PURPOSE: We investigated the effect of the protease inhibitor, aprotinin, on mean arterial pressure (MAP), hematocrit (Hct), blood loss, and survival rate in rats with experimental splenic injury. METHODS: We created an experimental splenic injury model in anesthetized rats by cutting the splenic parenchyma into three fragments. We analyzed the effect of aprotinin on three different treatment groups. The aprotinin treatment group received a single dose of 30,000 U/kg of aprotinin in 10 ml/kg normal saline, the tranexamic acid group was treated with a single dose of 100 mg/kg of tranexamic acid in 10ml/kg normal saline, and the saline control group was treated with only 10 ml/kg normal saline. In addition, a sham-operated group (laparotomy without splenectomy) was treated with 10 ml/kg normal saline. RESULTS: MAP was higher in the sham-operated group and the aprotinin group than in the other groups. There were no significant differences for hematocrit except that the saline group exhibited a lower level than the other groups at the six-hour time point. The amount of intraperitoneal blood loss in the sham-operated and aprotinin groups due to splenic injury was significantly lower than in the tranexamic acid and saline groups. The survival rate in the aprotinin group was similar to the tranexamic acid group, but, the survival rate of the aprotinin-treated group was statistically higher than that of the saline control group. CONCLUSION: Hemodynamic changes resulting from splenic injury can be diminished by aprotinin treatment. Aprotinin could be considered in preference to other drugs as a first line treatment in hemodynamically unstable splenic injury patients.
Animals ; Aprotinin* ; Arterial Pressure ; Hematocrit ; Hemodynamics ; Hemoperitoneum ; Hemorrhage* ; Humans ; Protease Inhibitors ; Rats* ; Splenic Rupture ; Survival Rate ; Tranexamic Acid

Objective: Previous studies focused primarily on drivers or front-seat passengers in motor vehicle accidents. Recent research has shown improvements in front-seat occupant protection. This study examined the risk factors contributing to severe injury in rear-seat occupants. Methods: This study was conducted retrospectively. The variables related to the crash data were acquired from the Emergency Department-based Injury In-depth Surveillance registry and electronic medical record of the authors’hospital between 2019 and 2020. Multivariate logistic regression analysis was used to identify the risk factors contributing to severe injury in rear-seat occupant. Results: One hundred and forty rear-seat occupants were analyzed. The occupants were categorized by the abbreviated injury scale into severe (n=39; 27.9%) and non-severe injury (n=101; 72.1%). The collision with a large-size vehicle (odds ratio [OR], 4.278; 95% confidence interval [CI], 1.617-18.000; P=0.015) and fixed objects (OR, 3.459; 95% CI, 1.347-8.883; P=0.049) was independently associated severe injury. Seatbelt use was also an independent risk factor of severe injury (OR, 2.649; 95% CI, 1.178-5.940; P=0.018). Common severe injuries encountered in rear seats were chest (12.1%), spine (9.3%), and abdomen (5.7%). Conclusion In contrast to the fact that seat belt use reduces the severity of injuries, seatbelt use was associated with severe injury in this study. Further research will be needed to assess the effects of seatbelt use. In addition, awareness should be raised about the relationship between the accident mechanism, seatbelt use, and the commonly injured body region.

Objective: Alcohol consumption is a frequent risk factor for trauma. The shock index is widely used to predict the prognosis of trauma, and alcohol can influence the shock index in several ways. This study investigated the usefulness of the shock index in trauma patients who had ingested alcohol. Methods: This was a retrospective, observational, single-center study. We performed a logistic regression analysis to assess the association between alcohol consumption and massive transfusions. A receiver operating characteristic (ROC) curve was constructed to determine the predictive value of the shock index for patients who had ingested alcohol. Results: A total of 5,128 patients were included in the study. The alcohol-positive group had lower systolic blood pressure and higher heart rate; consequently, the shock index in this group was higher. There was no significant difference between the proportion of the alcohol-positive and alcohol-negative groups who underwent massive transfusions and suffered hospital mortality compared to the overall proportion of patients who underwent massive transfusion based on the shock index. In the logistic regression analysis, the alcohol-negative group showed higher odds ratios for massive transfusions compared to the alcohol-positive group. The area under the ROC curve for predicting massive transfusion was 0.831 for the alcohol-positive group and 0.825 for the alcohol-negative group. However, when a cutoff value of 1 was used, the false positive rate was significantly higher in the alcohol-positive group. Conclusion The shock index is a useful tool for predicting outcomes in patients with trauma. However, in patients who have ingested alcohol, the shock index should be interpreted with caution.

Objective: This study evaluated the accuracy of the pre-hospital shock index multiplied by the AVPU scale (PSIAVPU) as a predictor of massive transfusion (MT) and traumatic coagulopathy. Methods: This research was a retrospective single-center study that included patients consecutively presenting to a trauma center between 2017 and 2020. The predictive value of the PSIAVPU for MT, in-hospital mortality, and traumatic coagulopathy was measured using the area under the curve (AUC) of the receiver operating characteristic curve. The AUC of the PSIAVPU was compared with the Reverse Shock Index multiplied by the Glasgow Coma Scale (rSIG) measured at the trauma center presentation. Results: One thousand seven hundred and ninety-two patients were included, of which 163 patients (9.09%) received MT and 195 patients (10.88%) died during their hospital stay. Traumatic coagulopathy was observed in 245 patients. The AUC values for the PSIAVPU in terms of predicting MT, hospital mortality, and traumatic coagulopathy were 0.755, 0.752, and 0.736, respectively. Conclusion In patients with trauma, the predictive power of the PSIAVPU was higher than that of the prehospital shock index and was comparable to that of the rSIG. The PSIAVPU is a useful indicator that can be used easily and quickly for trauma patients at the prehospital stage.