J Trauma
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Comparative Study Controlled Clinical Trial
Brain death confirmation: comparison of computed tomographic angiography with nuclear medicine perfusion scan.
: Brain death is a difficult diagnosis to make, relying primarily on clinical examination. Ancillary tests are used when confounders exist. Nuclear medicine perfusion test (NMPT) is currently the preferred test for confirming brain death. Computed tomographic angiography (CTA) may be an alternative test to confirm brain death. It is readily available 24 hours a day at most level I trauma centers and is easy to perform. ⋯ : CTA is a quick and efficient test for brain death confirmation. CTA demonstrated no false negative studies. The resolution of CTA seems to have an increased sensitivity for cerebral blood flow. Further studies with larger sample sizes need to be performed.
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Multicenter Study
Quality of Care Within a Trauma Center Is not Altered by Injury Type.
: Previous studies have demonstrated variations in severity-adjusted mortality between trauma centers. However, it is not clear if outcomes vary by the type of injury being treated. ⋯ : Risk-adjusted outcomes are consistent within trauma centers across different types of injuries, suggesting that quality improvement efforts should measure, analyze, and focus on hospital-wide systems of care, rather than on isolated quality domains related to specific types of injury.
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Controlled Clinical Trial
Spleen artery embolization aggravates endotoxin hyporesponse of peripheral blood mononuclear cells in patients with spleen injury.
: Spleen artery embolization (SAE) increases the success of nonoperative management of spleen injury; however, the immune alternation after SAE is unclear. This study searched the endotoxin responses of peripheral blood mononuclear cells (PBMCs) in injured patients who received SAE. ⋯ : SAE dysregulates the NF-kB system and aggravates the cytokine hyporesponse upon ES of PBMCs in patients with spleen injury. These results implicate that SAE alters immune response and may increase susceptibility to infections in injured patients.
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: Despite serious documented limitations, the Trauma Injury Severity Score (TRISS) is still used for risk adjustment in trauma system evaluation and clinical research. Several modifications have been proposed to address TRISS limitations. We aimed to assess the impact of proposed TRISS modifications on the accuracy of mortality prediction for blunt trauma. ⋯ : Several modifications that have been proposed to address limitations of the TRISS lead to significant improvements in the accuracy of mortality prediction. This study provides valuable information in the quest to improve trauma mortality modeling.
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Clinical Trial
Patients education of a self-reduction technique for anterior glenohumeral dislocation of shoulder.
: Anterior dislocation of the shoulder (glenohumeral joint) is one of the most prevalent dislocations. Following a first dislocation recurrence rates of up to 80% have been reported. Many patients will seek medical assistance for reduction of the shoulder after each of these recurrent dislocations. We describe the results of reduction of anterior glenohumeral dislocation using a modified self manipulated Milch technique that can be performed by the patients themselves after simple guidance and demonstration. This method is directed to patients who are not willing or cannot have surgical stabilization and may be in a place where medical assistance is not available. ⋯ : The results illustrate the fact that most patients are able to reliably and reproducibly reduce glenohumeral dislocations by themselves. Subsequent dislocations can be reduced promptly decreasing the dislocation time thus avoiding further damage to the shoulder, achieving immediate pain relief, and removing the immediate necessity for medical attendance.