A multivariate logistic regression analysis of risk factors for blunt cerebrovascular injury.

Introduction: The diagnosis of blunt cerebrovascular injuries (BCVI) has improved with widespread adaptation of screening protocols and more accurate multi-detector computed tomography (MDCT-A) angiography. The population at risk and for whom screening is indicated is still controversial. To help determine which blunt trauma patients would best benefit from screening we performed a comprehensive analysis of risk factors associated with BCVI.

Early venous thromboembolism prophylaxis with enoxaparin in patients with blunt traumatic brain injury.

Objective: To determine the safety of early enoxaparin for venous thromboembolism (VTE) prophylaxis in patients with blunt traumatic brain injury (TBI).

Methods: Prospective observational study of patients with TBI who received enoxaparin within 48 hours after admission. Brain computed tomography (CT) scans were obtained at the time of admission, at 24 hours, and at variable intervals thereafter based on clinical course.

Internal carotid artery stenting for blunt carotid artery injuries with an associated pseudoaneurysm.

Background: Blunt carotid artery injuries (BCI) are being recognized and treated with increasing frequency because of improved screening protocols. Recent advances in endovascular techniques using microcoils, angioplasty, and stenting offer a new treatment strategy for those patients with traumatic pseudoaneurysms (PA) (BCI and PA). Experience with these techniques is limited because of the rarity of these injuries.

Off-pump coronary artery bypass is an alternative to conventional cardiopulmonary bypass when repair of traumatic coronary artery injuries is indicated.

Coronary artery injuries after penetrating cardiac trauma are rare. The standard approach to these injuries has traditionally been coronary artery ligation. When cardiac perfusion is profoundly compromised, cardiopulmonary bypass has been used to facilitate revascularization, although with serious morbidity.

Sixteen-slice multi-detector computed tomographic angiography improves the accuracy of screening for blunt cerebrovascular injury.

Background: Blunt cerebrovascular injuries (BCVI) are rare but potentially devastating injuries, particularly if the diagnosis is delayed. Only four-vessel cerebral angiography (FVCA) has been shown to be adequately sensitive and specific as a screening tool for BCVI but is resource-intensive and invasive. Computed tomography (CT) angiography has emerged as a possible alternative, but its accuracy has been poor, particularly for low-grade injuries.

Extracorporeal support for organ donation after cardiac death effectively expands the donor pool.

Background: We sought to evaluate the effect on short-term outcomes of normothermic, extracorporeal perfusion (ECMO) for donation of abdominal organs for transplantation after cardiac death (DCD). Study parameters included increase in number of donors and organs, types of organs procured, and viability of kidneys transplanted.

Methods: We retrospectively reviewed medical record data for all patients enrolled in our ECMO-supported DCD donor protocol between 10/1/2000 to 2/01/2004.

Bronchoalveolar lavage in diagnosis of ventilator-associated pneumonia in patients with burns.

Ventilator-associated pneumonia (VAP) remains a major cause of morbidity and mortality for patients with burns. In nonburn populations, bronchoalveolar lavage (BAL) excludes other pathology such as systemic inflammatory response syndrome. We hypothesized that BAL would decrease our false-positive VAP rate.

Blunt splenic injury: operation versus angiographic embolization.

Background: Splenic injuries, like other blunt traumatic injuries, are increasingly treated with non-operative management. Angiographic embolization (AE) has emerged as an alternative modality for treatment of splenic injuries. We hypothesized that splenic embolization would lead to equivalent, if not improved, outcomes in terms of mortality, total costs, complications, and duration of stay.

Pelvic ring fractures: implications of vehicle design, crash type, and occupant characteristics.

Background: Pelvic ring fractures (PRFs) are a major cause of morbidity and mortality in motor vehicle collisions (MVCs). Understanding the factors leading to PRFs may help improve vehicle design and safety. This study sought to determine the vehicular, crash, and occupant characteristics that contribute to PRFs.

Extracorporeal life support for severe acute respiratory distress syndrome in adults.

Objective: Severe acute respiratory distress syndrome (ARDS) is associated with a high level of mortality. Extracorporeal life support (ECLS) during severe ARDS maintains oxygen and carbon dioxide gas exchange while providing an optimal environment for recovery of pulmonary function. Since 1989, we have used a protocol-driven algorithm for treatment of severe ARDS, which includes the use of ECLS when standard therapy fails.

Gender differences in hip anatomy: possible implications for injury tolerance in frontal collisions.

Male occupants in frontal motor vehicle collisions have reduced tolerance for hip fractures than females in similar crashes. We studied 92 adult pelvic CT scans and found significant gender differences in bony pelvic geometry, including acetabular socket depth and femoral head width. Significant differences were also noted in the presentation angle of the acetabular socket to frontal loading.

Delayed repair for blunt thoracic aortic injury: is it really equivalent to early repair?

Background: Blunt thoracic aortic injury (BTAI) is a severe injury that traditionally has mandated immediate surgical repair. Delaying operative intervention for BTAI can allow other life-threatening injuries to be managed first, but potentially increases the risk of aortic rupture and death. The objective of this study was to evaluate the outcome of delayed repair (DR) compared with early repair (ER) for BTAI and to assess the effectiveness of a protocol for medical control of systolic blood pressure and heart rate in those patients whose repairs were delayed.