المؤلفون: David Martin, Ronald M. Stewart, Martin A. Schreiber, Nicole T. Gordon, Belinda H. McCully, Samantha J. Underwood, Laszlo N. Kiraly, Bryce R.H. Robinson, Bryan A. Cotton, Rondi K. Dean, Joseph P. Minei, Connor Wiles, Nathan W. Anderson, John B. Holcomb, Elizabeth A. Rick

المصدر: Journal of Trauma and Acute Care Surgery. 84:104-111

مصطلحات موضوعية: Adult, Male, Erythrocytes, Red Blood Cell Transfusion, 030204 cardiovascular system & hematology, Hematocrit, Critical Care and Intensive Care Medicine, Cryopreservation, Hemoglobins, 03 medical and health sciences, Injury Severity Score, 0302 clinical medicine, Trauma Centers, medicine, Humans, Obesity, Prospective Studies, Prospective cohort study, Randomized Controlled Trials as Topic, Analysis of Variance, medicine.diagnostic_test, business.industry, 030208 emergency & critical care medicine, Middle Aged, Oxygen, Red blood cell, medicine.anatomical_structure, Tissue oxygenation, Anesthesia, Wounds and Injuries, Female, Surgery, Erythrocyte Transfusion, Packed red blood cells, business

الوصف: Low tissue oxygenation (StO2) is associated with poor outcomes in obese trauma patients. A novel treatment could be the transfusion of cryopreserved packed red blood cells (CPRBCs), which the in vitro biochemical profile favors red blood cell (RBC) function. We hypothesized that CPRBC transfusion improves StO2 in obese trauma patients.Two hundred forty-three trauma patients at five Level I trauma centers who required RBC transfusion were randomized to receive one to two units of liquid packed RBCs (LPRBCs) or CPRBCs. Demographics, injury severity, StO2, outcomes, and biomarkers of RBC function were compared in nonobese (body mass index [BMI]30) and obese (BMI ≥ 30) patients. StO2 was also compared between obese patients with BMI of 30 to 34.9 and BMI ≥ 35. StO2 was normalized and expressed as % change after RBC transfusion. A p value less than 0.05 indicated significance.Patients with BMI less than 30 (n = 141) and BMI of 30 or greater (n = 102) had similar Injury Severity Score, Glasgow Coma Scale, and baseline StO2. Plasma levels of free hemoglobin, an index of RBC lysis, were lower in obese patients after CPRBC (125 [72-259] μg/mL) versus LPRBC transfusion (230 [178-388] μg/mL; p0.05). StO2 was similar in nonobese patients regardless of transfusion type, but improved in obese patients who received CPRBCs (104 ± 1%) versus LPRPCs (99 ± 1%, p0.05; 8 hours after transfusion). Subanalysis showed improved StO2 after CPRBC transfusion was specific to BMI of 35 or greater, starting 5 hours after transfusion (p0.05 vs. LPRBCs). CPRBCs did not improve clinical outcomes in either group.CPRBC transfusion is associated with increased StO2 and lower free hemoglobin levels in obese trauma patients, but did not improve clinical outcomes. Future studies are needed to determine if CPRBC transfusion in obese patients attenuates hemolysis to improve StO2.Therapeutic, level IV.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::655f234232e56273f3799835e1533a46
https://doi.org/10.1097/ta.0000000000001717

المؤلفون: Matthew J. Bradley, Clay Cothren Burlew, Julie A Dunn, Lisa D. Bush, Jill R. Cherry-Bukowiec, David Martin, Kenji Inaba, Asad J. Choudhry, Christian T. Minshall, Joshua P. Hazelton, Demetrios Demetriades, Galinos Barmparas, Matthew J. Martin, Kimberly A. Peck, Raul Coimbra, Matthew M. Carrick, Gina M. Berg, Chad G. Ball, Saskya Byerly, Carlos V.R. Brown, Bellal Joseph

المصدر: Journal of Trauma and Acute Care Surgery. 81:1122-1130

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Adolescent, MEDLINE, Wounds, Nonpenetrating, Critical Care and Intensive Care Medicine, Sensitivity and Specificity, Article, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Trauma Centers, medicine, Humans, Prospective Studies, Young adult, Prospective cohort study, Aged, Aged, 80 and over, medicine.diagnostic_test, business.industry, 030208 emergency & critical care medicine, Magnetic resonance imaging, Middle Aged, Magnetic Resonance Imaging, Surgery, medicine.anatomical_structure, Spinal Injuries, Blunt trauma, Cervical Vertebrae, Female, Cervical collar, Observational study, Radiology, Tomography, X-Ray Computed, business, 030217 neurology & neurosurgery, Cervical vertebrae

الوصف: For blunt trauma patients who have failed the NEXUS (National Emergency X-Radiography Utilization Study) low-risk criteria, the adequacy of computed tomography (CT) as the definitive imaging modality for clearance remains controversial. The purpose of this study was to prospectively evaluate the accuracy of CT for the detection of clinically significant cervical spine (C-spine) injury.This was a prospective multicenter observational study (September 2013 to March 2015) at 18 North American trauma centers. All adult (≥18 years old) blunt trauma patients underwent a structured clinical examination. NEXUS failures underwent a CT of the C-spine with clinical follow-up to discharge. The primary outcome measure was sensitivity and specificity of CT for clinically significant injuries requiring surgical stabilization, halo, or cervical-thoracic orthotic placement using the criterion standard of final diagnosis at the time of discharge, incorporating all imaging and operative findings.Ten thousand seven hundred sixty-five patients met inclusion criteria, 489 (4.5%) were excluded (previous spinal instrumentation or outside hospital transfer); 10,276 patients (4,660 [45.3%] unevaluable/distracting injuries, 5,040 [49.0%] midline C-spine tenderness, 576 [5.6%] neurologic symptoms) were prospectively enrolled: mean age, 48.1 years (range, 18-110 years); systolic blood pressure 138 (SD, 26) mm Hg; median, Glasgow Coma Scale score, 15 (IQR, 14-15); Injury Severity Score, 9 (IQR, 4-16). Overall, 198 (1.9%) had a clinically significant C-spine injury requiring surgery (153 [1.5%]) or halo (25 [0.2%]) or cervical-thoracic orthotic placement (20 [0.2%]). The sensitivity and specificity for clinically significant injury were 98.5% and 91.0% with a negative predictive value of 99.97%. There were three (0.03%) false-negative CT scans that missed a clinically significant injury, all had a focal neurologic abnormality on their index clinical examination consistent with central cord syndrome, and two of three scans showed severe degenerative disease.For patients requiring acute imaging for their C-spine after blunt trauma, CT was effective for ruling out clinically significant injury with a sensitivity of 98.5%. For patients with an abnormal neurologic examination as the trigger for imaging, there is a small but clinically significant incidence of a missed injury, and further imaging with magnetic resonance imaging is warranted.Diagnostic tests, level II.

URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::93c4759030883826ad534d176ad527f0
https://doi.org/10.1097/ta.0000000000001194