https://onlinelibrary.wiley.com/doi/pdf/10.1002/jor.21343

Effect of various concentrations of antibiotics on osteogenic cell viability and activity

Disparities in health outcomes have been uncovered for many conditions. Data indicate that black patients currently have higher mortality than white patients for 9 of the leading 15 causes of death. The life expectancy gap between black patients and white patients persists, although it has gradually

/pdf/disparities-in-trauma-care-and-outcomes-in-the-united-states-50boz08mej.pdf

Disparities in trauma care and outcomes in the United States: a systematic review and meta-analysis.

Background Risk-adjusted analyses are critical in evaluating trauma outcomes. The National Trauma Data Bank (NTDB) is a statistically robust registry that allows such analyses; however, analytical techniques are not yet standardized. In this study, we examined peer-reviewed manuscripts published using NTDB data, with particular attention to characteristics strongly associated with trauma outcomes. Our objective was to determine if there are substantial variations in the methodology and quality of risk-adjusted analyses and therefore, whether development of best practices for risk-adjusted analyses is warranted. Study Design A database of all studies using NTDB data published through December 2010 was created by searching PubMed and Embase. Studies with multivariate risk-adjusted analyses were examined for their central question, main outcomes measures, analytical techniques, covariates in adjusted analyses, and handling of missing data. Results Of 286 NTDB publications, 122 performed a multivariable adjusted analysis. These studies focused on clinical outcomes (51 studies), public health policy or injury prevention (30), quality (16), disparities (15), trauma center designation (6), or scoring systems (4). Mortality was the main outcome in 98 of these studies. There were considerable differences in the covariates used for case adjustment. The 3 covariates most frequently controlled for were age (95%), Injury Severity Score (85%), and sex (78%). Up to 43% of studies did not control for the 5 basic covariates necessary to conduct a risk-adjusted analysis of trauma mortality. Less than 10% of studies used clustering to adjust for facility differences or imputation to handle missing data. Conclusions There is significant variability in how risk-adjusted analyses using data from the NTDB are performed. Best practices are needed to further improve the quality of research from the NTDB.

Influence of the National Trauma Data Bank on the study of trauma outcomes: is it time to set research best practices to further enhance its impact?

Introduction Trauma remains a leading cause of death and disability and accounts for a substantial portion of health care expenditures.1 Therefore, research to improve trauma care is a leading public health priority. Spearheading this effort, the American College of Surgeons Committee on Trauma coordinated a landmark multi-institutional endeavor, the Major Trauma Outcomes Study.2 On its completion in 1989, the American College of Surgeons Committee on Trauma recognized the importance of national trauma data aggregation to inform quality improvement. In 1997, it formed a subcommittee to develop the National Trauma Data Bank (NTDB), a standardized collection of national trauma data (Box). Today, to our knowledge, the NTDB is the world’s largest trauma data repository, with more than 7.5 million electronic records from more than 900 trauma centers.

Practical Guide to Surgical Data Sets: National Trauma Data Bank (NTDB)

were discharged home (78.9%); fewer went to home health (3.3%), rehabilitation (5.0%), and nursing facilities (5.4%). When compared with white patients in adjusted analysis, relative risk ratios of discharge to rehabilitation were 0.61 (95% CI 0.56, 0.66) and 0.44 (95% CI 0.40, 0.49) for blacks and Hispanics, respectively. Compared with privately insured white patients, Hispanics had lower rates of discharge to rehabilitation whether privately insured (RRR 0.45, 95% CI 0.40, 0.52), publicly insured (RRR 0.51, 95% CI 0.42, 0.61), or uninsured (RRR 0.20, 95% CI 0.17, 0.24). Black patients had similarly low rates: private (RRR 0.63, 95% CI 0.56, 0.71), public (RRR 0.72, 95% CI 0.63, 0.82), or uninsured (RRR 0.27, 95% CI 0.23, 0.32). Relative risk ratios of discharge to home health or nursing facilities showed similar trends among blacks and Hispanics regardless of insurance, except for black patients with insurance whose discharge to nursing facilities was similar to their white counterparts. CONCLUSIONS: Disadvantaged populations have more limited use of posthospitalization care such as rehabilitation after trauma, suggesting a potential improvement in trauma care for the underprivileged. (J Am Coll Surg 2011;213:699–708. © 2011 by the American College of Surgeons)

https://www.journalacs.org/article/S1072-7515(11)01049-0/pdf

Racial, Ethnic, and Insurance Status Disparities in Use of Posthospitalization Care after Trauma

