roumen vesselinov | University of Maryland (original) (raw)

Papers by roumen vesselinov

The Journal of Heart and Lung Transplantation, 2018

Purpose: Frailty is a clinically recognized syndrome of decreased physiological reserve and a key... more Purpose: Frailty is a clinically recognized syndrome of decreased physiological reserve and a key contributor to suboptimal clinical outcomes in various lung disease groups. Interstitial lung disease (ILD) is now the most common indication for lung transplantation worldwide. Our aim was to assess whether frailty is a predictor of prognostic outcomes in patients with ILD referred for lung transplantation. Methods: Consecutive patients with ILD referred or on the waiting list for lung transplantation from May 2013 underwent frailty assessment using the Fried Frailty Phenotype (FFP). Frailty was defined as a positive response to three or more of the following five components; weak grip strength, slowed walking speed, poor appetite, physical inactivity and exhaustion. In addition, markers of disease severity were obtained and all patients underwent cognitive (Montreal Cognitive Assessment, MoCA) and depression (Depression in Medical Illness, DMI-10) screening. Results: 88 patients (68M:20F; age 58 ± 8 years, range 30-70) underwent frailty assessment. 21 / 88 (23%) were assessed as frail. Frailty was associated with lower hemoglobin, anemia and the use of supplemental oxygen (p < 0.05). There was no association between frailty and age, gender, measures of pulmonary dysfunction (PaO2 on room air, percent predicted FVC or DLCO/VA), cognitive impairment or depression. Frailty (Hazard ratio 3.3 [95% Confidence Interval 1.2-9.5]), percent predicted FVC (HR 0.95 [95% CI 0.92-0.99]) and DLCO/VA (HR 0.96 [95% CI 0.94-1.0]) were independent predictors of all-cause mortality: one-year actuarial survival was 85% ± 5% in the non-frail group compared with 54% ± 11% for the frail group (Figure 1, p= 0.001). Conclusion: Frailty is common among patients with ILD referred for lung transplantation and is associated with a marked increase in mortality.

Anticoagulation in Emergency General Surgery: Who Bleeds More? The EAST Multicenter Trials ACES study

Journal of Trauma and Acute Care Surgery

Biomarkers of endothelial cell dysfunction persist beyond resuscitation in patients with hemorrhagic shock

Journal of Trauma and Acute Care Surgery

Traumatic Brain Injury in Older Adults: Characteristics, Outcomes, and Considerations. Results From the American Association for the Surgery of Trauma Geriatric Traumatic Brain Injury (GERI-TBI) Multicenter Trial

Journal of the American Medical Directors Association, 2022

OBJECTIVES Describe the epidemiology of a large cohort of older adults with isolated traumatic br... more OBJECTIVES Describe the epidemiology of a large cohort of older adults with isolated traumatic brain injury (TBI) and identify predictors of mortality, palliative interventions, and discharge to preinjury residence in those presenting with moderate/severe TBI. DESIGN Prospective observational study of geriatric patients with TBI enrolled across 45 trauma centers. SETTING AND PARTICIPANTS Inclusion criteria were age ≥40 years, and computed tomography (CT)-verified TBI. Exclusion criteria were any other body region abbreviated injury scale score >2 and presentation at enrolling center >24 hours after injury. METHODS The analysis was restricted to individuals aged ≥65 and stratified into 3 age groups: young-old (65-74), middle-old (75-84), and oldest-old (≥85). Demographic, clinical, and injury data were collected. Predictors of mortality, palliative interventions, and discharge to preinjury residence in the moderate/severe TBI group were identified using Classification and Regression Tree and Generalized Linear Mixed Models. RESULTS Of the 3081 subjects enrolled in the study, 2028 were ≥65 years old. Overall, 339 (16.7%) presented with a moderate/severe TBI and experienced a 64% mortality rate. A Glasgow Coma Scale (GCS) score <9 was the main predictor of mortality, CT worsening (odds ratio [OR] = 1.7, P < .04), cerebral edema (OR = 2.4, P < .04), GCS <9, and age ≥75 (OR = 2.1, P = .007) were predictors for palliative interventions, and an injury severity score ≤24 (OR = 0.087, P = .002) was associated with increased likelihood of discharge to preinjury residence in the moderate/severe TBI group. CONCLUSION AND IMPLICATIONS In this prospective study of a large cohort of older adults with isolated TBI, comparisons across the older age groups with moderate/severe TBI revealed that survival and favorable discharge disposition were influenced more by severity of injury rather than age itself. Indicating that chronological age alone maybe insufficient to accurately predict outcomes, and increased representation of older adults in TBI research to develop better diagnostic and prognostic tools is warranted.

