J Trauma
-
Comparative Study
Combat-related craniofacial and cervical injuries: a 5-year review from the British military.
Recent international publications have noted a sustained increase in the incidence of head, face, and neck (HFN) wounds in comparison with total battle injuries from the 20th to the 21st century. The aim of this review was therefore to perform an analysis of the epidemiology of all HFN injuries sustained by British forces in Iraq and Afghanistan from March 1, 2003, to December 31, 2008. ⋯ The individual incidences of head (15%) and face (19%) injuries in relation to total battle injuries, although greater than seen in previous United Kingdom conflicts, were only slightly higher than that seen by US forces. The incidence of neck injury alone in relation to total battle injuries of 11% in United Kingdom forces in comparison with 3% to 5% found in US forces warrants further investigation. This article also provides further evidence to support the existing published opinion of multiple international authors in the requirement to develop innovative methods of protecting the vulnerable HFN regions.
-
Comparative Study
Liver dysfunction by model for end-stage liver disease score improves mortality prediction in injured patients with cirrhosis.
Cirrhosis is associated with poor outcomes in the trauma setting. We aimed to evaluate the utility of Model for End-Stage Liver Disease (MELD) in assessing additional mortality risk in trauma patients with cirrhosis. ⋯ In trauma patients with cirrhosis, a score that evaluates the degree of liver dysfunction enhances the ability of ISS alone to predict mortality. The MELD score is more readily available than the CTP score for the prediction of mortality in trauma patients.
-
Comparative Study
Risk factors associated with early reintubation in trauma patients: a prospective observational study.
After mechanical ventilation, extubation failure is associated with poor outcomes and prolonged hospital and intensive care unit (ICU) stays. We hypothesize that specific and unique risk factors exist for failed extubation in trauma patients. The purpose of this study was to identify the risk factors in trauma patients. ⋯ Independent risk factors for trauma patients to fail extubation include spine fracture, initial intubation for airway, GCS at extubation, and delirium tremens. Trauma patients with these four risk factors should be observed for 24 hours after extubation, because the mean time to failure was 15 hours. In addition, increased complications, extended need for mechanical ventilation, and prolonged ICU and hospital stays should be expected for trauma patients who fail extubation.
-
The Leapfrog Group initiative has led to an increasing public demand for dedicated intensivists providing critical care services. The Acute Care Surgery training initiative promotes an expansion of trauma/surgical care and operative domain, redirecting some of our focus from critical care. Will we be able to train and enforce enough intensivists to care for critically ill surgical patients? ⋯ EPs training in a Surgical Critical Care Fellowship can acquire critical care knowledge equivalent to that of surgeons. EPs trained in a Surgical Critical Care paradigm can potentially expand the intensive care unit workforce for Surgical Critical Care patients.
-
Comparative Study
Modified posterior closing wedge osteotomy for the treatment of posttraumatic thoracolumbar kyphosis.
Posttraumatic thoracolumbar deformities can occur in patients after conservative or inadequate surgical treatment. Anterior, posterior, or combined anterior and posterior procedures of Smith-Peterson osteotomy technique have been developed to correct thoracolumbar kyphosis to various degrees. Recently, many reports have addressed the specific problem of local posttraumatic thoracolumbar deformity; however, there is significant controversy over the ideal management. The objectives are to illustrate the technique of modified closing wedge osteotomy for the treatment of posttraumatic kyphosis and to report the radiographic results and clinical outcome of patients treated with the technique. ⋯ The modified wedge closing osteotomy achieves satisfactory kyphosis correction and good fusion with less blood loss and complications than other approaches, implying an alternative method in patients with posttraumatic kyphosis.