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[PMID]:29428043
[Au] Autor:Golob JF; Como JJ; Claridge JA
[Ti] Título:Trauma Surgeons Save Lives-Scribes Save Trauma Surgeons!
[So] Source:Am Surg;84(1):144-148, 2018 Jan 01.
[Is] ISSN:1555-9823
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:With the advent of the electronic medical record, the documentation burden of the trauma surgeon has become overwhelming. To help, our trauma division added scribes to the rounding team. We hypothesized that scribe utilization would improve our documentation efficiency and offer a financial benefit to the institution. A review of trauma surgeon documentation and billing was performed at a Level I trauma center over two time periods: January to May 2014 (no scribes) and January to May 2015 (scribes). The number of notes written by trauma surgeons was obtained, as were documentation charges. Documentation efficiency was determined by noting both the hour of the day in which inpatient progress notes were written and the number of notes written after patient discharge. In the 2014 period, a total of 9726 notes were written by trauma attendings. In the 2015 period, 10,933 were written. Despite having 407 fewer trauma patient-days in the 2015 period, the group wrote 343 notes/week versus 298 notes/week (P = 0.008). More inpatient progress notes were written earlier in the working day and fewer were written in the evening. Fewer notes were written after patient discharge (12.7 vs 8.4%). A total of 1,664 hours of scribe time were used over the 5-month period, generating an expense of $32,787. The additional notes generated by scribes resulted in $191,394 in charges. Conservatively, assuming a 20 per cent charge reimbursement, the cost of the scribes was covered. The addition of scribes to the daily trauma rounding team improved note efficiency and increased charge capture at our center.
[Mh] Termos MeSH primário: Custos e Análise de Custo/economia
Documentação/economia
Registros Eletrônicos de Saúde
Preços Hospitalares
Administradores de Registros Médicos/economia
Centros de Traumatologia/economia
Centros de Traumatologia/recursos humanos
[Mh] Termos MeSH secundário: Registros Eletrônicos de Saúde/economia
Registros Eletrônicos de Saúde/normas
Seres Humanos
Pacientes Internados
Alta do Paciente
Cirurgiões/economia
Estados Unidos
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180212
[St] Status:MEDLINE


  2 / 8726 MEDLINE  
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[PMID]:29428042
[Au] Autor:Hafiz S; Zubowicz EA; Abouassaly C; Ricotta JJ; Sava JA
[Ti] Título:Extremity Vascular Injury Management: Good Outcomes Using Selective Referral to Vascular Surgeons.
[So] Source:Am Surg;84(1):140-143, 2018 Jan 01.
[Is] ISSN:1555-9823
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Revascularization after extremity vascular injury has long been considered an important skill among trauma surgeons. Increasingly, some trauma surgeons defer vascular repair in response to training or practice patterns. This study was designed to document results of extremity revascularization surgery to evaluate trauma surgeon outcomes and judicious referral of more complex injuries to vascular surgeons (VAS). The trauma registry of an urban level I trauma center was used to identify all patients from 2003 to 2013 who underwent an early (<24 hours) procedure for urgent management of acute injury to extremity vessels. Patients were managed by trauma (TRA) versus VAS based on the practice pattern of the on-call trauma surgeon. Injury and outcome variables were recorded. Of 115 patients, 84 patients were revascularized by trauma and 31 vascular surgeries. There was no difference in complication rates or frequency of any type of complication associated with repairs performed by VAS or TRA. There were similar rates between the two groups for patients with multiple injuries, such as venous, bone or tendon, and nerve injury to the affected extremity. One VAS patient and two TRA patients developed compartment syndrome. In appropriately selected patients, trauma surgeons achieve good outcomes after revascularization of injured extremities.
