The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Aug 2012
Multicenter Study Comparative StudyA multicenter prospective analysis of pediatric trauma activation criteria routinely used in addition to the six criteria of the American College of Surgeons.
The American College of Surgeons has defined six minimum activation criteria (ACS-6) for the highest level of trauma activations at trauma centers. The verification criteria also allow for the inclusion of additional criteria at the institution's discretion. The purpose of this prospective multicenter study was to evaluate the ACS-6 as well as commonly used activation criteria to evaluate overtriage and undertriage rates for pediatric trauma team activation. ⋯ The ACS-6 provides a reliable overtriage or undertriage rate for pediatric patients. The inclusion of two additional criteria can further improve these rates while maintianing a simplified triage list for children.
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J Trauma Acute Care Surg · Aug 2012
Multicenter Study Comparative StudyDebunking the survival bias myth: characterization of mortality during the initial 24 hours for patients requiring massive transfusion.
Controversy surrounds the optimal ratios of blood (packed red blood cell [PRBC]), plasma (fresh frozen plasma [FFP]) and platelet (PLT) use for patients requiring massive transfusion (MT) owing to possible survival bias in previous studies. We sought to characterize mortality during the first 24 hours while controlling for time varying effects of transfusion to minimize survival bias. ⋯ Despite similar degrees of early shock and coagulopathy, high FFP/PRBC and PLT/PRBC ratios are associated with a survival benefit as early as 6 hours and throughout the first 24 hours, even when time-dependent fluctuations of component transfusion are accounted for. This suggests that the observed mortality benefit associated with high component transfusion ratios is unlikely owing to survivor bias and that early attainment of high transfusion ratios may significantly lower the risk of mortality in MT patients.
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J Trauma Acute Care Surg · Aug 2012
Comparative StudyRegional variations in cost of trauma care in the United States: who is paying more?
The study of regional variations in costs of care has been used to identify areas of savings for several diseases and conditions. This study investigates similar potential regional differences in the cost of adult trauma care using an all-payer, nationally representative sample. ⋯ Even after controlling for factors known to influence medical care cost, as well as controlling for geographic differences in pricing, significant regional differences exist in the cost of trauma care. Exploring these variations may assist in identifying potential areas for cost savings.
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J Trauma Acute Care Surg · Aug 2012
Multicenter Study Comparative Study"SCIP"ping antibiotic prophylaxis guidelines in trauma: The consequences of noncompliance.
The Surgical Care Improvement Project (SCIP) established surgical antibiotic prophylaxis guidelines as part of a national patient safety initiative aimed at reducing surgical complications such as surgical site infection (SSI). Although these antibiotic prophylaxis guidelines have become well established in surgical patients, they remain largely unstudied in patients with injury from trauma undergoing operative procedures. We sought to determine the role of these antibiotic prophylaxis guidelines in preventing SSI in patients undergoing trauma laparotomy. ⋯ Our results suggest that SCIP antibiotic prophylaxis guidelines effectively reduce the risk of SSI in patients undergoing trauma laparotomy. Despite the emergent nature of operative procedures for trauma, efforts to adhere to these antibiotic guidelines should be maintained.
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J Trauma Acute Care Surg · Aug 2012
A novel sponge-based wound stasis dressing to treat lethal noncompressible hemorrhage.
Noncompressible hemorrhage is the leading cause of preventable death caused by hemorrhage on the battlefield. Currently, there are no hemostatic agents with the ability to control noncompressible hemorrhage. A wound stasis dressing based upon rapidly expanding cellulose minisponges (MS) was developed and tested in a lethal noncompressible model in swine, by fully transecting subclavian artery and vein. MS were compared with conventional hemostasis dressings, Combat Gauze (CG), in a randomized comparison. ⋯ The use of MS is a novel approach for the rapid, simple treatment of severe noncompressible hemorrhage, which provided statistically significant improvement in hemostasis and survival 60 minutes after injury and a large reduction in blood loss, resuscitation fluid requirement, and medic treatment time compared with conventional hemorrhage control dressings in a swine model.