The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · May 2014
Multicenter StudyDerivation and validation of a quality indicator for 30-day unplanned hospital readmission to evaluate trauma care.
Unplanned readmissions represent 20% of all admissions and cost $12 billion annually in the United States. Despite the burden of injuries for the health care system, no quality indicator (QI) based on readmissions is available to evaluate trauma care. The objective of this study was to derive and internally validate a QI for a 30-day unplanned hospital readmission to evaluate trauma care. ⋯ Prognostic study, level III.
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J Trauma Acute Care Surg · May 2014
Multicenter StudyBenchmarking trauma centers on mortality alone does not reflect quality of care: implications for pay-for-performance.
Trauma centers are currently benchmarked on mortality outcomes alone. However, pay-for-performance measures may financially penalize centers based on complications. Our objective was to determine whether the results would be similar to the current standard method of mortality-based benchmarking if trauma centers were profiled on complications. ⋯ Prognostic/epidemiologic study, level III.
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J Trauma Acute Care Surg · May 2014
Comparative StudyA risk-adapted approach is beneficial in the management of bilateral femoral shaft fractures in multiple trauma patients: an analysis based on the trauma registry of the German Trauma Society.
Today, there is a trend toward damage-control orthopedics (DCO) in the management of multiple trauma patients with long bone fractures. However, there is no widely accepted concept. A risk-adapted approach seems to result in low acute morbidity and mortality. Multiple trauma patients with bilateral femoral shaft fractures (FSFs) are considered to be more severely injured. The objective of this study was to validate the risk-adapted approach in the management of multiple trauma patients with bilateral FSF. ⋯ Therapeutic study, level IV. Epidemiologic study, level III.
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J Trauma Acute Care Surg · May 2014
Comparative StudyOpen extremity fractures: impact of delay in operative debridement and irrigation.
Early (<8 hours) operative debridement and irrigation (D&I) of open fractures are considered essential to reduce the risk of deep infection. With the advent of powerful antimicrobials, this axiom has been challenged. The current study evaluates the rates of deep infections of open fractures in relation to the time to the first D&I. ⋯ Therapeutic study, level IV.
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J Trauma Acute Care Surg · May 2014
Comparative StudyPredicting the need for abdominal hemorrhage control in major pelvic fracture patients: the importance of quantifying the amount of free fluid.
In our institution, the computed tomographic (CT) scan has largely replaced the ultrasound for the rapid detection of intraperitoneal free fluid (FF) and abdominal injuries in severely injured patients.We hypothesized that in major pelvic fracture patients, quantifying the size of FF on CT improves the predictive value for the need for abdominal hemorrhage control (AHC). ⋯ Therapeutic study, level IV; prognostic study, level III.