Decreased mortality in patients with isolated severe blunt traumatic brain injury receiving higher plasma to packed red blood cells transfusion ratios.

INTRODUCTION: Higher transfusion ratios of plasma to packed red blood cells (PRBC) and platelets (PLT) to PRBC have been shown to be associated with decreased mortality in major trauma patients. However, little is known about the effect of transfusion ratios on mortality in patients with isolated severe traumatic brain injury (TBI). The aim of this study was to investigate the effect of transfusion ratios on mortality in patients with isolated severe blunt TBI. We hypothesized that higher transfusion ratios of plasma to PRBC and PLT to PRBC are associated with a lower mortality rate in these patients. METHODS: Retrospective observational study. Patients with isolated severe blunt TBI (AIS head≥3, AIS extracranial <3) admitted to an urban level I trauma centre were included. Clinical data were extracted from the institution's trauma registry, blood transfusion data from the blood bank database. The effect of higher transfusion ratios on in-hospital mortality was analysed using univariate and multivariable regression analysis. RESULTS: A total of 385 patients were included. Median age was 32 years (IQR 2-50), 71.4% were male, and 76.6% had an ISS≥16. Plasma:PRBC transfusion ratios≥1 were identified as an independent predictor for decreased in-hospital mortality (adjusted OR 0.43 [CI 0.22-0.81]). PLT:PRBC transfusion ratios≥1 were not significantly associated with mortality (adjusted OR 0.39 [CI 0.08-1.92]). CONCLUSION: This study revealed plasma to PRBC transfusion ratios≥1 as an independent predictor for decreased in-hospital mortality in patients with isolated severe blunt TBI.

Infrared thermal imaging: a review of the literature and case report.

Intraoperative Thermal Imaging (ITI) is a novel neuroimaging technique that can potentially locate the margins of primary and metastatic brain tumors. As a result, the additional real-time anatomical and pathophysiological information may significantly contribute to an improved extent of tumor resection. Our objectives in this article are i) to briefly discuss the current status of intraoperative imaging modalities including ITI and ii) to present a case report that evaluates the usefulness of ITI in detection of brain tumor and its margins. In this case report, ITI was used in a patient with a metastatic intracortical melanoma. The thermal profile of the tumor and surrounding normal cerebral cortex were mapped with a ThermaCAM P60 (TCP60) infrared camera by FLIR Systems. The data obtained by TCP60, intra-operatively, revealed a clear demarcation of tumor with significant temperature differences, up to 3.3 degrees C, between the tumor core (36.4 degrees C) and the surrounding normal tissue (33.1 degrees C). Ultrasound and pre-resection MR and CT confirmed the position and size of the metastasis. The volume of the tumor was preoperatively calculated using the CyberKnife software and postoperative volumetric measurement of the tumor residual was calculated by the Gamma Knife software. Our result, along with previously published results of others, suggests that thermal imaging could be used to provide a rapid, non-invasive, and real-time intra-operative imaging.