Heidi L Frankel

University of Southern California, Los Ángeles, California, United States

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Publications (96)249.5 Total impact

  • Kelly N Vogt · Heidi Frankel

    No preview · Article · Aug 2014 · Journal of Trauma and Acute Care Surgery
  • K Matsushima · M Khan · H L Frankel
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    ABSTRACT: Post-trauma resuscitation has evolved based on civilian and wartime experiences over the last decade. Similarly, data from large multicenter randomized trials have changed the management of critically ill trauma patients in the intensive care unit. This is a review of the literature focusing on areas relevant to the management of trauma patients in the intensive care unit. The following topics are included: (1) ventilator management, (2) trauma sepsis, (3) use of vasopressors in hemorrhage, (4) glucose control, (5) nutrition, and (6) hemodynamic monitoring. This review demonstrated the most recent data of trauma-related critical care. Further studies will be needed to settle growing controversies in the management of critically injured patients.
    No preview · Article · Apr 2014

  • No preview · Article · Feb 2014 · The American surgeon
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    ABSTRACT: We sought to demonstrate that a well-staffed, surgeon-directed, critical care ultrasound program (CCUP) is financially sustainable and provides administrative and educational support for point-of-care ultrasound. The CCUP provides a clinical service and training as well as conducts research. Initial costs, annual costs (C), revenue (R), and savings (S) were prospectively recorded. Using data from the first 3 years, we calculated the projected C, R, and S at 5 years. We determined CCUP sustainability by C < R and C < R + S at 3 years and 5 years. During 36 months, the CCUP covered four surgical intensive care units (55 beds). Start-up costs included one basic and one cardiovascular device per 25 beds and a data storage system linking reports and images to the electronic medical record ($203,650). Billing increased threefold from Years 1 to 3, with a 21% increase between Years 2 to 3. Yearly costs included 0.5 full-time equivalent (FTE) sonographer and 0.2 FTE surgeon ($106,025); this was increased to 1 FTE and 0.25 FTE, respectively, for Years 4 and 5. The total 3-year cost was $521,725 and projected to be $863,325 by Year 5. The total 3-year revenue was $290,775 and projected to be $891,600 at 5 years. The total 3-year savings associated with the CCUP was $600,035 and is projected to be $1,194,220. With the use of the C < R, the CCUP meets operating expenses at Year 3 and covers overall cost at 5 years. If savings are included, then the CCUP is sustainable by its third year and is potentially profitable by Year 5. A surgeon-directed CCUP is financially sustainable, addresses administrative issues, and provides valuable training in point-of-care ultrasound.
    No preview · Article · Feb 2014
  • Mansoor A. Khan · Heidi L. Frankel

    No preview · Article · Oct 2013 · Current problems in surgery
  • Mansoor A. Khan · Heidi L Frankel

    No preview · Article · Oct 2013 · Current problems in surgery
  • Article: In brief
    Heidi L Frankel · Lewis J Kaplan

