J Trauma
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Review Multicenter Study
Bladder rupture after blunt trauma: guidelines for diagnostic imaging.
The purpose of this study was to establish guidelines for diagnostic imaging for bladder rupture in the blunt trauma victim with multiple injuries, in whom the delay caused by unnecessary testing can hamper the trauma surgeon and threaten outcome. ⋯ The classic combination of pelvic fracture and gross hematuria constitutes an absolute indication for immediate cystography in blunt trauma victims. Existing data do not support lower urinary tract imaging in all patients with either pelvic fracture or hematuria alone. Clinical indicators of bladder rupture may be used to identify atypical patients at higher risk. Patients with isolated hematuria and no physical signs of lower urinary tract injury may be spared the morbidity, time, and expense of immediate cystographic evaluation.
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Abnormal hemostasis is associated with many of the complications of trauma-associated morbidity and mortality. Platelets are integral in the maintenance of hemostasis. ⋯ Severe injury usually results in increased platelet activation and function. However, the combination of increased platelet activation with decreased function was associated with increased mortality.
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The Burn Specific Health Scale (BSHS) is an outcome scale designed specifically for burn patients. The scale has been abbreviated (BSHS-A) and revised (BSHS-R). We used a factor analytic approach to further improve the scale for clinical use. ⋯ The BSHS-B is a valid but shorter alternative to the previously described BSHS-A. Important domains of postburn distress are captured better in the BSHS-B than in the BSHS-R.
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Submersion victims are frequently considered at high risk for cervical spine (C-spine) injury regardless of whether they sustain a traumatic injury. We hypothesized that C-spine injury is unlikely in submersion victims who do not sustain high-impact injuries. ⋯ Submersion victims are at risk for C-spine injury only if they have also sustained a traumatic injury. Routine C-spine immobilization does not appear to be warranted solely on the basis of a history of submersion.
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Multicenter Study
Low-impact falls: demands on a system of trauma management, prediction of outcome, and influence of comorbidities.
Falls from a low height are an extremely common source of injury, the severity of which is often underestimated. As a result, low fall patients are usually not transferred to Level I trauma centers. There are surprisingly few systematic data relating to the demands made on systems of trauma care by patients with low falls. This study addresses this issue using information from a comprehensive national trauma database. The performance of TRISS methodology, and the factors associated with prolonged hospital stay, in low fall patients is also examined. ⋯ Patients with low falls make considerable demands on a system of trauma care. TRISS methodology performs less well in this group than with other types of injury. Chronic medical conditions are associated with increased mortality and more prolonged stay after a low fall. Between-institutional variation in length of stay was considerable and this, along with the poor performance of predictive models derived from routinely collected clinical data, make it unlikely that length of stay could be used as a measure of institutional performance. More robust audit measures for patients with low falls are required.