Pneumatosis Intestinalis Predictive Evaluation Study (PIPES): a multicenter epidemiologic study of the Eastern Association for the Surgery of Trauma.

BACKGROUND: Pneumatosis intestinalis (PI) is associated with numerous adult conditions, ranging from benign to life threatening. To date, series of PI outcomes consist of case reports and small retrospective series. METHODS: We conducted a retrospective multicenter study, involving eight centers, of PI from January 2001 to December 2010. Demographics, medical history, clinical presentation, and outcomes were collected. Primary outcome was the presence of pathologic PI defined as confirmed transmural ischemia at surgery or the withdrawal of clinical care and subsequent mortality. Forward logistic regression and a regression tree analysis was used to generate a clinical prediction rule for pathologic PI. RESULTS: During the 10-year study period, 500 patients with PI were identified. Of this number, 299 (60%) had benign disease, and 201 (40%) had pathologic PI. A wide variety of variables were statistically significant predictors of pathologic PI on univariate comparison. In the regression model, a lactate of 2.0 or greater was the strongest independent predictor of pathologic PI, with hypotension or vasopressor need, peritonitis, acute renal failure, active mechanical ventilation, and absent bowel sounds also demonstrating significance. Classification and regression tree analysis was used to create a clinical prediction rule. In this tree, the presence of a lactate value of 2.0 or greater and hypotension/vasopressor use had a predictive probability of 93.2%. CONCLUSION: Discerning the clinical significance of PI remains a challenge. We identified the independent predictors of pathologic PI in the largest population to date and developed of a basic predictive model for clinical use. Prospective validation is warranted. LEVEL OF EVIDENCE: Epidemiologic study, level III.

Wr u txting b4 u crashed?

BACKGROUND: Texting has become popular, particularly among young adults. Texting while driving has been identified as a factor in accidents. Literature is lacking about the overall attitudes and utilization of texting. PURPOSE: Understand attitudes and behaviors surrounding texting. METHODS: A survey to evaluate attitudes and behaviors concerning texting was developed in conjunction with a social scientist. The survey (2009) was administered to university freshmen via an anonymous, web based program. The study was approved by the IRB. RESULTS: 426 university freshmen completed the survey. 67% reported texting was more useful than speaking by phone. 53% report they text more than 50 times per day. 24% report they text more than 100 times per day. 73% report they text while driving, though only 9% responded they do so frequently. 92% believe texting affects their concentration while driving. 84% reported they are passengers when the driver texts and 75% report they do not feel safe in the car when the driver is texting. 77% disagreed with the statement "It is no big deal to text while driving." 53% reported they can not safely text and drive and 60% agreed texting while driving should be illegal. 92% reported texting was less safe then talking on the cell phone while driving. CONCLUSIONS: Texting is commonly used by young adults, though many believe texting while driving decreases concentration and is unsafe. A majority report to texting while driving. Injury prevention and awareness programs are needed to decrease this behavior.

Do we glow? Evaluation of trauma team work habits and radiation exposure.

BACKGROUND: Health care workers' potential exposure to ionizing radiation has increased. Annual radiation exposure limit for the general public per US Nuclear Regulatory Commission is 100 mrem (1 mSv). The whole-body annual occupational radiation exposure limit is 5,000 mrem (50 mSv). Studies have been done to evaluate patient radiation exposure. To date, there has been no study to evaluate the radiation exposure of trauma team members or evaluate their behaviors and attitudes. METHODS: Forty primary providers (residents, physician assistants) rotating on the trauma service at an American College of Surgeons Level 1 trauma center participated. Dosimeters were worn by participants, and the radiation doses were measured monthly. A survey detailing the frequency of involvement in radiographic studies, use of protective equipment, and knowledge of education programs was completed monthly. RESULTS: The range of radiation measured was 1 mrem to 56 mrem, with an average effective dose of 10 mrem per month. Thirty-two (80%) of 40 reported daily exposure to x-rays and 28 (70%) of 40 to computed tomographic scans. Thirty-four (85%) of 40 reported that they never or seldom wore lead apron in trauma bay as opposed to 1 (3%) of 40 who failed to wear it during fluoroscopy. Twenty (50%) reported that an apron was not available, while 20 (50%) reported that it was too hot or did not fit. Thirty-nine (97%) of 40 reported that they received training in radiation safety. CONCLUSION: Despite inconsistent use of protective equipment by resident staff, the actual radiation exposure remains low. Hospitals should be sure lead aprons and collars are available. Additional education concerning the availability of programs during pregnancy is needed. LEVEL OF EVIDENCE: Epidemiologic study, level III.

Is the Broselow tape a reliable indicator for use in all pediatric trauma patients?: A look at a rural trauma center.

OBJECTIVE: The purpose of this study was to determine the effectiveness of the Broselow tape in the evaluation of pediatric trauma patients. METHODS: The trauma registry of a rural level I trauma center was examined. All pediatric trauma patients 16 years or younger were reviewed from 2002 to 2006, totaling 2358 patients. The Broselow tape measures to 146.5 cm. Patients whose height correlated with the tape and had their heights and weights in the medical record were included. The constant variable was the heights by which the estimated weights of the Broselow tape were compared with the actual weights of the patients. RESULTS: A total of 657 patients matched this height and had both heights and weights in their record. Most children (349/657; 53.1%) fell outside the predicted weight range, and of these, 77.1% of the actual weights were greater than those predicted by the Broselow scale. This is observed across all age groups. In patients with heights less than 75 cm, two thirds of patients' weights correlated with the Broselow estimated weight; however, those that deviated did so by 2 to 3 color intervals larger. This deviation was statistically significant in all groups. CONCLUSIONS: In our population, the Broselow tape is an ineffective tool to predict weight in more than 50% of pediatric trauma patients. This may lead to the underdosing of emergency medications and blood products.