J Trauma
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Comparative Study
Field trauma triage: combining mechanism of injury with the prehospital index for an improved trauma triage tool.
The objective of this study was to combine a physiologic triage score (prehospital index, PHI) with criteria regarding mechanism of injury (MOI) to increase the efficacy of trauma triage. The specific question being asked was: will the combined score improve the sensitivity and specificity over that of the individual scores? ⋯ The combined PHI/MOI score was better at identifying those patients with ISS scores > or = 16 compared with the PHI and MOI scores alone. Although this permitted superior triage (and minimized overtriage), the combined score did not identify all major trauma patients.
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The Pediatric Risk Index (PRI) uses established measures of physiologic derangement (Pediatric Trauma Score and Glasgow Coma Scale) and anatomic severity (Injury Severity Score) to identify those patients at risk of death, impairment, or extensive resource utilization. ⋯ The PRI effectively identifies injured patients at risk for dying, impairment, or extensive intensive care unit care.
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Use of mechanical ventilation is associated with several major complications despite its lifesaving potential. Timely discontinuation of mechanical ventilation is critical to control of duration of intensive care unit stay and reduction of complications associated with mechanical ventilation. Difficulty in discontinuation (or weaning) of patients from mechanical ventilatory support is in part attributable to inadequate understanding of the mechanisms responsible for unsuccessful outcome and a lack of guidelines regarding the optimal approach to the process of discontinuation of mechanical ventilation. ⋯ In either case, the above weaning techniques appear to be superior to intermittent mandatory ventilation in separating patients from mechanical ventilatory support. Based on available clinical trials, pressure support ventilation or T-piece trials appear to be the preferred methods for discontinuation of mechanical ventilatory support. A method using a simple T-piece trial technique is described.
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Clinical Trial Controlled Clinical Trial
Clinical utility of human polymerized hemoglobin as a blood substitute after acute trauma and urgent surgery.
We have previously documented the safety of 1 unit (50 gram) of human polymerized hemoglobin (Poly SFH-P) in healthy volunteers. This report describes the first patient trial to assess the therapeutic benefit of Poly SFH-P in acute blood loss. Thirty-nine patients received 1 (n = 14), 2 (n = 2), 3 (n = 15), or 6 (n = 8) units of Poly SFH-P instead of red cells as part of their blood replacement after trauma and urgent surgery. ⋯ Twenty-three patients (59%) avoided allogeneic transfusions during the first 24 hours after blood loss. Poly SFH-P effectively loads and unloads O2 and maintains total hemoglobin in lieu of red cells after acute blood loss, thereby reducing allogeneic transfusions. Poly SFH-P seems to be a clinically useful blood substitute.
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Comparative Study
Direct transport to tertiary trauma centers versus transfer from lower level facilities: impact on mortality and morbidity among patients with major trauma.
The purpose of the study was to compare the outcome of severely injured patients who were transported directly to a Level I, tertiary trauma center with those who were transferred after being first transported to less specialized hospitals. ⋯ The results of this study have shown that transportation of severely injured patients from the scene directly to Level I trauma centers is associated with a reduction in mortality and morbidity. Further studies are required for the evaluation of transport protocols for rural trauma. Economic and cost-effectiveness considerations of patient triage are also essential.