The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Mar 2012
ReviewEffects on mortality, treatment, and time management as a result of routine use of total body computed tomography in blunt high-energy trauma patients.
Currently, total body computed tomography (TBCT) is rapidly implemented in the evaluation of trauma patients. With this review, we aim to evaluate the clinical implications-mortality, change in treatment, and time management-of the routine use of TBCT in adult blunt high-energy trauma patients compared with a conservative approach with the use of conventional radiography, ultrasound, and selective computed tomography. ⋯ Current literature has predominantly suboptimal design to prove terminally that the routine use of TBCT results in improved survival of blunt high-energy trauma patients. TBCT can give a change of treatment and improves time intervals in the emergency department as compared with its selective use.
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J Trauma Acute Care Surg · Mar 2012
Comparative StudyVentilator-associated pneumonia: bacteremia and death after traumatic injury.
The implications of bacteremia in critically ill patients are uncertain. Some reports suggest bacteremia is linked to higher mortality whereas others do not. These differences may, in part, be because of differences in patient cohorts. To address the potential independent relationship between bacteremia and outcome, we focused on critically ill trauma patients with ventilator-associated pneumonia (VAP), of whom a significant proportion had concomitant bacteremia. We tested the hypothesis that bacteremia was associated with death in trauma patients who developed VAP. ⋯ VAP with bacteremia is associated with an increased mortality in comparison with VAP alone after severe traumatic injury.
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J Trauma Acute Care Surg · Mar 2012
Multicenter Study Comparative StudyHomicide as a medical outcome: racial disparity in deaths from assault in US Level I and II trauma centers.
Since 1900, thousands of medical journal articles have been published on the topic of racial disparities in health and medical outcomes in the United States, including overlapping disparities based on health insurance status. But research on the question of such disparities in the medical treatment of injury from assault-matters of public safety, considerable public expense, and policy debate-is lacking. ⋯ I, prognostic study.
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J Trauma Acute Care Surg · Mar 2012
Comparative StudyThe value of cervical magnetic resonance imaging in the evaluation of the obtunded or comatose patient with cervical trauma, no other abnormal neurological findings, and a normal cervical computed tomography.
The value of magnetic resonance imaging (MRI) in the evaluation of the obtunded or comatose patient with a potential neck injury is a controversial subject. Some authors have suggested that MRI of the cervical spine adds no value in the evaluation of patients with a normal computed tomography (CT) of the neck. However, others have suggested that MRI is the gold standard for clearing the cervical spine in a clinically suspicious or unevaluatable blunt trauma patient. The purpose of this study is to evaluate our data in regard to these conflicting hypotheses. ⋯ The addition of a cervical MRI to the evaluation protocol of obtunded or comatose patients with an otherwise normal neurologic examination and a normal cervical CT did not provide any additional useful information to change the management of these patients.
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J Trauma Acute Care Surg · Mar 2012
Comparative StudyUtility of a point-of-care device for rapid determination of prothrombin time in trauma patients: a preliminary study.
Rapid and accurate determination of prothrombin time in trauma patients may help to faster control of bleeding induced coagulopathy. The goal of this prospective observational study was to investigate the accuracy of bedside measurements of prothrombin time by the mean of a point-of-care device (INRatio) in trauma patients. ⋯ INRatio may be a useful device in the management of trauma patients with ongoing or suspected coagulopathy that may help to save at least 60 minutes in the process of obtaining a prothrombin time result. It may allow earlier detection of coagulopathy and, together with vital sign and hemoglobin, may help to guide fresh frozen plasma transfusion.