J Trauma
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Comparative Study
Extrication collars can result in abnormal separation between vertebrae in the presence of a dissociative injury.
Cervical collars are applied to millions of trauma victims with the intent of protecting against secondary spine injuries. Adverse clinical outcomes during the management of trauma patients led to the hypothesis that extrication collars may be harmful in some cases. The literature provides indirect support for this observation. The purpose of this study was to directly evaluate cervical biomechanics after application of a cervical collar in the presence of severe neck injury. ⋯ This study was consistent with previous evidence that extrication collars can result in abnormal distraction within the upper cervical spine in the presence of a severe injury. These observations support the need to prioritize additional research to better understand the risks and benefits of cervical stabilization methods and to determine whether improved stabilization methods can help to avoid potentially harmful displacements between vertebrae.
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Comparative Study
Trauma center designation correlates with functional independence after severe but not moderate traumatic brain injury.
The mortality of traumatic brain injury (TBI) continues to decline, emphasizing functional outcomes. Trauma center designation has been linked to survival after TBI, but the impact on functional outcomes is unclear. The objective was to determine whether trauma center designation influenced functional outcomes after moderate and severe TBI. ⋯ ACS trauma center designation is significantly associated with FI and IE after severe, but not moderate TBI. Prospective study is warranted to verify and explore factors contributing to this discrepancy.
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Comparative Study
Reducing leukocyte trafficking preserves hepatic function after sepsis.
Leukocyte trafficking may induce hepatic dysfunction in sepsis. Herein, we hypothesize that reduction in leukocyte adhesion and, hence, leukocyte-endothelial interaction by activated protein C (aPC) may preserve hepatic function after sepsis. ⋯ Our data demonstrate that sepsis may, in part, induce hepatic dysfunction by augmenting leukocyte trafficking into hepatic sinusoids. Treatment with aPC attenuated leukocyte trafficking and, in doing so, preserved hepatic function and improved survival. Collectively, these data suggest an important role for protein C-dependent leukocyte-endothelial interaction in sepsis.
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To identify predictors of mortality and long-term outcomes in survivors after pentobarbital coma (PBC) in patients failing current treatment standards for severe traumatic brain injuries (TBI). This is a retrospective cohort study of severe TBI patients receiving PBC at Level I Trauma Center and tertiary university hospital. ⋯ In patients with severe TBI and RICH, survival at discharge of 40% with good functional outcomes in 68% of survivors at 1 year or more can be achieved with PBC after failure of HOsmRx. Based on 50% mortality cut-points, analysis suggests the limits of HOsmRx to be Na of 160 mEq/L and Osm of 330 mOsm/Kg H2O. Maintenance of higher cerebral perfusion pressure after PBC is associated with survival. PBC treatment of RIH may be even more important when other treatments of RIH, such as decompressive craniectomy, are not available.
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Previous studies have demonstrated that the transfusion of older blood is independently associated with higher rates of infectious complications, multiple organ failure, and mortality. Putative mechanisms implicate leukocytes in stored blood that generate immunomodulatory mediators as the stored blood ages. The purpose of this retrospective cohort study was to describe the effect of prestorage leukoreduction (PS-LR) on the detrimental clinical effects of increasing age on blood products used in trauma patients. ⋯ Our data suggest that the deleterious effects of aging on banked blood are ameliorated by PS-LR. We are currently conducting a prospective observational study in an effort to duplicate the findings of this retrospective investigation.