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Latest & greatest articles for trauma
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The reliability of nonreconstructed computerized tomographic scans of the abdomen and pelvis in detecting thoracolumbar spine injuries in blunt trauma patients with altered mental status Computerized tomography, traditionally utilized to evaluate and detect visceral abdominal and pelvic injuries in multiply injured patients with altered mental status, also has been useful for detecting thoracolumbar spine fractures and dislocations. The purpose of the present study was to test the reliability (...) of nonreconstructed computerized tomography of the abdomen and pelvis as a screening tool for thoracolumbar spine injuries in blunt trauma patients with altered mental status.The study consisted of fifty-nine consecutive patients with altered mental status who were admitted to a Level-II trauma center. Each patient had a nonreconstructed computerized tomographic scan of the abdomen and pelvis (5-mm slices), and of the chest when indicated, as well as anteroposterior and lateral radiographs of the thoracolumbar
Clinical prediction rules for identifying adults at very low risk for intra-abdominal injuries after blunt trauma We derive and validate clinical prediction rules to identify adult patients at very low risk for intra-abdominal injuries after blunt torso trauma.We prospectively enrolled adult patients (>or=18 years old) after blunt torso trauma for whom diagnostic testing for intra-abdominal injury was performed. In the derivation phase, we used binary recursive partitioning to create a rule (...) in the evaluation of adult patients after blunt torso trauma. Patients without any of these variables are at very low risk for having intra-abdominal injury, particularly intra-abdominal injury requiring acute intervention, and are unlikely to benefit from abdominal computed tomography scanning.
Validation of a prediction rule for the identification of children with intra-abdominal injuries after blunt torso trauma We validate the accuracy of a previously derived clinical prediction rule for the identification of children with intra-abdominal injuries after blunt torso trauma.We conducted a prospective observational study of children with blunt torso trauma who were evaluated for intra-abdominal injury with abdominal computed tomography (CT), diagnostic laparoscopy, or laparotomy (...) at a Level I trauma center during a 3-year period to validate a previously derived prediction rule. The emergency physician providing care documented history and physical examination findings on a standardized data collection form before knowledge of the results of diagnostic imaging. The clinical prediction rule being evaluated included 6 "high-risk" variables, the presence of any of which indicated that the child was not at low risk for intra-abdominal injury: low age-adjusted systolic blood pressure
Cost-effectiveness of guidelines for insertion of inferior vena cava filters in high-risk trauma patients Cost-effectiveness of guidelines for insertion of inferior vena cava filters in high-risk trauma patients Cost-effectiveness of guidelines for insertion of inferior vena cava filters in high-risk trauma patients Spangler EL, Dillavou ED, Smith KJ Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains (...) a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. CRD summary The study objective was to assess the cost-effectiveness of prophylactic versus therapeutic retrievable interior vena cava filters placement in high-risk trauma patients. The authors concluded that their results suggested that prophylactic filters were not cost-effective. The quality of the study methodology was adequate. Methods
A greater incidence of post local anesthesia soft tissue trauma occurs in children less than 4 years of age compared to other children. UTCAT622, Found CAT view, CRITICALLY APPRAISED TOPICs University: | | ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM View the CAT / Title A Greater Incidence Of Post Local Anesthesia Soft Tissue Trauma Occurs In Children Less Than 4 Years Of Age Compared To Other Children Clinical Question What is the incidence of post local anesthesia and post operative soft (...) tissue trauma in young children following administration of local anesthetic in comparison to adolescents? Clinical Bottom Line 18% of children under 4 years of age experienced soft tissue trauma as opposed to only 7% of children over 12. (See Comments on the CAT below) Best Evidence (you may view more info by clicking on the PubMed ID link) PubMed ID Author / Year Patient Group Study type (level of evidence) #1) College/2000 Children Prospective Case Series Key results Soft tissue trauma occurred
A systematic review of the diagnostic accuracy of ocular signs in pediatric abusive head trauma Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.
Does prehospital ultrasound improve treatment of the trauma patient? A systematic review Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.
