Current management and clinical outcomes for patients with haemorrhagic shock due to pelvic fracture in Korean regional trauma centres: a multi-institutional trial

Community-acquired pneumonia (CAP) is a significant cause of morbidity, mortality, and increased cost. Despite numerous managementguidelines, CAP continues to existas a challenge to the learned clinician. Due to a lack of sensitive diagnostic testing, causative pathogens are often not identified, making most therapy empiric. Increasing levels of bacterial resistance to available antimicrobials worldwide has been implicated in driving up the costs of treatment and adversely effecting clinical outcomes. Pharmacists can be part of the solution by encouraging appropriate antimicrobial selection based on resistance patterns in their communities and ensuring appropriate vaccines are employed to prevent CAP.

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Impact of Blood Transfusion During Definitive Stabilization Surgeries on Pelvic Fracture Patient Clinical Outcomes

10.21203/rs.3.rs-145241/v1 ◽

2021 ◽

Author(s):

Xiuqiao Xie ◽

Jie Wang ◽

Xueyuan Huang ◽

Rong Gui ◽

Yuanshuai Huang

Keyword(s):

Blood Transfusion ◽

Hemorrhagic Shock ◽

Clinical Outcomes ◽

Pelvic Fracture ◽

Pelvic Injury ◽

Total Serum Protein ◽

Total Serum ◽

Serum Globulin ◽

Packed Red Blood Cells ◽

Blood Tests

Abstract Background: Orthopaedic definitive stabilization surgeries are conducted when pelvic fracture patients are stabilized and blood transfusion is usually inevitable for patients undergo major surgeries and few studies provide insight into the influence of the intraoperative transfusion of packed red blood cells (PRBCs) on the outcomes of pelvic patients . As it presents a risk to the recipient by inducing uncertain morbidity and mortality, this study was aiming at the influence of PRBCs during such surgeries on clinical outcomes of pelvic fracture patients.Methods: 300 patients were collected and 103 patients were analyzed after exclusion. According to the units of intraoperative transfused PRBCs, 52 patients were in the <3U PRBCs group, 39 patients were in the 3-6U group and 12 patients were in the >6U group. Their characteristics, blood tests, details during surgeries, and outcomes were evaluated.Results: Patients in the>6U PRBCs group were more likely admitted with hemorrhagic shock, lower blood platelet count (BPC) and higher Abbreviated Injury Scale (AIS) (all p<0.05). Blood tests of them at admission revealed higher levels of serum creatinine (Scr), prothrombin time (PT) and thromboplastin time (APTT), lower level of total serum protein (TSP), serum albumin (SA), and serum globulin (SG) (all p<0.05). They underwent more subsequent surgeries and intensive care unit (ICU) stays (all p<0.001). No significant differences between complications and clinical outcomes were observed among three groups. Increased intraoperative transfusion of PRBCs was an independent factor for increased numbers of subsequent surgeries after orthopaedic surgeries, and prolonged ICU days.Conclusions: More intraoperative transfusion during orthopedic fixation surgeries indicated patients with more possibilities of hemorrhagic shock, severe pelvic injury, renal injury, and coagulopathy at admission. Increased intraoperative blood transfusion was associated with more ICU days and increased re-operations, whereas it wouldn’t increase the risk of more complications or worsen clinical outcomes.

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Relationship between door-to-embolization time and clinical outcomes after transarterial embolization in trauma patients with complex pelvic fracture

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-021-01601-7 ◽

2021 ◽

Author(s):

Hohyun Kim ◽

Chang Ho Jeon ◽

Jae Hun Kim ◽

Hoon Kwon ◽

Chang Won Kim ◽

...

Keyword(s):

