J Trauma
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Multicenter Study Comparative Study
Early use of vasopressors after injury: caution before constriction.
Recent evidence suggests that overly aggressive crystalloid resuscitation is associated with poor outcome. This has led to a renewed interest in the use of vasopressors for hemodynamic support during resuscitation after injury. We sought to characterize early vasopressor (EV) use and aggressive early crystalloid resuscitation (ECR) and their association with mortality in severely injured patients. ⋯ These findings provide evidence that the early use of vasopressors for hemodynamic support after hemorrhagic shock may be deleterious, and should be used cautiously and not in place of aggressive crystalloid resuscitation after severe blunt injury.
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Multicenter Study Clinical Trial
Racial disparities in long-term functional outcome after traumatic brain injury.
Ethnic disparities have been demonstrated in several diseases, but not in trauma. We hypothesized that access to acute rehabilitation and long-term functional outcomes among traumatic brain injury (TBI) patients are influenced by patient race and ethnicity. ⋯ Despite equal access to acute rehabilitation, ethnic minorities have significantly worse long-term functional outcomes after TBI, which is related to lack of health insurance.
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Ethnic disparities in access to acute rehabilitation and in long-term global neurologic outcomes after traumatic brain injury (TBI) have been previously documented. The current study was undertaken to determine whether there are specific types of functional deficits that disproportionately affect ethnic minorities after TBI. ⋯ Ethnic minorities with TBI suffer worse long-term deficits in three specific functional domains. TBI rehabilitation programs should target these specific areas to reduce disparities in functional outcomes in ethnic minorities.
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The National Study on the Costs and Outcomes of Trauma Care (NSCOT) was designed to address the need for better information on the value of trauma center care. It is a multi-institutional, prospective study that involved the examination of costs and outcomes of care received by over 5,000 adult trauma patients 18 to 84 years of age treated at 69 hospitals located in 12 states. ⋯ We also present a description of the study population to serve as a basis of future reports. We conclude with lessons learned and some recommendations for future research.
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Multicenter Study Comparative Study Clinical Trial
Predicting the severity of systemic inflammatory response syndrome (SIRS)-associated coagulopathy with hemostatic molecular markers and vascular endothelial injury markers.
The changes in biomarkers of coagulation or fibrinolysis, anticoagulation, inflammation, and endothelial damage occur in patients with systemic inflammatory response syndrome (SIRS). The purpose of this study is to assess the prognostic value of these markers in patients with SIRS-associated hypercoagulopathy. ⋯ The changes in some hemostatic molecular markers and vascular endothelial markers were conspicuous in patients with organ dysfunction. The AT activity is considered to be the most useful predictor of organ dysfunction.