Massive Transfusion Protocols: Indications, Ratios and Mortality in the Non-Trauma Setting

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 2348-2348 ◽  
Author(s):  
Robert A. DeSimone ◽  
Cheryl A. Goss ◽  
Yen-Michael S. Hsu ◽  
Thorsten Haas ◽  
Melissa M. Cushing
Keyword(s):  
Blood Product ◽  
Massive Transfusion ◽  
Conflicts Of Interest ◽  
Medical Center ◽  
Binary Logistic Regression ◽  
Blood Bank ◽  
P Value ◽  
Trauma Patients ◽  
Number Of Patients ◽  
Significant Difference

Abstract Background: Many institutions have implemented massive transfusion protocols (MTPs) to prevent hemodilution and to restore normal coagulation function, with the ultimate goal of controlling hemorrhage and reducing complications. Our institution issues two different MTPs: trauma (T-) and non-trauma (NT-). T-MTPs have a 1:1 ratio for red blood cell (RBC):plasma issued by the blood bank, whereas NT-MTPs have a 1.8:1 ratio. Appropriate blood product ratios, indications and patient outcomes in the NT-MTP setting are not well studied. To determine how various MTP parameters impact 24-hour patient mortality, we retrospectively reviewed MTP activations at our large academic urban medical center. Methods: All activated MTPs over a 3-year period (2012-2014) were reviewed. Data was collected from blood bank quality assurance and inpatient electronic medical records. NT-MTPs were sub-classified into indication by type of hemorrhage. All statistical analyses (binary logistic regression, Kruskal-Wallis) were performed using STATA version 11. A p value of <0.05 was considered significant. Results: From 2012-2014, there were 177 MTP activations for 167 patients, of which 98 were male (59%) and 69 were female (41%). The average age of all patients was 56 years, with a range of 7 months to 95 years. Trauma patients (mean age 40 years) tended to be younger than non-trauma patients (mean age 60 years). Refer to Table 1 for types of hemorrhage and ratios of blood products transfused. Thirty-eight patients (22.8%) died within 24 hours of MTP activation, including 10 (30.3%) of the trauma patients and 28 (21.7%) of the non-trauma patients (Figure 1). Mortality did not vary significantly by type of hemorrhage or by ratio of RBC:plasma transfused, including patients receiving no plasma. For each additional RBC unit transfused, patients had a higher chance of dying (odds ratio [OR] 1.17; p=0.002, confidence interval 1.1-1.3) within 24 hours, after controlling for number of platelet, plasma, and cryoprecipitate units received. The overall median RBC:plasma ratio transfused was 1.7 (interquartile range [IQR] 1.3-2); T-MTPs had a median ratio of 1.4 (IQR 1.1-1.9) and NT-MTPs had a median ratio of 1.7 (IQR 1.3-2.1). There was no significant difference in RBC:plasma ratios clinicians transfused for different types of hemorrhage, despite the blood bank issuing different ratios to the clinicians for T-MTPs and NT-MTPs. The total number of RBCs, platelet units, and plasma units transfused did not differ by type of hemorrhage. In all MTPs, transfusion of platelets did not have a significant impact on 24-hour survival. Conclusions: We found that only the number of RBC units transfused had a significant association (OR 1.17) with 24-hour mortality during an MTP. The RBC:plasma ratio, number of platelets or plasma, and use of platelets during an MTP did not affect 24-hour mortality. The number of RBC units transfused most likely reflects the clinician's assessment of the severity of the situation, and does not imply that the RBCs affected the 24-hour mortality. We found the ratio of products issued during an MTP was not what was actually transfused to patients, indicating that clinicians were not transfusing according to protocol. Specifically, for NT-MTPs overall, the RBC:plasma ratio transfused was lower than what the blood bank issued, indicating clinicians are choosing to infuse more plasma despite a lack of evidence in the non-trauma setting. Prospective randomized trials comparing different RBC:plasma:platelet ratios in NT-MTPs are warranted. Table 1. Blood Product Ratios Transfused by Type of Hemorrhage Type of Hemorrhage Number of Patients (%) RBC:Plasma - Median (IQR) RBC:Platelets - Median (IQR) Overall 167 (100%) 1.7 (1.3-2) 5 (4-7) Trauma 33 (20%) 1.4 (1.1-1.9) 5.5 (3.7-8.4) Postoperative 50 (30%) 1.6 (1.3-1.8) 5 (3.5-6) Gastrointestinal 29 (17%) 2 (1.7-2) 5 (4-7) Intraoperative 20 (12%) 1.6 (1.3-2.7) 6.2 (3.3-7.5) Abdominal 11 (7%) 2 (1.3-3.3) 6 (4-7) Vascular 9 (5%) 1.3 (1-2) 5 (2-5) Obstetrical 8 (5%) 2.2 (2-2.3) 5 (4-7) Central Nervous System 4 (2%) 1.8 (1.2-4) 4.2 (4-4.3) Pulmonary 2 (1%) 2 2 Superficial Soft Tissue 1 (0.5%) 1 N/A Figure 1. 24-Hour Mortality by Type of Hemorrhage Figure 1. 24-Hour Mortality by Type of Hemorrhage Disclosures No relevant conflicts of interest to declare.

