The journal of trauma and acute care surgery
-
J Trauma Acute Care Surg · Dec 2015
Multicenter Study Observational StudyRecursive partitioning identifies greater than 4 U of packed red blood cells per hour as an improved massive transfusion definition.
Massive transfusion (MT) is classically defined as greater than 10 U of packed red blood cells (PRBCs) in 24 hours. This fails to capture the most severely injured patients. Extending the previous work of Savage and Rahbar, a rolling hourly rate-based definition of MT may more accurately define critically injured patients requiring early, aggressive resuscitation. ⋯ Prognostic/epidemiologic study, level III.
-
J Trauma Acute Care Surg · Dec 2015
Multicenter StudyThe found down patient: A Western Trauma Association multicenter study.
Unconscious patients who present after being "found down" represent a unique triage challenge. These patients are selected for either trauma or medical evaluation based on limited information and have been shown in a single-center study to have significant occult injuries and/or missed medical diagnoses. We sought to further characterize this population in a multicenter study and to identify predictors of mistriage. ⋯ Epidemiologic study, level III.
-
J Trauma Acute Care Surg · Nov 2015
Multicenter Study Comparative StudyRisk factors for the development of heterotopic ossification in seriously burned adults: A National Institute on Disability, Independent Living and Rehabilitation Research burn model system database analysis.
Heterotopic ossification (HO) is a debilitating complication of burn injury; however, incidence and risk factors are poorly understood. In this study, we use a multicenter database of adults with burn injuries to identify and analyze clinical factors that predict HO formation. ⋯ Prognostic study, level III.
-
J Trauma Acute Care Surg · Oct 2015
Multicenter Study Comparative StudyImplementation of resuscitative endovascular balloon occlusion of the aorta as an alternative to resuscitative thoracotomy for noncompressible truncal hemorrhage.
Hemorrhage remains the leading cause of death in trauma patients. Proximal aortic occlusion, usually performed by direct aortic cross-clamping via thoracotomy, can provide temporary hemodynamic stability, permitting definitive injury repair. Resuscitative endovascular balloon occlusion of the aorta (REBOA) uses a minimally invasive, transfemoral balloon catheter, which is rapidly inserted retrograde and inflated for aortic occlusion, and may control inflow and allow time for hemostasis. We compared resuscitative thoracotomy with aortic cross-clamping (RT) with REBOA in trauma patients in profound hemorrhagic shock. ⋯ Therapeutic study, level IV.
-
J Trauma Acute Care Surg · Sep 2015
Multicenter StudyOutcomes after emergency abdominal surgery in patients with advanced cancer: Opportunities to reduce complications and improve palliative care.
There is increasing emphasis on the appropriateness and quality of acute surgical care for patients with serious illness and at the end of life. However, there is a lack of evidence regarding outcomes after emergent major abdominal surgery among patients with advanced cancer to guide treatment decisions. This analysis sought to characterize adverse outcomes (mortality, complications, institutional discharge) and to identify factors independently associated with 30-day mortality among patients with disseminated cancer who undergo emergent abdominal surgery for intestinal obstruction or perforation. ⋯ Prognostic study, level III; therapeutic study, level IV.