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https://www.readbyqxmd.com/read/27918852/anomaly-detection-outperforms-logistic-regression-in-predicting-outcomes-in-trauma-patients
#1
Zachary D W Dezman, Chen Gao, Shiming Yang, Peter Hu, Li Yao, Hsiao-Chi Li, Chein-I Chang, Colin Mackenzie
OBJECTIVE: Recent advancements in trauma resuscitation have shown a great benefit of early identification and control of hemorrhage, which is the most common cause of death in injured patients. We introduce a new analytical approach, anomaly detection (AD), as an alternative method to the traditional logistic regression (LR) method in predicting which injured patients receive transfusions, intensive care, and other interventions. METHODS: We abstracted routinely collected prehospital vital sign data from patient records (adult patients who survived more than 15 minutes after being directly admitted to a level 1 trauma center)...
December 5, 2016: Prehospital Emergency Care
https://www.readbyqxmd.com/read/27911066/-conservative-management-of-liver-trauma-and-its-complications-current-gold-standard
#2
R Gander, J A Molino, S Santiago, A Laín, G Guillén, C Giné, G Royo, S López, M Pérez, I Díez, S Cañadas, J Lloret, J Bueno
INTRODUCTION: The liver is the second most frequently involved organ in abdominal trauma in children. The aim of this study was to review the characteristics of liver traumas (LT) in children, its treatment and complications. MATERIAL AND METHODS: Retrospective study of patients with LT treated between 2010-2014. We analyzed data regarding diagnosis, conservative management (CM), complications and treatment. RESULTS: Twenty-four patients of LT with a mean age of 9...
January 25, 2016: Cirugía Pediátrica: Organo Oficial de la Sociedad Española de Cirugía Pediátrica
https://www.readbyqxmd.com/read/27898431/improving-outcome-of-trauma-patients-by-implementing-patient-blood-management
#3
Christoph Füllenbach, Kai Zacharowski, Patrick Meybohm
PURPOSE OF REVIEW: Patient blood management aims to improve patient outcome and safety by reducing the number of unnecessary red blood cell transfusions and vitalizing patient-specific anemia reserves. While this is increasingly recognized as best clinical practice in elective surgery, the implementation in the setting of trauma is restrained because of typically nonelective (emergency) surgery and, in specific circumstances, allogeneic blood transfusions as life-saving therapy. RECENT FINDINGS: Viscoelastic diagnostics allow a precise identification of trauma-induced coagulopathy...
November 24, 2016: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27895932/coagulation-complications-following-trauma
#4
REVIEW
Wenjun Z Martini
Traumatic injury is one of the leading causes of death, with uncontrolled hemorrhage from coagulation dysfunction as one of the main potentially preventable causes of the mortality. Hypothermia, acidosis, and resuscitative hemodilution have been considered as the significant contributors to coagulation manifestations following trauma, known as the lethal triad. Over the past decade, clinical observations showed that coagulopathy may be present as early as hospital admission in some severely injured trauma patients...
2016: Military Medical Research
https://www.readbyqxmd.com/read/27894500/prediction-of-massive-transfusion-in-trauma
#5
REVIEW
Paul M Cantle, Bryan A Cotton
Hemorrhage is the leading cause of preventable death in trauma. Damage control resuscitation relies on permissive hypotension, minimizing crystalloid use, and early implementation of massive transfusion protocols with established blood component ratios. These protocols improve the survival of the severely injured patient. Trauma physicians must quickly and accurately predict when a massive transfusion protocol should be activated. Several validated transfusion scores have been developed for this purpose. Many of these scores are useful for resuscitation research...
