Predicting the need for massive transfusion in trauma patients: The Traumatic Bleeding Severity Score

Ogura, Takayuki MD; Nakamura, Yoshihiko MD; Nakano, Minoru MD, PhD; Izawa, Yoshimitsu MD; Nakamura, Mitsunobu MD, PhD; Fujizuka, Kenji MD; Suzukawa, Masayuki MD, PhD; Lefor, Alan T. MD, MPH

Journal of Trauma and Acute Care Surgery:

May 2014 - Volume 76 - Issue 5 - p 1243-1250

In the development phase, five predictors of massive transfusion were identified, including age, systolic blood pressure, the Focused Assessment with Sonography for Trauma scan, severity of pelvic fracture, and lactate level. The maximum TBSS is 57 points. In the validation study, the average TBSS in patients who received massive transfusion was significantly greater (24.2 [6.7]) than the score of patients who did not (6.2 [4.7]) (p < 0.01). The area under the receiver operating characteristic curve, sensitivity, and specificity for a TBSS greater than 15 points was 0.985 (significantly higher than the other scoring systems evaluated at 0.892 and 0.813, respectively), 97.4%, and 96.2%, respectively.

CONCLUSION
The TBSS is simple to calculate using an available iOS application and is accurate in predicting the need for massive transfusion. Additional multicenter studies are needed to further validate this scoring system and further assess its utility.

Hydration in contrast-induced acute kidney injury

Carlo Briguori, Gerolama Condorelli

 

 

The Lancet, Volume 383, Issue 9931, Pages 1786 - 1788, 24 May 2014

Contrast-induced acute kidney injury is associated with prolonged hospital stay, increased health-care costs, and raised risk of both further deterioration of kidney function and unfavourable clinical outcome.1 A general consensus exists for the beneficial effect of hydration in preventing contrast-induced acute kidney injury. Hydration increases urine flow rates,2 reduces the concentration of contrast media in the tubule, and expedites excretion of contrast media, thus reducing the length of time that tubular cells are exposed to the toxic effects of contrast media. 

The use of furosemide in critically ill trauma patients: A retrospective review

Daniel Dante Yeh, Julin F. Tang, and Yuchiao Chang

J Emerg Trauma Shock. 2014 Apr-Jun; 7(2): 83–87.

The data suggests that the administration of furosemide in hemodynamically stable, critically ill trauma patients is effective in limiting excessive fluid gain without causing detrimental effects in heart rate, blood pressure, or renal function.

Restrictive Deferred Hydration Combined with Preemptive Norepinephrine Infusion during Radical Cystectomy Reduces Postoperative Complications and Hospitalization Time: A Randomized Clinical Trial

Wuethrich, Patrick Y. M.D.; Burkhard, Fiona C. M.D.; Thalmann, George N. M.D.; Stueber, Frank M.D.; Studer, Urs E. M.D.

Anesthesiology:

February 2014 - Volume 120 - Issue 2 - p 365–377

 

The incidence of major complications was significantly reduced, with a relative risk of 0.7 (95% CI, 0.55–0.88). The duration of hospitalization was also significantly reduced from a median of 17 to 15 days. 

Patient Blood Management in Elective Total Hip- and Knee-replacement Surgery (Part 2): A Randomized Controlled Trial on Blood Salvage as Transfusion Alternative Using a Restrictive Transfusion Policy in Patients with a Preoperative Hemoglobin above 13 g/dl

So-Osman, Cynthia M.D., Ph.D., M.Sc.; Nelissen, Rob G. H. H. M.D., Ph.D.; Koopman-van Gemert, Ankie W. M. M. M.D., Ph.D.; Kluyver, Ewoud M.D.; Pöll, Ruud G. M.D., Ph.D.; Onstenk, Ron M.D.; Van Hilten, Joost A. Ph.D.; Jansen-Werkhoven, Thekla M. Ph.D.; van den Hout, Wilbert B. Ph.D.; Brand, Ronald Ph.D.; Brand, Anneke M.D., Ph.D.

Anesthesiology:

April 2014 - Volume 120 - Issue 4 - p 852–860

 In this prospective randomized controlled trial including 1,759 patients with a preoperative hemoglobin level greater than 13 g/dl (and therefore ineligible for erythropoietin) undergoing hip or knee arthroplasty, autologous intra- and postoperative blood salvage devices were not effective as transfusion alternatives. The use of these devices did not reduce erythrocyte use and increased costs.