J Trauma
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To test the diagnostic utility of the triage serum glucose in differentiating major from minor injuries. ⋯ Serum glucose was as discriminating as BD or LAC in differentiating minor from major injury. An initial glucose >/=11.1 mMol/L had a low sensitivity (15%) but a high specificity (94%) for major injury.
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During the wars in Iraq and Afghanistan, extremity injuries have predominated; however, no systematic review of field and stabilization care with subsequent infectious complications exists. This study evaluates the infectious complications and possible risk factors of British military casualties with mangled extremities, highlighting initial care and infections. ⋯ Infections occurred in 24% of those with mangled extremities including 6% with osteomyelitis. Certain procedures, likely reflective of injury severity, were associated with infections along with certain bacteria, P. aeruginosa and possibly S. aureus. Continued clarification is required for antimicrobial coverage (penicillin-based regimens vs. additional anaerobic coverage) and certain surgical procedures to improve casualty care.
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Comparative Study
Optimal thoracic and lumbar spine imaging for trauma: are thoracic and lumbar spine reformats always indicated?
Computed tomography (CT) of the thoracic and lumbar (T/L) spine with reformats has become the imaging modality of choice for the identification of T/L spine fractures. The objective of this study was to directly compare chest/abdomen/pelvis CT (CAP CT) with CT with T/L reformats (T/L CT) for the identification of T/L spine fractures. ⋯ Patients who have a CAP CT do not require reformats for clearance of the T/L spine.
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Hemorrhagic shock and resuscitation (HSR) induces pulmonary inflammation that leads to acute lung injury. Carbon monoxide (CO), a by-product of heme catalysis, was shown to have potent cytoprotective and anti-inflammatory effects. The aim of this study was to examine the effects of CO inhalation at low concentration on lung injury induced by HSR in rats. ⋯ These findings suggest that inhaled CO at a low concentration ameliorated HSR-induced lung injury and attenuated inflammatory cascades by up-regulation of anti-inflammatory IL-10.
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The Trauma Quality Improvement Project has demonstrated significant variations in risk-adjusted mortality rates across the designated trauma centers. It is not known whether the outcome differences are related to provider-level clinical decision making. We hypothesized that centers with good outcomes undertake critical operative interventions aggressively, thereby avoiding complications and deaths. ⋯ Trauma centers with higher risk-adjusted mortality rates are more likely to undertake operative interventions for solid organ injuries. Hence, there is a need to focus quality improvement efforts on medical decision-making and perioperative processes of care.