Inadequate Management of Patients with Acute Aortic Symptoms Before Transfer from Emergency Departments

Journal of Emergencies, Trauma, and Shock, 2020

Journal of Emergencies, Trauma, and Shock ¦ Volume 13 ¦ Issue 3 ¦ July-September 2020 234 Acute a... more Journal of Emergencies, Trauma, and Shock ¦ Volume 13 ¦ Issue 3 ¦ July-September 2020 234 Acute aortic symptoms (AAS) encompass a group of similar emergency clinical conditions: aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, and aortic rupture.[1] Aortic dissection is the most common subgroup[2] but it is still a relatively uncommon disease, and emergency clinicians may only encounter one case every 3–4 years.[3] The American Heart Association (AHA) published a set of guidelines to provide a framework for the management of AAS.[2] This guideline recommends: (1) maintaining patients’ systolic blood pressure (SBP) ≤120 mm Hg, (2) maintaining the patient’s heart rate (HR) ≤60 bpm, and (3) adequate pain control.[2] However, how effectively patients with AAS are treated in the emergency department (ED) is relatively unknown.

Journal of the American College of Surgeons, 2020

Objectives: Social determinants of health (SDOH) have been demonstrated to correlate with clinica... more Objectives: Social determinants of health (SDOH) have been demonstrated to correlate with clinical outcomes, but to date screening has not been widely implemented. The purpose of this project is to assess feasibility of SDOH screening for adults after injury and identify common SDOH needs in the trauma population at our institution. Methods: A pilot initiative to implement SDOH screening among adults (age ≥ 18) with traumatic injuries admitted to floor or stepdown units was conducted at our rural level I trauma center. An internal screening questionnaire consisting of 19 validated questions across 10 different domains, already utilized in our outpatient medicine clinic, was administered. Patients with positive screens were offered social work consultation for help with available resources. Results: Over an 8 week trial period, 75 of 81 (92.5%) eligible patients were screened, with 5 unable due to mental status and 1 refusal. The average age for screened patients was 59.2 ± 20.8, and...

Age-based variability in the association between restraint use and injury type and severity

ABSTRACTPurposePrevious studies have shown elderly individuals receive less relatively less prote... more ABSTRACTPurposePrevious studies have shown elderly individuals receive less relatively less protection from seat belts against fatal injuries, however it is less clear how seat belt protection against severe and torso injury changes with age. We estimated age-based variability in seat belt protection against fatal injuries, injuries with maximum abbreviated injury scale greater than 2 (MAIS3+), and torso injuries.MethodsWe leveraged the Crash Outcome Data Evaluation System (CODES) to analyze binary indicators of fatal, MAIS3+, and torso injuries. Using a matched cohort design and conditional Poisson regression, we estimated age-based relative risks (RR) of the outcomes associated with seat belt use.ResultsSeat belts were highly protective against fatal injuries for all ages. For ages 16-30, seat belt use was associated with 66% lower risk of MAIS3+ injury (RR 0.34, 95% CI 0.30, 0.38), whereas for ages 75 and older, seat belt use was associated with 38% lower risk of MAIS3+ injury (R...

Variability in antemortem and postmortem blood alcohol concentration levels among fatally injured adults

The American Journal of Drug and Alcohol Abuse, 2020

Background: Excessive alcohol use is a risk factor for injury-related deaths. Postmortem blood sa... more Background: Excessive alcohol use is a risk factor for injury-related deaths. Postmortem blood samples are commonly used to approximate antemortem blood alcohol concentration (BAC) levels. Objectives: To assess differences between antemortem and postmortem BACs among fatally injured adults admitted to one shock trauma center (STC). Method: Fifty-two adult decedents (45 male, 7 female) admitted to a STC in Baltimore, Maryland during 2006–2016 were included. STC records were matched with records from Maryland’s Office of the Chief Medical Examiner (OCME). The antemortem and postmortem BAC distributions were compared. After stratifying by antemortem BACs <0.10 versus ≥0.10 g/dL, differences in postmortem and antemortem BACs were plotted as a function of length of hospital stay. Results: Among the 52 decedents, 22 died from transportation-related injuries, 20 died by homicide or intentional assault, and 10 died from other injuries. The median BAC antemortem was 0.10 g/dL and postmort...

Psychiatric Services, 2003

Journal of Women's Health, 2008

Objectives: Previous research has identified an inverse relationship between religiosity/spiritua... more Objectives: Previous research has identified an inverse relationship between religiosity/spirituality and depressive symptoms. However, prospective studies are needed. This study investigates the association between antenatal religiosity/spirituality and postpartum depression, controlling for antenatal depressive symptoms, social support, and other potential confounders. Methods: This is a prospective cohort study. Women receiving prenatal care were enrolled from three obstetrics practices. Follow-up assessment was conducted at the 6-week postpartum clinic visit. Four measures of religiosity and two measures of spirituality were assessed at baseline. A measure of overall religiosity/spirituality was also created using principal component factor analysis. Depressive symptoms were measured at baseline and again at followup using the Edinburgh Postnatal Depression Scale (EPDS). A cutoff score of Ն13 was used to identify women with significant depressive symptoms. Results: Four hundred four women were enrolled, and 374 completed follow-up. Thirty women experienced pregnancy loss, leaving 344 with postpartum assessment; 307 women had complete data and were used for analyses. Thirty-six women (11.7%) scored above the EPDS screening cutoff. Controlling for significant covariates (baseline EPDS score and social support), women who participated in organized religious activities at least a few times a month were markedly less likely (OR ‫؍‬ 0.18, 95% CI) to exhibit high depressive symptom scores. No other religiosity/spirituality measure was statistically significant. Conclusions: Organized religious participation appears to be protective from postpartum depressive symptoms. Because this association is independent of antenatal depressive symptoms, we hypothesize that religious participation assists in coping with the stress of early motherhood.

