Browsing by Author "Jenkins, Peter"

Now showing 1 - 5 of 5
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    Bilateral trauma case conferences: an approach to global surgery equity through a virtual education exchange
    (Springer Nature, 2023) Bhatia, Manisha B.; Munda, Beryl; Okoth, Philip; Carpenter, Kyle L.; Jenkins, Peter; Keung, Connie H.; Hunter‑Squires, JoAnna L.; Saruni, Seno I.; Simons, Clark J.; Surgery, School of Medicine
    Purpose: With increased interest in international surgical experiences, many residency programs have integrated global surgery into their training curricula. For surgical trainees in low- and middle-income countries (LMICs), physical exchange can be costly, and laws in high-income countries (HICs) prevent LMIC trainees from practicing surgery while on visiting rotations. To enrich the educational experience of trainees in both settings, we established a monthly virtual trauma conference between surgery training programs. Methods: General surgery teams from two public institutions, a public university with two surgical training programs in Kenya and a public university with two level I trauma centers in the United States, meet monthly to discuss complex and interesting trauma patients. A trainee from each institution presents a clinical case vignette and supplements the case with pertinent peer-reviewed literature. The attendees then answer a series of multiple-choice questions like those found on surgery board exams. Results: Monthly case conferences began in September 2017 with an average of 24 trainees and consultant surgeons. Case discussions serve to stimulate dialogue on patient presentation and management, highlighting cost-conscious, high-quality care and the need to adapt practice patterns to meet resource constraints and provide culturally appropriate care. Conclusion: Our 5-year experience with this virtual case conference has created a unique and robust surgical education experience for trainees and surgeons who have withstood the effects of the pandemic. These case conferences have not only strengthened the camaraderie between our departments, but also promoted equity in global surgery education and prioritized the learning of trainees from both settings.
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    Eleven-Year Experience Treating Blunt Thoracic Aortic Injury at a Tertiary Referral Center
    (Elsevier, 2020) McCurdy, Chelsea M.; Faiza, Zainab; Namburi, Niharika; Hartman, Timothy J.; Corvera, Joel S.; Jenkins, Peter; Timsina, Lava R.; Lee, Lawrence S.; Surgery, School of Medicine
    Background Blunt thoracic aortic injury treatment has evolved over the past decade particularly with respect to endovascular intervention options. We investigated the trends in blunt thoracic aortic injury management and outcomes over an 11-year span at the sole tertiary referral center in our state. Methods We retrospectively reviewed all patients who presented to our institution with blunt traumatic aortic injury between 2007 and 2017. Baseline demographics including aortic injury grade, injury severity score, and abbreviated injury scale were collected. Outcomes were compared by type and timing of treatment, which included either nonoperative management, endovascular repair, or open surgical repair. Bivariate and multivariable analyses were performed to examine treatment group differences and factors associated with 30-day mortality. Results In total, 229 patients were reviewed. The distribution of injury severity was grade 1 (30%), grade 2 (8%), grade 3 (30%), and grade 4 (31%). Overall, 27% of patients underwent endovascular repair, 29% open surgery, and 44% definitive nonoperative management. Over the study period, there was a dramatic decline in open surgery and a corresponding rise in endovascular treatment. Thirty-day mortality for the entire cohort was 22%. Mortality by treatment subgroup was 30% for nonoperative management, 8.2% for endovascular treatment, and 21% for open surgery. Delaying endovascular or open surgical treatment by at least 24 hours after admission was associated with significantly improved 30-day survival. Conclusions Procedural intervention, whether endovascular or surgical, is associated with improved mortality compared with nonoperative treatment. Delayed intervention, particularly in the case of high-grade injuries, may allow for initial patient stabilization and improved outcomes.
