J Trauma
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Multicenter Study Clinical Trial
Does the rural trauma team development course shorten the interval from trauma patient arrival to decision to transfer?
The Rural Trauma Team Development Course (RTTDC) was developed by the ad hoc Rural Trauma Committee of the American College of Surgeons, Committee on Trauma to address the increased mortality of the rural trauma patient. The effectiveness of the RTTDC in shortening the interval from patient arrival to decision to transfer and the effect on the transfer process of communication training emphasizing team building is the focus of this study. ⋯ The RTTDC alone and with the embedded communication module significantly reduce delays in the transfer process of the rural trauma patient.
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Clinical Trial
Is early venous thromboembolism prophylaxis safe in trauma patients with intracranial hemorrhage.
Patients with traumatic brain injuries (TBIs) are at high risk for venous thromboembolic sequelae; however, prophylaxis is often delayed because of the perceived risk of intracranial hemorrhagic exacerbation. The goal of this study was to determine whether enoxaparin for early venous thromboembolism (VTE) prophylaxis is safe for hemodynamically stable patients with TBIs. ⋯ We found no evidence that early VTE prophylaxis increases the rate of IHI progression in hemodynamically stable patients with TBIs. The natural rate of IHI progression observed is comparable with previous studies. Although not powered to detect differences in the incidence of DVT and pulmonary embolism, the data trend toward increased proportions of both VTE outcomes in the late group.
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Postinjury multiple organ failure (MOF) remains the leading cause of morbidity and late mortality after severe trauma. Our previous work consistently identified an association between thrombocytopenia and progression to MOF. In addition, recent studies suggest that platelets play a critical role in postinjury hyperinflammation. Therefore, we hypothesized that postinjury thrombocytopenia is a marker for progression to MOF. ⋯ Early postinjury thrombocytopenia is an independent risk factor for MOF, death, and other complications. Following platelet count dynamics over the first several days postinjury can help predict which high-risk patient will develop these adverse outcomes.
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Computed tomography (CT) has a high sensitivity and specificity for detecting abdominal injuries. Expeditious abdominal imaging in "quasi-stable" patients may prevent negative laparotomy. However, the significance of potential delay to laparotomy secondary to abdominal imaging remains unknown. We sought to analyze whether the use of abdominal CT (ABD CT) in patients with abdominal injury requiring laparotomy results in a significant delay and a higher risk of poor outcome. ⋯ Delay secondary to abdominal imaging in patients who require operative intervention results in an independent higher risk of mortality. ABD CT imaging is an important and useful tool after injury; however, these results suggest that delay caused by overreliance on ABD CT may result in poor outcome in specific patients. Clinicians who take care of critically injured patients should be aware of and understand these potential risks.
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Cervical spine (CS) clearance in obtunded blunt trauma patients (OBTPs) remains controversial. When computed tomography (CT) of the CS is negative for injury, debate continues over the role of magnetic resonance imaging (MRI). Use of MRI in OBTPs is costly, time-consuming, and potentially dangerous. Our study evaluated the safety of a protocol to discontinue the cervical collar in OBTPs based on CT scan alone. ⋯ Removal of CS precautions in OBTPs with gross movement of all extremities is safe and efficacious if CT CS is negative for injury. Supplemental MRI CS is not needed in this patient population.