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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Comparative Study
A comparative study of the patients with bilateral or unilateral chronic subdural hematoma: precipitating factors and postoperative outcomes.
: Chronic subdural hematoma (CSDH) is a relatively frequent problem in neurologic or neurosurgical practice. Although CSDH is a well-known disease, data on bilateral CSDH are scarce compared with data on unilateral CSDH. The purpose of this study was to compare the clinical presentations, precipitating factors, computed tomography (CT) scan findings, postoperative complications, and outcomes between patients with bilateral and unilateral CSDH. ⋯ : Bilateral CSDH tended to occur more in patients with anticoagulant or antiplatelet therapy. Compared with patients with unilateral CSDH, patients with bilateral CSDH had more symptoms of increased intracranial pressure and lower incidences of midline shift on CT scans. Most patients with either bilateral or unilateral CSDH had a good postoperative outcome.