J Trauma
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This study aims to determine the cost-benefit analysis of adding a full emergency general surgery (EGS) arm to a trauma/critical care (TCC) service with limited EGS activity in a Level I trauma center. ⋯ Integrating a full EGS into a TCC service encumbers increased nontrauma unscheduled clinical activity in the operating room, clinic, and floors, which resulted in enhanced billings. These beneficial effects were accrued at the expense of individual time and investment in recruiting additional faculty.
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Comparative Study
Spinal cord injury: outcomes of ventilatory weaning and extubation.
Spinal cord injury (SCI) carries potentially devastating respiratory implications depending on injury level. Optimal strategies for mechanical ventilation in this setting remain poorly described. We reviewed our experience of ventilatory weaning and extubation outcomes in this patient population. ⋯ Higher level of SCI correlates strongly with failure to wean and extubate; despite this, a subset of patients with high cord injury who can be safely weaned and extubated exists. A multicenter study is warranted to specifically identify patients with high SCI who merit weaning and extubation trials.
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Multicenter Study Comparative Study
Pain as an indication for rib fixation: a bi-institutional pilot study.
In trauma patients, open reduction and internal fixation of rib fractures remain controversial. We hypothesized that patients who have open reduction and internal fixation of rib fractures would experience less pain compared with controls and thus require fewer opiates. Further, we hypothesized that improved pain control would result in fewer pulmonary complications and decreased length of stay. ⋯ The need for analgesia was significantly reduced after rib fixation in patients with multiple rib fractures. However, no difference in outcomes was observed when these patients were compared with matched controls in this pilot study. Further study is required to investigate these preliminary findings.
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Comparative Study
Minimal aortic injury after blunt trauma: selective nonoperative management is safe.
An increasing number of minimal aortic injuries (MAIs) are being identified with modern computed tomography (CT) imaging techniques. The optimal management and natural history of these injuries are unknown. We have adopted a policy of selective multidisciplinary nonoperative management of MAI. This study examines our experience with these patients from July 2004 to June 2009. ⋯ Almost one-third of our BAI were safely managed nonoperatively. Patients with MAI should be considered for selective nonoperative management in a multidisciplinary approach with close radiographic follow-up. We recommend that patients with MAIs should be considered for selective nonoperative management.
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Comparative Study
A prospective longitudinal study of posttraumatic stress disorder symptom trajectories after burn injury.
Psychologic problems are common after burns, and symptoms of posttraumatic stress disorder (PTSD) are some of the most prevalent. Risk factors for PTSD have been identified, but little is known about the onset and course of these symptoms. The objective was to investigate whether there are different PTSD symptom trajectories after burns. ⋯ There are subgroups among patients with burns that have different patterns of PTSD symptom development. These findings may have implications for clinical practice, such as the timing of assessment and the management of patients who present with these symptoms.