1
|
Al Tannir AH, Pokrzywa CJ, Dodgion C, Boyle KA, Eddine SBZ, Biesboer EA, Milia DJ, de Moya MA, Carver TW. Physiologic parameters and radiologic findings can predict pulmonary complications and guide management in traumatic rib fractures. Injury 2024; 55:111508. [PMID: 38521636 DOI: 10.1016/j.injury.2024.111508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 02/17/2024] [Accepted: 03/11/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Traumatic rib fracture is associated with a high morbidity rate and identifying patients at risk of developing pulmonary complications (PC) can guide management and potentially decrease unnecessary intensive care admissions. Therefore, we sought to assess and compare the utility of a physiologic parameter, vital capacity (VC), with the admission radiologic findings (RibScore) in predicting PC in patients with rib fractures. METHODS This is a single-center retrospective review (2015-2018) of all adult (≥18 years) patients admitted to a Level I trauma center with traumatic rib fracture. Exclusion criteria included no CT scan and absence of VC within 48 h of admission. The cohort was stratified into two groups based on presence or absence of PC (pneumonia, unplanned intubation, unplanned transfer to the intensive care unit for a respiratory concern, or the need for a tracheostomy). Multivariable logistic regression models were constructed to identify predictors of PC. RESULTS A total of 654 patients met the inclusion criteria of whom 70 % were males. The median age was 51 years and fall (48 %) was the most common type of injury. A total of 36 patients (5.5 %) developed a pulmonary complication. These patients were more likely to be older, had a higher ISS, and were more likely to require a tube thoracostomy placement. On multivariable logistic regression, first VC ≤30 % (AOR: 4.29), day 1 VC ≤30 % (AOR: 3.61), day 2 VC ≤30 % (AOR: 5.54), Δ(Day2-Day1 VC) (AOR: 0.96), and RibScore ≥2 (AOR: 3.19) were significantly associated with PC. On discrimination analysis, day 2 VC had the highest area under the receiver operating characteristic curve (AuROC), 0.81, and was superior to first VC and day 1 VC in predicting PC. There was no statistically significant difference in predicting PC between day 2 VC and RibScore. On multivariable analysis, first VC ≤30 %, day 1 VC ≤30 %, day 2 VC ≤30 %, and admission RibScore ≥2 were associated with prolonged hospital and ICU LOS. CONCLUSION VC and RibScore emerged as independent predictors of PC. However, VC was not found to be superior to RibScore in predicting PC. Further prospective research is warranted to validate the findings of this study.
Collapse
Affiliation(s)
- Abdul Hafiz Al Tannir
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Courtney J Pokrzywa
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Christopher Dodgion
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Kelly A Boyle
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Savo Bou Zein Eddine
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Elise A Biesboer
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - David J Milia
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Marc A de Moya
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Thomas W Carver
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
| |
Collapse
|
2
|
Al Tannir AH, Golestani S, Tentis M, Murphy PB, Schramm AT, Peschman J, Dodgion C, Holena D, Miranda S, Carver TW, de Moya MA, Schellenberg M, Morris RS. Early venous thromboembolism chemoprophylaxis in traumatic brain injury requiring neurosurgical intervention: Safe and effective. Surgery 2024; 175:1439-1444. [PMID: 38388229 DOI: 10.1016/j.surg.2024.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/25/2023] [Accepted: 01/17/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Traumatic brain injury patients who require neurosurgical intervention are at the highest risk of worsening intracranial hemorrhage. This subgroup of patients has frequently been excluded from prior research regarding the timing of venous thromboembolism chemoprophylaxis. This study aims to assess the efficacy and safety of early venous thromboembolism chemoprophylaxis in patients with traumatic brain injuries requiring neurosurgical interventions. METHODS This is a single-center retrospective review (2016-2020) of traumatic brain injury patients requiring neurosurgical intervention admitted to a level I trauma center. Interventions included intracranial pressure monitoring, subdural drain, external ventricular drain, craniotomy, and craniectomy. Exclusion criteria included neurosurgical intervention after chemoprophylaxis initiation, death within 5 days of admission, and absence of chemoprophylaxis. The total population was stratified into Early (≤72 hours of intervention) versus Late (>72 hours after intervention) chemoprophylaxis initiation. RESULTS A total of 351 patients met the inclusion criteria, of whom 204 (58%) had early chemoprophylaxis initiation. Overall, there were no significant differences in baseline and admission characteristics between cohorts. The Early chemoprophylaxis cohort had a statistically significant lower venous thromboembolism rate (5% vs 13%, P < .001) with no increased risk of worsening intracranial hemorrhage (10% vs 13%, P = .44) or neurosurgical reintervention (8% vs 10%, P = .7). On subgroup analysis, a total of 169 patients required either a craniotomy or a craniectomy before chemoprophylaxis. The Early chemoprophylaxis cohort had statistically significant lower venous thromboembolism rates (2% vs 11%, P < .001) with no increase in intracranial hemorrhage (8% vs 11%, P = .6) or repeat neurosurgical intervention (8% vs 10%, P = .77). CONCLUSION Venous thromboembolism prophylaxis initiation within 72 hours of neurosurgical intervention is safe and effective. Further prospective research is warranted to validate the results of this study.
