Non-traumatic Patients Research Articles

Cardiovascular parameters on computed tomography are independently associated with in-hospital complications and outcomes in level-1 trauma patients

BackgroundIn-hospital complications after trauma may result in prolonged stays, higher costs, and adverse functional outcomes. Among reported risk factors for complications are pre-existing cardiopulmonary comorbidities. Objective and quick evaluation of cardiovascular risk would be beneficial for risk assessment in trauma patients. Studies in non-trauma patients suggested an independent association between cardiovascular abnormalities visible on routine computed tomography (CT) imaging and outcomes. However, whether this applies to trauma patients is unknown.PurposeTo assess the association between cardiopulmonary abnormalities visible on routine CT images and the development of in-hospital complications in patients in a level-1 trauma center.MethodsAll trauma patients aged 16 years or older with CT imaging of the abdomen, thorax, or spine and admitted to the UMC Utrecht in 2017 were included. Patients with an active infection upon admission or severe neurological trauma were excluded. Routine trauma CT images were analyzed for visible abnormalities: pulmonary emphysema, coronary artery calcifications, and abdominal aorta calcification severity. Drug-treated complications were scored. The discharge condition was measured on the Glasgow Outcome Scale.ResultsIn total, 433 patients (median age 50 years, 67% male, 89% ASA 1–2) were analyzed. Median Injury Severity Score and Glasgow Coma Scale score were 9 and 15, respectively. Seventy-six patients suffered from at least one complication, mostly pneumonia (n = 39, 9%) or delirium (n = 19, 4%). Left main coronary artery calcification was independently associated with the development of any complication (OR 3.9, 95% CI 1.7–8.9). An increasing number of calcified coronary arteries showed a trend toward an association with complications (p = 0.07) and was significantly associated with an adverse discharge condition (p = 0.02). Pulmonary emphysema and aortic calcifications were not associated with complications.ConclusionCoronary artery calcification, visible on routine CT imaging, is independently associated with in-hospital complications and an adverse discharge condition in level-1 trauma patients. The findings of this study may help to identify trauma patients quickly and objectively at risk for complications in an early stage without performing additional diagnostics or interventions.

Outcomes associated with intra-arrest hyperoxaemia in out-of-hospital cardiac arrest: A registry-based cohort study

BackgroundAn association between post-arrest hyperoxaemia and worse outcomes has been reported for out-of-hospital cardiac arrest (OHCA) patients, but little is known about the relationship between intra-arrest hyperoxaemia and clinically relevant outcomes. This study aimed to investigate the association between intra-arrest hyperoxaemia and outcomes for OHCA patients. MethodsThis was an observational study using a registry database of OHCA cases that occurred between 2014 and 2017 in Japan. We included adult, non-traumatic OHCA patients who were in cardiac arrest at the time of hospital arrival and for whom partial pressure of arterial oxygen (PaO2) levels was measured during resuscitation. Main exposure was intra-arrest PaO2 level, which was divided into three categories: hypoxaemia, PaO2 < 60 mmHg; normoxaemia, 60–300; or hyperoxaemia, ≥300. Primary outcome was favourable functional survival at one month or at hospital discharge. Multivariable logistic regression was performed to adjust for clinically relevant variables. ResultsAmong 16,013 patients who met the eligibility criteria, the proportion of favourable functional survival increased as the PaO2 categories became higher: 0.5 % (57/11,484) in hypoxaemia, 1.1 % (48/4243) in normoxaemia, and 5.2 % (15/286) in hyperoxaemia (p-value for trend < 0.001). Higher PaO2 categories were associated with favourable functional survival and the adjusted odds ratios increased as the PaO2 categories became higher: 2.09 (95 % CI: 1.39–3.14) in normoxaemia and 5.04 (95 % CI: 2.62–9.70) in hyperoxaemia when compared to hypoxaemia as a reference. ConclusionIn this observational study of adult OHCA patients, intra-arrest normoxaemia and hyperoxaemia were associated with better functional survival, compared to hypoxaemia.

Health disparities in regional anesthesia and analgesia for the management of acute pain in trauma patients.

Health disparities in regional anesthesia and analgesia for the management of acute pain in trauma patients.

