Publications by authors named "Amy Goldberg"

111 Publications

Formal Training Improves Resident Understanding and Communication Regarding Brain Death/Death by Neurologic Criteria.

J Surg Educ 2021 Sep 7. Epub 2021 Sep 7.

Gift of Life Donor Program, Philadelphia, Pennsylvania.

Objective: Residents often are involved in discussions with families regarding brain death/death by neurologic criteria (BD/DNC); however, they receive no standardized training on this topic. We hypothesized that residents are uncomfortable with explaining BD/DNC and that formal didactic and simulated training will improve residents' comfort and skill in discussions surrounding BD/DNC.

Design: We partnered with our organ procurement organization (OPO) to create an educational program regarding BD/DNC consisting of a didactic component, and role-play scenarios with immediate individualized feedback. Residents completed pre- and post-training surveys.

Setting: This study included participants from 16 academic and community institutions across New Jersey, Pennsylvania, and Delaware that are within our OPO's region.

Participants: Subjects were recruited using convenience sampling based on the institution and training programs' willingness to participate. A total of 1422 residents at participated in the training from 2009 to 2020.  1389 (97.7%) participants competed the pre-intervention survey, while 1361 (95.7%) completed the post-intervention survey.

Results: Prior to the training, only 56% of residents correctly identified BD/DNC as synonymous with death. Additionally, 40% of residents had explained BD/DNC to families at least once, but 41% of residents reported never having been taught how to do so. The biggest fear reported in discussing BD/DNC with families was being uncomfortable in explaining BD/DNC (48%). After participating in the training, 99% of residents understood the definition of BD/DNC and 92% of residents felt comfortable discussing BD/DNC with families.

Conclusions: Participation in a standardized curriculum improves residents' understanding of BD/DNC and their comfort in discussing BD/DNC with families.
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http://dx.doi.org/10.1016/j.jsurg.2021.08.018DOI Listing
September 2021

Human-Mediated Admixture and Selection Shape the Diversity on the Modern Swine (Sus scrofa) Y Chromosomes.

Mol Biol Evol 2021 Oct;38(11):5051-5065

National Key Laboratory for Swine Genetic Improvement and Production Technology, Jiangxi Agricultural University, Nanchang, Jiangxi Province, P.R. China.

Throughout its distribution across Eurasia, domestic pig (Sus scrofa) populations have acquired differences through natural and artificial selection, and have often interbred. We resequenced 80 Eurasian pigs from nine different Asian and European breeds; we identify 42,288 reliable SNPs on the Y chromosome in a panel of 103 males, among which 96.1% are newly detected. Based on these new data, we elucidate the evolutionary history of pigs through the lens of the Y chromosome. We identify two highly divergent haplogroups: one present only in Asia and one fixed in Europe but present in some Asian populations. Analyzing the European haplotypes present in Asian populations, we find evidence of three independent waves of introgression from Europe to Asia in last 200 years, agreeing well with the literature and historical records. The diverse European lineages were brought in China by humans and left significant imprints not only on the autosomes but also on the Y chromosome of geographically and genetically distinct Chinese pig breeds. We also find a general excess of European ancestry on Y chromosomes relative to autosomes in Chinese pigs, an observation that cannot be explained solely by sex-biased migration and genetic drift. The European Y haplotype is associated with leaner meat production, and we hypothesize that the European Y chromosome increased in frequency in Chinese populations due to artificial selection. We find evidence of Y chromosomal gene flow between Sumatran wild boar and Chinese pigs. Our results demonstrate how human-mediated admixture and selection shaped the distribution of modern swine Y chromosomes.
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http://dx.doi.org/10.1093/molbev/msab230DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8557463PMC
October 2021

Development of a Multi-Session Curriculum Addressing Domestic Minor Sex Trafficking for High-Risk Male Youth.

J Child Sex Abus 2021 Aug-Sep;30(6):667-683. Epub 2021 Jul 23.

Hasbro Children's Hospital, Providence, RI, USA.

Males, in particular adolescents and young adults, have been increasingly recognized as involved in domestic minor sex trafficking (DMST). However, there are very sparse resources and organizations that provide prevention, identification, and interventions for boys and young men who are involved in or at-risk for DMST involvement. The objective was to develop and assess an educational curriculum to prevent adolescent male involvement in DMST through a three-pronged educational approach: as victims of sexual exploitation; receiving financial benefit as exploiters; as buyers of sex. Through quality improvement cycles, changes were made to enhance the curriculum by utilizing the outcome measures of participant questionnaires and feedback from a steering committee of clinical experts. Male youth at the state's juvenile detention center were asked to participate in pilot groups, as they were identified as a high-risk population of adolescents to become involved. The curriculum was modified by adding sessions, including additional community guest speakers, and providing a more holistic educational experience that involves trafficking prevention from both a victimization and perpetration standpoint. Our goal is to expand this educational opportunity to be utilized in multiple settings (e.g., schools, hospitals) across the country.
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http://dx.doi.org/10.1080/10538712.2021.1937427DOI Listing
October 2021

Police transport of firearm-injured patients-more often and more injured.

J Trauma Acute Care Surg 2021 07;91(1):164-170

From the Division of Trauma and Critical Care, Department of Surgery, (Z.M., J.H.B., E.D., A.P., T.A.S., L.O.S., A.J.G.), Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania; Department of Surgery (M.C.), Yale School of Medicine, New Haven, Connecticut; Lewis Katz School of Medicine at Temple University (S.F., G.V.T.), Philadelphia, Pennsylvania, and Department of Clinical Sciences (H.Z.), Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania.

Background: Police transport (PT) of penetrating trauma patients decreases the time between injury and trauma center arrival. Our study objective was to characterize trends in the rate of PT and its impact on mortality. We hypothesized that PT is increasing and that these patients are more injured.

