J Trauma
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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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Comparative Study
The use of the 3-mm K-Wire to supplement reduction of humeral supracondylar fractures in children.
Most children with humeral supracondylar fractures can be treated with simple closed reduction and cross-fixation with Kirschner (K)-wires. However, in a small proportion of cases, an acceptable closed reduction cannot be obtained, and open reduction becomes necessary. An alternative to open reduction is the use of a temporary 3-mm K-wire to manipulate and reduce the distal fragment. This report introduces the method of manipulation, as well as indications, and draws comparisons with complete close reduction cases. ⋯ The closed reduction method should be used for children with humeral supracondylar fractures, whenever possible. The 3-mm K-wire manipulation method reduces the probability that open reduction will be required in some severe cases. This is a simple method without complications. The prognosis is the same as for closed reduction cases.
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This study aimed to determine whether glial fibrillary acidic protein (GFAP) is released after traumatic brain injury (TBI), whether GFAP is related to brain injury severity and outcome after TBI, and whether GFAP is released after multiple trauma without TBI. ⋯ The findings showed that GFAP is released after TBI, that GFAP is related to brain injury severity and outcome after TBI, and that GFAP is not released after multiple trauma without brain injury.