J Trauma
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Comparative Study
Identifying injuries and motor vehicle collision characteristics that together are suggestive of diaphragmatic rupture.
Diaphragmatic rupture (DR) remains a diagnostic challenge because of the lack of an accurate test demonstrating the injury. Our purpose was to identify motor vehicle collision (MVC) characteristics and patient injuries that collectively could identify the presence of a DR. ⋯ Specific MVC characteristics combined with patient injuries have been identified that are highly suggestive of DR. For this subpopulation, additional invasive procedures including exploratory laparotomy, laparoscopy, or thoracoscopy may be warranted to exclude DR.
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Review Meta Analysis
Does the pulse examination in patients with traumatic knee dislocation predict a surgical arterial injury? A meta-analysis.
This systematic review aimed at evaluating the diagnostic accuracy of pulse examination in detecting surgical arterial lesions associated with knee dislocation. ⋯ Our findings suggest that the isolated presence of abnormal pedal pulses on initial examination of patients with knee dislocations is not sensitive enough to detect a surgical vascular injury. On the basis of this meta-analysis, an algorithm for the evaluation of these patients is presented.
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Comparative Study
Prospective evaluation of the sensitivity of physical examination in chest trauma.
Chest radiographs are routine for patients presenting with blunt and penetrating chest trauma. The accuracy of physical examination in the diagnosis of hemopneumothorax in these patients is unclear. A prospective study was performed to define the utility of routine portable chest radiographs in 676 trauma patients. ⋯ Blunt chest trauma patients who are hemodynamically stable with a normal physical examination do not require a routine chest radiograph. In contrast, all victims of penetrating trauma require chest radiographs because many will have hemopneumothorax in the absence of clinical findings.
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Comparative Study
An assessment of the potential for reducing future combat deaths through medical technologies and training.
We examined clinical records of combat casualties that died subsequent to reaching a medical treatment facility in an effort to determine whether new medical technologies or enhanced training might contribute to a reduction in combat deaths. ⋯ Surgeons reviewing records of past combat deaths indicated that reductions in the incidence of combat deaths through deployment of improved medical technologies and training is possible. Deployment of the noted technologies and proficiency in the cited training has the potential for reducing deaths by 8% to 25% when compared with the died-in-hospital incidence among casualties in the last sustained conflict.
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Comparative Study
Pelvic radiography in blunt trauma resuscitation: a diminishing role.
An anteroposterior pelvic radiograph (PXR) continues to be recommended by Advanced Trauma Life Support protocol as an early diagnostic adjunct in the resuscitation of blunt trauma patients. At the same time, computed tomographic (CT) scanning has become a practice standard for diagnosis of most abdominal and pelvic injury. The objective of this study was to determine the necessity of obtaining an early PXR in stable trauma patients who will undergo CT scanning during the initial resuscitation. ⋯ The PXR has limited sensitivity for detecting pelvic fractures compared with CT scanning. Selected hemodynamically stable patients who undergo CT scanning during their immediate resuscitation do not need a routine PXR. The PXR may continue to be beneficial in unstable patients, those with positive physical findings, or those who cannot undergo CT scanning because of other clinical priorities.