Cost Savings of Whole Blood Versus Component Therapy at a Community Level 1 Trauma Center

BACKGROUND

Blood product component-only resuscitation (CORe) has been the standard of practice in both military and civilian trauma care with a 1:1:1 ratio used in attempt to recreate whole blood (WB) until recent data demonstrated WB to confer a survival advantage, leading to the emergence of WB as the contemporary resuscitation strategy of choice. Little is known about the cost and waste reduction associated with WB vs CORe.

METHODS

This study is a retrospective single-center review of adult trauma patients admitted to a community trauma center who received WB or CORe as part of their massive transfusion protocol (MTP) resuscitation from 2017 to 2021. The WB group received a minimum of one unit WB while CORe received no WB. Univariate and multivariate analyses were completed. Statistical analysis was conducted using a 95% confidence level. Non-normally distributed, continuous data were analyzed using the Wilcoxon rank sum test.

RESULTS

576 patients were included (201 in WB and 375 in CORe). Whole blood conveyed a survival benefit vs CORe (OR 1.49 P < .05, 1.02-2.17). Whole blood use resulted in an overall reduction in products prepared (25.8%), volumes transfused (16.5%), product waste (38.7%), and MTP activation (56.3%). Cost savings were $849 923 annually and $3 399 693 over the study period.

DISCUSSION

Despite increased patient volumes over the study period (43.7%), the utilization of WB as compared to CORe resulted in an overall $3.39 million cost savings while improving mortality. As such, we propose WB should be utilized in all resuscitation strategies for the exsanguinating trauma patient.

Cross-Resistance of Succinate Dehydrogenase Inhibitors (SDHI) in Botrytis cinerea and Development of Molecular Diagnostic Tools for SDHI Resistance Detection

Succinate dehydrogenase inhibitors (SDHIs) are keystone synthetic fungicides used to manage Botrytis cinerea in several hosts. In this study, we investigated the cross-resistance between five new SDHIs (pyraziflumid, isofetamid, benzovindiflupyr, fluxapyroxad, and pydiflumetofen) with commonly used SDHIs boscalid and fluopyram. Different mutations were detected in the sdhB gene in B. cinerea collected from Michigan grapes, and their frequency and EC50 value were determined. Among 216 B. cinerea boscalid-resistant isolates, five different mutations were detected, including H272R/Y, P225F/H, and N230I, at frequencies of 82.6, 4.3, 11.5, 0.4, and 5.3%, respectively. Five isolates of each genotype were used to screen the cross-resistance of the SDHIs. We classified the resistance profile of our mutants into five patterns. We report that all tested mutants were sensitive to benzovindiflupyr, indicating that it can be used as an effective fungicide against all B. cinerea mutants identified in this study. In addition, fluopyram, pydiflumetofen, and isofetamid can provide effective control according to which type of mutation is present in the field. We also developed and compared two molecular diagnostic tools, rhAMP and TaqMan assays, for rapid detection of SDHI resistance-associated mutants in B. cinerea. We report that the TaqMan assay was more successful than the rhAMP assay in detecting the B. cinerea mutant DNA at ≤10 pg and in a single assay was capable of monitoring two amino acid positions. Our results provide essential information about new SDHIs and provide molecular tools for monitoring SDHI resistance mutations, which will assist in gray mold disease control.

Whole Blood Trauma Resuscitation in Community Trauma Centers Confers Survival Benefit Over Component Therapy

Whole blood (WB) for trauma resuscitation in civilian populations has become more common. The utilization of WB in community trauma centers has not been reported. Previous studies have centered around large academic medical centers. We hypothesized that WB-based resuscitation compared to component-only resuscitation (CORe) would demonstrate a survival benefit and that WB resuscitation is safe, feasible, and benefits trauma patients regardless of setting. Our results indicate that receiving whole blood during resuscitation conferred a clear survival benefit to discharge, and this benefit was independent of ISS, age, gender, and initial SBP. We conclude WB should be incorporated into all resuscitation protocols for exsanguinating trauma patients and preferred over component therapy in all centers treating trauma patients.