Criminal Justice and Behavior, 2004

Actuarial models for violencerisk assessment have proliferatedin recent years. In this article, w... more Actuarial models for violencerisk assessment have proliferatedin recent years. In this article, we describe an approach that integrates the predictions of many actuarial risk-assessment models, each of which may capture a different but important facet of the interactive relationship between the measured risk factors and violence. Using this multiple-models approach, we ultimately combined the results of five prediction models generated by the iterative classification tree (ICT) methodology developed in the MacArthur Violence Risk Assessment Study. This combination of models produced results not only superior to those of any of its constituent models, but superior to any other actuarial violence risk-assessment procedure reported in the literature to date.

The Impact of Treatment on the Public Safety Outcomes of Mental Health Court Participants

American Behavioral Scientist, 2012

Three mental health courts (MHCs) are included in this study of whether enrollment in MHC affects... more Three mental health courts (MHCs) are included in this study of whether enrollment in MHC affects community treatment access, utilization, time to service, program outcome, arrests, and jail days. Researchers approached newly enrolled MHC participants ( n = 296) and similar “treatment as usual” (TAU) jail detainees ( n = 386) screened as eligible for study participation. Baseline and 6-month interviews were conducted, and respondents allowed researchers access to their mental health and criminal justice records. We found that on discharge from jail on target charges, MHC participants accessed community treatment more quickly than did the TAU respondents. Furthermore, prior to enrollment in MHC, this sample had twice as many crisis treatment episodes as the TAUs, and they received more therapeutic treatment episodes. One year after enrollment, the MHC sample had more intensive and therapeutic treatment episodes than the TAUs. We found no relationship between the type of treatment int...

Journal of Consulting and Clinical Psychology, 2000

Using a standardized schedule of questions, this study examined (a) the prevalence of self-report... more Using a standardized schedule of questions, this study examined (a) the prevalence of self-report of violent thoughts by patients hospitalized for mental disorders compared with nonpatients, (b) the persistence of violent thoughts after discharge, and (c) the relation between patients' violent thoughts while hospitalized and violent acts within 20 weeks after hospital discharge. About 1/3 of the patients reported thoughts of violence while hospitalized, more than twice the proportion found among nonpatients. Reporting violent thoughts in hospital was significantly related to engaging in violent acts within 20 weeks after discharge for non-White patients, patients without major mental disorder but with substance abuse diagnoses, patients with high symptom severity, and patients whose reports of violent thoughts persisted after discharge. Reporting violent thoughts was significantly related to measures of psychopathy, anger, and impulsiveness. Asking patients whether they have had thoughts about harming others has long been a standard part of mental status examinations (Appelbaum & Gutheil, 1991). The underlying assumption, of course, is that a positive self-report about harming someone may foreshadow aggressive behavior and that a denial of such thoughts mitigates the risk of harm to others within the near future. Research has examined the relationship between self-reports of thoughts of harming others and actual aggression among sexual psychopaths (e.g.,

Original contribution Religiosity, spirituality and antenatal anxiety in Southern U.S. women

1 Department of Family and Preventive Medicine, University of South Carolina School of Medicine, ... more 1 Department of Family and Preventive Medicine, University of South Carolina School of Medicine, Columbia, South Carolina, U.S.A. 2 University of South Carolina Arnold School of Public Health, Columbia, South Carolina, U.S.A. 3 Department of Obstetrics and Gynecology, University of South Carolina School of Medicine, Columbia, South Carolina, U.S.A. 4 Department of Statistics, University of South Carolina, Columbia, South Carolina, U.S.A. 5 East Lakeland Ob=Gyn Associates, Jackson, Mississippi, U.S.A.

The Critical Care Resuscitation Unit Transfers More Patients From Emergency Departments Faster and Is Associated With Improved Outcomes