A Trauma Transfusion Pathway Decreases Coagulopathy without Increasing Blood Product Utilization

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4071-4071
Author(s):  
Leonard A. Minuk ◽  
Kathleen Eckert ◽  
Tanya Charyk Stewart ◽  
Neil Parry ◽  
Daryl Gray ◽  
...  
Keyword(s):  
Injury Severity ◽  
Blood Product ◽  
Massive Transfusion ◽  
Fixed Ratio ◽  
Trauma Team ◽  
Control Group ◽  
P Value ◽  
Trauma Patients ◽  
Severe Traumatic Injury ◽  
Mean Time

Abstract Background: Trauma patients often require massive transfusion and their resuscitation is commonly complicated by coagulopathy. Debate persists regarding optimal massive transfusion strategies, which have traditionally adopted 2 approaches: coagulation laboratory based therapy (LBT) versus fixed ratio trauma transfusion pathways (TTP). The proponents of a LBT strategy cite “rational use” and avoidance of over-transfusion. This system may not adequately address the dynamic trauma situation where a delay in coagulation results may be detrimental. A TTP more rapidly meets the needs of trauma patients but may increase blood product utilization. Objective: Retrospectively compare our preliminary early experience with a TTP compared to our previous LBT strategy. Method: Retrospective cohort study using our transfusion database comparing 14 patients who activated the TTP with 28 patients treated before the pathways introduction. Inclusion criteria included severe traumatic injury (Injury Severity Score (ISS) &gt;12), massive transfusion (defined as &gt;8 units of red blood cells (RBCs) in the first 24 hours). The TTP is activated by the trauma team and results in the immediate release of 4 units of uncrossmatched RBCs. Blood product is then issued in trauma packs (TPs). Each trauma pack contains 4 units of RBCs and 4 units of frozen plasma (FP) and every second pack contains one pool of platelets (PLTs). A dose of recombinant factor VIIa (rFVIIa) is made available after TP #3. Cryoprecipitate (CRYO) is issued only at the request of the trauma team. A CBC, INR, PTT, and fibrinogen is measured at TTP activation and after every other TP. Outcomes: Outcome variables included total blood product utilization (RBC, FP, CRYO, PLTs), time to first and second set of FP (time 0 is release of 1st RBC unit), number of RBC units issued until first and second set of FP, coagulopathy at presentation and highest INR during first 24 hours of resuscitation. Results: The results are summarized in the attached table. There was no difference in ISS between groups. The introduction of the TTP resulted in no difference in the amount of blood product utilization when compared to the pre-pathway control group. Significant differences included a much shorter time to first and second FP delivery and fewer RBC units before the first and second FP delivery. The majority of the patients were coagulopathic on presentation (defined as INR &gt; 1.4) and the TTP group achieved a significantly lower peak INR during the first 24 hours of resuscitation compared to the pre-pathway group. Conclusion: This pilot study shows that the introduction of a trauma transfusion pathway significantly improves coagulopathy and reduces time to FP administration without increasing blood product utilization. Pre-Pathway (n=28) Trauma Transfusion Pathway (n=14) P-value Mean ISS 42.0 ± 12.5 34 ± 15.1 NS Mean RBC units used 23.4 ± 14.5 23.1 ± 10.7 NS Mean FP units used 13.4 ± 9.6 16.1 ± 8.3 NS Mean PLT pools used 1.8 ± 1.5 2.7 ± 1.8 NS Mean CRYO pools used 0.46 ± 0.64 0.71 ± 0.83 NS Mean time to 1stFP (min) 89.9 ± 55.5 55.4 ± 49.2 0.02 Mean time to 2ndFP (min) 237.0 ± 206.8 103.0 ± 59.4 0.0004 Mean #RBC units to 1st set FP 10.4 ± 9.0 7.8 ± 1.6 0.02 Mean #RBC units to 2nd set FP 17.6 ± 8.8 12.9 ± 3.4 0.016 # Patients coagulopathic on initial testing (INR&gt;1.4) 12 (43%) 8 (62%) NS Mean initial INR 1.5 ± 0.55 1.7 ± 0.58 NS Mean of highest INR in first 24h 2.3 ± 1.70 1.4 ± 0.25 0.006 # Patients given rFVIIa 6 (21%) 5 (36%) NS

