Articles: trauma.
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Meta Analysis
Shock index as predictor of massive transfusion and mortality in patients with trauma: a systematic review and meta-analysis.
Management of bleeding trauma patients is still a difficult challenge. Massive transfusion (MT) requires resources to ensure the safety and timely delivery of blood products. Early prediction of MT need may be useful to shorten the time process of blood product preparation. The primary aim of this study was to assess the accuracy of shock index to predict the need for MT in adult patients with trauma. For the same population, we also assessed the accuracy of SI to predict mortality. ⋯ Our study demonstrated that SI may have a limited role as the sole tool to predict the need for MT in adult trauma patients. SI is not accurate to predict mortality but may have a role to identify patients with a low risk of mortality.
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The most widely used prehospital strategy for the management of hemorrhagic shock or trauma accompanied by hypotension is fluid resuscitation. Though current guidelines suggest early and aggressive fluid resuscitation, contemporary literature suggests a more restrictive approach. Our objective was to evaluate the effectiveness of low/ no IV fluids in comparison to standard resuscitation in reducing mortality for trauma patients in the prehospital setting. ⋯ Weak, primarily observational evidence suggests that standard fluid resuscitation has no significant mortality benefit over restricting/withholding IV fluids in severe/hypotensive trauma. This review adds evidence to questioning the requirement for IV fluids in trauma given the lack of mortality benefit, in addition to demonstrating the need for more randomized studies in this area.
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Review
ACE: "What Happened to You" Screening for Adverse Childhood Experiences or Trauma-Informed Care.
Trauma is common within the United States. It is important for individuals to understand how trauma may affect their health and how trauma in childhood can have adverse effects on a child's development and health. ⋯ When screening for trauma, it is important to take a family-centered approach and provide appropriate referrals if a patient screens positive for trauma. Primary care providers are essential players in addressing and preventing trauma.
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Severe trauma represents a major global public health burden and the management of post-traumatic bleeding continues to challenge healthcare systems around the world. Post-traumatic bleeding and associated traumatic coagulopathy remain leading causes of potentially preventable multiorgan failure and death if not diagnosed and managed in an appropriate and timely manner. This sixth edition of the European guideline on the management of major bleeding and coagulopathy following traumatic injury aims to advise clinicians who care for the bleeding trauma patient during the initial diagnostic and therapeutic phases of patient management. ⋯ A multidisciplinary approach and adherence to evidence-based guidelines are pillars of best practice in the management of severely injured trauma patients. Further improvement in outcomes will be achieved by optimising and standardising trauma care in line with the available evidence across Europe and beyond.
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Review
Spinal Intradural Arachnoid Cysts in Adults: An Institutional Experience and Literature Review.
Adult spinal intradural arachnoid cysts are rare pathologic entities with an unclear etiopathogenesis. These lesions can be dichotomized into primary (idiopathic) or secondary (related to inflammation, intradural surgery, or trauma) etiologies. Limited series have depicted optimal management strategies and clinical outcomes. ⋯ Surgical intervention for spinal intradural arachnoid cysts improves thoracic back pain. The literature supports surgical intervention for symptomatic primary spinal intradural arachnoid cysts with improved clinical outcomes. Surgery should be cautiously considered for secondary cysts given worse outcomes.