Browsing by Author "Coleman, Jamie J."

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    Increased Trauma Activation Is Not Equally Beneficial For All Elderly Trauma Patients
    (Wolters Kluwer, 2018-05) Carr, Bryan W.; Hammer, Peter M.; Timsina, Lava; Rozycki, Grace; Feliciano, David V.; Coleman, Jamie J.; Surgery, School of Medicine
    Background Physiologic changes in the elderly lead to higher morbidity and mortality after injury. Increasing level of trauma activation has been proposed to improve geriatric outcomes; but, the increased cost to the patient and stress to the hospital system are significant downsides. The purpose of this study was to identify the age at which an increase in activation status is beneficial. Methods A retrospective review of trauma patients ≥ 70 years old from October 1, 2011, to October 1, 2016 was performed. On October 1, 2013, a policy change increased the activation criteria to the highest level for patients ≥ 70 years of age with a significant mechanism of injury. Patients who presented prior to (PRE) were compared to those after the change (POST). Data collected included age, injury severity score (ISS), length of stay (LOS), complications and mortality. Primary outcome was mortality and secondary outcome was LOS. Multivariable regressions controlled for age, ISS, injury mechanism, and number of complications. Results 4341 patients met inclusion criteria, 1919 in PRE and 2422 in POST. Mean age was 80.4 and 81 years in PRE and POST groups respectively (p=0.0155). Mean ISS values were 11.6 and 12.4 (p<0.0001) for the PRE and POST groups. POST had more level 1 activations (696 vs. 220, p<0.0001). After controlling for age, ISS, mechanism of injury, and number of complications, mortality was significantly reduced in the POST group ≥ age 77 years (OR 0.53, 95% CI: 0.3 - 0.87), (Figure 1). Hospital LOS was significantly reduced in the POST group ≥ age 78 (regression coefficient -0.55, 95% CI: -1.09, -0.01) (Figure 2). Conclusions This study suggests geriatric trauma patients ≥ 77 years benefit from the highest level of trauma activation with shorter LOS and lower mortality. A focused approach to increasing activation level for elderly patients may decrease patient cost. Level of Evidence Level III Type of Study Economic/Decision
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    To Sleep, Perchance to Dream: Acute and Chronic Sleep Deprivation in Acute Care Surgeons
    (Elsevier, 2019) Coleman, Jamie J.; Robinson, Caitlin K.; Zarzaur, Ben L.; Timsina, Lava; Rozycki, Grace S.; Feliciano, David V.; Surgery, School of Medicine
    Background Acute and chronic sleep deprivation are significantly associated with depressive symptoms and felt to be contributors to the development of burnout. In-house call (IHC) inherently includes frequent periods of disrupted sleep and is common amongst acute care surgeons (ACS). The relationship between IHC and sleep deprivation (SD) amongst ACS has not been previously studied. The goal of this study was to determine prevalence and patterns of SD in ACS. Study Design: A prospective study of ACS with IHC responsibilities from two Level I trauma centers was performed. Participants wore a sleep tracking device continuously over a 3-month period. Data collected included age, gender, schedule of IHC, hours and pattern of each sleep stage (light, slow wave (SWS), and REM), and total hours of sleep. Sleep patterns were analyzed for each night excluding IHC and categorized as normal (N), acute sleep deprivation (ASD), or chronic sleep deprivation (CSD). Results 1421 nights were recorded amongst 17 ACS. (35.3% female; ages 37-65, mean 45.5 years). Excluding IHC, average amount of sleep was 6.54 hours with 64.8% of sleep patterns categorized as ASD or CSD. Average amount of sleep was significantly higher on post-call day 1 (6.96 hours, p=0.0016), but decreased significantly on post-call day 2 (6.33 hours, p=0.0006). Sleep patterns with ASD and CSD peaked on post-call day 2, and returned to baseline on post-call day 3 (p=0.046). Conclusion Sleep patterns consistent with ASD and CSD are common amongst ACS and worsen on post-call day 2. Baseline sleep patterns were not recovered until post-call day 3. Future study is needed to identify factors which impact physiologic recovery after IHC and further elucidate the relationship between SD and burnout.