Audit filters for improving processes of care and clinical outcomes in trauma systems. Traumatic injuries represent a considerable public health burden with significant personal and societal costs. The care of the severely injured patient in a trauma system progresses along a continuum that includes numerous interventions being provided by a multidisciplinary group of healthcare personnel. Despite the recent emphasis on quality of care in medicine, there has been little research to direct (...) trauma clinicians and administrators on how optimally to monitor and improve upon the quality of care delivered within a trauma system. Audit filters are one mechanism for improving quality of care and are defined as specific clinical processes or outcomes of care that, when they occur, represent unfavorable deviations from an established norm and which prompt review and feedback. Although audit filters are widely utilized for performance improvement in trauma systems they have not been subjected
Prophylactic antibiotics for penetrating abdominal trauma. Penetrating abdominal trauma occurs when the peritoneal cavity is breached. Routine laparotomy for penetrating abdominal injuries began in the 1800s, with antibiotics first being used in World War II to combat septic complications associated with these injuries. This practice was marked with a reduction in sepsis-related mortality and morbidity. Whether prophylactic antibiotics are required in the prevention of infective complications (...) following penetrating abdominal trauma is controversial, however, as no randomised placebo controlled trials have been published to date. There has also been debate about the timing of antibiotic prophylaxis. In 1972 Fullen noted a 7% to 11% post-surgical infection rate with pre-operative antibiotics, a 33% to 57% infection rate with intra-operative antibiotic administration and 30% to 70% infection rate with only post-operative antibiotic administration. Current guidelines state there is sufficient
Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. CT imaging of head-injured children has risks of radiation-induced malignancy. Our aim was to identify children at very low risk of clinically-important traumatic brain injuries (ciTBI) for whom CT might be unnecessary.We enrolled patients younger than 18 years presenting within 24 h of head trauma with Glasgow Coma Scale scores of 14-15 in 25 North American
The trauma risk adjustment model: a new model for evaluating trauma care The trauma injury severity score (TRISS) has been used for over 20 years for retrospective risk assessment in trauma populations. The TRISS has serious limitations, which may compromise the validity of trauma care evaluations.To derive and validate a new mortality prediction model, the trauma risk adjustment model (TRAM), and to compare the performance of the TRAM to that of the TRISS in terms of predictive validity (...) and risk adjustment.The Quebec Trauma Registry (1998-2005), based on the mandatory participation of 59 designated provincial trauma centers, was used to derive the model. The American National Trauma Data Bank (2000-2005), based on the voluntary participation of any US hospitals treating trauma, was used for the validation phase. Adult patients with blunt trauma respecting at least one of the following criteria were included: hospital stay >2 days, intensive care unit admission, death, or hospital
Closed loop control of inspired oxygen concentration in trauma patients Transport of mechanically ventilated patients in a combat zone presents challenges, including conservation of resources. In the battlefield setting, provision of oxygen supplies remains an important issue. Autonomous control of oxygen concentration can allow a reduction in oxygen usage and reduced mission weight.Trauma patients requiring ventilation and inspired oxygen concentration (FIO(2)) > 0.40 were evaluated for study (...) no differences in the number of episodes of SpO(2) < 88%. Oxygen usage was reduced by 32% during closed loop control.Closed loop control of FIO(2) offers the opportunity for maximizing oxygen resources, reducing mission weight, and providing targeted normoxemia without increasing risk of hypoxemia in ventilated trauma patients.
Emergency trauma score: an instrument for early estimation of trauma severity Early estimation of the mortality risk of severely injured patients is mandatory. To estimate the seriousness of the condition of patients with trauma, we developed the emergency trauma score (EMTRAS) for ease of use, with simple parameters that are available within 30 minutes.Prospective analysis of the German Trauma Registry of multitrauma patients.EMTRAS was derived from data from 1993 through 2003. Potential (...) , respectively. Prothrombin time: <80%, 80% through 50%, 49% through 20%, and >20% received a score of 0, 1, 2, and 3, respectively. In the validation dataset, the area under the receiver operating characteristic curve for EMTRAS was 0.828.EMTRAS combines four early parameters from the emergency room and accurately predicts mortality. Knowledge of the anatomical injuries is not necessary. The determination of the EMTRAS will inform caregivers of the seriousness of patients with trauma at an early stage.
