Injury
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Comparative Study
The selective conservative management of penetrating thoracic trauma is still appropriate in the current era.
Traumatic pleural collections secondary to penetrating chest trauma are generally managed by intercostal chest drainage (ICD), but these protocols were developed a few decades ago when stabs (SWs) predominated over gunshot wounds (GSWs). This study reviews the outcome of a selective conservative approach to penetrating thoracic trauma to establish if it is still appropriate in the current era. ⋯ SWs continue to predominate over GSWs. PTXs were more commonly associated with SWs, whilst HPTX are more commonly associated with GSWs. A policy of selective conservatism is still applicable to the management of traumatic pleural collections.
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Red blood cell (RBC) transfusion is often essential during trauma resuscitation but is associated with high cost and potential adverse outcomes. This study aimed to determine the incidence of potentially avoidable RBC transfusions (PAT) among adult major trauma patients. ⋯ PAT after trauma was common and often delivered to haemodynamically stable patients who did not require surgical procedures. Clinical decision pathways for trauma resuscitation should aim to limit PAT.
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Observational Study
Association of high volumes of hydroxyethyl starch with acute kidney injury in elderly trauma patients.
Initial fluid resuscitation in trauma is still controversial. Hydroxyethyl starch (HES), a commonly used fluid for resuscitation in trauma patients, has potential nephrotoxic effects. Advancing age is a known risk factor for acute kidney injury (AKI) in trauma patients. Therefore, the objective of this study was to evaluate the impact of large volumes of HES 130/0.4 on renal function in trauma patients, with a particular focus on the significance of age. ⋯ Fluid resuscitation with more than 2000ml HES (130kD/0.4) during the first twenty four hours after trauma was not associated with an increased incidence of AKI or need for RRT in trauma patients compared to patients who were administered<2000ml HES (130kD/0.4). The analysis of patients older than 59 years of age did not demonstrate any difference in the incidence of AKI or the need for RRT.
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We performed a simple biomechanical study to compare the fixation strength of titanium mesh with traditional tension-band augmentation, which is a standard treatment for transverse patella fractures. We hypothesised that titanium mesh augmentation is not inferior in fixation strength to the standard treatment. ⋯ Titanium mesh augmentation is not inferior to tension-band wire augmentation when comparing ultimate force required for failure in this simplified biomechanical model. Results also indicate that stiffness of the two constructs is similar but that the mesh maintains a smaller fracture gap prior to failure. The results of this study indicate that the use of titanium mesh plating augmentation as a low-profile alternative to tension-band wiring for fixation of transverse patella fractures warrants further investigation.
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Observational Study
A procedural check list for pleural decompression and intercostal catheter insertion for adult major trauma.
Intercostal catheter (ICC) insertion is the standard pleural decompression and drainage technique for blunt and penetrating traumatic injury. Potentially high complication rates are associated with the procedure, with the literature quoting over 20% in some cases (1-4). Empyema in particular is a serious complication. Risk adverse industries such as the airline industry and military services regularly employ checklists to standardise performance and decrease human errors. The use of checklists in medical practice is exemplified by introduction of the WHO Surgical Safety checklist. ⋯ Quality control checklists - such as the ICC checklist described - are a sensible and functional means to standardise practice, to decrease procedural error and to reduce complication rates during trauma resuscitation.