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Background: Thromboelastometry like ROTEM ® is a point-of-care method used to assess the coagulation status of patients in a rapid manner being particularly useful in critical care settings, such as trauma, where quick and accurate assessment of coagulation can guide timely and appropriate treatment. Currently, this method is not yet comprehensively available with sparse data on its effectiveness in resuscitation rooms. The aim of this study was to assess the effect of early thromboelastometry on the probability of mass transfusions and mortality of severely injured patients. Methods: The TraumaRegister DGU ® was retrospectively analyzed for severely injured patients (2011 until 2020) with information available regarding blood transfusions and Trauma-Associated Severe Hemorrhage (TASH) score components. Patients with an estimated risk of mass transfusion >2% were included in a matched-pair analysis. Cases with and without use of ROTEM ® diagnostic were matched based on risk categories for mass transfusion. A total of 1722 patients with ROTEM ® diagnostics could be matched with a non-ROTEM ® patient with an identical risk category. Adult patients (≥16) admitted to a trauma center in Germany, Austria, or Switzerland with Maximum Abbreviated Injury Scale severity ≥3 were included. Results: A total of 83,798 trauma victims were identified after applying the inclusion and exclusion criteria. For 7740 of these patients, the use of ROTEM ® was documented. The mean Injury Severity Score (ISS) in patients with ROTEM ® was 24.3 compared to 19.7 in the non-ROTEM ® group. The number of mass transfusions showed no significant difference (14.9% ROTEM ® group vs. 13.4% non-ROTEM ® group, p = 0.45). Coagulation management agents were given significantly more often in the ROTEM ® subgroup. Mortality in the ROTEM ® group was 4.1% less than expected (estimated mortality based on RISC II 34.6% vs. observed mortality 30.5% (n = 525)). In the non-ROTEM ® group, observed mortality was 1.6% less than expected. Therefore, by using ROTEM ® analysis, the expected mortality could be reduced by 2.5% (number needed to treat (NNT) 40; SMR of ROTEM ® group: 1:0.88; SMR of non-ROTEM ® group: 1:0.96; p = 0.081). Conclusions: Hemorrhage is still one of the leading causes of death of severely injured patients in the first hours after trauma. Early thromboelastometry can lead to a more targeted coagulation management, but is not yet widely available. This study demonstrated that ROTEM ® was used for the more severely injured patients and that its use was associated with a less than expected mortality as well as a higher utilization of hemostatic products.

Objective: Mixed Martial Arts (MMA) is a relatively young combat sport. In contrast to classic boxing, MMA combines techniques of grappling and striking. However, characteristic long-term effects of MMA on the wrist are discussed controversially. Aim of this study was to elucidate characteristic degenerative changes of the wrist from MMA fighters in comparison to classic boxers., Methods: In this study, eleven professional MMA fighters and ten professional boxers with chronic wrist pain were examined and compared. Age, weight, number of fights and weekly hours of training were recorded. Wrist and hand of each fighter were examined using a 3T-MR scanner. Degenerations of the radial, central and ulnar column were analyzed according to Navarro's three-column theory and degenerative changes were categorized based on the classification of Fredericson., Results: There was no significant difference of age, weight and number of fights between MMA fighters and boxers ( p  > 0.15). However, MMA fighters practiced significantly more hours per week (19.5 (MMA) vs. 8.5 (boxing) hours/week, p  < 0.001). No significant associations were found between different training times per Week in terms of degenerative changes of the wrist in MMA and boxing based on the three column theory. The comparison of degenerative changes in the columns between MMA and boxing showed no significant differences. The MRI showed a significantly higher degeneration in the radial column compared to the central column among MMA fighters for ligaments ( p  = 0.01) and bones ( p  = 0.03)., Conclusion: Due to different fighting techniques, different physical traumas, including falls, pattern of degenerations of the wrist between MMA fighters and boxers are different. MMA fighters suffer of a highly degenerative radial column and boxers suffer of a homogeneous degeneration of all three columns.

[This corrects the article DOI: 10.1371/journal.pone.0229431.].

Background: Current guidelines underline the importance of high-quality chest compression during cardiopulmonary resuscitation (CPR), to improve outcomes. Contrary to this many studies show that chest compression is often carried out poorly in clinical practice, and long interruptions in compression are observed. This prospective cohort study aimed to analyse whether chest compression quality changes when a real-time feedback system is used to provide simultaneous audiovisual feedback on chest compression quality. For this purpose, pauses in compression, compression frequency and compression depth were compared., Methods: The study included 292 out-of-hospital cardiac arrests in three consecutive study groups: first group, conventional resuscitation (no-sensor CPR); second group, using a feedback sensor to collect compression depth data without real-time feedback (sensor-only CPR); and third group, with real-time feedback on compression quality (sensor-feedback CPR). Pauses and frequency were analysed using compression artefacts on electrocardiography, and compression depth was measured using the feedback sensor. With this data, various parameters were determined in order to be able to compare the chest compression quality between the three consecutive groups., Results: The compression fraction increased with sensor-only CPR (group 2) in comparison with no-sensor CPR (group 1) (80.1% vs. 87.49%; P < 0.001), but there were no further differences belonging compression fraction after activation of sensor-feedback CPR (group 3) (P = 1.00). Compression frequency declined over the three study groups, reaching the guideline recommendations (127.81 comp/min vs. 122.96 comp/min, P = 0.02 vs. 119.15 comp/min, P = 0.008) after activation of sensor-feedback CPR (group 3). Mean compression depth only changed minimally with sensor-feedback (52.49 mm vs. 54.66 mm; P = 0.16), but the fraction of compressions with sufficient depth (at least 5 cm) and compressions within the recommended 5-6 cm increased significantly with sensor-feedback CPR (56.90% vs. 71.03%; P = 0.003 and 28.74% vs. 43.97%; P < 0.001)., Conclusions: The real-time feedback system improved chest compression quality regarding pauses in compression and compression frequency and facilitated compliance with the guideline recommendations. Compression depth did not change significantly after activation of the real-time feedback. Even the sole use of a CPR-feedback-sensor ("sensor-only CPR") improved performance regarding pauses in compression and compression frequency, a phenomenon known as the 'Hawthorne effect'. Based on this data real-time feedback systems can be expected to raise the quality level in some parts of chest compression quality., Trial Registration: International Clinical Trials Registry Platform of the World Health Organisation and German Register of Clinical Trials (DRKS00009903), Registered 09 February 2016 (retrospectively registered)., Competing Interests: We have read the journal's policy and the authors of this manuscript state the following competing interests: F.L. received travel grants for scientific congresses from GS Elektromedizinische Geräte G. Stemple GmbH, Kaufering, Germany. M.H. is employed at GS Elektromedizinische Geräte G. Stemple GmbH, Kaufering, Germany. This does not alter our adherence to PLOS ONE policies on sharing data and materials.