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https://www.readbyqxmd.com/read/28647680/a-retrospective-review-of-unintentional-opioid-overdose-risk-and-mitigating-factors-among-acutely-injured-trauma-patients
#1
Jannette Baird, Mark Faul, Traci C Green, Jonathan Howland, Charles A Adams, Ann George, Michael J Mello
BACKGROUND: Opioid medication to treat acutely injured patients is usual care in trauma settings. A higher prevalence of alcohol and other substance misuse in this population compared to the general population increases the vulnerability of such patients to both misuse of their prescribed opioids, and also unintentional opioid overdose. The primary purpose of this study was to assess the prevalence of substance use and unintentional opioid overdose risk among acutely injured trauma patients, and to examine the frequency and predictors of high opioid dose at discharge...
June 13, 2017: Drug and Alcohol Dependence
https://www.readbyqxmd.com/read/28647520/percutaneous-intramedullary-screw-fixation-of-distal-fibula-fractures-a-case-series-and-systematic-review
#2
REVIEW
Vladimir V Loukachov, Merel F N Birnie, Siem A Dingemans, Vincent M de Jong, Tim Schepers
The current reference standard for unstable ankle fractures is open reduction and internal fixation using a plate and lag screws. This approach requires extensive dissection and wound complications are not uncommon. The use of intramedullary screw fixation might overcome these issues. The aim of our study was to provide an overview of the published data regarding intramedullary screw fixation of fibula fractures combined with a small consecutive case series. We performed a search of published studies to identify the studies in which fibula fractures were treated with percutaneous intramedullary screw fixation...
June 21, 2017: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
https://www.readbyqxmd.com/read/28647046/assessment-of-emergency-general-surgery-care-based-on-formally-developed-quality-indicators
#3
Angela Ingraham, Avery Nathens, Andrew Peitzman, Allison Bode, Gina Dorlac, Warren Dorlac, Preston Miller, Mahsa Sadeghi, Deena D Wasserman, Karl Bilimoria
BACKGROUND: Emergency general surgery outcomes vary widely across the United States. The utilization of quality indicators can reduce variation and assist providers in administering care aligned with established recommendations. Previous quality indicators have not focused on emergency general surgery patients. We identified indicators of high-quality emergency general surgery care and assessed patient- and hospital-level compliance with these indicators. METHODS: We utilized a modified Delphi technique (RAND Appropriateness Methodology) to develop quality indicators...
June 21, 2017: Surgery
https://www.readbyqxmd.com/read/28645215/upper-extremity-trauma-resulting-from-agricultural-accidents-mechanism-and-severity-for-patients-with-and-without-upper-extremity-injury
#4
Louis C Grandizio, Benjamin Wagner, Jove Graham, Joel C Klena
BACKGROUND: Farming remains the most dangerous occupation in the United States and upper extremity (UE) injuries occur frequently in agricultural accidents. The purpose of this study is to describe the injury mechanisms, severity, and health care costs of UE injuries resulting from agricultural accidents and to compare patients with and without injuries to the UE. METHODS: We performed a 6-year retrospective review of our level I trauma center registry from January 2006 to May 2013, identifying all patients injured in an agricultural accident...
June 1, 2017: Hand: Official Journal of the American Association for Hand Surgery
https://www.readbyqxmd.com/read/28644901/vascular-geometry-as-a-risk-factor-for-non-penetrating-traumatic-injuries-of-the-aortic-arch
#5
Andreas Schicho, Lukas Luerken, Christian Stroszczynski, Ramona Meier, Andreas G Schreyer, Lena-Marie Dendl, Stephan Schleder
PURPOSE: To assess biomechanical factors in aortic arch geometry contributing to the development of non-penetrating aortic arch injury (NAAI) in multiply injured patients with an Injury Severity Score (ISS) ≥ 16. MATERIAL AND METHODS: 230 consecutive multiply injured trauma patients with an ISS ≥ 16 admitted to our Level-I trauma center during a consecutive 24-month period were prospectively included of whom 13 presented with NAAI (5.7%). Standardized whole-body CT in a 2x128-detector-row scanner included a head-and-neck CTA...
