The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Jul 2018
The role of four-factor prothrombin complex concentrate in coagulopathy of trauma: A propensity matched analysis.
Coagulopathy is a common complication after severe trauma. The efficacy of 4-factor prothrombin complex concentrate (4-PCC) as an adjunct to fresh frozen plasma (FFP) in reversal of coagulopathy of trauma (COT) has not been studied. The aim of our study is to compare 4-PCC + FFP versus FFP alone for the treatment of COT. ⋯ Therapeutic studies, level IV.
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J Trauma Acute Care Surg · Jul 2018
Multicenter Study Comparative StudyDeconstructing dogma: Nonoperative management of small bowel obstruction in the virgin abdomen.
Management of small bowel obstruction (SBO) has become more conservative, especially in those patients with previous abdominal surgery (PAS). However, surgical dogma continues to recommend operative exploration for SBO with no PAS. With the increased use of computed tomography imaging resulting in more SBO diagnoses, it is important to reevaluate the role of mandatory operative exploration. Gastrografin (GG) administration decreases the need for operative exploration and may be an option for SBO without PAS. We hypothesized that the use of GG for SBO without PAS will be equally effective in reducing the operative exploration rate compared with that for SBO with PAS. ⋯ Therapeutic, level IV.
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J Trauma Acute Care Surg · Jul 2018
Observational StudyOver Resuscitation With Plasma is Associated With Sustained Fibrinolysis Shutdown and Death in Pediatric Traumatic Brain Injury.
Elevated International Normalized Ratio (INR) is a marker of poor outcome but not necessarily bleeding or clinical coagulopathy in injured children. Conversely, children with traumatic brain injury (TBI) tend to be hypercoagulable based on rapid thromboelastography (rTEG) parameters. Many clinicians continue to utilize INR as a treatment target. ⋯ Prognostic and epidemiological study, level III.
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J Trauma Acute Care Surg · Jul 2018
Prehospital airway procedures performed in trauma patients by ground forces in Afghanistan.
Airway management is of critical importance in combat trauma patients. Airway compromise is the second leading cause of potentially survivable death on the battlefield and accounts for approximately 1 in 10 preventable deaths. Reports from the Iraq and Afghanistan wars indicate 4% to 7% incidence of airway interventions on casualties transported to combat hospitals. The goal of this study was to describe airway management in the prehospital combat setting and document airway devices used on the battlefield. ⋯ Prognostic and epidemiological study, level III.
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J Trauma Acute Care Surg · Jul 2018
Frailty screening and a frailty pathway decrease length of stay, loss of independence, and 30-day readmission rates in frail geriatric trauma and emergency general surgery patients.
Frail geriatric trauma and emergency general surgery (TEGS) patients have longer lengths of stay (LOS), more readmissions, and higher rates of postdischarge institutionalization than their nonfrail counterparts. Despite calls to action by national trauma coalitions, there are few published reports of prospective interventions. The objective of this quality improvement project was to first develop a frailty screening program, and, then, if frail, implement a novel frailty pathway to reduce LOS, 30-day readmissions, and loss of independence. ⋯ Therapeutic study, level IV.