J Trauma
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Comparative Study
Midline shift after severe head injury: pathophysiologic implications.
To investigate the mechanism of the adverse effect of midline shift after severe traumatic brain injury. ⋯ Midline shift after severe traumatic brain injury is associated with reduced CMRo2, regardless of whether or not SDH is present. The deleterious effects of subdural blood may be related more to the mass effect of large SDHs than to the biochemical abnormalities caused by small amounts of blood in the subdural space.
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New York State instituted a statewide trauma system beginning in 1990. By 1993, that system included uniform emergency medical system triage guidelines, designated trauma centers, transfer agreements between trauma centers and noncenters, and a trauma registry containing data on seriously injured patients in each region and the state as a whole. We reviewed the first 4 years of registry data for the Finger Lakes Region to determine what effects the institution of a trauma system has had on the outcome of trauma care in this region. ⋯ Improved outcomes for patients with blunt trauma can occur early in the implementation of a trauma system. This improvement may be attributable in part to changes in field triage and early transport to trauma centers.
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Motor vehicle collisions are the most common mechanism of traumatic death. Speeding is often implicated as a causal factor in motor vehicle crashes. One potential intervention, to prevent speeding, is the placement of a roadside unmanned police car. This study sought to answer the following questions: is speeding reduced by this intervention, does this intervention lose effectiveness over time, and when the car is removed, do motorists resume speeding? ⋯ Parking an unmanned police car beside a road was associated with a large reduction in speeding over a 10-day period. Removal of the unmanned police car resulted in a return to preintervention speeding.