J Trauma
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The aim of this study was to evaluate the relationship of age to the injury types, distribution, and severity in motorcycle crash (MCC) victims admitted to Los Angeles County emergency hospitals in California. ⋯ Injuries related to MCCs show age-related injury distribution, severity, and mortality rates. Older patients are significantly more likely to suffer severe trauma, severe head and chest injuries, and spinal fractures. Adaptation of trauma team activation criteria and more aggressive triage of older victims of motorcycle trauma should be considered.
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Marginal posterior wall fractures are often fixed by lag screws, which may be technically difficult and risks articular penetration. Spring plates are used to avoid articular penetration. Both lag screws and spring plates are usually buttressed by reconstruction plates. ⋯ The marginal fracture is fixed using monocortical locking head screws. This technique has been performed on three patients; none had secondary displacement or nonunion. Fixing marginal posterior acetabular wall fractures using locking reconstruction plates and monocortical screws saves additional lag screws or spring plates without risking articular penetration.
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Multicenter Study
A critical assessment of the out-of-hospital trauma triage guidelines for physiologic abnormality.
It remains unclear whether the American College of Surgeons Committee on Trauma (ACSCOT) "step 1" field physiologic criteria could be further restricted without substantially sacrificing sensitivity. We assessed whether more restrictive physiologic criteria would improve the specificity of this triage step without missing high-risk patients. ⋯ We were unable to omit or further restrict any ACSCOT step 1 physiologic measures in a decision rule practical for field use without missing high-risk trauma patients.
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Obesity is a risk factor for postinjury complications; in particular, obese patients develop multiple organ failure (MOF) at a greater rate than do normal weight counterparts. Evaluation of differences in resuscitative practices altered by body mass index (BMI) might provide an explanation for the increased risk of MOF seen in these high-risk patients. ⋯ Morbidly obese trauma patients show prolonged metabolic acidosis despite receiving similar volumes and attaining similar end points of resuscitation when compared with patients in other BMI groups. Inadequate resuscitation based on inaccurate end points and metabolic disturbances associated with increased BMI are likely responsible; identification of the etiology, sources, and consequences of this acidosis may provide further insight into the susceptibility of the morbidly obese patient to develop postinjury organ failure.
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Our country suffers from a chronic shortage of organ donors, and the list of individuals in desperate need of life-saving organ transplants is growing every year. Family consent represents an important limiting factor for successful donation. We hypothesize that specific barriers to obtaining family consent can be identified and improved upon to increase organ donation consent rates. The purpose of this study was to compare families who declined organ donation to those who granted consent, specifically to identify barriers to family consent for successful organ donation. ⋯ Several barriers exist to family consent for successful organ donation. Family members of minority populations, medical brain deaths, and older potential donors more often decline consent for organ donation. Family education and resource utilization toward these specific populations of potential organ donors may help to improve organ donation consent rates. In addition, delayed family approach by OPO seems to be associated with decreased consent rates. System improvements to expedite family approach by OPO may likewise lead to improved consent rates.