Causes and Timing of Unplanned ICU Admissions Among Trauma Patients at a Level 1 Trauma Center.

BACKGROUND: Unexpected ICU admissions are a key quality metric in trauma care. The purpose of this study is to identify the most common causes of unplanned ICU admissions among trauma patients at an ACS-verified level 1 trauma center. METHODS: A retrospective review was conducted of all trauma patients with unplanned admission to the ICU at a level 1 trauma center between 2019 and 2021. Unplanned ICU admissions were categorized into (1) "bounce-backs," patients previously admitted to the ICU and (2) "upgrades," patients who had not previously been cared for in the ICU. RESULTS: Of 300 unexpected ICU transfers, bounce-backs accounted for 69% and upgrades 31%. The most common injuries were traumatic brain injuries (40%) and rib fractures (41.3%). In-hospital mortality rate was 10% and did not significantly differ between bounce-backs and upgrades (12 vs 5%, P = .92). Respiratory distress was the most common cause of transfer (41.1%), followed by neurologic (29.6%) and cardiovascular decline (21.2%). Patients were on average 928 mL fluid positive 72 hours prior to transfer (t > 0, P < .0001), and 295 mL fluid positive in the 24 hours prior to transfer (t > 0, P .0003). Patients transferred for respiratory distress were no more fluid over-balanced than those transferred for other reasons. CONCLUSION: We found a large percent of unplanned transfers occurring within 48 hours of admission or transfer out of the ICU suggesting under-triage as a leading cause of bounce-backs and upgrades. Respiratory distress was the leading cause of transfer. These findings highlight opportunities for targeted interventions.

Level III Trauma Centers Achieve Comparable Outcomes in Blunt Splenic Injury as Level I Centers.

INTRODUCTION: Identifying patients who can be safely managed in lower-level trauma centers is critical to avoid overburdening level I centers. This study examines the transfer patterns and outcomes of blunt splenic injury (BSI) patients cared for at 2 regional level III trauma centers as compared to an associated level I center. METHODS: A retrospective cohort study was conducted including all trauma patients with BSI admitted to 2 level III trauma centers (TC3) and a level I center (TC1) between 2012 and 2022. Patients were broken into 3 categories: TC1, TC3, and transfer patients (transferred from TC3 to TC1). RESULTS: A total of 1480 patients were admitted to TC1, 208 patients to TC3, and 128 were transferred. 22.7% of transfer patients were children. No difference in splenic injury grade was seen between patients managed at TC1 and TC3. Patients presenting to TC1 had more severe concomitant injuries. Patients underwent urgent splenectomy at similar rates at TC1 and TC3 (15.1 vs 18.7%, P = .1). Successful nonoperative management was achieved at similar rates (81.3 vs 75.5%, P = .1). When controlling for ISS and ED disposition, there was no significant difference in length of stay (LOS), ICU LOS, and inpatient mortality between TC1 and TC3. CONCLUSION: Level III centers effectively managed BSI achieving comparable outcomes to the level 1 center. Transfers commonly occurred in pediatric and multisystem trauma patients, though high-grade splenic injuries were not predictive of transfer. High-grade BSI can be safely managed at level III centers without need for transfer.

Selection of Forage Resources by Juvenile Goats in a Cafeteria Trial: Effect of Browsing Experience, Nutrient and Secondary Compound Content.

We evaluated the effect of browsing experience, nutritional quality and secondary compounds of forage resources, and the interaction between these factors on the selection and intake of goats in a cafeteria trial. Twelve juvenile Criollo goats from 7 to 9 months of age, weighing 22 ± 3 kg, were divided into two groups: (a) browser goats group (n = 6, BG), and (b) naïve goats group (n = 6, NG), formed according to their previous browsing experience (with and without, respectively). Animals were housed in individual pens. The cafeteria experiment lasted 21 days considering pen adaptation, foliage adaptation, and measurements, which included the selection index (SI) of experimental forage resources (Chesson's alpha) and their dry matter intake (DMI/Kg0.75), using a multiple Latin square design. Furthermore, correlation and regression analyses were used to assess the relationship between the aforementioned factors. The NG did not show any selection pattern, while the BG selected Piscidia piscipula and Senegalia gaumeri (p = 0.0002). The BG consumed smaller amounts of secondary compounds compared to NG (p = 0.0001). In the BG, the flavonoids affected negatively their selection (R2 = 97.51, p = 0.0001), while the DMI was affected by in vitro DM digestibility and flavonoids (R2 = 99.85; p = 0.0001). For the NG, the crude protein and organic matter contents were associated with DMI, but none had a significant relationship with SI. The BG selected and consumed forages with suitable nutritional quality avoiding those with high content of secondary compounds such as flavonoids. Conversely, NG did not show a clear pattern for their selection or intake.

Small Ruminant Production Based on Rangelands to Optimize Animal Nutrition and Health: Building an Interdisciplinary Approach to Evaluate Nutraceutical Plants.

The plant kingdom can influence the productivity and health of herbivores at different levels. However, demonstrating this process in a scientific manner entails substantial endeavors from different disciplines. In the present review, we will describe the features of a native vegetation system traditionally used by small ruminants and use its particularities to build an interdisciplinary approach to evaluate the nutraceutical properties of plants. Initially, we will establish the context of the low deciduous forest (LDF), considering some botanical and nutritional aspects, as well as the presence of plant secondary compounds (PSC) and gastrointestinal nematodes (GIN). Furthermore, we will focus on coevolutionary aspects that undoubtedly shaped the plants-nutrients-PSC-GIN-herbivore relationship. In addition, the concept of nutraceutical will be discussed to provide clarity and aspects to be considered for their evaluation. Then, ethological, agronomical, nutritional, PSC, parasitological and animal species issues are deepened placing emphasis on methodological approaches. Special focus is given to condensed tannins, as they are the fourth largest group of PSCs and the most studied in livestock sciences. Validation of the nutraceutical properties of plants from native vegetation systems should be seen as a process derived from many scientific disciplines that feed into each other in a cyclic manner.