The FI is an independent predictor of in-hospital complications and adverse discharge disposition in geriatric trauma patients. This index should be used as a clinical tool for risk stratification in this patient group.

A new pharyngeal pH probe which detects aerosolized and liquid acid overcomes the artifacts that occur in measuring pharyngeal pH with existing catheters. Discriminating pH thresholds were selected and normal values defined to identify patients with an abnormal pharyngeal pH environment.

We conducted preregistered replications of 28 classic and contemporary published findings with protocols that were peer reviewed in advance to examine variation in effect magnitudes across sample and setting. Each protocol was administered to approximately half of 125 samples and 15,305 total participants from 36 countries and territories. Using conventional statistical significance (p < .05), fifteen (54%) of the replications provided evidence in the same direction and statistically significant as the original finding. With a strict significance criterion (p < .0001), fourteen (50%) provide such evidence reflecting the extremely high powered design. Seven (25%) of the replications had effect sizes larger than the original finding and 21 (75%) had effect sizes smaller than the original finding. The median comparable Cohen’s d effect sizes for original findings was 0.60 and for replications was 0.15. Sixteen replications (57%) had small effect sizes (< .20) and 9 (32%) were in the opposite direction from the original finding. Across settings, 11 (39%) showed significant heterogeneity using the Q statistic and most of those were among the findings eliciting the largest overall effect sizes; only one effect that was near zero in the aggregate showed significant heterogeneity. Only one effect showed a Tau > 0.20 indicating moderate heterogeneity. Nine others had a Tau near or slightly above 0.10 indicating slight heterogeneity. In moderation tests, very little heterogeneity was attributable to task order, administration in lab versus online, and exploratory WEIRD versus less WEIRD culture comparisons. Cumulatively, variability in observed effect sizes was more attributable to the effect being studied than the sample or setting in which it was studied.

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Prognostic study, level II.

Epidemiologic study, level III.

INTRODUCTION Renewed interest in whole blood (WB) resuscitation in civilians has emerged following its military use. There is a paucity of data on its role in civilians where balanced component therapy (CT) resuscitation is the standard of care. The aim of this study was to assess nationwide outcomes of using WB as an adjunct to CT versus CT alone in resuscitating civilian trauma patients. METHODS We analyzed the (2015–2016) Trauma Quality Improvement Program. We included adult (age, ≥18 years) trauma patients presenting with hemorrhagic shock and requiring at least 1 U of packed red blood cells (pRBCs) within 4 hours. Patients were stratified into WB-CT versus CT only. Primary outcomes were 24-hour and in-hospital mortality. Secondary outcomes were hospital length of stay and major complications. Hierarchical logistic regression was performed to account for clustering effect within hospitals and adjusting for patient- and hospital-level potential confounding factors. RESULTS A total of 8,494 patients were identified, of which 280 received WB-CT (WB, 1 [1–1]; pRBC, 16 [10–23]; FFP, 9 [6–16]; platelets, 3 [2–5]) and 8,214 received CT only (pRBC, 15 [10–24]; FFP, 10 [6–16]; platelets, 2 [1–4]). Mean ± SD age was 34 ± 16 years, 79% were male, Injury Severity Score was 33 (24–43), and 63% had penetrating injuries. Patients who received WB-CT had a lower 24-hour mortality (17% vs. 25%; p = 0.002), in-hospital mortality (29% vs. 40%; p < 0.001), major complications (29% vs. 41%; p < 0.001), and a shorter length of stay (9 [7–12] vs. 15 [10–21]; p = 0.011). On regression analysis, WB was independently associated with reduced 24-hour mortality (odds ratio [OR], 0.78 [0.59–0.89]; p = 0.006), in-hospital mortality (OR, 0.88 [0.81–0.90]; p = 0.011), and major complications (OR, 0.92 [0.87–0.96]; p = 0.013). CONCLUSION The use of WB as an adjunct to CT is associated with improved outcomes in resuscitation of severely injured civilian trauma patients. Further studies are required to evaluate the role of adding WB to massive transfusion protocols. LEVEL OF EVIDENCE Therapeutic, level IV.