J Trauma
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Comparative Study
Percutaneous endoscopic gastrostomy: the preferred method of elective feeding tube placement in trauma patients.
The purpose of this study was to determine whether gastric feeding tubes placed by the percutaneous endoscopic route resulted in fewer and less severe complications than open surgical gastrostomy (SG). ⋯ Gastrostomy tubes placed via the percutaneous endoscopic route had a significantly lower complication rate than surgically placed tubes. In addition, the charges incurred for their placement were also significantly less. Based on the findings of this study, PEG should be considered as the method of choice for gastric feeding tube placement for trauma patients who do not have specific contraindications to the procedure.
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Clinical Trial
Surgical treatment for distal clavicle fracture with coracoclavicular ligament disruption.
Surgical reconstruction is usually indicated for distal clavicle fractures with coracoclavicular ligament disruption due to a high rate of nonunion and delayed union. We report the outcome of a surgical technique for this type of fracture. ⋯ The advantages of this technique include that the disrupted coracoclavicular articulation is rigidly restored and then the fracture site can be easily reduced and fixed with a wire. This technique allows for stable fixation with early mobilization and early return to work and sports.
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The ability to rapidly and accurately triage, evacuate, and utilize appropriate interventions can be problematic in the early decision-making process of trauma care. With current methods of prehospital data collection and analysis, decisions are often based upon single data points. This information may be insufficient for reliable decision-making. To date, no studies have attempted to utilize data at multiple time points for purposes of enhancing prediction, nor have studies attempted to synthesize prediction models with data reflecting both large-vessel venous and arterial injuries. Therefore, we performed a retrospective study to examine the potential utility of dynamic neural networks in predicting mortality using highly discretized uncontrolled hemorrhagic shock data. ⋯ This study demonstrates that PNN models can effectively harness the dynamic nature of uncontrolled hemorrhagic shock data, despite utilizing data from large-vessel arterial and venous injuries. Utilizing the dynamic nature of hemorrhagic shock data in PNNs may ultimately allow the development of novel decision assist devices.
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Little research has examined trauma outcomes in the very elderly (>80 years), the fastest growing subset of our geriatric population. Our objective was to describe demographics, mechanism of injury and injury severity of very elderly trauma patients and examine the association between trauma center (TC) verification and hospital mortality in this age group. ⋯ Risk-adjusted outcomes, in this population, differed between TC and AC settings. Head injury, injury severity, and lack of TC verification are associated with hospital mortality in very elderly trauma patients.
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The objective of this study was to describe a population of children admitted to a tertiary care pediatric hospital with severe trauma to identify key areas for injury prevention research, and programming. ⋯ Research efforts and activities to prevent severe pediatric trauma in our region should focus on road safety, protection from head injuries, avoidance of falls, and prevention of child abuse.