J Trauma
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Acute stress disorder (ASD) can interfere with satisfactory recovery of children with severe burn injuries. Recent studies have found propranolol to be effective in reducing posttraumatic symptoms, but the benefits of this medication with ASD are unknown. Therefore, we hypothesized that individuals who were administered propranolol acutely would be less likely to develop ASD than those who were not. ⋯ Propranolol was not found to influence the risk for subsequent ASD. This finding is in contrast to the observed benefit of propranolol reported in other studies with different at risk populations. Further exploration is warranted to assess the possible long-term benefit on posttraumatic symptoms in pediatric burn survivor patients.
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Multicenter Study
Visceral adiposity is not associated with inflammatory markers in trauma patients.
Excess visceral adiposity induces chronic subclinical inflammation resulting in the metabolic syndrome. Whether excess visceral adiposity impacts posttraumatic inflammatory profiles more is unknown. We hypothesized that obese patients (body mass index >30 kg/m) with higher visceral to subcutaneous adipose tissue distribution would have increased inflammatory outcomes. ⋯ Visceral body fat distribution in obese patients is not associated with increased inflammatory profiles or clinical outcomes after trauma. The impact of injury severity on acute inflammation likely overwhelms the metabolic disturbances and subclinical inflammation associated with visceral obesity in the chronic setting.
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The Educational Initiative on Critical Bleeding in Trauma was formed to assess current data and to guide future research and practice in the management of coagulopathy after severe trauma. The Educational Initiative on Critical Bleeding in Trauma recently published structured literature reviews on animal models and mechanisms of trauma-associated coagulopathy and the results of a survey of international clinical practice. The authors convened a symposium in July 2008 and invited researchers and opinion leaders in trauma care, transfusion medicine, and coagulation research to discuss current understanding and management and to identify future areas of exploration. ⋯ The association between trauma and bleeding from patient registries, basic science, and clinical studies was confirmed, as was the association between the coagulopathy that presents early after major injury and excess mortality. Meeting participants identified the need for consensus definitions and common terminology to describe coagulopathy after trauma, including the term acute coagulopathy of trauma shock to describe the early coagulopathy induced by tissue injury/shock and the global term trauma-induced coagulopathy to describe coagulopathy after injury and its sequelae (loss, consumption, acidemia, acute coagulopathy, and dilution). Other conclusions included the need for increased clinical awareness, new methods and tools for early diagnosis, consistent early preventative strategies, and evidence-based therapies for these conditions.
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Artifacts produced by metallic fragments and orthopedic hardware limit the usefulness of conventional computed tomography in many military trauma patients. Contemporary literature suggests that multidetector computed tomographic angiography (MDCTA) by resolving these limitations may provide a useful noninvasive alternative to invasive arteriography. The objective of this study is to review the utility of MDCTA in the evaluation of recent combat casualties with vascular injuries. ⋯ MDCTA yielded high resolution images that were very useful for the delayed evaluation of combat casualties. The presence of metallic fragments or orthopedic hardware did not significantly interfere with MDCTA. It is a reliable and promising alternative to traditional arteriography for evaluating clinically occult vascular trauma.
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We retrospectively analyzed 112 intertrochanteric femur fracture patients and 136 femoral neck fracture patients to determine mortality rates and factors affecting mortality. Internal fixation is the standard treatment method for intertrochanteric femur fracture patients in our institute, and arthroplasty, as a treatment choice, shows an increase in mortality rates. We wanted to convey if there was any decrease in mortality rate of intertrochanteric femur fracture patients when compared with femoral neck fracture patients who were almost always treated with arthroplasty. ⋯ We think that, in addition to the shorter delay in surgery, internal fixation choice led to decrease the mortality rate of intertrochanteric femur fracture patients. In conclusion, to decrease the mortality rate after hip fracture, since age and sex cannot be changed, needless delays in surgery should be avoided. Also, we recommend internal fixation and regional anesthesia to decrease the mortality rate.