Viscoelastic Hemostatic Assays and Outcomes in Traumatic Brain Injury: A Systematic Literature Review.

BACKGROUND: Coagulopathy in traumatic brain injury (TBI) occurs frequently and is associated with poor outcomes. Conventional coagulation assays (CCA) traditionally used to diagnose coagulopathy are often not time sensitive and do not assess complete hemostatic function. Viscoelastic hemostatic assays (VHAs) including thromboelastography and rotational thromboelastography provide a useful rapid and comprehensive point-of-care alternative for identifying coagulopathy, which is of significant consequence in patients with TBI with intracranial hemorrhage. METHODS: A systematic review was performed in accordance with PRISMA guidelines to identify studies comparing VHA with CCA in adult patients with TBI. The following differences in outcomes were assessed based on ability to diagnose coagulopathy: mortality, need for neurosurgical intervention, and progression of traumatic intracranial hemorrhage (tICH). RESULTS: Abnormal reaction time (R time), maximum amplitude, and K value were associated with increased mortality in certain studies but not all studies. This association was reflected across studies using different statistical parameters with different outcome definitions. An abnormal R time was the only VHA parameter found to be associated with the need for neurosurgical intervention in 1 study. An abnormal R time was also the only VHA parameter associated with progression of tICH. Overall, many studies also reported abnormal CCAs, mainly activated partial thromboplastin time, to be associated with poor outcomes. CONCLUSIONS: Given the heterogenous nature of the available evidence including methodology and study outcomes, the comparative difference between VHA and CCA in predicting rates of neurosurgical intervention, tICH progression, or mortality in patients with TBI remains inconclusive.

Understanding Breast Implant Illness, Before and After Explantation: A Patient-Reported Outcomes Study.

BACKGROUND: Breast implant illness (BII) after aesthetic breast augmentation remains a poorly defined syndrome encompassing a wide spectrum of symptoms. While previously published series have observed overall symptomatic improvement after breast implant removal, there is a lack of studies evaluating changes in specific symptoms over time. The purpose of this study was to gain an understanding of symptoms associated with BII, and to evaluate how these symptoms change after removal of breast implants and total capsulectomy (explantation). We hypothesized that patients presenting with BII would experience both immediate and sustained improvement in constitutional symptoms after explantation. METHODS: A retrospective study of all patients who underwent explantation by a single surgeon over 2 years was conducted. Repeated-measures analysis of variance accounting for dependency was used to compare symptoms before and after surgery. Multivariate analyses and linear regression models were used to examine the impact of patient- and implant-related factors on changes in symptoms. RESULTS: Seven hundred fifty patients met inclusion criteria. Mean preoperative survey score (26.19 ± 11.24) was significantly different from mean postoperative survey score at less than 30 days (9.49 ± 7.56) and greater than 30 days (9.46 ± 7.82, P < 0.001). Patients with a BMI greater than 30 or those with clinically detectable contracture on examination showed greater improvement on their survey scores (P = 0.039, 0.034, respectively). CONCLUSIONS: Although BII encompasses a large range of symptoms, subjects in this study demonstrated significant and sustained improvement in 11 common symptom domains. This improvement was demonstrable within the first 30 days postoperatively and was maintained beyond 30 days. The study demonstrated a strong association of explantation and specific symptom improvement within the patient population studied. Future investigation will further elucidate possible biologic phenomena to better characterize the pathophysiology and mechanism of BII.

Outcomes After Intracranial Hemorrhage in Patients with Left Ventricular Assist Devices: A Systematic Review of Literature.

BACKGROUND: Intracranial hemorrhage (ICH) is a common complication in patients with left ventricular assist devices (LVADs) and carries a dismal prognosis. Limited data are available on the management and outcomes in this population, which are essential to determine an optimal treatment strategy. We conducted a systematic literature review to determine the clinical characteristics and survival of this population. METHODS: PubMed, Ovid, Embase. Scopus, Cochrane, CENTRAL, and Web of Science articles were selected using the following terms: ("Heart-Assist Devices" or "left ventricular assist device" or "LVAD") AND ("intracranial hemorrhage" OR "cerebral hemorrhage" OR "brain hemorrhage" OR "intracerebral hemorrhage" OR "intraparenchymal hemorrhage" OR "hemorrhagic stroke"). Abstracts and articles were screened according to inclusion and exclusion criteria that were determined a priori. Potential studies were reviewed by 4 authors, who reached a consensus on the final studies to be included. RESULTS: The literature review yielded 609 abstracts, which were screened according to predetermined inclusion criteria. A total of 143 full-text articles were reviewed, and 8 articles were included in the final qualitative analysis. These studies reviewed data for 597 patients with LVADs who had ICH. The mortality for ICH was widely variable across studies and ranged from 16% to 100%. CONCLUSIONS: There is minimal existing literature on patients with LVAD with ICH that report patient outcomes in a nonstandardized fashion. The studies included in this analysis report mortality consistent with previous reports, indicating a need for further investigation to identify risk factors and improve outcomes in these patients.