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Ram Nirula
( out of 38 reviews )

Ram Nirula, MD, MPH

Languages spoken: English

Clinical Locations

University of Utah Hospital

General Surgery, Area E
801-585-7403
  • Dr. Nirula's clinical interests lie in general surgery with a specific interest in chronic pain from rib fractures, hernias, abdominal wall reconstruction, emergency and urgent surgical conditions.

    Board Certification

    American Board of Surgery (Sub: General Surgery)
    American Board of Surgery (Sub: Surgical Critical Care)

    Patient Rating

    4.6 /5
    ( out of 38 reviews )

    The patient rating score is an average of all responses on our patient experience survey. The rating averages scores for all questions about care from our providers.

    The scale on which responses are measured is 1 to 5 with 5 being the best score.

    Patient Comments

    Patient comments are gathered from our patient experience survey and displayed in their entirety.
    Patients are de-identified for confidentiality and patient privacy.

    February 22, 2023
    UH HOSPITALS AND CLINICS

    Friendly had lots of confidence gave me confidence

    January 19, 2023
    UH HOSPITALS AND CLINICS

    Awesome I'm elated maybe temporaryly if the operation is a no go

    January 10, 2023
    UH HOSPITALS AND CLINICS

    Dr is knowledgeable and very respectful.

    September 04, 2022
    UH HOSPITALS AND CLINICS

    Very patient with the patient and his wife was the doctor.

    May 30, 2022
    UH HOSPITALS AND CLINICS

    Dr seemed to care little about my situation. My wife said, "we just want to get him (me) healthy." Dr replied, "well, that's not going to happen." It was very disappointing.

    January 22, 2022
    UH HOSPITALS AND CLINICS

    The Dr. Told me he would contact mt with his decision once imageing was available to him. No body has called, It has ben about 2 weeks.

  • Dr. Nirula's clinical interests lie in general surgery with a specific interest in chronic pain from rib fractures, hernias, abdominal wall reconstruction, emergency and urgent surgical conditions.

    Board Certification and Academic Information

    Academic Departments Surgery -Primary
    Academic Divisions General Surgery
    Board Certification
    American Board of Surgery (Sub: General Surgery)
    American Board of Surgery (Sub: Surgical Critical Care)

    Education history

    Fellowship Surgical Critical Care - University of Washington Harborview Medical Center Fellow
    University of Washington M.P.H.
    Residency General Surgery - Santa Barbara Cottage Hospital Resident
    General Surgery - Santa Barbara Cottage Hospital Intern
    Professional Medical Medicine - University of Manitoba M.D.
    Life Sciences - Queen's University, Kingston B.A.