The Journal of Emergency Medicine

BACKGROUND Transfer delays of critically ill patients from other hospitals' emergency departm... more BACKGROUND Transfer delays of critically ill patients from other hospitals' emergency departments (EDs) to an appropriate referral hospital's intensive care unit (ICU) are associated with poor outcomes. OBJECTIVES We hypothesized that an innovative Critical Care Resuscitation Unit (CCRU) would be associated with improved outcomes by reducing transfer times to a quaternary care center and times to interventions for ED patients with critical illnesses. METHODS This pre-post analysis compared 3 groups of patients: a CCRU group (patients transferred to the CCRU during its first year [July 2013 to June 2014]), a 2011-Control group (patients transferred to any ICU between July 2011 and June 2012), and a 2013-Control group (patients transferred to other ICUs between July 2013 and June 2014). The primary outcome was time from transfer request to ICU arrival. Secondary outcomes were the interval between ICU arrival to the operating room and in-hospital mortality. RESULTS We analyzed 1565 patients (644 in the CCRU, 574 in the 2011-Control, and 347 in 2013-Control groups). The median time from transfer request to ICU arrival for CCRU patients was 108 min (interquartile range [IQR] 74-166 min) compared with 158 min (IQR 111-252 min) for the 2011-Control and 185 min (IQR 122-283 min) for the 2013-Control groups (p < 0.01). The median arrival-to-urgent operation for the CCRU group was 220 min (IQR 120-429 min) versus 439 min (IQR 290-645 min) and 356 min (IQR 268-575 min; p < 0.026) for the 2011-Control and 2013-Control groups, respectively. After adjustment with clinical factors, transfer to the CCRU was associated with lower mortality (odds ratio 0.64 [95% confidence interval 0.44-0.93], p = 0.019) in multivariable logistic regression. CONCLUSION The CCRU, which decreased time from outside ED's transfer request to referral ICU arrival, was associated with lower mortality likelihood. Resuscitation units analogous to the CCRU, which transfer resource-intensive patients from EDs faster, may improve patient outcomes.

Evaluating Barriers to Community CPR Education in Baltimore, Maryland, USA

The American Journal of Emergency Medicine

OBJECTIVE The primary objective of this study is to better understand the preferences of the gene... more OBJECTIVE The primary objective of this study is to better understand the preferences of the general public regarding cardiopulmonary resuscitation (CPR) education as it relates to both format and the time and place of delivery. METHODS Survey data were collected from a convenience sample at large public gatherings in Baltimore, Maryland, between May 23, 2015, and February 11, 2017. The survey was a 23-item single-page instrument administered at fairs and festivals. RESULTS A total of 516 surveys were available for analysis. Twenty-four percent of the total population reported being very confident in performing CPR (scoring 8 to 10 on a Likert scale). Thirty-two percent of respondents who had previously taken a CPR class reported being very confident in performing CPR. A stepwise decline in reported confidence in performing CPR was observed as the time from last CPR class increased. Among all respondents the most favored instruction style was an instructor-led class. Least favorable was a local learning station at an event. The most favored location for instruction were libraries, while community festivals were least favored. CONCLUSION Respondent preferences regarding the location and style of the training differed little between socioeconomic groups. Instructor-led instruction at local libraries was the most preferred option. CPR education offered at local learning stations during events and at community festivals were least favored among respondents. This study's findings can be used to more effectively structure CPR outreach and educational programs in an attempt to increase rates of bystander CPR.

Correlation Between the Revised Trauma Score and Injury Severity Score: Implications for Prehospital Trauma Triage

Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, Jan 23, 2018

Prehospital triage of the seriously injured patient is fraught with challenges, and trauma scorin... more Prehospital triage of the seriously injured patient is fraught with challenges, and trauma scoring systems in current triage guidelines warrant further investigation. The primary objective of this study was to assess the correlation of the physiologically based Revised Trauma Score (RTS) and MGAP score (mechanism of injury, Glasgow Coma Scale, age, blood pressure) with the anatomically based Injury Severity Score (ISS). The secondary objectives for this study were to compare the accuracy of the MGAP score and the RTS for the prediction of in-hospital mortality for trauma patients. This study was a retrospective cohort including 10 years of patient data in a large single-center trauma registry at a primary adult resource center (Level I) for trauma patients. Participants included adults (age ≥18 years). The primary outcome measure was injury severity (measured by ISS) and a secondary analysis compared the RTS and MGAP for the prediction of patient mortality. Descriptive statistics we...

Serving those Who Served: Outcomes from the San Diego Veterans Treatment Review Calendar (SDVTRC) Pilot Program

Psychological Injury and Law

Veterans Treatment Courts (VTCs) are a type of specialty treatment, problem-solving, criminal cou... more Veterans Treatment Courts (VTCs) are a type of specialty treatment, problem-solving, criminal court. Though the number of VTCs has increased over the past decade, few research studies have examined their effectiveness. This paper examines the data collected concerning a particular VTC experience, the first 82 Veterans enrolled in the Veterans Treatment Review Calendar Pilot Program conducted by the California Superior Court of the county of San Diego from February 2011 until July 2014 (SDVTRC.) The evidence presented herein concerns the nature of this cohort’s population, the SDVTRC program structure in which these Veterans participated, and the outcomes of participation. SDVTRC participants showed a significant decrease in symptoms on 11 of 12 clinical measures from baseline to 12 months. Particular outcomes of the SDVTRC program were related to factors of military service, such as length of service, number of awards, and discharge status. There were also significant relationships between symptom decrease and court process factors, such as length of time in program and sanctions imparted. This court has a 0% recidivism rate, which is believed to be related to its systematic data collection process that was used to inform individualized treatment plans for participants. Implications for other VTCs are provided.

