J Trauma
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Injuries are a major cause of total health care costs. Cost estimations may help identify injuries and high risk-groups to be considered for potential intervention. ⋯ Elderly patients aged 65 years and older, especially women, consume a disproportionate share of hospital resources for trauma care, mainly caused by hip fractures and fractures of the knee/lower leg, which indicates the importance of prevention and investing in trauma care for this specific patient group.
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The purpose of this research was to compare associated injuries and mortality in multiply injured patients with scapular fractures with those without scapular fractures. ⋯ In an observational study of multiply injured trauma patients from motor vehicle crashes, we report the following: (1) scapular fractures occur 3.7% of the time; (2) the presence of a scapular fracture was associated with a lower mortality; and (3) scapular fractures should alert healthcare personnel to the presence of other injuries, such as chest injuries, clavicle fractures, rib fractures, spine fractures, tibial fractures, and spleen and liver injuries. Our findings should be interpreted cautiously, because the mechanism of the association between scapular fractures and mortality remains unclear.
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Uncrossmatched type-O packed red blood cells (UORBC) are recommended for immediate transfusion in hemorrhaging trauma patients. The potential for alloimmunization with this technique is controversial, and has been reported to be as high as 80%. We examined a 1-year experience with UORBC transfusion to determine the incidence of allergic reaction and alloimmunization. ⋯ The need for UORBC is associated with significant injury and the need for subsequent massive transfusion. In this largest reported trauma series, the use of UORBC enabled rapid administration of red cells to hemorrhaging patients, without discernible risk for transfusion-related complications. The rate of seroconversion of Rh-patients is lower than reported in the literature, perhaps due to immune suppression associated with hemorrhagic shock.
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We reviewed our experience with the open abdomen and hypothesized that the known high wound complication rates were related to the timing and method of wound closure. ⋯ Morbidity associated with wound complications from the open abdomen remains high (25%). Morbidity is associated with the timing and method of wound closure and transfusion volume, but independent on injury severity. Also, delayed primary fascial closure before 8 days is associated with the best outcomes with the least charges.
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Trauma registries have been developed to describe the pattern of trauma and trauma workload, provide data for research, and to demonstrate changes in patient outcomes. Quality improvement using trauma registries at a system-wide level has been difficult to achieve. In Victoria, Australia, a statewide trauma system and trauma registry has been established to monitor and feedback the process of management and outcomes of major trauma patients across all healthcare providers. ⋯ VSTR data indicate that the statewide trauma system is working well and provides a method for ongoing monitoring and trauma care feedback.