J Trauma
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Critical care-trained trauma surgeons are the ideal care provider for severely injured patients. This "captain of the ship" (COS) assumes complete responsibility of the patient, from initial resuscitation to eventual discharge. Unlike American College of Surgeons-verified Level I centers, many nonacademic, community hospital trauma centers use a more fragmented approach, with care in the intensive care unit (ICU) delegated to a committee of multiple specialists. We hypothesized that dedicated trauma intensivists as COS in a community hospital could improve ICU outcome. ⋯ A trauma intensivist-driven model can be successfully adopted in a nonacademic community trauma program, without the need for a residency program. A decentralized ICU care model produces inefficiencies, diminishes the role of the trauma service, and decreases the overall throughput of trauma patients.
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Occurrence on weekends or at night has been associated with poor outcomes for time-sensitive conditions including ST elevation myocardial infarction, stroke, and cardiac arrest. We sought to determine whether the "weekend effect" exists for injured patients at our trauma center. ⋯ Differential mortality on off-hours is not seen at our Level I trauma center. Outcomes that are independent of time of day and day of week may be because of the explicit requirements for trauma centers to be fully staffed and operational at all times. There are implications for staffing and systems solutions for other time-sensitive disease including ST elevation myocardial infarction, stroke, and cardiac arrest. Interventions may include the development of a categorization system based on emergency care capabilities, development of explicit staffing requirements, and requiring an emergency care-specific quality improvement program.
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Trauma centers are designed to improve survival and outcome of the injured patient. The implementation of these centers in the United States has shown to reduce the number of preventable deaths from serious injuries. This study compares outcomes of trauma patients during two separate time periods in a Dutch Level I trauma center, before and after obtaining the trauma center status. ⋯ This study implies that the implementation of a trauma center reduces mortality, shortens hospital stay, and decreases the number of intensive care unit admittances in Utrecht, the Netherlands.
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Comparative Study
Preservation of splenic immunocompetence after splenic artery angioembolization for blunt splenic injury.
Splenic artery angioembolization (SAE) is increasingly being used as an adjunct to nonoperative management for stable patients with blunt splenic injury (BSI). However, little is known about splenic immunocompetence after SAE. This study aims at assessing splenic immunocompetence after SAE for BSI. ⋯ Splenic immune function, measured by T-cell subset, generated only in the presence of an immunocompetent spleen, is preserved after SAE for BSI, main or partial.
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Comparative Study
Lateral gastrocnemius flap cover for distal thigh soft tissue loss.
The gastrocnemius muscle flap has been used extensively for cover around the knee. However, the use of the lateral gastrocnemius for cover of the distal thigh has not been well described. ⋯ The lateral gastrocnemius muscle flap is effective in the cover of the lateral distal thigh.