J Trauma
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To establish whether the Insurance Institute for Highway Safety (IIHS) offset crash test ratings are linked to different mortality rates in real world frontal crashes. ⋯ After adjusting for occupant, vehicular, and crash factors, drivers of vehicles rated good by the IIHS experienced a lower risk of death in frontal crashes.
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Injury is consistently a leading cause of death for young children, and social stressors can increase injury risk. We investigated the incidence of injury and developmental and health outcomes among children up to 3 years of age in a cohort of vulnerable families. ⋯ Children in vulnerable families are at high risk for injury. In particular, children injured within the first year of life are at high risk for recurrent injury and poor health outcomes. Increased support and targeted interventions may improve outcomes and decrease childhood injury burden among at-risk families.
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Comparative Study
Trauma surgery to acute care surgery: defining the paradigm shift.
Trauma surgery is gradually evolving into acute care surgery (ACS). We sought to better define this evolution by using work relative value units (wRVU) to characterize the current practices of trauma and ACS. ⋯ Trauma surgeons are distinctly different from their colleagues, with a greater emphasis on intensive care unit "cognitive" work. The number of procedures performed by trauma surgeons is comparable to other disciplines but with more "bedside" procedures. Trauma surgeons' high appendectomy wRVUs may be a reflection of the transition to an ACS model. The characterization of trauma surgery as nonoperative and intensive care unit-based is in part substantiated but there are indications of a paradigm shift toward more operative experience with transition to an ACS model.
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Comparative Study
Prothrombin complex concentrate versus recombinant factor VIIa for reversal of hemodilutional coagulopathy in a porcine trauma model.
Fluid resuscitation after traumatic injury may necessitate coagulation factor replacement to prevent bleeding complications of dilutional coagulopathy. Recombinant activated factor VII (rFVIIa) is being widely investigated as a hemostatic agent in trauma. Multicomponent therapy with prothrombin complex concentrate (PCC) containing coagulation factors II, VII, IX, and X might offer potential advantages. ⋯ In a pilot study involving an in vivo large-animal model of spleen trauma, PCC accelerated hemostasis and augmented thrombin generation compared with rFVIIa. Further investigations are warranted on PCC as a hemostatic agent in trauma.