Injury
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The adoption of evidence-based orthopaedics has shifted the focus from expert base opinions and anecdotal evidence to a focus on integrating the best available clinical research. This shift has led to an increased focus on randomized controlled trials (RCTs) within the field. Although RCTs are considered the highest level of evidence, methodologic errors can introduce bias and limit the validity of the results. Early trials were hampered by lack of blinding, inadequate sample sizes and other design flaws. The objective of this review was to examine the current literature to determine if the design and execution of RCTs has improved. ⋯ Although marked improvements have been made in the design and implementation of trials, there is still considerable room for improvement. Adequately blinded and powered studies evaluating clinically important outcomes and differences should be key considerations in trial design moving forward.
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A measure of effect size, such as observed difference (OD) and its 95% confidence interval (CI), is necessary to determine clinical relevance (CR) of research findings. The purpose of this paper is to (1) determine the interobserver reliability (IOR) of determining CR when presented with only the OD and CI and (2) to determine if a ratio of OD over CI (OD/CI) had a stronger association with CR than the p-value. ⋯ Determining CR from the OD and CI alone had weak interobserver reliability. The OD/CI ratio had a stronger association with CR than the p-value making it potentially useful in evaluating the CR of research findings.
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Cairns Hospital is the northernmost tertiary referral hospital in Far North Queensland (FNQ) and manages trauma from a large catchment area. A large burden of stab injuries occurs in at-risk patient groups, such as Indigenous and mental health patients, in this region. This research aims to present an overview of the demographics, injury patterns, management and outcomes for stabbings injuries in FNQ. ⋯ Stab injuries annually in FNQ are comparable to other centres in Australia. Overall injury severity was low, with excellent survival rates and outcomes for patients who reached hospital. Operative intervention rates for abdominal stab wounds were low in FNQ compared to available data and imaging again appears protective against negative laparotomy rate.
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Fibrin stabilizing factor (FXIII) plays a crucial role in blood clotting, tissue repair, and immune defense. FXIII deficiency after trauma can lead to prolonged wound healing due to persistent infections or coagulation disorders. The aim of this study was to describe the prevalence of acquired FXIII deficiency after trauma and to provide a description of the time-course changes of important coagulation parameters in relation to FXIII activity. In this context, patient characteristics, laboratory data, and treatment modalities were examined with respect to their influence on FXIII activity. Furthermore, the effects of in vitro administration of FXIII on clot firmness and outcomes in patients with severe traumatic brain injury were investigated. ⋯ We demonstrated that trauma-associated FXIII deficiency is a common coagulation disorder, with FXIII deficiency increasing further in the first 7 days after trauma, the period of early surgical care. In vitro administration of FXIII was able to demonstrate significant clot stabilizing effects. For trauma patients with sTBI, FXIII activity could serve as a prognostic parameter, as it differed significantly between patients with good and poor clinical outcomes.
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The purpose of this study was to evaluate the safety and efficacy of early venous thromboembolism (VTE) chemoprophylaxis following blunt solid organ injury. ⋯ Stable hemoglobin in the first 24 h is an efficacious, objective measure that allows early initiation of VTE chemoprophylaxis in solid organ injury. This practice is associated with earlier initiation of and fewer VTE events.