Bio

Bio


General Surgery Resident (2017-) in professional development time. MSc student in Epidemiology & Clinical Research (2019-2020), and Biomedical Informatics (2020-). Co-President of SWAT (Surgeons Writing About Trauma); helping students get excited about clinical research is my passion.

My interest is encouraging cross-disciplinary collaborations to tackle challenging research questions in trauma surgery. To better lives of injured patients and their families, our research teams explore evidence synthesis (meta analysis), computer vision applications, decision analysis/cost-effectiveness analysis, epidemiological/clinical outcomes research, and prognostication tool development. If you are interested in collaborating, please reach out.

Honors & Awards


  • CWIS-KLS Martin Resident Research Fellowship in Chest Wall Injury Outcomes, Chest Wall Injury Society (2020)
  • Division of General Surgery Resident Professional Development Award, Stanford Department of Surgery (2020)
  • Neil and Claudia Doerhoff Scholar, Neil and Claudia Doerhoff fund (2019)
  • Travel Scholarship, American Association for the Surgery of Trauma (2018)
  • Vascular Surgery Intern of the Year, Stanford Department of Surgery (2018)
  • Best Medical Student Research Award, Emile F. Holman Lecture & Research Day (2017)
  • Trainee Award, Technological Innovations in Immunology, American Association of Immunologists (2016)
  • Best Basic Science Research, World Korean Medical Organization (2014)
  • Best Cultural Essay, World Korean Medical Organization (2014)
  • Medical Scholars Award, Stanford University School of Medicine (2014)
  • Young Innovator Award, American Society of Transplantation (2014)

Boards, Advisory Committees, Professional Organizations


  • Research Committee, Chest Wall Injury Society (2021 - Present)
  • Provisional Member, Eastern Association for the Surgery of Trauma (2021 - Present)
  • Associate Member, Society of Asian Academic Surgeons (2020 - Present)
  • Candidate member, Association for Academic Surgery (2020 - Present)
  • Member, American College of Surgeons (2016 - Present)
  • Rapid reponse team lead, Resident Safety Council, Stanford Healthcare (2019 - 2020)
  • Member, Gold Humanism Honor Society (2016 - Present)
  • Member, American Association of Immunologists (2015 - 2017)

Membership Organizations


Professional Education


  • Master of Science, Stanford University, EPIDM-MS (2021)
  • Master of Science, Stanford University, Biomedical Informatics, expected 2021
  • Internship (General Surgery), Stanford University
  • Doctor of Medicine, Stanford University, MED-MD (2017)
  • Bachelor of Science, Cornell University, Policy Analysis and Management (2013)

Publications

All Publications


  • Safety of Foregoing Operation for Small Bowel Obstruction in the Virgin Abdomen: Systematic Review and Meta-Analysis. Journal of the American College of Surgeons Choi, J. n., Fisher, A. T., Mulaney, B. n., Anand, A. n., Carlos, G. n., Stave, C. D., Spain, D. A., Weiser, T. G. 2020

    Abstract

    Our objective was to assess the safety of foregoing surgery in patients without abdominopelvic surgery history presenting with small bowel obstruction (SBO). Classic dogma has counseled early surgical intervention for small bowel obstruction (SBO) in the virgin abdomen - patients without abdominopelvic surgery history - given their presumed higher risk of malignant or potentially catastrophic etiologies compared to those who underwent prior abdominal operations. The term virgin abdomen was coined before widespread use of computed tomography, which now elucidates many SBO etiologies. Despite recent efforts to re-evaluate clinical management standards, the prevalence of SBO etiologies in the virgin abdomen and the current management landscape (non-operative vs operative) in these patients remain unclear. Our random-effects meta-analysis of six studies including 442 patients found the prevalence of malignant etiologies in patients without abdominopelvic surgery history presenting with SBO varied from 7.7% [95% CI:3.0-14.1] to 13.4% [95% CI:7.6-20.3] on sensitivity analysis. Most malignant etiologies were not suspected prior to surgery. De novo adhesions (54%) were the most common etiology. Over half of patients underwent a trial of non-operative management, which often failed. Subgroups of patients likely have variable risk profiles for underlying malignant etiologies, yet no study had consistent follow-up data and we did not find convincing evidence that foregoing operative management altogether in this population can be generally recommended.

