Abstract
International guidelines for trauma care still recommend the traditional advanced trauma life support investigations for the primary survey: plain radiographs of the chest, cervical spine and pelvis with FAST ultrasounds. However, an increasing amount of data suggest that plain X-rays have excessively low sensitivity. Cervical X-ray may miss up to 35% of the spine injuries, chest X-ray may miss as many as many as 50% of traumatic pneumothorax and a significant percentage of pelvic fractures may not be detected on the pelvis X-ray. CT scan and extended emergency ultrasound (EUs) have a much higher sensitivity if compared with plain X-rays. Moreover, EUs is even less time consuming. Therefore since 2004 we have adopted EUs and/or total body CT scan as the first-line diagnostic tools for major trauma (MT) victims. In a benchmarking analysis of Italian trauma centers (TCs), our hospital ranked first for patient mortality and long-term disability [1]. These results were associated with the shortest diagnostic time. The aim of this study is to assess whether these results were associated with a real change in the diagnostic process.
Highlights
We previously showed that erythropoietin (EPO) attenuates the morphological signs of spinal cord ischemia/reperfusion (I/R) injury in swine [1] without, improving neurological function
The clinical use of EPO has been cautioned most recently due to serious safety concerns arising from an increased mortality in acute stroke patients treated with EPO and simultaneously receiving systemic thrombolysis [2]
Sodium 4-phenylbutyrate (PBA) has been reported to act as a chemical chaperone inhibiting Unfolded protein response (UPR)-mediated apoptosis triggered by ischemia in various organs other than the heart
Summary
We previously showed that erythropoietin (EPO) attenuates the morphological signs of spinal cord ischemia/reperfusion (I/R) injury in swine [1] without, improving neurological function. Methods We studied 90 patients affected by severe sepsis or septic shock previously enrolled in a prospective trial regarding the impact of glycemic control on inflammation and coagulation. In a retrospective analysis of the data from the SBITS-trial [1] we investigated whether the initial level of serum IgG on admission to the hospital in patients with sepsis and septic shock (before the first administration of the first dose of intravenous immunoglobulins) could be seen as a prognostic parameter for the primary outcome, lethality on day 28, or the secondary endpoints, lethality on day 7 or on the ICU. The aim of this analysis was to assess the impact of real-time continuous glucose monitoring (CGM) on glucose variability in critically ill patients receiving intensive insulin therapy (IIT) Methods This is the post hoc analysis of a prospective, randomized, controlled trial [2]. Respecting anonymity we have statistically evaluated 103 replies (response rate was 13.8%) and compared with data from other European countries
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