American journal of surgery
-
Randomized Controlled Trial Multicenter Study
The OPTICC trial: a multi-institutional study of occult pneumothoraces in critical care.
The management of pneumothoraces detected on CT but not on supine chest radiographs remains controversial, especially in those undergoing positive pressure ventilation (PPV) who are at risk for complications with both observation and treatment. Previous limited study yielded confusion regarding the need for routine drainage of these occult pneumothoraces (OPTXs). We conducted a pilot study at 2 trauma centers to address the feasibility and safety of randomizing traumatized patients undergoing PPV to drainage or observation. ⋯ With no important differences in morbidity, the OPTICC pilot lays the foundation for a future definitive trial comparing drainage or observation in posttraumatic OPTXs requiring PPV.
-
Multicenter Study
A high ratio of plasma and platelets to packed red blood cells in the first 6 hours of massive transfusion improves outcomes in a large multicenter study.
In trauma, most hemorrhagic deaths occur within the first 6 hours. This study examined the effect on survival of high ratios of fresh frozen plasma (FFP) and platelets (PLTs) to packed red blood cells (PRBCs) in the first 6 hours. ⋯ The early administration of high ratios of FFP and platelets improves survival and decreases overall PRBC need in massively transfused patients. The largest difference in mortality occurs during the first 6 hours after admission, suggesting that the early administration of FFP and platelets is critical.
-
Little evidence exists that links teamwork to patient outcomes. We conducted this study to determine if patients of teams with good teamwork had better outcomes than those with poor teamwork. ⋯ When teams exhibited infrequent team behaviors, patients were more likely to experience death or major complication.
-
Physiologic variables used in trauma triage criteria may be significantly affected by age, decreasing their predictive value in geriatric trauma. ⋯ Elderly trauma victims are less likely to undergo rapid trauma evaluation and have significantly worse outcomes compared with younger patients. Standard physiologic triage variables may not identify severe injury in older patients.