Injury
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Skateboard injuries have been described in the media and scientific journals as a problem prevalent among children and adolescents. Skateboarding popularity has continued to grow since the 1970s with ridership increasing to include all age groups. Recently, surgeons at one trauma centre at an urban hospital noted an increase in the number of older skateboarders with life-threatening injuries. We hypothesise that the clinical and epidemiological features of skateboard-related injuries from one trauma centre (TC) will be different from injured skateboarders identified in the U.S. National Trauma Data Bank (NTDB). We also sought to identify factors related to poor outcomes in the TC and NTDB patient groups. ⋯ From our Trauma Centre we describe an older injured skateboarding population, clinically and epidemiologically different from injured patients identified in the NTDB as well as those described in the literature. The greater severity of injury, including traumatic brain injury, has direct implications for preventive and educational measures and the planning of emergency surgical response.
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Comparative Study
Utility of interim ROTEM(®) values of clot strength, A5 and A10, in predicting final assessment of coagulation status in severely injured battle patients.
Proactive management of trauma-related coagulopathy requires early identification and rapid assessment in order to allow targeted resuscitation. This study determined whether early (interim) ROTEM(®) (TEM International GmbH, Munich, Germany) values could predict hypocoagulopathy in seriously injured military patients. ⋯ The A10 value of ROTEM(®) provides an early sensitive and specific assessment of coagulopathy after military trauma and may be of utility in guiding bespoke resuscitation. We found some speculative evidence that in major trauma platelet function is particularly affected.
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Early transfusion (ET=within 24h) has been shown to be required in approximately 5% of trauma patients. Critical care transfusion guidelines control transfusion triggers by evidence based cut-offs. Empirical guidelines influence decision making for ET in trauma. ⋯ The prospective evaluation of acutely transfused trauma patients showed a distinct pattern of transfusion triggers as the patient passes from ED to the OT and arrives to the ICU. The conventional transfusion trigger (haemoglobin level) is not appropriate in ET as early transfusion triggers are based on vital signs, blood gas results, injury patterns and anticipated major bleeding.
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Comparative Study
Selective non-operative management of abdominal gunshot wounds: survey of practise.
There is a growing body of evidence attesting to the effectiveness and safety of selective non-operative management (SNOM) of abdominal gunshot wounds. However, much of the research which supports this conclusion has originated from a few centres, and the actual utilisation of SNOM by trauma surgeons is not known. We therefore conducted a survey to assess the acceptance of this strategy and evaluate variations in practise. ⋯ SNOM of abdominal gunshot wounds is practised by trauma surgeons in all four countries surveyed, but is not universally accepted, and there are variations in how it is practised.