J Trauma
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Comparative Study
A new method for estimating probability of survival in pediatric patients using revised TRISS methodology based on age-adjusted weights.
TRISS methodology estimates probability of survival (P(s)) based on coefficients derived largely from adult data. We developed a novel pediatric age-specific method to estimate P(s). ⋯ PAAT offers a more reliable methodology than TRISS and ASCOT for comparing pediatric trauma outcomes.
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Thoracostomy tube (TT) placement constitutes primary treatment for traumatic hemopneumothorax. Practice patterns vary widely, and criteria for management and removal remain poorly defined. In this cohort study, we examined the impact of implementation of a practice guideline (PG) on improving management efficiency of thoracostomy tube. ⋯ Implementation of a thoracostomy tube practice guideline was associated with improved management efficiency in trauma patients.
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Optimal timing of femur fracture fixation remains controversial. This study examines the association between the timing of femur fracture fixation and outcome in patients with concomitant chest and head injuries. ⋯ Our data show that early femur fracture fixation (< 24 hours) is associated with an improved outcome, even in patients with coexistent head and/or chest trauma. Fixation of femur fractures at 2 to 5 days was associated with a significant increase in pulmonary complications, particularly with concomitant head or chest trauma, and length of stay. Chest and head trauma are not contraindications to early fixation with reamed intramedullary nailing.
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Clinical Trial Controlled Clinical Trial
Immediate spinal cord decompression for cervical spinal cord injury: feasibility and outcome.
The effect of immediate surgical spinal cord decompression on neurologic outcome after spinal cord injury is controversial. Experimental models strongly suggest a beneficial effect of early decompression but there is little supportive clinical evidence. This study is designed to evaluate the feasibility and outcome of an immediate spinal cord decompression treatment protocol for cervical spinal cord injury in a tertiary treatment center. ⋯ We conclude that immediate spinal column stabilization and spinal cord decompression, based on magnetic resonance imaging, may significantly improve neurologic outcome. The feasibility of such a treatment protocol in a tertiary treatment center is well demonstrated. Additional multicenter trials are necessary to achieve definitive conclusions regarding clinical efficacy.
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Performance improvement is an essential component of the trauma center. TRISS methodology has been applied as a national standard against which trauma centers can compare their outcomes. Earlier reviews of TRISS unexpected survivors sustained the classification of unexpected survivor in the vast majority of cases. Our hypothesis was that the level of care that is currently expected has made the TRISS unexpected survivors a statistical phenomenon only. ⋯ Only 10.7% of survivors classified as unexpected by TRISS were corroborated as unexpected by a blinded, peer-review process. TRISS needs to be updated for meaningful interpretation; modifications need to be made and coefficients need to be revised.