[Mh] Termos MeSH primário: Extremidade Inferior/irrigação sanguínea
Seleção de Pacientes
Extremidade Superior/irrigação sanguínea
Lesões do Sistema Vascular/diagnóstico
Lesões do Sistema Vascular/cirurgia
Ferimentos Penetrantes/diagnóstico
Ferimentos Penetrantes/cirurgia
[Mh] Termos MeSH secundário: Adulto
Síndromes Compartimentais/prevenção & controle
Feminino
Seres Humanos
Tempo de Internação
Masculino
Meia-Idade
Padrões de Prática Médica
Estudos Retrospectivos
Fatores de Risco
Fatores de Tempo
Centros de Traumatologia
Índices de Gravidade do Trauma
Resultado do Tratamento
Procedimentos Cirúrgicos Vasculares
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180212
[St] Status:MEDLINE


  3 / 8726 MEDLINE  
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[PMID]:29428034
[Au] Autor:Duchesne J; Majoue C; Duke M; Robledo R; Achord C; McHale L; Davis B; Nahapetyan L
[Ti] Título:Impact of Trauma-Certified Registered Nurse Anesthetists Team on Intra-Operative Resuscitation and Postoperative Outcomes of Trauma Patients.
[So] Source:Am Surg;84(1):93-98, 2018 Jan 01.
[Is] ISSN:1555-9823
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:A Trauma Certified Registered Nurse Anesthetists Team (TCT) was created and trained to provide trauma-focused anesthesia and resuscitation. The purpose of this study was to examine patient outcomes after implementation of TCT. We conducted retrospective analyses of trauma patients managed with surgical intervention from March to December 2015. During the first five months, patients managed before the development of TCT were grouped No-TCT, patients managed after were grouped TCT. To assess outcomes, we used hospital and intensive care unit length of stay, ventilator days, and a validated 10-point intraoperative Apgar score (IOAS). IOAS is calculated using the estimated blood loss, lowest heart rate, and lowest mean arterial pressure during surgery. Higher IOAS are associated with significantly decreased complications and mortality after surgery. We used t test and nonparametric tests for analyses. Fifty two patients were included (mean age 39 years, 75% male; 46.2% managed with TCT). Patients in the No-TCT group had significantly lower use of vasopressors (0.019), lower mean IOAS (P = 0.02), and spent more days on ventilator (P = 0.005) than patients in the TCT. These results suggest that trauma centers should take into consideration implementation of TCT to improve intraoperative and overall outcomes.
[Mh] Termos MeSH primário: Cuidados Intraoperatórios/enfermagem
Enfermeiras Anestesistas
Enfermeiras e Enfermeiros
Cuidados Pós-Operatórios/enfermagem
Ressuscitação/enfermagem
Centros de Traumatologia
[Mh] Termos MeSH secundário: Adulto
Idoso
Feminino
Seres Humanos
Unidades de Terapia Intensiva
Cuidados Intraoperatórios/mortalidade
Masculino
Meia-Idade
Cuidados Pós-Operatórios/mortalidade
Reprodutibilidade dos Testes
Ressuscitação/mortalidade
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; VALIDATION STUDIES
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180212
[St] Status:MEDLINE


  4 / 8726 MEDLINE  
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[PMID]:29428017
[Au] Autor:Marek AP; Morancy JD; Chipman JG; Nygaard RM; Roach RM; Loor MM
[Ti] Título:Long-Term Functional Outcomes after Traumatic Thoracic and Lumbar Spine Fractures.
[So] Source:Am Surg;84(1):20-27, 2018 Jan 01.
[Is] ISSN:1555-9823
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The incidence of thoracolumbar spine fractures in blunt trauma is 4 to 5 per cent. These fractures may lead to neurologic injury, chronic back pain, and disability. Most studies from United States trauma centers focus on neurologic sequelae and/or compare treatment modalities. However, most patients with spine fractures do not have a neurologic deficit. Our primary objective was to determine the long-term outcome of traumatic thoracolumbar spine fractures, specifically addressing quality of life, chronic pain, and employment using a validated patient outcome survey. A chart review of 138 adult blunt trauma patients who sustained a thoracolumbar spine fracture and were admitted to our Level I trauma center from 2008 to 2013 was performed. A phone interview based on the Short-Form 12®, a general health survey, was then conducted. Of the 134 patients who met the inclusion criteria, 46 (34%) completed the survey. The average Short-Form 12® scores were 51.0 for the physical health component score and 52.9 for the mental health component score. These did not differ significantly from the national norm. Furthermore, 83 per cent (38) of the survey respondents returned to work full-time at the same level as before their injury. Majority of the patients (76%) said they did not have pain two to seven years after injury. Despite a commonly held belief that back injury leads to chronic pain and disability, after sustaining a thoracic or lumbar fracture, patients are generally able to return to work and have a comparable quality of life to the general population. This knowledge may be useful in counseling patients regarding expectations for recovery from trauma.
