J Trauma
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Commotio cordis is a term used to describe cases of blunt thoracic impact causing fatality without gross structural damage of the heart and internal organs. Death is attributed to ventricular fibrillation or cardiac arrhythmia aggravated by traumatic apnea. The biomechanical response related to the risk of commotio cordis has not been determined. ⋯ Based on this in-depth analysis, the viscous criterion is the relevant biomechanical response to assess the risk of commotio cordis and more severe thoracic injury in high-speed blunt impact.
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Injured children represent 25% of all injured patients in the United States and have unique needs that may require treatment at a pediatric trauma center or a trauma center with pediatric commitment. This work attempts to determine if there is existing evidence that pediatric trauma centers, trauma centers with pediatric commitment, or trauma systems have improved the care of injured children. ⋯ Further analysis is necessary to demonstrate whether trauma systems make a difference in pediatric outcome. Injury prevention will have the greatest impact on future pediatric injury outcomes.
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Trauma registries offer distinct advantages and disadvantages when assessing the effectiveness of trauma systems. Detailed injury data and statistical comparisons that use TRISS methodology and the Major Trauma Outcome Study norms provide advantages over population-based or preventable death studies. However, miscodings and registry differences in injury severity coding limit the validity and generalizability of findings. The purpose of this study was to identify these strengths and weaknesses and to determine whether registry studies provide evidence of trauma system efficacy. ⋯ These studies provide evidence of the effectiveness of trauma systems. However, future studies that use trauma registries would be strengthened by including both prehospital and postdischarge trauma deaths, standardizing trauma registry inclusion criteria and developing a contemporary national reference norm for trauma outcome.
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Comparative Study
Assessing the effectiveness and optimal structure of trauma systems: a consensus among experts.
To determine whether a consensus exists among experts regarding the effect of organized trauma systems on patient outcomes based on peer-reviewed, published evidence. Second, to ascertain whether experts agree on the optimal structure of trauma systems. ⋯ A consensus does exist among trauma system experts regarding the effectiveness of trauma systems and the optimal structure of trauma systems. Additional research is needed to determine whether trauma system benefits extend to other patient subgroups in other geographic regions. Consensus theory provides an impressive model for assessing rater agreement by controlling for response bias and providing a probability measure to determine whether a true consensus exists.