Journal of Trauma and Acute Care Surgery最新文献

{"title":"\"Pager trauma\" as a new and destructive type of blast injuries: Retraction.","authors":"Hamid Reza Rasouli, Hadi Khoshmohabat, Fathollah Ahmadpour","doi":"10.1097/TA.0000000000004595","DOIUrl":"https://doi.org/10.1097/TA.0000000000004595","url":null,"abstract":"","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes among patients with isolated traumatic brain injury before and after Medicaid expansion.","authors":"Michael S Rallo, Ryan E Radwanski, Amanda L Teichman, Mayur Narayan, Anil Nanda, Rachel L Choron","doi":"10.1097/TA.0000000000004555","DOIUrl":"https://doi.org/10.1097/TA.0000000000004555","url":null,"abstract":"<p><strong>Introduction: </strong>Insurance coverage is a critical determinant of access to care. Uninsured patients suffer poorer outcomes including increased risk of morbidity/mortality. To reduce uninsurance among adults, the Affordable Care Act provisioned states the option to expand Medicaid eligibility. We hypothesized that patients with isolated traumatic brain injury (TBI) had more insurance coverage and better outcomes after Medicaid expansion as compared with before.</p><p><strong>Methods: </strong>National data on trauma admissions were obtained from the American College of Surgeons Trauma Quality Program Public Use File for 3 years preceding and following the implementation of Medicaid expansion in 2014. Isolated TBI admissions were identified by an Abbreviated Injury Scale-Head score of ≥2 without significant bodily injury. Only patients between the ages 18 and 64 years were included, as that was the Medicaid expansion target demographic. Univariate and multivariate analyses controlling for injury severity were used to detect changes in insurance coverage (Medicaid, private/other insurance, uninsured), outcomes, and discharge disposition.</p><p><strong>Results: </strong>There were 267,716 and 313,664 admissions for isolated TBI in pre- and postexpansion years. The proportion of patients insured by Medicaid rose significantly from 13.8% to 22.6% (+8.8%, p < 0.01) in postexpansion years with a concomitant decrease in self-pay/uninsurance (-6.7%, p < 0.01) and private/other insurance (-2.1%, p < 0.01). While there was no significant difference in isolated TBI mortality pre- to postexpansion (3.4% vs. 3.5%, p = 0.18), patients in the postexpansion period were more likely to receive posthospital care at an inpatient facility or via home health service compared with pre-expansion (odds ratio [OR], 1.3; p < 0.01). After controlling for injury severity, patients with Medicaid in the postexpansion period had reduced odds of mortality (OR, 0.6; p < 0.01) and increased rates of posthospital care (OR, 2.1; p < 0.01).</p><p><strong>Conclusion: </strong>Medicaid expansion corresponded to increased Medicaid coverage and a higher rate of posthospital care among adults with isolated TBI. Following expansion, patients with Medicaid were 1.6 times as likely to survive and 2.1 times as likely to be discharged under medical care compared with uninsured patients.</p><p><strong>Level of evidence: </strong>Retrospective Analysis; Level IV.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The consequences of parental injury: Impacts on children's health care utilization and financial barriers to care.","authors":"Arnav Mahajan, Ruchika Kamojjala, Saba Ilkhani, Caleb W Curry, Penelope Halkiadakis, Prerna Ladha, Megen Simpson, Sarah A Sweeney, Vanessa P Ho","doi":"10.1097/TA.0000000000004553","DOIUrl":"https://doi.org/10.1097/TA.0000000000004553","url":null,"abstract":"<p><strong>Background: </strong>Unintentional traumatic injuries pose a significant public health challenge, impacting not only injured individuals but also their families. Existing research has largely focused on the effects of a child's injury on their family, with limited attention to the consequences of parental injury on children's health. This study aims to explore the consequences of unintentional parental injury on children's health outcomes, health care utilization, and socioeconomic barriers to care.</p><p><strong>Methods: </strong>We utilized data from the National Health Interview Survey (NHIS) for 2020, 2021, and 2023, creating parent-child dyads where the parent was injured. Injury was defined by a positive response to experiencing an injury and seeking medical consultation after. Children aged 5 years to 17 years and their parents were included. Three outcome domains were examined: health outcomes, health care utilization, and socioeconomic health impacts. Bivariate and logistic regression analyses were conducted to assess the impact of parental injury on these outcomes.