The journal of trauma and acute care surgery
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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.
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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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To study the incidence and outcome of pulmonary edema in patients admitted with near hanging. ⋯ Pulmonary edema can be due to neurogenic, cardiogenic, postobstructive causes or an interplay of the three. Takotsubo cardiomyopathy/myocardial stunning related pulmonary edema seems more common than the others. Pulmonary edema occurred irrespective of level of consciousness or electrocardiographic changes and was not associated with mortality. Victims of near hanging with pulmonary edema can be effectively treated with supportive therapy.
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J Trauma Acute Care Surg · Jan 2012
Comparative StudyA cost-minimization analysis of phenytoin versus levetiracetam for early seizure pharmacoprophylaxis after traumatic brain injury.
Recent data indicate comparable efficacy and safety for levetiracetam (LEV) when compared with phenytoin (PHT) for prophylaxis of early seizures after traumatic brain injury. The purpose of this study was to conduct a cost-minimization analysis, from the perspective of both the acute care institution (cost) and patient (charges), comparing these two strategies. ⋯ From both institutional and patient perspectives, PHT is less expensive than LEV for routine pharmacoprophylaxis of early seizures among traumatic brain injury patients. Pending compelling efficacy data, LEV should not replace PHT as a first-line agent for this indication.
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J Trauma Acute Care Surg · Jan 2012
Conductor-assisted nasal sonography: an innovative technique for rapid and accurate detection of nasal bone fracture.
Nasal bone is frequently involved in craniofacial trauma. We sought to investigate the role of conductor-assisted nasal sonography (CANS) in patients with nasal trauma. ⋯ CANS technique could detect nasal bone fracture more accurately compared with conventional methods. We recommend it as a new standard of diagnostic tool for nasal fracture.