J Trauma
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: Generations of clinicians have used the Baux score, defined as the sum of age in years and percent body burn, to predict percent mortality after trauma, but advances in burn care have rendered the predictions of this score too pessimistic. Additionally, this score does not include the effects of inhalation injury. ⋯ : Our proposed revised Baux score is simple enough for mental calculation, and its inverse logit transformation (provided with a calculator or nomogram) can provide precise predictions of mortality. Better predictions can be obtained using our more complex statistical model. Burn surgeons and nurses accustomed to using the original Baux score may welcome an updated version.
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: Recent media and political attention have focused on a "rising tide" of youth violence and alcohol-related problems in Scotland. Facial injuries in Scotland are most commonly sustained as a result of interpersonal violence, and young men are a high risk group for facial injuries. Facial injuries are known to be associated with alcohol consumption but the sociodemographic determinants are not fully known. ⋯ : The role of poverty as the major determinant of alcohol-related facial injuries has thus far not been explicitly acknowledged. Interventions to change behavior alone are unlikely to succeed unless they are supported by measures designed to improve socioeconomic circumstances and to reduce socioeconomic inequalities.
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Comparative Study
A comparative study of the patients with bilateral or unilateral chronic subdural hematoma: precipitating factors and postoperative outcomes.
: Chronic subdural hematoma (CSDH) is a relatively frequent problem in neurologic or neurosurgical practice. Although CSDH is a well-known disease, data on bilateral CSDH are scarce compared with data on unilateral CSDH. The purpose of this study was to compare the clinical presentations, precipitating factors, computed tomography (CT) scan findings, postoperative complications, and outcomes between patients with bilateral and unilateral CSDH. ⋯ : Bilateral CSDH tended to occur more in patients with anticoagulant or antiplatelet therapy. Compared with patients with unilateral CSDH, patients with bilateral CSDH had more symptoms of increased intracranial pressure and lower incidences of midline shift on CT scans. Most patients with either bilateral or unilateral CSDH had a good postoperative outcome.
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: Treatment of odontoid fractures remains controversial. There are conflicting data in the literature with regard to timing of operative fixation (OP), as well as whether OP should be performed. Within our own institution, treatment is variable depending largely on surgeon preference. This study was undertaken in an attempt to develop management consensus by examining outcomes in elderly patients with odontoid fractures and comparing OP to a nonoperative (non-OP) approach. ⋯ : Despite being an older population, elderly patients with odontoid fracture who were managed non-OP had similar mortality, UTI, and pneumonia rates compared with their younger counterparts who underwent OP. The need for tracheostomy and PEG and discharge disposition was similar among all three groups. Elderly patients with odontoid fracture managed non-OP had a reduction in HLOS and ventilator days compared with either operative group and less DVT compared with the early operative group. Based on these results, non-OP management should be given strong consideration in elderly patients with traumatic odontoid fractures.
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: The objective was to evaluate the newly developed Radiographic Union Score for Tibial fractures (RUST). Because there is no "gold standard," it was hypothesized that the RUST score would provide substantial improvements compared with previous scores presented in the literature. ⋯ : The RUST score exhibits substantial improvements in reliability from previously published scores and produces equally reproducible results among a variety of orthopedic specialties and experience levels. Because no "gold standards" currently exist against which RUST can be compared, this study provides only the initial step in the score's full validation for use in a clinical context.