J Trauma
-
Comparative Study
Can we rely on computed tomographic scanning to diagnose pulmonary embolism in critically ill surgical patients?
Spiral computed tomographic pulmonary angiography (CTPA) is gaining an increasing role in pulmonary embolism (PE) diagnosis because it is more convenient and less invasive than conventional pulmonary angiography (PA). Encouraging reports on the reliability of CTPA for medical patients have prompted widespread use despite the fact that its value in critically ill surgical patients has been inadequately explored. Hemodynamic and respiratory issues of critical illness may interfere with CTPA's diagnostic accuracy. The objective of this study was to compare CTPA with PA for the diagnosis of PE in critically ill surgical patients. ⋯ PA remains the "gold standard" for diagnosis of PE in critically ill surgical patients. CTPA should be explored further before being universally accepted. Clinical criteria are unreliable for detecting PE in this population and therefore a high index of suspicion should be maintained.
-
Multicenter Study Comparative Study
Splenic embolization revisited: a multicenter review.
Splenic embolization can increase nonoperative salvage. However, complications are not clearly defined. A retrospective multicenter review was performed to delineate the risks and benefits of splenic embolization. ⋯ Splenic embolization remains a valuable technique in splenic salvage, especially in higher grade injuries. Complications are common but do not seem to affect outcome.
-
Comparative Study
Prehospital endotracheal intubation for trauma does not improve survival over bag-valve-mask ventilation.
Few data exist supporting a survival benefit to prehospital endotracheal intubation (ETI) over bag-valve-mask ventilation (BVM) in trauma patients. ⋯ In our trauma system, when corrected for mechanism and severity of anatomic and physiologic injury, ETI confers no survival advantage over BVM and slightly increases prehospital time.
-
Cerebral hypoxia (cerebral cortical oxygenation [Pbro2] < 20 mm Hg) monitored by direct measurement has been shown in animal and small clinical studies to be associated with poor outcome. We present our preliminary results observing Pbro2 in patients with traumatic brain injury (TBI). ⋯ Cerebral oxymetry is confirmed safe in the patient with multiple injuries with TBI. Occult cerebral hypoxia is present in the traumatic brain injured patient despite normal traditional measurements of cerebral perfusion. Further research is necessary to determine whether management protocols aimed at the prevention of cerebral cortical hypoxia will affect outcome.
-
Regionalization of trauma care services aims to improve outcomes by limiting trauma care delivery to a select group of dedicated trauma centers. However, the evidence linking trauma center volume and outcome is not conclusive. The objective of this study was to examine the volume-mortality relation for patients with severe trauma in the National Trauma Databank. ⋯ The findings of this study do not support the position that higher trauma center volumes are associated with improved survival. The implication of this study is that the hospital volume criteria established by the American College of Surgeons may need to be reexamined.