摘要:

ObjectiveAnalysis of variables predictive of trauma outcome by the CHAID (chi-square automatic interaction detection) statistical program.DesignRetrospective analysis of a prospectively maintained trauma database.Methods15).Main ResultsThe overall mortality fell from 26.6 to 16% (chi squared test = 14.7, p = 0.01) during the study period. The emergency room Glasgow Coma Scale (GCS) score (preresuscitation) was the strongest predictor of death or survival. CHAID segmented the study group into three categories based on GCS scores ({3}, {4-12}, and {13-15}), each with significantly different outcome predictability. The mortality rate in those with a GCS score of 3 (n = 89) was 67%. Systolic blood pressure was the strongest predictor of outcome in this subset. The mortality in those with GCS score of 4-12 (n = 160) was 18%. Injury Severity Score was the strongest predictor in this subset. The mortality rate in those with GCS score of 13-15 was 5%. Age was the strongest predictor in this group.ConclusionThe CHAID-generated flowchart has proved useful in this pilot study to analyze the interrelation between variables predictive of outcome in an Australian urban trauma population.

ISSN:0022-5282    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Objectiveor = to50 mg/dL (BAC+50).MethodsDemographic, clinical, and BAC data were collected from the clinical trauma registry and toxicology data base at a Level I trauma center. Logistic regression was used to analyze data from 11,206 patients to develop a predictive model, which was validated using a subsequent cohort of 3,523 patients.ResultsIn the model development cohort, alcohol was detected in the blood of 3,180 BAC-tested patients (28.7%), of whom 91.2% had a BAC+50 status. Preliminary analysis revealed associations between a BAC+50 status and sex, age, race, injury type (intentional vs. unintentional), and time of injury (night vs. day and weekend vs. weekday). A predictive model using four attributes (sex and injury type) identified patients at low, medium, and high risk for being BAC+50. The model was validated using the second group of patients.ConclusionInjured patients with a high probability of being alcohol positive can be identified using a simple scoring system based on readily available demographic and clinical information.

ISSN:0022-5282    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

This study evaluated the potential for dehydroepiandrosterone (DHEA) to protect skeletal muscle from reperfusion injury using intravital microscopic observations of isolated rat cremaster muscle flaps. The flaps were subjected to warm ischemia followed by reperfusion in three groups of rats. In group 1 (control, n = 14), muscle flaps were subjected to 6 hours of ischemia and then evaluated after either 90 minutes (n = 8) or 24 hours (n = 6) of reperfusion. Group 2 animals (propylene glycol pretreatment, n = 8) were pretreated with a propylene glycol vehicle, then underwent 6 hours of ischemia and were evaluated after 90 minutes reperfusion. Group 3 animals (DHEA pretreatment, n = 12) were pretreated with DHEA dissolved in propylene glycol, subjected to 6 hours of ischemia, and then evaluated after either 90 minutes (n = 6) or 24 hours (n = 6) of reperfusion.Red blood cell velocity in the flap's main arteriole, functional capillary density, venular constriction index (the ratio of internal to external diameter of postcapillary venules), and microemboli formation were measured. Muscle samples were evaluated by electron microscopy.Control animals showed a 61% reduction in red blood cell velocity (p < 0.05) accompanied by a 69% reduction in functional capillary density (p <.05) acutely and total cessation of flow by 24 hours. No differences between control and propylene glycol treated animals were noted. In DHEA-pretreated animals, reflow occurred in 100% of the flaps, there was a temporary 39% reduction (p < 0.05) in functional capillary density, and all flaps remained viable at 24 hours.In this study, DHEA pretreatment markedly improved muscle flap microcirculatory hemodynamics and protected flaps against ischemia/reperfusion injury.