    View details for DOI 10.1016/j.jamcollsurg.2020.06.010

    View details for PubMedID 32574687

  • Nationwide Cost-Effectiveness Analysis of Surgical Stabilization of Rib Fractures by Flail Chest Status and Age Groups. The journal of trauma and acute care surgery Choi, J. n., Mulaney, B. n., Laohavinij, W. n., Trimble, R. n., Tennakoon, L. n., Spain, D. A., Salomon, J. A., Goldhaber-Fiebert, J. D., Forrester, J. D. 2020

    Abstract

    SSRF is increasingly utilized to manage patients with rib fractures. Benefits of performing SSRF appear variable and the procedure is costly, necessitating cost-effectiveness analysis for distinct subgroups. We aimed to assess the cost-effectiveness of surgical stabilization of rib fractures (SSRF) vs non-operative management among patients with rib fractures aged <65 vs ≥65 years, with vs without flail chest. We hypothesized that compared to non-operative management, SSRF is cost-effective only for patients with flail chest.This economic evaluation used a decision-analytic Markov model with a lifetime time horizon incorporating US population-representative inputs to simulate benefits and risks of SSRF compared to non-operative management. We report quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs). Deterministic and probabilistic sensitivity analyses accounted for most plausible clinical scenarios.Compared to non-operative management, SSRF was cost-effective for patients with flail chest at willingness-to-pay threshold of $150,000/QALY gained. SSRF cost $25,338 and $123,377/QALY gained for those with flail chest aged <65 and ≥65 years, respectively. SSRF was not cost-effective for patients without flail chest; costing $172,704 and $243,758/QALY gained for those aged <65 and ≥65 years, respectively. One-way sensitivity analyses showed that under most plausible scenarios, SSRF remained cost-effective for subgroups with flail chest and non-operative management remained cost-effective for patients aged >65 without flail chest. Probability that SSRF is cost-effective ranged from 98% among patients aged <65 with flail chest to 35% among patients aged ≥65 without flail chest.SSRF is cost effective for patients with flail chest. SSRF may be cost-effective in some patients without flail chest, but delineating these patients requires further study.level II.

    View details for DOI 10.1097/TA.0000000000003021

    View details for PubMedID 33559982

  • Surgical Stabilization of Rib Fracture to Mitigate Pulmonary Complication and Mortality: A Systematic Review and Bayesian Meta-Analysis. Journal of the American College of Surgeons Choi, J. n., Gomez, G. I., Kaghazchi, A. n., Borghi, J. A., Spain, D. A., Forrester, J. D. 2020

    View details for DOI 10.1016/j.jamcollsurg.2020.10.022

    View details for PubMedID 33212228

  • Pain Scores in Geriatric vs Nongeriatric Patients With Rib Fractures. JAMA surgery Choi, J. n., Khan, S. n., Zamary, K. n., Tennakoon, L. n., Spain, D. A. 2020

    View details for DOI 10.1001/jamasurg.2020.1933

    View details for PubMedID 32609366

  • Prospective Study of Short-Term Quality-of-Life After Traumatic Rib Fractures. The journal of trauma and acute care surgery Choi, J. n., Khan, S. n., Hakes, N. A., Carlos, G. n., Seltzer, R. n., Jaramillo, J. D., Spain, D. A. 2020

    Abstract

    Post-discharge convalescence after traumatic rib fractures remains unclear. We hypothesized that patients with rib fractures, even as an isolated injury, have associated poor QoL after discharge.We prospectively enrolled adult patients at our Level I trauma center with rib fractures between July 2019 and January 2020. We assessed QoL at 1 and 3-months after discharge using the Trauma-specific Quality-of-Life (T-QoL: 43-question survey evaluating five QoL domains on a four-point Likert scale. "4" indicates optimal and "1" worst QoL) and supplementary questionnaires. We used generalized estimating equations to assess T-QoL score trends over time and effect of age, sex, injury pattern, self-perceived injury severity, and injury severity score.We enrolled 139 patients (108 completed the first and 93 completed both surveys). Three months after discharge, 33% of patients were not working at pre-injury capacity and 7% were still using opioid analgesia. Suffering rib fractures most impacted recovery and resilience (T-QoL score, mean [robust standard error] at 1-month: 2.7[0.1], 3-months: 3.0[0.1]) and physical well-being domains (1-month: 2.5[0.1]; 3-months 2.9[0.1]). QoL improved over time across all domains. Compared with patients who perceived their injuries as mild/moderate, patients who perceived their injuries as severe/very severe reported worse T-QoL scores across all domains. In contrast, injury severity score did not affect QoL. Patients aged ≥65 years (-0.6[0.1]) and females (-0.6[0.2]) reported worse functional engagement compared with those aged ≤65 years and males, respectively.We found that patients with traumatic rib fractures experience suboptimal QoL after discharge. QoL improved over time, but even three months after discharge, patients reported challenges performing activities of daily living, slower-than-expected recovery, and not returning to work at pre-injury capacity. Perception of injury severity had a large effect on QoL. Patients with rib fractures may benefit from close short-term follow-up.Prognostic and Epidemiological LEVEL OF EVIDENCE: Level III.

