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INTRODUCTION: Based on recommendations by CMS elective surgery was stopped during the first wave of COVID-19. Despite hospitals being open for emergent surgery, there were some studies that showed a decrease in surgical volume. METHODS: A retrospective analysis for all surgeries from 185 affiliated hospitals from the first wave of the COVID-19 pandemic (March 2020 to May 2020) and as a comparison the previous year, March 2019 to May 2019 were obtained. Five surgeries were further analyzed: appendectomies, cholecystectomies, craniotomies, exploratory laparotomies, and endoscopic retrograde cholangiopancreatographies (ERCPs). RESULTS: Between March 2019 and May 2019, 326,726 surgeries were performed, and between March 2020 and May 2020, 237,809 surgeries were performed. The highest specialty for both years was gastroenterology. In 2020, 15.7% of the patients were admitted to the ICU versus 13.7% in 2019. For appendectomies, cholecystectomies, craniotomies, exploratory laparotomies and ERCPs, there was an increase from 2019 to 2020 in acute kidney injuries rate, infection, systemic inflammatory response syndrome (SIRS), and sepsis. All the changes in surgical volumes for the five surgeries from 2019 to 2020 were significant. For appendectomy, the statistically significant complications were infection and SIRS and sepsis. CONCLUSIONS: Across the board, there was a decrease in surgical volume during the COVID-19 pandemic first wave. There was a statistically significant decrease in appendectomy, cholecystectomy, exploratory laparotomy, craniotomy, and ERCP. For all five surgeries, we did see an increase in mortality rates and several complications. The only statistically significant complications were infection and SIRS and sepsis, for appendectomy.
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COVID-19 , Sepse , Humanos , Estudos Retrospectivos , COVID-19/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Pandemias , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Síndrome de Resposta Inflamatória SistêmicaRESUMO
BACKGROUND: Blunt cerebrovascular injuries (BCVIs) are associated with long-term neurological effects. The first-line treatment for BCVIs is antithrombotics, but consensus on the optimal choice and timing of treatment is lacking. METHODS: This was a retrospective study on patients aged at least 18 years admitted to 6 level 1 trauma centers between 1/1/2014 and 12/31/2017 with grade 1-4 BCVI and treated with antithrombotics. Differences in treatment practices were examined across the 6 centers. The primary outcome was ischemic stroke, and secondary outcomes were related to bleeding complications: blood transfusion and intracranial hemorrhage (ICH). Treatment characteristics examined were time to diagnosis and first computerized tomography angiography, time of total treatment course, time on each antithrombotic (anticoagulants, antiplatelets, combination), time from hospital arrival to antithrombotic initiation, and treatment interruption, i.e., treatment halted for a surgical procedure and restarted postoperatively. Chi-square, Fisher exact, Spearman's rank-order correlation, Wilcoxon rank-sum, Kruskal-Wallis, and Cox proportional hazards models with time-varying covariates were used to evaluate associations with the outcomes. RESULTS: A total of 189 patients with BCVI were included. The median (IQR) time from arrival to antithrombotic initiation was 27 (8-61) hours, and 28% of patients had treatment interrupted. The ischemic stroke rate was 7.5% (nâ¯=â¯14), with most strokes (64%, nâ¯=â¯9) occurring between arrival and treatment initiation. Treatment interruption was associated with ischemic stroke (75% of patients with stroke had an interruption versus 24% of patients with no stroke; P < .01). Time on anticoagulants was not associated with ischemic stroke (Pâ¯=â¯.78), transfusion (Pâ¯=â¯.43), or ICH (Pâ¯=â¯.96). Similarly, time on antiplatelets (Pâ¯=â¯.54, Pâ¯=â¯.65, Pâ¯=â¯.60) and time on combination therapy (Pâ¯=â¯.96, Pâ¯=â¯.38, Pâ¯=â¯.57) were not associated with these outcomes. CONCLUSIONS: The timing and consistency of antithrombotic administration are critical in preventing adverse outcomes in patients with BCVI. Most ischemic strokes in this study population occurred between arrival and antithrombotic initiation, representing events that may potentially be intervened upon by earlier treatment. Future studies should examine the safety of continuing treatment through surgical procedures.
