J Trauma
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Randomized Controlled Trial Multicenter Study
Quality of life after severe trauma: results from the global trauma trial with recombinant Factor VII.
Physical disability and psychologic morbidity are frequent and important complications of severe trauma injury with serious consequences for long-term health-related quality of life (HRQOL). Little prospective data exist, however, in a global trauma population on the risk factors for poor HRQOL. ⋯ Three months after severe trauma injury, survivors report very poor HRQOL. Physical wellbeing is generally more negatively affected than mental wellbeing. A trauma-specific HRQOL instrument reveals more diverse mental health problems than generic instruments. In a global trauma population, postinjury HRQOL is predicted by demographic and socioeconomic characteristics, type of injury, and treatment received.
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Multicenter Study
Out-of-hospital decision making and factors influencing the regional distribution of injured patients in a trauma system.
The decision-making processes used for out-of-hospital trauma triage and hospital selection in regionalized trauma systems remain poorly understood. The objective of this study was to assess the process of field triage decision making in an established trauma system. ⋯ Provider cognitive reasoning for field trauma triage is more heuristic than algorithmic and driven primarily by provider judgment, rather than specific triage criteria.
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Venous thromboembolism is a major cause of morbidity and mortality after injury. Prophylactic anticoagulation is often delayed as a result of injuries or required procedures. Those patients at highest risk in this early vulnerable window postinjury are not well characterized. We sought to determine those patients at highest risk for an early pulmonary embolism (PE) after injury. ⋯ Early lower extremity/pelvis orthopedic fixation is the single independent predictor of EARLY PE in this patient cohort. Venous thromboembolism/PE prevention strategies should be made a priority in this group of patients, including early preoperative institution of anticoagulation prophylaxis. These results suggest that those with contraindications to early anticoagulation may benefit from insertion of retrievable inferior vena cava filters preoperatively.
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Most Brazilian hospitals have no medical radiologists for emergencies. The radiologic evaluation is provided by doctors with heterogeneous generalist training. The objective is to demonstrate the need for systematization in the care of trauma in the interpretation of cervical spine and chest radiographs. Is it possible that, through a continuing education program, generalist doctors could be trained in the evaluation of these radiographs? ⋯ The systematized training, through the advanced trauma life support protocol, significantly increased the success rate of the evaluation of cervical spine and chest radiographs.