Transthoracic Focused Rapid Echocardiographic Examination (FREE) Janurary

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1 JournalofTrauma of 2011 John B. Cone, MD UAMS 2012 Transthoracic Focused Rapid Echocardiographic Examination (FREE) Janurary 53 Trauma Patients Goal: Evaluate fluid status vs Cardiac status 54 % FREE resulted in a change in care. Measured IVC diameter LV EF 80% success 1

2 Figure 1 Transthoracic Focused Rapid Echocardiographic Examination: Real Time Evaluation of Fluid Status in Critically Ill Trauma Patients Ferrada, Paula; Murthi, Sarah; Anand, Rahul J.; Bochicchio, Grant V.; Scalea, Thomas Surgery. 70(1):56 64, January doi: /TA.0b013e318207e6ee Figure 1. Three of the views of the FREE. (A) Parasternal long view. (B) Parasternal short view. (C) Apical four chamber view. LA, left atrium; LV, left ventricle; MV, mitral valve; Ao, aorta. Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins. 3 Figure 3 Transthoracic Focused Rapid Echocardiographic Examination: Real Time Evaluation of Fluid Status in Critically Ill Trauma Patients Ferrada, Paula; Murthi, Sarah; Anand, Rahul J.; Bochicchio, Grant V.; Scalea, Thomas Surgery. 70(1):56 64, January doi: /TA.0b013e318207e6ee Figure 3. Probe position to obtain the three of the views of the FREE. (1) Parasternal long view and parasternal short. (2) Apical four chamber view. (3) SX view. Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins. 4 2

3 Figure 2 Transthoracic Focused Rapid Echocardiographic Examination: Real Time Evaluation of Fluid Status in Critically Ill Trauma Patients Ferrada, Paula; Murthi, Sarah; Anand, Rahul J.; Bochicchio, Grant V.; Scalea, Thomas Surgery. 70(1):56 64, January doi: /TA.0b013e318207e6ee Figure 2. The fourth view of the FREE, SA view, with M mode demonstrating collapsibility of the IVC. Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins. 5 Results 80 % LVEF determined LV dysfunction in 56% RV dysfunction in 25 % IVC measurements determined in 80% Change in plan in 54 % of patients. Takes 10 minutes to complete exam. 3

4 Emergency Department Crystalloid Resuscitation of 1.5 L or More is Assosciated with Increased Mortality in Elderly and Nonelderly Trauma Patients Feburary 2000 to 2008 Level I trauma center >70 yrs = elderly 3137 patients Table 1 Emergency Department Crystalloid Resuscitation of 1.5 L or More is Associated With Increased Mortality in Elderly and Nonelderly Trauma Patients Ley, Eric J.; Clond, Morgan A.; Srour, Marissa K.; Barnajian, Moshe; Mirocha, James; Margulies, Dan R.; Salim, Ali Surgery. 70(2): , February doi: /TA.0b013e318208f99b TABLE 1. Patient Demographics Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins. 8 4

5 Table 2 Emergency Department Crystalloid Resuscitation of 1.5 L or More is Associated With Increased Mortality in Elderly and Nonelderly Trauma Patients Ley, Eric J.; Clond, Morgan A.; Srour, Marissa K.; Barnajian, Moshe; Mirocha, James; Margulies, Dan R.; Salim, Ali Surgery. 70(2): , February doi: /TA.0b013e318208f99b TABLE 2. Multivariate Logistic Regression Model for Nonelderly Patients Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins. 9 Table 3 Emergency Department Crystalloid Resuscitation of 1.5 L or More is Associated With Increased Mortality in Elderly and Nonelderly Trauma Patients Ley, Eric J.; Clond, Morgan A.; Srour, Marissa K.; Barnajian, Moshe; Mirocha, James; Margulies, Dan R.; Salim, Ali Surgery. 70(2): , February doi: /TA.0b013e318208f99b TABLE 3. Estimated Odds Ratios for Various Fluid Resuscitation Volumes in the Nonelderly Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins. 10 5