    Selected Publications

    Journal Article

    1. Albert RK, Jurkovich GJ, Connett J, Helgeson ES, Keniston A, Voelker H, Lindberg S, Proper JL, Bochicchio G, Stein DM, Cain C, Tesoriero R, Brown CVR, Davis J, Napolitano L, Carver T, Cipolle M, Cardenas L, Minei J, Nirula R, Doucet J, Miller PR, Johnson J, Inaba K, Kao L (2023). Sigh Ventilation in Patients With Trauma: The SiVent Randomized Clinical Trial. JAMA.
    2. Gruen DS, Brown JB, Guyette FX, Johansson PI, Stensballe J, Li SR, Leeper CM, Eastridge BJ, Nirula R, Vercruysse GA, OKeeffe T, Joseph B, Neal MD, Sperry JL (2023). Prehospital tranexamic acid is associated with a dose-dependent decrease in syndecan-1 after trauma: A secondary analysis of a prospective randomized trial. J Trauma Acute Care Surg.
    3. Deeb AP, Guyette FX, Daley BJ, Miller RS, Harbrecht BG, Claridge JA, Phelan HA, Eastridge BJ, Joseph B, Nirula R, Vercruysse GA, Sperry JL, Brown JB (2023). Time to early resuscitative intervention association with mortality in trauma patients at risk for hemorrhage. J Trauma Acute Care Surg, 94(4), 504-512.
    4. Mukherjee K, Schubl SD, Tominaga G, Cantrell S, Kim B, Haines KL, Kaups KL, Barraco R, Staudenmayer K, Knowlton LM, Shiroff AM, Bauman ZM, Brooks SE, Kaafarani H, Crandall M, Nirula R, Agarwal SK Jr, Como JJ, Haut ER, Kasotakis G (2022). Non-surgical management and analgesia strategies for older adults with multiple rib fractures: A systematic review, meta-analysis, and practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg, 94(3), 398-407.
    5. Campwala I, Guyette FX, Brown JB, Yazer MH, Daley BJ, Miller RS, Harbrecht BG, Claridge JA, Phelan HA, Eastridge B, Nirula R, Vercruysse GA, OKeeffe T, Joseph B, Neal MD, Zuckerbraun BS, Sperry JL (2023). Evaluation of critical care burden following traumatic injury from two randomized controlled trials. Sci Rep, 13(1), 1106.
    6. Place A, McCrum M, Bell T, Nirula R (2022). EGS plus: Predicting futility in LVAD patients with emergency surgical disease. Am J Surg, 224(6), 1421-1425.
    7. Colonna AL, Robbins R, Stefanucci J, Creem-Regeh S, Patterson B, Engel BT, Fischer A, Nirula R (2022). Trauma Bay Virtual Reality - A Game Changer for ATLS Instruction and Assessment. J Trauma Acute Care Surg, 93, 353-359.
    8. Knudson MM, Moore EE, Kornblith LZ, Shui AM, Brakenridge S, Bruns BR, Cipolle MD, Costantini TW, Crookes BA, Haut ER, Kerwin AJ, Kiraly LN, Knowlton LM, Martin MJ, McNutt MK, Milia DJ, Mohr A, Nirula R, Rogers FB, Scalea TM, Sixta SL, Spain DA, Wade CE, Velmahos GC (2021). Challenging Traditional Paradigms in Posttraumatic Pulmonary Thromboembolism. JAMA Surg, 157, e216356.
    9. McCormick BJ, Horns JJ, Das R, Paudel N, Hanson HA, McCrum M, Nirula R, Myers JB (2021). Nephrectomy Is Not Associated with Increased Risk of Mortality or Acute Kidney Injury After High-Grade Renal Trauma: A Propensity Score Analysis of the Trauma Quality Improvement Program (TQIP). J Urol, 207, 101097JU0000000000002253.
    10. Li SR, Guyette F, Brown J, Zenati M, Reitz KM, Eastridge B, Nirula R, Vercruysse GA, OKeeffe T, Joseph B, Neal MD, Zuckerbraun BS, Sperry JL (2022). Early Prehospital Tranexamic Acid Following Injury Is Associated With a 30-day Survival Benefit: A Secondary Analysis of a Randomized Clinical Trial. Ann Surg, 274(3), 419-426.
