Scene Of Injury Research Articles

Transverse process fractures of the thoracic vertebrae\u2014the significance of this injury in the context of medicolegal opinions on high-energy trauma cases

Thoracic transverse process fractures (TTPFs) are injuries that go unnoticed during traditional autopsies, as demonstrated by a lack of medicolegal publications regarding TTPFs. However, postmortem computed tomography (PMCT) has made detection of this type of injury easy. Thus, the goal of our study was to analyze the significance of TTPFs in the context of medicolegal opinions. Forensic autopsy reports and PMCT scans of 116 people who had died from high-energy trauma were analyzed. TTPFs were found in 34.48% (n = 40) of the total test group. The highest proportions of TTPFs were found in drivers (50%, n = 8) and in victims of falls from heights (41%, n = 14). Among seven car passengers, only one victim had suffered TTPFs. In comparison with persons without TTPFs, persons with TTPFs demonstrated more severe general injuries, especially to the chest and abdomen, and more often (in 90% of cases) died at the scene of injury (all these differences were statistically significant; p < 0.0001). Pedestrian TTPFs were present only in victims struck from their front or back. TTPFs in victims of falls were found only in those cases in which the height of the fall was at least 9 m. The presence of TTPFs indicates that the application of a very strong force leads to injuries that, in most cases, result in death at the scene of the event. Detecting TTPFs provides additional information about the mechanism of trauma, especially in pedestrians, drivers, passengers, and victims of falls from heights.

Association between the Japan Coma Scale scores at the scene of injury and in-hospital outcomes in trauma patients: an analysis from the nationwide trauma database in Japan

ObjectiveJapan Coma Scale (JCS) is a grading system used to evaluate disturbed consciousness in prehospital care settings. We aimed to identify the association between the JCS levels at the scene...

Abstract 4: Predictors of Definitive Airway sans Hypoxia/Hypotension on First Attempt (DASH 1A) Success in Traumatically Injured Patients Undergoing Prehospital Intubation

Objective Prehospital intubation success is routinely treated as a dichotomous outcome based on an endotracheal tube passing through vocal cords regardless of number of attempts or occurrence of hypoxia, or hypotension, which are associated with worse outcomes. We explore patient, provider, and procedure-related variables associated with successful definitive airway sans hypoxia/hypotension on first attempt (DASH-1A) in traumatically injured subjects undergoing endotracheal intubation at the scene of injury by a helicopter EMS system. Methods This single-center retrospective chart review included patients with traumatic injuries and at least one attempted intubation by helicopter EMS at the scene of injury. Demographic and clinical variables were tested for association with DASH-1A and overall first-attempt success using univariate comparisons and multivariable logistic regression to produce adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Purposeful backwards stepwise elimination was used to develop logistic regression models for outcomes. Initial inclusion of covariates in multivariable models was based on clinical judgement, known or suspected risk factors and confounders for intubation success, and univariate associations. Results Of 419 subjects screened, 263 met inclusion criteria. Median age was 34 years and the majority of subjects were Caucasian (95%), male (76%), and suffered blunt trauma (90%). A total of 142 (55.3%) subjects had a successful DASH-1A airway, 198 (75%) had a successful first attempt non-DASH-1A airway, and overall, 246 (94%) had an endotracheal tube passed successfully before hospital arrival. Factors significantly associated with successful DASH-1A were no ground EMS intubation attempt prior to arrival (aOR 2.2), lack of airway secretions (1.9), Cormack-Lehane Score of I and II (12.3 & 3.2, respectively), and bougie use (5.4). For endotracheal tube passing only, the following were significantly associated with first pass success: grade of view I and II (87.3 & 6.8, respectively), lack of secretions (4.9), bougie use (7.8), direct laryngoscopy (5.1) and not using apneic oxygenation through a nasal cannula (2.5). Conclusions In our helicopter EMS system, successful endotracheal intubation on the first attempt and without an episode of hypoxia was associated with no ground EMS intubation attempt prior to flight crew arrival, lack of airway secretions, Cormack-Lehane Score, and bougie use.

