J Trauma
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General mediastinal width, left mediastinal width, and mediastinal width ratio were compared as radiographic predictors of aortic injury. ⋯ Both an LMW of 6 cm or more and an MWR of 0.60 or more are better radiographic criteria than an MW of 8 cm or more for predicting blunt aortic injury. Trauma patients with positive test results based on the combined LMW and MWR criteria should proceed immediately to aortography or helical computed tomography.
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Increasing geriatric trauma is producing disproportionate use of resources. In burn victims, age and burn extent correlate with mortality, yielding the establishment of criteria for futile resuscitation. Such criteria would be useful to trauma patients and their families in making withdrawal-of-care decisions while reducing resource use. Our objective, therefore, was to identify injury and physiologic parameters that would indicate a high probability of futile resuscitation among geriatric trauma patients. ⋯ Geriatric trauma patients with severe chest and/or abdominal trauma with moderate shock and mild to moderate head injury have an exceedingly low probability of survival. These data support early withdrawal of care in these individuals.
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The risk of arterial injury with knee dislocation is well known. The most effective method for rapidly and accurately diagnosing arterial injury in this setting remains a topic of debate. Both physical examination and arteriography have been advocated, although each of these methods has its critics. The authors propose that the ankle-brachial index (ABI) can accurately predict whether patients with knee dislocations have sustained vascular injury. ⋯ The ABI is a rapid, reliable, noninvasive tool for diagnosing vascular injury associated with knee dislocation. Routine arteriography for all patients with knee dislocation is not supported.
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Among older trauma patients, those with preexisting chronic medical conditions (CMCs) appear to have an elevated risk of death. Whether this association is dependent on the severity of injury or other occult factors remains unanswered. This study evaluated the association between preexisting CMCs and risk of death among older trauma patients according to injury severity. ⋯ Older trauma patients with CMCs who present with minor injuries should be considered to have an increased risk of death when compared with their nonchronically ill counterparts.