Journal of trauma nursing : the official journal of the Society of Trauma Nurses
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Review Meta Analysis
A synthesis of research examining timely removal of cervical collars in the obtunded trauma patient with negative computed tomography: an evidence-based review.
Currently, the standard to clear the cervical spine in obtunded blunt trauma patients is computed tomography in combination with plain films, dynamic fluoroscopy, or magnetic resonance imaging. The objective of this study was to answer the question "Can computed tomography alone provide adequate clinical information to clear the cervical spine in the obtunded patient?" ⋯ The results suggest that CT alone is a reliable clinical indicator to clear the cervical spine in obtunded patients.
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Comparative Study
Increased mortality in adult patients with trauma transfused with blood components compared with whole blood.
Hemorrhage is a preventable cause of death among patients with trauma, and management often includes transfusion, either whole blood or a combination of blood components (packed red blood cells, platelets, fresh frozen plasma). We used the 2009 National Trauma Data Bank data set to evaluate the relationship between transfusion type and mortality in adult patients with major trauma (n = 1745). Logistic regression analysis identified 3 independent predictors of mortality: Injury Severity Score, emergency medical system transfer time, and type of blood transfusion, whole blood or components. Transfusion of whole blood was associated with reduced mortality; thus, it may provide superior survival outcomes in this population.
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Traumatic brain injury continues to be a major socioeconomic problem, costing the United States $76.5 billion in the year of 2000. Despite the advances in the field of medicine, there are still no definitive treatments for traumatic brain injury. ⋯ The search for effective treatment in human studies has been unfruitful. In this review, the mechanisms of primary and secondary brain injury are discussed along with potential neuroprotective interventions such as hyperosmolar therapies, hypothermia, statins, and cyclosporin A.
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Propofol use may lead to hypotension in trauma patients intubated in the emergency department. In this study, predictors of hypotension were identified. ⋯ In the multivariate analysis, hypotension was associated with patient age greater than 55 years (odds ratios [OR], 3.61; 95% confidence interval [CI], 1.32-9.86; P = .012), obesity (OR, 2.66; 95% CI, 1.08-6.55; P = .034), and lower baseline blood pressure (OR, 1.59 [per 10-mm Hg decrease]; 95% CI, 1.29-1.96; P = .000). Age greater than 55 years, obesity, and lower baseline systolic blood pressure are associated with a higher risk of propofol-induced hypotension in trauma patients.
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Comparative Study
Characteristics and risk factors of trauma patients readmitted to the ICU within the same hospitalization.
There is little evidence about the characteristics and outcomes of unplanned intensive care unit (ICU) readmission for adult trauma patients. This retrospective study examined the characteristics, risks factors, and outcomes for trauma patients with and without ICU readmission. With 5 years of data, 1117 patients met inclusion criteria for the study. Patient characteristics for readmission included increased age and diabetes, while identified risk factors included increased time between injury and ICU admission, admission from surgery or outside hospital, higher Injury Severity Score, along with glucose, albumin, and lower Glasgow Coma Scale values on the day of ICU discharge.