Eur J Trauma Emerg S
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Eur J Trauma Emerg S · Oct 2009
Development and validation of the revised injury severity classification score for severely injured patients.
Trauma scores are often used for prognostication and the adjustment of mortality data. The appropriate consideration of identified prognostic factors is mandatory for a valid score with good outcome prediction properties. The Trauma Registry of the German Society for Trauma Surgery (TR-DGU) initially used the Trauma and Injury Severity Score (TRISS) but various reasons led to the development of a new scoring system, the Revised Injury Severity Classification (RISC). ⋯ Outcome prediction including initial laboratory values was able to significantly improve the ability to discriminate between survivors and nonsurvivors. The adjustment of mortality rates should be based on the best available prediction model.
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Eur J Trauma Emerg S · Oct 2009
Role of lung contusions on posttraumatic inflammatory response and organ dysfunction in traumatized patients.
Multiple trauma is often accompanied by lung contusion leading to secondary pulmonary inflammation and organ dysfunction. The particular role of lung contusions on the systemic inflammatory response remains unclear. Therefore, the aim of the present study was to compare the degree of lung contusion with markers of inflammation and multiple organ failure (MOF) in trauma patients. ⋯ Our data show that severe lung contusions contributes to an immediate onset of posttraumatic inflammation in severely traumatized patients, resulting in MOF, while in severely injured patients without lung contusion, this development requires up to 5 days.
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Eur J Trauma Emerg S · Oct 2009
Traumatic deaths in the emergency room: A retrospective analysis of 115 consecutive cases.
The aim of the present study was to characterise traumatic deaths occurring in the emergency room (ER) and to assess retrospectively the quality of given emergency care by evaluating whether any of the deaths could be identified as potentially preventable. ⋯ Missed injuries did not play a major role in the preventable deaths. Seven potentially preventable deaths were considered to be failures in the surgical decision-making process, resulting in futile non-operative treatment or a delay in surgical bleeding control.
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Eur J Trauma Emerg S · Oct 2009
Management of blunt bowel and mesenteric injuries: Experience at the Alfred hospital.
The incidence of blunt bowel and mesenteric injury (BBMI) has increased recently in blunt abdominal trauma, possibly due to an increasing number of high-speed motor accidents and the use of seat belts. ⋯ The timing of surgical intervention in cases of BBMI is mostly determined by the clinical examination and the results of the helical CT scan findings. The FAST lacks sensitivity and specificity for identifying bowel and mesenteric trauma. A delayed diagnosis of > 48 h has a significantly higher bowelrelated morbidity but not mortality.
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Eur J Trauma Emerg S · Oct 2009
Base excess determined within one hour of admission predicts mortality in patients with severe pelvic fractures and severe hemorrhagic shock.
Unstable pelvic ring fractures with exsanguinating hemorrhages are rare but potentially lifethreatening injuries. The aim of this retrospective study was to evaluate whether early changes in acid- base parameters predict mortality of patients with severe pelvic trauma and hemorrhagic shock. ⋯ Base excess, lactate, and pH discriminate early survivors from nonsurvivors suffering from severe pelvic trauma and hemorrhagic shock. Base excess measured 1 h after admission best predicted early mortality following pelvic trauma with concomitant hemorrhage.