The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Jan 2012
A management of blunt thoracic trauma in an emergency department observation unit: pre-post observational study.
The best management of patients with isolated blunt thoracic trauma at high risk of pulmonary complications (HRPC-BTT: ≥3 isolated rib fractures, sternal fracture, single or few pulmonary contusions or minimal pneumothorax) is still unclear. We compared efficacy and cost-effectiveness of a new clinical pathway involving an Emergency Department Observation Unit (EDOU) with routine care. ⋯ In managing patients affected by HRPC-BTT, a clinical pathway involving the EDOU seems to be more effective than routine care with little impact on cost.
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J Trauma Acute Care Surg · Jan 2012
Multicenter StudyBlunt splenic trauma: splenectomy increases early infectious complications: a prospective multicenter study.
The purpose of this study was to evaluate the effect of the method of splenic injury management on early infectious complications. ⋯ Splenectomy is an independent risk factor for early infectious complications. Splenic-preserving techniques should be considered more liberally.
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J Trauma Acute Care Surg · Jan 2012
Multicenter StudyManagement of post-traumatic retained hemothorax: a prospective, observational, multicenter AAST study.
The natural history and optimal management of retained hemothorax (RH) after chest tube placement is unknown. The intent of our study was to determine practice patterns used and identify independent predictors of the need for thoracotomy. ⋯ RH in trauma is associated with high rates of empyema and pneumonia. VATS can be performed with high success rates, although optimal timing is unknown. Approximately, 25% of patients require at least two procedures to effectively clear RH or subsequent pleural space infections and 20.4% require thoracotomy.
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J Trauma Acute Care Surg · Jan 2012
The Baux score is dead. Long live the Baux score: a 27-year retrospective cohort study of mortality at a regional burns service.
To assess trends in mortality after burn injuries treated in a regional specialist burns service between 1982 and 2008. ⋯ Mortality is markedly improved over earlier data from this study and other historical series and compares favorably with outcomes published from the US National Burn Repository. The Baux Score continues to provide an indication of the risk of mortality. Survival after major burn injury is increasingly common, and decisions by nonspecialist about initial triage, management, and futility of care should be made after consultation with a specialist burn service.