Teaching how to stop the bleed: does it work? A prospective evaluation of tourniquet application in law enforcement officers and private security personnel.

Stop the Bleed (STB) program was launched by the White House, for the use of bleeding control techniques at the scene of traumatic injury. The purpose of this study was to conduct an STB course in private security and law enforcement personnel. Pre- and post-questionnaire using the Likert scale was shared with participants on their knowledge and comfort level with the use of tourniquets. Participants were also observed while placing tourniquets and the time for placement recorded. The didactic portion and practical session of the STB was then taught and participants were again observed placing tourniquets and a questionnaire distributed. Fisher's exact tests or Wilcoxon matched-pairs signed-ranks tests were used to compare pre-post measurements. A total of 151 subjects were enrolled over the course of seven sessions. The tourniquet was applied correctly by 17.2% (26/151) and 92.7% (140/151) at the pre- and post-instruction assessments, respectively (p < 0.001). Mean times to apply the tourniquet were 29.8 ± 18.5 and 18.7 ± 6.7s, respectively (p < 0.001). Subjects reported their level of comfort with the tourniquet to be 5.1 ± 3.3 and 8.8 ± 2.2, respectively (p < 0.001), and their familiarity with anatomy and bleeding control to be 5.2 ± 3.1 and 8.2 ± 2.4, respectively (p < 0.001). At the end of the course, the mean score in response to a question about the extent to which the explanation had helped was 9.0 ± 1.9 (95% CI 8.7-9.4) and to a question about the extent to which teaching would make them feel more secure and safe was 9.2 ± 1.9 (95% CI 8.9-9.5). STB course improved correct tourniquet placement, demonstrated dramatic improvements in application time, and increased levels of comfort. These findings validate the need for ongoing teaching and education.

Thermal fatalities in Pretoria: A 5-year retrospective review

In South Africa, research on burn mortality has emanated primarily from specialised burn centres and has focused on specific age groups and hospital-based fatalities. This study describes the demographic profile and the pathology of trauma related to burn fatalities as seen at the Pretoria Medico-Legal Laboratory (PTA MLL), a large urban medico-legal mortuary over a 5-year period from January 2011 to December 2015. Mortuary admission records and autopsy reports were used to gather information on demographics, circumstances of injury, apparent manner and cause of death, pathology of burns, toxicology and histology reports and identification of the decedents. ResultsOf the 9558 unnatural deaths admitted to the PTA MLL during this time period, 291 (3.0%) of the fatalities met the inclusion criteria. The male:female ratio was 2.9:1. Most fatalities occurred between the ages of 0–4 years. One hundred and forty-two (142) decedents were charred beyond recognition. Identification was confirmed in 134 (94.4%) of the charred remains. In 208 (69.8%) of the cases the manner of death was deemed to be accidental, 23 (7.9%) were homicidal and 11 (3.8%) were suicides. Two hundred and fifty-five (87.4%) of the fatalities were as a result of open flames/fires. Shack fires were responsible for 105 (36%) of all fatalities. In 32 (11.0%) cases of open flame/fire fatalities where death occurred at the scene of injury, more than one fatality was reported per incident. In 122 (79.2%) of scene fatalities, soot deposition was noted in the upper and lower airways. Forty-five (32.8%) of hospital fatalities occurred within 24 h of admission. The most common complications in hospital fatalities were from the respiratory system. The mean blood alcohol concentrations (BAC) was 0.09 g/100 ml. The mean carboxyhaemoglobin concentrations (COHb) was 19.9%. All available cyanide results were negative. ConclusionThe study is the first of its kind in South Africa to generate bimodal descriptive statistics for burn fatalities. Approximately 3% of unnatural deaths at the PTA-MLL were due to burns, occurring at a rate of ±1 death per week. The data provides a platform for funding, collaborative research, planning and development of public health programs.

The incidence and characteristics of homicides in elderly compared with non-elderly age groups in Johannesburg, South Africa.

