bluuebunny/crossref_metadata_2025_split huggingface dataset:
Research Priorities for Plasma and Platelet Transfusion Strategies in Critically Ill Children: From the Transfusion and Anemia EXpertise Initiative–Control/Avoidance of Bleeding
Authors: Nellis Marianne E. , Remy Kenneth E. , Lacroix Jacques , Cholette Jill M. , Bembea Melania M. , Russell Robert T. , Steiner Marie E. , Goobie Susan M. , Vogel Adam M. , Crighton Gemma , Valentine Stacey L. , Delaney Meghan , Parker Robert I. ,   for the Pediatric Critical Care Transfusion and Anemia EXpertise Initiative–Control/Avoidance of Bleeding (TAXI-CAB), in collaboration with the Pediatric Critical Care Blood Research Network (BloodNet), and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network
Published: January 2022

Objectives:
To present a list of high-priority research initiatives for the study of plasma and platelet transfusions in critically ill children from the Transfusion and Anemia EXpertise Initiative–Control/Avoidance of Bleeding.

Design:
Systematic review and consensus conference of international, multidisciplinary experts in platelet and plasma transfusion management of critically ill children.

Setting:
Not applicable.

Patients:
Critically ill pediatric patients at risk of bleeding and receiving plasma and/or platelet transfusions.

Interventions:
None.

Measurements and Main Results:
A panel of 13 experts developed research priorities for the study of plasma and platelet transfusions in critically ill children which were reviewed and ratified by the 29 Transfusion and Anemia EXpertise Initiative–Control/Avoidance of Bleeding experts. The specific priorities focused on the following subpopulations: severe trauma, traumatic brain injury, intracranial hemorrhage, cardiopulmonary bypass surgery, extracorporeal membrane oxygenation, oncologic diagnosis or stem cell transplantation, acute liver failure and/or liver transplantation, noncardiac surgery, invasive procedures outside of the operating room, and sepsis and/or disseminated intravascular coagulation. In addition, tests to guide plasma and platelet transfusion, as well as component selection and processing, were addressed. We developed four general overarching themes and 14 specific research priorities using modified Research and Development/University of California, Los Angeles methodology.

Conclusions:
Studies are needed to focus on the efficacy/harm, dosing, timing, and outcomes of critically ill children who receive plasma and/or platelet transfusions. The completion of these studies will facilitate the development of evidence-based recommendations.
Prevalence of and Associations With Avascular Necrosis After Pediatric Sepsis: A Single-Center Retrospective Study
Authors: Periasamy Uvaraj , Chilutti Marianne , Kaplan Summer L. , Hickey Christopher P. , Hayes Katie , Pennington Jeffrey W. , Balamuth Fran , Fitzgerald Julie C. , Weiss Scott L. 
Published: January 2022

OBJECTIVES:
Avascular necrosis (AVN) is a rare, but serious, complication after sepsis in adults. We sought to determine if sepsis is associated with postillness diagnosis of AVN, as well as potential-associated risk factors for AVN in children with sepsis.

DESIGN:
Retrospective observational study.

SETTING:
Single academic children’s hospital.

PATIENTS:
Patients less than 18 years treated for sepsis or suspected bacterial infection from 2011 to 2017. Patients who developed AVN within 3 years after sepsis were compared with patients who developed AVN after suspected bacterial infection and with patients with sepsis who did not develop AVN.

INTERVENTION:
None.

MEASUREMENTS AND MAIN RESULTS:
AVN was determined using International Classification of Diseases, 9th Edition/10th Edition codes and confirmed by chart review. The prevalence of AVN after sepsis was 0.73% (21/2,883) and after suspected bacterial infection was 0.43% (53/12,276; risk difference, 0.30; 95% CI, 0.0–0.63; p = 0.05). Compared with 43 sepsis controls without AVN, AVN in the 21 sepsis cases was associated with being older, having sickle cell disease and malignancy, higher body mass index, unknown source of infection, and low platelet count in the first 7 days of sepsis. Half of sepsis patients were treated with corticosteroids, and higher median cumulative dose of steroids was associated with AVN (23.2 vs 5.4 mg/kg; p < 0.01). Older age at infection (odds ratio [OR], 1.3; 95% CI, 1.1–1.4), malignancy (OR, 8.8; 95% CI, 2.6–32.9), unknown site of infection (OR, 12.7; 95% CI, 3.3–48.6), and minimal platelet count less than 100,000/µL in first 7 days of sepsis (OR, 5.0; 95% CI, 1.6–15.4) were identified as potential risk factors for AVN after sepsis following adjustment for multiple comparisons.

