European journal of trauma and emergency surgery : official publication of the European Trauma Society
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Eur J Trauma Emerg Surg · Oct 2019
Management of mild traumatic brain injury-trauma energy level and medical history as possible predictors for intracranial hemorrhage.
Head trauma is common in the emergency department. Identifying the few patients with serious injuries is time consuming and leads to many computerized tomographies (CTs). Reducing the number of CTs would reduce cost and radiation. The aim of this study was to evaluate the characteristics of adults with head trauma over a 1-year period to identify clinical features predicting intracranial hemorrhage. ⋯ This study demonstrates that patients younger than 59 years with low-energy head trauma, who were not on anticoagulants or platelet inhibitors could possibly be discharged based on patient history. Maybe, there is no need for as extensive medical examination as currently recommended. These findings merit further studies.
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Eur J Trauma Emerg Surg · Oct 2019
Successful non-operative management of haemodynamically unstable traumatic splenic injuries: 4-year case series in a UK major trauma centre.
Management of traumatic splenic injury may be operative or non-operative (including embolization and conservative management). Traditionally, haemodynamic instability has been an indication for operative intervention. We aimed to report our experience of managing traumatic splenic injury at a regional major trauma centre in the UK over a 4-year period, with a particular focus on the non-operative management (NOM) of haemodynamically unstable patients. ⋯ These data support the safe application of non-operative management to haemodynamically unstable patients with traumatic splenic injury, particularly in those with low-grade injuries. Additional prospective work is required to define the subgroup of patients for whom this is appropriate and to determine the long-term outcomes of NOM.
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Eur J Trauma Emerg Surg · Oct 2019
Pneumomediastinum and pneumopericardium following blunt thoracic trauma: much ado about nothing?
Pneumomediastinum is the hallmark of intrathoracic aerodigestive trauma, but rare following blunt injury. ⋯ The presence of PM/PC following BTC is incidental and benign. Increased injury severity with a flail chest is associated with a significant increase in the presence of free gas within the mediastinum. In the absence of complications, no obvious injury to the intrathoracic aero-digestive tract on CT scanning, and no difference in mortality, a conservative management policy is warranted.
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Eur J Trauma Emerg Surg · Oct 2019
ReviewTotal knee arthroplasty for distal femoral fractures in osteoporotic bone: a systematic literature review.
Distal femoral fractures in the elderly are associated with high morbidity and mortality and their incidence is increasing with an ageing population. Management of these fractures has evolved over recent decades and there is now an accepted recognition of the important role that acute arthroplasty may have in treatment of these fractures. Our purpose was to systematically review the evidence available in the literature for arthroplasty as a treatment option for distal femoral fractures. ⋯ Although there is limited evidence in the literature available, our review suggests that there is a role for acute knee arthroplasty in distal femoral fractures. This mode of treatment has satisfactory mortality and revision rates, and may result in faster time to mobilisation and discharge. There is a need for a higher level of evidence to delineate this issue further.
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Eur J Trauma Emerg Surg · Oct 2019
Comparative StudyObserved versus expected mortality in pediatric patients intubated in the field with Glasgow Coma Scale scores < 9.
A Glasgow Coma Scale (GCS) score of 8 or less in patients suffering from severe traumatic brain injury (TBI) represents a decision-making marker in terms of intubation. This study evaluated the impact of prehospital intubation on the mortality of these TBI cases among different age groups. ⋯ The observed mortality in the intubated children 1-6 years old suffering from severe TBI seemed to be higher than expected. Whether or not a GCS score of 8 or less is the only reliable criterion for intubation in this age group should be investigated in further trials.