Tranexamic Acid Improves Survival in the Setting of Severe Head Injury in Combat Casualties.

INTRODUCTION: Approximately 1.7 million people sustain traumatic brain injuries (TBI) annually in the US. To reduce morbidity and mortality, management strategies aim to control progressive intracranial bleeding. This study analyzes the association between Tranexamic Acid (TXA) administration and mortality among casualties within the Department of Defense Trauma Registry, specifically focusing on subsets of patients with varying degree of head injury severities. METHODS: Besides descriptive statistics, we used inverse probability weighted (for age, military service category, mechanism of injury, total units of blood units administered), and injury severity (ISS) and Abbreviated Injury Scale (AIS) head score adjusted generalized linear models to analyze the association between TXA and mortality. Specific subgroups of interest were increasing severities of head injury and further stratifying these by Glasgow Coma Score of 3-8 and severe overall bodily injuries (ISS>=15). RESULTS: 25,866 patients were included in the analysis. 2,352 (9.1%) received TXA and 23,514 (90.9%) did not receive TXA. Among those with ISS>=15 (n=6,420), 21.2% received TXA. Among those with any head injury (AIS head injury severity score>=1; n=9,153), 7.2% received TXA. The median ISS scores were greater in the TXA versus no-TXA group (17 versus 6). Weighted and adjusted models showed overall, there was 25% lower mortality risk between those who received TXA at any point and those who did not (OR:0.75, 95% CI: 0.59, 0.95). Further, as the AIS severity score increased from >=1 (1.08; 0.80, 1.47) to >=5 (0.56; 0.33, 0.97), the odds of mortality decreased. CONCLUSIONS: TXA may potentially be beneficial in patients with severe head injuries, especially those with severe overall injury profiles. There is a need of definitive studies to confirm this association.

A meta-analysis of bariatric surgery-related outcomes in accredited versus unaccredited hospitals in the United States.

The American Society for Bariatric Surgery established a set of standards for bariatric surgery Centers of Excellence accreditation programme in 2003. While several research efforts have shown that post-bariatric surgery outcomes were poorer in unaccredited as compared to accredited hospitals, others have questioned the same. This research effort sought to use random effects meta-analysis to quantitatively summarize the existing research efforts analysing this association, which were published between January 2000 and October 2018. Out of the total 559 articles, 13 that quantitatively analysed the effect of accreditation on post-operative mortality- and morbidity-related outcomes were included in the analysis. Overall, the weighted pooled estimates showed that compared to accredited, in the unaccredited hospitals, the odds of mortality were twice as high (odds ratio: 1.83; confidence interval: 1.49, 2.25), and those for morbidity were 1.23 times higher (1.11, 1.36). Estimates varied by the data source used, and the effect estimate used (odds or risk ratios). Overall, the odds of poor post-operative outcomes were higher among unaccredited hospitals as compared to accredited. However, there were analytic differences and other limitations among the existing efforts. Future research efforts conducting independent analyses on these data sources, keeping the methodology consistent are needed.

A longitudinal study of work-related psychosocial factors and injuries: Implications for the aging United States workforce.

INTRODUCTION: This study aimed to identify psychosocial work factors that may individually or, in combination, influence injury outcomes among aging United States (U.S.) workers. METHODS: Data from the U.S. Health and Retirement Study (HRS) of 3305 working adults, aged 50 years and above, were used to identify associations between work-related psychosocial factors and injury incidence from 2006 to 2014, using adjusted incidence rate ratios. RESULTS: Employees perceiving their work as high in psychological and physical demands/efforts, low in support, and rewards, compared to those in workplaces with low demands, high support, and high rewards, had a risk of injury two times greater. Males, compared with females, had a greater risk for injuries when interactions among several psychosocial work-related factors were modeled. CONCLUSIONS: The fact that important gender-based differences emerged when interactions among the psychosocial factors and injury were modeled, suggests opportunities for further research and potential interventions to enhance the working environment.

Standardized morbidity ratios of four chronic health conditions among World Trade Center responders: Comparison to the National Health Interview Survey.

PURPOSE: We conducted external comparisons for the prevalence of asthma, hypertension, diabetes, and cancer among World Trade Center (WTC) general responders using the National Health Interview Survey (NHIS) as the reference, along with internal comparisons for the incidence of asthma. METHODS: Standardized Morbidity Ratios (SMRs) were calculated for the prevalence of the health conditions, and risk ratios (RRs) for asthma incidence. RESULTS: Relative to the NHIS, asthma prevalence was in excess in responders over the study years (age-adjusted SMRs = 1.3-2.8). Hypertension prevalence began to exceed expected from 2006 while diabetes was lower than expected. An upward trend towards excess cancer prevalence was observed. Internal comparisons showed elevated asthma incidence among protective service and utility workers compared to construction workers; while those who arrived at the WTC site in the morning of 9/11 had a lower asthma risk than those who arrived in the afternoon. CONCLUSIONS: The use of NHIS data as a reference population demonstrates and reconfirms several important patterns of excess risk in WTC responders. External comparisons are an alternative for disaster cohorts without an established comparison group.

New onset of asthma and job status change among world trade center responders and workers.

BACKGROUND: Despite the high rates, the consequences of new onset asthma among the World Trade Center (WTC) responders in terms of the change in job status have not been studied. METHODS: This study consists of a cohort of 8132 WTC responders out of the total 25 787 responders who held a full-time job at the baseline visit, and participated in at least one follow-up visit. RESULTS: Overall, 34% of the study cohort changed their job status from full-time at a follow-up visit. Multivariable models showed that asthmatics were respectively 27% and 47% more likely to have any job status change and get retired, and twice as likely to become disabled as compared to non-asthmatics. CONCLUSIONS: With asthma incidence from WTC exposure, negative job status change should be considered as a potential long-term consequence of WTC exposure.