The journal of cardiothoracic trauma最新文献

{"title":"Relationship between maximum intracranial pressure and traumatic lesions detected by T2*-weighted imaging in diffuse axonal injury.","authors":"Y. Yanagawa, T. Sakamoto, A. Takasu, Y. Okada","doi":"10.1097/TA.0b013e3181469857","DOIUrl":"https://doi.org/10.1097/TA.0b013e3181469857","url":null,"abstract":"BACKGROUND We prospectively investigated whether the number of traumatic lesions detected by magnetic resonance imaging correlated with the level of intracranial pressure (ICP) and outcome among patients with diffuse axonal injury (DAI). MATERIALS We prospectively studied 19 patients with closed head injuries who were admitted to the Critical Care and Trauma Services at our medical center and who fulfilled the following criteria: did not recover to a Glasgow Coma Scale score greater than 8 after impact, without fixed dilated pupils, and with initial computed tomography findings compatible with DAI. All subjects (n = 19) underwent ICP monitoring for at least 4 days, and T2*-gradient echo imaging was performed within 4 weeks of the impact. RESULTS A significantly positive correlation was found between the number of lesions detected by magnetic resonance imaging and maximum ICP. The average Glasgow Coma Scale in the good outcome group (Glasgow Outcome Scale IV and V, n = 8) was significantly greater than that in the poor outcome group (Glasgow Outcome Scale I-III, n = 11). The average maximum ICP and the number of lesions in the good outcome group were significantly less than those in the poor outcome group. CONCLUSION The number of lesions detected by T2*-gradient echo imaging correlates with the degree of intracranial hypertension and outcome in DAI.","PeriodicalId":92962,"journal":{"name":"The journal of cardiothoracic trauma","volume":"73 1","pages":"162-5"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86100795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Angular stable fixation of proximal humeral fractures.","authors":"G. Thalhammer, P. Platzer, G. Oberleitner, C. Fialka, M. Greitbauer, V. Vécsei","doi":"10.1097/TA.0b013e31815ede7b","DOIUrl":"https://doi.org/10.1097/TA.0b013e31815ede7b","url":null,"abstract":"BACKGROUND Proximal humeral fractures requiring surgical stabilization remain a therapeutic challenge. High rates of treatment-related complications have been reported to be associated, particularly in elderly patients with unstable fracture types and diminished bone quality. In recent years, angular stable implants have been introduced to improve the patients' outcome. The purpose of this study was to assess the clinical and radiographic long-term results after angular stable plate fixation of proximal humeral fractures at this Level I trauma center, with special emphasis on fracture healing, functional outcome and treatment related complications. METHODS We retrospectively analyzed functional and radiographic results of 42 patients (average age: 57.8 years) after angular stable plate fixation of proximal humeral fractures at an average time of 3.2 (+/-0.8) years after trauma. Functional results were defined by the Constant shoulder score (CS) and the individual Constant score (CSindiv). Radiographic results were assessed by a three-view trauma series (anteroposterior, lateral, and axillary view). For operative treatment, two different angular stable implants were used. Twenty-seven patients were stabilized by a HOFER plate, fifteen patients by a Locking Proximal Humerus Plate. RESULTS Clinical results revealed an average CS of 74.0 points and an average individual CSindiv of 79.2% points. Fourteen patients had an excellent functional outcome, eight patients a good outcome and fourteen patients had moderate functional results. Six patients (14%) had a poor outcome with less than 55% on CSindiv. Regarding the radiographic outcome, we had an overall union rate of 95% (40 of 42). Failures of reduction and fixation occurred in fourteen patients (33%), and in nine patients (21%) we had signs of a humeral head necrosis. Re-operation due to treatment-related complications was necessary in two patients (5%). Statistical analysis revealed that the fracture type and the age of the patients had a significant influence on the clinical outcome and on the incidence of treatment-related complications. CONCLUSION With regards to fracture healing and functional outcome of the patients, we had a satisfactory outcome after angular stable plate fixation of proximal humeral fractures. However, we experienced a notably high rate of technical failures and partial humeral head necrosis. Advanced surgical skills and experiences are necessary to achieve correct anatomic reduction and implant fixation, to reduce the risk of these treatment-related complications.","PeriodicalId":92962,"journal":{"name":"The journal of cardiothoracic trauma","volume":"376 1","pages":"204-10"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79805162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative 3D imaging: value and consequences in 248 cases.","authors":"D. Kendoff, M. Citak, M. Gardner, T. Stübig, C. Krettek, T. Hüfner","doi":"10.1097/TA.0b013e31815ede5d","DOIUrl":"https://doi.org/10.1097/TA.0b013e31815ede5d","url":null,"abstract":"BACKGROUND Intraoperative visualization of articular surfaces is technically demanding, and standard two-dimensional fluoroscopic imaging frequently does not provide adequate detail of nonplanar joints. New imaging modalities allow for intraoperative 3D visualization, which are useful in articular fractures. Purpose of this study was to evaluate the utility of 3D imaging in articular fracture reconstruction. METHODS In a prospective cohort study, we evaluated 248 consecutive patients with intra-articular fractures. After fracture fixation using standard fluoroscopy, 3D imaging was performed intraoperatively using the Iso-C3D system for all patients. Surgeons filled out questionnaires regarding the utility and perceived accuracy of the 3D system. Postoperative CT scans were performed on approximately half of the patients. Main outcome measurements were based on the surgeons decision to immediately revise the articular reduction or implant position. The setup time for the system was recorded. For patients with postoperative CT scans, articular surface gaps of 2 mm or intra-articular hardware placement was again evaluated. RESULTS In 19% of all cases, intraoperative image analysis resulted in immediate adjustment of the reduction or hardware exchange. These revisions were based on Iso-C3D views of the articular surface that were not visible using fluoroscopy. Of the 129 postoperative CT scans, five cases revealed a technical error of the joint reconstruction, and a secondary revision procedure was performed. CONCLUSION In conclusion, the Iso-C3D was a valuable intraoperative tool, providing additional information about the articular surface compared with conventional fluoroscopy in a variety of anatomic regions.","PeriodicalId":92962,"journal":{"name":"The journal of cardiothoracic trauma","volume":"47 1","pages":"232-8"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88310973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The standardized live patient and mechanical patient models--their roles in trauma teaching.","authors":"J. Ali, Khalid Al Ahmadi, Jack I. Williams, R. Cherry","doi":"10.1097/TA.0b013e318193ba84","DOIUrl":"https://doi.org/10.1097/TA.0b013e318193ba84","url":null,"abstract":"BACKGROUND We have previously demonstrated improved medical student performance using standardized live patient models in the Trauma Evaluation and Management (TEAM) program. The trauma manikin has also been offered as an option for teaching trauma skills in this program. In this study, we compare performance using both models. METHODS Final year medical students were randomly assigned to three groups: group I (n = 22) with neither model, group II (n = 24) with patient model, and group III (n = 24) with mechanical model using the same clinical scenario. All students completed pre-TEAM and post-TEAM multiple choice question (MCQ) exams and an evaluation questionnaire scoring five items on a scale of 1 to 5 with 5 being the highest. The items were objectives were met, knowledge improved, skills improved, overall satisfaction, and course should be mandatory. Students (groups II and III) then switched models, rating preferences in six categories: more challenging, more interesting, more dynamic, more enjoyable learning, more realistic, and overall better model. Scores were analyzed by ANOVA with p < 0.05 being considered statistically significant. RESULTS All groups had similar scores (means % +/- SD)in the pretest (group I - 50.8 +/- 7.4, group II - 51.3 +/- 6.4, group III - 51.1 +/- 6.6). All groups improved their post-test scores but groups II and III scored higher than group I with no difference in scores between groups II and III (group I - 77.5 +/- 3.8, group II - 84.8 +/- 3.6, group III - 86.3 +/- 3.2). The percent of students scoring 5 in the questionnaire are as follows: objectives met - 100% for all groups; knowledge improved: group I - 91%, group II - 96%, group III - 92%; skills improved: group I - 9%, group II - 83%, group III - 96%; overall satisfaction: group I - 91%, group II - 92%, group III - 92%; should be mandatory: group I - 32%, group II - 96%, group III - 100%. Student preferences (48 students) are as follows: the mechanical model was more challenging (44 of 48); more interesting (40 of 48); more dynamic (46 of 48); more enjoyable (48 of 48); more realistic (32/48), and better overall model (42 of 48). CONCLUSIONS Using the TEAM program, we have demonstrated that improvement in knowledge and skills are equally enhanced by using mechanical or patient models in trauma teaching. However, students overwhelmingly preferred the mechanical