An analysis of blood transfusion practices in gunshot wound patients at a peripheral trauma-blood centre unit.

Objective: This study aims to characterize the demographic, clinical, and radiological features of gunshot wound (GSW) patients as well as identify predictors of prolonged hospitalization.Methods:In this retrospective study, a consecutive sampling method was used, including all patients with GSWs in any anatomical region. Data collection included demographic and clinical information, radiological findings, treatment specifics, and outcome variables, such as hospitalization length of stay (LOS) as the primary outcome. To identify predictive factors associated with prolonged LOS, logistic regression analysis was used.Results:We studied 212 GSW cases, including 95.8% were men and 4.2% were women. The mean age of the studied group was 30.17±7.80 years. GSWs occurred in extremities (80.2%), abdomen (9.0%), thorax (4.7%), and head or neck (5.2%). Two patients (0.9%) had both abdominal and thoracic GSWs. The most prevalent radiological study was an X-ray (83.0%). Patients with head and neck GSWs had the longest emergency department stay, while patients with abdominal GSW patients had the shortest (p=0.068). The highest rates of blood product transfusion were observed in abdominal GSWs (63.2%), emergency surgery (63.2%), and ICU admission (42.1%). Head and neck GSWs had the longest hospitalization LOS (7.5 days). Longer LOS was significantly associated with abnormalities in radiological findings, receiving blood products, and ICU admission (p≤0.001). Significant predictors of prolonged LOS were major abnormalities in radiological findings [odds ratio (OR)=5.3; 95% confidence interval (CI):2.8-10.2], head and neck GSWs (OR=6.1; 95% CI:1.2-31.9), and blood product transfusion (OR=4.1; 95% CI: 1.0-16.3).Conclusion:This study provides insights into factors influencing prolonged hospitalization in GSW patients, highlighting the importance of radiological findings, head and neck injuries, and blood product transfusion.

Background: The ABO blood group system invented by Karl Landstiner is popular blood grouping system and considered as the most vitalin blood transfusion safety. Approximately, 20% of individuals having A2 subgroup and 80% have A1 subgroup. Aims and Objectives: The objective of the present study is to find the prevalence of A1B and A2B subgroups in samples of patients in blood center of our tertiary care center. Materials and Methods: This observational study was carried out at blood center of tertiary care hospital. Blood group is separated into A, B, AB, and O-positive/negative. Based on serological reactivity, blood group was classified into A2B positive/A2B negative. Results: ABO blood grouping was analyzed for 5435 samples. Of these, 430 (7.91%) belonged to Group AB. Out of 430 AB group, 13 (3.1%) were having A2B-positive blood group and 417 (96.9%) were having A1B-positive blood group. Conclusion: Among AB blood group, frequency of A1B subgroup is higher than A2B. The study of this subgrouping can make blood transfusion more safe and can improve overall practice of transfusion.

Aim : AB0 and Rh blood groups have been associated with various malignancies. This study aims to investigate the relationship between AB0/Rh blood groups and chondroid neoplasia. Material and Methods : We evaluated 276 patients with chondroid neoplasia retrospectively. The blood groups and tumor localization of the patients who were operated between 2014-2019 were recorded. 129 patients who donated blood to our hospital in 2019 constituted the control group.We compared the demographic characteristics and blood groups of the patients with the control group using the chi-square test. Results : The mean age was 52±14.6, 49±15.9, and 37±10.3 years, respectively, for enchondroma, chondrosarcoma and the control group. The tumor was mostly localized to the distal femur in both enchondroma and chondrosarcoma patients. Although the 0Rh (+) blood group rate was higher and the B (Rh (+) blood group rate was lower in patients with enchondroma and chondrosarcoma compared to the control group, this difference was not statistically significant. The A and AB blood group rates of the case and control groups were similar. Conclusion : There was no relationship between AB0 blood groups and chondroid neoplasia. Studies investigating the relationship of different benign and malignant bone tumors with AB0 and Rh blood groups in large patient series are needed.

ObjectiveWe aim to calculate the 5-year mortality after surviving to hospital discharge after a firearm injury and estimate the association of firearm injury with later mortality.MethodsWe performed a retrospective cohort...

