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Jinlong Z, Cheng W, Chengqi H. Associations of RBC counts and incidence of DVT in patients with spinal cord injury: a five year observational retrospective study. J Orthop Surg Res 2024; 19:349. [PMID: 38867298 PMCID: PMC11167836 DOI: 10.1186/s13018-024-04838-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 06/05/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND The role of red blood cell (RBC) counts as potential independent risk factors for deep vein thrombosis (DVT) in patients with spinal cord injury (SCI) remains uncertain. This study aims to clarify the associations between RBC counts and DVT incidence among this population. METHODS A retrospective analysis was performed on 576 patients with SCI admitted to the rehabilitation medicine department from January 1, 2017 to December 31, 2021. After exclusions, 319 patients were analyzed, among which 94 cases of DVT were identified. RESULTS Mode of injury, D-dimer and anticoagulant therapy were significant covariates (P < 0.05). Age, fibrinogen, D-dimer, anticoagulant therapy and American Spinal Cord Injury Association impairment scale (AIS) grades were associated with RBC counts and DVT incidence (P < 0.05). Adjusting for these factors, a 1.00 × 10^12/L increase in RBC counts correlated with a 45% decrease in DVT incidence (P = 0.042), revealing a "U" shaped relationship with a pivot at 4.56 × 10^12/L (P < 0.05). CONCLUSION RBC counts below 4.56 × 10^12/L serve as a protective factor against DVT, while counts above this threshold pose a risk. These findings could inform the development of DVT prevention strategies for patients with SCI, emphasizing the need for targeted monitoring and management of RBC counts.
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Affiliation(s)
- Zhang Jinlong
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, PR China
| | - Wang Cheng
- Department of Rehabilitation Medicine, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui Province, 230031, PR China
| | - He Chengqi
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, PR China.
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Berndtson AE, Cross A, Yorkgitis BK, Kennedy R, Kochuba MP, Tignanelli C, Tominaga GT, Jacobs DG, Ashley DW, Ley EJ, Napolitano L, Costantini TW. American Association for the Surgery of Trauma/American College of Surgeons Committee on Trauma clinical protocol for postdischarge venous thromboembolism prophylaxis after trauma. J Trauma Acute Care Surg 2024; 96:980-985. [PMID: 38523134 DOI: 10.1097/ta.0000000000004307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
ABSTRACT Trauma patients are at an elevated risk for developing venous thromboembolism (VTE), which includes pulmonary embolism and deep vein thrombosis. In the inpatient setting, prompt pharmacologic prophylaxis is utilized to prevent VTE. For patients with lower extremity fractures or limited mobility, VTE risk does not return to baseline levels postdischarge. Currently, there are limited data to guide postdischarge VTE prophylaxis in trauma patients. The goal of these postdischarge VTE prophylaxis guidelines are to identify patients at the highest risk of developing VTE after discharge and to offer pharmacologic prophylaxis strategies to limit this risk.
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Affiliation(s)
- Allison E Berndtson
- From the Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery (A.E.B., T.W.C.), UC San Diego School of Medicine, San Diego, California; University of Oklahoma Health Science Center (A.C.), Oklahoma City, Oklahoma; Division of Acute Care Surgery, Department of Surgery (B.K.Y., M.P.K.), University of Florida-Jacksonville, Jacksonville, Florida; Department of Surgery (R.K.), Baylor University Medical Center, Dallas, Texas; Department of Surgery (C.T.), University of Minnesota, Minneapolis, Minnesota; Trauma Services (G.T.T.), Scripps Memorial Hospital La Jolla, La Jolla, California; Division of Acute Care Surgery, Department of Surgery (D.G.J.), Atrium Health-Carolinas Medical Center, Charlotte, North Carolina; Mercer University School of Medicine (D.W.A.), Atrium Health Navicent, Macon, Georgia; Cedars-Sinai Medical Center (E.J.L.), Los Angeles, California; and Trauma and Surgical Critical Care, Department of Surgery (L.N.), University of Michigan Health System, Ann Arbor, Michigan
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Hall LM, Nnoromele CC, Lalla AT, Hentschel CB, Slocum C. Considerations for Contraception Following Spinal Cord Injury: A Systematic Review. Top Spinal Cord Inj Rehabil 2024; 30:1-8. [PMID: 38799610 PMCID: PMC11123607 DOI: 10.46292/sci23-00081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Introduction Counseling and education on women's health, specifically contraception, following spinal cord injury (SCI) is an important component of care for women with SCI. While a plethora of available contraceptive options exists, research in this area is scarce. Objectives This systematic review assesses the quality and quantity of research on contraception for individuals with SCI. Methods Literature searches of three medical databases were performed to identify articles that addressed contraception and family planning for women with SCI. Articles were then screened in a two-stage selection process and evaluated for content. Results Of 165 articles, 21 were identified that fit the inclusion criteria. The majority (66%) of articles were literature reviews or professional practice guidelines. Fourteen (66%) included information on short-acting hormonal oral contraception, 11 (52%) included information on long-acting reversible contraception, 15 (71%) included information on barrier methods, 6 (29%) included information on fertility awareness, 9 (43%) included information on permanent contraception, and one (5%) included information on emergency contraception. Discussion This systematic review demonstrates a paucity of evidence-based information on contraception tailored to women with SCI. It highlights a need for research and comprehensive guidelines on primary and emergency contraception in this population.