A 15 Hour Dosing-Collection Interval for Plerixafor Is at Least as Effective as the Standard 10 Hour Interval.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2152-2152 ◽  
Author(s):  
Eric R Rosenbaum ◽  
Mayumi Nakagawa ◽  
Gina Pesek ◽  
John Theus ◽  
Bart Barlogie ◽  
...  
Keyword(s):  
Phase I ◽  
Conflicts Of Interest ◽  
P Value ◽  
Number Of Patients ◽  
Cd34 Cells ◽  
Significant Difference ◽  
The Difference ◽  
Student’S T ◽  
Age Range ◽  
Total Average

Abstract Abstract 2152 Poster Board II-129 Introduction: Plerixafor (formerly AMD3100) is a reversible CXCR4 inhibitor used to mobilize CD34+ cells for collection and use in hematopoietic transplant. Since beginning phase I trials, the drug has been given at 10 pm and collection initiated 10h later at 8 am. After recent FDA approval, we examined use of a dosing-collection interval of 15h (5 pm administration/8 am collection) for patient (pt) convenience. Here we compare results retrospectively from phase I and II trials at our institution using the 10h interval with post-approval collections using the 15h interval. We also evaluated prechemotherapy platelet (plt) count as a predictor of response to plerixafor+G-CSF. Materials and Methods: We reviewed data for all pts (n=107) at our institution who received plerixafor using the 10h (n=79) and 15h (n=34) intervals. This group was reduced to only those who received 4 consecutive days of plerixafor (n=76), of which 67 had the 10h interval and 21 had the 15h interval. The age range of the 10h group was 30-79y (median 62) and the range of the 15h group was 45-78y (median 57). The primary disease in both groups was multiple myeloma, but included 2 NHL in the 10h group, and 5 NHL in the 15h group. Chemotherapy given prior to mobilization for both the 10h and 15h interval groups were similar and plerixafor was administered with G-CSF in all pts. CD34+ cells collected on days 1-4 were quantified by flow cytometry. Finally, some patients (n=9) underwent mobilization with plerixafor two or more times, of which 4 did so on both the 10h and 15h intervals. These instances were recorded as separate events. Prechemotherapy plt counts were also reviewed for each patient and subcategorized into 3 groups: <100, 100-150, and >150,000/uL. Mean CD34+ cells collected were compared between the plt subcategories for both the 10h and 15h groups. Results: The mean number of CD34+ cells collected for the 10h group on days 1-4 of plerixafor administration was 1.26, 1.04, 0.71, and 0.55 ×10e6 CD34+ cells/kg, respectively, with total average collection of 3.56 × 10e6 CD34+ cells/kg. For the 15h group, the average number of CD34+ cells collected on days 1-4 were 2.20, 1.61, 1.44, and 1.01 × 10e6 CD34+ cells/kg, respectively, with total average collection of 6.26 × 10e6 CD34+ cells/kg. The two groups were compared using two-tailed student's t-tests. There was no statistically significant difference between the quantity of CD34+ cells collected on days 1 or 2 for the 10h and 15h groups, however there was a statistically significant difference on days 3 and 4. On these latter two days, the 15h group collected a significantly higher number of CD34+ cells compared to the 10h group. The difference in average total collection for the two groups over all 4 days was statistically significant at an alpha level of 0.05 (p-value: 0.03). The different prechemotherapy plt groups were compared using one-way ANOVA statistical analysis. Within the 10h group the <100 group had the least amount collected (mean 2.46×10e6 CD34+/kg), the 100-150 had an intermediate amount (mean 3.30×10e6CD34+/kg), and the >150 group the most (4.30×10e6CD34+/kg; p-value 0.02). The same comparison within the 15h group showed similar findings but the number of patients in each subcategory was too small to be statistically significant. Conclusion: Administration of plerixafor with the 15h interval (5 pm dosing/8 am collection) appears to be equivalent to the standard 10h interval with regard to quantity of CD34+ cells collected over the first 2 days, and is superior to the 10 h schedule if the collection continues for 4 days. Further, prechemotherapy plt count is predictive of ability to mobilize CD34+ cells with perixafor+G-CSF for the 10h interval, as has been previously shown by our group for G-CSF alone in a similar population. Additional pts are needed to demonstrate conclusively the same finding for the 15h dosing/collection interval. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Refining Blood Products Utilization: Every One (unit) Matters. Post-Intervention Study

