J Trauma
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The Clinical Pulmonary Infection Score (CPIS) has received much attention recently. Advocates have touted its use for the diagnosis and duration of therapy in patients with ventilator-associated pneumonia (VAP). However, little has been written about its utility in trauma patients. The clinical, physiologic, and radiologic components of the CPIS may be difficult to differentiate from the systemic effects of injury. Quantitative cultures of the lower airway have been shown to be efficacious in differentiating VAP from the systemic inflammatory response syndrome (SIRS). In this study, we evaluated the potential use of CPIS as the sole means for diagnosis of VAP in critically injured patients. ⋯ CPIS cannot differentiate VAP from SIRS in critically injured patients. Using CPIS to initiate antibiotic therapy in trauma patients could be harmful. Whether CPIS is useful to determine duration of antibiotic therapy is unknown.
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The conventional view that admission lactate levels predict outcome in trauma patients stems from simple comparisons of mean blood levels between groups and small sample sizes. To better address this question, we performed more rigorous statistical analyses of lactate in a larger patient sample. ⋯ This large retrospective examination of admission lactate levels failed to show useful predictive accuracy for hospital death. Serum lactate levels need not be obtained routinely but can be reserved for patients who will be admitted to the intensive care unit and/or require an emergency operation.
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Focus of motor vehicle crashes death prevention is actually placed on preinjury period. The purpose of this study was to estimate predictors of using seatbelts, helmet and children safety seats. ⋯ Protective device use is associated with sociodemographic, health, and wealth-related variables, and type of exposure to traffic. There are also ecological variables associated with the behaviors studied. These findings should be helpful for planning safer habits promotion programs. Further research, from the discourse analysis of people with different risk profile, should be performed to improve the understanding of the use of protective devices.
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Comparative Study
The burden of noncompliance with seat belt use on a trauma center.
It is well-known that noncompliance with seat belt use results in worse injury. The impact of noncompliance on hospital resource consumption and hospital charges is less well known. This study was carried out to examine the economic burden of noncompliance with seat belt use. ⋯ These data quantify the burden placed on a trauma center by noncompliance with seat belt use. This information should drive more focused education and injury prevention programs. It should also be clearly articulated to legislators to stimulate more support for more stringent legislative policy and improved trauma center funding.
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Comparative Study
Multi-slice CT angiography for arterial evaluation in the injured lower extremity.
With the evolution of multi-slice helical computed tomographic angiography (MCTA), the optimal imaging modality for arterial injury in the traumatized lower extremity has been challenged. The objective of this study was to evaluate the ability of MCTA to detect arterial injury in the traumatized lower extremity. Our hypothesis was that MCTA is a sensitive and specific test for the non-invasive evaluation of lower extremity arterial injury. ⋯ MCTA is a sensitive and specific non-invasive imaging modality for arterial evaluation in the injured lower extremity that may replace catheter-based angiography in most patients.