Natural history and clinical implications of nondepressed skull fracture in young children.

Background: Head injury is the most common cause of neurologic disability and mortality in children. Previous studies have demonstrated that depressed skull fractures (SFs) represent approximately one quarter of all SFs in children and approximately 10% percent of hospital admissions after head injury. We hypothesized that nondepressed SFs (NDSFs) in children are not associated with adverse neurologic outcomes.

Spatial analysis of injury-related deaths in Dallas County using a geographic information system.

This study applied a geographic information system (GIS) to identify clusters of injury-related deaths (IRDs) within a large urban county (26 cities; population, 2.4 million). All deaths due to injuries in Dallas County (Texas) in 2005 (N = 670) were studied, including the geographic location of the injury event.

Focused bedside echocardiography in the surgical intensive care unit: comparison of 3 methods to estimate cardiac index.

We sought to determine which of 3 methods used to evaluate cardiac index (CI) is the most accurate using focused bedside echocardiography (ECHO). We hypothesized that the fractional shortening (FS) method would provide a more accurate estimate of CI than the left ventricular outflow tract/velocity-time integral (LVOT/VTI) or Simpson's methods. This was a prospective observational cohort study conducted in the surgical ICU of an urban level 1 trauma center utilizing all patients with a pulmonary artery catheter (PAC) in place.

Changing epidemiology of trauma deaths leads to a bimodal distribution.

Injury mortality was classically described with a trimodal distribution, with immediate deaths at the scene, early deaths due to hemorrhage, and late deaths from organ failure. We hypothesized that the development of trauma systems has improved prehospital care, early resuscitation, and critical care and altered this pattern. This population-based study of all trauma deaths in an urban county with a mature trauma system reviewed data for 678 patients (median age, 33 years; 81% male; 43% gunshot, 20% motor vehicle crashes).

Peripherally inserted central catheters may lower the incidence of catheter-related blood stream infections in patients in surgical intensive care units.

Background: Long-term central venous catheterization is associated with a higher rate of catheter-related blood stream infections (CR-BSI). It is unclear whether there is a difference in the CR-BSI rate associated with central venous catheters (CVCs) and peripherally inserted central catheters (PICCs) in long-stay patients in surgical intensive care units (SICUs). We hypothesized that PICC use reduces the rate of CR-BSI compared with use of antiseptic CVCs in these patients.

Universal consent practice in academic intensive care units (ICUs).

Unlabelled: The purpose of this study was to determine national practice for obtaining consent in academic adult intensive care units (ICUs) for routine bedside procedures and to define universal consent rates by patient demographics within our own institution's ICUs.

Methods: A 10-question survey was sent to the program directors for all U.S.

Trauma operative skills in the era of nonoperative management: the trauma exposure course (TEC).

Background: Declining trauma operative experience adversely impacts learning and retention of operative skills. Current solutions, such as acute care surgery, may not provide relevant operative experience. We hypothesized that a structured skills curriculum using fresh cadavers would improve participants' self-confidence in surgical exposure of human anatomic structures for trauma.

Accuracy of cardiac function and volume status estimates using the bedside echocardiographic assessment in trauma/critical care.

Background: Critically ill patients often require invasive monitoring to evaluate and optimize cardiac function and preload. With questionable outcomes associated with pulmonary artery catheters (PACs), some have evaluated the role of less invasive monitors. We hypothesized that the Bedside Echocardiographic Assessment in Trauma (BEAT) examination would generate cardiac index (CI) and central venous pressure (CVP) estimates that correlate with that of a PAC.

Increased risk of death associated with hypotension is not altered by the presence of brain injury in pediatric trauma patients.

Background: Hypotension is a well-known predictor of mortality in pediatric trauma patients. However, it is unknown whether the mortality rate is higher in patients with traumatic brain injury (TBI) than in those without TBI. We hypothesized that systemic hypotension increases mortality in pediatric patients with TBI more than it does in pediatric patients with extracranial injuries only.

Effects of early use of external pelvic compression on transfusion requirements and mortality in pelvic fractures.

Background: We hypothesized that early use of external mechanical compression (EMC) reduces hemorrhage and mortality associated with pelvic fractures.

Methods: Patients with pelvic fractures and one of the following risk factors for hemorrhage were studied retrospectively: (1) unstable fracture pattern, or (2) any fracture in patients older than 55 years of age, or (3) fracture with systemic hypotension. Starting in November of 2003, EMC was performed using circumferential pelvic binders on patient arrival and continued for 24 to 72 hours.

Transfusion of blood products and nosocomial infection in surgical patients.

Purpose Of Review: Liberal transfusion of blood products may be associated with a worse clinical outcome, including in-hospital mortality. This review focuses on the mechanisms by which transfusions may result in an increased risk of bacterial infection.

Recent Findings: The association between blood transfusion and worse outcome has been attributed to suppression of the recipient's immune function, the so called transfusion-related immunomodulation effect, as well as changes that may occur as blood ages.