6 Table 4 Emergency Department Crystalloid Resuscitation of 1.5 L or More is Associated With Increased Mortality in Elderly and Nonelderly Trauma Patients Ley, Eric J.; Clond, Morgan A.; Srour, Marissa K.; Barnajian, Moshe; Mirocha, James; Margulies, Dan R.; Salim, Ali Surgery. 70(2): , February doi: /TA.0b013e318208f99b TABLE 4. Multivariate Logistic Regression Model for Elderly Patients Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins. 11 Table 5 Emergency Department Crystalloid Resuscitation of 1.5 L or More is Associated With Increased Mortality in Elderly and Nonelderly Trauma Patients Ley, Eric J.; Clond, Morgan A.; Srour, Marissa K.; Barnajian, Moshe; Mirocha, James; Margulies, Dan R.; Salim, Ali Surgery. 70(2): , February doi: /TA.0b013e318208f99b TABLE 5. Odds Ratio for Mortality With Crystalloid Resuscitation in the Elderly Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins. 12 6

7 Table 1 Prevalence and Prognostic Factors of Disability After Major Trauma Ringburg, Akkie N.; Polinder, Suzanne; van Ierland, Marie Catherine P.; Steyerberg, Ewout W.; van Lieshout, Esther M. M.; Patka, Peter; van Beeck, Ed F.; Schipper, Inger B. Surgery. 70(4): , April doi: /TA.0b013e3181f6bce8 TABLE 1. Characteristics of the Study Population (Patients Surviving Major Trauma at 12 mo Follow Up) by Gender Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins. 13 Results For equal severity of injury and age, more than liters of crystalloid tllidis associated itdwith increased mortality. 7

8 Prevalence and Prognostic Factors of Disability After Major Trauma April 246 patients at a Level I trauma center, one year post injury. 97 % blunt trauma Avg ISS 22 Table 2 Prevalence and Prognostic Factors of Disability After Major Trauma Ringburg, Akkie N.; Polinder, Suzanne; van Ierland, Marie Catherine P.; Steyerberg, Ewout W.; van Lieshout, Esther M. M.; Patka, Peter; van Beeck, Ed F.; Schipper, Inger B. Surgery. 70(4): , April doi: /TA.0b013e3181f6bce8 TABLE 2. HRQoL of Severely Injured Patients at 12 mo After Trauma by Sociodemographic, Physical, and Injury Related Factors and Type of Prehospital Care Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins. 16 8

9 Figure 1 Prevalence and Prognostic Factors of Disability After Major Trauma Ringburg, Akkie N.; Polinder, Suzanne; van Ierland, Marie Catherine P.; Steyerberg, Ewout W.; van Lieshout, Esther M. M.; Patka, Peter; van Beeck, Ed F.; Schipper, Inger B. Surgery. 70(4): , April doi: /TA.0b013e3181f6bce8 Figure 1. Prevalence of physical and physiological limitations (moderate or severe) of the EQ 5D (A) and HUI3 (B) health domains by gender. The percentage of patients with limitations in any of the health domain is shown. Differences between males and females were tested with the χ2 test. Asterisk indicates p Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins. 17 Conclusions One year after major blunt trauma 70 % have still not returned dto their preinjury health status. Pre existing co morbidities increase the risk. This is a tremendous loss of productive life. We need to know how and how much optimal rehabilitation can improve these results. 9

10 Pain as an Indication for Rib Fixation: a Bi Institutional Pilot Study. December Retrospective case controlled study Compared narcotic administration 16 patients Plated on Day 5 Figure 1 Pain as an Indication for Rib Fixation: A Bi Institutional Pilot Study de Moya, Marc; Bramos, Thanos; Agarwal, Suresh; Fikry, Karim; Janjua, Sumbal; King, David R.; Alam, Hasan B.; Velmahos, George C.; Burke, Peter; Tobler, William Surgery. 71(6): , December doi: /TA.0b013e31823c85e9 Figure 1. (A) Three dimensional reconstruction of a patient with several severely displaced rib fractures. (B) Threedimensional reconstruction of the same patient after fixation. Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins

