J Trauma
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To establish whether the Insurance Institute for Highway Safety (IIHS) offset crash test ratings are linked to different mortality rates in real world frontal crashes. ⋯ After adjusting for occupant, vehicular, and crash factors, drivers of vehicles rated good by the IIHS experienced a lower risk of death in frontal crashes.
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Comparative Study
Prothrombin complex concentrate versus recombinant factor VIIa for reversal of hemodilutional coagulopathy in a porcine trauma model.
Fluid resuscitation after traumatic injury may necessitate coagulation factor replacement to prevent bleeding complications of dilutional coagulopathy. Recombinant activated factor VII (rFVIIa) is being widely investigated as a hemostatic agent in trauma. Multicomponent therapy with prothrombin complex concentrate (PCC) containing coagulation factors II, VII, IX, and X might offer potential advantages. ⋯ In a pilot study involving an in vivo large-animal model of spleen trauma, PCC accelerated hemostasis and augmented thrombin generation compared with rFVIIa. Further investigations are warranted on PCC as a hemostatic agent in trauma.
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Injury is consistently a leading cause of death for young children, and social stressors can increase injury risk. We investigated the incidence of injury and developmental and health outcomes among children up to 3 years of age in a cohort of vulnerable families. ⋯ Children in vulnerable families are at high risk for injury. In particular, children injured within the first year of life are at high risk for recurrent injury and poor health outcomes. Increased support and targeted interventions may improve outcomes and decrease childhood injury burden among at-risk families.
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The American College of Surgeons Committee on Trauma guidelines for trauma center verification stipulate that the responsible surgeon be present within 15 minutes of the arrival of a critically injured patient. Recently, these guidelines were liberalized, extending the response time to 30 minutes in level III trauma centers. This study evaluated the potential impact of this guideline change on the delivery of care at Ohio's level III trauma centers. We hypothesized that there would be no measurable difference in the emergency department (ED) length of stay (LOS), ED disposition, and facility mortality after enactment of this mandate, which extended the surgeon response time from 15 minutes to 30 minutes at level III trauma centers. ⋯ The extension of the surgeon response time from 15 minutes to 30 minutes did not adversely affect the outcomes of trauma patients at Ohio's level III trauma centers. Furthermore, the surgeon response time was similar before and after the rule change.