The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · May 2014
Comparative StudyPreinjury ambulatory status is associated with 1-year mortality following lateral compression Type I fractures in the geriatric population older than 80 years.
Lateral compression pelvic Type I fractures in the elderly population are most often low-energy osteoporosis related fractures. Previous literature comparing pelvic fractures in young versus elderly patients called into question the general consideration of these injuries as benign injuries with favorable prognoses; however, the geriatric population older than 80 years is often underrepresented. This article focuses on the mortality and functional outcomes after low-energy pelvic fractures in a population of patients older than 80 years. ⋯ Prognostic and epidemiologic, level IV.
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J Trauma Acute Care Surg · May 2014
Comparative StudyPulmonary embolism without deep venous thrombosis: De novo or missed deep venous thrombosis?
Pulmonary embolus (PE) is thought to arise from a deep venous thrombosis (DVT). Recent data suggest that PE can present without DVT, inferring that PE can originate de novo (DNPE). We examined the relationship between DVT and PE in trauma patients screened for DVT with duplex sonography (DS). We sought to validate the incidence of PE without evidence of DVT and to examine the clinical significance of this entity. ⋯ Care management study, level III.
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J Trauma Acute Care Surg · May 2014
Comparative StudyMitochondrial damage-associated molecular patterns released by abdominal trauma suppress pulmonary immune responses.
Historically, fever, pneumonia, and sepsis after trauma are ascribed to pain and poor pulmonary toilet. No evidence supports that assertion however, and no known biologic mechanisms link injury to infection. Our studies show that injured tissues release mitochondria (MT). Mitochondrial damage-associated molecular patterns (mtDAMPs) however can mimic bacterial pathogen-associated danger molecules and attract neutrophils (PMN). We hypothesized that mtDAMPs from traumatized tissue divert neutrophils from the lung, causing susceptibility to infection. ⋯ Rather than acting as a "second hit" to enhance PMN-mediated lung injury, mtDAMPs from trauma and pathogen-associated danger molecules from peritoneal infection diminish PMN accumulation in a contused lung. This may make the lung susceptible to pneumonia. This paradigm provides a novel mechanistic model of the relationship among blunt tissue trauma, systemic inflammation, and pneumonia that can be studied to improve trauma outcomes.
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J Trauma Acute Care Surg · May 2014
Multicenter Study Comparative StudyVenovenous extracorporeal life support improves survival in adult trauma patients with acute hypoxemic respiratory failure: a multicenter retrospective cohort study.
Venovenous extracorporeal life support (VV ECLS) has been reported in adult trauma patients with severe respiratory failure; however, ECLS is not available in many trauma centers, few trauma surgeons have experience initiating ECLS and managing ECLS patients, and there is currently little evidence supporting its use in severely injured patients. This study seeks to determine if VV ECLS improves survival in such patients. ⋯ Therapeutic study, level III.