January 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/27890745/mini-open-thoracolumbar-corpectomy-perioperative-outcomes-and-hospital-cost-analysis-compared-to-open-corpectomy
#6
Olawale A R Sulaiman, Juanita Garces, Mansour Mathkour, Tyler Scullen, R Benson Jones, Teresa Arrington, Cuong J Bui
BACKGROUND: Standard open surgical management of thoracolumbar infection, trauma and tumor is associated with significant morbidity. Mini-open and less morbid surgical techniques are being introduced. Our objective is to compare perioperative and immediate post-operative morbidity of open and mini-open thoracolumbar corpectomy techniques including direct hospital costs. METHODS: We retrospectively reviewed the medical records of all patients who underwent open or mini-open corpectomy along with their demographics (age, sex, body mass index (BMI), primary diagnosis), operative data (length of surgery, EBL, blood transfusion-BT), surgical level, pre- and post-operative neurologic status (using ASIA scale), immediate peri-operative complications (within 30 days post-op), overall length of stay (LOS-A), length of stay from surgery (LOS-S), and total direct hospital costs were tabulated and analyzed...
November 24, 2016: World Neurosurgery
https://www.readbyqxmd.com/read/27889307/efficacy-of-a-single-dose-and-an-additional-dose-of-tranexamic-acid-in-reduction-of-blood-loss-in-total-knee-arthroplasty
#7
Qi Sun, Xiao Yu, JieZhou Wu, Wei Ge, Ming Cai, Shaohua Li
BACKGROUND: This study aimed at evaluating the efficacy and safety of different regimens with a single dose and an additional postoperative dose of tranexamic acid (TA) in reducing blood loss in total knee arthroplasty (TKA). METHODS: A total of 180 patients who were scheduled to undergo primary unilateral TKA in our level I trauma center were recorded and divided into groups A, B, C, and D randomly. Preoperative dose, an additional postoperative dose, and 2 postoperative additional doses of TA were infused intravenously in groups A (30 mg/kg), B (15 mg/kg), and C (10 mg/kg), respectively, and TA was not infused in group D...
October 12, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/27875491/assessing-the-efficacy-of-prothrombin-complex-concentrate-in-multiply-injured-patients-with-high-energy-pelvic-and-extremity-fractures
#8
Bellal Joseph, Mazhar Khalil, Caitlyn Harrison, Tianyi Swartz, Narong Kulvatunyou, Ansab A Haider, Tahereh O Jokar, David Burk, Ali Mahmoud, Rifat Latifi, Peter Rhee
OBJECTIVES: Prothrombin complex concentrate (PCC) is being increasingly used for reversing induced coagulopathy of trauma. However, the use of PCC for reversing coagulopathy in multiply injured patients with pelvic and/or lower extremity fractures remains unclear. The aim of our study was to assess the efficacy of PCC for reversing coagulopathy in this group of patients. DESIGN: Two-year retrospective analysis. SETTING: Our level I trauma center...
December 2016: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/27871539/liberal-or-restrictive-fluid-management-during-elective-surgery-a-systematic-review-and-meta-analysis
#9
REVIEW
Pim B B Schol, Ivon M Terink, Marcus D Lancé, Hubertina C J Scheepers
This article reviews if a restrictive fluid management policy reduces the complication rate if compared to liberal fluid management policy during elective surgery. The PubMed database was explored by 2 independent researchers. We used the following search terms: "Blood transfusion (MESH); transfusion need; fluid therapy (MESH); permissive hypotension; fluid management; resuscitation; restrictive fluid management; liberal fluid management; elective surgery; damage control resuscitation; surgical procedures, operative (MESH); wounds (MESH); injuries (MESH); surgery; trauma patients...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27857892/arterial-ammonia-levels-prognostic-marker-in-traumatic-hemorrhage
#10
Anurag Singla, Satinder Kaur, Navjot Kaur, C S Gill
BACKGROUND: In blunt trauma, extent of hemorrhage cannot be determined by physical examination, and vital signs may also not give clear picture in all the patients, especially young healthy ones. Hemorrhagic shock has been reported to increase blood ammonia levels. Arterial ammonia was analyzed in blunt trauma abdomen patients and correlated with shock index (SI). Its predictive value was determined for timely decision of intervention. MATERIALS AND METHODS: Hundred blunt trauma abdomen patients presented in the emergency ward of tertiary care hospital were included in the study...
