J Trauma
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Low-dose acetylsalicylate acid (LDA) therapy is accepted as a major risk factor for intracranial hemorrhages (ICH) in head injuries. Coincidentally, patient admissions that might be indicated for in hospital observation of neurologic function causes increased health care costs. In the literature, there is no evidence concerning the incidence of secondary intracranial hemorrhagic events (SIHE) in patients with LDA prophylaxis that had negative primary computed tomography (CT)-scan of the head. ⋯ The incidence of SIHE has been neglected until now. The current study revealed that patients with LDA prophylaxis after mild head injury with negative primary head CT should be subjected to RRHCT within 12 hours to 24 hours to accurately identify SIHE. Alternatively to RRHCT, patients should be subjected to a prolonged in-hospital observation for at least 48 hours.
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Advances in computed tomography capabilities have enabled trauma surgeons to screen for and diagnose the severity of blunt cervical vascular injury (BCVI) using computed tomographic angiography (CTA) alone. We hypothesized that the use of CTA-alone screening and diagnostic methods would reduce the time interval from admission to diagnosis and, hence, also reduce the stroke rates associated with these injuries. ⋯ The initiation of a CTA-based screening and diagnostic program, along with interdisciplinary standardized treatment guidelines, reduced the time to diagnosis of BCVI 12-fold and the institutional stroke rate due to BCVI fourfold. This may be due to earlier diagnosis and initiation of definitive therapy.
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The incidence of concomitant, particularly noncontiguous, spine injuries in the pediatric population has not been well described. There is a balance between limiting radiation exposure and not missing concomitant injuries; understanding of this risk of concomitant spine injuries in this population is important. We hypothesize that the rate of concomitant spinal injuries in children is similar to adults. ⋯ Pediatric spine injuries are more common in patients over age 8 years of age; these patients are more likely to have multiple levels of injury. Of patients sustaining a spine injury, 6% had noncontiguous second fractures, which is a rate similar to adults. Imaging studies evaluating patients with spinal injuries should include at least three levels above and below the primary level of injury as well as the entire thoracic spine and thoracolumbar junction.
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: To study whether trauma center patients with positive toxicology findings for cocaine-positive (COC+) are at a higher risk for suicide, homicide, and unintentional injury death after discharge than cocaine-negative (COC+) trauma patients. ⋯ : COC+ trauma patients are at an increased risk of subsequent unintentional injury death after discharge from a trauma center. Suicide and homicide occurrence seems to be unaffected.