bluuebunny/crossref_metadata_2025_split huggingface dataset:
Speckle Tracking Analysis of Left Ventricular Systolic Function Following Traumatic Brain Injury: A Pilot Prospective Observational Cohort Study
Authors: Krishnamoorthy Vijay , Chaikittisilpa Nophanan , Lee James , Mackensen G. Burkhard , Gibbons Edward F. , Laskowitz Daniel , Hernandez Adrian , Velazquez Eric , Lele Abhijit V. , Vavilala Monica S. 
Published: January 2019

Background:
Systolic dysfunction and reduction in left ventricular ejection fraction (LVEF) has been documented after traumatic brain injury (TBI). Speckle tracking is an emerging technology for myocardial strain assessment which has been utilized to identify subclinical myocardial dysfunction, and is most commonly reported as global longitudinal strain (GLS). We examined myocardial strain and regional strain patterns following moderate-severe TBI.

Materials and Methods:
We conducted a prospective cohort study of moderate-severe TBI patients (Glasgow Coma Scale≤12) and age/sex-matched controls. Transthoracic echocardiography was performed within the first day and 1 week following TBI. Myocardial function was assessed using both GLS and LVEF, and impaired systolic function was defined as GLS >−16% or LVEF ≤50%. Regional strain patterns and individual strain trajectories were examined.

Results:
Thirty subjects were included, 15 patients with TBI and 15 age/sex-matched controls. Among patients with adequate echocardiographic windows, systolic dysfunction was observed in 2 (17%) patients using LVEF and 5 (38%) patients using GLS within the first day after TBI. Mean GLS was impaired in patients with TBI compared with controls (−16.4±3.8% vs. −20.7±1.8%, P=0.001). Regional myocardial examination revealed impaired strain primarily in the basal and mid-ventricular segments. There was no improvement in GLS from day 1 to day 7 (P=0.81).

Conclusions:
Myocardial strain abnormalities are common and persist for at least 1 week following moderate-severe TBI. Speckle tracking may be useful for the early diagnosis and monitoring of systolic dysfunction following TBI.
The Relevance of the Judet and Letournel Acetabular Fracture Classification System in the Modern Era: A Review
Authors: Butler Bennet A. , Lawton Cort D. , Hashmi Sohaib Z. , Stover Michael D. 
Published: January 2019

Summary:
The Judet and Letournel acetabular fracture classification system, based on the idea of bicolumnar support of the acetabulum, was first described in a landmark article published in the 1960s. It has stood the test of time and continues to be the preferred method for describing acetabular fractures for the majority of orthopaedic trauma surgeons. Still, there have been attempts to modify or replace Letournel system since its introduction for a variety of reasons, chief among them a perceived inability of the classification system to account for a number of transitional fracture patterns and injury modifiers that may affect surgical decision making and patient outcomes. In this review, we present the literature related to the Judet and Letournel acetabular fracture classification system, over 50 years after its first formal description. We summarize its strengths, weaknesses, and its place in our current understanding of acetabular fractures and their recommended management.
Do We Need a Separate Classification for Fragility Fractures of the Pelvis?
Authors: Rommens Pol Maria , Wagner Daniel , Hofmann Alexander 
Published: January 2019

Summary:
Fragility fractures of the pelvis are occurring with increasing frequency. These fractures, occurring in the geriatric patient population, are low-energy injuries and are dissimilar in many ways from those caused by high-energy trauma. For example, the mechanism of injury is different and emergency treatment is usually not necessary. Having diminished bone strength, fragility fracture lines follow areas of low bone mineral density and loss of pelvic stability may increase over time. Based on our clinical experience, we propose a comprehensive classification of pelvic fragility fractures separate from the existing pelvic ring injury classification to provide a framework for distinguishing the different fragility fracture types and their recommended treatment. This classification is derived first from the degree of fracture instability, followed by the location of the fracture. Anterior pelvic fractures are differentiated from posterior pelvic ring fractures, nondisplaced fractures from displaced, and unilateral from bilateral. It is our belief that this new in-depth analysis of these lesions will assist the clinician in identifying the specific patterns of fragility fracture instability and selecting the appropriate choice of treatment. Further investigation is required to determine the ultimate value of this proposed pelvic fragility fracture classification system.

