The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Jul 2012
Comparative Study Clinical TrialA comparison of fluid instillation volumes to assess intra-abdominal pressure using Kron's methods.
Intra-abdominal pressure (IAP) measurement has become an important tool in the assessment of critically ill patients. The World Society of the Abdominal Compartment Syndrome consensus guidelines recommend using a maximum volume of 25 mL of sterile saline instilled into the bladder for intermittent IAP measurements. It is postulated that the volume of fluid instilled may have an impact on the estimation of IAP. ⋯ Diagnostic study, level II.
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J Trauma Acute Care Surg · Jul 2012
Criteria for empiric treatment of hyperfibrinolysis after trauma.
Recent studies identify a survival benefit from the administration of antifibrinolytic agents in patients with severe injury and trauma. However, identification of hyperfibrinolysis requires thromboelastography, which is not widely available. We hypothesized that analysis of patients with thromboelastography-diagnosed hyperfibrinolysis would identify clinical criteria for empiric antifibrinolytic treatment in the absence of thromboelastography. ⋯ Prognostic study, level III.
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The increased morbidity and mortality associated with coagulopathy and thrombocytopenia after trauma are well described. However, few studies have assessed platelet function after injury. ⋯ In this prognostic study, we identify clinically significant platelet dysfunction after trauma in the presence of an otherwise reassuring platelet count and standard clotting studies, with profound implications for mortality. Multiple electrode impedance aggregometry reliably identifies this dysfunction in injured patients, and admission AA and collagen responsiveness are sensitive and specific independent predictors of both early and late mortality.
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J Trauma Acute Care Surg · Jul 2012
Impact of operative intervention delay on pediatric trauma outcomes.
Establishing quality indicators is an essential step in improving mortality and disability among pediatric patients with trauma. We hypothesized that timing of craniotomy, intracranial pressure (ICP) monitoring for traumatic brain injury, and abdominal operation for solid organ injury correlates with a reduced risk of death, shorter stay, and reduced risk of requiring assistance at discharge. ⋯ Therapeutic study, level III.
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J Trauma Acute Care Surg · Jul 2012
Predicting outcomes after traumatic brain injury: the development and validation of prognostic models based on admission characteristics.
Early estimation of prognosis for the patient with traumatic brain injury is an important factor in making treatment decisions, resource allocation, classify patients, or communicating with family. We aimed to develop and validate practical prognostic models for mortality at 30 days and for 6 months unfavorable outcome after moderate and severe traumatic brain injury. ⋯ Our validated prognostic models have good performance and are generalizable to be used to predict outcome of new patients. We recommend the use of prognostic models to complement clinical decision making.