Emergency medicine journal : EMJ
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To summarise the risk factors for mortality in patients with flail chest based on available evidence in the literature. ⋯ The main independent predictors of mortality in patients with flail chest were reported to be increased age and ISS. More data are needed regarding the association of hospital length of stay, presence of pulmonary contusion and bilateral flail chest.
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Multicenter Study
The effect of preinjury warfarin use on mortality rates in trauma patients: a European multicentre study.
To define the relationship between preinjury warfarin use and mortality in a large European sample of trauma patients. ⋯ Preinjury warfarin use has been demonstrated to be an independent predictor of mortality in trauma patients. Clinicians managing major trauma patients on warfarin need to be aware of the vulnerability of this group.
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Attempts to resuscitate patients in traumatic cardiac arrest (TCA) have, in the past, been viewed as futile. However, reported outcomes from TCA in the past five years, particularly from military series, are improving. The pathophysiology of TCA is different to medical causes of cardiac arrest, and therefore, treatment priorities may also need to be different. This article reviews recent literature describing the pathophysiology of TCA and describes how the military has challenged the assumption that outcome is universally poor in these patients.
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Prediction models for trauma outcome routinely control for age but there is uncertainty about the need to control for comorbidity and whether the two interact. This paper describes recent revisions to the Trauma Audit and Research Network (TARN) risk adjustment model designed to take account of age and comorbidities. In addition linkage between TARN and the Office of National Statistics (ONS) database allows patient's outcome to be accurately identified up to 30 days after injury. Outcome at discharge within 30 days was previously used. ⋯ The new model includes comorbidity and this has improved outcome prediction. There was no interaction between age and comorbidity, suggesting that both independently increase vulnerability to mortality after injury.