Thyboblevins4073

lood loss.BACKGROUND Three years after the terror attacks in Paris and Nice, this study aims to determine the level of interest, the technical skills and level of surgical activity in exsanguinating trauma care for a non-selected population of practising French surgeons. METHODS A questionnaire was sent between July and December 2017 to French students and practising surgeons, using the French Surgical Colleges' mailing lists. Items analysed included education, training, interest and clinical activity in trauma care and damage control surgery (DCS). RESULTS 622 questionnaires were analysed and was composed of 318 (51%) certificated surgeons, of whom 56% worked in university teaching hospitals and 47% in level 1 Trauma Centres (TC1); 44% were digestive surgeons and 7% were military surgeons. The mean score of 'interest in trauma care' was 8/10. Factors associated with a higher score were being a resident doctor (p=0.01), a digestive surgeon (p=0.0013), in the military (p=1,71 x10) and working in TC1 (p=0.034). The mean 'DCS techniques knowledge' score was 6.2/10 and factors significantly associated with a higher score were being a digestive surgeon (respectively p=0.0007 and p=0.001) and in the military (respectively p=1.74 x10 and p=3.94 x10). Reported clinical activity in trauma and DCS were low. Additional continuing surgical education courses in trauma were completed by 23% of surgeons. CONCLUSIONS French surgeons surveyed showed considerable interest in trauma care and treatment. Despite this, and regardless of surgical speciality, their theoretical and practical knowledge of necessary DCS skills remain inadequate. LEVEL OF EVIDENCE Level III STUDY TYPE Survey.BACKGROUND Mortality-based metrics like the International Classification of Diseases (ICD) Injury Severity Score (ICISS) may underestimate burden of pediatric traumatic disease due to lower mortality rates in children. The purpose of this study was to develop and validate two resource-based severity of injury (SOI) measures, then compare these measures and the ICISS across a broad age spectrum of injured patients. METHODS The ICISS and two novel SOI measures, termed ICD Critical Care Severity Score (ICASS) and ICD General Anesthesia Severity Score (IGASS), were derived from Florida state administrative 2012-2016 data and validated with 2017 data. The ICASS and IGASS predicted the need for critical care services and anesthesia services, respectively. Logistic regression was used to validate each SOI measure. Distributions of ICISS, ICASS, and IGASS were compared across pediatric (0-15 yrs), adult (16-64 yrs), and elderly (65-84 yrs) age groups. RESULTS The derivation and validation cohorts consisted of 668,346ve data. They may complement mortality-based measures in pediatric trauma. LEVEL OF EVIDENCE III, prognostic study.BACKGROUND Coagulopathy has been associated with poor outcomes in adult and pediatric trauma. Previous clinical trials have shown benefits with balanced transfusion ratios in trauma resuscitation in adults, but smaller retrospective studies have not established the same in pediatrics. We constructed a pediatric trauma database at a level one trauma center for analysis. METHODS The institutional trauma registry was queried for all pediatric trauma activations from 2008 to 2018. Patient identifiers were used to identify laboratory data from the electronic data warehouse. RESULTS 2769 pediatric trauma patients were identified with 1492 arriving direct from the scene. Of those with complete transport data available, 81% arrived within 60 minutes from time of injury. 52 patients were transfused in the first 24 hours, with 25 receiving greater than an estimated 40 ml/kg of blood products. No significant difference in ratios of red cell to plasma transfused at 24 hours was observed between patients surviving to discharge (1.4, 95% CI 1.0 to 1.6) and deceased (1.7, 95% CI 1.4 to 1.9) (P = 0.087).Among direct admissions, an abnormal prothrombin time (PT) or partial thromboplastin time (PTT) taken within 2 hours of arrival was significantly associated with in-hospital mortality (P = 0.003 and less then 0.001), but no significant associations were seen for abnormal fibrinogen or platelet counts. Red cell to plasma transfusion ratios were not significantly associated with length of stay or ventilator days (P = 0.74 and 0.28). CONCLUSIONS There was no significant difference between transfusion ratios of surviving and deceased patients at 3- and 24-hour time points, including in a weight-adjusted highly transfused subgroup. Coagulopathy remains an important issue in pediatric trauma and may guide future multicenter studies in optimizing transfusion ratios in pediatric trauma. LEVEL OF EVIDENCE Level III, retrospective comparative study.BACKGROUND Randomized clinical trials(RCTs) support the use of pre-hospital plasma in traumatic hemorrhagic shock, especially in long transports. The citrate added to plasma binds with calcium, yet most pre-hospital trauma protocols have no guidelines for calcium replacement. We reviewed the experience of two recent pre-hospital plasma RCTs regarding admission ionized-calcium (i-Ca) blood levels and its impact on survival. We hypothesized that pre-hospital plasma is associated with hypocalcemia, which in turn is associated with lower survival. METHODS We studied patients enrolled in two institutions participating in pre-hospital plasma RCTs (Control=Standard-of-care; Experimental=Plasma), with i-Ca collected prior to calcium supplementation. Adults with traumatic hemorrhagic shock(SBP≤70 mmHg or 71-90mmHg+HR≥108bpm) were eligible. We use generalized linear mixed models with random intercepts and Cox proportional hazards models with robust standard errors to account for clustered data by institution. Hypocalcemia was defined as i-Ca less then 1.0mmol/L. RESULTS Of 160 subjects(76% men), 48% received pre-hospital plasma, median age 40years(IQR28-53), 71% suffered blunt trauma, median ISS=22(IQR17-34). Pre-hospital plasma and control patients were similar regarding age, sex, ISS, blunt mechanism, and brain injury. Pre-hospital plasma recipients had significantly higher rates of hypocalcemia compared to controls (53% vs 36%, Adjusted Relative Risk, aRR=1.48; 95%CI 1.03-2.12, p=0.03). Severe hypocalcemia was significantly associated with decreased survival(Adjusted Hazard Ratio1.07;95%CI1.02-1.13, p=0.01) and massive transfusion(aRR= 2.70;95%CI1.13-6.46, p=0.03), after adjustment for confounders(randomization group, age, ISS, and shock index). CONCLUSION Pre-hospital plasma in civilian trauma is associated with hypocalcemia, which in turn predicts lower survival and massive transfusion. Alantolactone These data underscore the need for explicit calcium supplementation guidelines in pre-hospital hemotherapy. LEVEL OF EVIDENCE