The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Jan 2012
Multicenter StudyBlunt splenic trauma: splenectomy increases early infectious complications: a prospective multicenter study.
The purpose of this study was to evaluate the effect of the method of splenic injury management on early infectious complications. ⋯ Splenectomy is an independent risk factor for early infectious complications. Splenic-preserving techniques should be considered more liberally.
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J Trauma Acute Care Surg · Jan 2012
Monitoring and prediction of intracranial hypertension in pediatric traumatic brain injury: clinical factors and initial head computed tomography.
Control of intracranial hypertension (ICH) in patients with traumatic brain injury (TBI) is standard care. However, predicting risk for ICH is essential to balance risks and benefits of intracranial pressure (ICP) monitoring. Current recommendations for ICP monitoring in pediatric trauma patients are extrapolated from adult studies. ⋯ Among children with severe TBI, a normal head CT does not exclude ICH. Need for ICP monitoring should be determined by depth of coma in addition to radiographic imaging.
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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
Western Trauma Association critical decisions in trauma: management of the mangled extremity.
The operative management of mangled extremities after trauma remains controversial. We have sought to develop an evidence-based algorithm to help guide practitioners when faced with these relatively infrequent but very challenging clinical dilemmas. ⋯ Patients with mangled extremities remain a significant management challenge. This algorithm represents a guideline based on the best evidence available in the literature and expert opinion. It does not establish a standard of care. It should provide a framework for treating physicians and other healthcare professionals to guide therapy, considering individual patients' clinical status and institutional resources.