Papers by Mallory Williams
Trauma surgery & acute care open, 2021
Background The COVID-19 pandemic has had farreaching effects on healthcare systems and society wi... more Background The COVID-19 pandemic has had farreaching effects on healthcare systems and society with resultant impact on trauma systems worldwide. This study evaluates the impact the pandemic has had in the Washington, DC Metropolitan Region as compared with similar months in 2019. Design A retrospective multicenter study of all adult trauma centers in the Washington, DC region was conducted using trauma registry data between
Journal of Surgical Education, Nov 1, 2022
American Journal of Surgery, Dec 1, 2016
A significant proportion of hospital admissions in the US are secondary to emergency general surg... more A significant proportion of hospital admissions in the US are secondary to emergency general surgery (EGS). The aim of this study is to quantify outcomes for EGS patients with cancer. The Nationwide Inpatient Sample (2007 to 2011) was queried for patients with a diagnosis of an EGS condition as determined by the American Association for the Surgery of Trauma. Of these, patients with a diagnosis of malignant cancers (ICD-9-CM diagnosis codes; 140-208.9, 238.4, 289.8) were identified. Patients with and without cancer were matched across baseline characteristics using propensity-scores. Outcome measures included all-cause mortality, complications, failure-to-rescue, length of stay, and cost. Multivariable logistic regression analyses further adjusted for hospital characteristics and volume. Analysis of 3,625,906 EGS patients revealed an 8.9% prevalence of concurrent malignancies. The most common EGS conditions in cancer patients included gastro-intestinal bleeding (24.8%), intestinal obstruction (13.5%), and peritonitis (10.7%). EGS patients with cancer universally had higher odds of complications (odds ratio [OR] 95% confidence interval [CI]: 1.20 [1.19 to 1.21]), mortality (OR [95% CI]: 2.00 [1.96 to 2.04]), failure-to-rescue (OR [95% CI]: 1.52 [1.48 to 1.56]), and prolonged hospital stay (OR [95% CI]: 1.69 [1.67 to 1.70]). EGS patients with concurrent cancer have worse outcomes compared with patients without cancer after risk-adjustment.
Journal of the National Medical Association, Feb 1, 2018
While much progress has occurred since the civil rights act of 1964, minorities have continued to... more While much progress has occurred since the civil rights act of 1964, minorities have continued to suffer disparate and discriminatory access to economic opportunities, education, housing, health care and criminal justice. The latest challenge faced by the physicians and public health providers who serve the African American community is the detrimental, and seemingly insurmountable, causes and effects of violence in impoverished communities of color. According to statistics from the Centers for Disease Control (CDC), the number one killer of black males ages 10e35 is homicide, indicating a higher rate of violence than any other group. Black females are four times more likely to be murdered by a boyfriend or girlfriend than their white counterparts, and although intimate partner violence has declined for both black and white females, black women are still disproportionately killed. In addition, anxiety and depression that can lead to suicide is on the rise among African American adolescents and adults. Through an examination of the role of racism in the perpetuation of the violent environment and an exploration of the effects of gang violence, intimate partner violence/child maltreatment and police use of excessive force, this work attempts to highlight the repercussions of violence in the African American community. The members of the National Medical Association have served the African American community since 1895 and have been advocates for the patients they serve for more than a century. This paper, while not intended to be a comprehensive literature review, has been written to reinforce the need to treat violence as a public health issue, to emphasize the effect of particular forms of violence in the African American community and to advocate for comprehensive policy reforms that can lead to the eradication of this epidemic. The community of African American physicians must play a vital role in the treatment and prevention of violence as well as advocating for our patients, family members and neighbors who suffer from the preventable effects of violence.
The American Surgeon™
Background This study aimed to investigate the relationship between community-level economic depr... more Background This study aimed to investigate the relationship between community-level economic deprivation, as measured by the Distressed Communities Index (DCI) and ED visits on account of firearm injuries (assaults and unintentional). Methods A retrospective analysis was conducted using the Maryland State Emergency Department Databases (SEDD) from January 2019 to December 2020 to explore the association between the DCI and ED visits because of firearm injuries (assaults and unintentional). The DCI utilizes 7 variables, based on zip codes, generating 5 levels of socioeconomic distress (prosperous, comfortable, mid-tier, at-risk, and distressed). In a multivariate analysis, we adjusted for age, sex, mental conditions, alcohol addiction, substance abuse, smoking, race/ethnicity, insurance type, and median income. Results Of the 2725 ED visits for firearm injuries, 84.5% were Black and 88.5% male. The median age was 27 (21-35) years, and the mortality rate was 17.7%. A statistically sig...
