bluuebunny/crossref_metadata_2025_split huggingface dataset:
Application of electronic medical record–derived analytics in critical care: Rothman Index predicts mortality and readmissions in surgical intensive care unit patients
Authors: Alarhayem Abdul Q. , Muir Mark T. , Jenkins Donald J. , Pruitt Basil A. , Eastridge Brian J. , Purohit Maulik P. , Cestero Ramon F. 
Published: January 2019

INTRODUCTION
The Rothman Index (RI) is an objective measurement of a patient's overall condition, automatically generated from 26 variables including vital signs, laboratory data, cardiac rhythms, and nursing assessments. The purpose of this study was to assess the validity of RI scores in predicting surgical ICU (SICU) readmission rates and mortality.

METHODS
We conducted a single-center retrospective analysis of surgical patients who were transferred from the SICU to the surgical floor from December 2014 to December 2016. Data included demographics, length of stay (LOS), mortality, and RI at multiple pretransfer and post-transfer time points.

RESULTS
A total of 1,445 SICU patients were transferred to the surgical floor; 79 patients (5.5%) were readmitted within 48 hours of transfer. Mean age was 52 years, and 67% were male. Compared to controls, patients readmitted to the SICU within 48 hours experienced higher LOS (29 vs. 11 days, p < 0.05) as well as higher mortality (2.5% vs. 0.6%, p < 0.05). Patients requiring readmission also had a lower RI at 72, 48, and 24 hours before transfer as well as at 24 and 48 hours after transfer (p < 0.05 for all). Rothman Index scores were categorized into higher-risk (<40), medium-risk (40–65), and lower-risk groups (>65); RI scores at 24 hours before transfer were inversely proportional to overall mortality (RI < 40 = 2.5%, RI 40–65 = 0.3%, and RI > 65 = 0%; p < 0.05) and SICU readmission rates (RI < 40 = 9%, RI 40–65 = 5.2%, and RI > 65 = 2.8%; p < 0.05). Patients transferred with RI scores greater than 83 did not require SICU readmission within 48 hours.

CONCLUSION
Surgical ICU patients requiring readmission within 48 hours of transfer have a significantly higher mortality and longer LOS compared to those who do not. Patients requiring readmission also have significantly lower pretransfer and post-transfer RI scores compared to those who do not. Rothman Index scores may be used as a clinical tool for evaluating patients before transfer from the SICU. Prospective studies are warranted to further validate use of this technology.

LEVEL OF EVIDENCE
Retrospective database review, level III.
A trauma mortality prediction model based on the ICD-10-CM lexicon: TMPM-ICD10
Authors: Osler Turner M. , Glance Laurent G. , Cook Alan , Buzas Jeffrey S. , Hosmer David W. 
Published: January 2019

BACKGROUND
Outcome prediction models allow risk adjustment required for trauma research and the evaluation of outcomes. The advent of ICD-10-CM has rendered risk adjustment based on ICD-9-CM codes moot, but as yet no risk adjustment model based on ICD-10-CM codes has been described.

METHODS
The National Trauma Data Bank provided data from 773,388 injured patients who presented to one of 747 trauma centers in 2016 with traumatic injuries ICD-10-CM codes and Injury Severity Score (ISS). We constructed an outcome prediction model using only ICD-10-CM acute injury codes and compared its performance with that of the ISS.

RESULTS
Compared with ISS, the TMPM-ICD-10 discriminated survivors from non-survivors better (ROC TMPM-ICD-10 = 0.861 [0.860–0.872], ROC [reviever operating curve] ISS = 0.830 [0.823–0.836]), was better calibrated (HL [Hosmer-Lemeshow statistic] TMPM-ICD-10 = 49.01, HL ISS = 788.79), and had a lower Akaike information criteria (AIC TMPM-ICD10 = 30579.49; AIC ISS = 31802.18).

CONCLUSIONS
Because TMPM-ICD10 provides better discrimination and calibration than the ISS and can be computed without recourse to Abbreviated Injury Scale coding, the TMPM-ICD10 should replace the ISS as the standard measure of overall injury severity for data coded in the ICD-10-CM lexicon.

