Liberalized Screening for Blunt Carotid and Vertebral Artery Injuries Is Justified
BACKGROUNDCurrent literature suggests that blunt carotid injuries (BCIs) and vertebral artery injuries (BVIs) are more common than once appreciated. Screening criteria have been suggested, but only one previous study has attempted to identify factors that predict the presence of BCI/BVI. This curren...
Gespeichert in:
| Veröffentlicht in: | The Journal of trauma, injury, infection, and critical care injury, infection, and critical care, 2001-08, Vol.51 (2), p.308-314 |
|---|---|
| Hauptverfasser: | , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 314 |
|---|---|
| container_issue | 2 |
| container_start_page | 308 |
| container_title | The Journal of trauma, injury, infection, and critical care |
| container_volume | 51 |
| creator | Kerwin, Andrew J. Bynoe, Raymond P. Murray, Julie Hudson, Edwin R. Close, Timothy P. Gifford, Robert R. M. Carson, Kevin W. Smith, Lenwood P. Bell, Richard M. |
| description | BACKGROUNDCurrent literature suggests that blunt carotid injuries (BCIs) and vertebral artery injuries (BVIs) are more common than once appreciated. Screening criteria have been suggested, but only one previous study has attempted to identify factors that predict the presence of BCI/BVI. This current study was conducted for two reasons. First, we wanted to determine the incidence of BCI/BVI in our institution. Second, we wanted to determine the incidence of abnormal four-vessel cerebral angiograms ordered for injuries and signs believed to be associated with BCI/BVI and thus to determine whether the screening protocol developed was appropriate.
METHODSFrom August 1998, we used liberalized screening criteria for patients who were prospectively identified and suspected to be at high risk for BCI/BVI if any of the following were presentanisocoria, unexplained mono-/hemiparesis, unexplained neurologic exam, basilar skull fracture through or near the carotid canal, fracture through the foramen transversarium, cerebrovascular accident or transient ischemic attack, massive epistaxis, severe flexion or extension cervical spine fracture, massive facial fractures, or neck hematoma. Four-vessel cerebral angiograms were used for screening for BCI/BVI.
RESULTSOver the 18-month study period, 48 patients were angiographically screened, with 21 patients (44%) being identified as having a total of 19 BCIs and 10 BVIs. Nine patients had unilateral carotid artery injuries and three patients had bilateral carotid artery injuries. Vertebral artery injuries were unilateral in six patients. One patient had bilateral carotid artery injuries and a unilateral vertebral artery injury. One patient had a unilateral carotid artery injury and a unilateral vertebral artery injury, and one patient had a unilateral carotid artery injury and bilateral vertebral artery injuries. During the same study period, 2,331 trauma patients were admitted, with 1,941 (83%) secondary to blunt trauma. The overall incidence of BCI/BVI was 1.1%. The frequency of abnormal angiograms ordered for cerebrovascular accident or transient ischemic attack, massive epistaxis, or severe cervical spine fractures was 100%. The frequency of abnormal angiograms ordered for the other indications was as followsfracture through foramen transversarium, 60%; unexplained mono- or hemiparesis, 44%; basilar skull fracture, 42%; unexplained neurologic examination, 38%; anisocoria, 33%; and severe facial fractures, 0%.
