The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Apr 2014
Multicenter StudyDecompressive craniectomy or medical management for refractory intracranial hypertension: an AAST-MIT propensity score analysis.
Moderate/severe traumatic brain injury (TBI) management involves minimizing cerebral edema to maintain brain oxygen delivery. While medical therapy (MT) consisting of diuresis, hyperosmolar therapy, ventriculostomy, and barbiturate coma is the standard of care, decompressive craniectomy (DC) for refractory intracranial hypertension (ICH) has gained renewed interest. Since TBI treatment guidelines consider DC a second-tier intervention after MT failure, we sought to determine if early DC (<48 hours) was associated with improved survival in patients with refractory ICH. ⋯ Therapeutic care/management, level III.
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J Trauma Acute Care Surg · Apr 2014
Multicenter StudyDeveloping best practices to study trauma outcomes in large databases: an evidence-based approach to determine the best mortality risk adjustment model.
The National Trauma Data Bank (NTDB) is an invaluable resource to study trauma outcomes. Recent evidence suggests the existence of great variability in covariate handling and inclusion in multivariable analyses using NTDB, leading to differences in the quality of published studies and potentially in benchmarking trauma centers. Our objectives were to identify the best possible mortality risk adjustment model (RAM) and to define the minimum number of covariates required to adequately predict trauma mortality in the NTDB. ⋯ Prognostic study, level III.
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J Trauma Acute Care Surg · Apr 2014
Multicenter Study Comparative StudyEpidemiology and risk factors of multiple-organ failure after multiple trauma: an analysis of 31,154 patients from the TraumaRegister DGU.
In the severely injured who survive the early posttraumatic phase, multiple-organ failure (MOF) is the main cause of morbidity and mortality. An enhanced prediction of MOF might influence individual monitoring and therapy of severely injured patients. ⋯ Epidemiologic study, level III.
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J Trauma Acute Care Surg · Apr 2014
Multicenter StudyEvolution in the management of traumatic diaphragmatic injuries: a multicenter review.
Traumatic diaphragmatic injury (TDI) is uncommon and has historically been identified by chest x-ray and repaired by laparotomy with nonabsorbable suture. Blunt TDI was more frequently (90%) detected on the left. With advances in imaging and operative techniques, our objective was to evaluate evolution in incidence, location, and management of TDI. ⋯ Epidemiologic study, level III. Therapeutic study, level IV.
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J Trauma Acute Care Surg · Apr 2014
Multicenter StudyBlood component transfusion increases the risk of death in children with traumatic brain injury.
Blood transfusion has been associated with worse outcomes in adult trauma patients with traumatic brain injury (TBI). However, the effects in injured children have not been evaluated. We hypothesize that blood transfusion is also associated with worse outcomes in children with TBI. ⋯ Epidemiologic study, level III. Therapeutic study, level IV.