The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Aug 2012
Multicenter StudyPrehospital interventions performed in a combat zone: a prospective multicenter study of 1,003 combat wounded.
Battlefield care given to a casualty before hospital arrival impacts clinical outcomes. To date, the published data regarding care given in the prehospital setting of a combat zone are limited. The purpose of this study was to describe the incidence and efficacy of specific prehospital lifesaving interventions (LSIs; interventions that could affect the outcome of the casualty), consistent with the Tactical Combat Casualty Care paradigm, performed during the resuscitation of casualties in a combat zone. ⋯ In our prospective study of prehospital LSIs performed in a combat zone, we observed a higher rate of incorrectly performed and missed LSIs in airway and chest (breathing) interventions than hemorrhage control interventions. The most commonly performed LSIs had lower incorrect and missed LSI rates.
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J Trauma Acute Care Surg · Aug 2012
Multicenter Study Comparative StudyA multicenter prospective analysis of pediatric trauma activation criteria routinely used in addition to the six criteria of the American College of Surgeons.
The American College of Surgeons has defined six minimum activation criteria (ACS-6) for the highest level of trauma activations at trauma centers. The verification criteria also allow for the inclusion of additional criteria at the institution's discretion. The purpose of this prospective multicenter study was to evaluate the ACS-6 as well as commonly used activation criteria to evaluate overtriage and undertriage rates for pediatric trauma team activation. ⋯ The ACS-6 provides a reliable overtriage or undertriage rate for pediatric patients. The inclusion of two additional criteria can further improve these rates while maintianing a simplified triage list for children.
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J Trauma Acute Care Surg · Aug 2012
Multicenter Study Comparative StudyHypothermia in massive transfusion: have we been paying enough attention to it?
The development of acidosis, coagulopathy, and hypothermia has been shown to adversely affect survival after injury. Significant attention has focused on the correction of the early coagulopathy in those requiring massive transfusion (MT). We sought to characterize the importance of temperature as a risk factor for poor outcome relative to the changes in MT resuscitation that have occurred. ⋯ A temperature of 34°C seems to define a clinically significant hypothermia in MT. The independent risks of mortality were greatest in those who received a low FFP/PRBC transfusion ratio. These data suggest that the prevention of hypothermia may be as important as addressing early coagulopathy. Further research is required to verify if the prevention or correction of hypothermia improves the outcome of patients requiring MT.
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J Trauma Acute Care Surg · Aug 2012
Multicenter Study Comparative StudyDebunking the survival bias myth: characterization of mortality during the initial 24 hours for patients requiring massive transfusion.
Controversy surrounds the optimal ratios of blood (packed red blood cell [PRBC]), plasma (fresh frozen plasma [FFP]) and platelet (PLT) use for patients requiring massive transfusion (MT) owing to possible survival bias in previous studies. We sought to characterize mortality during the first 24 hours while controlling for time varying effects of transfusion to minimize survival bias. ⋯ Despite similar degrees of early shock and coagulopathy, high FFP/PRBC and PLT/PRBC ratios are associated with a survival benefit as early as 6 hours and throughout the first 24 hours, even when time-dependent fluctuations of component transfusion are accounted for. This suggests that the observed mortality benefit associated with high component transfusion ratios is unlikely owing to survivor bias and that early attainment of high transfusion ratios may significantly lower the risk of mortality in MT patients.
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J Trauma Acute Care Surg · Aug 2012
Multicenter Study Comparative Study"SCIP"ping antibiotic prophylaxis guidelines in trauma: The consequences of noncompliance.
The Surgical Care Improvement Project (SCIP) established surgical antibiotic prophylaxis guidelines as part of a national patient safety initiative aimed at reducing surgical complications such as surgical site infection (SSI). Although these antibiotic prophylaxis guidelines have become well established in surgical patients, they remain largely unstudied in patients with injury from trauma undergoing operative procedures. We sought to determine the role of these antibiotic prophylaxis guidelines in preventing SSI in patients undergoing trauma laparotomy. ⋯ Our results suggest that SCIP antibiotic prophylaxis guidelines effectively reduce the risk of SSI in patients undergoing trauma laparotomy. Despite the emergent nature of operative procedures for trauma, efforts to adhere to these antibiotic guidelines should be maintained.