The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · May 2018
Multicenter StudyEffect of door-to-angioembolization time on mortality in pelvic fracture: Every hour of delay counts.
Angioembolization (AE) is widely used for hemorrhagic control in patients with pelvic fracture. The latest version of the Resources for Optimal Care of the Injured Patient issued by the American College of Surgeons Committee on Trauma requires interventional radiologists to be available within 30 minutes to perform an emergency AE. However, the impact of time-to-AE on patient outcomes remains unknown. We hypothesized that a longer time-to-AE would be significantly associated with increased mortality in patients with pelvic fracture. ⋯ Therapeutic/care management, level IV.
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J Trauma Acute Care Surg · May 2018
Multicenter StudyHospital variation in mortality after emergent bowel resections: The role of failure-to-rescue.
Hospital variation in failure-to-rescue (FTR) rates has partially explained nationwide differences in mortality after elective surgeries. To examine the role of FTR among emergency general surgery, we compared nationwide risk-adjusted mortality, complications, and FTR rates after emergent bowel resections. ⋯ Prognostic and epidemiological study, level IV.
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J Trauma Acute Care Surg · Mar 2018
Multicenter Study Observational StudyContemporary management of high-grade renal trauma: Results from the American Association for the Surgery of Trauma Genitourinary Trauma study.
The rarity of renal trauma limits its study and the strength of evidence-based guidelines. Although management of renal injuries has shifted toward a nonoperative approach, nephrectomy remains the most common intervention for high-grade renal trauma (HGRT). We aimed to describe the contemporary management of HGRT in the United States and also evaluate clinical factors associated with nephrectomy after HGRT. ⋯ Prognostic/epidemiologic study, level III; Therapeutic study, level IV.
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J Trauma Acute Care Surg · Mar 2018
Multicenter Study Observational StudyIncreased risk of fibrinolysis shutdown among severely injured trauma patients receiving tranexamic acid.
The association between tranexamic acid (TXA) and fibrinolysis shutdown is unknown. We hypothesize that TXA is associated with fibrinolysis shutdown in critically injured trauma patients. ⋯ Therapeutic, level III.
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J Trauma Acute Care Surg · Mar 2018
Multicenter StudyLower emergency general surgery (EGS) mortality among hospitals with higher-quality trauma care.
Patients undergoing emergency general surgery (EGS) procedures are up to eight times more likely to die than patients undergoing the same procedures electively. This excess mortality is often attributed to nonmodifiable patient factors including comorbidities and physiologic derangements at presentation, leaving few targets for quality improvement. Although the hospital-level traits that contribute to EGS outcomes are not well understood, we hypothesized that facilities with lower trauma mortality would have lower EGS mortality. ⋯ Epidemiological, level III; Care management, level IV.