Collapse
Affiliation(s)
- Abdul Hafiz Al Tannir
- Department of Surgery, Division of Trauma and Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI. https://twitter.com/tannir_abed
| | - Simin Golestani
- Department of Surgery, Division of Trauma and Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Morgan Tentis
- Department of Surgery, Division of Trauma and Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Patrick B Murphy
- Department of Surgery, Division of Trauma and Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Andrew T Schramm
- Department of Surgery, Division of Trauma and Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Jacob Peschman
- Department of Surgery, Division of Trauma and Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Christopher Dodgion
- Department of Surgery, Division of Trauma and Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Daniel Holena
- Department of Surgery, Division of Trauma and Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Stephen Miranda
- Department of Neurology, University of Pennsylvania, Philadelphia, PA
| | - Thomas W Carver
- Department of Surgery, Division of Trauma and Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Marc A de Moya
- Department of Surgery, Division of Trauma and Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Morgan Schellenberg
- Department of Surgery, Division of Trauma and Critical Care Surgery, University of Southern California, Los Angeles, CA
| | - Rachel S Morris
- Department of Surgery, Division of Trauma and Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI.
| |
Collapse
|
3
|
Al Tannir AH, Golestani S, Tentis M, Maring M, Biesboer EA, Dodgion C, Murphy PB, Holena DN, Trevino CM, Peschman JR, Carver TW, Milia DJ, Schellenberg M, de Moya MA, Morris RS. A Collaborative Multidisciplinary Trauma Program Improvement Team Improves VTE Chemoprophylaxis Guideline Compliance In Non-Operative Stable TBI. J Trauma Acute Care Surg 2024:01586154-990000000-00646. [PMID: 38437527 DOI: 10.1097/ta.0000000000004294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
BACKGROUND Delays in initiating venous thromboembolism (VTE) prophylaxis in patients suffering from traumatic brain injury (TBI) persist despite guidelines recommending early initiation. We hypothesized that the expansion of a Trauma Program Performance Improvement (PI) team will improve compliance of early (24-48 hour) initiation of VTE prophylaxis and will decrease VTE events in TBI patients. METHODS We performed a single-center retrospective review of all TBI patients admitted to a Level I trauma center before (2015-2016,) and after (2019-2020,) the expansion of the Trauma Performance Improvement and Patient Safety (PIPS) team and the creation of trauma process and outcome dashboards. Exclusion criteria included discharge or death within 48 hours of admission, expanding intracranial hemorrhage on CT scan, and a neurosurgical intervention (craniotomy, pressure monitor, or drains) prior to chemoprophylaxis initiation. RESULTS A total of 1,112 patients met the inclusion criteria, of which 54% (n = 604) were admitted after Trauma PIPS expansion. Following the addition of a dedicated PIPS nurse in the trauma program and creation of process dashboards, the time from stable CT to VTE prophylaxis initiation decreased (52 hours to 35 hours; p < 0.001) and more patients received chemoprophylaxis at 24-48 hours (59% from 36%, p < 0.001) after stable head CT. There was no significant difference in time from first head CT to stable CT (9 vs 9 hours; p = 0.15). The Contemporary group had a lower rate of VTE events (1% vs 4%; p < 0.001) with no increase in bleeding events (2% vs 2%; p = 0.97). On multivariable analysis, being in the Early cohort was an independent predictor of VTE events (aOR: 3.74; 95%CI: 1.45-6.16). CONCLUSION A collaborative multidisciplinary Trauma PIPS team improves guideline compliance. Initiation of VTE chemoprophylaxis within 24-48 hours of stable head CT is safe and effective. LEVEL OF EVIDENCE Level III, Therapeutic/Care Management.
