J Trauma
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Multicenter Study Comparative Study
Scottish urban versus rural trauma outcome study.
Outcome following trauma and health care access are important components of health care planning. Resources are limited and quality information is required. We set the objective of comparing the outcomes for patients suffering significant trauma in urban and rural environments in Scotland. ⋯ Long prehospital times in the rural environment were not associated with differences in mortality or length of stay in moderately and severely injured patients in the west of Scotland. This may lend support to a policy of rationalization of trauma services in Scotland.
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Multicenter Study Clinical Trial
Emergent stabilization of pelvic ring injuries by controlled circumferential compression: a clinical trial.
Pelvic ring injuries are associated with a high incidence of mortality mainly due to retroperitoneal hemorrhage. Early stabilization is an integral part of hemorrhage control. Temporary stabilization can be provided by a pelvic sheet, sling, or an inflatable garment. However, these devices lack control of the applied circumferential compression. We evaluated a pelvic circumferential compression device (PCCD), which allows for force-controlled circumferential compression. In a prospective clinical trial, we documented how this device can provide effective reduction of open-book type pelvic injuries without causing overcompression of lateral compression type injuries. ⋯ A PCCD can effectively reduce pelvic ring injuries. It poses a minimal risk for overcompression and complications as compared with reduction alternatives that do not provide a feedback on the applied reduction force.
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A variety of policy groups recommend that screening and brief intervention (SBI) programs for alcohol-use disorders be widely implemented in health care settings. This article reports the extent to which trauma surgeons support SBI programs and the feasibility of implementing these programs in trauma centers. ⋯ Most trauma surgeons supported alcohol screening and interventions. Preliminary data showed that one half-time research assistant at each facility could successfully screen most injured patients and implement brief interventions. An alcohol screening and brief intervention program seems feasible in any trauma center committed to implementation.
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Comparative Study
Screening for blunt cerebrovascular injury: evaluating the accuracy of multidetector computed tomographic angiography.
Digital subtraction angiography (DSA) has been widely considered the "gold standard" for diagnosing blunt cerebral vascular injury, but recent advances in multidetector computed tomographic angiography (CTA) may have led to improved accuracy compared with DSA. ⋯ The sensitivity of CTA for carotid artery injury at our center was higher than in previous studies. This might be attributable to the superior quality of multidetector CTA images. Our conclusions on CTA accuracy in the vertebral artery are limited by the small number of injuries.
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To investigate the effect of ventilator-associated pneumonia (VAP) on the prognosis of head trauma patients. ⋯ We conclude that the occurrence of VAP caused by high-risk organisms in cranial trauma patients may increase the risk of death, the mechanical ventilation duration, the intensive care unit stay, and the hospital stay.