Journal of the American College of Surgeons
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The aims of this prospective observational study were to describe early hemodynamic patterns of blunt and penetrating truncal injury and to evaluate outcomes prediction using noninvasive hemodynamic monitoring with a mathematical model tested against actual in-hospital outcomes. The hypothesis was that traumatic shock is a circulatory disorder that can be monitored by noninvasive hemodynamic parameters that reflect cardiac, pulmonary, and tissue perfusion functions. ⋯ Early noninvasive hemodynamic monitoring with a computerized information system provided a feasible pattern recognition program for outcomes prediction and therapeutic decision support.
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Cirrhosis as an independent predictor of poor outcomes in trauma patients was identified in 1990. We hypothesized that the degree of preinjury hepatic dysfunction is, by itself, an independent predictor of mortality. ⋯ The mortality rate for class C cirrhotic patients posttrauma continues to be higher than that predicted by TRISS, although patients with less severe hepatic dysfunction do not appear to have significantly lower than predicted survival. The degree of hepatic dysfunction remains an independent predictor of mortality and CTP C criteria must be considered when determining outcomes for patients posttrauma.
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Sixteen-slice CT angiography in patients with suspected blunt carotid and vertebral artery injuries.
We sought to determine whether 16-slice multidetector CT angiography (CTA) has sufficient negative predictive value for use as the initial imaging examination for patients with suspected blunt carotid and vertebral artery injury (BCVI) and to estimate the positive predictive value of different screening criteria in assessing BCVI. ⋯ Multidetector CTA misses relatively few injuries and adequately supplants DSA as a screening study in patients with risk factors for BCVI. Radiologists should maintain a high degree of suspicion in patients who meet screening criteria. Optimal imaging strategies should focus on the most predictive criteria.