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
Multicenter StudyChanges in massive transfusion over time: an early shift in the right direction?
Increasing evidence suggests that high fresh frozen plasma:packed red blood cell (FFP:PRBC) and platelet:PRBC (PLT:PRBC) transfusion ratios may prevent or reduce the morbidity associated with early coagulopathy which complicates massive transfusion (MT). We sought to characterize changes in resuscitation which have occurred over time in a cohort severely injured patients requiring MT. ⋯ In a severely injured cohort requiring MT, FFP:PRBC and PLT:PRBC ratios have not changed over time, whereas the rate of MT overall has significantly decreased. During the recent time period (after December 2007), significantly higher transfusion ratios and a greater percent of 6-hour/24-hour FFP and PLT were found in the sub-MT group, those patients just below the PRBC transfusion threshold definition of MT. These data suggest early, more aggressive attainment of high transfusions ratios may reduce the requirement for MT and may shift overall blood requirements below those which currently define MT. Further prospective evidence is required to verify these findings.
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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
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.