    View details for DOI 10.1097/TA.0000000000002917

    View details for PubMedID 32925583

  • The impact of trauma systems on patient outcomes. Current problems in surgery Choi, J., Carlos, G., Nassar, A. K., Knowlton, L. M., Spain, D. A. 2021; 58 (1): 100840

    View details for DOI 10.1016/j.cpsurg.2020.100840

    View details for PubMedID 33431135

  • Complication to consider: delayed traumatic hemothorax in older adults Trauma Surgery Acute Care Open Choi, J., Anand, A., Sborov, K. D., Walton, W., Chow, L., Guillamondegui, O., Dennis, B. M., Spain, D., Staudenmayer, K. 2021
  • Heterogeneity in managing rib fractures across non-trauma and level I, II, and III trauma centers. American journal of surgery Choi, J. n., Kaghazchi, A. n., Dickerson, K. L., Tennakoon, L. n., Spain, D. A., Forrester, J. D. 2021

    Abstract

    We aimed to elucidate management patterns and outcomes of high-risk patients with rib fractures (elderly or flail chest) across non-trauma and trauma centers. We hypothesized highest-capacity (level I) centers would have best outcomes for high-risk patients.We queried the 2016 National Emergency Department Sample to identify adults presenting with rib fractures. Multivariable regression assessed ED and inpatient events across non-trauma and level III/II/I trauma centers.Among 504,085 rib fracture encounters, 46% presented to non-trauma centers. Elderly patients with multiple rib fractures had stepwise increase in inpatient admission odds and stepwise decrease in pneumonia odds at higher-capacity trauma centers compared to non-trauma centers. Among patients with flail chest, odds of undergoing surgical stabilization (SSRF) increased at trauma centers. Undergoing SSRF was associated with reduced mortality but remained underutilized.Half of patients with rib fractures present to non-trauma centers. Nationwide care-optimization for high-risk patients requires further effort.

    View details for DOI 10.1016/j.amjsurg.2021.02.013

    View details for PubMedID 33612257

  • Concomitant Sternal Fractures: Harbinger of Worse Pulmonary Complications and Mortality in Patients With Rib Fractures. The American surgeon Choi, J. n., Mulaney, B. n., Sun, B. n., Trimble, R. n., Tennakoon, L. n., Spain, D. A., Forrester, J. D. 2021: 3134821991978

    Abstract

    Sternal and rib fractures are common concomitant injuries. However, the impact of concurrent sternal fractures on clinical outcomes of patients with rib fractures is unclear. We aimed to unveil the pulmonary morbidity and mortality impact of concomitant sternal fractures among patients with rib fractures.We identified adult patients admitted with traumatic rib fractures with vs. without concomitant sternal fractures using the 2012-2014 National Inpatient Sample (NIS). After 2:1 propensity score matching and adjustment for residual imbalances, we compared risk of pulmonary morbidity and mortality between patients with vs. without concomitant sternal fractures. Subgroup analysis in patients with flail chest assessed whether sternal fractures modify the association between undergoing surgical stabilization of rib fractures (SSRF) and pulmonary morbidity or mortality.Of 475 710 encounters of adults admitted with rib fractures, 24 594 (5%) had concomitant sternal fractures. After 2:1 propensity score matching, patients with concomitant sternal fractures had 70% higher risk (95% CI: 50-90% higher, P < 0.001) of undergoing tracheostomy, 40% higher risk (30-50% higher, P <.001) of undergoing intubation, and 20% higher risk of respiratory failure (10-30% higher, P <.001) and mortality (10-40% higher, P =.007). Subgroup analysis of 8600 patients with flail chest showed concomitant sternal fractures did not impact the association between undergoing SSRF and any pulmonary morbidity or mortality.Concomitant sternal fractures are associated with increased risk for pulmonary morbidity and mortality among patients with rib fractures. However, our findings are limited by a binary definition of sternal fractures, which encompasses heterogeneous injury patterns with likely variable clinical relevance.

