J Trauma
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This study aimed to analyze the relation of hyperglycemia to outcome in cases of severe traumatic brain injury, and to examine factors that may be responsible for the hyperglycemic state. ⋯ Early hyperglycemia is associated with poor outcomes for patients with severe traumatic brain injury. Tighter control of serum glucose without reduction of nutritional support may improve the prognosis for these critically ill patients.
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The purpose of this study was to assess the prevalence and determinants of disabilities and return to work after severe injury in a Dutch, Level I trauma center. ⋯ Severe trauma has a substantial impact on long-term functioning. Empiric quantitative data, as presented in this study, enable us to estimate the burden of injury and to evaluate the quality of trauma care programs.
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Comparative Study
Comparison of Maryland hospital discharge and trauma registry data.
This study aimed to examine the validity of using Maryland hospital discharge data to characterize injuries sustained by trauma patients. ⋯ The Maryland hospital discharge data are a valid source for documenting the nature and severity of injuries sustained by trauma patients, except for those with a relatively minor head injury.
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Empiric antibiotic therapy is routinely initiated for patients with presumed ventilator-associated pneumonia (VAP). The impact of inadequate empiric antibiotic therapy (IEAT) may vary among critically ill populations. The purpose of this retrospective study was to determine the effect of IEAT on the outcome for adult trauma patients with VAP. ⋯ Critically ill trauma patients experiencing multiple episodes of IEAT for VAP have increased morbidity and mortality. These findings reinforce the importance of developing and refining a unit-specific pathway for the empiric management of VAP.
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It has been shown that spinal fracture fixation within 3 days can reduce the incidence of pneumonia, length of stay, number of ventilator days, and hospital charges. Our institutional protocol calls for surgical stabilization of spinal fractures within 3 days of admission. We hypothesized that compliance with an early spinal fracture fixation protocol (within 3 days of admission) would improve non-neurologic outcome in patients with spinal fractures. ⋯ Reasonable compliance with an early spinal fracture fixation protocol produced some outcome improvements in non-neurologic outcome. Early spine stabilization reduced hospital length of stay in all patients. Patients with thoracic spine trauma and a spinal cord injury had the greatest benefit in reduction of morbidity, HLOS and ICULOS from early stabilization. There was a trend toward poorer outcome in some groups with early spine stabilization. A rigid protocol requiring early surgical spine stabilization in all patients does not appear justified. Although early spine stabilization should be performed whenever possible to reduce hospital length of stay, the timing of this procedure should be individualized to allow patients with the most severe physiologic derangements to be optimized preoperatively.