An analysis of analgesia and opioid prescribing for veterans after thoracic surgery.

The opioid crisis is a public health issue and has been linked to physician overprescribing. Pain management after thoracic surgery is not standardized at many centers, and we hypothesized that excessive narcotics were being dispensed on discharge. As a quality improvement initiative, we sought to understand current prescribing practices to better align the amount of opioids dispensed on discharge to actual patient needs.

The Incidence of Transfusion-Related Acute Lung Injury at a Large, Urban Tertiary Medical Center: A Decade's Experience.

Background: While transfusion-related acute lung injury (TRALI) remains the primary cause of transfusion-related fatalities (37%), recent reports estimate the incidence of TRALI at 0.008% per unit of plasma transfused and 0.004% per all products transfused.

Splenectomy is associated with hypercoagulable thrombelastography values and increased risk of thromboembolism.

Background: Previous investigators have demonstrated that postinjury thrombocytosis is associated with an increase in thromboembolic (TE) risk. Increased rates of thrombocytosis have been found specifically in patients after splenectomy for trauma. We hypothesized that patients undergoing splenectomy (1) would demonstrate a more hypercoagulable profile during their hospital stay and (2) that this hypercoagulable state would be associated with increased TE events.

Hypercoagulability after energy drink consumption.

Background: Energy drink consumption in the United States has more than doubled over the last decade and has been implicated in cardiac arrhythmias, myocardial infarction, and even sudden cardiac death. We hypothesized that energy drink consumption may increase the risk of adverse cardiovascular events by increasing platelet aggregation, thereby resulting in a relatively hypercoagulable state and increased risk of thrombosis.

Methods: Thirty-two healthy volunteers aged 18-40 y were given 16 oz of bottled water or a standardized, sugar-free energy drink on two separate occasions, 1-wk apart.

Clinical gestalt and the prediction of massive transfusion after trauma.

Introduction: Early recognition and treatment of trauma patients requiring massive transfusion (MT) has been shown to reduce mortality. While many risk factors predicting MT have been demonstrated, there is no universally accepted method or algorithm to identify these patients. We hypothesised that even among experienced trauma surgeons, the clinical gestalt of identifying patients who will require MT is unreliable.

Early surgical intervention for blunt bowel injury: the Bowel Injury Prediction Score (BIPS).

Background: Computed tomography (CT) scan of the abdomen has been used for 30 years to evaluate the stable blunt trauma patient. However, the early diagnosis of blunt hollow viscus injury (BHVI) remains a challenge. Delayed diagnosis and intervention of BHVI lead to significant morbidity and mortality.

Early diagnosis of clinically significant hyperfibrinolysis using thrombelastography velocity curves.

Background: Clot lysis values (LY30) determined by rapid thrombelastography (rTEG) predict postinjury transfusion needs and mortality risk. However, the first derivative velocity curve values generated by rTEG measuring lysis—maximum rate of lysis (MRL) and total lysis (TL)—have not been evaluated. Although recent data support use of antifibrinolytics in trauma, the population that would benefit remains poorly defined.

Measuring thrombin generation as a tool for predicting hemostatic potential and transfusion requirements following trauma.

Background: Thrombin is the central coagulation protease that activates clotting proteins, triggers platelet aggregation, and converts fibrinogen to fibrin. Relationships between thrombin generation (TG) and clinical outcomes have not been defined following trauma. We hypothesize that TG is predictive of transfusion requirements and patient outcomes.

Time to first take-back operation predicts successful primary fascial closure in patients undergoing damage control laparotomy.

Background: Failure to achieve primary fascial closure (PFC) after damage control laparotomy is costly and carries great morbidity. We hypothesized that time from the initial laparotomy to the first take-back operation would be predictive of successful PFC.

Methods: Trauma patients managed with open abdominal techniques after damage control laparotomy were prospectively followed at 14 Level 1 trauma centers during a 2-year period.

Hypercoagulability after injury in premenopausal females: a prospective, multicenter study.

Background: Recent studies suggest there are gender-specific differences in injury response that may be related to coagulation. The objective of this study was to test the hypothesis that rapid thrombelastography (rTEG) coagulation profiles differ by gender.

Methods: Adult trauma patients were prospectively followed at 3 level 1 trauma centers over a 14-month period.