Articulated digital reconstructions of two diplodocid sauropods revealed cervical poses and feeding envelopes. The necks of Diplodocus and Apatosaurus were nearly straight but gently declined such that the heads, which were themselves angled downward relative to the neck, were close to ground level in their neutral, undeflected posture. Both necks were less flexible than conventionally depicted, and Diplodocus was less capable of lateral and dorsal curvature than Apatosaurus. The results suggest that these sauropods were adapted to ground feeding or low browsing, contrary to the view that diplodocid sauropods were high browsers.

Background Risk-adjusted analyses are critical in evaluating trauma outcomes. The National Trauma Data Bank (NTDB) is a statistically robust registry that allows such analyses; however, analytical techniques are not yet standardized. In this study, we examine peer-reviewed manuscripts published using NTDB data, with particular attention to characteristics strongly associated with trauma outcomes. Our objective is to determine if there are substantial variations in the methodology and quality of risk-adjusted analyses and thus, whether the development of best practices for risk-adjusted analyses is warranted. Study Design A database of all studies utilizing NTDB data published through December 2010 was created by searching Pubmed and Embase. Studies with multivariate risk-adjusted analyses were examined for their central question, main outcome measures, analytical techniques, the co-variates in adjusted analyses, and handling of missing data. Results Of 286 NTDB publications, 122 performed a multivariable adjusted analysis. These studies focused on Clinical Outcomes (51), Public Health Policy or Injury Prevention (30), Quality (16), Disparities (15), Trauma Center Designation (6) or Scoring Systems (4). Mortality was the main outcome in 98 of these studies. There were considerable differences in the co-variates used for case adjustment. The three most frequently controlled for co-variates were age (95%), Injury Severity Score (85%) and gender (78%). Up to 43% of studies did not control for the five basic covariates necessary to conduct a risk-adjusted analysis of trauma mortality. Less than 10% of studies used clustering to adjust for facility differences or imputation to handle missing data. Conclusions There is significant variability in how risk-adjusted analyses using data from the NTDB are performed. Best practices are needed to further improve the quality of research from the NTDB.

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Prehospital spine immobilization is associated with higher mortality in penetrating trauma and should not be routinely used in every patient with penetrating trauma.