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Viscoelastic Hemostatic Assays are Associated With Mortality and Blood Transfusion in a Multicenter Cohort
Get PDFObjectives: Trauma-induced coagulopathy (TIC) carries significant risks, including increased mortality. Traditional TIC definitions rely on laboratories that result slowly and do not highlight therapeutic targets. We hypothesized that a TIC score, based on thromboelastography (TEG) and rotational thromboelastometry (ROTEM), collectively termed viscoelastic hemostatic assays, is associated with in-hospital mortality and packed red blood cell (pRBC) transfusion. Methods: This retrospective cohort study used a database of adult patients undergoing institutional massive transfusion at seven level 1 trauma centers (2013-2018). A “TIC score” was developed, with 1 point assigned for abnormal TEG R-time ( ≥ 9 min) or ROTEM clot time ( ≥ 80 sec), ɑ-angle ( \u3c 65o), or maximum amplitude ( \u3c 55 mm). TIC+ patients (TIC score 1-3) were compared with TIC− patients (TIC score 0). TIC Score composition and abnormal cutoff values were adjusted to investigate optimal weighting and thresholds. Multiple logistic and negative binomial regression was used to control confounders while evaluating the association between abnormal TIC values, in-hospital mortality, and 24-hour pRBC transfusion. Results: Of 1499 patients in the final analysis, 591 (39.4%) were TIC+. Each 1-point increase in TIC score was associated with a 53% increase in the odds of mortality (odds ratio [OR], 1.53, 95% CI, 1.33-1.76, P \u3c .001) and a 25% increase in pRBC transfusion volumes (incidence rate ratio, 1.25, 95% CI, 1.16-1.34, P \u3c .001). Abnormal maximum amplitude was associated with both mortality (OR 1.50, 95% CI, 1.03-2.19, P = .034) and pRBC transfusion volumes (P \u3c .001), whereas abnormal ɑ-angle was associated with mortality (OR, 1.59, 95% CI, 1.09-2.32, P = .015). The unequal weighting of TIC score components and adjustments to normal/abnormal cutoff thresholds were maintained but did not improve the model\u27s predictive power. Conclusion: A viscoelastic hemostatic assay-based TIC score is independently associated with mortality and pRBC transfusion volumes. This association persists with unequal weighting and adjustment of normal/abnormal cutoff thresholds of TEG components
Early Surgical Decompression for the Treatment of Hourglass-Like Constriction of the Posterior Interosseus Nerve
Get PDFPosterior interosseous nerve (PIN) syndrome refers to a rare compressive neuropathy of the PIN resulting in motor dysfunction of the forearm extensor compartment. Often, surgical exploration will reveal extrinsic structures that mechanically compress the nerve. Less frequently, PIN syndrome has been reported with a visible hourglass-like constriction and no identifiable causative adjacent structures. In our report, we describe an adolescent patient with PIN syndrome and associated hourglass-like constriction of the PIN. For diagnosis, we used physical examination, preoperative imaging, nerve studies, and intraoperative findings. To monitor recovery, we performed serial neurological examinations and documented patient-reported functional outcomes. The patient underwent early surgical decompression ( \u3c 6 weeks from presentation). Complete resolution of pain was reported 2 weeks after surgery. Complete resolution of wrist extension motor function occurred at 28 weeks after surgery. We demonstrate effective pain relief and complete motor recovery with early surgical release in this adolescent high-level athlete
Anatomy Sketch Book: Spine by C. Kruger
No full text11.5 x 8 Pen and Inkhttps://digitalscholar.lsuhsc.edu/art_med/1062/thumbnail.jp
Our Big Year (7 Geese) by A. M. Jacobs
No full text30 x 24 Acrylic on Canvashttps://digitalscholar.lsuhsc.edu/art_med/1057/thumbnail.jp
Ideal Anatomy by G. Peterman
No full text4 x 3 x 3.5 3D Printed Sculpturehttps://digitalscholar.lsuhsc.edu/art_med/1043/thumbnail.jp
If Only I Can Dance with the Stars by N. H. Ngo
No full text16 x 8 Acrylic on Canvashttps://digitalscholar.lsuhsc.edu/art_med/1042/thumbnail.jp
Market Canal by Z. St. Pierre
No full text12 x 24 Oil on Canvashttps://digitalscholar.lsuhsc.edu/art_med/1022/thumbnail.jp
Yala, Sri Lanka by T. de Silva
No full text26 x 32 Oil on Canvashttps://digitalscholar.lsuhsc.edu/art_med/1001/thumbnail.jp