Mortality Risk Assessment in COVID-19 Venovenous Extracorporeal Membrane Oxygenation

The Annals of Thoracic Surgery

The Journal of Heart and Lung Transplantation, 2018

Purpose: Frailty is a clinically recognized syndrome of decreased physiological reserve and a key... more Purpose: Frailty is a clinically recognized syndrome of decreased physiological reserve and a key contributor to suboptimal clinical outcomes in various lung disease groups. Interstitial lung disease (ILD) is now the most common indication for lung transplantation worldwide. Our aim was to assess whether frailty is a predictor of prognostic outcomes in patients with ILD referred for lung transplantation. Methods: Consecutive patients with ILD referred or on the waiting list for lung transplantation from May 2013 underwent frailty assessment using the Fried Frailty Phenotype (FFP). Frailty was defined as a positive response to three or more of the following five components; weak grip strength, slowed walking speed, poor appetite, physical inactivity and exhaustion. In addition, markers of disease severity were obtained and all patients underwent cognitive (Montreal Cognitive Assessment, MoCA) and depression (Depression in Medical Illness, DMI-10) screening. Results: 88 patients (68M:20F; age 58 ± 8 years, range 30-70) underwent frailty assessment. 21 / 88 (23%) were assessed as frail. Frailty was associated with lower hemoglobin, anemia and the use of supplemental oxygen (p < 0.05). There was no association between frailty and age, gender, measures of pulmonary dysfunction (PaO2 on room air, percent predicted FVC or DLCO/VA), cognitive impairment or depression. Frailty (Hazard ratio 3.3 [95% Confidence Interval 1.2-9.5]), percent predicted FVC (HR 0.95 [95% CI 0.92-0.99]) and DLCO/VA (HR 0.96 [95% CI 0.94-1.0]) were independent predictors of all-cause mortality: one-year actuarial survival was 85% ± 5% in the non-frail group compared with 54% ± 11% for the frail group (Figure 1, p= 0.001). Conclusion: Frailty is common among patients with ILD referred for lung transplantation and is associated with a marked increase in mortality.

Anticoagulation in Emergency General Surgery: Who Bleeds More? The EAST Multicenter Trials ACES study

Journal of Trauma and Acute Care Surgery

Biomarkers of endothelial cell dysfunction persist beyond resuscitation in patients with hemorrhagic shock

Journal of Trauma and Acute Care Surgery

Traumatic Brain Injury in Older Adults: Characteristics, Outcomes, and Considerations. Results From the American Association for the Surgery of Trauma Geriatric Traumatic Brain Injury (GERI-TBI) Multicenter Trial

Journal of the American Medical Directors Association, 2022

OBJECTIVES Describe the epidemiology of a large cohort of older adults with isolated traumatic br... more OBJECTIVES Describe the epidemiology of a large cohort of older adults with isolated traumatic brain injury (TBI) and identify predictors of mortality, palliative interventions, and discharge to preinjury residence in those presenting with moderate/severe TBI. DESIGN Prospective observational study of geriatric patients with TBI enrolled across 45 trauma centers. SETTING AND PARTICIPANTS Inclusion criteria were age ≥40 years, and computed tomography (CT)-verified TBI. Exclusion criteria were any other body region abbreviated injury scale score >2 and presentation at enrolling center >24 hours after injury. METHODS The analysis was restricted to individuals aged ≥65 and stratified into 3 age groups: young-old (65-74), middle-old (75-84), and oldest-old (≥85). Demographic, clinical, and injury data were collected. Predictors of mortality, palliative interventions, and discharge to preinjury residence in the moderate/severe TBI group were identified using Classification and Regression Tree and Generalized Linear Mixed Models. RESULTS Of the 3081 subjects enrolled in the study, 2028 were ≥65 years old. Overall, 339 (16.7%) presented with a moderate/severe TBI and experienced a 64% mortality rate. A Glasgow Coma Scale (GCS) score <9 was the main predictor of mortality, CT worsening (odds ratio [OR] = 1.7, P < .04), cerebral edema (OR = 2.4, P < .04), GCS <9, and age ≥75 (OR = 2.1, P = .007) were predictors for palliative interventions, and an injury severity score ≤24 (OR = 0.087, P = .002) was associated with increased likelihood of discharge to preinjury residence in the moderate/severe TBI group. CONCLUSION AND IMPLICATIONS In this prospective study of a large cohort of older adults with isolated TBI, comparisons across the older age groups with moderate/severe TBI revealed that survival and favorable discharge disposition were influenced more by severity of injury rather than age itself. Indicating that chronological age alone maybe insufficient to accurately predict outcomes, and increased representation of older adults in TBI research to develop better diagnostic and prognostic tools is warranted.