Clinical Outcomes ◽

Pelvic Fracture ◽

Proportional Hazards ◽

Transarterial Embolization ◽

Negative Relationship ◽

Cox Proportional Hazards ◽

Red Blood Cell Transfusion ◽

Trauma Patients ◽

Regression Analyses ◽

Arterial Bleeding

Abstract Background While transarterial embolization (TAE) is an effective way to control arterial bleeding associated with pelvic fracture, the clinical outcomes according to door-to-embolization (DTE) time are unclear. This study investigated how DTE time affects outcomes in patients with severe pelvic fracture. Methods Using a trauma database between November 1, 2015 and December 31, 2019, trauma patients undergoing TAE were retrospectively reviewed. The final study population included 192 patients treated with TAE. The relationships between DTE time and patients’ outcomes were evaluated. Multiple binomial logistic regression analyses, multiple linear regression analyses, and Cox hazard proportional regression analyses were performed to estimate the impacts of DTE time on clinical outcomes. Results The median DTE time was 150 min (interquartile range, 121–184). The mortality rates in the first 24 h and overall were 3.7% and 14.6%, respectively. DTE time served as an independent risk factor for mortality in the first 24 h (adjusted odds ratio = 2.00, 95% confidence interval [CI] = 1.20–3.34, p = 0.008). In Cox proportional hazards regression analyses, the adjusted hazard ratio of DTE time for mortality at 28 days was 1.24 (95% CI = 1.04–1.47, p = 0.014). In addition, there was a positive relationship between DTE time and requirement for packed red blood cell transfusion during the initial 24 h and a negative relationship between DTE time and ICU-free days to day 28. Conclusion Shorter DTE time was associated with better survival in the first 24 h, as well as other clinical outcomes, in patients with complex pelvic fracture who underwent TAE. Efforts to minimize DTE time are recommended to improve the clinical outcomes in patients with pelvic fracture treated with TAE.

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Current management strategies and long-term clinical outcomes of upper extremity venous thrombosis

Journal of Thrombosis and Haemostasis ◽

10.1111/jth.13291 ◽

2016 ◽

Vol 14 (5) ◽

pp. 973-981 ◽

Cited By ~ 18

Author(s):

S. M. Bleker ◽

N. van Es ◽

A. Kleinjan ◽

H. R. Büller ◽

P. W. Kamphuisen ◽

...

Keyword(s):

Venous Thrombosis ◽

Clinical Outcomes ◽

Upper Extremity ◽

Management Strategies ◽

Current Management

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Current management and clinical outcomes for catheter ablation of atrioventricular nodal re-entrant tachycardia

EP Europace ◽

10.1093/europace/eux110 ◽

2017 ◽

Vol 20 (4) ◽

pp. e51-e59 ◽

Cited By ~ 13

Author(s):

Jonathan Chrispin ◽

Satish Misra ◽

Joseph E Marine ◽

John Rickard ◽

Andreas Barth ◽

...

Keyword(s):

Catheter Ablation ◽

Clinical Outcomes ◽

Current Management

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Relationship Between Door-to-Embolization Time and Clinical Outcomes After Transarterial Embolization in Trauma Patients With Severe Pelvic Fracture

10.21203/rs.3.rs-29651/v1 ◽

2020 ◽

Author(s):

Hohyun Kim ◽

Chang Ho Jeon ◽

Jae Hun Kim ◽

Hoon Kwon ◽

Chang Won Kim ◽

...

Keyword(s):

Clinical Outcomes ◽

Pelvic Fracture ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Transarterial Embolization ◽

Negative Relationship ◽

Red Blood Cell Transfusion ◽

Trauma Patients ◽

Regression Analyses ◽

Arterial Bleeding

Abstract Background: While transarterial embolization (TAE) is an effective way to control arterial bleeding associated with pelvic fracture, the clinical outcomes according to door-to-embolization (DTE) time are unclear. This study investigated how DTE time affects outcomes in patients with severe pelvic fracture.Methods: Using a trauma database between November 1, 2015 and December 31, 2019, trauma patients undergoing TAE were retrospectively reviewed. The final study population included 204 patients treated with TAE. The relationships between DTE time and patients’ outcomes were evaluated. Multivariate binomial logistic regression analyses, multivariate linear regression analyses, and multivariate Cox hazard proportional regression analyses were performed to estimate the impacts of DTE time on clinical outcomes.Results: The median DTE time was 150 min (interquartile range, 123–186). The mortality rates at 7 and 28 days and overall were 8.3%, 13.7%, and 15.7%, respectively. DTE time served as an independent risk factor for mortality at 7 and 28 days (adjusted odds ratio = 1.62, 95% confidence interval [CI] = 1.14–2.30, p = 0.007; adjusted odds ratio = 1.48, CI = 1.05–2.07, p = 0.023, respectively). In multivariate Cox proportional hazards regression analyses, the adjusted hazard ratio of DTE time for mortality at 28 days was 1.28 (CI = 1.08–1.30, p = 0.005). In addition, there was a positive relationship between DTE time and requirement for packed red blood cell transfusion during the initial 24 h and a negative relationship between DTE time and ICU-free days to day 28.Conclusions: Shorter DTE time was associated with better survival at 7 and 28 days, as well as other clinical outcomes, in patients with severe pelvic fracture who underwent TAE. Efforts to minimize DTE time are recommended to improve the clinical outcomes in patients with pelvic fracture treated with TAE.

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