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Lesões Encefálicas Traumáticas/tratamento farmacológico , Isquemia Encefálica/etiologia , Hemorragia Cerebral Traumática/etiologia , Fibrinolíticos/administração & dosagem , Acidente Vascular Cerebral/etiologia , Ferimentos não Penetrantes/tratamento farmacológico , Adulto , Transfusão de Sangue , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Lesões Encefálicas Traumáticas/etiologia , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/terapia , Hemorragia Cerebral Traumática/diagnóstico por imagem , Hemorragia Cerebral Traumática/terapia , Esquema de Medicação , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/terapia , Fatores de Tempo , Tempo para o Tratamento , Resultado do Tratamento , Estados Unidos , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/etiologiaRESUMO
Massive transfusion protocols are part of damage control resuscitation for hemorrhaging trauma patients with the goal of returning the patient to hemodynamic stability. It is essential that patients receive blood products immediately and in the proper ratios. At our metropolitan Level 1 trauma center, we identified several challenges to deploying massive transfusion rapidly and within the recommended ratio guidelines. In 2016, we implemented a quality improvement project addressing 4 opportunities: fresh frozen plasma (FFP) bag breakage, plasma options, blood bank equipment, and multidisciplinary policy revision. Implementing packaging and shipping improvements, utilization of new products, and updating protocols have resulted in a 50% decrease in FFP bag breakage rates, a dramatic decrease in time for patients receiving massive transfusion to receive plasma products (mean time 3.5 min), and patients being administered the recommended ratio of blood products.
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Transfusão de Sangue/normas , Hemorragia/terapia , Avaliação de Resultados em Cuidados de Saúde , Plasma , Padrões de Prática em Enfermagem/normas , Ferimentos e Lesões/terapia , Colorado , Esquema de Medicação , Hemorragia/enfermagem , Humanos , Ressuscitação/normas , Fatores de Tempo , Centros de Traumatologia , Ferimentos e Lesões/enfermagemRESUMO
Cutaneous melanoma is an aggressive skin cancer with a high propensity for distant metastasis. Peritoneal metastasis from cutaneous malignant melanoma is extremely rare and associated with a low five-year overall survival rate. This report reviews a case of a 78-year-old man with peritoneal carcinomatosis after a wide local excision of a T1a invasive malignant melanoma of the scalp 10 months prior. Although rare, patients with a recent history of melanoma who present with obscure or odd symptoms should be worked up for metastatic disease by their surgeon or medical oncologist. Carcinomatosis can develop, and early treatment with immunotherapy has been shown to improve five-year overall survival and progression-free survival in patients with advanced melanoma.
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An inferior epigastric artery pseudoaneurysm is an exceptionally rare occurrence. Formation of an inferior epigastric artery pseudoaneurysm can be seen following surgical intervention and is more common after laparoscopy. A sixty-eight-year-old male presented with a right upper quadrant bulge at his incision site two months following laparoscopic appendectomy. The patient reported sudden onset of a non-reducible bulge at a 5 mm trocar incision site with minimal pain and without obstructive symptoms. Computed tomography of his abdomen and pelvis with intravenous contrast revealed a 4.2 cm pseudoaneurysm with peripheral thrombosis within the right inferior epigastric artery. The patient subsequently underwent open exploration with the evacuation of pseudoaneurysm thrombus and ligation of arteriovenous fistula. The patient recovered well without complication from pseudoaneurysm. Inferior epigastric artery pseudoaneurysm following any laparoscopic procedure is rare. This case highlights the importance of understanding the abdominal wall anatomy and its vascular supply to avoid such injury. We present this case to bring light to this rare occurrence and to highlight the importance of proper trocar placement during any laparoscopic procedure.