Even though the rate of eldercide(homicide in the age group ≥60 years) in South Africa (SA) is higher than the global rate, it receives little attention compared with homicide in younger (&lt;60 years) age groups. To: (i) establish the proportion and rates of eldercide relative to homicide in young adult and middle-aged populations, and determine whether proportions of homicide across the age groups differ by race; and (ii) determine differences in homicide victim and incident characteristics across the three age categories and establish whether these differences vary by race. This retrospective study analysed homicide data for adults (aged ≥15 years) drawn from the National Injury Mortality Surveillance System (NIMSS) for the City of Johannesburg, SA (2001 - 2010). Percentages and rates were used to describe the incidence of eldercide (age ≥60 years) relative to homicide in middle age (35 - 59 years) and youth (15 - 34 years). Eldercide and middle-age and youth homicides were compared by sex, race, weapon used, scene of injury, day of the week and time of death. For the 10-year period 2001 - 2010, NIMSS registered a total of 14678 adult homicide deaths for Johannesburg. Of these, a very small proportion (3.8%) were eldercides, 46.9% were middle-age homicides, and the majority (58.4%) were young adult homicides. The average annual eldercide rate (23.1/100 000) was also lower than the rate for the middle-aged (46.9/100 000) and young adult (58.4/100000) groups. However, the difference in rates between the age groups decreased considerably over the study period. Race-specific patterns were observed in the distribution of homicide across age groups. Compared with the circumstantial patterns for youth and middle-age homicides, eldercide involved higher proportions of females and white victims, and greater use of blunt force and strangulation. Whereas homicides in the other age groups tended to occur in public spaces and during weekends and nights, eldercides occurred mainly in a home, during the week and during daytime. The characteristics of eldercide differ from those of youth and middle-age homicides. The specificities of the circumstances suggest that interventions should take cognisance of the temporal and spatial dimensions of eldercide and go beyond the regular security and policing measures to ensure the safety of the elderly in Johannesburg.

Google Street View assessment of environmental safety features at the scene of pedestrian automobile injury.

Pedestrians struck by automobiles are at significant risk for mortality. Multiple environmental features have been developed to promote separation of pedestrians from motor vehicles. However, data on the effectiveness of these pedestrian traffic safety features are lacking. The purpose of this study was to use Google Street View to assess the locations of pedestrian-automobile injury and evaluate the relationship of environmental pedestrian safety features to pedestrian involved crashes. Our trauma registry was queried for pedestrians injured by automobile collision. Google Street View was used to identify safety features present at each injury location. A composite safety score was created by summing the number of safety features at each crash location. A logistic regression model was performed to evaluate the impact of safety features on mortality. Our sample consisted of 631 patients (69.3% male) with an average age of 40.4 ± 17.0 years and median Injury Severity Score of 10 (5-22). A multivariate logistic regression revealed safety score (range, 0-6) significantly predicted mortality with each one-unit increment associated with a 27.8% decrease in risk of mortality. Increasing number of safety features as represented in a composite score may decrease risk of pedestrian mortality. Google Street View appears to be a viable tool to study the presence and effectiveness of these pedestrian safety features. Epidemiological, level III.

Prehospital quick sequential organ failure assessment score to predict in-hospital mortality among patients with trauma

ObjectiveThe quick sequential organ failure assessment (qSOFA) score is calculated from three variables measured at the scene of trauma—systolic blood pressure, respiratory rate and consciousness. This study aimed to evaluate the discriminative ability of the prehospital qSOFA score for in-hospital mortality in patients with trauma. MethodsThis retrospective multicenter study used data from 42,722 patients with trauma included in a Japanese nationwide trauma registry. All included patients were aged ≥18 years old and transferred to hospitals from the scenes of injury. The primary outcome was in-hospital mortality. ResultsThe included patients had a mean age of 59.4 ± 21.5 years and a male predominance (63%). In-hospital mortality occurred in 2612 patients (6%), while 2-day mortality occurred in 1189 of 42,339 patients (3%). When patients were stratified by qSOFA scores, in-hospital mortality rates of 0.9% (105/11783), 5% (941/17839), 12% (1280/11132) and 15% (286/1968) were associated with qSOFA scores of 0, 1, 2 and 3, respectively (P < 0.0001 for trend). The area under the receiver operating characteristics curve of the qSOFA score for in-hospital mortality was 0.70 (95% confidence interval: 0.69–0.71). A qSOFA score cutoff value ≥1 yielded a sensitivity and specificity of 0.96 and 0.29, respectively, overall, and a sensitivity of 0.99 in patients younger than 65 years. ConclusionsThe prehospital qSOFA score was strongly associated with in-hospital mortality in patients with trauma. A prehospital qSOFA score cutoff of ≥1 can be used to identify patients at a very low risk of death, especially in younger age groups.