Outcomes of Cold-Stored, Low Titer Group O Whole Blood Transfusions in Non-Trauma Massive Transfusion Protocol Activations in Patients with Cirrhosis

Introduction: There has been significant debate on the best transfusion practices in cirrhotic patients with massive hemorrhage. As the liver is responsible for the synthesis of many proteins involved in coagulation and anticoagulation, cirrhosis can lead to multiple coagulation abnormalities. Portal hypertension, endothelial dysfunction, renal failure, and sepsis further contribute to increased bleeding tendency in cirrhosis. A growing area of interest is transfusion of cold-stored, low-titer Group O whole blood (LTOWB). The primary advantage of LTOWB versus component-based transfusion is that it provides a balanced resuscitation of all components that is closest to physiologic blood. Additionally, it contains lower quantities of anticoagulant and preservative solution compared to individual blood components. Previous studies suggest that LTOWB is at least equivalent if not superior to component therapy in resuscitation of life-threatening hemorrhage in trauma patients. The goal of the present study is to determine whether this positive effect is also observed in cirrhotic patients requiring activation of massive transfusion protocol (MTP) for non-traumatic bleeding. Methods: We retrospectively collected data from cirrhotic patients receiving MTP with at least one unit of LTOWB transfusion between January 2019 and November 2021. LTOWB is obtained from the American Red Cross and leukoreduced with a platelet sparing filter from Terumo (Lakewood, CO). It is stored for up to 14 days, and if unused is subsequently converted to red blood cells. Low titer is defined as < 1:256. Baseline samples were collected just prior to initiation of LTOWB MTP. Post-transfusion samples were collected 24 hours following the activation of the MTP. We describe the degree of anemia, thrombocytopenia, coagulopathy, and hemolysis before and after LTOWB MTPs. The difference between post-transfusion total bilirubin and pre-transfusion total bilirubin was used as a surrogate for hemolysis. Pre- and post-transfusion thromboelastography (TEG) was used to assess clot formation, clot strength, and fibrinolysis. Data are reported as mean ± standard deviation for normally distributed variables, or median with 1st and 3rd quartiles if non-normal. The Wilcoxon signed rank test was employed to test changes between pre-and post-transfusion parameters (p<0.05 considered statistically significant). Results: Of 810 patients who received LTOWB MTP between January 2019 and November 2021, 317 were for non-traumatic bleeding, and of these 61 patients had cirrhosis. Table 1 describes patient characteristics. The most common etiology of cirrhosis was alcohol-associated liver disease. The most common cause of bleeding was upper GI bleed, followed by procedural bleeding. 16.4% of the patients received LTOWB only, and 83.6% of patients received both LTOWB and component therapy. On average, patients received one unit of red blood cells and one unit of platelets in addition to 3 units of LTOWB. Table 2 shows outcome variables. Of the 61 patients who received LTOWB MTP, Hemoglobin significantly increased 1.7 g/dL (P <0.001). Similarly, INR and PTT significantly decreased following LTOWB MTP (P <0.01 for both). Interestingly, there was a 17.5 K/cu mm decrease in platelet count (P = 0.001). The total bilirubin, calcium, and fibrinogen levels were unaffected by LTOWB MTP. The TEG K time was significantly prolonged following LTOWB MTP, while the lysis time at 30 minutes was decreased (P <0.05). One patient had a transfusion reaction. Conclusions: To our knowledge, this is the first study examining LTOWB transfusion in non-trauma patients with cirrhosis. This proof of concept study suggests that LTOWB transfusion is a feasible option for this patient population. We observed a significant improvement in hemoglobin and PTT/INR, without observed signs of hemolysis. Our TEG results suggest decreased fibrinolysis following LTOWB MTP. An important limitation of this study is the lack of an appropriate control group. Ongoing work indicates that we will soon have enough data to compare our LTOWB versus component-only MTP cohorts. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Abstract 214: A Counterfactual Machine Learning Model Study To Estimate The Impact Of Coronary Angiography For Out Of Hospital Cardiac Arrest

