Injury
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Multicenter Study
The use of recombinant activated factor VII in trauma patients: Experience from the Australian and New Zealand haemostasis registry.
There is increasing use of rFVIIa (eptagog alpha, Novoseven) in injured patients with critical bleeding. The role of rFVIIa is not defined in this group of patients. Registries provide an opportunity to review the patients, reported response and adverse events for rFVIIa. ⋯ The best approach to managing critical bleeding in trauma patients is not agreed. The role of rFVIIa will only be clarified if there is a standardised approach to fluid management and transfusion of blood products. The registry allows tracking of current practice, outcomes and adverse events and will complement present phase 2 and 3 trials.
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Multicenter Study
Assessment of the status of resources for essential trauma care in Hanoi and Khanh Hoa, Vietnam.
The World Health Organization and the International Association for Trauma Surgery and Intensive Care have published the Guidelines for Essential Trauma Care. This provides recommendations for the human and physical resources needed to provide an adequate, essential level of trauma care services in countries at all economic levels worldwide. We sought to use this set of recommendations as a basis to assess the trauma care capabilities in two locations in Vietnam and thus to identify affordable and sustainable methods to strengthen trauma care nationwide. ⋯ This study has identified several low-cost ways in which to strengthen trauma care in Vietnam. These include greater use of continuing education courses for trauma care and more attention to trauma related curriculum in schools of medicine and nursing. These also include defining and assuring the availability of a core set of essential trauma related equipment and supplies. A policy recommendation that follows from the above findings is the need for programs to strengthen the organization and planning for trauma care.
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Multicenter Study
Versatility of the sural fasciocutaneous flap in coverage defects of the lower limb.
We present in this work, our experience with the sural fasciocutaneous flap to treat coverage defects following a lower limb posttraumatic lesion. This paper is a review of these flaps carried out in different centres between 2000 and 2005. The series consists of 14 patients, 12 men and 2 women with an average age of 38 years (23-54) and with a medium follow-up time of 2 years (12-48 months). ⋯ The sural fasciocutaneous flap is useful for the treatment of complex injuries of the lower limbs and their complications. Its technical advantages are: easy dissection with preservation of more important vascular structures in the limb, complete coverage of the soft tissue defect in just one operation without the need of microsurgical anastomosis. All this results in a well vascularised cutaneous islet and thus a reliable flap.
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Multicenter Study
Is routine portable pelvic X-ray in stable multiple trauma patients always justified in a high technology era?
According to the Advanced Trauma Life Support, portable pelvis radiography (PXR) is mandatory in multiple trauma patients, and is performed following initial clinical evaluation. The purpose of an early PXR is to identify pelvic fractures that may have haemodynamic consequences. Today, ultrafast multi-detector CT scanners (MDCT) are readily available and widely used in the evaluation of stable trauma patients. The objective of this study was to determine the impact of PXR in stable blunt multiple trauma patients, who required CT scan for full evaluation of the abdomen and pelvis. ⋯ PXR in stable blunt multiple trauma patients did not change the therapeutic policy in our patients. CTA of the abdomen and pelvis is the imaging modality of choice in blunt multiple trauma, regardless of the findings of PXR. Benefit of routine PXR is questionable in hospitals where MDCT is available. Based on our results, we suggest re-evaluating the current practice of routine mandatory portable pelvis radiography.
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Multicenter Study
The German Multicentre Pelvis Registry: a template for an European Expert Network?
The range of severity of pelvic injuries is wide and can include simple, undisplaced pelvic fractures, which may limit the activity of the individual patient for only a short period of time, and severe, complex or even open pelvic fractures, causing immediate life threatening situations. Even with continuous progress in development of techniques and treatment protocols, primary treatment and definitive reconstruction of pelvic ring injuries and acetabular fractures there is still an ongoing debate about specific problems in the evaluation of injuries and fractures. Because of the low incidence of pelvic fractures (37/100,000) the individual experience, which can be acquired by the surgical team, even in major Trauma Centres, is limited and can only be acquired over a longer period of time. ⋯ As this registry is already designed as an open platform, not limited in capacity and regions, it provides a platform, which may easily be expanded to the European level allowing for international multicentre studies and case sampling. Therefore this type of pelvic registry could act as a basis for further scientific evaluation of specific topics in the field of pelvic and acetabular surgery and could be a template for a European Expert Network. Driven by the differences of healthcare systems and organisation of trauma care within Europe and the challenge that pelvic fractures not only can lead to permanent disability, but also play an important role in posttraumatic fatalities, a clear need can be shown for detailed analysis of the present situation within the different European nations.