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 27-28
Author(s):  
Caroline Hana ◽  
Khaled Deeb ◽  
Kayla DeSuza ◽  
Sweet Gerlie Smith ◽  
Stanislav Ivanov ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Conflicts Of Interest ◽  
Medical Center ◽  
Intervention Group ◽  
Transfusion Practice ◽  
Lower Number ◽  
Post Intervention ◽  
Number Of Patients ◽  
Significant Difference ◽  
Transfusion Guidelines

INTRODUCTION: Transfusion of red blood cells (RBCs) is a balance between providing benefits for patients while avoiding risks of transfusion. Meta-analyses of randomized controlled trials (RCT) comparing restricted versus liberal blood transfusion showed that there was no significant difference in terms of morbidity, mortality, or risk of myocardial infarction. In fact, the restrictive strategy had a significantly lower risk of all-cause mortality in patients with gastrointestinal bleeding. It also resulted in a significantly lower number of transfused units and a lower number of patients needing a transfusion. Examining the extent of adherence to the American Association of Blood Banks (AABB) transfusion guidelines in our VA medical center showed that the average transfused units were 1.4 units per person. The Average pre-transfusion hemoglobin (Hgb) was 7.6. 54% received 2 units, whereas 46% received 1 unit. AIM OF THE WORK: To improve the blood transfusion practice in our VA medical center to better comply with the (AABB) transfusion guidelines and to establish a culture of change to improve patient safety, minimize risks of transfusion reaction and reduce the cost. METHODOLOGY: This is a prospective analysis of transfused patients in the period of November 2019 to April 2020 (n=228) as a continuation of the prior retrospective analysis of randomly selected patients in 2018 (n=162). The data was retrieved from an electronic medical record database, which included patient gender, age, co-morbidities, mean baseline Hgb, pre- and post-transfusion Hgb, hemodynamic status, ordering division, and the number of units transfused. INTERVENTIONS We implemented a two-tier auditing system, based on a low and high priority, which reflects the timeline to address non-compliant transfusion orders. Low priority orders were evaluated during the periodic meeting of the transfusion committee, and high priority orders were addressed within a few hours of the transfusion order. All transfusion orders of Hgb &gt; 7-8 g/dL were flagged with low priority, whereas those with Hgb &gt; 8 g/dL and/or with orders exceeding one unit were flagged with high priority. The appropriate approval was obtained through the institutional review board (IRB), patients' consents for enrollment, and anonymity was maintained all through the study. RESULTS: The total number of transfused PRBC units was 386 units with a mean of 1.6 units per patient compared to 1.7 units in the pre-intervention group (p=0.056). The average Hgb before transfusion was 7.7 mg/dL compared to 7.5 mg/dL in the pre- versus the post-intervention group (p=0.659). Comparing the pre-transfusion Hgb values in both groups per ordering division showed that the average Hgb values were lower after the intervention among all divisions except for the hematology/oncology department. This difference was statistically significant in the Intensive Care Unit (ICU). In terms of the number of transfused units, overall, there was a decrease in the number of transfused units, however, this was not statistically significant.(table 1) The department with the highest number of transfused units was internal medicine. DISCUSSION: Our study showed that the application of an auditing system within the electronic medical system resulted in significant improvement in the transfusion practice in the ICU department. The lack of significant effects among other departments can be attributed to the lower number of cases in the pre- versus post-intervention cohorts, e.g. 22 versus 50 in the Hematology/Oncology department and 6 versus 26 in the Emergency Department. Besides, it was difficult to gauge the reasoning for blood transfusion among the different departments whether it was for objectively significant blood loss despite the stable hemodynamics, or due to symptomatic anemia. The overall acceptance of the new system should be further investigated through a qualitative study e.g. individual interviewing or group discussions to explore reasons for possible resistance to change. CONCLUSION: Changing the transfusion order can help in improving the transfusion practice in healthcare facilities. However, this strategy alone may not be effective, and further investigations into the root causes of the non-significant change in some departments are needed. Enforcing the electronic auditing system along with staff development workshops may result in better outcomes. Disclosures No relevant conflicts of interest to declare.