Background: The American Heart Association guidelines for resuscitation 2020 recommends emergency coronary angiography (CAG) in cases of out-of-hospital cardiac arrest (OHCA) after return of spontaneous circulation (ROSC) with ST-segment elevation(STE) and, it is unclear how much CAG actually contributes to improved outcomes in various OHCA patient populations. The aim of this study is to estimate the impact of CAG on OHCA using a counterfactual machine learning model. Methods: We analyzed adult non-traumatic OHCA patients (43,977 cases) from June 2014 to December 2019 from the JAAM (Japan Association for Acute Medicine)-OHCA registry, which includes post-hospitalization data from 140 Japanese hospitals. We defined outcomes as favorable neurological outcomes (Cerebral Performance Categories (CPC) 1-2) and survival at 30 and 90 days. We estimated the outcome assuming that all patients had received CAG using a machine learning and counterfactual hypothetical model, and also estimated the outcome assuming that all patients had not received CAG. An average of each individual difference between the two estimations was calculated as average treatment effect (ATE) (%), which represents the effect of CAG on improving outcomes for the population. In addition, subgroup analysis was performed based on ROSC, STE and initial documented rhythm. Results: The ATE(%, 95% confidence interval) of CAG in all OHCA patients for CPC 1-2 at 30 and 90 days was 3.11% (2.92-3.30) and 1.85% (1.74-1.95), and survival at 30 and 90 days was 6.25%(5.93-6.57) and 2.20%(1.88-2.52), respectively. The subgroup analysis of ATE for CPC 1-2 at 90 days was particularly lower in the no STE group, initial pulseless electrical activity (PEA) group and initial asystole group than in the STE group and initial ventricular fibrillation(VF) group (Figure). Conclusions: In the JAAM-OHCA registry, we used a counterfactual machine learning model to estimate the effect of CAG on OHCA.

Abstract 188: Resuscitative Endovascular Occlusion Of The Aorta (REBOA) As A Mechanical Method For Increasing The Coronary Perfusion Pressure In Non-traumatic Out-of-hospital Cardiac Arrest Patients

Goal: Resuscitative endovascular balloon occlusion of the aorta (REBOA), originally designed to block blood flow to the distal part of the aorta by placing a balloon in trauma patients, has recently been shown to increase coronary perfusion in cardiac arrest patients. This study evaluated REBOA in increasing the aortic pressure and coronary perfusion pressure (CPP) in non-traumatic out-of-hospital cardiac arrest (OHCA) patients. Methods: Adult OHCA patients with cerebral performance category 1 or 2 prior to cardiac arrest, and without evidence of aortic disease, were enrolled from Jan. to Dec. 2021. Aortic pressure and right atrial pressure were measured before and after balloon occlusion. CPP was calculated using the measured aortic and right atrial pressures, and the values before and after the balloon occlusion were compared. Results: Fifteen non-traumatic OHCA patients were enrolled in the study. The median call to balloon time was 46.0 (IQR, 38.0-54.5) min. The median CPP before and after balloon occlusion was 13.5 (IQR, 5.8-25.0) and 25.2 (IQR, 12.0-44.6) mmHg, respectively (P=0.001). The median increase in the estimated CPP after balloon occlusion was 86.7%. Conclusion: The results of this study suggest that REBOA may increase the CPP during cardiopulmonary resuscitation (CPR) in patients with non-traumatic OHCA.

Abstract 128: Yield Of Computed Tomography After Non-Traumatic Out-of-Hospital Cardiac Arrest

Background Computed tomography (CT) can identify the etiology of cardiac arrest and injuries related cardiopulmonary resuscitation (CPR). Diagnostic yield of CT has only been characterized in a few small cohort studies with varied imaging practices. Purpose To determine diagnostic yield of CT imaging after out-of-hospital cardiac arrest (OHCA). Methods We included non-traumatic OHCA patients treated at a single center February 2019 to February 2021. Our practice during the study period was to obtain unenhanced head CT in all comatose patients and CT of the cervical spine, chest, abdomen, and pelvis in most cases. We abstracted patient age and sex, CPR duration, and initial neurological examination from our prospective registry. We reviewed clinical records and identified CT imaging obtained within 24 hours of arrival. We reviewed radiology reports, and summarized findings for each body region. Results We included 505 subjects. Mean age was 60 [SD 16] years and 144 (29%) had an initial shockable rhythm. Median CPR duration was 21 [IQR 12-35] minutes and 448 (89%) subjects were comatose on presentation. Almost all subjects had brain imaging (n=481, 95%), of which 33 (7% [95% CI 5-9%]) had intracranial hemorrhage and 157 (33% [95% CI 28-37%]) had cerebral edema. Fewer subjects had a cervical spine CT (n=202, 40%) though 4 (2% [95% CI 0-4%]) had vertebral fractures. Most subjects had a CT of the chest (n=396, 76%), and abdomen and pelvis (n= 347, 69%). Identified chest pathologies included rib or sternal fractures (222, 56% [95% CI 51-61%]), pneumothorax (27, 7% [95% CI 5-10%]), aspiration or pneumonia (300, 76% [95% CI 71-80%]), mediastinal hematoma (18, 5% [95% CI 3-7%]), and pulmonary embolism (13, 3% [95% CI 2-6%]). Significant abdomen and pelvis findings were bowel ischemia (23, 7% [95% CI 4-10%]), and splenic or liver laceration (7, 2% [95% CI 1-4%]). Conclusions Cross sectional imaging identifies clinically important pathology that informs early management.