Level of Evidence:
Diagnostic Level V.
The Ilioinguinal Surgical Approach Using a Modified Medial Window: Origin, Evolution, and Applications. A 34-Year Perspective
Authors: Mayo Keith , Unno Florence 
Published: January 2019

Summary:
Emile Letournel’s ilioinguinal approach provided unprecedented surgical access to the anterior aspect of the innominate bone. A refinement of this approach is described which incorporates a modified medial window that limits dissection around the external iliac vessels, expands surgical exposure of the anterior pelvic ring, and provides additional reduction possibilities while preserving the capabilities of the lateral and middle windows.
Geriatric Acetabular Surgery: Letournel's Contraindications Then and Now—Data From the German Pelvic Registry
Authors: Herath Steven C. , Pott Hendrik , Rollmann Mika F. R. , Braun Benedikt J. , Holstein Jörg H. , Höch Andreas , Stuby Fabian M. , Pohlemann Tim ,   on behalf of the German Pelvic Multicenter Study Group
Published: January 2019

Objective:
In his original series of 129 surgically treated acetabular fractures, Letournel did not operate on patients older than 60 years. Almost 30 years later, he still emphasized that no patients with reduced bone quality should be operated on. The aim of the study was to analyze epidemiologic characteristics and treatment modes for today's cohort of elderly patients with acetabular fractures.

Design:
Retrospective analysis.

Setting:
Multicenter registry/Level I trauma center.

Patients:
Three thousand seven hundred ninety-three patients who had sustained a fracture of the acetabulum.

Intervention:
Operative and nonoperative treatment of acetabular fractures.

Main Outcome Measurements:
Epidemiologic characteristics, treatment mode, in-hospital mortality, rate of secondary hip arthroplasty, and quality of life indicated by EQ-5D score.

Results:
For the multicenter registry, more than 50% of all patients with acetabular fractures had an age of 60 years or over. The age peak was found at 75–80 years. Fifty percent of the elderly patients were treated surgically. The in-hospital mortality was significantly higher in elderly patients than patients younger than 60 years. In our Level I trauma center, surgical treatment by open reduction and internal fixation did not influence in-hospital mortality or quality of life of elderly patients with acetabular fractures.

Conclusions:
Today, elderly persons represent the dominant cohort among patients with fractures of the acetabulum. Fifty-five years after the publication of Letournel's original case series, data indicate that currently, surgical treatment is a common and necessary option in the therapy of acetabular fractures in elderly patients.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Current Trends in the Surgical Treatment of Open-Book Pelvic Ring Injuries: An International Survey Among Experienced Trauma Surgeons
Authors: Moed Berton R. , Barla Jorge , Israel Heidi A. , Tovar Shandher , Joeris Alexander 
Published: January 2019

Introduction:
In the open-book, rotationally unstable (OTA/AO type 61-B1.1) pelvic ring injury, the posterior sacroiliac complex is believed to remain intact. Therefore, anterior ring stabilization alone has been the standard treatment recommendation. However, treatment failures using this method have caused a reconsideration of this management strategy. Anterior plus posterior fixation is the main alternative. In the absence of any specific new guidelines, the choice of treatment currently relies on the preference of the treating surgeon. The objective of this survey was to determine the relative use of anterior plus posterior fixation, as opposed to the standard anterior fixation alone, for the treatment of open-book pelvic ring injuries.

Methods:
An international group of 176 practicing trauma surgeons experienced in pelvic ring fracture fixation participated in an AO Foundation survey asking for their preferred standard surgical fixation (anterior alone or anterior plus posterior combined) for OTA/AO type 61-B1.1 open-book pelvic fractures.

Results:
Anterior plate fixation alone (group 1) was preferred by 56% of the survey participants, and combined anterior plus posterior fixation (group 2) was preferred by 44%. Statistical analysis revealed that group 1 participants were significantly older than group 2 participants (P = 0.03) and had more years of surgical experience (P = 0.02).

Conclusions:
Concern regarding the inadequacy of anterior fixation alone has led many surgeons, especially those more recently in practice, to add posterior fixation, despite limited data to determine its indications. No doubt the OTA/AO type B 1.1 pelvic ring disruption actually represents a wide spectrum of injury. Further study is needed to determine the best fixation method.
The Role of the Computed Tomographic Scan in the Diagnosis of Acetabular Fracture in the Immature Pelvis
Authors: Shaath M. Kareem , Ippolito Joseph A. , Adams Mark R. , Sirkin Michael S. , Reilly Mark C. 
Published: January 2019

Objectives:
We present a series of skeletally immature patients sustaining acetabular fractures. We hypothesized that if the secondary ossification centers of the acetabulum are not completely ossified, fractures often will not be identified on plain radiography. Our objective was to determine the efficacy of diagnostic plain radiography in these patients.