Background Surgical length of stay (LOS) has been correlated with quality of care, with shorter stays implying better care. The relationship between LOS and postdischarge complications (PDCs) has not been evaluated effectively. Methods The 2005 to 2007 National Surgical Quality Improvement Program data were queried for patients undergoing elective colectomies. The outcome of interest was the development of a PDC. Multivariate analysis was then performed adjusting for demographics, surgical approach, and comorbidities. Results A total of 12,956 colectomies were analyzed with an overall PDC of 8.7%. LOS was not associated with increased odds of developing a PDC. The laparoscopic approach reduced the risk of PDCs by 30% (odds ratio = .70, 95% confidence interval, 0.61–0.81). Body mass index, female sex, the presence of diabetes mellitus, and prolonged operative time increased the odds of developing a PDC. Conclusions A shorter LOS did not correlate with a reduction in the likelihood of PDCs. Further investigation into the role of LOS as a measure of quality care is needed.

http://lib.ajaums.ac.ir/booklist/1-s2.0-S0002961012003017-main.pdf

Predictors of postdischarge complications: role of in-hospital length of stay.

The pediatric melanoma population is not well described, and current guidelines for their management are not well defined. Our study aims to identify this population, treatment modalities, and outcomes using a national population-based database. We reviewed the Surveillance, Epidemiology, and End Results database (2004-2008). Patients ≤21 years old with melanoma were included and grouped into ≤12 years of age, 13 to 18 years, and 19 to 21 years. Clinical characteristics were analyzed across the groups. A total of 1255 patients were included: 52.7 per cent were 19 to 21 years of age, 36.3 per cent were 13 to 18 years of age, and 11.0 per cent were ≤12 years of age. The 19- to 21-year-olds had the highest proportion of stage I (50.5%) versus ≤12 years of age (31.9%); the ≤12-year-olds had the highest proportion of stage IV (3.6%) versus 19 to 21 years of age (0.9%), P < 0.001. The 19- to 21-year-olds had the highest proportion receiving wide local excisions only (34.8%) versus ≤12 years of age (26.4%); the ≤12-year-olds had the highest proportion of patients without any surgeries (16.0%) versus 13 to 18 years of age (9.4%), P = 0.169. On adjusted analysis, the 19- to 21-year-olds had worse survival compared with ≤12 years of age (hazard ratio: 5.26, P = 0.017, 95% confidence interval 1.34-20.65). Disparities were found in the ≤12-year-old melanoma population, as they had later stage melanomas, less invasive surgery, and lower survival. Clearer prognostic factors are needed to better elucidate their management.

An Age-Based Analysis of Pediatric Melanoma: Staging, Surgery, and Mortality in the Surveillance, Epidemiology, and End Results Database.

Management of bone infection and resulting bony defects is one of the major issues in Orthopaedic surgery. Systemic antibiotic therapy alone does not usually eradicate bacteria because of poor penetration into bone. Therefore, local application of aminoglycoside antibiotics at the site of infection can provide high drug concentrations to eradicate the bacteria. Aminoglycosides have been shown to be toxic to certain cells in the ears and in the kidneys. Approximately 5-10% of the people who are treated with aminoglycosides experience some side effect, affecting their hearing, sense of balance, or kidneys. Little information exists in the literature addressing the effects of the aminoglycoside, Tobramycin, on osteoblast cells. MG63 osteoblast-like cell line, were treated with varying concentrations of Tobramycin (0, 10, 50, 100microM) over a period of 24, 48 and 72 hours, harvesting them after each time period and performing assays to test their metabolic function (Glutathione assay) and cell membrane viability (MDA). The results show that Tobramycin at concentrations greater than the minimum inhibitory concentration (MIC) caused marked reductions in cell number with increased membrane damage as early as 48 hours. Glutathione levels within the cells were increased in the 50uM and 100uM treatments as early as 24 hours indicating impaired metabolic function. These results may have implications for using Tobramycin as antibacterial prophylaxis in Orthopaedic surgery, as its toxic effects may interfere with the osteoblasts ability to form bone, and delay healing.

The effects of tobramycin on MG63 cell viability and function.

1100: Impact Of Coagulopathy On Traumatic Splenic Injuries

Multiple Imputation in Trauma Disparity Research

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