LEVEL OF EVIDENCE
Prognostic/Epidemiologic, level II.
From the battlefield to main street: Tourniquet acceptance, use, and translation from the military to civilian settings
Authors: Goodwin Tress , Moore Krista N. , Pasley Jason David , Troncoso Ruben , Levy Matthew J. , Goolsby Craig 
Published: January 2019

ABSTRACT
Throughout history, battlefield medicine has led to advancements in civilian trauma care. In the most recent conflicts of Operation Enduring Freedom in Afghanistan/Operation Iraqi Freedom, one of the most important advances is increasing use of point-of-injury hemorrhage control with tourniquets. Tourniquets are gradually gaining acceptance in the civilian medical world—in both the prehospital setting and trauma centers. An analysis of Emergency Medical Services (EMS) data shows an increase of prehospital tourniquet utilization from 0 to nearly 4,000 between 2008 and 2016. Additionally, bystander educational campaigns such as the Stop the Bleed program is expanding, now with over 125,000 trained on tourniquet placement. Because the medical community and the population at large has broader acceptance and training on the use of tourniquets, there is greater potential for saving lives from preventable hemorrhagic deaths.
The “Top 10” research and development priorities for battlefield surgical care: Results from the Committee on Surgical Combat Casualty Care research gap analysis
Authors: Martin Matthew J. , Holcomb John B. , Polk Travis , Hannon Matthew , Eastridge Brian , Malik Saafan Z. , Blackman Virginia S. , Galante Joseph M. , Grabo Daniel , Schreiber Martin , Gurney Jennifer , Butler Frank K. , Shackelford Stacy 
Published: January 2019

BACKGROUND
The US Military has achieved the highest casualty survival rates in its history. However, there remain multiple areas in combat trauma that present challenges to the delivery of high-quality and effective trauma care. Previous work has identified research priorities for pre-hospital care, but there has been no similar analysis for forward surgical care.

METHODS
A list of critical “focus areas” was developed by the Committee on Surgical Combat Casualty Care (CoSCCC). Individual topics were solicited and mapped to appropriate focus areas by group consensus and review of Eastern Association for the Surgery of Trauma (EAST) and Joint Trauma System guidelines. A web-based survey was distributed to the CoSCCC and the military committees of EAST and the American Association for the Surgery of Trauma. Topics were rated on a Likert scale from 1 (low) to 10 (high priority). Descriptives, univariate statistics, and inter-rater correlation analysis was performed.

RESULTS
13 research focus areas were identified (eight clinical and five adjunctive categories). Ninety individual topics were solicited. The survey received 64 responses. The majority of respondents were military (90%) versus civilians (10%). There was moderate to high agreement (inter-rater correlation coefficient = 0.93, p < 0.01) for 10 focus areas. The top five focus areas were Personnel/Staffing (mean, 8.03), Resuscitation and Hemorrhage Management (7.49), Pain/Sedation/Anxiety Management (6.96), Operative Interventions (6.9), and Initial Evaluation (6.9). The “Top 10” research priorities included four in Personnel/Staffing, four in Resuscitation/Hemorrhage Management, and three in Operative Interventions. A complete list of the topics/scores will be presented.

CONCLUSIONS
This is the first objective ranking of research priorities for combat trauma care. The “Top 10” priorities were all from three focus areas, supporting prioritization of personnel/staffing of austere teams, resuscitation/hemorrhage control, and damage-control interventions. This data will help guide Department of Defense research programs and new areas for prioritized funding of both military and civilian researchers.

LEVEL OF EVIDENCE
Study design, level IV.
A prospective study in severely injured patients reveals an altered gut microbiome is associated with transfusion volume
Authors: Nicholson Susannah E. , Burmeister David M. , Johnson Taylor R. , Zou Yi , Lai Zhao , Scroggins Shannon , DeRosa Mark , Jonas Rachelle B. , Merrill Daniel R. , Zhu Caroline , Newton Larry M. , Stewart Ronald M. , Schwacha Martin G. , Jenkins Donald H. , Eastridge Brian J. 
Published: January 2019

BACKGROUND
Traumatic injury can lead to a compromised intestinal epithelial barrier and inflammation. While alterations in the gut microbiome of critically injured patients may influence clinical outcomes, the impact of trauma on gut microbial composition is unknown. Our objective was to determine if the gut microbiome is altered in severely injured patients and begin to characterize changes in the gut microbiome due to time and therapeutic intervention.

METHODS
We conducted a prospective, observational study in adult patients (n = 72) sustaining severe injury admitted to a Level I Trauma Center. Healthy volunteers (n = 13) were also examined. Fecal specimens were collected on admission to the emergency department and at 3, 7, 10, and 13 days (±2 days) following injury. Microbial DNA was isolated for 16s rRNA sequencing, and α and β diversities were estimated, according to taxonomic classification against the Greengenes database.

