Author
Avery B. Nathens
Other affiliations: University Health Network, Harborview Medical Center, Washington University in St. Louis ...read more
Bio: Avery B. Nathens is an academic researcher from St. Michael's Hospital. The author has contributed to research in topics: Poison control & Population. The author has an hindex of 54, co-authored 100 publications receiving 12438 citations. Previous affiliations of Avery B. Nathens include University Health Network & Harborview Medical Center.
Papers published on a yearly basis
Papers
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TL;DR: It is shown that the risk of death is significantly lower when care is provided in a trauma center than in a non-trauma center and argue for continued efforts at regionalization.
Abstract: BACKGROUND Hospitals have difficulty justifying the expense of maintaining trauma centers without strong evidence of their effectiveness. To address this gap, we examined differences in mortality between level 1 trauma centers and hospitals without a trauma center (non-trauma centers). METHODS Mortality outcomes were compared among patients treated in 18 hospitals with a level 1 trauma center and 51 hospitals non-trauma centers located in 14 states. Patients 18 to 84 years old with a moderate-to-severe injury were eligible. Complete data were obtained for 1104 patients who died in the hospital and 4087 patients who were discharged alive. We used propensity-score weighting to adjust for observable differences between patients treated at trauma centers and those treated at non-trauma centers. RESULTS After adjustment for differences in the case mix, the in-hospital mortality rate was significantly lower at trauma centers than at non-trauma centers (7.6 percent vs. 9.5 percent; relative risk, 0.80; 95 percent confidence interval, 0.66 to 0.98), as was the one-year mortality rate (10.4 percent vs. 13.8 percent; relative risk, 0.75; 95 percent confidence interval, 0.60 to 0.95). The effects of treatment at a trauma center varied according to the severity of injury, with evidence to suggest that differences in mortality rates were primarily confined to patients with more severe injuries. CONCLUSIONS Our findings show that the risk of death is significantly lower when care is provided in a trauma center than in a non-trauma center and argue for continued efforts at regionalization.
2,222 citations
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TL;DR: Clinicians can diagnose and report TRALI cases to the blood bank and researchers can use this definition to determine incidence, pathophysiology, and strategies to prevent this leading cause of transfusion-associated mortality.
Abstract: Background:Transfusion-related acute lung injury (TRALI) is now the leading cause of transfusion-associated mortality, even though it is probably still underdiagnosed and underreported.National Heart, Lung, and Blood Institute Action:The National Heart, Lung, and Blood Institute convened a working g
668 citations
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TL;DR: A strong association exists between trauma center volume and outcomes, with significant improvements in mortality and LOS when volume exceeds 650 cases per year, and benefits are only evident in patients at high risk for adverse outcomes.
Abstract: ContextThe premise underlying regionalization of trauma care is that larger
volumes of trauma patients cared for in fewer institutions will lead to improved
outcomes. However, whether a relationship exists between institutional volume
and trauma outcomes remains unknown.ObjectiveTo evaluate the association between trauma center volume and outcomes
of trauma patients.DesignRetrospective cohort study.SettingThirty-one academic level I or level II trauma centers across the United
States participating in the University Healthsystem Consortium Trauma Benchmarking
Study.PatientsConsecutive patients with penetrating abdominal injury (PAI; n = 478)
discharged between November 1, 1997, and July 31, 1998, or with multisystem
blunt trauma (minimum of head injury and lower-extremity long-bone fractures;
n = 541) discharged between June 1 and December 31, 1998.Main Outcome MeasuresInpatient mortality and hospital length of stay (LOS), comparing high-volume
(>650 trauma admissions/y) and low-volume (≤650 admissions/y) centers.ResultsAfter multivariate adjustment for patient characteristics and injury
severity, the relative odds of death was 0.02 (95% confidence interval [CI],
0.002-0.25) for patients with PAI admitted with shock to high-volume centers
compared with low-volume centers. No benefit was evident in patients without
shock (P = .50). The adjusted odds of death in patients
with multisystem blunt trauma who presented with coma to a high-volume center
was 0.49 (95% CI, 0.26-0.93) vs low-volume centers. No benefit was observed
in patients without coma (P = .05). Additionally,
a shorter LOS was observed in patients with PAI and New Injury Severity Scores
of 16 or higher (difference in adjusted mean LOS, 1.6 days [95% CI, −1.5
to 4.7 days]) and in all patients with multisystem blunt trauma admitted to
higher-volume centers (difference in adjusted mean LOS, 3.3 days [95% CI,
0.91-5.70 days]).ConclusionsOur results indicate that a strong association exists between trauma
center volume and outcomes, with significant improvements in mortality and
LOS when volume exceeds 650 cases per year. These benefits are only evident
in patients at high risk for adverse outcomes.
545 citations
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TL;DR: To determine the effectiveness of early, routine antioxidant supplementation using α-tocopherol and ascorbic acid in reducing the rate of pulmonary morbidity and organ dysfunction in critically ill surgical patients.
Abstract: ObjectiveTo determine the effectiveness of early, routine antioxidant supplementation using α-tocopherol and ascorbic acid in reducing the rate of pulmonary morbidity and organ dysfunction in critically ill surgical patients.Summary Background DataOxidative stress has been associated with the develo
478 citations
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University of Cincinnati1, Washington University in St. Louis2, Stanford University3, University of Virginia4, University of Washington5, University of Georgia6, Georgia Regents University7, Centers for Disease Control and Prevention8, Tufts University9, University of British Columbia10, Johns Hopkins University School of Medicine11
TL;DR: This work presents a meta-analysis of 125 cases of Clostridium difficile infection in mice over a 12-month period and shows clear patterns of disease progression that are consistent with tick-borne disease and suggest fungal infection.
