The Journal of trauma (J Trauma Inj Infect Crit Care )

Publisher: American Association for the Surgery of Trauma; Eastern Association for the Surgery of Trauma; Trauma Association of Canada; Western Trauma Association

Description

The Journal of Trauma® Injury, Infection, and Critical Care provides a specific focus on traumatic injury, as well as a wide range of subjects within this general field. Emphasizing clinical applications, techniques, and new developments in trauma care, each issue presents practical information of immediate use to the physician caring for critically injured patients.

  • Impact factor
    2.35
  • 5-year impact
    2.94
  • Cited half-life
    8.50
  • Immediacy index
    0.37
  • Eigenfactor
    0.04
  • Article influence
    0.88
  • Website
    Journal of Trauma, Injury, Infection, and Critical Care, The website
  • Other titles
    Journal of trauma (Online), The journal of trauma, Journal of trauma: injury infection, and critical care
  • ISSN
    1529-8809
  • OCLC
    44001014
  • Material type
    Document, Periodical, Internet resource
  • Document type
    Internet Resource, Computer File, Journal / Magazine / Newspaper

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Weaning from mechanical ventilation; trauma; pulmonary contusion
    The Journal of trauma 01/2014; 76(1):249.
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    ABSTRACT: BACKGROUND: Crush syndrome (CS) is characterized by ischemia/reperfusion-induced rhabdomyolysis and the subsequent onset of systemic inflammation. CS is associated with a high mortality, even when patients are treated with conventional therapy. We hypothesized that treatment of lethal CS rat model with dexamethasone (DEX) have therapeutic effects on the laboratory findings and clinical course and outcome. METHODS: To create a CS model, anesthetized rats were subjected to bilateral hind limb compression with rubber tourniquets for 5 hours and randomly divided into three groups as follows: saline-treated CS group, CS groups treated with low (0.1 mg/kg) and high doses (5.0 mg/kg) of DEX. Saline for the CS group or DEX for the DEX-treated CS groups was intravenously administered immediately before reperfusion. Under continuous monitoring and recording of arterial blood pressures, blood and tissue samples were collected for histologic and biochemical analysis at designated period before and after reperfusion. RESULTS: Ischemic compression of rat hind limbs reduced the nitrite content in the crushed muscle, and the subsequent reperfusion induced reactive oxygen species-mediated circulatory collapse and systemic inflammation, finally resulting in a mortality rate of 76% by 48 hours after reperfusion. A single injection of high-dose DEX immediately before reperfusion activated endothelial nitric oxide synthase (eNOS) by sequential phosphorylation through the nongenomic phosphoinositide 3-kinase (PI3K)-Akt-eNOS signaling pathway. DEX also exhibited anti-inflammatory effects by modulating proinflammatory and anti-inflammatory mediators, consequently suppressing myeloperoxidase activities and subsequent systemic inflammation, showing a complete recovery of the rats from lethal CS. CONCLUSION: These results indicate that high-dose DEX reduces systemic inflammation and contributes to the improved survival rate in a rat CS model.
    The Journal of trauma 05/2013;
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    ABSTRACT: BACKGROUND: Proximal traumatic lower-extremity amputation has become the signature injury of the war in Afghanistan. Casualties present in extremis and often require immediate operative control of arterial inflow to prevent exsanguination. This study evaluated the use of this strategy and its complications. METHODS: This is a retrospective analysis of case notes of UK service personnel, identified from the UK Joint Theatre Trauma Registry, who sustained traumatic lower-extremity amputation requiring suprainguinal vascular control, following improvised explosive device injury in Afghanistan, between July 2008 and December 2010. RESULTS: Fifty-one casualties were identified with a median Injury Severity Score (ISS) of 30. In 10 casualties, control was obtained via an extraperitoneal approach, and in 41, control was obtained via midline laparotomy and intraperitoneal (IP) approach. The most commonly controlled vessel in extraperitoneal control was the external iliac artery, and in IP control, the common iliac artery. Within the 41 patients who had IP control, 13 also required a therapeutic laparotomy, and 9 patients had bilateral injuries at the level of the proximal femur or higher. One patient, who had undergone IP control, experienced an injury to the common iliac vein, which was repaired. There were no other immediate complications recorded, and 39 casualties survived to discharge. CONCLUSION: This is the first study to characterize the methods of proximal control in high wartime lower-extremity amputees. Although some casualties will have abdominal injuries that necessitate laparotomy, the majority in our study did not; however, in the critically ill casualty, rapid proximal control is required. Novel methods of temporary hemorrhage control may reduce the need for, and burden of, cavity surgery.