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Parede Abdominal , Falso Aneurisma , Laparoscopia , Masculino , Humanos , Idoso , Artérias Epigástricas/anatomia & histologia , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Apendicectomia/efeitos adversos , Laparoscopia/efeitos adversosRESUMO
BACKGROUND: The sport of surfing has grown exponentially. Early studies of surfing injuries are outdated as newer and more accessible surf technology has become available. This study's goal was to describe surfing injury patterns, incidence, and disposition of pediatric and adult surfers. STUDY DESIGN: A retrospective review of surfing injuries from 2009 to 2020 of adult (>18 years of age) and pediatric (<18 years of age) patients was performed using the National Electronic Injury Surveillance System (NEISS) database. The consumer product code 1261 (Surfing) was used to identify injury patterns. Chi-squared test was performed on all categorical variables. Logistic regression was used on significant variables from the frequency tables. All analysis was performed with R-statistical programming software. RESULTS: There was an overall decreasing trend of surfing injuries over time. Injuries for both adult and pediatric patients tended to occur most within the summer season (p<0.001). The odds of an adult surfing injury victim being male is 2.89 (95% CI 1.87-4.44). The head/neck/face were the most injured body part in both groups. The pediatric group had a significantly higher rate of concussions at 6.5% compared to the adult group at 3.2%. Overall, the most common injury type was to the skin (p<0.001). Disposition between groups were similar with most patients being discharged home. Mortality was rare with three reported fatalities in the adult group and none in the pediatric group. CONCLUSION: The incidence of surfing injuries is continuing to decline despite more people surfing, revealing the improved safety of the sport over the last decade. Head/neck/face injuries are common injury locations, and pediatric surfers are particularly at increased risk of concussions. Continued education, usage of safety equipment such as protective headgear, and awareness of injury patterns, could further lessen potential injuries.
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The cardiac box has been used to guide the management of trauma patients for decades. However, improper imaging can lead to erroneous assumptions about operative management in this patient population. In this study, we used a thoracic model to demonstrate imaging's effect on chest radiography. The data demonstrate that even small changes in rotation can lead to large discrepancies in results.
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Radiografia Torácica , Traumatismos Torácicos , Humanos , Radiografia Torácica/métodos , Coração , Traumatismos Torácicos/diagnóstico por imagem , Traumatismos Torácicos/cirurgiaRESUMO
Background Breast trauma is an often under-recognized injury, especially in female polytrauma patients. The purpose of this study was to assess the prevalence of breast injuries and their association with injury severity score (ISS) in trauma patients nationally. Method A retrospective review was performed using data from the National Trauma Data Bank® (NTDB®) from 2016 to 2019, using all applicable International Classification of Diseases (ICD) codes for three outlined subgroups (abrasions, contusions, and open wounds/punctures/lacerations) with minors excluded. All continuous variables were tested as non-normally distributed, and all test results for continuous variables used the Kruskal-Wallis test. All categorical variables were tested using a chi-squared test. Results Patients with traumatic breast abrasions and contusions had a higher rate of intensive care unit (ICU) admissions (23.8%; n=395 and 25.3%; n=48, respectively) compared to patients with open wounds/punctures/lacerations (13.6%; n=205). Patients with abrasions and contusions to the breast had a significantly higher ISS compared to those with visible open wounds/punctures/lacerations (9 and 9, vs 5, p <0.001). Mortality rates were highest among patients with breast abrasions and contusions, 15% (n=213) and 14% (n=23), respectively, compared to patients with open wounds/punctures/lacerations at 11% (n=132), p<0.017. Conclusion Traumatic breast abrasions and contusions were associated with higher rates of ICU admission, elevated ISS, and overall mortality compared to open breast wounds, punctures, or lacerations. This indicates the importance of traumatic breast injuries as a prognostic indicator in the standard workup of a trauma patient.
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Bear attacks are rare, although global incidents have been increasing. Injury patterns of bear attacks against humans consistently include injuries to the face, head, neck, chest, and upper extremities. Here, we have a brief report of a 59-year-old male hunter who was attacked by a grizzly bear in Wyoming. He sustained multiple lacerations to his face which included an avulsion of his nose and upper lip, as well as extensive associated facial fractures. Additional injuries included soft tissue and bony injuries to the upper extremities. He underwent 53 operations during his first hospitalization, primarily of facial reconstruction, which required nose and upper lip replant to his arm. His course was complicated by pressure ulcers, bacteria, acute kidney injury, and a urinary tract infection. After successful coordinated multidisciplinary care and a prolonged hospitalization, he was ultimately discharged to his home.