[Ultrasound anatomy of the liver]

The authors review the modern concept of liver anatomy, related to the needs of surgeons in segmental resections. Important anatomical structures are described participating in division of the liver into four basic segments. The ultrasound anatomy of portal system, hepatic veins, hepatic fissures and liver hilus are dealt with in detail. Criteria for perfect examination of the liver by ultrasound are defined and representability of key anatomical structure under optimal conditions is analyzed in a group of 100 patients. The only non-constantly represented structure was fissura interlobaris (44%). Hepatic veins proved to be the most variable structures (17%). The results show that segmental anatomy of the liver may be very well represented by ultrasound. The authors discuss the importance of perfect knowledge of anatomy for quality examination.

Melanotic neuroectodermal neurocranial tumor of infancy of extra-intra-and subdural right temporal location: CT examination, surgical treatment, literature review

A melanotic neuroectodermal neurocranial tumor of infancy of extra-intra-subdural right temporal location, examined by CT and successfully operated in a 33-month-old boy is reported in context with the literature. Out of 30 cases (including our case) of melanotic neuroectodermal neurocranial and intracranial tumors (MNNIT) 18 were located in the neurocranium (MNNT) and 12 intracranially, i.e. in the brain and cerebellum (MNIT). 23 tumors were located medially (11 at the anterior fontanel, one at the posterior fontanel, one in the 3rd ventricle, one in the sella turcica, one in the pineal region, 8 in the cerebellar vermis) and 7 laterally (five involved the temporal bone, one of which with intracranial propagation (our case), one in the temporal lobe of the brain, one in the skull posterior to the mastoid process). Twenty-eight cases were children (16 boys, 8 girls, four not stated), two adults. The location is important in respect to biology and surgery: MNNIT can be grouped as to its relation to the arachnoid barrier layer into malignant and benign. MNIT localised medially subarachnoidally are malignant. MNNT of small dimensions localised medially and laterally extraarachnoidally are benign. MNNT of extreme dimensions localised medially extra-intradurally are also benign, but difficult to treat. In the MNNT when diagnosed early and operated radically, the mortality can be lowered. Our case, presented on CT (1978) as first case of combined extra-intra-subdural location, represents the 173rd MNT and the 18th related to neurocranium.

Computed tomography of calcaneal fractures

Computed tomography (CT) of 25 fractured calcanei was performed to investigate the potential of CT in evaluating the pattern and biomechanics of these fractures. The characteristic findings of typical fractures are presented, including the number and type of principal fragments, size and dislocation of the sustentacular fragment, and involvement of the anterior and posterior facets of the subtalar joint. In 17 cases, the calcaneus consisted of four or more fragments. Furthermore, in 17 cases the sustentacular fragment included all or part of the posterior facet joint. In 18 of the 25 cases, the sustentacular fragment was displaced. It is concluded that well performed CT is an invaluable adjunct in understanding the fracture mechanism and in detecting pain-provoking impingement between the fibular malleolus and the tuberosity fragment. CT analysis can provide the orthopedic surgeon with comprehensive information on which to base decisions regarding surgical/nonsurgical treatment as well as surgical approach and technique.

Computed tomography of the calcaneus: normal anatomy

The normal sectional anatomy of the calcaneus was studied as the background for interpretation of computed tomography (CT) of fractures. Multiplanar CT examination of the normal calcaneus was obtained, and sections were matched with a simplified anatomic model. Sectional anatomy in the four most important planes is described. This facilitates three-dimensional understanding of the calcaneus from sections and interpretation of CT sections obtained in any atypical plane.

A comparison of area-equivalent phases of systole and diastole as a method for evaluation of left ventricular movement

A method of left ventricular motion evaluation is described that does not use the end-diastolic contour as a reference point. The systolic outline in the RAO view was divided into four equal time periods. The systolic outline at the end of each period was paired to the diastolic outline with approximately the same area. Index values were calculated in order to elucidate any existing asymmetry of movement between the anterior and diaphragmatic left ventricular wall. In a group of 14 patients with coronary artery disease without obvious local left ventricular contractility disturbances, pathological asymmetry index values were found in 10. In a group of 16 patients with local left ventricular contractility disturbances, abnormal asymmetry index values were found in eight. This index of assymmetry demonstrated pathological changes of left ventricular motion in spite of a normal appearance of local left ventricular contractility during visual evaluation.