J Trauma
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Comparative Study
Systemic inflammatory response syndrome in the trauma intensive care unit: who is infected?
Systemic inflammatory response syndrome (SIRS) is common in trauma patients, and infection represents an important and treatable source of SIRS. C-Reactive protein (CRP), an acute phase protein, is elevated in infection and discriminates between infected and uninfected patients in other patient populations. Our goal was to examine the ability of CRP and other commonly used markers of infection (maximum temperature [Tmax], and white blood cell count [WBC]) to distinguish between infectious and noninfectious causes of SIRS. ⋯ Infection must be presumed to be the source of SIRS in patients with CRP more than 17 mg/dL and Tmax more than 102 degrees F after postinjury day 4. WBC is not useful in determining the presence of infection.
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The neurologic outcome of comatose patients has a wide variation from complete reawakening to death. Methods of predicting the outcome of coma caused by either head injury or cardiac arrest have been the subject of much discussion in the literature. However, prediction of neurologic prognosis in comatose trauma patients without head injury has rarely been discussed. We reviewed our experience in treating patients with presumptive hypoxic-ischemic coma after trauma and tried to identify factors relating to their neurologic outcomes. ⋯ Hypoxic-ischemic coma in patients sustaining major trauma yielded a significantly better survival and neurologic outcome than that induced by cardiac arrest or head injury. Decision-making in the first 24 hours after injury should not be affected by the patient's neurologic status at that time. A motor response worse than withdrawal at 24 hours after injury and an absence of pupillary light reflex at 48 hours after injury predicted a poor neurologic outcome.
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Case Reports Randomized Controlled Trial Comparative Study Clinical Trial
Randomized trial of hydroxyethyl starch versus gelatine for trauma resuscitation.
Previous studies have demonstrated the rapid increase in systemic capillary permeability after blunt trauma and its association with poor outcome. There are theoretical advantages in resuscitation with colloid fluids, which are well retained in the vascular compartment during times of capillary leak. The aim of this study was to compare the effects of posttrauma resuscitation with hydroxyethyl starch (HES) (molecular mass, 250 kDa) or gelatine (molecular mass, 30 kDa), the hypothesis being that HES would reduce capillary leak. ⋯ The results suggest that compared with gelatine, resuscitation with HES reduces posttrauma capillary leak.
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Comparative Study
Temporal bone fractures: otic capsule sparing versus otic capsule violating clinical and radiographic considerations.
To assess the practicality and utility of the traditional classification system for temporal bone fracture (transverse vs. longitudinal) in the modern Level I trauma setting and to determine whether a newer system of designation (otic capsule sparing vs. otic capsule violating fracture) is practical from a clinical and radiographic standpoint. ⋯ The use of a classification system for temporal bone fractures that emphasizes violation or lack of violation of the otic capsule seems to offer the advantage of radiographic utility and stratification of clinical severity, including severity of Glasgow Coma Scale scores and intracranial complications such as subarachnoid hemorrhage and epidural hematoma.
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As a method of crime reduction among teenagers, several cities, counties, and states across the country have enacted, or attempted to enact, curfew laws. A curfew law was successfully implemented in Dade County, Florida, in January of 1996. Although its efficacy for crime reduction has been questioned, its benefit for trauma prevention may be real. ⋯ Although the overall trauma admissions and juvenile trauma admissions during the noncurfew hours remained relatively stable, juvenile trauma admissions during curfew hours dropped significantly in the 2 years after enforcement of the curfew law compared with the 2 years before the curfew law. This finding suggests that attempts to prevent late-night nonproductive street presence among teens can decrease the incidence of trauma occurrences.