J Trauma
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The ability to rapidly and accurately triage, evacuate, and utilize appropriate interventions can be problematic in the early decision-making process of trauma care. With current methods of prehospital data collection and analysis, decisions are often based upon single data points. This information may be insufficient for reliable decision-making. To date, no studies have attempted to utilize data at multiple time points for purposes of enhancing prediction, nor have studies attempted to synthesize prediction models with data reflecting both large-vessel venous and arterial injuries. Therefore, we performed a retrospective study to examine the potential utility of dynamic neural networks in predicting mortality using highly discretized uncontrolled hemorrhagic shock data. ⋯ This study demonstrates that PNN models can effectively harness the dynamic nature of uncontrolled hemorrhagic shock data, despite utilizing data from large-vessel arterial and venous injuries. Utilizing the dynamic nature of hemorrhagic shock data in PNNs may ultimately allow the development of novel decision assist devices.
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Comparative Study
Percutaneous endoscopic gastrostomy: the preferred method of elective feeding tube placement in trauma patients.
The purpose of this study was to determine whether gastric feeding tubes placed by the percutaneous endoscopic route resulted in fewer and less severe complications than open surgical gastrostomy (SG). ⋯ Gastrostomy tubes placed via the percutaneous endoscopic route had a significantly lower complication rate than surgically placed tubes. In addition, the charges incurred for their placement were also significantly less. Based on the findings of this study, PEG should be considered as the method of choice for gastric feeding tube placement for trauma patients who do not have specific contraindications to the procedure.
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The objective of this study was to describe a population of children admitted to a tertiary care pediatric hospital with severe trauma to identify key areas for injury prevention research, and programming. ⋯ Research efforts and activities to prevent severe pediatric trauma in our region should focus on road safety, protection from head injuries, avoidance of falls, and prevention of child abuse.
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Clinical Trial
Surgical treatment for distal clavicle fracture with coracoclavicular ligament disruption.
Surgical reconstruction is usually indicated for distal clavicle fractures with coracoclavicular ligament disruption due to a high rate of nonunion and delayed union. We report the outcome of a surgical technique for this type of fracture. ⋯ The advantages of this technique include that the disrupted coracoclavicular articulation is rigidly restored and then the fracture site can be easily reduced and fixed with a wire. This technique allows for stable fixation with early mobilization and early return to work and sports.
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The 372 cases of crush syndrome that followed the 1995 Hanshin-Awaji earthquake have provided a unique opportunity to investigate the long-term physical outcomes and to establish indications for specific treatments in such patients. The objectives of this study were to identify independent predictors of physical outcome in patients suffering from crush syndrome and to clarify the influence of fasciotomy on outcomes. ⋯ Secondary compartment syndrome affects physical outcome in crush syndrome patients. We obtained no evidence that fasciotomy improves outcome. Delayed rescue, delayed fasciotomy, and radical debridement may worsen the physical prognosis. Indications for fasciotomy in crush syndrome during the acute phase need further deliberation.