    View details for DOI 10.1177/0003134821991978

    View details for PubMedID 33522281

  • Early National Landscape of Surgical Stabilization of Sternal Fractures. World journal of surgery Choi, J. n., Khan, S. n., Syed, M. n., Tennakoon, L. n., Forrester, J. D. 2021

    Abstract

    Operative management of chest wall injuries aims to restore respiratory mechanics and mitigate pulmonary complications. Extensive studies support surgical stabilization of rib fractures (SSRF) for select patients, but role for surgical stabilization of sternal fractures (SSSF) remains unclear. We aimed to understand national prevalence of SSSF and compare outcomes after surgical stabilization and non-operative management of sternal fractures.We retrospectively analyzed adult patients (age ≥ 18 years) admitted with sternal fractures after blunt trauma using the 2016 National Trauma Data Bank. We compared odds of inpatient mortality, pneumonia, and respiratory failure for propensity score matched patients (4:1) who underwent non-operative management vs SSSF. We characterized subgroup of patients with concurrent rib and sternal fractures who underwent concomitant SSRF-SSSF.We identified 14,760 encounters of adults admitted with sternal fractures; 270 (1.8%) underwent SSSF. Compared to matched patients who underwent non-operative management, patients who underwent SSSF had lower odds of mortality (OR [95%CI]: 0.19 [0.06-0.62], p = 0.006). Adjusted for trauma center level, Mantel-Haenszel mortality odds remained lower for patients who underwent SSSF. Odds of pneumonia and respiratory failure were similar between matched groups. Among 46% of patients who had concomitant rib fractures, 0.3% (n = 18) underwent concurrent SSRF-SSSF and these patients survived hospitalization without pneumonia or respiratory failure.A vast majority of patients who suffer sternal fractures undergo non-operative management. Potential mortality benefit of SSSF and concurrent SSRF-SSSF's role for commonly concomitant rib and sternal fractures deserve further study. Our preliminary findings call for delineating heterogeneity of sternal fractures and establishing consensus SSSF indications.

    View details for DOI 10.1007/s00268-021-06007-5

    View details for PubMedID 33604709

  • Incidence and Management of Arterial Vascular Trauma in the US Kashikar, A., Choi, J., Tennakoon, L., Spain, D., Arya, S. ELSEVIER SCIENCE INC. 2020: E263–E264
  • Common, Severe, and Preventable: Agricultural Machinery Trauma in the US Hakes, N. A., Jaramillo, J. D., Choi, J., Spain, D. A., Tennakoon, L., Forrester, J. D. ELSEVIER SCIENCE INC. 2020: E231
  • Outcome after surgical stabilization of rib fractures versus nonoperative treatment in patients with multiple rib fractures and moderate to severe traumatic brain injury (CWIS-TBI). The journal of trauma and acute care surgery Prins, J. T., Van Lieshout, E. M., Ali-Osman, F. n., Bauman, Z. M., Caragounis, E. C., Choi, J. n., Benjamin Christie, D. n., Cole, P. A., DeVoe, W. B., Doben, A. R., Eriksson, E. A., Forrester, J. D., Fraser, D. R., Gontarz, B. n., Hardman, C. n., Hyatt, D. G., Kaye, A. J., Ko, H. J., Leasia, K. N., Leon, S. n., Marasco, S. F., McNickle, A. G., Nowack, T. n., Ogunleye, T. D., Priya, P. n., Richman, A. P., Schlanser, V. n., Semon, G. R., Su, Y. H., Verhofstad, M. H., Whitis, J. n., Pieracci, F. M., Wijffels, M. M. 2020

    Abstract

    Outcomes after surgical stabilization of rib fractures (SSRF) have not been studied in patients with multiple rib fractures and traumatic brain injury (TBI). We hypothesized that SSRF, as compared to nonoperative management, is associated with favorable outcomes in patients with TBI.A multicenter, retrospective cohort study was performed in patients with rib fractures and TBI between January 2012 and July 2019. Patients who underwent SSRF were compared to those managed nonoperatively. The primary outcome was mechanical ventilation-free days. Secondary outcomes were Intensive Care Unit (ICU-LOS) and hospital length of stay (HLOS), tracheostomy, occurrence of complications, neurologic outcome, and mortality. Patients were further stratified into moderate (GCS 9-12) and severe (GCS ≤8) TBI.The study cohort consisted of 456 patients of which 111 (24.3%) underwent SSRF. SSRF was performed at a median of 3 days and SSRF-related complication rate was 3.6%. In multivariable analyses, there was no difference in mechanical ventilation-free days between the SSRF and nonoperative groups. The odds of developing pneumonia (OR 0.59 (95% CI 0.38-0.98), p=0.043) and 30-day mortality (OR 0.32 (95% CI 0.11-0.91), p=0.032) were significantly lower in the SSRF group. Patients with moderate TBI had similar outcome in both groups. In patients with severe TBI, the odds of 30-day mortality was significantly lower after SSRF (0.19 (95% CI 0.04-0.88), p=0.034).In patients with multiple rib fractures and TBI, the mechanical ventilation-free days did not differ between the two treatment groups. In addition, SSRF was associated with a significantly lower risk of pneumonia and 30-day mortality. In patients with moderate TBI, outcome was similar. In patients with severe TBI a lower 30-day mortality was observed. There was a low SSRF-related complication risk. These data suggest a potential role for SSRF in select patients with TBI.Therapeutic, level IV.