    11. Heiner SM, Keihani S, McCormick BJ, Fang E, Hagedorn JC, Voelzke B, Nocera AP, Selph JP, Arya CS, Sensenig RL, Rezaee ME, Moses RA, Dodgion CM, Higgins MM, Gupta S, Mukherjee K, Majercik S, Smith BP, Glavin K, Broghammer JA, Schwartz I, Elliott SP, Breyer BN, Becerra CMC, Baradaran N, DeSoucy E, Zakaluzny S, Erickson BA, Miller BD, Santucci RA, Askari R, Carrick MM, Burks FN, Norwood S, Nirula R, Myers JB, in conjunction with the Trauma and Urologic Reconstruction Network of Surgeons (2021). Nephrectomy After High-Grade Renal Trauma is Associated With Higher Mortality: Results From the Multi-Institutional Genitourinary Trauma Study (MiGUTS). Urology, 157, 246-252.
    12. Emigh B, Kobayashi L, Kopp M, Daley M, Teal L, Haan J, Burlew CC, Nirula R, Moore F, Burruss S, Kaminski S, Dunn J, Carrick M, Schroeppel T, Thurston B, Quick J, Bosarge P, Brown CV (2021). The AAST prospective observational multicenter study of the initial experience with reversal of direct oral anticoagulants in trauma patients. Am J Surg, 222(2), 264-269.
    13. Walker HR, Evans E, Nirula R, Hyngstrom J, Matsen C, Nelson E, Pickron B, Zurbuchen E, Morrow EH (2021). "I need to have a fulfilling job": A qualitative study of surgeon well-being and professional fulfillment. Am J Surg, 223(1), 6-11.
    14. Brecha FS, Ozanne EM, Esplin J, Stoddard GJ, Nirula R, Huang LC, Cohan JN (2020). Patient Willingness to Accept Antibiotic Side Effects to Reduce Surgical Site Infection After Colorectal Surgery. J Surg Res, 261, 417-422.
    15. McCrum ML, Wan N, Lizotte SL, Han J, Varghese T, Nirula R (2022). Use of the spatial access ratio to measure geospatial access to emergency general surgery services in California. J Trauma Acute Care Surg, 90(5), 853-860.
    16. Keihani S, Wang SS, Joyce RP, Rogers DM, Gross JA, Nocera AP, Selph JP, Fang E, Hagedorn JC, Voelzke BB, Rezaee ME, Moses RA, Arya CS, Sensenig RL, Glavin K, Broghammer JA, Higgins MM, Gupta S, Castillejo Becerra CM, Baradaran N, Zhang C, Presson AP, Nirula R, Myers JB, in conjunction with the Trauma and Urologic Reconstruction Network of Surgeons (2020). External validation of a nomogram predicting risk of bleeding control interventions after high-grade renal trauma: The Multi-institutional Genito-Urinary Trauma Study. J Trauma Acute Care Surg, 90(2), 249-256.
    17. Armas-Phan M, Keihani S, Agochukwu-Mmonu N, Cohen AJ, Rogers DM, Wang SS, Gross JA, Joyce RP, Hagedorn JC, Voelzke B, Moses RA, Sensenig RL, Selph JP, Gupta S, Baradaran N, Erickson BA, Schwartz I, Elliott SP, Mukherjee K, Smith BP, Santucci RA, Burks FN, Dodgion CM, Carrick MM, Askari R, Majercik S, Nirula R, Myers JB, Breyer BN (2020). Clinical and Radiographic Factors Associated With Failed Renal Angioembolization: Results From the Multi-institutional Genitourinary Trauma Study (Mi-GUTS). Urology, 148, 287-291.
    18. Keihani S, Gross JA, Joyce RP, Wang SS, Rogers DM, Fang E, Hagedorn JC, Voelzke BB, Nocera AP, Selph JP, Rezaee ME, Moses RA, Arya CS, Sensenig RL, Glavin K, Broghammer JA, Higgins MM, Gupta S, Castillejo Becerra CM, Baradaran N, Kozar RA, Nirula R, Myers JB (2020). The American Association for the Surgery of Trauma Renal Grading System-Should Segmental Kidney Infarction be Classified as a Grade IV Injury? J Urol, 205(1), 165-173.
    19. Guyette FX, Brown JB, Zenati MS, Early-Young BJ, Adams PW, Eastridge BJ, Nirula R, Vercruysse GA, OKeeffe T, Joseph B, Alarcon LH, Callaway CW, Zuckerbraun BS, Neal MD, Forsythe RM, Rosengart MR, Billiar TR, Yealy DM, Peitzman AB, Sperry JL, STAAMP Study Group (2020). Tranexamic Acid During Prehospital Transport in Patients at Risk for Hemorrhage After Injury: A Double-blind, Placebo-Controlled, Randomized Clinical Trial. JAMA Surg.