    No preview · Article · Oct 2013 · Current problems in surgery
  • Source
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    ABSTRACT: Background: Optimal management of adolescent trauma patients with blunt abdominal solid organ injury (SOI) remains controversial. The purpose of this study was to identify management differences in adolescents with SOI treated at adult trauma centers (ATC) versus pediatric trauma centers (PTC). We hypothesized that adolescents with SOI would undergo different treatment at ATC and PTC. Materials and methods: Retrospective review of the Pennsylvania Trauma Systems Foundation database from 2005-2010 was performed. Adolescent patients (13-18 y old) with SOI (spleen, liver, and kidney injury) were included. Patient baseline characteristics and care processes for each injury were compared between ATC and PTC. Results: A total of 1532 patients with at least one SOI were identified: 946 patients had a splenic injury, 505 had a liver injury, and 424 had a kidney injury. Spleen and liver procedures were performed more often at ATC than at PTC irrespective of injury grade (respectively, 16.1% versus 3.2%, 5.9% versus 0%; P < 0.01). Transarterial embolization for splenic injury was more frequently performed at ATC (2.8% versus 0.6%; P = 0.02). After adjusting for potential confounding factors, care at PTC was significantly associated with lower odds of splenic procedure for patients with splenic injury (OR: 0.16, 95% CI: 0.08-0.36, P < 0.001). In a subgroup analysis of nontransfer patients, care at PTC remained significantly associated with lower odds of splenic procedure (OR: 0.24, 95% CI: 0.10-0.59, P = 0.002) despite higher median injury severity score than ATC. Conclusions: Significant differences in the management of adolescents with SOI were identified in Pennsylvania. Operative intervention for SOI was more often performed at ATC than at PTC. Further study will be needed to address the impact of these disparities on patient outcomes.
    Full-text · Article · Mar 2013 · Journal of Surgical Research
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    ABSTRACT: Adolescent injury victims receive care at adult trauma centers (ATCs) and pediatric trauma centers (PTCs). The purpose of this study was to identify care variations and their impact on the outcome of adolescent trauma patients treated at PTC versus ATC. We queried the Pennsylvania Trauma Systems Foundation database for trauma patients between 13 and 18 years of age from 2005 to 2010. Mortality and hospital complication rates between ATC and PTC were compared in univariable and multivariable analysis. In addition, the differences in the delivery of care were also compared. Of 9033 total patients, 6027 (67%) received care at an ATC. Patients in the ATC group were older (16.7 vs 14.9 years, P < 0.001) and more severely injured (Injury Severity Score: 14.5 vs 12.2, P < 0.001). Admission diagnostic computed tomography (CT), emergent laparotomy and craniotomy, blood transfusion, and drug screening were more frequently performed at an ATC. After adjustment for potential confounders in multivariable regression models, treatment at a PTC was significantly associated with fewer CTs for transferred patients (odds ratio [OR], 0.28; P < 0.001) and with less frequent emergent laparotomy for all patients (OR, 0.65; P = 0.007). The ATC group had a significantly higher hospital mortality rate (2.9 vs 0.9%, P < 0.001) and complication rate (9.7 vs 4.8%, P < 0.001). However, these outcomes were not significantly different between PTC and ATC in multivariable regression models. In the state of Pennsylvania, there were no significant differences in risk-adjusted outcomes between PTC and ATC despite significant difference in use of CT scanning and emergent laparotomy.
    No preview · Article · Mar 2013 · The American surgeon

  • No preview · Article · Feb 2013 · Journal of Trauma and Acute Care Surgery
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    ABSTRACT: Background: Despite the availability of more accurate imaging modalities, specifically multidetector computed tomography (MDCT), the diagnosis of non-ischemic (NI-) and ischemic (I-) blunt hollow viscus and mesenteric injury (BHVMI) remains challenging. We hypothesized that BHVMI can be still missed with newer generations of MDCT and that patients with I-BHVMI have a poorer outcome than those with NI-BHVMI. Methods: We performed an eight-year retrospective review at a level 1 trauma center. Ischemic-BHVMI was defined as devascularization confirmed at laparotomy. Non-ischemic-BHVMI included perforation, laceration, and hematoma without devascularization. The sensitivity of each generation of MDCT for BHVMI was calculated. Potential predictors and outcomes of I-BHVMI were compared to the NI-BHVMI group. Results: Of 7,875 blunt trauma patients, 67 patients (0.8 %) were included in the BHVMI group; 13 patients did not have any CT findings suggestive of BHVMI (sensitivity 81 %), and 11 of them underwent surgical intervention without delay (<5 h). Newer generations of MDCT were not associated with higher sensitivity. Patients with I-BHVMI had a significantly higher rate of delayed laparotomy ≥ 12 h (23 % versus 2 %; p = 0.01) and a significantly longer length of hospital stay (median 14 versus 9 days; p = 0.02) than those with NI-BHVMI. Conclusions: Even using an advanced imaging technique, the diagnosis of I-BHVMI can be delayed, with significant negative impact on patient outcome.
    No preview · Article · Dec 2012 · World Journal of Surgery

