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Effect of Low-Dose Supplementation of Arginine Vasopressin on Need for Blood Product Transfusions in Patients With Trauma and Hemorrhagic Shock: A Randomized Clinical Trial Current therapies for traumatic blood loss focus on hemorrhage control and blood volume replacement. Severe hemorrhagic shock, however, is associated with a state of arginine vasopressin (AVP) deficiency, and supplementation of this hormone may decrease the need for blood products in resuscitation.To determine whether low (...) -dose supplementation of AVP in patients with trauma (hereinafter referred to as trauma patients) and with hemorrhagic shock decreases their need for transfused blood products during resuscitation.This randomized, double-blind placebo-controlled clinical trial included adult trauma patients (aged 18-65 years) who received at least 6 U of any blood product within 12 hours of injury at a single urban level 1 trauma center from May 1, 2013, through May 31, 2017. Exclusion criteria consisted
Penetrating Trauma-Lower Abdomen and Pelvis. American College of Radiology End User License Agreement ACR Appropriateness Criteria is a registered trademark of the American College of Radiology. By accessing the ACR Appropriateness Criteria®, you expressly agree and consent to the terms and conditions as described at: http://www.acr.org/~/media/ACR/Documents/AppCriteria/TermsandConditions.pdf Personal use of material is permitted for research, scientific and/or information purposes only. You (...) may not modify or create derivative works based on American College of Radiology material. No part of any material posted on the American College of Radiology Web site may be copied, downloaded, stored in a retrieval system, or redistributed for any other purpose without the expressed written permission of American College of Radiology. Date of origin: 1996 Last review date: 2013 ACR Appropriateness Criteria ® 1 Suspected Lower Urinary Tract Trauma American College of Radiology ACR Appropriateness
Head Trauma- Child Date of origin: 2014 ACR Appropriateness Criteria ® 1 Head Trauma — Child American College of Radiology ACR Appropriateness Criteria ® Clinical Condition: Head Trauma — Child Variant 1: Minor head injury (GCS >13) =2 years of age without neurologic signs or high risk factors (eg, altered mental status, clinical evidence of basilar skull fracture). Excluding nonaccidental trauma. Radiologic Procedure Rating Comments RRL* CT head without IV contrast 3 This is a known low-yield (...) ACR Appropriateness Criteria ® 2 Head Trauma — Child Clinical Condition: Head Trauma — Child Variant 2: Minor head injury (GCS >13), 13 . Approximately 3%–5% of children with minor head trauma have identifiable abnormalities by imaging, and typically less than 1% require neurosurgical intervention [6-9]. Noncontrast CT has a central role in screening for intracranial traumatic injury due to its wide availability, speed, and ability to detect significant hemorrhage, herniation, hydrocephalus
Acute Trauma to the Foot Date of origin: 2010 Last review date: 2014 ACR Appropriateness Criteria ® 1 Acute Trauma to the Foot American College of Radiology ACR Appropriateness Criteria ® Clinical Condition: Acute Trauma to the Foot Variant 1: Adult or child >5 years old. Acute injury to the foot; positive Ottawa Rules, suspicious for fracture. First study. Radiologic Procedure Rating Comments RRL* X-ray foot 9 ? CT foot without IV contrast 1 The RRL for the adult procedure is ? . ?? CT foot (...) is ? . ?? CT foot without and with IV contrast 1 The RRL for the adult procedure is ? . ?? MRI foot without IV contrast 1 O MRI foot without and with IV contrast 1 O US foot 1 O Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate *Relative Radiation Level ACR Appropriateness Criteria ® 2 Acute Trauma to the Foot Clinical Condition: Acute Trauma to the Foot Variant 4: Adult or child >5 years old. Acute injury to the foot; does not meet the Ottawa Rules; patient