    View details for DOI 10.1097/TA.0000000000002994

    View details for PubMedID 33093293

  • Necessity of routine chest radiograph in blunt trauma resuscitation: time to evaluate dogma with evidence. The journal of trauma and acute care surgery Choi, J. n., Forrester, J. D., Spain, D. A. 2020

    View details for DOI 10.1097/TA.0000000000002793

    View details for PubMedID 32467468

  • Pulmonary contusions in patients with rib fractures: The need to better classify a common injury. American journal of surgery Choi, J. n., Tennakoon, L. n., You, J. G., Kaghazchi, A. n., Forrester, J. D., Spain, D. A. 2020

    Abstract

    Pulmonary contusions are common injuries. Computed tomography reveals vast contused lung volume spectrum, yet pulmonary contusions are defined dichotomously (unilateral vs bilateral). We assessed whether there is stepwise increased risk of pulmonary complications among patients without, with unilateral, and with bilateral pulmonary contusion.We identified adults admitted with rib fractures using the largest US inpatient database. After propensity-score-matching patients without vs with unilateral vs bilateral pulmonary contusions and adjusting for residual confounders, we compared risk for pneumonia, ventilator-associated pneumonia (VAP), respiratory failure, intubation, and mortality.Among 148,140 encounters of adults with multiple rib fractures, 19% had concomitant pulmonary contusions. Matched patients with pulmonary contusions had increased risk of pneumonia 19% [95%CI:16-33%], respiratory failure 40% [95%CI: 31-50%], and intubation 46% [95%CI: 33-61%]. Delineation showed bilateral contusions, not unilateral contusions, attributed to increased risk of complications.There is likely a correlation between contused lung volume and risk of pulmonary complications; dichotomously classifying pulmonary contusions is insufficient. Better understanding this correlation requires establishing the clinically significant contusion volume and a correspondingly refined classification system.

    View details for DOI 10.1016/j.amjsurg.2020.07.022

    View details for PubMedID 32854902

  • Surgical Infection Society Guidelines for Antibiotic Use in Patients with Traumatic Facial Fractures. Surgical infections Forrester, J. D., Wolff, C. J., Choi, J. n., Colling, K. P., Huston, J. M. 2020

    Abstract

    Background: Facial fractures are common in traumatic injury. Antibiotic administration practices for traumatic facial fractures differ widely. Methods: The Surgical Infection Society's (SIS's) Therapeutics and Guidelines Committee convened to develop guidelines for antibiotic administration in the management of traumatic facial fractures. PubMed, Embase, and the Cochrane database were searched for pertinent studies. Pre-operative antibiotics were defined as those administered more than 1 hour before surgery. Peri-operative antibiotics were those administered within 1 hour of the start of surgery depending on the type of antibiotic and as late as ≤24 hours after surgery. Post-operative antibiotics were defined as those administered >24 hours after surgery. Prophylactic antibiotics were those administered for >24 hours without a documented infection. Evaluation of the published evidence was performed with the GRADE system. Using a process of iterative consensus, all committee members voted to accept or reject each recommendation. Results: We recommend that in adult patients with non-operative upper face, midface, or mandibular fractures, prophylactic antibiotics not be prescribed and that in adult patients with operative, non-mandibular fractures, pre-operative antibiotics likewise not be prescribed. We recommend that in adult patients with operative, mandibular fractures, pre-operative antibiotics not be prescribed; and in adult patients with operative, non-mandibular facial fractures, post-operative (>24 hours) antibiotics again not be prescribed. We recommend that in adult patients with operative, mandibular facial fractures, post-operative antibiotics (> 24 hours) not be prescribed. Conclusions: This guideline summarizes the current SIS recommendations regarding antibiotic management of patients with traumatic facial fractures.

