J Trauma
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Comparative Study
Development and validation of an age-risk score for mortality predication after thermal injury.
In burn patients, the risk of mortality typically decreases as children mature, reaches a nadir at age 21, rises linearly thereafter, and levels off in old age. We hypothesized that a single "age-risk score" (AGESCORE), incorporating a cubic functional form, can be used in predictive models for mortality after burns. ⋯ The benefits of a standardized index of age risk include ease of comparison, reduction of bias, and increased efficiency attributable to statistical parsimony. The applicability of this approach to nonthermal trauma patients remains to be seen.
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Abnormal blood lactate and base deficit (BD) reflect hypoperfusion and have been documented to predict outcome in trauma. Alcohol and drug use may also induce metabolic acidosis in trauma victims, potentially diminishing the predictive accuracy of lactate and BD. We, therefore, sought to examine the effect of alcohol and drug use on the predictive accuracy of admission blood lactate and BD in trauma. ⋯ Alcohol and drug use are common in trauma, but do not impair the predictive accuracy of admission lactate and BD in trauma outcome. Admission lactate and BD are therefore confirmed as significant independent predictors of trauma outcome in patients with acute alcohol and drug use in this largest clinical study to date.
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Comparative Study
Aggressive organ donor management significantly increases the number of organs available for transplantation.
The shortage of transplantable organs has become a national crisis. Despite various attempts to expand the donor pool, the difference between organ supply and organ demand continues to widen. With no foreseeable increase in the number of donors, it is necessary to maximize the utilization of organs from the existing donor pool. ⋯ A policy of ADM increases the referral pool for organ donation and reduces the number of organ donors lost due to cardiovascular collapse. The net result is a significant increase in the number of organs available for transplantation.
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To determine whether prehospital clinical assessments are associated with the survival of traumatic cardiopulmonary arrest (TCPA) patients and to test recently issued clinical guidelines for prehospital cessation of resuscitative efforts published by the National Association of Emergency Physicians and the American College of Surgeons Committee on Trauma. ⋯ +/- Prehospital clinical assessments are not reliable for the triage of TCPA patients. Patients should be transported to the ED for further evaluation and care. The guidelines should not adopted until more thorough studies are conducted.