The impact of select chronic diseases on outcomes after trauma: a study from the National Trauma Data Bank.

Background: Data regarding pre-existing comorbidities is often poorly recorded in trauma registries, and reports of their impact on outcomes are conflicting. Additionally, many previous reports, when conducting data analysis, do not reliably account for differences in case and control cohorts. Our objective was to identify a subset of patients with reliable comorbidity and complication data in the National Trauma Data Bank (NTDB) in order to determine the impact of select chronic organ system dysfunction on morbidity and mortality using case-control methodology.

Out-of-hospital hypertonic resuscitation after traumatic hypovolemic shock: a randomized, placebo controlled trial.

Objective: To determine whether out-of-hospital administration of hypertonic fluids would improve survival after severe injury with hemorrhagic shock.

Background: Hypertonic fluids have potential benefit in the resuscitation of severely injured patients because of rapid restoration of tissue perfusion, with a smaller volume, and modulation of the inflammatory response, to reduce subsequent organ injury.

Methods: Multicenter, randomized, blinded clinical trial, May 2006 to August 2008, 114 emergency medical services agencies in North America within the Resuscitation Outcomes Consortium.

Early detection of complete vascular occlusion in a pedicle flap model using quantitative [corrected] spectral imaging.

Background: Vascular occlusion after tissue transfer is a devastating complication that can lead to complete flap loss. Spatial frequency domain imaging is a new, noncontact, noninvasive, wide-field imaging technology capable of quantifying oxygenated and deoxygenated hemoglobin levels, total hemoglobin, and tissue saturation.

Methods: Pedicled fasciocutaneous flaps on Wistar rats (400 to 500 g) were created and underwent continuous imaging using spatial frequency domain imaging before and after selective vascular occlusion.

The clinical significance of occult thoracic injury in blunt trauma patients.

Increased use of thoracic CT (TCT) in diagnosis of blunt traumatic injury has identified many injuries previously undetected on screening chest x-ray (CXR), termed "occult injury". The optimal management of occult rib fractures, pneumothoraces (PTX), hemothoraces (HTX), and pulmonary contusions is uncertain. Our objective was to determine the current management and clinical outcome of these occult blunt thoracic injuries.

Out-of-hospital hypertonic resuscitation following severe traumatic brain injury: a randomized controlled trial.

Context: Hypertonic fluids restore cerebral perfusion with reduced cerebral edema and modulate inflammatory response to reduce subsequent neuronal injury and thus have potential benefit in resuscitation of patients with traumatic brain injury (TBI).

Objective: To determine whether out-of-hospital administration of hypertonic fluids improves neurologic outcome following severe TBI.

Design, Setting, And Participants: Multicenter, double-blind, randomized, placebo-controlled clinical trial involving 114 North American emergency medical services agencies within the Resuscitation Outcomes Consortium, conducted between May 2006 and May 2009 among patients 15 years or older with blunt trauma and a prehospital Glasgow Coma Scale score of 8 or less who did not meet criteria for hypovolemic shock.

Severe traumatic injury: regional variation in incidence and outcome.

Objectives: The public health implications of regional variation in incidence and outcome of severe traumatic injury remain to be analyzed. The objective of this study was to determine whether the incidence and outcome associated with severe traumatic injury differs across geographic regions of North America.

Methods: A prospective, observational study was conducted of the Resuscitation Outcomes Consortium of all patients in 9 North American sites (6 US and 3 Canadian) sustaining severe traumatic injury from April 1, 2006 to March 31, 2007 followed to hospital discharge.

Inhibition of intraluminal pancreatic enzymes with nafamostat mesilate improves clinical outcomes after hemorrhagic shock in swine.

Background: Recent studies suggest that intraluminal pancreatic enzymes play a major role in the initiation of the inflammatory cascade by the gut after hemorrhagic shock. Previous animal models have shown that the inhibition of enteral pancreatic enzymes with a serine protease inhibitor, nafamostat mesilate (NM), decreases leukocyte activation and transfusion requirements after hemorrhagic shock. The objective of this study was to determine whether enteroclysis with NM would improve the clinical outcomes in swine after hemorrhagic shock and intestinal hypoperfusion.

Standard prophylactic enoxaparin dosing leads to inadequate anti-Xa levels and increased deep venous thrombosis rates in critically ill trauma and surgical patients.

Background: Deep venous thromboses (DVT) continue to cause significant morbidity in critically ill patients. Standard prophylaxis for high risk patients includes twice-daily dosing with 30 mg enoxaparin. Despite prophylaxis, DVT rates still exceed 10% to 15%.

Improved bariatric surgery outcomes for Medicare beneficiaries after implementation of the medicare national coverage determination.

Objective: To compare the outcomes of Medicare beneficiaries who underwent bariatric surgery within 18 months before and after implementation of the national coverage determination (NCD) for bariatric surgery.

Design: Analysis of the University HealthSystem Consortium database from October 1, 2004, through September 31, 2007.

Setting: A total of 102 academic medical centers and approximately 150 of their affiliated hospitals, representing more than 90% of the nation's nonprofit academic medical centers.

Educational initiative on critical bleeding in trauma: Chicago, July 11-13, 2008.

The Educational Initiative on Critical Bleeding in Trauma was formed to assess current data and to guide future research and practice in the management of coagulopathy after severe trauma. The Educational Initiative on Critical Bleeding in Trauma recently published structured literature reviews on animal models and mechanisms of trauma-associated coagulopathy and the results of a survey of international clinical practice. The authors convened a symposium in July 2008 and invited researchers and opinion leaders in trauma care, transfusion medicine, and coagulation research to discuss current understanding and management and to identify future areas of exploration.

Pancreatic duct: A suitable route to oxygenate tissue during pancreas hypothermic preservation?

The effectiveness of Two-Layer Method has been questioned recently. In this study we hypothesized that pancreatic duct might be an appropriate route to oxygenate the organ and prevent cold ischemic injury. Male Sprague-Dawley rats were employed for the pancreas procurement.

Injury patterns in frontal crashes: the association between knee-thigh-hip (KTH) and serious intra-abdominal injury.

Safety belts protect occupants in frontal impacts by reducing occupant deceleration and preventing the occupant from hitting interior vehicle components likely to cause injury. However, occupants moving forward during the impact may contact the safety belt webbing across their chest and abdomen. We hypothesized that if the occupant loaded their knee-thigh-hip (KTH) region with enough force to result in injury to this region-it might prevent compression (and injury) of their abdomen by the safety belt.

Early predictors of the need for emergent surgery to control hemorrhage in hypotensive trauma patients.

Twenty-five to 30 per cent of hypotensive trauma patients require an emergent surgery, however, we have no reliable means to quickly determine that need. Our goal was to determine, via retrospective review, parameters available within minutes of arrival that predict the need for emergent surgery to control hemorrhage in hypotensive trauma patients. Inclusion criterion was initial systolic blood pressure (SBP) < 90 mm Hg in the emergency department (ED).