J Trauma
-
Comparative Study
Value of thoracic computed tomography in the first assessment of severely injured patients with blunt chest trauma: results of a prospective study.
The aim of this prospective study was to evaluate whether early thoracic computed tomography (TCT) is superior to routine chest x-ray (CXR) in the diagnostic work-up of blunt thoracic trauma and whether the additional information influences subsequent therapeutic decisions on the early management of severely injured patients. ⋯ TCT is highly sensitive in detecting thoracic injuries after blunt chest trauma and is superior to routine CXR in visualzing lung contusions, pneumothorax, and hemothorax. Early TCT influences therapeutic management in a significant number of patients. We therefore recommend TCT in the initial diagnostic work-up of patients with multiple injuries and with suspected chest trauma because early and exact diagnosis of all thoracic injuries along with sufficient therapeutic consequences may reduce complications and improve outcome of severely injured patients with blunt chest trauma.
-
Comparative Study
Analysis of cellular and decellular allogeneic dermal grafts for the treatment of full-thickness wounds in a porcine model.
The need for a reliable skin substitute to improve burn treatment has been long apparent. We have investigated the use of cryopreserved cellular and decellularized porcine allogeneic dermal grafts (CADGs or DADGs) in conjunction with an overlying thin split-thickness autograft (STSG) in a one-step technique. Control mirror-image wounds were treated with thin STSG alone. Autograft "take" rates and wound contraction were determined; biopsies were taken at weeks 2, 5, and 8, and blinded scar assessment was performed at week 10. ⋯ CADGs and DADGs permitted simultaneous engraftment of an overlying thin STSG. Although CADGs had no effect on wound contraction and cosmetic outcome, DADGs significantly reduced wound contraction and improved cosmetic outcome of full-thickness wounds in a porcine model. The use of DADGs may represent a potential improvement in burn care.
-
Early burn wound excision restores immunocompetence and improves patient survival, but the exact mechanisms have not yet been defined. Burn injury impairs cytotoxic T lymphocyte (CTL) activity as a function of burn size, increasing the risk of infection. The purpose of this study was to determine if early wound excision improved viral-specific CTL function. ⋯ Burn injury inhibits viral-specific CTL activity. Early, complete wound excision augments CTL function. Improved CTL activity after burn may reduce the risk of infection, providing an immunologic rationale for expeditious wound excision.
-
Comparison of trauma survival rates between institutions and reference data bases is hampered by different injury severity mixes. To overcome this, a standardized comparison using a stratified W statistic (Ws) has been proposed. Ws enables comparisons but does not represent actual survival rates at an institution. ⋯ Ws is useful for comparison between centers. Trauma and Injury Severity Score methodology overpredicts survival in certain probability of survival intervals. Adjustment can be made to estimate the actual survival rate. When applied to an integrated trauma system, such adjustments demonstrate overall improved survival, most noticeable in a more severely injured subgroup.