Sédation et analgésie en structure d’urgence (aéactualisation de la Conférence d’experts de la Sfar of 1999)

Medical pre-hospital management reduces mortality in severe blunt trauma: a prospective epidemiological study

International audience; INTRODUCTION: Severe blunt trauma is a leading cause of premature death and handicap. However, the benefit for the patient of pre-hospital management by emergency physicians remains controversial because it may delay admission to hospital. This study aimed to compare the impact of medical pre-hospital management performed by SMUR (Service Mobile d'Urgences et de Réanimation) with non-medical pre-hospital management provided by fire brigades (non-SMUR) on 30-day mortality. METHODS: The FIRST (French Intensive care Recorded in Severe Trauma) study is a multicenter cohort study on consecutive patients with severe blunt trauma requiring admission to university hospital i…

Les facteurs pronostiques du traumatisme sévère en fonction de la sévérité de l’atteinte thoracique

Etat de la question Le traumatisme severe est associe a un risque eleve de morbidite et de mortalite. L’atteinte thoracique est souvent presente. Le but de l’etude etait de determiner si les facteurs pronostiques du traumatisme severe sont modifies par la severite de l’atteinte thoracique. Materiel et methodes Une analyse ancillaire de l’etude FIRST, une cohorte multicentrique incluant des patients ayant un traumatisme severe necessitant une admission a dans l’une des reanimations des centres hospitalo-universitaires (CHU) participants dans les 72 heures post-traumatiques. Les patients admis initialement dans un hopital general ont ete exclus. Resultats Parmi les 2052 patients analyses, 583…

Impact of whole-body computed tomography on mortality and surgical management of severe blunt trauma

International audience; IntroductionThe mortality benefit of whole-body computed tomography (CT) in early trauma management remains controversial and poorly understood. The objective of this study was to assess the impact of whole-body CT compared with selective CT on mortality and management of patients with severe blunt trauma.MethodsThe FIRST (French Intensive care Recorded in Severe Trauma) study is a multicenter cohort study on consecutive patients with severe blunt trauma requiring admission to intensive care units from university hospital trauma centers within the first 72 hours. Initial data were combined to construct a propensity score to receive whole-body CT and selective CT used…

The motor component does not convey all the mortality prediction capacity of the Glasgow Coma Scale in trauma patients.

Abstract Purpose We tested the hypothesis that the motor component of the Glasgow Coma Scale (GCS) conveys most of the predictive information of triage scores (Triage Revised Trauma Score [T-RTS] and the Mechanism, GCS, Age, arterial Pressure score [MGAP]) in trauma patients. Method We conducted a multicenter prospective observational study and evaluated 1690 trauma patients in 14 centers. We compared the GCS, T-RTS, MGAP, and Trauma Related Injury Severity Score (reference standard) using the full GCS or its motor component only using logistic regression model, area under the receiver operating characteristic curve, and reclassification technique. Results Although some changes were noted f…