The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · May 2012
Comparative StudyFocused rapid echocardiographic evaluation versus vascular cather-based assessment of cardiac output and function in critically ill trauma patients.
Focused rapid echocardiographic evaluation (FREE) is a comprehensive transthoracic echocardiogram tailored for the intensive care unit. It assesses both the cardiac index (CI) and left ventricular ejection fraction (EF). FREE and vascular catheter-derived CI was compared, and the ability of CI to detect moderate to severe dysfunction (EF <40%) was determined. ⋯ III, diagnostic study.
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J Trauma Acute Care Surg · May 2012
Comparative StudyLate reconstruction of posterior acetabular wall fractures using iliac crest.
Reconstructing late posterior acetabular wall fractures is challenging. This study evaluates the use of the iliac crest strut graft for posterior acetabular wall reconstruction. ⋯ IV, therapeutic study.
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J Trauma Acute Care Surg · May 2012
Multicenter Study Comparative StudyQuality indicators used by trauma centers for performance measurement.
To describe the quality indicators (QIs) that trauma centers use for quality measurement and performance improvement. Measuring and reporting quality of care is a critical step to improve the quality of care. QIs compare actual trauma care against ideal criteria and identify patients in whom care may have been suboptimal and should be further reviewed. ⋯ Our study provides the first description of the QIs used by verified trauma centers in four high-income countries with similar systems of trauma care. The majority of trauma centers measure QIs designed to examine the safety, effectiveness, efficiency, and timeliness of hospital processes and outcomes. Opportunities exist to standardize existing QIs to allow broader implementation and develop new QIs to examine patient-centered care and equality of care.
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J Trauma Acute Care Surg · May 2012
Comparative StudyTraditional systolic blood pressure targets underestimate hypotension-induced secondary brain injury.
Vital signs, particularly blood pressure, are often manipulated to maximize perfusion and optimize recovery from severe traumatic brain injury (sTBI). We investigated the utility of automated continuously recorded vital signs to predict outcomes after sTBI. ⋯ III, prognostic study.
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J Trauma Acute Care Surg · May 2012
Comparative StudyA web-based model to support patient-to-hospital allocation in mass casualty incidents.
In a mass casualty situation, evacuation of severely injured patients to the appropriate health care facility is of critical importance. The prehospital stage of a mass casualty incident (MCI) is typically chaotic, characterized by dynamic changes and severe time constraints. As a result, those involved in the prehospital evacuation process must be able to make crucial decisions in real time. This article presents a model intended to assist in the management of MCIs. The Mass Casualty Patient Allocation Model has been designed to facilitate effective evacuation by providing key information about nearby hospitals, including driving times and real-time bed capacity. These data will enable paramedics to make informed decisions in support of timely and appropriate patient allocation during MCIs. The model also enables simulation exercises for disaster preparedness and first response training. ⋯ The dynamic and evolving nature of MCIs requires that decisions regarding prehospital management be made under extreme time pressure. This model provides tools for these decisions to be made in an informed fashion with continuously updated hospital capacity information. In addition, it permits complex MCI simulation for response and preparedness training.