J Trauma
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: Emergency thoracotomy (ET) is a life-saving procedure used to control hemorrhage and relieve cardiac tamponade. It has been in routine use at Ulleval University Hospital since 1987. Our objective was to see the outcome of patients subjected to ET in recent times. ⋯ : An overall survival of 18% suggests that ET is a life saving procedure. It is difficult to find good predictors of survival from logistic regression analysis. It should, for a trained trauma team, be a liberal attitude toward performing the procedure on the agonal patient.
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Comparative Study Controlled Clinical Trial
Brain death confirmation: comparison of computed tomographic angiography with nuclear medicine perfusion scan.
: Brain death is a difficult diagnosis to make, relying primarily on clinical examination. Ancillary tests are used when confounders exist. Nuclear medicine perfusion test (NMPT) is currently the preferred test for confirming brain death. Computed tomographic angiography (CTA) may be an alternative test to confirm brain death. It is readily available 24 hours a day at most level I trauma centers and is easy to perform. ⋯ : CTA is a quick and efficient test for brain death confirmation. CTA demonstrated no false negative studies. The resolution of CTA seems to have an increased sensitivity for cerebral blood flow. Further studies with larger sample sizes need to be performed.
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Multicenter Study
Quality of Care Within a Trauma Center Is not Altered by Injury Type.
: Previous studies have demonstrated variations in severity-adjusted mortality between trauma centers. However, it is not clear if outcomes vary by the type of injury being treated. ⋯ : Risk-adjusted outcomes are consistent within trauma centers across different types of injuries, suggesting that quality improvement efforts should measure, analyze, and focus on hospital-wide systems of care, rather than on isolated quality domains related to specific types of injury.
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Controlled Clinical Trial
Spleen artery embolization aggravates endotoxin hyporesponse of peripheral blood mononuclear cells in patients with spleen injury.
: Spleen artery embolization (SAE) increases the success of nonoperative management of spleen injury; however, the immune alternation after SAE is unclear. This study searched the endotoxin responses of peripheral blood mononuclear cells (PBMCs) in injured patients who received SAE. ⋯ : SAE dysregulates the NF-kB system and aggravates the cytokine hyporesponse upon ES of PBMCs in patients with spleen injury. These results implicate that SAE alters immune response and may increase susceptibility to infections in injured patients.