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Affiliation(s)
- Lauren M. Hall
- Spaulding Rehabilitation Hospital, Boston, Massachusetts
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
| | - Chinenye C. Nnoromele
- Shirley Ryan Ability Lab, Chicago, Illinois
- Department of Physical Medicine and Rehabilitation, Northwestern Memorial Hospital, Chicago, Illinois
| | - Amber Trujillo Lalla
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Claudia B. Hentschel
- Spaulding Rehabilitation Hospital, Boston, Massachusetts
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
| | - Chloe Slocum
- Spaulding Rehabilitation Hospital, Boston, Massachusetts
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
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Wiles MD, Benson I, Edwards L, Miller R, Tait F, Wynn-Hebden A. Management of acute cervical spinal cord injury in the non-specialist intensive care unit: a narrative review of current evidence. Anaesthesia 2024; 79:193-202. [PMID: 38088443 DOI: 10.1111/anae.16198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 01/11/2024]
Abstract
Each year approximately one million people suffer spinal cord injury, which has significant physical, psychosocial and economic impacts on patients and their families. Spinal cord rehabilitation centres are a well-established part of the care pathway for patients with spinal cord injury and facilitate improvements in functional independence and reductions in healthcare costs. Within the UK, however, there are a limited number of spinal cord injury centres, which delays admission. Patients and their families often perceive that they are not receiving specialist care while being treated in non-specialist units. This review aimed to provide clinicians who work in non-specialist spinal injury centres with a summary of contemporary studies relevant to the critical care management of patients with cervical spinal cord injury. We undertook a targeted literature review including guidelines, systematic reviews, meta-analyses, clinical trials and randomised controlled trials published in English between 1 June 2017 and 1 June 2023. Studies involving key clinical management strategies published before this time, but which have not been updated or repeated, were also included. We then summarised the key management themes: acute critical care management approaches (including ventilation strategies, blood pressure management and tracheostomy insertion); respiratory weaning techniques; management of pain and autonomic dysreflexia; and rehabilitation.