RESULTS
The gut microbiome of trauma patients was altered on admission (i.e., within 30 minutes following injury) compared to healthy volunteers. Patients with an unchanged gut microbiome on admission were transfused more RBCs than those with an altered gut microbiome (p < 0.001). Although the gut microbiome started to return to a β-diversity profile similar to that of healthy volunteers over time, it remained different from healthy controls. Alternatively, α diversity initially increased postinjury, but subsequently decreased during the hospitalization. Injured patients on admission had a decreased abundance of traditionally beneficial microbial phyla (e.g., Firmicutes) with a concomitant decrease in opportunistic phyla (e.g., Proteobacteria) compared to healthy controls (p < 0.05). Large amounts of blood products and RBCs were both associated with higher α diversity (p < 0.001) and a β diversity clustering closer to healthy controls.

CONCLUSION
The human gut microbiome changes early after trauma and may be aided by early massive transfusion. Ultimately, the gut microbiome of trauma patients may provide valuable diagnostic and therapeutic insight for the improvement of outcomes postinjury.

LEVEL OF EVIDENCE
Prognostic and Epidemiological, level III.
Association between age and acute respiratory distress syndrome development and mortality following trauma
Authors: Killien Elizabeth Y. , Mills Brianna , Vavilala Monica S. , Watson R. Scott , O'Keefe Grant E. , Rivara Frederick P. 
Published: January 2019

BACKGROUND
Improved understanding of the relationship between patient age and acute respiratory distress syndrome (ARDS) development and mortality following traumatic injury may help facilitate generation of new hypotheses about ARDS pathophysiology and the role of novel treatments to improve outcomes across the age spectrum.

METHODS
We conducted a retrospective cohort study of trauma patients included in the National Trauma Data Bank who were admitted to an intensive care unit from 2007 to 2016. We determined ARDS incidence and mortality across eight age groups for the entire 10-year study period and by year. We used generalized linear Poisson regression models adjusted for underlying mortality risk (injury mechanism, Injury Severity Score, admission Glasgow Coma Scale score, admission heart rate, and admission hypotension).

RESULTS
Acute respiratory distress syndrome occurred in 3.1% of 1,297,190 trauma encounters. Acute respiratory distress syndrome incidence was lowest among pediatric patients and highest among adults aged 35 to 64 years. Acute respiratory distress syndrome mortality was highest among patients 80 years or older (43.9%), followed by 65 to 79 years (30.6%) and 4 years or younger (25.3%). The relative risk of mortality associated with ARDS was highest among the pediatric age groups, with an adjusted relative risk (aRR) of 2.06 (95% confidence interval [CI], 1.72–2.70) among patients 4 years or younger compared with an aRR of 1.51 (95% CI, 1.42–1.62) for the entire cohort. Acute respiratory distress syndrome mortality increased over the 10-year study period (aRR, 1.03 per year; 95% CI, 1.02–1.05 per year), whereas all-cause mortality decreased (aRR, 0.98 per year; 95% CI, 0.98–0.99 per year).

CONCLUSIONS
While ARDS development following traumatic injury was most common in middle-aged adults, patients 4 years or younger and 65 years or older with ARDS experienced the highest burden of mortality. Children 4 years or younger were disproportionately affected by ARDS relative to their low underlying mortality following trauma that was not complicated by ARDS. Acute respiratory distress syndrome–associated mortality following trauma has worsened over the past decade, emphasizing the need for new prevention and treatment strategies.

LEVEL OF EVIDENCE
Prognostic/epidemiological study, level III.
Complications in low-risk older adult trauma patients: A case-control study
Authors: Tessler Robert A. , Rangel Melissa M. , Rosser Micaela L. , Rivara Frederick P. , Bulger Eileen , Vavilala Monica S. , Reed May J. , Arbabi Saman 
Published: January 2019

BACKGROUND
Although some geriatric trauma patients may be at low risk of complications, poor outcomes are pronounced if complications do occur. Prevention in this group decreases the risk of excess morbidity and mortality.

METHODS
We performed a case-control study of trauma patients 65 years or older treated from January 2015 to August 2016 at a Level I trauma center with a Trauma Quality Improvement Program–predicted probability of complication of less than 20%. Cases had one of the following complications: unplanned admission to the intensive care unit (ICU), unplanned intubation, pneumonia, or unplanned return to the operating room. Two age-matched controls were randomly selected for each case. We collected information on comorbidities, home medications, and early medical care and calculated odds ratios using multivariable conditional logistic regression.

