J Trauma
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Multicenter Study Comparative Study
Emergency medical services transport decisions in posttraumatic circulatory arrest: are national practices congruent?
To catalog the 9-1-1 emergency medical services (EMS) transport practices for posttraumatic circulatory arrest patients (PTCAPs) in the majority of the nation's largest municipalities and to compare those practices to guidelines recommended by the National Association of EMS Physicians (NAEMSP) and American College of Surgeons Committee on Trauma (ACSCOT). ⋯ Many of the nation's highest volume EMS systems transport certain PTCAPs emergently, contrary to NAEMSP-ACSCOT guidelines to terminate resuscitative efforts in such cases. Reasons for these discrepancies should be evaluated to help better delineate applicable consensus guidelines for large urban EMS agencies.
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To assess the depressant effects of alcohol on the level of consciousness of patients admitted with head injuries, this study examined the changes that occur in the Glasgow Coma Scale (GCS) of traumatic brain injury patients over time. ⋯ This study concludes that the GCS increases significantly over time in alcohol intoxicated patients with traumatic brain injury.
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Multicenter Study Comparative Study
Variable application and misapplication of cricoid pressure.
In 1961, Sellick described a three-finger technique of cricoid pressure used to prevent gastric regurgitation during induction of anesthesia. The "Sellick maneuver" is now used worldwide. The authors have observed great variability in the application of cricoid pressure by health care providers and have suspected that misapplication occurs. The objectives of this observational study were to determine how many different techniques of cricoid pressure were being used and to identify the reasons for such variability of technique. ⋯ This observational study demonstrates that there is great variability in the application of cricoid pressure, identifying 10 different techniques in 32 observations. Misapplication does occur with possible patient harm. We suggest four possible reasons for this variability of technique. The authors use the three-finger cricoid pressure technique as originally described by Sellick and thought that this technique is effective, easy to teach, and safely keeps the fingers in the midline of the cricoid cartilage.
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Comparative Study
Hips can lie: impact of excluding isolated hip fractures on external benchmarking of trauma center performance.
Trauma centers (TCs) vary in the inclusion of patients with isolated hip fractures (IHFs) in their registries. This inconsistent case ascertainment may have significant implications on the assessment of TC performance and external benchmarking efforts. ⋯ Given the fact that IHFs in the elderly significantly influence risk-adjusted outcomes and are variably reported by TCs, these patients should be excluded from subsequent benchmarking efforts.
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Comparative Study
Complications in multitrauma patients in a Dutch level 1 trauma center.
Complication registration is an important part of monitoring the quality of health care. The aim of this article was to describe the incidence, type, and impact of complications occurring within 6 months after the initial trauma in multitrauma patients. ⋯ Multitrauma patients are at high risk for developing complications. Most frequently encountered complications were infections. The majority of complications resolved completely without a surgical intervention.