Objective: This meta-analysis comprehensively evaluated the association between ABO blood group and the risk of preeclampsia (PE).Design: Systematic review and meta-analysis.Data sources: PubMed, Web of Science, and ScienceDirect databases from their inception to September 23, 2020.Methods: Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were obtained through random-effects and fixed-effects models according to heterogeneity. Meta-regression analysis was applied to explore the source of heterogeneity. We conducted a subgroup analysis by the publication year, study design, state, and Newcastle-Ottawa Scale (NOS) score. In addition, we calculated the rate of each ABO blood group in PE by total pooled effects.Results: A total of 12 articles with 714,153 patients were included in our analysis. Compared with people without PE (control group), the O blood group presented a lower risk of PE (OR 0.95, 95% CI 0.93–0.97). The AB (OR 1.46, 95% CI 1.12–1.91) blood group presented a higher risk. However, the total pooled OR and 95% CI for the A (OR 1.02, 95% CI 0.90–1.16) and B (OR 1.02, 95% CI 0.98–1.05) blood groups were not significant. The funnel plot and linear regression equation showed that there was no publication bias for the O, A, or B blood groups (all P > 0.05). However, the funnel plot and linear regression equation for the AB blood group were obviously asymmetric (P < 0.05), and the publication bias persisted even after the trim-and-fill method was applied (P < 0.05). Multivariable meta-regression analysis did not find a specific source of heterogeneity. The A blood group showed an association with early-onset PE (OR 0.53, 95% CI 0.33–0.83), and the other blood groups showed no significant differences. In PE, the rates of the O, A, B, and AB blood groups decreased gradually (0.39, 0.33, 0.19, 0.07).Conclusion: These findings suggest that pregnant women with AB blood group are more likely to develop PE, and more attention should be paid to AB blood group whose blood pressure is high but not sufficient to diagnose PE.Systematic Review Registration: Prospero CRD42021227930.

Objectives: Thoracic trauma is among the most important causes of mortality in emergency departments. In this study of penetrating stab wounds (PSWs) and gunshot wounds (GSWs) admitted to the emergency department with penetrating thoracic trauma cases clinical findings, emergency treatment approaches and survivals were compared with literature information. Methods: One hundred fifty-two patients who applied to Bakırköy Dr. Sadi Konuk Training and Research Hospital Emergency Department with penetrating thoracic trauma on 1 January 2014 and 31 December 2014 were evaluated retrospectively the patients. SPSS 22.0, NY, USA program was used in the analyzes. Results: Patients administered with PSW were 79.6%, with GSW were 20.4%. Patients in the group GSW were admitted to the emergency department with more serious symptoms than patients in the group PSW (Triage level 2, GSW: 87.1%, PSW: 62.8% and Triage level 3, GSW: 12.9% vs. PSW: 37.2%), (p = 0.010). Hemothorax (25.8%) in PSW patients and pneumothorax (40.5%) in GSW patients was detected more frequently. Surgical treatment was performed in 14.9% of patients with PSW, tube thoracostomy was performed in 24%, and 62.82% were treated with conservative treatment. Surgical treatment was performed in 35.5% of GSW patients and tube thoracostomy was performed in 29%, and 48.4% were treated with conservative treatment (p &amp;gt; 0.05). Conclusion: Despite the lower incidence of GSW than PSW in emergency departments, GSW require more surgical intervention and have a higher mortality rate.

National data on transfusion-related adverse events (TAEs) in the United States are limited. Administrative and payment-related data may augment hemovigilance systems to assess transfusion safety. A nationwide administrative database was analyzed to characterize transfusion-related hospitalizations and TAEs by trends, patient/hospital characteristics, and outcomes. Transfusions and TAEs were identified using medical codes and charges. Generalized estimating equations (GEE) modeled transfusion trends, while logistic regression assessed transfusion-associated circulatory overload (TACO) and transfusion-related acute lung injury (TRALI) risk factors. During 2016-2020, 8.4% of hospitalizations involved transfusions, with red blood cell (RBC) transfusion being most common (5.2%). In 2020, compared to 2016, hospitalizations with RBC transfusion decreased by 2% (Rate Ratio (RR) 0.98; 95% CI: 0.97-0.99), while plasma transfusion hospitalizations increased by 13% (RR 1.13; 95% CI: 1.08-1.19). TAEs occurred in 0.35% of hospitalizations (3.5/1000 transfusion hospitalizations). Among the TAEs included in the study, TACO, febrile nonhemolytic reactions, and TRALI were most common. In 27% of cases, the specific TAE was unidentified. TAEs were associated with higher inpatient mortality and longer lengths of stay. Variability in TAE rates was observed by patient and hospital characteristics. Risk factors for TACO included age >64, female sex, teaching hospitals, rural location, and Northeast region. TRALI risk was higher in teaching hospitals and those with >200 beds. Administrative data provide insights into transfusion practices and associated morbidity and mortality but have limitations. Linking administrative, electronic health record, and blood bank data may enhance TAE identification.

