J Trauma
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Comparative Study
Do trauma centers improve functional outcomes: a national trauma databank analysis?
The development of a tiered trauma care system has lead to improved survival for the critically injured. The question as to whether the increased survival associated with the establishment of tiered levels of trauma care is paralleled by an improved functional outcome has not, however, been addressed. ⋯ These data indicate that the complex care delivered by advanced level trauma centers is associated with improved functional outcomes. Further investigations to identify the reasons for differences in these outcomes are necessary to improve care at lower tiered hospitals particularly for minimally injured patients.
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Unintentional firearm deaths among children have been declining steadily in the United States. This study investigates whether Child Access Prevention (CAP) laws are associated with this decline. ⋯ Unintentional firearm deaths are declining in the United States, with the rate for children under age 15 declining faster than adults. States that allowed felony prosecution of offenders experienced a greater effect of CAP laws than states that did not. CAP laws may have had some influence on the continued reduction in national death rates.
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Multicenter Study Comparative Study
Spiral computed tomography for the initial evaluation of spine trauma: A new standard of care?
Although spiral computed tomographic scanning (SCT) is frequently used for spinal imaging in injured patients, many trauma centers continue to rely on plain film radiography (PFR). The purpose of this study was to determine the effects of a trauma center's transition from PFR to SCT for initial spine evaluation in trauma patients by comparing diagnostic sensitivity, time required for radiographic imaging, costs, charges, and radiation exposure. ⋯ SCT is a more rapid and sensitive modality for evaluating the spine compared with PFR and is obtained at a similar cost. The advantages of SCT suggest that this readily available diagnostic modality may replace PFR as the standard of care for the initial evaluation of the spine in trauma patients.
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Multicenter Study Comparative Study
Variation in the management of pediatric splenic injuries in the United States.
This study examines the existence and sources of variation in the management of pediatric splenic injuries among hospitals in the United States and the factors associated with splenectomy. ⋯ Nationally, children cared for at freestanding pediatric hospitals have a significantly lower risk of splenectomy than children treated at either adult hospitals or pediatric hospitals within an adult hospital. This may have implications for education, trauma triage and the establishment of practice guidelines.
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Comparative Study
Increased mortality in rural vehicular trauma: identifying contributing factors through data linkage.
Fatality rates from rural vehicular trauma are almost double those found in urban settings. Causes of this difference in rural and urban trauma fatality rates have yet to be fully explored. The purpose of this study is to identify prehospital causes of the higher rural fatality rates by linking, analyzing, and comparing prehospital data for rural and urban vehicular crashes. ⋯ In a setting of rural MVC, increased EMS response time, time on scene and distance to the scene are associated with higher rural trauma mortality rates.