The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Sep 2016
Sex differences in mortality following isolated traumatic brain injury among older adults.
Older adults have the highest rates of hospitalization and mortality from traumatic brain injury (TBI), yet outcomes in this population are not well studied. In particular, contradictory reports on the protective effect of female sex on mortality following TBI may have been related to age differences in TBI and other injury severity and mechanism. The objective of this study was to determine if there are sex differences in mortality following isolated TBI among older adults and compare with findings using all TBI. A secondary objective was to characterize TBI severity and mechanism by sex in this population. ⋯ Prognostic/epidemiologic study, level IV.
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J Trauma Acute Care Surg · Sep 2016
The National Trauma Institute: Lessons learned in the funding and conduct of 16 trauma research studies.
To increase trauma-related research and elevate trauma on the national research agenda, the National Trauma Institute (NTI) issued calls for proposals, selected funding recipients, and coordinated 16 federally funded (Department of Defense) trauma research awards over a 4-year period. We sought to collect and describe the lessons learned from this activity to inform future researchers of barriers and facilitators. ⋯ Lessons learned in the conduct of the first two funding rounds managed by NTI are instructive in four key areas: regulatory processes, multisite coordination, adequate funding, and the importance of an established research infrastructure to ensure study success. Recommendations for addressing institution-related and investigator-related challenges are discussed along with ongoing advocacy efforts to secure sustained federal funding of a national trauma research program commensurate with the burden of injury.
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J Trauma Acute Care Surg · Sep 2016
Prehospital lactate improves accuracy of prehospital criteria for designating trauma activation level.
Trauma activation level is determined by prehospital criteria. The American College of Surgeons (ACS) recommends trauma activation criteria; however, their accuracy may be limited. Prehospital lactate has shown promise in predicting trauma center resource requirements. Our objective was to investigate the added value of incorporating prehospital lactate in an algorithm to designate trauma activation level. ⋯ Therapeutic/care management study, level III; prognostic/epidemiologic study, level III.
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J Trauma Acute Care Surg · Sep 2016
The impact of patient protection and Affordable Care Act on trauma care: A step in the right direction.
The Patient Protection and Affordable Care Act (ACA) was implemented to guarantee financial coverage for health care for all Americans. The implementation of ACA is likely to influence the insurance status of Americans and reimbursement rates of trauma centers. The aim of this study was to assess the impact of ACA on the patient insurance status, hospital reimbursements, and clinical outcomes at a Level I trauma center. We hypothesized that there would be a significant decrease in the proportion of uninsured trauma patients visiting our Level I trauma center following the ACA, and this is associated with improved reimbursement. ⋯ Economic and value-based evaluation, level III.
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J Trauma Acute Care Surg · Sep 2016
Does sex matter? Effects on venous thromboembolism risk in screened trauma patients.
Sex is associated with disparate risk of venous thromboembolism (VTE) in nontrauma patients, with increased risk seen during pregnancy and in women on hormone-containing medications. Sex effects on VTE after trauma are unclear. Some studies have demonstrated no effect whereas others have instead shown a higher incidence of VTE among men. We hypothesized that male sex would increase the risk of VTE across all age groups in trauma patients undergoing standardized duplex screening. ⋯ Epidemiologic study, level III; therapeutic study, level V.