The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Mar 2018
Resuscitative endovascular balloon occlusion of the aorta for pelvic blunt trauma and life-threatening hemorrhage: A 20-year experience in a Level I trauma center.
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is increasingly used as a noninvasive clamp of the aorta after diverse posttraumatic injuries. Balloon inflation in zone 3 (from the lower renal artery to the aortic bifurcation) can be performed to stop ongoing bleeding after severe pelvic trauma with life-threatening hemorrhage. The aim of our study was to describe our 20-year experience with REBOA in terms of efficacy and safety in patients with a suspicion of severe pelvic trauma and extreme hemorrhagic shock. ⋯ Therapeutic, level IV.
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J Trauma Acute Care Surg · Mar 2018
Multicenter Study Observational StudyContemporary management of high-grade renal trauma: Results from the American Association for the Surgery of Trauma Genitourinary Trauma study.
The rarity of renal trauma limits its study and the strength of evidence-based guidelines. Although management of renal injuries has shifted toward a nonoperative approach, nephrectomy remains the most common intervention for high-grade renal trauma (HGRT). We aimed to describe the contemporary management of HGRT in the United States and also evaluate clinical factors associated with nephrectomy after HGRT. ⋯ Prognostic/epidemiologic study, level III; Therapeutic study, level IV.
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J Trauma Acute Care Surg · Mar 2018
Multicenter Study Observational StudyIncreased risk of fibrinolysis shutdown among severely injured trauma patients receiving tranexamic acid.
The association between tranexamic acid (TXA) and fibrinolysis shutdown is unknown. We hypothesize that TXA is associated with fibrinolysis shutdown in critically injured trauma patients. ⋯ Therapeutic, level III.
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J Trauma Acute Care Surg · Mar 2018
Multicenter StudyLower emergency general surgery (EGS) mortality among hospitals with higher-quality trauma care.
Patients undergoing emergency general surgery (EGS) procedures are up to eight times more likely to die than patients undergoing the same procedures electively. This excess mortality is often attributed to nonmodifiable patient factors including comorbidities and physiologic derangements at presentation, leaving few targets for quality improvement. Although the hospital-level traits that contribute to EGS outcomes are not well understood, we hypothesized that facilities with lower trauma mortality would have lower EGS mortality. ⋯ Epidemiological, level III; Care management, level IV.
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J Trauma Acute Care Surg · Mar 2018
Safety and efficacy of brain injury guidelines at a Level III trauma center.
Patients with mild to moderate traumatic brain injury (TBI) are often primarily managed by emergency medicine and trauma/acute care physicians. The Brain Injury Guidelines (BIG) were developed at an American College of Surgeons-accredited Level 1 trauma center to triage mild to moderate TBI patients and help identify patients who warrant neurosurgical consultation. The BIG have not been validated at a Level III trauma center. We hypothesized that BIG criteria can be safely adapted to an American College of Surgeons-accredited Level III trauma center to guide transfers to a higher echelon of care. ⋯ Care management, level IV.