The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Apr 2012
Multicenter StudyCrystalloid to packed red blood cell transfusion ratio in the massively transfused patient: when a little goes a long way.
Massive transfusion (MT) protocols have emphasized the importance of ratio-based transfusion of plasma and platelets relative to packed red blood cells (PRBCs); however, the risks attributable to crystalloid resuscitation in patients requiring MT remain largely unexplored. We hypothesized that an increased crystalloid:PRBC (C:PRBC) ratio would be associated with increased morbidity and poor outcome after MT. ⋯ In patients requiring MT, crystalloid resuscitation in a ratio greater than 1.5:1 per unit of PRBCs transfused was independently associated with a higher risk of MOF, ARDS, and ACS. These results suggest overly aggressive crystalloid resuscitation should be minimized in these severely injured patients. Further research is required to determine whether incorporation of the C:PRBC ratio into MT protocols improves outcome.
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J Trauma Acute Care Surg · Apr 2012
Continuously recorded oxygen saturation and heart rate during prehospital transport outperform initial measurement in prediction of mortality after trauma.
Available trauma scoring systems that predict need for higher echelons of care require data not available in the field. We hypothesized that analysis of continuous vital sign data in comparison to trauma registry data predicts mortality early in trauma patient management. ⋯ Injury Severity Score and Trauma-Injury Severity Score are predictive of mortality but rely on the inclusion of intra-abdominal and intrathoracic diagnostic data that are not readily available during field assessment. Automated vital signs data collection and analysis from a single noninvasive device with decision support has the potential to alleviate the dual burdens of patient triage and documentation required of the prehospital provider.
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J Trauma Acute Care Surg · Apr 2012
Multicenter StudyEpidemiology and predictors of cervical spine injury in adult major trauma patients: a multicenter cohort study.
Patients with cervical spine injuries are a high-risk group, with the highest reported early mortality rate in spinal trauma. ⋯ 3.5% of patients suffered cervical spine injury. Patients with a lowered GCS or systolic blood pressure, severe facial fractures, dangerous injury mechanism, male gender, and/or age ≥ 35 years are at increased risk. Contrary to common belief, head injury was not predictive for cervical spine involvement.
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J Trauma Acute Care Surg · Apr 2012
Moving from "optimal resources" to "optimal care" at trauma centers.
The Trauma Quality Improvement Program has shown that risk-adjusted mortality rates at some centers are nearly 50% higher than at others. This "quality gap" may be due to different clinical practices or processes of care. We have previously shown that adoption of processes called core measures by the Joint Commission and Centers for Medicare and Medicaid Services does not improve outcomes of trauma patients. We hypothesized that improved compliance with trauma-specific clinical processes of care (POC) is associated with reduced in-hospital mortality. ⋯ Unlike adoption of core measures, compliance with T-POC is associated with reduced mortality in trauma patients. Trauma centers with excess in-hospital mortality may improve patient outcomes by consistently applying T-POC. These processes should be explored for potential use as Core Trauma Center Performance Measures.
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J Trauma Acute Care Surg · Apr 2012
Comparative StudySingle-drug sedation with fentanyl for prehospital postintubation sedation in trauma patients.
A fentanyl-only (FO) regimen for prehospital postintubation sedation in trauma patients was compared with the standard protocol (SP) of fentanyl + benzodiazepine. ⋯ In this study, an FO regimen was associated with similar hemodynamic but worse neurologic variables compared with the SP regimen. Prospective evaluation is warranted before adoption of this regimen, especially in TBI patients.