J Trauma
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Clinical studies have shown that resuscitation with fresh frozen plasma (FFP) is associated with improved outcome after severe hemorrhagic shock (HS). We hypothesized that in addition to its effects on hemostasis, FFP has protective and stabilizing effects on the endothelium that translate into diminished endothelial cell (EC) permeability and improved resuscitation in vivo after HS. We further hypothesized that the beneficial effects of FFP would diminish over 5 days of routine storage at 4 degrees C. ⋯ Both in vitro and in vivo studies show that FFP has beneficial effects on endothelial permeability, vascular stability, and resuscitation in rats after HS. The benefits are independent of hemostasis and diminish between days 0 and 5 of storage.
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The objective of this study is to compare locking and nonlocking single and dual plating constructs in maintaining posteromedial fragment reduction in a bicondylar tibial plateau fracture model. We hypothesized that posteromedial fragment fixation with medial and lateral nonlocked constructs would tolerate higher loads than with lateral locked constructs alone. ⋯ The posteromedial fragment tolerated higher loads with the CP + 1/3 tubular plate construct. The superiority of this construct may be caused by unreliable penetration of this fragment by the lateral locking screws.
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As the population of the United States ages and as the healthcare system undergoes significant change, cost effectiveness of care will become more important, particularly for older injured patients. The purpose of this study was to evaluate the cost per 2-year survivor stratified by age after moderate- to severe-nonneurologic injury. ⋯ Although costs are similar by age at time of discharge, cost per 2-year survivor increases as age increases. However, cost per 2-year survivor does not exceed current cost-utility thresholds for any age group. Any future healthcare financing reforms should include aggressive funding for injury prevention efforts aimed at vulnerable populations instead of rationing care once an injury occurs.
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Elderly trauma patients have a higher incidence of medical comorbidities when compared with their younger cohorts. Currently, the minimally accepted criteria established by the Committee on Trauma for the highest level of trauma activation (Level I) does not include age as a factor. Should patients older than 60 years with multiple injuries and/or a significant mechanism of injury be considered as part of the criteria for Level I activation? Would these patients benefit from a higher level of activation? ⋯ Patients with an ISS between 0 and 15 are often triaged to Level II activation. Our data would suggest that patients older than 60 years should be a criterion for the highest level of trauma activation.
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The objective of this study was to position the iliosacral screws speedily, easily, and safely, we sought to delineate readily reproducible radiographic anatomic clues of the pedicel of S1 for the iliosacral screw placement. ⋯ The sacral pedicel axial view projection is a optimal radiographic technique for percutaneous placement of iliosacral screws in clinical practice. We can get the limpid axial view of pedicel of S1 to applicate this project method, which provides a speedier method with less radiation exposure for percutaneous placement of iliosacral screws.