J Trauma
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Randomized Controlled Trial
The role of acute blood transfusion in the development of acute respiratory distress syndrome in patients with severe trauma.
Patients with major trauma necessitating the transfusion of packed red blood cells (PRBCs) are at increased risk for the acute respiratory distress syndrome (ARDS). However, it is presently unknown whether the amount of transfused blood is independently associated with development of ARDS in patients with severe trauma. ⋯ In severely injured trauma patients who require administration of packed red blood cells, the amount of transfused blood is independently associated with both the development of ARDS and hospital mortality.
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We conducted a comparison of methods for predicting survival using survival risk ratios (SRRs), including new comparisons based on International Classification of Diseases, Ninth Revision (ICD-9) versus Abbreviated Injury Scale (AIS) six-digit codes. ⋯ Predictions of survival based on anatomic injury alone can be performed using ICD-9 codes, with no advantage from extra coding of AIS diagnoses. Predictions based on the single worst SRR were closer to actual outcomes than those based on multiplying SRRs.
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This article summarizes current knowledge about the accuracy of screening tests and the efficacy of interventions for substance use disorders in different medical settings (including trauma centers) where the practitioners are not specialists in the management of substance use disorders. In the first section, we introduce basic screening approaches for psychoactive substance use disorders and issues of natural history, risk factors, and populations at risk. ⋯ We found strong evidence to support the effectiveness of brief interventions in managing at-risk drinkers; however, the evidence is only suggestive for drug use disorders. Finally, we explore the implications of the findings for developing a public health approach to early intervention, particularly as it relates to the unique needs of trauma centers.
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The aim of the study was to quantify trauma-related mortality in injured adults over 10 years postinjury. ⋯ Estimates of the total mortality burden, based on the early inpatient period alone, substantially underestimates the true burden from injury.
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To investigate the effect of ventilator-associated pneumonia (VAP) on the prognosis of head trauma patients. ⋯ We conclude that the occurrence of VAP caused by high-risk organisms in cranial trauma patients may increase the risk of death, the mechanical ventilation duration, the intensive care unit stay, and the hospital stay.