J Trauma
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In the United States, only motor vehicle crashes and cancer claim more lives among children than do firearms. This national study attempts to determine whether firearm prevalence is related to rates of unintentional firearm deaths, suicides, and homicides among children. ⋯ A disproportionately high number of 5-14 year olds died from suicide, homicide, and unintentional firearm deaths in states and regions where guns were more prevalent.
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Optimal timing of femur fracture fixation remains controversial. This study examines the association between the timing of femur fracture fixation and outcome in patients with concomitant chest and head injuries. ⋯ Our data show that early femur fracture fixation (< 24 hours) is associated with an improved outcome, even in patients with coexistent head and/or chest trauma. Fixation of femur fractures at 2 to 5 days was associated with a significant increase in pulmonary complications, particularly with concomitant head or chest trauma, and length of stay. Chest and head trauma are not contraindications to early fixation with reamed intramedullary nailing.
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Clinical Trial Controlled Clinical Trial
Immediate spinal cord decompression for cervical spinal cord injury: feasibility and outcome.
The effect of immediate surgical spinal cord decompression on neurologic outcome after spinal cord injury is controversial. Experimental models strongly suggest a beneficial effect of early decompression but there is little supportive clinical evidence. This study is designed to evaluate the feasibility and outcome of an immediate spinal cord decompression treatment protocol for cervical spinal cord injury in a tertiary treatment center. ⋯ We conclude that immediate spinal column stabilization and spinal cord decompression, based on magnetic resonance imaging, may significantly improve neurologic outcome. The feasibility of such a treatment protocol in a tertiary treatment center is well demonstrated. Additional multicenter trials are necessary to achieve definitive conclusions regarding clinical efficacy.
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Comparative Study
A new method for estimating probability of survival in pediatric patients using revised TRISS methodology based on age-adjusted weights.
TRISS methodology estimates probability of survival (P(s)) based on coefficients derived largely from adult data. We developed a novel pediatric age-specific method to estimate P(s). ⋯ PAAT offers a more reliable methodology than TRISS and ASCOT for comparing pediatric trauma outcomes.
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Echocardiography has been shown to be valuable in critically ill surgical patients. Transthoracic echocardiography (TTE) often fails to provide adequate imaging in critically ill patients, necessitating subsequent transesophageal echocardiography (TEE). The objective of this study was to determine and quantify factors associated with failure of transthoracic echocardiography (TTE) in critically ill surgical patients, and to define a cost-effective strategy for echocardiography in these patients. ⋯ The routine use of TTE to initially evaluate all critically ill surgical patients who require echocardiography should be abandoned because it is not cost-effective. TEE appears to be the most cost-effective echocardiographic modality in the surgical intensive care unit.