2017: PloS One
https://www.readbyqxmd.com/read/28644311/hemobilia-an-uncommon-but-notable-cause-of-upper-gastrointestinal-bleeding
#6
Scott Cathcart, John W Birk, Michael Tadros, Micheal Schuster
GOAL AND BACKGROUND: A literature review to improve practitioners' knowledge and performance concerning the epidemiology, diagnosis, and management of hemobilia. STUDY: A search of Pubmed, Google Scholar, and Medline was conducted using the keyword hemobilia and relevant articles were reviewed and analyzed. The findings pertaining to hemobilia etiology, investigation, and management techniques were considered and organized by clinicians practiced in hemobilia. RESULTS: The majority of current hemobilia cases have an iatrogenic cause from either bile duct or liver manipulation...
June 21, 2017: Journal of Clinical Gastroenterology
https://www.readbyqxmd.com/read/28644121/intercondylar-fractures-of-the-distal-humerus-in-patients-younger-than-20-years-capsulectomy-results
#7
W Andrew Eglseder, Ebrahim Paryavi
Few reports in the literature have been dedicated to young patients with distal fractures of the humerus, and few have addressed subsequent indications to improve range of motion (ROM). This article is a retrospective review of the elbow flexion-extension ROM in 31 patients (age, 12-19 years) who had been treated with open reduction and internal fixation of intercondylar fractures of the distal humerus at a level I trauma center from 1991 through 2013. The ROM of patients who underwent capsulectomy was compared with that of those who did not...
2017: Journal of Surgical Orthopaedic Advances
https://www.readbyqxmd.com/read/28644101/safety-and-cost-efficiency-of-a-restrictive-transfusion-protocol-in-patients-with-traumatic-brain-injury
#8
Laura B Ngwenya, Catherine G Suen, Phiroz E Tarapore, Geoffrey T Manley, Michael C Huang
OBJECTIVE Blood loss and moderate anemia are common in patients with traumatic brain injury (TBI). However, despite evidence of the ill effects and expense of the transfusion of packed red blood cells, restrictive transfusion practices have not been universally adopted for patients with TBI. At a Level I trauma center, the authors compared patients with TBI who were managed with a restrictive (target hemoglobin level > 7 g/dl) versus a liberal (target hemoglobin level > 10 g/dl) transfusion protocol. This study evaluated the safety and cost-efficiency of a hospital-wide change to a restrictive transfusion protocol...
June 23, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28643996/age-related-outcome-of-patients-after-traumatic-brain-injury-a-single-centre-observation
#9
Rolf Erlebach, Alberto Pagnamenta, Stephanie Klinzing, Federica Stretti, Silvia Cottini, Reto Schüpbach, Peter Steiger, Giovanna Brandi
BACKGROUND: Study-purpose is to analyze clinical features of patients with traumatic brain injury (TBI), their age-related outcomes and determinants of long- term outcome. METHODS: This retrospective cohort study was conducted in a level I University Swiss trauma center. Consecutive patients with moderate to severe TBI admitted for more than 48 hours to the Intensive Care Unit were included. Patients' and trauma characteristics, management during ICU-stay, prognostic scores and long- term outcomes were analyzed...
June 22, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28641392/alcohol-is-not-protective-against-mortality-following-traumatic-brain-injury
#10
Jennifer S Albrecht, Majid Afshar, Deborah M Stein, Gordon S Smith
Alcohol exposure results in reduced mortality following traumatic brain injury (TBI) in animal models, yet clinical studies reported conflicting results and clinical trials based on proposed mechanisms have been disappointing. Methodological issues common to many of the clinical studies may have contributed to spurious results. Our objective was to evaluate the association between blood alcohol concentration (BAC) and in-hospital mortality following TBI, overcoming methodological problems of prior studies. We conducted a retrospective cohort study on individuals treated for isolated TBI at the R Adams Cowley Shock Trauma Center between 1997-2012 (n = 1,084)...
