J Trauma
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The purpose of this study was to determine the adequacy and accuracy of lateral cervical spine radiographs in the initial evaluation of alert, high-risk trauma patients evaluated at a Level I trauma center. ⋯ The higher accuracy and lower negative predictive probability make the absence of cervical symptoms in the alert, high-risk, blunt trauma patient a better screening test than lateral cervical spine radiography. We suggest that lateral cervical spine radiography is not needed in the initial evaluation of alert patients who have sustained blunt trauma.
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To determine if the quantity of skeletal injuries (and the timing to fixation) increases the mortality or pulmonary morbidity in patients with and without chest injuries. ⋯ The combination of skeletal and chest injuries does not seem to amplify the pulmonary morbidity and mortality compared with chest injury alone. The quantity of the skeletal injury and the time to fixation of structures affecting mobilization seem to have an effect on pulmonary morbidity and mortality. Better scientific studies on the effects of skeletal injury and timing to fixation in relation to pulmonary morbidity and mortality are required.
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Randomized Controlled Trial Clinical Trial
Inhaled nitric oxide in acute respiratory distress syndrome.
Inhaled nitric oxide has been shown to improve oxygenation in select patients with acute respiratory distress syndrome (ARDS). ⋯ Inhaled NO was successful in increasing PaO2/FiO2 by > 20% in 65% of the surgical patients in this trial. Response to NO could not be predicted by initial PaO2/FiO2 or pulmonary artery pressures. A trial of inhaled NO at a dose of < 10 ppm may be helpful in ARDS patients requiring increasing FiO2 and positive end-expiratory pressure.
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Comparative Study
A modification of the injury severity score that both improves accuracy and simplifies scoring.
The Injury Severity Score (ISS) has served as the standard summary measure of anatomic injury for more than 20 years. Nevertheless, the ISS has an idiosyncrasy that both impairs its predictive power and complicates its calculation. We present here a simple modification of the ISS called the New Injury Severity Score (NISS), which significantly outperforms the venerable but dated ISS as a predictor of mortality. ⋯ NISS should replace ISS as the standard summary measure of human trauma.