Injury
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The Pain, Inspiratory effort, Cough score (PIC) has been developed and widely adopted to guide clinical prognostication for patients with chest wall injury. To date, the efficacy, accuracy, and safety of a PIC based triage system has not been validated. Therefore, this study sought to evaluate the use of a modified-PIC score to triage and down-grade trauma patients with chest wall injury at a single institution. ⋯ This is the largest study, to date, evaluating the impact of a modified-PIC triage system on clinical outcomes. The results suggest a modified-PIC triage system may lead to decreased ICU days, ARDS rates, and rates of cardiac arrest w/ ROSC, potentially improving hospital resource allocation. Further prospective and multi-center studies are needed to validate our understanding on the impact of a chest wall scoring system on triage and outcomes.
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Introduction Computed Tomography (CT) to rule out pulmonary embolus (PE) is often ordered during post-trauma laparotomy clinical decompensation (CD) involving fever, tachycardia, tachypnea, and/or leukocytosis. We hypothesize this diagnostic modality is low-yield in the postoperative period when surgery-related sequelae are more probable. Methods This is a single-center retrospective cohort study of patients who underwent trauma laparotomy and had subsequent CT for CD from March 19, 2019 to June 30, 2022. ⋯ Predictors of clinical intervention required based on CT imaging were GI tract injury (AOR: 1.65, p = 0.0182), and elevated WBC (AOR: 1.038, p = 0.010 Conclusion Saddle and lobar PE incidence post-trauma laparotomy is low. SIRS-type symptoms prompting postoperative CT commonly have no procedural or antibiotic requirement. Postoperative decompensation is more likely related post-operative complications, and less likely a PE.
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Older adults remain active for longer and continue sports and activities that require rotation on one leg later in life. The rate of anterior cruciate ligament (ACL) tears is therefore increasing in those over 40 years old, with an associated increase in the rate of surgical reconstruction (ACLR), but there is limited literature on its effectiveness. Our aim was to compare the outcomes of elderly patients who have undergone ACLR with those of a younger group of patients. ⋯ The long-term results of ACL reconstruction in older athletes are comparable to those of younger patients, both in terms of knee function and patient satisfaction. Furthermore, there is no difference in outcomes for older patients over the age of 40 compared to those in their 50 s or even 60 s. There is still insufficient published evidence to define an upper age limit for ACL reconstruction in older athletes.
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The purpose of this study is to report the data for patients followed-up in our intensive care unit due to the 6th February 2023, earthquake in Kahramanmaraş, Türkiye, and to investigate parameters affecting mortality. ⋯ Not only increased SOFA, serum potassium, serum phosphorus, and serum magnesium, but also decreased bicarbonate, and base deficit were associated with mortality in earthquake victims with crush syndrome in ICU.
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Multicenter Study
Propensity weighted analysis of chemical venous thromboembolism prophylaxis agents in isolated severe traumatic brain injury: An EAST sponsored multicenter study.
In patients with severe traumatic brain injury (TBI), clinicians must balance preventing venous thromboembolism (VTE) with the risk of intracranial hemorrhagic expansion (ICHE). We hypothesized that low molecular weight heparin (LMWH) would not increase risk of ICHE or VTE as compared to unfractionated heparin (UH) in patients with severe TBI. ⋯ Level III, Therapeutic Care Management.