Methods: We conducted a single-center, retrospective cohort study of adult (≥18 years) patients presenting with gunshot wounds (GSWs) to a level 1 center from 2012 to 2018. Patients transported by police or ambulance (emergency medical service [EMS]) were included. The association between mode of transport (PT vs. EMS) and mortality was evaluated using χ2, t tests, Mann-Whitney U tests, and logistic regression.

Results: Of 2,007 patients, there were 1,357 PT patients and 650 EMS patients. Overall in-hospital mortality was 23.7%. The rate of GSW patients arriving by PT increased from 48.9% to 78.5% over the study period (p < 0.001). Compared with EMS patients, PT patients were sicker on presentation with lower initial systolic blood pressure (98 vs. 110, p < 0.001), higher Injury Severity Score (median [interquartile range], 10 [2-75] vs. 9 [1-17]; p < 0.001) and more bullet wounds (3.5 vs. 2.9, p < 0.001). Police-transported patients more frequently underwent resuscitative thoracotomy (19.2% vs. 10.0%, p < 0.001) and immediate surgical exploration (31.3% vs. 22.6%, p < 0.001). There was no difference in adjusted in-hospital mortality between transport groups. Of patients surviving to discharge, PT patients had higher Injury Severity Score (9.6 vs. 8.3, p = 0.004) and lower systolic blood pressure on arrival (126 vs. 130, p = 0.013) than EMS patients.

Conclusion: Police transport of GSW patients is increasing at our urban level 1 center. Compared with EMS patients, PT patients are more severely injured but have similar in-hospital mortality. Further study is necessary to understand the impact of PT on outcomes in specific subsets in penetrating trauma patients.

Level Of Evidence: Epidemiological, level III.
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http://dx.doi.org/10.1097/TA.0000000000003225DOI Listing
July 2021

A Comparison of Growth Factors and Cytokines in Fresh Frozen Plasma and Never Frozen Plasma.

J Surg Res 2021 08 24;264:51-57. Epub 2021 Mar 24.

Tulane University School of Medicine, Center for Translational Research in Infection and Inflammation, New Orleans, Louisiana.

Background: Fresh frozen plasma (FFP) contains proinflammatory mediators released from cellular debris during frozen storage. In addition, recent studies have shown that transfusion of never-frozen plasma (NFP), instead of FFP, may be superior in trauma patients. We hypothesized that FFP would have higher levels of inflammatory mediators when compared to NFP.

Materials And Methods: FFP (n = 8) and NFP (n = 8) samples were obtained from an urban, level 1 trauma center blood bank. The cytokines in these samples were compared using a Milliplex (Milliplex Sigma) human cytokine magnetic bead panel multiplex assay for 41 different biomarkers.

Results: Growth factors that were higher in NFP included platelet-derived growth factor-AA (PDGF-AA; 8.09 versus 108.00 pg/mL, P < 0.001) and PDGF-AB (0.00 versus 215.20, P= 0.004). Soluble CD40-ligand (sCD40L), a platelet activator and pro-coagulant, was higher in NFP (31.81 versus 80.45 pg/mL, P< 0.001). RANTES, a leukocyte chemotactic cytokine was higher in NFP (26.19 versus 1418.00 pg/mL, P< 0.001). Interleukin-4 (5.70 versus 0.00 pg/mL, P= 0.03) and IL-8 (2.20 versus 0.52 pg/ml, P= 0.03) levels were higher in were higher in FFP.

Conclusions: Frozen storage of plasma may result in decrease of several growth factors and/or pro-coagulants found in NFP. In addition, the freezing and thawing process may induce release of pro-inflammatory chemokines. Further studies are needed to determine if these cytokines result in improved outcomes with NFP over FFP in transfusion of trauma patients.
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http://dx.doi.org/10.1016/j.jss.2021.02.002DOI Listing
August 2021

Skin deep: The decoupling of genetic admixture levels from phenotypes that differed between source populations.

Am J Phys Anthropol 2021 06 27;175(2):406-421. Epub 2021 Mar 27.

Department of Biology, Stanford University, Stanford, California, USA.

Objectives: In genetic admixture processes, source groups for an admixed population possess distinct patterns of genotype and phenotype at the onset of admixture. Particularly in the context of recent and ongoing admixture, such differences are sometimes taken to serve as markers of ancestry for individuals-that is, phenotypes initially associated with the ancestral background in one source population are assumed to continue to reflect ancestry in that population. Such phenotypes might possess ongoing significance in social categorizations of individuals, owing in part to perceived continuing correlations with ancestry. However, genotypes or phenotypes initially associated with ancestry in one specific source population have been seen to decouple from overall admixture levels, so that they no longer serve as proxies for genetic ancestry. Here, we aim to develop an understanding of the joint dynamics of admixture levels and phenotype distributions in an admixed population.

Methods: We devise a mechanistic model, consisting of an admixture model, a quantitative trait model, and a mating model. We analyze the behavior of the mechanistic model in relation to the model parameters.

Results: We find that it is possible for the decoupling of genetic ancestry and phenotype to proceed quickly, and that it occurs faster if the phenotype is driven by fewer loci. Positive assortative mating attenuates the process of dissociation relative to a scenario in which mating is random with respect to genetic admixture and with respect to phenotype.

Conclusions: The mechanistic framework suggests that in an admixed population, a trait that initially differed between source populations might serve as a reliable proxy for ancestry for only a short time, especially if the trait is determined by few loci. It follows that a social categorization based on such a trait is increasingly uninformative about genetic ancestry and about other traits that differed between source populations at the onset of admixture.
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http://dx.doi.org/10.1002/ajpa.24261DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8202736PMC
June 2021

Human genetic admixture.

PLoS Genet 2021 03 11;17(3):e1009374. Epub 2021 Mar 11.

Department of Evolutionary Anthropology, Duke University, Durham, North Carolina, United States of America.

