Journal of the American College of Surgeons
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Venous thromboembolism (VTE) is reported to occur among 7% to 58% of trauma patients. Variability in VTE rates might reflect differences in case mix and quality of care, but also screening practices or data capture. We explored the variation in VTE rates across trauma centers to determine its use as a measure of the quality of patient care. ⋯ There was substantial variation in rates of VTE across trauma centers. There was no relationship between DVT and PE outlier status, which is counter to the understanding of the biologic relationship between the two. Lastly, the very low Intraclass correlation coefficient for PE compared with DVT suggests that to a large extent, practice variation has very little impact on PE rates. In light of these findings and concerns about patient ascertainment of DVT, VTE rates might not be a useful measure of quality of care.
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Decreasing manpower available to care for trauma patients both in and out of the ICU has led to a number of proposed solutions, including increasing involvement of emergency medicine-trained physicians in the care of these patients. We performed a descriptive comparative study in an effort to define the role of fellowship-trained emergency medicine physicians as full-time traumatologists. ⋯ These data suggest that emergency traumatologists can provide trauma care effectively within a defined scope of practice and may provide an effective solution to manpower issues confronting trauma centers.
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Two uncommon but serious complications after subclavian central venous port (SCVP) placement are pneumothorax (PNX) and malposition of the catheter. Chest x-rays (CXR) are commonly obtained after SCVP placement to identify these complications, but their use is controversial. ⋯ In our study, incidence of PNX after SCVP placement was low, and PNX was not detected by intraoperative fluoroscopy or by routine postprocedure CXR. We conclude that the practice of routine postprocedure CXR after SCVP placement is not necessary and should be replaced with diagnostic chest radiography only if symptoms develop.
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Although a large proportion of patients with traumatic thoracic aortic injury die before undergoing definitive repair, those who survive still face ongoing risk of death and morbidity. Endovascular therapy may offer a minimally invasive alternative in the repair of the aortic injury. ⋯ Although patients who undergo endovascular repair of traumatic thoracic aortic transections typically have significant concomitant injuries, the procedure itself is well tolerated and can be performed rapidly with minimal blood loss and contrast administration. But close followup is necessary given the risk of late complications.