Trauma patients on prescribed warfarin therapy sustaining intracranial hemorrhage can be difficult to manage. Rapid normalization of coagulopathy is imperative to operative intervention and may affect outcomes. To identify and expedite warfarin reversal, we designed a protocol to administer a prothrombin complex concentrate. A Proplex T protocol was instituted in May 2004. It dictated that trauma patients with an International Normalized Ratio (INR) greater than 1.5, history of prescribed warfarin therapy, and intracranial hemorrhage on CT scan receive a prothrombin complex concentrate for reversal of their coagulopathy. Neither the protocol nor the factor concentrate was validated for use in this subset of trauma patients; therefore, adherence to the protocol and use of the factor concentrate was not mandatory. Patients not administered the prothrombin complex concentrate received vitamin K and fresh-frozen plasma. The protocol resulted in an increased number of patients receiving Proplex T (54.3% vs 35.4%, P = 0.047). Protocol patients had improved times to normalization of INR (331.3 vs 737.8 minutes, P = 0.048), number of patients with reversal of coagulopathy (73.2% vs 50.9%, P = 0.026), and time to operative intervention (222.6 vs 351.3 minutes, P = 0.045) compared with control subjects. There were no differences in intensive care unit (ICU) days, hospital days, or mortality. The Proplex T protocol increased the number of patients who received prothrombin complex concentrate, provided rapid normalization of INR, and improved time to operative intervention.

The American Association for the Surgery of Trauma challenged the trauma community to improve a 22 per cent average removal rate for retrievable inferior vena cava filters (r-IVCFs). Since 2006, we maintained a “filter registry” documenting all IVCFs placed in trauma patients. Our goal was to improve removal rates for r-IVCF. Patients receiving an IVCF before implementation of filter registry, 2003–2005, comprised the control group. Patients receiving an IVCF after implementation of filter registry, 2006–2009, comprised the study group. Data obtained included age, gender, Injury Severity Score (ISS), length of stay (LOS), mortality, filter inserted, placement indication, removal rates, and reasons why removal did not occur. Fisher exact test and chi square were used for nominal variables. Stepwise logistic regression analysis was used to define predictors of removing and not removing an IVCF. Three hundred seven patients received an IVCF, 142 preregistry and 165 post-registry. No significant difference existed between groups in age, gender, ISS, placement indication, or mortality. A significant difference existed between groups in LOS and presence of deep vein thrombosis (DVT) and pulmonary embolism. A total of 98.2 per cent of postregistry patients received a Günther Tulip filter and all retrievals were performed by Interventional Radiology. Retrieval rates improved, 15.5 to 31.5 per cent post registry ( P < 0.001). No differences existed in lost to follow-up (LTF) between groups. Univariate analysis identified age, IVC clot, DVT, and LTF as predictors for not removing a filter. Stepwise logistic regression revealed the filter registry independently predicts the removal of an r-IVCF. A filter registry is effective in improving rates of removal for r-IVCFs.

BackgroundBurn related injuries from natural disasters are not well described and natural disasters are not identified as an etiology of burn injury in the National Burn Repository (NBR) of the American Burn Association. The natural disaster Super Storm Hurricane Sandy had devastating effects. Our goal was to detail the burn related injuries following this natural disaster and to compare the data to the NBR.MethodsThis was a retrospective chart review of thirty four patients who sustained burn related injuries following Super Storm Hurricane Sandy (SSHS) and were managed at Staten Island University Hospital Burn Center. Institutional Review Board approval was obtained. Data variables included age, gender, race, past medical history (PMHx), burn type, percentage total body surface area (%TBSA), hospital length of stay (HLOS), and mortality. We compared data from SSHS to the 2003-2013 NBR. Categorical data were summarized using frequency counts, percentages and Clopper-Pearson 95 % confidence interval for proportion. Continuous outcome data were summarized by descriptive statistics. Data analyses performed with SAS® System Version 9.3 (SAS Institute Inc., Cary, NC) and p < 0.05 was significant.ResultsIn the SSHS group, average age was 36 + 24 years, range 1-80 years, and 44.1 % were males (15/34, 95 % CI: 27.2 - 62.1). Caucasians comprised 58.8 %, (20/34, 95 % CI: 40.7, 75.4) and 73.5 % had no PMHx (25/34, 95 % CI: 55.6, 87.1). The most common burn type was scald, 55.9 %, (19/34, 95 % CI: 37.9, 72.8) and %TBSA ranged 1 %–47 %, average of 7 % + 12 %. The average HLOS was 13 + 26 days, range of 1–113 days. Mortality was 2.9 % (1/34, 95 % CI: 0.07–15). In comparison, the NBR reported an average age of 32 years and 69 % were males. Caucasians comprised 59.1 %. The most common burn type was flame, 43.2 % and the %TBSA ranged 1 %–9.9 %. HLOS ranged 8.4–10.2 days and mortality was 3.4 %.ConclusionWe conclude that burn related injuries following a natural disaster differ as compared to those most commonly reported in the NBR.

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