Hyperglycemia at admission is an independent predictor of outcome and infection in trauma patients. Future investigation on the effects of hyperglycemia are warranted.

This study represents a preliminary effort to examine the possible impacts of chronic, low level Domoic Acid (DA) exposure on memory in the CoASTAL cohort. Five hundred thirteen men and women representing three Native American Tribes were studied with standard measures of cognition and razor clam consumption (a known vector of DA exposure) over a four year period. In addition, a pilot metric of DA concentration exposure was used which took into consideration average DA concentration levels in source beaches as well as consumption. Based upon GEE analysis, controlling for age, sex, race, year, education level, tribe, and employment status, findings indicated that high razor clam consumers (15 or more per month) had isolated decrements on some measures of memory (p=.02 to .03), with other cognitive functions unaffected. The relatively lower memory scores were still within normal limits, thus not clinically significant. The pilot DA exposure metric had no association with any aspect of cognition or behavior. There is a possible association between long term, low level exposure to DA through heavy razor clam consumption and memory. The availability of a reliable biological marker for human exposure to DA is needed.

Unanticipated pathogens were isolated in each class of pneumonia. The clinician must be aware of significant risk factors that may predispose patients to pathogens that are not ordinarily covered with standard antibiotic therapy.

There is a paucity of data evaluating serum albumin on admission as a predictor of outcome in adult trauma patients. Our objectives were to evaluate whether or not hypoalbuminemia on admission is a predictor of adverse outcome in trauma patients. Prospective data was collected daily on 1023 patients over a 2-year period. Patients were stratified by serum albumin level on admission, age, gender, injury severity, and comorbid conditions. Outcome was measured by ICU and hospital length of stay, ventilator days, incidence of infection, and mortality. Student t test, χ2, and multilinear regression analysis were used to determine level of significance. Blunt injuries accounted for the majority (78%) of the admissions. The mean age of the study population was 43 ± 21 years with a mean Injury Severity Score (ISS) of 21.4 ± 12. The majority of patients were male (74.5%). The mean albumin level on admission was 2.9 ± 1.8. Five hundred ninety-three (58%) patients were admitted with a serum albumin level of ≥2.6 as compared to 430 patients (42%) with an admission albumin level of <2.6. Patients with a lower serum albumin level were found to have a significantly greater ICU (17.1 vs 14.2 days) and hospital length of stay (17.3 vs 20.1 days, P < 0.05), ventilator days (11.1 vs 13.5 days, P < 0.05), and mortality ( P = 0.008) when matched for age and injury severity. The relative risk of infection and mortality increased greater than 2.5-fold in patients with increased age and low serum albumin when analyzed by multilinear regression analysis, P < 0.001. An admission serum albumin level of <2.6 g/dL is a significant independent predictor of morbidity and mortality in trauma patients. The combination of increased age and low albumin level was most predictive of infection and mortality. Early nutrition should be considered in these high-risk patients.