The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · May 2013
Multicenter StudyAggressive early crystalloid resuscitation adversely affects outcomes in adult blunt trauma patients: an analysis of the Glue Grant database.
Evidence suggests that aggressive crystalloid resuscitation is associated with significant morbidity in various clinical settings. We wanted to assess whether aggressive early crystalloid resuscitation adversely affects outcomes in adult blunt trauma patients. ⋯ Crystalloid resuscitation is associated with a substantial increase in morbidity, as well as ICU and hospital LOS in adult blunt trauma patients.
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J Trauma Acute Care Surg · May 2013
Multicenter Study Comparative StudyA comparison of methods to obtain a composite performance indicator for evaluating clinical processes in trauma care.
Process performance indicators that evaluate trauma centers in clinical case management provide information essential to the improvement of trauma care. However, multiple indicators are needed to adequately evaluate process performance, which renders comparisons cumbersome. Several methods are available for generating composite indicators that measure global performance. The goal of this study was to compare three composite methods that are widely used in other health care domains to identify the most appropriate for trauma care process performance evaluation. ⋯ Results suggest that of the three composite scores evaluated, only the indicator average demonstrates content and predictive criterion validity, discriminates between centers, and has good forecasting properties. In addition, this score is simple and intuitive and not subject to variation in weights over trauma systems and time. The observed association between higher indicator average scores and lower risk-adjusted mortality and complication rates suggests that improving process performance may improve patient outcome.
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J Trauma Acute Care Surg · May 2013
Multicenter StudyGoal-directed resuscitation in the prehospital setting: a propensity-adjusted analysis.
The scope of prehospital (PH) interventions has expanded recently--not always with clear benefit. PH crystalloid resuscitation has been challenged, particularly in penetrating trauma. Optimal PH crystalloid resuscitation strategies remain unclear in blunt trauma as does the influence of PH hypotension. The objective was to characterize outcomes for PH crystalloid volume in patients with and without PH hypotension. ⋯ In severely injured blunt trauma patients, PH crystalloid more than 500 mL was associated with worse outcome in patients without PH hypotension but not with PH hypotension. HIGH crystalloid was associated with corrected PH hypotension. This suggests that PH resuscitation should be goal directed based on the presence or absence of PH hypotension.
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J Trauma Acute Care Surg · Apr 2013
Multicenter Study Comparative StudyA simple clinical risk nomogram to predict mortality-associated geriatric complications in severely injured geriatric patients.
This study aimed to (1) identify inpatient complications associated with the greatest differential mortality risk between young and old patients with traumatic injury and (2) identify older patients at elevated risk for mortality-associated complications. ⋯ Prognostic/epidemiologic study, level III.
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J Trauma Acute Care Surg · Apr 2013
Multicenter Study Comparative StudyEmergency general surgery: definition and estimated burden of disease.
Acute care surgery encompasses trauma, surgical critical care, and emergency general surgery (EGS). While the first two components are well defined, the scope of EGS practice remains unclear. This article describes the work of the American Association for the Surgery of Trauma to define EGS. ⋯ This article provides the first list of ICD-9 diagnoses codes that define the scope of EGS based on current clinical practices. These findings have wide implications for EGS workforce training, access to care, and research.