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 Comparative Study Clinical Trial
Geriatric Syndromes Predict Postdischarge Outcomes Among Older Emergency Department Patients: Findings From the interRAI Multinational Emergency Department Study.
Identifying older emergency department (ED) patients with clinical features associated with adverse postdischarge outcomes may lead to improved clinical reasoning and better targeting for preventative interventions. Previous studies have used single-country samples to identify limited sets of determinants for a limited number of proxy outcomes. The objective of this study was to identify and compare geriatric syndromes that influence the probability of postdischarge outcomes among older ED patients from a multinational context. ⋯ Despite markedly different health care systems, the probability of long hospital lengths of stay and repeat hospital use among older ED patients is detectable at the multinational level with moderate accuracy. This study demonstrates the potential utility of incorporating common geriatric clinical features in routine clinical examination and disposition planning for older patients in EDs.
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Multicenter Study
Recurrent and High-frequency Use of the Emergency Department by Pediatric Patients.
The authors sought to describe the epidemiology of and risk factors for recurrent and high-frequency use of the emergency department (ED) by children. ⋯ Risk factors for recurrent ED use by children include age, race and ethnicity, and insurance status. Although asthma plays an important role in recurrent ED use, acute illnesses account for the majority of recurrent ED visits.
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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
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.