  • No preview · Article · Jul 2012
  • Steven R Allen · Heidi L Frankel
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    ABSTRACT: Delirium is a common feature of the postoperative period, leading to increased morbidity and mortality and significant costs. Multiple factors predispose a patient to delirium in its hypoactive, hyperactive, or mixed forms. Tools have been validated for its quick and accurate identification to ensure timely and effective multidisciplinary intervention and treatment. A significant percentage of patients may require placement in skilled nursing facilities or similar care environments because of the long-lasting effects. The physician must be vigilant in the search for and identification of all forms of delirium and must effectively treat the underlying medical condition and symptoms.
    No preview · Article · Apr 2012 · Surgical Clinics of North America
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    ABSTRACT: Globally, the compliance of resident work-hour restrictions has no impact on trauma outcome. However, the effect of protected education time (PET), during which residents are unavailable to respond to trauma patients, has not been studied. We hypothesized that PET has no impact on the outcome of trauma patients. We conducted a retrospective review of relevant patients at an academic level I trauma center. During PET, a trauma attending and advanced practice providers (APPs) responded to trauma activations. PGY1, 3, and 4 residents were also available at all other times. The outcome of new trauma patient activations during Thursday morning 3-hours resident PET was compared with same time period on other weekdays (non-PET) using a univariate and multivariate analysis. From January 2005 to April 2010, a total of 5968 trauma patients were entered in the registry. Of these, 178 patients (2.98%) were included for study (37 PET and 141 non-PET). The mean injury severity score (ISS) was 16.2. Although no significant difference were identified in mortality, complications, or length of stay (LOS), we do see that length of emergency department stay (ED-LOS) tends to be longer during PET, although not significantly (314 vs 381 minutes, p = 0.74). On the multiple logistic regression model, PET was not a significant factor of complications, LOS, or ED-LOS. Few trauma activations occur during PET. New trauma activations can be staffed safely by trauma activations and APPs. However, there could be some delays in transferring patients to appropriate disposition. Additional study is required to determine the effect of PET on existing trauma inpatients.
    No preview · Article · Mar 2012 · Journal of Surgical Education
  • Heidi Frankel · Clinton J. Pace
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    ABSTRACT: The principal goal of EMS providers caring for penetrating injured patients in an urban environment is rapid transport to definitive care while delivering life-saving interventions. In most circumstances, this is accomplished by ground transport with Advanced Life Support techniques. Wound location and hemodynamic information should be communicated before arrival in a concise report to best prepare the trauma team to deliver rapid and appropriate definitive care. Depending on the trauma system, it may be beneficial to transport unstable patients to facilities with in-house trauma/general surgeons to address torso injuries and neurosurgeons to address brain injuries. Certainly, 24-h immediate access to the operating theater, transfusion services, interventional radiology, and CT scan (particularly for neurosurgical patients) are optimal in these patients. Hemodynamically unstable patients may benefit from resuscitative measures delivered while en route. These may include establishment and protection of the airway, decompressive needle thoracostomy, and judicious fluid administration and application of tourniquets for exsanguinating extremity wound. If definitive airway control is to be established for head-injured patients, tracheal intubation with care must be accomplished to protect against hypoventilation and elevations in intracranial pressure. Additional focus on resuscitative measures, including blood administration to maintain a perfusing pressure, may be required in penetrating injured patients in a rural environment or those with long transport times to the hospital. Air transportation may expedite delivery to definitive care.
    No preview · Chapter · Dec 2011
  • Daniel E Carney · Kazuhide Matsushima · Heidi L Frankel
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    ABSTRACT: Since the Surviving Sepsis Campaign Guidelines (SSG) were published in 2004, critical care physicians can readily access the evidence and current recommendations regarding management of patients with severe sepsis and septic shock. However, several issues including a potential conflict of interest in developing the guidelines were disclosed. There have also been dramatic changes in the management of sepsis, supported by high levels of evidence. SSG 2008 was developed to update the evidence using a new grading system. We reviewed select topics, routinely addressed by intensivists in the surgical intensive care unit, that have changed between SSG 2004 and SSG 2008: namely, glucose control, and administration of steroids, recombinant human activated protein C (rhAPC) and total parenteral nutrition.
    No preview · Article · Nov 2011 · The Israel Medical Association journal: IMAJ
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    ABSTRACT: Significant glycemic excursions (so-called glucose variability) affect the outcome of generic critically ill patients but has not been well studied in patients with traumatic brain injury (TBI). The purpose of this study was to evaluate the impact of glucose variability on long-term functional outcome of patients with TBI. A noncomputerized tight glucose control protocol was used in our intensivist model surgical intensive care unit. The relationship between the glucose variability and long-term (a median of 6 months after injury) functional outcome defined by extended Glasgow Outcome Scale (GOSE) was analyzed using ordinal logistic regression models. Glucose variability was defined by SD and percentage of excursion (POE) from the preset range glucose level. A total of 109 patients with TBI under tight glucose control had long-term GOSE evaluated. In univariable analysis, there was a significant association between lower GOSE score and higher mean glucose, higher SD, POE more than 60, POE 80 to 150, and single episode of glucose less than 60 mg/dL but not POE 80 to 110. After adjusting for possible confounding variables in multivariable ordinal logistic regression models, higher SD, POE more than 60, POE 80 to 150, and single episode of glucose less than 60 mg/dL were significantly associated with lower GOSE score. Glucose variability was significantly associated with poorer long-term functional outcome in patients with TBI as measured by the GOSE score. Well-designed protocols to minimize glucose variability may be key in improving long-term functional outcome.
    No preview · Article · Oct 2011 · Journal of critical care
  • Dan A Galvan · Kazuhide Matsushima · Heidi L Frankel
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    ABSTRACT: Ultrasonography in the intensive care unit (ICU) has become a valuable tool for expeditiously, safely and effectively diagnosing and treating a myriad of conditions commonly encountered in this setting. Most surgeons are familiar with FAST (Focused Assessment with Sonography in Trauma) and can readily grasp the fundamentals of a limited or directed ultrasonographic exam. Thus, with appropriate training and practice, surgeons can utilize this tool in visualizing, characterizing and treating life-threatening conditions in their role as intensivists in the surgical ICU (SICU). In this review we will discuss the role of ultrasonography in evaluating the acute cardiac status of a patient in the SICU as well as its use in general critical care for assessing the thoracic, abdominal and vascular systems.
    No preview · Article · Oct 2011 · The Israel Medical Association journal: IMAJ