Design:
Retrospective case series.

Setting:
Urban, level-I trauma center.

Patients/Participants:
Skeletally immature patients with acetabular fractures following blunt force trauma.

Intervention:
We obtained a dedicated axial computed tomographic (CT) scan of the pelvis with sequential sections of 2.5-mm thickness.

Main Outcome Measures:
The accuracy of plain radiography as compared with CT in diagnosing acetabular fractures in skeletally immature patients.

Results:
Fourteen patients with 16 fractures of the acetabulum were identified by CT scan; however, 69% (11 of 16) were not visible on plain radiography. Radiographs were less likely to identify acetabular fractures compared with pelvic ring fractures [31% (5/16) vs. 92% (11/12); odds ratio, 0.04; 95% confidence interval, 0.01–0.37; P = 0.001]. Patients younger than 12 years were less likely to have acetabular fractures identified on plain radiography [9% (1/11) vs. 80% (4/5); odds ratio, 0.03; 95% confidence interval 0.01–0.59; P = 0.013]. The mean age of patients whose acetabular fractures were not identified on plain radiography was less than those whose fractures were identified on plain radiography (7.6 ± 2.9 vs. 12.8 ± 1.6; P = 0.004). Acetabular fractures visible on plain radiography were more likely to require operative stabilization [60% (3/5) vs. 0% (0/11); P = 0.004].

Conclusions:
In skeletally immature patients with suspected injury to the pelvis, particularly in patients younger than 12 years, diagnostic evaluation using plain radiographs alone may lead to missed injuries. If an acetabular fracture is identified, patients should be followed closely both clinically and radiographically to ensure early identification of any developing posttraumatic deformity.

Level of Evidence:
Level IV; Diagnostic—Investigating a diagnostic test.
Combined Pelvic Ring Disruption and Acetabular Fracture: Outcomes Using a Sequential Reduction Protocol and an Anterior Subcutaneous Pelvic Fixator (INFIX)
Authors: Vaidya Rahul , Blue Kevin , Oliphant Bryant , Tonnos Fred 
Published: January 2019

Objective:
The purposes of this article were to (1) compare our combined pelvic ring and acetabular fracture patients' rate of mortality and Injury Severity Score (ISS) to those of patients with isolated injuries at our center and to those with combined injuries as reported in the literature, (2) describe our treatment algorithm using the INFIX for these combination injuries, and (3) report our patients' radiographic and functional outcomes.

Design:
Retrospective IRB-approved case series and literature review.

Setting:
US Level 1 Trauma Center.

Patients/Participants:
Thousand six hundred ninety-seven with acetabular or pelvic ring injury, 174 patients with combination pelvic ring acetabular injuries, and 39 patients with 41 acetabular injuries treated with a surgical protocol.

Intervention:
Pelvic ring reduction using INFIX and posterior fixation followed by acetabular reduction fixation. Anterior injury fixed with INFIX.

Main Outcome:
Mortality, ISS, pelvic reduction by Keshishyan index, acetabular reduction by the Matta criteria, and functional outcome by the Majeed score.

Results:
Mortality was 5.7% and ISS was 12.5 for 174 combined injury patients. In the 39 patients with 41 injuries, excellent pelvic reduction was found in 39, and acetabular reduction was anatomic in 25 (61%), imperfect in 12 (29%), and poor in 4 (10%). Clinically 78% of the patients had good or excellent outcome and 22% had a fair or poor outcome. Nonanatomic acetabular reduction, persistent sciatic nerve palsy, and heterotopic ossification associated with poor clinical outcome.

Conclusions:
Our treatment protocol resulted in excellent pelvic reduction, anatomic acetabular reduction in 61% of patients, and 78% good to excellent clinical outcome.

Level of Evidence:
Case series Level IV.
Use of Gabapentin in Posterior Spinal Fusion is Associated With Decreased Postoperative Pain and Opioid Use in Children and Adolescents
Authors: Trzcinski Stacey , Rosenberg Rebecca E. , Vasquez Montes Dennis , Sure Akhila , Zhou Peter , Tishelman Jared , Mansky Robert , McLeod Lisa , Tracy Joanna , Buckland Aaron J. , Errico Thomas J. 
Published: January 2019

Study Design:
Retrospective cohort study.

