ABSTRACT
BACKGROUND: The current study assessed a recently developed resuscitation protocol for bleeding trauma patients called the Targeted Transfusion Protocol (TTP) and compared its results with those of the standard Massive Transfusion Protocol (MTP). METHODS: Per capita utilization of blood products such as packed red blood cells (RBCs), fresh frozen plasma (FFP), and platelet concentrates was compared along with mortality rates during two 6-month periods, one in 2011 (when the standard MTP was followed) and another in 2014 (when the TTP was used). In the TTP, patients were categorized into three groups based on the presence of head injuries, long bone fractures, or penetrating injuries involving the trunk, extremities, or neck who were resuscitated according to separate algorithms. All cases had experienced motor vehicle accidents and had injury severity scores over 16. RESULTS: No statistically significant differences were observed between the study groups at hospital admission. Per capita utilization of RBC (4.76 ± 0.92 vs. 3.37 ± 0.55; P = 0.037), FFP (3.71 ± 1.00 vs. 2.40 ± 0.52; P = 0.025), and platelet concentrate (1.18 ± 0.30 vs. 0.55 ± 0.18; P = 0.006) blood products were significantly lower in the TTP epoch. Mortality rates were similar between the two study periods (P = 0.74). CONCLUSIONS: Introduction of the TTP reduced the requirements for RBCs, FFP, and platelet concentrates in severely injured trauma patients.
Subject(s)
Humans , Blood Platelets , Craniocerebral Trauma , Erythrocytes , Extremities , Fractures, Bone , Hemorrhage , Injury Severity Score , Mortality , Motor Vehicles , Neck , Plasma , Resuscitation , Wounds and InjuriesABSTRACT
Objective: To investigate the determinants of outcome in patients with traumatic brain injury [TBI] undergoing decompressive craniectomy [DC] in a large level I trauma center in southern Iran
Methods: This retrospective cross-sectional study was conducted during an 18-month period from 2013 to 2014 in Shahid Rajaei hospital, a Level I trauma center in Southern Iran. Patients with TBI who had undergone DC were included and the medical charts were reviewed regarding demographics, clinical, radiological and outcome characteristics. The outcome was determined by extended Glasgow outcome scale [GOS-E] after one year of surgery. The variables were compared between those with favorable and unfavorable outcome to investigate the outcome determinants
Results: Overall 142 patients with mean age of 34.8+/-15.5 [ranging from 15 to 85] years were included. There were 127 [89.4%] men and 15 [10.6%] women among the patients. After 1-year, the mortality rate was 58 [40.8%] and 8 [5.6%] patients were persistent vegetative state. The final outcome was found to be unfavorable in 77 [54.2%] patients. Unfavorable outcome was associated with lower GCS on admission [p<0.001] as well as occurrence of postoperative hydrocephalus [p=0.011]. Formation of the postoperative subdural hygroma after the operation was found to be associated with favorable outcome [p=0.019]
Conclusion: DC in patients with TBI is associated with favorable outcome in most of them. On admission GCS, postoperative hydrocephalus and presence of postoperative subdural hygroma are among the important predictors of outcome in TBI patients undergoing DC
ABSTRACT
Deep vein thrombosis [DVT] and pulmonary embolism [PTE] are known as venous thromboembolism [VTE]. DVT occurs when a thrombus [a blood clot] forms in deep veins of the body, usually in the lower extremities. It can cause swelling or leg pain, but sometimes may occur with no symptoms. Awareness of DVT is the best way to prevent the VTE. Patients with trauma are at increased risk of DVT and subsequent PE because of coagulopathy in patients with multiple trauma, DVT prophylaxis is essential but the VTE prophylaxis strategy is controversial for the trauma patients. The risk factors for VTE includes pelvic and lower extremity fractures, and head injury
ABSTRACT
Objective: to determine the effects of application of anti-adhesive films [OrthoWrap[TM]] in traumatic decompressive craniectomy on prevention of adhesion formation and facilitation of subsequent cranioplasty
Methods: this was a retrospective cohort study being performed in ShahidRajaei hospital [Shiraz Level I trauma center] during a 12-month period [from March 2012 to April 2013] including 93 patients undergoing traumatic decompressivecraniectomy.Patients who received OrthoWrap[TM] during the initial craniectomy [n=44] were compared to those who did not [n=49]. Two study groups were matched regarding the baseline characteristics. The perioperative indices including the surgical time, amount of bleeding, transfusion and 6-month Glasgow Outcome Scale [GOS] were compared between two study groups
Results: there was no significant difference between two study groups regarding the baseline characteristics. We found that the cranioplasty duration [113.3 +/- 33.2 vs. 146.9 +/- 34.9 minutes; p<0.001] and amount of intraoperative bleeding [182.1 +/- 98.3 vs. 270.6 +/- 77.6 mL; p=0.043] was significantly lower in those who had OrthoWrap[TM] compared to control group. The final GCS [p=0.052] as well as GOSE [p=0.653] was comparable between groups. The infection rate was comparable between two study groups [p=0.263]