October 2016: International Journal of Applied and Basic Medical Research
https://www.readbyqxmd.com/read/27851196/1561-mortality-following-high-blood-product-transfusion-among-severely-injured-trauma-patients
#11
Christopher Wybourn, April Mendoza, Mitchell Cohen, Rachael Callcut
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27815579/extracorporeal-membrane-oxygenation-improves-coagulopathy-in-an-experimental-traumatic-hemorrhagic-model
#12
M Larsson, P Forsman, P Hedenqvist, A Östlund, J Hultman, A Wikman, L Riddez, B Frenckner, M Bottai, C-M Wahlgren
PURPOSE: Hemorrhage is the most common cause of preventable death after trauma. Coagulopathy plays a central role in uncontrolled bleeding and is caused by multiple factors. Extracorporeal Membrane Oxygenation (ECMO) is an established treatment for patients with respiratory failure and has in recent years also been used in severely injured trauma patients with cardiopulmonary failure and coexisting bleeding shock. The aim of this study was to evaluate the effect of ECMO on hypothermia, acidosis, and coagulopathy in a traumatic hemorrhagic rabbit model...
November 4, 2016: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/27814956/shock-index-pediatric-age-adjusted-sipa-is-more-accurate-than-age-adjusted-hypotension-for-trauma-team-activation
#13
Shannon N Acker, Brooke Bredbeck, David A Partrick, Ann M Kulungowski, Carlton C Barnett, Denis D Bensard
BACKGROUND: We demonstrated previously that shock index, pediatric age-adjusted identifies severely injured children accurately after blunt trauma. We hypothesized that an increased shock index, pediatric age-adjusted would identify more accurately injured children requiring the highest trauma team activation than age-adjusted hypotension. METHODS: We reviewed all children age 4-16 admitted after blunt trauma with an injury severity score ≥15 from January 2007-June 2013...
November 1, 2016: Surgery
https://www.readbyqxmd.com/read/27812103/association-of-an-in-house-blood-bank-with-therapy-and-outcome-in-severely-injured-patients-an-analysis-of-18-573-patients-from-the-traumaregister-dgu%C3%A2
#14
Florian Debus, Rolf Lefering, Philipp Lechler, Tim Schwarting, Benjamin Bockmann, Erwin Strasser, Carsten Mand, Steffen Ruchholtz, Michael Frink
INTRODUCTION: Hemorrhagic shock remains one of the most common causes of death in severely injured patients. It is unknown to what extent the presence of a blood bank in a trauma center influences therapy and outcome in such patients. MATERIAL AND METHODS: We retrospectively analyzed prospectively recorded data from the TraumaRegister DGU® and the TraumaNetzwerk DGU®. Inclusion criteria were Injury Severity Score (ISS) ≥ 16, primarily treated patients, and hospital admission 2 years before or after the audit process...
2016: PloS One
https://www.readbyqxmd.com/read/27805995/rapid-thrombelastography-r-teg-thresholds-for-goal-directed-resuscitation-of-patients-at-risk-for-massive-transfusion
#15
Peter M Einersen, Ernest E Moore, Michael P Chapman, Hunter B Moore, Eduardo Gonzalez, Christopher C Silliman, Anirban Banerjee, Angela Sauaia
BACKGROUND: Uncontrolled hemorrhage is a leading cause of mortality following trauma accounting for up to 40% of deaths. Massive transfusion protocols (MTPs) offer a proven benefit in resuscitation of these patients. Recently, the superiority of thrombelastography (TEG)-guided resuscitation over strategies guided by conventional clotting assays (CCA) has been established. We seek to determine optimal thresholds for r-TEG driven resuscitation. METHODS: R-TEG data were reviewed for 190 patients presenting to our Level 1 Trauma Center from 2010 to 2015...
