The journal of trauma and acute care surgery
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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 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
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.
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J Trauma Acute Care Surg · Jan 2012
Incidence and pattern of cervical spine injury in blunt assault: it is not how they are hit, but how they fall.
The injury mechanism of blunt cervical spine injury (CSI) involves two forces: (1) an acceleration-deceleration force or change in velocity (delta v) that causes significant head and neck movement, resulting in flexion-extension injury pattern and (2) a direct force to the head or face against an immovable object with force transmitted down the cervical spine. Combining those two forces creates what bioengineers call imparted energy (IE). In blunt assault to the head or face, IE is low; hence, the reported incidence of CSI is low. The goal of our study was to identify the incidence, pattern, and outcome of CSI in blunt assaulted patients. ⋯ The incidence of CSI after blunt assault is very low, and the pattern of injury and severity is related to a fall occurring after the assault. Our results should encourage clinicians to find out if patient falls after the assault.
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J Trauma Acute Care Surg · Jan 2012
Emergency uncrossmatched transfusion effect on blood type alloantibodies.
Trauma patients receive emergency transfusions of unmatched Type O Rh-negative (Rh-) blood until matched blood is available. We hypothesized that patients given uncrossmatched blood may develop alloantibodies, placing them at risk for hemolytic transfusion reactions (HTRs). ⋯ High rates of injury recidivism in trauma patients increase the likelihood of multiple blood transfusions during their lifetime. Rh- patients who receive Rh+ blood are at risk of developing anti-Rh antibodies, putting them at risk for HTR. The conservation of Rh- blood for use in female patients may be detrimental to Rh- male patients. Laboratory diagnostic criteria for HTR are nonspecific in the trauma population and should be used with caution.