The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Mar 2013
Randomized Controlled Trial Multicenter Study Comparative StudyA prospective multicenter comparison of levetiracetam versus phenytoin for early posttraumatic seizure prophylaxis.
Brain Trauma Foundation guidelines recommend seizure prophylaxis for preventing early posttraumatic seizure (PTS). Phenytoin (PHE) is commonly used. Despite a paucity of data in traumatic brain injury, levetiracetam (LEV) has been introduced as a potential replacement, which is more costly but does not require serum monitoring. The purpose of this study was to compare the efficacy of PHE with that of LEV for preventing early PTS. ⋯ Therapeutic study, level III.
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J Trauma Acute Care Surg · Mar 2013
Randomized Controlled Trial Multicenter StudyOccult pneumothoraces in critical care: a prospective multicenter randomized controlled trial of pleural drainage for mechanically ventilated trauma patients with occult pneumothoraces.
Patients with an occult pneumothoraces (OPTXs) may be at risk of tension pneumothoraces (TPTXs) without drainage or pleural drainage complications if treated. ⋯ Therapeutic study, level III.
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J Trauma Acute Care Surg · Mar 2013
Multicenter Study Comparative StudyAnalysis of radiation exposure among pediatric trauma patients at national trauma centers.
Injured children undergo radiologic studies as part of trauma evaluations. Children are more sensitive than adult patients to the effects of ionizing radiation. Few studies have described the radiation exposure to pediatric patients during trauma evaluations. We sought to describe the rate of use of radiology studies and to estimate the effective dose of radiation delivered to pediatric trauma patients presenting to trauma centers within the United States. ⋯ Epidemiologic study, level III.
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J Trauma Acute Care Surg · Mar 2013
Multicenter Study Comparative StudyLimb salvage after complex repairs of extremity arterial injuries is independent of surgical specialty training.
Major peripheral vascular trauma is managed by several surgical specialties. The impact of surgical specialty training and certification on outcome has not been evaluated. We hypothesized that general surgeons without specialty training in vascular surgery would have outcomes equivalent to surgeons with vascular training in the management of extremity arterial injuries requiring interposition grafting. ⋯ Therapeutic/care management, level III.
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J Trauma Acute Care Surg · Feb 2013
Multicenter Study Clinical TrialNational Trauma Institute prospective evaluation of the ventilator bundle in trauma patients: does it really work?
Since its introduction by the Institute for Healthcare Improvement, the ventilator bundle (VB) has been credited with a reduction in ventilator-associated pneumonia (VAP). The VB consists of stress ulcer prophylaxis, deep venous thrombosis prophylaxis, head-of-bed elevation, and daily sedation vacation with weaning assessment. While there is little compelling evidence that the VB is effective, it has been widely accepted. The Centers for Medical and Medicaid Services has suggested that VAP should be a "never event" and may reduce payment to providers. To provide evidence of its efficacy, the National Trauma Institute organized a prospective multi-institutional trial to evaluate the utility of the VB. ⋯ Therapeutic study, level III.