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https://www.readbyqxmd.com/read/27918852/anomaly-detection-outperforms-logistic-regression-in-predicting-outcomes-in-trauma-patients
#1
Zachary D W Dezman, Chen Gao, Shiming Yang, Peter Hu, Li Yao, Hsiao-Chi Li, Chein-I Chang, Colin Mackenzie
OBJECTIVE: Recent advancements in trauma resuscitation have shown a great benefit of early identification and control of hemorrhage, which is the most common cause of death in injured patients. We introduce a new analytical approach, anomaly detection (AD), as an alternative method to the traditional logistic regression (LR) method in predicting which injured patients receive transfusions, intensive care, and other interventions. METHODS: We abstracted routinely collected prehospital vital sign data from patient records (adult patients who survived more than 15 minutes after being directly admitted to a level 1 trauma center)...
December 5, 2016: Prehospital Emergency Care
https://www.readbyqxmd.com/read/27871682/factors-affecting-mortality-after-penetrating-cardiac-injuries-10-year-experience-at-urban-level-i-trauma-center
#2
Michael J Mina, Rashi Jhunjhunwala, Rondi B Gelbard, Stacy D Dougherty, Jacquelyn S Carr, Christopher J Dente, Jeffrey M Nicholas, Amy D Wyrzykowski, Jeffrey P Salomone, Gary A Vercruysse, David V Feliciano, Bryan C Morse
BACKGROUND: Despite the lethality of injuries to the heart, optimizing factors that impact mortality for victims that do survive to reach the hospital is critical. METHODS: From 2003 to 2012, prehospital data, injury characteristics, and clinical patient factors were analyzed for victims with penetrating cardiac injuries (PCIs) at an urban, level I trauma center. RESULTS: Over the 10-year study, 80 PCI patients survived to reach the hospital...
October 15, 2016: American Journal of Surgery
https://www.readbyqxmd.com/read/27846895/development-and-validation-of-a-prehospital-prediction-model-for-acute-traumatic-coagulopathy
#3
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/27836253/bi-manual-proximal-external-aortic-compression-after-major-abdominal-pelvic-trauma-and-during-ambulance-transfer-a-simulation-study
#4
M J Douma, D O'Dochartaigh, P G Brindley
BACKGROUND: Applying manual pressure after hemorrhage is intuitive, cost-free, and logistically-simple. When direct abdominal-pelvic compression fails, clinicians can attempt indirect proximal-external-aortic-compression (PEAC), while expediting transfer and definitive rescue. This study quantifies the sustainability of simulated bi-manual PEAC both immediately on scene and during subsequent ambulance transfer. The goal is to understand when bi-manual PEAC might be clinically-useful, and when to prioritize compression-devices or endovascular-occlusion...
November 5, 2016: Injury
https://www.readbyqxmd.com/read/27832843/time-is-the-enemy-mortality-in-trauma-patients-with-hemorrhage-from-torso-injury-occurs-long-before-the-golden-hour
#5
A Q Alarhayem, J G Myers, D Dent, L Liao, M Muir, D Mueller, S Nicholson, R Cestero, M C Johnson, R Stewart, Grant O'Keefe, B J Eastridge
INTRODUCTION: The concept of the "Golden Hour" has been a time-honored tenet of prehospital trauma care, despite a paucity of data to substantiate its validity. Non-compressible torso hemorrhage has been demonstrated to be a significant cause of mortality in both military and civilian settings. We sought to characterize the impact of prehospital time and torso injury severity on survival. Furthermore, we hypothesized that time would be a significant determinant of mortality in patients with higher Abbreviated Injury Scale (AIS) grades of torso injury (AIS ≥ 4) and field hypotension (prehospital SBP ≤ 110 mmHg) as these injuries are commonly associated with hemorrhage...
October 20, 2016: American Journal of Surgery
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
#6
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/27779578/does-small-volume-resuscitation-with-crystalloids-or-colloids-influence-hemostasis-and-survival-of-rabbits-subjected-to-lethal-uncontrolled-hemorrhage
#7
Bijan S Kheirabadi, Nahir Miranda, Irasema B Terrazas, Mary D Gonzales, Rose C Grimm, Michael A Dubick
INTRODUCTION: Prehospital, small-volume resuscitation of combat casualties with a synthetic colloid [6% hydroxyethyl starch (HES) 670/0.75] has been recommended when blood or blood components are unavailable. We studied hemostatic effects of a newer synthetic colloid (6% HES 130/0.4,) compared to either a natural colloid (albumin) or to crystalloids in an uncontrolled hemorrhage model. METHODS: Spontaneously breathing NZW rabbits (3.4±0.1 kg) were anesthetized, instrumented and subjected to a splenic injury with uncontrolled bleeding...
