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9% and BIG 1 category was 42.7%. There were no differences in demographics (age, gender, comorbidities), mechanism of injury, or imaging when comparing ECI patients with no-ECI patients. GCS was lower in the ECI group (14.4 vs. 14.7, p less then 0.001). Patients with ECI were also less likely to be discharged home (58.2% vs. 78.3%, p less then 0.001). Lower GCS-verbal, BIG category 3, and presence of pelvic/extremity fractures were strong risk factors for ECI in a logistic regression model adjusted for age, loss of consciousness, anticoagulants, narcotic administration, and Rotterdam score. CONCLUSION Half of all patients with ICH and mild TBI had ECI. Both lower initial GCS and BIG category 3 were associated with increased likelihood of ECI. Therefore, we recommend all patients with ICH and mild TBI undergo cognitive evaluation.Retrospective, Prognostic Study LEVEL OF EVIDENCE Level III.BACKGROUND While there is little debate that pediatric trauma centers (PTC) are uniquely equipped to manage pediatric trauma patients, the extent to which adolescents benefit from treatment there remains controversial. We sought to elucidate differences in management approach and outcome between PTC and adult trauma centers (ATC) for the adolescent penetrating trauma population. We hypothesized that improved mortality would be observed at ATC for this subset of patients. METHODS Adolescent patients (aged 15-18 years) presenting to Pennsylvania-accredited trauma centers between 2003-2017 with penetrating injury were queried from the Pennsylvania Trauma Outcome Study (PTOS) database. Dead on arrival, transfer patients, and those admitted to a Level III or IV trauma center were excluded from analysis. Patient length of stay (LOS), number of complications, surgical intervention, and mortality were compared between ATC and PTC. Multilevel mixed effects logistic regression models with trauma center as the clustering variable were used to assess the impact of center type (ATC/PTC) on management approach and mortality adjusted for appropriate covariates. RESULTS A total of 2,630 adolescent patients met inclusion criteria (PTC n=428 [16.3%]; ATC n=2,202 [83.7%]). find more PTC's had a lower adjusted odds of mortality ([AOR] 0.35; 95% confidence interval [CI], 0.17-0.74; p=0.006) and a lower adjusted odds of surgery (AOR 0.67; 95% CI, 0.0.48-0.93; p =0.016) than their ATC counterparts. There were no differences in complication rates (AOR 0.94; 95% CI, 0.57-1.55; p=0.793) or LOS > 4 days (AOR 0.95; 95% CI, 0.61-1.48; p=0.812) between the PTC or ATC centers. There were also differences in penetrating injury type between PTC and ATC. CONCLUSION The adolescent penetrating trauma patient population treated at PTC had less surgery performed with improved mortality compared to ATC. LEVEL OF EVIDENCE Epidemiologic study, level III.BACKGROUND Anemia in patients who decline transfusion has been associated with increased morbidity and mortality. We hypothesized that the time to death decreases with increasing severity of anemia in patients for whom transfusion is not an option. METHODS With IRB approval, a retrospective review of registered adult blood refusal patients with at least one hemoglobin (Hb) value ≤12.0g/dL during hospital admission at a single institution from January 2004 to September 2015 was performed. The association of nadir Hb category and time to death (all-cause 30-day mortality) was determined using Kaplan-Meier plots, log rank tests, and Cox proportional hazard models. We investigated if there was a nadir Hb level between the values of 5.0 and 6.0g/dL at which mortality risk significantly increased, and then categorized nadir Hb by the traditional cut points, and the newly identified "critical" cut point. RESULTS The study population included 1011 patients. The Cox proportional hazard models showed a more than 50% increase in hazard of death per 1g/dL decrease in Hb (adjusted hazard ratio (HR) 1.55 (1.40, 1.72), p less then 0.001). A Hb value of 5.0g/dL was identified as defining 'critical anemia.' We found a strong association between anemia severity level and mortality (p less then 0.001). Time to death was shorter (median 2 days) in patients with critical anemia than in those having higher Hb (median time to death of 4 or 6 days, in severe or moderate anemia). CONCLUSION In anemic patients unable to be transfused, critical anemia was associated with a significantly and clinically important reduced time to death. LEVEL OF EVIDENCE III (Prognostic).BACKGROUND According to the Joint Theater Trauma Registry, 26-33% of war casualties develop Acute Respiratory Distress Syndrome (ARDS), with high mortality. Here we aimed to describe ARDS incidence and severity among patients evacuated from war zones and admitted to French intensive care units (ICUs). METHODS We performed an observational retrospective multicentric review of all patients evacuated from war zones and admitted to French ICUs between 2003-2018. Our analysis included all medical and trauma patients developing ARDS according to the Berlin definition. We evaluated ARDS incidence, and determined ARDS severity from arterial blood gas analysis. Analyzed parameters included invasive ventilation duration, ARDS treatments, ICU stay length, and 30-day and 90-day mortality. RESULTS Among 141 included patients (84% military; median age, 30 years), 57 (42%) developed ARDS. ARDS was mild in 13 patients (22%), moderate in 24 (42%), and severe in 20 (36%). Evacuation occurred in less then 26 hours for 32 war casualties, 17 non-war-related trauma patients, and 8 medical patients. Among severe trauma patients, median ISS was 34, and AIS thorax was 3. Upon French ICU admission, median PaO2/fiO2 ratio was 241 [144-296]. Administered ARDS treatments included intubation (98%, n = 56), protective