Sleeve gastrectomy is the most common cause of Gastro-esophageal Reflux Disease in comparison with other bariatric operations

2021 ◽  
Author(s):  
majdi abu sneineh ◽  
malek abu sneineh ◽  
Monther Abu Sneineh ◽  
mustafa abu sneineh ◽  
muneer abu snineh ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Medical Center ◽  
Bariatric Procedure ◽  
P Value ◽  
Significant Difference ◽  
Symptomatic Gerd ◽  
Swallow Study ◽  
Contrast Swallow ◽  
Gerd Symptoms

Abstract Introduction GERD is one of the complications of bariatric operations that might affect the quality of life. We aim to perform a retrospective cohort study to determine the incidence of symptomatic GERD following different types of bariatric surgery and which operations are considered a contraindication of GERD. Besides, we are attempting to identify the risk factors of GERD after bariatric surgery. Methods Medical records of 729 patients undergone bariatric operations between January 2010 and June 2019 at Shamir (Assaf Harofeh) Medical Center were reviewed. Results There was a significant difference between the type of bariatric procedure and the incidence of GERD symptoms after the operation. The incidence of symptomatic GERD in patients who underwent SG was 39.9% (p =0.0131). This was significantly higher compared to 16.4% following roux en y gastric bypass, 23.4% following LAGB, and 11% following OAGB. 113 patients out of 718 had a positive swallow test and of these patient 71 developed GERD symptoms post-operatively without correlation to the degree of reflux at the swallow test but with statistically significant correlation to the type of operation especially for SG (P-value <0.001) and to our knowledge this was never reported in the literature. Conclusion SG is a good bariatric procedure option but should be contraindicated in asymptomatic reflux contrast swallow study and symptomatic GERD patients preoperatively because of high levels of symptomatic GERD post-operatively. Asymptomatic reflux at contrast swallow study pre-operatively should be considered a risk factor for GERD after the operation.

Blood Provision for Cardiac Ablation (CA) Procedures in the Catheterization Laboratory; a Veteran Affairs Medical Center (VAMC) Experience in a Non-Trauma Center Setting

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S167-S168
Author(s):  
J M Petersen ◽  
V Patel ◽  
D Jhala
Keyword(s):  
Quality Assurance ◽  
Massive Transfusion ◽  
Medical Center ◽  
Case Series ◽  
Blood Bank ◽  
Cardiac Ablation ◽  
Cardiac Perforation ◽  
Catheterization Laboratory ◽  
Massive Transfusion Protocol ◽  
Transfusion Protocol

Abstract Introduction/Objective Cardiac perforation is a life-threatening complication (~1% risk, with reported rates between 0.2% to 5%) of CA procedures. As cardiac perforation may lead to extensive bleeding, it would be reasonable for a medical center carrying out CA to be capable of arranging for a massive transfusion protocol and for surgical repair as required. However, there is sparse literature to guide a non-trauma medical center implementing a CA program on what the number of red blood cell (RBC) units for crossmatch should be for each case. Methods In interdisciplinary collaborative meetings, the CA program logistics were agreed to between the multiple clinical services. Given the case series on the amount of drained blood in complicated cases, there was agreement that three units of RBCs would be crossmatched for each case. Education was provided on the massive transfusion protocol and on blood bank procedures. As part of quality assurance/quality improvement, records were reviewed from the beginning of the CA program (10/1/2019) to 1/31/2019 to determine number of patient cases, crossmatched units, and transfused units for quality assurance purposes. Results A total of fifteen patients underwent CA procedures, for which three units were crossmatched for each patient. As there were no cardiac perforations with the cardiac ablation procedures so far, no units were transfused. The organized approach for ensuring adequate blood bank support and education led to the reassurance, alleviation of clinical anxiety, and building of a successful CA program. Education sessions completed with thorough understanding of blood bank procedures including the massive transfusion protocol, labeling of blood bank specimens, and on ordering of blood for crossmatch. Conclusion This study provides a reference that may provide helpful guidance to other blood banks on what the number of RBCs to be crossmatched prior to each CA procedure. Multidisciplinary collaborative meetings in advance are an essential component for ensuring adequate support for CA procedures or any new service that requires blood product support. Thorough education of clinical staff on blood bank procedures particularly the massive transfusion protocol is also recommended. This procedure for massive transfusion should be available to be referred to in real time.