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Traumatismos Faciais , Fraturas Cranianas , Lesões dos Tecidos Moles , Ursidae , Masculino , Animais , Humanos , Pessoa de Meia-Idade , Wyoming , Traumatismos Faciais/cirurgiaRESUMO
BACKGROUND: Despite the growing prevalence of depression and anxiety among adolescents, fewer than half access appropriate mental health care. Single-session interventions (SSIs) for depression and anxiety offered in primary care are a promising approach to bridging the treatment gap. OBJECTIVE: We aimed to implement a clinical workflow for primary care and behavioral health providers to refer patients aged 13 to 17 years with mild to moderate depression and anxiety symptoms to Project YES (Youth Empowerment and Support), an open-access SSI platform, in a large group medical practice with an integrated behavioral health department. METHODS: Pediatric primary care and integrated behavioral health providers will be educated on the benefits of Project YES for adolescent anxiety and depression and trained in a workflow integrated within the electronic health record system, Epic, to refer patients during well-child visits and pediatric behavioral health visits. Patients with mild to moderate internalizing symptoms based on the 17-item Pediatric Symptom Checklist or youth Pediatric Symptom Checklist will be invited to try an SSI through Project YES. We will examine provider uptake and perceptions of acceptability, feasibility, and appropriateness over time. RESULTS: The rollout will take place between November 2022 and May 2023, when outcomes will be evaluated. Data analysis and manuscript writing are anticipated to be completed during the summer of 2023. CONCLUSIONS: SSIs such as those available through Project YES have the potential to provide low-cost, evidence-based mental health treatment to adolescents with mild to moderate depression and anxiety. If deemed feasible and acceptable, providing SSIs in primary care settings could significantly improve access to mental health care without taxing pediatric primary care and behavioral health providers. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/45666.
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Surgical stabilization of rib fractures has demonstrated benefits in patients with complex thoracic injuries. Limited information exists regarding patients with thoracic injuries and concomitant spinal injuries. We hypothesized that patients who suffer both thoracic cage and spinal fractures and undergo surgical fixation (FIX) will have improved outcomes compared to non-fixation (NFIX) patients. In our retrospective review, adult patients with rib injuries from 2015 to 2019 were pooled from the National Trauma Data Bank. Mortality with FIX rib fractures with spinal fractures decreased by 6.1% vs the NFIX group. Mortality of FIX of rib fractures without spinal fractures decreased by 2.2% vs the NFIX group. Patients with rib fractures with concomitant spinal fracture (RFWSF) are more likely to receive rib FIX than those with rib fractures without spinal fractures. Rib FIX in patients with RFWSF vs those with RFWO facilitates less ventilators days and shorter ICU and hospital length of stay (LOS) as well as decreases mortality.
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Fraturas das Costelas , Fraturas da Coluna Vertebral , Adulto , Humanos , Fraturas das Costelas/complicações , Fraturas das Costelas/cirurgia , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/cirurgia , Tempo de Internação , Estudos RetrospectivosRESUMO
Burn patients with concomitant traumatic injuries suffer increased morbidity and mortality. Complex care coordination is necessary for these patients, and the prevalence of resulting inter-facility transfers has not yet been quantified by literature. This study examined the outcomes for traumatically injured burn patients to identify the occurrence of trauma system transfers in this group. The National Trauma Data Bank was reviewed from the years 2007-2016 for 6,565,577 patients with traumatic, burn, and concomitant burn & traumatic injuries. There were 5068 patients with both traumatic and burn injuries, 145,890 patients with burn injuries, and 6,414,619 patients with traumatic injuries. Trauma/burn patients were more often admitted to the ICU from the ED at a rate of 35.5% compared to 27.1% for burn and 19.4% for trauma (P < 0.001). For disposition when discharged from the hospital, trauma/burn patients required more inter-facility transfers at a rate of 2.5% compared to 1.7% for burn and 1.3% for trauma (P < 0.001). For level I trauma centers, 5.5% of trauma/burn, 7.1% of burn, and 0.5% of trauma patients required inter-facility transfers. For level II trauma centers, 29.1% of trauma/burn, 47.0% of burn, and 2.8% of trauma patients required inter-facility transfers. Among level I and level II trauma centers, patients with only burns and burn patients with concomitant traumatic injuries required more inter-facility transfers, and level II trauma centers required more inter-facility transfers for all patients. Quantifying these findings is the first step toward improving triage decisions and allocation of health care resources while expediting appropriate care.
