J Trauma
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The aim of this study was to assess the outcome of immediate plate osteosynthesis in the surgical treatment of open humeral shaft fractures. ⋯ Immediate plate osteosynthesis for open humeral shaft fractures has been shown to produce excellent results regarding bone union and absence of deep infections and is a safe technique in the management of these injuries.
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Multicenter Study
Posttraumatic stress disorder after injury: does admission to intensive care unit increase risk?
This study aimed to index the prevalence of posttraumatic stress disorder (PTSD) after injury requiring intensive care unit (ICU) admission to investigate whether an ICU admission after injury increases risk for PTSD and to identify predictors of PTSD after ICU admission. ⋯ Injury patients are three times more likely to develop later PTSD if they have an ICU admission. Given we controlled for many risk variables, it seems that an ICU admission itself may contribute to the development of PTSD. Mental health services such as screening and early intervention may be particularly useful for this population.
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Multicenter Study
Management of patients with traumatic intracranial injury in hospitals without neurosurgical service.
Many patients with intracranial bleeding (ICB) are being evaluated in hospitals with no neurosurgical service. Some of the patients may be safely managed in the primary hospital without transferring them to a designated neurosurgical center. In Israel, there are three approaches to alert patients with ICB: mandatory transfer, remote telemedicine neurosurgical consultation, and clinical-radiologic guidelines. We evaluated the outcome of alert patients with low-risk ICB who were managed in centers without neurosurgical service. ⋯ Despite the small sample size of this study, the presented data suggest that some patients with ICB can be safely and definitively managed in centers with no on-site neurosurgical service. The need for transfer may be based on telemedicine consultation or clinical -radiologic guidelines. Further larger scale studies are warranted.
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Randomized Controlled Trial
A randomized prospective trial of airway pressure release ventilation and low tidal volume ventilation in adult trauma patients with acute respiratory failure.
Airway pressure release ventilation (APRV) is a mode of mechanical ventilation, which has demonstrated potential benefits in trauma patients. We therefore sought to compare relevant pulmonary data and safety outcomes of this modality to the recommendations of the Adult Respiratory Distress Syndrome Network. ⋯ For patients sustaining significant trauma requiring mechanical ventilation for greater than 72 hours, APRV seems to have a similar safety profile as the LOVT. Trends for APRV patients to have increased ventilator days, ICU LOS, and ventilator-associated pneumonia may be explained by initial worse physiologic derangement demonstrated by higher Acute Physiology and Chronic Health Evaluation II scores.
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The aim of this study was to examine the long-term physical and psychological consequences of multiple blunt forced trauma at ≥ 10-year follow-up for patients with and without traumatic brain injury (TBI). ⋯ Prospective studies are needed with a broader range of measures that may be sensitive to the consequences of TBI. Evidence-based interventions to facilitate physical and psychological rehabilitation, designed to target at risk patients, are warranted.