I am earnestly intrigued by the academic contribution of Traboulsy et al. in their published study [ ]. I have undertaken a comprehensive review of the article and wish to respectfully address some matters that have come to my attention. Please allow me to present my concerns.
In the domain of trauma patients, the prevailing concept of the “golden hour” underscores the pivotal importance of the timely provision of primary and secondary medical care in shaping patient mortality outcomes [ ]. Firstly, I seek clarification on whether a comparative analysis has been conducted to scrutinize to critical conditions such as open pneumothorax, tension pneumothorax, massive hemothorax, and cardiac tamponade within the context of thoracic injuries. It is noteworthy that rib fractures can lead to chest instability, and, in some instances, affected patients may not immediately present at healthcare facilities. In these cases, it becomes apparent that the primary determinant of the ultimate patient outcome rests upon the prompt intervention afforded at primary care centers.
Further, I am interested in understanding the surgical outcomes and capabilities of Level 2 and Level 3 hospitals. Specifically, within the cohort of 128 patients who received blood transfusions in these facilities, I am inquiring about the number of individuals who subsequently underwent surgical interventions. Additionally, I am curious to ascertain the presence of thoracic surgical capabilities at these Level 2 and Level 3 hospitals. Among the 16 patients with penetrating trauma who were directed to Level 2 and Level 3 centers, I am interested to know the proportion of individuals who underwent surgical procedures. Moreover, I am intrigued as to whether statistical comparisons can be meaningfully derived from the sample sizes of 21 penetrating trauma patients in Level 1, 12 in Level 2, and 4 in Level 3. The data you have presented also indicates that out of these patient cohorts, 99 originated from Level 1 trauma centers, 74 from Level 2, and 8 from Level 3, and were subsequently directed to the operating room. May we consider these figures as indicative of a preference for Level 3 centers, even for cases that necessitate surgical interventions, such as those involving open pneumothorax, tension pneumothorax, massive hemothorax, and cardiac tamponade? Secondly, I am interested in learning more about the observation in your study that indicates a mortality rate of 33.9% among patients brought to Level 3 centers, as opposed to 17.5% for those arriving at Level 1 centers. You have made a brief mention of the absence of significant disparities between Level 1 and Level 2, except in the context of academic research. I kindly request an elaboration on this aspect.
Turning to the issue of patients who have received blood transfusions, it is noteworthy that 80 individuals within the total patient cohort have been categorized as “unknown/not recorded.” Specifically, 7 of these individuals have been attributed to Level 1, 23 to Level 2, and 50 to Level 3, for whom data retrieval has not been feasible. The striking observation that 83.3% of Level 3 patients feature data gaps when contrasted against the overall patient numbers underscores the need to evaluate whether meaningful inter-group comparisons are feasible concerning the necessity for blood transfusion. I would be most appreciative of your scholarly insights on this subject.
Finally, I kindly seek clarification regarding the rationale for the comparative analysis involving patient cohorts described as “Arrived with no signs of life.” Is there a particular clinical or academic significance attributed to the admission of patients displaying no signs of life to healthcare facilities? I would greatly value your elucidation on this matter.
I extend my gratitude for your consideration of these inquiries and anticipate your valued response.
Yours Sincerely,
Author statement
This article has not been previously presented at any event (congress, symposium etc.)
Human rights
The principles set out in the Helsinki Declaration were followed. The need for informed consent was waived due to the retrospective nature of the study.
Financial support
This research did not receive any specific grant from funding agencies in the public, commercial, or not for profit sectors.
CRediT authorship contribution statement
Nihat Müjdat Hökenek: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing.
Declaration of Competing Interest
The author declare no conflict of interest.
References
Related posts:
CT-based diagnosis in patients presenting with throat pain: A single institutional review
Is the shock index correlated with blood loss? An experimental study on a controlled hemorrhagic shock model in piglets
Injury patterns and mortality associated with near-hanging in children
High risk and low prevalence diseases: Infected urolithiasis
D-dimer measurement is a useful tool of acute aortic syndrome
Ramen noodle neuropathy: an atypical case of partial paralysis from malnutrition
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
