The Journal of surgical research
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Patients with traumatic intracranial hemorrhage (TIH) anticoagulated with warfarin are at an increased risk of mortality. Fresh frozen plasma (FFP) and vitamin K have been the standard treatment for warfarin reversal; however, guidelines now recommend the use of prothrombin complex concentrate (PCC) for warfarin reversal in patients with life-threatening bleeding. Our protocol uses one vial (∼1000 units) of activated PCC (aPCC) for warfarin reversal, regardless of the weight or presenting international normalized ratio (INR). The purpose of this study was to determine the safety and efficacy of using fixed, low-dose aPCC for warfarin reversal in patients with TIH. ⋯ Fixed, low-dose aPCC is safe and more effective at reversing the effects of warfarin than FFP in patients with TIH.
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Review
Trauma registry implementation in low- and middle-income countries: challenges and opportunities.
Trauma registries are an essential part of trauma quality improvement programs aimed at decreasing morbidity and mortality in high-income countries. In low- and middle-income countries (LMICs), where the burden of injury is disproportionately high, hospitals have faced challenges in adapting trauma registry models implemented in high-income countries. We analyze the barriers to trauma registry implementation in LMICs to inform development of sustainable models in resource-constrained settings. ⋯ Many LMICs face unique challenges to implementation that must be overcome to create sustainable trauma databases. Understanding these barriers and taking steps to evaluate the effectiveness of proposed solutions may further improve trauma care to address the high burden in these settings.
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Massive transfusion protocols (MTPs) are necessary for hemodynamically unstable trauma patients with active bleeding. Thrombotic events have been associated with blood transfusion; however, the risk factors for the development of venous thromboembolism (VTE) in trauma patients receiving MTP are unknown. ⋯ The risk for VTE in trauma patients requiring massive transfusion is proportional to the number of packed red blood cells transfused. Liberal screening protocols and maintenance of a high index of suspicion for VTE in these high-risk patients is justified.
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Observational Study
Pediatric bicycle helmet legislation and crash-related traumatic brain injury in Illinois, 1999-2009.
Bicycling is one of the most popular forms of play and exercise for children in the US. However, over 200,000 children per year are injured in bicycle crashes, and an estimated 22,000 pediatric bicycle-related traumatic brain injuries (TBIs) occur annually. Bicycle helmets are known to decrease the risk of head injury, but efficacy and magnitude of the effect of helmet legislation have not been fully elucidated. ⋯ Helmet use was protective against TBI, but socioeconomic and racial disparities exist in usage. Local legislation did not appear to impact helmet usage or admissions for bicycle-related TBIs in these areas.
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Comparative Study
Comparison of the Lund and Browder table to computed tomography scan three-dimensional surface area measurement for a pediatric cohort.
Treating burns effectively requires accurately assessing the percentage of the total body surface area (%TBSA) affected by burns. Current methods for estimating %TBSA, such as Lund and Browder (L&B) tables, rely on historic body statistics. An increasingly obese population has been blamed for increasing errors in %TBSA estimates. However, this assumption has not been experimentally validated. We hypothesized that errors in %TBSA estimates using L&B were due to differences in the physical proportions of today's children compared with children in the early 1940s when the chart was developed and that these differences would appear as body mass index (BMI)-associated systematic errors in the L&B values versus actual body surface areas. ⋯ While today's population is more obese than those studied by L&B, their body region proportions scale surprisingly well. The primary error in %TBSA estimation is not due to changing physical proportions of today's children and may instead lie in the application of the L&B table.