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Study Objective: Enoxaparin is standard of care for venous thromboembolism (VTE) prophylaxis in adult trauma patients, but fixed‐dose protocols are suboptimal. Dosing based on body mass index (BMI) or total body weight (TBW) improves target prophylactic anti‐Xa level attainment and reduces VTE rates. A novel strategy using estimated blood volume (EBV) may be more effective based on results of a single‐center study. This study compared BMI‐, TBW‐, EBV‐based, and hybrid enoxaparin dosing strategies at achieving target prophylactic anti‐Factor Xa (anti‐Xa) levels in trauma patients. Design: Multicenter, retrospective review. Data Source: Electronic health records from participating institutions. Patients: Adult trauma patients who received enoxaparin twice daily for VTE prophylaxis and had at least one appropriately timed anti‐Xa level (collected 3 to 6 hours after the previous dose after three consecutive doses) from January 2017 through December 2020. Patients were excluded if the hospital‐specific dosing protocol was not followed or if they had thermal burns with > 20% body surface area involvement. Intervention: Dosing strategy used to determine initial prophylactic dose of enoxaparin. Measurements: The primary end point was percentage of patients with peak anti‐Xa levels within the target prophylactic range (0.2‐0.4 units/mL). Main Results: Nine hospitals enrolled 742 unique patients. The most common dosing strategy was based on BMI (43.0%), followed by EBV (29.0%). Patients dosed using EBV had the highest percentage of target anti‐Xa levels (72.1%). Multiple logistic regression demonstrated EBV‐based dosing was significantly more likely to yield anti‐Xa levels at or above target compared to BMI‐based dosing (adjusted odds ratio (aOR) 3.59, 95% confidence interval (CI) 2.29‐5.62, p < 0.001). EBV‐based dosing was also more likely than hybrid dosing to yield an anti‐Xa level at or above target (aOR 2.30, 95% CI 1.33‐3.98, p = 0.003). Other pairwise comparisons between dosing strategy groups were nonsignificant. Conclusions: An EBV‐based dosing strategy was associated with higher odds of achieving anti‐Xa level within target range for enoxaparin VTE prophylaxis compared to BMI‐based dosing and may be a preferred method for VTE prophylaxis in adult trauma patients. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the effectiveness of a body mass index (BMI)‐based enoxaparin prophylaxis dosing protocol at achieving target anti‐factor Xa (anti‐Xa) concentrations in the trauma population. Methods: This retrospective chart review evaluated anti‐Xa concentrations in adult trauma patients who received prophylactic enoxaparin over a three‐month period. The primary outcome was the percentage of patients that achieved target anti‐Xa concentrations after ≥3 doses of enoxaparin. Secondary outcomes included correlations of anti‐Xa concentrations with enoxaparin dose per BMI, total body weight (TBW), and estimated blood volume (EBV). The prevalence of clinically relevant bleeding and venous thromboembolism was also recorded. Multivariable logistic regression was used to identify associated variables for target anti‐Xa concentration attainment. Results: Ninety‐nine consecutive patients were included in the study. Included patients were predominately male (69.7%) and Black (50.5%) with a mean age of 44.1 years. Target anti‐Xa concentrations were achieved in 62.6% of patients. Anti‐Xa concentrations were moderately correlated with enoxaparin dose per EBV (ρ = 0.57), followed by dose per TBW (ρ = 0.46), and dose per BMI (ρ = 0.20). Multivariable logistic regression demonstrated that categorization of enoxaparin dose per EBV and per TBW were the only statistically significant predictors of reaching target anti‐Xa concentrations (p = <0.001). Conclusions: In adult trauma patients, the rate of achieving target anti‐Xa concentrations remains suboptimal and provides room for further improvement. Enoxaparin dose per EBV was more closely correlated with anti‐Xa concentrations when compared to TBW and BMI. Dosing per EBV and TBW was the only variables associated with reaching target anti‐Xa concentrations within the study. Further investigation is warranted to elucidate optimal EBV‐ and TBW‐based dosing regimens. [ABSTRACT FROM AUTHOR]

