J Trauma
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Comparative Study
Combat musculoskeletal wounds in a US Army Brigade Combat Team during operation Iraqi Freedom.
A prospective, longitudinal analysis of musculoskeletal combat injuries sustained by a large combat-deployed maneuver unit has not previously been performed. ⋯ A large burden of complex orthopedic injuries has resulted from the combat experience in Operation Iraqi Freedom. This is because of increased enemy reliance on explosive devices, the use of individual and vehicular body armor, and improved survivability of combat-injured soldiers.
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Comparative Study
Validation of the "HAMP" mapping algorithm: a tool for long-term trauma research studies in the conversion of AIS 2005 to AIS 98.
There are significant changes in the abbreviated injury scale (AIS) 2005 system, which make it impractical to compare patients coded in AIS version 98 with patients coded in AIS version 2005. ⋯ The HAMP algorithm successfully converted injuries coded in AIS 2005 to AIS 98. This algorithm will be useful when comparing trauma patient clinical data across populations coded in different versions, especially for longitudinal studies.
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Comparative Study
Risk factors associated with early reintubation in trauma patients: a prospective observational study.
After mechanical ventilation, extubation failure is associated with poor outcomes and prolonged hospital and intensive care unit (ICU) stays. We hypothesize that specific and unique risk factors exist for failed extubation in trauma patients. The purpose of this study was to identify the risk factors in trauma patients. ⋯ Independent risk factors for trauma patients to fail extubation include spine fracture, initial intubation for airway, GCS at extubation, and delirium tremens. Trauma patients with these four risk factors should be observed for 24 hours after extubation, because the mean time to failure was 15 hours. In addition, increased complications, extended need for mechanical ventilation, and prolonged ICU and hospital stays should be expected for trauma patients who fail extubation.
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Comparative Study
Combat-related craniofacial and cervical injuries: a 5-year review from the British military.
Recent international publications have noted a sustained increase in the incidence of head, face, and neck (HFN) wounds in comparison with total battle injuries from the 20th to the 21st century. The aim of this review was therefore to perform an analysis of the epidemiology of all HFN injuries sustained by British forces in Iraq and Afghanistan from March 1, 2003, to December 31, 2008. ⋯ The individual incidences of head (15%) and face (19%) injuries in relation to total battle injuries, although greater than seen in previous United Kingdom conflicts, were only slightly higher than that seen by US forces. The incidence of neck injury alone in relation to total battle injuries of 11% in United Kingdom forces in comparison with 3% to 5% found in US forces warrants further investigation. This article also provides further evidence to support the existing published opinion of multiple international authors in the requirement to develop innovative methods of protecting the vulnerable HFN regions.
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Comparative Study
Liver dysfunction by model for end-stage liver disease score improves mortality prediction in injured patients with cirrhosis.
Cirrhosis is associated with poor outcomes in the trauma setting. We aimed to evaluate the utility of Model for End-Stage Liver Disease (MELD) in assessing additional mortality risk in trauma patients with cirrhosis. ⋯ In trauma patients with cirrhosis, a score that evaluates the degree of liver dysfunction enhances the ability of ISS alone to predict mortality. The MELD score is more readily available than the CTP score for the prediction of mortality in trauma patients.