Analysis of Electronic Cigarette-Related Injury Presenting to U.S. Emergency Departments, 2008-2017.

BACKGROUND: Several types of injuries associated with electronic cigarette malfunction have been reported in the literature since their introduction to the U.S. market in 2007. The traumatic consequences of electronic nicotine delivery system (ENDS) malfunction remain an under-researched topic. OBJECTIVES: Using information from a national database of emergency department (ED) visits, we sought to characterize the nature and frequency of ENDS injuries over a 10-year study period. METHODS: Archived information from the National Electronic Injury Surveillance System was accessed for the years 2008 to 2017. Incidents related to ENDS-related trauma were manually identified. Data extracted included patient demographics, injury type and location, and patient disposition. RESULTS: A total of 49 incidents were recorded during the years 2008 to 2017, including 18 cases in 2017, 25 cases in 2016, five cases in 2015, and one case in 2013. There were no identified ED visits for an e-cigarette-related burn or explosion prior to 2013. Using statistical weights, the estimated annual national incidence is 835 cases. Most of the injuries were thermal burns. The primary location of injury was in the lower extremity, followed by the upper extremity and hand. CONCLUSIONS: Our study demonstrates a significant increase in the number of ENDS-related injuries over the study period, particularly in males under the age of 45 years. This rise mirrors the growth of the ENDS market and this trend can be expected to continue. As the use of ENDS is expected to increase, physicians should become familiar with the nature of associated injuries.

Underuse of exon mutational analysis for gastrointestinal stromal tumors.

BACKGROUND: Tyrosine kinase inhibitors (TKI) have become the guideline-recommended therapy for high-risk resected and advanced gastrointestinal stromal tumors (GISTs). Exon mutational analysis (EMA) is used to inform pretherapy response to TKI and may predict overall prognosis. Despite these benefits, EMA remains underused, and its impact on TKI therapy decision-making remains unexplored. MATERIALS AND METHODS: A retrospective cohort was established from 104 patients receiving treatment for GISTs from 2006 to 2017. Current National Comprehensive Cancer Network guidelines indicate that EMA should be considered for all patients undergoing TKI therapy to identify genotypes that are likely, or unlikely, to respond to treatment. We first tracked guideline-considered EMA use and subsequent impact on treatment decision-making. A questionnaire was then administered to gastrointestinal medical oncologists to assess EMA perception. RESULTS: Among 104 GIST patients, 54 (52%) received TKI therapy. Of these, only 22 (41%) received EMA. Informed by EMA, treatment decisions included 59% who continued with original TKI therapy, 32% who switched to an alternative TKI, and 9% who discontinued or received no TKI. Although 92% of physicians indicated EMA was a valuable tool, only 62% indicated they used it "frequently" or "always" to inform treatment decisions. CONCLUSIONS: Less than half of patients receiving TKI therapy for GISTs received EMA at a comprehensive cancer center. Despite this low uptake, when it was performed, EMA guided alternative treatment decision in 41% of patients. Physician survey responses indicated that interventions targeting physician education and an electronic medical record reminder may improve EMA uptake.