The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Apr 2012
Moving from "optimal resources" to "optimal care" at trauma centers.
The Trauma Quality Improvement Program has shown that risk-adjusted mortality rates at some centers are nearly 50% higher than at others. This "quality gap" may be due to different clinical practices or processes of care. We have previously shown that adoption of processes called core measures by the Joint Commission and Centers for Medicare and Medicaid Services does not improve outcomes of trauma patients. We hypothesized that improved compliance with trauma-specific clinical processes of care (POC) is associated with reduced in-hospital mortality. ⋯ Unlike adoption of core measures, compliance with T-POC is associated with reduced mortality in trauma patients. Trauma centers with excess in-hospital mortality may improve patient outcomes by consistently applying T-POC. These processes should be explored for potential use as Core Trauma Center Performance Measures.
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J Trauma Acute Care Surg · Apr 2012
Comparative StudySingle-drug sedation with fentanyl for prehospital postintubation sedation in trauma patients.
A fentanyl-only (FO) regimen for prehospital postintubation sedation in trauma patients was compared with the standard protocol (SP) of fentanyl + benzodiazepine. ⋯ In this study, an FO regimen was associated with similar hemodynamic but worse neurologic variables compared with the SP regimen. Prospective evaluation is warranted before adoption of this regimen, especially in TBI patients.
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J Trauma Acute Care Surg · Apr 2012
Comparative StudyResection and primary anastomosis with proximal diversion instead of Hartmann's: evolving the management of diverticulitis using NSQIP data.
The emergency surgical treatment of acute diverticulitis with feculent or purulent peritonitis has traditionally been the Hartmann's procedure (HP). Debate continues over whether primary resection with anastomosis and proximal diversion may be performed in the setting of a high-risk anastomosis in complicated diverticular disease. In contrast to a loop ileostomy takedown, the morbidity of a Hartmann's reversal is preventative for many patients, leaving them with a permanent stoma. Our study compared the surgical outcomes of patients with perforated diverticulitis who underwent a HP to primary anastomosis with proximal diversion (PAPD). ⋯ The treatment of acute diverticulitis in the setting of contamination can be safely treated with resection, primary anastomosis, and proximal diversion as opposed to a HP in certain circumstances. Given the decreased morbidity of subsequent loop ileostomy takedown compared with a Hartmann's reversal, this procedure should be given consideration in the management of acute, perforated diverticulitis but may not be warranted in cases of feculent peritonitis.
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J Trauma Acute Care Surg · Apr 2012
Advanced endotracheal tube biofilm stage, not duration of intubation, is related to pneumonia.
Biofilms are complex communities of living bacteria surrounded by a protective glycocalyx. Biofilms have been implicated in the development of infections such as dental caries and hardware infections. Biofilms form on endotracheal tubes (ETT) and can impact airway resistance. The lifecycle of a biofilm has four stages. We hypothesize that there is a relationship between the stage of biofilm on the ETT and development of pneumonia. ⋯ Advanced biofilm stage (stage IV) is associated with pneumonia. Duration of intubation does not predict biofilm stage.
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J Trauma Acute Care Surg · Apr 2012
Clinical TrialSurgical treatment of transverse patella fractures by the cable pin system with a minimally invasive technique.
Transverse patella fractures are the most common type of patella fractures. Minimally invasive surgical technique for treatment of transverse patella fractures with the Cable Pin System has not been previously reported. ⋯ Surgical treatment of transverse patella fractures by the Cable Pin System with a minimally invasive technique was shown to provide satisfactory clinical results and excellent knee functions, with less pain and low incidence of complications. It could be a new option for treatment of transverse patella fractures.