The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Feb 2015
Posterior component separation and transversus abdominis muscle release for complex incisional hernia repair in patients with a history of an open abdomen.
The best reconstructive approach for large fascial defects precipitated from a previous open abdomen has not been elucidated to date. We use a posterior component separation with transversus abdominis muscle release (TAR) in this scenario. ⋯ Therapeutic study, level V.
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J Trauma Acute Care Surg · Feb 2015
Multicenter StudyUnderstanding traumatic shock: out-of-hospital hypotension with and without other physiologic compromise.
Among trauma patients with out-of-hospital hypotension, we evaluated the predictive value of systolic blood pressure (SBP) with and without other physiologic compromise for identifying trauma patients requiring early critical resources. ⋯ Prognostic study, level II.
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J Trauma Acute Care Surg · Feb 2015
Cell necrosis-independent sustained mitochondrial and nuclear DNA release following trauma surgery.
Mitochondrial DNA (mtDNA), a potent proinflammatory damage-associated molecular pattern, is released in large titers following trauma. The effect of trauma surgery on mtDNA concentration is unknown. We hypothesized that mtDNA and nuclear DNA (nDNA) levels would increase proportionately with the magnitude of surgery and both would then decrease rapidly. ⋯ Prospective study, level III.
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J Trauma Acute Care Surg · Feb 2015
Hospital-acquired pneumonia is an independent predictor of poor global outcome in severe traumatic brain injury up to 5 years after discharge.
Long-term outcomes following traumatic brain injury (TBI) correlate with initial head injury severity and other acute factors. Hospital-acquired pneumonia (HAP) is a common complication in TBI. Limited information exists regarding the significance of infectious complications on long-term outcomes after TBI. We sought to characterize risks associated with HAP on outcomes 5 years after TBI. ⋯ Prognostic study, level III.
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J Trauma Acute Care Surg · Feb 2015
Systolic blood pressure criteria in the National Trauma Triage Protocol for geriatric trauma: 110 is the new 90.
Undertriage is a concern in geriatric patients. The National Trauma Triage Protocol (NTTP) recognized that systolic blood pressure (SBP) less than 110 mm Hg may represent shock in those older than 65 years. The objective was to evaluate the impact of substituting an SBP of less than 110 mm Hg for the current SBP of less than 90 mm Hg criterion within the NTTP on triage performance and mortality. ⋯ Diagnostic study, level IV.