    The Journal of trauma 01/2013; 75((2 Suppl 2)):S233-7.
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    ABSTRACT: BACKGROUND: Hemorrhage following traumatic injury is a leading cause of military and civilian mortality. Noncompressible torso hemorrhage (NCTH) has been identified as particularly lethal, especially in the prehospital setting. METHODS: All patients sustaining NCTH between August 2002 and July 2012 were identified from the UK Joint Theatre Trauma Registry. NCTH was defined as injury to a named torso axial vessel, pulmonary injury, solid-organ injury (Grade 4 or greater injury to the liver, kidney, or spleen) or pelvic fracture with ring disruption. Patients with ongoing hemorrhage were identified using either a systolic blood pressure of less than 90 mm Hg or the need for immediate surgical hemorrhage control. Data on injury pattern and location as well as cause of death were analyzed using univariate and multivariate analyses. RESULTS: During 10 years, 296 patients were identified with NCTH, with a mortality of 85.5%. The majority of deaths occurred before hospital admission (n = 222, 75.0%). Of patients admitted to hospital, survivors (n = 43, 14.5%) had a higher median systolic blood pressure (108 [43] vs. 89 [46], p = 0.123) and Glasgow Coma Scale (GCS) (14 [12] vs. 3 [0], p < 0.001) compared with in-hospital deaths (n = 31, 10.5%). Hemorrhage was the more common cause of death (60.1%), followed by central nervous system disruption (30.8%), total body disruption (5.1%), and multiple-organ failure (4.0%). On multivariate analysis, major arterial and pulmonary hilar injury are most lethal with odds ratio (95% confidence interval) of 16.44 (5.50-49.11) and 9.61 (1.06-87.00), respectively. CONCLUSION: This study demonstrates that the majority of patients sustaining NCTH die before hospital admission, with exsanguination and central nervous system disruption contributing to the bulk cause of death. Major arterial and pulmonary hilar injuries are independent predictors of mortality.
    The Journal of trauma 01/2013; 75((2 Suppl 2)):S263-8.
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    ABSTRACT: Unintentional injuries are one of the leading causes of death in the United States. Many of these injuries are preventable, and unintentional firearm injuries, in particular, may be responsive to prevention efforts. We investigated the relationship between unintentional firearm death and urbanicity among adults. This study was a retrospective analysis of national death certificate data. Unintentional adult firearm deaths in the United States from 1999 to 2006 were identified using the Multiple Cause of Death Data files from the National Center for Health Statistics. Decedents were assigned to a county of death and classified along an urban-rural continuum defined by population density and proximity to metropolitan areas. Total unintentional firearm death rates by county were analyzed in adjusted analyses using negative binomial regression. A total of 4,595 unintentional firearm injury deaths of adults occurred in the United States during the study period (a mean of 574.4 per year). Adjusted rates of unintentional firearm death showed increases from urban to rural counties. Americans in the most rural counties were significantly more likely to die of unintentional firearm deaths than those in the most urban counties (relative rate, 2.16; 95% confidence interval, 1.44-3.21, p = 0.002). Rates of unintentional firearm death are significantly higher in rural counties than in urban counties. Prevention strategies should be tailored to account for both geographic location and manner of firearm injury. Epidemiologic study, level III.
    The Journal of trauma 09/2012; 73(4):1006-10.
  • The Journal of trauma 01/2012; 72(1):316-317.
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    ABSTRACT: In trauma patients, open reduction and internal fixation of rib fractures remain controversial. We hypothesized that patients who have open reduction and internal fixation of rib fractures would experience less pain compared with controls and thus require fewer opiates. Further, we hypothesized that improved pain control would result in fewer pulmonary complications and decreased length of stay. This is a retrospective bi-institutional matched case-control study. Cases were matched 1:2 by age, injury severity Score, chest abbreviated injury severity score, head abbreviated injury severity score, pulmonary contusion score, and number of fractured ribs. The daily total doses of analgesic drugs were converted to equianalgesic intravenous morphine doses, and the primary outcome was inpatient narcotic administration. Sixteen patients between July 2005 and June 2009 underwent rib fixation in 5 ± 3 days after injury using an average of 3 (1-5) metallic plates. Morphine requirements decreased from 110 mg ± 98 mg preoperatively to 63 ± 57 mg postoperatively (p = 0.01). There were no significant differences between cases and controls in the mean morphine dose (79 ± 63 vs. 76 ± 55 mg, p = 0.65), hospital stay (18 ± 12 vs. 16 ± 11 days, p = 0.67), intensive care unit stay (9 ± 8 vs. 7 ± 10 days, p = 0.75), ventilation days (7 ± 8 vs. 6 ± 10, p = 0.44), and pneumonia rates (31% vs. 38%, p = 0.76). The need for analgesia was significantly reduced after rib fixation in patients with multiple rib fractures. However, no difference in outcomes was observed when these patients were compared with matched controls in this pilot study. Further study is required to investigate these preliminary findings.
