J Trauma
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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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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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To assess clinical and functional outcomes as well as the relative stability of various configurations of tension band wiring approaches for treating olecranon fractures, a retrospective cohort study was conducted. ⋯ Placement of the ends of Kirschner wires in the proximal ulnar canal should be avoided whenever possible. Because placement of the ends of Kirschner wires through the anterior ulnar cortex may produce serious complications as reported in medical literature, placement of the ends of Kirschner wires in the distal ulnar canal may be the most effective approach.
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Meta Analysis Comparative Study
Computed tomography alone versus computed tomography and magnetic resonance imaging in the identification of occult injuries to the cervical spine: a meta-analysis.
Ruling out injuries of the cervical spine in obtunded blunt trauma patients is controversial. Although computed tomography (CT) readily demonstrates fractures and malalignment, it provides limited direct evaluation of ligamentous integrity, leading some to advocate a magnetic resonance imaging (MRI) in obtunded patients. Thus, the question remains: does adding an MRI provide useful information that alters treatment when a CT scan reveals no evidence of injury? ⋯ Reliance on CT imaging alone to "clear the cervical spine" after blunt trauma can lead to missed injuries. This study supports a role for the addition of MRI in evaluating patients who are obtunded, or unexaminable, despite a negative CT scan.