J Trauma
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Comparative Study
First echelon hospital care before trauma center transfer in a rural trauma system: does it affect outcome?
Rural trauma has been associated with higher mortality because of a number of geographic and demographic factors. Many victims, of necessity, are first cared for in nearby hospitals, many of which are not designated trauma centers (TCs), and then transferred to identified TCs. This first echelon care might adversely affect eventual outcome. We have sought to examine the fate of trauma patients transferred after first echelon hospital evaluation and treatment. ⋯ In this rural setting, care at first echelon hospitals, most (95%) of which were not designated TCs, seemed to augment, rather than detract from, favorable outcomes realized after definitive care at the TC.
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We aimed to determine the effect of femur fractures on mortality, pulmonary complications, and adult respiratory distress syndrome (ARDS). In addition, we aimed to compare the effect of femur fractures with other major musculoskeletal injuries and to determine the effect of timing to surgery on these complications. ⋯ Femur fractures are a major musculoskeletal injury and increase the risk of mortality and pulmonary complications as much as any other musculoskeletal injuries. There is a unique relationship between ARDS and femur fractures, and this must be considered carefully in treatment planning for these patients.
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The severity of the injury is the most important factor to return to work (RTW) when it comes to hand injuries. The purpose of our study is to examine the relationship between the initial anatomic severity, evaluated by the Hand Injury Severity Scoring (HISS) system, and probability of RTW in occupational hand injured patients. ⋯ HISS is a useful instrument to predict the opportunity of RTW while restricted to the compensated patients. We also verified that the relationship between HISS severity and the probability of RTW existed for groups but not for individual patients.
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We aimed to investigate the value of the diameter of the inferior vena cava (IVC) on initial computed tomography (CT) to predict hemodynamic deterioration in patients with blunt torso trauma. ⋯ In cases of blunt torso trauma, patients with FVC on initial CT may exhibit hemodynamic deterioration, necessitating early blood transfusion and therapeutic intervention.
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Delayed splenic hemorrhage after proximal splenic artery embolotherapy (SAE) in patients with blunt splenic injury is a well-known outcome. The hemorrhage is thought to be due to rupture of a splenic parenchymal pseudoaneurysm. This study attempts to explain at least part of the mechanism involved in the delayed hemorrhage event. ⋯ The arterial pressure in the distal splenic artery after SAE is highly variable and may depend on the robustness of pre-SAE collaterals.