Bernsteinstorgaard8386

UT was higher in rural patients (8.6% vs 3.4%, p less then 0.01). Rural setting was associated with UT after adjusting for distance and prehospital time (OR 3.52; 95%CI 1.82-6.78, p less then 0.01). Different triage criteria were associated with UT in rural/urban settings. selleck Rural setting was associated with UT for patients transferred to an urban center (OR 3.32; 95%CI 1.75-6.25, p less then 0.01), but not a rural center (OR 0.68; 95%CI 0.08-5.53, p=0.72). Rural setting was associated with UT for ground (OR 5.01; 95% 2.65-9.46, p less then 0.01) but not air transport (OR 1.18; 95%CI 0.54-2.55, p=0.68). CONCLUSIONS UT is more common in rural settings. Specific triage criteria are associated with UT in rural settings. Lack of a rural trauma center requiring transfer to an urban center is a risk factor for UT of rural patients. Air medical transport mitigated the risk of UT in rural patients. Provider and system interventions may help reduce UT in rural settings. LEVEL OF EVIDENCE Level III, Prognostic study.BACKGROUND Motor Vehicle Crashes(MVC) fatalities have been declining while states passed various legislation targeting driver behavior. This study assesses the impact of state laws on MVC fatality rates to determine which laws were effective. METHODS Publically available data were collected on driver-related motor vehicle laws, law strengths, enactment years, and numbers of verified-trauma centers. Prospective data on crash characteristics and MVC fatalities age≥16 from Fatality Analysis Reporting System(FARS) 1999-2015(n=850) was obtained. Generalize Linear Autoregressive Modelling was used to assess the relative contribution of state laws to the crude MVC fatality rate while controlling for other factors. RESULTS Lowering the minimum blood alcohol content(BAC) was associated with largest declines for all ages, especially the older cohorts16-20years(B=0.23[p65 years cohort, but speed camera laws had no effect. Graduated Driver License laws were associated with declines for 16-21years(B=-0.06[p less then 0.001]) only. Laws targeting specific risks(elderly, motorcycles, marijuana) showed no effect on declining MVC mortality rates during the study-period or were enacted too recently(cell phones). CONCLUSIONS States have passed a wide variety of laws with varying effectiveness. A few key laws, specifically laws lowering allowable BAC, implementing red light cameras, and mandating seatbelt use significantly reduced MVC mortality rates from 1999-2015. Simply adding more laws/penalties may not equate directly to lives saved. Continued research on state laws will better inform policy makers to meet evolving public health needs in the management of MVC fatalities. LEVEL OF EVIDENCE Prospective study level III.Prognostic and Epidemiological.BACKGROUND Adhesive small bowel obstruction (ASBO) is one of the most frequent causes of emergency hospital admissions and surgical treatment. Current surgical treatment of ASBO consist of open adhesiolysis. With laparoscopic procedures rising, the question arises if laparoscopy for ASBO is safe and results in better patient outcomes. Although adhesiolysis was among the first surgical procedures to be approached laparoscopically, uncertainty remains about its potential advantages over open surgery. Therefore, we performed a systematic review and meta-analysis on the benefits and harms of laparoscopic surgery for ASBO. METHODS A systematic literature review was conducted for papers published up to May 2019. Two reviewers screened all articles and did the quality assessment. Consecutively a meta-analysis was performed. In order to reduce selection bias, only matched studies were used in our primary analyses. All other studies were used in a sensitivity analyse. All the outcomes were measured within the 30th poss (RR 0.51, 95% CI 0.46 - 0.56) and early unplanned reoperations (RR 0.82, 95% CI 0.70 - 0.96). CONCLUSIONS Results of this systematic review indicate that laparoscopic surgery for ASBO is safe and feasible. Laparoscopic surgery is not associated with better or worse postoperative outcomes compared with open adhesiolysis. Future research should focus on the correct selection of those patients who are suitable for laparoscopic approach and may benefit from this approach. LEVEL OF EVIDENCE Level IITherapeutic.BACKGROUND Trauma is the leading cause of death for young Americans. Nonspecific histone deacetylase (HDAC) inhibitors, such as valproic acid (VPA), have been shown to improve survival in preclinical models of lethal trauma, hemorrhage and sepsis. The doses needed to achieve a survival benefit are higher than FDA-approved doses, and the nonspecificity raises concerns about unintended adverse effects. The isoform specific HDAC-6 inhibitor, ACY-1083, has been found to be as efficacious as VPA in a rodent model of hemorrhagic shock. We hypothesized that ACY-1083 treatment would improve survival in a swine model of lethal hemorrhage, polytrauma and bacteremia. METHODS Swine were subjected to 45% blood volume hemorrhage, brain injury, femur fracture, rectus crush, splenic and liver lacerations, and colon injury. After 1 hour of shock (mean arterial pressure 30-35 mmHg), animals were randomized to normal saline resuscitation (control) or normal saline+ACY-1083 30mg/kg treatment (n=5/group). After 3 hours (simulating delayed evacuation), packed red blood cells and antibiotics were administered, the colon injury was repaired, and the abdomen was closed. Animals were then monitored for another 4 hours. Survival was assessed using Kaplan-Meier and log-rank test. RESULTS This combination of injuries was lethal. All animals became bacteremic, in addition to the severe hemorrhagic shock. Survival in the control group was 0% and ACY-1083 treatment increased survival to 80% (p=0.019). There was no difference in the brain lesion size between the groups. CONCLUSION A single dose of ACY-1083 markedly improves survival in an otherwise lethal model of polytrauma, hemorrhagic shock and bacteremia. LEVEL OF EVIDENCE Basic science.BACKGROUND The mechanisms of aberrant circulating platelet behavior following injury remain unclear. Platelets retain megakaryocyte immature ribonucleic acid (RNA) splicing and protein synthesis machinery to alter their functions based on physiologic signals. We sought to identify fluctuating platelet-specific RNA transcripts in cell free plasma (CFP) from traumatic brain injury (TBI) patients as proof-of-concept for using RNA sequencing to improve our understanding of post-injury platelet behavior. We hypothesized that we could identify differential expression of activated platelet-specific spliced RNA transcripts from CFP of patients with isolated severe fatal TBI (fTBI) compared to minimally-injured trauma controls (t-controls), filtered by healthy control (h-control) datasets. METHODS High-read depth RNA sequencing was applied to CFP from ten patients with fTBI (abbreviated injury scale [AIS] for head ≥3, AIS for all other categories 1.5 or less then .67 fold ex-vivo non-activated platelet-specific RNA transcripts.