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Affiliation(s)
- M D Wiles
- Academic Department of Anaesthesia and Peri-operative Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Centre for Applied Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - I Benson
- National Spinal Injuries Centre, Buckinghamshire Hospitals NHS Trust, Stoke Mandeville, UK
| | - L Edwards
- University of Nottingham, Nottingham, UK
| | - R Miller
- Critical Care Department, Northampton General Hospital, Northampton, UK
| | - F Tait
- Critical Care Department, Northampton General Hospital, Northampton, UK
| | - A Wynn-Hebden
- Department of Anaesthesia and Critical Care, University Hospitals of Leicester NHS Trust, Leicester, UK
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Costantini TW, Bulger E, Price MA, Haut ER. Research priorities in venous thromboembolism after trauma: Secondary analysis of the National Trauma Research Action Plan. J Trauma Acute Care Surg 2023; 95:762-769. [PMID: 37322589 DOI: 10.1097/ta.0000000000004074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a significant cause of morbidity and mortality during recovery from injury and can result in significant health care costs. Despite advances in the past several decades in our approach to VTE prophylaxis after injury, opportunities exist to improve the delivery and implementation of optimal VTE prophylaxis. Here, we aim to identify consensus research questions related to VTE across all National Trauma Research Action Plan (NTRAP) Delphi expert panels to further guide the research agenda aimed at preventing VTE after injury. METHODS This is a secondary analysis of consensus-based research priorities that were collected using a Delphi methodology by 11 unique NTRAP panels that were charged with unique topic areas across the spectrum of injury care. The database of questions was queried for the keywords "VTE," "venous thromboembo," and "DVT" and then grouped into relevant topic areas. RESULTS There were 86 VTE-related research questions identified across 9 NTRAP panels. Eighty-five questions reached consensus with 24 rated high priority; 60, medium priority; and 1, low priority. Questions related to the timing of VTE prophylaxis (n = 17) were most common, followed by questions related to risk factors for the development of VTE (n = 16), the effects of tranexamic acid on VTE (n = 11), the approach to dosing of pharmacologic prophylaxis (n = 8), and the pharmacologic prophylactic medication choice for optimal VTE prophylaxis (n = 6). CONCLUSION National Trauma Research Action Plan panelists identified 85 consensus-based research questions that should drive dedicated extramural research funding opportunities to support quality studies aimed at optimizing VTE prophylaxis after injury. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level IV.
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Affiliation(s)
- Todd W Costantini
- From the Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery (T.W.C.), UC San Diego School of Medicine, San Diego, California; Division of Trauma, Burns, and Critical Care, Department of Surgery (E.B.), University of Washington, Seattle, Washington; Harborview Medical Center (E.B.), Seattle, Washington; Coalition for National Trauma Research (M.A.P.), San Antonio, Texas; Division of Acute Care Surgery, Department of Surgery (E.R.H.), Department of Anesthesiology and Critical Care Medicine (E.R.H.), and Department of Emergency Medicine (E.R.H.), The Johns Hopkins University School of Medicine, Baltimore, Maryland; The Armstrong Institute for Patient Safety and Quality (E.R.H.), Johns Hopkins Medicine, Baltimore, Maryland; and Department of Health Policy and Management (E.R.H.), The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Kyros PN, Sheppard FR, Sawhney JS, Cullinane DC, Falank CR, Smith KE, Ontengco JB, Turner EN, Chung B, Shurtleff E, Morse BC. Outcomes of Protocol-Driven Venous Thromboembolic Chemo-Prophylaxis in Trauma Patients: A Trauma Quality Improvement Project Analysis. Am Surg 2023; 89:3811-3816. [PMID: 37387458 DOI: 10.1177/00031348231173716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
INTRODUCTION Low molecular weight heparin (LMWH) is the standard for venous thromboembolic (VTE) chemo-prophylaxis in trauma patients; however, inconsistencies in the use of LMWH exist. The objective of this study was to assess VTE outcomes in response to a chemo-prophylaxis protocol guided by patient physiology (eg, creatinine clearance) and comorbidities. METHODS ACS TQIP Benchmark Reports at a level 1 trauma center using a patient physiology and comorbidity directed VTE chemo-prophylaxis protocol were analyzed for Spring 2019 to Fall 2021. Patient demographics, VTE rates and pharmacologic VTE prophylaxis type were collected for "All Patients" and "Elderly" (TQIP: age ≥ 55 years) cohorts. RESULTS Data was analyzed for 1919183 "All Hospitals" (AH) and 5843 patients single institution (SI) using the physiologic and comorbidity guided VTE chemo-prophylaxis protocol. Elderly subgroup had 701965 (AH) and 2939 (SI) patients. Use of non-LMWH chemo-prophylaxis was significantly higher at SI: All patients = 62.6% SI vs 22.1% (P < .01); Elderly = 68.8% SI vs 28.1% AH (P < .01). VTE, DVT, and PE rates for All Patients and Elderly subgroup were significantly reduced at SI, except Elderly PE which was statistically equivalent. CONCLUSIONS Protocol-driven VTE chemo-prophylaxis was associated with significantly lower LMWH use accompanied by significant reductions in All VTE, DVT, PE, and Elderly VTE and DVT with no difference in Elderly PE rates. These results may imply that adherence to a physiologic and comorbidity directed chemo-prophylaxis protocol, rather than LMWH, reduces VTE events in trauma patients. Further investigation to elucidate best practice is warranted.
