Determinants of mortality in trauma patients following massive blood transfusion

AIM: This study was designed to find out the factors influencing mortality in trauma patients receiving massive blood transfusion (MBT). MATERIALS AND METHODS: Records of all patients admitted during December 2007 to November 2008 at a Level I Trauma Center emergency and who underwent massive transfusion (≥10 units of packed red cells in 24 h) were retrospectively analyzed. Death during the hospital stay was considered as the study outcome and various demographic, laboratory, and clinical parameters were included as its potential determinants. STATISTICAL ANALYSIS: Bivariate and multivariate logistic regression analyses were done to identify the risk factors associated with mortality. RESULTS: Of the 4054 transfused patients who were admitted to the trauma center during the study period, 71 (1.8%) patients underwent massive transfusion. Of this, there were 37 survivors and 34 nonsurvivors (48%). The median overall ISS was 27 (22–34). The patients who died had shorter mean length of hospital stay, shorter mean duration of intensive care unit (ICU) stay, and low admission Glasgow Coma Scale (GCS) compared to the survivors (P < 0.01). The mean prothrombin time (PT) and the mean activated partial thromboplastin time was significantly high (P < 0.01) among nonsurvivors. Total leukocyte count (TLC ≥ 10,000 cells/cubic mm), GCS ≤ 8, the presence of coagulopathy and major vascular surgery were the four independent determinants of mortality in multivariate logistic regression analysis. The FFP:PRBC (fresh frozen plasma:packed red cells) ratio and PC:PRBC (platelet concentrate:packed red cells) ratio calculated in our study was not statistically significant in correlation to the in hospital mortality. CONCLUSIONS: Overall mortality among the MBT patients was comparable with the studies in the literature. Mortality is not affected by the amount of packed red cells given in the first 12 h and the total number of packed red cells transfused. Prospective studies are required to further validate the determinants of mortality and establish guidelines for MBT

Incidence, clinical predictors and outcome of acute renal failure among North Indian trauma patients

Context: There is a need for identifying risk factors aggravating development of acute renal failure after attaining trauma and defining new parameters for better assessment and management. Aim of the study was to determine the incidence of acute renal failure among trauma patients, and its correlation with various laboratory and clinical parameters recorded at the time of admission and in-hospital mortality. Subjects and Methods: The retrospective cohort study included admitted 208 trauma patients over a period of one year. 135 trauma patients at the serum creatinine level >2.0 mg/dL were enrolled in under the group of acute renal failure. 73 patients who had normal creatinine level made the control group. They were further assessed with clinical details and laboratory investigations. Results: Incidence of acute renal failure was 3.1%. There were 118 (87.4%) males and average length of stay was 9 (1, 83) days. Severity of injury (ISS, GCS) was relatively more among the renal failure group. Renal failure was transient in 35 (25.9%) patients. They had higher incidence of bone fracture (54.0%) (P = 0.04). Statistically significant association was observed between patients with head trauma and mortality 72 (59.0%) (P = 0.001). Prevalence of septic 24 (59.7%) and hemorrhagic 9 (7.4%) shock affected the renal failure group. Conclusion: Trauma patients at the urea level >50 mg/dL, ISS >24 on the first day of admission had 23 times and 7 times the risk of developing renal failure. Similarly, patients with hepatic dysfunction and pulmonary dysfunction were 12 times and 6 times. Patients who developed cardiovascular dysfunction, hematological dysfunction and post-trauma renal failure during the hospital stay had risk for mortality 29, 7 and 8 times, respectively. The final prognostic score obtained was: 14FNx01hepatic dysfunction + 11FNx01cISS + 18FNx01cUrea + 12FNx01cGlucose + 10FNx01pulmonary dysfunction. Optimal score cut-off for prediction of renal failure was found to be ≥25 with specificity, sensitivity and positive likelihood ratio to be 84.9%, 78.4% and 3.9, respectively

Accuracy of visual assessment by school teachers in school eye screening program in Delhi

Background: Although school eye screening is a major activity of the National Program for Control of Blindness, inadequate evidence exists about accuracy of school teachers in screening. Objectives: Compare quality of referral for subnormal vision by school teachers and primary eye care workers (PECW) in school children and to establish appropriate cutoff for identification of subnormal vision in school going children. Materials and Methods: This was a cross-sectional study involving school children studying in classes 1 to 9 in different schools of Delhi evaluated for sub-normal vision. Vision was recorded by the teacher and a primary eye care worker especially trained for the study using the optotypes of Early treatment Diabetic Retinopathy Survey (ETDRS) vision chart with standard lighting. Results: The total number of children enlisted in the 20 selected schools was 10,114. Of these, 9838 (97.3%) children were examined in the study. The mean age of children enrolled in the study was 11.6 ± 2.19 years with 6752 (66.9%) males. The sensitivity and specificity of teachers in comparison to PECW using 6/9.5 vision level as cutoff for referral was 79.2% and 93.3%, respectively compared to 77.0% and 97.1%, respectively on using the 6/12 optotype. The results showed significantly higher sensitivity and lower specificity for private schools against government schools and for older against younger children. Conclusions: Our results show that the use of teachers and shift to use of the 6/12 sized "E" for the school eye screening (SES) program is appropriate and would substantially reduce the work of eye care providers while improving its overall efficiency

Status of serum vitamin D and calcium levels in women of reproductive age in national capital territory of India

Context: In India, Vitamin D deficiency is a major public health problem, associated with lack of sunlight exposure in spite of abundant sunshine usually accompanied by reduced dietary intake. In women of reproductive age, Vitamin D deficiency in pregnancy has been associated with an increased risk of gestational diabetes mellitus, preeclampsia, maternal and perinatal morbidity and mortality. Aims: The aim of the present cross-sectional study was to evaluate the levels of serum Vitamin D 25(OH) D and calcium in women of reproductive age from India. Settings and Design: A cross-sectional study was carried on a total of 224 healthy nonpregnant and nonlactating women in the reproductive age group of 20–49 years. Materials and Methods: Demographic, socioeconomic class, and biochemical parameters for the estimation of serum 25(OH)D and calcium levels in women of reproductive age were studied. Statistical Analysis: Statistical Package for Social Sciences version 20.0 was utilized for conducting the statistical analysis of the data. Results: Vitamin D deficiency (<20 ng/ml) was present in 88% of women. Women from middle socioeconomic class had the lowest mean serum 25(OH) D levels (9.6 ± 6 ng/ml) as compared to women from upper middle (11.4 ± 8 ng/ml), lower (11.2 ± 8 ng/ml), and upper (10 ± 8.6 ng/ml) socioeconomic class. Serum calcium levels were found in the normal range of 8.5–10.5 mg/dl for all the study subjects. Conclusions: There is a high prevalence of hypovitaminosis D among women of reproductive age. These women may possibly have a higher risk of development of osteoporosis and pregnancy-related complications in future life