Throughout human history, large-scale migrations have facilitated the formation of populations with ancestry from multiple previously separated populations. This process leads to subsequent shuffling of genetic ancestry through recombination, producing variation in ancestry between populations, among individuals in a population, and along the genome within an individual. Recent methodological and empirical developments have elucidated the genomic signatures of this admixture process, bringing previously understudied admixed populations to the forefront of population and medical genetics. Under this theme, we present a collection of recent PLOS Genetics publications that exemplify recent progress in human genetic admixture studies, and we discuss potential areas for future work.
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http://dx.doi.org/10.1371/journal.pgen.1009374DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7951803PMC
March 2021

An Eastern Association for the Surgery of Trauma multicenter trial examining prehospital procedures in penetrating trauma patients.

J Trauma Acute Care Surg 2021 07;91(1):130-140

From the Division of Trauma and Critical Care, Department of Surgery (S.T., C.A., S.N., J.D.), Tulane University School of Medicine, New Orleans, Louisiana; Department of Surgery, Division of Trauma and Acute Care Surgery (Z.M., A.J.G.), Temple University Hospital, Philadelphia, Pennsylvania; Department of Surgery (G.C., M.M.), Mount Sinai Hospital; Department of Trauma and Burn (L.C.T., P.M.), Cook County Health, Chicago, Illinois; Division of Traumatology, Surgical Critical Care & Emergency Surgery, Department of Surgery (S.R., J.J.K.), University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Surgery (S.B., M.R.), Loma Linda University Medical Center, Loma Linda; Division of Trauma, Acute Care Surgery, and Surgical Critical Care, Department of Surgery (L.E.C., D.V.S.), University of California Davis Medical Center, Sacramento, California; Department of Surgery (A.G.-S., A.B.), Cooper University Hospital, Camden, New Jersey; Department of Surgery, Division of Trauma and Acute Care Surgery (M.C.S., A.L.), Grant Medical Center, Columbus, Ohio; Trauma Specialist Program (E.B., D.T.), Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana; Department of Surgery (M.R.N., J.B.), Allegheny General Hospital, Pittsburgh, Pennsylvania; Department of Surgery (M.C.N.), Cape Fear Valley Hospital, Fayetteville, North Carolina; Trauma Administration (L.E.J., J.W.), Ascension St. Vincent Hospital, Indianapolis, Indiana; Division of Acute Care Surgery and Trauma, Department of Surgery (M.V., K.D.), University of Rochester Medical Center, Rochester, New York; Division of Acute Care Surgery, Department of Surgery (T.Z.H., E.H.), Sydney & Lois Eskenazi Hospital (Smith Level I Shock Trauma), Indianapolis, Indiana; Department of Surgery (M.J.L.), Research Medical Center, Kansas City, Missouri; Division of Trauma/Critical Care (J.D.B., D.R.M.), Broward Health Medical Center, Ft Lauderdale, Florida; Division of Trauma, Burn, Surgical Critical Care and Emergency General Surgery, Department of Surgery (R.A., B.U.O.), Brigham & Women's Hospital, Boston, Massachusetts; Division of Acute Care Surgery, Department of Surgery (E.R.H., E.W.E.), The Johns Hopkins University School of Medicine; Division of Acute Care Surgery, Department of Surgery (R.F., S.L.R.), Johns Hopkins Bayview Medical Center, Baltimore, Maryland; Division of Acute Care Surgery, Department of Surgery (L.W., A.C.B.), University of Kentucky, Lexington, Kentucky; Trauma Services (J.M.H., K.L.L.), Ascension Via Christi Hospital St Francis, Wichita, Kansas; Trauma Service (S.C.N., J.M.), University of Texas Health at Tyler, Tyler, Texas; Envision Surgical Services (M.A.G., M.M.C.), Medical City Plano, Plano, Texas; and Division of Trauma and Acute Care Surgery, Department of Surgery (N.B., A.T.), Tufts Medical Center, Boston, Massachusetts.

Background: Prehospital procedures (PHP) by emergency medical services (EMS) are performed regularly in penetrating trauma patients despite previous studies demonstrating no benefit. We sought to examine the influence of PHPs on outcomes in penetrating trauma patients in urban locations where transport to trauma center is not prolonged. We hypothesized that patients without PHPs would have better outcomes than those undergoing PHP.

Methods: This was an Eastern Association for the Surgery of Trauma-sponsored, multicenter, prospective, observational trial of adults (18+ years) with penetrating trauma to the torso and/or proximal extremity presenting at 25 urban trauma centers. The impact of PHPs and transport mechanism on in-hospital mortality were examined.

Results: Of 2,284 patients included, 1,386 (60.7%) underwent PHP. The patients were primarily Black (n = 1,527, 66.9%) males (n = 1,986, 87.5%) injured by gunshot wound (n = 1,510, 66.0%) with 34.1% (n = 726) having New Injury Severity Score of ≥16. A total of 1,427 patients (62.5%) were transported by Advanced Life Support EMS, 17.2% (n = 392) by private vehicle, 13.7% (n = 312) by police, and 6.7% (n = 153) by Basic Life Support EMS. Of the PHP patients, 69.1% received PHP on scene, 59.9% received PHP in route, and 29.0% received PHP both on scene and in route. Initial scene vitals differed between groups, but initial emergency department vitals did not. Receipt of ≥1 PHP increased mortality odds (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.01-1.83; p = 0.04). Logistic regression showed increased mortality with each PHP, whether on scene or during transport. Subset analysis of specific PHP revealed that intubation (OR, 10.76; 95% CI, 4.02-28.78; p < 0.001), C-spine immobilization (OR, 5.80; 95% CI, 1.85-18.26; p < 0.01), and pleural decompression (OR, 3.70; 95% CI, 1.33-10.28; p = 0.01) had the highest odds of mortality after adjusting for multiple variables.

Conclusion: Prehospital procedures in penetrating trauma patients impart no survival advantage and may be harmful in urban settings, even when performed during transport. Therefore, PHP should be forgone in lieu of immediate transport to improve patient outcomes.

Level Of Evidence: Prognostic, level III.
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http://dx.doi.org/10.1097/TA.0000000000003151DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8216597PMC
July 2021

Sexual Abuse as a Cause of Prepubertal Genital Bleeding: Understanding the Role of Routine Physical Examination.

