Shark-Related Injuries in the United States: A National Trauma Data Bank Analysis.

BACKGROUND: Shark-related injuries (SRIs) are a dreaded, but rare, source of injury that have not been well described. The present study aims to examine the incidence, injuries, and outcomes of SRIs presenting to US trauma centers. STUDY DESIGN: The National Trauma Data Bank was queried from 2015 to 2018 to identify SRIs using ICD-10 e-codes W56.41XA, W56.42XA, and W56.49XA. Descriptive analyses were conducted on patient demographics, injuries, hospital course, procedures, and outcomes. RESULTS: Fifty-three patients were identified with a mechanism of injury that was shark-related. The median age was 29 years (range: 3-67) and median injury severity score was 5 (IQR: 3-10). The majority of patients (96%) were admitted to the hospital (median length of stay (LOS): 4.0 days, IQR: 3.0-8.0), 55% went directly to the operating room, and 53% required intensive care unit (ICU) admission (median ICU LOS: 4.5 days, IQR: 1.3-7.0). Extremity injuries were common: 47% suffered lower extremity injuries, 40% had upper extremity injuries, and 13% had both. The majority of patients underwent surgical procedures: 83% had soft tissue injuries requiring debridement, flap coverage, or skin grafting; 28% suffered neurovascular injuries (17% requiring nerve repair and 2% requiring arterial bypass); and 59% required orthopedic intervention. Six patients (11%) required amputation(s). All patients survived to discharge. CONCLUSION: Although an exceedingly rare source of trauma, SRIs are frequently associated with devastating injuries. Given the severity of injuries and associated procedures required, these patients warrant referral to a trauma center capable of providing comprehensive care.

Reversal of warfarin anticoagulation in geriatric traumatic brain injury due to ground-level falls.

BACKGROUND: The efficacy of prothrombin complex concentrate (PCC) compared with fresh frozen plasma (FFP) for reversal of oral anticoagulants has not been investigated in geriatric patients suffering intracranial hemorrhage (ICH) due to a ground-level fall (GLF). METHODS: Patients 65 years and older who were treated at Santa Barbara Cottage Hospital between January 2011 and March 2018 with ICH after a GLF while taking warfarin were reviewed. Patients were reversed with either FFP (n=25) or PCC (n=27) and patient outcomes were compared. Separate analyses were conducted for patients who received adjuvant vitamin K administration and those who did not. RESULTS: Mortality rates, hospital length of stay, intensive care unit admission and length of stay were similar for both FFP and PCC intervention. There was no difference in radiological progression of hemorrhage within the first 24 hours of admission (FFP: 36%, PCC: 43%, p=0.365). In patients who had international normalized ratio (INR) values measured prior to intervention, 81% (17 out of 21) of the PCC group reached an INR value below 1.5 within an 8-hour period, whereas only 29% (4 out of 14) of the FFP group did (p=0.002). Vitamin K was concomitantly given to 28% of the patients receiving FFP, and 81% of those patients receiving PCC. No significant differences in outcomes were found whether adjunctive vitamin K was administered or not, in either FFP or PCC group. However, when vitamin K was not administered, the PCC group had a higher rate of INR reversal (80% vs. 10% for FFP, p=0.006). CONCLUSION: Administration of PCC is as effective in short-term outcomes as FFP in treating geriatric patients on warfarin sustaining an ICH after a GLF. INR reversal was more successful, significantly faster, and required lower infusion volumes in patients receiving PCC. LEVEL OF EVIDENCE: Level III.