29, 95% CI = 1.24-1.36; women aOR = 1.17, 95% CI = 1.12-1.22), parasomnia (men aOR = 3.74, 95% CI = 3.44-4.07; women aOR = 2.69, 95% CI = 2.44-2.96), sleep-related movement disorder (men aOR = 1.09, 95% CI = 1.07-1.11; women aOR = 1.22, 95% CI = 1.20-1.25), and any sleep disorder (men aOR = 1.06, 95% CI = 1.05-1.08; women aOR = 1.15, 95% CI = 1.13-1.17) with PD status.
Overall, hospitalized men are more likely to experience PD with insomnia or parasomnia, whereas hospitalized women are more likely to experience PD with sleep-related movement disorder or any sleep disorder. Prospective cohort studies are needed to replicate these cross-sectional findings.
Overall, hospitalized men are more likely to experience PD with insomnia or parasomnia, whereas hospitalized women are more likely to experience PD with sleep-related movement disorder or any sleep disorder. Prospective cohort studies are needed to replicate these cross-sectional findings.
In patients with heart failure with preserved ejection fraction (HFpEF), whether living alone could contribute to a poor prognosis remains unknown. We sought to investigate the association of living alone with clinical outcomes in patients with HFpEF.
Symptomatic patients with HFpEF with a follow-up of 3.3 years (data collected from August 2006 to June 2013) in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist trial were classified as patients living alone and those living with others. The primary outcome was defined as a composite of cardiovascular death, aborted cardiac arrest, or HF hospitalization.
A total of 3103 patients with HFpEF were included; 25.2% of them were living alone and were older, predominantly female, and less likely to be White and have more comorbidities compared with the other patients. After multivariate adjustment for confounders, living alone was associated with increased risks of HF hospitalization (hazard ratio [HR] = 1.29, 95% confidence interval [CI] = 1.03-1.61) and any hospitalization (HR = 1.26, 95% CI = 1.12-1.42). A significantly increased risk of any hospitalization (HR = 1.16, 95% CI = 1.01-1.34) was also observed in the Americas-based sample. In addition, each year increase in age, female sex, non-White race, New York Heart Association functional classes III and IV, dyslipidemia, and chronic obstructive pulmonary disease were independently associated with living alone.
We assessed the effect of living arrangement status on clinical outcomes in patients with HFpEF and suggested that living alone was associated with an independent increase in any hospitalization.Clinical Trial Registration ClinicalTrials.gov identifier NCT00094302.
We assessed the effect of living arrangement status on clinical outcomes in patients with HFpEF and suggested that living alone was associated with an independent increase in any hospitalization.Clinical Trial Registration ClinicalTrials.gov identifier NCT00094302.
Damage control resuscitation (DCR) improves survival in severely bleeding patients. However, deviating from balanced transfusion ratios during a resuscitation may limit this benefit. We hypothesize that maintaining a balanced resuscitation during DCR is independently associated with improved survival.
This was a secondary analysis of the PRospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study. Patients receiving ≥3 units packed red blood cells (PRBC) in one-hour over the first 6-hours and surviving beyond 30-minutes were included. Linear regression assessed the effect of percent time in a high-ratio range on 24-hour survival. We identified an optimal ratio and percent of time above the target ratio threshold by Youden's index. We compared patients with a 6-hour ratio above the target and above the percent time threshold (On-Target) with all others (Off-Target). Kaplan-Meier analysis assessed the combined effect of blood product ratio and percent time over the target ratio on 24-hourt in a high-ratio range.
Epidemiologic/prognostic study, Level II.
Epidemiologic/prognostic study, Level II.
Low-molecular-weight heparin (LMWH) is widely used for venous thromboembolism (VTE) chemoprophylaxis following injury. However, unfractionated heparin (UFH) is a less expensive option. We compared LMWH and UFH for prevention of post-traumatic deep venous thrombosis (DVT) and pulmonary embolism (PE).
Trauma patients aged 15 years and older with at least one administration of VTE chemoprophylaxis at two Level I trauma centers with similar DVT-screening protocols were identified. Center 1 administered UFH every eight hours for chemoprophylaxis and Center 2 used twice-daily anti-factor Xa-adjusted LMWH. Clinical characteristics and primary chemoprophylaxis agent were evaluated in a two-level logistic regression model. Primary outcome was incidence of DVT and PE.
There were 3,654 patients 1,155 at Center 1 and 2,499 at Center 2. The unadjusted DVT rate at Center 1 was lower than at Center 2 (3.5% vs. 5.0%; p=0.04); PE rates did not significantly differ (0.4% vs. 0.6%; p=0.64). Patients at Center 2 were older (mean 50.3 vs. 47.3 years, p<0.001) and had higher Injury Severity Scores (median 10 vs. 9, p<0.001), longer stays in the hospital (mean 9.4 vs. 7.0 days, p<0.001) and intensive care unit (mean 3.0 vs. 1.3 days, p<0.001), and a higher mortality rate (1.6% vs. 0.6%, p=0.02) than patients at Center 1. Center 1's patients received their first dose of chemoprophylaxis earlier than patients at Center 2 (median 1.0 vs. 1.7 days, p<0.001). After risk adjustment and accounting for center effects, primary chemoprophylaxis agent was not associated with risk of DVT (odds ratio, 1.01; 95% confidence interval, 0.69-1.48; p=0.949). Cost calculations showed UFH was less expensive than LMWH.
Primary utilization of UFH is not inferior to LMWH for post-traumatic DVT chemoprophylaxis and rates of PE are similar. RIN1 Given UFH is lower in cost, the choice of this chemoprophylaxis agent may have major economic implications.
Level II. Prognostic and Epidemiological.
Level II. Prognostic and Epidemiological.
Prehospital tourniquet (PHT) utilization has increased in response to mass casualty events. We aimed to describe the incidence, therapeutic effectiveness and morbidity associated with tourniquet placement in all patients treated with PHT application.
A retrospective observational cohort study was performed to evaluate all adults with a PHT who presented at two level 1 trauma centers between January 2015 and December 2019. Medically trained abstractors determined if the PHT was clinically indicated (placed for limb amputation, vascular hard signs, injury requiring hemostasis procedure, or significant documented blood loss). PHTs were further designated as appropriately or inappropriately applied (based on PHT anatomic placement location, occurrence of a venous tourniquet, or ischemic time defined as >2 hours). Statistical analyses were performed to generate primary and secondary results.
A total of 147 patients met study inclusion criteria, of which 70% met criteria for trauma registry inclusion. Total incidence of PHT utilization increased from 2015-2019, with increasing proportions of PHTs placed by non-EMS personnel.RIN1
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