    The Journal of trauma 12/2011; 71(6):1750-4.
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    ABSTRACT: Recent studies have demonstrated that black patients receive substandard care compared with white patients across healthcare settings. The purpose of this study was to evaluate the association of race on the management (salvage vs. amputation) of traumatic lower extremity open fractures. Data analysis was conducted using the American College of Surgeon's National Trauma Data Bank. Open tibial and fibular (OTFF) and open femoral (OFF) fractures among adults above the age of 18 were identified by International Classification of Diseases, 9th Revision codes. Injuries were identified as amputated based on the presence of one of three types of knee amputations. Statistical analysis included logistic regression stratified for sex, age, race, mechanism of injury, severity, and insurance type. From the National Trauma Data Bank, 10,082 OFF and 22,479 OTFF were identified. Amputation rates were 3.1% for OFF and 4.2% for OTFF. With age stratification, the ratio of amputation odds for blacks to amputation odds for whites (i.e., the Racial Odds for Amputation Ratio [ROAR]) demonstrated a significant interaction between black and age in both the OFF (p = 0.028) and OTFF (p = 0.008) groups. In younger patients, a lower ROAR (p = 0.016) favored salvage in blacks, while the ROAR in older patients favored amputation in blacks (p = 0.013). The higher prevalence of penetrating injuries in blacks only accounted for 12.7% of the lower ROAR among younger adults. There exists a racial disparity in the management of lower extremity open fractures. Older blacks have greater odds of amputation that is not explained by mechanism. In contrast, younger blacks have lower odds for amputation that is only partially explained by mechanism of injury.
    The Journal of trauma 12/2011; 71(6):1732-6.
  • The Journal of trauma 12/2011; 71(6):1921.
  • The Journal of trauma 12/2011; 71(6):1873-4.
  • The Journal of trauma 12/2011; 71(6):1925.
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    ABSTRACT: Although avoiding hypotension is a primary focus after trauma, elevated systolic blood pressure (SBP) is frequently disregarded. The purpose of this study was to determine the association between elevated admission SBP and delayed outcomes after trauma. The Los Angeles County Trauma System Database was queried for all patients between 2003 and 2008 with blunt injuries who survived for at least 2 days after admission. Demographics and outcomes (pneumonia and mortality) were compared at various admission SBP subgroups (≥160 mm Hg, ≥170 mm Hg, ≥180 mm Hg, ≥190 mm Hg, ≥200 mm Hg, ≥210 mm Hg, and ≥220 mm Hg). Patients with moderate-to-severe traumatic brain injury (TBI), defined as head Abbreviated Injury Score ≥3, were then identified and compared with those without using multivariable logistic regression. Data accessed from 14,382 blunt trauma admissions identified 2,601 patients with moderate-to-severe TBI (TBI group) and 11,781 without moderate-to-severe TBI (non-TBI group) who were hospitalized ≥2 days. Overall mortality was 2.9%, 7.1% for TBI patients, and 1.9% for non-TBI patients. Overall pneumonia was 4.6%, 9.5% for TBI patients, and 3.6% for non-TBI patients. Regression modeling determined SBP ≥160 mm Hg was a significant predictor of mortality in TBI patients (adjusted odds ratio [AOR], 1.59; confidence interval [CI], 1.10-2.29; p = 0.03) and non-TBI patients (AOR, 1.47; CI, 1.14-1.90; p = 0.003). Similarly, SBP ≥160 mm Hg was a significant predictor for increased pneumonia in TBI patients (AOR, 1.79; CI, 1.30-2.46; p = 0.0004), compared with non-TBI patients (AOR, 1.28; CI, 0.97-1.69; p = 0.08). In blunt trauma patients with or without TBI, elevated admission SBP was associated with worse delayed outcomes. Prospective research is necessary to determine whether algorithms that manage elevated blood pressure after trauma, especially after TBI, affect mortality or pneumonia.
