J Trauma
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Multicenter Study
Relative bradycardia in hypotensive trauma patients: a reappraisal.
The inability to mount tachycardia (T) after trauma-related hypotension is labeled relative bradycardia (RB). The objective of this study was to examine RB incidence and prognosis in a large cohort of patients. ⋯ RB was common in hypotensive adult trauma patients; overall, it was associated with increased mortality. Patients older than 55 years and with a higher Glasgow coma scale score demonstrated decreased mortality with RB. When RB was further divided, a HR between 60 and 90 demonstrated a significant lower mortality compared with a HR <60 and to T.
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Blunt cerebrovascular injuries (BCVI) in trauma patients are rare but potentially devastating injuries, particularly if the diagnosis is delayed. Conventional angiography (CA) has been the screening and diagnostic modality of choice for identifying BCVI. With the advent of high-resolution computed tomography (CT), CT angiography has become a common modality for the screening of BCVI. A liberalized screening approach has suggested that cerebrovascular injuries are missed in many patients; however, no standard BCVI screening protocol exists. Early diagnosis of the BCVI can prevent long-term sequelae. ⋯ Neither 16- nor 64-slice CT angiography is as accurate as CA as a screening tool for BCVI.
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This study was performed to determine the agreement between and within surgeons concerning the influence on treatment plan of routine versus selective multidetector-row computed tomography (MDCT) findings in blunt trauma patients. ⋯ All surgeons agreed that the traumatic injuries additionally found by routine MDCT, frequently resulted in a change of treatment plan. There was a moderate-to-excellent agreement between and within surgeons that these additional findings resulted in a change of treatment plan.
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Comparative Study
Immunologic function in the elderly after injury--the neutrophil and innate immunity.
Aging is associated with a decline in immune function. This may contribute to decreased ability of an elderly patient to mount an appropriate innate inflammatory response when injured. This study examined elderly trauma patients to determine whether there was a difference in neutrophil response to injury when compared with controls. ⋯ Injury results in differences in innate immune function in the elderly when compared with controls. The clinical significance of this is uncertain and warrants further investigation.