Anastomotic Outcomes in Military Exploratory Laparotomies in the Modern Combat Era

2022 ◽  
pp. 000313482110502
Author(s):  
Patrick F. Walker ◽  
Joseph D. Bozzay ◽  
David W. Schechtman ◽  
Faraz Shaikh ◽  
Laveta Stewart ◽  
...  
Keyword(s):  
Medical Center ◽  
Damage Control ◽  
Surgical Site Infections ◽  
Trauma Patients ◽  
Intestinal Anastomoses ◽  
Military Hospitals ◽  
Anastomotic Failure ◽  
Significant Difference ◽  
Regional Medical Center ◽  
Outcome Differences

Background Intestinal anastomoses in military settings are performed in severely injured patients who often undergo damage control laparotomy in austere environments. We describe anastomotic outcomes of patients from recent wars. Methods Military personnel with combat-related intra-abdominal injuries (June 2009-December 2014) requiring laparotomy with resection and anastomosis were analyzed. Patients were evacuated from Iraq or Afghanistan to Landstuhl Regional Medical Center (Germany) before being transferred to participating U.S. military hospitals. Results Among 341 patients who underwent 1053 laparotomies, 87 (25.5%) required ≥1 anastomosis. Stapled anastomosis only was performed in 57.5% of patients, while hand-sewn only was performed in 14.9%, and 9.2% had both stapled and hand-sewn techniques (type unknown for 18.4%). Anastomotic failure occurred in 15% of patients. Those with anastomotic failure required more anastomoses (median 2 anastomoses, interquartile range [IQR] 1-3 vs. 1 anastomosis, IQR 1-2, P = .03) and more total laparotomies (median 5 laparotomies, IQR 3-12 vs. 3, IQR 2-4, P = .01). There were no leaks in patients that had only hand-sewn anastomoses, though a significant difference was not seen with those who had stapled anastomoses. While there was an increasing trend regarding surgical site infections (SSIs) with anastomotic failure after excluding superficial SSIs, it was not significant. There was no difference in mortality. Discussion Military trauma patients have a similar anastomotic failure rate to civilian trauma patients. Patients with anastomotic failure were more likely to have had more anastomoses and more total laparotomies. No definitive conclusions can be drawn about anastomotic outcome differences between hand-sewn and stapled techniques.

Prevalence of Helicobacter Pylori Antibody among Outpatients of Federal Medical Center, Yenagoa, Niger Delta Region of Nigeria

2021 ◽  
Vol 8 (07) ◽  
pp. 5521-5527
Author(s):  
Dr Oluwayemisi Agnes Olorode ◽  
Ofonime M. Ogba ◽  
Williams E. Ebisin
Keyword(s):  
Helicobacter Pylori ◽  
Blood Test ◽  
Medical Center ◽  
P Value ◽  
World Population ◽  
Age Group ◽  
Test Kit ◽  
Significant Difference ◽  
Chi Square Analysis ◽  
Helicobacter Pylori Antibody

