J Trauma
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Comparative Study
Comparison of clinical, radiologic, and serum marker as prognostic factors after severe head injury.
S-1OOB, a protein of astroglial cells, is described as a marker for neuronal damage. Reliable outcome prediction from severe head injury is still unresolved. Clinical scores such as the Glasgow Coma Scale score (GCS) and diagnostic scores such as the Marshall Computed Tomographic Classification are well established and investigated, but there are still some concerns about these tools. The aim of this study was to investigate the predictive value of the initial serum level of S-100B compared with the predictive value of the GCS score and the Marshall Computed Tomographic Classification to outcome after severe head injury. ⋯ The serum level of S-100B calculated within 1 to 6 hours of a severe head injury is a useful additional outcome predictor.
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To apply case-matching methodology to a statewide trauma registry to identify for peer review one trauma center's patients with "unexpected" survival deaths, complications or prolonged length of stay in hospital (H-LOS) or in Intensive Care Unit (ICU-LOS). ⋯ Peer review of patients identified by case-matching methodology uncovered opportunities for system improvement that were missed by the concurrent performance improvement process. This method may also allow identification of anticipated H-LOS and ICU-LOS to promote earlier discharge.
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Trauma patients with acute alcohol intoxication or chronic alcohol dependence are at greater risk for morbidity and mortality. We hypothesized that relying on clinical suspicion to detect acute alcohol intoxication and chronic alcohol dependence in trauma patients is inaccurate, influenced by injury factors, and biased by race, gender, age, and socioeconomic status. ⋯ Formal alcohol screening should be routine because clinical detection of acute alcohol intoxication and dependence is inaccurate. Screening should also be routine to avoid discriminatory bias attributable to patient characteristics.
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Comparative Study
Hypothermic aortic arch flush for preservation during exsanguination cardiac arrest of 15 minutes in dogs.
Trauma victims rarely survive cardiac arrest from exsanguination. Survivors may suffer neurologic damage. Our hypothesis was that a hypothermic aortic arch flush of 500 mL of isotonic saline solution at 4 degrees C, compared with 24 degrees C (room temperature), administered at the start of prolonged exsanguination cardiac arrest (CA) would improve functional neurologic outcome in dogs. ⋯ At the start of 15 minutes of exsanguination cardiac arrest in dogs, hypothermic aortic arch flush allows resuscitation to survival with normal neurologic function and histologically almost clean brains.