Optimizing access and configuration of trauma centre care in New South Wales

IntroductionGetting the right patient, to the right place, at the right time is dependent on a multitude of modifiable and non-modifiable factors. One potentially modifiable factor is the number and location of trauma centres (TC). Overabundance of TC dilutes volumes and could be associated with worse outcomes. We describe a methodology that evaluates trauma system reconfiguration without reductions in potential access to care. We used the mature trauma system of New South Wales (NSW) as a model given the perceived overabundance of urban major trauma centres (MTC). MethodsWe first evaluated potential access to TC care via ground and air transport through the use of geographic information systems (GIS) network analysis. Potential access was defined as the proportion of the population living within 60-min transport time from a potential scene of injury to a TC by ground or rotary-wing aircraft. Sensitivity analyses were carried out in order to account for potential pre-hospital interventions and/or transport delays; travel times of 15-, 30-, 45-, 60-, and 90-min were also analyzed. We then evaluated if the current configuration of the system (number of urban MTS in the Sydney basin) could be optimized without reductions in potential access to care using two GIS methodologies: location-allocation and individual removal of MTC. Results86% of the NSW population has potential access to a TC within 60 min ground travel time; potential access improves to 99% with rotary-wing transport. The 1% of the population without potential TC access lives in 48% of the land area (>384,000km2). Utilizing two different methodologies we identified that there was no change in potential access by ground transport after removing 1 or 2 MTC in the Sydney basin at the 30-, 45-, and 60-min transport times. However, 0.02% and 0.5% of the population would not have potential access to MTC care at 15 min after removing one and two MTC respectively. DiscussionRedistribution of the number of MTC in the Sydney basin could be achieved without a significant impact on potential access to care. Our approach can be utilized as an initial tool to evaluate a trauma system where overabundance of coverage is present.

Age-adjusted shock index: From injury to arrival

BackgroundStudies have demonstrated the superiority of the shock index, pediatric age-adjusted (SIPA) in predicting outcomes in pediatric blunt trauma patients. However, all have utilized SIPA calculated on emergency department (ED) arrival. We sought to evaluate the utility of SIPA at the trauma scene and describe changes in SIPA from the trauma scene to the ED. MethodsWe used 2014–2016 Trauma Quality Improvement Program Data to identify blunt trauma patients 1–15 years old with an injury severity score (ISS) > 15. We calculated SIPA using vitals obtained at the trauma scene and on ED arrival. Outcome measures included ISS, transfusion within 24 h, intensive care unit (ICU), hospital length of stay (LOS), ventilator days, and mortality. ResultsWe identified 2917 patients, and 34.2% had a persistently elevated SI from the injury scene to ED arrival, whereas 17.9% had a persistently elevated SIPA. An elevated SIPA at the trauma scene was more predictive of greater ISS, LOS, and ventilator requirements. Furthermore, a SIPA that remained abnormal was associated with greater ISS, LOS, ICU admission, mechanical ventilation, and mortality. ConclusionsPrehospital SIPA values predict worse outcomes in pediatric trauma patients, and their change over time may have greater predictive utility than a single value alone. Level of EvidenceII Type of StudyPrognosis Study.

Paramedics’ experiences of administering fascia iliaca compartment block to patients in South Wales with suspected hip fracture at the scene of injury: results of focus groups

ObjectivesTo explore paramedics’ experience of delivering fascia iliaca compartment block (FICB) to patients with suspected hip fracture at the scene of injury.DesignFocus groups within a randomised controlled trial.SettingParamedics based at...

