The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Apr 2012
Prediction of minimally conscious state with somatosensory evoked potentials in long-term unconscious patients after traumatic brain injury.
To evaluate the predictive power of somatosensory evoked potentials (SEPs) for minimally conscious state (MCS) in long-term unconscious patients after traumatic brain injury (TBI). ⋯ SEPs are excellent in predicting the outcome of long-term unconscious patients after TBI. SEPs should be considered more often and more routinely used after TBI.
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Growing evidence suggests that for many treatments, a relationship exists between provider volume and patient outcomes. This relationship is less clear in injury management. We sought to evaluate whether a relationship exists between trauma center volume and the nature of quality improvement (QI) programs. ⋯ Both low- and high-volume centers reported being engaged in QI. Small differences in the types of quality indicators used by centers were observed according to volume, with high-volume centers more likely than low-volume centers to use report cards and benchmarking as QI tools.
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J Trauma Acute Care Surg · Apr 2012
The impact of plasma preparations and their storage time on short-term posttransfusion mortality: a population-based study using the Scandinavian Donation and Transfusion database.
The treatment of coagulopathy and bleeding in severe trauma requires rapid delivery of large amounts of plasma to emergency wards. The resulting need for adequate supplies of nonfrozen or thawed plasma has consequences for storage strategies. Using extensive population data from a setting where both fresh-frozen plasma (FFP) and cold-stored liquid plasma were used, this study investigates whether there is an association between short-term mortality after receipt of FFP or liquid plasma of different storage times. ⋯ Compared with exclusive use of never-frozen plasma, FFP was associated with increased short-term mortality in the era before leukocyte depletion. FFP from female donors had a significantly higher risk than male FFP. For non-FFP, duration of storage was unrelated to mortality. These findings can help to inform policies for managing high plasma demand in critical care.
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J Trauma Acute Care Surg · Apr 2012
Ex vivo evaluation of the polymerization temperatures during cement augmentation of proximal femoral nail antirotation blades.
Previous studies have clearly demonstrated superior biomechanical behavior of augmented proximal femoral nail antirotation (PFNA) blades compared with nonaugmented ones with respect to implant cutout. Nevertheless, there is concern about thermal bone necrosis due to exothermic curing of polymethylmethacrylate (PMMA)-based bone cements. The objective of this study was to quantify the temperatures arising around perforated titanium PFNA blades when augmenting with PMMA. ⋯ The results of this study suggest that augmentation of titanium PFNA blades is not associated with a risk of thermal bone necrosis when using up to 6 mL of PMMA. However, larger amounts of cement lead to higher temperatures. PMMA application should therefore be kept low to minimally alter the biological system.
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J Trauma Acute Care Surg · Apr 2012
Pain and satisfaction in hospitalized trauma patients: the importance of self-efficacy and psychological distress.
Unmanaged pain has been found to predict delayed return to work, psychologic distress, and chronic pain and disability in patients with traumatic injury. However, little is known about the pain experience during hospitalization. The primary objective of this study was to determine pain intensity, pain interference, and satisfaction with pain treatment in orthopedic trauma patients at hospital discharge. A secondary objective was to examine whether patient self-efficacy and psychologic distress were associated with pain and satisfaction. ⋯ Results suggest that orthopedic trauma patients have a significant pain burden but are satisfied with pain treatment during the hospital stay. Efforts are needed to improve pain assessment and management and findings imply that addressing self-efficacy and depressive symptoms may decrease pain and increase satisfaction at hospital discharge. Brief educational interventions that incorporate pain coping skills and self-management techniques may be a feasible approach to improving self-efficacy in the acute care setting. Additional recommendations include routine hospital screening for depression and increased communication between surgeons and mental health providers to identify patients at high risk for unmanaged pain and facilitate provision of early mental health services.