Collapse
Affiliation(s)
- Abdul Hafiz Al Tannir
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Simin Golestani
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Morgan Tentis
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Morgan Maring
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Elise A Biesboer
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Christopher Dodgion
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Patrick B Murphy
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Daniel N Holena
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Colleen M Trevino
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Jacob R Peschman
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Thomas W Carver
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - David J Milia
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Morgan Schellenberg
- Department of Surgery, Division of Trauma & Critical Care Surgery, USC+LAC, Los Angeles, California
| | - Marc A de Moya
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Rachel S Morris
- Department of Surgery, Division of Trauma & Critical Care Surgery, Medical College of Wisconsin, Milwaukee, WI
| |
Collapse
|
4
|
Beyer CA, Byrne JP, Moore SA, McLauchlan NR, Rezende-Neto JB, Schroeppel TJ, Dodgion C, Inaba K, Seamon MJ, Cannon JW. Predictors of initial management failure in traumatic hemothorax: A prospective multicenter cohort analysis. Surgery 2023; 174:1063-1070. [PMID: 37500410 DOI: 10.1016/j.surg.2023.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/06/2023] [Accepted: 06/23/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Traumatic hemothorax is common, and management failure leads to worse outcomes. We sought to determine predictive factors and understand the role of trauma center performance in hemothorax management failure. METHODS We prospectively examined initial hemothorax management (observation, pleural drainage, surgery) and failure requiring secondary intervention in 17 trauma centers. We defined hemothorax management failure requiring secondary intervention as thrombolytic administration, tube thoracostomy, image-guided drainage, or surgery after failure of the initial management strategy at the discretion of the treating trauma surgeon. Patient-level predictors of hemothorax management failure requiring secondary intervention were identified for 2 subgroups: initial observation and immediate pleural drainage. Trauma centers were divided into quartiles by hemothorax management failure requiring secondary intervention rate and hierarchical logistic regression quantified variation. RESULTS Of 995 hemothoraces in 967 patients, 186 (19%) developed hemothorax management failure requiring secondary intervention. The frequency of hemothorax management failure requiring secondary intervention increased from observation to pleural drainage to surgical intervention (12%, 22%, and 35%, respectively). The number of ribs fractured (odds ratio 1.12 per fracture; 95% confidence interval 1.00-1.26) and pulmonary contusion (odds ratio 2.25, 95% confidence interval 1.03-4.91) predicted hemothorax management failure requiring secondary intervention in the observation subgroup, whereas chest injury severity (odds ratio 1.58; 95% confidence interval 1.17-2.12) and initial hemothorax volume evacuated (odds ratio 1.10 per 100 mL; 95% confidence interval 1.05-1.16) predicted hemothorax management failure requiring secondary intervention after pleural drainage. After adjusting for patient characteristics in the logistic regression model for hemothorax management failure requiring secondary intervention, patients treated at high hemothorax management failure requiring secondary intervention trauma centers were 6 times more likely to undergo an intervention after initial hemothorax management failure than patients treated in low hemothorax management failure requiring secondary intervention trauma centers (odds ratio 6.18, 95% confidence interval 3.41-11.21). CONCLUSION Failure of initial management of traumatic hemothorax is common and highly variable across trauma centers. Assessing patient selection for a given management strategy and center-level practices represent opportunities to improve outcomes from traumatic hemothorax.
