J Trauma
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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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Pelvic fractures can be an important source of major hemorrhage in victims of blunt trauma. However, no rapid and reliable noninvasive method exists for predicting which subjects will have major hemorrhage. The objective of this study is to use information available upon presentation to the trauma center to develop a clinical prediction rule to identify subjects with pelvic fracture who are at high risk of major hemorrhage. ⋯ Probability of major pelvic fracture related hemorrhage can be estimated from initial pelvic radiograph, pulse, and hematocrit.
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A modified below-knee (BK) amputation with the medial saphenous artery-based skin flap coverage was designed to preserve a functional BK stump for those who were unable to receive the conventional long posterior flap or skew-type amputation. ⋯ With a skin flap that was perfused by a direct cutaneous vessel, saphenous artery, and innerved by the saphenous nerve, the medial saphenous artery-based flap used in the modified BK amputation comprises one valuable alternative when conventional techniques are unsuitable.