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Affiliation(s)
- Peter N Kyros
- Division of Acute Care Surgery, Department of Surgery, Maine Medical Center, Portland, ME, USA
| | - Forest R Sheppard
- Division of Acute Care Surgery, Department of Surgery, Maine Medical Center, Portland, ME, USA
| | - Jaswin S Sawhney
- Division of Acute Care Surgery, Department of Surgery, Maine Medical Center, Portland, ME, USA
| | - Daniel C Cullinane
- Division of Acute Care Surgery, Department of Surgery, Maine Medical Center, Portland, ME, USA
| | - Carolyne R Falank
- Division of Acute Care Surgery, Department of Surgery, Maine Medical Center, Portland, ME, USA
| | - Kathryn E Smith
- Division of Acute Care Surgery, Department of Surgery, Maine Medical Center, Portland, ME, USA
| | - Julianne B Ontengco
- Division of Acute Care Surgery, Department of Surgery, Maine Medical Center, Portland, ME, USA
| | - Elizabeth N Turner
- Division of Acute Care Surgery, Department of Surgery, Maine Medical Center, Portland, ME, USA
| | - Bruce Chung
- Division of Acute Care Surgery, Department of Surgery, Maine Medical Center, Portland, ME, USA
| | - Eric Shurtleff
- Division of Acute Care Surgery, Department of Surgery, Maine Medical Center, Portland, ME, USA
| | - Bryan C Morse
- Division of Acute Care Surgery, Department of Surgery, Maine Medical Center, Portland, ME, USA
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Ratnasekera A, Geerts W, Haut ER, Price M, Costantini T, Murphy P. Implementation science approaches to optimizing venous thromboembolism prevention in patients with traumatic injuries: Findings from the 2022 Consensus Conference to Implement Optimal Venous Thromboembolism Prophylaxis in Trauma. J Trauma Acute Care Surg 2023; 94:490-494. [PMID: 36729882 PMCID: PMC9974883 DOI: 10.1097/ta.0000000000003850] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
ABSTRACT Disease burden of venous thromboembolism (VTE) without pharmacologic prophylaxis is high in trauma patients. Although VTE prophylaxis guidelines exist, studies on real-world use of VTE prophylaxis in trauma shows limited uptake of guideline recommendations. Despite existing guidelines, reports indicate that VTE prophylaxis implementation across trauma centers is lagging. Implementation barriers of VTE prophylaxis in trauma are multifactorial, and VTE prescribing practices require further optimization. Implementation science methods can help standardize and improve care; well-established approaches in medical and surgical hospitalized patients and their effects on clinical outcomes such as VTE and bleeding complications must be investigated because they apply to trauma patients. Nonadministration of VTE prophylaxis medications in hospitalized patients is associated with VTE events and remains a barrier to providing optimal defect-free care. Further investigations are required for VTE prophylaxis implementation across all trauma populations.
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Affiliation(s)
- Asanthi Ratnasekera
- From the Department of Surgery (A.R.), Division of Trauma and Surgical Critical Care, Drexel College of Medicine, Philadelphia, Pennsylvania; Christianacare Health (A.R.), Newark, Delaware; Thromboembolism Program, Sunnybrook Health Sciences Centre, Department of Medicine (W.G.), University of Toronto, Toronto, Canada; Division of Acute Care Surgery, Department of Surgery (E.R.H.), Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Anesthesiology and Critical Care Medicine (E.R.H.), Johns Hopkins University School of Medicine, Baltimore, Maryland; and Department of Emergency Medicine (E.R.H.), Johns Hopkins University School of Medicine, Baltimore, Maryland, Armstrong Institute for Patient Safety and Quality (E.R.H.), Johns Hopkins Medicine Baltimore, Maryland; Department of Health Policy and Management (E.R.H.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Coalition for National Trauma Research (M.P.), San Antonio, Texas; Division of Trauma, Surgical Critical Care and Burn Surgery, Department of Surgery (T.C.), University of California San Diego, California; and Division of Trauma and Acute Care Surgery, Department of Surgery (P.M.), Medical College of Wisconsin, Milwaukee, Wisconsin
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