Computed Tomography with Intravenous Contrast is Not Associated with Development of Acute Kidney Injury in Severely Injured Pediatric Patients

Data for the incidence of acute kidney injury (AKI) related to intravenous contrast administration in the pediatric trauma population are limited. Obtaining a creatinine value before elective CT scans is a relatively accepted standard of care. We sought to determine whether there was any significant difference in the incidence of AKI between severely injured patients who received IV contrast and those who did not. We reviewed data from the trauma registry at our Level I pediatric trauma center. We limited the patients to severely injured pediatric traumas (<15 years old) directly transported from the scene of injury with a creatinine level measured on arrival. Two hundred and eleven patients were included in the study. AKI was defined by the criteria of the AKI Network. We then compared incidence of AKI in those who received a CT scan with IV contrast with those who did not receive IV contrast. The two groups were comparable in age, gender, Glasgow Coma Scale, Injury Severity Score, mean creatinine on arrival, and mean creatinine post-CT scan/arrival. There was no significant difference in AKI between the two. In a subgroup analysis of patients presenting in shock, there was no significant difference in AKI. Our study suggests that IV contrast is not associated with the development of AKI in severely injured pediatric trauma patients. Although obtaining a creatinine value before exposure is ideal, a CT scan with IV contrast in severely injured children should not be delayed to obtain a creatinine value.

Humerus Shaft Fractures Occurring in Fly Fishing Boat Riding: Injury Scene Analysis

Humerus Shaft Fractures Occurring in Fly Fishing Boat Riding: Injury Scene Analysis

Impact of a physician-led pre-hospital critical care team on outcomes after major trauma.

The deployment of physician-led pre-hospital enhanced care teams capable of critical care interventions at the scene of injury may confer a survival benefit to victims of major trauma. However, the evidence base for this widely adopted model is disputed. Failure to identify a clear survival benefit has been attributed to several factors, including an inherently more severely injured patient group who are attended by these teams. We undertook a novel retrospective analysis of the impact of a regional enhanced care team on observed vs. predicted patient survival based on outcomes recorded by the UK Trauma Audit and Research Network (TARN). The null hypothesis of this study was that attendance of an enhanced care team would make no difference to the number of 'unexpected survivors'. Patients attended by an enhanced care team were more seriously injured. Analysis of Trauma Audit and Research Network patient outcomes did not demonstrate an improved adjusted survival rate for trauma patients who were treated by a physician-led enhanced care team, but confirmed differences in patient characteristics and severity of injury for those who were attended by the team. We conclude that a further prospective multicentre analysis is warranted. An essential prerequisite for this would be to address the current blind spot in the Trauma Audit and Research Network database - patients who die from trauma before ever reaching hospital. We speculate that early on-scene critical care may convert this cohort of invisible trauma deaths into patients who might survive to reach hospital. Routine collection of data from these patients is warranted to include them in future studies.

Injury death certificates without specification of the circumstances leading to the fatal injury \u2013 the Norwegian Cause of Death Registry 2005\u20132014

BackgroundFor injury deaths, the underlying cause of death is defined as the circumstances leading to the injury. When this information is missing, the ICD-10 code X59 (Exposure to unspecified factor) is used. Lack of knowledge of factors causing injuries reduces the value of the cause of death statistics. The aim of this study was to identify predictors of X59-coded deaths in Norway, and to assess methods to identify the true underlying cause of injury deaths.MethodsWe used data from the Norwegian Cause of Death Registry from 2005 to 2014. We used logistic regression to identify determinants of X59-coded deaths. For redistribution of the X59 deaths, we used a multinomial logistic regression model based on the cases where injury circumstances were known. The data were divided into training and test sets. The model was developed on the training set and assessed on the test set before it was applied to the X59 deaths. The models used death certificate information on the nature of injury and demographic characteristics as predictor variables. Furthermore, we mailed a query to the certifying physicians of X59 deaths reported in the year 2015, where we asked for additional information on the circumstances leading to the fatal injury.ResultsThere were 24,963 injury deaths reported to the Cause of Death Registry of Norway 2005–2014. Of these, 6440 (25.8%) lacked information on the circumstances leading to the death. The strongest predictor for a X59 death was the nature of injury (hip fracture), followed by lack of information on the scene of injury. Applying our redistribution algorithm, we estimated that 97% of the X59-coded deaths were accidental falls. The strongest covariate was the nature of injury, followed by place of death and age at death. In 2015, there were 591 X59-coded deaths. Queries were sent to the certifying doctors in 559 cases. Among the informative replies to the query, 88% of the deaths were reclassified to accidental falls.ConclusionsA large proportion of injury deaths in Norway lack information on the circumstances leading to the fatal injury. Typically, these deaths represent accidental falls causing hip fracture in elderly individuals.

