The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Mar 2016
Automated continuous vital signs predict use of uncrossed matched blood (UnXRBC) and massive transfusion (MT) following trauma.
Recognizing the use of uncross-matched packed red blood cells (UnXRBC) or predicting need for massive transfusion (MT) in injured patients with hemorrhagic shock can be challenging. A validated predictive model could accelerate decision making regarding transfusion. ⋯ Level III.
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J Trauma Acute Care Surg · Mar 2016
Brain hypoxia is exacerbated in hypobaria during aeromedical evacuation in swine with TBI.
There is inadequate information on the physiological effects of aeromedical evacuation on wounded warfighters with traumatic brain injury (TBI). At altitudes of 8,000 ft., the inspired oxygen is lower than standard sea level values. In troops suffering TBI, this reduced oxygen may worsen or cause secondary brain injury. We tested the hypothesis that the effects of prolonged aeromedical evacuation on critical neurophysiological parameters (i.e., brain oxygenation [PbtO2]) of swine with a fluid percussion injury (FPI) -TBI would be detrimental compared to ground (normobaric) transport. ⋯ A 4 h aeromedical evacuation at simulated flight altitude of 8,000 ft. caused a notable reduction in neurophysiological parameters compared to normobaric conditions in this TBI swine model. Results suggest hypobaric conditions exacerbate cerebral hypoxia and may worsen TBI in casualties already in critical condition.Evidence Level II, Animal Research.
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J Trauma Acute Care Surg · Mar 2016
Timing of withdrawal of life-sustaining therapies in severe traumatic brain injury: Impact on overall mortality.
The care of patients with severe traumatic brain injury (TBI) is complex and confounded by uncertainty in prognoses. Studies have demonstrated significant unexplained variation in mortality between centers. Possible explanations include differences in the quality and intensity of care across centers, including the appropriateness and timing of withdrawal of life-sustaining therapies. We postulated that centers with a preponderance of early deaths might have a more pessimistic approach to the TBI patient, which would be reflected in an increased hospital TBI-related mortality. ⋯ Prognostic and epidemiologic study, level III.
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J Trauma Acute Care Surg · Mar 2016
Multicenter StudyA paradigm for achieving successful pediatric trauma verification in the absence of pediatric surgical specialists while ensuring quality of care.
Pediatric trauma centers (PTCs) are concentrated in urban areas, leaving large areas where children do not have access. Although adult trauma centers (ATCs) often serve to fill the gap, disparities exist. Given the limited workforce in pediatric subspecialties, many adult centers that are called upon to care for children cannot sufficiently staff their program to meet the requirements of verification as a PTC. We hypothesized that ATCs in collaboration with a PTC could achieve successful American College of Surgeons (ACS) verification as a PTC with measurable improvements in care. This article serves to provide an initial description of this collaborative approach. ⋯ Therapeutic/care management, level IV.
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J Trauma Acute Care Surg · Mar 2016
The Massive Transfusion Score as a decision aid for resuscitation: Learning when to turn the massive transfusion protocol on and off.
Previous work proposed a Massive Transfusion Score (MTS) calculated from values obtained in the emergency department to predict likelihood of massive transfusion (MT). We hypothesized the MTS could be used at Hour 6 to differentiate who continues to require balanced resuscitation in Hours 7 to 24 and to predict death at 28 days. ⋯ Prognostic study, level 3.