J Trauma
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Controversies regarding how urgent bowel perforation should be diagnosed and treated exist in recent reports. The approach for early diagnosis is also debatable. The purposes of this study were to evaluate the relationship between treatment delay and outcome of small bowel perforation after blunt abdominal trauma and to determine the best assessment plan for the diagnosis of this injury. ⋯ Small bowel perforation has low mortality and complication rates if it is treated earlier than 24 hours after injury. The principle of "rushing to the operation suite" for a stable blunt abdominal trauma patients without detailed systemic examination is not justified. The priority of treatment for the small bowel perforation should be lower than the limb-threatening injuries. Diagnostic peritoneal lavage provides high sensitivity and specificity rates for the diagnosis of small bowel perforation if a specially designed positive criterion is applied.
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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.
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Comparative Study
Adult versus pediatric prehospital trauma care: is there a difference?
Management of the injured child in the prehospital setting continues to be debated. Issues raised in the literature include time spent on scene, skill maintenance and performance, and reported poorer outcomes compared with adults. ⋯ Paramedics are able to provide pediatric trauma patients a level of care comparable to that provided adult patients with similar outcome.