The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Aug 2012
Comparative StudyThe utility of procalcitonin in critically ill trauma patients.
Procalcitonin (PCT), the prohormone of calcitonin, has an early and highly specific increase in response to systemic bacterial infection. The objectives of this study were to determine the natural history of PCT for patients with critical illness and trauma, the utility of PCT as a marker of sepsis versus systemic inflammatory response syndrome (SIRS), and the association of PCT level with mortality. ⋯ PCT levels are significantly higher in ICU patients with trauma and sepsis and may help differentiate sepsis from SIRS in critical illness. An elevated PCT level was associated with increased mortality.
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J Trauma Acute Care Surg · Aug 2012
Comparative StudyDetermining venous thromboembolic risk assessment for patients with trauma: the Trauma Embolic Scoring System.
This study aimed to determine the relative "weight" of risk factors known to be associated with venous thromboembolism (VTE) for patients with trauma based on injuries and comorbidities. ⋯ The TESS provides an objective measure of classifying VTE risk for patients with trauma. The TESS could allow informed decision making regarding prophylaxis strategies in patients with trauma.
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J Trauma Acute Care Surg · Aug 2012
Comparative StudyThe dangers of being a "weekend warrior": a new call for injury prevention efforts.
Nonprofessionals routinely perform high-risk home maintenance activities otherwise regulated by the Occupational Health and Safety Administration when professionals perform the same work. Reducing the risks taken by these "weekend warriors" has not been the focus of injury prevention efforts. This study describes injury patterns and outcomes for nonprofessionals attempting home roof and tree maintenance. ⋯ Weekend warriors performing home roof and tree maintenance sustain serious injuries with a potential for a long-term disability at young ages. Injury prevention efforts should educate the public about the hazards of high-risk home maintenance, possibly encouraging Occupational Health and Safety Administration-regulated protective measures or deferral to trained professionals.
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J Trauma Acute Care Surg · Aug 2012
Comparative StudyChemical venous thromboembolic prophylaxis is safe and effective for patients with traumatic brain injury when started 24 hours after the absence of hemorrhage progression on head CT.
Venous thromboembolism (VTE) continues to be an important complication for patients with trauma, including patients with intracranial hemorrhage. We implemented a protocol starting chemical prophylaxis 24 hours after the absence of progression of hemorrhage on computed tomography (CT) to increase consistency with the use of chemical venous thromboembolic prophylaxis in this population. The objective of this study was to review the protocol of VTE prophylaxis for patients with traumatic brain injury at our institution to determine whether it has been effective and safe in preventing VTE without increasing intracranial hemorrhage. ⋯ A protocol based on an early use of chemical venous thromboembolic prophylaxis after the absence of progression of tramatic intracranial hemorrhage does not result in increased progression of intracranial hemorrhage and reduced the rate of venous thromboembolic events at our institution.
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J Trauma Acute Care Surg · Aug 2012
Checklists change communication about key elements of patient care.
Combat casualty care is distributed across professions and echelons of care. Communication within it is fragmented, inconsistent, and prone to failure. Daily checklists used during intensive care unit (ICU) rounds have been shown to improve compliance with evidence-based practices, enhance communication, promote consistency of care, and improve outcomes. Checklists are criticized because it is difficult to establish a causal link between them and their effect on outcomes. We investigated how checklists used during ICU rounds affect communication. ⋯ Checklists modify communication patterns. Improved communication facilitated by checklists may be one mechanism behind their effectiveness. Checklists are powerful tools that can rapidly alter patient care delivery. Implementing checklists could facilitate the rapid dissemination of clinical practice changes, improve communication between echelons of care and between individuals involved in patient care, and reduce missed information.