June 21, 2017: American Journal of Epidemiology
https://www.readbyqxmd.com/read/28641385/development-of-an-electronic-medical-record-based-child-physical-abuse-alert-system
#11
Rachel P Berger, Richard A Saladino, Janet Fromkin, Emily Heineman, Srinivasan Suresh, Tom McGinn
Objective: Physical abuse is a leading cause of pediatric morbidity and mortality. Physicians do not consistently screen for abuse, even in high-risk situations. Alerts in the electronic medical record may help improve screening rates, resulting in early identification and improved outcomes. Methods: Triggers to identify children < 2 years old at risk for physical abuse were coded into the electronic medical record at a freestanding pediatric hospital with a level 1 trauma center...
June 21, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28640779/nonoperative-management-rather-than-endovascular-repair-may-be-safe-for-grade-ii-blunt-traumatic-aortic-injuries-an-eleven-year-retrospective-analysis
#12
Stephen M Spencer, Karen Safcsak, Chadwick P Smith, Michael L Cheatham, Indermeet S Bhullar
BACKGROUND: The Society of Vascular Surgery (SVS) guidelines currently suggest thoracic endovascular aortic repair (TEVAR) for grade II-IV and non-operative management (NOM) for grade I blunt traumatic aortic injury (BTAI). However, there is increasing evidence that grade II may also be observed safely. The purpose of this study was to compare the outcome of TEVAR and NOM for grade I-IV BTAI and determine if grade II can be safely observed with NOM. METHODS: The records of patients with BTAI from 2004 to 2015 at a Level I trauma center were retrospectively reviewed...
June 20, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28640776/early-fever-after-trauma-does-it-matter
#13
Holly E Hinson, Susan Rowell, Cynthia Morris, Amber L Lin, Martin A Schreiber
BACKGROUND: Fever is strongly associated with poor outcome after traumatic brain injury (TBI). We hypothesized that early fever is a direct result of brain injury and thus would be more common in TBI than in patients without brain injury, and associated with inflammation. METHODS: We prospectively enrolled patients with major trauma with and without TBI from a busy level I trauma center ICU. Patients were assigned to one of four groups based on their presenting Head Abbreviated Injury Severity Scale scores (HAIS): Polytrauma: Head AIS score >2, one other region>2, Isolated Head: Head AIS score>2, all other regions <3, Isolated Body: One region >2, excluding Head/Face, Minor Injury: No region with AIS>2...
June 20, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28640775/prevalence-of-non-accidental-trauma-among-children-at-acs-verified-pediatric-trauma-centers
#14
David D A Bogumil, Natalie E Demeter, Karen Imagawa, Jeffrey S Upperman, Rita V Burke
BACKGROUND: Child abuse remains a national epidemic that has detrimental effects if unnoticed in the clinical setting. Extreme cases of child abuse, or non-accidental trauma (NAT), have large financial burdens associated with them due to treatment costs and long-term effects of abuse. Clinicians that have additional training and experience with pediatric trauma are better equipped to detect signs of NAT and have more experience reporting it. This additional training and experience can be measured by using the American College of Surgeons (ACS) Pediatric Trauma Verification...
June 20, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28640677/constant-lethality-of-gunshot-injuries-from-firearm-assault-united-states-2003-2012
#15
Philip J Cook, Ariadne E Rivera-Aguirre, Magdalena Cerdá, Garen Wintemute
OBJECTIVES: To investigate the validity of the apparent downward trend in the national case-fatality rate for gunshot wounds from assault. METHODS: We reanalyzed the estimated annual number of nonfatal firearm injuries the National Electronic Injury Surveillance System reported from 2003 to 2012. We adjusted the estimates for discontinuities created by the substitution of 1 hospital for another in the sample and for a downward trend in the percentage of gunshot injuries classified as "unknown circumstance...