CONCLUSIONS:
Although rare, sepsis was associated with a higher risk of subsequent AVN than suspected bacterial infection in children. Older age, malignancy, unknown site of infection, and minimum platelet count were potential risk factors for AVN after sepsis.
Agreement Between Peak Inspiratory Pressure in Decelerating-Flow Ventilation and Plateau Pressure in Square-Flow Ventilation in Pediatric Acute Respiratory Distress Syndrome*
Authors: Patel Bhavesh , Thomas Neal J. , Yehya Nadir 
Published: January 2022

OBJECTIVES:
Acute respiratory distress syndrome guidelines suggest limiting plateau pressures to 28–30 cm H2O. Plateau pressure is most accurately measured in square-flow modes, such as volume control. In children, decelerating-flow modes, such as pressure-regulated volume control and pressure control, are more common. Consequently, plateau pressures are rarely obtained, and pressure limits are instead provided for peak inspiratory pressure. The degree to which peak inspiratory pressure in decelerating-flow overestimates plateau pressure is unknown. Therefore, we assessed the correlation and accuracy of peak inspiratory pressure in decelerating-flow ventilation for approximating plateau pressure during square-flow ventilation.

DESIGN:
Prospective, observational study.

SETTING:
Tertiary, academic PICU.

PATIENTS:
Fifty-two intubated children with acute respiratory distress syndrome enrolled between January 2020 and May 2021.

INTERVENTIONS:
Measurement of peak inspiratory pressure in decelerating-flow ventilation and plateau pressure after transition to square-flow ventilation.

MEASUREMENTS AND MAIN RESULTS:
Peak inspiratory pressure in decelerating-flow was highly correlated (r
2 = 0.99; p < 0.001) with plateau pressure in square-flow. Peak inspiratory pressure was 1.0 ± 0.6 cm H2O higher than plateau pressure, with 96% of values within 2 cm H2O. The single outlier had coexistent asthma and inspiratory flows that did not reach zero.

CONCLUSIONS:
Peak inspiratory pressure measured during decelerating-flow ventilation may be an adequate surrogate of plateau pressure in pediatric acute respiratory distress syndrome when inspiratory flow approaches zero. Practitioners should be aware that peak inspiratory pressures in decelerating-flow may not be substantially higher than plateau pressures.
Quantification of Pneumothorax Volume on Chest X-Ray
Authors: Aguinagalde Borja , Zabaleta Jon , López Iker , Izquierdo Jose M. , Mendoza Mikel , Garmendia Eñaut , Fernandez-Monge Arantza , Lizarbe Jon A. 
Published: January 2022

Purpose:
Owing to the extent of lung collapse estimated on chest radiograph it is still the complementary test most commonly used in the management of patients with pneumothorax. There are several indices to assess the extent of lung collapse. The objective of this study was to develop a more accurate index, using the 3D printing technology.

Materials and Methods:
We created physical hemithorax models using 3D printing. In this way, we obtained simple radiographs of models for which the lung volume was known accurately. In the first part of the study, we estimated the intraobserver and interobserver agreement as well as the agreement between methods. We created 2 new indices and the results obtained with these; the Light index and the Collins method were compared with data on real lung volume loss using linear regression analysis and by calculating the coefficient of determination (r
2). In the second part of the study, we validated the 4 equations, comparing the Light index, the Collins method, and the 2 new indices using regression analysis. For this analysis, we used STATA V14.

Results:
Both intraobserver and interobserver agreements were very high (<0.9). The agreement between the Collins method and the Light index was poor, with a mean difference of 18.6%. The equation that best represented real lung collapse was the new equation 2.

Conclusions:
This study demonstrates the poor agreement between the Light index and Collins method for measuring the extent of lung collapse in pneumothorax and proposes a more accurate equation for this measurement based on a simple chest radiograph.
Socioeconomic disadvantage is associated with greater mortality after high-risk emergency general surgery
Authors: Cain Brian T. , Horns Joshua J. , Huang Lyen C. , McCrum Marta L. 
Published: January 2022

BACKGROUND
Socioeconomic disadvantage is associated with worse outcomes after elective surgery, but the effect on emergency general surgery (EGS) remains unclear. We examined the association of socioeconomic disadvantage and outcomes after EGS procedures and investigated whether admission to hospitals with comprehensive clinical and social resources mitigated this effect.

