J Trauma
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Patients with traumatic brain injury (TBI) and traumatic intracranial hemorrhage are frequently admitted to the intensive care unit (ICU) but never require critical care interventions. Improved ICU triage in this patient population can improve resource utilization and decrease health care costs. We sought to identify a low-risk group of patients with TBI who do not require admission to an ICU. ⋯ Patients with TBI without a critical care intervention before admission are at low risk for requiring future critical care interventions. Future studies are required to validate if this low-risk criteria can serve as a safe, cost-effective triage tool for ICU admission.
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Despite substantial improvements in trauma care, severe injuries often result in significant long-term consequences for otherwise young, healthy individuals. Providing patient-centered care and extensive psychosocial support services is difficult for trauma centers. ⋯ The Trauma Survivors Network provides a critical component of trauma care that can be adapted for local needs throughout the country. Implementation of these services is a necessary step in the development of comprehensive trauma systems that not only save lives but also reduce long-term disability among survivors.
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Venous thromboembolism is a major cause of morbidity and mortality after injury. Prophylactic anticoagulation is often delayed as a result of injuries or required procedures. Those patients at highest risk in this early vulnerable window postinjury are not well characterized. We sought to determine those patients at highest risk for an early pulmonary embolism (PE) after injury. ⋯ Early lower extremity/pelvis orthopedic fixation is the single independent predictor of EARLY PE in this patient cohort. Venous thromboembolism/PE prevention strategies should be made a priority in this group of patients, including early preoperative institution of anticoagulation prophylaxis. These results suggest that those with contraindications to early anticoagulation may benefit from insertion of retrievable inferior vena cava filters preoperatively.
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To evaluate functional, radiologic, and subjective outcome after volar locking plate osteosynthesis (VLPO) for unstable distal radius fractures (DRF). ⋯ VLPO for the treatment of unstable DRF is a reliable technique with excellent subjective, objective, and radiologic outcome.
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The early resuscitation occurs in the emergency department (ED) where intensive care unit protocols do not always extend and monitoring capabilities vary. Our hypothesis is that increased ED length of stay (LOS) leads to increased hospital mortality in patients not undergoing immediate surgical intervention. ⋯ In this patient population, a longer ED LOS is associated with an increased hospital mortality even when controlling for physiologic, demographic, and anatomic factors. This highlights the importance of rapid progression of patients through the initial evaluation process to facilitate placement in a location that allows implementation of early goal directed trauma resuscitation.