J Trauma
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The purpose of this study was to compare the abilities of nine Abbreviated Injury Scale (AIS)- and (ICD-9)-based scoring algorithms in predicting mortality. ⋯ Differences in performance were relatively small. Complex scores such as the ICISS and the APS provide improvement in discrimination relative to the maxAIS and the ISS. Trauma registries should move to include the ICISS and the APS. The ISS and maxAIS perform moderately well and have bedside benefits.
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Comparative Study
Lumbar fractures in adult blunt trauma: axial and single-slice helical abdominal and pelvic computed tomographic scans versus portable plain films.
Our hypothesis was that abdominal and pelvic computed tomographic (AP-CT) scans are equivalent to portable two-view plain films in detecting lumbar spine fractures in adults. Since many trauma patients often undergo AP-CT scanning to evaluate for possible intra-abdominal injuries, using the AP-CT scan to screen for lumbar fractures could make the trauma evaluation process more efficient. ⋯ Both AP-CT scans and plain films failed to diagnose significant lumbar fractures that required therapy. When screening for lumbar fractures, obtaining both AP-CT scans and portable two-view plain films may decrease missed lumbar fractures in blunt adult trauma.
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Head injury is the leading cause of death and critical injury in skiing and snowboarding accidents. ⋯ Skier-tree collision was the most common mechanism for head injuries in patients admitted to our Level I trauma center, and resulted in the most severe injuries and the highest mortality rate. Because most traumatic brain injuries treated at our facility resulted from a direct impact mechanism, we believe that the use of helmets can reduce the incidence and severity of head injuries occurring on the ski slopes.
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Efficacy of circulation depends on interactions between the heart and the vascular system. Ventricular-arterial coupling (VAC) has been described as an important determinant of cardiovascular function during resuscitation from shock. However, no prospective studies examining VAC and systemic perfusion have been performed. VAC is measured by the ratio of afterload (aortic input impedance [E ]) to contractility (end-systolic elastance [E ]). Lowering E /E is associated with better VAC and improved myocardial work efficiency. Our hypothesis was that optimizing VAC during resuscitation results in improved myocardial work efficiency while simultaneously improving systemic perfusion. ⋯ Improved ventricular-arterial coupling during resuscitation is associated with improved myocardial efficiency and systemic tissue perfusion. Perfusion can be improved at lower energy cost to the heart by focusing on thermodynamic principles during resuscitation.
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Comparative Study
Systemic hypothermia, but not regional gut hypothermia, improves survival from prolonged hemorrhagic shock in rats.
Extracorporeal blood perfusion of the gut or enterectomy can improve survival during hemorrhagic shock (HS), suggesting that the gut may be of primary importance in resuscitation. We hypothesized that cooling the gut alone could improve survival in a rat HS model and avoid potential deleterious effects of systemic hypothermia. ⋯ Cooling the gut alone does not improve acute survival from HS, suggesting that early deaths are not secondary to gut ischemia. Mild systemic hypothermia allowed 100% survival from prolonged HS.