Intranasal sufentanil versus intravenous morphine for acute severe trauma pain: A double-blind randomized non-inferiority study Intravenous morphine (IVM) is the most common strong analgesic used in trauma, but is associated with a clear time limitation related to the need to obtain an access route. The intranasal (IN) route provides easy administration with a fast peak action time due to high vascularization and the absence of first-pass metabolism. We aimed to determine whether IN sufentanil
Guidelines on the Evaluation and Treatment of Patients with Thoracolumbar Spine Trauma cns.org ');//]]> Register today for the only neurosurgery meeting you can’t miss! Register today for the only neurosurgery meeting you can’t miss! Register today for the only neurosurgery meeting you can’t miss! Register today for the only neurosurgery meeting you can’t miss! Register today for the only neurosurgery meeting you can’t miss! We're Sorry. We cannot find the page you requested. The file you
External validation of a clinical prediction rule for very low risk pediatric blunt abdominal trauma Computed tomography (CT) is frequently used to identify intra-abdominal injuries in children with blunt abdominal trauma (BAT). The Pediatric Emergency Care Applied Research Network (PECARN) proposed a prediction rule to identify children with BAT who are at very low risk for clinically-important intra-abdominal injuries (CIIAI) in whom CT can be avoided.To determine the sensitivity (...) of this prediction rule in identifying patients at very low risk for CIIAI in our pediatric trauma registry.Retrospective review of our institutional trauma registry to identify patients with CIIAI. CIIAI included cases resulting in death, therapeutic intervention at laparotomy, angiographic embolization of intra-abdominal arterial bleeding, blood transfusion for intra-abdominal hemorrhage, and administration of intravenous fluids for two or more nights for pancreatic or gastrointestinal injuries. Patients were
A new clinical score for cranial computed tomography in emergency department non-trauma patients: Definition and first validation Well recognized guidelines are available for the use of cranial computed tomography (CCT) in traumatic patients, while no definitely accepted standards exists to for CCT in patients without history of head injury. The aim of this study is to propose an easy clinical score to stratify the need of CCT in emergency department (ED) patients with suspect non-traumatic
Evaluation of the Thoracic and Lumbar Spine in Blunt Trauma Evaluation of the Thoracic and Lumbar Spine in Blunt Trauma | Emergency Medicine | Washington University in St. Louis Open Menu Back Close Menu Search for: Loading... Welcome Sections Education Fellowships Research Journal Club Events Open Search Vignette You’re working a shift at a level II trauma center in the community one rainy afternoon when EMS brings in Mr. Q a 62-year old man with hypertension and hyperlipidemia who (...) imaging choices, and a quick look online directs you to a Wondering what other literature there is, you begin to conduct a more thorough search…. PICO Question Population: Adult patients suffering blunt trauma Intervention: Aspects of history (e.g. mechanism of injury) and physical exam, plain radiography Comparison: CT scan, surgical findings, follow up Outcome: Need for surgical intervention or TLSO bracing Search Strategy A systematic review and meta-analysis, recently published by a collaboration
Urological Trauma Urological Trauma | Uroweb › Urological Trauma Urological Trauma To access the pdfs & translations of individual guidelines, please as EAU member. Non-EAU members can view the web versions. To become an EAU member, click . N.D. Kitrey (Chair), N. Djakovic, P. Hallscheidt, F.E. Kuehhas, N. Lumen, E. Serafetinidis, D.M. Sharma Guidelines Associates: Y. Abu-Ghanem, A. Sujenthiran, M. Waterloos TABLE OF CONTENTS REFERENCES 1. Radmayr, C., et al., EAU Guidelines on Paediatric (...) Urology. In: EAU Guidelines, edition presented at the annual EAU Congress Barcelona 2019. ISBN 978-94-92671-04-2. 2. Martinez-Pineiro, L., et al. EAU Guidelines on Urethral Trauma. Eur Urol, 2010. 57: 791. 3. Summerton, D.J., et al. EAU guidelines on iatrogenic trauma. Eur Urol, 2012. 62: 628. 4. Lumen, N., et al. Review of the current management of lower urinary tract injuries by the EAU Trauma Guidelines Panel. Eur Urol, 2015. 67: 925. 5. Serafetinides, E., et al. Review of the current management