model.","PeriodicalId":92962,"journal":{"name":"The journal of cardiothoracic trauma","volume":"482 1","pages":"98-102"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83612692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adult portal hypertension secondary to posttraumatic extrahepatic portal vein thrombosis treated with Rex shunt.","authors":"Wesley B. Vanderlan, A. Bansal, M. Abouljoud","doi":"10.1097/TA.0b013e3181825b87","DOIUrl":"https://doi.org/10.1097/TA.0b013e3181825b87","url":null,"abstract":"","PeriodicalId":92962,"journal":{"name":"The journal of cardiothoracic trauma","volume":"127 1","pages":"260-3"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87981397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum procalcitonin levels in patients with multiple injuries including visceral trauma.","authors":"M. Maier, S. Wutzler, M. Lehnert, Maika Szermutzky, H. Wyen, T. Bingold, D. Henrich, F. Walcher, I. Marzi","doi":"10.1097/TA.0b013e31817c966f","DOIUrl":"https://doi.org/10.1097/TA.0b013e31817c966f","url":null,"abstract":"Procalcitonin (PCT) is known to be a reliable biomarker of sepsis and infection. Elevation of serum or plasma PCT has also been observed after major surgery or trauma. The association of PCT with the severity or location of injury in multiple traumatized (polytrauma) patients has not been clearly established, to date. The aim of this study was therefore to evaluate the sensitivity of PCT as a biomarker for the diagnosis of abdominal trauma. In a prospective clinical study, PCT, interrleukin-6, and C-reactive protein were measured in blood (serum) samples obtained in the emergency room (D0) from 74 patients with multiple injuries and in serum samples obtained on the 2 days after trauma (D1, D2). PCT significantly increased during the first two posttraumatic days in patients with severe multiple injuries (n = 24, day 1: 3.37 ng/mL +/- 0.92 ng/mL; day 2: 3.27 ng/mL +/-0.97 ng/mL) as compared with patients with identical Injury Severity Score but without abdominal injury (day 1: 0.6 ng/mL +/- 0.18 ng/mL; 0.61 ng/mL +/- 0.21 ng/mL). Interrleukin-6 and C-reactive protein serum levels were not able to discriminate between patients with and without abdominal injury during the 2-day posttrauma observation period. In a specific evaluation of the abdominal injury pattern, a significant increase of serum PCT concentrations was observed on day 1 after trauma of the liver (4.04 ng/mL +/- 0.99 ng/mL) and the gut (4.63 ng/mL +/- 1.12 ng/mL) compared with other abdominal lesions (0.62 ng/mL +/- 0.2 ng/mL). Markedly elevated PCT concentrations were also evident after severe multiple injuries, including the liver/spleen in combination with thorax trauma (9.37 ng/mL +/- 2.71 ng/mL). Assessment of serum PCT seems to be significantly increased after abdominal trauma in severe multiple traumatized patients and may serve as a useful biomarker to support other diagnostic methods including ultrasound and CT scan. Although elevated levels of PCT during the first 2 days after trauma are more likely to be indicative of traumatic impact than of an ongoing status of sepsis, multiple events such as surgery, massive transfusion, and intensive care therapy might influence the PCT concentration.","PeriodicalId":92962,"journal":{"name":"The journal of cardiothoracic trauma","volume":"13 11 1","pages":"243-9"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90375059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemiarthroplasty of the shoulder after four-part fracture of the humeral head: a long-term analysis of 34 cases.","authors":"L. Besch, M. Daniels-Wredenhagen, Michael Mueller, D. Varoga, R. Hilgert, A. Seekamp","doi":"10.1097/TA.0b013e31815d9649","DOIUrl":"https://doi.org/10.1097/TA.0b013e31815d9649","url":null,"abstract":"OBJECTIVE To assess the treatment outcomes of patients with four-part fracture of the humeral head after primary and secondary hemiarthroplasty. PATIENTS Retrospective long-term analysis of 46 patients from 1996 to 2002 of patients with 47 four-part fractures of humeral head. Patients with malignant disease were excluded. INTERVENTION Aequalis (Tornier, Burscheid, Germany). MAIN OUTCOME MEASUREMENTS Absolute and relative constant scores at 5-year follow-up examination without age or sex normalization, radiographic parameters of calcification, dislocation of tuberosities, prosthetic loosening, and dislocation of joint. RESULTS Eighteen patients treated by primary and 16 patients treated by secondary arthroplasty were assessed clinically and radiologically after a mean follow-up of 64 (60-96) months. The absolute Constant scores at follow-up were 54.9 to 48.5 points, respectively. The relative scores were 61.4% and 57.3%, respectively. Dislocation of tuberosities with severe loss of function was found in five cases treated by primary arthroplasty (13.5%) and in 12 treated by secondary arthroplasty (75.0%). CONCLUSIONS The majority of patients in