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https://www.readbyqxmd.com/read/29140953/contemporary-management-of-rectal-injuries-at-level-i-trauma-centers-the-results-of-an-american-association-for-the-surgery-of-trauma-multi-institutional-study
#1
Carlos V R Brown, Pedro G Teixeira, Elisa Furay, John P Sharpe, Tashinga Musonza, John Holcomb, Eric Bui, Brandon Bruns, H Andrew Hopper, Michael S Truitt, Clay C Burlew, Morgan Schellenberg, Jack Sava, John VanHorn, Brian Eastridge, Alicia M Cross, Richard Vasak, Gary Vercruysse, Eleanor E Curtis, James Haan, Raul Coimbra, Phillip Bohan, Stephen Gale, Peter G Bendix
INTRODUCTION: Rectal injuries have been historically treated with a combination of modalities including direct repair, resection, proximal diversion, presacral drainage, and distal rectal washout. We hypothesized that intraperitoneal rectal injuries may be selectively managed without diversion and the addition of distal rectal washout and pre-sacral drainage in the management of extraperitoneal injuries are not beneficial. METHODS: This is an American Association for the Surgery of Trauma multi-institutional retrospective study from 2004-2015 of all patients who sustained a traumatic rectal injury and were admitted to one of the 22 participating centers...
November 14, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29140952/-don-t-lose-hope-early-hemorrhagic-diffuse-axonal-injury-on-head-ct-is-not-associated-with-poor-outcome-in-moderate-severe-tbi-patients
#2
Nils Henninger, Rebecca A Compton, Muhammad W Khan, Raphael Carandang, Wiley Hall, Susanne Muehlschlegel
BACKGROUND: Diffuse axonal injury (DAI) on MRI has been associated with poor functional outcome after moderate-severe traumatic brain injury (msTBI). Yet, DAI assessment with highly-sensitive MRI-techniques is unfeasible in the acute trauma setting, and CT remains the key diagnostic modality despite its lower sensitivity. We sought to determine whether CT-defined-hemorrhagic-DAI (hDAI) is associated with discharge and favorable 3-and 12-month functional outcome (Glasgow Outcome Score ≥4) after msTBI...
November 14, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29140951/platelet-aggregation-after-blunt-trauma-is-associated-with-the-acute-respiratory-distress-syndrome-and-altered-by-cigarette-smoke-exposure
#3
Farzad Moazed, Carolyn Hendrickson, Mary Nelson, Amanda Conroy, Mitchell J Cohen, Carolyn S Calfee
BACKGROUND: The risk of the acute respiratory distress syndrome (ARDS) is increased in passive and active smokers after blunt trauma. However, the mechanisms responsible, including the role of platelet aggregation, for this association are unknown. METHODS: We analyzed 215 patients with severe blunt trauma from a prospective observational cohort at a Level 1 trauma center between 2010 - 2015. Subjects underwent impedance-based platelet aggregometry in response to platelet agonists arachidonic acid (ASPI), adenosine diphosphate (ADP), collagen (COL) and thrombin receptor activating peptide-6 (TRAP)...
November 14, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29138486/the-impact-of-a-specialized-spinal-cord-injury-center-as-compared-with-non-specialized-centers-on-the-acute-respiratory-management-of-patients-with-complete-tetraplegia-an-observational-study
#4
Andréane Richard-Denis, Debbie Feldman, Cynthia Thompson, Martin Albert, Jean-Marc Mac-Thiong
STUDY DESIGN: Retrospective cohort study. OBJECTIVES: To compare the proportion of tracheostomy placement and duration of mechanical ventilation (MV) in patients with a complete cervical spinal cord injury (SCI) that were managed early or lately in a specialized acute SCI-center. The second objective was to determine the impact of the timing of admission to the SCI-center on the MV support duration. SETTING: A single Level-1 trauma center specialized in SCI care in Quebec (Canada)...