CONCLUSIONTh |
| doi_str_mv | 10.1097/00005373-200108000-00013 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_71068824</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>71068824</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4803-8771995bca2561c573869571dc5b4f72d6836fba028f07e6bdf59d7a56af2ebc3</originalsourceid><addsrcrecordid>eNp1kd9LHDEQgIO06Kn9F0oeSt-2zY_NJnm0h22vHAhV-xqyyaTG5nZtsovoX2_0rupLA8PMwDcz8AUhTMknSrT8TOoTXPKGEUKJql1Tg_I9tKCC6UYpot-gBSGMNYIpdoAOS7muSNtytY8OKG01l0ov0M917CHbFO_B43OXAYY4_MZhzPhLmocJL20ep-ixHTz-BXmCvtL4pBb5Dq-G6zlHKHhV8I-5TDFE8MfobbCpwLtdPkKXX08vlt-b9dm31fJk3bhWEd4oKanWoneWiY46IbnqtJDUO9G3QTLfKd6F3hKmApHQ9T4I7aUVnQ0MeseP0Mft3ps8_p2hTGYTi4OU7ADjXIykpFOKtRVUW9DlsZQMwdzkuLH5zlBiHn2afz7Ns0_z5LOOvt_dmPsN-JfBncAKfNgBtjibQraDi-UVR7qWPO5pt9jtmKq58ifNt5DNFdg0XZn_fSd_AP8ZjAE</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>71068824</pqid></control><display><type>article</type><title>Liberalized Screening for Blunt Carotid and Vertebral Artery Injuries Is Justified</title><source>MEDLINE</source><source>Journals@Ovid Complete</source><creator>Kerwin, Andrew J. ; Bynoe, Raymond P. ; Murray, Julie ; Hudson, Edwin R. ; Close, Timothy P. ; Gifford, Robert R. M. ; Carson, Kevin W. ; Smith, Lenwood P. ; Bell, Richard M.</creator><creatorcontrib>Kerwin, Andrew J. ; Bynoe, Raymond P. ; Murray, Julie ; Hudson, Edwin R. ; Close, Timothy P. ; Gifford, Robert R. M. ; Carson, Kevin W. ; Smith, Lenwood P. ; Bell, Richard M.</creatorcontrib><description>BACKGROUNDCurrent literature suggests that blunt carotid injuries (BCIs) and vertebral artery injuries (BVIs) are more common than once appreciated. Screening criteria have been suggested, but only one previous study has attempted to identify factors that predict the presence of BCI/BVI. This current study was conducted for two reasons. First, we wanted to determine the incidence of BCI/BVI in our institution. Second, we wanted to determine the incidence of abnormal four-vessel cerebral angiograms ordered for injuries and signs believed to be associated with BCI/BVI and thus to determine whether the screening protocol developed was appropriate.
METHODSFrom August 1998, we used liberalized screening criteria for patients who were prospectively identified and suspected to be at high risk for BCI/BVI if any of the following were presentanisocoria, unexplained mono-/hemiparesis, unexplained neurologic exam, basilar skull fracture through or near the carotid canal, fracture through the foramen transversarium, cerebrovascular accident or transient ischemic attack, massive epistaxis, severe flexion or extension cervical spine fracture, massive facial fractures, or neck hematoma. Four-vessel cerebral angiograms were used for screening for BCI/BVI.
RESULTSOver the 18-month study period, 48 patients were angiographically screened, with 21 patients (44%) being identified as having a total of 19 BCIs and 10 BVIs. Nine patients had unilateral carotid artery injuries and three patients had bilateral carotid artery injuries. Vertebral artery injuries were unilateral in six patients. One patient had bilateral carotid artery injuries and a unilateral vertebral artery injury. One patient had a unilateral carotid artery injury and a unilateral vertebral artery injury, and one patient had a unilateral carotid artery injury and bilateral vertebral artery injuries. During the same study period, 2,331 trauma patients were admitted, with 1,941 (83%) secondary to blunt trauma. The overall incidence of BCI/BVI was 1.1%. The frequency of abnormal angiograms ordered for cerebrovascular accident or transient ischemic attack, massive epistaxis, or severe cervical spine fractures was 100%. The frequency of abnormal angiograms ordered for the other indications was as followsfracture through foramen transversarium, 60%; unexplained mono- or hemiparesis, 44%; basilar skull fracture, 42%; unexplained neurologic examination, 38%; anisocoria, 33%; and severe facial fractures, 0%.
