The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · May 2015
A pilot single-institution predictive model to guide rib fracture management in elderly patients.
Rib fractures (RFx) remain the most prevalent injury in an elderly population that will increase from 40 to 81 million for the next 30 years. We sought to create an accurate cost-effective algorithm to triage elderly patients with RFx that accounted for both frailty and trauma burden. ⋯ Prognostic and epidemiologic study, level III.
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J Trauma Acute Care Surg · May 2015
Absence of clinical findings reliably excludes unstable cervical spine injuries in children 5 years or younger.
Increased accessibility and rapidity of computed tomography (CT) have led to increased use and radiation exposure to pediatric trauma patients. The thyroid is radiosensitive and therefore at risk for developing malignancy from radiation exposure during cervical spine CT. This analysis aimed to determine which preelementary trauma patients warrant cervical spine CT by defining incidence and clinical characteristics of preelementary cervical spine injury. ⋯ Therapeutic study, level IV.
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J Trauma Acute Care Surg · May 2015
SIRT1 mediates a primed response to immune challenge after traumatic lung injury.
Pulmonary contusion (PC) is a common, potentially lethal injury that results in priming for exaggerated inflammatory responses to subsequent immune challenge like infection (second hit). The molecular mechanism of priming and the second hit phenomenon after PC remain obscure. With the use of a mouse model of PC, this study explores the role of sirtuin 1 (SIRT1), an NAD+-dependent deacetylase, in priming for a second hit after injury. ⋯ These results showed that PC decreased SIRT1 levels in the lung correlated with enhanced responses to infectious or inflammatory stimuli in injured mice. Treatment of injured mice with a SIRT1 activator, resveratrol, decreased LPS inflammatory response and increased survival after CLP. Our results suggest that SIRT1 participates in the second-hit response after injury.
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J Trauma Acute Care Surg · May 2015
Multicenter StudyAcute outcomes of isolated cerebral contusions in children with Glasgow Coma Scale scores of 14 to 15 after blunt head trauma.
Little data exist to guide the management of children with cerebral contusions after minor blunt head trauma. We therefore aimed to determine the risk of acute adverse outcomes in children with minor blunt head trauma who had cerebral contusions and no other traumatic brain injuries on computed tomography (i.e., isolated cerebral contusions). ⋯ Epidemiologic study, level IV.
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J Trauma Acute Care Surg · May 2015
Multicenter StudyImpact of specific postoperative complications on the outcomes of emergency general surgery patients.
The relative contribution of specific postoperative complications on mortality after emergency operations has not been previously described. Identifying specific contributors to postoperative mortality following acute care surgery will allow for significant improvement in the care of these patients. ⋯ Prognostic and epidemiologic study, level III.