J Trauma
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Multicenter Study
Prehospital hypoxia affects outcome in patients with traumatic brain injury: a prospective multicenter study.
The goals of this study were to determine the incidence and duration of hypotension and hypoxia in the prehospital setting in patients with potentially survivable brain injuries, and to prospectively examine the association of these secondary insults with mortality and disability at hospital discharge. ⋯ Secondary insults after TBI are common, and these insults are associated with disability. Hypoxia in the prehospital setting significantly increases the odds of mortality after brain injury controlled for multiple variables.
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Multicenter Study
Cervical spine injury is highly dependent on the mechanism of injury following blunt and penetrating assault.
The mechanism of injury has not been highly regarded as an important variable when evaluating cervical spine injuries. The aim of this study was to determine the incidence of cervical spine fracture (CSF) and cervical spinal cord injury (CSCI) based on mechanism following blunt and penetrating assault to better aid prioritization of management. ⋯ The rate of CSF or CSCI is low following assault and dependent on mechanism of injury. Thus the concern and extent of evaluation should also be dependent on the mechanism of injury. Neurologic deficits from penetrating assault were established and final at the time of presentation. Concern for protecting the neck should not hinder the evaluation process or life saving procedures.
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Comparative Study
External circular fixation: a comparison of infection rates between wires and conical half-pins with threads outside or inside the skin.
The purpose of this study was to evaluate if there is a difference in the rates of infection between Ilizarov wires and half-pins and between half-pins with threads outside and inside the skin in circular fixators modified by Catagni and Cattaneo. ⋯ We conclude that the circular Ilizarov fixation with conical half-pins and wires has similar rate of infection compared with conventional Ilizarov circular fixator. Moreover, there is no difference in infection rates between pins with threads inside the skin as compared to those with threads outside the skin.
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Obesity has proven to be an independent risk factor of mortality in the intensive care unit (ICU) in both nontrauma and trauma patients. The purpose of this study was to determine whether the detrimental effect of obesity extend to morbidity as well as mortality in the intensive and nonintensive care blunt trauma patients. ⋯ This group of obese blunt trauma patients had similar mortality rates to their leaner counterparts possibly because their complications were minimized. Despite this finding, a subset of obese patients had longer hospital stays which increases the financial burden to the patient and hospital. Effort should be made to facilitate their discharge to avoid complications and minimize cost.
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Pre-existing medical conditions (PMCs) have been shown to increase mortality after trauma even after adjustment for the effect of chronological aging. It has been suggested that there is an interaction between injury severity and physiologic reserve, such that diminished physiologic reserve will have an adverse effect on survival at lower injury severity, but that at higher levels of injury severity, physiologic reserve will have much less of an impact. ⋯ These findings support the hypothesis of an interaction between physiologic reserve and injury severity, where PMCs are associated with increased mortality when combined with low to moderate severity injuries, but not when combined with more severe injuries.