CONCLUSIONThe liberalized screening criteria used in this study were appropriate to identify patients with BCI/BVI. This study suggests BCI/BVI to be more common than previously believed and justifies that screening should be liberalized.</description><identifier>ISSN: 0022-5282</identifier><identifier>EISSN: 1529-8809</identifier><identifier>DOI: 10.1097/00005373-200108000-00013</identifier><identifier>PMID: 11493789</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins, Inc</publisher><subject>Adolescent ; Adult ; Biological and medical sciences ; Cardiovascular system ; Carotid Artery Injuries - diagnosis ; Carotid Artery Injuries - epidemiology ; Cerebral Angiography ; Cross-Sectional Studies ; Female ; Heparin - administration & dosage ; Humans ; Incidence ; Investigative techniques, diagnostic techniques (general aspects) ; Male ; Mass Screening ; Medical sciences ; Middle Aged ; Prognosis ; Radiodiagnosis. Nmr imagery. Nmr spectrometry ; Risk Factors ; Treatment Outcome ; Vertebral Artery - injuries ; Wounds, Nonpenetrating - diagnosis ; Wounds, Nonpenetrating - epidemiology</subject><ispartof>The Journal of trauma, injury, infection, and critical care, 2001-08, Vol.51 (2), p.308-314</ispartof><rights>2001 Lippincott Williams & Wilkins, Inc.</rights><rights>2001 INIST-CNRS</rights><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4803-8771995bca2561c573869571dc5b4f72d6836fba028f07e6bdf59d7a56af2ebc3</citedby><cites>FETCH-LOGICAL-c4803-8771995bca2561c573869571dc5b4f72d6836fba028f07e6bdf59d7a56af2ebc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>309,310,314,776,780,785,786,23909,23910,25118,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1106403$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11493789$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kerwin, Andrew J.</creatorcontrib><creatorcontrib>Bynoe, Raymond P.</creatorcontrib><creatorcontrib>Murray, Julie</creatorcontrib><creatorcontrib>Hudson, Edwin R.</creatorcontrib><creatorcontrib>Close, Timothy P.</creatorcontrib><creatorcontrib>Gifford, Robert R. M.</creatorcontrib><creatorcontrib>Carson, Kevin W.</creatorcontrib><creatorcontrib>Smith, Lenwood P.</creatorcontrib><creatorcontrib>Bell, Richard M.</creatorcontrib><title>Liberalized Screening for Blunt Carotid and Vertebral Artery Injuries Is Justified</title><title>The Journal of trauma, injury, infection, and critical care</title><addtitle>J Trauma</addtitle><description>BACKGROUNDCurrent literature suggests that blunt carotid injuries (BCIs) and vertebral artery injuries (BVIs) are more common than once appreciated. Screening criteria have been suggested, but only one previous study has attempted to identify factors that predict the presence of BCI/BVI. This current study was conducted for two reasons. First, we wanted to determine the incidence of BCI/BVI in our institution. Second, we wanted to determine the incidence of abnormal four-vessel cerebral angiograms ordered for injuries and signs believed to be associated with BCI/BVI and thus to determine whether the screening protocol developed was appropriate.
METHODSFrom August 1998, we used liberalized screening criteria for patients who were prospectively identified and suspected to be at high risk for BCI/BVI if any of the following were presentanisocoria, unexplained mono-/hemiparesis, unexplained neurologic exam, basilar skull fracture through or near the carotid canal, fracture through the foramen transversarium, cerebrovascular accident or transient ischemic attack, massive epistaxis, severe flexion or extension cervical spine fracture, massive facial fractures, or neck hematoma. Four-vessel cerebral angiograms were used for screening for BCI/BVI.
RESULTSOver the 18-month study period, 48 patients were angiographically screened, with 21 patients (44%) being identified as having a total of 19 BCIs and 10 BVIs. Nine patients had unilateral carotid artery injuries and three patients had bilateral carotid artery injuries. Vertebral artery injuries were unilateral in six patients. One patient had bilateral carotid artery injuries and a unilateral vertebral artery injury. One patient had a unilateral carotid artery injury and a unilateral vertebral artery injury, and one patient had a unilateral carotid artery injury and bilateral vertebral artery injuries. During the same study period, 2,331 trauma patients were admitted, with 1,941 (83%) secondary to blunt trauma. The overall incidence of BCI/BVI was 1.1%. The frequency of abnormal angiograms ordered for cerebrovascular accident or transient ischemic attack, massive epistaxis, or severe cervical spine fractures was 100%. The frequency of abnormal angiograms ordered for the other indications was as followsfracture through foramen transversarium, 60%; unexplained mono- or hemiparesis, 44%; basilar skull fracture, 42%; unexplained neurologic examination, 38%; anisocoria, 33%; and severe facial fractures, 0%.
