J Trauma
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Terrorist bombings remain a significant threat in the United States. However, minimal longitudinal data exists regarding the medical and public health impact because of bombings. ⋯ Illegal bombings and related injuries commonly occur in the United States. Because of the easy availability of bombing materials, government agencies and healthcare providers should prepare for potential mass-casualty bombings.
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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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Trauma scoring systems have been developed to help surgeons predict who will die after injury. However, some patients may not actually die of their injuries but may undergo withdrawal of life-sustaining therapy (WLST). The goal of this study was to determine which factors were associated with WLST among older patients who died. We hypothesized that patients with comorbid illnesses, higher injury severity scores (ISS), complications, and existing advanced directives (AD) would be more likely to have WLST and that patients having WLST would receive more medication for symptom relief in the 24 hours before death. ⋯ Expected associations with WLST such as age, ISS, comorbidities, and complications were not present in this population. Although trends may exist regarding patient wishes and ADs, larger studies are needed to corroborate these findings. Given the percentage of patients having supportive care withdrawn, trauma registries and scoring systems should include WLST.
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Multicenter Study Clinical Trial
Surgeon-performed bedside organ assessment with sonography after trauma (BOAST): a pilot study from the WTA Multicenter Group.
Although nonoperative management of solid organ injuries is a well-accepted practice, a rapid method to assess the progression of the injury, the early development of organ-related complications, and the frequency with which follow-up computed tomography (CT) scans are needed has yet to be determined. The use of ultrasound in this setting may provide information that would improve the rate of organ salvage and decrease the patient's morbidity. The objectives of this study were to determine whether surgeons could successfully use a bedside organ assessment with sonography after trauma (BOAST) examination to: (1) detect a solid organ injury; and (2) assess for changes in the size of the organ injury, an increase or decrease in hemoperitoneum, and the development of organ-related complications. ⋯ (1) BOAST has limitations in identifying solid organ injuries, especially those that are lower grade; (2) the US heme score is a valuable adjunct to the clinical examination in following patients with high-grade solid organ injuries and a dropping hemoglobin; and (3) although uncommon, organ-related complications may be identified using BOAST.