November 15, 2017: Spinal Cord
https://www.readbyqxmd.com/read/29137199/epidemiology-of-bone-fracture-in-female-trauma-patients-based-on-risks-of-osteoporosis-assessed-using-the-osteoporosis-self-assessment-tool-for-asians-score
#5
Cheng-Shyuan Rau, Shao-Chun Wu, Pao-Jen Kuo, Yi-Chun Chen, Peng-Chen Chien, Hsiao-Yun Hsieh, Ching-Hua Hsieh
Background: Osteoporotic fractures are defined as low-impact fractures resulting from low-level trauma. However, the exclusion of high-level trauma fractures may result in underestimation of the contribution of osteoporosis to fractures. In this study, we aimed to investigate the fracture patterns of female trauma patients with various risks of osteoporosis based on the Osteoporosis Self-Assessment Tool for Asians (OSTA) score. Methods: According to the data retrieved from the Trauma Registry System of a Level I trauma center between 1 January 2009 and 31 December 2015, a total of 6707 patients aged ≥40 years and hospitalized for the treatment of traumatic bone fracture were categorized as high-risk (OSTA < -4, n = 1585), medium-risk (-1 ≥ OSTA ≥ -4, n = 1985), and low-risk (OSTA > -1, n = 3137) patients...
November 13, 2017: International Journal of Environmental Research and Public Health
https://www.readbyqxmd.com/read/29137197/effect-of-age-on-glasgow-coma-scale-in-patients-with-moderate-and-severe-traumatic-brain-injury-an-approach-with-propensity-score-matched-population
#6
Cheng-Shyuan Rau, Shao-Chun Wu, Yi-Chun Chen, Peng-Chen Chien, Hsiao-Yun Hsieh, Pao-Jen Kuo, Ching-Hua Hsieh
Background: The most widely used methods of describing traumatic brain injury (TBI) are the Glasgow Coma Scale (GCS) and the Abbreviated Injury Scale (AIS). Recent evidence suggests that presenting GCS in older patients may be higher than that in younger patients for an equivalent anatomical severity of TBI. This study aimed to assess these observations with a propensity-score matching approach using the data from Trauma Registry System in a Level I trauma center. Methods: We included all adult patients (aged ≥20 years old) with moderate to severe TBI from 1 January 2009 to 31 December 2016...
November 13, 2017: International Journal of Environmental Research and Public Health
https://www.readbyqxmd.com/read/29137016/binding-pancreaticogastrostomy-anastomosis-in-central-pancreatectomy-a-single-center-experience
#7
Pengcheng Kang, Zhidong Wang, Kaiming Leng, Xiangyu Zhong, Hao Wang, Ming Wan, Sheng Tai, Yunfu Cui
A growing number of central pancreatectomies are performed. However, reconstruction of pancreaticoenteral digestive continuity after central pancreatectomy remains debated. This study evaluates the short-term outcomes of binding pancreaticogastrostomy anastomosis in central pancreatectomy.We have reviewed our experience with 52 patients who underwent binding pancreaticogastrostomy following central pancreatectomy from February 2009 to March 2015. Indication includes 6 noninvasive intraductal papillary mucinous neoplasms, 11 neuroendocrine tumors, 12 solid pseudopapillary tumor, 9 serous cystadenoma, 6 mucinous cystadenoma, and 8 focal pancreatic traumas...
November 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29135664/pain-relief-after-operative-treatment-of-an-extremity-fracture-a-noninferiority-randomized-controlled-trial
#8
Gijs T T Helmerhorst, Ruben Zwiers, David Ring, Peter Kloen
BACKGROUND: Opioid pain medication is frequently given to patients recovering from a surgical procedure for an extremity fracture in spite of evidence that acetaminophen may be adequate. The aim of this study was to determine whether prescription of step 1 pain medication (acetaminophen) is noninferior to step 2 pain medication (acetaminophen and tramadol) after operative treatment of an extremity fracture. METHODS: Fifty-two patients with a single extremity fracture were randomized from July 2012 to March 2015 in this 2-week follow-up, noninferiority trial in a level-I trauma center in the Netherlands...
November 15, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/29134161/pneumatization-patterns-of-the-petrous-apex-and-lateral-sphenoid-recess
#9
Alexander Malone, Margherita Bruni, Robert Wong, Mark Tabor, K Paul Boyev
Introduction  The petrous apex poses a challenge for surgical intervention due to poor access. As intraoperative image guidance and surgical instrumentation improve, newer endoscopic approaches are increasingly favored. This study aims to provide normative data on the anatomy of the lateral sphenoid sinus recess and petrous apex. These normative data could assist in determining the efficacy of a transnasal transsphenoidal approach to lesions of the anteroinferior petrous apex. Methods  This is a retrospective study investigating normative data on all maxillofacial computed tomography (CT) scans performed at a level I trauma center over a 6-month period...