Inadequate Management of Patients with Acute Aortic Symptoms Before Transfer from Emergency Departments

Journal of Emergencies, Trauma, and Shock, 2020

Journal of Emergencies, Trauma, and Shock ¦ Volume 13 ¦ Issue 3 ¦ July-September 2020 234 Acute a... more Journal of Emergencies, Trauma, and Shock ¦ Volume 13 ¦ Issue 3 ¦ July-September 2020 234 Acute aortic symptoms (AAS) encompass a group of similar emergency clinical conditions: aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, and aortic rupture.[1] Aortic dissection is the most common subgroup[2] but it is still a relatively uncommon disease, and emergency clinicians may only encounter one case every 3–4 years.[3] The American Heart Association (AHA) published a set of guidelines to provide a framework for the management of AAS.[2] This guideline recommends: (1) maintaining patients’ systolic blood pressure (SBP) ≤120 mm Hg, (2) maintaining the patient’s heart rate (HR) ≤60 bpm, and (3) adequate pain control.[2] However, how effectively patients with AAS are treated in the emergency department (ED) is relatively unknown.

Journal of the American College of Surgeons, 2020

Objectives: Social determinants of health (SDOH) have been demonstrated to correlate with clinica... more Objectives: Social determinants of health (SDOH) have been demonstrated to correlate with clinical outcomes, but to date screening has not been widely implemented. The purpose of this project is to assess feasibility of SDOH screening for adults after injury and identify common SDOH needs in the trauma population at our institution. Methods: A pilot initiative to implement SDOH screening among adults (age ≥ 18) with traumatic injuries admitted to floor or stepdown units was conducted at our rural level I trauma center. An internal screening questionnaire consisting of 19 validated questions across 10 different domains, already utilized in our outpatient medicine clinic, was administered. Patients with positive screens were offered social work consultation for help with available resources. Results: Over an 8 week trial period, 75 of 81 (92.5%) eligible patients were screened, with 5 unable due to mental status and 1 refusal. The average age for screened patients was 59.2 ± 20.8, and...

Age-based variability in the association between restraint use and injury type and severity

ABSTRACTPurposePrevious studies have shown elderly individuals receive less relatively less prote... more ABSTRACTPurposePrevious studies have shown elderly individuals receive less relatively less protection from seat belts against fatal injuries, however it is less clear how seat belt protection against severe and torso injury changes with age. We estimated age-based variability in seat belt protection against fatal injuries, injuries with maximum abbreviated injury scale greater than 2 (MAIS3+), and torso injuries.MethodsWe leveraged the Crash Outcome Data Evaluation System (CODES) to analyze binary indicators of fatal, MAIS3+, and torso injuries. Using a matched cohort design and conditional Poisson regression, we estimated age-based relative risks (RR) of the outcomes associated with seat belt use.ResultsSeat belts were highly protective against fatal injuries for all ages. For ages 16-30, seat belt use was associated with 66% lower risk of MAIS3+ injury (RR 0.34, 95% CI 0.30, 0.38), whereas for ages 75 and older, seat belt use was associated with 38% lower risk of MAIS3+ injury (R...

Variability in antemortem and postmortem blood alcohol concentration levels among fatally injured adults

The American Journal of Drug and Alcohol Abuse, 2020

Background: Excessive alcohol use is a risk factor for injury-related deaths. Postmortem blood sa... more Background: Excessive alcohol use is a risk factor for injury-related deaths. Postmortem blood samples are commonly used to approximate antemortem blood alcohol concentration (BAC) levels. Objectives: To assess differences between antemortem and postmortem BACs among fatally injured adults admitted to one shock trauma center (STC). Method: Fifty-two adult decedents (45 male, 7 female) admitted to a STC in Baltimore, Maryland during 2006–2016 were included. STC records were matched with records from Maryland’s Office of the Chief Medical Examiner (OCME). The antemortem and postmortem BAC distributions were compared. After stratifying by antemortem BACs <0.10 versus ≥0.10 g/dL, differences in postmortem and antemortem BACs were plotted as a function of length of hospital stay. Results: Among the 52 decedents, 22 died from transportation-related injuries, 20 died by homicide or intentional assault, and 10 died from other injuries. The median BAC antemortem was 0.10 g/dL and postmort...

Psychiatric Services, 2003

Journal of Women's Health, 2008

Objectives: Previous research has identified an inverse relationship between religiosity/spiritua... more Objectives: Previous research has identified an inverse relationship between religiosity/spirituality and depressive symptoms. However, prospective studies are needed. This study investigates the association between antenatal religiosity/spirituality and postpartum depression, controlling for antenatal depressive symptoms, social support, and other potential confounders. Methods: This is a prospective cohort study. Women receiving prenatal care were enrolled from three obstetrics practices. Follow-up assessment was conducted at the 6-week postpartum clinic visit. Four measures of religiosity and two measures of spirituality were assessed at baseline. A measure of overall religiosity/spirituality was also created using principal component factor analysis. Depressive symptoms were measured at baseline and again at followup using the Edinburgh Postnatal Depression Scale (EPDS). A cutoff score of Ն13 was used to identify women with significant depressive symptoms. Results: Four hundred four women were enrolled, and 374 completed follow-up. Thirty women experienced pregnancy loss, leaving 344 with postpartum assessment; 307 women had complete data and were used for analyses. Thirty-six women (11.7%) scored above the EPDS screening cutoff. Controlling for significant covariates (baseline EPDS score and social support), women who participated in organized religious activities at least a few times a month were markedly less likely (OR ‫؍‬ 0.18, 95% CI) to exhibit high depressive symptom scores. No other religiosity/spirituality measure was statistically significant. Conclusions: Organized religious participation appears to be protective from postpartum depressive symptoms. Because this association is independent of antenatal depressive symptoms, we hypothesize that religious participation assists in coping with the stress of early motherhood.