Annals of Surgery, 2021
Objective: To examine patterns and trends of firearm injuries in a nationally representative samp... more Objective: To examine patterns and trends of firearm injuries in a nationally representative sample of US women. Summary of Background Data: Gun violence in the United States exceeds rates seen in most other industrialized countries. Due to the paucity of data little is known regarding demographics and temporal variations in firearm injuries among women. Methods: Data were extracted from the Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System (2001–2017) for women 18 years and older. Number of nonfatal firearm assaults and homicide per year were extracted and crude population-based injury rates were calculated. Sub-stratification by age-group and time period were performed. Results: Between 2001 and 2017, there were 88,823 nonfatal firearm assaults involving women and 29,106 firearm homicides. There were 4116 victims of nonfatal firearm assault in 2001 (3.8 per 105) and 12,959 by 2017 (10.0 per 105). Homicide rates were 1.5 per 105...
The American Surgeon, 2021
Firearms are a leading cause of injury and death among children in the United States. Most gun vi... more Firearms are a leading cause of injury and death among children in the United States. Most gun violence studies highlight mortality, but few have examined the morbidity in disfiguring injuries suffered by children. Using National Trauma Data Bank 2007-2015, children who suffered gunshot injuries and underwent procedures with lasting physical disfigurement formed the cohort of this study. We identified 28 593 children as victims of firearm injuries. Most were aged 13-18 (84%). There was a preponderance of male gender (86%) and black race/ethnicity (57%). Total mortality was 3774 (13%), and 1500 (5.4%) were identified with one or more disfigurements: 220 amputations, 191 craniectomy, 100 enucleation, 533 ileostomy/colostomy, and 557 tracheostomies. This report highlights the large toll firearm injuries take on American children, specifically in non-concealable disfigurements. These injuries are very impactful to their education and overall socialization and therefore must be a part of...
Journal of The National Medical Association, 2020
Let V be a finite-dimensional vector space over a finite field and let f be a trilinear alternati... more Let V be a finite-dimensional vector space over a finite field and let f be a trilinear alternating form over V. For such forms, we introduce two new invariants. Together with a generalized radical polynomial used for classification of forms in dimension 8 over GF(2), they are sufficient to distinguish between all trilinear alternating forms in dimension 9 over GF(2). To prove the completeness of the list of forms, we computed their groups of automorphisms. There are 31 degenerate and 317 nondegenerate forms. We point out some forms with either small or large automorphism group.
Journal of the American College of Surgeons, 2019
RESULTS: During the study period, 12,633 had firearm-related injuries that took place at home. 6,... more RESULTS: During the study period, 12,633 had firearm-related injuries that took place at home. 6,285 cases (49.75%) were victims of assault. Self-inflicted injuries came in second with 4,497 cases (35.65%) and unintentional injuries at 14.45%. Case fatality rates were highest among self-inflicted injuries at 52.19%, followed by assault (12.85%) and unintentional injuries at 5.87%. Age less than 45, black and Hispanic race were disproportionately the victims of assault. Elderly and white patients were prone to self-inflicted injuries. Psychiatric illness and alcohol use disorder play a role in self-inflicted injuries, whereas drug use disorder was associated with assault. White race and American Indian status were associated with unintentional injuries. CONCLUSION: Assaults are the most common cause of homerelated gun violence, while suicide remains the most lethal. Strategies that address psychiatric illness and substance abuse appear to be options in reducing injuries due to gun-related incidents in the home.
Journal of Pediatric Surgery, 2019
Introduction: Acute rehabilitation following traumatic injuries is associated with improved funct... more Introduction: Acute rehabilitation following traumatic injuries is associated with improved functional recovery. Access is often limited to patients at the time of hospital discharge. This phenomenon remains less well described in children, who may have more to benefit with rehabilitation posttrauma. This study aims to determine factors influencing access to rehabilitation among children with traumatic injuries utilizing a nationally representative sample. Methods: The Kids Inpatient Database (2000-2012) was queried for trauma patients. The outcome measure of interest was discharge with rehabilitative services [acute rehabilitation facilities or home healthcare (HHC)]. Patients that did not survive and those that did not meet hospital admission criteria were excluded. Multivariable models adjusted for age, race/ethnicity, gender, insurance-status, income, injury severity score, year, children's hospital designation, hospital-volume, teaching status, location, and geographical region. Results: A total of 811,941 records were included. These were predominantly male (65.9%) with an average age of 11.6 (±6.7) years. 4.2% were discharged to rehabilitation facilities, and 3.9% were discharged with HHC. African-American and Hispanic patients were less likely to be placed/have access to rehabilitation facilities (p b 0.001). Similarly, uninsured patients were less likely to receive these services postdischarge (p b 0.05). However, patients with government insurance, those in the highest income-quartile, those treated at children's hospitals, and those treated at teaching and urban hospitals were more likely to be placed/have access to rehabilitation services. Conclusion: Race/ethnicity and insurance status are associated with disparities in access to postdischarge rehabilitation in pediatric trauma patients. Moreover, treatment at designated children's, teaching and urban hospitals betterfacilitates discharge planning with rehabilitative services.
