J Trauma
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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.
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Comparative Study
Prospective evaluation of multidetector computed tomography for extremity vascular trauma.
Multidetector computed tomographic angiography (MDCTA) is increasingly being used for the assessment of extremity vascular injury. However, to date, there are only retrospective series and a single small prospective study evaluating its efficacy. Therefore, the objective of this study was to prospectively evaluate the ability of MDCTA to detect arterial injury in the injured upper and lower extremities. ⋯ Physical examination is critical in the decision-making process for the injured extremity and can accurately reduce unnecessary imaging. If imaging is required, MDCTA is a sensitive and a specific noninvasive modality for arterial evaluation and may replace conventional angiography as the diagnostic modality of choice for the evaluation of the acutely injured extremity.
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The treatment of fractures of the proximal phalanx in three-phalanx fingers has for a long time been the domain of conservative static treatment in a plaster cast. After removal of the plaster, there was usually limitation of mobility of the interphalangeal joints. Fractures of the proximal phalanx are managed with conservative functional treatment in our clinic. The aim of this method is to achieve bony healing and free mobility at the same time and not in succession. We evaluated our treatment outcomes in a follow-up study. ⋯ The aim of functional treatment of proximal phalanx fractures is to achieve bony healing and free mobility at the same time and not in succession. Active exercises in the proximal and distal interphalangeal joints prevent limitations of mobility and the subsequent occurrence of rotational and axial deformities.