This population-based study uses data from a large health claims database to evaluate the incidence of bone fracture and characteristics that may be associated with nonunion of the fractures.
This prospective analysis showed that time to irrigation and debridement did not affect the development of local infectious complications, provided it was performed within 24 hours of arrival.
This cohort study examines whether a blunt or penetrating mechanism of injury alters the risk of venous thromboembolism.
This population-based survey assesses the performance of bellwether procedures as a proxy for performing essential surgery, maps population-level spatial access to essential surgery, and identifies first-level referral hospitals that would most improve access to essential surgery if strengthened in Ghana.
This case series discusses the inpatient resources, including imaging, nursing overtime, and blood bank needs, that were used to treat 63 individuals injured in the Asiana Airlines flight 214 crash.
Stable pelvic fractures (SPFs) that do not need operative fixation are only infrequently associated with significant bleeding (SigBleed). Our hypothesis is that simple indicators, easily detectable at the bedside, can alert the clinician about the likelihood of bleeding and the need for closer monitoring or early intervention in patients with SPFs.
Retrospective review of medical records.
Academic level 1 trauma center.
The medical records of patients with SPFs admitted to our academic level 1 trauma center from January 1, 2002, to June 30, 2007, were reviewed. Stable pelvic fractures were defined as fractures not requiring external or internal fixation. SigBleed was defined as the need for blood transfusion and/or intervention for bleeding control within the first 24 hours after admission. The patients were divided into group A, which included patients without SigBleed; group B, which included patients with SigBleed of a nonpelvic cause; and group C, which included patients with SigBleed caused by the SPF. The 3 groups were compared by univariate and multivariate analysis.
Significant bleeding from SPFs.
Of 391 patients with SPFs, 280 (72%) were in group A, 90 (23%) were in group B, and 21 (5%) were in group C. Compared with group A patients, those in group C were older and had a lower hematocrit and systolic blood pressure on admission. They also had longer hospital stays and a higher mortality. The following independent predictors of SigBleed from SPF were identified: hematocrit of 30% or lower (odds ratio [OR], 43.93; 95% confidence interval [CI], 9.78-197.32; P < .001); presence of pelvic hematoma on computed tomographic scan (OR, 39.37; 95% CI, 4.58-338.41; P < .001); and systolic blood pressure of 90 mm Hg or lower (OR, 18.352; 95% CI, 1.98-169.87; P = .01). When all independent predictors were present, 100% of the patients had SigBleed; when all were absent, no one had SigBleed.
The incidence of SigBleed due to SPFs is low (5% in this study) and independently predicted by an admission hematocrit of 30% or lower, the presence of a pelvic hematoma on computed tomographic scan, and systolic blood pressure of 90 mm Hg or lower.
This review of 536 423 pediatric patients 0 to 17 years old using the National Trauma Data Bank from 2007 to 2012 develops a risk prediction calculator for venous thromboembolism in children admitted to the hospital after traumatic injury.
This analysis assesses the reported prevalence of domestic violence among trauma patients.
This cohort analysis compares the outcomes in patients with traumatic brain injury before and after implementation of the Brain Injury Guidelines protocol.
Rodriguez et al validate the derived decision instrument (NEXUS Chest) for identification of blunt trauma patients with very low risk of thoracic injury seen on chest imaging hypothesizing that NEXUS Chest would have high sensitivity (>98%) for the prediction of and clinical significance for thoracic injury seen on chest imaging.