[Mh] Termos MeSH primário: Tempo de Internação
Vértebras Lombares/lesões
Qualidade de Vida
Fraturas da Coluna Vertebral/terapia
Traumatismos Torácicos/terapia
Vértebras Torácicas/lesões
Ferimentos não Penetrantes/terapia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Dor Crônica/etiologia
Emprego
Feminino
Seguimentos
Seres Humanos
Masculino
Meia-Idade
Estudos Retrospectivos
Fatores de Risco
Fraturas da Coluna Vertebral/etiologia
Inquéritos e Questionários
Traumatismos Torácicos/complicações
Centros de Traumatologia
Índices de Gravidade do Trauma
Resultado do Tratamento
Ferimentos não Penetrantes/complicações
Ferimentos não Penetrantes/etiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180212
[St] Status:MEDLINE


  5 / 8726 MEDLINE  
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[PMID]:27774614
[Au] Autor:Dunbar NM; Olson NJ; Szczepiorkowski ZM; Martin ED; Tysarcyk RM; Triulzi DJ; Alarcon LH; Yazer MH
[Ad] Endereço:Department of Pathology and Laboratory Medicine, the Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
[Ti] Título:Blood component transfusion and wastage rates in the setting of massive transfusion in three regional trauma centers.
[So] Source:Transfusion;57(1):45-52, 2017 01.
[Is] ISSN:1537-2995
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The purpose of massive transfusion protocols (MTPs) is to provide large quantities of blood products rapidly to exsanguinating patients. The expected rates of blood product transfusion and wastage in this setting have not been defined. This study was undertaken to assess the transfusion and wastage rates for bleeding patients requiring emergency issue of blood components at three American Level I trauma centers. STUDY DESIGN AND METHODS: Three hospitals participated, all of which are Level I trauma centers that have MTPs in place where uncrossmatched red blood cells (RBCs) can be ordered with or without platelets (PLTs), plasma, and cryoprecipitate. Data on the transfusion, return to blood bank, and wastage rates were recorded on all products issued within 3 hours after MTP activation. RESULTS: The majority of products were issued to the emergency department and/or operating room at all three institutions (84%-95%). The percentage of RBCs, plasma, and PLTs transfused during MTPs were 39% to 65%, 43% to 66%, and 75% to 100%, respectively. Wastage rates were comparable for RBCs (0%-9%), plasma (0%-7%), and PLTs (0%-7%). Cryoprecipitate had the highest wastage rates at all three sites (7%-33%). CONCLUSION: A large portion of blood products issued during MTPs are not transfused. Some are wasted due to stringent storage requirements and/or limited shelf lives. The optimum ratio of transfused to returned products in these patients is likely to be determined more by clinical need than by transfusion service policy.
[Mh] Termos MeSH primário: Bancos de Sangue
Transfusão de Componentes Sanguíneos
Centros de Traumatologia
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Masculino
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1706
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE
[do] DOI:10.1111/trf.13880


  6 / 8726 MEDLINE  
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[PMID]:29259005
[Au] Autor:Chen N; Zhang C; Hu S
[Ad] Endereço:Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai,200233, China.
[Ti] Título:Strengthening trauma care in China.
[So] Source:BMJ;359:j5545, 2017 12 19.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Acidentes de Trânsito/mortalidade
Assistência à Saúde/normas
Centros de Traumatologia/estatística & dados numéricos
Ferimentos e Lesões/mortalidade
[Mh] Termos MeSH secundário: Acidentes de Trânsito/prevenção & controle
China/epidemiologia
Assistência à Saúde/organização & administração
Socorristas/educação
Custos de Cuidados de Saúde/estatística & dados numéricos
Necessidades e Demandas de Serviços de Saúde
Seres Humanos
Incidência
Centros de Traumatologia/organização & administração
Centros de Traumatologia/normas
Triagem/normas
Ferimentos e Lesões/economia
Ferimentos e Lesões/epidemiologia
[Pt] Tipo de publicação:EDITORIAL
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180223
[Lr] Data última revisão:
180223
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171221
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.j5545


  7 / 8726 MEDLINE  
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Registro de Ensaios Clínicos
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[PMID]:29233854
[Au] Autor:Mohan D; Farris C; Fischhoff B; Rosengart MR; Angus DC; Yealy DM; Wallace DJ; Barnato AE
[Ad] Endereço:Scaife Hall, 3550 Terrace St, University of Pittsburgh, Pittsburgh, PA 15261, USA.
