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tal from July 1999 to June 2002. International Emergency Medicine is coordinated by Jeffrey Arnold, MD, ofTufts University School of Medicine and Baystate Medical Center, Springfield, Massachusetts.Recombinant Activated Coagulation Factor VII and Bleeding Trauma PatientsRizoli, Sandro B. MD, PhD; Nascimento, Bartolomeu Jr MD; Osman, Fahima MD; Netto, Fernando SpencerMD, PhD; Kiss, Alex PhD; Callum, Jeannie MD; Brenneman, Frederick D. MD; Tremblay, Lorraine MD, PhD;Tien, Homer C. MDJournal of Trauma-Injury Infection & Critical Care. 61(6):1419-1425, December 2006.ABSTRACTBackground: Recombinant activated coagulation factor VII (rFVIIa) is increasingly being administered to massivelybleeding trauma patients. rFVIIa has been shown to correct coagulopathy and to decrease transfusion requirements.However, there is no conclusive evidence to suggest that rFVIIa improves the survival of thesepatients. The purpose of this study was to determine whether or not rFVIIa has an effect on the in-hospital survivalof massively bleeding trauma patients. Methods: A retrospective cohort study was conducted from January1, 2000 to January 31, 2005, at a Level I trauma center in Toronto, Canada. Inclusion criteria includedtrauma patients requiring transfusion of 8 or more units of packed red cells within the first 12 hours of admission.The primary exposure of interest was the administration of rFVIIa. Primary outcome was a 24-hour survivaland secondary outcome was overall in-hospital survival. Results: There were 242 trauma patientsidentified who met inclusion criteria; 38 received rFVIIa. rFVIIa patients were younger, had more penetratinginjuries, and fewer head injuries. However, rFVIIa patients required more red cell transfusions initially, and weremore acidotic. Administering rFVIIa was associated with improved 24-hour survival, after adjusting for baselinedemographics and injury factors. The odds ratio (OR) for survival was 3.4 (1.2-9.8). Furthermore, therewas a strong trend toward increased overall in-hospital survival. The OR of in-hospital survival was 2.5 (0.8-7.6). Also, subgroup analysis of rFVIIa patients showed that 24-hour survivors required a slower initial rate ofred cell transfusion (4.5 vs. 2.9 units/hr, p = 0.002), had higher platelet counts (175 vs. 121 [x10-9/L], p = 0.05)and smaller base deficits (7.1 vs. 14.3, p = 0.001) compared with rFVIIa patients who died during the first 24hours. Conclusion: rFVIIa may be able to improve the early survival of massively bleeding trauma patients.However, surgical control of massive hemorrhage still has primacy, as rFVIIa did not appear efficacious if extremelyhigh red cell transfusion rates were required. Also, correction of acidosis and thrombocytopenia maybe important for rFVIIa efficacy. Prospective studies are required.Resolution and Severity in Decompression IllnessVann, Richard D.; Denoble, Petar J.; Howle, Laurens E.; Weber, Paul W.; Freiberger, John J.; Pieper, Carl F.Aviation, Space, and Environmental Medicine, Volume 80, Number 5, May 2009 , pp. 466-471(6)ABSTRACTWe review the terminology of decompression illness (DCI), investigations of residual symptoms of decompressionsickness (DCS), and application of survival analysis for investigating DCI severity and resolution.The Type 1 and Type 2 DCS classifications were introduced in 1960 for compressed air workers andadapted for diving and altitude exposure with modifications based on clinical judgment concerning severityand therapy. In practice, these proved ambiguous, leading to recommendations that manifestations, not cases,be classified. A subsequent approach assigned individual scores to manifestations and correlated total casescores with the presence of residual symptoms after therapy. The next step used logistic regression to find thestatistical association of manifestations to residual symptoms at a single point in time. Survival analysis, acommon statistical method in clinical trials and longitudinal epidemiological studies, is a logical extension oflogistic regression. The method applies to a continuum of resolution times, allows for time varying information,can manage cases lost to follow-up (censored), and has potential for investigating questions such as optimaltherapy and DCI severity. There are operational implications as well. Appropriate definitions of mild andserious manifestations are essential for computing probabilistic decompression procedures where severity determinesthe DCS probability that is acceptable. Application of survival analysis to DCI data would require morespecific case information than is commonly recorded.Abstracts From Current Literature55