Injury
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The systemic inflammatory response syndrome (SIRS) has been advocated as a significant predictor of outcome in trauma. Recent trauma literature has proposed SIRS as a surrogate for physiological derangements characteristic of polytrauma with some authors recommending its inclusion into the definition of polytrauma. The practicality of daily SIRS collection outside of specifically designed prospective trials is unknown. The purpose of this study was to assess the availability of SIRS variables and its appropriateness for inclusion into a definition of polytrauma. We hypothesised SIRS variables would be readily available and easy to collect, thus represent an appropriate inclusion into the definition of polytrauma. ⋯ Based on the experience of our level-1 trauma centre, the practicability of including SIRS into the definition of polytrauma as a surrogate for physiological derangement appears questionable even in prospective fashion.
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Blunt chest wall trauma is a common injury treated in the Emergency Departments and has a high reported morbidity and mortality. No national guidelines exist for the management of this patient group unless the patient has severe immediate life-threatening injuries. The aim of this study was to investigate current management of blunt chest wall trauma patients in the UK and to gather expert opinion of the risk factors for morbidity and mortality. ⋯ Variation exists in the management of blunt chest wall trauma patients in the UK. This study provides the expert opinion of a sample of 90 physicians working in Emergency Departments in the UK regarding the risk factors for morbidity and mortality in blunt chest wall trauma patients.
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Whilst more than 90% of injury related deaths are estimated to occur in low-and-middle-income countries (LMICs), the epidemiology of fatal and hospitalised injuries in Pacific Island Countries has received scant attention. This study describes the development and piloting of a population-based trauma registry in Fiji to address this gap in knowledge. ⋯ The injury surveillance system piloted provides the opportunity to inform national injury control strategies in Fiji and increase the capacity for injury prevention and more focused research addressing risk factors in the local context.
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Bone defects associated with non-unions occur as a result of the initial insult or as a consequence of bone excision following non-union development. Historically management of this clinical scenario consisted mainly of amputation, which provided a short recovery period but a significant loss of limb function. Today treatment has evolved and multiple options are available for reconstruction of the bone defect. Broadly these are: bone shortening with lengthening later or bone transport and 'docking' (distraction osteogenesis based techniques); the use of vascularised and non-vascularised bone grafts; bone substitutes; stem cells; growth factors; scaffolds and gene therapy.
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Acute coagulopathy, hypothermia, and acidosis are the lethal triad of conditions manifested by major trauma patients. Recent animal studies have reported that hypothermia improves survival in animals subjected to controlled haemorrhagic shock. The objective of this study was to investigate the effect of hypothermia on coagulation in rats subjected to uncontrolled haemorrhagic shock. ⋯ Blood clotted less firmly in traumatic haemorrhagic shock, and hypothermia prolonged clotting. However, clot firmness maximised rapidly under normothermic haemorrhagic shock. Haemorrhage would continue for a longer time in hypothermic haemorrhagic shock. Survival of hypothermic shock was not significantly different compared to that of normothermic haemorrhagic shock.