An Analysis of the Association of Whole Blood Transfusion With the Development of Acute Respiratory Distress Syndrome.

Objectives: To determine the association of whole blood and other blood products (components, prothrombin complex concentrate, and fibrinogen concentrate) with the development of acute respiratory distress syndrome (ARDS) among blood recipients.

Design: Retrospective cohort study.

Setting: American College of Surgeons Trauma Quality Improvement Program (TQIP) database between 2020 and 2021.

An Analysis of Junctional Tourniquet Use Within the Department of Defense Trauma Registry.

Background: Junctional hemorrhage is a leading cause of battlefield death. Multiple FDA-approved junctional tourniquet (JTQ) models demonstrate effective hemorrhage control in laboratory settings. However, there are few real-world use cases within the literature.

An Analysis of 24-Hour Survival Based on Arrival by Atypical Ground Transport Versus Ground Emergency Medical Services.

Objectives: Studies comparing police, privately owned vehicle (POV), and ground Emergency Medical Services (GEMS) trauma transports reveal mixed results. It remains unclear whether using nonstandard transport methods may be beneficial in the setting of certain injuries. We sought to determine 24-h survival after transport by police or POV when compared to GEMS.

DOES WHOLE BLOOD RESUSCITATION INCREASE RISK FOR VENOUS THROMBOEMBOLISM IN TRAUMA PATIENTS? A COMPARISON OF WHOLE BLOOD VS COMPONENT THERAPY IN 3468 PATIENTS.

Background: Whole blood (WB) resuscitation has been shown to provide mortality benefit. However, the impact of whole blood transfusions on the risk of venous thromboembolism (VTE) remains unclear. We sought to compare the VTE risk in patients resuscitated with WB vs component therapy (COMP).

Neurologic Complications Associated With Burn Injury and Resuscitation.

Background: Treatment for large burn injuries relies on adequate fluid resuscitation secondary to the severe systemic inflammatory response. With improved critical care and better understanding of the complications of over and under resuscitation, morbidity and mortality rates are decreasing. Neurologic complications are not often considered as an over-resuscitation complication after burn injury but may be considered an additional form of compartment syndrome-intracranial compartment syndrome; however, it has not been evaluated for a possible threshold similar to the Ivy Index for abdominal compartment syndrome.

Traumatic brain injury in companion animals: Pathophysiology and treatment.

Traumatic brain injuries (TBI) are common in dogs and cats that have sustained head trauma from a variety of causes. In moderate to severe TBI, damage from both the primary and secondary injuries can be life-threatening. TBI management may be further complicated by concurrent injuries in polytrauma patients.

Characterising practice patterns of human derived, lyophilized coagulation concentrates within the trauma quality improvement program registry.

Objectives: We seek to describe the current practice pattern use of prothrombin complex concentrate (PCC) and fibrinogen concentrate (FC) in trauma patients.

Background: Trauma-induced coagulopathy (TIC) and endotheliopathy of trauma (EOT) contribute significantly to mortality from traumatic haemorrhage. FC, and 4-factor PCC are potential treatments for EOT and TIC, respectively.

Venous thromboembolic events associated with blood product administration in an era of whole blood use.

Background: The risks associated with blood product administration and venous thromboembolic events remains unclear. We sought to determine which blood products were associated with the development of deep vein thrombosis (DVT) and pulmonary embolism (PE).

Methods: We analyzed data from patients ≥18 years of age in the Trauma Quality Improvement Program (TQIP) database that received ≥1 blood product and survived ≥24 ​h.

Incidence of Coagulopathy After Resuscitation at a Role 1 Facility: The Prehospital Trauma Registry Experience.

Background: The development of acute traumatic coagulopathy is associated with increased mortality and morbidity in patients with battlefield traumatic injuries. Currently, the incidence of acute traumatic coagulopathy in the Role 1 setting is unclear.

Methods: We queried the Prehospital Trauma Registry (PHTR) module of the Department of Defense Trauma Registry (DoDTR) for all encounters from inception through May 2019.

Repeat Bronchoscopies Are Poorly Predictive of Outcomes Following Inhalation Injury.

Inhalation injury is an independent predictor of mortality after burn injury. Although bronchoscopy remains the gold standard for diagnosing inhalation injury, there is a paucity of evidence to support repeat bronchoscopies for following inhalation injury during a patient's clinical course. This study looks at the ability of serial bronchoscopies to prognosticate outcomes.

Early Vital Sign Thresholds Associated with 24-Hour Mortality among Trauma Patients: A Trauma Quality Improvement Program (TQIP) Study.

Background: Identifying patients at imminent risk of death is critical in the management of trauma patients. This study measures the vital sign thresholds associated with death among trauma patients.

Methods: This study included data from patients ≥15 years of age in the American College of Surgeons Trauma Quality Improvement Program (TQIP) database.

Precursors to oliguria during major burn resuscitation: An analysis of a prospective observational trial at 5 major US burn centers.

Currently, urine output is the leading variable used to tailor fluid resuscitation in patients with large TBSA burns. However, this metric often lags with respect to resuscitation. Our group sought to identify derangements in variables that precede development of oliguria (<30 cc/hr) that we hypothesize will aid in more efficient resuscitation.

A survey of low titer O whole blood use within the trauma quality improvement program registry.

Introduction: The use of low titer O whole blood (LTOWB) has expanded although it remains unclear how many civilian trauma centers are using LTOWB.

Methods: We analyzed data on civilian LTOWB recipients in the American College of Surgeons Trauma Quality Improvement Program (TQIP) database 2020-2021. Unique facility keys were used to determine the number of centers that used LTOWB in that period.

An Assessment of Clinical Accuracy of Vital Sign-based Triage Tools Among U.S. and Coalition Forces.

Introduction: Early appropriate allocation of resources for critically injured combat casualties is essential. This is especially important when inundated with an overwhelming number of casualties where limited resources must be efficiently allocated, such as during mass casualty events. There are multiple scoring systems utilized in the prehospital combat setting, including the shock index (SI), modified shock index (MSI), simple triage and rapid treatment (START), revised trauma score (RTS), new trauma score (NTS), Glasgow Coma Scale + age + pressure (GAP), and the mechanism + GAP (MGAP) score.

Subcutaneous Anti-inflammatory Therapies to Prevent Burn Progression in a Swine Model of Contact Burn Injury.

Introduction: If left untreated, burn injuries can deepen or progress in depth within the first 72 hours after injury as a result of increased wound inflammation, subsequently worsening healing outcomes. This can be especially detrimental to warfighters who are constrained to resource-limited environments with delayed evacuation times to higher roles of care and more effective treatment. Preventing this burn progression at the point of injury has the potential to improve healing outcomes but requires a field-deployable therapy and delivery system.

American Burn Association Clinical Practice Guidelines on Burn Shock Resuscitation.

This Clinical Practice Guideline (CPG) addresses the topic of acute fluid resuscitation during the first 48 hours following a burn injury for adults with burns ≥20% of the total body surface area (%TBSA). The listed authors formed an investigation panel and developed clinically relevant PICO (Population, Intervention, Comparator, Outcome) questions. A systematic literature search returned 5978 titles related to this topic and after 3 levels of screening, 24 studies met criteria to address the PICO questions and were critically reviewed.

Epidemiology and clinical significance of persistent bacteremia in severely burned patients.

Background: The utility of follow-up blood cultures (FUBC) for gram-negative bloodstream infections (BSIs) are controversial due to low rates of positivity. However, recent studies suggest higher rates of positivity in critically ill patients. The utility of FUBC in gram-negative BSI in patients with severe burn injuries is unknown.