ventilation (87%, n = 49), neuromuscular blockade (76%, n = 43), prone position (16%, n = 9), inhaled nitric oxide (10%, n = 6), almitrine (7%, n = 7), and extracorporeal life support (ECLS) (4%, n = 2). Median duration of invasive ventilation was 13 days, ICU stay was 18 days, 30-day mortality was 14%, and 90-day mortality was 21%. CONCLUSIONS ARDS was frequent and severe among French patients evacuated from war theaters. Improved treatment capacities are needed in the forward environment-for example, a specialized US team can provide ECLS for highly hypoxemic war casualties. LEVEL OF EVIDENCE Prognostic and epidemiological study, level III.PRECIS This clinical trial compares a modified trabeculectomy technique (ESST) to conventional trabeculectomy (SST) regarding success rate and bleb morphology. ESST showed comparable results with lower incidence of bleb-related complications and need for postoperative anti-glaucoma medications. BACKGROUND To evaluate the outcome of modified trabeculectomy with extended subscleral tunnel "ESST" versus conventional subscleral trabeculectomy "SST" in the management of uncontrolled primary open-angle glaucoma. METHODS This is a randomized clinical trial including 40 eyes (40 patients) divided into 2 equal groups. link2 In the first group, a conventional SST with adjuvant 0.3% mitomycin-C was performed. In the second group; the ESST group, an additional 1.00▒mm wide longitudinal scleral groove was dissected and excised in the center of the deep scleral bed extending 1.00▒mm beyond the posterior margin of the flap. Patients were examined on days 1, 7, 14, 30, 90, 180 and at 1 year with special emphasis on intraocular pressure (IOP) and bleb morphology. Postoperative ultrasound biomicroscopy was done to evaluate the surgical area. RESULTS Both groups showed significant reduction in IOP with the ESST group showing significantly lower values on days 7,14,30,90 and 180 (P=0.001,0.004,0.026, 0.001,0.048) but no significant differences on day 1 and at 1 year (P=0.06,0.07). The need for postoperative anti-glaucoma medications was significantly lower in the ESST group (P=0.043). Visually significant cataract and bleb related complications were more in the SST group (P=0.044, less then 0.001). Eyes that showed normal bleb vascularity and wider extent were significantly more in the ESST group. CONCLUSIONS ESST offers a guarded posterior flow with comparable success rate to conventional SST. ESST could minimize bleb-related complications and bleb-dysesthesia with better long term bleb morphology and vascularity. link3 It could also minimize the need for further adjuvant postoperative anti-glaucoma medications.We present a recommended patient-oriented glaucoma classification to facilitate patient-ophthalmologist dialog. By improving patients understanding of their precise diagnosis, we hope to optimize management outcomes. We invite our colleagues to evolve this classification with us.PRECIS High risk alleles of risk-associated SNPs within the LOXL1 gene are associated with pseudoexfoliation in patients recruited from an Irish population. PURPOSE Single nucleotide polymorphisms (SNPs) within the lysyl oxidase-like (LOXL) 1 gene have been identified as a major risk factor for pseudoexfoliation syndrome (PXF) and PXF glaucoma (PXFG), specifically SNPs within exon 1 and intron 1 regions of the gene. The common haplotype (G-G) of 2 SNPs within exon 1, rs1048661 and rs3825942, is the strongest associated risk factor for PXF in Caucasian populations, but are switched in some populations to act as protective or low risk. Herein, a study was undertaken to genotype an Irish population for PXF/PXFG risk-associated SNPs within LOXL1. METHODS Patient cohorts of PXFG, PXF, and controls were recruited and genotyped for risk associated SNPs within exon 1 (rs1048661 and rs3825942), along with 3 SNPs within intron 1 (rs1550437, rs6495085, and rs6495086) of LOXL1. RESULTS The risk G alleles of rs1048661 and rs3825942 were most prevalent in PXFG patients and a significant association was found between the rs3825942 and pseudoexfoliation (P=0.04). Genotypes of several intron 1 SNPs were found to be present at higher frequencies within the pseudoexfoliation patient cohort (PXF/PXFG) compared to control patients, where rs6495085 showed statistical association (P=0.04). The G-G-G haplotype of rs1048661, rs3825942 and rs6495085 were the most prevalent in PXFG patients compared to control patients or patients with PXF alone. Patients with the G-G-G haplotype were more likely to need surgery, suggestive of a more severe form of disease. CONCLUSIONS Collectively, these results represent the first study to assess the association of LOXL1 SNPs with PXFG in an Irish population.The authors aimed to evaluate quality of life after septal surgery with Short Form-36 survey, and the effectiveness of the survey. Nasal symptoms (nasal obstruction, facial pain, catarrh), and general quality of life (using the Turkish version of the Short Form-36 questionnaire) were assessed preoperatively and at 1st and 6th postoperative months. Acoustic rhinometry and rhinomanometry were assessed preoperatively and at 6th postoperative month. Data from 78 patients were analyzed. This prospective clinical study was conducted on patients complaining of nasal obstruction with nasal septal deviation. Seventy-eight patients were included in the study. Fourty-two patients (53.8%) were male and 36 patients (46.2%) were female. At 1st postoperative month, nasal obstruction, facial pain and catarrh scores significantly improved in all, 46, 18 patients, respectively (P  less then  0.0001). At 6th postoperative month, scores nonsignificantly worsened by 1 point in 12, 6, 12 patients, respectively. Nasal volume significantly increased and total resistance significantly decreased at 6th month (P  less then  0.