Abstract: Joseph S. Solomkin, John E. Mazuski, Ellen J. Baron, Robert G. Sawyer, Avery B. Nathens, Joseph T. DiPiro, Timothy Buchman, E. Patchen Dellinger, John Jernigan, Sherwood Gorbach, Anthony W. Chow, and John Bartlett Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Surgery, Washington University School of Medicine, St. Louis, Missouri; Department of Microbiology, Stanford University School of Medicine, Palo Alto, California; Department of Surgery, University of Virginia, Charlottesville; Department of Surgery, University of Washington, Seattle; University of Georgia College of Pharmacy, Department of Surgery, Medical College of Georgia, Augusta, and Centers for Disease Control and Prevention, Atlanta; Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; and Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
477 citations
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TL;DR: Mice adds new functionality for imputing multilevel data, automatic predictor selection, data handling, post-processing imputed values, specialized pooling routines, model selection tools, and diagnostic graphs.
Abstract: The R package mice imputes incomplete multivariate data by chained equations. The software mice 1.0 appeared in the year 2000 as an S-PLUS library, and in 2001 as an R package. mice 1.0 introduced predictor selection, passive imputation and automatic pooling. This article documents mice, which extends the functionality of mice 1.0 in several ways. In mice, the analysis of imputed data is made completely general, whereas the range of models under which pooling works is substantially extended. mice adds new functionality for imputing multilevel data, automatic predictor selection, data handling, post-processing imputed values, specialized pooling routines, model selection tools, and diagnostic graphs. Imputation of categorical data is improved in order to bypass problems caused by perfect prediction. Special attention is paid to transformations, sum scores, indices and interactions using passive imputation, and to the proper setup of the predictor matrix. mice can be downloaded from the Comprehensive R Archive Network. This article provides a hands-on, stepwise approach to solve applied incomplete data problems.
10,234 citations
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TL;DR: Prevalence and severity of health loss were weakly correlated and age-specific prevalence of YLDs increased with age in all regions and has decreased slightly from 1990 to 2010, but population growth and ageing have increased YLD numbers and crude rates over the past two decades.
7,021 citations
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TL;DR: It is estimated that each year in the United States there are 190,600 cases of acute lung injury, which are associated with 74,500 deaths and 3.6 million hospital days, considerably higher than previous reports have suggested.
Abstract: BACKGROUND Acute lung injury is a critical illness syndrome consisting of acute hypoxemic respiratory failure with bilateral pulmonary infiltrates that are not attributed to left atrial hypertension. Despite recent advances in our understanding of the mechanism and treatment of acute lung injury, its incidence and outcomes in the United States have been unclear. METHODS We conducted a prospective, population-based, cohort study in 21 hospitals in and around King County, Washington, from April 1999 through July 2000, using a validated screening protocol to identify patients who met the consensus criteria for acute lung injury. RESULTS A total of 1113 King County residents undergoing mechanical ventilation met the criteria for acute lung injury and were 15 years of age or older. On the basis of this figure, the crude incidence of acute lung injury was 78.9 per 100,000 person-years and the age-adjusted incidence was 86.2 per 100,000 person-years. The in-hospital mortality rate was 38.5 percent. The incidence of acute lung injury increased with age from 16 per 100,000 person-years for those 15 through 19 years of age to 306 per 100,000 person-years for those 75 through 84 years of age. Mortality increased with age from 24 percent for patients 15 through 19 years of age to 60 percent for patients 85 years of age or older (P<0.001). We estimate that each year in the United States there are 190,600 cases of acute lung injury, which are associated with 74,500 deaths and 3.6 million hospital days. CONCLUSIONS Acute lung injury has a substantial impact on public health, with an incidence in the United States that is considerably higher than previous reports have suggested.
3,358 citations
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TL;DR: It is concluded that multiple Imputation for Nonresponse in Surveys should be considered as a legitimate method for answering the question of why people do not respond to survey questions.
Abstract: 25. Multiple Imputation for Nonresponse in Surveys. By D. B. Rubin. ISBN 0 471 08705 X. Wiley, Chichester, 1987. 258 pp. £30.25.
3,216 citations
01 Sep 2008
TL;DR: The Methodology used to Prepare the Guideline Epidemiology Incidence Etiology and Recommendations for Assessing Response to Therapy Suggested Performance Indicators is summarized.
Abstract: Executive Summary Introduction Methodology Used to Prepare the Guideline Epidemiology Incidence Etiology Major Epidemiologic Points Pathogenesis Major Points for Pathogenesis Modifiable Risk Factors Intubation and Mechanical Ventilation Aspiration, Body Position, and Enteral Feeding Modulation of Colonization: Oral Antiseptics and Antibiotics Stress Bleeding Prophylaxis, Transfusion, and Glucose Control Major Points and Recommendations for Modifiable Risk Factors Diagnostic Testing Major Points and Recommendations for Diagnosis Diagnostic Strategies and Approaches Clinical Strategy Bacteriologic Strategy Recommended Diagnostic Strategy Major Points and Recommendations for Comparing Diagnostic Strategies Antibiotic Treatment of Hospital-acquired Pneumonia General Approach Initial Empiric Antibiotic Therapy Appropriate Antibiotic Selection and Adequate Dosing Local Instillation and Aerosolized Antibiotics Combination versus Monotherapy Duration of Therapy Major Points and Recommendations for Optimal Antibiotic Therapy Specific Antibiotic Regimens Antibiotic Heterogeneity and Antibiotic Cycling Response to Therapy Modification of Empiric Antibiotic Regimens Defining the Normal Pattern of Resolution Reasons for Deterioration or Nonresolution Evaluation of the Nonresponding Patient Major Points and Recommendations for Assessing Response to Therapy Suggested Performance Indicators
2,961 citations