Prehospital triage for mass casualty incidents using the META method for early surgical assessment: retrospective validation of a hospital trauma registry.

In mass casualty incidents (MCI), death usually occurs within the first few hours and thus early transfer to a trauma centre can be crucial in selected cases. However, most triage systems designed to prioritize the transfer to hospital of these patients do not assess the need for surgery, in part due to inconclusive evidence regarding the value of such an assessment. Therefore, the aim of the present study was to evaluate the capacity of a new triage system-the Prehospital Advanced Triage Method (META)-to identify victims who could benefit from urgent surgical assessment in case of MCI. Retrospective, descriptive, observational study of a multipurpose cohort of patients included in the severe trauma registry of the Gregorio Marañón University General Hospital (Spain) between June 1993 and December 2011. All data were prospectively evaluated. All patients were evaluated with the META system to determine whether they met the criteria for urgent transfer. The META defines patients in need of urgent surgical assessment: (a) All penetrating injuries to head, neck, torso and extremities proximal to elbow or knee, (b) Open pelvic fracture, (c) Closed pelvic fracture with mechanical or haemodynamic instability and (d) Blunt torso trauma with haemodynamic instability. Patients who fulfilled these criteria were designated as "Urgent Evacuation for Surgical Assessment" (UESA) cases; all other cases were designated as non-UESA. The following variables were assessed: patient status at the scene; severity scales [RTS, Shock index, MGAP (Mechanism, Glasgow coma scale, Age, pressure), GCS]; need for surgery and/or interventional procedure to control bleeding (UESA); and mortality. The two groups (UESA vs. non-UESA) were then compared. A total of 1882 cases from the database were included in the study. Mean age was 39.2years and most (77%) patients were male. UESA patients presented significantly worse on-scene hemodynamic parameters (systolic blood pressure and heart rate) and greater injury severity (RTS, shock index, and MGAP scales). No differences were observed for respiratory rate, need for orotracheal intubation, or GCS scores. The anatomical injuries of patients in the UESA group were less severe but these patients had a greater need for urgent surgery and higher mortality rates. These findings suggest that the META triage classification system could be beneficial to help identify patients with severe trauma and/or in need of urgent surgical assessment at the scene of injury in case of MCI. These findings demonstrate that, in this cohort, the META fulfils the purpose for which it was designed.

Abstract 04: The Most Accurate Massive Transfusion Prediction Score at the Scene of Injury: The Pre-Hospital Traumatic Bleeding Severity Score