October 25, 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27689248/trends-and-predictors-of-limb-tourniquet-use-by-civilian-emergency-medical-services-in-the-united-states
#8
Mazen J El Sayed, Hani Tamim, Aurelie Mailhac, N Clay Mann
BACKGROUND: Tourniquet use by Emergency Medical Services (EMS) can be life saving for severely injured patients. The adoption of this intervention is not well described in civilian settings. This study describes patterns and trends of tourniquet use by civilian EMS and identifies predictors of such use. METHODS: A retrospective study of four consecutive releases of the U.S. National Emergency Medical Services Information System (NEMSIS) public research dataset (2011-14) was conducted...
September 30, 2016: Prehospital Emergency Care
https://www.readbyqxmd.com/read/27679533/characteristics-and-outcomes-of-very-elderly-enrolled-in-a-prehospital-stroke-research-study
#9
Nerses Sanossian, Kathleen C Apibunyopas, David S Liebeskind, Sidney Starkman, Adrian M Burgos, Robin Conwit, Marc Eckstein, Frank Pratt, Sam Stratton, Scott Hamilton, Jeffrey L Saver
BACKGROUND AND PURPOSE: Greater numbers of individuals aged ≥80 years enjoy a high quality of life, yet historically stroke trials have excluded this population. We aimed to describe a population of very elderly successfully enrolled into an acute stroke trial and compare their characteristics and outcomes with the younger cohort. METHODS: We analyzed consecutive patients enrolled <2 hours of symptom onset in a prehospital stroke treatment trial, the FAST-MAG clinical trial (Field Administration of Stroke Therapy-Magnesium)...
November 2016: Stroke; a Journal of Cerebral Circulation
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
#10
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/27642014/ultra-acute-diagnostics-for-stroke-large-scale-implementation-of-prehospital-biomarker-sampling
#11
O S Mattila, H Harve, S Pihlasviita, J Ritvonen, G Sibolt, M Pystynen, D Strbian, S Curtze, M Kuisma, T Tatlisumak, P J Lindsberg
OBJECTIVES: Blood-based biomarkers could enable early and cost-effective diagnostics for acute stroke patients in the prehospital setting to support early initiation of treatments. To facilitate development of ultra-acute biomarkers, we set out to implement large-scale prehospital blood sampling and determine feasibility and diagnostic timesavings of this approach. MATERIALS AND METHODS: Emergency medical services (EMS) personnel of the Helsinki metropolitan area were trained to collect prehospital blood samples from thrombolysis candidates using a cannula adapter technique...
September 18, 2016: Acta Neurologica Scandinavica
https://www.readbyqxmd.com/read/27636529/do-ems-providers-accurately-ascertain-anticoagulant-and-antiplatelet-use-in-older-adults-with-head-trauma
#12
Daniel K Nishijima, Samuel Gaona, Trent Waechter, Ric Maloney, Troy Bair, Adam Blitz, Andrew R Elms, Roel D Farrales, Calvin Howard, James Montoya, Jeneita M Bell, Victor C Coronado, David E Sugerman, Dustin W Ballard, Kevin E Mackey, David R Vinson, James F Holmes
OBJECTIVE: Prehospital provider assessment of the use of anticoagulant or antiplatelet medications in older adults with head trauma is important. These patients are at increased risk for traumatic intracranial hemorrhage and therefore field triage guidelines recommend transporting these patients to centers capable of rapid evaluation and treatment. Our objective was to evaluate EMS ascertainment of anticoagulant and antiplatelet medication use in older adults with head trauma. METHODS: A retrospective study of older adults with head trauma was conducted throughout Sacramento County...
September 16, 2016: Prehospital Emergency Care
https://www.readbyqxmd.com/read/27627087/-methanol-the-threat-of-intoxication-is-still-there
#13
Daniela Pelclová, Sergey Zakharov
UNLABELLED: Methanol mass poisoning occurs across the world quite frequently, but the complete clinical and laboratory data of the patients are only rarely available. Approximately 138 cases of poisoning were documented in the Czech Republic, 107 patients were hospitalized. Another 31 persons died out of hospital. About 60 % of the hospitalized patients survived intoxication without consequences, one half of the remaining 40 % died and the other half survived with the CNS and/or sight impaired...
2016: Vnitr̆ní Lékar̆ství
https://www.readbyqxmd.com/read/27623805/prehospital-control-of-life-threatening-truncal-and-junctional-haemorrhage-is%C3%A2-the-ultimate-challenge-in-optimizing-trauma-care-a-review-of-treatment-options-and-their-applicability-in-the-civilian-trauma-setting
#14
REVIEW
S E van Oostendorp, E C T H Tan, L M G Geeraedts
INTRODUCTION: Exsanguination following trauma is potentially preventable. Extremity tourniquets have been successfully implemented in military and civilian prehospital care. Prehospital control of bleeding from the torso and junctional area's remains challenging but offers a great potential to improve survival rates. This review aims to provide an overview of potential treatment options in both clinical as preclinical state of research on truncal and junctional bleeding. Since many options have been developed for application in the military primarily, translation to the civilian situation is discussed...
