 36 (42%) patients. Initial ART indicated platelet dysfunction in 54 (64%) patients, including 42% of patients without a documented history of ASA use. Of the patients with a documented history of ASA, 2.4% had a normal ART. Of those with an initial ART of <550 ASA response units, 45 received platelets. Repeat ART demonstrated reversal of inhibition in 29 patients (64.4%). Initial responders to transfusion received a greater volume of platelets, suggesting a dose-response relationship. Logistic regression revealed a trend toward higher mortality in nonresponders to transfusion (P = .09). Receiver operating characteristic curve analysis revealed that ART results increased prediction of poor outcome compared with ASA history alone (area under the curve = 0.760 and 0.775, respectively). The ART should be used to better target and guide platelet transfusions in TBI patients with known or suspected ASA use history. Patients with occult platelet dysfunction can be identified, unnecessary platelet transfusions avoided, and the adequate volume of platelets administered to correct drug-induced dysfunction. A dose-response relationship between quantity of platelets transfused and reversal of ASA inhibition was observed.
    Surgery 10/2011; 150(4):836-43. DOI:10.1016/j.surg.2011.07.059 · 3.37 Impact Factor
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    Burns: journal of the International Society for Burn Injuries 02/2011; 37(4):e19-23. DOI:10.1016/j.burns.2011.01.022 · 1.95 Impact Factor
  • The Journal of trauma 01/2008; 63(6):1230-3. DOI:10.1097/TA.0b013e31815b8413 · 2.35 Impact Factor