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Trauma Center Quality Improvement Programs in the United States, Canada, and Australasia

This study compared the quality improvement (QI) programs of trauma centers in 4 high-income countries. The authors surveyed medical directors and program managers from 330 trauma centers verified by professional trauma organizations in the United States (n = 263), Canada (n = 46), Australia (n = 18) and New Zealand (n = 3) regarding their QI programs. 76% responded to the survey. Trauma centers in the United States were more likely than those in Canada and Australasia to report measuring quality indicators, using report cards and benchmarking. QI programs were largely local in nature, used different criteria to identify patients under QI purview, and employed diverse quality indicators and improvement strategies. Few centers evaluated the effectiveness of their QI program. This study provides the first international comparison of trauma center QI programs, but significant variation exists in how trauma centers perform QI activities.

Annals of Surgery 2012;256(1):163–169



Placebo-Controlled Trial of Amantadine for Severe Traumatic Brain Injury

This study compared the effect of amantadine hydrochloride in promoting functional recovery following traumatic brain injury. The authors enrolled 184 patients who were in a vegetative or minimally conscious state 4 to 16 weeks after traumatic brain injury and who were receiving inpatient rehabilitation and randomly assigned them to receive amantadine or placebo for 4 weeks and were followed for 2 weeks after the treatment was discontinued. The rate of functional recovery on the Disability Rating Scale (DRS; range, 0 to 29, with higher scores indicating greater disability) was compared over the 4 weeks of treatment (primary outcome) and during the 2-week washout period with the use of mixed-effects regression models. During the 4-week treatment period, recovery was significantly faster in the amantadine group than in the placebo group, as measured by the DRS score, indicating a benefit with respect to the primary outcome measure. In a prespecified subgroup analysis, the treatment effect was similar for patients in a vegetative state and those in a minimally conscious state. The rate of improvement in the amantadine group slowed during the 2 weeks after treatment and was significantly slower than the rate in the placebo group. Amantadine accelerates the pace of functional recovery during active treatment in patients with post-traumatic disorders of consciousness.

N Engl J Med 2012; 366:819-826





Outcome of selective nonoperative management of penetrating abdominal injuries from the North American National Trauma Database

This study published in the British Journal of Surgery attempted to investigate the trends and failures in selective non-operative management (SNOM) for penetrating abdominal injury (PAI) using the National Trauma Data Bank between 2002–2008. Multi-regression analysis was performed on a total of 12 707 patients with abdominal gunshot and 13 030 with stab wounds. Rates of SNOM were 22·2% for gunshot and 33·9% for stab wounds. SNOM failed in 20·8% and 15·2% with gunshot and stab wounds respectively. Factors predicting failure included the need for blood transfusion and a higher injury score. Failed SNOM was independently associated with mortality in both groups.

British Journal of Surgery 2011; 99(Suppl 1): 155–165



Non-operative management and immune function after splenic injury

This review published in the British Journal of Surgery examines the changing treatment of splenic injury over the last century. Non-operative management continues to be reported as a successful approach inhaemodynamically stable patients without other indications for laparotomy and achieves high success rates in both children and adults. Angiographic embolization is generally reported to increase success rates of non-operative management, currently approaching 95 per cent. However, the optimal use of angioembolization is still not clear. Splenic immunocompetence after angioembolization remains questionable, although existing studies seem to indicate preserved splenic function.

British Journal of Surgery 2012; 99(Suppl 1): 59–65


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