J Trauma
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Multicenter Study
Socioeconomic disparities in infant mortality after nonaccidental trauma: a multicenter study.
While disparities in abuse-related mortality between minority and white infants have been reported, the influence of socioeconomic status on outcome has not been evaluated. The goal of this study was to determine the impact of socioeconomic status and race on outcomes for abused infants using multiinstitutional data. ⋯ There are significant differences in mortality among abused infants associated with insurance status and income even after controlling for injury severity. These associations show a need to better understand and address socioeconomic variations in outcome.
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The purpose of this article is to describe the clinical course and outcome of drowning cases related to current US military combat operations. ⋯ Drowning associated with combat operations was associated with severe acute respiratory distress syndrome and cardiovascular shock. GCS score and the need for CPR at the scene of injury were associated with eventual mortality because of anoxic brain injury in all cases.
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Comparative Study
Serum glial fibrillary acidic protein is a highly specific biomarker for traumatic brain injury in humans compared with S-100B and neuron-specific enolase.
Serum glial fibrillary acidic protein (GFAP) is a specific predictor of brain damage and neurologic outcome in patients with traumatic brain injury (TBI). In this study, serum GFAP, S-100B, and neuron-specific enolase (NSE) were compared in the same samples from severe trauma patients to assess their ability to predict abnormalities detectable on head computed tomography (CT). ⋯ Serum GFAP has remarkable diagnostic value for TBI, defined by abnormal head CT findings, in prehospital-triaged patients with severe trauma.
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Comparative Study
Association of shock, coagulopathy, and initial vital signs with massive transfusion in combat casualties.
Timely initiation of a massive transfusion (MT) protocol is associated with improved survival and reduced transfusion for patients requiring MT; however, a priori identification of this population is difficult. The objective of this study was to compare the results of an MT prediction model and actual MT incidence in combat casualties. ⋯ The decision to implement an MT seems to rely heavily on clinical evaluation of severity of abdominal and extremity injury rather than physiologic derangement. Using a model based on the physiologic parameters--a more objective measure--may decrease mortality in combat casualties.
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Comparative Study
Predictors of early acute lung injury at a combat support hospital: a prospective observational study.
Acute lung injury (ALI) is a syndrome consisting of noncardiogenic acute hypoxemic respiratory failure with the presence of bilateral pulmonary infiltrates and occurs in up to 33% of critically ill trauma patients. Retrospective and observational studies have suggested that a blood component resuscitation strategy using equal ratios of packed red blood cells (PRBCs) and fresh frozen plasma (FFP) may have a survival benefit in combat casualties. The purpose of this study was to determine whether this strategy is associated with an increased incidence of ALI. ⋯ On the basis of this small, prospective, descriptive study of severely injured patients admitted to the ICU, we determined that the presence of pulmonary injury had the greatest impact on the incidence of early ALI. There was also an independent relationship between the amount of FFP transfused and the incidence of early ALI. Further studies are required to determine the effects of the development of early ALI from FFP transfusion on short- and long-term survival.