both groups was free of pain or suffered minor pain as determined by the Constant score. Safe fixation of the tuberosities is a prerequisite for functional exercises and is better achieved in primary arthroplasty. A computed tomography scan before operative therapy aids in making the decision between open reduction and internal fixation or hemiarthroplasty.","PeriodicalId":92962,"journal":{"name":"The journal of cardiothoracic trauma","volume":"4 1","pages":"211-4"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90097465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coagulopathy in severe traumatic brain injury: a prospective study.","authors":"P. Talving, Rodd J. Benfield, P. Hadjizacharia, K. Inaba, L. Chan, D. Demetriades","doi":"10.1097/TA.0b013e318190c3c0","DOIUrl":"https://doi.org/10.1097/TA.0b013e318190c3c0","url":null,"abstract":"BACKGROUND The incidence and risk factors for traumatic brain injury (TBI)-associated coagulopathy after severe TBI (sTBI) and the effect of this complication on outcomes have not been evaluated in any large prospective studies. METHODS Prospective study of all patients admitted to the surgical intensive care unit (ICU) of an urban, Level I trauma center from June 2005 through May 2007 with sTBI (head Abbreviated Injury Scale score of >or=3). Criteria for TBI-coagulopathy included a clinical condition consistent with coagulopathy, i.e. sTBI, in conjunction with a platelet count <100,000 mm3 and/or elevated international normalized ratio and/or activated partial thromboplastin time. The following potential risk factors with p < 0.2 on bivariate analysis were included in a stepwise logistic regression analysis to identify independent risk factors for TBI coagulopathy and its association with mortality: age, mechanism of injury (blunt [B] or penetrating [P]), presence of hypotension upon admission, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), head and other body area Abbreviated Injury Scale, isolated head injury, diffuse axonal injury, cerebral edema, intracranial hemorrhage (intraventricular, parenchymal, subarachnoid, or subdural), pneumocephalus, and presence of midline shift. RESULTS A total of 436 patients (392 blunt, 44 penetrating) met study criteria, of whom 387 patients had isolated SHI. TBI coagulopathy occurred in 36% of all patients (B: 33%, P: 55%; p < 0.0075) and in 34% of patients with isolated head injury (B: 32%, P: 54%; p = 0.0062). Independent risk factors for TBI-coagulopathy in isolated sTBI were found to include a GCS score of <or=8, ISS >or=16, presence of cerebral edema, subarachnoid hemorrhage, and midline shift. ICU lengths of stay were significantly longer in SHI patients who developed TBI coagulopathy (12.7 vs. 8.8 days; p = 0.006). The development of TBI coagulopathy in SHI was associated with increased mortality, adjusted odds ratio (95% confidence interval): 9.61 (4.06-25.0); p < 0.0001. CONCLUSION The incidence of TBI coagulopathy in SHI is high, especially in penetrating injuries. Independent risk factors for coagulopathy in isolated head injuries include GCS score of <or=8, ISS >or=16, hypotension upon admission, cerebral edema, subarachnoid hemorrhage, and midline shift. The development of TBI coagulopathy is associated with longer ICU length of stay and an almost 10-fold increased risk of death.","PeriodicalId":92962,"journal":{"name":"The journal of cardiothoracic trauma","volume":"35 1","pages":"55-61; discussion 61-2"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77749202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The in vivo effect of propranolol on cerebral perfusion and hypoxia after traumatic brain injury.","authors":"Eric J. Ley, J. Scehnet, R. Park, S. Schroff, Grant Dagliyan, P. Conti, D. Margulies, A. Salim","doi":"10.1097/TA.0b013e31819388be","DOIUrl":"https://doi.org/10.1097/TA.0b013e31819388be","url":null,"abstract":"BACKGROUND Recent epidemiologic evidence has identified beta-blockade as independently associated with improved survival in patients with isolated traumatic brain injury (TBI). Reduced sympathetic discharge and catecholamine release may improve circulation in the injured areas and influence delayed demise. The purpose of this study was to investigate the cerebral effect of beta-blockade in a murine TBI model using immunohistochemical and microPET analysis. METHODS Balb/c mice underwent TBI as in a previously described model and were randomized to receive treatment with propranolol or placebo in a blinded fashion. Immunofluorescent images were obtained for vessel density (CD31), vessel perfusion (Ricinus communis agglutinin [RCA]-lectin), and cerebral hypoxia (hypoxyprobe-1) and compared by digital quantification. Perfusion measurements were acquired using positron emission tomography microPET scans with [64Cu]-pyruvaldehyde bis(N4-methylthiosemicarbazone) ([64Cu]-PTSM) and converted into standardized uptake values (SUV) for analysis. RESULTS