The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Mar 2017
Randomized Controlled Trial Multicenter Study Pragmatic Clinical TrialDamage control laparotomy utilization rates are highly variable among Level I trauma centers: Pragmatic, Randomized Optimal Platelet and Plasma Ratios findings.
Damage control laparotomy (DCL) is intended to limit deleterious effects from trauma-induced coagulopathy. DCL has been associated with mortality reduction, but may increase complications including sepsis, abscess, respiratory failure, hernia, and gastrointestinal fistula. We hypothesized that (1) DCL incidence would vary between institutions; (2) mortality rates would vary with DCL rates; (3) standard DCL criteria of pH, international normalized ratio, temperature and major intra-abdominal vascular injury would not adequately capture all patients. ⋯ Therapeutic study, level III.
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J Trauma Acute Care Surg · Mar 2017
ReviewReview of military and civilian trauma registries: Does consensus matter?
Structural collection of data from combat injuries is important to improve provided care and the outcome of (combat) casualties. Trauma registries are used in civilian and military health care systems for systematic administration of injury data. However, these registries often use different methods of data management, compromising international comparison of trauma systems. The aim of this review is to aid in reaching international (coalition-wide) consensus for compatible data collection methods with uniform definitions, which is needed for transnational research and subsequent improvement of medical support organizations. ⋯ Well-established and reliable trauma registries and databases are fundamental in (military) trauma care. We recommend implementation of a (concurrent) UN/NATO wide registry system with a track and follow-up system to further improve the quality of care and registration of casualties. Further research should focus on real time aids available on the battlefield and direct storage/upload in trauma databases in theater. Ultimately, sound and valid data support medical decision process and evaluation necessary to save lives on the battlefield.
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J Trauma Acute Care Surg · Mar 2017
Comparative StudyManagement of anticoagulation with rivaroxaban in trauma and acute care surgery: Complications and reversal strategies as compared to warfarin therapy.
Rivaroxaban has gained popularity as an anticoagulant (AC) for stroke prevention in nonvalvular atrial fibrillation (afib) and venous thromboembolism (VTE). Although adverse bleeding events are associated with all AC, lack of point-of-care testing to measure the effect of rivaroxaban in emergent situations has contributed to perceived increased risk among physicians. ⋯ Therapeutic study, level II.
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J Trauma Acute Care Surg · Mar 2017
The mangled extremity score and amputation: Time for a revision.
The Mangled Extremity Severity Score (MESS) was developed 25 years ago in an attempt to use the extent of skeletal and soft tissue injury, limb ischemia, shock, and age to predict the need for amputation after extremity injury. Subsequently, there have been mixed reviews as to the use of this score. We hypothesized that the MESS, when applied to a data set collected prospectively in modern times, would not correlate with the need for amputation. ⋯ Prospective, prognostic study, level III.
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J Trauma Acute Care Surg · Mar 2017
Analysis of aeromedical retrieval coverage using elliptical isochrones: An evaluation of helicopter fleet size configurations in Scotland.
Trauma systems in remote and rural regions often rely on helicopter emergency medical services to facilitate access to definitive care. The siting of such resources is key, but often relies on simplistic modeling of coverage, using circular isochrones. Scotland is in the process of implementing a national trauma network, and there have been calls for an expansion of aeromedical retrieval capacity. The aim of this study was to analyze population and area coverage of the current retrieval service configuration, with three aircraft, and a configuration with an additional helicopter, in the North East of Scotland, using a novel methodology. Both overall coverage and coverage by physician-staffed aircraft, with enhanced clinical capability, were analyzed. ⋯ Epidemiological study, level IV; therapeutic study, level IV.