  • No preview · Article · Oct 2011 · The Journal of trauma
  • Kazuhide Matsushima · Heidi L Frankel
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    ABSTRACT: The use of ultrasound for the management of the injured patient has expanded dramatically in the last decade. The focused assessment with sonography for trauma (FAST) has become one of the fundamental skills incorporated into the initial evaluation of the trauma patient. However, there are significant limitations of this diagnostic modality as initially described. Novel ultrasound examinations of the injured patient, although useful, must also be considered carefully. Increasing evidence supports the high specificity of FAST for detecting a pericardial effusion and intra-abdominal free fluid (hemorrhage) in the patient with blunt injury. On the other hand, a so-called negative FAST result still requires further diagnostic work up given its low sensitivity. Similarly, the role of FAST in penetrating abdominal trauma appears to be limited because of lower sensitivity for visceral injury compared to other modalities. Extended FAST (EFAST), that adds a focused thoracic examination, has high accuracy for the detection of pneumothorax comparable to computed tomographic scan, the significance of which is not currently known. Finally, the utility of intensivist-performed ultrasound in the ICU is expanding to limited hemodynamic assessment and facilitation of central venous catheter placement. The indications for FAST and additional ultrasound studies in the injured patient continue to evolve. Application of sound clinical evidence will avoid unsubstantiated indications for ultrasound to creep into our clinical practice.
    No preview · Article · Sep 2011 · Current opinion in critical care

Publication Stats

1k Citations
249.50 Total Impact Points


  • 2013-2014
    • University of Southern California
      • Department of Surgery
      Los Ángeles, California, United States
    • University of California, Los Angeles
      Los Ángeles, California, United States
  • 2010-2014
    • Penn State Hershey Medical Center and Penn State College of Medicine
      • Trauma - Acute Care and Critical Care Surgery
      هرشي، بنسيلفانيا, Pennsylvania, United States
    • Baylor Health Care System
      Dallas, Texas, United States
  • 2011-2013
    • University of Maryland, Baltimore
      Baltimore, Maryland, United States
  • 2006-2010
    • University of Texas Southwestern Medical Center
      • • Division of Burn/Trauma/Critical Care
      • • Division of Neurocritical Care
      Dallas, Texas, United States
    • Staten Island University Hospital
      New York, United States
  • 2009
    • Southern Adventist University
      Collegedale, Tennessee, United States
  • 2008-2009
    • University of Texas at Dallas
      Richardson, Texas, United States
  • 2002-2007
    • Yale University
      • Department of Surgery
      New Haven, Connecticut, United States
  • 2003-2006
    • Yale-New Haven Hospital
      New Haven, Connecticut, United States
  • 2000-2002
    • Hospital of the University of Pennsylvania
      • Division of Trauma and Surgical Critical Care
      Philadelphia, Pennsylvania, United States
  • 1998
    • University of Pennsylvania
      • Division of Trauma and Surgical Critical Care
      Filadelfia, Pennsylvania, United States