METHODS
Adults undergoing 1 of the 10 most burdensome high- and low-risk EGS procedures were identified in six 2014 State Inpatient Databases. Socioeconomic disadvantage was assessed using Area Deprivation Index (ADI) of patient residence. Multivariable logistic regression models adjusting for patient and hospital factors were used to evaluate the association between ADI quartile (high >75 percentile vs. low <25 percentile), and 30-day readmission, in-hospital mortality, and discharge disposition. Effect modification between ADI and (a) level 1 trauma center and (b) safety-net hospital status was tested.

RESULTS
A total of 103,749 patients were analyzed: 72,711 low-risk (70.1%) and 31,038 high-risk procedures (29.9%). Patients from neighborhoods with high socioeconomic disadvantage had a higher proportion with ≥3 comorbidities (41.9% vs. 32.0%), minority race/ethnicity (66.3% vs. 42.4%), and Medicaid (28.8% vs. 14.7%) and were less likely to be treated at level 1 trauma centers (18.3% vs. 27.7%; p < 0.001 for all). Adjusting for competing factors, high socioeconomic disadvantage was associated with increased in-hospital mortality after high-risk procedures (odd ratio, 1.30; 95% confidence interval, 1.01–1.66; p = 0.04) and higher odds of non–home discharge (odd ratio, 1.15; 95% confidence interval, 1.02–1.30; p = 0.03) for low-risk procedures. Socioeconomic disadvantage was not associated with 30-day readmission for either procedure group. Level 1 trauma status and safety-net hospital did not meaningfully mitigate effect of ADI for any outcome.

CONCLUSION
Socioeconomic disadvantage is associated with increased mortality after high-risk procedures and higher odds of non–home discharge after low-risk procedures. This effect was not mitigated by either level 1 trauma or safety-net hospitals. Interventions that specifically address the needs of socially vulnerable communities will be required to significantly improve EGS outcomes for this population.

LEVEL OF EVIDENCE
Prognostic and Epidemiologic, level III.
Can blood loss be assessed by echocardiography? An experimental study on a controlled hemorrhagic shock model in piglets
Authors: Grau-Mercier Laura , Coisy Fabien , Markarian Thibaut , Muller Laurent , Roger Claire , Lefrant Jean-Yves , Claret Pierre-Géraud , Bobbia Xavier 
Published: January 2022

BACKGROUND
Assessment of the volemic loss is a major challenge during the management of hemorrhagic shock. Echocardiography is an increasingly used noninvasive tool for hemodynamic assessment. In mechanically ventilated patients, some studies suggest that respiratory variations of mean subaortic time-velocity integral (∆VTI) would be predictive of fluid filling response. An experimental model of controlled hemorrhagic shock provides a precise approach to study correlation between blood volume and cardiac ultrasonographic parameters.

OBJECTIVES
The main objective was to analyze the ∆VTI changes during hemorrhage in an anesthetized-piglet model of controlled hemorrhagic shock. The secondary objective was to evaluate ∆VTI during the resuscitation process after hemorrhage and other echocardiographic parameters changes during the whole protocol.

METHODS
Twenty-four anesthetized and ventilated piglets were bled until mean arterial pressure reached 40 mm Hg. Controlled hemorrhage was maintained for 30 minutes before randomizing the piglets to two resuscitation groups: fluid filling group resuscitated with saline solution and noradrenaline group resuscitated with saline solution and noradrenaline. Echocardiography and hemodynamic measures, including pulsed pressure variations (PPV), were performed at different stages of the protocol.

RESULTS
The correlation coefficient between ΔVTI and PPV with the volume of bleeding during the hemorrhagic phase were respectively 0.24 (95% confidence interval, 0.08–0.39; p < 0.01) and 0.57 (95% CI, 0.44–0.67; p < 0.01). Two parameters had a moderate correlation coefficient with hemorrhage volume (over 0.5): mean subaortic time-velocity index (VTI) and mitral annulus diastolic tissular velocity (E′).

