J Trauma
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Extensive United States combat operations commenced for the first time in over decade in 2003. Early in 2004 there was no human research protection regulatory review and approval mechanism based in a deployed military combatant command. The absence of such a system presented a critical impediment to implementation of the time-honored tradition of a robust combat casualty care research effort. ⋯ On July 20, 2005, the first DOD Assurance of Compliance for the Protection of Human Research Subjects was approved for MNC-I. This assurance allows the conduct of human subjects research in full compliance with all Federal, DOD, and Army regulatory requirements. This article describes that unique process.
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Randomized Controlled Trial
Trauma training in simulation: translating skills from SIM time to real time.
: Training surgical residents to manage critically injured patients in a timely fashion presents a significant challenge. Simulation may have a role in this educational process, but only if it can be demonstrated that skills learned in a simulated environment translate into enhanced performance in real-life trauma situations. ⋯ : A trauma curriculum incorporating simulation shows promise in developing crisis management skills that are essential for evaluation of critically injured patients.
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Comparative Study
Isolated cervical spine fractures in the elderly: a deadly injury.
Traumatic injury in the elderly is an increasing problem and studies have shown that elderly patients (>/=65 years old) with cervical spine fractures and spinal cord injury (SCI) carry a mortality rate of 21% to 30%. However, little has been described with regard to outcomes for elderly patients with isolated cervical spine fractures (ICSF). ⋯ ICSFs were associated with an unfavorable outcome in the elderly population regardless of ATI or SCI. These unfavorable outcomes were also associated with long-term mortality. Strategies to reduce morbidity and mortality in this devastating injury will be essential to improve outcomes and maximize resource utilization.
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Multicenter Study
Mortality in patients with pelvic fractures: results from the German pelvic injury register.
Pelvic and acetabular fractures are rare injuries and account for approximately 3% to 8% of all fractures. Often the result of high energy blunt trauma, most of the patients sustaining pelvic injuries are at high risk of associated injuries strongly influencing outcome and survival rates. Because of anatomic differences it has been suggested that pediatric pelvic fractures are different injuries as compared with that of adults. However, this has been controversially discussed. Aim of this multicenter register study was to identify similarities and differences between pediatric and adult pelvic trauma and evaluate the influence of changes in medical treatment by comparison of two treatment periods. ⋯ The survival rate of patients sustaining pelvic fracture has improved significantly within the last decade. Most deaths in patients with pelvic fractures are not caused by the pelvic fracture itself but are linked to associated injuries. Despite anatomic and epidemiologic differences there are significant similarities between pediatric and adult patients with pelvic injuries and the mortality rate of children is not different from that of adults.
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Comparative Study
Injury severity and outcome of overweight and obese patients after vehicular trauma: a crash injury research and engineering network (CIREN) study.
This study investigates the influence of overweight and obesity on outcome from vehicular trauma. ⋯ After adjusting for age, gender, and crash factors, overweight patients (but not obese patients) experienced more severe injuries. Obese and overweight patients experience higher unadjusted and adjusted mortality rates.