J Trauma
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Review Meta Analysis
A systematic review and meta-analysis comparing outcome of severely injured patients treated in trauma centers following the establishment of trauma systems.
The establishment of trauma systems was anticipated to improve overall survival for the severely injured patient. We systematically reviewed the published literature to assess if outcome from severe traumatic injury is improved for patients following the establishment of a trauma system. ⋯ The results of the meta-analysis showed a 15% reduction in mortality in favor of the presence of a trauma system. Evaluation of trauma system effectiveness must remain an uncompromising commitment to optimal outcome for the injured patient.
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Accurate prehospital triage of trauma patients is difficult, especially in mass casualty situations. Accordingly, the U.S. Military has initiated a program directed toward improving noninvasive prehospital triage algorithms based on available physiologic data. The purpose of this study was to assess heart rate variability and its association with mortality in prehospital trauma patients. ⋯ Analysis of heart rate variability provides insight into adequacy of autonomic compensation to severe trauma. In our cohort of trauma patients, low pulse pressures coupled with relatively higher parasympathetic than sympathetic modulation characterized and separated patients who died versus patients who survived traumatic injuries when standard physiologic measurements are not different. These data do not suggest advantages of heart rate variability analysis over GCS scores, but suggest future possibilities for remote noninvasive triage of casualties when GCS scores are unattainable.
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Azygous venous system injuries are rare. Although not commonly classified as a thoracic great vessel, the azygous system manifests morbidity and mortality that is similar to that of other great vessel injuries. ⋯ Injuries to the azygous venous system have a significant associated lethality. As an azygous venous injury is not typically the indication for operation, anterior incisions are often employed, making exposure difficult. In the majority of injured patients, the azygous system injury was found after excluding injuries to the heart, lung, and great vessels. A key finding in detecting these injuries through an anterior incision is continued hemorrhage of dark blood from a posterior location in the thoracic cavity. The azygous venous system should be considered early as a source of significant hemorrhage from the posterior mediastinum.
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Split-depression fractures of the lateral tibial plateau (Schatzker II) are associated with a significant risk of capsuloligamentous and meniscal injury. We hypothesized that the amount of fracture depression and widening on anteroposterior (AP) plain radiographs would correlate with the incidence of injury to these structures on magnetic resonance imaging (MRI). ⋯ Due to the limited availability of MRI in some centers, correlation of lateral condylar depression and widening, as measured on plain radiographs, to injury of various soft-tissue structures may be extremely helpful in planning open or arthroscopic treatment methods. Using these guidelines, Schatzker II fractures with depression or widening approaching 5 mm deserve heightened vigilance in diagnosing and treating these concomitant soft-tissue injuries.