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BACKGROUND Bleeding pelvic fractures (BPF) carry mortality as high as 60%, yet controversy remains over optimal initial management. Some base initial intervention on fracture pattern, with immediate external fixation (EX FIX) in amenable fractures aimed at controlling venous bleeding. Others feel ongoing hemodynamic instability indicates arterial bleeding,(More)
BACKGROUND Nonoperative management of blunt injury to the spleen in adults has been applied with increasing frequency. However, the criteria for nonoperative management are controversial. The purpose of this multi-institutional study was to determine which factors predict successful observation of blunt splenic injury in adults. METHODS A total of 1,488(More)
BACKGROUND This study attempts to validate the American Association for the Surgery of Trauma (AAST) Organ Injury Scale (OIS) for spleen, liver, and kidney injuries using the National Trauma Data Bank (NTDB). STUDY DESIGN All NTDB entries with Abbreviated Injury Scale codes for spleen, liver, and kidney were classified by OIS grade. Injuries were(More)
INTRODUCTION Recent randomized prospective data suggest that early hyperglycemia is associated with excess mortality in critically ill patients, and tight glucose control leads to improved outcome. This concept has not been carefully examined in trauma patients, and the relationship of early hyperglycemia to mortality from sepsis in this population is(More)
BACKGROUND The use of open abdomen techniques in damage control laparotomy and abdominal compartment syndrome has led to development of several methods of temporary abdominal closure. All of these methods require creation of a planned hernia with later reconstruction in patients unable to undergo fascial closure in the early postoperative period. We review(More)
HYPOTHESIS Use of the vacuum assisted closure device (VAC) for securing split-thickness skin grafts (STSGs) is associated with improved wound outcomes compared with bolster dressings. DESIGN Consecutive case series. PATIENTS AND SETTING Consecutive patients at a level I trauma center requiring STSG due to traumatic or thermal tissue loss during an(More)
The American College of Surgeons Committee on Trauma's Advanced Trauma Life Support Course is currently taught in 50 countries. The 8th edition has been revised following broad input by the International ATLS subcommittee. Graded levels of evidence were used to evaluate and approve changes to the course content. New materials related to principles of(More)
CT is the technique of choice for initial examination of hemodynamically stable patients after blunt abdominal trauma. It is highly sensitive, specific, and accurate for use in detecting the presence or absence of injury and defining its extent. Nonoperative management of many posttraumatic injuries, particularly in the liver, spleen, and kidney, is(More)
Viewpoints regarding the use of computed tomography (CT) and diagnostic peritoneal lavage (DPL) in the evaluation of stable blunt abdominal trauma patients remain polarized and their respective roles are ill-defined. To further clarify their independent and combined value, the authors report the results of a prospective study of their use in adult patients(More)
To evaluate the role of nonoperative management in the treatment of blunt liver trauma we examined all victims of blunt hepatic trauma admitted to our institution during a 36-month period under a protocol of nonoperative management. One hundred twenty-six patients had the diagnosis of blunt hepatic injury confirmed by abdominal computed tomographic (CT)(More)