Articles: trauma.
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To conduct a literature review and provide a summary of the evidence surrounding prehospital administration of antibiotics for open fractures and other major open wounds. ⋯ Prehospital administration of prophylactic antibiotics for trauma appears safe and may be considered in some specific patient populations. Universal and widespread adoption of this intervention needs further study to identify the true impact on patient-centered outcomes and identification of patients who might confer greatest benefit. Local practice characteristics may support adoption of multidisciplinary-developed prudent and practicable protocols incorporating the use of prophylactic antibiotics for some trauma patients such as those with open fractures or those with significant delays in transport to definitive care. Future research should attempt to address the appropriate identification of wounds and injury patterns that have the highest likelihood of benefit from prehospital administration of antibiotics, the ideal timing of administering the antibiotic(s) following initial injury, impact on infection rates, and other important patient outcomes.
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Anesthesia and analgesia · Jan 2025
Preoperative Psychological Factors, Postoperative Pain Scores, and Development of Posttraumatic Stress Disorder Symptoms After Pediatric Anterior Cruciate Ligament Reconstruction.
Acute orthopedic injuries and subsequent surgical repair can be challenging for children and adolescents and result in posttraumatic stress reactions that can be problematic after the acute perioperative period. In a cohort of patients undergoing anterior cruciate ligament reconstruction (ACLR), we investigated the incidence and explored risk factors associated with the development of posttraumatic stress disorder (PTSD) symptoms after surgery. ⋯ A portion of patients undergoing ACLR are at risk for the development of symptoms consistent with PTSD. Risk factors include preoperative anxiety or depression and high postoperative pain scores. Interventions designed to address preoperative risk factors and optimization of postoperative pain may represent opportunities to improve outcomes in this patient population.
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Unstable ankle injuries often comprise multiple fracture lines; including a posterior malleolus fracture in up to 40% of cases. Surgical fixation of such injuries often requires multiple incisions. The configuration of the posterior malleolus fracture can also vary greatly, and the presence of this fracture is known to poorly affect patient outcomes. In this paper, the authors describe a modified posterolateral approach to the ankle which provides three windows for fixation of complex ankle fractures.
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The early administration of tranexamic acid is recognised as significantly reducing mortality in traumatically injured patients with major haemorrhage, typically given via intravenous or intramuscular routes. In the context of mass casualty events, there may exist multiple traumatically injured casualties that would benefit from tranexamic acid, however, it's administration may be delayed through the need to establish intravenous access. Additionally, if the initial assessment of the traumatically injured casualty is undertaken by an individual who cannot administer intravenous or intramuscular medications, time to administration will be further delayed. This concepts paper seeks to discuss the potential for utilising oral tranexamic acid, in the context of mass casualty events, as an alternative administration route.
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Scand J Trauma Resus · Jan 2025
Identification of major trauma using the simplified abbreviated injury scale to estimate the injury severity score: a diagnostic accuracy and validation study.
The Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) grade the severity of injuries and are useful for trauma audit and benchmarking. However, AIS coding is complex and requires specifically trained staff. A simple yet reliable scoring system is needed. The aim of this study was two-fold. First, to develop and validate a simplified AIS (sAIS) chart centred on the most frequent injuries for use by non-trained healthcare professionals. Second, to evaluate the diagnostic accuracy of the sAIS (index test) to calculate the simplified ISS (sISS) to identify major trauma, compared with the reference AIS (rAIS) to calculate the reference ISS (rISS). ⋯ The sAIS is accurate, but slightly imprecise in calculating the ISS. The development of this scale increases the possibilities to use a scoring system for severely injured patients in settings with a reduced availability of the AIS.