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Latest & greatest articles for trauma
The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on trauma or other clinical topics then use Trip today.
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Whole-body CT In trauma patients BestBets: Whole-body CT In trauma patients Whole-body CT In trauma patients Report By: Tang Man Chun, Scott - Undergraduate, Mb ChB Programme Search checked by Giles Cattermole - Assistant Professor Institution: The Chinese University of Hong Kong Date Submitted: 27th May 2009 Date Completed: 7th September 2010 Last Modified: 8th September 2010 Status: Green (complete) Three Part Question In [patients with multiple trauma in the emergency department] is [use (...) of non-selective whole body CT scanning] associated with [improved survival]? Clinical Scenario A multisystem trauma victim arrives in the emergency department and the trauma team is activated. After initial resuscitation, you wonder if whole-body CT scan would benefit this patient by improving his chance of survival. Search Strategy Ovid MEDLINE(R) 1950–2010 March week 2. Ovid EMBASE 1980–2010 week 11. exp Tomography, x-ray Computed/ AND (trauma.mp. OR exp “Wounds and Injuries”/ OR exp Multiple
Radiation therapy for heterotopic ossification prophylaxis acutely after elbow trauma: a prospective randomized study Heterotopic ossification around the elbow can result in pain, loss of motion, and impaired function. We hypothesized that a single dose of radiation therapy could be administered safely and acutely after elbow trauma, could decrease the number of elbows that would require surgical excision of heterotopic ossification, and might improve clinical results.A prospective randomized (...) after elbow trauma for prophylaxis against heterotopic ossification, may play a role in increasing the rate of nonunion at the site of the fracture or an olecranon osteotomy. The clinical efficacy of radiation therapy could not be determined on the basis of the sample size. Further research is needed to determine the role of limited-field radiation for prophylaxis against heterotopic ossification after elbow trauma.
Impact of ABO-identical vs ABO-compatible nonidentical plasma transfusion in trauma patients Exposure to ABO-compatible nonidentical plasma will result in worse outcomes than transfusion with ABO-identical plasma only.Retrospective study.Level I trauma center.All patients requiring plasma (from 2000-2008) were identified. Propensity scores were used to match patients exposed to ABO-compatible plasma with those receiving exclusively ABO-identical plasma.Mortality and complications (acute
Effectiveness of an educational intervention on levels of pain, anxiety and self-efficacy for patients with musculoskeletal trauma This paper is a report of a study of the effectiveness of a pain management educational intervention on level of pain, anxiety and self-efficacy among patients with musculoskeletal trauma and consequent orthopaedic surgery.Substantial evidence supports the use of preoperative education to improve patient outcomes. Educational interventions are common in preparing (...) evaluation, a statistically significant effect on anxiety level was found in favour of the experimental group.Patients may benefit from this educational intervention in terms of relieving pain, anxiety and improving self-efficacy, and the educational intervention could be incorporated as part of routine care to prepare musculoskeletal trauma patients for surgery.