Collapse
Affiliation(s)
- Carl A Beyer
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - James P Byrne
- Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD. https://twitter.com/DctrJByrne
| | - Sarah A Moore
- Division of Acute Care Surgery, Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM. https://twitter.com/AnnieMooreMD
| | - Nathaniel R McLauchlan
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Joao B Rezende-Neto
- Department of Trauma and Acute Care Surgery, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Thomas J Schroeppel
- Department of Surgery, University of Colorado School of Medicine, UCHealth Memorial Hospital, Colorado Springs, CO
| | - Christopher Dodgion
- Division of Trauma and Critical Care, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI. https://twitter.com/ChrisDodgion
| | - Kenji Inaba
- Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC Medical Center, Los Angeles, CA
| | - Mark J Seamon
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. https://twitter.com/MarkSeamonMD
| | - Jeremy W Cannon
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| |
Collapse
|
5
|
Sawhney JS, Kasotakis G, Goldenberg A, Abramson S, Dodgion C, Patel N, Khan M, Como JJ. Management of rhabdomyolysis: A practice management guideline from the Eastern Association for the Surgery of Trauma. Am J Surg 2021; 224:196-204. [PMID: 34836603 DOI: 10.1016/j.amjsurg.2021.11.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/08/2021] [Accepted: 11/17/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND The treatment of rhabdomyolysis remains controversial. Although there is no question that any associated compartment syndrome needs to be identified and released, debate persists regarding the benefit of further therapy including aggressive intravenous fluid resuscitation (IVFR), urine alkalization with bicarbonate, and the use of mannitol. The goal of this practice management guideline was to evaluate the effects of bicarbonate, mannitol, and aggressive intravenous fluids on patients with rhabdomyolysis. METHODS A systematic review and meta-analysis comparing treatments in patients with rhabdomyolysis was performed. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was applied to assess the quality of evidence and to create evidence-based recommendations regarding the use of bicarbonate, mannitol, and aggressive IVFR in patients with rhabdomyolysis. RESULTS A total of 12 studies were identified for analysis. On quantitative analysis, IVFR decreased the incidence of acute renal failure (ARF) and need for dialysis in patients with rhabdomyolysis. Neither bicarbonate nor mannitol administration improved the incidence of acute renal failure and need for dialysis in patients with rhabdomyolysis. Quality of evidence was deemed to be very low, with the vast majority of the literature being retrospective studies. CONCLUSION In patients with rhabdomyolysis, we conditionally recommend for aggressive IVFR to improve outcomes of ARF and lessen the need for dialysis. We conditionally recommend against treatment with bicarbonate or mannitol in patients with rhabdomyolysis.
Collapse
Affiliation(s)
| | | | | | - Stuart Abramson
- Indiana University School of Medicine, Indianapolis, IN, USA.
| | | | | | - Mansoor Khan
- Brighton and Sussex University Hospital, Kemptown, Brighton, UK.
| | - John J Como
- MetroHealth Medical Center, Cleveland, OH, USA.
| |
Collapse
|
6
|
Long KL, Galukande M, Kyamanywa P, Tarpley MJ, Dodgion C. Developing Research Potential and Building Partnerships: A Report of the Fundamentals of Surgical Research Course at the College of Surgeons of East, Central, and Southern Africa. J Surg Res 2020; 259:34-38. [PMID: 33278795 DOI: 10.1016/j.jss.2020.11.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/05/2020] [Accepted: 11/01/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Approximately a decade after the inaugural Fundamentals of Surgical Research Course (FSRC) at the West African College of Surgeons meeting (2008), the Association for Academic Surgery expanded the course offering to the annual meeting of the College of Surgeons of East, Central and Southern Africa (COSECSA). After the second annual offering of the course in 2019, participants were surveyed to assess the impact of the course. METHODS A survey was distributed to the attendees of the 2019 second COSECSA FSRC course, held in December 2019 in Kampala, Uganda. Approximately 80 people attended at least a portion of the full-day course. Forty-nine participants completed the voluntary survey questionnaire distributed to assess each session of the course at course completion. RESULTS Ten different countries were represented among the attendees. Of the 49 evaluations, 35 respondents were male and six were female. Eight respondents did not identify a gender. Surgical residents comprised 19 of the 49 attendees, and one of the 49 attendees was a medical student. Thirty-five respondents indicated that their views of surgical research had changed after attending the course. CONCLUSIONS The second annual FSRC at COSECSA confirmed significant interest in building research skills and partnerships in sub-Saharan Africa. A wide variety of learners attended the course, and a majority of the sessions received overwhelmingly positive feedback. Multiple conference attendees expressed interest in serving as faculty for the course moving forward, highlighting a viable path for sustainability as the Association for Academic Surgery develops an international research education platform.
