The journal of trauma and acute care surgery
-
Failure to rescue (FTR) is defined as death after an adverse event. The original metric was derived in elective surgical populations and reclassifies deaths not preceded by recorded adverse events as FTR cases under the assumption these deaths resulted from missed adverse events. This approach lacks face validity in trauma because patients often die without adverse events as a direct result of injury. Another common approach simply excludes deaths without recorded adverse events, but this approach reduces the reliability of the FTR metric. We hypothesized that a hybrid metric excluding expected deaths but otherwise including patients without recorded adverse events in FTR analysis would improve face validity and reliability relative to existing methods. ⋯ Retrospective cohort study, outcomes, level III.
-
J Trauma Acute Care Surg · Oct 2017
Randomized Controlled Trial Multicenter StudyValidation of a clinical trial composite endpoint for patients with necrotizing soft tissue infections.
Our objective was to develop and validate a composite endpoint for patients with necrotizing soft tissue infections that incorporates: local tissue injury, systemic organ dysfunction, and mortality. ⋯ Prognostic/Epidemiological, level III; Therapeutic, level IV.
-
J Trauma Acute Care Surg · Oct 2017
Prehospital administration of freeze-dried plasma, is it the solution for trauma casualties?
Hemorrhage is the leading cause of possible preventable death in the battlefield. There is an increasing evidence for the effectiveness of blood component therapy in general, and plasma infusion in particular but their use is less applicable in the prehospital setting due to logistic difficulties. Israeli Defense Force has implemented the use of freeze-dried plasma (FDP) at the point of injury (POI), this adoption of FDP use entailed doubts regarding the feasibility and effectiveness of this practice. In this article, we present our experience with the use of FDP at the POI and prehospital setting regarding the feasibility, safety, adverse reactions, and adherence to clinical practice guidelines. ⋯ Retrospective case series study, level IV.
-
J Trauma Acute Care Surg · Oct 2017
Consequences of pediatric undertriage and overtriage in a statewide trauma system.
With increasing attention to the quality of health care delivery, evaluating trauma triage decisions in a large system of emergency care can help decision makers reduce mortality, morbidity, unnecessary transfers, and health care costs. ⋯ Prognostic and epidemiological, level III.
-
J Trauma Acute Care Surg · Oct 2017
Comparative Study Observational StudyComparison of compensatory reserve and arterial lactate as markers of shock and resuscitation.
During traumatic hemorrhage, the ability to identify shock and intervene before decompensation is paramount to survival. Lactate is extremely sensitive to shock, and its clearance has been demonstrated a useful gauge of shock and resuscitation status. Though lactate can be measured in the field, logistical constraints render it impractical in certain environments. The compensatory reserve represents a new clinical measurement reflecting the remaining capacity to compensate for hypoperfusion. We hypothesized the compensatory reserve index (CRI) would be an effective surrogate marker of shock and resuscitation compared to lactate. ⋯ Diagnostic, Level II.