Objective:
The objective of this study was to examine associations of gabapentin use with inpatient postoperative daily pain scores and opioid use in children undergoing PSF for AIS.

Summary of Background Data:
Gabapentin use in posterior spinal fusion (PSF) postoperative pain management for adolescent idiopathic scoliosis (AIS) is increasingly common in order to decrease opioid use and improve pain control, though there is conflicting data on dosing and effectiveness to support this practice in real world settings.

Methods:
Retrospective cohort study of children aged 10 to 21 years undergoing PSF for AIS between January 2013 and June 2016 at an urban academic tertiary care center. Adjuvant gabapentin exposure was defined as at least 15 mg/kg/d by postoperative day (POD) 1 with an initial loading dose of 10 mg/kg on day of surgery. Primary outcomes were daily postoperative mean pain score and opioid use [morphine milligram equivalents/kg/day(mme/kg/d)]. Secondary outcomes were short and long-term complications.

Results:
Among 129 subjects (mean age, 14.6 y, 74% female, mean coronal cobb, 55.2 degrees), 24 (19%) received gabapentin. Unadjusted GABA exposure was associated with significantly lower opioid use on POD1 and 2 (49% and 31%mme/kg/d, respectively) and lower pain scores (14%) on POD2. Adjusting for preexisting back pain, preoperative coronal Cobb angle, and site, GABA use was associated with significantly lower mean pain scores on POD1 through POD3 (−0.68, P=0.01; −0.86, P=0.002; −0.63, P=0.04). Gabapentin use was also associated with decreased opioid use on POD1 and POD2 (−0.39mme/kg/d, P<0.001; −0.27, P=0.02). There was no difference in complications by gabapentin exposure.

Conclusions:
Addition of gabapentin as adjuvant therapy for adolescent PSF, beginning on day of surgery, is associated with improved pain scores and decreased opioid use in the first 48 to 72 hours postoperatively.

Level of Evidence:
This is a retrospective cohort study, classified as Level III under “Therapeutic Studies Investigating the Results of a Treatment.”
Evaluating Tele-ICU Implementation Based on Observed and Predicted ICU Mortality: A Systematic Review and Meta-Analysis*
Authors: Fusaro Mario V. , Becker Christian , Scurlock Corey 
Published: January 2019

Objectives:
Past studies have examined numerous components of tele-ICU care to decipher which elements increase patient and institutional benefit. These factors include review of the patient chart within 1 hour, frequent collaborative data reviews, mechanisms for rapid laboratory/alert review, and interdisciplinary rounds. Previous meta-analyses have found an overall ICU mortality benefit implementing tele-ICU, however, subgroup analyses found few differences. The purpose of this systematic review and meta-analysis was to explore the effect of tele-ICU implementation with regard to ICU mortality and explore subgroup differences via observed and predicted mortality.

Data Sources:
We searched PubMed, Cochrane Library, Embase, and European Society of Intensive Care Medicine for articles related to tele-ICU from inception to September 18, 2018.

Study Selection:
We included all trials meeting inclusion criteria which looked at the effect of tele-ICU implementation on ICU mortality.

Data Extraction:
We abstracted study characteristics, patient characteristics, severity of illness scores, and ICU mortality rates.

Data Synthesis:
We included 13 studies from 2,766 abstracts identified from our search strategy. The before-after tele-ICU implementation pooled odds ratio for overall ICU mortality was 0.75 (95% CI, 0.65–0.88; p < 0.001). In subgroup analysis, the pooled odds ratio for ICU mortality between the greater than 1 versus less than 1 observed to predicted mortality ratios was 0.64 (95% CI, 0.52–0.77; p < 0.001) and 0.98 (95% CI, 0.81–1.18; p = 0.81), respectively. Test for interaction was significant (p = 0.002).