    The Journal of trauma 12/2011; 71(6):1689-93.
  • The Journal of trauma 12/2011; 71(6):1923.
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    ABSTRACT: In the treatment of facial nerve paralysis after temporal bone trauma, it is important to appropriately determine whether nerve decompression surgery is indicated. The aim of this study was to examine the efficacy of facial nerve decompression surgery according to fracture location and the ideal time for surgery after trauma by analyzing the therapeutic outcome of traumatic facial nerve paralysis. In total, 66 patients with facial nerve paralysis after temporal bone trauma who were treated at our institution between 1979 and 2009 were studied retrospectively. The patients were divided into five subgroups, according to the fracture location and the period of time between trauma and surgery. The number of patients who achieved complete recovery of House-Brackmann (H-B) grade 1 was 31 of 66 (47.0%). There was no difference in therapeutic outcomes among the subgroups classified by fracture location. The rate of good recovery to H-B grade 1 or 2 in patients undergoing decompression surgery within 2 weeks after trauma reached 92.9%, resulting in a significantly better outcome than that of patients undergoing later decompression surgery (p < 0.01). The results of this study demonstrated that the ideal time for decompression surgery for facial nerve paralysis after temporal bone fracture was the first 2 weeks after trauma in patients with severe, immediate-onset paralysis. Our study also showed that surgery should be performed within 2 months at the latest. These findings provide useful information for patients and help to determine the priority of treatment when concomitant disease exists.
    The Journal of trauma 12/2011; 71(6):1789-92; discussion 1792-3.
  • The Journal of trauma 12/2011; 71(6):1869-72.
  • The Journal of trauma 12/2011; 71(6):E136.
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    ABSTRACT: Traumatic sternal fractures occur in approximately 3% to 8% of all blunt trauma patients. Most of these fractures are treated conservatively, but a small number require operative intervention. Only a few studies have reported operative fixation of sternal fractures, and no investigation to our knowledge has systematically reviewed the literature on this intervention. We conducted a systematic review of the literature published from 1990 through September 2010 regarding the treatment of traumatic sternal fractures. We analyzed the available evidence regarding the surgical fixation of these fractures, the type of fixation used, the timing of the surgery, complications, and patient outcomes. Twelve articles with 76 cases of surgically repaired sternal fractures met our study criteria. The indications for surgery, timing, and methods used for fixation were diverse. For instance, plates were used in 52 patients and wiring was selected in 24 patients for fixation. General and cardiothoracic surgeons treated the majority of sternal fractures requiring operative fixation. No serious postoperative complications were found in our review. Although the outcomes were generally positive, only one-half of the articles documented patient follow-up. In future studies, focus needs to be placed on long-term results and specific indications for surgery. The first step toward a standardized sternal fracture operative trial must be a prospective study of incidence and nonoperative long-term outcomes. It is likely that as the interest and demand for plate fixation increases, the demand for orthopedic involvement with sternal fractures will also increase.
    The Journal of trauma 12/2011; 71(6):1875-9.
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    ABSTRACT: The aim of this study was to evaluate the role of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and its quantitative coefficient (K(trans)) in the assessment of the extent of traumatic brain injury (TBI) in a rabbit model. A weight-drop device (height, 20 cm) was used with varying impact force, 30-, 60-, or 90-g weight, to induce mild, moderate, or severe TBI, respectively. DCE-MRI and T2-weighted MRI was used to examine the injured groups and a sham group 1 day after TBI. We analyzed the relationship between K(trans) and the lesion volume on the basis of T2-weighted images in each group. The lesion volumes in both the severe and the moderate injury groups were greater than those observed in the mild injury group (p < 0.01). Furthermore, the lesion volumes in the severe injury group tended to be greater than those seen in the moderate injury group (p = 0.053). The K(trans) values in all injury groups were greater than those observed in the sham group (p < 0.01). In addition, the K(trans) values in the severe and moderate injury groups were greater than those of the mild injury group (p < 0.01), and the values seen in the severe injury group tended to be greater than those of the moderate injury group (p = 0.08). Moreover, we observed a correlation between the K(trans) value and lesion volume in all injury groups (mild injury group: r = 0.766, p = 0.01; moderate injury group: r = 0.731, p = 0.04; and severe injury group: r = 0.886, p = 0.019). DCE-MRI and its quantitative coefficient, K(trans), have the potential to accurately assess the blood-brain barrier and the extent of injury in an in vivo model of TBI.
    The Journal of trauma 12/2011; 71(6):1645-50; discussion 1650-1.