</p><p><strong>Results: </strong>We identified 414 (weighted = 1,338,068) injured parent-child dyads and 10,352 noninjured dyads. Children of injured parents had higher odds of being diagnosed with attention-deficit hyperactivity disorder/attention-deficit disorder (odds ratio [OR], 1.69; 95% confidence interval [CI], 1.31-2.40; p = 0.005), higher Washington Group Composite Disability Scores (OR, 1.77; 95% CI, 1.25-2.47; p = 0.001), and increased injury odds (OR, 2.29; 95% CI, 1.58-3.28; p < 0.001). They also showed higher rates of urgent care visits, with significantly higher emergency department visits (OR, 1.49; 95% CI, 1.02-2.13; p = 0.03). Financial toxicity was significant, with increased odds of delaying (OR, 2.37; 95% CI, 1.14-5.40; p = 0.03) or avoiding care (OR, 3.06; 95% CI, 1.06-7.76; p = 0.02) due to cost.</p><p><strong>Conclusion: </strong>This study highlights the broad-reaching impact of parental injury on children, including worse health outcomes, increased health care utilization, and significant financial barriers. These findings underscore the need for comprehensive trauma care that addresses the holistic needs of families, incorporating strategies to mitigate both health and socioeconomic challenges.</p><p><strong>Level of evidence: </strong>Prognostic/Epidemiological; Level II.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between prehospital tranexamic acid and cerebral edema in patients with moderate or severe traumatic brain injury.","authors":"William Ian McKinley, Christos Lazaridis, Ali Mansour, Lea Hoefer, Ann Polcari, Andrew Benjamin, Martin Schreiber, Susan E Rowell","doi":"10.1097/TA.0000000000004516","DOIUrl":"https://doi.org/10.1097/TA.0000000000004516","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) contributes to substantial morbidity and mortality worldwide. Tranexamic acid (TXA) has been shown to reduce mortality in patients with traumatic intracranial hemorrhage (ICH) when given within 2 hours of injury. Although TXA is an antifibrinolytic, most studies have observed no difference in ICH progression; recent studies suggest that TXA may reduce cerebral edema in TBI. Our objective was to determine if prehospital TXA administered within 2 hours of injury is associated with surrogates of cerebral edema in patients with moderate or severe TBI.</p><p><strong>Methods: </strong>We performed a retrospective analysis of a multinational prehospital trial of TXA administered within 2 hours of injury in patients with moderate or severe TBI. Patients with prehospital Glasgow Coma Scale score of <13 and systolic blood pressure of >90 mm Hg were randomized to placebo, 2-g TXA bolus, or 1-g TXA bolus followed by 1 g 8-hour TXA infusion. Patients who received an intracranial pressure (ICP) monitor were selected for analysis. Baseline demographic, injury severity, and infusion characteristics were compared between TXA dosing cohorts. Proportion of hours spent with ICP of >20 mm Hg, cerebral perfusion pressure (CPP) of <60 mm Hg, and need for craniectomy were compared between groups.</p><p><strong>Results: </strong>A total of 108 patients with ICP monitors made up the study population (placebo, n = 31; 1 g + 1 g, n = 38; 2-g bolus, n = 39). No differences were identified in age, sex, Abbreviated Injury Scale head, Glasgow Coma Scale, Injury Severity Score, crystalloid and blood product infused in first 24 hours, Marshall score, ICH, or mortality between the three treatment arms. No differences in proportions of hours in which ICP of >20 mm Hg or CPP of <60 mm Hg were identified between treatment arms; rate of craniectomy was also similar.</p><p><strong>Conclusion: </strong>No association could be identified between TXA treatment and ICP elevation, CPP depression, or need for craniectomy. These results question TXA's potential impact on cerebral edema. Further study is needed to confirm this finding based on the exploratory nature and limited number of subjects in this study.</p><p><strong>Level of evidence: </strong>Therapeutic/Care Management; Level IV.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longer time to surgery for pelvic ring injuries is associated with increased systemic complications.","authors":"Mihir Patel, Gerald McGwin, Clay Spitler","doi":"10.1097/TA.0000000000004547","DOIUrl":"https://doi.org/10.1097/TA.0000000000004547","url":null,"abstract":"<p><strong>Background: </strong>Increased time to surgery is a well-established risk factor for complication and mortality among patients undergoing hip fracture fixation. However, few studies have been completed evaluating the association between time to surgery and complication rates in patients undergoing operative fixation of pelvic ring injuries.