The American surgeon
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The American surgeon · Nov 2008
On-scene intravenous line insertion adversely impacts prehospital time in rural vehicular trauma.
Fatality rates from rural vehicular trauma are almost double those found in urban settings. Increased emergency medical services (EMS) prehospital time has been implicated as one of the causative factors for higher rural fatality rates. Advanced Trauma Life Support guidelines suggest scene time should not be extended to insert an intravenous catheter (IV). ⋯ Excluding dead on-scene patients, mean EMS time on-scene when mortalities occurred in rural and urban settings was 18.9 minutes and 10.8 minutes, respectively (P < 0.005). On-scene IV insertion occurred with significantly greater frequency in rural than urban settings. This incurs greater EMS time on-scene and prehospital time that may be associated with increased vehicular fatality rates in rural settings.
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The American surgeon · Nov 2008
Intracranial pressure monitoring in severe isolated pediatric blunt head trauma.
Very little research regarding standard treatments for pediatric traumatic brain injury (PTBI) exists. The objective of this study was to examine the use of intracranial pressure (ICP) monitoring devices in PTBI and to determine if its use was associated with any outcome benefit. Data were collected from the Trauma Registry over an 11-year period (1996-2006) on all blunt trauma pediatric patients (age < 14 years) with an initial Glasgow Coma Scale score < or =8. ⋯ After multivariable analysis to adjust for the differences between the two study groups, the use of ICP monitor provided no survival benefit (adjusted odds ratio: 1.1; 95% confidence interval [CI]: 0.3-4.1; adjusted P value = 0.85). The use of ICP monitor was, however, independently associated with a higher risk of developing extracranial complications (adjusted odds ratio: 4.3; 95% CI: 1.2-16.4; adjusted P value = 0.025). In conclusion, the use of ICP monitors in pediatric patients with severe isolated head injury provided no survival benefit and was associated with an increased risk of complications.
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The American surgeon · Nov 2008
Adding insult to injury: neck exploration for penetrating pediatric neck trauma.
Penetrating neck injuries are uncommon in children, and management involves mandatory exploration of the neck. This results in a number of unnecessary operations. Adult experience is moving towards selective exploration. ⋯ The hospital length of stay was longer in the patients who underwent exploration. Mandatory exploration of the neck in children should not be performed unless clinically indicated. Preoperative imaging should be used liberally to limit nontherapeutic explorations, improve diagnostic accuracy, and reduce morbidity.
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The American surgeon · Oct 2008
Multicenter Study Comparative StudyManagement of high-grade splenic injury in children.
Using the National Trauma Databank, we identified 413 children (age < or = 14 years) who sustained high-grade blunt splenic injury (Abbreviated Injury Scale scores > or = 4) from 2001 to 2005. Overall mortality was 13.5 per cent. Early operation within 6 hours of injury (EOM) was performed in 128 patients (31%). ⋯ Failure of NOM was associated with increased mortality compared with successful NOM, but had similar mortality and length of hospital or intensive care unit stay compared with EOM. We conclude that operative treatment is necessary in nearly half of pediatric patients with high-grade splenic injury. With careful selection, nonoperative management is usually successful but must include close monitoring, because 16 per cent required delayed operation.
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The American surgeon · Oct 2008
Comparative StudyTissue oxygen saturation predicts the need for early blood transfusion in trauma patients.
Near-infrared spectroscopy (NIRS) has been used to measure regional tissue oxygen saturation (StO2) in skeletal muscle as an indicator of perfusion in trauma patients. In an effort to prospectively examine the usefulness of StO2 in identifying trauma patients in hemorrhagic shock, we evaluated the need for blood transfusion within 24 hours of injury as a marker of significant hemorrhage. A 6-month prospective, observational study was conducted at a university-affiliated, urban Level I trauma center using a convenience sample of 26 trauma patients thought to be at high risk for hemorrhagic shock. ⋯ The positive predictive value was 64 per cent and the negative predictive value was 93 per cent. The need for blood transfusion within 24 hours of arrival was not predicted by hypotension, tachycardia, arterial lactate, base deficit, or hemoglobin. StO2 may represent an important screening tool for identifying trauma patients who require blood transfusion or other limited medical resources.