September 13, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/27595109/hypotensive-resuscitation-among-trauma-patients
#15
REVIEW
Matthew M Carrick, Jan Leonard, Denetta S Slone, Charles W Mains, David Bar-Or
Hemorrhagic shock is a principal cause of death among trauma patients within the first 24 hours after injury. Optimal fluid resuscitation strategies have been examined for nearly a century, more recently with several randomized controlled trials. Hypotensive resuscitation, also called permissive hypotension, is a resuscitation strategy that uses limited fluids and blood products during the early stages of treatment for hemorrhagic shock. A lower-than-normal blood pressure is maintained until operative control of the bleeding can occur...
2016: BioMed Research International
https://www.readbyqxmd.com/read/27484298/characteristics-and-outcomes-of-blood-product-transfusion-during-critical-care-transport
#16
Jorge Mena-Munoz, Udayan Srivastava, Christian Martin-Gill, Brian Suffoletto, Clifton W Callaway, Francis X Guyette
BACKGROUND: Civilian out-of-hospital transfusions have not been adequately studied. This study seeks to characterize patients receiving out-of-hospital blood product transfusion during critical care transport. STUDY DESIGN AND METHODS: We studied patients transported by a regional critical care air-medical service who received blood products during transport. This service carries two units of uncrossmatched packed Red Blood Cells (pRBCs) on every transport in addition to blood obtained from referring facilities...
September 2016: Prehospital Emergency Care
https://www.readbyqxmd.com/read/27450599/preliminary-comparison-of-pneumatic-models-of-tourniquet-for-prehospital-control-of-limb-bleeding-in-a-manikin-model
#17
Rudy Gibson, James K Aden, Michael A Dubick, John F Kragh
BACKGROUND: Emergency tourniquet use has been associated with hemorrhage control and improved survival during the wars since 2001, but little is known of the differential performance of pneumatic tourniquet models. The purpose of this study was to compare the performance of three models of pneumatic tourniquets in a laboratory setting to aid a possible decision to field test suitable models for medic preference. METHODS: A laboratory experiment was designed to test the effectiveness of tourniquets on a manikin thigh...
December 0: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/27424129/prognostic-factors-of-early-outcome-and-discharge-status-in-patients-undergoing-surgical-intervention-following-traumatic-intracranial-hemorrhage
#18
Tatsuhiro Fujii, Gabriela Moriel, Daniel R Kramer, Frank Attenello, Gabriel Zada
Over the past several decades, the rate of traumatic brain injury (TBI)-related emergency room visits in the United States has steadily increased, yet mortality in these patients has decreased. This improvement in outcome is largely due to advances in prehospital care, intensive care unit management, and the effectiveness of neurosurgical procedures, such as decompressive craniectomies. It is imperative to identify clinical factors predictive of patients who benefit from early mobilization of resources and operative treatment...
September 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/27405067/tactical-study-of-care-originating-in-the-prehospital-environment-tacscope-acute-traumatic-coagulopathy-on-the-contemporary-battlefield
#19
Robert T Gerhardt, Elon Glassberg, John B Holcomb, Robert L Mabry, Martin B Schreiber, Philip C Spinella
BACKGROUND: Uncontrolled major hemorrhage and delayed evacuation remain substantial contributors to potentially survivable combat death, along with mission, environment, terrain, logistics, and hostile action. Life-saving interventions and the onset of acute traumatic coagulopathy (ATC) may also contribute. OBJECTIVE: Analyze US casualty records from the DoD Trauma Registry, using International Normalized Ratio (INR) of 1.5 for onset of ATC. METHODS: Retrospective cohort study from September 2007 to June 2011, inclusive...
September 2016: Shock
https://www.readbyqxmd.com/read/27380529/what-if-i-don-t-have-blood-hextend-is-superior-to-3-saline-in-an-experimental-model-of-far-forward-resuscitation-after-hemorrhage
#20
Peter L Jernigan, Richard S Hoehn, Daniel Cox, Judy Heyl, Warren C Dorlac, Timothy A Pritts
INTRODUCTION: Hypertonic crystalloid solutions, colloids, and fresh whole blood (FWB) have all been proposed for prehospital resuscitation after hemorrhage. However, there are no direct comparisons of the efficacy of these different fluids. We compared Hextend, 3% hypertonic saline (HS), and FWB in a porcine model of hemorrhagic shock. MATERIALS AND METHODS: Female swine (n = 5/group) underwent splenectomy and pressure-controlled hemorrhage followed by resuscitation with Hextend, 3% HS, or FWB...
September 2016: Shock
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