J Trauma
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Plasma gelsolin depletion has been associated with poor outcome of critically ill patients. However, there is a paucity of data available on circulating plasma gelsolin concentration in traumatic brain injury (TBI). Thus, we sought to investigate change in plasma gelsolin level after TBI and to evaluate its relation with disease outcome. ⋯ Decreased plasma gelsolin level is associated with GCS scores and an independent prognostic marker of mortality after TBI. Reversing plasma gelsolin deficiency may be an effective treatment for TBI.
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Use of cephalomedullary devices for pertrochanteric fractures has been associated with complications of cutout, fracture distal to the tip of the implant, infection, and hardware failure. The goal of recent design changes (a trapezoidal shape of the proximal device, with interdigitation of the cephalocervical screws) in cephalomedullary nails was to improve fracture fixation and stability of pertrochanteric fractures. This is a retrospective review of the first 127 surgeries using this new cephalomedullary nail to review early complications seen with this device. ⋯ In our study population, we found this newer cephalomedullary device had complications similar to those reported with devices in previous studies.
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Comparative Study
Age: is it all in the head? Factors influencing mortality in elderly patients with head injuries.
Elderly patients, an increasing segment of the population, who sustain traumatic brain injury (TBI) are known to have worse outcomes, including higher mortality. This objective of this study was to examine the Crash Injury Research Engineering Network and to determine at what age motor vehicle crash fatalities from head injuries increased. ⋯ There was a higher mortality secondary to head injuries in those older than 60 years involved in motor vehicle crashes. Improved safety measures in vehicle design may decrease the number of head injuries seen in the older population.
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Prehospital care of combat casualties is a critical phase of emergency medical practice on the battlefield. The Joint Theater Trauma Registry (JTTR) was developed to standardize a system of data collection for combat casualty care; however, the degree of population and granularity of prehospital data were unknown. ⋯ Both poor population of data points and poor granularity of prehospital data entered into the JTTR were observed. It appears that the volume and quality of reporting of role-I data were better for OIF than OEF for this study period. Further investigations into the obstacles to free flow of role-I casualty clinical data, and the means to mitigate this situation, are warranted.