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https://www.readbyqxmd.com/read/27846895/development-and-validation-of-a-prehospital-prediction-model-for-acute-traumatic-coagulopathy
#1
Ithan D Peltan, Ali Rowhani-Rahbar, Lisa K Vande Vusse, Ellen Caldwell, Thomas D Rea, Ronald V Maier, Timothy R Watkins
BACKGROUND: Acute traumatic coagulopathy (ATC) is a syndrome of early, endogenous clotting dysfunction that afflicts up to 30% of severely injured patients, signaling an increased likelihood of all-cause and hemorrhage-associated mortality. To aid identification of patients within the likely therapeutic window for ATC and facilitate study of its mechanisms and targeted treatment, we developed and validated a prehospital ATC prediction model. METHODS: Construction of a parsimonious multivariable logistic regression model predicting ATC - defined as an admission international normalized ratio >1...
November 16, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27814743/prehospital-fibrinolysis-versus-primary-percutaneous-coronary-intervention-in-st-elevation-myocardial-infarction-a-systematic-review-and-meta-analysis-of-randomized-controlled-trials
#2
Vincent Roule, Pierre Ardouin, Katrien Blanchart, Adrien Lemaitre, Julien Wain-Hobson, Damien Legallois, Joachim Alexandre, Rémi Sabatier, Paul Milliez, Farzin Beygui
BACKGROUND: Primary percutaneous coronary intervention (PPCI) is the preferred reperfusion strategy in patients with ST-elevation myocardial infarction (STEMI), but its benefit over prehospital fibrinolysis (FL) is not clear. METHODS: We performed a systematic review and meta-analysis of randomized controlled trials in which outcomes of patients with STEMI managed with FL early in the prehospital setting versus PPCI were compared. RESULTS: Compared with PPCI, FL was consistently associated with similar rates of short-term (30-90 days) death (relative risk [RR] 0...
November 5, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27648770/prehospital-shock-index-and-pulse-pressure-heart-rate-ratio-to-predict-massive-transfusion-after-severe-trauma-retrospective-analysis-of-a-large-regional-trauma-database
#3
Julien Pottecher, François-Xavier Ageron, Clémence Fauché, Denis Chemla, Eric Noll, Jacques Duranteau, Laurent Chapiteau, Jean-François Payen, Pierre Bouzat
BACKGROUND: Early and accurate detection of severe hemorrhage is critical for a timely trigger of massive transfusion (MT). Hemodynamic indices combining heart rate (HR) and either systolic (shock index [SI]) or pulse pressure (PP) (PP/HR ratio) have been shown to track blood loss during hemorrhage. The present study assessed the accuracy of prehospital SI and PP/HR ratio to predict subsequent MT, using the gray-zone approach. METHODS: This was a retrospective analysis (January 1, 2009, to December 31, 2011) of a prospectively developed trauma registry (TRENAU), in which the triage scheme combines patient severity and hospital facilities...
October 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27168573/evaluation-of-miniature-wireless-vital-signs-monitor-in-a-trauma-intensive-care-unit
#4
Jonathan P Meizoso, Casey J Allen, Juliet J Ray, Robert M Van Haren, Laura F Teisch, Xiomara Ruiz Baez, Alan S Livingstone, Nicholas Namias, Carl I Schulman, Kenneth G Proctor
A previous study demonstrated basic proof of principle of the value of a miniature wireless vital signs monitor (MWVSM, MiniMedic, Athena GTX, Des Moines, Iowa) for battlefield triage However, there were unanswered questions related to sensor reliability and uncontrolled conditions in the prehospital environment. This study determined whether MWVSM sensors track vital signs and allow for appropriate triage compared to a gold standard bedside monitor in trauma patients. This was a prospective study in 59 trauma intensive care unit patients...
May 2016: Military Medicine
https://www.readbyqxmd.com/read/27027555/automated-continuous-vital-signs-predict-use-of-uncrossed-matched-blood-and-massive-transfusion-following-trauma
#5
Nehu Parimi, Peter F Hu, Colin F Mackenzie, Shiming Yang, Stephen T Bartlett, Thomas M Scalea, Deborah M Stein
BACKGROUND: Recognizing the use of uncross-matched packed red blood cells (UnXRBCs) or predicting the need for massive transfusion (MT) in injured patients with hemorrhagic shock can be challenging.A validated predictive model could accelerate decision making regarding transfusion. METHODS: Three transfusion outcomes were evaluated in adult trauma patients admitted to a Level I trauma center during a 4-year period (2009-2012): use of UnXRBC, use of greater than 4 U of packed red blood cells within 4 hours (MT1), and use of equal to or greater than 10 U of packed red blood cells within 24 hours (MT2)...