</p><p><strong>Methods: </strong>A retrospective cohort study was performed at a Level I trauma center including all patients with operative pelvic ring injuries from 2015 to 2022. Time from hospital admission to surgery, basic demographics, and comorbidities were determined for all patients. Systemic complications including acute respiratory distress syndrome, pneumonia, sepsis, deep venous thrombosis, pulmonary embolus, ileus, acute kidney injury, myocardial infarction, and mortality were recorded. The association between time to surgery and overall complications and each complication individually was estimated using multivariable statistical models.</p><p><strong>Results: </strong>A total of 1,056 patients were included in the final cohort. Patients who underwent surgery within 48 hours (n = 724) had an overall lower complication rate (17.8%) compared with those patients (n = 332) who underwent surgery greater than 48 hours after admission (34.9%). Each additional hour delay to surgery from admission was associated with a 0.4% increased odds of any complication. With respect to specific complications, each additional hour also increased the odds of sepsis (0.7%), deep venous thrombosis (0.3%), acute kidney injury (0.3%), myocardial infarction (0.5%), and pneumonia (0.4%). The odds of overall complication was 2.10 when patients underwent surgery within 42 hours after admission and increased at every time point afterwards.</p><p><strong>Conclusion: </strong>Among patients with pelvic ring injuries, increased time to surgery was associated with an increased odds of systemic complication. This underscores the importance of aggressive resuscitation and prompt surgical intervention to reduce morbidity and improve overall patient outcomes.</p><p><strong>Level of evidence: </strong>Prognostic and Epidemiological; Level III.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neighborhood deprivation is a risk factor for severe child physical abuse: A multicenter cohort investigation.","authors":"Nicole A Wilson, Luis Ruffolo, Peter Juviler, Tiffany Fabiano, William Kelly, Denise Lillvis, Mary Edwards, Natalie Vu, Ryan Chiou, Kim Wallenstein, Amanda Craven, Rafael Klein-Cloud, Francesca Bullaro, Jency Philipose, Irim Salik, John Fisher, Derek S Wakeman","doi":"10.1097/TA.0000000000004560","DOIUrl":"https://doi.org/10.1097/TA.0000000000004560","url":null,"abstract":"<p><strong>Background: </strong>Our purpose was to investigate whether neighborhood deprivation is associated with outcomes in a multicenter population of children with suspected or confirmed child physical abuse. We hypothesized that community level social determinants of health are associated with worse outcomes following child physical abuse.</p><p><strong>Methods: </strong>This multicenter retrospective review included children (18 years or younger) admitted with suspected or confirmed physical abuse at six pediatric trauma centers. A national Area Deprivation Index (ADI) score was assigned to each patient based on home address. Area Deprivation Index was divided into quartiles using the distribution of our dataset. Exclusion of a caregiver at discharge was used as a proxy for confirmed physical abuse. Descriptive statistics and stepwise logistic regression were used to identify covariates. Multiple logistic regression was used to test for associations between ADI and caregiver exclusion.</p><p><strong>Results: </strong>Of 1,105 included patients, 512 had confirmed abuse. These patients were younger (median [interquartile range], 0.50 [1.50] vs. 0.83 [1.67]; p = 0.002), more likely to be Black or African American (28.3% vs. 19.5%, p < 0.001), and had higher ADI scores (81.0 [35.0] vs. 66.0 [60.0], p < 0.001). A dose-dependent relationship between ADI and caregiver exclusion was identified. Compared with those from the least vulnerable neighborhoods (ADI first quartile), patients from the most vulnerable neighborhoods (ADI fourth quartile) had 2.65 (95% confidence interval, 1.73-4.08; p < 0.001) times higher odds of confirmed abuse. Despite no differences in Injury Severity Scores (8.0 [6.0] vs. 9.0 [10.0], p = 0.163), they also had longer lengths of hospital stay (1.0 [2.0] vs. 3.0 [2.8], p = 0.002) and higher mortality (1.5% vs. 5.0%, p = 0.028).