CONCLUSION
In this hemorrhagic shock model, ΔVTI had a low correlation with the volume of bleeding, but VTI and E′ had a correlation with blood volume comparable to that of PPV.
Risk factors for stroke in penetrating carotid trauma—An analysis from the PROOVIT Registry
Authors: O'Banion Leigh Ann , Dirks Rachel C. , Siada Sammy S. , Dubose Joseph J. , Inaba Kenji , Byerly Saskya , Rajani Ravi R. , Morrison Jonathan J. , Lucero Leah , Magee Gregory A. 
Published: January 2022

BACKGROUND
Penetrating carotid injuries are associated with an up to 20% risk of stroke. This study evaluated patients in the American Association for Surgery of Trauma PROspective Observational Vascular Injury Trial, with the aim of determining factors associated with stroke and stroke or death.

METHODS
Penetrating extracranial carotid injuries in the American Association for Surgery of Trauma PROspective Observational Vascular Injury Trial registry from 2012 to 2020 were queried. Isolated external carotid injuries were excluded. Patients with documented postinjury in-hospital stroke were compared with those without. Significant predictors (p < 0.1) for stroke and stroke or death on univariate analysis were included in multivariate analyses.

RESULTS
One hundred two patients from 17 institutions were included. Mean age was 35 ± 18 years, and 80% were male. Average Glasgow Coma Scale (GCS) score on presentation was 9 ± 5, with an Injury Severity Score [ISS] of 22 ± 13. Operative management occurred in 51% of patients who were significantly more hypotensive (systolic blood pressure: 109 vs. 131 mm Hg; p = 0.015) with a lower initial pH (7.17 vs. 7.31; p = 0.001) and presented with hard signs of vascular injury (74% vs. 26%; p < 0.001). Overall stroke rate was 17% (23% operative vs. 10% nonoperative, p = 0.076). Rate of stroke or death was 27% (64% operative and 36% nonoperative). On multivariate analysis, lower GCS (p = 0.05) and completion angiography (p = 0.04) were associated with stroke. Likewise lower GCS (p = 0.015) and ISS (p = 0.04) were associated with stroke or death.

CONCLUSION
Penetrating carotid trauma undergoing operative management had a stroke rate of 23%. Low GCS on arrival and need for completion angiography are independently associated with postinjury in-hospital stroke, whereas low GCS on arrival and ISS were associated with stroke or death. The ideal treatment strategy remains elusive, thus a dedicated multicenter study may help to achieve higher fidelity data on this rare but devastating injury.

LEVEL OF EVIDENCE
Prognostic and Epidemiological, Level III.
Screening tools for predicting posttraumatic stress disorder in acutely injured adult trauma patients: A systematic review
Authors: Jensen Stephanie Marie , Abrahamsen Imani , Baumgarten Mark , Gallaher Jared , Feltner Cynthia 
Published: January 2022

BACKGROUND
Adult trauma patients are at risk of developing posttraumatic stress disorder (PTSD). Early intervention reduces the development of PTSD, but few trauma patients seek and obtain care. Valid and reliable screening tools are needed to identify patients at risk of developing PTSD. The objective of this review is to identify existing screening tools and evaluate their accuracy for predicting PTSD outcomes.

METHODS
PubMed, PsychInfo, and ClinicalTrials.gov were searched for studies evaluating the predictive accuracy of PTSD screening tools among traumatically injured adult civilians. Eligible studies assessed patients during acute hospitalization and at least 1 month following injury to measure PTSD outcome. Eligible outcomes included measures of predictive accuracy, such as sensitivity and specificity. The Quality Assessment of Diagnostic Accuracy Studies 2 tool was used to assess the risk of bias of each study, and the strength of evidence was assessed following the Agency for Healthcare Research and Quality guidelines.

RESULTS
Forty-nine studies were included evaluating the predictive accuracy of 38 screening tools. Most tools were assessed in a single study. Questionnaire-style tools had more favorable predictive ability than diagnostic interview assessments. The Injured Trauma Survivor Screen, Posttraumatic Adjustment Screen, the PTSD Checklist for DSM-5, and the Richmond et al. tool demonstrated the most favorable predictive accuracy, with high sensitivity (75–100%) and specificity (67–94%). Common sources of bias were selection bias due to high attrition rate and using nondiagnostic tools to assess PTSD symptoms at follow-up.

CONCLUSION
Although sensitivity and specificity of PTSD predictive tools varied widely, several emerged with favorable predictive accuracy. Further research is needed to define the ability of screening and intervention to prevent PTSD in injured trauma survivors. The results of this review can inform screening tool options for screening programs and future intervention studies.

