J Trauma
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Comparative Study
Genitourinary injuries in pelvic fracture morbidity and mortality using the National Trauma Data Bank.
Pelvic fractures from blunt force trauma place the bladder and urethra at risk for injury, often resulting in significant complications. We sought to compare morbidity, mortality, and health care resource utilization in patients with and without genitourinary injuries (GUI) associated with pelvic fractures. ⋯ Patients sustaining a pelvic fracture with GUI have an increase in morbidity. Although GUI was not an independent predictor of mortality, patients who sustained a pelvic fracture with GUI had a greater number of concomitant injuries resulting in an increase in overall mortality compared with those without an associated GUI.
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Review Case Reports
Dyskalemia following head trauma: case report and review of the literature.
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Hyperglycemia is associated with increased mortality in the severely injured; intensive insulin protocols reduce mortality, improve wound healing, and decrease susceptibility to infection. High glucose variability creates challenges to glycemic control and may be a marker of poor outcome. We wondered whether glycemic variability alone might identify patients at higher risk of death. ⋯ High glucose variability (>50% of values outside 80-110 mg/dL) is associated with increased mortality in the severely burned. Individuals with frequent excursions outside the glucose target range of 80 mg/dL to 110 mg/dL are at greater risk of death.
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Mortality is worse after injuries occurring in rural areas. However, most trauma patients survive their injuries, and little is known about functional outcomes after nonfatal injuries that occur in rural areas compared with those that happen in the urban setting. We hypothesized that disability at hospital discharge is worse for those injured in nonurban areas. ⋯ Injuries in a nonurban location are associated with worse functional outcomes at hospital discharge. The magnitude of risk of a poor functional outcome is highest for patients who are injured in a rural location. These findings are important when considering allocation of trauma resources.
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Male and female nervous systems respond differently to traumatic brain injury (TBI) and in vivo research relates this difference to neuroprotection from female sex hormones. Attempts to replicate female sex hormone-related neuroprotection in clinical studies have been unsuccessful. The objective of this study was to determine whether gender or menopausal status affects mortality in patients with moderate to severe TBI. ⋯ Female gender is independently associated with reduced mortality and decreased complications after TBI. As peri- and postmenopausal women demonstrated improved survival, and premenopausal women did not, estrogen unlikely confers neuroprotection in women after TBI. Future TBI treatment may benefit with further research focused on why peri- and postmenopausal women show decreased mortality after TBI.