Articles: trauma.
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Treatment of traumatic vascular injury is evolving because of endovascular therapies. National guidelines advocate for embolization of injuries to lower extremity branch vessels, including pseudoaneurysms or arteriovenous fistulas, in hemodynamically normal patients without hard signs of vascular injury. However, patient stability and injury type may limit endovascular applicability at some centers. We hypothesized that for penetrating trauma, indications for endovascular treatment of peripheral vascular injuries, as outlined by national guidelines, are infrequent. ⋯ According to national guidelines, indications for endovascular treatment of penetrating peripheral vascular injury are infrequent. Nearly two-thirds of patients with penetrating peripheral vascular injuries were hemodynamically unstable or had multiple vessels injured, making endovascular repair less desirable. Additionally, over 80% presented at night and/or on the weekend, which could delay treatment at some centers due to mobilization of the endovascular team. Trauma centers need to consider their resources when incorporating national guidelines in their treatment algorithms of penetrating vascular trauma.
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ANZ journal of surgery · Jul 2014
Are Australian and New Zealand trauma service resources reflective of the Australasian Trauma Verification Model Resource Criteria?
The Australasian Trauma Verification Program was developed in 2000 to improve the quality of care provided at services in Australia and New Zealand. The programme outlines resources required for differing levels of trauma services. This study compares the human resources in Australia and New Zealand trauma services with those recommended by the Australasian College of Surgeons Trauma Verification Program. ⋯ Human resources in Australian and NZ trauma services are not reflective of those recommended by the Australasian Trauma Verification Program. This impacts on the ability to coordinate trauma monitoring and performance improvement. Review of the Australasian Trauma Verification Model Resource Criteria is required. Injury surveillance in Australia and NZ is hampered by insufficient trauma registry resources.
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Prehospital spine immobilization has long been applied to victims of trauma in the United States and up to 5 million patients per year are immobilized mostly with a cervical collar and a backboard. ⋯ The implementation of a SMR training program significantly decreases the use of backboards and allows alternative methods of maintaining spine precautions.
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This study determined inter- and intra-observer reliability for measurement of the angles of Böhler and Gissane, for the decision between surgical or conservative management and for the three mostly used classification systems for calcaneal fractures with the use of 2D-CT imaging versus 2D- and 3D-CT imaging. A consecutive series of 38 fractures in 36 patients, treated at a level II trauma centre between 2005 and 2008, were evaluated in two rounds by five observers. We measured the inter- and intraobserver reliability for the Sanders', Zwipp and Essex-Lopresti classification systems using the kappa values as described by Cohen. ⋯ The intraobserver reliability was fair for measurement of the angle of Gissane and it was moderate for the Sanders', Zwipp and Essex-Lopresti classification systems and for the measurement of the angle of Böhler. The addition of three-dimensional CT imaging did not increase inter- and intraobserver reliability for the classification of calcaneal fractures. Authors commented they experienced no additional benefit from 3D-CT imaging for the assessment of calcaneal fractures.