Cost Savings of Whole Blood Versus Component Therapy at a Community Level 1 Trauma Center.

BACKGROUND: Blood product component-only resuscitation (CORe) has been the standard of practice in both military and civilian trauma care with a 1:1:1 ratio used in attempt to recreate whole blood (WB) until recent data demonstrated WB to confer a survival advantage, leading to the emergence of WB as the contemporary resuscitation strategy of choice. Little is known about the cost and waste reduction associated with WB vs CORe. METHODS: This study is a retrospective single-center review of adult trauma patients admitted to a community trauma center who received WB or CORe as part of their massive transfusion protocol (MTP) resuscitation from 2017 to 2021. The WB group received a minimum of one unit WB while CORe received no WB. Univariate and multivariate analyses were completed. Statistical analysis was conducted using a 95% confidence level. Non-normally distributed, continuous data were analyzed using the Wilcoxon rank sum test. RESULTS: 576 patients were included (201 in WB and 375 in CORe). Whole blood conveyed a survival benefit vs CORe (OR 1.49 P < .05, 1.02-2.17). Whole blood use resulted in an overall reduction in products prepared (25.8%), volumes transfused (16.5%), product waste (38.7%), and MTP activation (56.3%). Cost savings were $849 923 annually and $3 399 693 over the study period. DISCUSSION: Despite increased patient volumes over the study period (43.7%), the utilization of WB as compared to CORe resulted in an overall $3.39 million cost savings while improving mortality. As such, we propose WB should be utilized in all resuscitation strategies for the exsanguinating trauma patient.

Interpersonal Violence and Social Determinants of Health.

Social determinants of health (SDOH) influence patient outcomes and risk assessment. This study focuses on interpersonal violence, trauma outcomes, and SDOH. We hypothesized patients with lower SDOH experience worse trauma outcomes and present from higher-risk communities. Demographics, SDOH, and outcomes for patients admitted to surgical trauma suffering interpersonal violence were collected and analyzed. Home addresses were plotted, identifying areas of need compared with Area Deprivation Index (ADI). Only 18.8% of patients had documented SDOH, yielding small sample size. Analysis revealed no statistically significant associations (P < .05) between SDOH and trauma outcomes, including ICU length of stay and stress concern (P = .0804). Heat mapping revealed several hot spots across our catchment area, correlating with higher-ranked ADIs and increased deprivation. This study demonstrated SDOH can bring value in determining patient risk, emphasizing resource dedication to documenting these factors. Home addresses in conjunction with ADIs can ascertain areas for resource allocation within communities.

Identification and apportionment of groundwater nitrate sources in Chakari Plain (Afghanistan).

The Chakari alluvial aquifer is the primary source of water for human, animal, and irrigation applications. In this study, the geochemistry of major ions and stable isotope ratios (δ2H-H2O, δ18O-H2O, δ15N-NO3̄, and δ18O-NO3̄) of groundwater and river water samples from the Chakari Plain were analyzed to better understand characteristics of nitrate. Herein, we employed nitrate isotopic ratios and BSIMM modeling to quantify the proportional contributions of major sources of nitrate pollution in the Chakari Plain. The cross-plot diagram of δ15N-NO3̄ against δ18O-NO3̄ suggests that manure and sewage are the main source of nitrate in the plain. Nitrification is the primary biogeochemical process, whereas denitrification did not have a significant influence on biogeochemical nitrogen dynamics in the plain. The results of this study revealed that the natural attenuation of nitrate in groundwater of Chakari aquifer is negligible. The BSIMM results indicate that nitrate originated mainly from sewage and manure (S&M, 75‰), followed by soil nitrogen (SN, 13‰), and chemical fertilizers (CF, 9.5‰). Large uncertainties were shown in the UI90 values for S&M (0.6) and SN (0.47), whereas moderate uncertainty was exhibited in the UI90 value for CF (0.29). The findings provide useful insights for decision makers to verify groundwater pollution and develop a sustainable groundwater management strategy.