Backround-Physicians reverse patients' warfarin anticoagulation with frozen plasma or prothrombin complex concentrate.Our objective was to determine adverse event frequency after urgent reversal with frozen plasma versus the prothrombin complex concentrate Octaplex. Methods and Results-This natural before-after retrospective cohort study in 2 tertiary care emergency departments compared anticoagulation reversal with frozen plasma (September 2006-August 2008 and with Octaplex (September 2008-August 2010, without other system changes. We included adult patients on warfarin with an international normalized ratio ≥1.5 who received frozen plasma or Octaplex. Our primary outcome was serious adverse events (death, ischemic stroke, myocardial infarction, heart failure, venous thromboembolism, or peripheral arterial thromboembolism) within 7 days. Secondary outcomes included time to international normalized ratio reversal, hospital length of stay, and red blood cells transfused within 48 hours. We included 149 patients receiving frozen plasma and 165 receiving Octaplex. The incidence of serious adverse events for the frozen plasma group was 19.5% compared with 9.7% for the Octaplex group (P=0.014; relative risk, 2.0; 95% confidence interval, 1.1-3.5). This remained significant after adjustment for baseline history and reason for treatment (P=0.038; adjusted relative risk, 1.85; 95% confidence interval, 1.03-3.3) in multivariable regression analysis. Median international normalized ratio reversal was 11.8 hours with frozen plasma and 5.7 hours with Octaplex (P<0.0001). Mean red cell transfusion was 3.2 with frozen plasma and 1.4 with Octaplex (P<0.0001). Conclusions-Octaplex Hickey et al Complications From Octaplex Versus FFP 361The objective of this study is to compare the efficacy and safety of frozen plasma with that of Octaplex, the available 4-factor prothrombin complex concentrate, in our emergency departments (EDs) during the study period. Specifically, we examine adverse effects, time to INR reversal, hospital length of stay, and red cell transfusion requirements. Methods Design and SettingThis retrospective cohort study was conducted using health records of patients who were treated with frozen plasma or Octaplex for emergency reversal of warfarin anticoagulation therapy in 2 tertiary EDs at our institution, which see a total of ≈120 000 ED visits per year. We compared patients who received frozen plasma over a 2-year period before the introduction of Octaplex in September 2008 with those who received Octaplex over an equivalent time period after September 2008. The treatments for both groups were given or started in the ED. The dose of Octaplex administered during the study period was governed by the department of Transfusion Medicine. A standard dose of 1500 IU was administered to patients with intracranial hemorrhage, and a dose of 1000 IU was used for all other patients. This study was approved by our institution's research ethics board. Study PopulationWe included patients who were ≥18 years of age, were ...

Background Rapid response teams (RRTs) respond to hospitalized patients experiencing clinical deterioration and help determine subsequent management and disposition. We sought to evaluate and compare the prognostic accuracy of the Hamilton Early Warning Score (HEWS) and the National Early Warning Score 2 (NEWS2) for prediction of in-hospital mortality following RRT activation. We secondarily evaluated a subgroup of patients with suspected infection. Methods We retrospectively analyzed prospectively collected data (2012–2016) of consecutive RRT patients from two hospitals. The primary outcome was in-hospital mortality. We calculated the number needed to examine (NNE), which indicates the number of patients that need to be evaluated in order to detect one future death. Results Five thousand four hundred ninety-one patients were included, of whom 1837 (33.5%) died in-hospital. Mean age was 67.4 years, and 51.6% were male. A HEWS above the low-risk threshold (≥ 5) had a sensitivity of 75.9% (95% confidence interval (CI) 73.9–77.9) and specificity of 67.6% (95% CI 66.1–69.1) for mortality, with a NNE of 1.84. A NEWS2 above the low-risk threshold (≥ 5) had a sensitivity of 84.5% (95% CI 82.8–86.2), and specificity of 49.0% (95% CI: 47.4–50.7), with a NNE of 2.20. The area under the receiver operating characteristic curve (AUROC) was 0.76 (95% CI 0.75–0.77) for HEWS and 0.72 (95% CI: 0.71–0.74) for NEWS2. Among suspected infection patients ( n = 1708), AUROC for HEWS was 0.79 (95% CI 0.76–0.81) and for NEWS2, 0.75 (95% CI 0.73–0.78). Conclusions The HEWS has comparable clinical accuracy to NEWS2 for prediction of in-hospital mortality among RRT patients. Electronic supplementary material The online version of this article (10.1186/s13054-019-2355-3) contains supplementary material, which is available to authorized users.

Intralesional curettage as an alternative to wide resection for extrapelvic grade I chondrosarcoma of bone does not greatly increase the risk for local recurrence or metastasis. Overall effect estimates, however, should be interpreted with caution as a result of the relatively small number of events.

BackgroundFalling down a flight of stairs is a common injury mechanism in major trauma patients, but little research has been undertaken into the impact of age and alcohol intoxication on the injury patterns of these patients. The aim of this study was to compare the impact of age and alcohol intoxication on injury pattern and severity in patients who fell down a flight of stairs.MethodsThis was a retrospective observational study of prospectively collected trauma registry data from a major trauma centre in the United Kingdom comparing older and younger adult patients admitted to the Emergency Department following a fall down a flight of stairs between July 2012 and March 2015.ResultsOlder patients were more likely to suffer injuries to all body regions and sustained more severe injuries to the spine; they were also more likely to suffer polytrauma (23.6% versus 10.6%; p < 0.001). Intoxicated patients were more likely to suffer injuries to the head and neck (42.9% versus 30.5%; p = 0.006) and were significantly younger than sober patients (53 versus 69 years; p < 0.001).ConclusionOlder patients who fall down a flight of stairs are significantly different from their younger counterparts, with a different injury pattern and a greater likelihood of polytrauma. In addition, alcohol intoxication also affects injury pattern in people who have fallen down a flight of stairs, increasing the risk of traumatic brain injury. Both age and intoxication should be considered when managing these patients.