Route of delivery and neonatal birth trauma We sought to examine rates of birth trauma in 2 groupings (all International Classification of Diseases, Ninth Revision codes for birth trauma, and as defined by the Agency for Healthcare Research and Quality Patient Safety Indicator [PSI]) among infants born by vaginal and cesarean delivery.Data on singleton infants were obtained from the 2004-2005 Healthcare Cost and Utilization Project Nationwide Inpatient Sample.The rates of Agency for Healthcare (...) Research and Quality PSI and all birth trauma were 2.45 and 25.85 per 1000 births, respectively. Compared with vaginal, cesarean delivery was associated with increased odds of PSI birth trauma (odds ratio [OR], 1.71), primarily due to an increased risk for "other specified birth trauma" (OR, 2.61). Conversely, cesarean delivery was associated with decreased odds of all birth trauma (OR, 0.55), due to decreased odds of clavicle fractures (OR, 0.07), brachial plexus (OR, 0.10), and scalp injuries
Mechanism, glasgow coma scale, age, and arterial pressure (MGAP): a new simple prehospital triage score to predict mortality in trauma patients Prehospital triage of trauma patients is of paramount importance because adequate trauma center referral improves survival. We developed a simple score that is easy to calculate in the prehospital phase.Multicenter prospective observational study.Prehospital physician-staffed emergency system in university and nonuniversity hospitals.We evaluated 1360 (...) trauma patients receiving care from a prehospital mobile intensive care unit in 22 centers in France during 2002. The association of prehospital variables with in-hospital death was tested using logistic regression, and a simple score (the Mechanism, Glasgow coma scale, Age, and Arterial Pressure [MGAP] score) was created and compared with the triage Revised Trauma Score, Revised Trauma Score, and Trauma Related Injury Severity Score. The model was validated in 1003 patients from 2003 through 2005
Assessment of the posterior ligamentous complex following acute cervical spine trauma Magnetic resonance imaging is commonly used to assess the integrity of the posterior ligamentous complex following cervical trauma, but its accuracy and reliability have not been documented, to our knowledge. The purpose of this study was to determine the diagnostic accuracy of magnetic resonance imaging in detecting injury to specific components of the posterior ligamentous complex of the cervical (...) is sensitive for the evaluation of injury to the posterior ligamentous complex in the setting of acute cervical trauma. However, it has a lower positive predictive value and specificity, suggesting that injury to the posterior ligamentous complex may be "over-read" on magnetic resonance images. If magnetic resonance imaging is used in isolation to guide treatment, the high rate of false-positive findings may lead to unnecessary surgery. Other factors, including the morphology of the injury
Diagnosis and treatment of forefoot disorders. Section 5. Trauma. Guidelines and Measures | Agency for Healthcare Research & Quality HHS.gov Search ahrq.gov Search ahrq.gov Menu Topics A - Z Healthcare Delivery Latest available findings on quality of and access to health care Searchable database of AHRQ Grants, Working Papers & HHS Recovery Act Projects AHRQ Projects funded by the Patient-Centered Outcomes Research Trust Fund You are here Guidelines and Measures Funding for the National
Spine immobilization in penetrating trauma: more harm than good? Previous studies have suggested that prehospital spine immobilization provides minimal benefit to penetrating trauma patients but takes valuable time, potentially delaying definitive trauma care. We hypothesized that penetrating trauma patients who are spine immobilized before transport have higher mortality than nonimmobilized patients.We performed a retrospective analysis of penetrating trauma patients in the National Trauma (...) for spine immobilization.In total, 45,284 penetrating trauma patients were studied; 4.3% of whom underwent spine immobilization. Overall mortality was 8.1%. Unadjusted mortality was twice as high in spine-immobilized patients (14.7% vs. 7.2%, p < 0.001). The odds ratio of death for spine-immobilized patients was 2.06 (95% CI: 1.35-3.13) compared with nonimmobilized patients. Subset analysis showed consistent trends in all populations. Only 30 (0.01%) patients had incomplete spinal cord injury
