The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Jan 2015
Obesity and clotting: Body mass index independently contributes to hypercoagulability after injury.
Although obese patients have high thrombosis rates following injury, the role of obesity in coagulation after trauma remains unknown. We hypothesized that body mass index (BMI) is independently associated with increased measures of hypercoagulability longitudinally after injury. ⋯ Prognostic study, level III.
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J Trauma Acute Care Surg · Jan 2015
Clearly defining pediatric massive transfusion: cutting through the fog and friction with combat data.
Massive transfusion (MT) in pediatric patients remains poorly defined. Using the largest existing registry of transfused pediatric trauma patients, we sought a data-driven MT threshold. ⋯ Diagnostic study, level II. Prognostic/epidemiologic study, level III.
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J Trauma Acute Care Surg · Jan 2015
Multicenter StudyVariations in the implementation of acute care surgery: results from a national survey of university-affiliated hospitals.
To date, no studies have reported nationwide adoption of acute care surgery (ACS) or identified structural and/or process variations for the care of emergency general surgery (EGS) patients within such models. ⋯ The potential of the ACS on the national crisis in access to EGS care is not fully met. Variations in EGS processes of care among adopters of ACS suggest that standardized criteria for ACS implementation, much like trauma center verification criteria, may be beneficial.
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J Trauma Acute Care Surg · Jan 2015
Regional collaborative quality improvement for trauma reduces complications and costs.
Although evidence suggests that quality improvement to reduce complications for trauma patients should decrease costs, studies have not addressed this question directly. In Michigan, trauma centers and a private payer have created a regional collaborative quality initiative (CQI). This CQI program began as a pilot in 2008 and expanded to a formal statewide program in 2010. We examined the relationship between outcomes and expenditures for trauma patients treated in collaborative participant and nonparticipant hospitals. ⋯ Economic/value-based evaluation, level III.
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J Trauma Acute Care Surg · Jan 2015
Does resuscitation with plasma increase the risk of venous thromboembolism?
Resuscitation with blood products improves survival in patients with traumatic hemorrhage. However, the risk of venous thromboembolic (VTE) complications associated with fresh frozen plasma (FFP) resuscitation is unknown. We hypothesized that a higher ratio of FFP to packed red blood cells (PRBCs) given during acute resuscitation increases the risk of VTE independent of severity of injury and shock. ⋯ Care management study, level III.