J Trauma
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Diffuse axonal injury (DAI) is usually associated to severe trauma. Recent imaging advances made its diagnosis easier. Its prognosis impact is not yet well established. The aim of this article is to describe the epidemiologic, clinical, and radiologic features of posttraumatic DAI and to study its prognosis impact on mortality and outcome according to Glasgow Outcome Scale. ⋯ Dysautonomia, hyperglycemia, and subdural hematoma are the main factors associated to higher mortality when DAIs are diagnosed, whereas a DAI count≥6 is associated to poor outcome. Magnetic resonance imaging classification did not have a prognosis value even in patients with pure DAI.
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Tachycardia is an important early sign of shock in trauma. Although the base deficit (BD) and lactate are indicative of hypoperfusion and known to predict mortality, some cases show a discrepancy between heart rate (HR) and BD or lactate; such cases have poor prognosis. The objective of this study was to examine whether lack of tachycardia after hypoperfusion is associated with increased mortality. ⋯ The lack of tachycardia in the presence of hypoperfusion is associated with poor prognosis independent of injury severity, SBP, and head injury. A discrepancy between HR and indicators of hypoperfusion could be considered as a predictor of mortality in trauma patients.
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The primary objective was to prospectively determine the 12-month prevalence of cognitive impairment and psychologic difficulties in moderately versus severely injured adult trauma intensive care unit (TICU) survivors without intracranial hemorrhage. ⋯ Long-term cognitive impairment is highly prevalent in TICU survivors without intracranial hemorrhage as are psychologic difficulties. Injury severity, concussion status, and delirium duration were not risk factors for the development of neuropsychological deficits in this cohort. Individuals with moderately severe injuries seem to be as likely as their more severely injured counterparts to experience marked cognitive impairment and psychologic difficulties; thus, screening efforts should focus on this potentially overlooked patient group.
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Glial fibrillary acidic protein (GFAP) is a monomeric intermediate filament protein found in the astroglial cytoskeleton and is not found outside the central nervous system. It is a brain-specific protein that is released after traumatic brain injury (TBI). ⋯ These results suggest that determination of serum levels of GFAP may add to the clinical assessment of the primary damage and prediction of outcome after severe TBI.
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The epidemiology of vascular injuries in the geriatric patient population has not been described. The purpose of this study was to examine nationwide data on vascular injuries in the geriatric patients and to compare this with the nongeriatric adult patients with respect to the incidence, injury mechanisms, and outcomes. ⋯ Vascular trauma is rare in the geriatric patient population. These injuries are predominantly blunt, with the thoracic aorta being the most commonly injured vessel. Although vascular injuries occur less frequently than in the nongeriatric cohort, in the geriatric patient, vascular injury is associated with a fourfold increase in adjusted mortality.