Criminal Justice and Behavior, 2004

Actuarial models for violencerisk assessment have proliferatedin recent years. In this article, w... more Actuarial models for violencerisk assessment have proliferatedin recent years. In this article, we describe an approach that integrates the predictions of many actuarial risk-assessment models, each of which may capture a different but important facet of the interactive relationship between the measured risk factors and violence. Using this multiple-models approach, we ultimately combined the results of five prediction models generated by the iterative classification tree (ICT) methodology developed in the MacArthur Violence Risk Assessment Study. This combination of models produced results not only superior to those of any of its constituent models, but superior to any other actuarial violence risk-assessment procedure reported in the literature to date.

The Impact of Treatment on the Public Safety Outcomes of Mental Health Court Participants

American Behavioral Scientist, 2012

Three mental health courts (MHCs) are included in this study of whether enrollment in MHC affects... more Three mental health courts (MHCs) are included in this study of whether enrollment in MHC affects community treatment access, utilization, time to service, program outcome, arrests, and jail days. Researchers approached newly enrolled MHC participants ( n = 296) and similar “treatment as usual” (TAU) jail detainees ( n = 386) screened as eligible for study participation. Baseline and 6-month interviews were conducted, and respondents allowed researchers access to their mental health and criminal justice records. We found that on discharge from jail on target charges, MHC participants accessed community treatment more quickly than did the TAU respondents. Furthermore, prior to enrollment in MHC, this sample had twice as many crisis treatment episodes as the TAUs, and they received more therapeutic treatment episodes. One year after enrollment, the MHC sample had more intensive and therapeutic treatment episodes than the TAUs. We found no relationship between the type of treatment int...

Journal of Consulting and Clinical Psychology, 2000

Using a standardized schedule of questions, this study examined (a) the prevalence of self-report... more Using a standardized schedule of questions, this study examined (a) the prevalence of self-report of violent thoughts by patients hospitalized for mental disorders compared with nonpatients, (b) the persistence of violent thoughts after discharge, and (c) the relation between patients' violent thoughts while hospitalized and violent acts within 20 weeks after hospital discharge. About 1/3 of the patients reported thoughts of violence while hospitalized, more than twice the proportion found among nonpatients. Reporting violent thoughts in hospital was significantly related to engaging in violent acts within 20 weeks after discharge for non-White patients, patients without major mental disorder but with substance abuse diagnoses, patients with high symptom severity, and patients whose reports of violent thoughts persisted after discharge. Reporting violent thoughts was significantly related to measures of psychopathy, anger, and impulsiveness. Asking patients whether they have had thoughts about harming others has long been a standard part of mental status examinations (Appelbaum & Gutheil, 1991). The underlying assumption, of course, is that a positive self-report about harming someone may foreshadow aggressive behavior and that a denial of such thoughts mitigates the risk of harm to others within the near future. Research has examined the relationship between self-reports of thoughts of harming others and actual aggression among sexual psychopaths (e.g.,

Original contribution Religiosity, spirituality and antenatal anxiety in Southern U.S. women

1 Department of Family and Preventive Medicine, University of South Carolina School of Medicine, ... more 1 Department of Family and Preventive Medicine, University of South Carolina School of Medicine, Columbia, South Carolina, U.S.A. 2 University of South Carolina Arnold School of Public Health, Columbia, South Carolina, U.S.A. 3 Department of Obstetrics and Gynecology, University of South Carolina School of Medicine, Columbia, South Carolina, U.S.A. 4 Department of Statistics, University of South Carolina, Columbia, South Carolina, U.S.A. 5 East Lakeland Ob=Gyn Associates, Jackson, Mississippi, U.S.A.

The Critical Care Resuscitation Unit Transfers More Patients From Emergency Departments Faster and Is Associated With Improved Outcomes

