The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Mar 2015
Multicenter Study Observational StudyProspective derivation of a clinical decision rule for thoracolumbar spine evaluation after blunt trauma: An American Association for the Surgery of Trauma Multi-Institutional Trials Group Study.
Unlike the cervical spine (C-spine), where National Emergency X-Radiography Utilization Study (NEXUS) and the Canadian C-spine Rules can be used, evidence-based thoracolumbar spine (TL-spine) clearance guidelines do not exist. The aim of this study was to develop a clinical decision rule for evaluating the TL-spine after injury. ⋯ Diagnostic test, level III.
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J Trauma Acute Care Surg · Mar 2015
Multicenter StudyIntracranial pressure monitoring and inpatient mortality in severe traumatic brain injury: A propensity score-matched analysis.
Although intracranial pressure (ICP) monitoring in severe traumatic brain injury (TBI) is recommended by the Brain Trauma Foundation, the benefits remain controversial. We sought to determine the impact of ICP monitor placement on inpatient mortality within a regional trauma system after correcting for selection bias through propensity score matching. ⋯ Therapeutic/care management study, level III.
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J Trauma Acute Care Surg · Mar 2015
Risk of pulmonary embolism with repair or ligation of major venous injury following penetrating trauma.
There are many benefits of repair over ligation of major venous injuries (MVIs) following penetrating trauma, but the risk of pulmonary embolism (PE) is not well defined. We hypothesized that rates of PE are comparable between repair and ligation of MVI. ⋯ Epidemiologic study, level III.
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J Trauma Acute Care Surg · Mar 2015
Multicenter StudyEvolving beyond the vicious triad: Differential mediation of traumatic coagulopathy by injury, shock, and resuscitation.
A subset of trauma patients with critical injury present with coagulopathy, portending markedly worse outcomes. Clinical practice is evolving to treat the classical risk factors of hypothermia, hemodilution, and acidosis; however, coagulopathy persists even in the absence of these factors. We sought to determine the relative importance of injury- and shock-specific factors compared with resuscitation-associated factors in coagulopathy after trauma. ⋯ Prognostic and epidemiologic study, level II.
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J Trauma Acute Care Surg · Mar 2015
Adherence to an established diagnostic threshold for ventilator-associated pneumonia contributes to low false-negative rates in trauma patients.
The diagnosis of ventilator-associated pneumonia (VAP) in our institution has followed an established diagnostic threshold (DT) of equal to or greater than 10 colony-forming units (CFU) per milliliter on bronchoalveolar lavage (BAL) based on our previous study (PS). Because mortality from VAP is related to treatment delay, some have advocated a lower DT. The purpose of the current study (CS) was to evaluate the impact of adherence to this DT for VAP on false-negative (FN) rates and mortality in trauma patients. ⋯ Prognostic study, level III.