Feasibility of a Hybrid Web-Based and In-Person Self-management Intervention Aimed at Preventing Acute to Chronic Pain Transition After Major Lower Extremity Trauma (iPACT-E-Trauma): A Pilot Randomized Controlled Trial Objective 1) To assess the feasibility of research methods to test a self-management intervention aimed at preventing acute to chronic pain transition in patients with major lower extremity trauma (iPACT-E-Trauma) and 2) to evaluate its potential effects at three and six months (...) postinjury. Design A pilot randomized controlled trial (RCT) with two parallel groups. Setting A supraregional level 1 trauma center. Methods Fifty-six adult patients were randomized. Participants received the intervention or an educational pamphlet. Several parameters were evaluated to determine the feasibility of the research methods. The potential efficacy of iPACT-E-Trauma was evaluated with measures of pain intensity and pain interference with activities. Results More than 80% of eligible patients
CanadiEM MVP Infographic Series – The Canadian C-spine rule for radiography in alert and stable trauma patients CanadiEM MVP Infographic Series - The Canadian C-spine rule for radiography in alert and stable trauma patients - CanadiEM CanadiEM MVP Infographic Series – The Canadian C-spine rule for radiography in alert and stable trauma patients In , , by Kevin Lam January 25, 2019 This issue of the MVP Infographic Series is focused on “The Canadian C-spine rule for radiography in alert (...) and stable trauma patients” published by Stiell et al. 1 Prior to the use of clinical decision rules, such as the Canadian C-spine Rule (CCR), clinicians varied up to 6-fold in how often they ordered C-spine X-rays. Although such X-rays have a low individual cost, they carry a high systems-level cost due to the volume of tests ordered. As such, a good clinical decision rule with high sensitivity to rule out C-spine injuries was much needed. Prior to the development of the CCR, the NEXUS criteria
Suspected Spine Trauma ? Child New 2018 ACR Appropriateness Criteria ® 1 Suspected Spine Trauma–Child American College of Radiology ACR Appropriateness Criteria ® Suspected Spine Trauma–Child Variant 1: Child, 3 to 16 years of age, acute cervical spine trauma, meets low risk criteria (based on PECARN or NEXUS). Initial imaging. Procedure Appropriateness Category Relative Radiation Level Radiography cervical spine Usually Not Appropriate ?? Arteriography cervicocerebral Usually Not Appropriate (...) Not Appropriate O MRI cervical spine without IV contrast Usually Not Appropriate O US cervical spine Usually Not Appropriate O Variant 2: Child, 3 to 16 years of age, acute cervical spine trauma, at least one risk factor with reliable clinical examination (based on PECARN or NEXUS). Initial imaging. Procedure Appropriateness Category Relative Radiation Level Radiography cervical spine Usually Appropriate ?? CT cervical spine without IV contrast May Be Appropriate (Disagreement) ???? MRI cervical spine without
Evaluation and comparison of different prehospital triage scores of trauma patients on in-hospital mortality Introduction: Several prehospital major trauma patient triage scores have been developed, the triage revised trauma score (T-RTS), Vittel criteria, Mechanism/Glasgow Coma Scale/Age/Systolic blood pressure score (MGAP), and the new trauma score (NTS). These scoring schemes allow a rapid and accurate prognostic assessment of the severity of potential lesions. The aim of our study (...) was to compare these scores with in-hospital mortality predictions in a cohort of consecutive trauma patients admitted in a Level 1 trauma center. Materials: Between 2013 and 2016, 1,112 patients were admitted to the "major trauma" spinneret of a Level 1 trauma center in the south of France. All prehospital data needed to calculate the T-RTS, Vittel criteria, the MGAP score, and the NTS were collected. The main evaluation criterion was in-hospital mortality at 30 days for all causes. The predictive
Parachute use to prevent death and major trauma when jumping from aircraft: randomized controlled trial. To determine if using a parachute prevents death or major traumatic injury when jumping from an aircraft.Randomized controlled trial.Private or commercial aircraft between September 2017 and August 2018.92 aircraft passengers aged 18 and over were screened for participation. 23 agreed to be enrolled and were randomized.Jumping from an aircraft (airplane or helicopter) with a parachute versus