    View details for DOI 10.1089/sur.2020.107

    View details for PubMedID 32598227

  • Creation and implementation of a novel clinical workflow based on the AAST uniform anatomic severity grading system for emergency general surgery conditions. Trauma surgery & acute care open Bessoff, K. E., Choi, J. n., Bereknyei Merrell, S. n., Nassar, A. K., Spain, D. n., Knowlton, L. M. 2020; 5 (1): e000552

    Abstract

    Emergency general surgery (EGS) conditions encompass a variety of diseases treated by acute care surgeons. The heterogeneity of these diseases limits infrastructure to facilitate EGS-specific quality improvement (QI) and research. A uniform anatomic severity grading system for EGS conditions was recently developed to fill this need. We integrated this system into our clinical workflow and examined its impact on research, surgical training, communication, and patient care.The grading system was integrated into our clinical workflow in a phased fashion through formal education and a written handbook. A documentation template was also deployed in our electronic medical record to prospectively assign severity scores at the time of patient evaluation. Mixed methods including a quantitative survey and qualitative interviews of trainees and attending surgeons were used to evaluate the impact of the new workflow and to identify obstacles to its adoption.We identified 2291 patients presenting with EGS conditions during our study period. The most common diagnoses were small bowel obstruction (n=470, 20.5%), acute cholecystitis (n=384, 16.8%), and appendicitis (n=370, 16.1%). A total of 21 qualitative interviews were conducted. Twenty interviewees (95.2%) had a positive impression of the clinical workflow, citing enhanced patient care and research opportunities. Fifteen interviewees (75.0%) reported the severity grading system was a useful framework for clinical management, with five participants (25.0%) indicating the system was useful to facilitate clinical communication. Participants identified solutions to overcome barriers to adoption of the clinical workflow.The uniform anatomic severity grading system can be readily integrated into a clinical workflow to facilitate prospective data collection for QI and research. The system is perceived as valuable by users. Educational initiatives that focus on increasing familiarity with the system and its benefits will likely improve adoption of the classification system and the clinical workflow that uses it.Level III.

    View details for DOI 10.1136/tsaco-2020-000552

    View details for PubMedID 32953998

    View details for PubMedCentralID PMC7481073

  • Prospectively Assigned AAST Grade versus Modified Hinchey Class and Acute Diverticulitis Outcomes. The Journal of surgical research Choi, J. n., Bessoff, K. n., Bromley-Dulfano, R. n., Li, Z. n., Gupta, A. n., Taylor, K. n., Wadhwa, H. n., Seltzer, R. n., Spain, D. A., Knowlton, L. M. 2020

    Abstract

    The American Association for the Surgery of Trauma (AAST) recently developed a classification system to standardize outcomes analyses for several emergency general surgery conditions. To highlight this system's full potential, we conducted a study integrating prospective AAST grade assignment within the electronic medical record.Our institution integrated AAST grade assignment into our clinical workflow in July 2018. Patients with acute diverticulitis were prospectively assigned AAST grades and modified Hinchey classes at the time of surgical consultation. Support vector machine-a machine learning algorithm attuned for small sample sizes-was used to compare the associations between the two classification systems and decision to operate and incidence of complications.67 patients were included (median age of 62 y, 40% male) for analysis. The decision for operative management, hospital length of stay, intensive care unit admission, and intensive care unit length of stay were associated with both increasing AAST grade and increasing modified Hinchey class (all P < 0.001). AAST grade additionally showed a correlation with complication severity (P = 0.02). Compared with modified Hinchey class, AAST grade better predicted decision to operate (88.2% versus 82.4%).This study showed the feasibility of electronic medical record integration to support the full potential of AAST classification system's utility as a clinical decision-making tool. Prospectively assigned AAST grade may be an accurate and pragmatic method to find associations with outcomes, yet validation requires further study.

    View details for DOI 10.1016/j.jss.2020.10.016

    View details for PubMedID 33248670

  • A Novel Approach to Deliver Therapeutic Extracellular Vesicles Directly into the Mouse Kidney Cells Ullah, M., Liu, D. D., Rai, S., Razavi, M., Choi, J., Wang, J., Concepcion, W., Thakor, A. S. 2020; 9 (4): 937

    View details for DOI 10.3390/cells9040937

  • Concurrent large bowel obstruction secondary to idiopathic mesenteroaxial gastric volvulus. Trauma surgery & acute care open Anand, A., Choi, J., Jaramillo, J. D., Lau, J. 2020; 5 (1): e000582

    View details for DOI 10.1136/tsaco-2020-000582

    View details for PubMedID 33024829

  • The impact of trauma systems on patient outcomes Current Problems in Surgery Choi, J., Carlos, G., Nassar, A. K., Knowlton, L. M., Spain, D. A. 2020
  • Lessons from Epidemics, Pandemics, and Surgery. Journal of the American College of Surgeons Hakes, N. A., Choi, J. n., Spain, D. A., Forrester, J. D. 2020