December 2017: Journal of Neurological Surgery. Part B, Skull Base
https://www.readbyqxmd.com/read/29133706/a-randomized-placebo-controlled-trial-of-progesterone-with-or-without-hypothermia-in-patients-with-acute-severe-traumatic-brain-injury
#10
Sumit Sinha, Amol Raheja, Neha Samson, Keshav Goyal, Sanjeev Bhoi, Arul Selvi, Pushpa Sharma, Bhawani Shankar Sharma
OBJECTIVE: Among newer neuroprotectant modalities, hypothermia and progesterone have shown a beneficial role in preliminary studies enrolling patients with severe traumatic brain injury (sTBI). The primary objective of this study was to evaluate the efficacy of progesterone with or without prophylactic hypothermia in acute sTBI patients. MATERIALS AND METHODS: This is a prospective, outcome assessor, statistician blinded, randomized, and placebo-controlled phase II trial of progesterone with or without hypothermia (factorial design)...
November 2017: Neurology India
https://www.readbyqxmd.com/read/29133650/epidemiology-clinical-profile-and-factors-predicting-final-visual-outcome-of-pediatric-ocular-trauma-in-a-tertiary-eye-care-center-of-central-india
#11
Satendra Singh, Bhavana Sharma, Kavita Kumar, Aditi Dubey, Kanchan Ahirwar
PURPOSE: Ocular trauma constitutes an important cause of preventable visual morbidity worldwide. This study was done to study the incidence, sociodemographic pattern, and clinical profile of ocular trauma in pediatric age group. Also to evaluate the factors influencing final visual outcome in these patients. METHODS: This was a prospective interventional study concerning ocular trauma in pediatric patients up to 16 years of age of either sex. Various variables having an impact on final visual outcome were studied, and results were analyzed using statistical indices - relative risk, Chi-square test, P value, and linear regression analysis...
November 2017: Indian Journal of Ophthalmology
https://www.readbyqxmd.com/read/29133262/911-emergency-medical-services-and-re-triage-to-level-i-trauma-centers
#12
Eric Kuncir, Dean Spencer, Kelly Feldman, Cristobal Barrios, Kenneth Miller, Stephanie Lush, Matthew Dolich, Michael Lekawa
BACKGROUND: Interfacility transfer of under-triaged patients to higher level trauma centers has been found to result in a delay of appropriate care and increase in mortality. To address this, for the last 10 years, our region has utilized 911 EMS paramedics for rapid re-triage of under-triaged patients to our institution's Level I trauma center. We sought to determine if utilizing 911 EMS for re-triage (911-RT) to our institution was associated with worse outcomes-with mortality as the primary outcome-compared to direct EMS transport from point of injury...
September 27, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/29132593/the-impact-of-helicopter-emergency-medical-service-night-operations-in-south-east-england
#13
Leigh Curtis, Mark Salmon, Richard M Lyon
OBJECTIVE: This study sought to assess the impact of a helicopter emergency medical service (HEMS) capable of night operations. METHODS: This is a retrospective case review of all night HEMS missions attended by a charity air ambulance service in South East England over a 2-year period (October 1, 2013, to October 1, 2015). RESULTS: During the 2-year trial period, the HEMS service undertook a total of 5,004 missions and attended to 3,728 patients...
November 2017: Air Medical Journal
https://www.readbyqxmd.com/read/29132580/the-kids-are-alright-pediatric-trauma-pearls
#14
REVIEW
Angelo Mikrogianakis, Vincent Grant
Pediatric patients with trauma pose unique challenges, both practical and cognitive, to front-line care providers. The combination of anatomic, physiologic, and metabolic factors leads to unique injury patterns with different approaches and responses to treatment compared with adults. A similar traumatic mechanism can lead to slightly different internal injuries with unique management and treatment strategies between the two groups. This article is intended for community, nonpediatric trauma centers, and emergency physicians who are frequently required to assess, resuscitate, and stabilize injured children before they can be safely transferred to a pediatric trauma center for ongoing definitive care and rehabilitation...
