Resuscitative Thoracotomy: The Effect of Field Time on Outcome

Clevenger, Frederick W.; Yarbrough, Dabney R.; Reines, H. David

doi:10.1097/00005373-198804000-00004

Cited by 80 publications

(33 citation statements)

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“…2,[21][22][23][24][25][26] However, these studies have had very small sample sizes and did not control for key variables such as injury severity, treatment, or demographics. Other published studies have disputed the ''shorter is better'' philosophy.…”

Section: 19mentioning

confidence: 99%

The Golden Hour: Scientific Fact or Medical “Urban Legend”?

Lerner

Moscati

2001

Academic Emergency Medicine

402

220

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Abstract. The term ''golden hour'' is commonly used to characterize the urgent need for the care of trauma patients. This term implies that morbidity and mortality are affected if care is not instituted within the first hour after injury. This concept justifies much of our current trauma system. However, definitive references are generally not provided when this concept is discussed. It remains unclear whether objective data exist. This article discusses a detailed literature and historical record search for support of the ''golden hour'' concept. None is identified.

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Section: 19mentioning

confidence: 99%

The Golden Hour: Scientific Fact or Medical “Urban Legend”?

Lerner

Moscati

2001

Academic Emergency Medicine

402

220

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“…Appeared a likely source of this increased risk of indirect central neurologic injury. CSI iatrogenia may have facilitated indirect neurologic injury by negatively impacting the "ischemic penumbra" [2][3][4][5][6]15,[22][23][24]27,29,30].…”

Section: Discussionmentioning

confidence: 99%

“…CSI has been shown to cause treatment delay, obscure injury, impair care delivery, respiration, increase intracranial pressure, effect negative outcomes and exacerbate and impede control of hemorrhage in penetrating cervical trauma [2][3][4][5][6]15,[22][23][24]27,29,30]. Both patients with indirect central neurologic injuries secondary to carotid arterial disruption received CSI.…”

Section: Discussionmentioning

confidence: 99%

“…Transport delays for CSI vary from an average of 8-30 mins [23,24]. Average total field times are reduced 34% from 46-20 mins by initiation of a "scoop and run" policy [24].…”

Section: Introductionmentioning

confidence: 99%

“…Transport delays for CSI vary from an average of 8-30 mins [23,24]. Average total field times are reduced 34% from 46-20 mins by initiation of a "scoop and run" policy [24]. The effect of time on patient outcome is critical as a 10% increase in mortality accompanies every incremental 10 min delay in reaching definitive ganglia, cerebellum or brain stem structures.…”

Section: Introductionmentioning

confidence: 99%

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Cervical spine immobilization in penetrating cervical trauma is associated with an increased risk of indirect central neurological injury

Turnock¹,

Carney²,

Fleischer³

et al. 2016

Trauma Emerg Care

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This study hypothesized that cervical spine immobilization (CSI) in penetrating cervical trauma is associated with increased central neurologic injury rather than prevention. Data abstraction proceeded from a previously constructed patient database formed via retrospective chart analysis of the trauma registries of two independent American College of Surgeons verified Level 1 Trauma centers. Neurologic injuries were categorized as peripheral or central. Central neurologic injuries were further subdivided into spinal cord and brain injuries. Patients were grouped according to the presence and type of neurologic injury, the presence and type of cervical spine fracture, death, and the presence or absence of respiratory and vascular injury. Vascular injury was further subdivided into major and minor categories. Groups were compared statistically. Significance was accepted for p<0.05. Cervical spine fracture (CSFx) was a significant risk factor for cervical spinal cord injury (CSCI) (p<0.00001; RR 20.56; 95% CI 8.44-26.47) but all patients with unstable CSFx presented with complete spinal neurologic devastation. Major vascular injury was associated with brain injury (p=0.01; RR 10.21; 95% CI 6.67-15.65) but was not associated with CSCI (p=0.99) or CSFx (p=0.67). Hypoperfusion was a strong independent risk cervical cord and brain injury (p<0.00001; RR 38.4; 95% CI 16.17-91.2). CSI was a significant risk factor for indirect central neurologic injury (p<0.001; RR 1.63; 95% CI 1.23-1.95). Brain injury was not associated with CSFx (p=0.35) or CSCI (p=0.08). No benefit of CSI in penetrating cervical trauma could be determined from this study. CSI entailed an absolute risk increase for central neurologic injury of 18.69% with a 5.3 number needed to harm (NNH).

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Special Resuscitation Situations

1992

JAMA

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Resuscitative Thoracotomy: The Effect of Field Time on Outcome

Cited by 80 publications

References 0 publications

The Golden Hour: Scientific Fact or Medical “Urban Legend”?

The Golden Hour: Scientific Fact or Medical “Urban Legend”?

Cervical spine immobilization in penetrating cervical trauma is associated with an increased risk of indirect central neurological injury

Special Resuscitation Situations

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