J Trauma
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Comparative Study
Assessing the effectiveness and optimal structure of trauma systems: a consensus among experts.
To determine whether a consensus exists among experts regarding the effect of organized trauma systems on patient outcomes based on peer-reviewed, published evidence. Second, to ascertain whether experts agree on the optimal structure of trauma systems. ⋯ A consensus does exist among trauma system experts regarding the effectiveness of trauma systems and the optimal structure of trauma systems. Additional research is needed to determine whether trauma system benefits extend to other patient subgroups in other geographic regions. Consensus theory provides an impressive model for assessing rater agreement by controlling for response bias and providing a probability measure to determine whether a true consensus exists.
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Comparative Study
Adult versus pediatric prehospital trauma care: is there a difference?
Management of the injured child in the prehospital setting continues to be debated. Issues raised in the literature include time spent on scene, skill maintenance and performance, and reported poorer outcomes compared with adults. ⋯ Paramedics are able to provide pediatric trauma patients a level of care comparable to that provided adult patients with similar outcome.
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Head motion, an important factor in acute subdural hematoma (ASDH), can be broken down into translational and rotational elements. We used three-dimensional finite element analysis to examine the thresholds of angular and tangential acceleration required to tear bridging veins in humans during head impact. ⋯ Impact direction and orientation of bridging veins are both important factors in ASDH. Threshold criteria for ASDH can be expressed in terms of tangential and rotational acceleration.