J Trauma
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Comparative Study
Impact of American College of Surgeons verification on trauma outcomes.
The purpose of this study was to compare the impact of trauma patient outcomes before and after Level II American College of Surgeons (ACS) verification was received in a not-for-profit community hospital. ⋯ This study suggests that the efforts and resources consumed achieving ACS Level II trauma center verification appear to result in desired outcomes as evidenced by decreased LOS, reduced in-hospital mortality rates, reduced cost, and improved contribution margins.
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Comparative Study Clinical Trial Controlled Clinical Trial
Liver cirrhosis: an unfavorable factor for nonoperative management of blunt splenic injury.
Nonoperative management (NOM) of blunt splenic injury (BSI) is currently a well-accepted treatment modality for hemodynamically stable patients. More than 60% of BSI patients can be successfully treated without operation. Old age, high-grade injury, contrast blush, and multiple associated injuries were reported to have a higher failure rate but not to be exclusive of NOM. The purpose of this study was to review the treatment courses and results of a special group of BSI patients with coexistent liver cirrhosis. Factors leading to poor results were analyzed and treatment strategy was proposed accordingly. ⋯ Liver cirrhosis with subsequent development of portal hypertension, splenomegaly, and coagulopathy makes spontaneous hemostasis of the injured spleen difficult. NOM for BSI patients with coexistent liver cirrhosis carries a high failure and mortality rate. NOM may be successful in only a small group of patients with low-grade single-organ injury and with a normal or mildly elevated PT. Aggressive correction of coagulopathy should be performed in these patients. High-grade splenic injury, multiple associated injuries, and an elevated PT are indicators for early surgery. The mortality rate is high in patients with a severely prolonged PT irrespective of treatment modalities.
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Comparative Study
Pelvic fractures in pediatric and adult trauma patients: are they different injuries?
Many aspects of pediatric trauma are considerably different from adult trauma. Very few studies have performed comprehensive comparisons between pediatric and adult pelvic fractures. The purpose of this study was to compare the incidence of pelvic fracture, the epidemiologic characteristics, type of associated abdominal injuries, and outcomes between pediatric (age 16 years) patients. ⋯ Pediatric trauma patients are significantly less likely than adults to suffer pelvic fractures, although the age group is not a significant risk factor for the severity of pelvic fracture. The incidence of associated abdominal injuries is high and similar in the two age groups. Motor vehicle crash, fall from a height, and pelvis AIS score >/= 4 were significant predictors of associated abdominal injuries in the adult but not the pediatric patients. The need for blood transfusion is similar in both groups irrespective of Injury Severity Score and pelvis AIS score. The mortality resulting from exsanguination related to pelvic fractures is very low, especially in pediatric patients.
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Comparative Study
Comparative analysis of hemostatic agents in a swine model of lethal groin injury.
Techniques for better hemorrhage control after injury could change outcome. A large-animal model of lethal, uncontrolled hemorrhage was developed to test whether the use of various hemostatic agents would decrease bleeding and improve early survival. ⋯ Of the hemostatic agents tested, QuikClot improved survival and decreased bleeding in a swine model of lethal vascular and soft tissue injury.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Prevention of venous thromboembolism in the rehabilitation phase after spinal cord injury: prophylaxis with low-dose heparin or enoxaparin.
This prospective, multicenter study compared low-dose unfractionated heparin (UFH) with enoxaparin for prophylaxis against venous thromboembolism (VTE) during the rehabilitation phase after spinal cord injury. ⋯ In this nonrandomized comparison, enoxaparin appeared more effective than heparin in the prevention of thromboembolic complications during rehabilitation after spinal cord injury. Both interventions were safe in this population.