    View details for DOI 10.1016/j.jamcollsurg.2020.08.736

    View details for PubMedID 32828842

  • National readmission rates after surgical stabilization of traumatic rib fractures The Journal of Cardiothoracic Trauma Cha, P. I., Hakes, N. A., Choi, J., Tennakoon, L., Spain, D. A., Forrester, J. D. 2020; 5 (1): 16-21

    View details for DOI 10.4103/jctt.jctt_6_20

  • Intravenous lidocaine as a non-opioid adjunct analgesic for traumatic rib fractures. PloS one Choi, J. n., Zamary, K. n., Barreto, N. B., Tennakoon, L. n., Davis, K. M., Trickey, A. W., Spain, D. A. 2020; 15 (9): e0239896

    Abstract

    Pain management is the pillar of caring for patients with traumatic rib fractures. Intravenous lidocaine (IVL) is a well-established non-opioid analgesic for post-operative pain, yet its efficacy has yet to be investigated in trauma patients. We hypothesized that IVL is associated with decreased inpatient opioid requirements among patients with rib fractures.We retrospectively evaluated adult patients presenting to our Level 1 trauma center with isolated chest wall injuries. After 1:1 propensity score matching patients who received vs did not receive IVL, we compared the two groups' average daily opioid use, opioid use in the last 24 hours of admission, and pain scores during admissions hours 24-48. We performed multivariable linear regression for these outcomes (with sensitivity analysis for the opioid use outcomes), adjusting for age as a moderating factor and controlling for hospital length of stay and injury severity.We identified 534 patients, among whom 226 received IVL. Those who received IVL were older and had more serious injury. Compared to propensity-score matched patients who did not receive IVL, patients who received IVL had similar average daily opioid use and pain scores, but 40% lower opioid use during the last 24 hours of admission (p = 0.002). Multivariable regression-with and without sensitivity analysis-did not show an effect of IVL on any outcomes.IVL was crudely associated with decreased opioid requirements in the last 24 hours of admission, the time period associated with opioid use at 90 days post-discharge. However, we did not observe beneficial effects of IVL on multivariable adjusted analyses; we are conducting a randomized control trial to further evaluate IVL's opioid-sparing effects for patients with rib fractures.

    View details for DOI 10.1371/journal.pone.0239896

    View details for PubMedID 32986770

  • Evidenced-Based Practice Among Trainees: A Survey on Facial Trauma Wound Management. Journal of surgical education Choi, J. n., Traboulsi, A. A., Okland, T. S., Sadauskas, V. n., Perrault, D. n., Spain, D. A., Lorenz, H. P., Weiser, T. G. 2020

    Abstract

    Assess whether facial trauma wound care and antibiotic use recommendations are guided by evidence-based practice (EBP) or practice patterns, and investigate strategies to improve EBP adoption among surgical trainees.We conducted a survey of all trainees who manage facial trauma (general surgery, emergency medicine, plastic surgery, otolaryngology) to assess clinical knowledge and sources of treatment recommendations. Clinical questions were based on Oxford Center for Evidence-Based Medicine Level 1 or 2 evidence. We measured internal validity of questions using Cronbach's α. Results were weight-adjusted for nonresponse and then analyzed using Welch t test and descriptive statistics.Stanford Hospital and Clinics, a Level I trauma center.Response rate was 50.3% overall (78/155). For recommendations on facial trauma wound and antibiotic use, nonspecialty junior residents most frequently relied on their own senior or specialty residents (79.1%); nonspecialty senior residents relied on specialty residents (67.9%). Specialty junior residents most often relied on their own senior residents (51.0%), the majority of whom made recommendations based on their own knowledge (73.2%). Questions assessing EBP knowledge had Cronbach's α of 0.98; response accuracy was similar between specialty and nonspecialty residents (54.6% vs 55.5%, p = 0.96). When provided recommendations that conflict with EBP, both nonspecialty and specialty residents more frequently followed recommendations rather than EBP; junior residents reported doing so to avoid conflict with superiors. Total 92.6% of surveyed residents felt cross-departmental EBP guidelines would improve patient care.Facial trauma wound care and antibiotic recommendations disseminate down seniority and from craniofacial specialty to nonspecialty residents, yet knowledge of EBP among senior specialty and nonspecialty residents was weak. EBP may be difficult to adopt in the absence of consensus society guidelines. To address this gap, we published a review of EBP for facial trauma and plan to update our trauma manual with cross-departmental guidelines to facilitate EBP adoption among trainees.

