Preinjury statin use and thromboembolic events in trauma: a 10-year retrospective evaluation.

BACKGROUND: Traumatic injury is well known to increase the risk of venous thromboembolic events (VTEs), occurring in up to 58% of trauma patients. Statin medications have significant anti-inflammatory properties and have been shown to reduce the risk of VTE. We hypothesized that trauma patients who received statin medication before injury would have a lower incidence of VTE after injury. METHODS: A 10-y retrospective review identified all patients admitted to our trauma service with an injury severity score >9 and an intensive care unit stay of >3 d. This population was categorized as either "statin recipient" (SR) or "statin naïve," with subsequent categorical division by occurrence of VTE. Our primary outcome measure was the occurrence of documented VTE in both statin naïve and SR subjects. RESULTS: A total of 2519 trauma patients were included with 97 (3.8%) developing VTE. Pretrauma statin use in males remained as an independent predictor of VTE (odds ratio = 2.25, 95% confidence interval = 1.25-4.04, P < 0.01). The median time to VTE onset was 3 d longer in SRs (10.0 d; confidence interval = 7.3-12.7, P < 0.05). CONCLUSIONS: Pretrauma statin use does not appear to have a protective benefit of VTE prevention in trauma patients, as we have shown pretrauma SR male trauma patients to have a twofold increased incidence of VTE. However, when considering the 3 d longer median time to VTE onset found in SRs, we consider the protective benefit of statin use reported in the current literature as likely attributable to this observed delayed onset.

Association between seatbelt sign and internal injuries in the contemporary airbag era: A retrospective cohort study.

BACKGROUND: Literature predating routine availability of airbags reported an association between seatbelt signs and internal injuries. We measured this association among patients involved in motor vehicle crashes (MVCs) with airbag deployment. METHODS: We conducted a retrospective cohort study by chart review of all MVC patients presenting to our Emergency Department (ED) during 1 January 2008-30 September 2015. We included all adult MVC patients in the driver or front passenger seats with both shoulder and lap seatbelts and airbag deployment. Two trained chart abstractors recorded data regarding restraints and airbag deployment. We obtained all other data via electronic medical record abstraction including demographics, injuries, and survival. We compared the prevalence of cervicothoracic and intra-abdominopelvic injuries between patients with a documented seatbelt sign versus no seatbelt sign using a logistic regression model. RESULTS: Of 1379 MVC patients, 350 met inclusion criteria. Of these, 138 (39.4%) had a seatbelt sign. The prevalence of cervicothoracic injury was higher among subjects with a documented seatbelt sign (54.3% versus 42.9%, p=0.036) Seatbelt sign predicted cervicothoracic injury with a positive likelihood ratio of 1.3 (95% CI 1.0-1.7) and negative likelihood ratio of 0.8 (95% CI 0.7-1.0). The odds ratio of cervicothoracic injury among patients with a seatbelt sign versus no seatbelt sign was 1.58 (95% confidence interval 1.02-2.46) in the logistic regression model. There was no association between seatbelt sign and intra-abdominopelvic injury (p=0.418). CONCLUSIONS: In the setting of airbag deployment, there is an association between seatbelt sign and cervicothoracic injury but not intra-abdominopelvic injury.

Prevalence and impact of late defecation in the critically ill, thermally injured adult patient.

The aim of this study was to determine the prevalence of late defecation (absence of laxation for more than 6 days after admission) as an indicator of lower-gastrointestinal (GI) tract dysfunction in burn patients. In addition, the authors wanted to determine whether the addition of polyethylene glycol 3350 to the standard bowel regimen led to improvement in markers of lower-GI function and outcomes. The authors conducted a retrospective chart review of patients admitted to the burn intensive care unit during a 26-month period. Inclusion criteria were 20% or more TBSA burn, requirement for mechanical ventilation, and age over 18 years. Of 83 patients included, the prevalence of late defecation was 36.1% (n = 30). There was no association between late defecation and mortality. Patients with late defecation had more frequent episodes of constipation after first defecation (P =.03), of feeding intolerance (P =.007), and received total parenteral nutrition more frequently (P =.005). The addition of polyethylene glycol to the standard bowel regimen did not affect markers of lower-GI function. Late defecation occurs in more than one third of critically ill burn patients. Late defecation was associated with ongoing lower-GI dysfunction, feeding intolerance, and the use of total parenteral nutrition. The causal relationship between these problems has not been determined. A prospective study at the authors' institution is currently planned to attempt to validate late defecation as a marker of lower-GI tract dysfunction, determine its relationship to various outcomes, and determine risk factors for its development.