J Trauma
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Multicenter Study
The Trauma Quality Improvement Program: pilot study and initial demonstration of feasibility.
The American College of Surgeons Committee on Trauma has created a "Trauma Quality Improvement Program" (TQIP) that uses the existing infrastructure of Committee on Trauma programs. As the first step toward full implementation of TQIP, a pilot study was conducted in 23 American College of Surgeons verified or state designated Level I and II trauma centers. This study details the feasibility and acceptance of TQIP among the participating centers. ⋯ Using the National Trauma Data Bank infrastructure to provide risk-adjusted benchmarking of trauma center mortality is feasible and perceived as useful. There are differences in O/E ratios across similarly verified or designated centers. Substantial work is required to allow for morbidity benchmarking.
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Obesity is a risk factor for postinjury complications; in particular, obese patients develop multiple organ failure (MOF) at a greater rate than do normal weight counterparts. Evaluation of differences in resuscitative practices altered by body mass index (BMI) might provide an explanation for the increased risk of MOF seen in these high-risk patients. ⋯ Morbidly obese trauma patients show prolonged metabolic acidosis despite receiving similar volumes and attaining similar end points of resuscitation when compared with patients in other BMI groups. Inadequate resuscitation based on inaccurate end points and metabolic disturbances associated with increased BMI are likely responsible; identification of the etiology, sources, and consequences of this acidosis may provide further insight into the susceptibility of the morbidly obese patient to develop postinjury organ failure.
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Our country suffers from a chronic shortage of organ donors, and the list of individuals in desperate need of life-saving organ transplants is growing every year. Family consent represents an important limiting factor for successful donation. We hypothesize that specific barriers to obtaining family consent can be identified and improved upon to increase organ donation consent rates. The purpose of this study was to compare families who declined organ donation to those who granted consent, specifically to identify barriers to family consent for successful organ donation. ⋯ Several barriers exist to family consent for successful organ donation. Family members of minority populations, medical brain deaths, and older potential donors more often decline consent for organ donation. Family education and resource utilization toward these specific populations of potential organ donors may help to improve organ donation consent rates. In addition, delayed family approach by OPO seems to be associated with decreased consent rates. System improvements to expedite family approach by OPO may likewise lead to improved consent rates.
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Comparative Study
Resuscitation with fresh whole blood ameliorates the inflammatory response after hemorrhagic shock.
Hemorrhagic shock is the leading cause of potentially preventable death after traumatic injury. Hemorrhage and subsequent resuscitation may result in a dysfunctional systemic inflammatory response and multisystem organ failure, leading to delayed mortality. Clinical evidence supports improved survival and reduced morbidity when fresh blood products are used as resuscitation strategies. We hypothesized that the transfusion of fresh whole blood (FWB) attenuates systemic inflammation and reduces organ injury when compared with conventional crystalloid resuscitation after hemorrhagic shock. ⋯ Resuscitation with LR results in increased systemic inflammation, vascular permeability, and lung injury after hemorrhagic shock. Resuscitation with FWB attenuates the inflammation and lung injury seen with crystalloid resuscitation. These findings suggest that resuscitation strategies using fresh blood products potentially reduce systemic inflammation and organ injury after hemorrhagic shock.