    View details for DOI 10.1016/j.jsurg.2020.03.015

    View details for PubMedID 32461098

  • Review of Facial Trauma Management. The journal of trauma and acute care surgery Choi, J. n., Lorenz, H. P., Spain, D. A. 2020

    Abstract

    Facial trauma afflicts significant morbidity and mortality with potential to compromise critical adjacent structures. Facial trauma management is often entrusted to the hands of the craniofacial surgeon; evidence-based practice may be difficult to distinguish from outdated practice for the non-craniofacial trauma surgeon. We review up-to-date evidence in facial trauma management relevant for trauma surgeons, and highlight areas needing further research.Review.

    View details for DOI 10.1097/TA.0000000000002589

    View details for PubMedID 31972757

  • Altered Mental Status and Hypercalcemia with a Splenic Mass. The journal of trauma and acute care surgery Khan, S., Choi, J., Patel, S. A., Spain, D. A. 2019

    View details for DOI 10.1097/TA.0000000000002534

    View details for PubMedID 31688787

  • Atraumatic acute forearm compartment syndrome due to systemic heparin. Trauma surgery & acute care open Chavez, G. n., Choi, J. n., Fogel, N. n., Jaramillo, J. D., Murphy, M. n., Spain, D. n. 2019; 4 (1): e000399

    View details for DOI 10.1136/tsaco-2019-000399

    View details for PubMedID 31799418

    View details for PubMedCentralID PMC6861105

  • Meckel's Diverticulum Fistulization: Another Complication to Consider. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract Choi, J. n., Hawn, M. n. 2019

    View details for DOI 10.1007/s11605-019-04378-8

    View details for PubMedID 31468335

  • LAPRA-TY for laparoscopic repair of traumatic diaphragmatic hernia without intracorporeal knot tying. Trauma surgery & acute care open Choi, J. n., Pan, J. n., Forrester, J. D., Spain, D. n., Browder, T. D. 2019; 4 (1): e000334

    Abstract

    A 38-year-old man was brought in by ambulance as a trauma activation after sustaining a self-inflicted stab wound in the left upper quadrant with a kitchen knife. His primary survey was unremarkable and his vital signs were normal. Secondary survey revealed a 2 cm transverse stab wound inferior and medial to the left nipple. Extended focused assessment with sonography for trauma (FAST) did not show intra-abdominal or pericardial fluid and chest X-ray did not show a definite pneumothorax or hemothorax.Wound exploration at bedside.Admit for observation and serial examinations.Exploratory laparotomy and open repair of traumatic diaphragmatic injury (TDI).Thoracotomy and open repair of TDI.Diagnostic laparoscopy and laparoscopic repair of TDI.

    View details for DOI 10.1136/tsaco-2019-000334

    View details for PubMedID 31321313

    View details for PubMedCentralID PMC6606065

  • Perianal Extramammary Paget's Disease: More Than Meets the Eye. Digestive diseases and sciences Choi, J. n., Zemek, A. n., Lee, G. K., Kin, C. n. 2018

    View details for PubMedID 29696480

  • A Novel Approach for Therapeutic Delivery to the Rodent Pancreas Via Its Arterial Blood Supply. Pancreas Choi, J. n., Wang, J. n., Ren, G. n., Thakor, A. S. 2018; 47 (7): 910–15

    Abstract

    Endovascular techniques can now access the arterial blood supply of the pancreas in humans to enable therapeutics to reach the gland in high concentrations while concurrently avoiding issues related to non-targeted delivery. However, there is no way to replicate this in small animals. In a rat model, we therefore developed a novel non-terminal technique to deliver therapeutics to different regions of the pancreas, via its arterial blood supply.In female Wistar rats, selective branches of the celiac artery were temporarily ligated, depending on the region of the pancreas being targeted. Trypan blue dye was then administered as a surrogate marker for a therapeutic agent, via the celiac artery, and its staining/distribution throughout the pancreas determined. Postoperatively, animals were monitored daily, and serum was evaluated for markers of pancreatitis, liver, and metabolic function.Using this technique, we could selectively target the head, body/tail, or entire gland of the pancreas, via its arterial blood supply, with minimal nontarget staining. Following the procedure, all animals recovered with no evidence of pancreatitis or liver/metabolic dysfunction.Our study demonstrates a novel technique that can be used to selectively deliver therapeutics directly to the rat pancreas in a safe manner with full recovery of the animal.

    View details for PubMedID 29975350

  • Systems approach to uncover signaling networks in primary immunodeficiency diseases. journal of allergy and clinical immunology Choi, J., Fernandez, R., Maecker, H. T., Butte, M. J. 2017

    View details for DOI 10.1016/j.jaci.2017.03.025

    View details for PubMedID 28412396

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