The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Mar 2016
Multicenter StudyA paradigm for achieving successful pediatric trauma verification in the absence of pediatric surgical specialists while ensuring quality of care.
Pediatric trauma centers (PTCs) are concentrated in urban areas, leaving large areas where children do not have access. Although adult trauma centers (ATCs) often serve to fill the gap, disparities exist. Given the limited workforce in pediatric subspecialties, many adult centers that are called upon to care for children cannot sufficiently staff their program to meet the requirements of verification as a PTC. We hypothesized that ATCs in collaboration with a PTC could achieve successful American College of Surgeons (ACS) verification as a PTC with measurable improvements in care. This article serves to provide an initial description of this collaborative approach. ⋯ Therapeutic/care management, level IV.
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J Trauma Acute Care Surg · Mar 2016
Multicenter StudyTrauma center care is associated with reduced readmissions after injury.
Trauma center care has been associated with improved mortality. It is not known if access to trauma center care is also associated with reduced readmissions. We hypothesized that receiving treatment at a trauma center would be associated with improved care and therefore would be associated with reduced readmission rates. ⋯ Epidemiologic study, level III; therapeutic/care management study, level IV.
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J Trauma Acute Care Surg · Feb 2016
Multicenter StudyTIMP2•IGFBP7 biomarker panel accurately predicts acute kidney injury in high-risk surgical patients.
Acute kidney injury (AKI) is an important complication in surgical patients. Existing biomarkers and clinical prediction models underestimate the risk for developing AKI. We recently reported data from two trials of 728 and 408 critically ill adult patients in whom urinary TIMP2•IGFBP7 (NephroCheck, Astute Medical) was used to identify patients at risk of developing AKI. Here we report a preplanned analysis of surgical patients from both trials to assess whether urinary tissue inhibitor of metalloproteinase 2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) accurately identify surgical patients at risk of developing AKI. ⋯ Prognostic study, level I.
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J Trauma Acute Care Surg · Feb 2016
Multicenter StudyMulticenter external validation of the Geriatric Trauma Outcome Score: A study by the Prognostic Assessment of Life and Limitations After Trauma in the Elderly (PALLIATE) consortium.
A prognostic tool for geriatric mortality after injury called the Geriatric Trauma Outcome Score (GTOS), where GTOS = [age] + [ISS × 2.5] + [22 if transfused any PRBCs by 24 hours after admission], was previously developed based on 13 years of data from geriatric trauma patients admitted to Parkland Hospital. We sought to validate this model. ⋯ Prognostic study, level III.
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J Trauma Acute Care Surg · Dec 2015
Multicenter StudyThe role of computed tomographic scan in ongoing triage of operative hepatic trauma: A Western Trauma Association multicenter retrospective study.
A subset of patients explored for abdominal injury have persistent hepatic bleeding on postoperative computed tomography (CT) and/or angiography, either not identified or not manageable at initial laparotomy. To identify patients at risk for ongoing hemorrhage and guide triage to angiography, we investigated the relationship of early postoperative CT scan with outcomes in operative hepatic trauma. ⋯ Care management/therapeutic study, level IV; epidemiologic/prognostic study, level III.