J Trauma
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Definition of the hemodynamic response to volume expansion (VE) could be useful in shocked critically ill patients in absence of cardiac index (CI) measurements. The aim of this study is to evaluate whether central venous oxygen saturation variations (ΔScvO(2)) after VE could be an alternative to classify responders (R) and nonresponders (NR) to volume therapy. ⋯ ScvO2 variations after VE was able to categorize VE efficiently and could be suggested as an alternative marker to define fluid responsiveness in absence of invasive CI measurement.
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Comparative Study
External validation of a prognostic model for early mortality after traumatic brain injury.
Traumatic brain injury (TBI) is a major cause of lost disability-adjusted life years, and a valid model allowing prediction of outcome would be welcome. For a clinical prediction model to be valid, generalization to other populations must be possible. The aim of this study was to externally validate a model for in-hospital mortality in patients with TBI, which was recently development at the University of Southern California (USC). ⋯ The findings question the external validity of the USC model, suggesting that it should not be implemented as a tool for short-term mortality prediction in our TBI population.
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Comparative Study
Prehospital serum lactate as a predictor of outcomes in trauma patients: a retrospective observational study.
Lactate is associated with morbidity and mortality; however, the value of prehospital lactate (pLA) is unknown. Our objective was to determine whether pLA improves identification of mortality and morbidity independent of vital signs. ⋯ The pLA measurements improve prediction of mortality, surgery, and MODS. Lactate may improve the identification of patients who require monitoring, resources, and resuscitation.
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Comparative Study
Influence of arm positioning on radiation dose for whole body computed tomography in trauma patients.
Multislice whole body computed tomography is regarded as the method of choice for primary investigation of hemodynamically stable patients with multiple injuries. However, a disadvantage of this method is the high level of radiation to which the patient is exposed. Various recommendations on how to position the patient's arms during whole body computed tomography have been given in the literature, but conclusive data are missing. Therefore, the aim of our study was to investigate the relationship between different arm positions and radiation dose in patients undergoing whole body computed tomography. ⋯ Based on our retrospective investigation, it can be recommended with reference to whole body computed tomography screening that the arms should be in the arms-up position during thorax or abdomen scanning of a severely injured patient, provided there are no clear clinical indications of shoulder injury. For the patient, this position is associated with a significantly reduced radiation dose without noticeable loss of time.