Ocular trauma score in open-globe injuries To determine the value of calculating an ocular trauma score (OTS) for patients with open-globe injuries. OTS evaluating system can provide valuable prognostic information, and its use may be an asset in counseling patients with open-globe injuries.This study was conducted as a retrospective review of 114 eyes of 114 patients who presented with open-globe injuries between January 2001 and July 2006. OTS variables (visual acuity, rupture (...) study, category 2 of LP/HM ratio (p < 0.0001) was statistically higher than in the OTS study. The likelihood of the final visual acuities (NLP, LP/HM, 1/200 to 19/200, 20/200 to 20/50, and > or = 20/40) in the other OTS categories in this group was similar to those in the OTS study group. The OTS showed positive correlation with final visual acuity (p < 0.001).In open-globe injuries, a commonly accepted system for calculating ocular trauma score (OTS) can provide reliable prognostic information.
Impact of plasma transfusion in massively transfused trauma patients The objective of this study was to determine the optimal use of fresh-frozen plasma (FFP) in trauma. Our hypothesis was that a higher FFP: packed red blood cells (PRBC) ratio is associated with improved survival.This is a 6-year retrospective trauma registry and blood bank database study in a level I trauma center. All massively transfused patients (> or =10 PRBC during 24 hours) were analyzed. Patients with severe head trauma (...) (head Abbreviated Injury Severity score > or =3) were excluded from the analysis. Patients were classified into four groups according to the FFP:PRBC ratio received: low ratio (< or =1:8), medium ratio (>1:8 and < or =1:3), high ratio (>1:3 and < or =1:2), and highest ratio (>1:2).Of 25,599 trauma patients, 4,241 (16.6%) received blood transfusion. Massive transfusion occurred in 484 (11.4%) of the transfused. After exclusion of 101 patients with severe head injury 383 patients were available
Major pelvic trauma Major Pelvic Trauma – New guidance Trauma Emergencies April 2009 Page 1 of 8 1. INTRODUCTION Major pelvic injuries are predominantly observed when there is a high- energy transfer to the patient such as might occur following road traffic collision, 1 2 pedestrian accident, fall from height, or crush injury. 3-11 Less serious pelvic injuries may also occur following low-energy transfer events, particularly in the elderly 4 12 13 (such as a simple fall), amongst patients (...) with degenerative bone disease or receiving radiotherapy, and rarely as a direct consequence of seizure activity. 14 15 The majority of pelvic injuries do not result in major disruption of the pelvic ring, but rather involve fractures of the pubic ramus or acetabulum. 16 Presentation of these injuries is very similar to neck of femur fractures therefore please refer to the limb trauma guideline for management of these less serious pelvic injuries. 2. INCIDENCE Pelvic fractures represent 3% to 6% of all
Advanced trauma life support training for hospital staff. Injury is responsible for an increasing global burden of death and disability. As a result, new models of trauma care have been developed. Many of these, though initially developed in high-income countries (HICs), are now being adopted in low and middle-income countries (LMICs). One such trauma care model is advanced trauma life support (ATLS) training in hospitals, which is being promoted in LMICs as a strategy for improving outcomes (...) for victims of trauma. The impact of this health service intervention, however, has not been rigorously tested by means of a systematic review in either HIC or LMIC settings.To quantify the impact of ATLS training for hospital staff on injury mortality and morbidity in hospitals with and without such a training program.We searched the CENTRAL, MEDLINE, EMBASE, PUBMED, CINAHL and ZETOC databases and the Cochrane Injuries Group's Specialised Register. For this update, the search strategy was expanded
Early prediction of massive transfusion in trauma: simple as ABC (assessment of blood consumption)? Massive transfusion (MT) occurs in about 3% of civilian and 8% of military trauma patients. Although many centers have implemented MT protocols, most do not have a standardized initiation policy. The purpose of this study was to validate previously described MT scoring systems and compare these to a simplified nonlaboratory dependent scoring system (Assessment of Blood Consumption [ABC] score (...) ).Retrospective cohort of all level I adult trauma patients transported directly from the scene (July 2005 to June 2006). Trauma-Associated Severe Hemorrhage (TASH) and McLaughlin scores calculated according to published methods. ABC score was assigned based on four nonweighted parameters: penetrating mechanism, positive focused assessment sonography for trauma, arrival systolic blood pressure of 90 mm Hg or less, and arrival heart rate > or = 120 bpm. Area under the receiver operating characteristic curve