Creating a nationally representative sample of patients from trauma centers.

Background: The National Trauma Data Bank (NTDB) was developed as a convenience sample of registry data from contributing trauma centers (TCs), thus, inferences about trauma patients may not be valid at the national level. The NTDB National Sample was created to obtain nationally representative estimates of trauma patients treated in the US level I and II TCs.

Methods: Level I and II TCs in the Trauma Information Exchange Program were identified and a random stratified sample of 100 TCs was selected.

Traumatic injury and children: a national assessment.

Before beginning a study of trauma care for children, it is necessary to understand contemporary injury patterns of children, specifically the volume and types of injury, injury severity, and institutions where children are hospitalized for trauma. This article was designed to address these issues using the Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID) 2003 that contains over 7 million discharge records from hospitalized children in the United States. Our classification of hospitals into pediatric experience and trauma experience are a first step in better defining what hospital characteristics are important to the optimal care of an injured child.

State trauma registries: survey and update-2004.

Background: This study was undertaken to assess the current status of statewide trauma registries to facilitate a design and plans for a National Trauma Registry for Children.

Methods: A telephone survey was administered to state EMS or state trauma registry managers. Summary data for each state was compiled and state EMS or trauma registry managers reviewed the information for accuracy.

Endothelium-derived microparticles induce endothelial dysfunction and acute lung injury.

Acute lung injury (ALI) carries a high mortality in critically ill patients. Recent reports correlate elevated concentrations of endothelium-derived microparticles (EMPs) with diseases of endothelial dysfunction. Many of these diseases have ALI sequelae.

Are statewide trauma registries comparable? Reaching for a national trauma dataset.

Background: Statewide trauma registries have proliferated in the last decade, suggesting that information could be aggregated to provide an accurate depiction of serious injury in the United States.

Objectives: To determine whether variability exists in the composition and content of statewide trauma registries, specifically addressing case-acquisition, case-definition (inclusion criteria), and registry-coding conventions.

Methods: A cross-sectional, two-part survey was administered to managers of all statewide trauma registries.

Variation in treatment of pediatric spleen injury at trauma centers versus nontrauma centers: a call for dissemination of American Pediatric Surgical Association benchmarks and guidelines.

Background: American Pediatric Surgical Association consensus guidelines for children with blunt spleen injuries have been defined and validated in children's hospitals, but large administrative data sets indicate that only 10% to 15% of children with blunt spleen injuries are treated at children's hospitals. We sought to identify the frequency and compare the treatment of children with spleen injury in hospitals with and without recognized trauma expertise, with the aim of identifying a meaningful target for dissemination of benchmarks and consensus guidelines.

Study Design: State health departments' administrative data sets from California, Florida, New Jersey, and New York were analyzed for 2000, 2001, and 2002.

Outcomes and delivery of care in pediatric injury.

Purpose: To design effective pediatric trauma care delivery systems, it is important to correlate site of care with corresponding outcomes. Using a multistate administrative database, we describe recent patient allocation and outcomes in pediatric injury.

Methods: The 2000 Kids' Inpatient Database, containing 2,516,833 inpatient discharge records from 27 states, was filtered by E-code to yield pediatric injury cases.

Pediatric pelvic injury: functional outcome at 6-month follow-up.

Background/purpose: Data on functional outcomes after pediatric pelvic fractures are limited to those obtained at hospital discharge. This study assesses functional status at both hospital discharge and at 6 months after injury.

Methods: A national multicenter prospective study began in February 2002 and is ongoing.

Bariatric surgery for severely overweight adolescents: concerns and recommendations.

As the prevalence of obesity and obesity-related disease among adolescents in the United States continues to increase, physicians are increasingly faced with the dilemma of determining the best treatment strategies for affected patients. This report offers an approach for the evaluation of adolescent patients' candidacy for bariatric surgery. In addition to anthropometric measurements and comorbidity assessments, a number of unique factors must be critically assessed among overweight youths.

Hypoxia-induced acute lung injury in murine models of sickle cell disease.

Vaso-occlusive events are the major source of morbidity and mortality in sickle cell disease (SCD); however, the pathogenic mechanisms driving these events remain unclear. Using hypoxia to induce pulmonary injury, we investigated mechanisms by which sickle hemoglobin increases susceptibility to lung injury in a murine model of SCD, where mice either exclusively express the human alpha/sickle beta-globin (halphabetaS) transgene (SCD mice) or are heterozygous for the normal murine beta-globin gene and express the halphabetaS transgene (mbeta+/-, halphabetaS+/-; heterozygote SCD mice). Under normoxia, lungs from the SCD mice contained higher levels of xanthine oxidase (XO), nitrotyrosine, and cGMP than controls (C57BL/6 mice).

L-4F, an apolipoprotein A-1 mimetic, dramatically improves vasodilation in hypercholesterolemia and sickle cell disease.

Background: Hypercholesterolemia and sickle cell disease (SCD) impair endothelium-dependent vasodilation by dissimilar mechanisms. Hypercholesterolemia impairs vasodilation by a low-density lipoprotein (LDL)-dependent mechanism. SCD has been characterized as a chronic state of inflammation in which xanthine oxidase (XO) from ischemic tissues increases vascular superoxide anion (O2*-) generation.