J Trauma
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Comparative Study
Ventilator-associated pneumonia in trauma patients is associated with lower mortality: results from EU-VAP study.
Differences in trauma patients developing ventilator-associated pneumonia (VAP) are described regarding etiology and risk factors associated. We aim to describe the differences in outcomes in trauma and nontrauma patients with VAP. ⋯ Trauma patients developing VAP had different demographic characteristics and episodes of etiology. After adjustment for potential confounders, VAP episodes in trauma patients are associated with lower mortality when compared with nontrauma patients.
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High-energy tibial plateau fractures may present with an acute or impending compartment syndrome requiring emergent fasciotomy. There is little information regarding the optimal management of the fasciotomy wound with respect to the subsequent definitive internal fixation of the tibial plateau fracture. The purpose of this study was to compare the rate of infection complication after internal fixation of tibial plateau fractures in patients requiring fasciotomy for compartment syndrome with patients in whom a fasciotomy was not required. ⋯ Definitive internal fixation of tibial plateau fractures in the presence of open fasciotomy wounds does not seem to be associated with an increased infection risk.
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Federal law prohibits firearm possession by felons and certain others. Little is known about criminal activity resulting in new ineligibility to possess firearms among persons who have previously purchased them. ⋯ Among legal purchasers of handguns, the incidence of new felonious and violent criminal activity resulting in ineligibility to possess firearms is low for those with no prior criminal history but is substantially higher for those with a prior criminal record and is affected by demographic characteristics.
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Anemia is almost universal in trauma patients admitted to the intensive care unit (ICU). Hepcidin is a liver-derived peptide that is a negative regulator of iron stores. Hepcidin synthesis is suppressed by erythropoiesis and iron deficiency and upregulated by iron overload and inflammation. Hepcidin has been shown to have an important role in the anemia of chronic inflammatory diseases but has not been previously studied in the setting of trauma. We sought to define the link between traumatic injury, hepcidin, and inflammation. ⋯ Hepcidin levels rise to extremely high but variable levels after trauma and are positively correlated with injury severity measured by ISS and duration of anemia and negatively correlated with hypoxia. Hepcidin is likely a key factor in the impaired erythropoiesis seen in critically injured trauma patients.
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The differentiation between anteroposterior compression (APC)-I and APC-II pelvic fracture patterns is critical in determining operative versus nonoperative treatment. We instituted a protocol in which a stress examination was performed for patients presenting with an APC-I injury diagnosed with static radiographs to reveal the true extent of the injury. ⋯ Measurements of symphyseal diastasis can significantly vary depending on the radiographic modality (CT vs. plain films) and during application of a stress force. The use of stress examination under general anesthesia in the acute setting of pelvic injury can be beneficial in accurately diagnosing the severity of injury and choosing appropriate treatment.