Trauma is the leading cause of death in pediatric patients, with major vascular injuries significantly worsening outcomes. This study aimed to evaluate the mortality and complication profile of pediatric trauma patients suffering from major vascular injuries as a result of gunshot wounds (GSWs) compared with blunt mechanisms. We queried the American College of Surgeons Trauma Quality Improvement Program database from 2013 to 2021 for pediatric (≤12 years old) trauma patients who suffered a major vascular injury as a result of either blunt trauma or a GSW. Patients were excluded if they had a head or face Abbreviated Injury Scale ≥2 or an Abbreviated Injury Scale of 6 in any other region. These groups were examined regarding demographics, clinical characteristics, and in-hospital outcomes. In order to adjust for confounding, Poisson regression models with robust standard errors were employed. After applying the inclusion and exclusion criteria 1,605 patients remained for further analysis. Of these, 18.1% patients (n = 292) suffered a GSW. GSW patients were significantly more injured than blunt trauma patients (Injury Severity Score ≥ 16: 59.6% vs. 33.6%, p < 0.001). GSW patients had significantly higher rates of major intrathoracic as well as femoral vascular injuries, whereas intraabdominal aortic and renal vascular injuries were more common in blunt trauma patients. GSW patients accordingly demonstrated significantly higher rates of in-hospital mortality (21.2% vs. 5.3%, p < 0.001) and overall complications (13.7% vs. 8.4%, p = 0.007). After adjusting for potential confounding, suffering a major vascular injury due to a GSW was associated with an 80% higher rate of mortality ( p = 0.013). The overall lethality and complication rate for major vascular injury is greater after GSWs than blunt trauma. These findings underscore the importance of firearm injury prevention and provide further insight into the new leading cause of death in children. Therapeutic/Care Management; Level IV.

Literature showcases conflicting findings regarding the outcomes of ballistic fragment removal from the spine in gunshot wounds (GSW) patients. Further research in this area is needed to better comprehend the nuances of risks and benefits surrounding ballistic fragment removal from the spine in GSW patients. In this case report, we discuss the late-onset cervical prevertebral abscess which developed when a previously embedded bullet fragment migrated into the retropharyngeal space 11 years after an initial GSW. A 29-year-old male sustained a gunshot wound to the face in 2011. He was stabilized with a posterior C3-C6 lateral mass instrumentation and fusion. There were no attempts to remove the bullet fragments. In 2023, the patient returned with worsening neck pain. Imaging demonstrated a retropharyngeal abscess with interval rotation of the ballistic fragment by 90°. An abscess was noted anterior to the cervical vertebrae with a freely mobile ballistic fragment within. This case highlights several questions: What is the criteria for radiographic surveillance of retained hardware? If there is documented movement, should this trigger further investigation? What complications can occur that warrant careful removal?

An increase of terror-related activities may necessitate treatment of mass casualty incidents, requiring a broadening of existing skills and knowledge of various injury mechanisms. To characterize and compare injuries from gunshot and explosion caused by terrorist acts. A retrospective cohort study of patients recorded in the Israeli National Trauma Registry (ITR), all due to terror-related injuries, between October 1, 2000, to June 30, 2002. The ITR records all casualty admissions to hospitals, in-hospital deaths, and transfers at 9 of the 23 trauma centers in Israel. All 6 level I trauma centers and 3 of the largest regional trauma centers in the country are included. The registry includes the majority of severe terror-related injuries. Injury diagnoses, severity scores, hospital resource utilization parameters, length of stay (LOS), survival, and disposition. A total of 1155 terror-related injuries: 54% by explosion, 36% gunshot wounds (GSW), and 10% by other means. This paper focused on the 2 larger patient subsets: 1033 patients injured by terror-related explosion or GSW. Seventy-one percent of the patients were male, 84% in the GSW group and 63% in the explosion group. More than half (53%) of the patients were 15 to 29 years old, 59% in the GSW group and 48% in the explosion group. GSW patients suffered higher proportions of open wounds (63% versus 53%) and fractures (42% versus 31%). Multiple body-regions injured in a single patient occurred in 62% of explosion victims versus 47% in GSW patients. GSW patients had double the proportion of moderate injuries than explosion victims. Explosion victims have a larger proportion of minor injuries on one hand and critical to fatal injuries on the other. LOS was longer than 2 weeks for 20% (22% in explosion, 18% in GSW). Fifty-one percent of the patients underwent a surgical procedure, 58% in the GSW group and 46% in explosion group. Inpatient death rate was 6.3% (65 patients), 7.8% in the GSW group compared with 5.3% in the explosion group. A larger proportion of gunshot victims died during the first day (97% versus 58%). GSW and injuries from explosions differ in the body region of injury, distribution of severity, LOS, intensive care unit (ICU) stay, and time of inpatient death. These findings have implications for treatment and for preparedness of hospital resources to treat patients after a terrorist attack in any region of the world. Tailored protocol for patient evaluation and initial treatment should differ between GSW and explosion victims. Hospital organization toward treating and admitting these patients should take into account the different arrival and injury patterns.

