The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Jan 2012
Comparative StudyA cost-minimization analysis of phenytoin versus levetiracetam for early seizure pharmacoprophylaxis after traumatic brain injury.
Recent data indicate comparable efficacy and safety for levetiracetam (LEV) when compared with phenytoin (PHT) for prophylaxis of early seizures after traumatic brain injury. The purpose of this study was to conduct a cost-minimization analysis, from the perspective of both the acute care institution (cost) and patient (charges), comparing these two strategies. ⋯ From both institutional and patient perspectives, PHT is less expensive than LEV for routine pharmacoprophylaxis of early seizures among traumatic brain injury patients. Pending compelling efficacy data, LEV should not replace PHT as a first-line agent for this indication.
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J Trauma Acute Care Surg · Jan 2012
Conductor-assisted nasal sonography: an innovative technique for rapid and accurate detection of nasal bone fracture.
Nasal bone is frequently involved in craniofacial trauma. We sought to investigate the role of conductor-assisted nasal sonography (CANS) in patients with nasal trauma. ⋯ CANS technique could detect nasal bone fracture more accurately compared with conventional methods. We recommend it as a new standard of diagnostic tool for nasal fracture.
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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.
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Trauma centers nationwide have been experiencing an increase in their elderly trauma patients because of an ever growing elderly population within the United States. Many studies have demonstrated the physiologic differences between an older trauma patient versus a younger trauma patient. Coupling these differences with their coexisting medical comorbidities, makes caring for this population extremely challenging. To meet these challenges, we organized a geriatric trauma unit specifically designed with a multidisciplinary approach to take a more aggressive stance to the care of the geriatric trauma patient. ⋯ Our data from the 1-year experience of our G-60 unit show that addressing the specific needs of elderly trauma patients will lead to better outcomes.
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J Trauma Acute Care Surg · Jan 2012
Is contrast exposure safe among the highest risk trauma patients?
Despite improvements in the diagnosis and management of acute kidney injury (AKI), posttraumatic renal dysfunction continues to be associated with increased morbidity and mortality. Intravenous (IV) contrast is known to induce AKI in high-risk groups including the elderly and critically ill. We sought to determine whether IV contrast exposure among high-risk trauma patients resulted in renal dysfunction as defined by the Acute Kidney Injury Network criteria. ⋯ A complete trauma workup including studies requiring IV contrast exposure should be considered safe even among high-risk trauma patients.