February 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29132578/major-trauma-outside-a-trauma-center-prehospital-emergency-department-and-retrieval-considerations
#15
REVIEW
Preston J Fedor, Brian Burns, Michael Lauria, Clare Richmond
Care of the critically injured begins well before the patient arrives at a large academic trauma center. It is important to understand the continuum of care from the point of injury in the prehospital environment, through the local hospital and retrieval, until arrival at a trauma center capable of definitive care. This article highlights the important aspects of trauma assessment and management outside of tertiary or quaternary care hospitals. Key elements of each phase of care are reviewed, including management pearls and institutional strategies to facilitate effective and efficient treatment of trauma patients from the point of injury forward...
February 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29131913/unilateral-congenital-cataract-clinical-profile-and-presentation
#16
Sudarshan Khokhar, Cijin P Jose, Ramanjit Sihota, Neha Midha
PURPOSE: To study the clinical profile and presentation of children with unilateral cataract. METHODS: In this hospital-based, observational, cross-sectional study, patients 15 years of age or younger who presented with unilateral cataract were recruited. Cases of cataract secondary to causes such as trauma or uveitis were excluded. Age at detection and presentation, distance from the treatment center, presenting complaints, cataract morphology, and biometry were noted for each case...
November 11, 2017: Journal of Pediatric Ophthalmology and Strabismus
https://www.readbyqxmd.com/read/29130874/do-routine-radiographs-obtained-at-initial-outpatient-postoperative-visit-change-management
#17
Eric Grenier, Dave Tennent, Jean Patzkowski, Joseph Hsu, Anthony Johnson
Routine postoperative radiographs are commonly obtained at the initial postoperative visit. The purpose of this study was to demonstrate the clinical utility of routine postoperative radiographs and quantify the radiation exposure and cost to the health care system. All orthopaedic surgeries performed during 2007 at a level I trauma center were retrospectively analyzed. Surgical procedures that were likely to require follow-up radiographs were included. Analysis demonstrated 878 procedures with 471 procedures (54%) receiving initial postoperative radiographs...
October 2017: Journal of Surgical Orthopaedic Advances
https://www.readbyqxmd.com/read/29127770/the-burden-of-firearm-violence-in-the-united-states-stricter-laws-result-in-safer-states
#18
Faisal Jehan, Viraj Pandit, Terence O'Keeffe, Asad Azim, Arpana Jain, Saad A Tai, Andrew Tang, Muhammad Khan, Narong Kulvatunyou, Lynn Gries, Bellal Joseph
BACKGROUND: Increasing firearm violence has resulted in a strong drive for stricter firearm legislations. Aim of this study was to determine the relationship between firearm legislations and firearm-related injuries across states in the United States. METHODS: We performed a retrospective analysis of all patients with trauma related hospitalization using the 2011 Nationwide Inpatient Sample database. Patients with firearm-related injury were identified using E-codes...
November 11, 2017: Journal of Injury & Violence Research
https://www.readbyqxmd.com/read/29126550/trends-in-pediatric-adjusted-shock-index-predict-morbidity-and-mortality-in-children-with-severe-blunt-injuries
#19
Robert J Vandewalle, Julia K Peceny, Scott C Dolejs, Jodi L Raymond, Thomas M Rouse
PURPOSE: The utility of measuring the pediatric adjusted shock index (SIPA) at admission for predicting severity of blunt injury in pediatric patients has been previously reported. However, the utility of following SIPA after admission is not well described. METHODS: The trauma registry from a level-one pediatric trauma center was queried from January 1, 2010 to December 31, 2015. Patients were included if they were between 4 and 16years old at the time of admission, sustained a blunt injury with an Injury Severity Score≥15, and were admitted less than 12h after their injury (n=286)...
October 14, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/29123899/venous-thromboembolism-in-major-trauma-patients-a-single-center-retrospective-cohort-study-of-the-epidemiology-and-utility-of-d-dimer-for-screening
#20
Tetsuya Yumoto, Hiromichi Naito, Yasuaki Yamakawa, Atsuyoshi Iida, Kohei Tsukahara, Atsunori Nakao
Aim: Venous thromboembolism (VTE) can be a life-threatening complication after major trauma. The aim of this study was to investigate the epidemiology of VTE and to assess the usefulness of D-dimer for screening for VTE in major trauma cases among the Japanese population. Methods: We examined a single-center retrospective cohort of severely injured trauma patients who had been admitted to the emergency intensive care unit at Okayama University Hospital (Okayama, Japan) from April 2013 through to March 2016...
October 2017: Acute Medicine & Surgery
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