Noninvasive ventilation reduces intubation in chest trauma-related hypoxemia: a randomized clinical trial Guidelines for noninvasive mechanical ventilation (NIMV) recommend continuous positive airway pressure in patients with thoracic trauma who remain hypoxic despite regional anesthesia. This recommendation is rated only by level C evidence because randomized controlled trials in this specific population are lacking. Our aim was to determine whether NIMV reduces intubation in severe trauma (...) -related hypoxemia.This was a single-center randomized clinical trial in a nine-bed ICU of a level I trauma hospital. Inclusion criteria were patients with Pao(2)/Fio(2)<200 for >8 h while receiving oxygen by high-flow mask within the first 48 h after thoracic trauma. Patients were randomized to remain on high-flow oxygen mask or to receive NIMV. The interface was selected based on the associated injuries. Thoracic anesthesia was universally supplied unless contraindicated. The primary end point
Sensitivity of bedside ultrasound and supine anteroposterior chest radiographs for the identification of pneumothorax after blunt trauma. Supine anteroposterior (AP) chest radiographs in patients with blunt trauma have poor sensitivity for the identification of pneumothorax. Ultrasound (US) has been proposed as an alternative screening test for pneumothorax in this population. The authors conducted an evidence-based review of the medical literature to compare sensitivity of bedside US and AP (...) chest radiographs in identifying pneumothorax after blunt trauma.MEDLINE and EMBASE databases were searched for trials from 1965 through June 2009 using a search strategy derived from the following PICO formulation of our clinical question: patients included adult (18 + years) emergency department (ED) patients in whom pneumothorax was suspected after blunt trauma. The intervention was thoracic ultrasonography for the detection of pneumothorax. The comparator was the supine AP chest radiograph
Computed tomographic angiography versus conventional angiography for the diagnosis of blunt cerebrovascular injury in trauma patients Blunt cerebrovascular injuries (BCVI) in trauma patients are rare but potentially devastating injuries, particularly if the diagnosis is delayed. Conventional angiography (CA) has been the screening and diagnostic modality of choice for identifying BCVI. With the advent of high-resolution computed tomography (CT), CT angiography has become a common modality
Clinical practice guideline: red blood cell transfusion in adult trauma and critical care To develop a clinical practice guideline for red blood cell transfusion in adult trauma and critical care.Meetings, teleconferences and electronic-based communication to achieve grading of the published evidence, discussion and consensus among the entire committee members.This practice management guideline was developed by a joint taskforce of EAST (Eastern Association for Surgery of Trauma (...) and diseases; (E) RBC transfusion risks; (F) Alternatives to RBC transfusion; and (G) Strategies to reduce RBC transfusion.Evidence-based recommendations regarding the use of RBC transfusion in adult trauma and critical care will provide important information to critical care practitioners.
Iliac artery injuries and pelvic fractures: a national trauma database analysis of associated injuries and outcomes Although infrequent, injury to the common or external iliac artery in association with pelvic fractures can be devastating, and descriptive data are lacking. This study was performed to determine the incidence, injury patterns, and outcomes of blunt iliac artery injuries (BIAIs) in association with moderate or severe pelvic fractures.Patients with moderate or severe pelvic (...) fractures (abbreviated injury score of 3 or 4) were identified from the National Trauma Databank. Records with and without common or external BIAI were compared. Admission variables included Emergency Department (ED) hypotension (systolic blood pressure <90), Glasgow Coma Score or=25, femur or lumbosacral fractures, solid organ injury, vascular injury, and hollow viscus injury. The association of BIAI with moderate or severe pelvic fractures was studied. Outcomes were
Advanced trauma life support training for ambulance crews. There is an increasing global burden of injury especially in low- and middle-income countries (LMICs). To address this, models of trauma care initially developed in high income countries are being adopted in LMIC settings. In particular, ambulance crews with advanced life support (ALS) training are being promoted in LMICs as a strategy for improving outcomes for victims of trauma. However, there is controversy as to the effectiveness (...) of this health service intervention and the evidence has yet to be rigorously appraised.To quantify the impact of ALS-trained ambulance crews versus crews without ALS training on reducing mortality and morbidity in trauma patients.Searches were not restricted by date, language or publication status. We searched the Cochrane Injuries Group Specialised Register, CENTRAL (The Cochrane Library 2009, Issue 3), MEDLINE (Ovid SP), EMBASE (Ovid SP), CINAHL (EBSCO) and PubMed in all years up to July 2009. We also
