The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Jan 2020
Desmopressin is a transfusion sparing option to reverse platelet dysfunction in patients with severe traumatic brain injury.
Platelet dysfunction (PD) is an independent predictor of mortality in patients with severe traumatic brain injury (sTBI). Platelet transfusions (PLTs) have been shown to be an effective treatment strategy to reverse platelet inhibition. Their use is contingent on availability and may be associated with increased cost and transfusion-related complications, making desmopressin (DDAVP) attractive. We hypothesized that DDAVP would correct PD similarly to PLTs in patients with sTBI. ⋯ Therapeutic, level IV.
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J Trauma Acute Care Surg · Jan 2020
Prehospital plasma in injured patients is associated with survival principally in blunt injury: Results from two randomized prehospital plasma trials.
Recent evidence demonstrated that prehospital plasma in patients at risk of hemorrhagic shock was safe for ground transport and resulted in a 28-day survival benefit for air medical transport patients. Whether any beneficial effect of prehospital plasma varies across injury mechanism remains unknown. ⋯ Therapeutic, I.
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J Trauma Acute Care Surg · Jan 2020
Use of ketamine for prehospital pain control on the battlefield: A systematic review.
Intravenous ketamine is commonly used for pain management in the civilian prehospital setting. Several studies have evaluated its effectiveness in the military setting. To date, there has been no report reviewing the published data on the use of ketamine in this context. The objective of this systematic review was to analyze the content and quality of published data on the use of ketamine for prehospital pain management in military trauma. ⋯ Systematic Review, Level IV.
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J Trauma Acute Care Surg · Jan 2020
Rotational thromboelastometry predicts transfusion and disability in pediatric trauma.
Trauma-induced coagulopathy seen on rotational thromboelastometry (ROTEM) is associated with poor outcomes in adults; however, this relationship is poorly understood in the pediatric population. We sought to define thresholds for product-specific transfusion and evaluate the prognostic efficacy of ROTEM in injured children. ⋯ Prognostic, Level III; Therapeutic, Level IV.
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J Trauma Acute Care Surg · Jan 2020
The impact of Medicaid expansion on trauma-related emergency department utilization: A national evaluation of policy implications.
The impact of the 2014 Affordable Care Act (ACA) upon national trauma-related emergency department (ED) utilization is unknown. We assessed ACA-related changes in ED use and payer mix, hypothesizing that post-ACA ED visits would decline and Medicaid coverage would increase disproportionately in regions of widespread policy adoption. ⋯ Economic, level III.