Collapse
Affiliation(s)
- Kristin L Long
- Division of Endocrine Surgery, Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin.
| | | | - Patrick Kyamanywa
- Department of Surgery, Kampala International University Western Campus, Kampala, Uganda
| | - Margaret J Tarpley
- Department of Surgery, Vanderbilt University, Nashville, Tennessee; Department of Medical Education, University of Botswana, Gaborone, Botswana
| | - Christopher Dodgion
- Division of Trauma and Acute Care Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | |
Collapse
|
7
|
Durbin S, DeAngelis R, Peschman J, Milia D, Carver T, Dodgion C. Superficial Surgical Infections in Operative Abdominal Trauma Patients: A Trauma Quality Improvement Database Analysis. J Surg Res 2019; 243:496-502. [DOI: 10.1016/j.jss.2019.06.101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 06/01/2019] [Accepted: 06/28/2019] [Indexed: 11/25/2022]
|
8
|
Smith S, Fair K, Goodman A, Watson J, Dodgion C, Schreiber M. Consumption of alcohol leads to platelet inhibition in men. Am J Surg 2019; 217:868-872. [PMID: 30826005 DOI: 10.1016/j.amjsurg.2019.02.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 02/15/2019] [Accepted: 02/18/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Alcohol consumption has been shown to alter coagulation. However, thromboelastography with platelet mapping (TEG PM) to evaluate platelet function has not been studied. METHODS A prospective, non-randomized study of healthy volunteers was conducted. Baseline TEG PM were collected. Subjects consumed alcoholic or non-alcoholic beverages for 2 h. Repeat TEG PM was collected. RESULTS Fifty-four volunteers entered either the experimental group (EG, 17 women and 16 men) or control group (CG, 11 women and 10 men). After 2 h of alcohol or non-alcoholic drink consumption the median breath alcohol level was 0.08 [IQR 0.05, 0.12] in the EG and 0.00 in the CG. After consumption of alcohol, male EG subjects demonstrated higher median Adenosine Diphosphate (ADP) inhibition of platelet function (15.7% [3.9, 39.3] vs 8.2% [0, 30.1), p = 0.035), but female subjects did not. There was no evidence of increased arachidonic acid (AA) platelet inhibition in the EG compared to CG. Clot strength (TEG maximum amplitude) was not different between groups. CONCLUSION After consumption of alcohol, healthy male volunteers demonstrate ADP platelet inhibition by TEG PM.
Collapse
|
9
|
Keihani S, Moses R, Xu Y, Putbrese B, Rogers D, Luo-Owen X, Mukherjee K, Morris B, Majercik S, Piotrowski J, Dodgion C, Sherwood B, Erickson B, Schwartz I, Elliott S, DeSoucy E, Zakaluzny S, Baradaran N, Breyer B, Smith B, Miller B, Santucci R, Carrick M, Kocik J, Hewitt T, Burks F, Heilbrun M, Hotaling J, Presson A, Nirula R, Myers J. MP25-18 IMAGING FINDINGS ASSOCIATED WITH RENAL BLEEDING INTERVENTIONS AFTER HIGH-GRADE RENAL TRAUMA: RESULTS FROM THE AMERICAN ASSOCIATION FOR SURGERY OF TRAUMA (AAST) GENITO-URINARY TRAUMA STUDY. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
10
|
Nichol PF, Byrne JL, Dodgion C, Saijoh Y. Clinical considerations in gastroschisis: Incremental advances against a congenital anomaly with severe secondary effects. Am J Med Genet 2008; 148C:231-40. [DOI: 10.1002/ajmg.c.30180] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|