Annals of surgery
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Multicenter Study
The association between fluid administration and outcome following major burn: a multicenter study.
To determine patient and injury variables that influence fluid requirements following burn injury and examine the association between fluid volume received and outcome. ⋯ TBSA, age, weight, and intubation status on admission were significant predictors of fluid received. Patients who received larger volumes of resuscitation fluid were at higher risk for injury complications and death.
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To determine the effect of resuscitation with hypertonic saline/dextran (HSD) on the innate immune response after injury. ⋯ HSD resuscitation results in transient inhibition of PMN CD11b expression and partial restoration of the normal monocyte phenotype early after injury.
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Almost 50% of traumatic brain-injured (TBI) patients are alcohol intoxicated. The Glasgow Coma Scale (GCS) is frequently used to direct diagnostic and therapeutic decisions in these patients. It is commonly assumed that alcohol intoxication reduces GCS, thus limiting its utility in intoxicated patients. The purpose of this study was to test the hypothesis that the presence of blood alcohol has a clinically significant impact on GCS in TBI patients. ⋯ Alcohol use does not result in a clinically significant reduction in GCS in trauma patients. Attributing low GCS to alcohol intoxication in TBI patients may delay necessary diagnostic and therapeutic interventions.
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To determine whether and to what extent preexisting medical comorbidities influence mortality risk and length of hospitalization in patients with acute burn injury. ⋯ A number of preexisting medical conditions influence outcomes in acute burn injury. Patients with preburn HIV/AIDS, metastatic cancer, liver disease, and renal disease have particularly poor prognoses.
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Review the evidence regarding methods to prevent wrong site operations and present a framework that healthcare organizations can use to evaluate whether they have reduced the probability of wrong site, wrong procedure, and wrong patient operations. ⋯ There is limited evidence of behavioral interventions to reduce wrong site, patient, and surgical procedures. We have outlined a framework of measures that healthcare organizations can use to start evaluating whether they have reduced adverse events in operations.