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Queimaduras , Humanos , Queimaduras/complicações , Queimaduras/epidemiologia , Queimaduras/terapia , Centros de Traumatologia , Triagem , Bases de Dados Factuais , Transferência de Pacientes , Estudos RetrospectivosRESUMO
The Gaboon viper (Bitis gabonica) is an exotic snake native to sub-Saharan Africa. Gaboon viper venom is an extremely toxic hemotoxin, causing severe coagulopathy and local tissue necrosis. These are not aggressive snakes and therefore bites involving humans are rare and there is not a substantial amount of literature documenting how to manage these injuries and resultant coagulopathies. We report a 29-year-old male presenting 3 hours after a Gaboon viper envenomation resulting in coagulopathy requiring massive resuscitation and multiple doses of antivenom. The patient received various blood products based on thromboelastography (TEG) and also underwent early continuous renal replacement therapy (CRRT) to assist in correction of severe acidosis and acute renal failure. The combination of TEG to guide resuscitation, administration of antivenom, and early implementation of CRRT allowed our team to correct venom-induced consumptive coagulopathy and ultimately allow the patient to survive following this extremely deadly Gaboon viper envenomation.
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Transtornos da Coagulação Sanguínea , Mordeduras de Serpentes , Masculino , Animais , Humanos , Adulto , Antivenenos/uso terapêutico , Bitis , Mordeduras de Serpentes/complicações , Mordeduras de Serpentes/terapia , Tromboelastografia , Venenos de Víboras/uso terapêutico , Venenos de Víboras/toxicidade , Transtornos da Coagulação Sanguínea/terapia , Transtornos da Coagulação Sanguínea/complicaçõesRESUMO
Trauma triage criteria are constantly being refined for improved identification of severely injured patients. When errors occur, they should be tracked, and triage criteria adjusted to minimize these events. Two time periods of trauma registry data at a single rural level II trauma center were retrospectively compared to evaluate demographics, injuries, and outcomes to identify triage errors. In 300 activated trauma patients during 2011, overtriage was 23% and undertriage was 3.7%. In 1035 activated trauma patients during 2019, overtriage was 20.5% and undertriage was 2.2%. Mortality decreased over time overall. In 2019, Trauma I patients were older, spent more time on the ventilator, and in the ICU (all P < .001). Trauma II patients were also older, had lower ISS, hospital days, and ventilator days (all P < .001). During rapid growth, evaluation of overtriage and undertriage can provide useful feedback for hospital staff to refine triage choices and improve patient outcomes.
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Centros de Traumatologia , Ferimentos e Lesões , Humanos , Estudos Retrospectivos , Comitês Consultivos , Triagem , Hospitais , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/terapia , Escala de Gravidade do FerimentoRESUMO
INTRODUCTION: Escalators and moving stairways are omnipresent in modern life. No study to date has examined nationwide incidence and outcomes associated with injuries directly related to escalator use. The aim of this study was to describe the injury patterns, incidence, and disposition as it pertains to youth compared to adults. METHODS: Descriptive and comparative analyses were performed using National Electronic Injury Surveillance System data. The frequencies of categorical variables were calculated across the two age groups. Chi-squared test was performed on all categorical variables. Significance was defined as two-tailed P < 0.05. Logistic regression was used on variables that were determined to be significant from the frequency tables, with additional variable selection being used to arrive on a final model for each outcome. RESULTS: From 2009 to 2019, there were 810 youth and 3669 adults injured in escalator-associated emergency department visits. Incidence in the youth population decreased over time. Disposition was similar between groups. Injury types were similar among groups. White female adults were more likely to sustain injuries related to escalator use. Adult patients were also significantly more likely to sustain head/neck/facial trauma. Last, adult patients were found to be more likely to suffer a fatal event in comparison to the youth population. DISCUSSION: Differences in the injury patterns between youth and adult patients related to the use of escalators illustrate a need for improved injury prevention. Improved education and safety guidelines, particularly in individuals in ages 18 and up, would likely lessen the discrepancies between age groups identified in this study.
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Elevadores e Escadas Rolantes/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Distribuição de Qui-Quadrado , Traumatismos Craniocerebrais/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Traumatismos Faciais/epidemiologia , Feminino , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço/epidemiologia , Estudos Retrospectivos , Estações do Ano , Distribuição por Sexo , Traumatismos Torácicos/epidemiologia , Ferimentos e Lesões/etiologia , Adulto JovemRESUMO
From 2009 to 2019 there were 77 youth and 1046 adults injured in tree stand-related emergency department visits. There was no statistically significant different in sex or gender. Injury types were similar among groups and were categorized by body part. Despite the above-mentioned insignificant differences between the groups, we did identify several statistically significant findings. Adults that were not Caucasian or African-American were more likely to sustain injuries related to tree stands when compared to their youth counterparts (P-value 0.029). Adult patients were also more likely to sustain trauma to their torso (P-value 0.017). Lastly, adult patients were found to be more likely to require hospitalization in comparison to the youth population (P-value 0.018). Improved education and safety guidelines in the use of tree stands, particularly in individuals in ages 18 and up, would likely lessen the discrepancies between age groups identified in this study.