ISSN:0022-5282    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The aim of this study is to establish whether tracheobronchial cytology is useful in the diagnosis of inhalation injury.Twenty patients diagnosed to have inhalation injury by existing clinical criteria and 20 control patients were admitted into the study. Bronchoscopy and brush biopsies were carried out. They were then scored using a Total Cellular Score and Differential Cellular Score. These were compared with clinical and bronchoscopic scores and respiratory outcome.The average Total Cellular Score of the patients with inhalation injury was 497.4 +/- 281.9 and that of the control patients was 1004.2 +/- 88.4. There was a strong correlation between clinical, bronchoscopic, and total cellular scores. The Differential Cellular Score showed a left shift in patients with inhalation injury.This study shows that tracheobronchial cytology is a useful adjunct in diagnosing and assessing the severity of inhalation injury. Furthermore, our results suggest that it may be superior to current methods in predicting respiratory outcome.

ISSN:0022-5282    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine the frequency and extent of hemothorax, pneumothorax, and hemopneumothorax missed by auscultation in penetrating chest injury.DesignA retrospective chart and chest radiograph review.Materials and MethodsOne hundred and eighteen patients suffering penetrating chest injuries during 1993 were studied. A missed auscultation was defined as a patient with normal breath sounds but shown by chest radiograph to have a hemothorax, pneumothorax, or hemopneumothorax. The amount of hemothorax was recorded after chest tube placement or at thoracotomy. The degree of pneumothorax was determined by Rhea's method.ResultsSeventy-one patient (60%) had a hemothorax, pneumothorax, or hemopneumothorax. Auscultation to detect hemothorax, pneumothorax, or hemopneumothorax had a sensitivity of 58%, a specificity of 98%, and a positive predictive value of 98%. Thirty of 71 patients (42%) were found to have pleural space blood or air missed by auscultation. Twelve patients (41%) had a hemopneumothorax, 11 patients (36%) had hemothorax, and seven patients (23%) had pneumothorax. Auscultation missed hemothorax up to 600 mL, pneumothorax up to 28%, and hemopneumothorax up to 800 mL and 28%.ConclusionHemopneumothorax and hemothorax are the conditions most likely to be missed by auscultation, especially in patients with gunshot wounds. Auscultation has a high positive predictive value because it indicates injury with a fair degree of certainty; however, a negative auscultation does not rule out injury.

ISSN:0022-5282    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The low occurrence, nonspecific signs and symptoms, and high rate of associated morbidity and mortality of pulmonary embolus (PE) create major problems in the prevention, diagnosis, and treatment of PE. The purpose of this study was to analyze the frequency and outcome of PE in an entire state's trauma population using a large, population-based, hospital discharge data base. With the inclusion of an entire population, the reported incidence, high risk groups of patients, and specific risk factors regarding PE were assessed. A multivariate, logistic regression model was created from the data to determine predictive power of selected risk factors in patients at risk.MethodsThe data source was a statewide, hospital discharge data base that includes data on all hospitalized patients for all of the hospitals in North Carolina. Data were available from 1988 to 1993. Using primary discharge diagnosis and nine additional ICD-9 coded diagnoses from the discharge abstract, patients were selected by presence of diagnostic codes for traumatic injury (800-959.9) and PE (415.1). Statistical analysis was performed using univariate and multivariate analysis to determine significant risk factors and to create a candidate model for the prediction of risk in the study population.ResultsOf 318,554 patients, 952 (0.30%) had a recorded diagnosis of PE. The mortality rate for patients with PE (26%) was 10 times higher than the mortality rate in patients without PE (2.6%). In evaluating specific risk factors, age was a significant predictor of the risk of PE: 0.05% for patients under age 55 and 0.7% in those 55 years and over. The rate of PE, 0.3%, was low for the entire study population, but was highest in patients with injuries of the extremities, 0.53%. Increasing Injury Severity Score and Abbreviated Injury Scale score for determined body systems were also found to correlate with an increasing risk of PE.Over the course of the study, the incidence of PE among patients discharged from non-trauma centers showed a significant decrease. There was also a decrease in the mortality in non-trauma centers for PE. This finding cannot be due to coding changes coincident with the advent of diagnosis related groups because it would be associated with more vigorous combing of charts for diagnoses? It may well be that the use of prophylactic measures in injured patients initially used at trauma centers was adopted by the physicians at non-trauma centers over this time with the resultant decline in PE and associated mortality. From the univariate linear regression models, a logistic regression model was created that confirmed age as the most significant risk factor, followed by Injury Severity Score and Abbreviated Injury Scale score for soft tissue, extremity, and chest. The calculated area under the receiver operator characteristic curve was 0.72.ConclusionUsing a large, population-based data base, we were able to determine the reported incidence of PE among trauma patients and establish specific risk factors. The reported incidence of PE in this population is low, 0.30%. The mortality among those with PE, however, is significant at 26%. In this study, age, Injury Severity Score, and injury to specific body regions (soft tissue, extremity, chest) were associated with an increased risk of PE. The investigation of prophylaxis of PE and the general management of injured patients may be influenced by the overall low reported frequency of PE and the specific high risk populations described in this study. In light of the low incidence of PE in patients without specific risk factors, prophylactic interventions cannot be routinely recommended unless their benefits clearly outweigh their risks.