[Ti] Título:Efficacy of educational video game versus traditional educational apps at improving physician decision making in trauma triage: randomized controlled trial.
[So] Source:BMJ;359:j5416, 2017 12 12.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To determine whether a behavioral intervention delivered through a video game can improve the appropriateness of trauma triage decisions in the emergency department of non-trauma centers. DESIGN: Randomized clinical trial. SETTING: Online intervention in national sample of emergency medicine physicians who make triage decisions at US hospitals. PARTICIPANTS: 368 emergency medicine physicians primarily working at non-trauma centers. A random sample (n=200) of those with primary outcome data was reassessed at six months. INTERVENTIONS: Physicians were randomized in a 1:1 ratio to one hour of exposure to an adventure video game (Night Shift) or apps based on traditional didactic education (myATLS and Trauma Life Support MCQ Review), both on iPads. Night Shift was developed to recalibrate the process of using pattern recognition to recognize moderate-severe injuries (representativeness heuristics) through the use of stories to promote behavior change (narrative engagement). Physicians were randomized with a 2×2 factorial design to intervention (game traditional education apps) and then to the experimental condition under which they completed the outcome assessment tool (low high cognitive load). Blinding could not be maintained after allocation but group assignment was masked during the analysis phase. MAIN OUTCOME MEASURES: Outcomes of a virtual simulation that included 10 cases; in four of these the patients had severe injuries. Participants completed the simulation within four weeks of their intervention. Decisions to admit, discharge, or transfer were measured. The proportion of patients under-triaged (patients with severe injuries not transferred to a trauma center) was calculated then (primary outcome) and again six months later, with a different set of cases (primary outcome of follow-up study). The secondary outcome was effect of cognitive load on under-triage. RESULTS: 149 (81%) physicians in the game arm and 148 (80%) in the traditional education arm completed the trial. Of these, 64/100 (64%) and 58/100 (58%), respectively, completed reassessment at six months. The mean age was 40 (SD 8.9), 283 (96%) were trained in emergency medicine, and 207 (70%) were ATLS (advanced trauma life support) certified. Physicians exposed to the game under-triaged fewer severely injured patients than those exposed to didactic education (316/596 (0.53) 377/592 (0.64), estimated difference 0.11, 95% confidence interval 0.05 to 0.16; P<0.001). Cognitive load did not influence under-triage (161/308 (0.53) 155/288 (0.54) in the game arm; 197/300 (0.66) 180/292 (0.62) in the traditional educational apps arm; P=0.66). At six months, physicians exposed to the game remained less likely to under-triage patients (146/256 (0.57) 172/232 (0.74), estimated difference 0.17, 0.09 to 0.25; P<0.001). No physician reported side effects. The sample might not reflect all emergency medicine physicians, and a small set of cases was used to assess performance. CONCLUSIONS: Compared with apps based on traditional didactic education, exposure of physicians to a theoretically grounded video game improved triage decision making in a validated virtual simulation. Though the observed effect was large, the wide confidence intervals include the possibility of a small benefit, and the real world efficacy of this intervention remains uncertain. TRIAL REGISTRATION: clinicaltrials.gov; NCT02857348 (initial study)/NCT03138304 (follow-up).
[Mh] Termos MeSH primário: Aplicativos Móveis/utilização
Médicos/estatística & dados numéricos
Triagem/métodos
Jogos de Vídeo/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adulto
Tomada de Decisões
Tomada de Decisões Assistida por Computador
Medicina de Emergência/normas
Serviço Hospitalar de Emergência/normas
Feminino
Heurística
Seres Humanos
Masculino
Meia-Idade
Aplicativos Móveis/estatística & dados numéricos
Avaliação de Resultados (Cuidados de Saúde)
Centros de Traumatologia/normas
[Pt] Tipo de publicação:CLINICAL TRIAL; COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180223
[Lr] Data última revisão:
180223
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171214
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.j5416


  8 / 8726 MEDLINE  
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[PMID]:29391099
[Au] Autor:Kozyr S; Ponce S; Feramisco H; Pakula A; Skinner R
[Ad] Endereço:Department of Surgery, Trauma Division, Kern Medical, Bakersfield, California, USA.
