J Trauma
-
Using a standardized liver injury model of uncontrolled hemorrhage, we tested the effect of different fluid resuscitation regimens on hemodynamics, oxygen delivery, oxygen consumption, bleeding volume, and fluid resuscitation requirements. Rats were randomized into three bolus resuscitation groups 15 minutes after liver injury: lactated Ringer's solution (LR, n = 10), hypertonic saline (HS, n = 10), and hypertonic sodium acetate (HA, n = 10). In all resuscitation groups, a 4 mL/kg bolus was first infused at a rate of 0.4 mL/min. ⋯ Animals in the HS group had significantly higher oxygen extraction ratios at the conclusion of the experiment. The use of different bolus fluids for the resuscitation of uncontrolled hemorrhage resulted in significant differences in hemodynamics, oxygen metabolism, and blood loss even when subsequent resuscitation was the same in all groups. Results from large vessel injury animal models and clinical studies of patients with penetrating trauma may not apply to solid parenchymal injuries.
-
Randomized Controlled Trial Clinical Trial
Use of low molecular weight heparin in preventing thromboembolism in trauma patients.
To investigate the safety and effectiveness of low molecular weight heparin (LMWH) in preventing deep venous thrombosis (DVT) in high-risk trauma patients, compared with mechanical methods of prophylaxis. ⋯ The administration of LMWH is a safe and extremely effective method of preventing DVT in high-risk trauma patients. When heparin is contraindicated, aggressive attempts at mechanical compression are warranted.
-
Multicenter Study
Continuous use of standard process audit filters has limited value in an established trauma system.
To evaluate the ability of five quality assurance/ quality improvement audit filters to identify opportunities for improvement in patient care in a mature trauma system. ⋯ The non-death process based audit filters that we evaluated in our trauma system documented adherence to care process standards but found few opportunities for quality improvement, suggesting that audit filters should be periodically evaluated and changed when their goals have been accomplished.
-
Determine whether severe injury results in decreased plasma antithrombin (AT) activity and whether this decreased AT activity is associated with thromboembolic complications. ⋯ AT activity was depressed in critically injured patients. Patients with head injury developed supranormal AT activity. The risk factors for AT deficiency mimicked those for thromboembolism. Patients with decreased AT activity were at increased risk for thromboembolic complications. Given heparin's dependence on AT, these data call into question the use of unmonitored heparin thromboembolism prophylaxis.
-
The Injury Severity Score (ISS) has served as the standard summary measure of human trauma for 20 years. Despite its stalwart service, the ISS has two weaknesses: it relies upon the consensus derived severity estimates for each Abbreviated Injury Scale (AIS) injury and considers, at most, only three of an individual patient's injuries, three injuries that often are not even the patient's most severe injuries. Additionally, the ISS requires that all patients have their injuries described in the AIS lexicon, an expensive step that is currently taken only at hospitals with a zealous commitment to trauma care. We hypothesized that a data driven alternative to ISS that used empirically derived injury severities and considered all of an individual patient's injuries would more accurately predict survival. ⋯ We conclude that ICISS is a much better predictor of survival than ISS in injured patients. The use of the ICD-9 lexicon may avoid the need for AIS coding, and thus may add an economic incentive to the statistical appeal of ICISS. It is possible that a similar data driven revision of ISS using the AIS vocabulary might perform as well or better than ICISS. Indeed, the actual lexicon used to divide up the injury "landscape" into individual injuries may be of little consequence so long as all injuries are considered and empirically derived SRRs are used to calculate the final injury measure.