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Association of Facial Trauma, Severity of Head Injury, and Helmets in Bicycle Riders: A National Trauma Data Bank Study

Authors:
Association of Facial Trauma, Severity of Head Injury, and
Helmets in Bicycle Riders: A National Trauma Data Bank
Study
Ansab A Haider, MD, Peter M Rhee, MD, FACS,
Mazhar Khalil, MD, Narong Kulvatunyou, MD, FACS,
Bardiya Zangbar, MD, Terence O’Keeffe, MB, ChB, FACS,
Andrew L Tang, MD, FACS, Rifat Latifi, MD, FACS,
Randall S Friese, MD, FACS, Bellal Joseph, MD, FACS
University of Arizona, Tucson, AZ
INTRODUCTION: Helmets are known to reduce the incidence of
traumatic brain injury after bicycle-related accidents. However,
whether helmets reduce the severity of injury in patients who sus-
tain an intracranial bleed after bicycle-related accidents has never
been studied. The aim of this study was to assess the association
of helmets with severity of traumatic brain injury and facial frac-
tures after bicycle-related accidents.
METHODS: We performed an analysis of the 2012 National
Trauma Data Bank and abstracted information of all patients with
an intracranial hemorrhage after bicycle-related accidents. Regression
analysis was performed to determine the association between severity
of traumatic brain injury, facial fractures, mortality, and helmet use.
RESULTS: A total of 6,267 patients with traumatic brain injury af-
ter bicycle-related accidents were included, with a mean age of
3421 years and median Injury Severity Score of 10 (range
5e17). A total of 1,573 (25.1%) of bicycle riders were helmeted.
Overall, 52.4% (n¼3,284) of patients had severe traumatic brain
injury, and the mortality rate was 2.8% (n¼176). After controlling
for potential confounders, helmeted bicycle riders had 58% reduced
odds of severe traumatic brain injury (0.42; 95% CI, 0.36-0.49;
p<0.001) and 59% reduced odds of mortality (0.41; 95% CI,
0.24-0.69; p¼0.001). Helmet use also reduced the odds of crani-
otomy by 61% (0.44; 95% CI, 0.24-0.63; p<0.001) and facial frac-
tures by 26% (0.27; 95% CI, 0.64-0.84; p<0.001) (Fig).
CONCLUSIONS: In patients who sustain an intracranial injury af-
ter a bicycle-related accident, helmeted riders have significantly
reduced severity of injury and mortality. Given the fact that major-
ity of bicycle riders were non-helmeted, injury prevention programs
should focus on increasing the practice of helmet use.
Impact of Volume in the Aftermath of Diverticulitis
Damage Control Operations
Christopher T Aquina, MD, Christian P Probst, MD,
Bradley J Hensley, MD, MBA, James C Iannuzzi, MD, MPH,
Adan Z Becerra, Katia Noyes, PhD, MPH,
John R Monson, MB, BCH, FACS, Fergal Fleming, MD
University of Rochester Medical Center, Rochester, NY
INTRODUCTION: Colostomy reversal after a Hartmann’s proce-
dure for diverticulitis is a morbid procedure, and information
regarding factors associated with reversal and subsequent outcomes
are lacking. The impact of patient, surgeon, and hospital character-
istics on both the rate of stoma reversal and adverse postoperative
outcomes after reversal was investigated.
METHODS: Patients who underwent urgent or emergent Hart-
mann’s resection for diverticulitis between 2000 and 2012 in New
York State were selected by ICD-9 code from the Statewide Planning
and Research Cooperative System. Surgeon and hospital volumes
were calculated based on the number of colorectal resections per-
formed each year and characterized into tertiles. Bivariate and multi-
level multivariable analyses were performed to assess factors associated
with colostomy reversal and the outcomes of a laparoscopic approach,
ICU admission, increased length of stay, 30-day readmission, and
90-day postoperative mortality after Hartmann’s reversal.
RESULTS: Among 10,829 patients who underwent Hartmann’s
resection and survived to discharge, 62% of the patients
(n¼6,709) had their colostomy reversed within 1 year. Factors inde-
pendently associated with stoma reversal were younger age, lower
Table. Factors Associated with Outcomes after Hartmann’s
Reversal for Acute Diverticulitis
Outcome
Overall
rate
or median
High annual
surgeon volume
(20 colorectal
resections)
High annual
hospital volume
(200 colorectal
resections)
Laparoscopic
approach
(OR, 95% CI) 10.6% 1.77 (1.36, 2.30) 1.73 (1.27, 2.35)
ICU admission
(OR, 95% CI) 18.5% 0.67 (0.55, 0.81) 0.46 (0.36, 0.60)
Postoperative length
of stay, (IRR,
95% CI) 6 Days 0.86 (0.82, 0.91) 0.95 (0.89, 1.00)
30-d unplanned
readmission
(OR, 95% CI) 9.7% 0.79 (0.63, 0.98) 0.99 (0.79, 1.26)
90-d mortality
(OR, 95% CI) 0.9% 0.36 (0.19, 0.70) 1.75 (0.85, 3.62)
All effect estimates are with low surgeon volume or low hospital volume set
as the reference.
S134 Scientific Forum Abstracts J Am Coll Surg
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