J Trauma
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Multicenter Study Comparative Study
A comparison among the abilities of various injury severity measures to predict mortality with and without accompanying physiologic information.
A few recent studies have compared the abilities of different injury severity measures to predict inpatient mortality. This study extended previous studies in that it used a registry with noncenters as well as centers, and examined the relative marginal abilities of competing severity measures to predict mortality when physiologic data also are available. ⋯ On the average, the ICISS had the best discrimination of all of the measures, as well as a slight edge with respect to calibration in predicting trauma mortality with or without the aid of demographic or physiologic measures.
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Multicenter Study
Variability in trauma center outcomes for patients with moderate intracranial injury.
The variability of outcome between Trauma Centers has not been extensively studied as a possible avenue for performance improvement. Trauma Center variability in severity-adjusted survival for patients with moderate intracranial injury (MII) was studied in order to determine the association of MII-related process of care variables with outcomes. The analytic results were supplemented with peer review of MII patients with unexpected outcomes and identified potential process of care variables. ⋯ Two severity adjustment methods identified significant variability in trauma center outcomes for patients with MII. The difference in outcomes between the centers with better than expected (2PZW) and poorer than expected outcomes (3NZW) was substantial. Peer review identified significant opportunities for reducing unexpected deaths, stays in hospital and in ICU, and the occurrence of complications. Trauma registry data and peer reviews found little relationship between available process of care variables and patient outcomes. This study should stimulate discussions to understand reasons for outcome variability and ways to reduce it.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Use of presumptive antibiotics following tube thoracostomy for traumatic hemopneumothorax in the prevention of empyema and pneumonia--a multi-center trial.
To determine whether presumptive antibiotics reduce the risk of empyema or pneumonia following tube thoracostomy for traumatic hemopneumothorax. ⋯ The incidence of empyema was low and the use of presumptive antibiotics did not appear to reduce the risk of empyema or pneumonia.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Treatment of complex tibial plateau fractures using the less invasive stabilization system plate: clinical experience and a laboratory comparison with double plating.
Bicondylar tibial plateau fractures are complex injuries, historically associated with high complication rates. The purpose of this study was: 1) to evaluate the clinical use L.I.S.S plating system for stabilization of bicondylar tibial plateau fractures. 2) To compare the biomechanics of this plating system with a double plate construct. ⋯ The L.I.S.S plating system provides stable fixation of complex bicondylar tibial plateau fractures allowing early range of knee motion with favorable clinical results.
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Multicenter Study Comparative Study
The New Injury Severity Score: a more accurate predictor of in-hospital mortality than the Injury Severity Score.
The purpose of this study was to determine whether the New Injury Severity Score (NISS) is a better predictor of mortality than the Injury Severity Score (ISS) in general and in subgroups according to age, penetrating trauma, and body region injured. ⋯ The NISS is a more accurate predictor of in-hospital death than the ISS and should be chosen over the ISS for case-mix control in trauma research, especially in certain subpopulations such as head/neck-injured patients.