ISSN:0022-5282    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

PurposeThe need to study methods of thromboembolism prophylaxis in high-risk trauma patients is well established. The purpose of this study was to evaluate the feasibility of a proposed study design, including current methods of prophylaxis, performance of a risk assessment profile scale, and the use of serial color-flow duplex studies in detecting deep venous thrombosis (DVT).MethodsPatients were enrolled into the study, stratified as to their ability to receive anticoagulation and randomized to low-dose unfractionated heparin, low molecular weight heparin, pneumatic compression devices, or foot pumps with or without vena caval filters. Serial ultrasound scans were performed at designated intervals for 4 weeks. Pulmonary angiograms were obtained for clinical signs or symptoms of pulmonary embolism.ResultsFifty-three patients, 32 male and 21 female patients with a mean age of 44 years, completed the study. The incidence of DVT was 43% (23 of 53 patients) and significantly higher in older patients. There were no pulmonary embolisms. Color-flow duplex proved to be a sensitive method for detecting both proximal and distal thrombi. The risk assessment profile for thromboembolism (RAPT) scale identified a group of patients with a high incidence of DVT. However, the occurrence of DVT was not correlated with the magnitude of the RAPT score.ConclusionThe ability to identify a population with a high incidence of thromboembolism by using the RAPT score to detect asymptomatic DVT, and the suggested advantage of low molecular weight heparin, all support the need for an appropriately powered randomized clinical trial.

ISSN:0022-5282    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

BackgroundAggressive squamous cell carcinoma (SCC) is known to occur in scars that develop after a burn injury, especially in the underdeveloped areas of the world where care is lacking. Because most SCC are associated with abnormalities in tumor suppressor genes, particularly p53, we postulated that similar mechanisms may underlie the development of burn-associated SCC.MethodsWe analyzed tissue DNA from a patient who died from an aggressive SCC in a burn scar for evidence of p53 gene abnormalities by polymerase chain reaction and immunohistochemical staining for p53 protein.ResultsUsing polymerase chain reaction, the p53 gene could not be detected in DNA from the patient's cancer. The p53 protein was also undetectable by immunohistochemical staining.ConclusionThese studies indicate that there was a homozygous deletion of the p53 gene in this burn-related carcinoma. Further studies of other patients may lead to new understanding of this cancer, explain in part the usual aggressive behavior, and lead to new methods of prevention and treatment.

ISSN:0022-5282    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Unilateral pulmonary contusion after blunt thoracic trauma can prove to be a devastating injury. Regional disturbances in blood flow and alveolar ventilation can significantly alter pulmonary function. We present a case report of unilateral pulmonary contusion that resulted in significant pulmonary dysfunction. This patient was successfully managed with multimodality therapy consisting of differential lung ventilation and inhaled nitric oxide. The effect of nitric oxide applied to the "normal" lung, the "injured" lung, and both lungs is described. The use of inhaled nitric oxide was associated with an increase in oxygenation when applied to the normal or both lungs. The use of nitric oxide in conjunction with differential lung ventilation appeared to offer benefit in this patient with severe unilateral pulmonary contusion.

ISSN:0022-5282    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1997

数据来源: OVID