Injury
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Rotational thromboelastometry (ROTEM(®)) relies on citrated blood samples, which are regarded as biologically stable for up to 4 h after venepuncture. However, this recommendation is based on data from normal volunteers. The aim of this study was to evaluate possible temporal changes in the coagulability of blood samples from coagulopathic trauma patients. ⋯ Repeated ROTEM(®) EXTEM analysis of citrated samples from coagulopathic trauma patients shows a spontaneous improvement in coagulability with time. The absence of parallel changes on FIBTEM analysis suggests that this effect may be due to a change in platelet function.
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Injury severity, disability and care dependency are frequently used as surrogate measures for rehabilitation requirements following trauma. The true rehabilitation needs of patients may be different but there are no validated tools for the measurement of rehabilitation complexity in acute trauma care. The aim of the study was to evaluate the potential utility of the Rehabilitation Complexity Scale (RCS) version 2 in measuring acute rehabilitation needs in trauma patients. ⋯ The RCS outperformed the ISS and the Barthel in its ability to identify rehabilitation requirements in relation to injury severity, rehabilitation complexity, length of stay and discharge destination. The RCS is potentially a feasible and useful tool for the assessment of rehabilitation complexity in acute trauma care by providing specific measurement of patients' rehabilitation requirements. A larger longitudinal study is needed to evaluate the RCS in the assessment of patient need, service provision and trauma system performance.
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Accidental hypothermia seems to predispose multiple trauma patients to the development of posttraumatic complications, such as Systemic Inflammatory Response Syndrome (SIRS), sepsis, Multiple Organ Dysfunction Syndrome (MODS), and increased mortality. However, the role of accidental hypothermia as an independent prognostic factor is controversially discussed. The aim of the present study was to evaluate the incidence of accidental hypothermia in multiple trauma patients and its effects on the development of posttraumatic complications and mortality. ⋯ Accidental hypothermia is very common in multiply injured patients. However, it could be assumed that the increase of mortality in hypothermic patients is primarily caused by the injury severity and does not reflect an independent adverse effect of hypothermia. Furthermore, hypothermia was not shown to be an independent risk factor for posttraumatic complications.
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High rates of trauma recidivism associated with alcohol use indicate the need to screen for alcohol consumption and related harm. Routine collection of prevalence data relating to alcohol use in Australian trauma settings is not undertaken currently, and diverse screening approaches are used across different settings. This study sought to examine the feasibility of routine screening for alcohol related injury and harmful alcohol use, and determine the prevalence of alcohol related injury and risky alcohol consumption amongst trauma patients in Western Australia. ⋯ Preliminary findings suggest a high prevalence of alcohol-related injury, and harmful alcohol consumption. These findings point to an urgent need to develop reliable and economical screening protocols for harmful alcohol use across Australian trauma settings and the adoption of strategies to ensure their compliance, to enable accurate identification of those most likely to benefit from interventions to reduce alcohol related harm.
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Comparative Study
Monotherapy vs. polytherapy in the treatment of forearm non-unions and bone defects.
To determinate the efficacy of "polytherapy", a surgical technique that utilize all the components of the diamond concept (mesenchymal stem cells, bone morphogenetic proteins and scaffold) versus a "monotherapy", a surgical technique that utilize only one component of the diamond conceptin the treatment of severe forearm non-unions. ⋯ The polytherapy technique with the use of recombinant morphogenetic proteins, autologous MSCs and scaffold in the same surgical time appears to be an effective treatment for patients with severe forearm non-unions.