The Journal of Emergency Medicine

BACKGROUND Transfer delays of critically ill patients from other hospitals' emergency departm... more BACKGROUND Transfer delays of critically ill patients from other hospitals' emergency departments (EDs) to an appropriate referral hospital's intensive care unit (ICU) are associated with poor outcomes. OBJECTIVES We hypothesized that an innovative Critical Care Resuscitation Unit (CCRU) would be associated with improved outcomes by reducing transfer times to a quaternary care center and times to interventions for ED patients with critical illnesses. METHODS This pre-post analysis compared 3 groups of patients: a CCRU group (patients transferred to the CCRU during its first year [July 2013 to June 2014]), a 2011-Control group (patients transferred to any ICU between July 2011 and June 2012), and a 2013-Control group (patients transferred to other ICUs between July 2013 and June 2014). The primary outcome was time from transfer request to ICU arrival. Secondary outcomes were the interval between ICU arrival to the operating room and in-hospital mortality. RESULTS We analyzed 1565 patients (644 in the CCRU, 574 in the 2011-Control, and 347 in 2013-Control groups). The median time from transfer request to ICU arrival for CCRU patients was 108 min (interquartile range [IQR] 74-166 min) compared with 158 min (IQR 111-252 min) for the 2011-Control and 185 min (IQR 122-283 min) for the 2013-Control groups (p < 0.01). The median arrival-to-urgent operation for the CCRU group was 220 min (IQR 120-429 min) versus 439 min (IQR 290-645 min) and 356 min (IQR 268-575 min; p < 0.026) for the 2011-Control and 2013-Control groups, respectively. After adjustment with clinical factors, transfer to the CCRU was associated with lower mortality (odds ratio 0.64 [95% confidence interval 0.44-0.93], p = 0.019) in multivariable logistic regression. CONCLUSION The CCRU, which decreased time from outside ED's transfer request to referral ICU arrival, was associated with lower mortality likelihood. Resuscitation units analogous to the CCRU, which transfer resource-intensive patients from EDs faster, may improve patient outcomes.

Evaluating Barriers to Community CPR Education in Baltimore, Maryland, USA

The American Journal of Emergency Medicine

OBJECTIVE The primary objective of this study is to better understand the preferences of the gene... more OBJECTIVE The primary objective of this study is to better understand the preferences of the general public regarding cardiopulmonary resuscitation (CPR) education as it relates to both format and the time and place of delivery. METHODS Survey data were collected from a convenience sample at large public gatherings in Baltimore, Maryland, between May 23, 2015, and February 11, 2017. The survey was a 23-item single-page instrument administered at fairs and festivals. RESULTS A total of 516 surveys were available for analysis. Twenty-four percent of the total population reported being very confident in performing CPR (scoring 8 to 10 on a Likert scale). Thirty-two percent of respondents who had previously taken a CPR class reported being very confident in performing CPR. A stepwise decline in reported confidence in performing CPR was observed as the time from last CPR class increased. Among all respondents the most favored instruction style was an instructor-led class. Least favorable was a local learning station at an event. The most favored location for instruction were libraries, while community festivals were least favored. CONCLUSION Respondent preferences regarding the location and style of the training differed little between socioeconomic groups. Instructor-led instruction at local libraries was the most preferred option. CPR education offered at local learning stations during events and at community festivals were least favored among respondents. This study's findings can be used to more effectively structure CPR outreach and educational programs in an attempt to increase rates of bystander CPR.

Correlation Between the Revised Trauma Score and Injury Severity Score: Implications for Prehospital Trauma Triage

Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, Jan 23, 2018

Prehospital triage of the seriously injured patient is fraught with challenges, and trauma scorin... more Prehospital triage of the seriously injured patient is fraught with challenges, and trauma scoring systems in current triage guidelines warrant further investigation. The primary objective of this study was to assess the correlation of the physiologically based Revised Trauma Score (RTS) and MGAP score (mechanism of injury, Glasgow Coma Scale, age, blood pressure) with the anatomically based Injury Severity Score (ISS). The secondary objectives for this study were to compare the accuracy of the MGAP score and the RTS for the prediction of in-hospital mortality for trauma patients. This study was a retrospective cohort including 10 years of patient data in a large single-center trauma registry at a primary adult resource center (Level I) for trauma patients. Participants included adults (age ≥18 years). The primary outcome measure was injury severity (measured by ISS) and a secondary analysis compared the RTS and MGAP for the prediction of patient mortality. Descriptive statistics we...

Serving those Who Served: Outcomes from the San Diego Veterans Treatment Review Calendar (SDVTRC) Pilot Program

Psychological Injury and Law

Veterans Treatment Courts (VTCs) are a type of specialty treatment, problem-solving, criminal cou... more Veterans Treatment Courts (VTCs) are a type of specialty treatment, problem-solving, criminal court. Though the number of VTCs has increased over the past decade, few research studies have examined their effectiveness. This paper examines the data collected concerning a particular VTC experience, the first 82 Veterans enrolled in the Veterans Treatment Review Calendar Pilot Program conducted by the California Superior Court of the county of San Diego from February 2011 until July 2014 (SDVTRC.) The evidence presented herein concerns the nature of this cohort’s population, the SDVTRC program structure in which these Veterans participated, and the outcomes of participation. SDVTRC participants showed a significant decrease in symptoms on 11 of 12 clinical measures from baseline to 12 months. Particular outcomes of the SDVTRC program were related to factors of military service, such as length of service, number of awards, and discharge status. There were also significant relationships between symptom decrease and court process factors, such as length of time in program and sanctions imparted. This court has a 0% recidivism rate, which is believed to be related to its systematic data collection process that was used to inform individualized treatment plans for participants. Implications for other VTCs are provided.

Mortality Risk Assessment in COVID-19 Venovenous Extracorporeal Membrane Oxygenation

The Annals of Thoracic Surgery