The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Feb 2014
Do one-time intracompartmental pressure measurements have a high false-positive rate in diagnosing compartment syndrome?
Intracompartmental pressure measurements are frequently used in the diagnosis of compartment syndrome, particularly in patients with equivocal or limited physical examination findings. Little clinical work has been done to validate the clinical use of intracompartmental pressures or identify associated false-positive rates. We hypothesized that diagnosis of compartment syndrome based on one-time pressure measurements alone is associated with a high false-positive rate. ⋯ Diagnostic study, level II.
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J Trauma Acute Care Surg · Feb 2014
Comparative StudyEnteral albuterol decreases the need for chronotropic agents in patients with cervical spinal cord injury-induced bradycardia.
Cervical spinal cord injury (CSCI) is often complicated by autonomic instability and life-threatening bradycardia. β-adrenergic receptors offer a potential target for modulating cardiac vagal activity and heart rate. Enteral albuterol may mitigate symptomatic bradycardia in CSCI patients. The purpose of this study was to examine the effect of enteral albuterol on the frequency of symptomatic bradycardia and the need for rescue therapy in CSCI patients. ⋯ Therapeutic study, level IV.
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J Trauma Acute Care Surg · Feb 2014
Comparative StudyEvaluation of the oxygenation index in adult respiratory failure.
The oxygenation index (mean airway pressure × FIO2 divided by PaO2) was originally devised to measure severity of illness and predict outcome in neonatal respiratory failure. We evaluated the discrimination of a modified oxygenation index (modified with age) for predicting 28-day mortality in adults with respiratory failure (adult respiratory distress syndrome [ARDS]) using the ALVEOLI section of the ARDSNet database and validated the results in the full ARDSNet database. ⋯ Prognostic, level III.
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J Trauma Acute Care Surg · Feb 2014
Comparative StudyThe impact of preinjury anticoagulants and prescription antiplatelet agents on outcomes in older patients with traumatic brain injury.
Anticoagulants and prescription antiplatelet (ACAP) agents widely used by older adults have the potential to adversely affect traumatic brain injury (TBI) outcomes. We hypothesized that TBI patients on preinjury ACAP agents would have worse outcomes than non-ACAP patients. ⋯ Therapeutic study, level IV.
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J Trauma Acute Care Surg · Feb 2014
Comparative StudyOutcomes of adding acute care nurse practitioners to a Level I trauma service with the goal of decreased length of stay and improved physician and nursing satisfaction.
The trauma service experienced preventable delays caused by an Accreditation Council for Graduate Medical Education work restrictions and a 16% increase in patient census. Furthermore, nurses needed a consistently accessible provider for the coordination of care. We hypothesized that using experienced acute care nurse practitioners (ACNPs) on the stepdown unit would improve throughput and decrease length of stay (LOS) and hospital charges. Moreover, we hypothesized that adding ACNPs would improve staff satisfaction. On December 1, 2011, the Vanderbilt University Medical Center Division of Trauma reassigned ACNPs to the stepdown area 5 days a week for a pilot program. ⋯ Economic/decision study, level III.