J Pediatr Adolesc Gynecol 2021 Jun 19;34(3):288-290. Epub 2021 Jan 19.

The Warren Alpert Medical School of Brown University, Providence, Rhode Island; Hasbro Children's Hospital, Providence, Rhode Island. Electronic address:

Although accidental trauma is the most common mechanism for genital bleeding, sexual abuse should be considered when the patient is prepubertal and/or a vague history of bleeding is provided. Prepubertal female genital exams should be completed routinely; this clinical technique is critical for pediatricians to assess pubertal progression, to identify pathologies or differences in sexual differentiation, and to narrow a broad differential diagnosis of bleeding. Physical evidence of sexual abuse on exam is rarely found, and therefore the diagnosis relies on a child's disclosure. Physicians should be cognizant of barriers to patient disclosure. In this commentary we aim to provide general pediatricians and trainees with a framework for evaluating genital/vaginal bleeding in prepubertal girls, by discussing the following: (1) the importance of a complete anogenital exam in generating a differential diagnosis; and (2) the possibility of sexual abuse as an etiology with recognition that the disclosure process is complex.
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http://dx.doi.org/10.1016/j.jpag.2021.01.003DOI Listing
June 2021

Rapid adaptation to malaria facilitated by admixture in the human population of Cabo Verde.

Elife 2021 01 4;10. Epub 2021 Jan 4.

Department of Evolutionary Anthropology, Duke University, Durham, United States.

Humans have undergone large migrations over the past hundreds to thousands of years, exposing ourselves to new environments and selective pressures. Yet, evidence of ongoing or recent selection in humans is difficult to detect. Many of these migrations also resulted in gene flow between previously separated populations. These recently admixed populations provide unique opportunities to study rapid evolution in humans. Developing methods based on distributions of local ancestry, we demonstrate that this sort of genetic exchange has facilitated detectable adaptation to a malaria parasite in the admixed population of Cabo Verde within the last ~20 generations. We estimate that the selection coefficient is approximately 0.08, one of the highest inferred in humans. Notably, we show that this strong selection at a single locus has likely affected patterns of ancestry genome-wide, potentially biasing demographic inference. Our study provides evidence of adaptation in a human population on historical timescales.
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http://dx.doi.org/10.7554/eLife.63177DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7815310PMC
January 2021

7000 years of turnover: historical contingency and human niche construction shape the Caribbean's Anthropocene biota.

Proc Biol Sci 2020 05 20;287(1927):20200447. Epub 2020 May 20.

Department of Evolutionary Anthropology, Duke University, Durham, NC 27708, USA.

The human-mediated movement of species across biogeographic boundaries-whether intentional or accidental-is dramatically reshaping the modern world. Yet humans have been reshaping ecosystems and translocating species for millennia, and acknowledging the deeper roots of these phenomena is important for contextualizing present-day biodiversity loss, ecosystem functioning and management needs. Here, we present the first database of terrestrial vertebrate species introductions spanning the entire anthropogenic history of a system: the Caribbean. We employ this approximately 7000-year dataset to assess the roles of historical contingency and priority effects in shaping present-day community structure and conservation outcomes, finding that serial human colonization events contributed to habitat modifications and species extinctions that shaped the trajectories of subsequent species introductions by other human groups. We contextualized spatial and temporal patterns of species introductions within cultural practices and population histories of Indigenous, colonial and modern human societies, and show that the taxonomic and biogeographic diversity of introduced species reflects diversifying reasons for species introductions through time. Recognition of the complex social and economic structures across the 7000-year human history of the Caribbean provides the necessary context for interpreting the formation of an Anthropocene biota.
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http://dx.doi.org/10.1098/rspb.2020.0447DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7287370PMC
May 2020

Pediatric Rib Fractures Identified by Chest Radiograph: A Comparison Between Accidental and Nonaccidental Trauma.

Pediatr Emerg Care 2020 May 4. Epub 2020 May 4.

Department of Pediatrics, The Warren Alpert Medical School of Brown University.

Objective: The objective of this study was to determine the prevalence of rib fractures (RFs) identified by chest x-ray (CXR) among children younger than 2 years who sustained accidental versus nonaccidental injuries. It is hypothesized that RFs are uncommon among all accidental pediatric trauma mechanisms (eg, falls, motor vehicle crashes) as compared with the prevalence of RFs in the setting of nonaccidental trauma (NAT).

Methods: A retrospective chart review of sequential CXRs of children younger than 2 years evaluated at a pediatric level 1 trauma center for accidental trauma and possible NAT was conducted from January 1, 2011, to October 31, 2016. Data collected included demographics, CXR indication and findings, history of cardiopulmonary resuscitation, trauma mechanism, associated injuries, final diagnoses, and outcomes.

Results: Two (<1%) of 226 CXRs obtained to evaluate accidental trauma demonstrated acute RFs. Ten (19.6%) of 51 CXRs obtained in the setting of concern for NAT revealed RFs (9/10 identified only healing RFs and 1/10 identified acute RFs). Among patients with a final diagnosis of NAT (ie, not neglect, accidental trauma, etc; n = 38), the overall prevalence increased to 26.3%.

Conclusions: The presence of RFs in pediatric accidental trauma is uncommon even in the setting of high-force mechanisms, and when identified, these RFs are acute. Comparatively, the overall prevalence of RFs identified on CXR among cases with a final diagnosis of NAT was much higher and almost exclusively healing RFs. These data provide support that identification of RFs is highly concerning for NAT even if an accidental mechanism is provided. When RFs are identified, a full NAT work-up should be considered.
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http://dx.doi.org/10.1097/PEC.0000000000002061DOI Listing
May 2020

Assortative mating by population of origin in a mechanistic model of admixture.

Theor Popul Biol 2020 08 7;134:129-146. Epub 2020 Apr 7.

Department of Biology, Stanford University, Stanford, CA, USA.