June 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/26985695/computer-modelling-using-prehospital-vitals-predicts-transfusion-and-mortality
#6
Zachary D W Dezman, Eric Hu, Peter F Hu, Shiming Yang, Lynn G Stansbury, Rhonda Cooke, Raymond Fang, Catriona Miller, Colin F Mackenzie
OBJECTIVE: Test computer-assisted modeling techniques using prehospital vital signs of injured patients to predict emergency transfusion requirements, number of intensive care days, and mortality, compared to vital signs alone. METHODS: This single-center retrospective analysis of 17,988 trauma patients used vital signs data collected between 2006 and 2012 to predict which patients would receive transfusion, require 3 or more days of intensive care, or die. Standard transmitted prehospital vital signs (heart rate, blood pressure, shock index, and respiratory rate) were used to create a regression model (PH-VS) that was internally validated and evaluated using area under the receiver operating curve (AUROC)...
September 2016: Prehospital Emergency Care
https://www.readbyqxmd.com/read/26953537/association-of-prehospital-shock-index-and-trauma-bay-uncrossmatched-red-blood-cell-transfusion-with-multiple-transfusion
#7
Darcy L Day, Kathleen M Anzelon, Franscisco A Conde
Early resuscitation of bleeding trauma patients with multiple blood products improves outcome, yet transfusion initiation is not standardized. Shock index (heart rate/systolic blood pressure) and trauma bay uncrossmatched red blood cell (RBC) transfusion were evaluated for association with multiple transfusions, defined as 6 or more RBCs during the first 6 hrs of hospital presentation. A prehospital shock index of 1 was significantly associated with multiple transfusions (p = .02). Subjects receiving uncrossmatched RBCs required more RBCs during the first 6 hrs (10...
March 2016: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
https://www.readbyqxmd.com/read/26683104/trends-of-hemoglobin-oximetry-do-they-help-predict-blood-transfusion-during-trauma-patient-resuscitation
#8
COMPARATIVE STUDY
Shiming Yang, Peter F Hu, Amechi Anazodo, Cheng Gao, Hegang Chen, Christine Wade, Lauren Hartsky, Catriona Miller, Cristina Imle, Raymond Fang, Colin F Mackenzie
BACKGROUND: A noninvasive decision support tool for emergency transfusion would benefit triage and resuscitation. We tested whether 15 minutes of continuous pulse oximetry-derived hemoglobin measurements (SpHb) predict emergency blood transfusion better than conventional oximetry, vital signs, and invasive point-of-admission (POA) laboratory testing. We hypothesized that the trends in noninvasive SpHb features monitored for 15 minutes predict emergency transfusion better than pulse oximetry, shock index (SI = heart rate/systolic blood pressure), or routine POA laboratory measures...
January 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/26662813/noradrenalin-effectively-rescues-mice-from-blast-lung-injury-caused-by-laser-induced-shock-waves
#9
Hiroki Miyawaki, Daizoh Saitoh, Kohsuke Hagisawa, Midori Noguchi, Shunichi Sato, Manabu Kinoshita, Hiromi Miyazaki, Yasushi Satoh, Nahoko Harada, Toshihisa Sakamoto
BACKGROUND: Blast lung injuries (BLI) caused by blast waves are extremely critical in the prehospital setting, and hypotension is thought to be the main cause of death in such cases. The present study aimed to elucidate the pathophysiology of severe BLI using laser-induced shock wave (LISW) and identify the initial treatment. METHODS: The current investigation comprised two parts. For the validation study, mice were randomly allocated to groups that received a single shot of 1...
December 2015: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/26585200/acute-care-diagnostics-collaboration-assessment-of-a-bayesian-clinical-decision-model-integrating-the-prehospital-sepsis-score-and-point-of-care-lactate
#10
Amado Alejandro Baez, Laila Cochon
UNLABELLED: Previous research demonstrated that shock index and respiratory rate are highly predictive of intensive care unit admissions. OBJECTIVE: The objective of the study is to evaluate the integration of the prehospital sepsis project score (PSP-S) and point-of-care lactate in assisting prediction of severity of illness using Bayesian statistical modeling. METHODS: The PSP-S incorporates fever (38°C [100.4°F]) allotted with 1 point, shock index greater than or equal to 0...