Damage control surgery for abdominal trauma. Trauma is one of the leading causes of death in any age group. The 'lethal triad' of acidosis, hypothermia, and coagulopathy has been recognized as a significant cause of death in patients with traumatic injuries. In order to prevent the lethal triad two factors are essential, early control of bleeding and prevention of further heat loss. In patients with major abdominal trauma, damage control surgery (DCS) avoids extensive procedures on unstable (...) , EMBASE, Web of Science: Science Citation Index & ISI Proceedings, Current Controlled Trials MetaRegister, Clinicaltrials.gov, Zetoc, and CINAHL for all published and unpublished randomised controlled trials. We did not restrict the searches by language, date, or publication status. Searches were conducted in August 2008.Randomised controlled trials of DCS versus immediate traditional surgical repair were included in this review. We included patients with major abdominal trauma (Abbreviated Injury
Pregnancy and Trauma Pregnancy and Trauma - Practice Management Guideline Search » Pregnancy and Trauma Published 2010 Citation: Authors Barraco, Robert D. MD, MPH; Chiu, William C. MD; Clancy, Thomas V. MD; Como, John J. MD; Ebert, James B. MD; Hess, L. Wayne MD; Hoff, William S. MD; Holevar, Michele R. MD; Quirk, J. Gerald MD, PhD; Simon, Bruce J. MD; Weiss, Patrice M. MD Author Information From the Department of Surgery (R.D.B.), Lehigh Valley Health Network, Allentown, Pennsylvania (...) ; Department of Surgery (W.C.C.), University of Maryland School of Medicine, Baltimore, Maryland; Department of Surgery (T.V.C.), New Hanover Regional Medical Center, Wilmington, North Carolina; Division of Trauma, Critical Care, Burn, and Metro Life Flight (J.J.C.), MetroHealth Medical Center, Cleveland, Ohio; Department of Emergency Medicine (J.B.E.), Elmhurst Memorial Occupational, Elmhurst, Illinois; Department of Obstetrics & Gynecology (W.H., P.M.W.), Carilion Clinic Roanoke, Virginia; Departments
Triage of the Trauma Patient Triage of the Trauma Patient - Practice Management Guideline Search » Triage of the Trauma Patient Published 2010 Authors The EAST Practice Management Guidelines Work Group: Robert D. Barraco, MD, MPH, Chair William C. Chiu, MD, Vice Chair Michael R. Bard, MD Faran Bokhari, MD Anthony Borzotta, MD Osbert Blow, MD, PhD Jeannette Capella, MD Marie Dieter, RN Thomas Z. Hayward III, MD William S. Hoff, MD Col. John C. Holcomb, MD John F. McCarthy, DO Michael Moncure, MD (...) Donna A. Nayduch, RN, MS Consultants Barbara Gaines, MD Mark C. Henry, MD Stanley Kurek, DO Ellen J. MacKenzie, PhD Statement of the Problem The optimal triage of trauma patients has been the source of vigorous debate over the years. Clearly, as from the French, an efficient “sorting” of potentially injured patients translates into decreased transport times to definitive care, better outcomes as well as improved resource utilization. As a result, a trauma field triage decision scheme has been
Penetrating Abdominal Trauma, Selective Non-Operative Management of Penetrating Abdominal Trauma, Selective Non-Operative Management of - Practice Management Guideline Search » Penetrating Abdominal Trauma, Selective Non-Operative Management of Published 2010 Citation: Authors Eastern Association for the Surgery of Trauma: Practice Management Guidelines Committee John J. Como, MD Faran Bokhari, MD William C. Chiu, MD Therese M. Duane, MD Michele R. Holevar, MD Margaret A. Tandoh, MD Rao R (...) . Ivatury, MD Thomas M. Scalea, MD November 27, 2009 Study Group Chairman John J. Como, MD MetroHealth Medical Center Case School of Medicine Cleveland, OH Committee Members Faran Bokhari, MD Stroger Hospital of Cook County Rush Medical College Chicago, IL William C. Chiu, MD R Adams Cowley Shock Trauma Center University of Maryland School of Medicine Baltimore, MD Therese M. Duane, MD Virginia Commonwealth University Medical Center Medical College of Virginia Richmond, VA Michele R. Holevar, MD Mount
Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Tranexamic acid can reduce bleeding in patients undergoing elective surgery. We assessed the effects of early administration of a short course of tranexamic acid on death, vascular occlusive events, and the receipt of blood transfusion in trauma patients.This randomised controlled trial was undertaken in 274 (...) hospitals in 40 countries. 20 211 adult trauma patients with, or at risk of, significant bleeding were randomly assigned within 8 h of injury to either tranexamic acid (loading dose 1 g over 10 min then infusion of 1 g over 8 h) or matching placebo. Randomisation was balanced by centre, with an allocation sequence based on a block size of eight, generated with a computer random number generator. Both participants and study staff (site investigators and trial coordinating centre staff) were masked
2010LancetControlled trial quality: predicted high