The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Jan 2012
Disruption of Nrf2 exacerbated the damage after spinal cord injury in mice.
Nuclear factor erythroid 2-related factor 2 (Nrf2) is a key transcriptional factor for antioxidant response element-regulated genes. After spinal cord injury (SCI), the Nrf2-antioxidant response element pathway is activated in the spinal cord. However, the function of Nrf2 after SCI has not yet been studied. ⋯ Genetic ablation of Nrf2 exacerbated the neurologic deficit and inflammation after SCI in mice. These findings raise the possibility that Nrf2 could be relevant in improving outcome after SCI.
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J Trauma Acute Care Surg · Jan 2012
Comparative StudyComparison of massive blood transfusion predictive models in the rural setting.
Hemorrhage is the leading cause of preventable death in trauma patients, of which 3% require massive transfusion (MT). MT predictive models such as the Assessment of Blood Consumption (ABC), Trauma-Associated Severe Hemorrhage (TASH), and McLaughlin scores have been developed, but only included patients requiring blood transfusion during their hospital stay, excluding a large percentage of trauma patients. Our purpose was to validate these MT predictive models in our rural Level I trauma center patient population, using all major trauma victims, regardless of blood product requirements. ⋯ The ABC score correctly identified 89% of MT patients and was predictive of MT in major trauma patients at our rural Level I trauma center; the TASH and McLaughlin scores were not. The ABC score is simpler, faster, and more accurate. Based on this work, we strongly recommend adoption of the ABC score for MT prediction.
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J Trauma Acute Care Surg · Jan 2012
Multicenter StudyManagement of post-traumatic retained hemothorax: a prospective, observational, multicenter AAST study.
The natural history and optimal management of retained hemothorax (RH) after chest tube placement is unknown. The intent of our study was to determine practice patterns used and identify independent predictors of the need for thoracotomy. ⋯ RH in trauma is associated with high rates of empyema and pneumonia. VATS can be performed with high success rates, although optimal timing is unknown. Approximately, 25% of patients require at least two procedures to effectively clear RH or subsequent pleural space infections and 20.4% require thoracotomy.
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J Trauma Acute Care Surg · Jan 2012
The Baux score is dead. Long live the Baux score: a 27-year retrospective cohort study of mortality at a regional burns service.
To assess trends in mortality after burn injuries treated in a regional specialist burns service between 1982 and 2008. ⋯ Mortality is markedly improved over earlier data from this study and other historical series and compares favorably with outcomes published from the US National Burn Repository. The Baux Score continues to provide an indication of the risk of mortality. Survival after major burn injury is increasingly common, and decisions by nonspecialist about initial triage, management, and futility of care should be made after consultation with a specialist burn service.
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J Trauma Acute Care Surg · Jan 2012
A management of blunt thoracic trauma in an emergency department observation unit: pre-post observational study.
The best management of patients with isolated blunt thoracic trauma at high risk of pulmonary complications (HRPC-BTT: ≥3 isolated rib fractures, sternal fracture, single or few pulmonary contusions or minimal pneumothorax) is still unclear. We compared efficacy and cost-effectiveness of a new clinical pathway involving an Emergency Department Observation Unit (EDOU) with routine care. ⋯ In managing patients affected by HRPC-BTT, a clinical pathway involving the EDOU seems to be more effective than routine care with little impact on cost.