The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Feb 2014
Routine repeat brain computed tomography in all children with mild traumatic brain injury may result in unnecessary radiation exposure.
Computed tomography (CT) for pediatric traumatic brain injury (TBI) is common. Evidence suggests that 1 in 1,200 children undergoing CT will die of malignancy from radiation exposure. Presently, there is no protocol for surveying children with mild TBI; repeat CT (rCT) is often performed. We hypothesized that rCT could be avoided. Outcomes of similar patients who underwent rCT were compared with those of patients followed by clinical examination alone. ⋯ Therapeutic study, level IV.
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J Trauma Acute Care Surg · Feb 2014
Comparative StudyThe Mayo Clinic experience with Morel-Lavallée lesions: establishment of a practice management guideline.
Although uncommon, Morel-Lavallée lesions (also called closed degloving injuries) are associated with considerable morbidity in trauma patients. There is lack of consensus regarding proper management of these lesions. Management options include nonoperative therapies, along with percutaneous and operative techniques. We sought to define the factors associated with failure of percutaneous aspiration to better identify patients requiring immediate operative management. ⋯ Therapeutic/care management study, level III.
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J Trauma Acute Care Surg · Feb 2014
Cost-utility analysis of prehospital spine immobilization recommendations for penetrating trauma.
The American College of Surgeons' Committee on Trauma's recent prehospital trauma life support recommendations against prehospital spine immobilization (PHSI) after penetrating trauma are based on a low incidence of unstable spine injuries after penetrating injuries. However, given the chronic and costly nature of devastating spine injuries, the cost-utility of PHSI is unclear. Our hypothesis was that the cost-utility of PHSI in penetrating trauma precludes routine use of this prevention strategy. ⋯ Economic and value-based evaluation, level II.
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J Trauma Acute Care Surg · Feb 2014
Comparative StudyManagement of pelvic ring fracture patients with a pelvic "blush" on early computed tomography.
The sliding computed tomographic (CT) scanner in our trauma resuscitation room can be used early in the assessment of pelvic ring fracture patients. We determined the association between the presence of a pelvic blush on CT scan and the need for pelvic hemorrhage control (PHC). We hypothesized that many pelvic blushes found early in the resuscitation phase can be safely managed without intervention. ⋯ Therapeutic study, level IV. Prognostic/epidemiologic study, level III.
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J Trauma Acute Care Surg · Feb 2014
Comparative StudyEarly or delayed stabilization in severely injured patients with spinal fractures? Current surgical objectivity according to the Trauma Registry of DGU: treatment of spine injuries in polytrauma patients.
Because of a lack of evidence, the appropriate timing of surgical stabilization of thoracic and lumbar spine injuries in severely injured patients is still controversial. Data of a large international trauma register were analyzed to investigate the medical care situation of unstable spinal column fractures in patients with multiple injuries, so as to examine the outcome related to timing of surgical stabilization. ⋯ Therapeutic study, level III.