J Trauma
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Comparative Study
Ostomy as a risk factor for posttraumatic infection in penetrating colonic injuries: univariate and multivariate analyses.
Primary repair for penetrating colonic injury is an acceptable practice in uncomplicated injuries, but it is still viewed with trepidation in high risk patients. ⋯ Although most of the above factors are beyond the control of the trauma surgeon, the creation of an ostomy is a clinical decision. The creation of an ostomy in high-risk patients does not protect them from septic complications and, indeed, may independently contribute to local abdominal infections.
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The standard evaluation of mediastinal gunshot wounds usually requires angiography and either esophagoscopy or esophagography. In the present study, we have evaluated the role of helical computed tomographic (CT) scanning in reducing the need for angiographic and esophageal studies. ⋯ The helical CT scan provides a rapid, readily available, noninvasive means to evaluate missile trajectories. This permits accurate assessment of potential mediastinal injury and reduces the need for routine angiographic and esophageal studies.
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Understanding the etiology of missed injuries is essential in minimizing its occurrence. A retrospective review was conducted to identify the incidence, contributing factors, and clinical outcomes of missed injuries. ⋯ Patients with missed injuries tend to be more severely injured with initial neurologic compromise. The majority of missed injuries are potentially avoidable with repeat clinical assessments and a high index of suspicion.
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Due to the highly lethal nature of trauma of the thoracic aorta and aortic arch branches (TA-AAB), autopsy studies are essential for the investigation of its epidemiologic characteristics. ⋯ Major differences between blunt and penetrating TA-AAB injuries were revealed, regarding their location, patterns of concomitant injuries, and victims' survival time. Patients injured in motor vehicle crashes, as opposed to various other causes of trauma, were found to have the best chances of reaching the hospital alive.