J Trauma
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Advances in care such as damage control surgery, hemostatic resuscitation, protocol-driven cerebral perfusion management, and lung-protective ventilation have promised to improve survival after major trauma. We examined injury severity, mortality, and preventability in a mature trauma system during a 12-year period to assess the overall benefits of these and other improvements. ⋯ Survival after severe trauma and survival benchmarked against predicted risk improved significantly at our center during the past 12 years despite generally increasing age and worsening injuries. Advances in trauma care have kept pace with an aging population and greater severity of injury, but overall survival has not improved.
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The aim of this study was to examine the long-term physical and psychological consequences of multiple blunt forced trauma at ≥ 10-year follow-up for patients with and without traumatic brain injury (TBI). ⋯ Prospective studies are needed with a broader range of measures that may be sensitive to the consequences of TBI. Evidence-based interventions to facilitate physical and psychological rehabilitation, designed to target at risk patients, are warranted.
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The complication rate of periprosthetic femoral fractures above well-fixed total knee arthroplasties is high. The Less Invasive Stabilization System (LISS) was introduced to reduce surgical dissections at the fracture site. The purpose of this retrospective study was to evaluate the midterm functional outcome of a group of patients with periprosthetic fractures above well-fixed total knee arthroplasties treated with the LISS. ⋯ We found that a minimally invasive, locked plating system permitted stable fixation, early knee motion with good midterm results, and minimal complications. These techniques should be used in place of less stable and more invasive methods.
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Community-acquired methicillin-resistant Staphylococcal aureus (CA-MRSA) infection is approaching endemic proportions nationally, and it is a potential cause for early ventilator-associated pneumonia (VAP) in the acutely injured patient. We sought to determine the prevalence of early (≤4 days) and late (>4 days) MRSA pneumonia in ventilated multisystem trauma patients and to correlate findings with admission nasal swabs. ⋯ Despite an increase of MRSA nationally, we found a low incidence of early and late MRSA VAP in trauma patients, which was not identified by nasal swab screening. On the basis of our results, we question the efficacy of empiric vancomycin therapy in early (≤4 days) S. aureus VAP. Furthermore, nasal swabs were not helpful in identifying patients at risk for MRSA VAP.
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This study was performed to determine the effects of orthopedic trauma on pregnancy outcomes in pregnant trauma patients. ⋯ Our findings indicate that traumatized pregnant women with orthopedic injuries are high-risk obstetrical patients and may benefit from referral to a medical center capable of handling both the primary injury and the potential preterm birth associated with the injury.