11 Figure 2 Pain as an Indication for Rib Fixation: A Bi Institutional Pilot Study de Moya, Marc; Bramos, Thanos; Agarwal, Suresh; Fikry, Karim; Janjua, Sumbal; King, David R.; Alam, Hasan B.; Velmahos, George C.; Burke, Peter; Tobler, William Surgery. 71(6): , December doi: /TA.0b013e31823c85e9 Figure 2. Intraoperative image of rib fixation. Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins. 21 Table 1 Pain as an Indication for Rib Fixation: A Bi Institutional Pilot Study de Moya, Marc; Bramos, Thanos; Agarwal, Suresh; Fikry, Karim; Janjua, Sumbal; King, David R.; Alam, Hasan B.; Velmahos, George C.; Burke, Peter; Tobler, William Surgery. 71(6): , December doi: /TA.0b013e31823c85e9 TABLE 1. Patients Characteristics in the Two Groups Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins

12 Table 2 Pain as an Indication for Rib Fixation: A Bi Institutional Pilot Study de Moya, Marc; Bramos, Thanos; Agarwal, Suresh; Fikry, Karim; Janjua, Sumbal; King, David R.; Alam, Hasan B.; Velmahos, George C.; Burke, Peter; Tobler, William Surgery. 71(6): , December doi: /TA.0b013e31823c85e9 TABLE 2. Additional Injuries (Other Than Thoracic) and Procedures (Other Than Rib Fixation) Cases and Controls Had Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins. 23 Table 3 Pain as an Indication for Rib Fixation: A Bi Institutional Pilot Study de Moya, Marc; Bramos, Thanos; Agarwal, Suresh; Fikry, Karim; Janjua, Sumbal; King, David R.; Alam, Hasan B.; Velmahos, George C.; Burke, Peter; Tobler, William Surgery. 71(6): , December doi: /TA.0b013e31823c85e9 TABLE 3. Frequency of Rib Fixation Per Rib Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins

13 Figure 3 Pain as an Indication for Rib Fixation: A Bi Institutional Pilot Study de Moya, Marc; Bramos, Thanos; Agarwal, Suresh; Fikry, Karim; Janjua, Sumbal; King, David R.; Alam, Hasan B.; Velmahos, George C.; Burke, Peter; Tobler, William Surgery. 71(6): , December doi: /TA.0b013e31823c85e9 Figure 3. Mean dose of opiates during the preoperative and postoperative periods. The narcotics administered during the operation day excluded from the analysis. Error bars represent SEM. Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins. 25 Figure 4 Pain as an Indication for Rib Fixation: A Bi Institutional Pilot Study de Moya, Marc; Bramos, Thanos; Agarwal, Suresh; Fikry, Karim; Janjua, Sumbal; King, David R.; Alam, Hasan B.; Velmahos, George C.; Burke, Peter; Tobler, William Surgery. 71(6): , December doi: /TA.0b013e31823c85e9 Figure 4. Mean daily dosages of patients with rib fixation versus controls. Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins

14 Table 4 Pain as an Indication for Rib Fixation: A Bi Institutional Pilot Study de Moya, Marc; Bramos, Thanos; Agarwal, Suresh; Fikry, Karim; Janjua, Sumbal; King, David R.; Alam, Hasan B.; Velmahos, George C.; Burke, Peter; Tobler, William Surgery. 71(6): , December doi: /TA.0b013e31823c85e9 TABLE 4. Comparison Between Cases and Controls in Primary and Secondary Outcomes Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins. 27 Conclusions Early rib fixation significantly reduced the requirement tfor pain medication There was no improvement in pulmonary conplications, length of stay or functional outcome documented. Very small study. 14

15 Retroperitoneal Pelvic Packing in the Management of Hemodynamically Unstable Pelvic Fractures: A Level I Trauma Center Experience October Two diffferent time periods in a trauma center Prior to 2008 everyone got early angiography N=13 After 2008 initially everyone got pelvic packing and then angio if packing failed N=11 Figure 1 Retroperitoneal Pelvic Packing in the Management of Hemodynamically Unstable Pelvic Fractures: A Level I Trauma Center Experience Tai, Dora K. C.; Li, Wing Hong; Lee, Kin Yan; Cheng, Mina; Lee, Kin Bong; Tang, Lap Fai; Lai, Albert Kwok Hung; Ho, Hiu Fai; Cheung, Moon Tong Surgery. 71(4):E79 E86, October doi: /TA.0b013e31820cede0 Figure 1. Protocol for the management of hemodynamically unstable casualties with pelvic fractures at Queen Elizabeth Hospital, ICU, intensive care unit. Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins

16 Figure 2 Retroperitoneal Pelvic Packing in the Management of Hemodynamically Unstable Pelvic Fractures: A Level I Trauma Center Experience Tai, Dora K. C.; Li, Wing Hong; Lee, Kin Yan; Cheng, Mina; Lee, Kin Bong; Tang, Lap Fai; Lai, Albert Kwok Hung; Ho, Hiu Fai; Cheung, Moon Tong Surgery. 71(4):E79 E86, October doi: /TA.0b013e31820cede0 Figure 2. Protocol for the management of hemodynamically unstable casualties with pelvic fractures at Queen Elizabeth Hospital, ICU, intensive care unit. Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins. 31 Figure 3 Retroperitoneal Pelvic Packing in the Management of Hemodynamically Unstable Pelvic Fractures: A Level I Trauma Center Experience Tai, Dora K. C.; Li, Wing Hong; Lee, Kin Yan; Cheng, Mina; Lee, Kin Bong; Tang, Lap Fai; Lai, Albert Kwok Hung; Ho, Hiu Fai; Cheung, Moon Tong Surgery. 71(4):E79 E86, October doi: /TA.0b013e31820cede0 Figure 3. An 8 cm incision is made over the lower abdomen. Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins

17 Figure 4 Retroperitoneal Pelvic Packing in the Management of Hemodynamically Unstable Pelvic Fractures: A Level I Trauma Center Experience Tai, Dora K. C.; Li, Wing Hong; Lee, Kin Yan; Cheng, Mina; Lee, Kin Bong; Tang, Lap Fai; Lai, Albert Kwok Hung; Ho, Hiu Fai; Cheung, Moon Tong Surgery. 71(4):E79 E86, October doi: /TA.0b013e31820cede0 Figure 4. Postlaparotomy, external fixation, and retroperitoneal pelvic packing. Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins. 33 Table 1 Retroperitoneal Pelvic Packing in the Management of Hemodynamically Unstable Pelvic Fractures: A Level I Trauma Center Experience Tai, Dora K. C.; Li, Wing Hong; Lee, Kin Yan; Cheng, Mina; Lee, Kin Bong; Tang, Lap Fai; Lai, Albert Kwok Hung; Ho, Hiu Fai; Cheung, Moon Tong Surgery. 71(4):E79 E86, October doi: /TA.0b013e31820cede0 TABLE 1. Overview of Age, Injury Severity, Physiological Parameters, and Mortality in the Two Study Groups (Mean ±SD) (N = 24) Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins

18 Table 2 Retroperitoneal Pelvic Packing in the Management of Hemodynamically Unstable Pelvic Fractures: A Level I Trauma Center Experience Tai, Dora K. C.; Li, Wing Hong; Lee, Kin Yan; Cheng, Mina; Lee, Kin Bong; Tang, Lap Fai; Lai, Albert Kwok Hung; Ho, Hiu Fai; Cheung, Moon Tong Surgery. 71(4):E79 E86, October doi: /TA.0b013e31820cede0 TABLE 2. Pelvic Fracture Type in the 2 Study Groups Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins. 35 Table 3 Retroperitoneal Pelvic Packing in the Management of Hemodynamically Unstable Pelvic Fractures: A Level I Trauma Center Experience Tai, Dora K. C.; Li, Wing Hong; Lee, Kin Yan; Cheng, Mina; Lee, Kin Bong; Tang, Lap Fai; Lai, Albert Kwok Hung; Ho, Hiu Fai; Cheung, Moon Tong Surgery. 71(4):E79 E86, October doi: /TA.0b013e31820cede0 TABLE 3. Overview of Age, Injury Severity, Physiological Parameters Between Survivors and Nonsurvivors (Mean ±SD) Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins

19 Table 4 Retroperitoneal Pelvic Packing in the Management of Hemodynamically Unstable Pelvic Fractures: A Level I Trauma Center Experience Tai, Dora K. C.; Li, Wing Hong; Lee, Kin Yan; Cheng, Mina; Lee, Kin Bong; Tang, Lap Fai; Lai, Albert Kwok Hung; Ho, Hiu Fai; Cheung, Moon Tong Surgery. 71(4):E79 E86, October doi: /TA.0b013e31820cede0 TABLE 4. Characteristics of Non survivors Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins. 37 Results ANGIO= took longer 140 min. vs Packing 69 minutes Mortality: Angio 69% vs Packing 36% Packing: one patient died of uncontrolled liver lac. Angio: 3 patients died from uncontrolled pelvic hemorrhage. 19

20 Conclusions Retroperitoneal pelvic packing can be an effective technique for controlling hemorrhateh following pelvic fractures. This is a small study where the options do not appear to have been blended well. Pelvic packing can supplement angio and external fixation but not replace them Validating the Western Trauma Association Algorithm for Managing Patients with Anterior Abdominal Stab Wounds December Multi center, prospective trial 222 total patients 28 % immediate lap, 87 % judged therapeutic 160 stable and asymptomatic 81 % (51% managed per protocol ) 25% discharged from ED, 14 % when to OR. 20

21 Figure 2 Validating the Western Trauma Association Algorithm for Managing Patients With Anterior Abdominal Stab Wounds: A Western Trauma Association Multicenter Trial Biffl, Walter L.; Kaups, Krista L.; Pham, Tam N.; Rowell, Susan E.; Jurkovich, Gregory J.; Burlew, Clay Cothren; Elterman, J.; Moore, Ernest E. Surgery. 71(6): , December doi: /TA.0b013e31823ba1de Figure 2. Flow diagram for patients. Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins. 41 Table 2 Validating the Western Trauma Association Algorithm for Managing Patients With Anterior Abdominal Stab Wounds: A Western Trauma Association Multicenter Trial Biffl, Walter L.; Kaups, Krista L.; Pham, Tam N.; Rowell, Susan E.; Jurkovich, Gregory J.; Burlew, Clay Cothren; Elterman, J.; Moore, Ernest E. Surgery. 71(6): , December doi: /TA.0b013e31823ba1de TABLE 2. Summary of Outcomes Associated With Primary Management Strategies Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins

22 Table 3 Validating the Western Trauma Association Algorithm for Managing Patients With Anterior Abdominal Stab Wounds: A Western Trauma Association Multicenter Trial Biffl, Walter L.; Kaups, Krista L.; Pham, Tam N.; Rowell, Susan E.; Jurkovich, Gregory J.; Burlew, Clay Cothren; Elterman, J.; Moore, Ernest E. Surgery. 71(6): , December doi: /TA.0b013e31823ba1de TABLE 3. Summary of SENS, SPEC, PPV, and NPV of Tests for THER LAP Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins. 43 Table 4 Validating the Western Trauma Association Algorithm for Managing Patients With Anterior Abdominal Stab Wounds: A Western Trauma Association Multicenter Trial Biffl, Walter L.; Kaups, Krista L.; Pham, Tam N.; Rowell, Susan E.; Jurkovich, Gregory J.; Burlew, Clay Cothren; Elterman, J.; Moore, Ernest E. Surgery. 71(6): , December doi: /TA.0b013e31823ba1de TABLE 4. CT Findings and Management Among the 47 Patients Undergoing CT Scanning Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins

23 Table 5 Validating the Western Trauma Association Algorithm for Managing Patients With Anterior Abdominal Stab Wounds: A Western Trauma Association Multicenter Trial Biffl, Walter L.; Kaups, Krista L.; Pham, Tam N.; Rowell, Susan E.; Jurkovich, Gregory J.; Burlew, Clay Cothren; Elterman, J.; Moore, Ernest E. Surgery. 71(6): , December doi: /TA.0b013e31823ba1de TABLE 5. DPL Findings and LAP Results Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins. 45 Table 6 Validating the Western Trauma Association Algorithm for Managing Patients With Anterior Abdominal Stab Wounds: A Western Trauma Association Multicenter Trial Biffl, Walter L.; Kaups, Krista L.; Pham, Tam N.; Rowell, Susan E.; Jurkovich, Gregory J.; Burlew, Clay Cothren; Elterman, J.; Moore, Ernest E. Surgery. 71(6): , December doi: /TA.0b013e31823ba1de TABLE 6. Comparison of Patients Managed According to Protocol With Patients Whose Management Deviated From Protocol Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins

24 Conclusions It s very difficult to standardize patient management in a clinical i l trial ti This study demonstrated that the WTA algorithm is safe compared to the others. It does not appear to offer advantages: neither early discharge, lower rate of nontherapeutic laps or better patient outcomes. 24

25 25

26 Table 1 Risk of Venous Thromboembolism After Spinal Cord Injury: Not All Levels Are the Same Maung, Adrian A.; Schuster, Kevin M.; Kaplan, Lewis J.; Maerz, Linda L.; Davis, Kimberly A. Surgery. 71(5): , November doi: /TA.0b013e318235ded0 TABLE 1. Comparison of the Baseline Demographics and Hospital Course of Patients With Spinal Cord Injury With and Without Venous Thromboembolism Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins. 51 Table 2 Risk of Venous Thromboembolism After Spinal Cord Injury: Not All Levels Are the Same Maung, Adrian A.; Schuster, Kevin M.; Kaplan, Lewis J.; Maerz, Linda L.; Davis, Kimberly A. Surgery. 71(5): , November doi: /TA.0b013e318235ded0 TABLE 2. Rates of Venous Thromboembolism at Different Spinal Cord Injury Levels Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins

27 Table 3 Risk of Venous Thromboembolism After Spinal Cord Injury: Not All Levels Are the Same Maung, Adrian A.; Schuster, Kevin M.; Kaplan, Lewis J.; Maerz, Linda L.; Davis, Kimberly A. Surgery. 71(5): , November doi: /TA.0b013e318235ded0 TABLE 3. Comparison of Baseline Demographics and Hospital Course Among Different Spinal Cord Injury Levels Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins. 53 Figure 1 Impact of Interhospital Transfer on Outcomes for Trauma Patients: A Systematic Review Hill, Andrea D.; Fowler, Robert A.; Nathens, Avery B. Surgery. 71(6): , December doi: /TA.0b013e31823ac642 Figure 1. Flowchart of the study selection process. Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins

28 Figure 2 Impact of Interhospital Transfer on Outcomes for Trauma Patients: A Systematic Review Hill, Andrea D.; Fowler, Robert A.; Nathens, Avery B. Surgery. 71(6): , December doi: /TA.0b013e31823ac642 Figure 2. (A) Pooled estimate of transfer on in hospital and 30 day mortality. (B) Pooled estimate of transfer on in hospital and 30 day mortality: potential transfers included. Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins. 55 Table 4 Risk of Venous Thromboembolism After Spinal Cord Injury: Not All Levels Are the Same Maung, Adrian A.; Schuster, Kevin M.; Kaplan, Lewis J.; Maerz, Linda L.; Davis, Kimberly A. Surgery. 71(5): , November doi: /TA.0b013e318235ded0 TABLE 4. Comparison of Admitting Comorbidities Among Different Spinal Cord Injury Levels Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins

29 Table 5 Risk of Venous Thromboembolism After Spinal Cord Injury: Not All Levels Are the Same Maung, Adrian A.; Schuster, Kevin M.; Kaplan, Lewis J.; Maerz, Linda L.; Davis, Kimberly A. Surgery. 71(5): , November doi: /TA.0b013e318235ded0 TABLE 5. Development of In Hospital Complications Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins. 57 Table 6 Risk of Venous Thromboembolism After Spinal Cord Injury: Not All Levels Are the Same Maung, Adrian A.; Schuster, Kevin M.; Kaplan, Lewis J.; Maerz, Linda L.; Davis, Kimberly A. Surgery. 71(5): , November doi: /TA.0b013e318235ded0 TABLE 6. Associated Injuries Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins

30 Table 7 Risk of Venous Thromboembolism After Spinal Cord Injury: Not All Levels Are the Same Maung, Adrian A.; Schuster, Kevin M.; Kaplan, Lewis J.; Maerz, Linda L.; Davis, Kimberly A. Surgery. 71(5): , November doi: /TA.0b013e318235ded0 TABLE 7. Binary Logistic Regression Copyright 2012 Surgery. Published by Lippincott Williams & Wilkins

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