Background Many models have been developed to predict severe outcomes from Clostridioides difficile infection. These models are usually developed at a single institution and largely are not externally validated. This aim of this study was to validate previously published risk scores in a multicenter cohort of patients with CDI. Methods Retrospective study on four separate inpatient cohorts with CDI from three distinct sites: The Universities of Michigan (2010-2012 and 2016), Chicago (2012), and Wisconsin (2012). The primary composite outcome was admission to an intensive care unit, colectomy, and/or death attributed to CDI within 30 days of positive testing. Both within each cohort and combined across all cohorts, published CDI severity scores were assessed and compared to each other and the IDSA guideline definitions of severe and fulminant CDI. Results A total of 3,646 patients were included for analysis. Including the two IDSA guideline definitions, fourteen scores were assessed. Performance of scores varied within each cohort and in the combined set (mean area under the receiver operator characteristic curve(AUC 0.61, range 0.53-0.66). Only half of the scores had performance at or better than IDSA severe and fulminant definitions (AUCs 0.64 and 0.63, respectively). Most of the scoring systems had more false than true positives in the combined set (mean: 81.5%, range:0-91.5%). Conclusions No published CDI severity score showed stable, good predictive ability for adverse outcomes across multiple cohorts/institutions or in a combined multicenter cohort.

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A 16-year-old female presented to the emergency department after a motor vehicle collision. Upon arrival, the patient was receiving group O D-red blood cells (RBCs) through intravenous lines inserted into the dorsal venous system of each hand. Retrospective analysis revealed trauma team personnel obtaining a blood sample for a type and cross from the cephalic vein of the patient during active transfusion (see figure). The table shows the forward blood type to be O Dwith a significantly weak reverse blood type.The forward and reverse type discordance was the result of obtaining blood downstream from the transfusion site with the blood sample consisting predominantly of donor RBCs with minimal plasma. A repeat sample from the patient was requested and additional group O D-RBC units and group AB freshfrozen plasma units were released for ongoing resuscitative efforts. The repeat sample from the femoral vein of the patient revealed a mixed field (MF) consistent with the blood group A D+. The patient was subsequently transitioned to blood type-specific products for additional transfusions and thus any potential ABO-incompatible plasma transfusion was successfully avoided. The hospital's phlebotomy standard operating procedure prohibits blood draws for ABO typing downstream from the transfusion site. This policy was reviewed with trauma team personnel and a teaching module is being prepared for further education.Our case illustrates the potential for erroneous ABO typing secondary to blood sampling error. Such miscues can theoretically result in the release of ABO-incompatible blood products, which have the potential to cause hemolytic transfusion reactions. Hemolytic transfusion reactions are a source of morbidity and are the second leading cause of Articles can be submitted directly online at: http://transfusion.manuscriptcentral.com Volume 52, September 2012 TRANSFUSION 1855 transfusion-related fatalities, accounting for 25% of transfusion-related deaths since 2005. 1 Preanalytical errors, such as blood sampling and tube labeling, are well-documented sources for the mistransfusion of ABO-incompatible blood products. [2][3][4] Ideally, a sample should be obtained before the initiation of transfusion to optimize both blood group identification and utilization of valuable products (group O D-RBCs). To ensure ABO typing accuracy in patients actively receiving blood products, one must obtain the blood sample from a venous site that is not directly downstream from the site of infusion. Education, communication between medical staff and laboratory personnel, and specimen acceptance policies are all important components in reducing preanalytical errors to further prevent ABO-related hemolytic transfusion reactions.

DM), Chronic Obstructive Pulmonary Disease (COPD), Coronary Artery Disease (CAD), and Hypertension (HTN) were assessed with respect to their incidence in the group that was readmitted and the group that was not. Results: The cohort consisted of 155 women and 133 men with a mean age of 59.0 ± 15.2 yr. One hundred fifty seven patients (57%) required ICU readmission (118 were discharged elsewhere, 13 expired). The mean CCI for ICU readmissions was not significantly different compared to those not readmitted (5.0 ± 2.9 vs. 4.6 ± 2.7, p = 0.22). Further subgroup analysis of those with HTN (67.3%), DM (52.7%), COPD (34.2%), and CAD (23.6%) was performed and demonstrated that patients who required ICU readmission had a higher incidence of these specific comorbidities compared to those who did not (mean number of comorbidities 1.9 ± 1.2 vs. 1.6 ± 1.0, p = 0.04). Conclusions: Comorbidity burden as represented by CCI does not strongly correlate with discharge disposition in survivors of critical illness. However, patients who are readmitted to the ICU have a greater total number of specific comorbidities. Thus, physicians should be mindful of the increased likelihood of readmission when DM, HTN, COPD, or CAD are present in ICU survivors.

Purpose: In 2006 UNOS introduced an electronic notification system known as DonorNet. It allowed electronic transmission of donor offers allowing detailed information about each potential donor to be viewed quickly by transplant centers, including their place on the allocation list (donor sequence number). We sought to examine the utilization of donors based on sequence number and also to assess if higher sequence number resulted in inferior long term survival compared to donors taken more readily at lower sequence number. Methods: A custom data request was made of UNOS to provide the data on transplants since the advent of DonorNet along with sequence number for accepted hearts. Demographics were compared with descriptive statistics and survival post transplant examined with Kaplan-Meier curves. Results: From 5/1/2007 -3/31/2014 there were 13481 adult heart transplants reported to UNOS with donor sequence numbers available. Transplant recipients consisted of 10037 males (74 %) with the majority having Type O or A hearts (38 % O, 41 % A). The mean donor age was 31.7 ± 11.7 years and the mean recipient age 52.6 ± 12.8 years. The mean ischemic time was 3.2 ± 1.1 hours. The mean left ventricular ejection fraction for the donors was 61.6 ± 7.1 %. Only 10 % of donors with an ejection fraction below 50 % were utilized for transplantation. The median donor sequence number was 3 and the 75th percentile for donor sequences was 10. 90 % of all donors in the database were accepted with a sequence number of 27 or less. This indicates that it was rare to transplant using a heart which had been turned down for more than 27 recipients. We analyzed graft survival by sequence number to assess whether this avoidance was warranted. The 5 year survival for 13438 evaluable patients was 74.5 %. When subdivided by donor sequence of 1-10 versus higher than 10, there was no difference (p= 0.21). Similarly, graft survival was similar with a cutpoint of donor sequence 30 or less (p= 0.10 log rank). Conclusion: Relatively few donors are taken with a sequence number greater than 27, yet the survival appears similar. Obviously these data are skewed by selection bias since the analysis only includes donors utilized for transplant. Nevertheless, these data suggest an opportunity to utilize more donors that are currently not being considered.