Abstract 14500: Association Between the Arrival Time of Paramedics and the Neurological Outcome at Discharge of Cardiac Arrest Patients

Introduction: Improving survival rate and neurological outcome of out-of-hospital cardiac arrest (OHCA) patients is a global public health challenge. Prompt and appropriate management by emergency medical service at the prehospital stage is essential to achieve a good outcome in OHCA patients. Hypothesis We hypothesized that the arrival time of the second ambulance may affect the prognosis of patients with cardiac arrest, and this study aimed to investigate the relationship between the arrival time of last-arrival ambulance and the neurological outcome at discharge. Methods This study was a retrospective analysis of a prospectively collected registry of OHCA patients. Adult non-traumatic OHCA patients from Jan 2017 to Dec 2018 were included. ROC analysis was performed for good neurological outcomes, according to the arrival time of the last-arrival ambulance. Comparing the early arrival team (response time of last-arrival ambulance less than 14 minutes) and the late arrival team (response time of last-arrival ambulance 14 minutes or longer) with propensity score matching. Results A total 3,289 OHCA patients from 12 cities of Gyeonggi province, metropolitan area located in the suburbs of the capital of Republic of Korea was included. optimal cut off was 14 minutes. After propensity score matching, Survival to admission, survival discharge and good neurological outcome were higher in the early arrival team than the late arrival team [26.1% versus 21.3, 12.6% versus 6.3% and 7.1% versus 3.2%]. The response time of last-arrival team 14-minute or longer group showed a significant association with poor neurological outcomes at discharge compared to the group with less than 14 minutes [Odds ratio 2.87, 95% confidence interval 1.65-5.11, P value &lt; 0.001]. Conclusion In two-tier ambulance system, response time of last-arrival team 14-minute or longer was associated with poor neurological outcomes upon discharge in out-of-hospital cardiac arrest patients.

Role of B-Scan Ultrasonography in Pre-Operative Cataract Patients Attending Services Hospital, Lahore

Aim: The present study aimed to assess the role of B-scan in pre-operative cataract patients. Material and Methods: This prospective diagnostic study was conducted on 94 cataract patients in Ophthalmology Department, Services Hospital, Lahore from January 2021 to June 2021. Patients of either gender regardless of age having cataract were enrolled. Clinical history, detailed examination, and B-scan ultrasound of each individual was recorded. Individuals were examined in a lie supine position on the table and contact method was used. Coupling gel was applied and a probe was placed on the closed eyelid. B-scan ultrasound took images of different sections such as longitudinal, axial, and transverse sections. Resolution of the images was optimized by maintaining adequate intensity with the lowest possible decibel gain. Results: Out of 94 cataract patients, the number of male and female patients was 54 (57.4%) and 40 (42.6%) respectively. The incidence of traumatic and non-traumatic cataract patients was 20 (21%) and 74 (79%) respectively. About 42 (44.7%) cataract patients had a rural background and 52 (55.3%) had an urban background. The age distribution of cataract patients was as follows: 12 (12.8%) 1-20 years, 4 (4.3%) in 21-30 years, 19 (20.2%) in 31-40 years, 21 (22.3%) in 41-50 years, 32 (34%) in 51-60 years, and 6 (6.4%) &gt;60 years. Of the traumatic cataract patients, posterior segment pathology was observed in 8 (40%) only whereas 12 (60%) had no posterior segment pathology. Out of traumatic cataract patient’s posterior segment pathology, the incidence of retinal detachment, vitreous hemorrhage, posterior vitreous detachment, intraocular foreign body and posterior staphyloma was 2 (25%), 1 (12.5%), 1 (12.5%), 3 (37.5%), and 0 (0%) respectively. Out of non-traumatic cataract patients, the incidence of posterior segment pathology and no posterior segment pathology was observed in 14 (18.9%) and 60 (81.1%) respectively. Among 14 posterior segment pathology, the incidence of retinal detachment, vitreous hemorrhage, posterior vitreous detachment, intraocular foreign body, and posterior staphyloma was 4 (28.6%), 3 (21.4%), 2 (14.3%), 2 (14.3%), and 3 (21.4%) respectively. Conclusion: The present study found that B-scan is a better diagnostic modality for the detection of posterior segment pathology in traumatic and non-traumatic cataract patients. Two dimensional B-scan can be effective in routine examination of pre-operative cataract patients. Three-dimensional B-scan could be considered in cases where two-dimensional does not provide sufficient help in assessment of posterior segment pathology in cataract patients. Keywords: Cataract patients, Traumatic cataract patients, Non-traumatic cataract patients, B-scan

