The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Jan 2018
Comparative StudyThe "mortality ascent": Hourly risk of death for hemodynamically unstable trauma patients at Level II versus Level I trauma centers.
Severely injured trauma patients have higher in-hospital mortality at Level II versus Level I trauma centers (TCs). To better understand these differences, we sought to determine if there were any periods during which hemodynamically unstable trauma patients are at higher risk of death at Level II versus Level I TCs within the first 24 hours postadmission. ⋯ Therapeutic/care management, level IV.
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Most combat casualties who die, do so in the prehospital setting. Efforts directed toward alleviating prehospital combat trauma death, known as killed in action (KIA) mortality, have the greatest opportunity for eliminating preventable death. ⋯ Therapy, level III.
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J Trauma Acute Care Surg · Jan 2018
Impact of Critical Care Air Transport Team (CCATT) ventilator management on combat mortality.
Aeromedical evacuation platforms such as Critical Care Air Transport Teams (CCATTs) play a vital role in the transport and care of critically injured and ill patients in the combat theater. Mechanical ventilation is used to support patients with failing respiratory function and patients requiring high levels of sedation. Mechanical ventilation, if not managed appropriately, can worsen or cause lung injury and contribute to increased morbidity. The purpose of this study was to evaluate the impact of ARDSNet protocol compliance during aeromedical evacuation of ventilated combat injured patients. ⋯ Therapeutic/care management, level IV.
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J Trauma Acute Care Surg · Jan 2018
Randomized Controlled TrialThe hyperfibrinolytic phenotype is the most lethal and resource intense presentation of fibrinolysis in massive transfusion patients.
Among bleeding patients, we hypothesized that the hyperfibrinolytic (HF) phenotype would be associated with the highest mortality, whereas shutdown (SD) patients would have the greatest complication burden. ⋯ Prognostic, level II.
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J Trauma Acute Care Surg · Jan 2018
Multicenter StudyA multicenter evaluation of the optimal timing of surgical stabilization of rib fractures.
The optimal timing of surgical stabilization of rib fractures (SSRF) remains debated. We hypothesized that (1) demographic, radiologic, and clinical variables are associated with time to surgery and (2) shorter time to SSRF improves acute outcomes. ⋯ Therapy, level III.