Prehospital tranexamic acid in trauma patients: a systematic review and meta-analysis of randomized controlled trials.

Background: Prehospital tranexamic acid (TXA) may hold substantial benefits for trauma patients; however, the data underlying its efficacy and safety is scarce. Methods: We searched PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov from inception to July 2023 for all randomized controlled trials (RCTs) investigating prehospital TXA in trauma patients as compared to placebo or standard care without TXA. Data were pooled under a random-effects model using RevMan 5.4 with risk ratio (RR) and mean difference (MD) as the effect measures. Results: A total of three RCTs were included in this review. Regarding the primary outcomes, prehospital TXA reduced the risk of 1-month mortality (RR 0.82, 95% CI 0.69-0.97) but did not increase survival with a favorable functional outcome at 6 months (RR 1.00, 95% CI 0.93-1.09). Prehospital TXA also reduced the risk of 24-h mortality but did not affect the risk of mortality due to bleeding and traumatic brain injury. There was no significant difference between the TXA and control groups in the incidence of RBC transfusion, and the number of ventilator- and ICU-free days. Prehospital TXA did not increase the risk of adverse events except for a small increase in the incidence of infections. Conclusion: Prehospital TXA is useful in reducing mortality in trauma patients without a notable increase in the risk of adverse events. However, there was no effect on the 6-month favorable functional status. Further large-scale trials are required to validate the aforementioned findings. Systematic review registration: PROSPERO (CRD42023451759).

Derivation and validation of the ED-SAS score for very early prediction of mortality and morbidity with acute pancreatitis: a retrospective observational study.

BACKGROUND: Existing scoring systems to predict mortality in acute pancreatitis may not be directly applicable to the emergency department (ED). The objective of this study was to derive and validate the ED-SAS, a simple scoring score using variables readily available in the ED to predict mortality in patients with acute pancreatitis. METHODS: This retrospective observational study was performed based on patient data collected from electronic health records across 2 independent health systems; 1 was used for the derivation cohort and the other for the validation cohort. Adult patients who were eligible presented to the ED, required hospital admission, and had a confirmed diagnosis of acute pancreatitis. Patients with chronic or recurrent episodes of pancreatitis were excluded. The primary outcome was 30-day mortality. Analyses tested and derived candidate variables to establish a prediction score, which was subsequently applied to the validation cohort to assess odds ratios for the primary and secondary outcomes. RESULTS: The derivation cohort included 599 patients, and the validation cohort 2011 patients. Thirty-day mortality was 4.2 and 3.9%, respectively. From the derivation cohort, 3 variables were established for use in the predictive scoring score: ≥2 systemic inflammatory response syndrome (SIRS) criteria, age > 60 years, and SpO2 < 96%. Summing the presence or absence of each variable yielded an ED-SAS score ranging from 0 to 3. In the validation cohort, the odds of 30-day mortality increased with each subsequent ED-SAS point: 4.4 (95% CI 1.8-10.8) for 1 point, 12.0 (95% CI 4.9-29.4) for 2 points, and 41.7 (95% CI 15.8-110.1) for 3 points (c-statistic = 0.77). CONCLUSION: An ED-SAS score that incorporates SpO2, age, and SIRS measurements, all of which are available in the ED, provides a rapid method for predicting 30-day mortality in acute pancreatitis.

Variable Rate Irrigation of Maize and Soybean in West-Central Nebraska Under Full and Deficit Irrigation.

Variable rate irrigation (VRI) may improve center pivot irrigation management, including deficit irrigation. A remote-sensing-based evapotranspiration model was implemented with Landsat imagery to manage irrigations for a VRI equipped center pivot irrigated field located in West-Central Nebraska planted to maize in 2017 and soybean in 2018. In 2017, the study included VRI using the model, and uniform irrigation using neutron attenuation for full irrigation with no intended water stress (VRI-Full and Uniform-Full treatments, respectively). In 2018, two deficit irrigation treatments were added (VRI-Deficit and Uniform-Deficit, respectively) and the model was modified in an attempt to reduce water balance drift; model performance was promising, as it was executed unaided by measurements of soil water content throughout the season. VRI prescriptions did not correlate well with available water capacity (R 2 < 0.4); however, they correlated better with modeled ET in 2018 (R 2 = 0. 69, VRI-Full; R 2 = 0.55, VRI-Deficit). No significant differences were observed in total intended gross irrigation depth in 2017 (VRI-Full = 351 mm, Uniform Full = 344). However, in 2018, VRI resulted in lower mean prescribed gross irrigation than the corresponding uniform treatments (VRI-Full = 265 mm, Uniform Full = 282 mm, VRI-Deficit = 234 mm, and Uniform Deficit = 267 mm). Notwithstanding the differences in prescribed irrigation (in 2018), VRI did not affect dry grain yield, with no statistically significant differences being found between any treatments in either year (F = 0.03, p = 0.87 in 2017; F = 0.00, p = 0.96 for VRI/Uniform and F = 0.01, p = 0.93 for Full/Deficit in 2018). Likewise, any reduction in irrigation application apparently did not result in detectable reductions in deep percolation potential or actual evapotranspiration. Additional research is needed to further vet the model as a deficit irrigation management tool. Suggested model improvements include a continuous function for water stress and an optimization routine in computing the basal crop coefficient.