The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Feb 2016
Multicenter StudyTIMP2•IGFBP7 biomarker panel accurately predicts acute kidney injury in high-risk surgical patients.
Acute kidney injury (AKI) is an important complication in surgical patients. Existing biomarkers and clinical prediction models underestimate the risk for developing AKI. We recently reported data from two trials of 728 and 408 critically ill adult patients in whom urinary TIMP2•IGFBP7 (NephroCheck, Astute Medical) was used to identify patients at risk of developing AKI. Here we report a preplanned analysis of surgical patients from both trials to assess whether urinary tissue inhibitor of metalloproteinase 2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) accurately identify surgical patients at risk of developing AKI. ⋯ Prognostic study, level I.
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J Trauma Acute Care Surg · Feb 2016
Multicenter StudyMulticenter external validation of the Geriatric Trauma Outcome Score: A study by the Prognostic Assessment of Life and Limitations After Trauma in the Elderly (PALLIATE) consortium.
A prognostic tool for geriatric mortality after injury called the Geriatric Trauma Outcome Score (GTOS), where GTOS = [age] + [ISS × 2.5] + [22 if transfused any PRBCs by 24 hours after admission], was previously developed based on 13 years of data from geriatric trauma patients admitted to Parkland Hospital. We sought to validate this model. ⋯ Prognostic study, level III.
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J Trauma Acute Care Surg · Feb 2016
ReviewA systematic review of the use of resuscitative endovascular balloon occlusion of the aorta in the management of hemorrhagic shock.
Torso hemorrhage remains a leading cause of potentially preventable death within trauma, acute care, vascular, and obstetric practice. A proportion of patients exsanguinate before hemorrhage control. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an adjunct designed to sustain the circulation until definitive hemostasis. A systematic review was conducted to characterize the current clinical use of REBOA and its effect on hemodynamic profile and mortality. ⋯ Systematic review, level IV.
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J Trauma Acute Care Surg · Feb 2016
Helicopter interfacility transport of pediatric trauma patients: Are we overusing a costly resource?
Helicopter emergency medical services (HEMS) provide an important service to decrease interfacility transport times compared with ground ambulances. Although transport via HEMS is typically faster, the decreased transportation time comes at the expense of increased risks to the patient and flight crew and higher costs. Therefore, it is important to balance the immediate patient needs with the risk and expense of HEMS transport. Our objective was to determine how frequently pediatric patients who are interfacility transported to a Level 1 pediatric trauma center (PTC) receive a time-sensitive intervention. ⋯ Epidemiologic study, level V.
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J Trauma Acute Care Surg · Feb 2016
Ulinastatin and/or thymosin α1 for severe sepsis: A systematic review and meta-analysis.
Ulinastatin (UTI) and thymosin α1 (Tα1) have been investigated for their immunoregulatory properties in patients with severe sepsis. However, it is unclear whether immunomodulatory therapy using UTI combined with Tα1 (UCT), UTI alone (UA), or Tα1 alone (TA) improves the disease outcome. The objective of this study was to analyze the effectiveness of UCT, UA, and TA for the treatment of severe sepsis. ⋯ Systematic review, level IV.