Inaccuracies Exist in Trauma Registry Data Regarding Shooting Intent for Pediatric Firearm Injuries.

BACKGROUND: Institutional trauma registries, which contribute data to the National Trauma Data Bank, are a fundamental resource for trauma research, though may have significant deficits in data accuracy. We hypothesize that inaccuracies in shooting intent exist at institutional registries of pediatric trauma centers. METHODS: Pediatric firearm injuries (ages 0-17 years) in a single county between 2018 and 2020 were identified from three Level I trauma centers. Demographics and Ecodes were extracted from each registry and shooting intent was compared to retrospective review of the hospital records, including bystander as a category. RESULTS: Of 410 pediatric firearm injuries included, the majority were male (84%), non-Hispanic Black (45%) or Hispanic White (40%), and 15-17 years old (69%). Compared to final reviewer designations, the trauma registry's assault category showed high sensitivity (88.5%), but low specificity (67%), and only 78% accuracy. The trauma registry's accidental category was less sensitive (88%) but more specific (88%), with an accuracy of 88%. The most specific and accurate intention category was intentional self-harm, which had 79% sensitivity, 99.5% specificity, and 99% accuracy. Bystander shootings were most commonly categorized as assault (75%), followed by accidental (18%). CONCLUSION: Significant inaccuracies in coding of pediatric firearm shooting intent exist in trauma registries. Additionally, there is no Ecode for bystander shootings, which overestimates other intent categories. Our study highlights the importance of improving the accuracy of firearm injury data collection to provide a better understanding of firearm injuries at a national level to inform targeted prevention efforts specific to shooting types. LEVEL OF EVIDENCE: III.

Disruption of thrombo-inflammatory response and activation of a distinct cytokine cluster after subarachnoid hemorrhage.

BACKGROUND: Unregulated inflammatory and thrombotic responses have been proposed to be important causes of early brain injury and worse clinical outcomes after subarachnoid hemorrhage (SAH). OBJECTIVE: We hypothesize that SAH is characterized by an increased inflammatory and thrombotic state and disruption of associations between these states. METHODS: This is a retrospective cohort study of 60 patients with SAH. 23 patients with unruptured aneurysms (UA) and 77 patients with traumatic brain injury (TBI) were chosen as controls. Plasma cytokine levels were measured using a 41-plex human immunoassay kit, and cytokine patterns associated with SAH, UA and TBI were identified using statistical and informatics methods. RESULTS: SAH was characterized by an increase in several cytokines and chemokines, platelet-derived factors, and growth factors. Cluster analysis identified several cytokine clusters common in SAH, UA and TBI groups - generally grouped as platelet-derived, vascular and pro-inflammatory clusters. In the UA group, the platelet-derived cluster had an inverse relationship with the inflammatory cluster which was absent in SAH. Additionally, a cluster comprising of growth and colony stimulating factors was unique to SAH. CONCLUSIONS: A cluster of cytokines involved in growth and colony stimulation was unique to SAH. Negative associations between the thrombotic and inflammatory molecules were observed in UA but not in SAH. Further studies to examine the pathophysiology behind the cluster unique to SAH and the associations between the thrombotic and inflammatory cytokines are required.

Thrombelastography Suggests Hypercoagulability in Patients with Renal Dysfunction and Intracerebral Hemorrhage.

BACKGROUND: The objective of this study was to quantify coagulopathy using thrombelastography (TEG) in patients with renal dysfunction and intracerebral hemorrhage (ICH). METHODS: We reviewed patients admitted with spontaneous ICH between November 2009 and May 2015. TEG was performed at the time of admission. Creatinine clearance (CCr) was calculated using the Cockroft-Gault equation. Patients were divided into 2 groups based on normal (CCr ≥ 90) or reduced renal function (CCr < 90). Multivariable regression models were conducted to compare the differences of TEG components. RESULTS: A total of 120 patients were included in the analysis. The normal CCr group was younger (56.1 versus 62.3 years, P < .01), was more often male (73.6% versus 53.7%, P = .03), and had higher mean admission hemoglobin (14.2 versus 13.2 mEq/L, P < .01) than the reduced renal function group. The 2 groups were similar with respect to antiplatelet or anticoagulant use, coagulation studies, and baseline ICH volume. Following multivariate analysis, the reduced renal function group was found to have shorter K (1.5 versus 2.2 min, P = 004), increased angle (66 versus 62.2 degrees, P = .04), increased MA (67.3 versus 62.3, P = .02), and increased G (11.3 versus 9.9 dynes/cm2, P = .04) compared with the normal group. Mortality, poor functional outcome (modified Rankin Scale score 4-6), hematoma enlargement, hospital length of stay, and surgical interventions were not different between the 2 groups. CONCLUSIONS: Patients with ICH and reduced CCr display faster clotting rate and increased clot strength, suggesting that patients with renal dysfunction present with a relatively hypercoagulable state based on TEG parameters thought to reflect platelet activity.