The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · May 2014
Multicenter StudyBenchmarking trauma centers on mortality alone does not reflect quality of care: implications for pay-for-performance.
Trauma centers are currently benchmarked on mortality outcomes alone. However, pay-for-performance measures may financially penalize centers based on complications. Our objective was to determine whether the results would be similar to the current standard method of mortality-based benchmarking if trauma centers were profiled on complications. ⋯ Prognostic/epidemiologic study, level III.
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J Trauma Acute Care Surg · May 2014
Comparative StudyOpen extremity fractures: impact of delay in operative debridement and irrigation.
Early (<8 hours) operative debridement and irrigation (D&I) of open fractures are considered essential to reduce the risk of deep infection. With the advent of powerful antimicrobials, this axiom has been challenged. The current study evaluates the rates of deep infections of open fractures in relation to the time to the first D&I. ⋯ Therapeutic study, level IV.
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J Trauma Acute Care Surg · May 2014
Comparative StudyRecovery of fibrinogen concentrate after intraosseous application is equivalent to the intravenous route in a porcine model of hemodilution.
Fibrinogen concentrate is increasingly considered as a hemostatic agent for trauma patients experiencing bleeding. Placing a venous access is sometimes challenging during severe hemorrhage. Intraosseous access may be considered instead. Studies of intraosseous infusion of coagulation factor concentrates are limited. We investigated in vivo recovery following intraosseous administration of fibrinogen concentrate and compared the results with intravenous administration. ⋯ Prospective, randomized, therapeutic feasibility study in an animal model, level V.
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J Trauma Acute Care Surg · May 2014
Comparative StudyLevothyroxine therapy before brain death declaration increases the number of solid organ donations.
Protocols call for the start of hormonal therapy with levothyroxine after the declaration of brain death. As the hormonal perturbations occur during the process of brain death, the role of the early initiation of levothyroxine therapy (LT) to salvage organs is not well defined. The aim of this study was to evaluate the impact of early LT (before the declaration of brain death) on the number of solid organs procured per donor. ⋯ Therapeutic/care management study, level IV.