Populations whose mating pairs have levels of similarity in phenotypes or genotypes that differ systematically from the level expected under random mating are described as experiencing assortative mating. Excess similarity in mating pairs is termed positive assortative mating, and excess dissimilarity is negative assortative mating. In humans, empirical studies suggest that mating pairs from various admixed populations - whose ancestry derives from two or more source populations - possess correlated ancestry components that indicate the occurrence of positive assortative mating on the basis of ancestry. Generalizing a two-sex mechanistic admixture model, we devise a model of one form of ancestry-assortative mating that occurs through preferential mating based on source population. Under the model, we study the moments of the admixture fraction distribution for different assumptions about mating preferences, including both positive and negative assortative mating by population. We demonstrate that whereas the mean admixture under assortative mating is equivalent to that of a corresponding randomly mating population, the variance of admixture depends on the level and direction of assortative mating. We consider two special cases of assortative mating by population: first, a single admixture event, and second, constant contributions to the admixed population over time. In contrast to standard settings in which positive assortment increases variation within a population, certain assortative mating scenarios allow the variance of admixture to decrease relative to a corresponding randomly mating population: with the three populations we consider, the variance-increasing effect of positive assortative mating within a population might be overwhelmed by a variance-decreasing effect emerging from mating preferences involving other pairs of populations. The effect of assortative mating is smaller on the X chromosome than on the autosomes because inheritance of the X in males depends only on the mother's ancestry, not on the mating pair. Because the variance of admixture is informative about the timing of admixture and possibly about sex-biased admixture contributions, the effects of assortative mating are important to consider in inferring features of population history from distributions of admixture values. Our model provides a framework to quantitatively study assortative mating under flexible scenarios of admixture over time.
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http://dx.doi.org/10.1016/j.tpb.2020.02.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7387155PMC
August 2020

Domestic Minor Sex Trafficking: A Case Series of Male Pediatric Patients.

J Interpers Violence 2021 12 16;36(23-24):11728-11742. Epub 2020 Jan 16.

Hasbro Children's Hospital, Providence, RI, USA.

Domestic minor sex trafficking (DMST) is the commercial sexual exploitation of children (<18 years old) who are U.S. citizens or lawful permanent residents, victimized within U.S. borders. There is limited knowledge and research in regard to male involvement in DMST outside the context of homelessness and runaway youth. To our knowledge, no research specifically examines at-risk or involved male youth from a larger dataset of youth who present to a child abuse outpatient medical clinic. The objective of the present case series was to describe the demographic, psychosocial, medical, and psychiatric characteristics of natal male participants (who did not identify as transgender) suspected of DMST involvement. Six medical records of male patients under the age of 18 who were referred to a child protection clinic for concern of DMST involvement between 8/1/13 and 12/31/18 were retrospectively reviewed. Our case series demonstrates that male participants present for concern of sex trafficking and have complex behavioral, medical, and psychiatric concerns similar to what has been identified in research focused on female victims. Therefore, testing (e.g., sexually transmitted infection (STI)/HIV testing, urine toxicology screening), DMST screening, and interventions (e.g., STI prophylaxis, referrals to mental health counselors) should be completed in male patients.
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http://dx.doi.org/10.1177/0886260519900323DOI Listing
December 2021

Examining mass shootings from a neighborhood perspective: An analysis of multiple-casualty events and media reporting in Philadelphia, United States.

Prev Med 2019 12;129:105856

Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.

Identifying the people and places affected by mass shootings depends on how "mass shooting" is defined. From the perspective of urban neighborhoods, it is likely the number of people injured within a proximate time and space, which determines the event's impact on perceptions of safety and social cohesion. We aimed to describe the incidence of "neighborhood" mass shootings in one US city and to determine how these events were communicated to the public through news media. This mixed-methods study analyzed Philadelphia, Pennsylvania police data from 2006 to 2015. Using rolling temporal and distance buffers, we isolated shooting events involving multiple victims within a defined time period and geography. Selecting a definition of neighborhood mass shooting consistent with other common mass shooting definitions in which ≥4 victims were shot within 1 h and 100 m, we identified 46 events involving 212 victims over 10 years. We then searched public news media databases and used directed content analysis to describe the range and headline content from reports associated with the 46 events. Neighborhood mass shooting victims were more likely to be younger and female compared to other firearm-injured individuals (p < 0.001). Seven (15%) events received no news media attention, and 30 (77%) of the 39 reported events were covered solely in local/regional news. Only one event was named a "mass shooting" in any associated headline. In Philadelphia, neighborhood mass shootings occur multiple times per year but receive limited media coverage. The population health impact of these events is likely under-appreciated by the public and policymakers.
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http://dx.doi.org/10.1016/j.ypmed.2019.105856DOI Listing
December 2019

Nanoparticle Encapsulation of Synergistic Immune Agonists Enables Systemic Codelivery to Tumor Sites and IFNβ-Driven Antitumor Immunity.

Cancer Res 2019 10 20;79(20):5394-5406. Epub 2019 Aug 20.

Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio.

Effective cancer immunotherapy depends on the robust activation of tumor-specific antigen-presenting cells (APC). Immune agonists encapsulated within nanoparticles (NP) can be delivered to tumor sites to generate powerful antitumor immune responses with minimal off-target dissemination. Systemic delivery enables widespread access to the microvasculature and draining to the APC-rich perivasculature. We developed an immuno-nanoparticle (immuno-NP) coloaded with cyclic diguanylate monophosphate, an agonist of the stimulator of interferon genes pathway, and monophosphoryl lipid A, and a Toll-like receptor 4 agonist, which synergize to produce high levels of type I IFNβ. Using a murine model of metastatic triple-negative breast cancer, systemic delivery of these immuno-NPs resulted in significant therapeutic outcomes due to extensive upregulation of APCs and natural killer cells in the blood and tumor compared with control treatments. These results indicate that NPs can facilitate systemic delivery of multiple immune-potentiating cargoes for effective APC-driven local and systemic antitumor immunity. SIGNIFICANCE: Systemic administration of an immuno-nanoparticle in a murine breast tumor model drives a robust tumor site-specific APC response by delivering two synergistic immune-potentiating molecules, highlighting the potential of nanoparticles for immunotherapy.
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http://dx.doi.org/10.1158/0008-5472.CAN-19-0381DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6801091PMC
October 2019

What's New in Trauma Resuscitation?