Retrospective Study of Indications and Outcomes of Open Abdomen with Negative Pressure Wound Therapy Technique for Abdominal Sepsis in a Tertiary Referral Centre.

In patients with advanced sepsis from abdominal disease, the open abdomen (OA) technique as part of a damage control surgery (DCS) approach enables relook surgery to control infection, defer intestinal anastomosis, and prevent intra-abdominal hypertension. Limited evidence is available on key outcomes, such as mortality and rate of definitive fascial closure (DFC), which are needed for surgeons to select patients and adequate therapeutic strategies. Abdominal closure with negative pressure wound therapy (NPWT) has shown rates of DFC around 90%. We conducted a retrospective study to evaluate in-hospital survival and factors associated with mortality in acute, non-trauma patients treated using the OA technique and NPWT for sepsis from abdominal disease. Fifty consecutive patients treated using the OA technique and NPWT between February 2015 and July 2022 were included. Overall mortality was 32%. Among surviving patients, 97.7% of cases reached DFC, and the overall complication rate was 58.8%, with one case of entero-atmospheric fistula. At univariable analysis, age (p = 0.009), ASA IV status (&lt;0.001), Mannheim Peritonitis Index &gt; 30 (p = 0.001) and APACHE II score (p &lt; 0.001) were associated with increased mortality. At multivariable analysis, higher APACHE II was a predictor of in-hospital mortality (OR 2.136, 95% CI 1.08-4.22; p = 0.029). Although very resource-intensive, DCS and the OA technique are valuable tools to manage patients with advanced abdominal sepsis, allowing reduced mortality and high DFC rates.

Bolus Vasopressor Use for Air Medical Rapid Sequence Intubation: The Vasopressor Intravenous Push to Enhance Resuscitation Trial

BackgroundRapid sequence intubation (RSI) may compromise perfusion because of the use of sympatholytic medications as well as subsequent positive pressure ventilation. The use of bolus vasopressor agents may reverse hypotension and prevent arrest. MethodsThis was a prospective, observational study enrolling air medical patients with critical peri-RSI hypotension (systolic blood pressure [SBP] < 90 mm Hg) to receive either arginine vasopressin (aVP), 2 U intravenously every 5 minutes, for trauma patients or phenylephrine (PE), 200 μg intravenously every 5 minutes, for nontrauma patients. The main outcome measures included an increase in SBP, a reversal of hypotension, and the occurrence of dysrhythmia or hypertension (SBP > 160 mm Hg) within 20 minutes of vasopressor administration. ResultsA total of 523 patients (344 aVP and 179 PE) were enrolled over 2 years. An increase in SBP was observed in 326 aVP patients (95%), with reversal of hypotension in 272 patients (79%). An increase in SBP was observed in 171 PE patients (96%), with reversal of hypotension in 148 patients (83%). A low rate of rebound hypertension was observed for both aVP and PE patients. ConclusionBoth aVP and PE appear to be safe and effective for treating critical hypotension in the peri-RSI period.