RESULTS
Ninety-four patients experienced unplanned admission to ICU (n = 51), unplanned intubation (n = 14), pneumonia (n = 21), and unplanned return to the operating room (n = 8). The 188 controls were more frequently intubated and had higher median ISS but were otherwise similar to cases. The adjusted odds of complication were higher for patients on a home β-blocker (adjusted odds ratio [aOR], 2.2; 95% confidence interval [CI], 1.2–4.0) and home anticoagulation (aOR, 2.2; 95% CI, 1.2–4.1). Patients with diabetes (aOR 2.0; 95% CI, 1.1–3.7) and dementia (aOR, 2.0; 95% CI, 1.0–4.3) also had higher odds of complication. The adjusted odds of complication for patients receiving geriatrics consultation was 0.4 (95% CI, 0.2–1.0; p = 0.05). Pain service consultation and indwelling pain catheter placement may be protective, but CIs included 1. There was no association between opiates, benzodiazepines, fluid administration, or blood products in the first 24 hours and odds of complication.

CONCLUSIONS
Geriatrics consultation was associated with lower odds of unplanned admission to the ICU, unplanned intubation, pneumonia, and unplanned return to the operating room in low-risk older adult trauma patients. Pathways that support expanding comanagement strategies with geriatricians are needed.

LEVEL OF EVIDENCE
Therapeutic/Care management, Level IV.
The why and how our trauma patients die: A prospective Multicenter Western Trauma Association study
Authors: Callcut Rachael A. , Kornblith Lucy Z. , Conroy Amanda S. , Robles Anamaria J. , Meizoso Jonathan P. , Namias Nicholas , Meyer David E. , Haymaker Amanda , Truitt Michael S. , Agrawal Vaidehi , Haan James M. , Lightwine Kelly L. , Porter John M. , San Roman Janika L. , Biffl Walter L. , Hayashi Michael S. , Sise Michael J. , Badiee Jayraan , Recinos Gustavo , Inaba Kenji , Schroeppel Thomas J. , Callaghan Emma , Dunn Julie A. , Godin Samuel , McIntyre Robert C. , Peltz Erik D. , O'Neill Patrick J. , Diven Conrad F. , Scifres Aaron M. , Switzer Emily E. , West Michaela A. , Storrs Sarah , Cullinane Daniel C. , Cordova John F. , Moore Ernest E. , Moore Hunter B. , Privette Alicia R. , Eriksson Evert A. , Cohen Mitchell Jay 
Published: January 2019

BACKGROUND
Historically, hemorrhage has been attributed as the leading cause (40%) of early death. However, a rigorous, real-time classification of the cause of death (COD) has not been performed. This study sought to prospectively adjudicate and classify COD to determine the epidemiology of trauma mortality.

METHODS
Eighteen trauma centers prospectively enrolled all adult trauma patients at the time of death during December 2015 to August 2017. Immediately following death, attending providers adjudicated the primary and contributing secondary COD using standardized definitions. Data were confirmed by autopsies, if performed.

RESULTS
One thousand five hundred thirty-six patients were enrolled with a median age of 55 years (interquartile range, 32–75 years), 74.5% were male. Penetrating mechanism (n = 412) patients were younger (32 vs. 64, p < 0.0001) and more likely to be male (86.7% vs. 69.9%, p < 0.0001). Falls were the most common mechanism of injury (26.6%), with gunshot wounds second (24.3%). The most common overall primary COD was traumatic brain injury (TBI) (45%), followed by exsanguination (23%). Traumatic brain injury was nonsurvivable in 82.2% of cases. Blunt patients were more likely to have TBI (47.8% vs. 37.4%, p < 0.0001) and penetrating patients exsanguination (51.7% vs. 12.5%, p < 0.0001) as the primary COD. Exsanguination was the predominant prehospital (44.7%) and early COD (39.1%) with TBI as the most common later. Penetrating mechanism patients died earlier with 80.1% on day 0 (vs. 38.5%, p < 0.0001). Most deaths were deemed disease-related (69.3%), rather than by limitation of further aggressive care (30.7%). Hemorrhage was a contributing cause to 38.8% of deaths that occurred due to withdrawal of care.

CONCLUSION
Exsanguination remains the predominant early primary COD with TBI accounting for most deaths at later time points. Timing and primary COD vary significantly by mechanism. Contemporaneous adjudication of COD is essential to elucidate the true understanding of patient outcome, center performance, and future research.

LEVEL OF EVIDENCE
Epidemiologic, level II.
Bilingualism in Primary Progressive Aphasia
Authors: Costa Ana S. , Jokel Regina , Villarejo Alberto , Llamas-Velasco Sara , Domoto-Reilley Kimiko , Wojtala Jennifer , Reetz Kathrin , Machado Álvaro 
Published: January 2019

Background:
Primary progressive aphasia (PPA) is a neurodegenerative disorder characterized by progressive deterioration of language. Being rare, reports of PPA in multilingual individuals are scarce, despite more than half of the world population being multilingual.

