The journal of trauma and acute care surgery
-
J Trauma Acute Care Surg · Aug 2013
Multicenter StudyWhole-body computed tomography is associated with decreased mortality in blunt trauma patients with moderate-to-severe consciousness disturbance: a multicenter, retrospective study.
Whole-body computed tomography (WBCT) has become commonly used in the management of blunt trauma (BT) in high-income countries, but its indications are controversial. Advanced trauma life support recommends conducting head CT for traumatized patients with a Glasgow Coma Scale (GCS) score of 3 to 12. This nationwide study was conducted to verify that WBCT is also beneficial for these patients. ⋯ In Japan, integration of WBCT into initial trauma management may decrease mortality in BT patients with a GCS score of 3 to 12 for whom head CT is indicated.
-
J Trauma Acute Care Surg · Aug 2013
Multicenter StudyThe Burns Evaluation and Mortality Study (BEAMS): predicting deaths in Australian and New Zealand burn patients admitted to intensive care with burns.
An understanding of prognosis following burns is important. It alleviates patient and familial stress, provides a framework for better resource use, and facilitates benchmarking of performance between specialist centers. ⋯ A highly discriminatory mortality prediction model was developed using logistic regression. Risk of death following major burns can be predicted from a combination of physiologic and burns specific parameters. Female sex is a highly significant risk factor.
-
J Trauma Acute Care Surg · Jul 2013
Multicenter StudyApplication of the Berlin definition in PROMMTT patients: the impact of resuscitation on the incidence of hypoxemia.
Acute lung injury following trauma resuscitation remains a concern despite recent advances. With the use of the PROMMTT study population, the risk of hypoxemia and potential modifiable risk factors are studied. ⋯ Severe chest injury, increasing age, and crystalloid-based resuscitation, but not blood transfusions, were associated with increased risk of developing moderate-to-severe hypoxemia following injury.
-
J Trauma Acute Care Surg · Jul 2013
Multicenter StudyThe impact of missing trauma data on predicting massive transfusion.
Missing data are inherent in clinical research and may be especially problematic for trauma studies. This study describes a sensitivity analysis to evaluate the impact of missing data on clinical risk prediction algorithms. Three blood transfusion prediction models were evaluated using an observational trauma data set with valid missing data. ⋯ Evaluating the accuracy clinical prediction models with missing data can be misleading, especially with many predictor variables and moderate levels of missingness per variable. The proposed sensitivity analysis describes the influence of missing data on risk prediction algorithms. Reporting upper-lower bounds for percent correct classification may be more informative than multiple imputation, which provided similar results to complete case analysis in this study.
-
J Trauma Acute Care Surg · Jul 2013
Multicenter StudyPrehospital intravenous fluid is associated with increased survival in trauma patients.
Delivery of intravenous crystalloid fluids (IVF) remains a tradition-based priority during prehospital resuscitation of trauma patients. Hypotensive and targeted resuscitation algorithms have been shown to improve patient outcomes. We hypothesized that receiving any prehospital IVF is associated with increased survival in trauma patients compared with receiving no prehospital IVF. ⋯ Prehospital IVF volumes commonly used by PRospective Observational Multicenter Massive Transfusion Study (PROMMTT) investigators do not result in increased systolic blood pressure but are associated with decreased in-hospital mortality in trauma patients compared with patients who did not receive prehospital IVF.