ABSTRACT
BACKGROUND: Thromboelastography (TEG) has been utilized for the guidance of blood component therapy (BCT). We aimed to investigate the association between emergent TEG-guided BCT and clinical outcomes in patients with traumatic abdominal solid organ (liver and/or spleen) injuries. METHODS: A single center retrospective study of patients who sustained traumatic liver and/or spleen injuries receiving emergent BCT was conducted. TEG was ordered in all these patients. Patient demographics, general injury information, outcomes, BCT, and TEG parameters were analyzed and compared in patients receiving TEG-guided BCT versus those without. RESULTS: A total of 166 patients were enrolled, of whom 52% (86/166) received TEG-guided BCT. A mortality of 12% was noted among patients with TEG-guided BCT when compared with 19% of mortality in patients with non-TEG-guided BCT (P > 0.05). An average of 4 units of packed red blood cell (PRBC) was received in patients with TEG-guided BCT when compared to an average of 9 units of PRBC received in non-TEG-guided BCT patients (P < 0.01). A longer hospital length of stay (LOS, 19 ± 16 days) was found among non-TEG-guided BCT patients when compared to the TEG-guided BCT group (14 ± 12 days, P < 0.05). TEG-guided BCT showed as an independent factor associated with hospital LOS after other variables were adjusted (coefficiency: 5.44, 95% confidence interval: 0.69 - 10.18). CONCLUSIONS: Traumatic abdominal solid organ injury patients receiving blood transfusions might benefit from TEG-guided BCT as indicated by less blood products needed and less hospitalization stay among the cohort.
ABSTRACT
Since the first prehistoric people started to dig for stone to make implements, rather than pick up loose material, humans have modified the landscape through excavation of rock and soil, generation of waste and creation of artificial ground. In Great Britain over the past 200 years, people have excavated, moved and built up the equivalent of at least six times the volume of Ben Nevis. It is estimated that the worldwide deliberate annual shift of sediment by human activity is 57,000 Mt (million tonnes) and exceeds that of transport by rivers to the oceans (22,000 Mt) almost by a factor of three. Humans sculpt and transform the landscape through the physical modification of the shape and properties of the ground. As such, humans are geological and geomorphological agents and the dominant factor in landscape evolution through settlement and widespread industrialization and urbanization. The most significant impact of this has been since the onset of the Industrial Revolution in the eighteenth century, coincident with increased release of greenhouse gases to the atmosphere. The anthropogenic sedimentological record, therefore, provides a marker on which to characterize the Anthropocene.