Mental health outcomes after major trauma in Ontario: a population-based analysis Major injury continues to be a common source of morbidity and mortality; improving the functional recovery of survivors of major trauma requires a better understanding of the mental health outcomes that may occur in this population. We assessed the association between major trauma and the development of a new mental health diagnosis or death by suicide.We completed a population-based, self-controlled, longitudinal (...) cohort analysis using linked administrative data on patients treated for major trauma in Ontario between 2005 and 2010. All survivors were included and composite rates of mental health diagnoses during inpatient admissions were compared between the 5 years after injury and the 5 years before injury, using Poisson regression with generalized estimating equations. The incidence of suicide was calculated for the 5 years after injury. Risk factors for suicide were calculated using Cox proportional hazard
Risk of Serious Trauma with Glucose-Lowering Drugs in Older Persons: A Nested Case-Control Study To assess the risk of hospitalization for trauma associated with use of hypoglycemic glucose-lowering drugs (GLDs) in individuals aged 65 and older.Observational, nested, case-control study.The Echantillon Généraliste de Bénéficiaires claims database, a 1/97th representative sample of the population covered by French healthcare insurance.All persons with a first hospitalization for trauma between (...) 2009 and 2015 were considered as potential cases. They were selected if they had been followed for 365 days or longer at index date, were aged 65 and older, and had no diagnosed cancer. Cases (n=10,743) were matched with up to 10 randomly selected controls on age, sex, and length of follow-up (n=106,629).GLD exposure was considered globally and according to use of hypoglycemic GLDs alone, nonhypoglycemic GLDs alone, or both types of GLDs. Risk of hospitalization for trauma was estimated using
What Physiologic Parameters Are Indicative of Severe Injury in Trauma? What Physiologic Parameters Are Indicative of Severe Injury in Trauma? TAKE-HOME MESSAGE Pulse rate, systolic blood pressure, shock index, respiratory rate, and lactate demonstrate poor sensitivity but high speci?city for predicting severe injury among trauma patients. No parameter in isolation is able to adequately predict the risk of severe injury. EBEM Commentators Brit Long, MD Michael D. April, MD, DPhil Department (...) trauma patients to identify those with severe injuries as measured by resource use (blood transfusion, critical care admission, lifesaving intervention), anatomic injury severity measures (eg, Injury Severity Score), mortality, or a combination of any of these parameters developed by stakeholders including the Agency for Healthcare Research and Quality and the National Highway Transportation Safety Administration. Authors did not restrict the type of trials included. Two or more authors independently
Novel preclinical murine model of trauma-induced elbow stiffness Peri-articular injury may result in functional deficits and pain. In particular, post-traumatic elbow stiffness is a debilitating condition, precluding patients from performing activities of daily living. As such, clinicians and basic scientists alike, aim to develop novel therapeutic interventions to prevent and treat elbow stiffness; thereby reducing patient morbidity. Yet, there is a paucity of pre-clinical models of peri (...) 29.87 ± 2.075 mm, ***, p < 0.0002). Additionally, plasminogen deficient animals developed capsule thickening, delayed skeletal muscle repair, fibrosis, chronic inflammation, and heterotopic ossification; all features characteristic of pathology observed in patients with trauma-induced elbow stiffness.A soft tissue injury to the peri-elbow soft tissue with a concomitant deficiency in plasminogen, instigates elbow stiffness and pathologic features similar to those observed in humans. This pre-clinical