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OBJECTIVE To understand the influence of obesity on the morbidity and mortality outcomes of patients who have sustained fractures of the femur and tibia. DESIGN Retrospective review. SETTING Multicenter level I trauma facilities. PATIENTS/PARTICIPANTS Motor vehicle crash victims enrolled in multicenter databases were reviewed. MAIN OUTCOME(More)
PURPOSE To evaluate the 15-year trend in the use of computed tomography (CT) in hospitalized pediatric trauma patients admitted to Harborview Medical Center (HMC) from 1996 to 2010. MATERIALS AND METHODS This Health Insurance Portability and Accountability Act-compliant retrospective study was approved by the institutional review board. The requirement(More)
PURPOSE Case series have shown a Fournier's gangrene mortality rate of 20% to 40% with an incidence of as high as 88% in some studies. Because to our knowledge there are no population based data, we used a national database to investigate the epidemiology of Fournier's gangrene. MATERIALS AND METHODS We used the State Inpatient Databases, the largest(More)
PURPOSE Replantation remains an important technique in the management of hand trauma. Given the resources necessary for a successful replantation program, regionalization of replantation care may ultimately be required. The purposes of this study were to analyze the geographic distribution of upper extremity replant procedures, analyze factors of patients(More)
We conducted a retrospective cohort study in children <13 yr with traumatic brain injury (TBI) at a Level 1 pediatric trauma center to describe risk factors for intraoperative hypotension (IH) during emergent decompressive craniotomy. Between 1994 and 2004, 108 children underwent emergent decompressive craniotomy for TBI. Overall, 56 (52%) patients had IH.(More)
BACKGROUND Construction of gastrointestinal anastomoses by using stapling devices has become a familiar procedure. Most studies have shown no significant differences in complication rates between stapled and sutured anastomoses performed during elective surgery. To date, no study has evaluated the incidence of complications of stapled anastomoses in the(More)
OBJECTIVE The utility of tracheostomy to expedite weaning and prevent complications in patients with acute respiratory failure is actively debated, with many physicians holding strong opinions regarding the value and timing of this intervention. We postulated that these opinions would be reflected in significant variation in tracheostomy rates across(More)
OBJECTIVE To examine the influence of definition and location (field, emergency department, or pediatric intensive care unit) of hypotension on outcome following severe pediatric traumatic brain injury. DESIGN Retrospective cohort study. SETTING Harborview Medical Center (level I pediatric trauma center), Seattle, WA, over a 5-yr period between 1998 and(More)
Necrotizing soft-tissue infections (NSTI) are often life-threatening illnesses that may be best treated at specialty care facilities such as burn centers. However, little is known about current treatment patterns nationwide. The purpose of this study was to describe the referral patterns for treatment of NSTI using a multistate discharge database and to(More)
CONTEXT Physicians have been encouraged to counsel families about risks associated with gun ownership, but the effectiveness of physician counseling regarding gun safety is unknown. OBJECTIVE To determine the effectiveness of gun safety counseling during well-child care visits. DESIGN Group randomized, controlled trial. Physicians, nurse practitioners,(More)