J Trauma
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Deep vein thrombosis (DVT) has been identified as a marker of quality of care by various governmental and consumer groups. However, the lack of standardized DVT screening systems across trauma centers may introduce surveillance bias in the rates of DVT reported. We hypothesize that trauma centers with higher rates of duplex ultrasound detect more DVTs and subsequently report higher DVT rates to the National Trauma Data Bank. ⋯ More aggressive screening procedures may be associated with higher DVT rates. Trauma centers that screen more and report higher DVT rates may be falsely labeled as having decreased quality of care. Using DVT rate alone as an independent quality measure should be reevaluated because of the potential for surveillance bias.
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Traumatic brain injury (TBI) is a primary cause of injury mortality in developed countries but less is known about the impact of TBI on postacute mortality in large study populations. This study investigates the rate and predictors of postacute mortality (1-9 years after the initial injury) of severely injured persons with TBI in the Province of Ontario from April 1, 1993 to March 31, 1995. ⋯ This research quantifies the elevated risk of premature death in the postacute period for seriously injured adults with TBI and identifies factors most associated with highest mortality rates in this population.
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Traumatic injury is a leading contributor to the global burden of disease, yet there has been little research on possible predictors of general health after major trauma. This study aims to explore possible predictors of general health after major physical trauma. ⋯ General health after major physical trauma is more strongly associated with factors relating to compensation than with the severity of the injury. Processes involved with claiming compensation after major trauma may contribute to poor patient outcomes.
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Management of penetrating colorectal injuries in the civilian trauma population has evolved away from diversionary stoma into primary repair or resection and primary anastomosis. With this in mind, we evaluated how injuries to the colon and rectum were managed in the ongoing war in Iraq. ⋯ Based upon injury severity, the complex nature of triage and medical evacuation, and the multiple levels of care involved for injured military personnel, temporary stoma usage should play a greater role in military casualties than in the civilian environment for penetrating colorectal injuries.
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Local hemostatics have recently been introduced for field use to control external hemorrhage. The objective of this report is to describe the initial clinical experience with QuikClot, a zeolite that works by absorbing water and concentrating coagulation factors to stop bleeding in a series of patients. ⋯ QuikClot has been effectively used by a wide range of providers in the field and hospital to control hemorrhage.