</p><p><strong>Conclusion: </strong>This large multicenter experience demonstrates a dose-dependent relationship between socioeconomic disadvantage and child physical abuse. We further demonstrate that disadvantage is associated with worse outcomes, including increased mortality, in child physical abuse. These findings provide objective data and lead to suggestions for interdisciplinary and multiscale approaches to primary prevention of child physical abuse.</p><p><strong>Level of evidence: </strong>Prognostic and Epidemiological; Level III.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early initiation of rehabilitation therapies in children with severe traumatic brain injury: An algorithm based on expert panel recommendations.","authors":"Christian M Niedzwecki, Michelle L Seymour, Emily Hermes, Betsy Lewis, Kathryn DeMarco, Shari L Wade, Stacy Suskauer, Bindi Naik-Mathuria, Mary E Fallat","doi":"10.1097/TA.0000000000004490","DOIUrl":"https://doi.org/10.1097/TA.0000000000004490","url":null,"abstract":"","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre- and postinjury financial hardship among trauma survivors: A national survey study.","authors":"Nina M Clark, Alex H Hernandez, Lisa M Knowlton, Barclay T Stewart, Eileen M Bulger, Alexander Malloy, Geoffrey Anderson, Joseph L Dieleman, Douglas Zatzick, John W Scott","doi":"10.1097/TA.0000000000004545","DOIUrl":"10.1097/TA.0000000000004545","url":null,"abstract":"<p><strong>Background: </strong>National estimates of financial hardship because of injury are lacking, which limits our ability to both define and mitigate the impacts of financial outcomes of trauma care. Furthermore, the absence of preinjury data limits our understanding of the association between injury and financial hardship.</p><p><strong>Methods: </strong>We analyzed data from the 2014-2021 Medical Expenditure Panel Survey. We compared injured adults (18-64 years old) to uninjured controls using coarsened-exact matching on age, sex, race/ethnicity, income, payer, survey panel, and comorbidities. Our main outcome of interest was financial hardship, a composite of difficulty paying medical bills, paying medical bills off over time, and delaying medical care because of cost. As a secondary analysis, we evaluated the link between difficulty paying medical bills, delaying care, and poor health.</p><p><strong>Results: </strong>We included a weighted sample of more than 79 million injured patients over the 8-year study period. Difference-in-differences analysis using uninjured, matched controls showed that injured patients experienced an 8.2 percentage point increase in financial hardship (23% relative increase, with 40.6% reporting financial hardship postinjury, p < 0.001) and 4.5 percentage point increase in poor health (20% relative increase, p < 0.001). Injured patients who reported difficulty with medical bills were more likely to report delaying care because of costs (adjusted odds ratio, 3.3; 95% confidence interval, 2.5-4.4), and those who delayed care were more likely to report poor health (adjusted odds ratio, 1.5; 95% confidence interval, 1.2-2.0).</p><p><strong>Conclusion: </strong>In this national analysis of financial hardship before and after injury, 40% of injured patients reported difficulty with medical bills and delayed medical care because of cost. Programs aimed at disrupting the path from injury to financial hardship to poor long-term health have the potential to benefit millions of injury survivors.</p><p><strong>Level of evidence: </strong>Retrospective Cohort Study; Level III.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prophylactic antibiotic use in trauma patients with non-operative facial fractures: A prospective AAST multicenter trial.","authors":"Rabiya K Mian, Heather M Grossman Verner, Cynthia I Villalta, Dana Farsakh, Joseph D Amos, Karen G Minoza, Rosemary Kozar, Andrew R Doben, Natasha Keric, Ernest E Moore, Claudia Alvarez, Jason Murry, Tatiana C P Cardenas, Richard H Lewis, James A Zebley, Caitlin M Blades, Gail Tominaga, Michael Charles, Michael W Cripps, Linda A Dultz, Justin Bailey, Tanya Egodage, Jin H Ra","doi":"10.1097/TA.0000000000004539","DOIUrl":"https://doi.org/10.1097/TA.0000000000004539","url":null,"abstract":"<p><strong>Background: </strong>Craniofacial trauma affects approximately 3 million individuals in the United States annually. Historically, low overall data quality and inadequate sample size have limited the development of clinical practice guidelines for prophylactic antibiotic use in facial fractures. We sought to examine the current use patterns and effects of prophylactic antibiotics in non-operative facial fractures.