J Trauma
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Multicenter Study Comparative Study Clinical Trial
Predicting the severity of systemic inflammatory response syndrome (SIRS)-associated coagulopathy with hemostatic molecular markers and vascular endothelial injury markers.
The changes in biomarkers of coagulation or fibrinolysis, anticoagulation, inflammation, and endothelial damage occur in patients with systemic inflammatory response syndrome (SIRS). The purpose of this study is to assess the prognostic value of these markers in patients with SIRS-associated hypercoagulopathy. ⋯ The changes in some hemostatic molecular markers and vascular endothelial markers were conspicuous in patients with organ dysfunction. The AT activity is considered to be the most useful predictor of organ dysfunction.
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The Glasgow Coma Scale (GCS) score is widely accepted as the cornerstone in the assessment of neurologic function after trauma and is being used to select patients for enrollment in prehospital (Ph) intervention trials. This study was performed to assess the degree of agreement between Ph-GCS and emergency department (ED)-GCS scores in our trauma system patients. ⋯ In this study, differences between Ph-GCS and ED-GCS were seen in the patient population with moderate to severe head injury. Individual component score agreement was moderate for all categories, with agreement worsening for patients with longer transport times. Although this suggests improvement in the patient's condition during transport, inter-rater variability between Ph and ED personnel cannot be excluded. The utility of Ph-GCS in Ph interventional trials for determining the presence of significant head injury will need to be further evaluated.
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To measure the combined contribution of change in velocity (Deltav), principal direction of force (PDOF), and restraint use on mortality after vehicular trauma. ⋯ A Deltav 40 km/h to 80 km/h, lack of restraint use, and lateral impact significantly affects mortality. A synergistic effect was found between Deltav 40-80 km/h and lateral PDOF.
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Although injured persons presenting to nontertiary hospitals are routinely transferred for further care, it is unknown whether there is an outcome benefit associated with this practice. We sought to assess whether the transfer of injured patients from nontertiary hospital emergency departments (EDs) is associated with improved survival. ⋯ After adjusting for injury severity and the nonrandom selection of patients for transfer, trauma patients transferred from nontertiary EDs to major trauma centers had lower inhospital mortality than patients remaining in nontrauma hospitals. Recognition and early transfer of at-risk rural trauma patients may improve survival in a regionalized trauma system.
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Heparin induced thrombosis (HIT) after low-molecular-weight (LMWH) administration for thrombosis prevention is a limb and life threatening condition. ⋯ Early recognition of the syndrome by monitoring daily platelet counts during heparin therapy is essential. In case of postheparin (LMWH or unfractionated) platelet decrease, heparin administration should be ceased after emergency testing for heparin induced antibodies. When HIT syndrome is confirmed to have occurred, heparin/LMWH must be replaced with thrombin-specific inhibitors.