On immunohistochemical analysis, the normal mouse cerebral perfusion was a quantitated mean of 325 +/- 20, the cerebral perfusion after TBI and treatment with placebo was 113 +/- 25, and the cerebral perfusion after TBI treated with propranolol was 172 +/- 23. Immunohistochemical analysis demonstrated treatment with propranolol improved cerebral perfusion by 152% (p value <0.01) and reduced cerebral hypoxia by 24.2% (p value <0.01) compared with treatment with placebo. MicroPET imaging of the normal mouse brain after injection with placebo measured a SUV of 0.7075 +/- 0.02; the normal mouse brain after treatment with propranolol measured a SUV of 0.400 +/- 0.02. After TBI and treatment with placebo, the SUV reduced to 0.395 +/- 0.01; after treatment with propranolol the SUV measured 0.515 +/- 0.04. MicroPET imaging demonstrated propranolol improved cerebral perfusion after TBI to 130% of placebo (p value <0.01). CONCLUSION Propranolol in vivo increased cerebral perfusion and decreased cerebral hypoxia. This research demonstrates beta-blockade may prevent additional brain damage after traumatic insult and should be the focus of future clinical trials.","PeriodicalId":92962,"journal":{"name":"The journal of cardiothoracic trauma","volume":"1 1","pages":"154-9; discussion 159-61"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83596771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reversal of coagulopathy in critically ill patients with traumatic brain injury: recombinant factor VIIa is more cost-effective than plasma.","authors":"D. Stein, R. Dutton, M. Kramer, T. Scalea","doi":"10.1097/TA.0b013e318191bc8a","DOIUrl":"https://doi.org/10.1097/TA.0b013e318191bc8a","url":null,"abstract":"BACKGROUND Traumatic brain injury (TBI) is the leading cause of death and disability after trauma. Coagulopathy is common in this patient population and requires rapid reversal to allow for safe neurosurgical intervention and prevent worsening of the primary injury. Typically reversal of coagulopathy is accomplished with the use of plasma. Recombinant factor VIIa (rFVIIa; NovoSeven, Novo Nordisk, Bagsvaerd, Denmark) has become increasingly used \"off-label\" in patients with neurosurgical emergencies to rapidly reverse coagulopathy. We hypothesized that the use of rFVIIa in this patient population would prove to be cost-effective as well as demonstrate clinical benefit. METHODS The trauma registry at the R Adams Cowley Shock Trauma Center was used to identify all coagulopatic trauma patients admitted between January 2002 and December 2007 with relatively isolated TBI (head Abbreviated Injury Scale score of >or=4). The medical records of patients were reviewed and demographics, injury-specific data, medications administered, laboratory values, blood product utilization, neurosurgical procedures, length of stay (LOS), discharge disposition, and outcome data were abstracted. Patients who received rFVIIa for reversal of coagulopathy were compared against those who did not receive rFVIIa. t Tests were used to compare differences between continuous variables, and chi2 analysis was used to compare categorical variables. A p value of <0.05 was considered significant for all statistical tests. RESULTS During a 6-year period, there were 179 patients who met inclusion criteria. One hundred eleven patients (62.0%) were treated with conventional therapy alone whereas 68 (38.0%) received rFVIIa. Baseline characteristics between the two groups were similar except that Injury Severity Score and admission International normalized ratio were higher in the rFVIIa group and the rFVIIa group had a higher percentage of patients with head Abbreviated Injury Scale score of 5 injuries, patients who underwent neurosurgical procedures and patients with preinjury warfarin use. There was no difference in total charges between these groups (mean US $63,403 in the conventionally treated group vs. $66,086). When patients who required admission to the intensive care unit were analyzed (n = 110, 50% received rFVIIa), total mean charges and costs were significantly lower in the group that received rFVIIa (mean US $108,900 vs. $77,907). Hospital LOS, days of mechanical ventilation, and plasma utilization were lower in the rFVIIa group. Mortality and thromboembolic complication rates were not different between the two groups. CONCLUSION In this study, we were able to demonstrate a significant economic benefit of the use of rFVIIa for reversal of coagulopathy in severely injured patients with TBI. Not all patients with coagulopathy and an anatomic brain injury benefit, but in patients who are neurologically or physiologically compromised, using rFVIIa decreases total charges and ","PeriodicalId":92962,"journal":{"name":"The journal of cardiothoracic trauma","volume":"70 1","pages":"63-72; discussion 73-5"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79569360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}