J Trauma
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The information about the long-term mortality and causes of death after multiple injuries is sparse. In general, most follow-up studies report on 1 year to 3 years maximum follow up. The current literature focuses on causes of death immediately after trauma or during the initial in-hospital stay. We report on long-term mortality and causes of death in patients with multiple injures up to 30 years after the initial injury. ⋯ PT patients who die after discharge from the initial hospitalization show other causes of death than age-matched controls of the general population. Among these are second major trauma and suicide. Future studies should investigate whether certain social or psychologic factors might play a role.
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Strict glycemic control has been shown to reduce both morbidity and mortality in critically ill surgical patients; however, overly aggressive management of hyperglycemia may also be associated with deleterious effects. We sought to characterize clinical outcomes associated with different levels of persistent hyperglycemia (PH) in a cohort of severely injured patients with trauma, when a strict glycemic control protocol (target glucose 80-110 mg/dL) was implemented. ⋯ Maintenance of daily maximum glucose values <145 mg/dL was independently associated with a survival benefit after injury. Patients with PH, despite aggressive insulin therapy, had a higher incidence of multiple organ failure and an associated higher risk of mortality. However, the strict glycemic control protocol in the current trauma cohort seems to have prevented the association of PH and infectious complications, which has been documented in prior studies. This analysis further validates the importance of strict glycemic control after injury, and highlights the need for further studies on the mechanism responsible for these findings.
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Base deficit (BD) and lactate are used as markers of mortality, injury severity, and resource utilization in the general trauma population. No study has defined the role of these markers in the triage and management of the normotensive injured elderly patient. ⋯ Both lactate and BD were associated with significantly increased mortality in normotensive elderly blunt trauma patients. However, because of the high baseline mortality rates in elderly trauma patients, "normal" lactate does not offer complete reassurance to the clinician.
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There is a heightened focus on postexplosion functional outcomes in combat casualties. Previously, we reported a high prevalence of posttraumatic stress disorder (PTSD) (32%) and mild traumatic brain injury (mTBI) (41%) in patients with explosion-related burns. We hypothesized that the prevalence of PTSD in patients with burn was associated with primary blast injuries (PBIs) and mTBI. ⋯ IED-wounded burn patients with PBI and mTBI have a greater prevalence of PTSD. Patients who did not have IED-related injuries did not have PTSD and only one had mTBI.
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Pathologic fractures of long bones are common complications of the metastatic disease; however, the influence of the primary tumor, the stage of metastatic disease, different surgical techniques, and the postoperative mobility on the postoperative survival has not been clearly defined. The aim of this retrospective study was to evaluate outcome after surgical treatment for pathologic femur fractures. ⋯ Although many studies describe the endoprosthetic replacement as the safer method to treat pathologic femur fractures, our data showed that intramedullary stabilization and endoprosthetic replacement to be safe, and equivalent alternatives to treat complete pathologic fractures of the femur in patients with advanced metastatic disease.