Helicobacter Pylori is the most common chronic bacterial infection (acquired early childhood) in humans affecting 50% of the world population and much attention has not been paid to this. This study was carried out between February and October 2019 to test for the presence of Helicobacter Pylori antibody among asymptomatic individuals attending Federal Medical Center, Yenagoa, Bayelsa State. A total of 200 {114(57%) males, 86(43%) females} blood samples were collected at ramdom into Ethylene diamine tetraacetic acid (EDTA) bottles and immediately transported to the laboratory for analysis using Helicobacter pylori Serology rapid blood test kit. Age was stratified to allow for comparison because the entire outcome was age dependent. Chi square analysis was conducted for the categorical variable. Findings showed that out of 200 samples examined, 88(44%) forty (40 (45%) males and 48(55%) females were positive to Helicobacter pylori infection while 112(56%) were negative. Females of age range 24 -33 had the highest prevalence of 24 (27%) while male of age group 14 to 23 had 21(24%); females of 34 to 44 was 16(18%); 54-63 had 4(05%) and the least was 44 to 53 years with prevalence of 3(03%).  There was a significant difference across the age group and socio-demographic characteristic at p-value = 0.0001 < 0.05 and p-value =0.002068 < 0.05, p-value = 0.000916 <0.05 respectively. Observations showed the higher prevalence in females (53%) than their males (47%) counterparts; likewise the infected individuals host this organism ignorantly and busy treating out of line.  Study with more than one diagnostic technique is recommended to determine the presence of Helicobacter pylori, as rapid blood test is limited due to the presence of antibody in the serum for long after eradication. In conclusion, routine medical examination on Helicobacter pylori is encouraged among individuals in respective of age and status.

Hyponatremia With Intravenous Sulfamethoxazole/Trimethoprim in Children

2019 ◽  
Vol 54 (4) ◽  
pp. 351-358 ◽  
Author(s):  
Katy Stephens ◽  
Jamie L. Miller ◽  
Teresa V. Lewis ◽  
Stephen Neely ◽  
Peter N. Johnson
Keyword(s):  
Cumulative Dose ◽  
Serum Sodium ◽  
A Priori ◽  
Sodium Concentration ◽  
Primary Objective ◽  
P Value ◽  
Number Of Children ◽  
Number Of Patients ◽  
Significant Difference ◽  
Dose Number

Background: Intravenous (IV) sulfamethoxazole/trimethoprim (SMX/TMP) has been associated with hyponatremia in adults. Objective: The primary objective was to identify the number of patients with a serum sodium <135 mEq/L. Secondary objectives between the hyponatremic versus nonhyponatremic groups included demographic comparisons, median serum sodium concentrations, SMX/TMP cumulative dose, number of diuretics, and other medications causing hyponatremia. Methods: This was a retrospective study of children <18 years receiving IV SMP/TMX. Comparisons were conducted via Mann-Whitney-Wilcoxon and Mantel-Haenszel χ2 tests with an a priori P value <0.05. Results: Sixty-one patients received 66 total courses; 20 courses (30.3%) were associated with hyponatremia with a decrease in the median nadir serum sodium concentration of 133 and 138 mEq/L in the hyponatremic and nonhyponatremic groups, respectively ( P<0.001). The median age (interquartile range) was lower in the hyponatremic versus nonhyponatremic group, but this was not statistically significant: 0.6 (0.1-5.5) versus 3.9 (0.3-11.0) years; P=0.077. There was no significant difference in the median cumulative dose (mg/kg) between groups; P=0.104. In addition, there was a significant difference in the number of children in the hyponatremic versus nonhyponatremic groups receiving diuretics (16 [80.0%] vs 23 [50.0%], P=0.023) and other medications that cause hyponatremia (7 [35.0%] vs 5 [10.9%], P=0.034), respectively. Furosemide was noted to be the medication most associated with hyponatremia. Conclusion and Relevance: Approximately one-third administered IV SMX/TMP developed hyponatremia. Concomitant furosemide administration was one of the most common risk factors. Clinicians should be aware of this potential adverse event when initiating IV SMX/TMP in children.

The Impact of In-house Attending Surgeon Supervision on the Rates of Preventable and Potentially Preventable Complications and Death at the Start of the New Academic Year

2013 ◽  
Vol 79 (11) ◽  
pp. 1134-1139 ◽  
Author(s):  
Kenji Inaba ◽  
Adam Hauch ◽  
Bernardino C. Branco ◽  
Stephen Cohn ◽  
Pedro G. R. Teixeira ◽  
...  
Keyword(s):  
Los Angeles ◽  
Trauma Center ◽  
Medical Center ◽  
Trauma Patients ◽  
University Of Southern California ◽  
Academic Level ◽  
Significant Difference ◽  
Level I ◽  
The Impact ◽  
Academic Year

