The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Oct 2018
Characterizing injury severity in nonaccidental trauma: Does Injury Severity Score miss the mark?
Children suffering nonaccidental trauma (NAT) are at high risk of death. It is unclear whether markers of injury severity for trauma center/system benchmarking such as Injury Severity Score (ISS) adequately characterize this. Our objective was to evaluate mortality prediction of ISS in children with NAT compared with accidental trauma (AT). ⋯ Epidemiologic study, level III.
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J Trauma Acute Care Surg · Oct 2018
Abdominal Aortic and Junctional Tourniquet release after 240 minutes is survivable and associated with small intestine and liver ischemia after porcine class II hemorrhage.
Uncontrolled hemorrhage is a leading cause of tactical trauma-related deaths. Hemorrhage from the pelvis and junctional regions are particularly difficult to control due to the inability of focal compression. The Abdominal Aortic and Junctional Tourniquet (AAJT) occludes aortic blood flow by compression of the abdomen. The survivability of tourniquet release beyond 120 minutes is unknown and fluid requirements to maintain sufficient blood pressure during prolonged application are undetermined. We therefore compared 60-minute and 240-minute applications and release of the AAJT for 30 minutes, with crystalloid fluid therapy, after a Class II hemorrhage. ⋯ Therapeutic study, level II.
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J Trauma Acute Care Surg · Sep 2018
ReviewA US military Role 2 forward surgical team database study of combat mortality in Afghanistan.
Timely and optimal care can reduce mortality among critically injured combat casualties. US military Role 2 surgical teams were deployed to forward positions in Afghanistan on behalf of the battlefield trauma system. They received prehospital casualties, provided early damage control resuscitation and surgery, and rapidly transferred casualties to Role 3 hospitals for definitive care. A database was developed to capture Role 2 data. ⋯ Therapeutic/Care Management, level IV.
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J Trauma Acute Care Surg · Sep 2018
Comparative StudyMotor vehicle crash fatalaties and undercompensated care associated with legalization of marijuana.
Half of the US states have legalized medical cannabis (marijuana), some allow recreational use. The economic and public health effects of these policies are still being evaluated. We hypothesized that cannabis legalization was associated with an increase in the proportion of motor vehicle crash fatalities involving cannabis-positive drivers, and that cannabis use is associated with high-risk behavior and poor insurance status. ⋯ Prognostic, level III.
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J Trauma Acute Care Surg · Sep 2018
Multicenter Study Comparative StudyAn AAST-MITC analysis of pancreatic trauma: Staple or sew? Resect or drain?
Pancreatic trauma results in high morbidity and mortality, in part caused by the delay in diagnosis and subsequent organ dysfunction. Optimal operative management strategies remain unclear. We therefore sought to determine CT accuracy in diagnosing pancreatic injury and the morbidity and mortality associated with varying operative strategies. ⋯ Epidemiologic/Diagnostic study, level III.