Articles: trauma.
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Eur J Trauma Emerg Surg · Dec 2024
Review Meta AnalysisThe efficacy and safety of pre-hospital plasma in patients at risk for hemorrhagic shock: an updated systematic review and meta-analysis of randomized controlled trials.
Plasma is a critical element in hemostatic resuscitation post-injury, and its prompt administration within the prehospital setting may reduce the complications resulting from hemorrhage and shock. Our objective is to assess the efficacy and safety of prehospital plasma infusion in patients susceptible to hemorrhagic shock. ⋯ Plasma infusion in trauma patients at risk of hemorrhagic shock does not significantly affect mortality or the incidence of multiple organ failure. However, it may lead to reduced packed red blood cell transfusions and increased INR at hospital arrival.
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Review Meta Analysis
Bedside-focused transthoracic echocardiography in acute atraumatic thoracic aortic syndrome: a systematic review and meta-analysis of diagnostic accuracy.
The objective of this review was to assess the diagnostic accuracy of bedside-focused transthoracic echocardiography (TTE) in acute atraumatic thoracic aortic syndrome in adults. We performed a systematic review and meta-analysis of publications that described the use of bedside-focused TTE on adults presenting to emergency care settings with suspected atraumatic thoracic aortic syndrome. Studies were identified using keyword and MeSH on relevant databases as well as grey literature, followed by abstract screening and study selection by two independent reviewers. ⋯ For type B dissection, pooled sensitivity was 65% (95% CI, 45-80%) and specificity was 100% (95% CI, 0.69-100%). Regarding indirect TTE signs, pooled sensitivities and specificities were 64% (5.2-98.2%) and 94% (92-96.1%), respectively for aortic valve regurgitation, 92% (54-99.2%) and 87% (62-97%) for thoracic aortic aneurysm and 39% (33.8-45%) and 94% (92-95%) for pericardial effusion. In this systematic review and meta-analysis, bedside-focused TTE has high specificity for type A and B dissection, a moderate to high sensitivity for type A but poor for type B, and unclear diagnostic accuracy for intramural haematoma and penetrating aortic ulcer.
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Eur J Trauma Emerg Surg · Dec 2024
ReviewCan "Stop The Bleed" training courses for laypersons improve hemorrhage control knowledge, skills, and attitudes? A systematic review.
In many regions of the world, most trauma deaths occur within 1-2 h of injury due to uncontrolled bleeding. For this reason, training lay first-person responders in trauma care, focusing on hemorrhage control, has been recommended. We hypothesized that STOP THE BLEED (STB) training courses that teach laypersons how to stop traumatic compressible bleeding immediately are needed to potentially prevent deaths due to hemorrhage. This systematic review will analyze the effect of the STB training course on the knowledge, skill, and attitudes of lay first-person responders for hemorrhage control. ⋯ STB courses for laypersons have demonstrated significant improvements in knowledge, skill, confidence, and willingness to intervene to stop traumatic exsanguination. The evaluation of clinically relevant patient outcomes, specifically their effect on preventable deaths from traumatic exsanguination, is needed to strengthen further the evidence behind the recommendations for more widespread teaching of "STB" courses.
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Spinal injuries occur in 3% of all patients with trauma, most commonly in males, and often as a result of high-velocity impact followed by abrupt deceleration. The most affected region after spinal trauma is the thoracolumbar junction because of the anterior center of gravity at the T12-L1 vertebral level and the relatively stiff thoracic spine uniting with the mobile lumbar spine. Many classifications exist to guide the choice of operative versus nonoperative management of traumatic injuries at this site. ⋯ Ignoring this aspect of thoracolumbar management often contributes to the development of posttraumatic malalignment and other complications. This review recommends that a new or modified classification system accounts for sagittal segmental alignment factors, including the level of the injured vertebra, the number of affected adjacent levels, imaging techniques with better specificity and sensitivity, and assessment for osteoporosis. Case studies are included to show the importance of segmental sagittal alignment and the vertebral level on patient outcomes.
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Multicenter Study
Whole Blood and Blood Component Resuscitation in Trauma: Interaction and Association with Mortality.
To evaluate the interaction between whole blood (WB) and blood component resuscitation in relation to mortality after trauma. ⋯ WB resuscitation, higher WB:TTV ratios, and balanced blood component transfusion in conjunction with WB were associated with lower mortality in patients with trauma presenting in shock requiring at least 4 units of red blood cells and/or WB transfusion within 4 hours of arrival.