The Presence of Nucleated Red Blood Cells as an Indicator for Increased Mortality and Morbidity in Burn Patients.

Nucleated red blood cells (NRBCs) have been studied in critically ill and injured patients as a predictor of increased in-hospital mortality and poor clinical outcomes. While prior studies have demonstrated the prognostic power of NRBCs in the critical patient, there has been a paucity of literature available describing their value as a prognostic indicator in the severely burned patient. This retrospective observational study was conducted from 2012 to 2017. Inclusion criteria for this study included all burn patients with total body surface area > 10% who were aged ≥ 15 years. Demographic and clinical data were collected from the electronic medical record system. Data analysis consisted of descriptive and comparative analysis using SPSS. Two hundred and nineteen patients (17.5%) met inclusion criteria with 51 (23.3%) patients positive for NRBCs. The presence of NRBCs had an increased mortality rate with an odds ratio of 6.0 (P = .001; 2.5, 14.5); was more likely to appear in older patients (P < .001); and was associated with increased hospital length of stay (P < .001), injury severity scores (P < .001), and complications. The presence of NRBCs even at the low concentrations reported in our study showed a 6-fold increase in the rate of mortality. With the current improvements in burn care leading to higher survival rates, the need to improve upon the numerous models that have been developed to predict mortality in severe burn patients is clear given the significantly increased risk of death that the presence of NRBCs portends.

Establishing reference values for cervical spine range of motion in pre-pubescent children.

Medical professionals, physical therapists, product designers, and computational models all use cervical spine range of motion reference values. To support these functions, researchers have collected a plethora of data to determine the normal range of motion of the cervical spine of adult subjects. However, little to no data exists for subjects under the age of 14. This study utilized the cervical range of motion device, referenced with respect to the Frankfort Plane, to measure the active cervical spine range of motion in all three cardinal planes of the human body, for 106 subjects whose ages ranged from 8 to 10 years. The active range of motion for flexion, extension, lateral extension, and rotation was calculated as 66+/-13 degrees , 85+/-14 degrees , 58+/-8 degrees , and 77+/-7 degrees , respectively, using linear statistics. The observed data significantly differed from the published American Medical Association guidelines for adults but fell within the range of the reference values for 10 year olds. Stratifying and analyzing the range of motion data with respect to gender yielded no significant effect. Appendix A analyzes the data using angular statistics, and produces virtually identical results as those from linear statistics.

A comparison of criminal sexual conduct defendants based on victim age.

This study compared defendants charged with Criminal Sexual Conduct whose victims were <6 years of age with defendants whose victims were 12 or more years of age. The study included 163 men referred to the evaluation unit of a state center for forensic psychiatry. Thirty-eight men had younger victims (YVs) and 125 men had older victims (OVs). The variables of comparison were defendant demographic and psychiatric variables frequently identified in the sex offender literature. Controlling for other demographic and psychiatric variables by use of logistic regression modeling, elderly defendants (60 years or greater), and incest offenders were three times more likely to have YVs (Odds Ratio [OR] 3.08 and 3.11, respectively). Unlike previous studies defendants with serious psychiatric pathology (psychosis or mania) were no more likely to have YVs (OR 0.66) than were defendants without psychosis.

The impact of early thromboelastography directed therapy in trauma resuscitation.

BACKGROUND: Conventional coagulation tests do not provide an accurate representation of the complex nature of trauma induced coagulopathy. Thrombelastography provides a prompt global overview of all dynamic sequential aspects of trauma induced coagulopathy. The objective of this study was to evaluate the impact of using thrombelastography on blood products utilization, crystalloids utilization, hospital, and intensive care using length of stay, and cost savings. METHODS: We retrospectively reviewed 134 patients (May of 2012 to February of 2015) meeting Class I trauma activation. Outcome data was compared between two groups: patients prior to thrombelastography implementation (n = 87) and patients with thrombelastography guided trauma resuscitation (n = 47). Blood product usage was compared for three time periods: first 4 h, the next 20 h, and first 24 h. RESULTS: For the first 24 h of treatment, patients with thrombelastography guided trauma resuscitation had lower packed red blood cells (p = 0.0022) and fresh frozen plasma (p = 0.0474), but higher jumbo pack platelets (p = 0.0476) utilization when compared to the patients prior to thrombelastography implementation. There was no statistical significant difference in the utilization of crystalloids for any of the three time intervals. Patients with thrombelastography guided trauma resuscitation had a shorter hospital length of stay (p = 0.0011) and intensive care unit length of stay (p = 0.0059) than the patients prior to thrombelastography implementation. Cost savings in blood products transfusion were most pronounced in patients with penetrating injuries. DISCUSSION: Using visco-elastic tests to guide blood transfusion was first used for liver transplant patients and then applied to cardiovascular surgery and trauma. Similar to other studies, this study showed using visco-elastic tests for trauma patietns corresponded to an overall reduction in the use of packed red blood cells and fresh frozen plasma during the first 24 hours of resuscitation. In addition, this study showed using visco-elastic tests corresponded to a significant reduction in both hospital and intensive care unit length of stay. CONCLUSION: This study demonstrates that Thrombelastography guided trauma resuscitation decreases the overall transfusion requirements of packed red blood cells and fresh frozen plasma. However, given the nature of under-recognized jumbo pack platelets dysfunction in the conventional laboratory parameters, jumbo pack platelets utilization is higher when following Thrombelastography directed resuscitation. The utilization of Thrombelastography corresponded to a reduction in hospital length of stay, intensive care unit length of stay and cost of transfused blood products.

Impact of MRI on changing management of the cervical spine in blunt trauma patients with a 'negative' CT scan.

BACKGROUND: Owing to the potential risks associated with missed injury, many blunt trauma patients with suspected cervical spine injury undergo some form of imaging technique which has progressed from primarily using plain radiography to relying on CT. Recently, studies have shown that in certain situations, adding MRI may improve the diagnostic accuracy over solely relying on CT. METHODS: Retrospective study of 3468 adult blunt trauma patients at a level I trauma center of which 94 with an initial negative CT scan underwent subsequent MRI. These 94 patients were classified as reliable or unreliable for examination; coded as either having a positive or negative MRI result; and assessed for a change in management. RESULTS: Of the 94 patients in the study population, 69 (73.4%) were deemed reliable and 25 (26.6%) deemed unreliable for examination. Overall, 65 (69.1%) patients had a positive MRI result-49 (71.0%) reliable and 16 (64.0%) unreliable-with some patients testing positive for more than one finding. There was no significant difference in positive MRI rates between reliable and unreliable patients. None of the 29 patients who had negative MRI had a change in management, while 31 of the 65 (47.7%) patients with positive MRI did have a change in management of either continued cervical collar immobilization or neck surgery. CONCLUSIONS: The use of CT scans should be continued as the primary imaging technique for patients with suspected cervical spine injuries. In cases where obtundation or clinical suspicion exists for a false-negative CT scan, MRI should be considered as a supplement and should not be rejected solely based on the negative result of the CT. LEVEL OF EVIDENCE: Level IV.