Conclusions:
After evaluating all included studies, tele-ICU implementation was associated with an overall reduction in ICU mortality. Subgroup analysis suggests that publications exhibiting observed to predicted ICU mortality ratios of greater than 1 before tele-ICU implementation was associated with a reduction in ICU mortality after tele-ICU implementation. No significant ICU mortality reduction was noted in the subgroup of observed to predicted ICU mortality ratio less than 1 before tele-ICU implementation. Future studies should confirm this finding using patient-level data.
Workforce, Workload, and Burnout Among Intensivists and Advanced Practice Providers: A Narrative Review
Authors: Pastores Stephen M. , Kvetan Vladimir , Coopersmith Craig M. , Farmer J. Christopher , Sessler Curtis , Christman John W. , D’Agostino Rhonda , Diaz-Gomez Jose , Gregg Sara R. , Khan Roozehra A. , Kapu April N. , Masur Henry , Mehta Gargi , Moore Jason , Oropello John M. , Price Kristen 
Published: January 2019

Objectives:
To assess—by literature review and expert consensus—workforce, workload, and burnout considerations among intensivists and advanced practice providers.

Design:
Data were synthesized from monthly expert consensus and literature review.

Setting:
Workforce and Workload section workgroup of the Academic Leaders in Critical Care Medicine Task Force.

Measurements and Main Results:
Multidisciplinary care teams led by intensivists are an essential component of critical care delivery. Advanced practice providers (nurse practitioners and physician assistants) are progressively being integrated into ICU practice models. The ever-increasing number of patients with complex, life-threatening diseases, concentration of ICU beds in few centralized hospitals, expansion of specialty ICU services, and desire for 24/7 availability have contributed to growing intensivist staffing concerns. Such staffing challenges may negatively impact practitioner wellness, team perception of care quality, time available for teaching, and length of stay when the patient to intensivist ratio is greater than or equal to 15. Enhanced team communication and reduction of practice variation are important factors for improved patient outcomes. A diverse workforce adds value and enrichment to the overall work environment. Formal succession planning for ICU leaders is crucial to the success of critical care organizations. Implementation of a continuous 24/7 ICU coverage care model in high-acuity, high-volume centers should be based on patient-centered outcomes. High levels of burnout syndrome are common among intensivists. Prospective analyses of interventions to decrease burnout within the ICU setting are limited. However, organizational interventions are felt to be more effective than those directed at individuals.

Conclusions:
Critical care workforce and staffing models are myriad and based on several factors including local culture and resources, ICU organization, and strategies to reduce burden on the ICU provider workforce. Prospective studies to assess and avoid the burnout syndrome among intensivists and advanced practice providers are needed.
Effect of Antihypertensive Medications on Sepsis-Related Outcomes: A Population-Based Cohort Study*
Authors: Kim Joohae , Kim Young Ae , Hwangbo Bin , Kim Min Jeong , Cho Hyunsoon , Hwangbo Yul , Lee Eun Sook 
Published: January 2019

Objectives:
Although the effect of antihypertensive agents on sepsis has been studied, evidence for survival benefit was limited in the literature. We investigated differences in sepsis-related outcomes depending on the antihypertensive drugs given prior to sepsis in patients with hypertension.

Design:
Population-based cohort study.

Setting:
Sample cohort Database of the National Health Insurance Service from 2003 to 2013 in South Korea.

Patients:
Patients over 30 years old who were diagnosed with sepsis after receiving hypertension treatment.

Interventions:
None.

Measurements and Main Results:
Primary outcomes, 30-day and 90-day mortality rates, were analyzed for differences among three representative antihypertensive medications: angiotensin- converting enzyme inhibitors or angiotensin II receptor blockers, calcium channel blockers, and thiazides. In total, 4,549 patients diagnosed with hypertension prior to hospitalization for sepsis were identified. The 30-day mortality was significantly higher among patients who did not receive any medications within 1 month before sepsis (36.8%) than among patients who did (32.0%; p < 0.001). The risk for 90-days mortality was significantly lower in prior angiotensin-converting enzyme inhibitors or angiotensin II receptor blocker users (reference) than in other drug users (odds ratio, 1.27; 95% CI, 1.07–1.52). There was no difference in the risk for 30-day and 90-day mortality depending on whether calcium channel blockers or thiazides were used. Use of calcium channel blockers was associated with a decreased risk for inotropic agent administration, compared with those of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (odds ratio, 1.23; 95% CI, 1.05–1.44) and thiazides (odds ratio, 1.33; 95% CI, 1.12–1.58).

Conclusions:
In patients with sepsis, lower mortality rate was associated with prior use of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers not with use of calcium channel blockers or thiazides. The requirement of inotropic agents was significantly lower in prior use of calcium channel blockers, although the survival benefits were not prominent.