Injury
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Multicenter Study Comparative Study
Liver cirrhosis but not alcohol abuse is associated with impaired outcome in trauma patients - a retrospective, multicentre study.
Liver cirrhosis has been shown to be associated with impaired outcome in patients who underwent elective surgery. We therefore investigated the impact of alcohol abuse and subsequent liver cirrhosis on outcome in multiple trauma patients. ⋯ Patients suffering from liver cirrhosis presented impaired outcome after multiple injuries. Pre-existing condition such as cirrhosis should be implemented in trauma scores to assess the individual mortality risk profile.
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The importance of health service planning for major incident management has been recognised since the World Trade Centre attacks of September 2001 and is highly relevant to planning for the 2012 Olympics. UK national Major Incident guidance stipulates the use of a system of triage for casualties to prioritise treatment and ensure "the greatest good for the greatest number". However, at least three triage systems are in use worldwide and no evidence exists to demonstrate their relative efficacy. The transport bombings in London on 7th July 2005 caused the largest number of casualties on mainland UK soil since World War 2. We aimed to validate three major incident triage systems using patient data from the 7th July bombings. ⋯ Systematic triage of mass casualties is effective but the amount of missing data seriously compromises any attempt to evaluate systems of trauma care in a major incident.
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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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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.
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Little is known about the costs of injury and their impact on injured persons and their families in Vietnam. This study aimed to examine the cost of injury in hospitalised patients and to identify the most costly injuries and those more likely to result in catastrophic household expenditure. ⋯ A high proportion of households experienced catastrophic expenditure following injury, highlighting the important need for programmes to prevent injuries, road traffic and fall-related injuries in particular. Furthermore, expansion of health insurance coverage may help individuals cope with the financial consequences of injury.