The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Aug 2020
Multicenter StudyRepeat computed tomography head scan is not indicated in trauma patients taking novel anticoagulation: A multicenter study.
The number of trauma patients on prehospital novel oral anticoagulants (NOACs) is increasing. After an initial negative computed tomography of the head (CTH), practice patterns are variable for obtaining repeat CTH to evaluate for delayed intracranial hemorrhage (ICH-d). However, the risks and outcomes of ICH-d for patients on NOACs are unclear. We hypothesized that, for these patients, the incidence of ICH-d is low, similar to that of warfarin, and when it occurs, it does not result in clinically significant worse outcomes. ⋯ Prognostic/epidemiologic study, level III.Therapeutic, level IV.
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J Trauma Acute Care Surg · Aug 2020
Historical ArticleThe Israel Defense Forces Trauma Registry: 22 years of point-of-injury data.
Trauma is the leading cause of death among casualties between 1 and 44 years. A large proportion of trauma deaths occurs even before arriving at a medical facility. The paucity of prehospital data is a major reason for the lagging development of prehospital trauma care research. This study aims to describe the Israel Defense Forces Prehopistal Trauma Registry, the steps taken to improve data collection and quality, the resulting trends, and the registry's contribution to policymaking. ⋯ Retrospective study, level III.
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J Trauma Acute Care Surg · Aug 2020
Nationwide analysis of whole blood hemostatic resuscitation in civilian trauma.
Renewed interest in whole blood (WB) resuscitation in civilians has emerged following its military use. There is a paucity of data on its role in civilians where balanced component therapy (CT) resuscitation is the standard of care. The aim of this study was to assess nationwide outcomes of using WB as an adjunct to CT versus CT alone in resuscitating civilian trauma patients. ⋯ Therapeutic, level IV.
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J Trauma Acute Care Surg · Aug 2020
Is magnetic resonance imaging becoming the new computed tomography for cervical spine clearance? Trends in magnetic resonance imaging utilization at a Level I trauma center.
Increasing evidence supports the limited use of magnetic resonance imaging (MRI) for cervical spine (C-spine) clearance following blunt trauma. We sought to characterize the utilization of MRI of the C-spine at a Level I trauma center. ⋯ Therapeutic/Care Management Study, Level III or IV. Diagnostic test, level IV.
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J Trauma Acute Care Surg · Aug 2020
High crystalloid volumes negate benefit of hemostatic resuscitation in pediatric wartime trauma casualties.
Recent data for adult trauma patients suggest improved survival when using hemostatic resuscitation, which includes limiting crystalloids and using closer to 1:1 ratios for both fresh frozen plasma (FFP) and platelets (PLTs) relative to packed red blood cells (PRBCs). Pediatric studies have shown similar but mixed results and often lack measuring crystalloids. We seek to evaluate in-hospital survival based on crystalloid administration and different blood product ratios in pediatric casualties during the recent conflicts. ⋯ Retrospective, comparative, level III.