J Trauma
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Multicenter Study Comparative Study
Comparison of abdominal damage control surgery in combat versus civilian trauma.
The majority of individuals who perform damage control surgery in the military arena are trained in civilian venues. Therefore, it is important to compare and contrast damage control performed in civilian and military settings. In contrast to civilian trauma, which is primarily caused by blunt injury and addressed at one or two surgical facilities, combat casualties primarily sustain explosion-related injuries and undergo treatment at multiple levels of care across continents. We aimed to compare patients undergoing abdominal damage control surgery across these two very different settings. ⋯ Military and civilian trauma patients who undergo damage control surgery experience similar fascial closure rates despite differing demographics and widely disparate mechanisms of injury. The MP undergoes a greater number of procedures than the CP, but complication rates do not differ between the groups.
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Multicenter Study Comparative Study
Multicenter validation of a simplified score to predict massive transfusion in trauma.
Several studies have described predictive models to identify trauma patients who require massive transfusion (MT). Early identification of lethal exsanguination may improve survival in this patient population. The purpose of the current study was to validate a simplified score to predict MT at multiple Level I trauma centers. ⋯ The ABC score is a valid instrument to predict MT early in the patient's care and across various demographically diverse trauma centers. Future research should focus on this score's ability to prospectively identify patients who will receive MT.
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Multicenter Study
Socioeconomic disparities in infant mortality after nonaccidental trauma: a multicenter study.
While disparities in abuse-related mortality between minority and white infants have been reported, the influence of socioeconomic status on outcome has not been evaluated. The goal of this study was to determine the impact of socioeconomic status and race on outcomes for abused infants using multiinstitutional data. ⋯ There are significant differences in mortality among abused infants associated with insurance status and income even after controlling for injury severity. These associations show a need to better understand and address socioeconomic variations in outcome.
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Multicenter Study
Prophylaxis for venous thromboembolism during rehabilitation for traumatic brain injury: a multicenter observational study.
Deep venous thrombosis (DVT) is a major cause of mortality and morbidity after traumatic brain injury (TBI). There is no consensus regarding appropriate screening, prophylaxis, or treatment during acute rehabilitation. ⋯ Prophylactic anticoagulation during rehabilitation seemed safe for TBI patients whose physicians deemed it appropriate, but did not conclusively reduce venous thromboembolism. Given the number of DVTs present before rehabilitation, screening and prophylaxis during acute care may be more important.
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Multicenter Study
A trauma outreach program provided by a level I trauma center is an effective way to initiate peer review at referring hospitals and foster process improvements.
The initial care of critically injured patients has profound effects on ultimate outcomes. The "golden hour" of trauma care is often provided by rural hospitals before definitive transfer. There are, however, no standardized methods for providing educational feedback to these hospitals for the purposes of performance improvement. We hypothesized that an outreach program would stimulate peer review and identify systematic deficiencies in the care of patients with injuries. ⋯ A formal outreach program can stimulate peer review at rural hospitals, provide continuing education in the care of patients with injuries, and foster process improvements at referring hospitals.