Selective computed tomographic angiography in traumatic subarachnoid hemorrhage: a pilot study.

Background: Computed tomographic angiography (CTA) tends to be overused in patients with traumatic subarachnoid hemorrhage (tSAH) to rule out intracranial aneurysmal disease. We hypothesized that there are two exclusive subsets of patients with tSAH that maybe at increased risk for aneurysm and thus should undergo CTA, those "found down" with an unknown mechanism of injury and those with "central subarachnoid hemorrhage" (CSH, in the subarachnoid cisterns and Sylvian fissures). This pilot study was performed to provide more information on the validity of our hypothesis.

Comorbidity-Polypharmacy Score as Predictor of Outcomes in Older Trauma Patients: A Retrospective Validation Study.

Introduction: Traditional injury severity assessment is insufficient in estimating the morbidity and mortality risk for older (≥45 years) trauma patients. Commonly used tools involve complex calculations or tables, do not consider all comorbidities, and often rely on data that are not available early in the trauma patient's hospitalization. The comorbidity-polypharmacy score (CPS), a sum of all pre-injury medications and comorbidities, was found in previous studies to independently predict morbidity and mortality in this older patient population.

Wind disasters: A comprehensive review of current management strategies.

Wind disasters are responsible for tremendous physical destruction, injury, loss of life and economic damage. In this review, we discuss disaster preparedness and effective medical response to wind disasters. The epidemiology of disease and injury patterns observed in the early and late phases of wind disasters are reviewed.

Assessing the academic and professional needs of trauma nurse practitioners and physician assistants.

Because of multiple changes in the health care environment, the use of services of physician assistants (PAs) and nurse practitioners (NPs) in trauma and critical care has expanded. Appropriate training and ongoing professional development for these providers are essential to optimize clinical outcomes. This study offers a baseline assessment of the academic and professional needs of the contemporary trauma PAs/NPs in the United States.

Distracted driving and implications for injury prevention in adults.

Distracted driving, a significant public safety issue, is typically categorized as cell phone use and texting. The increase of distracted driving behavior (DDB) has resulted in an increase in injury and death. The purpose of this study was to identify the frequency and perception of DDB in adults.

Long-term survival after major trauma in geriatric trauma patients: the glass is half full.

Background: The objective is to examine the long-term survival status of geriatric trauma patients (GTPs) after major trauma.

Methods: A 10-year retrospective review at a Level I trauma center was performed. GTP were defined as age ≥ 65 years, with Injury Severity Score ≥ 30.

Dynamic changes in respiratory frequency/tidal volume may predict failures of ventilatory liberation in patients on prolonged mechanical ventilation and normal preliberation respiratory frequency/tidal volume values.

Rapid shallow breathing index (RSBI, respiratory frequency [f] divided by tidal volume [Vt]) has been used to prognosticate liberation from mechanical ventilation (LMV). We hypothesize that dynamic changes in RSBI predict failed LMV better than isolated RSBI measurements. We conducted a retrospective study of patients who were mechanically ventilated (MV) for longer than 72 hours.

Blunt breast trauma: is there a standard of care?

The incidence of female blunt breast trauma (FBBT) is unknown, and there are no established treatment guidelines. The purpose of this study was to establish the incidence of FBBT, define associated injuries, and develop a treatment algorithm. This is a retrospective analysis of FBBT at a Level I trauma center from October 2000 through December 2008.

Utilization of PAs and NPs at a level I trauma center: effects on outcomes.

Objective: This study analyzes the impact of midlevel practitioners (MLPs) on patient care and resource utilization at a level I trauma center.

Methods: A retrospective review of trauma patients admitted during two periods was performed: PRE-MLP, during which limited MLP coverage was available; and POST-MLP, when MLP coverage was expanded. Demographics, injury severity scores (ISS), and preexisting medical conditions (PEC) were recorded.

Emergency traumatologists as partners in trauma care: the future is now.

Background: Decreasing manpower available to care for trauma patients both in and out of the ICU has led to a number of proposed solutions, including increasing involvement of emergency medicine-trained physicians in the care of these patients. We performed a descriptive comparative study in an effort to define the role of fellowship-trained emergency medicine physicians as full-time traumatologists.

Study Design: We performed a retrospective review of concurrent and prospectively collected data comparing process of care and outcomes for the resuscitative phase of trauma patients cared for by full-time fellowship-trained trauma surgeons (TS), a fellowship-trained emergency medicine physician (ET), and a first-year fellowship-trained trauma surgeon (TS1).

Emergency Nurse Documentation Improvement Tool.

Nursing documentation for trauma resuscitation has improved significantly at our level I trauma center because of the introduction of our Emergency Nurse Documentation Improvement Tool (END-IT). The END-IT system was implemented as a performance improvement model and utilizes existing computer software. It provides quick computerized feedback to professional nurses when documentation of trauma cases needs further attention.

Postmortem computed tomography, "CATopsy", predicts cause of death in trauma patients.

Background: The autopsy remains the gold standard for evaluating traumatic deaths. The number of autopsies performed has declined dramatically. This study examines whether postmortem computed tomography ("CATopsy") can be used to determine cause of death in trauma patients.