J Trauma
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Recent reports suggest that early fracture fixation worsens central nervous system (CNS) outcomes. We compared discharge Glasgow Coma Scale (GCS) scores, CNS complications, and mortality of severely injured adults with head injuries and pelvic/lower extremity fractures treated with early versus delayed fixation. ⋯ We found no evidence to suggest that early fracture fixation negatively influences CNS outcomes or mortality.
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The optimal method of evaluating blunt abdominal trauma remains controversial. A combination of a sensitive screening test, diagnostic peritoneal lavage (DPL), and a specific test, abdominal computed tomography (CT), may be a safe, efficient approach to adult blunt abdominal trauma. ⋯ Screening DPL, followed by abdominal CT if positive, is a safe, efficient method of evaluating adult blunt abdominal trauma that reduces the time required to evaluate the abdomen, does not result in increased nontherapeutic celiotomies, results in fewer missed injuries, and reduces the overall use of abdominal CT.
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In this article, we present our experience of group lightning injury. Individual injuries are most common after single strikes. ⋯ Although injured under the same circumstances, these patients presented with a wide range of symptoms and signs. We also describe a characteristic burn pattern, the "tip-toe sign."
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In Norway, most patients with severe head injuries are transported to, and operated in, the neurosurgical unit of the regional university hospital. However, some patients are still occasionally operated on in county central hospitals by orthopedic or general surgeons who do not have neurosurgical expertise. The aim was to analyze this surgical activity outside the neurosurgical units. ⋯ The present study indicates that, in Norway and countries with a similar hospital system, it must be difficult for general and orthopedic surgeons to achieve and maintain the skills required for emergency operations in patients with acute severe head injuries. Thus, it is probably to the patients' benefit to improve the general hospitals' competency and speed in the detection of candidates for surgical decompression, and stress the importance of these patients being transferred without unnecessary delay to a neurosurgical unit.
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Trauma registries frequently do not include the deaths of patients who do not get to trauma centers (TCs). Thus, complementary methods of monitoring the impact of trauma system initiatives should be considered. The objective of this study is to use National Highway Safety Traffic Administration's Fatality Analysis Reporting System (FARS) and New York State Department of Motor Vehicles data and to study the impact of state and regional initiatives over a 10-year period in the seven-county Hudson Valley New York (HV) region with one regional TC in Westchester County (WC) and to assess its face validity. ⋯ The drops in motor vehicle crash death rates may reflect injury prevention as well as trauma system initiatives. Thus, although FARS and New York State Department of Motor Vehicles data cannot establish cause and effect relationships, it can monitor the aggregated impact of multiple initiatives. Taken together with increasing percentages of seriously injured trauma patients going to trauma centers and comparisons with national FARS data, the association of decreasing deaths with the implementation of a trauma system seems to have face validity.