The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · May 2014
Comparative StudyA risk-adapted approach is beneficial in the management of bilateral femoral shaft fractures in multiple trauma patients: an analysis based on the trauma registry of the German Trauma Society.
Today, there is a trend toward damage-control orthopedics (DCO) in the management of multiple trauma patients with long bone fractures. However, there is no widely accepted concept. A risk-adapted approach seems to result in low acute morbidity and mortality. Multiple trauma patients with bilateral femoral shaft fractures (FSFs) are considered to be more severely injured. The objective of this study was to validate the risk-adapted approach in the management of multiple trauma patients with bilateral FSF. ⋯ Therapeutic study, level IV. Epidemiologic study, level III.
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J Trauma Acute Care Surg · May 2014
Multicenter StudyDerivation and validation of a quality indicator for 30-day unplanned hospital readmission to evaluate trauma care.
Unplanned readmissions represent 20% of all admissions and cost $12 billion annually in the United States. Despite the burden of injuries for the health care system, no quality indicator (QI) based on readmissions is available to evaluate trauma care. The objective of this study was to derive and internally validate a QI for a 30-day unplanned hospital readmission to evaluate trauma care. ⋯ Prognostic study, level III.
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J Trauma Acute Care Surg · May 2014
Guiding the management of intubated patients with pneumonia and ventilator-associated events using serial catheter-directed bronchoalveolar lavage.
We evaluated the role of serial catheter-directed bronchoalveolar lavage (CDBAL) in the diagnosis and management of pneumonia in ventilated surgical intensive care unit patients. ⋯ Diagnostic test, level III. Therapeutic study, level IV.
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J Trauma Acute Care Surg · May 2014
Multicenter Study Comparative StudyVenovenous extracorporeal life support improves survival in adult trauma patients with acute hypoxemic respiratory failure: a multicenter retrospective cohort study.
Venovenous extracorporeal life support (VV ECLS) has been reported in adult trauma patients with severe respiratory failure; however, ECLS is not available in many trauma centers, few trauma surgeons have experience initiating ECLS and managing ECLS patients, and there is currently little evidence supporting its use in severely injured patients. This study seeks to determine if VV ECLS improves survival in such patients. ⋯ Therapeutic study, level III.
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J Trauma Acute Care Surg · May 2014
Comparative StudyComplex penetrating duodenal injuries: less is better.
The traditional management of complex penetrating duodenal trauma (PDT) has been the use of elaborate temporizing and complex procedures such as the pyloric exclusion and duodenal diverticulization. We sought to determine whether a simplified surgical approach to the management of complex PDT injuries improves clinical outcome. ⋯ Therapeutic study, level IV.