J Trauma
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Comparative Study
External validation of a prognostic model for early mortality after traumatic brain injury.
Traumatic brain injury (TBI) is a major cause of lost disability-adjusted life years, and a valid model allowing prediction of outcome would be welcome. For a clinical prediction model to be valid, generalization to other populations must be possible. The aim of this study was to externally validate a model for in-hospital mortality in patients with TBI, which was recently development at the University of Southern California (USC). ⋯ The findings question the external validity of the USC model, suggesting that it should not be implemented as a tool for short-term mortality prediction in our TBI population.
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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.
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Comparative Study
Prehospital serum lactate as a predictor of outcomes in trauma patients: a retrospective observational study.
Lactate is associated with morbidity and mortality; however, the value of prehospital lactate (pLA) is unknown. Our objective was to determine whether pLA improves identification of mortality and morbidity independent of vital signs. ⋯ The pLA measurements improve prediction of mortality, surgery, and MODS. Lactate may improve the identification of patients who require monitoring, resources, and resuscitation.
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Comparative Study
Influence of arm positioning on radiation dose for whole body computed tomography in trauma patients.
Multislice whole body computed tomography is regarded as the method of choice for primary investigation of hemodynamically stable patients with multiple injuries. However, a disadvantage of this method is the high level of radiation to which the patient is exposed. Various recommendations on how to position the patient's arms during whole body computed tomography have been given in the literature, but conclusive data are missing. Therefore, the aim of our study was to investigate the relationship between different arm positions and radiation dose in patients undergoing whole body computed tomography. ⋯ Based on our retrospective investigation, it can be recommended with reference to whole body computed tomography screening that the arms should be in the arms-up position during thorax or abdomen scanning of a severely injured patient, provided there are no clear clinical indications of shoulder injury. For the patient, this position is associated with a significantly reduced radiation dose without noticeable loss of time.
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Comparative Study
Upper extremity injuries in restrained front-seat occupants after motor vehicle crashes.
Prior studies identified that crash severity (delta V), occupant position, and restraint systems as reliable predictors of crash injuries to lower extremity, but very little have been written on the subject of upper extremity. ⋯ Further improvement in vehicle safety performance in the form of "depowered" airbag and efficient energy absorbing material within the vehicle interior is warranted.