The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · May 2012
Multicenter Study Comparative StudyInjury pattern, injury severity, and mortality in 33,495 hospital-admitted victims of motorized two-wheeled vehicle crashes in The Netherlands.
Road traffic accidents involving motorized two-wheeled vehicle (MTV) riders often result in severe morbidity and mortality. The aim of this nationwide study is to describe the influence of the type of motorized two-wheeled vehicle on the patient injury severity and mortality on hospitalization, after MTV accidents in The Netherlands. ⋯ II, epidemiological study.
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J Trauma Acute Care Surg · May 2012
Multicenter StudyDeciphering the use and predictive value of "emergency medical services provider judgment" in out-of-hospital trauma triage: a multisite, mixed methods assessment.
"Emergency medical services (EMS) provider judgment" was recently added as a field triage criterion to the national guidelines, yet its predictive value and real world application remain unclear. We examine the use and independent predictive value of EMS provider judgment in identifying seriously injured persons. ⋯ Among this multisite cohort of trauma patients, EMS provider judgment was the most commonly used field trauma triage criterion, independently associated with serious injury, and useful in identifying high-risk patients missed by other criteria. However, there was variability in predictive value between sites.
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J Trauma Acute Care Surg · May 2012
Multicenter Study Comparative StudyQuality indicators used by trauma centers for performance measurement.
To describe the quality indicators (QIs) that trauma centers use for quality measurement and performance improvement. Measuring and reporting quality of care is a critical step to improve the quality of care. QIs compare actual trauma care against ideal criteria and identify patients in whom care may have been suboptimal and should be further reviewed. ⋯ Our study provides the first description of the QIs used by verified trauma centers in four high-income countries with similar systems of trauma care. The majority of trauma centers measure QIs designed to examine the safety, effectiveness, efficiency, and timeliness of hospital processes and outcomes. Opportunities exist to standardize existing QIs to allow broader implementation and develop new QIs to examine patient-centered care and equality of care.
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J Trauma Acute Care Surg · Apr 2012
Multicenter StudyCrystalloid to packed red blood cell transfusion ratio in the massively transfused patient: when a little goes a long way.
Massive transfusion (MT) protocols have emphasized the importance of ratio-based transfusion of plasma and platelets relative to packed red blood cells (PRBCs); however, the risks attributable to crystalloid resuscitation in patients requiring MT remain largely unexplored. We hypothesized that an increased crystalloid:PRBC (C:PRBC) ratio would be associated with increased morbidity and poor outcome after MT. ⋯ In patients requiring MT, crystalloid resuscitation in a ratio greater than 1.5:1 per unit of PRBCs transfused was independently associated with a higher risk of MOF, ARDS, and ACS. These results suggest overly aggressive crystalloid resuscitation should be minimized in these severely injured patients. Further research is required to determine whether incorporation of the C:PRBC ratio into MT protocols improves outcome.
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J Trauma Acute Care Surg · Apr 2012
Multicenter StudyEpidemiology and predictors of cervical spine injury in adult major trauma patients: a multicenter cohort study.
Patients with cervical spine injuries are a high-risk group, with the highest reported early mortality rate in spinal trauma. ⋯ 3.5% of patients suffered cervical spine injury. Patients with a lowered GCS or systolic blood pressure, severe facial fractures, dangerous injury mechanism, male gender, and/or age ≥ 35 years are at increased risk. Contrary to common belief, head injury was not predictive for cervical spine involvement.