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Impulsiveness is a personality trait that reflects an urge to act spontaneously, without thinking or planning ahead for the consequences of your actions. High impulsiveness is characteristic of a variety of problematic behaviors including attention deficit disorder, hyperactivity, excessive gambling, risk-taking, drug use, and alcoholism. Researchers studying attention and self-control often assess impulsiveness using personality questionnaires, notably the common Barratt Impulsiveness Scale version 11 (BIS-11; last revised in 1995). Advances in techniques for producing personality questionnaires over the last 20 years prompted us to revise and improve the BIS-11. We sought to make the revised scale shorter – so that it would be quicker to administer – and better matched to current behaviors. We analyzed responses from 1549 adults who took the BIS-11 questionnaire. Using a statistical technique called factor analysis, we eliminated 17 questions that did a poor job of measuring the three major types of impulsiveness identified by the scale: inattention, spontaneous action, and lack of planning. We constructed our ABbreviated Impulsiveness Scale (ABIS) using the remaining 13 questions. We showed that the ABIS performed well when administered to additional groups of 657 and 285 adults. Finally, we showed expected relationships between the ABIS and other personality measurements related to impulsiveness, and showed that the ABIS can help predict alcohol consumption. We present the ABIS as a useful and efficient tool for researchers interested in measuring impulsive personality.

Objectives: This study highlights demographics and orthopaedic injuries of electric scooter–related trauma that presented to our institution over a 27-month period. Design: Retrospective review. Setting: Urban Level 1 trauma center. Patients: Patients presenting to the emergency department, trauma bay, or outpatient clinic after electric scooter injury were identified from November 2017 through January 2020 using ICD-10 diagnosis codes. Main Outcomes: Patient charts were reviewed for demographics, injury characteristics, imaging, treatment, perioperative data, and Injury Severity Scores. Results: Four hundred eighty-five patients presented during the study period. Of these, 44% had orthopaedic injuries, including 30% with pelvis or extremity fractures. There were 21 (10%) polytraumatized patients in the orthopaedic cohort. The age ranged from 16 to 79 years (average 36 years), with 58% men, and 18% were visitors from out of town. Of 49 patients requiring orthopaedic surgery, 8 underwent surgery on an urgent basis. The average Injury Severity Score for orthopaedic patients was 8.4 with a median of 5.0 for nonoperative injuries versus a significantly higher median of 16.0 for operative injuries. Twenty-nine percent of patients were intoxicated and only 2% wore a helmet. Conclusions: Electric scooter injuries are increasing, and many patients sustain high-energy injuries. As electric scooter use continues to increase, the prevalence of orthopaedic injuries is also likely to rise. Further studies are needed to fully understand the impact scooter-related injuries have on individual patients and the health care system. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Malnutrition is not uncommon in arthroplasty patients, and hypoalbuminemia has been shown to be predictive of postoperative complications. The authors sought to compare albumin concentration with a global assessment of physical health, the American Society of Anesthesiologists (ASA) score, to further discriminate the importance of albumin in predicting postoperative complications. A cohort of 128,412 patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) were identified from 2005 to 2015 through use of the American College of Surgeons National Surgical Quality Improvement Program database. Patients were divided based on surgery performed, albumin concentration (with <3.5 g/dL defining hypoalbuminemia), and ASA score (≤2 vs >2). Postoperative complications were evaluated through multivariable regression analyses adjusted for age, sex, body mass index, and current smoking status. The study population included 48,751 THA and 79,661 TKA patients. On multivariable analyses, both hypoalbuminemia and ASA score were significant ( P <.05) predictors of complications such as death, superficial infection, pneumonia, renal insufficiency, reintubation, transfusion, readmission, and reoperation. Furthermore, hypoalbuminemia more robustly predicted deep infection for THA patients, as well as superficial infection for TKA patients. American Society of Anesthesiologists score was otherwise predictive of more postoperative complications than hypoalbuminemia within the TKA group and provided similar predictability within the THA group. Albumin is associated with complications following THA and TKA, and if used in conjunction with ASA score, albumin contributes to enhanced risk stratification. The authors recommend that a preoperative albumin concentration be obtained and efforts made to modify this risk factor prior to elective arthroplasty. [ Orthopedics . 2018; 41(6):354–362.]

Hip fractures are common in elderly patients, and which surgical modality to pursue is often debated. Malnutrition, which cannot be corrected preoperatively in this population, is often not considered. Therefore, the authors sought to investigate the association between hypoalbuminemia and postoperative outcomes based on surgical intervention. Patients undergoing arthroplasty (hemiarthroplasty or total hip arthroplasty), open reduction and internal fixation, and intramedullary nailing placement for treatment of hip fractures were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Patients were stratified by preoperative albumin level, with less than 3.5 g/dL indicating hypoalbuminemia. Albumin's association with postoperative complications was evaluated with multivariate logistic regression controlling for patient age, body mass index, American Society of Anesthesiologists score, and functional independence. A total of 20,278 patients with hip fractures and available albumin levels were included. Multivariate analysis revealed hypoalbuminemia was predictive of readmission, reintubation, mortality, and length of stay for all surgeries performed. When analyzing across surgical modalities, unique complications were identified for patients with hypoalbuminemia undergoing open reduction and internal fixation/prosthetic replacement (reoperation, P<.001) and arthroplasty (any infection, P=.028) compared with other treatment options. Hypoalbuminemia can predict postoperative complications for patients with hip fractures and should be considered preoperatively to guide surgical decision making in equivocal cases where multiple modalities may be used based on fracture pattern. This study supports that, compared with other interventions, intramedullary nailing is associated with fewer postoperative complications in patients with hypoalbuminemia. [Orthopedics. 2018; 41(6):e789-e796.].

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This document describes the two quality measures included in the Comprehensive Care for Joint Replacement (CJR) model, the collection and submission of patient-reported outcomes (PRO) and risk variable data for measure development, linking CJR participant hospitals' performance on quality measures to payment, and the public reporting of quality measure results for hospitals participating in CJR.