J Trauma
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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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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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Comparative Study
Acute renal failure in critically ill surgical patients: persistent lethality despite new modes of renal replacement therapy.
Despite improved resuscitation and sepsis care, acute renal failure (ARF) remains common in critically ill surgical patients. New methods of renal replacement therapy (RRT) are being used in surgical intensive care units (SICUs), including high-flux hemodialysis (HD) and continuous RRT (CRRT). RRT is being used increasingly early in the course of ARF, but data are scant to suggest that mortality is improved. Consequently, we determined whether outcomes were improved with CRRT in SICU patients, and hypothesized that CRRT lowers mortality for patients with ARF. ⋯ Despite more frequent RRT and the use of CRRT, the mortality of ARF in critically ill surgical patients remains high because of nonrenal organ dysfunction. Considering that ARF-related mortality was decreased by intermittent HD, and that intermittent RRT is less costly, patients who need RRT should be treated preferentially with HD.
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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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Comparative Study Controlled Clinical Trial
Hemodynamic and oxygen transport patterns after head trauma and brain death: implications for management of the organ donor.
The aims of the present study were to describe the temporal hemodynamic and oxygen transport patterns of patients with head injuries as well as the patterns of those who became brain dead to better understand the role of underlying central regulatory hemodynamic mechanisms and ultimately to improve rates of organ donation. ⋯ The hyperdynamic state with exaggerated peripheral tissue perfusion or oxygenation in brain-dead patients associated with loss of central vasoconstrictive mechanisms of the stress response resulted in unopposed peripheral metabolic vasodilatation producing high CI and tissue perfusion.