Digestive Diseases and Sciences, 2004
Essential Clinical Anesthesia, 2011
BMC Public Health, 2010
BackgroundSedentary behavior is considered a separate construct from physical activity and engagi... more BackgroundSedentary behavior is considered a separate construct from physical activity and engaging in sedentary behaviors results in health effects independent of physical activity levels. A major source of sedentary behavior in children is time spent viewing TV or movies, playing video games, and using computers. To date no study has examined the impact of neighborhood socioeconomic status (SES) on pre-school children's screen time behavior.MethodsProxy reports of weekday and weekend screen time (TV/movies, video games, and computer use) were completed by 1633 parents on their 4-5 year-old children in Edmonton, Alberta between November, 2005 and August, 2007. Postal codes were used to classified neighborhoods into low, medium or high SES. Multiple linear and logistic regression models were conducted to examine relationships between screen time and neighborhood SES.ResultsGirls living in low SES neighborhoods engaged in significantly more weekly overall screen time and TV/movie...
The American Surgeon™
Introduction The obesity epidemic is an important public health problem in the United States. Pre... more Introduction The obesity epidemic is an important public health problem in the United States. Previous studies have revealed the association between obesity and various surgical complications. Tracheostomy which is an important lifesaving procedure may prove technically challenging in an obese patient. This study sought to evaluate the association between obesity and early complications following standard tracheostomy using a national registry. Methods Adult patients who underwent tracheostomy from 2007 to 2017 were analyzed using the Nationwide Inpatient Sample (NIS). The population was stratified into obese and non-obese groups. Early complications following standard tracheostomy were identified and compared between the two groups. Multivariable logistic regression analyses were performed to assess the association between obesity and early complications following tracheostomy. Results Data pertaining to 205 032 adult patients were evaluated. Obese patients accounted for 12.1% (n =...
The American Surgeon™
Background The objective of this study was to identify predictors of mortality among patients pre... more Background The objective of this study was to identify predictors of mortality among patients presenting to the emergency department (ED) with attempted suicides. Methods We analyzed data on emergency department (ED) visits for attempted suicides from the Nationwide Emergency Department Sample (NEDS) database from January 2010 to December 2017. The predictors of mortality were determined in multivariate analysis including age, sex, insurance, annual income, region of the country, mechanism of injury, mental health conditions (schizophrenia; depression; and anxiety, bipolar, and personality disorders), chronic illnesses (hypertension, diabetes, obesity, and dementia), and social risk factors such as alcohol addiction, smoking, and substance abuse. Results From 2010 to 2017, there were 979,383 ED visits for attempted suicides in the NEDS database. Among these patients, 10,301 (1.1%) died. Of these completed suicides, 73.9% were male with the median age of 43 years (IQR, 30) while the ...
The American Surgeon
A retrospective review of 222 consecutive patients with duodenal injuries admitted to an urban Le... more A retrospective review of 222 consecutive patients with duodenal injuries admitted to an urban Level 1 Trauma Center who subsequently underwent laparotomy during the period July 1980 to April 2002 was performed in an effort to elucidate factors associated with mortality, infectious morbidity, and length of stay in these patients. Predictably, the patients were predominantly male (92.7%) and young (mean age, 31.6 years). The overall mortality rate was 22.5 per cent, with a mortality rate of 18 per cent seen in the first 48 hours. Penetrating trauma was suffered by 88.3 per cent of the patients. Multivariate analysis revealed the performance of a thoracotomy, initial emergency department (ED) systolic blood pressure (SBP) <90 mm Hg, final operating room (OR) core body temperature less than 35°C, and presence of a splenic injury to be the most important predictors of mortality (all P < 0.05). Mortality in the patients undergoing a resuscitative thoracotomy was 88.9 per cent versu...
The symptom triad of constipation, severe abdominal pain, and a distended abdomen is common in pa... more The symptom triad of constipation, severe abdominal pain, and a distended abdomen is common in patients with sigmoid volvulus. Sigmoid volvulus is responsible for 5% to 7% of all intestinal obstructions 1 and is the third leading cause of large bowel obstruction. 5 In the United States, sigmoid volvu-lus is classically described as an illness in elderly persons, persons with psychiatric disorders, or persons residing in nursing homes or mental institutions. 6 However, some reports suggest that sigmoid volvulus occurs in younger age-groups more frequently than has been reported. 7–10 This report reviews the case of a 46-year-old previously healthy man with sigmoid volvulus. A 46-year-old African-American man with a history of untreated hypertension presented to the emergency department for evaluation of constipation that had been present for 6 days and severe left lower quadrant abdominal pain that had been present for 6 hours. He was normotensive, nontachycardic, and in moderate acu...
Times in which natural disasters and crisis restrict movement of individuals are critical moments... more Times in which natural disasters and crisis restrict movement of individuals are critical moments of increase in intimate partner violence. Well-described contributing factors in the literature are social isolation, stress, substance abuse, economic anxiety, and lack of accessible public resources. COVID-19 provides healthcare providers with an intense model of how pandemics create an unfortunate perfect storm for the perpetuation of intimate partner violence and how we must be prepared to respond in the future.
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Papers by Mallory Williams