Articles: trauma.
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Review Observational Study
Imaging findings in penetrating injuries in the paediatric population - Experience from a major trauma Centre.
The primary objective of this study is to assess common sites of injury and the associated imaging findings in penetrating injuries. We pay particular attention to gluteal, anterior abdominal wall and junctional zone injuries. The aim is to highlight areas of diagnostic uncertainty and discrepancy between imaging and surgical findings, to improve review areas in trauma reporting. ⋯ Gluteal injuries are common and although the overall morbidity of these cases is low, these patients are at risk of serious and life threatening consequences such as vascular and rectal injury and it is imperative that these complications are considered and ruled out via dual phase CT or direct visualization. Anterior abdominal wall and junctional zone injuries are less common, but lead to greater morbidity and also greater diagnostic uncertainty. The use of other salient findings as described in this report can aid diagnostic accuracy and reduce discrepancies.
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Comparative Study
Comparison of continuous vital signs data analysis versus venous lactate for the prediction of lifesaving interventions in patients with traumatic shock.
Introduction: The prehospital environment is fraught with operational constraints, making it difficult to assess the need for resources such as lifesaving interventions (LSI) for adults with traumatic injuries. While invasive methods such as lactate have been found to be highly predictive for estimating injury severity and resource requirements, noninvasive methods, to include continuous vital signs ( VS ), have the potential to provide prognostic information that can be quickly acquired, interpreted, and incorporated into decision making. In this work, we hypothesized that an analysis of continuous VS would have predictive capacity comparable to lactate and other laboratory tests for the prediction of injury severity, need for LSIs and intensive care unit admission. ⋯ The model using all laboratory data yielded the highest sensitivity and sensitivity (AUROC, 0.77; 95% CI, 0.74-0.81). Discussion: The results from this study suggest that continuous VS obtained from autonomous monitors in an aeromedical environment may be helpful for predicting LSIs and the critical care requirements for traumatically injured adults. The collection and use of noninvasively obtained physiological data during the early stages of prehospital care may be useful for in developing user-friendly early warning systems for identifying potentially unstable trauma patients.
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Multicenter Study
Platelet to erythrocyte ratio and mortality in massively transfused trauma patients.
The optimal transfusion ratio of platelets (PLT), plasma and red blood cells (RBC) in trauma patients with massive haemorrhage is still a subject of discussion. The objective of this study is to assess the effect of platelet transfusion on mortality in trauma patients who received massive transfusion. ⋯ Although the optimal patient specific transfusion strategy in patients with traumatic haemorrhage is still not resolved, these results show that higher PLT to RBC ratios are associated with lower early mortality.
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Comparative Study
Validation and Comparison of Common Thoracolumbar Injury Classification Treatment Algorithms and a Novel Modification.
The most common thoracolumbar trauma classification systems are the Thoracolumbar Injury Classification and Severity Score (TLICS) and the Thoracolumbar AO Spine Injury Score (TL AOSIS). Predictive accuracy of treatment recommendations is a historical limitation. Our objective was to validate and compare TLICS, TL AOSIS, and a modified TLICS (mTLICS) that awards 2 points for the presence of fractured vertebral body height loss >50% and/or spinal canal stenosis >50% at the fracture site. ⋯ All systems performed well. The mTLICS had improved sensitivity and accuracy compared with TLICS and higher accuracy and specificity than TL AOSIS. The sensitivity of TL AOSIS was higher than that of TLICS. Prospective, multi-institutional reliability and validity studies of this mTLICS are needed for adoption.