Research Projects

  • Describing Cannabidiol Use Patterns and Effects on Quality of Life in a Convenience Sample of Children with Cerebral Palsy (MedScholars Project)

All Publications

  • Optimizing Orthopaedic Trauma Implant Pricing Through a Data-Driven and Surgeon-Integrated Approach. Journal of orthopaedic trauma Seltzer, R., Johnson, J. R., McFarlane, K., Chawla, A., Chamberlain, S., Kohler, M., Sheth, K., Wall, J. K., Bishop, J., Gardner, M., Shea, K. G. 2022


    To determine if market-based pricing could be coupled with surgeon integration into negotiation strategies to achieve lower pricing levels for orthopaedic trauma implants. A secondary aim was to identify specific types of implants that may offer larger opportunities for cost savings.Market pricing levels were reviewed from two industry implant databases. This information was used by surgeons and supply chain management (SCM) at our institution to select appropriate target pricing levels (25th percentile) for commonly used orthopaedic trauma implants. Target price values were provided to the existing 12 vendors utilized by our institution with a clear expectation that vendors meet these thresholds.Benchmark modeling projected a potential savings of 20.0% over our prior annual spend on trauma implants. Following two rounds of negotiation, savings amounted to 23.0% of prior annual spend. Total savings exceeded 1,000,000 USD with 11 of 12 vendors (91.7%) offering net savings. Total percent savings were highest for external fixators, drill bits, and K-wires. Plates and screws comprised the greatest proportion of our prior annual spend and achieved similar savings.A surgeon and supply chain coordinated effort led to major cost savings without a need for consolidation of vendors.

    View details for DOI 10.1097/BOT.0000000000002560

    View details for PubMedID 36728607

  • ICD-10 codes do not accurately reflect ankle fracture injury patterns. Injury Seltzer, R. A., Van Rysselberghe, N. L., Fithian, A. T., LaPrade, C. M., Sharma, J., Oquendo, Y. A., Michaud, J. B., DeBaun, M. R., Gardner, M. J., Bishop, J. A. 2021


    To determine the accuracy of International Classification of Disease Version 10 (ICD-10) coding for ankle fracture injury patterns.Retrospective cohort study PATIENTS: 97 adult patients with fractures about the ankle (rotational ankle fracture or distal tibia fracture) from 2016 to 2020, selected by stratified random sampling.Assignment of an ICD-10 code representative of a rotational ankle fracture, pilon fracture, or unspecified fracture of the lower leg.Injury radiographs were reviewed by three authors to determine the correct code. Agreement between the correct code and the electronic medical record (EMR) assigned code was determined using kappa's statistic in the aggregate as well as percent agreement, sensitivity, specificity, and positive predictive value (PPV) between individual codes.59 of 97 cases (60.8%) demonstrated discordance between the existing EMR and surgeon-assigned codes. Aggregate agreement between all codes was fair (K = 0.26). Lateral malleolus fracture codes demonstrated the highest PPV (0.91, 95% CI 0.72-0.99), while the lowest PPV was found for "other fractures of the lower leg" (0.05, 95% CI 0.0-0.24) and "other fracture of the fibula" (0.0, 95% CI 0.0-0.15). Generalized "other fracture" codes comprised 45% of EMR codes compared to only 6% of assigned codes (p < 0.001). EMR codes were specific but not sensitive.There is substantial discordance between existing EMR and surgeon-assigned ICD-10 codes for ankle fractures. Database research that relies on ICD-10 coding as a surrogate for primary clinical data should be interpreted with caution and institutions should make efforts to increase the accuracy of their coding.

    View details for DOI 10.1016/j.injury.2021.10.005

    View details for PubMedID 34654551

  • Changes in Pediatric Sports Injury Presentation During the COVID-19 Pandemic: A Multicenter Analysis. Orthopaedic journal of sports medicine Johnson, M. A., Halloran, K. n., Carpenter, C. n., Pascual-Leone, N. n., Parambath, A. n., Sharma, J. n., Seltzer, R. n., Ellis, H. B., Shea, K. G., Ganley, T. J. 2021; 9 (4): 23259671211010826


    The current coronavirus 2019 (COVID-19) pandemic has prompted a multitude of public health response measures including social distancing, school cancellations, and cessation of organized sports.To examine the impact of COVID-19 and corresponding public health measures on the characteristics of common pediatric musculoskeletal injuries associated with sports.Cohort study; Level of evidence, 3.This was a multicenter retrospective cohort study comparing patients with sports injuries presenting to 3 geographically diverse level I pediatric trauma hospitals and outpatient orthopaedic surgery clinics in the United States during the COVID-19 pandemic and a prepandemic period at the same institutions. Patients were included if they presented for care between February 15 and July 15 in 2020 (pandemic cohort) or between March 15 and April 15 in 2018 and 2019 (prepandemic cohort).Included were 1455 patients with an average age of 12.1 ± 4.5 years. When comparing patients presenting in 2018 and 2019 with those presenting in 2020, we observed a decrease in mean age during the pandemic (12.6 ± 4.0 vs 11.0 ± 5.2 years; P = .048). Additionally, a decrease in the proportion of injuries attributed to sports (48.8% vs 33.3%; P < .001) and those occurring at school (11.9% vs 4.0%; P = .001) was observed. The proportion of injuries attributable to clavicle fractures increased during the early stages of the pandemic (13.2% vs 34.7%; P < .001). There was no statistically significant delay to care in injuries presenting during the pandemic (41.5 ± 141.2 vs 19.23 ± 79.1 days; P = .175).Across 3 tertiary care institutions, patients were seen without significant delay during the pandemic. We observed a significant decline in pediatric musculoskeletal injuries associated with sports during the COVID-19 pandemic. This decrease has been accompanied by a shift in both injury type and mechanism.

    View details for DOI 10.1177/23259671211010826

    View details for PubMedID 33997072

    View details for PubMedCentralID PMC8107815

  • A Multidomain Approach to Assessing the Convergent and Concurrent Validity of a Mobile Application When Compared to Conventional Methods of Determining Body Composition. Sensors (Basel, Switzerland) Neufeld, E. V., Seltzer, R. A., Sazzad, T. n., Dolezal, B. A. 2020; 20 (21)


    Determining body composition via mobile application may circumvent limitations of conventional methods. However, the accuracy of many technologies remains unknown. This investigation assessed the convergent and concurrent validity of a mobile application (LS) that employs 2-dimensional digital photography (LS2D) and 3-dimensional photonic scanning (LS3D). Measures of body composition including circumferences, waist-to-hip ratio (WHR), and body fat percentage (BF%) were obtained from 240 healthy adults using LS and a diverse set of conventional methods-Gulick tape, bioelectrical impedance analysis (BIA), and skinfolds. Convergent validity was consistently high-indicating these methods vary proportionally and can thus reliably detect changes despite individual measurement differences. The span of the Limits of Agreement (LoA) using LS were comparable to the LoA between conventional methods. LS3D exhibited high agreement relative to Gulick tape in the measurement of WHR, despite poor agreement with individual waist and hip circumferences. In BF%, LS2D exhibited high agreement with BIA and skinfold methods, whereas LS3D demonstrated low agreement. Interestingly, the low inferred bias between LS3D and DXA using existing data suggests that LS3D may have high agreement with dual-energy x-ray absorptiometry. Overall, the suitability of LS2D and LS3D to replace conventional methods must be based on an individual user's criteria.

    View details for DOI 10.3390/s20216165

    View details for PubMedID 33138133

  • 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


    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

  • 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


    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