Adv Surg 2019 09 17;53:221-233. Epub 2019 May 17.

Department of Surgery, Lewis Katz School of Medicine at Temple University, 3401 North Broad Street, Zone C, 4th Floor, Philadelphia, PA 19140, USA.

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http://dx.doi.org/10.1016/j.yasu.2019.04.010DOI Listing
September 2019

Outcomes in Trauma Patients With Behavioral Health Disorders.

J Surg Res 2019 12 18;244:425-429. Epub 2019 Jul 18.

Temple University Hospital, Philadelphia, Pennsylvania. Electronic address:

Background: The relationship between behavioral health disorders (BHDs) and outcomes after traumatic injury is not well understood. The objective of this study was to evaluate the association between BHDs and outcomes in the trauma patient population.

Materials And Methods: We performed a review of the Trauma Quality Improvement Program database from 2013 to 2016 comparing patients with and without a BHD, which was defined as a psychiatric disorder, alcohol or drug use disorders, dementia, or attention deficit hyperactivity disorder. Outcomes of interest were mortality, length of stay (LOS), and inpatient complications.

Results: In the study population, 254,882 patients (25%) had a BHD. Of these, psychiatric disorders comprised 38.3% (n = 97,668) followed by alcohol (33.3%, n = 84,845) and drug (26.4%, n = 67,199) use disorders, dementia (20.2%, n = 51,553), and attention deficit hyperactivity disorder (1.7%, n = 4301). On multivariable analysis, overall mortality was lower in the BHD group (odds ratio [OR] 0.83, confidence interval [CI] 0.79-0.83; P < 0.001). Patients with dementia had higher mortality when controlling for other risk factors (OR 1.62, CI 1.56-1.69; P < 0.001). LOS was 8.5 d (s = 0.02) for patients with a BHD versus 7.4 d (s = 0.01) for patients without a BHD (P < 0.001). Comorbid BHD was associated with any inpatient complication (OR 1.19, CI 1.18-1.20; P < 0.001).

Conclusions: Trauma patients with a BHD had lower overall mortality compared with those without a BHD. However, on subgroup analysis, those with dementia had increased mortality. BHDs increased risk for any inpatient complication and prolonged LOS. Trauma patients with BHDs represent a vulnerable population and warrant special attention to minimize harm and improve outcomes.
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http://dx.doi.org/10.1016/j.jss.2019.06.061DOI Listing
December 2019

Patients Referred for Domestic Minor Sex Trafficking: A Comparison of Confirmed and Suspected Youth.

J Pediatr Adolesc Gynecol 2019 Dec 10;32(6):628-632. Epub 2019 Jun 10.

Department of Pediatrics, Hasbro Children's Hospital, Providence, Rhode Island; Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.

Study Objective: To compare characteristics of patients with confirmatory evidence (eg, disclosure, found by law enforcement) of domestic minor sex trafficking (DMST) involvement with those without confirmatory evidence but who were suspected of involvement.

Design: A retrospective chart review was conducted of all patients referred for DMST involvement. Confirmed DMST patients were compared with suspected patients with regard to demographic, psychosocial, medical, and psychiatric variables.

Setting: A child protection program at a children's hospital where patients are evaluated by child abuse pediatricians in outpatient, emergency department, and inpatient settings.

Participants: Patients 11-17 years old referred for concern of DMST involvement between August 1, 2013 and July 1, 2016 were included. Patients self-disclosed, had reported with evidence, and/or had histories that placed them at high risk for DMST involvement.

Interventions And Main Outcome Measures: We collected data on demographic, psychosocial, medical, and psychiatric variables from the medical records of patients referred for evaluation.

Results: A total of 67 patients were included. No statistically significant differences were identified between the confirmed and suspected groups.

Conclusion: Our preliminary data showed that confirmed and suspected patients presented with similar and high rates of concerning medical and psychosocial issues; therefore, medical providers should evaluate and treat all patients referred for DMST. Similar treatment includes referrals for psychological/substance abuse interventions, safety planning, and collaboration with a multidisciplinary team.
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http://dx.doi.org/10.1016/j.jpag.2019.06.002DOI Listing
December 2019

Coalescent Theory of Migration Network Motifs.

Mol Biol Evol 2019 10;36(10):2358-2374

Department of Biology, Stanford University, Stanford, CA.

Natural populations display a variety of spatial arrangements, each potentially with a distinctive impact on genetic diversity and genetic differentiation among subpopulations. Although the spatial arrangement of populations can lead to intricate migration networks, theoretical developments have focused mainly on a small subset of such networks, emphasizing the island-migration and stepping-stone models. In this study, we investigate all small network motifs: the set of all possible migration networks among populations subdivided into at most four subpopulations. For each motif, we use coalescent theory to derive expectations for three quantities that describe genetic variation: nucleotide diversity, FST, and half-time to equilibrium diversity. We describe the impact of network properties on these quantities, finding that motifs with a high mean node degree have the largest nucleotide diversity and the longest time to equilibrium, whereas motifs with low density have the largest FST. In addition, we show that the motifs whose pattern of variation is most strongly influenced by loss of a connection or a subpopulation are those that can be split easily into disconnected components. We illustrate our results using two example data sets-sky island birds of genus Sholicola and Indian tigers-identifying disturbance scenarios that produce the greatest reduction in genetic diversity; for tigers, we also compare the benefits of two assisted gene flow scenarios. Our results have consequences for understanding the effect of geography on genetic diversity, and they can assist in designing strategies to alter population migration networks toward maximizing genetic variation in the context of conservation of endangered species.
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http://dx.doi.org/10.1093/molbev/msz136DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6759081PMC
October 2019

Clustered Arrivals of Firearm-Injured Patients in an Urban Trauma System: A Silent Epidemic.