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    Impact of Individual Components of Emergency Department Pediatric Readiness on Pediatric Mortality in US Trauma Centers
    (Wolters Kluwer, 2023) Remick, Katherine; Smith, McKenna; Newgard, Craig D.; Lin, Amber; Hewes, Hilary; Jensen, Aaron R.; Glass, Nina; Ford, Rachel; Ames, Stefanie; Cook, Jenny; Malveau, Susan; Dai, Mengtao; Auerbach, Marc; Jenkins, Peter; Gausche-Hill, Marianne; Fallat, Mary; Kuppermann, Nathan; Mann, N. Clay; Surgery, School of Medicine
    Background: Injured children initially treated at trauma centers with high emergency department (ED) pediatric readiness have improved survival. Centers with limited resources may not be able to address all pediatric readiness deficiencies, and there currently is no evidence-based guidance for prioritizing different components of readiness. The objective of this study was to identify individual components of ED pediatric readiness associated with better-than-expected survival in US trauma centers to aid in the allocation of resources targeted at improving pediatric readiness. Methods: This cohort study of US trauma centers used the National Trauma Data Bank (2012-2017) matched to the 2013 National Pediatric Readiness Project assessment. Adult and pediatric centers treating at least 50 injured children (younger than 18 years) and recording at least one death during the 6-year study period were included. Using a standardized risk-adjustment model for trauma, we calculated the observed-to-expected mortality ratio for each trauma center. We used bivariate analyses and multivariable linear regression to assess for associations between individual components of ED pediatric readiness and better-than-expected survival. Results: Among 555 trauma centers, the observed-to-expected mortality ratios ranged from 0.07 to 4.17 (interquartile range, 0.93-1.14). Unadjusted analyses of 23 components of ED pediatric readiness showed that trauma centers with better-than-expected survival were more likely to have a validated pediatric triage tool, comprehensive quality improvement processes, a pediatric-specific disaster plan, and critical airway and resuscitation equipment (all p < 0.03). The multivariable analysis demonstrated that trauma centers with both a physician and a nurse pediatric emergency care coordinator had better-than-expected survival, but this association weakened after accounting for trauma center level. Child maltreatment policies were associated with lower-than-expected survival, particularly in Levels III to V trauma centers. Conclusion: Specific components of ED pediatric readiness were associated with pediatric survival among US trauma centers.
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    Infectious Complications in Obese Patients Following Trauma
    (Elsevier, 2016-04) Bell, Teresa Maria; Bayt, Demetria R.; Siedlecki, Charles B.; Stokes, Samantha M.; Yoder, Joseph; Jenkins, Peter; Fecher, Alison M.; Department of Surgery, IU School of Medicine
    Background Obesity is a public health concern in the United States due to its increasing prevalence, especially in younger age groups. Trauma is the most common cause of death for people under aged 40 y. The purpose of this study is to determine the association between obesity and specific infectious complications after traumatic injury. Materials and methods A retrospective analysis was conducted using data from the 2012 National Trauma Data Bank. The National Trauma Data Bank defined obesity as having a body mass index of 30 or greater. Descriptive statistics were calculated and stratified by obesity status. A hierarchical regression model was used to determine the odds of experiencing an infectious complication in patients with obesity while controlling for age, gender, diabetes, number of comorbidities, injury severity, injury mechanism, head injury, and surgical procedure. Results Patients with a body mass index of 30 or greater compared with nonobese patients had increased odds of having an infectious complication (Odds Ratio, 1.59; 1.49-1.69). In addition to obesity, injury severity score greater than 29, age 40 y or older, diabetes, comorbid conditions, and having a surgical procedure were also predictive of an infectious complication. Conclusions Our results indicate that trauma patients with obesity are nearly 60% more likely to develop an infectious complication in the hospital. Infection prevention and control measures should be implemented soon after hospital arrival for patients with obesity, particularly those with operative trauma.
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    Neighborhood Differences in COVID-19 Testing, Incidence, and Mortality in the State of Indiana
    (2020-04-15) Timsina, Lava; Nicole, Ashley; Haggstrom, David A.; Jenkins, Peter; Connors, Jill; Bell, Teresa M.
    Background: COVID-19 is a highly contagious pandemic disease. This study aims to identify neighborhood-level sociodemographic, health behaviors, adherence to social distancing policies, and healthcare access factors associated with geographic variability of COVID-19 testing, case incidence, and mortality in the U.S. state of Indiana. Methods: The study population included all Indiana residents. Geographic distribution of COVID-19 testing, positive cases, and mortality were estimated for each county and plotted using choropleth maps. Generalized bivariate and multivariable negative binomial regression were used to estimate effects of county-level factors. Results: Higher rates of testing, case detection, and mortality were associated with a greater proportion of non-white residents. Counties with better scores in social distancing and greater proportion of older residents had lower incidence of laboratory testing. We found the highest socioeconomic tertile was associated with higher rates of cases, but no difference in testing or mortality. Improved social distancing lowered the incidence of COVID-19 testing and cases. Densely populated counties had higher testing and incidence of COVID-19 cases per capita, however, higher mortality rates were observed in rural/mixed counties. Conclusion: Differences in COVID-19 testing, case detection, and mortality in Indiana are associated with neighborhood-level characteristics. Local contexts should be considered in COVID-19 response planning.