J Trauma
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Multicenter Study
Anemia and blood transfusion in trauma patients admitted to the intensive care unit.
Anemia is a common occurrence in the intensive care unit (ICU). Although resuscitation, including the use of blood, is a mainstay of early treatment of trauma victims, the safety and efficacy of red blood cell (RBC) transfusion has come under scrutiny recently. The issue of blood use in critically injured patients requires evaluation. ⋯ Anemia is common in critically injured trauma patients and persists throughout the duration of critical illness. These patients receive a large number of RBC transfusions during their ICU course with aged blood.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Prevention of venous thromboembolism in the rehabilitation phase after spinal cord injury: prophylaxis with low-dose heparin or enoxaparin.
This prospective, multicenter study compared low-dose unfractionated heparin (UFH) with enoxaparin for prophylaxis against venous thromboembolism (VTE) during the rehabilitation phase after spinal cord injury. ⋯ In this nonrandomized comparison, enoxaparin appeared more effective than heparin in the prevention of thromboembolic complications during rehabilitation after spinal cord injury. Both interventions were safe in this population.
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Multicenter Study
Multicenter prospective validation of prehospital clinical spinal clearance criteria.
Spine immobilization is one of the most frequently performed prehospital procedures. If trauma patients without significant risk for spine injury complications can be identified, spine immobilization could be selectively performed. The purpose of this study was to evaluate five prehospital clinical criteria-altered mental status, neurologic deficit, spine pain or tenderness, evidence of intoxication, or suspected extremity fracture-the absence of which identify prehospital trauma patients without a significant spine injury. ⋯ Absence of the study criteria may form the basis of a prehospital protocol that could be used to identify trauma patients who may safely have rigid spine immobilization withheld. Evaluation of such a protocol in practice should be performed.
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Multicenter Study Comparative Study
Variability in computed tomography and magnetic resonance imaging in patients with cervical spine injuries.
The purpose of this study was to describe the performance of adjunctive radiologic imaging in patients with cervical spine injury. ⋯ The majority of patients with cervical spine injury undergo MRI and/or CT imaging. In clinical practice, MRI is superior at identifying soft tissue injuries, whereas CT performs better in identifying bony injuries. Cervical myelograms and tomograms are rarely obtained.
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Multicenter Study
Trauma in the elderly: intensive care unit resource use and outcome.
As the population ages, the elderly will constitute a prominent proportion of trauma patients. The elderly suffer more severe consequences from traumatic injuries compared with the young, presumably resulting in increased resource use. In this study, we sought to examine ICU resource use in trauma on the basis of age and injury severity. ⋯ Age is confirmed as an independent predictor of outcome (mortality) in trauma after stratification for injury severity in this largest study of elderly trauma patients to date. Elderly patients with severe injury (ISS > 30) have decreased ICU resource use secondary to associated increased mortality rates.