J Am Coll Surg 2019 09 10;229(3):236-243. Epub 2019 Apr 10.

Department of Surgery, Division of Trauma Surgery and Surgical Critical Care, Lewis Katz School of Medicine, Temple University, Philadelphia, PA.

Background: Recent attention has been paid to the role trauma centers play in responding to mass shootings. Although high-profile public events are the primary focus of media and policy makers, firearm-injured patients (FIPs) present in clusters to urban trauma centers every day. We examined the burden of FIP clusters from an urban trauma system perspective.

Study Design: In this descriptive epidemiologic study, we used data from the Philadelphia Police Department registry of shootings from 2005 to 2015. Variables included patient demographics, injury date and time, receiving hospital, and mortality. We defined clustered FIPs as those arriving within 15 minutes of another FIP. We used rolling temporal windows to calculate the number of FIP clusters for each hospital, assessed patient demographic characteristics and mortality, and used linear regression models to evaluate trends in FIP cluster rates.

Results: Of the 14,217 FIPs included, 22.1% were clustered. There were 54 events when 4 or more FIPs presented within 15 minutes and 92 events when 4 or more FIPs presented within 60 minutes. Clusters of FIP occurred most frequently during night shifts (7:00 pm to 7:00 am) (73.1%) at level I trauma centers (93.6%), with geographic clustering demonstrated at the hospital level. Compared with the overall FIP population, clustered FIPs were more likely to be female (p = 0.039), injured at night (p = 0.031), but less likely to die (p = 0.014). The rate of FIP clusters and mortality remained steady over the course of the study.

Conclusions: In the trauma system studied, FIP clusters are common and are likely to occur at similar rates in other urban centers. Therefore, the immediate burden on health care resources caused by multiple FIPs presenting within a short period of time is not limited to traditionally defined mass shootings.
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http://dx.doi.org/10.1016/j.jamcollsurg.2019.03.020DOI Listing
September 2019

HIV and HCV screening among trauma patients.

Int J STD AIDS 2019 06 8;30(7):663-670. Epub 2019 Apr 8.

4 Department of Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.

The purpose of this study was to develop a hepatitis C virus (HCV) and HIV screening program for patients evaluated by the trauma service and link to care. Patients were offered screening for HCV antibody and HIV. Demographics were collected on gender, race, age, and history of intravenous drug use. A navigator connected patients to treatment. In total, 1160 trauma patients were screened for HCV and/or HIV. There were 162 (14%) patients with HCV antibodies. Patients who inject drugs comprised 39.5% (64) of the HCV antibody positive group. Forty-six (68.7%) patients received linkage to care services and 55 (34%) patients were actively engaged in treatment. There were 155 (10.5%) of all eligible patients screened for HIV. Twenty-one (13.5%) patients were living with HIV (PLWH) and there were two (1.3%) new HIV infections. All new PLWH were linked to care and a total of 14 (73.7%) PLWH were on antiretroviral therapy. This is the first HCV and HIV screening and linkage to care program of trauma surgery patients. In this interim program evaluation, we found high prevalence of HCV antibody and HIV prevalence and high linkage to care rates. Trauma service HCV and HIV screening is an opportunity to diagnose, link, and re-engage a vulnerable population.
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http://dx.doi.org/10.1177/0956462419829590DOI Listing
June 2019

Malignant Phyllodes Tumors of the Breast: Association Between Race, Clinical Features, and Outcomes.

J Surg Res 2019 07 18;239:278-283. Epub 2019 Mar 18.

Department of Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania. Electronic address:

Background: We sought to investigate associations between race, clinical characteristics, and outcomes among patients with malignant phyllodes of the breast.

Methods: Malignant phyllodes cases were identified using Surveillance Epidemiology and End Results database. We used chi-square tests to compare characteristics between racial groups and multinomial logistic regression to calculate relative risk ratios (RRR) and 95% confidence intervals (CI) comparing the likelihood of having particular characteristics by race. Survival analyses included Cox regression and Kaplan-Meier functions.

Results: Among 1202 patients included, mean age was 51.7 y and 55.2% were white. Compared to whites, blacks were younger (mean age 45.7 versus 55.1 y; P < 0.001), and more likely to have tumors 51-100 mm (RRR = 1.91; 95% CI: 1.20-3.05) and tumors > 100 mm (RRR = 2.52; 95% CI: 1.56-4.05) than tumors ≤ 50 mm in size. Compared to whites, Hispanics were younger (mean age 46.7 versus 55.1 y; P < 0.001), and more likely to have tumors 51-100 mm (RRR = 1.46; 95% CI: 1.01-2.11) than tumors ≤ 50 mm in size. Asians were more likely to have tumors 51-100 mm (RRR = 1.52; 95% CI: 1.01-2.30) and tumors > 100 mm (RRR = 1.61; 95% CI: 1.03-2.52) than tumors ≤ 50 mm in size, and more likely to have tumors that extended beyond the breast tissue (RRR = 1.87; 95% CI: 1.05-3.31), compared to whites. Survival was similar for blacks (HR = 1.48; 95% CI: 0.80-2.76), Hispanics (HR = 1.02; 95% CI: 0.54-1.93), and Asians (HR = 1.13; 95% CI: 0.63-2.01) compared to whites.

Conclusions: Further research into factors contributing to extensive disease at presentation among minorities is warranted.
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http://dx.doi.org/10.1016/j.jss.2019.01.054DOI Listing
July 2019

Domestic Minor Sex Trafficking: Guidance for Communicating With Patients.

Hosp Pediatr 2019 04 15;9(4):308-310. Epub 2019 Mar 15.

Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island; and.

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http://dx.doi.org/10.1542/hpeds.2018-0199DOI Listing
April 2019

Substance Use in a Domestic Minor Sex Trafficking Patient Population.