June 22, 2017: American Journal of Public Health
https://www.readbyqxmd.com/read/28638686/rheumatoid-arthritis-are-psychological-factors-effective-in-disease-flare
#16
Volkan Yılmaz, Ebru Umay, İbrahim Gündoğdu, Zeliha Özgür Karaahmet, Arif Erhan Öztürk
OBJECTIVE: Rheumatoid arthritis (RA) is clinically an undulant disease, and reasons for flare or remission vary. We aimed to identify factors potentially associated with disease flare and remission. MATERIAL AND METHODS: Two hundred and seventy-four patients with RA who were admitted to our center between January 2010 and January 2016 were included. Disease activity was evaluated using disease activity score 28 (DAS 28); functional status was evaluated using the modified Health Assessment Questionnaire (m-HAQ), a questionnaire that comprises flare or remission domains such as psychological stress and mood status, physical trauma, nutrition regimen, infection, antibiotic use, and seasonal weather changes...
June 2017: European Journal of Rheumatology
https://www.readbyqxmd.com/read/28637583/the-revised-trauma-score-plus-serum-albumin-level-improves-the-prediction-of-mortality-in-trauma-patients
#17
Seong Chun Kim, Dong Hoon Kim, Tae Yun Kim, Changwoo Kang, Soo Hoon Lee, Jin Hee Jeong, Yong Joo Park, Sang Bong Lee, Daesung Lim
INTRODUCTION: The Revised Trauma Score (RTS) is used worldwide in prehospital practice and in the emergency department (ED) settings to triage trauma patients. The main purpose of this study was to evaluate the value of the RTS plus serum albumin (RTS-A) and to compare it with other existing trauma scores as well as to compare the predictive performance of the Trauma and Injury Severity Score with the RTS-A (TRISS-A) with the original TRISS. METHODS: This was a single center, trauma registry based observational cohort study...
June 15, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28637569/assessing-field-triage-decisions-and-the-international-classification-injury-severity-score-iciss-at-predicting-outcomes-of-trauma-patients
#18
Casey J Allen, Daniel J Baldor, Carl I Schulman, Louis R Pizano, Alan S Livingstone, Nicholas Namias
Florida considers the International Classification Injury Severity Score (ICISS) from hospital discharges within a geographic region in the apportionment of trauma centers (TCs). Patients with an ICISS <0.85 are considered to require triage to a TC, yet many are triaged to an emergency department (ED). We assess outcomes of those with an ICISS <0.85 by the actual triage decision of emergency medical services (EMS). From October 2011 to October 2013, 39,021 consecutive admissions with injury ICD-9 codes were analyzed...
June 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28637560/despite-trauma-center-closures-trauma-system-regionalization-reduces-mortality-and-time-to-definitive-care-in-severely-injured-patients
#19
Jack C He, David Schechtman, Debra L Allen, Jillian J Cremona, Jeffrey A Claridge
The Northern Ohio Trauma System (NOTS), consisting of multiple hospital systems, was established in 2010 to improve trauma outcomes. This study assessed its impact on mortality and time to definitive care, focusing especially on the severely injured patients. NOTS trauma registry was queried for all trauma activations from 2008 to 2013. The years between 2008-2009 and 2011-2013 were designated as pre- and post-NOTS, respectively. Data from 2010 was excluded as a transitional year. Two trauma centers (TCs) closed in 2010...
June 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28637556/pretrauma-functional-independence-measure-score-predicts-survival-in-geriatric-trauma
#20
Brian Fletcher, Eric Bradburn, Christopher Baker, Bryan Collier, Mark Hamill, Katherine Shaver
The Functional Independence Measure (FIM) is used by rehabilitation professionals to access disability. The FIM score combines both motor and cognitive parameters to assess a patient's level of required assistance in performing activities of daily living (ADL). The geriatric trauma patient is becoming an increasingly important cohort for trauma services. FIM has been shown to predict discharge outcomes and those at high risk for falls. We hypothesized pretrauma FIM scores may predict survival in the geriatric trauma population...
June 1, 2017: American Surgeon
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