Abstract 3: Detailed Description of All Deaths in Both the Shock and Traumatic Brain Injury Cohorts of the Resuscitation Outcomes Consortium Hypertonic Saline Trials
Bibliographic record
Abstract
Introduction: In trials conducted by the Resuscitation Outcomes Consortium (ROC) in patients with traumatic hypovolemic shock (shock) or traumatic brain injury (TBI), hypertonic saline failed to demonstrate improved survival. We sought to identify causes of mortality in this patient population to determine targets for future studies. Methods: Retrospective review of patients enrolled in a multicenter, randomized, clinical trial performed 2006-2009 by 114 EMS agencies in North America within ROC. Inclusion criteria were injured patients, age ≥ 15 years with hypovolemic shock (SBP ≤ 70 mm Hg or SBP 71-90 mm Hg with HR ≥ 108) or severe TBI [Glasgow Coma Score (GCS) ≤8]. Initial resuscitation fluid administered by out-of-hospital providers was 250 mL of either 7.5% saline with 6% dextran 70, 7.5% saline or 0.9% saline. Results: 2071 subjects were enrolled (821 shock, 1250 TBI). Survivors were younger than non-survivors [30(IQR 23) vs 42(34)] and had a higher GCS, though similar hemodynamics. Greater than 90% of deaths occurred despite ongoing resuscitative efforts. Forty six percent of the deaths in the TBI cohort were within 24 hours, compared with 81% in the shock cohort and 72% in the cohort with both shock and TBI. Median time to death was 29 hours in the TBI cohort, 2 hours in the shock cohort, and 4 hours in patients with both. Conclusion: Most deaths from trauma occur within the first 24 hrs from hypovolemic shock or TBI. Late deaths from sepsis and multiple organ failure are rare. Novel resuscitation strategies should focus on early deaths.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.019 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.006 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.074 | 0.009 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".