J Trauma
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Trauma is the leading cause of morbidity and mortality in children. During the last few decades, trauma systems have evolved to improve the care of the injured with an ultimate goal of saving lives. As a result, pediatric trauma centers (PTC) have been established to optimize outcomes for injured children. We sought to determine whether injured children treated at PTC or adult trauma centers (ATC) with added qualifications to treat injured children receive better trauma care than those treated at other hospitals or trauma centers. ⋯ Although this analysis does not provide a definitive answer to the question as to which type of trauma center provides better care for injured pediatric patients, it identifies current gaps and disparities in the care of injured children that can be remedied through education and training.
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Improving trauma care and preparing for a disaster require data collection and analysis. Trauma registries capture data for research, measure trauma system outcomes, and support quality improvement through assessment of the appropriateness and effectiveness of the trauma system. ⋯ Aggregating existing data from state trauma registries or using the National Trauma Data Bank may facilitate development of statistical models to help predict survival, injury patterns, and important physiological thresholds. However, representative pediatric-specific trauma registry data are needed to obtain an adequate sample size in pediatric population to extrapolate data to represent the scale of a disaster.
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In November 2005, institution of a military-wide burn resuscitation guideline requested the documentation of the initial 24-hour resuscitation of severely burned military casualties on a burn flow sheet to provide continuity of care. The guidelines instruct the providers to calculate predicted 24-hour fluid requirements and initial fluid rate based on the American Burn Association Consensus recommendation of 2 (modified Brooke) mL x kg(-1) x % total body surface area (TBSA)(-1) to 4 (Parkland) mL x kg(-1) x %TBSA(-1) burn. The objective of this study was to evaluate the relationship between the estimated fluid volumes calculated, either by the Modified Brooke or the Parkland formulas, and actual volumes received. ⋯ In severely burned military casualties undergoing initial burn resuscitation, the modified Brooke formula resulted in significantly less 24-hour volumes without resulting in higher morbidity or mortality.
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Arteriography is the current "gold standard" for the detection of extremity vascular injuries. Less invasive than operative exploration, conventional arteriography (CA) still has a 1% to 3% risk of morbidity and may delay definitive repair. Recent improvements in computed tomography (CT) technology has since broadened the application of CT to include the diagnosis of cervical, thoracic, and now extremity vascular injury. We hypothesized that CT angiography (CTA) provides equivalent injury detection compared with the more invasive CA, but is more rapidly completed and more cost effective. ⋯ With acceptable injury detection, rapid availability, and a favorable cost profile, our results suggest that CTA may replace CA as the diagnostic study of choice for vascular injuries of the extremities.
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We describe a surgical treatment for a displaced fracture of the coracoid process associated with acromioclavicular dislocation. This treatment involves fixing the coracoid process using a cannulated screw without acromioclavicular fixation under fluoroscopic guidance. The benefits of this treatment are that fixation with a cannulated screw simultaneously reduces both the displaced fracture of the coracoid process and the acromioclavicular joint via the intact coracoclavicular ligament, thus reducing the complications associated with transacromial pin fixation.