J Trauma
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Multicenter Study Comparative Study
Blunt traumatic occult pneumothorax: is observation safe?--results of a prospective, AAST multicenter study.
An occult pneumothorax (OPTX) is found incidentally in 2% to 10% of all blunt trauma patients. Indications for intervention remain controversial. We sought to determine which factors predicted failed observation in blunt trauma patients. ⋯ Most blunt trauma patients with OPTX can be carefully monitored without tube thoracostomy; however, OPTX progression and respiratory distress are independently associated with observation failure.
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Multicenter Study Comparative Study
Routine follow-up imaging of kidney injuries may not be justified.
The purpose of this investigation was to determine the yield of repeat follow-up imaging in patients sustaining renal trauma. ⋯ Selective reimaging of renal injuries based on clinical and laboratory criteria seems to be safe regardless of injury mechanism or management. High-grade penetrating injuries undergoing operative intervention should carry the highest degree of vigilance and lowest threshold for repeat imaging.
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Multicenter Study Comparative Study
Complications and hardware removal after open reduction and internal fixation of humeral fractures.
The purpose of this study was to review internal fixation of humerus fractures using a large national database and assess the incidence of implant removal procedures based on patient characteristics. ⋯ These results suggest that the age of the patient and the patient's ability to pay may influence the likelihood of an implant removal procedure. The results will help identify patients who are at high risk for revision and who may benefit from preventative care.
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Multicenter Study Comparative Study
Directness of transport of major trauma patients to a level I trauma center: a propensity-adjusted survival analysis of the impact on short-term mortality.
Whether severely injured patients should be transported directly to tertiary trauma centers, bypassing closer nontertiary facilities, or be transported first to nearby, less-specialized facilities for immediate care and stabilization has been studied with mixed findings. Differences in study locale, case mix, and variation in the structure and level of maturation of the trauma system may explain some of the discrepancy in findings. In addition, risk adjustment strategies used in these studies did not take into account prehospital baseline characteristics as well as time since injury. ⋯ Transferred patients in a predominantly rural region are at an increased risk of short-term mortality. This suggests that severely injured patients should be transported directly to tertiary trauma centers. For patients requiring immediate stabilization at nontertiary facilities, this should be performed promptly without unnecessary delays.
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Randomized Controlled Trial Multicenter Study Comparative Study
Postinjury resuscitation with human polymerized hemoglobin prolongs early survival: a post hoc analysis.