The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Dec 2012
ACGME case logs: Surgery resident experience in operative trauma for two decades.
Surgery resident education is based on experiential training, which is influenced by changes in clinical management strategies, technical and technologic advances, and administrative regulations. Trauma care has been exposed to each of these factors, prompting concerns about resident experience in operative trauma. The current study analyzed the reported volume of operative trauma for the last two decades; to our knowledge, this is the first evaluation of nationwide trends during such an extended time line. ⋯ Epidemiologic study, level III; therapeutic study, level IV.
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J Trauma Acute Care Surg · Dec 2012
Objective estimates of the probability of death in acute burn injury: a proposed Taiwan burn score.
This study aimed to develop an objective model for predicting mortality after burn injury in Taiwan. ⋯ Prognostic study, level II.
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J Trauma Acute Care Surg · Dec 2012
Western Trauma Association critical decisions in trauma: resuscitative thoracotomy.
In the past three decades, there has been a significant clinical shift in the performance of resuscitative thoracotomy (RT), from a nearly obligatory procedure before declaring any trauma patient deceased to a more selective application of RT. We have sought to formulate an evidence-based guideline for the current indications for RT after injury in the patient. ⋯ The success of RT approximates 35% for the patient arriving in shock with a penetrating cardiac wound and 15% for all patients with penetrating wounds. Conversely, patient outcome is relatively poor when RT is performed for blunt trauma, 2% survival for patients in shock and less than 1% survival for patients with no vital signs. Patients undergoing CPR on arrival to the hospital should be stratified based on injury and transport time to determine the utility of RT. This algorithm represents a rational approach that could be followed at trauma centers with the appropriate resources; it may not be applicable at all hospitals caring for the injured. There will be patient, personnel, institutional, and situational factors that may warrant deviation from the recommended guideline. The annotated algorithm is intended to serve as a quick bedside reference for clinicians.
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J Trauma Acute Care Surg · Dec 2012
Transarterial embolization in children with blunt splenic injury results in postembolization syndrome: a matched case-control study.
Postembolization syndrome (PES) has been reported in adults following transarterial embolization (TAE) for blunt splenic injury (BSI), but not in children. We report the incidence of PES in a group of children who underwent TAE. ⋯ Prognostic study, level III; therapeutic study, level IV.
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J Trauma Acute Care Surg · Dec 2012
Transportable extracorporeal lung support for rescue of severe respiratory failure in combat casualties.
Advances in oxygenator membrane, vascular cannula, and centrifugal pump technologies led to the miniaturization of extracorporeal lung support (ECLS) and simplified its insertion and use. Support of combat injuries complicated by severe respiratory failure requires critical care resources not sustainable in the deployed environment. In response to this need, a unique international military-civilian partnership was forged to create a transportable ECLS capability to rescue combat casualties experiencing severe respiratory failure. ⋯ Therapeutic/care management study, level V.