The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Jul 2017
Combination therapy of levetiracetam and gabapentin against nonconvulsive seizures induced by penetrating traumatic brain injury.
Posttraumatic seizures are a medical problem affecting patients with traumatic brain injury. Yet effective treatment is lacking owing to the limitations of antiepileptic drugs (AEDs) applicable to these patients. ⋯ This study was the first attempt to apply isobolographic approach to studying AED combination therapy in the context of spontaneously occurring posttraumatic seizures. Despite the failure to achieve additivity from levetiracetam and gabapentin combination, it is important to recognize the objectivity of the isobolographic approach in the evaluation of AED combination therapy against seizures directly associated with brain injuries.
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J Trauma Acute Care Surg · Jul 2017
Multicenter StudyIncreased anatomic severity in appendicitis is associated with outcomes in a South African population.
Severity of emergency general surgery (EGS) diseases has not been standardized until recently. The American Association for the Surgery of Trauma (AAST) proposed an anatomic severity grading system for EGS diseases to facilitate communication and quality comparisons between providers and hospitals. Previous work has demonstrated validity of the system for appendicitis in the United States. To demonstrate generalizability, we aim to externally validate this grading system in South African patients with appendicitis. ⋯ Prognostic, level II.
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J Trauma Acute Care Surg · Jul 2017
Multicenter StudyIncompatible type A plasma transfusion in patients requiring massive transfusion protocol: Outcomes of an Eastern Association for the Surgery of Trauma multicenter study.
With a relative shortage of type AB plasma, many centers have converted to type A plasma for resuscitation of patients whose blood type is unknown. The goal of this study is to determine outcomes for trauma patients who received incompatible plasma transfusions as part of a massive transfusion protocol (MTP).
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J Trauma Acute Care Surg · Jul 2017
Computed tomography evidence of fluid in the hernia sac predicts surgical site infection following mesh repair of acutely incarcerated ventral and groin hernias.
Mesh placement during repair of acutely incarcerated ventral and groin hernias is associated with high rates of surgical site infection (SSI). The utility of preoperative computed tomography (CT) in this setting is unclear. We hypothesized that CT evidence of bowel wall compromise would predict SSI while accounting for physiologic parameters. ⋯ Prognostic study, level III; Therapeutic, level IV.
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J Trauma Acute Care Surg · Jul 2017
Early unplanned trauma readmissions in a safety net hospital are resource intensive but not due to resource limitations.
In an era of decreasing reimbursements, the incentive to decrease readmissions has never been greater. It has been suggested that trauma readmission is an indicator of poor hospital care or fragmented discharge. Even though trauma readmissions are relatively low, readmissions add significant cost, tie up already limited resources and lead to worse outcomes, including mortality. The literature on trauma readmissions is sparse, and the reasons and risk factors for readmission are inconsistent across studies. If readmissions are to serve as useful indicators of quality of care, we must elucidate factors that may predict readmissions. ⋯ Care management, level IV; Epidemiologic, level IV.