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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To determine the factors predictive of mortality in patients with unstable pelvic fractures after successful transcatheter arterial embolization. ⋯ The success rate of embolization was 100% in stopping arterial hemorrhage of unstable pelvic fractures. The survival rate after successful embolization was 82.4%. Patients who had rapid blood transfusion before embolization had a poor final outcome. The risk of dying increased by 62% for every 1 unit/h increase of transfusion rate.
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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.