The hidden mortality of pediatric firearm violence

BackgroundIn countries with a high incidence of interpersonal violence involving firearms, gunshot wound (GSW) related infection is a regular and serious complication. However, limited evidence supports the efficacy of antimicrobial prophylaxis (AP) in resource restricted areas. At Tygerberg Hospital, South Africa, it is standard care for GSW patients to receive one dose of amoxicillin-clavulanic acid or cefazolin to prevent GSW-related infection. For various reasons protocol adherence can be suboptimal. This study aimed to assess the efficacy in regard to reduction of in-hospital GSW infection and to identify opportunities for practice improvement.MethodsAll GSW patients admitted between October 12, 2017 and January 3, 2018 were prospectively included. Data regarding injury characteristics, circumstances of the incident, type of AP and surgery were obtained. The occurrence of in-hospital GSW infection was monitored over 30 days or until discharge, whichever occurred first. Univariate analyses were performed to compare characteristics of patients with- and without prophylaxis. A multivariate logistic regression model was used to obtain propensity scores. To correct for confounding, propensity score matching (PSM) and inverse probability weighting (IPW) methods were used to assess the effect of AP on the occurrence of GSW infection.ResultsA total of 165 consecutive patients were included. Hundred-and-three patients received AP according to protocol within 12 hours after admission, 62 patients did not. Only 63.9% of the multi-GSW patients and 69.1% of the patients with a fracture received AP. These conditions were associated with an uncorrected relative risk for infection of 2.08 (95% CI 1.32–3.26) and 1.81 (95% CI 1.08–3.04), respectively. PSM showed a reduced in-hospital GSW infection risk of 12% (95% CI 0.2–24%, P = 0.046) with AP. IPW showed that AP reduced the risk for infection by 14% (95% CI, 3–27%, P = 0.015).ConclusionProviding antimicrobial prophylaxis to GSW patients appeared to result in a clinically relevant lower risk of in-hospital GSW infection. In this study setting, optimization of provision of AP for all patients with multiple GSW’s or a GSW-related fracture are opportunities for reduction of GSW infection.DisclosuresAll authors: No reported disclosures.

Current Burden of Gunshot Wound Injuries at Two Los Angeles County Level I Trauma Centers

Blood products for resuscitation: moving forward by going backward.

The ABO blood types are associated with cancers, cardiovascular diseases and type 2 diabetes mellitus but whether they are also associated with gestational diabetes mellitus (GDM) is unknown. We examined the relationship between the ABO blood types and the risk of GDM in a prospective population-based Chinese cohort. From 2010 to 2012, we recruited 14,198 pregnant women within the first 12 weeks of gestation in Tianjin, China. All women had a glucose challenge test (GCT) at 24-28 gestational weeks, followed by a 75-g 2-h oral glucose tolerance test if the results from GCT were ≥7.8 mmol/L. GDM was diagnosed based on the glucose cut-points of the International Association of Diabetes and Pregnancy Study Group criteria. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for traditional risk factors. Stratified analysis was performed by family history of diabetes (yes versus no). Sensitivity analyses were also performed by using the World Health Organization (WHO) criteria for GDM. Women with blood groups A, B or O (i.e. non-AB) were associated with increased risk of GDM as compared with those with blood group AB (adjusted OR: 1.44, 95% CI: 1.13-1.83). Sensitivity analyses showed that the result was consistent using WHO criteria. The adjusted OR of blood group non-AB versus AB for GDM was enhanced among women with a family history of diabetes (2.69, 1.21-5.96) and attenuated among those without (1.33, 1.03-1.71). Blood group AB was a protective factor against GDM in pregnant Chinese women.