Articles: trauma.
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Observational Study
Diagnostic Yields, Charges, and Radiation Dose of Chest Imaging in Blunt Trauma Evaluations.
Chest radiography (CXR) is the most common imaging in adult blunt trauma patient evaluation. Knowledge of the yields, attendant costs, and radiation doses delivered may guide effective chest imaging utilization. ⋯ Despite greater diagnostic yield, chest CT entails substantially higher charges and radiation dose per injury diagnosed, especially when performed after a normal CXR. Selective chest imaging decision instruments should identify patients who require no chest imaging and patients who may benefit from chest CT after a normal CXR.
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Surgery is a posttraumatic immune stimulus which contributes to the systemic inflammatory response syndrome and multiple organ failure (MOF). Serum markers may facilitate post-injury immune monitoring, predict complications and guide the timing of surgery. ⋯ An increase in posttraumatic serum cytokines has been demonstrated after surgery, but without consistent clinical associations. The timing of surgery may modulate this increase. Future research directions include confirmation of findings in larger populations, clarifying clinical associations, and evaluation of other surgical interventions.
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Eur J Trauma Emerg Surg · Jun 2014
Acute traumatic fractures to the craniovertebral junction: preliminary experience with the "MILD" score scale.
Traumatic fractures to the craniovertebral junction (CVJ) are rare events requiring complex clinical management. Several classification systems are currently in use; however, recent improvements of junctional knowledge has focused attention on the role of ligaments and membranes in vertebral biomechanical stability. The aim of this study was to present our preliminary experience with the "MILD" score scale, which should allow fast and effective classification of all CVJ traumatic fractures based on vertebral instability in the acute setting. ⋯ The close association between the MILD scale and spinal instability is promising, although further studies are warranted in order to confirm our preliminary data.
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Acute respiratory distress syndrome (ARDS) is a heterogeneous syndrome that can develop at various times after major trauma. ⋯ Degree of hemorrhagic shock and severity of thoracic trauma are associated with an early-onset phenotype of ARDS after major trauma. Lung injury biomarkers suggest a dominant alveolar-capillary barrier injury pattern in this phenotype.
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Pediatric emergency care · Jun 2014
Risky Behaviors Associated With Pediatric Pedestrians and Bicyclists Struck by Motor Vehicles.
Road safety constitutes a crisis with important health and economic impacts. In 2010, 11,000 pedestrians and 3500 bicyclists were injured by motor vehicles in New York City (NYC). Motor vehicle injuries represent the second leading cause of injury-related deaths in NYC children aged 5 to 14 years. To better target injury prevention strategies, we evaluated demographics, behaviors, environmental factors, injuries, and outcomes of pediatric pedestrians and bicyclists struck by motor vehicles in NYC. ⋯ Risky behaviors are common among pediatric pedestrians and bicyclists injured by motor vehicles. Road safety education and prevention strategies must stress compliance with traffic laws, readdress the importance of supervision, and reinforce avoidance of common distractors including electronic devices.