Conclusion: application of OrthoWrap[TM] during decompressive craniectomy in those with severe traumatic brain injury is associated with shorter duration of operation and less intraoperative bleeding in subsequent cranioplasty. Infection rate and neurologic outcome was comparable between study groups
ABSTRACT
Objective: To determine the diagnostic value of serum white blood cell [WBC] count, fever [>38[degree]C] and WBC rise [>10%] for bacterial meningitis in patients with severe traumatic brain injury [TBI]
Method: This cross-sectional study was conducted in Shahid Rajaei hospital affiliated with Shiraz University of Medical Sciences during a 1-year period from 2013 to 2014. We included consecutively all the patients with severe TBI admitted to our center during the study period who were febrile [>38[degree]C orally] and underwent lumbar puncture [LP] and analysis and culture of cerebrospinal fluid [CSF]. Laboratory analysis of CSF and blood were performed within 2 hours of LP. CSF culture was considered the gold standard for diagnosis of bacterial meningitis. The sensitivity, specificity, positive and negative predictive value [PPV, NPV] of peripheral blood WBC count, fever [>38[degree]C] and WBC rise [>10%] was determined according to the CSF culture
Results: Overall we included242 consecutive patients with severe TBI. The mean age of the participants was 32.8 +/- 17.4 years. Acinetobacter was the most common organism found in the CSF cultures. The sensitivity and specificity of peripheral WBC count [>10,000]was 48.4% [95% CI: 0.42-0.56] and 47% [95% CI: 0.37-0.58] respectively. The PPV and NPV was 13.1% [95% CI: 0.33-0.52] and 84.8% [95% CI: 0.42-0.61], respectively. The AUC for WBC count was 0.478 [95% CI: 0.37-0.58] indicating low accuracy for the diagnosis of bacterial meningitis. The AUC for WBC rise [>10%] and temperature >38[degree]C was0.460 [95% CI: 0.351-0.569] and 0.517 [95% CI: 0.410-0.624] respectively, both indicating low accuracy for diagnosis of bacterial meningitis
Conclusion: The results of the current study indicates that peripheral blood leukocyte count, fever [>38[degree]C] and WBC rise [>10%] is a non-reliable marker for diagnosis of bacterial meningitis in patients with severe TBI
ABSTRACT
Objective: To evaluate and describe the sleep quality in seven subscales among the patients with mild traumatic brain injury [TBI] and compare it with normal patterns
Methods: This cross-sectional study was conducted within a 6-month period from February to August 2014 in Shahid Rajaei trauma center of Shiraz. Participants were selected randomly from all adult [18-60 years of age] patients admitted during the study period with impression of mild TBI [GCS of more than 13]. The patients' sleep quality and demographic characteristics were evaluated by Pittsburgh sleep quality index [PSQI] and selfreport questionnaire, respectively. Results were compared with normal data, which extracted from the normative data of PSQI manual
Results: Overall we included 60 patients with mild TBI with mean age of 36.2 +/- 13.4 years. All the patients had sleep disturbance. Among them there were 46 [76.7%] men and 14 [23.3%] women. The subjective sleep quality [p=0.01], sleep latency [p=0.01], habitual sleep efficiency [p=0.01], sleep disturbance [p=0.01], use of sleep medication [p=0.01] and day time dysfunction [p=0.01] were significantly impaired in patients with mild TBI when compared to normal values. There were no difference between men and women regarding the sleep quality. The sleep duration was comparable between the subjects and the normal values
Conclusion: Patients with mild TBI have poor sleep quality which should be considered as one of the main factors in interventions after the injury and it might lead to better quality of life
ABSTRACT
Mycotic aneurysm of external carotid artery is extremely rare. We herein report a case of external carotid artery [ECA] aneurysm following severe traumatic brain injury. A 24-year-old man with severe traumatic brain injury [TBI] following a car accident was referred to Rajaee Trauma Center Emergency Room affiliated to Shiraz University of Medical Sciences in Shiraz, Iran. He underwent ventriculostomy on arrival for intracerebral pressure [ICP] monitoring and for a second time due to hydrocephalus following decompressive craniectomy. He developed fulminant meningitis and ventriculitis during his hospital course. A bulged pulsatile lesion under the frontotemporal scalp resulted into the suspicion to underlying vascular pathology. Six-vessel angiography of brain was done which revealed mycotic aneurysm of external carotid artery. The patient underwent a two-week course of a combination of intravenous antibiotics. Follow-up angiography was performed which confirmed successful treatment of mycotic aneurysm of ECA. Mycotic aneurysm of ECA is extremely rare. To our knowledge, this is the first report of mycotic aneurysm of ECA following severe TBI which was successfully treated with antimicrobial therapy