[Ti] Título:High-Risk Prehospital Mechanisms in Tier II Trauma Codes: An Analysis of Under-Triage at a Level II Trauma Center.
[So] Source:Am Surg;83(10):1080-1084, 2017 Oct 01.
[Is] ISSN:1555-9823
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Under-triage is used as a surrogate for trauma quality. We sought to analyze factors that may impact under-triage at our institution by a detailed analysis of prehospital mechanisms and patient factors that were associated with the need for invasive intervention, intensive care unit monitoring, or death. Patients admitted to our Level II trauma center who met the criteria for under-triage using the Cribari method were studied, n = 160, and prominent mechanisms were motor vehicle collisions (MVCs). Patient demographics, detailed mechanism characteristics, ED vital signs, operative intervention, and outcomes were studied. The age of the study group and injury severity score were 42 ± 20 and 22 ± 6, respectively. Alcohol or drug use was common as were high-speed frontal collisions. Overall, 38 per cent of patients required surgery, and a monitored bed was required in 60 per cent of patients. Logistic regression identified drug use as predictive of mortality and MVC speeds ≥40 mph as predictive of intensive care unit admission. Patients requiring surgery had a high incidence of frontal collisions, 40 per cent. MVCs were predominant in under-triaged trauma patients. Operative intervention, intensive care unit monitoring, and deaths were associated with frontal impacts, high speeds, and drug use. Further study is warranted to assess the incorporation of high-risk injury patterns in triage algorithms aimed at enhancing trauma quality.
[Mh] Termos MeSH primário: Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos
Centros de Traumatologia
Triagem/métodos
Ferimentos e Lesões/diagnóstico
[Mh] Termos MeSH secundário: Adulto
Algoritmos
Serviços Médicos de Emergência/métodos
Serviços Médicos de Emergência/normas
Serviços Médicos de Emergência/estatística & dados numéricos
Feminino
Seres Humanos
Escala de Gravidade do Ferimento
Modelos Logísticos
Masculino
Meia-Idade
Estudos Retrospectivos
Medição de Risco
Fatores de Risco
Triagem/normas
Triagem/estatística & dados numéricos
Ferimentos e Lesões/etiologia
Ferimentos e Lesões/terapia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180214
[Lr] Data última revisão:
180214
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE


  9 / 8726 MEDLINE  
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[PMID]:29391090
[Au] Autor:Barmparas G; Ko A; Dhillon NK; Tatum JM; Choi M; Ley EJ; Margulies DR
[Ad] Endereço:Cedars-Sinai Medical Center, Department of Surgery, Division of Acute Care Surgery and Surgical Critical Care, Los Angeles, California, USA.
[Ti] Título:Extreme Interventions for Trauma Patients in Extremis: Variations among Trauma Centers.
[So] Source:Am Surg;83(10):1033-1039, 2017 Oct 01.
[Is] ISSN:1555-9823
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Although guidelines for the performance of an emergency department thoracotomy (EDT) are available, high level evidence remains scarce potentially leading to variation in decisions and practices among trauma surgeons. The National Trauma Databank was queried for all subjects who died in the emergency department (ED) between 2007 and 2011. Trauma centers were divided into four quartiles based on the rate of EDT among ED deaths. A total of 31,623 subjects admitted to 729 trauma centers met inclusion criteria. Most of of these centers (n = 328, 53%) never performed an EDT during the study period. Very few outlier centers (1.1%) performed this procedure in 50.0 per cent or more of all patients who died in the ED. Trauma centers in the highest quartiles in performing EDT were more likely to intervene with both surgical and nonsurgical procedures in patients who died in the ED, independent of the performance of an EDT. There are significant variations among trauma centers in the management of trauma patients who expire in the ED. Further research at a national level toward standardizing the management of the trauma patient in extremis and the decision to perform an EDT is necessary, given the extremely low survival associated with this procedure.