National Comparison of Mechanical Chest Compression Devices and Manual Cardiopulmonary Resuscitation in Trauma and Nontrauma Patients

INTRODUCTION: Most trials comparing mechanical chest compression devices and manual CPR exclude trauma patients. The purpose of this study was to perform a retrospective comparison of mechanical chest compression devices and manual CPR in trauma and nontrauma patients. METHODS: The National Emergency Medical Services Information System (NEMSIS) database was queried for all patients undergoing CPR in 2020. The primary outcome was the return of spontaneous circulation (ROSC). Chi-square tests and multivariable logistic regression were performed. RESULTS: There were 160,838 patients undergoing CPR during the study period. The rate of ROSC was 24.8% (n = 39,813). A mechanical compression device was used in 15.0% (n = 24,170), and trauma patients composed 6.3% (p = 10,072). The rate of ROSC with device use was 20.0% (n = 4,838, p < 0.001). Multivariable logistic regression found a decreased likelihood of ROSC with device use (odds ratio 0.73 [0.70 to 0.75], p < 0.001) and in trauma patients (odds ratio 0.39 [0.37 to 0.42], p < 0.001). Subgroup analysis of only trauma patients found that the rate of ROSC was 13.0% (n = 1,312). The rate of ROSC with device use in trauma patients was 11.7% (n = 146, p = 0.14). CONCLUSION: The likelihood of achieving ROSC was decreased in patients when a mechanical chest compression device was used. When evaluating only trauma patients, the rate of ROSC was decreased and was further decreased when a device was used. However, this decreased rate was not statistically significant compared with manual CPR. Further randomized controlled trials comparing mechanical vs manual chest compressions in trauma patients are warranted.

Increase in end-tidal carbon dioxide after defibrillation predicts sustained return of spontaneous circulation during out-of-hospital cardiac arrest

IntroductionGuidelines recommend monitoring end-tidal carbon dioxide (ETCO2) during out-of-hospital cardiac arrest (OHCA), though its prognostic value is poorly understood. This study investigated the relationship between ETCO2 and return of spontaneous circulation (ROSC) after defibrillation in intubated non-traumatic OHCA patients. MethodsThis retrospective, observational cohort analysis included adult OHCA patients who received a defibrillation shock during treatment by an urban EMS agency from 2015 to 2021. Peak ETCO2 values were determined for the 90-second periods before and after the first defibrillation in an intubated patient (shock of interest [SOI]). Values were analyzed for association between the change in ETCO2 from pre- to post-shock and the presence of ROSC on the subsequent pulse check. ResultsOf 518 eligible patients, mean age was 61, 72% were male, 50% had a bystander-witnessed arrest, and 62% had at least one episode of ROSC. The most common arrest etiology was medical (92%). Among all patients, peak ETCO2 during resuscitation prior to SOI was 36.8 mmHg (18.6). ETCO2 increased in patients who achieved ROSC immediately after SOI (from 38.3 to 47.6 mmHg; +9.3 CI: 6.5, 12.1); patients with sustained ROSC experienced the greatest increase in ETCO2 after SOI (from 37.8 to 48.2 mmHg; +10.4 CI: 7.2, 13.6), while ETCO2 in patients who did not achieve ROSC after SOI rose (from 36.4 to 37.8 mmHg; +1.4 CI: −0.1, 2.8). ConclusionsETCO2 rises after defibrillation in most patients during cardiac arrest. Patients with sustained ROSC experience larger rises, though the majority experience rises of less than 10 mmHg.

Hounsfield Unit Assessed Bone Density Amongst Non-Traumatic and Post-Traumatic Arthritic Total Ankle Arthroplasty Patients

Category: Ankle Arthritis; Ankle; Hindfoot; Trauma Introduction/Purpose: The etiology of ankle arthritis is multifactorial and secondary osseous changes to the tibiotalar joint can be variable. The relationship of bone density within the tibia and talus with respect to type of ankle arthritis is not well understood. Improved insight of osseous characteristics amongst ankle arthritis patients is helpful in determining optimal implant selection for total ankle arthroplasty. The purpose of this study is to retrospectively analyze pre-operative total ankle arthroplasty patients' films for osseous characteristics associated traumatic ankle arthritis compared to other forms of arthritis using computed tomography (CT) generated Hounsfield units (HU) to analyze bone mineral density and rate of cyst formation. Methods: A retrospective analysis was performed of 440 patients, under a single orthopedic practice, who underwent primary TAA between 2013-2019. Pre-operative HU of tibia and talus were analyzed amongst two groups (Non-traumatic OA, Post- traumatic OA) within one year prior to TAA. Results: Forty-nine qualified patients (23 NTA, 26 PTA) with mean follow-up in months of 19.98 (SD 15.22) were analyzed. Cystic changes at level of TAA cuts or retained bone: 5 tibia (10.2%), 7 talus (14.29%), 16 combined (32.65%). Overall tibial HU mean 270.23 (SD 91.28) and talus 463.26 (103.65). HU of the tibia amongst post-traumatic and non-traumatic patients was 257.21 (SD 93.9) and 284.94 (SD 87.9) (p=0.29137) and talus 434.53 (104.7) and 495.75 (94.33) (p=0.0365). Conclusion: Our results suggest with tibiotalar arthritis HU is a useful tool to predict bone quality. Clinical results amongst the NTA and PTA groups was comparable. Significantly lower HU values were recorded for the PTA groups. Rate of cystic formation within bone of distal tibia does not necessarily correlate with overall HU measured bone mineral density.