October 31, 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27798539/pediatric-minor-traumatic-brain-injury-with-intracranial-hemorrhage-identifying-low-risk-patients-who-may-not-benefit-from-icu-admission
#16
Erin Comer Burns, Beech Burns, Craig D Newgard, Amber Laurie, Rongwei Fu, Theresa Graif, Casey S Ward, Abbie Bauer, David Steinhardt, Laura M Ibsen, David M Spiro
BACKGROUND: Pediatric patients with any severity of traumatic intracranial hemorrhage (tICH) are often admitted to intensive care units (ICUs) for early detection of secondary injury. We hypothesize that there is a subset of these patients with mild injury and tICH for whom ICU care is unnecessary. OBJECTIVES: To quantify tICH frequency and describe disposition and to identify patients at low risk of inpatient critical care intervention (CCI). METHODS: We retrospectively reviewed patients aged 0 to 17 years with tICH at a single level I trauma center from 2008 to 2013...
October 28, 2016: Pediatric Emergency Care
https://www.readbyqxmd.com/read/27787442/temporary-abdominal-closure-for-trauma-and-intra-abdominal-sepsis-different-patients-different-outcomes
#17
Tyler J Loftus, Janeen R Jordan, Chasen A Croft, R Stephen Smith, Philip A Efron, Alicia M Mohr, Frederick A Moore, Scott C Brakenridge
BACKGROUND: Temporary abdominal closure (TAC) following damage control surgery (DCS) for injured patients has been generalized to septic patients. However, direct comparisons between these populations are lacking. We hypothesized that patients with intra-abdominal sepsis would have different resuscitation requirements and lower primary fascial closure rates than trauma patients. STUDY DESIGN: We performed a three year retrospective cohort analysis of patients managed with TAC for trauma (n=77) or intra-abdominal sepsis (n=147)...
October 25, 2016: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27785521/-the-cost-estimator-in-the-traumaregister-dgu
#18
R Lefering, L Mahlke, D Franz
BACKGROUND AND OBJECTIVES: Estimated treatment costs of severely injured patients were often added to registry-based analyses. In the past, the TraumaRegister DGU® used a modular cost estimator for this purpose. A recent research project initiated by the German Trauma Society (DGU) evaluated the reimbursement of severely injured patients in the German DRG system. This project also allowed the generation of an improved update of the registry's cost estimator. METHODS: Detailed cost data for the acute therapy of severely injured patients were available from 10 hospitals that also participate in the TraumaRegister DGU®...
October 26, 2016: Der Unfallchirurg
https://www.readbyqxmd.com/read/27779982/impact-of-massive-transfusion-and-aging-blood-in-acute-trauma
#19
Tanya Anand, Rajesh Ramnanan, Ruby Skinner, Maureen Martin
Blood transfusions cause altered immunity and the duration of storage is contributory. In the era of massive transfusion protocols (MTPs) this impact is unclear, particularly as it relates to balanced transfusions. Trauma patients requiring our MTP after admission to our Level II trauma center were studied. The average age of blood transfused was calculated; old blood was a storage time of ≥14 days versus new blood <14 days. Blood to plasma ratios of 1:1 were compared with ratios >1:1. Infections, organ dysfunction multiorgan injury (MOI), and death were compared based on ratios and blood storage times...
October 2016: American Surgeon
https://www.readbyqxmd.com/read/27779597/abnormalities-in-fibrinolysis-at-the-time-of-admission-are-associated-with-dvt-mortality-and-disability-in-a-pediatric-trauma-population
#20
Christine M Leeper, Matthew D Neal, Christine McKenna, Jason Sperry, Barbara A Gaines
BACKGROUND: Abnormalities in fibrinolysis are common and associated with increased mortality in injured adults. While hyperfibrinolysis (HF) and fibrinolysis shutdown (SD) are potential prognostic indicators and treatment targets in adults, these derangements are not well-described in a pediatric trauma cohort. METHODS: Prospective analysis of highest level trauma activations age 0-18 presenting to our academic center between 6/1/2015-7/31/2016 with admission rapid thromboelastogram (TEG)...
October 25, 2016: Journal of Trauma and Acute Care Surgery
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