J Trauma
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Multicenter Study Comparative Study
Volar locking plates versus K-wire fixation of dorsally displaced distal radius fractures--a functional outcome study.
Fractures of the distal radius are common. As the population of the western world ages, their incidence is set to increase further. There are various methods of treating these fractures, but optimal management remains controversial. In the United Kingdom, the most common surgical treatment of closed distal radius fractures is by Kirschner-wires (K-wires) or volar locking plate. In this study, we compared long-term functional outcomes of volar locking plates with those of K-wires. ⋯ We have been unable to demonstrate a clinically relevant advantage of using volar locking plates over K-wires at 1 year to 2 years postoperatively.
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Multicenter Study
Out-of-hospital decision making and factors influencing the regional distribution of injured patients in a trauma system.
The decision-making processes used for out-of-hospital trauma triage and hospital selection in regionalized trauma systems remain poorly understood. The objective of this study was to assess the process of field triage decision making in an established trauma system. ⋯ Provider cognitive reasoning for field trauma triage is more heuristic than algorithmic and driven primarily by provider judgment, rather than specific triage criteria.
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Most Brazilian hospitals have no medical radiologists for emergencies. The radiologic evaluation is provided by doctors with heterogeneous generalist training. The objective is to demonstrate the need for systematization in the care of trauma in the interpretation of cervical spine and chest radiographs. Is it possible that, through a continuing education program, generalist doctors could be trained in the evaluation of these radiographs? ⋯ The systematized training, through the advanced trauma life support protocol, significantly increased the success rate of the evaluation of cervical spine and chest radiographs.
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Multicenter Study Comparative Study
Directness of transport of major trauma patients to a level I trauma center: a propensity-adjusted survival analysis of the impact on short-term mortality.
Whether severely injured patients should be transported directly to tertiary trauma centers, bypassing closer nontertiary facilities, or be transported first to nearby, less-specialized facilities for immediate care and stabilization has been studied with mixed findings. Differences in study locale, case mix, and variation in the structure and level of maturation of the trauma system may explain some of the discrepancy in findings. In addition, risk adjustment strategies used in these studies did not take into account prehospital baseline characteristics as well as time since injury. ⋯ Transferred patients in a predominantly rural region are at an increased risk of short-term mortality. This suggests that severely injured patients should be transported directly to tertiary trauma centers. For patients requiring immediate stabilization at nontertiary facilities, this should be performed promptly without unnecessary delays.
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Multicenter Study Comparative Study
Blunt traumatic occult pneumothorax: is observation safe?--results of a prospective, AAST multicenter study.
An occult pneumothorax (OPTX) is found incidentally in 2% to 10% of all blunt trauma patients. Indications for intervention remain controversial. We sought to determine which factors predicted failed observation in blunt trauma patients. ⋯ Most blunt trauma patients with OPTX can be carefully monitored without tube thoracostomy; however, OPTX progression and respiratory distress are independently associated with observation failure.