The Journal of surgical research
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The objective of this study was to determine the utility of a lateral cervical spine plain film in the evaluation of blunt trauma patients. ⋯ LCS has no value as a screening tool in the blunt trauma patient since most are either inaccurate or incomplete. It should be eliminated from the Advanced Trauma Life Support algorithm, and CTC should receive emphasis as the diagnostic gold standard.
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The traditional view that tachycardia and hypotension accompany hemorrhagic shock following injury has been challenged. This is particularly true at extremes of age. Shock index (SI) may be an alternative indicator of life-threatening bleeding after injury. Because age negatively impacts physiological reserve, we hypothesized that age multiplied by SI (Age x SI) would be a better predictor of 48 h mortality (48 MORT) compared to heart rate (HR), systolic blood pressure (SBP), or SI. ⋯ SI and Age x SI are better predictors of 48 MORT in injured patients than HR or SBP alone. SI and Age x SI should be used to identify patients at risk for early mortality following injury.
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The treatment options for complicated appendicitis in children continue to evolve. Optimal management of complicated appendicitis relies on an accurate preoperative diagnosis. We examined the accuracy of our preoperative diagnosis including computed tomography (CT) and the influence on the management of children with perforated and nonperforated appendicitis. ⋯ The correct preoperative diagnosis of appendicitis appears statistically more accurate with CT scan compared to history and physical examination alone (PPV 96.4% versus 90.8%, P = 0.045). For those with clinically suspicious complicated appendicitis, CT evaluation may direct therapy toward initial nonoperative management. The efficacy of this regimen warrants further investigation.
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The purpose of this study was to determine if anemia in isolated head trauma patients results in a higher mortality rate that would justify a more liberal use of blood transfusions. ⋯ This study supports the need to balance mild anemia with judicious blood product use in the head trauma patient. Given the risk with blood product use, each transfusion should be carefully considered and the patient re-evaluated regularly to determine the need for further intervention.
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None of the parameters can predict the deterioration of sepsis early enough. A new predictor allowing earlier detection of changes in septic patients' condition is indispensable. ⋯ Up-regulated IL-10 mRNA expression and diminished HLA-DR expression could be indicators of poor outcome. Furthermore, IL-10 mRNA expression measurement could predict the onset of immunoparalysis indicated by diminished HLA-DR expression earlier than IL-10 blood level measurement, leading to earlier commencement of the treatment.