February 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/26406427/predicting-blood-transfusion-using-automated-analysis-of-pulse-oximetry-signals-and-laboratory-values
#11
Stacy Shackelford, Shiming Yang, Peter Hu, Catriona Miller, Amechi Anazodo, Samuel Galvagno, Yulei Wang, Lauren Hartsky, Raymond Fang, Colin Mackenzie
BACKGROUND: Identification of hemorrhaging trauma patients and prediction of blood transfusion needs in near real time will expedite care of the critically injured. We hypothesized that automated analysis of pulse oximetry signals in combination with laboratory values and vital signs obtained at the time of triage would predict the need for blood transfusion with accuracy greater than that of triage vital signs or pulse oximetry analysis alone. METHODS: Continuous pulse oximetry signals were recorded for directly admitted trauma patients with abnormal prehospital shock index (heart rate [HR] / systolic blood pressure) of 0...
October 2015: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/26113162/an-early-warning-scoring-system-to-identify-septic-patients-in-the-prehospital-setting-the-presep-score
#12
Ole Bayer, Daniel Schwarzkopf, Christoph Stumme, Angelika Stacke, Christiane S Hartog, Christian Hohenstein, Björn Kabisch, Jens Reichel, Konrad Reinhart, Johannes Winning
OBJECTIVES: The objective was to develop and evaluate an early sepsis detection score for the prehospital setting. METHODS: A retrospective analysis of consecutive patients who were admitted by emergency medical services (EMS) to the emergency department of the Jena University Hospital was performed. Because potential predictors for sepsis should be based on consensus criteria, the following parameters were extracted from the EMS protocol for further analysis: temperature, heart rate (HR), respiratory rate (RR), oxygen saturation (SaO2 ), Glasgow Coma Scale score, blood glucose, and systolic blood pressure (sBP)...
July 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/25803650/prehospital-hypotension-is-associated-with-altered-inflammation-dynamics-and-worse-outcomes-following-blunt-trauma-in-humans
#13
Khalid Almahmoud, Rami A Namas, Akram M Zaaqoq, Othman Abdul-Malak, Rajaie Namas, Ruben Zamora, Jason Sperry, Timothy R Billiar, Yoram Vodovotz
OBJECTIVE: To define the impact of prehospital hypotension on the dynamic, systemic acute inflammatory response to blunt trauma. DESIGN: Retrospective study. SETTINGS: Tertiary care institution. PATIENTS: Twenty-two hypotensive blunt trauma patients matched with 28 normotensive blunt trauma patients. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: From a cohort of 472 blunt trauma survivors studied following institutional review board approval, two stringently matched subcohorts were derived...
July 2015: Critical Care Medicine
https://www.readbyqxmd.com/read/25753142/accuracy-of-continuous-noninvasive-hemoglobin-monitoring-for-the-prediction-of-blood-transfusions-in-trauma-patients
#14
Samuel M Galvagno, Peter Hu, Shiming Yang, Cheng Gao, David Hanna, Stacy Shackelford, Colin Mackenzie
Early detection of hemorrhagic shock is required to facilitate prompt coordination of blood component therapy delivery to the bedside and to expedite performance of lifesaving interventions. Standard physical findings and vital signs are difficult to measure during the acute resuscitation stage, and these measures are often inaccurate until patients deteriorate to a state of decompensated shock. The aim of this study is to examine a severely injured trauma patient population to determine whether a noninvasive SpHb monitor can predict the need for urgent blood transfusion (universal donor or additional urgent blood transfusion) during the first 12 h of trauma patient resuscitation...
December 2015: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/25710433/a-comparison-of-prehospital-lactate-and-systolic-blood-pressure-for-predicting-the-need-for-resuscitative-care-in-trauma-transported-by-ground
#15
MULTICENTER STUDY
Francis X Guyette, Eric N Meier, Craig Newgard, Barbara McKnight, Mohamud Daya, Eileen M Bulger, Judy L Powell, Karen J Brasel, Jeffery D Kerby, Debra Egan, Michael Sise, Raul Coimbra, Timothy C Fabian, David B Hoyt
BACKGROUND: Reliance on prehospital trauma triage guidelines misses patients with serious injury. Lactate is a biomarker capable of identifying high-risk trauma patients. Our objective was to compare prehospital point-of-care lactate (P-LAC) with systolic blood pressure (SBP) for predicting the need for resuscitative care (RC) in trauma patients transported by ground emergency medical services. METHODS: This is a prospective observational study at nine sites within the Resuscitation Outcomes Consortium conducted from March 2011 to August 2012...
