J Trauma
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Multicenter Study
Derivation of a decision instrument for selective chest radiography in blunt trauma.
To derive a decision instrument (DI) that identifies patients who have virtually no risk of significant intrathoracic injury (SITI) visible on chest radiography and, therefore, no need for chest imaging. ⋯ We derived a DI consisting of seven clinical criteria that can identify SITI in blunt trauma patients with extremely high sensitivity. If validated, this instrument will allow for safe, selective chest imaging with potential resource savings.
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Controlled Clinical Trial
Ocular ultrasound to detect intracranial hypertension in trauma patients.
Increases in intracranial pressure (ICP) after head trauma require a rapid recognition to allow for adequate treatments. The aim of this study was to determine whether dilation of the optic nerve sheath, as detected by ocular ultrasound at the bedside, could reliably identify increases in ICP assessed with an intraparenchymal probe in adult head trauma patients. ⋯ When ICP was higher than 20 mm Hg, the ONSD diameter increased, whereas when the ICP was below 20 mm Hg, the ONSD returned to values equivalent to those assessed in control nontrauma patients. Accordingly, ocular ultrasound may be considered as a good alternative for a rapid indirect evaluation of head trauma patients' ICP.
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Comparative Study
Comparison of nonoperative management with renorrhaphy and nephrectomy in penetrating renal injuries.
We reviewed our experience with penetrating renal injuries to compare nonoperative management of penetrating renal injuries with renorrhaphy and nephrectomy in light of concerns for unnecessary explorations and increased nephrectomy rates. ⋯ Selective nonoperative management of penetrating renal injuries resulted in a lower mortality rate, lower incidence of blood transfusion, and shorter mean ICU and hospital stay compared with patients managed by nephrectomy but similar to renorrhaphy. Complication rates were low and similar to operative management.