Methods:
We describe clinical characteristics of 33 bilingual patients with PPA, including symptom presentation and language deficits pattern in their first (L1) and second language (L2), through a systematic literature review and new cases retrospectively identified in 5 countries.

Results:
In total, 14 patients presented with nonfluent/agrammatic variant, 6 with semantic variant, and 13 with logopenic variant, with a median symptom onset of 2 years. Word-finding difficulties was the first symptom in 65% of all cases, initially noticed in L2, and not always the dominant language. Our group had 22 different languages as L1, and 9 as L2. At the whole-group level there was a tendency for parallel impairment in both languages, in line with the shared bilingual neural substrate hypothesis, but each PPA variant showed some heterogeneity.

Discussion:
Each PPA variant showed heterogeneity, showing the need for comprehensive language and cognitive assessment across languages, as well as further clarification on the role of language mediators.
Spectrum of GABAA receptor variants in epilepsy
Authors: Maljevic Snezana , Møller Rikke S. , Reid Christopher A. , Pérez-Palma Eduardo , Lal Dennis , May Patrick , Lerche Holger 
Published: January 2019

Purpose of review
Recent publications point to an increasingly important role of variants in genes encoding GABAA receptor subunits associated with both common and rare forms of epilepsies. The aim of this review is to give an overview of the current clinical phenotypes, genetic findings and pathophysiological mechanisms related to GABAA receptor variants.

Recent findings
Early work showed that inherited variants in GABRG2 and GABRA1 cause relatively mild forms of monogenic epilepsies in large families. More recent studies have revealed that de novo variants in several GABAA receptor genes cause severe developmental and epileptic encephalopathies, inherited variants cause remarkably variable phenotypes within the same pedigrees ranging from asymptomatic carriers to developmental and epileptic encephalopathies, and variants in all GABAA receptor genes are enriched in common forms of epilepsy, namely rolandic epilepsy and genetic generalized epilepsy. Analyses from cellular expression systems and mouse models suggest that all variants cause a loss of GABAA receptor function resulting in GABAergic disinhibition.

Summary
Genetic studies have revealed a crucial role of the GABAergic system in the underlying pathogenesis of various forms of common and rare epilepsies. Our understanding of functional consequences of GABAA receptor variants provide an opportunity to develop precision-based therapeutic strategies that are hopefully free from the side-effect burden seen with currently available GABAergic drugs.
Teratogenicity of antiepileptic drugs
Authors: Tomson Torbjörn , Battino Dina , Perucca Emilio 
Published: January 2019

Purpose of review
We review data on the comparative teratogenicity of antiepileptic drugs (AEDs), focusing on major congenital malformations (MCMs), intrauterine growth restriction, impaired cognitive development, and behavioral adverse effects following prenatal exposure.

Recent findings
Prospective registries and meta-analyses have better defined the risk of MCMs in offspring exposed to individual AEDs at different dose levels. Valproate is the drug with the highest risk, whereas prevalence of MCMs is lowest with lamotrigine, levetiracetam, and oxcarbazepine. For valproate, phenobarbital, phenytoin, carbamazepine, and lamotrigine, the risk of MCMs is dose-dependent. Prenatal exposure to valproate has also been confirmed to cause an increased risk of cognitive impairments and autistic traits. In a population-based study, the risk of AED-induced autistic traits was attenuated by periconceptional folate supplementation.

Summary
The risk of adverse fetal effects differs in relation to the type of AED and for some AEDs also the daily dose. Although for MCMs the risk is primarily associated with the first trimester of gestation, influences on cognitive and behavioral development could extend throughout pregnancy. Available information now permits a more rational AED selection in women of childbearing potential, and evidence-based counseling on optimization of AED treatment before conception.
Petroclival Meningioma Presenting With an Ipsilateral Sixth Nerve Palsy and a Contralateral Homonymous Quadrantanopia: A Unique and Topographically Localizing Syndrome
Authors: Sharifi Ardalan , Lyons Lance J. , Vickers Aroucha , Lee Andrew G. 
Published: January 2019

Abstract:
An 84-year-old woman reported onset of headaches, diplopia, and blurred vision. On examination, she was found to have a left sixth nerve palsy and an incongruous right homonymous hemianopia. Brain MRI demonstrated a left petroclival meningioma, causing this unusual combination of clinical findings. The patient was treated with radiation therapy and has remained stable over 4 years of follow-up.