Injury
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Multicenter Study
Trends of clinical outcomes in patients with a Traumatic Brain Injury (TBI) in Canada between 2006 and 2012.
Traumatic brain injuries (TBI) are the leading cause of death for people aged <40 years. In Canada, the structure of trauma care has evolved independently across provinces during the last decade. However, little is known about the evolution of clinical outcomes. We aimed to compare trends in hospital mortality, unplanned readmission, hospital length of stay (LOS) and intensive care unit (ICU) LOS for TBI between 2006 and 2012 across Canadian provinces. ⋯ We observed significant decreases in mortality, hospital and ICU length of stay for TBI in Canada between 2006 and 2012 but only in certain provinces. This study may represent the first step towards a better understanding of the influence of trauma system configuration on the burden of injuries in Canada.
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Observational Study
The ATLANTIC study: Anti-Xa level assessment in trauma intensive care.
To quantify the pharmacodynamic (PD) activity of daily subcutaneous (SC) enoxaparin as venous thromboembolism (VTE) prophylaxis in high-risk trauma patients admitted to the intensive care unit (ICU). ⋯ In a cohort of high risk critically ill trauma patients receiving daily SC enoxaparin as VTE chemoprophylaxis, measured peak and trough plasma anti-Xa activity was inadequate in a significant proportion. On this basis, further systematic investigation concerning dose optimisation in this patient population appears warranted.
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Guidelines surrounding abdominal seat belt sign (SBS) were made prior to the use of modern computed tomography (CT) imaging. We sought to prospectively determine whether a negative CT scan is associated with the absence of hollow viscus injury (HVI), and we hypothesized that trauma patients with an abdominal SBS without CT imaging findings would not have a hollow viscus injury (HVI). ⋯ In this study, the incidence of HVI with SBS is lower than previously reported, and no patients with negative CT imaging required an operation for HVI-suggesting there is a population of patients with SBS who could be discharged from the emergency room. A prospective multicenter study is needed to confirm these findings.
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Observational Study
The medical and operational impact of the deployment of a scanner within Role 2 in Mali for the French army.
According to the NATO classification, the difference between Role 2 and Role 2+ is the presence of extra diagnostic and therapeutic means, including the deployment of a scanner. The aim of this study is to analyze the impact of this deployment at the front, in the Gao French Role 2 (Mali). Our main hypothesis is that the presence of a scanner at the front improves the servicemen's diagnostic and therapeutic management abilities. Secondly that scanner holds strategic relevance by limiting the repatriation of servicemen on medical grounds. ⋯ The scanner, a heavy logistic unit deployed within a forward surgical unit, holds therapeutic relevance for French servicemen's management with an important medical service provided for the therapeutic choices, although its operational impact has yet to be demonstrated.
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Globally, traumatic injury is a leading cause of morbidity and mortality in low-income countries. However, trauma centers in these environments have limited resources to manage complex trauma with minimal staffing and diagnostic tools. These limitations may be exacerbated at night. We hypothesized that there is an increase in trauma-associated mortality for patients presenting during nighttime hours. ⋯ We report the first description of diurnal variation in trauma-associated mortality in sub-Saharan Africa. Injured patients who presented at night had nearly twice the adjusted risk ratio of death compared to patients that presented during the daytime although there were yearly differences. Diurnal variation in trauma-associated mortality is a simple but important indicator of the maturity of a trauma system and should be tracked for health care system improvement.