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Article 1
Whole-body computed tomographic scanning leads to better survival as opposed to selective scanning in trauma patients: A systematic review and meta-analysis. Caputo ND, Stahmer C, Lim G, Shah K. J Trauma Acute Surg. 2014 Oct;77(4):534-9.
In recent year, there is an increasing amount of literature suggesting the value of pan-scan in blunt trauma. This study is a systemic review and meta-analysis of these literatures and further confirms the value of whole-body scan in trauma. The authors collected all publications regarding the study of difference between pan scan and selective scan in blunt trauma and performed a systemic review and meta-analysis. They included 7 from 465 publications. These 7 studies composed 25,782 trauma patients who received CT scan following trauma. Of the patients, 52% received pan scan and 48% received selective scanning. Although the overall ISS was significantly higher for patients receiving pan-scan versus those receiving selective scan (p < 0.001), the overall mortality rate was significantly lower for the pan-scan group versus selective scanning group (p < 0.0002), and a favorable pooled odds ratio for mortality rate was 0.75 (95% CI, 0.7-0.79) for whole body scan group. The authors suggested that in terms of overall mortality, whole body scan is preferable to selective scanning in trauma patients.
Article 2
Blood transfusion products contain mitochondrial DNA damage-associated molecular patterns: a potential effector oftransfusion-related acute lung injury. Lee YL, King MB, Gonzalez RP, Brevard SB, Frotan MA, Gillespie MN, Simmons JD. J Surg Res. 2014 Oct;191(2):286-9.
Although we all know that proinflammatory mediators present in transfused blood products are responsible for the initiation of transfusion-related acute lung injury (TRALI), we do not know exactly the true culprit of this pathophysiology. DAMPs (Damage-associated molecular pattern molecules) are molecules that can initiate and perpetuate immune response in the noninfectious inflammatory response. Dr Lee et al from the University of South Alabama College of Medicine hypothesized that mtDNA DAMPs are present in blood transfusion products. They extracted DNA from consecutive samples of packed red blood cells, FFP and platelets procured from the local blood bank. They performed a quantitative real-time polymerase chain reaction and quantify ≈200 bp sequences from the COX1, ND1, ND6, and D-loop regions of the mitochondrial genome. They found a range of mtDNA DAMPs in all blood components, with FFP displaying the largest variation. They therefore concluded that mtDNA DAMPs are present in packed red blood cells, FFP, and platelets. These observations provide proof of the concept that mtDNA DAMPs may be mediators of TRALI.
Article 3
Concomitant hollow viscus injuries in patients with blunt hepatic and splenic injuries: An analysis of a National Trauma Registry database. Swaid F, Peleg K, Alfici R, Matter I, Olsha O, Ashkenazi I, Givon A; Israel Trauma Group, Kessel B. Injury. 2014 Sep;45(9):1409-12.
Non-operative management of blunt solid intraabdominal organ injury has become the standard approach for stable patients. With the liberal use of computed tomography (CT), unnecessary immediate laparotomies have significantly reduced. However, due to its limited sensitivity in the diagnosis of hollow viscus injuries, conservative management of intraabdominal solid organ injury may be at the expense of a rise in the incidence of missed intrabdominal hollow organ injuries. This retrospective cohort study assessed the incidence of concomitant HVI in blunt trauma patients diagnosed with hepatic and/or splenic injuries, by using the the Israel National Trauma Registry database. The authors evaluated 57,130 blunt trauma patients and identified 2335 (4%) sustained hepatic injuries without splenic injuries, 3127 (5.4%) had splenic injuries without hepatic injuries, and 564 (1%) suffered from both hepatic and splenic injuries. Overall, 957 patients sustained 1063 hollow viscus injuries. The incidence of hollow organ injuries among blunt torso trauma victims who sustained neither splenic nor hepatic injuries was 1.5% which is significantly lower than in the spleen group (3.1%), liver group (3.1%), and the combined spleen and liver injury (6.7%) groups. In the spleen injury group, there was a clear correlation between the severity of the splenic injury and the incidence of hollow viscus injuries. The authors concluded that the presence of blunt splenic and/or hepatic injuries predicts a higher incidence of HVI, especially if combined. We should watch these patients with a vigilant eye.
Article 4
Characterization of the Sex Dimorphism Following Severe Thermal Injury. Summers JI, Ziembicki JA, Corcos AC, Peitzman AB, Billiar TR, Sperry JL. J Burn Care Res. 2014 Nov-Dec;35(6):484-90.
There is increasing evidence that sex-based outcome differences exist after thermal injury. Female sex has been demonstrated to be associated with worse outcome after burn injury, and this sex dimorphism may be different from the response following other nonthermal injuries. This is a secondary analysis with 548 patients’ data retrieved from a prospective observational study designed to characterize the genetic and inflammatory response after significant thermal injury (2003-2010). Clinical outcomes were compared across sex (female vs male). The authors found that female sex was independently associated with over a 2-fold higher mortality after controlling for important confounders. The higher independent mortality risk for women was exaggerated and remained significant only in pediatric patients and demonstrated a dose–response relationship with increasing burn size (%TBSA). Survival analysis demonstrated early separation of female and male curves, and a greater independent risk of multiple organ failure was demonstrated in the pediatric cohort. The authors therefore suggested that sex-based outcome differences may be different after thermal injury compared with traumatic injury and that the sex dimorphism may be exaggerated in patients with higher burn size and in those in the pediatric age group, with female sex being associated with poor outcome. These sex-based mortality differences occur early and may be a result of a higher risk of organ failure and early differences in the inflammatory response after burn injury.
Article 5
Positive blood alcohol is associated with reduced DVT in trauma. Cook MR, Louis SG, McCully SP, Stucke RS, Fabricant SP, Schreiber MA. Injury. 2015 Jan;46(1):131-5.
Many consider alcohol (EtOH) to be undesirable when associated with trauma. This interesting study demonstrates a favorable effect of EtOH on our trauma patients. The effects of EtOH consumption on coagulopathy in trauma patients was investigated in this study with data prospectively collected on 213 trauma patients and analyzed in a retrospective secondary analysis. Thrombelastography (TEG), standard laboratory tests and ETOH levels were performed. If the level was positive, patients were grouped as EtOH+ and all patients were screened for DVT using a standard protocol. The authors found that EtOH+ group was predominantly male (76%), was younger (p<0.05), had a lower BMI (p<0.05), and demonstrated a lower AIS extremity score (p<0.01) and was less likely to have a blunt injury (p<0.01) than the EtOH- group. TEG values in the alcohol group demonstrated a relative hypocoagulable state that was associated with a reduced DVT incidence, 1.4% versus 16.2%, (p<0.01). This difference was not detected with conventional assays. By using a multivariate logistic regression model, the authors revealed that a positive EtOH level on admission was independently associated with reduced DVT incidence.
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