Is a Positive Prehospital FAST Associated with Severe Bleeding? A Multicenter Retrospective Study.

INTRODUCTION: Severe hemorrhage is the leading cause of early preventable death in severe trauma patients. Delayed diagnosis is a poor prognostic factor, and severe hemorrhage prediction is essential. The aim of our study was to investigate if there was an association between the detection of peritoneal or pleural fluid on prehospital sonography for trauma and posttraumatic severe hemorrhage. METHODS: We retrospectively studied data from records of thoracic or abdominal trauma patients managed in mobile intensive care units from January 2017 to December 2021 in four centers in France. Severe hemorrhage was defined as a condition necessitating transfusion of at least four packed red blood cells or surgical intervention/radioembolization for hemostasis within the first 24 h. Using a multivariate analysis, we investigated the predictive performance of focused assessment with sonography for trauma (FAST) alone or in combination with the five Red Flags criteria validated by Hamada et al. RESULTS: Among the 527 patients analyzed, 371 (71%) were men, the mean age was 41 ± 19 years, and the Injury Severity Score was 11 (Interquartile range = [5; 22]). Seventy-three (14%) patients had severe hemorrhage - of whom 28 (38%) had a positive FAST, compared to 61 (13%) without severe hemorrhage (p < 0.01). For severe hemorrhage prediction, FAST had a sensitivity of 38% (95%CI = [27%; 50%]) and a specificity of 87% (95%CI = [83%; 90%]) (AUC = 0.62, 95%CI = [0.57; 0.68]). The comparison of the other outcomes between positive and negative FAST was: hemostatic procedure, 22 (25%) vs 28 (6%), p < 0.01; intensive care unit admission 71 (80%) vs 190 (43%), p < 0.01; mean length of hospital stay 11 [4; 27] vs 4 [0; 14] days, p = 0.02; 30-day mortality 13 (15%) vs 22 (5%), p < 0.01. CONCLUSION: A positive FAST performed in the prehospital setting is associated with severe hemorrhage and all prognostic criteria we studied.

Stakeholder consultations and the legitimacy of regulatory decision-making: A survey experiment in Belgium.

Agencies consult extensively with stakeholders such as industry associations, nongovernmental organizations, and trade unions. One rationale for consultations is that these improve procedural legitimacy and lead to greater acceptance of regulatory outcomes by citizens and the regulated industry. While this presumption of a positive relation between stakeholder consultations and the legitimacy of agencies is widespread, research analyzing this relationship remains scarce. Using a survey experiment, we examine the effect of open and closed consultations on the acceptance of procedures and regulatory outcomes in the field of environmental politics. The results demonstrate that consultation arrangements positively affect the acceptance of decision-making procedures, especially when regulators grant access to different types of stakeholders. However, although the consultation arrangement itself does not directly affect acceptance of the regulatory outcome, procedural legitimacy matters, as it increases decision acceptance among individuals who are negatively disposed toward government regulation.

Access to European Union Agencies: Usual Suspects or Balanced Interest Representation in Open and Closed Consultations?

To facilitate stakeholder representation, European Union (EU) agencies use a range of procedures, including closed consultation or advisory committees and open or public consultations. For analysing what kind of stakeholders gain access to advisory committees, we compare these two particular procedures. Two theoretical perspectives guide this analysis. The first is a resource-based account, which emphasizes informational needs and leads to the expectation that not only regulated interests but also EU-level associations and European Commission expert group members will gain representation through closed consultations. The second is a norm-based perspective that stresses the importance for agencies to establish a credible reputation, leading them to balance interest representation. A systematic comparison of stakeholders represented in agency committee with those participating in open consultations demonstrates that regulated interests have no systematic advantage in gaining access to closed consultations. Instead, closed consultations may diversify interest representation and facilitate the involvement of non-business interests.