The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Feb 2014
Comparative StudyBlunt cerebrovascular injury screening with 64-channel multidetector computed tomography: more slices finally cut it.
Aggressive screening to diagnose blunt cerebrovascular injury (BCVI) results in early treatment, leading to improved outcomes and reduced stroke rates. While computed tomographic angiography (CTA) has been widely adopted for BCVI screening, evidence of its diagnostic sensitivity is marginal. Previous work from our institution using 32-channel multidetector CTA in 684 patients demonstrated an inadequate sensitivity of 51% (Ann Surg. 2011,253: 444-450). Digital subtraction angiography (DSA) continues to be the reference standard of diagnosis but has significant drawbacks of invasiveness and resource demands. There have been continued advances in CT technology, and this is the first report of an extensive experience with 64-channel multidetector CTA. ⋯ Diagnostic study, level III.
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For older adults, even ground-level falls (GLFs) can result in multiple injuries and are associated with significant morbidity and mortality. Previous studies have focused on in-hospital outcomes and patients with isolated injuries. Our study examined outcomes following discharge for older adults who were hospitalized following a GLF. ⋯ Prognostic and epidemiologic study, level III.
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J Trauma Acute Care Surg · Feb 2014
Comparative StudyInternationally comparable diagnosis-specific survival probabilities for calculation of the ICD-10-based Injury Severity Score.
The International Statistical Classification of Diseases, 10th Revision (ICD-10)-based Injury Severity Score (ICISS) performs well but requires diagnosis-specific survival probabilities (DSPs), which are empirically derived, for its calculation. The objective was to examine if DSPs based on data pooled from several countries could increase accuracy, precision, utility, and international comparability of DSPs and ICISS. ⋯ Prognostic and epidemiological study, level III.
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J Trauma Acute Care Surg · Feb 2014
Routine repeat brain computed tomography in all children with mild traumatic brain injury may result in unnecessary radiation exposure.
Computed tomography (CT) for pediatric traumatic brain injury (TBI) is common. Evidence suggests that 1 in 1,200 children undergoing CT will die of malignancy from radiation exposure. Presently, there is no protocol for surveying children with mild TBI; repeat CT (rCT) is often performed. We hypothesized that rCT could be avoided. Outcomes of similar patients who underwent rCT were compared with those of patients followed by clinical examination alone. ⋯ Therapeutic study, level IV.
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J Trauma Acute Care Surg · Feb 2014
Making the financial case for a surgeon-directed critical care ultrasound program.
We sought to demonstrate that a well-staffed, surgeon-directed, critical care ultrasound program (CCUP) is financially sustainable and provides administrative and educational support for point-of-care ultrasound. ⋯ A surgeon-directed CCUP is financially sustainable, addresses administrative issues, and provides valuable training in point-of-care ultrasound.