    20. Senekjian L, Birkas Y, Buhavac M, Dayal S, Mukherjee K, Nygaard R, Pierce S, Buaza G, Sperry J, Eriksson E, Leon SM, Kopelman T, Spadafore P, Kopatsis A, Moore F, Taylor A, Colonna A, Enniss T, McCrum M, Nunez J, Young J, Nirula R (2020). Stop flailing: The impact of bicortically displaced rib fractures on pulmonary outcomes in patients with chest trauma - an American Association for the Surgery of Trauma multi-institutional study. J Trauma Acute Care Surg, 89(4), 658-664.
    21. Anderson RE, Keihani S, Moses RA, Nocera AP, Selph JP, Castillejo Becerra CM, Baradaran N, Glavin K, Broghammer JA, Arya CS, Sensenig RL, Rezaee ME, Morris BJ, Majercik S, Hewitt T, Burks FN, Schwartz I, Elliott SP, Luo-Owen X, Mukherjee K, Thomsen PB, Erickson BA, Miller BD, Santucci RA, Allen L, Norwood S, Fick CN, Smith BP, Piotrowski J, Dodgion CM, DeSoucy ES, Zakaluzny S, Kim DY, Breyer BN, Okafor BU, Askari R, Lucas JW, Simhan J, Khabiri SS, Nirula R, Myers JB (2020). Current Management of Extraperitoneal Bladder Injuries: Results from the Multi-Institutional Genito-Urinary Trauma Study (MiGUTS). J Urol, 204(3), 538-544.
    22. Keihani S, Rogers DM, Putbrese BE, Anderson RE, Stoddard GJ, Nirula R, Luo-Owen X, Mukherjee K, Morris BJ, Majercik S, Piotrowski J, Dodgion CM, Schwartz I, Elliott SP, DeSoucy ES, Zakaluzny S, Sherwood BG, Erickson BA, Baradaran N, Breyer BN, Fick CN, Smith BP, Okafor BU, Askari R, Miller BD, Santucci RA, Carrick MM, Allen L, Norwood S, Hewitt T, Burks FN, Heilbrun ME, Gross JA, Myers JB, in conjunction with the Trauma and Urologic Reconstruction Network of Surgeons (2019). The American Association for the Surgery of Trauma renal injury grading scale: Implications of the 2018 revisions for injury reclassification and predicting bleeding interventions. J Trauma Acute Care Surg, 88(3), 357-365.
    23. Harvin JA, Zarzaur BL, Nirula R, King BT, Malhotra AK (2020). Alternative clinical trial designs. Trauma Surg Acute Care Open, 5(1), e000420.
    24. Carlock TC, Barrett JR, Kalvelage JP, Young JB, Nunez JM, Colonna AL, Enniss TM, Nirula R, McCrum ML (2019). Telephone Follow-Up for Emergency General Surgery Procedures: Safety and Implication for Health Resource Use. J Am Coll Surg, 230(2), 228-236.
    25. McCrum ML, Zhang C, Presson AP, Nirula R (2019). Readmissions after nonoperative trauma: Increased mortality and costs with delayed intervention. J Trauma Acute Care Surg, 88(2), 219-229.
    26. Colonna AL, Bellows BK, Enniss TM, Young JB, McCrum M, Nunez JM, Nirula R, Nelson RE (2020). Reducing the pain: A cost-effectiveness analysis of transversus abdominis plane block using liposomal bupivacaine for outpatient laparoscopic ventral hernia repair. Surg Open Sci, 2(2), 75-80.
    27. Doucet JJ, Ferrada P, Murthi S, Nirula R, Edwards S, Cantrell E, Han J, Haase D, Singleton A, Birkas Y, Casola G, Coimbra R, AAST Multi-Institutional Trials Committee (2019). Ultrasonographic inferior vena cava diameter response to trauma resuscitation after 1 hour predicts 24-hour fluid requirement. J Trauma Acute Care Surg, 88(1), 70-79.
    28. Tonna JE, Johnson J, Presson A, Zhang C, Noren C, Lohse B, Bento H, Barton RG, Nirula R, Mone M, Marcus R (2019). Short-Term Clinical and Quality Outcomes Have Inconsistent Changes From a Quality Improvement Initiative to Increase Access to Physical Therapy in the Cardiovascular and Surgical ICU. Crit Care Explor, 1(10), e0055.
    29. Moses RA, Anderson RE, Keihani S, Hotaling JM, Nirula R, Vargo DJ, Myers JB (2019). High grade renal trauma management: a survey of practice patterns and the perceived need for a prospective management trial. Transl Androl Urol, 8(4), 297-306.
    30. Colonna AL, Griffiths TM, Robison DC, Enniss TM, Young JB, McCrum ML, Nunez JM, Nirula R, Hardman RL (2019). Cholecystostomy: Are we using it correctly? Am J Surg, 217(6), 1010-1015.
