The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Jun 2020
Comparative Study Observational StudyDiagnostic accuracy of different clinical screening criteria for blunt cerebrovascular injuries compared with liberal state of the art computed tomography angiography in major trauma.
Blunt cerebrovascular injuries (BCVI) can significantly impact morbidity and mortality if undetected and, therefore, untreated. Two diagnostic concepts are standard practice in major trauma management: Application of clinical screening criteria (CSC) does or does not recommend consecutive computed tomography angiography (CTA) of head and neck. In contrast, liberal CTA usage integrates into diagnostic protocols for suspected major trauma. First, this study's objective is to assess diagnostic accuracy of different CSC for BCVI in a population of patients diagnosed with BCVI after the use of liberal CTA. Second, anatomical locations and grades of BCVI in CSC false negatives are analyzed. ⋯ Diagnostic study, Level III.
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J Trauma Acute Care Surg · Jun 2020
Meta Analysis Comparative StudyLaparoscopic versus open approach for adhesive small bowel obstruction, a systematic review and meta-analysis of short term outcomes.
Adhesive small bowel obstruction (ASBO) is one of the most frequent causes of emergency hospital admissions and surgical treatment. Current surgical treatment of ASBO consists of open adhesiolysis. With laparoscopic procedures rising, the question arises if laparoscopy for ASBO is safe and results in better patient outcomes. Although adhesiolysis was among the first surgical procedures to be approached laparoscopically, uncertainty remains about its potential advantages over open surgery. Therefore, we performed a systematic review and meta-analysis on the benefits and harms of laparoscopic surgery for ASBO. ⋯ Systematic Review/Meta-analysis, Level III.
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J Trauma Acute Care Surg · Jun 2020
Observational StudyA journey upstream: Fluctuating platelet-specific genes in cell-free plasma as proof-of-concept for using ribonucleic acid sequencing to improve understanding of postinjury platelet biology.
The mechanisms of aberrant circulating platelet behavior following injury remain unclear. Platelets retain megakaryocyte immature ribonucleic acid (RNA) splicing and protein synthesis machinery to alter their functions based on physiologic signals. We sought to identify fluctuating platelet-specific RNA transcripts in cell-free plasma (CFP) from traumatic brain injury (TBI) patients as proof-of-concept for using RNA sequencing to improve our understanding of postinjury platelet behavior. We hypothesized that we could identify differential expression of activated platelet-specific spliced RNA transcripts from CFP of patients with isolated severe fatal TBI (fTBI) compared with minimally injured trauma controls (t-controls), filtered by healthy control (h-control) data sets. ⋯ Diagnostic tests, level V.
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J Trauma Acute Care Surg · Jun 2020
Comparative StudyA comparison of adolescent penetrating trauma patients managed at pediatric versus adult trauma centers in a mature trauma system.
While there is little debate that pediatric trauma centers (PTC) are uniquely equipped to manage pediatric trauma patients, the extent to which adolescents benefit from treatment there remains controversial. We sought to elucidate differences in management approach and outcome between PTC and adult trauma centers (ATC) for the adolescent penetrating trauma population. We hypothesized that improved mortality would be observed at ATC for this subset of patients. ⋯ Therapeutic, Level IV.
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J Trauma Acute Care Surg · Jun 2020
Observational StudyVasopressor selection during critical care management of brain dead organ donors and the effects on kidney graft function.
Delayed graft function (DGF), the need for dialysis in the first week following kidney transplant, affects approximately one quarter of deceased-donor kidney transplant recipients. Donor demographics, donor serum creatinine, and graft cold ischemia time are associated with DGF. However, there is no consensus on the optimal management of hemodynamic instability in organ donors after brain death (DBDs). Our objective was to determine the relationship between vasopressor selection during donor management and the development of DGF. ⋯ Prognostic study, Level III.