J Trauma
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Comparative Study
Outcome of adolescent trauma admitted to an adult surgical intensive care unit versus a pediatric intensive care unit.
Institutional protocol designates the adult trauma service as the primary manager of all adolescent traumas (age 14-18 years) unless admission to the pediatric intensive care unit (PICU) occurs. In the PICU, primary care becomes the responsibility of the pediatric intensivist, with trauma service as a consultant. The purpose of this study was to identify differences in the management of adolescent trauma between the pediatric intensivist in the PICU, and the adult trauma team in the surgical intensive care unit (SICU). ⋯ Adolescent trauma patients admitted to the PICU were less likely to be intubated or have a Swan-Ganz catheter placed. They had decreased LOS and days of mechanical ventilation. There was no difference in outcome measurements.
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Recombinant activated factor VII (rFVIIa) was approved for treatment of hemorrhages in patients with hemophilia who develop inhibitors to factors VIII or IX. Conditions with increased thromboembolic risk, including trauma with or without disseminated intravascular coagulation, were considered a contraindication for the drug. The mechanism of action of rFVIIa suggests enhancement of hemostasis limited to the site of injury without systemic activation of the coagulation cascade. Therefore, use of the drug in trauma patients suffering uncontrolled hemorrhage appears to be rational. ⋯ The results of this report suggest that in trauma patients rFVIIa may play a role as an adjunctive hemostatic measure, in addition to surgical hemostatic techniques, and provides the motivation for controlled animal and clinical trials.
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Randomized Controlled Trial Clinical Trial
Does the presence of ultrasound really affect computed tomographic scan use? A prospective randomized trial of ultrasound in trauma.
There is a paucity of evidence demonstrating that emergency department (ED) ultrasound changes clinical practice in trauma patients. We hypothesized that the presence of ultrasound would affect clinical decision making as evidenced through abdominal computed tomographic (CT) scan use in blunt multiple trauma patients. ⋯ In this trial, the routine use of abdominal ultrasound in the evaluation of patients with multiple blunt injuries resulted in significantly fewer abdominal CT scans being obtained. A larger trial is needed to more clearly define the clinical and financial impact of ultrasound in the management of blunt abdominal trauma.
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Accurate data are needed to evaluate clinical outcomes, therapeutic modalities, and quality of care in trauma. Administrative data, usually used for billing, and trauma registries, have been used to perform these functions. This study compares data for trauma patients from administrative and trauma registry databases at a Level I trauma center. ⋯ This study shows that administrative data have copious omissions of specific injuries, diagnostic and therapeutic interventions, as well as complications. The trauma registry recorded more of the diagnoses, diagnostics, procedures, and outcomes in the care of trauma patients. Trauma registries may be more useful than administrative databases in assessing quality of care and diagnostic and therapeutic interventions.