Background: Determination of the need for massive transfusion (MT) at the scene of injury is ideal for early activation of a MT protocol. We created and reported The Pre-hospital Traumatic Bleeding Severity Score (ph-TBSS) that is a simple and highly accurate scoring system to predict the need for MT at the scene of injury. However, the comparison study about the predictive value between the ph-TBSS and other MT predictors is not performed. Patients and Methods: A diagnostic comparison study using the registry data of the Gunma Prefectural Helicopter Emergency Medical Service (HEMS) was conducted. Records between Sep. 2012 and Apr. 2017 were reviewed, and adult trauma patients transported by the HEMS were included. A physician in the HEMS is always on board, primary survey including abdominal sonography scanning is performed at the scene of injury, and lactate was measured by portable equipment. The potential predictors of MT (10 units or more of packed red blood cells transfusion within 24 hours of injury) at the scene of injury were defined as following; The ph-TBSS, Assessment of Blood Consumption (ABS) score, the shock index, lactate concentration, and the presence of cold sweat. Each predictor was retrospectively calculated or reviewed from the registry data. Each predictive value was analyzed by the area under the receiver operating characteristic curve (AUROC) and the AUROC comparison analysis was performed. Results: 1025 patients were analyzed. Each AUROC for MT was following; ph-TBSS vs ABC score vs shock index vs lactate concentration vs presence of cold sweat = 0.97 [0.96-0.98] vs 0.83 [0.81-0.85] vs 0.89 [0.87-0.91] vs 0.91 [0.90-0.93] vs 0.70 [0.67-0.72]. The AUROC of the ph-TBSS was significantly higher compared to the AUROC of the other predictors (Bonferroni adjusted p&lt;0.01). Conclusion: At the scene of injury, the ph-TBSS represented the highest predictive value for MT, compared to the ABC score, shock index, lactate concentration, or presence of cold sweat.

Abstract 236: Lactate Level at the Scene of Injury can Accurately Predict the Need for Massive Transfusion

Introduction: The lactate has been widely recognized as a marker of tissue hypoxia/hypoperfusion. Hyperlactatemia is common among patients requiring critical care, and lactate levels and their trend may be reliable markers of illness severity and mortality. Elevated plasma lactate levels have been recommended as a parameter for hemodynamic resuscitation. The aim of this study is to investigate the predictive value of the lactate levels at the scene of injury for the need for Massive Transfusion (MT). Patients and Methods: A single-center retrospective diagnostic study was conducted. The records of the emergency medical service (EMS) between Sep. 2012 and Apr. 2017 were reviewed and adult high-energy trauma patients transported by the EMS were included. The data about the lactate levels and the need for MT (10 units or more of packed red blood cells transfusion within 24 hours of injury) was collected, and the predictive value of the lactate levels at the scene of injury was analyzed by the area under the receiver operating characteristic curve (AUROC). Our EMS system is always with specialized emergency physician, and lactate level was measured by portable equipment. Results: 1039 patients were enrolled and 1025 patients were analyzed after exclusion of 14 patients with insufficient data. The mean age was 55.0 years, 77.6% male, 98.1% blunt trauma, and 6.6% underwent MT. The AUROC of the lactate levels at the scene of injury for MT was 0.91 [95% confidential interval; 0.90-0.93]. Conclusion: The lactate levels at the scene of injury can accurately predict the need for Massive Transfusion. The further investigation is warranted.

To what extent are GCS and AVPU equivalent to each other when assessing the level of consciousness of children with head injury? A cross-sectional study of UK hospital admissions.

ObjectiveTo evaluate utility and equivalence of Glasgow Coma Scale (GCS) and the Alert, Voice, Pain, Unresponsive (AVPU) scale in children with head injury.DesignCross sectional study.SettingUK hospital admissions: September 2009–February 2010.Patients<15...

Vox Sanguinis International Forum on the use of prehospital blood products and pharmaceuticals in the treatment of patients with traumatic hemorrhage.

While specific practices and transported blood products vary around the world, most of the respondents in this International Forum transported at least one blood product for the transfusion to bleeding patients en route to the hospital. The most commonly carried product was RBCs, while the use of whole blood will likely increase given the recent reports of its successful use in the civilian setting, and because of the change in the AABB's Standards regulating its use. It will be interesting to see if plasma use in the prehospital setting becomes more widely used given today's enhanced appreciated of the coagulopathy of trauma and plasma's beneficial effect in reversing it, and if blood products are transported to the scene of injury by more vehicles, that is, not just predominantly in helicopters. It was not surprising that TXA is being widely administered as close to the time of injury as possible given its potential benefit in these patients. This International Forum highlights the importance of focusing attention on prehospital transfusion management with a need to further high‐quality research in this area to guide optimal resuscitation strategies.