The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Jan 2019
Meta AnalysisThe incidence and associations of acute kidney injury in trauma patients admitted to critical care: A systematic review and meta-analysis.
As more patients are surviving the initial effects of traumatic injury clinicians are faced with managing the systemic complications of severe tissue injury. Of these, acute kidney injury (AKI) may be a sentinel complication contributing to adverse outcomes. ⋯ Systematic review and meta-analysis, level III.
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J Trauma Acute Care Surg · Jan 2019
Multicenter Study Clinical TrialClearing the cervical spine in patients with distracting injuries: An AAST multi-institutional trial.
Single institution studies have shown that clinical examination of the cervical spine (c-spine) is sensitive for clearance of the c-spine in blunt trauma patients with distracting injuries. Despite an unclear definition, most trauma centers still adhere to the notion that distracting injuries adversely affect the sensitivity of c-spine clinical examination. A prospective AAST multi-institutional trial was performed to assess the sensitivity of clinical examination screening of the c-spine in awake and alert blunt trauma patients with distracting injuries. ⋯ Therapeutic/care management, level IV.
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J Trauma Acute Care Surg · Jan 2019
Comparative StudyAmerican College of Surgeons Committee on Trauma verification level affects trauma center management of pelvic ring injuries and patient mortality.
Pelvic ring fractures represent a complex injury that requires specific resources and clinical expertise for optimal trauma patient management. We examined the impact of treatment variability for this type of injury at Level I and II trauma centers on patient outcomes. ⋯ Economic/Decision, Level II.
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J Trauma Acute Care Surg · Jan 2019
The impact of prehospital administration of freeze-dried plasma on casualty outcome.
Hemorrhage is the most common preventable cause of death in both civilian and military trauma. There is no consensus regarding the appropriate fluid resuscitation protocol. Plasma, as a resuscitative fluid, has substantial benefits as a volume expander, owing to its relatively high oncotic pressure and its positive effect on trauma-induced coagulopathy by replenishing the lost coagulation factors, rather than diluting the casualty's remaining factors. The Israel Defense Force Medical Corps decided to use freeze-dried plasma (FDP) as the fluid of choice for casualties in hemorrhagic shock in the prehospital setting. The aim of our study is to compare the differences of coagulation, perfusion measurements, resource utilization, and outcome between casualties receiving FDP to casualties who did not receive FDP in the prehospital setting. ⋯ Therapeutic, level IV.
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J Trauma Acute Care Surg · Jan 2019
Tranexamic acid administration is associated with an increased risk of posttraumatic venous thromboembolism.
Tranexamic acid (TXA) is used as a hemostatic adjunct for hemorrhage control in the injured patient and reduces early preventable death. However, the risk of venous thromboembolism (VTE) has been incompletely explored. Previous studies investigating the effect of TXA on VTE vary in their findings. We performed a propensity matched analysis to investigate the association between TXA and VTE following trauma, hypothesizing that TXA is an independent risk factor for VTE. ⋯ Therapeutic, level III.