March 2015: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/25664983/automated-analysis-of-vital-signs-to-identify-patients-with-substantial-bleeding-before-hospital-arrival-a-feasibility-study
#16
Jianbo Liu, Maxim Y Khitrov, Jonathan D Gates, Stephen R Odom, Joaquim M Havens, Marc A de Moya, Kevin Wilkins, Suzanne K Wedel, Erin O Kittell, Jaques Reifman, Andrew T Reisner
Trauma outcomes are improved by protocols for substantial bleeding, typically activated after physician evaluation at a hospital. Previous analysis suggested that prehospital vital signs contained patterns indicating the presence or absence of substantial bleeding. In an observational study of adults (aged ≥18 years) transported to level I trauma centers by helicopter, we investigated the diagnostic performance of the Automated Processing of the Physiological Registry for Assessment of Injury Severity (APPRAISE) system, a computational platform for real-time analysis of vital signs, for identification of substantial bleeding in trauma patients with explicitly hemorrhagic injuries...
May 2015: Shock
https://www.readbyqxmd.com/read/25644852/predictors-of-survival-and-favorable-functional-outcomes-after-an-out-of-hospital-cardiac-arrest-in-patients-systematically-brought-to-a-dedicated-heart-attack-center-from-the-harefield-cardiac-arrest-study
#17
COMPARATIVE STUDY
M Bilal Iqbal, Abtehale Al-Hussaini, Gareth Rosser, Saleem Salehi, Maria Phylactou, Ramyah Rajakulasingham, Jayna Patel, Katharine Elliott, Poornima Mohan, Rebecca Green, Mark Whitbread, Robert Smith, Charles Ilsley
Despite advances in cardiopulmonary resuscitation (CPR), survival remains low after out-of-hospital cardiac arrest (OOHCA). Acute coronary ischemia is the predominating precipitant, and prompt delivery of patients to dedicated facilities may improve outcomes. Since 2011, all patients experiencing OOHCA in London, where a cardiac etiology is suspected, are systematically brought to heart attack centers (HACs). We determined the predictors for survival and favorable functional outcomes in this setting. We analyzed 174 consecutive patients experiencing OOHCA from 2011 to 2013 brought to Harefield Hospital-a designated HAC in London...
March 15, 2015: American Journal of Cardiology
https://www.readbyqxmd.com/read/25502152/ems-patients-and-walk-in-patients-presenting-with-severe-sepsis-differences-in-management-and-outcome
#18
COMPARATIVE STUDY
Jon Femling, Steven Weiss, Eric Hauswald, David Tarby
OBJECTIVES: Sepsis is a significant problem. The differences between patients with sepsis who walk into the emergency department (ED) and those who are transported via emergency medical services (EMS) have not been clarified. The aim of the study was to determine whether there was a difference in outcome between patients arriving by EMS and those presenting directly to the ED. METHODS: We prospectively collected and reviewed a cohort of all cases of severe sepsis and septic shock admitted to the medical intensive care unit from the ED from November 2009 to March 2012...
December 2014: Southern Medical Journal
https://www.readbyqxmd.com/read/25493120/shock-index-and-prediction-of-traumatic-hemorrhagic-shock-28-day-mortality-data-from-the-dclhb-resuscitation-clinical-trials
#19
MULTICENTER STUDY
Edward P Sloan, Max Koenigsberg, James M Clark, William B Weir, Nora Philbin
INTRODUCTION: To assess the ability of the shock index (SI) to predict 28-day mortality in traumatic hemorrhagic shock patients treated in the diaspirin cross-linked hemoglobin (DCLHb) resuscitation clinical trials. METHODS: We used data from two parallel DCLHb traumatic hemorrhagic shock efficacy trials, one in U.S. emergency departments, and one in the European Union prehospital setting to assess the relationship between SI values and 28-day mortality. RESULTS: In the 219 patients, the mean age was 37 years, 64% sustained a blunt injury, 48% received DCLHb, 36% died, and 88% had an SI≥1...
November 2014: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/25425230/prehospital-identification-of-trauma-patients-with-early-acute-coagulopathy-and-massive-bleeding-results-of-a-prospective-non-interventional-clinical-trial-evaluating-the-trauma-induced-coagulopathy-clinical-score-ticcs
#20
Martin L Tonglet, Jean Marc Minon, Laurence Seidel, Jean Louis Poplavsky, Michel Vergnion
INTRODUCTION: Identifying patients who need damage control resuscitation (DCR) early after trauma is pivotal for adequate management of their critical condition. Several trauma-scoring systems have been developed to identify such patients, but most of them are not simple enough to be used in prehospital settings in the early post-traumatic phase. The Trauma Induced Coagulopathy Clinical Score (TICCS) is an easy-to-measure and strictly clinical trauma score developed to meet this medical need...
2014: Critical Care: the Official Journal of the Critical Care Forum
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