[Mh] Termos MeSH primário: Serviço Hospitalar de Emergência/estatística & dados numéricos
Fidelidade a Diretrizes/estatística & dados numéricos
Disparidades em Assistência à Saúde/estatística & dados numéricos
Padrões de Prática Médica/estatística & dados numéricos
Toracotomia/utilização
Centros de Traumatologia/estatística & dados numéricos
Ferimentos e Lesões/cirurgia
[Mh] Termos MeSH secundário: Adulto
Estudos de Coortes
Bases de Dados Factuais
Serviço Hospitalar de Emergência/normas
Feminino
Mortalidade Hospitalar
Seres Humanos
Masculino
Guias de Prática Clínica como Assunto
Toracotomia/estatística & dados numéricos
Centros de Traumatologia/normas
Estados Unidos/epidemiologia
Ferimentos e Lesões/mortalidade
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180214
[Lr] Data última revisão:
180214
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE


  10 / 8726 MEDLINE  
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[PMID]:27776795
[Au] Autor:Chang R; Folkerson LE; Sloan D; Tomasek JS; Kitagawa RS; Choi HA; Wade CE; Holcomb JB
[Ad] Endereço:Center for Translational Injury Research, University of Texas Health Science Center, Houston, TX; Department of Surgery, University of Texas Health Science Center, Houston, TX. Electronic address: ronald.chang@uth.tmc.edu.
[Ti] Título:Early plasma transfusion is associated with improved survival after isolated traumatic brain injury in patients with multifocal intracranial hemorrhage.
[So] Source:Surgery;161(2):538-545, 2017 02.
[Is] ISSN:1532-7361
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Plasma-based resuscitation improves outcomes in trauma patients with hemorrhagic shock, while large-animal and limited clinical data suggest that it also improves outcomes and is neuroprotective in the setting of combined hemorrhage and traumatic brain injury. However, the choice of initial resuscitation fluid, including the role of plasma, is unclear for patients after isolated traumatic brain injury. METHODS: We reviewed adult trauma patients admitted from January 2011 to July 2015 with isolated traumatic brain injury. "Early plasma" was defined as transfusion of plasma within 4 hours. Purposeful multiple logistic regression modeling was performed to analyze the relationship of early plasma and inhospital survival. After testing for interaction, subgroup analysis was performed based on the pattern of brain injury on initial head computed tomography: epidural hematoma, intraparenchymal contusion, subarachnoid hemorrhage, subdural hematoma, or multifocal intracranial hemorrhage. RESULTS: Of the 633 isolated traumatic brain injury patients included, 178 (28%) who received early plasma were injured more severely coagulopathic, hypoperfused, and hypotensive on admission. Survival was similar in the early plasma versus no early plasma groups (78% vs 84%, P = .08). After adjustment for covariates, early plasma was not associated with improved survival (odds ratio 1.18, 95% confidence interval 0.71-1.96). On subgroup analysis, multifocal intracranial hemorrhage was the largest subgroup with 242 patients. Of these, 61 (25%) received plasma within 4 hours. Within-group logistic regression analysis with adjustment for covariates found that early plasma was associated with improved survival (odds ratio 3.34, 95% confidence interval 1.20-9.35). CONCLUSION: Although early plasma transfusion was not associated with improved in-hospital survival for all isolated traumatic brain injury patients, early plasma was associated with increased in-hospital survival in those with multifocal intracranial hemorrhage.
[Mh] Termos MeSH primário: Transfusão de Componentes Sanguíneos/métodos
Lesões Encefálicas Traumáticas/terapia
Mortalidade Hospitalar/tendências
Hemorragias Intracranianas/terapia
Sistema de Registros
[Mh] Termos MeSH secundário: Adulto
Anticoagulantes/administração & dosagem
Lesões Encefálicas Traumáticas/complicações
Lesões Encefálicas Traumáticas/diagnóstico
Lesões Encefálicas Traumáticas/mortalidade
Estudos de Coortes
Terapia Combinada
Feminino
Escala de Coma de Glasgow
Seres Humanos
Escala de Gravidade do Ferimento
Hemorragias Intracranianas/complicações
Hemorragias Intracranianas/diagnóstico
Hemorragias Intracranianas/mortalidade
Masculino
Meia-Idade
Plasma
Estudos Retrospectivos
Medição de Risco
Análise de Sobrevida
Centros de Traumatologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL
[Nm] Nome de substância:
0 (Anticoagulants)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:180201
[Lr] Data última revisão:
180201
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE



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