J Trauma
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Comparative Study
Prospective evaluation of a predictive model of mortality in patients with isolated head injury.
In a previous retrospective study, we developed a predictive model of survival in isolated head injuries based on easily available parameters such as age, mechanism of injury, Glasgow Coma Scale, and head Abbreviated Injury Scale (AIS). The purpose of the present study is to prospectively evaluate this predictive model. ⋯ When evaluated prospectively, our predictive model has similar accuracy in predicting survival of all patients with head trauma as our original retrospective study and performs better than other predictive models such as the Trauma and Injury Severity Score methodology. This study demonstrates that a simple table based on easily obtained admission patient characteristics can rapidly provide information about the probability of survival in patients with head injuries.
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Comparative Study
Regional blood flow after serial normovolemic exchange transfusion with HBOC-201 (Hemopure) in anesthetized swine.
This study determined individual organ blood flows and global hemodynamic, oxygen delivery and consumption parameters after normovolemic exchange transfusions with the hemoglobin based oxygen carrier (HBOC)-201 in a lightly anesthetized swine model. ⋯ Although the use of HBOC-201 caused alterations in systemic (minimal) and pulmonary (modest) pressures, these changes had no consequence on regional organ blood flow.
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Multicenter Study Comparative Study
Surgical trauma referrals from rural level III hospitals: should our community colleagues be doing more, or less?
Rural citizens die more frequently because of trauma than their urban counterparts. Skill maintenance is a potential issue among rural surgeons because of infrequent exposure to severely injured patients. The primary goal was to evaluate the outcomes of multiple injuries patients who required a laparotomy after referral from level III trauma centers. ⋯ Most severely injured patient referrals from level III and IV trauma centers in Western Canada are appropriate. The lack of consistent subspecialty coverage mandates most transfers from level III hospitals. This data will be used to engage rural Alberta physicians in an educational outreach program.
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Although the lethal triad of hypothermia, acidosis, and coagulopathy has been recognized for a decade, the underlying mechanisms related to the development of coagulopathy are not fully understood. Consequently, current strategy in treating trauma patients with coagulopathy is limited to "staying out of the trouble" instead of "getting out of trouble." A better understanding of the underlying mechanisms will facilitate the search for effective therapeutic approaches when this lethal triad cannot be avoided. ⋯ Hypothermia and acidosis impair thrombin generation and fibrinogen availability via different mechanisms. Current data indicate that pH correction alone cannot immediately correct acidosis-induced coagulation impairments. Future studies are warranted to test the effects of pH neutralization in conjunction with fibrinogen supplementation in normalizing acidosis-induced clotting complications.
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Comparative Study
The long-term outcome of open reduction and internal fixation of stable displaced isolated partial articular fractures of the radial head.
Excellent long-term results have been reported for nonoperative treatment of stable isolated displaced partial articular (Mason 2) fractures of the radial head, suggesting that the role of operative treatment can be questioned. This investigation reports the long-term outcome of operatively treated Mason 2 radial head fractures. ⋯ The long-term results of operative treatment of stable isolated displaced partial articular (Mason 2) fractures of the radial head demonstrate no appreciable advantage over the long-term results of nonoperative treatment of these fractures published in prior reports. Moreover, the appeal of operative treatment is diminished by the potential complications.