CONCLUSIONThe liberalized screening criteria used in this study were appropriate to identify patients with BCI/BVI. This study suggests BCI/BVI to be more common than previously believed and justifies that screening should be liberalized.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Cardiovascular system</subject><subject>Carotid Artery Injuries - diagnosis</subject><subject>Carotid Artery Injuries - epidemiology</subject><subject>Cerebral Angiography</subject><subject>Cross-Sectional Studies</subject><subject>Female</subject><subject>Heparin - administration & dosage</subject><subject>Humans</subject><subject>Incidence</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Male</subject><subject>Mass Screening</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Prognosis</subject><subject>Radiodiagnosis. Nmr imagery. Nmr spectrometry</subject><subject>Risk Factors</subject><subject>Treatment Outcome</subject><subject>Vertebral Artery - injuries</subject><subject>Wounds, Nonpenetrating - diagnosis</subject><subject>Wounds, Nonpenetrating - epidemiology</subject><issn>0022-5282</issn><issn>1529-8809</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2001</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kd9LHDEQgIO06Kn9F0oeSt-2zY_NJnm0h22vHAhV-xqyyaTG5nZtsovoX2_0rupLA8PMwDcz8AUhTMknSrT8TOoTXPKGEUKJql1Tg_I9tKCC6UYpot-gBSGMNYIpdoAOS7muSNtytY8OKG01l0ov0M917CHbFO_B43OXAYY4_MZhzPhLmocJL20ep-ixHTz-BXmCvtL4pBb5Dq-G6zlHKHhV8I-5TDFE8MfobbCpwLtdPkKXX08vlt-b9dm31fJk3bhWEd4oKanWoneWiY46IbnqtJDUO9G3QTLfKd6F3hKmApHQ9T4I7aUVnQ0MeseP0Mft3ps8_p2hTGYTi4OU7ADjXIykpFOKtRVUW9DlsZQMwdzkuLH5zlBiHn2afz7Ns0_z5LOOvt_dmPsN-JfBncAKfNgBtjibQraDi-UVR7qWPO5pt9jtmKq58ifNt5DNFdg0XZn_fSd_AP8ZjAE</recordid><startdate>200108</startdate><enddate>200108</enddate><creator>Kerwin, Andrew J.</creator><creator>Bynoe, Raymond P.</creator><creator>Murray, Julie</creator><creator>Hudson, Edwin R.</creator><creator>Close, Timothy P.</creator><creator>Gifford, Robert R. M.</creator><creator>Carson, Kevin W.</creator><creator>Smith, Lenwood P.</creator><creator>Bell, Richard M.</creator><general>Lippincott Williams & Wilkins, Inc</general><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200108</creationdate><title>Liberalized Screening for Blunt Carotid and Vertebral Artery Injuries Is Justified</title><author>Kerwin, Andrew J. ; Bynoe, Raymond P. ; Murray, Julie ; Hudson, Edwin R. ; Close, Timothy P. ; Gifford, Robert R. M. ; Carson, Kevin W. ; Smith, Lenwood P. ; Bell, Richard M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4803-8771995bca2561c573869571dc5b4f72d6836fba028f07e6bdf59d7a56af2ebc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2001</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>Cardiovascular system</topic><topic>Carotid Artery Injuries - diagnosis</topic><topic>Carotid Artery Injuries - epidemiology</topic><topic>Cerebral Angiography</topic><topic>Cross-Sectional Studies</topic><topic>Female</topic><topic>Heparin - administration & dosage</topic><topic>Humans</topic><topic>Incidence</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Male</topic><topic>Mass Screening</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Prognosis</topic><topic>Radiodiagnosis. Nmr imagery. Nmr spectrometry</topic><topic>Risk Factors</topic><topic>Treatment Outcome</topic><topic>Vertebral Artery - injuries</topic><topic>Wounds, Nonpenetrating - diagnosis</topic><topic>Wounds, Nonpenetrating - epidemiology</topic><toplevel>online_resources</toplevel><creatorcontrib>Kerwin, Andrew J.</creatorcontrib><creatorcontrib>Bynoe, Raymond P.</creatorcontrib><creatorcontrib>Murray, Julie</creatorcontrib><creatorcontrib>Hudson, Edwin R.</creatorcontrib><creatorcontrib>Close, Timothy P.</creatorcontrib><creatorcontrib>Gifford, Robert R. M.</creatorcontrib><creatorcontrib>Carson, Kevin W.</creatorcontrib><creatorcontrib>Smith, Lenwood P.</creatorcontrib><creatorcontrib>Bell, Richard M.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of trauma, injury, infection, and critical care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kerwin, Andrew J.</au><au>Bynoe, Raymond P.</au><au>Murray, Julie</au><au>Hudson, Edwin R.</au><au>Close, Timothy P.</au><au>Gifford, Robert R. M.</au><au>Carson, Kevin W.</au><au>Smith, Lenwood P.</au><au>Bell, Richard M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Liberalized Screening for Blunt Carotid and Vertebral Artery Injuries Is Justified</atitle><jtitle>The Journal of trauma, injury, infection, and critical care</jtitle><addtitle>J Trauma</addtitle><date>2001-08</date><risdate>2001</risdate><volume>51</volume><issue>2</issue><spage>308</spage><epage>314</epage><pages>308-314</pages><issn>0022-5282</issn><eissn>1529-8809</eissn><abstract>BACKGROUNDCurrent literature suggests that blunt carotid injuries (BCIs) and vertebral artery injuries (BVIs) are more common than once appreciated. Screening criteria have been suggested, but only one previous study has attempted to identify factors that predict the presence of BCI/BVI. This current study was conducted for two reasons. First, we wanted to determine the incidence of BCI/BVI in our institution. Second, we wanted to determine the incidence of abnormal four-vessel cerebral angiograms ordered for injuries and signs believed to be associated with BCI/BVI and thus to determine whether the screening protocol developed was appropriate.