Pediatr Emerg Care 2021 Apr;37(4):e159-e162

From the Department of Pediatrics, Hasbro Children's Hospital.

Abstract: Substance use and abuse have been documented as both a risk factor in and consequence of involvement in domestic minor sex trafficking (DMST). Domestic minor sex trafficking is defined as the commercial sexual exploitation of children in exchange for money, food, shelter, or any other valued entity. The current investigation sought to describe substance use in a cohort of DMST patients who present for medical evaluation. Findings revealed that 68 patients referred for DMST involvement reported high rates of alcohol/substance use and parental substance abuse. Further, many patients who had a urine toxicology screen had a positive result, most often identifying the presence of cannabinoids. Our data may inform the importance of comprehensive assessments and specialized interventions for substance abuse in this unique patient population.
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http://dx.doi.org/10.1097/PEC.0000000000001749DOI Listing
April 2021

Comments on "Prehospital Ground Transport Rapid Sequence Intubation for Trauma and Traumatic Brain Injury Outcomes".

Authors:
Amy Goldberg

Ann Surg 2019 03;269(3):e31

Lewis Katz School of Medicine at Temple University, Philadelphia, PA.

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http://dx.doi.org/10.1097/SLA.0000000000003151DOI Listing
March 2019

A Comprehensive Pediatric Acute Sexual Assault Protocol: From Emergency Department to Outpatient Follow-up.

Pediatr Emerg Care 2021 Feb;37(2):62-69

Hasbro Children's Hospital, Providence, RI.

Objective: Close medical follow-up after pediatric acute sexual assault is recommended and may mitigate adverse consequences and decrease long-term comorbidities. The objectives are to (1) examine adherence to a comprehensive outpatient medical follow-up protocol after evaluation in the emergency department in a pediatric population and (2) identify characteristics associated with patient adherence to inform the utilization of a medical follow-up protocol after pediatric acute sexual assault.

Methods: A retrospective medical record review was conducted of patients younger than 18 years presenting to the emergency department from January 1, 2010, to December 31, 2013, with a discharge diagnosis suggestive of sexual assault/abuse. We examined differences in demographics, assault characteristics, and medical/legal needs of patients who were evaluated in follow-up versus patients who were not.

Results: Of 182 patients, 60.4% completed follow-up appointments with the child protection center. Younger patients had follow-up rates higher than older patients (70.2% vs 50%; odds ratio [OR], 0.42). For patients where child protective services or law enforcement were called, follow-up rates were 74.2% and 64.7%, respectively (OR, 2.5; OR, 3.1). All patients with anogenital injuries on initial examination were seen in follow-up. The majority of patients who followed-up were accompanied by a caregiver/relative (95%).

Conclusions: (1) Caregivers should be integrated into the evaluation to facilitate compliance with follow-up; (2) child abuse specialists may be consulted to facilitate specific interventions and recommendations; (3) professionals should work as a multidisciplinary team; and (4) the patient's psychological status should be evaluated, and mental health interventions recommended.
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http://dx.doi.org/10.1097/PEC.0000000000001652DOI Listing
February 2021

The Provision of HIV Post-Exposure Prophylaxis in the Context of Child Sex Trafficking.

R I Med J (2013) 2018 Nov 1;101(9):23-26. Epub 2018 Nov 1.

Associate Professor of Pediatrics, Clinician Educator, The Warren Alpert Medical School of Brown University; Department of Pediatrics, Hasbro Children's Hospital, Providence, RI.

Child sex trafficking (CST) victims are at risk for HIV infection due to a convergence of both social and biological factors. However, sparse recommendations and guidelines exist for providers on the provision of HIV non-occupational post-exposure prophylaxis (nPEP) for CST patients. We evaluated whether pediatricians would provide HIV nPEP in a clinical vignette where a patient disclosed ongoing involvement in CST. Participants were relatively divided regarding whether they would provide HIV nPEP; 58.8% responded yes and 41.2% responded no. This highlights the need for medical guidelines to address the complex and case specific considerations of providing nPEP to these victims.
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November 2018

The Prevalence of Rib Fractures Incidentally Identified by Chest Radiograph among Infants and Toddlers.

J Pediatr 2019 01 5;204:208-213. Epub 2018 Oct 5.

Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, RI; Department of Pediatrics Child Protection Program, Hasbro Children's Hospital, Providence, RI.

Objectives: To determine the prevalence of incidental rib fractures identified by chest radiograph (CXR) obtained for indications unrelated to accidental trauma or nonaccidental trauma (NAT), and describe the histories associated with cases of incidental rib fractures and their proposed etiologies. It is hypothesized that incidental rib fractures are rare and alternative explanations for rib fractures occasionally used in a medico-legal context such as minor accidental trauma, undiagnosed medical conditions, and transient metabolic bone disturbances are unlikely to be the etiology of incidental rib fractures.

Study Design: A retrospective chart review of sequential CXRs of children ages 0 to <2 years was conducted from January 1, 2011 to October 31, 2016. CXRs were obtained in the emergency department, general pediatric or intensive care units, or outpatient pediatric clinics. Data collected included demographics, CXR indication and findings, history of cardiopulmonary resuscitation, laboratory and additional imaging results, and incidental rib fracture descriptions and proposed etiologies.

Results: A total of 7530 patients underwent 9720 CXRs associated with unique clinical encounters. Five CXRs had incidental rib fractures identified, making the prevalence of CXRs with incidental rib fractures in this cohort <0.1%. Of 5 identified incidental cases, mean age was 3.6 months, 3 were concerning for NAT, 1 was confirmed NAT, and 1 had radiographic findings consistent with osteopenia of prematurity.

Conclusions: Identification of incidental rib fracture on CXR is rare. When detected in the absence of corresponding trauma history and/or objective laboratory or radiographic metabolic abnormalities, work-up for NAT should be pursued.
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http://dx.doi.org/10.1016/j.jpeds.2018.08.067DOI Listing
January 2019
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