    31. Keihani S, Putbrese BE, Rogers DM, Zhang C, Nirula R, Luo-Owen X, Mukherjee K, Morris BJ, Majercik S, Piotrowski J, Dodgion CM, Schwartz I, Elliott SP, DeSoucy ES, Zakaluzny S, Sherwood BG, Erickson BA, Baradaran N, Breyer BN, Fick CN, Smith BP, Okafor BU, Askari R, Miller B, Santucci RA, Carrick MM, Kocik JF, Hewitt T, Burks FN, Heilbrun ME, Myers JB, in conjunction with the Trauma and Urologic Reconstruction Network of Surgeons (2019). The associations between initial radiographic findings and interventions for renal hemorrhage after high-grade renal trauma: Results from the Multi-Institutional Genitourinary Trauma Study. J Trauma Acute Care Surg, 86(6), 974-982.
    32. Keihani S, Rogers DM, Putbrese BE, Moses RA, Zhang C, Presson AP, Hotaling JM, Nirula R, Luo-Owen X, Mukherjee K, Morris BJ, Majercik S, Piotrowski J, Dodgion CM, Schwartz I, Elliott SP, DeSoucy ES, Zakaluzny S, Sherwood BG, Erickson BA, Baradaran N, Breyer BN, Smith BP, Okafor BU, Askari R, Miller B, Santucci RA, Carrick MM, Kocik JF, Hewitt T, Burks FN, Heilbrun ME, Myers JB, in conjunction with the Trauma and Urologic Reconstruction Network of Surgeons (2019). A nomogram predicting the need for bleeding interventions after high-grade renal trauma: Results from the American Association for the Surgery of Trauma Multi-institutional Genito-Urinary Trauma Study (MiGUTS). J Trauma Acute Care Surg, 86(5), 774-782.
    33. Keihani S, Putbrese BE, Rogers DM, Zhang C, Nirula R, Luo-Owen X, Mukherjee K, Morris BJ, Majercik S, Piotrowski J, Dodgion CM, Schwartz I, Elliott SP, DeSoucy ES, Zakaluzny S, Sherwood BG, Erickson BA, Baradaran N, Breyer BN, Fick CN, Smith BP, Okafor BU, Askari R, Miller B, Santucci RA, Carrick MM, Kocik JF, Hewitt T, Burks FN, Heilbrun ME, Myers JB, in conjunction with the Trauma and Urologic Reconstruction Network of Surgeons (2019). The Associations Between Initial Radiographic Findings and Interventions for Renal Hemorrhage After High-Grade Renal Trauma: Results from the Multi-institutional Genito-Urinary Trauma Study (MiGUTS). J Trauma Acute Care Surg.
    34. Keihani S, Putbrese BE, Rogers DM, Patel DP, Stoddard GJ, Hotaling JM, Nirula R, Luo-Owen X, Mukherjee K, Morris BJ, Majercik S, Piotrowski J, Dodgion CM, Schwartz I, Elliott SP, DeSoucy ES, Zakaluzny S, Sherwood BG, Erickson BA, Baradaran N, Breyer BN, Fick CN, Smith BP, Okafor BU, Askari R, Miller B, Santucci RA, Carrick MM, Kocik JF, Hewitt T, Burks FN, Heilbrun ME, Myers JB, in conjunction with the Trauma and Urologic Reconstruction Network of Surgeons (2019). Optimal timing of delayed excretory phase computed tomography scan for diagnosis of urinary extravasation after high-grade renal trauma. J Trauma Acute Care Surg, 86(2), 274-281.
    35. Kobayashi LM, Brito A, Barmparas G, Bosarge P, Brown CV, Bukur M, Carrick MM, Catalano RD, Holly-Nicolas J, Inaba K, Kaminski S, Klein AL, Kopelman T, Ley EJ, Martinez EM, Moore FO, Murry J, Nirula R, Paul D, Quick J, Rivera O, Schreiber M, Coimbra R (2018). Laboratory measures of coagulation among trauma patients on NOAs: results of the AAST-MIT. Trauma Surg Acute Care Open, 3(1), e000231.
    36. Morrow EH, Chen J, Patel R, Bellows B, Nirula R, Glasgow R, Nelson RE (2018). Watchful waiting versus elective repair for asymptomatic and minimally symptomatic paraesophageal hernias: A cost-effectiveness analysis. Am J Surg, 216(4), 760-763.
    37. Hirschi R, Rommel C, Letsinger J, Nirula R, Hawryluk GWJ (2018). Brain Trauma Foundation Guideline Compliance: Results of a Multidisciplinary, International Survey. World Neurosurg, 116, e399-e405.