LEVEL OF EVIDENCE
Systematic review, level III.
Preperitoneal packing versus angioembolization for the initial management of hemodynamically unstable pelvic fracture: A systematic review and meta-analysis
Authors: McDonogh Jack M. , Lewis Daniel P. , Tarrant Seth M. , Balogh Zsolt J. 
Published: January 2022

BACKGROUND
Hemodynamically unstable pelvic fracture patients are challenging to manage. Preperitoneal packing (PPP) and angioembolization (AE) are two interventions commonly used to help gain hemorrhage control. Recently, there has been a tendency to support PPP in hemodynamically unstable pelvic fracture seemingly in direct comparison with AE. However, it seems that key differences between published cohorts exist that limits a comparison between these two modalities.

METHODS
A systematic literature search of the MEDLINE, CINAHL, and EMBASE databases was conducted. Prospective and retrospective studies were eligible. No limitation was placed on publication date, with only manuscripts printed in English eligible (PROSPERO CRD42021236219). Included studies were retrospective and prospective cohort studies and a quasirandomized control trial. Studies reported demographic and outcome data on hemodynamically unstable patients with pelvis fractures that had either PPP or AE as their initial hemorrhage control intervention. The primary outcome was in-hospital mortality rate. Eighteen studies were included totaling 579 patients, of which 402 were treated with PPP and 177 with AE.

RESULTS
Significant differences were found between AE and PPP in regard to age, presence of arterial hemorrhage, Injury Severity Score, and time to intervention. The crude mortality rate for PPP was 23%, and for AE, it was 32% (p = 0.001). Analysis of dual-arm studies showed no significant difference in mortality. Interestingly, 27% of patients treated with PPP did not get adequate hemorrhage control and required subsequent AE.

CONCLUSION
Because of bias, heterogeneity, and inadequate reporting of physiological data, a conclusive comparison between modalities is impossible. In addition, in more than a quarter of the cases treated with PPP, the patients did not achieve hemorrhage control until subsequent AE was performed. This systematic review highlights the need for standardized reporting in this high-risk group of trauma patients.

LEVEL OF EVIDENCE
Systematic review and meta-analysis, level III.
Length of stay and trauma center finances: A disparity of payer source at a Level I trauma center
Authors: Chavez Marin A. , Bogert James N. , Soe-Lin Hahn , Jacobs Jordan V. , Chapple Kristina M. , Weinberg Jordan A. 
Published: January 2022

BACKGROUND
In an effort to reduce costs, hospitals focus efforts on reducing length of stay (LOS) and often benchmark LOS against the geometric LOS (GMLOS) as predicted by the assigned diagnosis-related group (DRG) used by the Centers for Medicare and Medicaid Services. The objective of this cross-sectional study was to evaluate the impact of exceeding GMLOS on hospital profit/loss with respect to payer source.

METHODS
Contribution margin for each insured patient admitted to a Level I trauma center between July 1, 2016, and June 30, 2019, was determined. Age, ethnicity, race, DRG weight, DRG version, injury severity, intensive care unit admission status, mechanical ventilation, payer, exceeding GMLOS, and the interaction between payer and exceeding the GMLOS were regressed on contribution margin to determine significant predictors of positive contribution margin.

RESULTS
Among 2,449 insured trauma patients, the distribution of payers was Medicaid (54.6%), Medicare (24.0%), and commercial (21.4%). Thirty-five percent (n = 867) of patient LOS exceeded GMLOS. Exceeding GMLOS by 10 or more days was significantly more likely for Medicaid and Medicare patients in stepwise fashion (commercial, 2.7%; Medicaid, 4.5%; Medicare, 6.0%; p = 0.030). Median contribution margin was positive for commercially insured patients ($16,913) and negative for Medicaid (−$8,979) and Medicare (−$2,145) patients. Adjusted multivariate modeling demonstrated that when exceeding GMLOS, Medicare and Medicaid cases were less likely than commercial payers to have a positive contribution margin (p < 0.001 and p < 0.001).

CONCLUSION
Government-insured patients, despite having a payer source, are a financial burden to a trauma center. Excess LOS among government insured patients, but not the commercially insured, exacerbates financial loss. A shift toward a greater proportion of government insured patients may result in a significant fiscal liability for a trauma center.

LEVEL OF EVIDENCE
Economic and Value-Based Evaluation, Level III.