Articles: trauma.
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Multicenter Study Observational Study
Occult Pneumothoraces in Children With Blunt Torso Trauma.
Plain chest x-ray (CXR) is often the initial screening test to identify pneumothoraces in trauma patients. Computed tomography (CT) scans can identify pneumothoraces not seen on CXR ("occult pneumothoraces"), but the clinical importance of these radiographically occult pneumothoraces in children is not well understood. The objectives of this study were to determine the proportion of occult pneumothoraces in injured children and the rate of treatment with tube thoracostomy among these children. ⋯ In pediatric patients with blunt torso trauma, pneumothoraces are uncommon, and most are not identified on the ED CXR. Nearly half of pneumothoraces, and most occult pneumothoraces, are managed without tube thoracostomy. Observation, including in children requiring endotracheal intubation, should be strongly considered during the initial management of children with occult pneumothoraces.
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Multicenter Study
Tourniquet use for peripheral vascular injuries in the civilian setting.
Haemorrhage in peripheral vascular injuries may cause life-threatening exsanguination. Tourniquets are used extensively by the military, with increased interest in the civilian setting to prevent deaths. This is a retrospective study of trauma patients at two large Canadian trauma centres with arterial injury after isolated extremity trauma. We hypothesized that tourniquet use may decrease mortality rate and transfusion requirements if applied early. ⋯ Tourniquets may prevent exsanguination in the civilian setting for patients suffering either blunt or penetrating trauma to the extremity. Future studies will help determine the utility of deploying tourniquets in the civilian setting, given the rarity of exsanguinating haemorrhage from isolated extremity trauma in this setting.
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Trauma registries are used worldwide to coordinate patient care as well as provide data for audit and research purposes. National registries collect this data, producing research opportunities, outcome standards and a means by which to benchmark trauma centre performance. The Trauma Audit and Research Network (TARN) is the UK national registry, with data upload being mandatory from all major trauma centres (MTCs), a process which is manual and time and resource intensive. ⋯ The wide range of software options and their lack of integration with the hospital electronic patient records results in the duplication of data as well as requiring time and resources. This may also be due to the difference in data required for coordinating on-going patient care and that required for upload to the TARN. Whilst some of these programmes do have the capabilities for automatic data upload, further efforts must be made to provide a cohesive system that provides the required integration and customisability in order to improve efficiency and ultimately trauma care.
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Multicenter Study Observational Study
Thromboelastometry and organ failure in trauma patients: a prospective cohort study.
Data on the incidence of a hypercoagulable state in trauma, as measured by thromboelastometry (ROTEM), is limited and the prognostic value of hypercoagulability after trauma on outcome is unclear. We aimed to determine the incidence of hypercoagulability after trauma, and to assess whether early hypercoagulability has prognostic value on the occurrence of multiple organ failure (MOF) and mortality. ⋯ The incidence of a hypercoagulable state after trauma is 10% up to 24 hours after admission, which is broadly comparable to the rate of hypocoagulability. Further work in larger studies should define the clinical consequences of identifying hypercoagulability and a possible role for very early, targeted use of anticoagulants.
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Multicenter Study
Acute costs and predictors of higher treatment costs of trauma in New South Wales, Australia.
Accurate economic data are fundamental for improving current funding models and ultimately in promoting the efficient delivery of services. The financial burden of a high trauma casemix to designated trauma centres in Australia has not been previously determined, and there is some evidence that the episode funding model used in Australia results in the underfunding of trauma. ⋯ This multicentre trauma costing study demonstrated the feasibility of trauma registry and financial data linkage. Discrepancies between the observed costs of care in these 12 trauma centres and the NSW average AR-DRG costs suggest that trauma care is currently underfunded in NSW.