METHODSFrom August 1998, we used liberalized screening criteria for patients who were prospectively identified and suspected to be at high risk for BCI/BVI if any of the following were presentanisocoria, unexplained mono-/hemiparesis, unexplained neurologic exam, basilar skull fracture through or near the carotid canal, fracture through the foramen transversarium, cerebrovascular accident or transient ischemic attack, massive epistaxis, severe flexion or extension cervical spine fracture, massive facial fractures, or neck hematoma. Four-vessel cerebral angiograms were used for screening for BCI/BVI.
RESULTSOver the 18-month study period, 48 patients were angiographically screened, with 21 patients (44%) being identified as having a total of 19 BCIs and 10 BVIs. Nine patients had unilateral carotid artery injuries and three patients had bilateral carotid artery injuries. Vertebral artery injuries were unilateral in six patients. One patient had bilateral carotid artery injuries and a unilateral vertebral artery injury. One patient had a unilateral carotid artery injury and a unilateral vertebral artery injury, and one patient had a unilateral carotid artery injury and bilateral vertebral artery injuries. During the same study period, 2,331 trauma patients were admitted, with 1,941 (83%) secondary to blunt trauma. The overall incidence of BCI/BVI was 1.1%. The frequency of abnormal angiograms ordered for cerebrovascular accident or transient ischemic attack, massive epistaxis, or severe cervical spine fractures was 100%. The frequency of abnormal angiograms ordered for the other indications was as followsfracture through foramen transversarium, 60%; unexplained mono- or hemiparesis, 44%; basilar skull fracture, 42%; unexplained neurologic examination, 38%; anisocoria, 33%; and severe facial fractures, 0%.
CONCLUSIONThe liberalized screening criteria used in this study were appropriate to identify patients with BCI/BVI. This study suggests BCI/BVI to be more common than previously believed and justifies that screening should be liberalized.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins, Inc</pub><pmid>11493789</pmid><doi>10.1097/00005373-200108000-00013</doi><tpages>7</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0022-5282 |
| ispartof | The Journal of trauma, injury, infection, and critical care, 2001-08, Vol.51 (2), p.308-314 |
| issn | 0022-5282 1529-8809 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_71068824 |
| source | MEDLINE; Journals@Ovid Complete |
| subjects | Adolescent Adult Biological and medical sciences Cardiovascular system Carotid Artery Injuries - diagnosis Carotid Artery Injuries - epidemiology Cerebral Angiography Cross-Sectional Studies Female Heparin - administration & dosage Humans Incidence Investigative techniques, diagnostic techniques (general aspects) Male Mass Screening Medical sciences Middle Aged Prognosis Radiodiagnosis. Nmr imagery. Nmr spectrometry Risk Factors Treatment Outcome Vertebral Artery - injuries Wounds, Nonpenetrating - diagnosis Wounds, Nonpenetrating - epidemiology |
| title | Liberalized Screening for Blunt Carotid and Vertebral Artery Injuries Is Justified |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-29T05%3A04%3A35IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Liberalized%20Screening%20for%20Blunt%20Carotid%20and%20Vertebral%20Artery%20Injuries%20Is%20Justified&rft.jtitle=The%20Journal%20of%20trauma,%20injury,%20infection,%20and%20critical%20care&rft.au=Kerwin,%20Andrew%20J.&rft.date=2001-08&rft.volume=51&rft.issue=2&rft.spage=308&rft.epage=314&rft.pages=308-314&rft.issn=0022-5282&rft.eissn=1529-8809&rft_id=info:doi/10.1097/00005373-200108000-00013&rft_dat=%3Cproquest_cross%3E71068824%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=71068824&rft_id=info:pmid/11493789&rfr_iscdi=true |