J Trauma
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Comparative Study
Range-of-motion restriction and craniofacial tissue-interface pressure from four cervical collars.
Occipital pressure ulcers are well-known complications for trauma patients wearing cervical collars. We assessed the effects of four commercial cervical collars (Aspen, Philadelphia, Miami J, and Miami J with Occian back [Miami J/Occian]) on cervical range of motion (CROM) and mandibular and occipital tissue-interface pressure (TIP). ⋯ Miami J and Philadelphia collars restricted CROM to the greatest extent. Miami J and Miami J/Occian back had the lowest levels of mandibular and occipital pressure; these collars may markedly reduce the risk of occipital pressure ulcers without compromising immobilization.
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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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It is widely accepted that all-terrain vehicles (ATVs) can be dangerous to operators. Understanding the mechanisms of ATV crashes, especially rollovers, can provide important insight to consumers, legislators, and manufacturers on ATV safety and protection of the users. ⋯ These findings suggest that nonrandom, modifiable factors are likely involved. Our data provide unique insight into specific mechanisms of ATV crashes, particularly rollovers, and those involving children. Findings may be applicable to changes in ATV design and education of users.
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Comparative Study
In vitro effect of activated recombinant factor VII (rFVIIa) on coagulation properties of human blood at hypothermic temperatures.
Recombinant activated factor VII (rFVIIa) is currently administered off-label to control diffuse coagulopathic bleeding of patients with traumatic injuries. These patients are often cold, acidotic, and coagulopathic upon arrival and each responds differently to rFVIIa therapy. This study investigated the effects of hypothermia on clotting and the potential benefit of rFVIIa administration on blood coagulation at different hypothermic temperatures. ⋯ Mild to moderate hypothermia delayed the initial clot reaction and reduced clot formation rate without affecting ultimate clot strength. FVIIa effectively compensated for the adverse effects of hypothermia except in severe cases. These results suggest that administration of FVIIa should be beneficial in enhancing hemostasis in hypothermic trauma patients without the need for prior correction of the patient's body temperature.
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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.