The purpose of this study was to examine the impact of in-house attending surgeon supervision on the rate of preventable deaths (PD) and complications (PC) at the beginning of the academic year. All trauma patients admitted to the Los Angeles County 1 University of Southern California Medical Center over an 8-year period ending in December 2009 were reviewed. Morbidity and mortality reports were used to extract all PD/PC. Patients admitted in the first 2 months (July/ August) of the academic year were compared with those admitted at the end of the year (May/June) for two distinct time periods: 2002 to 2006 (before in-house attending surgeon supervision) and 2007 to 2009 (after 24-hour/day in-house attending surgeon supervision). During 2002 to 2006, patients admitted at the beginning of the year had significantly higher rates of PC (1.1% for July/ August vs 0.6% for May/June; adjusted odds ratio [OR], 1.9; 95% confidence interval [CI], 1.1 to 3.2; P < 0.001). There was no significant difference in mortality (6.5% for July/August vs 4.6% for May/ June; adjusted OR, 1.1; 95% CI,0.8 to 1.5; P = 0.179). During 2007 to 2009, after institution of 24-hour/day in-house attending surgeon supervision of fellows and housestaff, there was no significant difference in the rates of PC (0.7% for July/August vs 0.6% for May/June; OR, 1.1; 95% CI, 0.8 to 1.3; P = 0.870) or PD (4.6% for July/August vs 3.7% for May/June; OR, 1.3; 95% CI, 0.9 to 1.7; P = 0.250) seen at the beginning of the academic year. At an academic Level I trauma center, the institution of 24-hour/day in-house attending surgeon supervision significantly reduced the spike of preventable complications previously seen at the beginning of the academic year.

Prehospital Blood Product Administration Opportunities in Ground Transport ALS EMS – A Descriptive Study

2018 ◽  
Vol 33 (3) ◽  
pp. 230-236 ◽  
Author(s):  
Felicia M. Mix ◽  
Martin D. Zielinski ◽  
Lucas A. Myers ◽  
Kathy S. Berns ◽  
Anurahda Luke ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Patient Care ◽  
Blood Product ◽  
Life Support ◽  
Descriptive Study ◽  
Blood Product Transfusion ◽  
Trauma Patients ◽  
Blood Products ◽  
Total Patient ◽  
Significant Difference

AbstractIntroductionHemorrhage remains the major cause of preventable death after trauma. Recent data suggest that earlier blood product administration may improve outcomes. The purpose of this study was to determine whether opportunities exist for blood product transfusion by ground Emergency Medical Services (EMS).MethodsThis was a single EMS agency retrospective study of ground and helicopter responses from January 1, 2011 through December 31, 2015 for adult trauma patients transported from the scene of injury who met predetermined hemodynamic (HD) parameters for potential transfusion (heart rate [HR]≥120 and/or systolic blood pressure [SBP]≤90).ResultsA total of 7,900 scene trauma ground transports occurred during the study period. Of 420 patients meeting HD criteria for transfusion, 53 (12.6%) had a significant mechanism of injury (MOI). Outcome data were available for 51 patients; 17 received blood products during their emergency department (ED) resuscitation. The percentage of patients receiving blood products based upon HD criteria ranged from 1.0% (HR) to 5.9% (SBP) to 38.1% (HR+SBP). In all, 74 Helicopter EMS (HEMS) transports met HD criteria for blood transfusion, of which, 28 patients received prehospital blood transfusion. Statistically significant total patient care time differences were noted for both the HR and the SBP cohorts, with HEMS having longer time intervals; no statistically significant difference in mean total patient care time was noted in the HR+SBP cohort.ConclusionsIn this study population, HD parameters alone did not predict need for ED blood product administration. Despite longer transport times, only one-third of HEMS patients meeting HD criteria for blood administration received prehospital transfusion. While one-third of ground Advanced Life Support (ALS) transport patients manifesting HD compromise received blood products in the ED, this represented 0.2% of total trauma transports over the study period. Given complex logistical issues involved in prehospital blood product administration, opportunities for ground administration appear limited within the described system.MixFM, ZielinskiMD, MyersLA, BernsKS, LukeA, StubbsJR, ZietlowSP, JenkinsDH, SztajnkrycerMD. Prehospital blood product administration opportunities in ground transport ALS EMS – a descriptive study. Prehosp Disaster Med. 2018;33(3):230–236.

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