J Trauma
-
Systemic inflammatory response syndrome (SIRS) score has been demonstrated to be an accurate predictor of outcome in critical surgical illness. To our knowledge, there is a paucity of data using SIRS score as a tool to predict posttraumatic infection. Our goal was to determine whether the severity of SIRS score at admission is an accurate predictor of infection in trauma patients. ⋯ An admission SIRS score of > or = 2 is a significant independent predictor of infection and outcome in blunt trauma. Daily SIRS scores may be a meaningful method of assessing postinjury risk of infection, and may initiate earlier diagnostic intervention for determination of infection.
-
Emergency Medical Services (EMS) personnel provide care in the out-of-hospital setting. The EMS report, including blood volume estimates, influences hospital management. Our objective was to assess the accuracy of EMS blood volume estimates. ⋯ EMS personnel are unable to estimate "blood" volume accurately irrespective of level of training.
-
Prolonged use of spinal precautions in unconscious trauma patients is associated with significant morbidity. The trauma service of the John Radcliffe Hospital uses full-length radiography, computed tomographic scanning, and dynamic screening of the cervical spine to clear the spine at the earliest opportunity. ⋯ Full length spinal radiography and dynamic cervical screening may allow early and safe discontinuation of spinal precautions in the unconscious trauma patient in whom clinical signs are absent or unreliable.
-
Multicenter Study
Penetrating colon injuries requiring resection: diversion or primary anastomosis? An AAST prospective multicenter study.
The management of colon injuries that require resection is an unresolved issue because the existing practices are derived mainly from class III evidence. Because of the inability of any single trauma center to accumulate enough cases for meaningful statistical analysis, a multicenter prospective study was performed to compare primary anastomosis with diversion and identify the risk factors for colon-related abdominal complications. ⋯ The surgical method of colon management after resection for penetrating trauma does not affect the incidence of abdominal complications, irrespective of associated risk factors. Severe fecal contamination, transfusion of > or = 4 units of blood within the first 24 hours, and single-agent antibiotic prophylaxis are independent risk factors for abdominal complications. In view of these findings, the reduced quality of life, and the need for a subsequent operation in colostomy patients, primary anastomosis should be considered in all such patients.
-
Activated platelets have been recently reported to produce platelet microparticles and to enhance platelet-leukocyte interaction. The precise role of platelets in systemic inflammatory response syndrome (SIRS) has not been clarified. The objective of this study was to evaluate microparticle formation and platelet-leukocyte interaction in severe trauma and sepsis. ⋯ Activated platelets enhance microparticle formation and platelet-leukocyte interaction in severe trauma and sepsis. Enhanced platelet-leukocyte interaction is dependent on P-selectin expression and may be involved in the systemic inflammatory response after severe inflammatory insult.