J Trauma
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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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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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Multicenter Study
Effect of the Uniform Accident and Sickness Policy Provision Law on alcohol screening and intervention in trauma centers.
Alcohol screening and intervention in trauma centers are widely recommended. The Uniform Accident and Sickness Policy Provision Law (UPPL) exists in most states, and allows insurers to refuse payment for treatment of injuries in patients with a positive alcohol or drug test. This article analyzed the UPPL's impact on screening and reimbursement, measured the knowledge of legislators about substance use problems in trauma centers, and determined their opinions about substance use-related exclusions in insurance contracts for trauma care. ⋯ The study documents strong support for screening and intervention programs by both trauma surgeons and legislators. Surgeons experience alcohol-related insurance denials but are not familiar with the state law that sanctions this practice. A majority of legislators are also not familiar with the UPPL but support elimination of insurance statutes that allow exclusion of coverage for trauma care on the basis of intoxication.