Analysis of the Validity of Perioperative Antibiotic Prophylaxis in Maxillofacial Surgery.

Perioperative antibiotic prophylaxis is the standard in surgical departments. The type of operation, the duration of the procedure, the degree of microbiological purity of the operating field and the current clinical condition of the patient determine its administration. The aim of this study was to validate the antibiotic prophylaxis used in a Maxillofacial Surgery Department for a group of trauma and non-trauma patients. To that end, an observational prospective cohort study was carried out. The study was conducted on a group of 83 patients of the Department of Cranio-Maxillo-Facial Surgery who were divided into a group of trauma patients (n = 43) and one of non-trauma patients (n = 40). In both groups, the classic microbiological tests were carried out, and the results were analyzed in relation to: the study group, age, sex, duration of surgery, type of surgical access. Most bacterial strains were isolated at the initial stage of the operation. Gram (+) cocci were isolated more often in the trauma group and Gram (−) rods in the non-trauma group. Significantly more often, strains of fungi were noted in the initial stage of the procedure in the trauma group. We conclude that the use of perioperative antibiotic prophylaxis in the Maxillofacial Surgery Departments is justified.

Evaluation of mortality prediction using SOFA and APACHE IV tools in trauma and non-trauma patients admitted to the ICU

BackgroundVarious tools have previously been introduced to predict the recuperation and mortality of patients in intensive care units and to classify them, which have particular advantages and disadvantages compared to each other. The present study compared the prediction power of mortality of trauma and non-trauma patients admitted to the ICU by SOFA and APACHE IV tools.MethodsIn this retrospective cohort study, patients admitted to the ICU of Kowsar Hospital in Sanandaj from the beginning of April 2020 to the end of December 2020 were assessed. Data were collected in the form of a questionnaire based on APACHE IV and SOFA criteria as well as the demographic information questionnaire. All collected data related to the first 24 h of patients' hospitalization was analyzed in SPSS V16 software using Chi-square, Mann–Whitney, Cox regression and Pearson correlation coefficient.ResultsThis study was performed on 404 patients admitted to the ICU, Out of which 273 people (67.6%) were male, 208 (51.5%) trauma patients and 196 (48.5%) non-trauma ones. Patients’ mean age was 54.76 ± 20.77 years and their average length of stay in the hospital was 10.05 ± 8.49 days. In general, the AUC obtained by APACHE IV tool (0.902) was slightly better than that of SOFA tool (0.895). However, in a specific study of traumatic and non-traumatic patients, it was found that APACHE IV and SOFA tools had better performance in predicting death innon-trauma and trauma patients based on the accuracy, AUC and sensitivity, respectively.ConclusionsBased on the results of this study, the difference between APACHE IV and SOFA tools in predicting death of patients admitted to the ICU was very small but the function of APACHE IV was better in predicting mortality of non-traumatic patients, while the function of SOFA was better in predicting the death of traumatic cases. This represents the applicability of these two tools in different patient subgroups.

