Characteristics and Outcomes of Blood Product Transfusion During Critical Care Transport.

BACKGROUND: Civilian out-of-hospital transfusions have not been adequately studied. This study seeks to characterize patients receiving out-of-hospital blood product transfusion during critical care transport. STUDY DESIGN AND METHODS: We studied patients transported by a regional critical care air-medical service who received blood products during transport. This service carries two units of uncrossmatched packed Red Blood Cells (pRBCs) on every transport in addition to blood obtained from referring facilities. The pRBC are administered according to a protocol for the treatment of hemorrhagic shock or based on medical command physician order. Transfusion amount was categorized into three groups based on the volume transfused (<350 mL, 350-700 mL, >700 mL). The association between prehospital transfusion and in-hospital outcomes (mortality, subsequent blood transfusion and emergent surgery) was estimated using logistic regression models, controlling for age, first systolic blood pressure, first heart rate, Glasgow Coma Score, time of transfer, and length of hospital admission. RESULTS: Among the 1,440 critical care transports with transfusions examined, 81% were for medical patients, being gastrointestinal hemorrhage the most common indication (26%, CI 24-28%). pRBC transfusions were associated with emergent surgery (OR = 1.81, 95% CI = 1.31-2.52) and in-hospital transfusions (OR = 2.00, 95% CI = 1.46-2.76). Those with transfusions >700 mL were associated with emergent surgery (OR = 1.79, 95% CI = 1.10-2.92) and mortality (OR = 2.11; 95% CI = 1.21-3.69). CONCLUSIONS: In this sample, the majority of patients receiving blood products during air-medical transport were transfused for medic conditions; gastrointestinal hemorrhage was the most common chief complaint. The pRBC transfusions were associated with emergent surgery and in-hospital transfusion. Transfusions of >700 mL were associated with mortality.

A Geospatial Analysis of Severe Firearm Injuries Compared to Other Injury Mechanisms: Event Characteristics, Location, Timing, and Outcomes.

OBJECTIVES: Relatively little is known about the context and location of firearm injury events. Using a prospective cohort of trauma patients, we describe and compare severe firearm injury events to other violent and nonviolent injury mechanisms regarding incident location, proximity to home, time of day, spatial clustering, and outcomes. METHODS: This was a secondary analysis of a prospective cohort of injured children and adults with hypotension or Glasgow Coma Scale score ≤ 8, injured by one of four primary injury mechanisms (firearm, stabbing, assault, and motor vehicle collision [MVC]) who were transported by emergency medical services to a Level I or II trauma center in 10 regions of the United States and Canada from January 1, 2010, through June 30, 2011. We used descriptive statistics and geospatial analyses to compare the injury groups, distance from home, outcomes, and spatial clustering. RESULTS: There were 2,079 persons available for analysis, including 506 (24.3%) firearm injuries, 297 (14.3%) stabbings, 339 (16.3%) assaults, and 950 (45.7%) MVCs. Firearm injuries resulted in the highest proportion of serious injuries (66.3%), early critical resources (75.3%), and in-hospital mortality (53.5%). Injury events occurring within 1 mile of a patient's home included 53.9% of stabbings, 49.2% of firearm events, 41.3% of assaults, and 20.0% of MVCs; the non-MVC events frequently occurred at home. While there was geospatial clustering, 94.4% of firearm events occurred outside of geographic clusters. CONCLUSIONS: Severe firearm events tend to occur within a patient's own neighborhood, often at home, and generally outside of geospatial clusters. Public health efforts should focus on the home in all types of neighborhoods to reduce firearm violence.

Domestic violence surveillance system: a model.

OBJECTIVE: To develop a domestic violence surveillance system. MATERIAL AND METHODS: The strategies included implementation of a standard digitalized reporting and analysis system along with advocacy with community decision makers, strengthening inter-institutional attention networks, consultation for constructing internal flow charts, sensitizing and training network teams in charge of providing health care in cases of domestic violence and supporting improved public policy prevention initiatives. RESULTS: A total of 6 893 cases were observed using 2004 and 2005 surveillance system data. The system reports that 80% of the affected were women, followed by 36% children under 14 years. The identified aggressors were mainly females' partners. The system was useful for improving victim services. CONCLUSIONS: Findings indicate that significant gains were made in facilitating the attention and treatment of victims of domestic violence, improving the procedural response process and enhancing the quality of information provided to policy-making bodies.

Domestic violence surveillance system: a model

OBJECTIVE: To develop a domestic violence surveillance system. MATERIAL AND METHODS: The strategies included implementation of a standard digitalized reporting and analysis system along with advocacy with community decision makers, strengthening inter-institutional attention networks, consultation for constructing internal flow charts, sensitizing and training network teams in charge of providing health care in cases of domestic violence and supporting improved public policy prevention initiatives. RESULTS: A total of 6 893 cases were observed using 2004 and 2005 surveillance system data. The system reports that 80 percent of the affected were women, followed by 36 percent children under 14 years. The identified aggressors were mainly females' partners. The system was useful for improving victim services. CONCLUSIONS: Findings indicate that significant gains were made in facilitating the attention and treatment of victims of domestic violence, improving the procedural response process and enhancing the quality of information provided to policy-making bodies.

OBJETIVO: Desarrollar un sistema de vigilancia sobre violencia doméstica. MATERIAL Y MÉTODOS: Las estrategias incluyeron la implementación de un sistema de análisis y reporte digitalizado estándar, a la par de hacer conciencia entre los tomadores de decisiones a nivel comunitario, fortalecer redes de atención interinstitucionales, consultoría para el diseño de diagramas de flujo internos, equipos de sensibilización y entrenamiento a cargo de proveer cuidados de salud en casos de violencia doméstica y de dar a poyo a iniciativas de prevención como parte de políticas públicas mejoradas. RESULTADOS: Se observó un total de 6893 casos a partir de datos de 2004 y 2005 de un sistema de vigilancia. El sistema informa que 80 por ciento de las víctimas fueron mujeres, seguidas de 36 por ciento de niños menores de 14 años. Los agresores identificados fueron principalmente los compañeros de las mujeres. El sistema resultó útil para mejorar los servicios a las víctimas. CONCLUSIONES: Los hallazgos indican que se lograron mejoras significativas en cuanto a facilitar la atención y tratamiento de las víctimas de violencia doméstica, mejorando el proceso de respuesta procedimental y la calidad de la información brindada a los organismos responsables de elaborar políticas.