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The effectiveness of cryoprecipitate (Cryo) in trauma has not been well established; the benefits of Cryo might have been overestimated in previous studies since the difference in the total amount of administered clotting factors was not considered. We aimed to evaluate the benefits of the concurrent use of Cryo in combination with fresh frozen plasma (FFP) for bleeding trauma patients.Retrospective cohort study.The American College of Surgeons Trauma Quality Improvement Program database between 2015 and 2019.Patients who received greater than or equal to 5 units of packed RBCs and at least 1 unit of FFP within the first 4 hours after arrival to a hospital were included and dichotomized according to whether Cryo was used within the first 4 hours of hospital arrival.None.The outcomes of patients treated with Cryo and FFP were compared with those treated with FFP only using propensity score-matching analysis. The dose of administered clotting factors in each group was balanced. The primary outcome was inhospital mortality, and the secondary outcome was the occurrence rate of adverse events. A total of 24,002 patients (Cryo+FFP group: 6,018; FFP only group: 17,984) were eligible for analysis, of whom 4,852 propensity score-matched pairs were generated. Significantly lower inhospital mortality (1,959 patients [40.4%] in the Cryo+FFP group vs 2,142 patients [44.1%] in the FFP only group; odds ratio [OR], 0.86; 95% CI, 0.79-0.93) was observed in the Cryo+FFP group; no significant difference was observed in the occurrence rate of adverse events (1,857 [38.3%] vs 1,875 [38.6%]; OR, 1.02; 95% CI, 0.94-1.10). Several sensitivity analyses showed similar results.Cryo use combined with FFP was significantly associated with reduced mortality in bleeding trauma patients. Future randomized controlled trials are warranted to confirm these results.

To investigate the impact of body temperature on disease severity, implementation of sepsis bundles, and outcomes in severe sepsis patients.Retrospective sub-analysis.Fifty-nine ICUs in Japan, from January 2016 to March 2017.Adult patients with severe sepsis based on Sepsis-2 were enrolled and divided into three categories (body temperature36°C, 36-38°C,38°C), using the core body temperature at ICU admission.None.Compliance with the bundles proposed in the Surviving Sepsis Campaign Guidelines 2012, in-hospital mortality, disposition after discharge, and the number of ICU and ventilator-free days were evaluated. Of 1,143 enrolled patients, 127, 565, and 451 were categorized as having body temperature less than 36°C, 36-38°C, and greater than 38°C, respectively. Hypothermia-body temperature less than 36°C-was observed in 11.1% of patients. Patients with hypothermia were significantly older than those with a body temperature of 36-38°C or greater than 38°C and had a lower body mass index and higher prevalence of septic shock than those with body temperature greater than 38°C. Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores on the day of enrollment were also significantly higher in hypothermia patients. Implementation rates of the entire 3-hour bundle and administration of broad-spectrum antibiotics significantly differed across categories; implementation rates were significantly lower in patients with body temperature less than 36°C than in those with body temperature greater than 38°C. Implementation rate of the entire 3-hour resuscitation bundle + vasopressor use + remeasured lactate significantly differed across categories, as did the in-hospital and 28-day mortality. The odds ratio for in-hospital mortality relative to the reference range of body temperature greater than 38°C was 1.760 (95% CI, 1.134-2.732) in the group with hypothermia. The proportions of ICU-free and ventilator-free days also significantly differed between categories and were significantly smaller in patients with hypothermia.Hypothermia was associated with a significantly higher disease severity, mortality risk, and lower implementation of sepsis bundles.

To evaluate the utility of the conventional lethal triad in current trauma care practice and to develop novel criteria as indicators of treatment strategy.Retrospective observational study.Fifteen acute critical care medical centers in Japan.In total, 796 consecutive trauma patients who were admitted to emergency departments with an injury severity score of greater than or equal to 16 from January 2012 to December 2012.None.All data were retrospectively collected, including laboratory data on arrival. Sensitivities to predict trauma death within 28 days of prothrombin time international normalized ratio greater than 1.50, pH less than 7.2, and body temperature less than 35°C were 15.7%, 17.5%, and 15.9%, respectively, and corresponding specificities of these were 96.4%, 96.6%, and 93.6%, respectively. The best predictors associated with hemostatic disorder and acidosis were fibrin/fibrinogen degradation product and base excess (the cutoff values were 88.8 µg/mL and -3.05 mmol/L). The optimal cutoff value of hypothermia was 36.0°C. The impact of the fibrin/fibrinogen degradation product and base excess abnormality on the outcome were approximately three- and two-folds compared with those of hypothermia. Using these variables, if the patient had a hemostatic disorder alone or a combined disorder with acidosis and hypothermia, the sensitivity and specificity were 80.7% and 66.8%.Because of the low sensitivity and high specificity, conventional criteria were unsuitable as prognostic indicators. Our revised criteria are assumed to be useful for predicting trauma death and have the potential to be the objective indicators for activating the damage control strategy in early trauma care.

OBJECTIVES:: To assess both the incidence of new-onset psychiatric illness after involvement in a motor vehicle accident in Japan for comparison with Western data and the predictors of psychiatric morbidity and posttraumatic stress disorder (PTSD) evaluated immediately after the accident. DESIGN:: Prospective cohort study of injured patients assessed immediately and 4-6 wks after involvement in a motor vehicle accident. SETTING:: Intensive care unit in a teaching hospital in Tokyo, Japan. PATIENTS:: Total of 100 consecutive patients with motor vehicle accident-related injuries (mean Injury Severity Score, 11.2; mean Glasgow Coma Scale, 14.5; age, 18-69 yrs) admitted to the intensive care unit. Patients with traumatic brain injury, suicidality, current psychiatric or neurologic illness, or cognitive impairment were excluded. MEASUREMENTS:: An extensive clinical interview and evaluation of vital signs, sociodemographic variables, previous traumatic events, family history of psychopathology, Impact of Event Scale-Revised, Hospital Anxiety and Depression Scale, Clinician-Administered PTSD Scale, and Mini-International Neuropsychiatric Interview. RESULTS:: A total of 31 patients showed some form of new-onset psychiatric illness at the 4- to 6-wk follow-up. The majority of illnesses consisted of depression (major depression, n = 16; minor depression, n = 7) and PTSD (full PTSD, n = 8; partial PTSD, n = 16). Other illnesses included alcohol dependence (n = 3), obsessive-compulsive disorder (n = 2), agoraphobia (n = 2), and social phobia (n = 1). Both psychiatric morbidity and PTSD were predicted by a sense of life threat (odds ratio, 4.2 and 6.2, respectively), elevated heart rate (odds ratio, 1.6 and 1.7), and higher Impact of Event Scale-Revised intrusion subscale score (odds ratio, 1.1 ands 1.1). CONCLUSION:: This study showed that psychopathology and PTSD after a motor vehicle accident in Japan is common and that the incidence is within the range of that in Western countries. A combination of a sense of life threat, heart rate, and Impact of Event Scale-Revised intrusion subscale allowed for significant prediction of psychiatric morbidity and PTSD. Language: en