Introduction: The Traumatic Brain Injury - Patient Reported Outcome (TBI-PRO) model was previously derived to predict long-term patient satisfaction as assessed by the Quality of Life After Brain Injury (QOLIBRI) score. The aim of this study is to externally and prospectively validate the TBI-PRO model to predict long-term patient-reported outcomes and to derive a new model using a larger dataset of older adults with TBI., Methods: Patients admitted to a Level I trauma center with TBI were prospectively followed for 1 y after injury. Outcomes predicted by the TBI-PRO model based on admission findings were compared to actual QOLIBRI scores reported by patients at 3,6, and 12 mo. When deriving a new model, Collaborative European NeuroTrauma Effectiveness Research in TBI and the Transforming Research and Clinical Knowledge in Traumatic Brain Injury databases were used to identify older adults (≥50 y) with TBI from 2014 to 2018. Bayesian additive regression trees were used to identify predictive admission covariates. The coefficient of determination was used to identify the fitness of the model., Results: For prospective validation, a total of 140 patients were assessed at 3 mo, with follow-up from 69 patients at 6 mo and 13 patients at 12 mo postinjury. The area under receiver operating curve of the TBI-PRO model for predicting favorable outcomes at 3, 6, and 12 mo were 0.65, 0.57, and 0.62, respectively. When attempting to derive a novel predictive model, a total of 1521 patients (80%) was used in the derivation dataset while 384 (20%) were used in the validation dataset. A past medical history of heart conditions, initial hospital length of stay, admission systolic blood pressure, age, number of reactive pupils on admission, and the need for craniectomy were most predictive of long-term QOLIBRI-Overall Scale. The coefficient of determination for the validation model including only the most predictive variables were 0.28, 0.19, and 0.27 at 3, 6, and 12 mo, respectively., Conclusions: In the present study, the prospective validation of a previously derived TBI-PRO model failed to accurately predict a long-term patient reported outcome measures in TBI. Additionally, the derivation of a novel model in older adults using a larger database showed poor accuracy in predicting long-term health-related quality of life. This study demonstrates limitations to current targeted approaches in TBI care. This study provides a framework for future studies and more targeted datasets looking to assess long-term quality of life based upon early hospital variables and can serve as a starting point for future predictive analysis., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Retained hemothorax (rHTX) requiring intervention occurs in up to 20% of patients who undergo chest tube (TT) placement for a hemothorax (HTX). Thoracic irrigation at the time of TT placement decreases the need for secondary intervention in this patient group but those findings are limited because of the single center design. A multi-center study was conducted to evaluate the effectiveness of thoracic irrigation., Methods: A multi-center, prospective, observational study was conducted between June 2018 and July 2023. Eleven sites contributed patients. Patients were included if they had a TT placed for a HTX and were excluded if: age < 18 years, TT for pneumothorax, thoracotomy or VATS performed within 6 hours of TT, TT >24 hours after injury, TT removed <24 hours, or death within 48 hours. Thoracic irrigation was performed at the discretion of the attending. Each hemithorax was considered separately if bilateral HTX. The primary outcome was secondary intervention for HTX-related complications (rHTX, effusion, or empyema). Secondary intervention was defined as: TT placement, instillation of thrombolytics, VATS, or thoracotomy. Irrigated and non-irrigated hemithoraces were compared using a propensity weighted analysis with age, sex, mechanism of injury, Abbreviated Injury Scale (AIS) chest and TT size as predictors., Results: 493 patients with 462 treated hemothoraces were included, 123 (25%) had thoracic irrigation at TT placement. There were no significant demographic differences between the cohorts. Fifty-seven secondary interventions were performed, 10 (8%) and 47 (13%) in the irrigated and non-irrigated groups, respectively (p = 0.015). Propensity weighted analysis demonstrated a reduction in secondary interventions in the irrigated cohort (Odds Ratio 0.56 (0.34-0.85); p = 0.005)., Conclusion: This Western Trauma Association multi-center study demonstrates a benefit of thoracic irrigation at the time of TT placement for a HTX. Thoracic irrigation reduces the odds of a secondary intervention for rHTX-related complications by 44%., Level of Evidence: Therapeutic Study, Level II., Competing Interests: Conflict of Interest: The authors report no conflicts of interest as related to this study. All Journal of Trauma and Acute Care Surgery Disclosure forms have been supplied, are up to date, and are provided as supplemental digital content (http://links.lww.com/TA/D783)., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)