The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · May 2019
Comorbidities, anticoagulants, and geriatric-specific physiology for the field triage of injured older adults.
Comorbid conditions and anticoagulants have been considered as field triage criteria to raise the sensitivity for identifying seriously injured older adults, but research is sparse. We evaluated the utility of comorbidities, anticoagulant use, and geriatric-specific physiologic measures to improve the sensitivity of the field triage guidelines for high-risk older adults in the out-of-hospital setting. ⋯ Prognostic/Epidemiologic, level II.
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J Trauma Acute Care Surg · Apr 2019
Redefining postinjury fibrinolysis phenotypes using two viscoelastic assays.
Fibrinolysis was initially defined using rapid thrombelastography (rTEG). The cutoffs for the pathologic extremes of the fibrinolytic system, hyperfibrinolysis and shutdown, were both defined based on association with mortality. We propose to redefine these phenotypes for both TEG and for rotational thrombelastometry, the other commonly used viscoelastic assay. ⋯ Diagnostic study, level III.
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J Trauma Acute Care Surg · Apr 2019
Observational StudyA prospective study in severely injured patients reveals an altered gut microbiome is associated with transfusion volume.
Traumatic injury can lead to a compromised intestinal epithelial barrier and inflammation. While alterations in the gut microbiome of critically injured patients may influence clinical outcomes, the impact of trauma on gut microbial composition is unknown. Our objective was to determine if the gut microbiome is altered in severely injured patients and begin to characterize changes in the gut microbiome due to time and therapeutic intervention. ⋯ Prognostic and Epidemiological, level III.
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J Trauma Acute Care Surg · Apr 2019
Evidence-based review of trauma center care and routine palliative care processes for geriatric trauma patients; A collaboration from the American Association for the Surgery of Trauma Patient Assessment Committee, the American Association for the Surgery of Trauma Geriatric Trauma Committee, and the Eastern Association for the Surgery of Trauma Guidelines Committee.
Despite an aging population and increasing number of geriatric trauma patients annually, gaps in our understanding of best practices for geriatric trauma patients persist. We know that trauma center care improves outcomes for injured patients generally, and palliative care processes can improve outcomes for disease-specific conditions, and our goal was to determine effectiveness of these interventions on outcomes for geriatric trauma patients. ⋯ Systematic review/guideline, level III.
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J Trauma Acute Care Surg · Mar 2019
Meta AnalysisThe effectiveness of junctional tourniquets: A systematic review and meta-analysis.
Junctional tourniquets have been incorporated into tactical combat casualty care for junctional vascular trauma. They apply external compression to stop blood flow in the groin and axilla. ⋯ Systematic review, level III.