J Trauma
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Randomized Controlled Trial
Prolonged prothrombin time after recombinant activated factor VII therapy in critically bleeding trauma patients is associated with adverse outcomes.
In trauma patients with significant hemorrhage, it is hypothesized that failure to normalize prothrombin time (PT) after recombinant activated factor VII (rFVIIa) treatment predicts poor clinical outcomes and potentially indicates a need for additional therapeutic interventions. ⋯ The presence of prolonged PT after rFVIIa or placebo therapy was associated with poor clinical outcomes. Because subjects with postdosing PT >or=18 seconds had low levels of hemoglobin, fibrinogen, and platelets, this group may benefit from additional blood component therapy.
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Comparative Study
Feasibility of using rotational thromboelastometry to assess coagulation status of combat casualties in a deployed setting.
Coagulopathy in trauma patients is currently defined by the results of standard laboratory tests (prothrombin time and activated partial thromboplastin time). These results offer little in the hemostatic resuscitation that occurs in the treatment of battlefield patients who receive massive transfusions. Thromboelastometry (TEM) is a technique that can offer rapid, near-patient testing of coagulation status. ⋯ It is feasible to use TEM in a deployed military setting. We have shown that rotational thromboelastometry significantly detects more abnormalities in the coagulation status than the standard laboratory tests (prothrombin time, and activated partial thromboplastin time).
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Comparative Study
Preventing hypothermia: comparison of current devices used by the US Army in an in vitro warmed fluid model.
The purpose of this study was to develop an in vitro torso model constructed with fluid bags and to determine whether this model could be used to differentiate between the heat prevention performance of devices with active chemical or radiant forced-air heating systems compared with passive heat loss prevention devices. ⋯ Our in vitro fluid bag "torso" model seemed sensitive to detect heat loss in the evaluation of several active or passive warming devices. All active and most passive devices were better than wool blankets. Under conditions near room temperature, passive warming methods (Blizzard blanket or the Hot Pocket) were as effective as active warming devices other than the original HPMK. Further studies are necessary to determine how these data can translate to field conditions in preventing heat loss in combat casualties.
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Multicenter Study
Socioeconomic disparities in infant mortality after nonaccidental trauma: a multicenter study.
While disparities in abuse-related mortality between minority and white infants have been reported, the influence of socioeconomic status on outcome has not been evaluated. The goal of this study was to determine the impact of socioeconomic status and race on outcomes for abused infants using multiinstitutional data. ⋯ There are significant differences in mortality among abused infants associated with insurance status and income even after controlling for injury severity. These associations show a need to better understand and address socioeconomic variations in outcome.
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Comparative Study
High transfusion ratios are not associated with increased complication rates in patients with severe extremity injuries.
High transfusion ratios of plasma to packed red blood cells (>1:2) have been associated with increased survival and increased complications in patients receiving massive transfusion (MT). We hypothesized that high ratio transfusion would be associated with no survival benefit and increased complications in combat victims with compressible hemorrhage. ⋯ Extremity injured patients receiving MT may benefit from high transfusion ratios and do not experience increased complications. No change in mortality or complications was observed in non-MT patients across transfusions ratios. High transfusion ratios are not associated with increased complications in patients with isolated extremity injury regardless of whether a MT is required.