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Acidentes por Quedas , Serviço Hospitalar de Emergência , Adolescente , Adulto , Hospitalização , Humanos , Estudos RetrospectivosRESUMO
The purpose of this study was to identify the population of pediatric patients who arrive without signs of life and describe outcomes using a national database.Patients eighteen and younger with no signs of life were pulled from the National Trauma Database (NTDB) from the years 2007-2016. A total of N = 7503 patients were separated into two cohorts for comparison. Subset analysis was also conducted for patients undergoing a thoracotomy. Statistical analysis was performed on the collected data. Over the 9-year period most patients died in the ED or hospital (95.7%), very few patients were discharged home (1.3%), and ED thoracotomies were performed rarely (9%) with most patients dying (97%).Arrival to the trauma bay without signs of life is associated with a dismal prognosis. Clinical judgment must be carefully applied to choose the small number of patients who would benefit from an aggressive approach.
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Parada Cardíaca , Criança , Bases de Dados Factuais , Serviço Hospitalar de Emergência , Parada Cardíaca/epidemiologia , Parada Cardíaca/etiologia , Humanos , Prognóstico , Estudos Retrospectivos , ToracotomiaRESUMO
Coronavirus disease 2019 (COVID-19) is linked with a hypercoagulable state called COVID-19-associated coagulopathy (CAC). Due to elevated levels of factor VIII and fibrinogen as well as inflammation-linked hyperviscosity of blood, the risk for venous thromboembolism is increased in patients who have CAC. We report the case of a patient with recent COVID-19 infection and no other past medical history who presented after a motorcycle collision with left middle and distal femur fractures, who underwent retrograde intramedullary nailing, and then developed immediate massive bilateral pulmonary emboli. The patient was treated with tissue plasminogen activator administration via bilateral pulmonary artery thrombolysis catheters without improvement, and was then placed on venoarterial extracorporeal membrane oxygenation for subsequent cardiogenic shock. During a 58-day hospital stay, the patient recovered and was discharged with a good long-term prognosis. In this report, we discuss CAC, the role of surgical critical care in the management of the disease, and issues specific to this patient's disease process and treatment.
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Transtornos da Coagulação Sanguínea , COVID-19 , Oxigenação por Membrana Extracorpórea , Transtornos da Coagulação Sanguínea/etiologia , Transtornos da Coagulação Sanguínea/terapia , COVID-19/complicações , Oxigenação por Membrana Extracorpórea/efeitos adversos , Humanos , Choque Cardiogênico/etiologia , Ativador de Plasminogênio TecidualRESUMO
Introduction The fellowship match process is convoluted, with each specialty having its match on its timeline- with some programs having a Post Graduate Year (PGY) 4th-year or 5th-year match. This study aims to identify tangible recommendations for osteopathic surgery residents to use to improve their applications and, ultimately, the success rate for matching into post-graduate fellowship training. Methods In October 2021, as a part of the American College of Osteopathic Surgeons (ACOS) Strategic Planning efforts, the ACOS Resident Student Section sent a questionnaire to the listed email contact for each surgical fellowship program. Fellowship coordinators and program directors were included in the survey. The programs that were included in the study were vascular, thoracic (which included cardiothoracic), surgical critical care, endocrine, hepatobiliary, transplant, pediatric, surgical oncology, breast, minimally invasive, and colorectal surgery. Results Of the 108 programs that answered the survey, 36% of them reported they currently had an osteopathic fellow, and another 29% said they had an osteopathic fellow in the past. 35% of the programs listed that they had never had an osteopathic fellow in their program. In regards to how residents can improve their application for fellowship matches the most common answer was research in the field, they were trying to match into. They wanted to see high scores on the United States Medical Licensing Examination (USMLE) and American Board of Surgery In-Training Examination (ABSITE) exams. They also noted that they wanted candidates from more well know residency programs, where they knew the residents would have gotten good training. Conclusion We recommend that any potential fellowship applicant focus on the following three areas increase competitiveness for matching into fellowship training: publication in the desired field, increased overall scholarly activity, and increased ABSITE scores.