The journal of trauma and acute care surgery
-
J Trauma Acute Care Surg · May 2014
Comparative StudyPreinjury ambulatory status is associated with 1-year mortality following lateral compression Type I fractures in the geriatric population older than 80 years.
Lateral compression pelvic Type I fractures in the elderly population are most often low-energy osteoporosis related fractures. Previous literature comparing pelvic fractures in young versus elderly patients called into question the general consideration of these injuries as benign injuries with favorable prognoses; however, the geriatric population older than 80 years is often underrepresented. This article focuses on the mortality and functional outcomes after low-energy pelvic fractures in a population of patients older than 80 years. ⋯ Prognostic and epidemiologic, level IV.
-
J Trauma Acute Care Surg · May 2014
Comparative StudyPulmonary embolism without deep venous thrombosis: De novo or missed deep venous thrombosis?
Pulmonary embolus (PE) is thought to arise from a deep venous thrombosis (DVT). Recent data suggest that PE can present without DVT, inferring that PE can originate de novo (DNPE). We examined the relationship between DVT and PE in trauma patients screened for DVT with duplex sonography (DS). We sought to validate the incidence of PE without evidence of DVT and to examine the clinical significance of this entity. ⋯ Care management study, level III.
-
J Trauma Acute Care Surg · May 2014
Comparative StudyMitochondrial damage-associated molecular patterns released by abdominal trauma suppress pulmonary immune responses.
Historically, fever, pneumonia, and sepsis after trauma are ascribed to pain and poor pulmonary toilet. No evidence supports that assertion however, and no known biologic mechanisms link injury to infection. Our studies show that injured tissues release mitochondria (MT). Mitochondrial damage-associated molecular patterns (mtDAMPs) however can mimic bacterial pathogen-associated danger molecules and attract neutrophils (PMN). We hypothesized that mtDAMPs from traumatized tissue divert neutrophils from the lung, causing susceptibility to infection. ⋯ Rather than acting as a "second hit" to enhance PMN-mediated lung injury, mtDAMPs from trauma and pathogen-associated danger molecules from peritoneal infection diminish PMN accumulation in a contused lung. This may make the lung susceptible to pneumonia. This paradigm provides a novel mechanistic model of the relationship among blunt tissue trauma, systemic inflammation, and pneumonia that can be studied to improve trauma outcomes.
-
J Trauma Acute Care Surg · May 2014
Predicting the need for massive transfusion in trauma patients: the Traumatic Bleeding Severity Score.
The ability to easily predict the need for massive transfusion may improve the process of care, allowing early mobilization of resources. There are currently no clear criteria to activate massive transfusion in severely injured trauma patients. The aims of this study were to create a scoring system to predict the need for massive transfusion and then to validate this scoring system. ⋯ Prognostic study, level III.
-
J Trauma Acute Care Surg · May 2014
Comparative StudyDefining the optimal time to the operating room may salvage early trauma deaths.
Early trauma deaths have the potential for salvage with immediate surgery. We studied time from injury to death in this group to qualify characteristics and quantify time to the operating room, yielding the greatest opportunity for salvage. ⋯ Epidemiologic study, level III.