</p><p><strong>Methods: </strong>A prospective analysis of adult patients with nonoperative facial fractures was conducted across 19 centers from January 2022 to December 2023. Kruskal-Wallis H, Mann-Whitney U, Pearson's χ2, Fisher's exact tests, and logistic regression models were used to evaluate the association between antibiotic duration (no antibiotics, ≤24 hours, and >24 hours) and facial fracture-associated infectious complications.</p><p><strong>Results: </strong>Among 1,835 patients, 1,168 (63.7%) received no antibiotics and 667 (36.4%) received antibiotics (≤24 hours, n = 264 (14.4%); >24 hours, n = 403 (22.0%). Nineteen (1.0%) patients developed infectious complications (0.7% in the no antibiotic group vs. 1.7% with antibiotics). Most patients (99.0%) did not develop an infection despite the majority (63.7%) receiving no antibiotics. Injuries were predominately closed fractures (86.3%), without mucosal disruption (83.9%) or foreign bodies (97.7%). Antibiotic administration had a statistically significant association with the occurrence of infectious complications (p = 0.050). However, no significant association was seen between antibiotic duration and infectious complications following multivariable logistic regression, adjusting for confounders (≤24 hours: adjusted odds ratio, 1.24; 95% confidence interval, 0.30-5.14; p = 0.766; >24 hours: adjusted odds ratio, 1.32; 95% confidence interval, 0.37-4.69; p = 0.668).</p><p><strong>Conclusion: </strong>Despite most patients not receiving antibiotics, infection rates remained low. This indicates prophylactic antibiotic use does not reduce the risk of fracture-associated infections for most injury patterns. While a randomized trial is optimal to validate these data, at this time, there is no evidence to support presumptive antibiotics for closed non-operative facial fractures.</p><p><strong>Level of evidence: </strong>Therapeutic/Care Management; Level II.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of the proportion of low-titer O whole blood for resuscitation in pediatric trauma patients on 6-, 12- and 24-hour survival.","authors":"Ethan M Petersen, Andrew D Fisher, Michael D April, Mark H Yazer, Maxwell A Braverman, Matthew A Borgman, Steven G Schauer","doi":"10.1097/TA.0000000000004564","DOIUrl":"https://doi.org/10.1097/TA.0000000000004564","url":null,"abstract":"<p><strong>Introduction: </strong>Hemorrhage is a leading cause of death in pediatric patients. Accumulating data suggest that low-titer group O whole blood (LTOWB) improves clinical outcomes in the pediatric population. We examined what ratio of LTOWB to total blood product conferred a survival benefit in transfused pediatric trauma patients.</p><p><strong>Methods: </strong>We retrospectively examined a cohort of injured subjects younger than 18 years from the Trauma Quality Improvement Program database who received any quantity of LTOWB and no documented prehospital cardiac arrest. We created a variable representing the volume of transfused LTOWB divided by the total volume of all transfused blood products administered within the first 4 hours of admission, that is, the proportion of LTOWB transfused. We analyzed increasing proportions of transfused LTOWB to determine whether there was an inflection point conferring increased survival.</p><p><strong>Results: </strong>From 2020 to 2022, 1,122 subjects were included in the analysis. The median (interquartile range) age was 16 (14-17) years. Firearms were the most common mechanism at 47% followed by collisions at 44%. The median composite injury severity score was 25 (16-34). Survival was 91% at 6 hours, 89% at 12 hours, and 88% at 24 hours. We noted an inflection point with improved survival at an LTOWB proportion of ≥30% of total volume of blood products received. The odds of survival at 6, 12, and 24 hours for those receiving ≥30% LTOWB was 1.85 (1.02-3.38), 2.09 (1.20-3.36), and 1.80 (1.06-3.08), and 3.55 (1.66-7.58), 3.71 (1.89-7.27), and 2.69 (1.44-5.02) when excluding those who died within 1 hour, respectively.</p><p><strong>Conclusion: </strong>Among LTOWB recipients, we found that a strategy of using LTOWB comprising at least 30% of the total transfusion volume within the first 4 hours was associated with improved survival at 6, 12, and 24 hours.</p><p><strong>Level of evidence: </strong>Therapeutic/Care Management; Level III.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}