J Trauma
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Brain injury as well as early inflammatory and endocrine responses were found to be indicators for infectious complications in patients with multiple injuries. In this context, brain-derived inflammatory response as well as centrally triggered neuroendocrine activation and systemic immunodepression seem to be of major importance. Therefore, we hypothesize that a circulating index of inflammatory or endocrine function measured soon after brain injury (in patients with admission Glasgow Coma Scale [GCS] score of 4-7) would discriminate severe from moderate injury as indexed by GCS status on postinjury day 7. ⋯ The IL-6 plasma level 1 day after the acute event with a cut-off of 100 pg/mL (Immulite) seems to be a predictor for short-term prognosis and infectious complications in brain-injured patients.
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Thoracostomy tube (TT) placement constitutes primary treatment for traumatic hemopneumothorax. Practice patterns vary widely, and criteria for management and removal remain poorly defined. In this cohort study, we examined the impact of implementation of a practice guideline (PG) on improving management efficiency of thoracostomy tube. ⋯ Implementation of a thoracostomy tube practice guideline was associated with improved management efficiency in trauma patients.
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Multicenter Study Comparative Study
Motor vehicle restraints: primary versus secondary enforcement and ethnicity.
Efforts to increase motor vehicle restraint use have been broadly based rather than focused on specific populations. Identifying specific issues, including populations with low restraint use, can help target educational campaigns. Previous studies have reported differences in restraint use by ethnicity. This study was performed to determine whether differences exist in motor vehicle restraint use by ethnicity and whether these differences are altered by the presence of primary versus secondary restraint laws. ⋯ In a state with secondary enforcement laws, restraint use varied significantly with ethnicity. Restraint use was markedly increased in all ethnic groups by the presence of a primary enforcement law. Implementation and enforcement of primary restraint laws is essential to improving motor vehicle restraint use. Educational campaigns to increase restraint use need to target specific populations.
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Performance improvement is an essential component of the trauma center. TRISS methodology has been applied as a national standard against which trauma centers can compare their outcomes. Earlier reviews of TRISS unexpected survivors sustained the classification of unexpected survivor in the vast majority of cases. Our hypothesis was that the level of care that is currently expected has made the TRISS unexpected survivors a statistical phenomenon only. ⋯ Only 10.7% of survivors classified as unexpected by TRISS were corroborated as unexpected by a blinded, peer-review process. TRISS needs to be updated for meaningful interpretation; modifications need to be made and coefficients need to be revised.