    38. Lombardo S, Millar D, Jurkovich GJ, Coimbra R, Nirula R (2018). Factor VIIa administration in traumatic brain injury: an AAST-MITC propensity score analysis. Trauma Surg Acute Care Open, 3(1), e000134.
    39. Keihani S, Xu Y, Presson AP, Hotaling JM, Nirula R, Piotrowski J, Dodgion CM, Black CM, Mukherjee K, Morris BJ, Majercik S, Smith BP, Schwartz I, Elliott SP, DeSoucy ES, Zakaluzny S, Thomsen PB, Erickson BA, Baradaran N, Breyer BN, Miller B, Santucci RA, Carrick MM, Hewitt T, Burks FN, Kocik JF, Askari R, Myers JB, Genito-Urinary Trauma Study Group (2018). Contemporary management of high-grade renal trauma: Results from the American Association for the Surgery of Trauma Genitourinary Trauma study. J Trauma Acute Care Surg, 84(3), 418-425.
    40. Ley EJ, Leonard SD, Barmparas G, Dhillon NK, Inaba K, Salim A, OBosky KR, Tatum D, Azmi H, Ball CG, Engels PT, Dunn JA, Carrick MM, Meizoso JP, Lombardo S, Cotton BA, Schroeppel TJ, Rizoli S, Chang DSJ, de Len LA, Rezende-Neto J, Jacome T, Xiao J, Mallory G, Rao K, Widdel L, Godin S, Coates A, Benedict LA, Nirula R, Kaul S, Li T, Beta Blockers TBI Study Group Collaborators (2017). Beta blockers in critically ill patients with traumatic brain injury: Results from a multicenter, prospective, observational American Association for the Surgery of Trauma study. J Trauma Acute Care Surg, 84(2), 234-244.
    41. Chabot E, Nirula R (2017). Open abdomen critical care management principles: resuscitation, fluid balance, nutrition, and ventilator management. Trauma Surg Acute Care Open, 2(1), e000063.
    42. de Moya M, Nirula R, Biffl W (2017). Rib fixation: Who, What, When? Trauma Surg Acute Care Open, 2(1), e000059.
    43. Lombardo S, Scalea T, Sperry J, Coimbra R, Vercruysse G, Enniss T, Jurkovich GJ, Nirula R (2017). Neuro, trauma, or med/surg intensive care unit: Does it matter where multiple injuries patients with traumatic brain injury are admitted? Secondary analysis of the American Association for the Surgery of Trauma Multi-Institutional Trials Committee decompressive craniectomy study. J Trauma Acute Care Surg, 82(3), 489-496.
    44. Brasel KJ, Lim HJ, Nirula R, Weigelt JA (2007). Length of stay: an appropriate quality measure? Arch Surg, 142(5), 461-5; discussion 465-6.
    45. Brasel KJ, Guse C, Gentilello LM, Nirula R (2007). Heart rate: is it truly a vital sign? J Trauma, 62(4), 812-7.
    46. Karmy-Jones R, Jurkovich GJ, Velmahos GC, Burdick T, Spaniolas K, Todd SR, McNally M, Jacoby RC, Link D, Janczyk RJ, Ivascu FA, McCann M, Obeid F, Hoff WS, McQuay N Jr, Tieu BH, Schreiber MA, Nirula R, Brasel K, Dunn JA, Gambrell D, Huckfeldt R, Harper J, Schaffer KB, Tominaga GT, Vinces FY, Sperling D, Hoyt D, Coimbra R, Rosengart MR, Forsythe R, Cothren C, Moore EE, Haut ER, Hayanga AJ, Hird L, White C, Grossman J, Nagy K, Livaudais W, Wood R, Zengerink I, Kortbeek JB (2007). Practice patterns and outcomes of retrievable vena cava filters in trauma patients: an AAST multicenter study. J Trauma, 62(1), 17-24; discussion 24-5.
    47. Parsons T, Spendlove I, Nirula R, Writer M, Carter G, Carr F, Durrant LG (2003). A novel CEA vaccine stimulates T cell proliferation, gammaIFN secretion and CEA specific CTL responses. Vaccine, 22(25-26), 3487-94.

    Other

    1. Deeb AP, Hoteit L, Li S, Guyette FX, Eastridge BJ, Nirula R, Vercruysse GA, OKeeffe T, Joseph B, Neal MD, Sperry JL, Brown JB (2022). Prehospital synergy: Tranexamic acid and blood transfusion in patients at risk for hemorrhage. J Trauma Acute Care Surg (93(1), pp. 52-58). United States.