J Trauma
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It is agreed that missed compartment syndrome is associated with significant morbidity, but controversy regarding its diagnosis remains. To our knowledge, no one has analyzed the effect of individual surgeon variation on the diagnosis of compartment syndrome. ⋯ The diagnosis of compartment syndrome is difficult, and the data reported herein show that significant practice variation is likely, even within a single institution. It is unknown what the "true" rate of compartment syndrome should be, considering that a rate that is too high indicates unnecessary surgery and a rate that is too low means missing a devastating injury. Our data indicate lack of consensus in practice regarding the diagnosis of compartment syndrome, even at a high-volume level I trauma center, and emphasize the possibility of false-positive results of compartment pressure checks in clinical practice.
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Hurricane Katrina, which struck the Gulf Coast of the United States in August 2005, initially displaced over a million people from their primary place of residence. Displaced older adults subsequently faced challenges, such as new or inferior living conditions, which could increase vulnerability to serious or life-threatening injuries such as hip fracture. The aim of this study was to determine whether Katrina victims who were displaced for a prolonged period of time were more likely to experience injuries than nondisplaced victims. ⋯ Prolonged displacement is associated with increased risk of fracture in older adults. Emergency planners should screen temporary housing for injury hazards, and clinicians should regard displaced older adults as a vulnerable population in need of interventions such as risk communication messaging.
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Is bigger better? The effect of obesity on pelvic fractures after side impact motor vehicle crashes.
Previous research has identified nearside impacts, intrusion, gender, age, and body mass index (BMI) as associated with pelvic fractures in motor vehicle crashes. This study assesses the role of BMI in predicting pelvic fracture and whether BMI modifies the effect of other potential risk factors. ⋯ BMI status influences other variables associated with pelvic fracture. Redesign of interior door panels, hardware, armrests, and the center console may be appropriate for motor vehicle manufacturers to consider in prevention of pelvic fracture during nearside impacts.
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Spinal injury in pediatric trauma is associated with significant morbidity and mortality, but no current consensus exists on the safest and most effective method of clearance in the high-risk pediatric trauma patient. ⋯ There is a need for an evidence-based protocol for the clearance of the spine in the obtunded and high-risk pediatric trauma patient. High-resolution CT with sagittal and coronal reconstructions should be the basis for cervical spinal clearance, in combination with the interpretation of films by an expert radiologist. All spinal regions should be imaged, and clearance should be formally documented. The role of magnetic resonance imaging in routine clearance remains controversial. Multicenter prospective studies are needed to develop consensus for an evidenced-based protocol for clearance in this high-risk group.
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Major improvements have been made in the development of novel dressings with hemostatic properties to control heavy bleeding in noncompressible areas. To test the relative efficacy of different formulations in bleeding control, recently manufactured products need to be compared using a severe injury model. ⋯ Celox, QuikClot ACS, WoundStat, and X-Sponge ranked superior in terms of low incidence of rebleeding, volume of blood loss, maintenance of mean arterial pressure >40 mm Hg, and survival.