Biomedical subjects
Karen Brasel
Publications and source records attributed to Karen Brasel.
Practice patterns and outcomes of retrievable vena cava filters in trauma patients: an AAST multicenter study.
BACKGROUND: The purpose of this study is to describe practice patterns and outcomes of posttraumatic retrievable inferior vena caval filters (R-IVCF). METHODS: A retrospective review of R-IVCFs placed during 2004 at 21 participating centers with follow up to July 1, 2005 was performed. Primary outcomes included major complications (migration, pulmonary embolism [PE], and symptomatic caval occlusion) and reasons for failure to retrieve. RESULTS: Of 446 patients (69% male, 92% blunt trauma) receiving R-IVCFs, 76% for prophylactic indications and 79% were placed by interventional radiology. Excluding 33 deaths, 152 were Gunter-Tulip (G-T), 224 Recovery (R), and 37 Optease (Opt). Placement occurred 6 +/- 8 days after admission and retrieval at 50 +/- 61 days. Follow up after discharge (5.7 +/- 4.3 months) was reported in 51%. Only 22% of R-IVCFs were retrieved. Of 115 patients in whom retrieval was attempted, retrieval failed as a result of technical issues in 15 patients (10% of G-T, 14% of R, 27% of Opt) and because of significant residual thrombus within the filter in 10 patients (6% of G-T, 4% of R, 46% Opt). The primary reason R-IVCFs were not removed was because of loss to follow up (31%), which was sixfold higher (6% to 44%, p = 0.001) when the service placing the R-IVCF was not directly responsible for follow up. Complications did not correlate with mechanism, injury severity, service placing the R-IVCF, trauma volume, use of anticoagulation, age, or sex. Three cases of migration were recorded (all among R, 1.3%), two breakthrough PE (G-T 0.6% and R 0.4%) and six symptomatic caval occlusions (G-T 0, R 1%, Opt 11%) (p < 0.05 Opt versus both G-T and R). CONCLUSION: Most R-IVCFs are not retrieved. The service placing the R-IVCF should be responsible for follow up. The Optease was associated with the greatest incidence of residual thrombus and symptomatic caval occlusion. The practice patterns of R-IVCF placement and retrieval should be re-examined.
Do trauma centers improve functional outcomes: a national trauma databank analysis?
BACKGROUND: The development of a tiered trauma care system has lead to improved survival for the critically injured. The question as to whether the increased survival associated with the establishment of tiered levels of trauma care is paralleled by an improved functional outcome has not, however, been addressed. METHODS: Multivariate logistic regression analysis of the National Trauma Data Bank from 1994 to 2001 was performed with functional independence measure (FIM) as the primary outcome. Trauma centers were dichotomized as Level II or above versus Level III or below. Blunt and penetrating trauma patients were analyzed separately. Other covariates included age, gender, shock, comorbidities, alcohol, drugs, as well as head, chest, abdominal, spine, and lower extremity injury. Confidence intervals were set at an alpha of 0.05. RESULTS: A total of 474,024 patients were analyzed. Among minimally injured penetrating trauma patients, those receiving care at a higher tiered center had a higher likelihood of total independence (odds ratio [OR] = 1.4, 95% confidence interval [CI] = 1.0, 2.0). Among minimal, moderate and severely injured blunt trauma patients those receiving care at a higher tiered center had a higher likelihood of total independence (OR = 1.2, 95% CI = 1.0, 1.4, OR = 1.3, 95% CI = 1.1, 1.6, OR = 1.3, 95% CI = 1.3, 1.5, respectively). CONCLUSIONS: These data indicate that the complex care delivered by advanced level trauma centers is associated with improved functional outcomes. Further investigations to identify the reasons for differences in these outcomes are necessary to improve care at lower tiered hospitals particularly for minimally injured patients.
Predicting significant torso trauma.
BACKGROUND: Identification of motor vehicle crash (MVC) characteristics associated with thoracoabdominal injury would advance the development of automatic crash notification systems (ACNS) by improving triage and response times. Our objective was to determine the relationships between MVC characteristics and thoracoabdominal trauma to develop a torso injury probability model. METHODS: Drivers involved in crashes from 1993 to 2001 within the National Automotive Sampling System were reviewed. Relationships between torso injury and MVC characteristics were assessed using multivariate logistic regression. Receiver operating characteristic curves were used to compare the model to current ACNS models. RESULTS: There were a total of 56,466 drivers. Age, ejection, braking, avoidance, velocity, restraints, passenger-side impact, rollover, and vehicle weight and type were associated with injury (p < 0.05). The area under the receiver operating characteristic curve (83.9) was significantly greater than current ACNS models. CONCLUSION: We have developed a thoracoabdominal injury probability model that may improve patient triage when used with ACNS.
The use of recombinant activated factor VII in trauma-associated hemorrhage with crush injury.
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Emergency care practitioners' barriers to mental health assessment, treatment, and referral of post-injury patients.
OBJECTIVE: Nearly half of all severely injured patients suffer some form of post-trauma mental stress, but little is known about factors that influence emergency care practitioners' decisions to refer injured patients to mental health care services. This study aimed to: (1) advance our understanding of the practice barriers that hinder mental health assessment, treatment, and referral of injured patients in emergency care settings, and (2) determine the preferred learning format of emergency care practitioners who desire to gain knowledge about mental health problems after injury. METHODS: Using a mail survey research design, data were collected from a random sample of emergency medicine physicians and nurses in Wisconsin and New York. RESULTS: Data was provided by 108 respondents with an average of 16 years of emergency care experience. More than half indicated they never refer trauma patients for mental health follow-up. Primary reasons for not dealing with trauma-related mental health issues were insufficient time and lack of symptoms. Providers who were most satisfied with their hospital's capacity to support mental health care were significantly more likely to refer patients. The top preference for receiving additional training related to mental health needs of trauma patients was on-site lectures. CONCLUSION: Injured patients rely on emergency care practitioners to provide multidimensional care. However, few practitioners facilitate mental health referrals for post-trauma victims, despite their known value.
Clinical research for surgeons in palliative care: challenges and opportunities.
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Determining and interpreting the accuracy of a test.
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