J Trauma
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The pattern and severity of crash injury depends on a complex interaction of biomechanical factors such as deceleration velocity at impact (delta-V), seat-belt and airbag use, and type of impact. Human body characteristics such as height and weight may play an important role. We hypothesized that body mass index (BMI) will influence crash injury patterns. ⋯ Although no difference in ISS was identified between the lean and obese cohorts, there was an increase in mortality with the obese cohort. The severity of lower extremity injuries increased with increasing BMI. The overweight cohort was associated with lower ISS and abdominal mAIS score compared with the lean cohort. This protection may be attributable to an increase in insulating tissue, or a "cushion effect," without a significant increase in mass and momentum.
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Comparative Study
Impact of American College of Surgeons verification on trauma outcomes.
The purpose of this study was to compare the impact of trauma patient outcomes before and after Level II American College of Surgeons (ACS) verification was received in a not-for-profit community hospital. ⋯ This study suggests that the efforts and resources consumed achieving ACS Level II trauma center verification appear to result in desired outcomes as evidenced by decreased LOS, reduced in-hospital mortality rates, reduced cost, and improved contribution margins.
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Rib fractures have a strong association with nonaccidental trauma (NAT) and severe trauma. The purposes of this study were to evaluate rib fractures in children to determine (1) the positive predictive value of a rib fracture in defining NAT and (2) the frequency of rib fractures as the only skeletal manifestation of NAT. ⋯ In this study, rib fracture(s) were the only skeletal manifestation of NAT in 29% of the children.
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Management of the open abdomen in trauma and nontrauma patients is difficult, and some areas of controversy remain. Gastrointestinal fistulas are serious complications that are associated with significant mortality. We present our method for management of patients with open abdomen and also present a logical technique of subsequent repair of the late giant ventral hernias that uniformly occur in these patients. ⋯ Immediate closure of the open abdomen with bilateral bipedicle anterior abdominal skin flaps is an effective technique for dealing with such potentially complicated problems. Management of late giant ventral hernias with retrorectus prosthetic mesh repair is theoretically reasonable and, so far, no recurrence has been observed in our patients.