J Trauma
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Comparative Study
Does hypoxia affect intensive care unit delirium or long-term cognitive impairment after multiple trauma without intracranial hemorrhage?
Within the traumatic brain injury population, outcomes are affected by hypoxic events in the early injury period. Previous work shows a high prevalence of cognitive deficits in patients with multiple injuries who do not have intracranial hemorrhage identified on admission head computed tomography scan. We hypothesize that intensive care unit (ICU) delirium and long-term cognitive impairment (LTCI) are more likely in patients who have a hypoxic event within the first 48 hours of ICU admission. ⋯ Hypoxic events in the ICU do not have a direct correlation with ICU delirium or LTCI in the patients with multiple injuries without evidence of intracranial hemorrhage.
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Review
Blunt abdominal trauma resulting in gallbladder injury: a review with emphasis on pediatrics.
Gallbladder injury in blunt abdominal trauma is a rare and difficult diagnosis. Gallbladder injury is reported to be between 1.9% and 2.1% of all abdominal traumas. It has vague symptoms usually with inconclusive investigation results; hence, it is often diagnosed at laparotomy. The patient typically has vague abdominal pain and occasionally a period of remission depending on the type of gallbladder injury. In pediatrics, blunt abdominal trauma presents additional challenges of difficult historians and compensating physiology. Any delay in diagnosis and definitive management will worsen the prognosis. Making the diagnosis requires astute clinical acumen and radiologic interpretation. The classification system of Losanoff has merit in guiding treatment. While cholecystectomy is the preferred treatment, there are occasions when the gallbladder may be left in situ and these are discussed. ⋯ The authors highlight the incidence of associated visceral injuries in gallbladder trauma (>90%). Gallbladder perforation is more likely in cases when the gallbladder is distended and thin-walled at the time of injury. Therefore, we recommend that gallbladder perforation is suspected in those patients who have drunk alcohol or eaten recently. Despite the developments in modern computed tomography, identifying gallbladder perforation is difficult because of the subtlety and rarity of the condition. We draw attention to the proposed anatomic classification systems because they are of some use in guiding treatment. In the absence of a diagnosis after blunt abdominal trauma and with intra-abdominal free fluid, the clinician faces the difficult decision of whether surgery is indicated for a potential visceral injury. After discussing the available evidence, the authors advocate a low index of suspicion for performing diagnostic laparoscopy.
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Comparative Study
Analysis of preventable trauma deaths and opportunities for trauma care improvement in utah.
The objective is to determine the rate of preventable mortality and the volume and nature of opportunities for improvement (OFI) in care for cases of traumatic death occurring in the state of Utah. ⋯ The preventable death rate from trauma demonstrated in Utah is similar to that found in other settings where the trauma system is under development but has not reached full maturity. OFIs predominantly exist in the ED and relate to airway management, fluid resuscitation, and chest injury management. Resource organization and education of ED primary care providers in basic principles of stabilization and initial treatment may be the most cost-effective method of reducing preventable deaths in this mixed urban and rural setting. Similar opportunities exist in the prehospital and post-ED phases of care.
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Comparative Study
National Emergency X-Radiography Utilization Study criteria is inadequate to rule out fracture after significant blunt trauma compared with computed tomography.
EAST guidelines now recommend computed tomography (CT) to evaluate cervical spine (c-spine) fractures after blunt trauma in patients who do not meet National Emergency X-Radiography Utilization Study criteria (NC), yet no imaging is required in those patients who do meet these criteria. NC are based on patients with both minor and severe (trauma team activation [TTA]) trauma. The purpose of this study was to evaluate the NC using CT as the gold standard in TTA patients. ⋯ As in our previous trial, NC is inaccurate compared with CT to diagnose c-spine fractures in TTA patients. CT should be used in all blunt TTA patients regardless of whether they meet NC.