The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Feb 2014
Flail chest injuries: a review of outcomes and treatment practices from the National Trauma Data Bank.
Flail chest injuries are associated with severe pulmonary restriction, a requirement for intubation and mechanical ventilation, and high rates of morbidity and mortality. Our goals were to investigate the prevalence, current treatment practices, and outcomes of flail chest injuries in polytrauma patients. ⋯ Epidemiologic/prognostic study, level IV.
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J Trauma Acute Care Surg · Feb 2014
Comparative StudyTraumatic brain injury and β-blockers: not all drugs are created equal.
Dysautonomia in traumatic brain injury patients may contribute to secondary injury. We hypothesize that propranolol is the best β-blocker (BB) to block the excess catecholamines and improve mortality in this patient population. ⋯ Therapeutic, study level III.
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J Trauma Acute Care Surg · Feb 2014
Comparative StudyFibrinogen and platelet contributions to clot formation: implications for trauma resuscitation and thromboprophylaxis.
Thromboelastography (TEG) is used to diagnose perturbations in clot formation and lysis that are characteristic of acute traumatic coagulopathy. With novel functional fibrinogen (FF) TEG, fibrin- and platelet-based contributions to clot formation can be elucidated to tailor resuscitation and thromboprophylaxis. We sought to describe the longitudinal contributions of fibrinogen and platelets to clot strength after injury, hypothesizing that low levels of FF and a low contribution of fibrinogen to clot strength on admission would be associated with coagulopathy, increased transfusion requirements, and worse outcomes. ⋯ Prognostic study, level III.
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J Trauma Acute Care Surg · Feb 2014
Comparative StudyComputer versus paper system for recognition and management of sepsis in surgical intensive care.
A system to provide surveillance, diagnosis, and protocolized management of surgical intensive care unit (SICU) sepsis was undertaken as a performance improvement project. A system for sepsis management was implemented for SICU patients using paper followed by a computerized system. The hypothesis was that the computerized system would be associated with improved process and outcomes. ⋯ Therapeutic study, level III.
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J Trauma Acute Care Surg · Feb 2014
Comparative StudyThe impact of preinjury anticoagulants and prescription antiplatelet agents on outcomes in older patients with traumatic brain injury.
Anticoagulants and prescription antiplatelet (ACAP) agents widely used by older adults have the potential to adversely affect traumatic brain injury (TBI) outcomes. We hypothesized that TBI patients on preinjury ACAP agents would have worse outcomes than non-ACAP patients. ⋯ Therapeutic study, level IV.