Akut solunum yetmezliğinde optik sinir kılıf çapının prognostik önemi

Purpose: The primary aim of this study was to determine the role of the optic nerve sheath diameter (ONSD) measured using ultrasonography in the differentiation of hypoxemic respiratory failure and hypercarbic respiratory failure. The secondary aim was to determine the value of ONSD in predicting the clinical outcome in hypercarbic patients.&#x0D; Materials and Methods: Non-traumatic adult patients presenting with dyspnea were included in this study. Arterial blood gas and concurrent ONSD measurements were obtained from all patients included in the study during presentation and at the second hour of treatment. The patients were divided into two groups - hypoxic and hypercarbic respiratory failure. An equivalent number of healthy volunteers were enrolled as the control group. &#x0D; Result: Mean ONSD values were 3.8±0.2 mm in the 24 patients with type 1 respiratory failure, 5.2 ± 0.5 mm in the 25 patients with type 2 respiratory failure, and 3.9±0.3 mm in the healthy controls. The ONSD of the hypercarbic patients was statistically significantly greater than that of the hypoxic patients and healthy volunteers. The ONSD of the hypercarbic patients was 5.2±0.5mm at baseline and 4.4±0.6 mm after treatment, the difference being statistically significant. However, the difference in ONSD was not statistically significant in predicting hospitalization and mortality. &#x0D; Conclusion: Sonographically measured ONSD may be an effective parameter in the differential diagnosis of type 1 and 2 respiratory failure. ONSD values changed significantly with treatment in patients with type 2 respiratory failure.

Wider perspectives: It's a changing world-The use of ABO-incompatible plasma for resuscitating massively bleeding patients.

Wider perspectives: It's a changing world-The use of ABO-incompatible plasma for resuscitating massively bleeding patients.

Weighty Matters: A Real-World Comparison of the Handtevy and Broselow Methods of Prehospital Weight Estimation.

The majority of pediatric medications are dosed according to weight and therefore accurate weight assessment is essential. However, this can be difficult in the unpredictable and peripatetic prehospital care setting, and medication errors are common. The Handtevy method and the Broselow tape are two systems designed to guide Emergency Medical Services (EMS) providers in both pediatric patient weight estimation and medication dosing. The accuracy of the Handtevy method of weight estimation as practiced in the field by EMS has not been previously examined. The primary objective of this study was to examine the field performance of the Handtevy method and the Broselow tape with respect to prehospital patient weight estimation. This was a retrospective chart review of trauma and non-trauma patients transported by EMS to the emergency department (ED) of a quaternary care children's hospital from January 1, 2021 through June 30, 2021. Demographic data, ED visit information, prehospital weight estimation, and medication dosing were collected and analyzed. Scale-based weight from the ED was used as the standard for comparison. A total of 509 patients <13 years of age were included in this study. The EMS providers using the Broselow method estimated patient weight to within +/-10% of ED scale weight in 51.3% of patients. When using the Handtevy method, the EMS providers estimated patient weight to within +/-10% of ED scale weight in 43.7% of patients. When comparing the Handtevy versus Broselow method of prehospital weight estimation, there was no significant association between method and categorized weight discrepancy (over, under, or accurate estimates - defined as within 10% of ED scale weight; P = .25) or percent weight discrepancy (P = .75). On average, prehospital weight estimation was 6.33% lower than ED weight with use of the Handtevy method and 6.94% lower with use of the Broselow method. This study demonstrated no statistically significant difference between the use of the Handtevy or Broselow methods with respect to prehospital weight estimation. While further research is necessary, these results suggest similar field performance of the Broselow and Handtevy methods.

Outcomes of Cold-Stored, Low-Titer Group O Whole Blood Transfusions in Nontrauma Massive Transfusion Protocol Activations.

The use of low-titer group O whole blood (LTOWB) in military and civilian trauma centers shows no significant difference in outcomes compared with component therapy. To compare the use of LTOWB with standard component therapy in nontrauma patients requiring massive transfusion at a major academic medical center. This is a retrospective cohort study comparing nontrauma patients who received at least 1 unit of cold-stored LTOWB during a massive transfusion with those who received only blood component therapy during a massive transfusion. Primary outcomes are mortality at 24 hours and 30 days. Secondary outcomes are degree of hemolysis, length of inpatient hospital stay, and time to delivery of blood products. One hundred twenty massive transfusion activations using 1570 blood products from 103 admissions were identified during the study period. Fifty-five admissions were included in the component cohort and 48 in the LTOWB cohort. There were no significant differences in primary outcomes: 24-hour mortality odds ratio, 2.12 (P = .14); 30-day mortality odds ratio, 1.10 (P = .83). Length of stay was found to be statistically significantly different and was 1.58 days shorter in the LTOWB cohort compared with the component cohort (95% CI, 1.44-1.73; P < .001). There were no significant differences in the remaining secondary outcomes. LTOWB therapy appears no worse than using standard component therapy in nontrauma patients requiring a massive transfusion activation, suggesting that LTOWB is a reasonable alternative to component therapy in nontrauma, civilian hospital patients, even when blood type is known.