摘要:

Objective: To determine the magnitude of the discrepancy in injury death rates between urban and rural counties and which types of injury deaths contribute most to this discrepancy.Design: A review of Nebraska death certificates over the period 1985–1989 was undertaken. Counties were divided into four groups according to population. Group I: urban counties (n = 3); group II: counties with a town of greater than 10,000 (n = 9); group III: counties with a total population of greater than 10,000 (n = 19); group IV: counties with a total population of less than 10,000 (n = 62). Age-adjusted death rates for heart disease, cancer, cerebrovascular disease, pneumonia, and injury were tabulated. Injury deaths were further categorized by intentional injury (homicide, suicide), and unintentional injury (motor vehicle-related, falls, drownings, poisoning, farm machinery-related, choking, firearms-related, fire-related and burns).Interventions: None.ResultsAge-adjusted death rates per 100,000 population (with 95% confidence intervals) in group IV were lower than in group I for heart disease: 209 (193.9–224.1) vs. 227.4 (216.3–238.5); cancer: 135.9 (123.7–148.1) vs. 176.3 (166.6–186.0); cerebrovascular disease: 39.9 (33.3–46.5) vs. 44.6 (39.7–49.5); pneumonia: 19.6 (15.0–24.2) vs. 23.4 (19.8–27.0); and intentional injury deaths: 13.3 (9.5–17.0) vs. 15.1 (12.2–18.0). However, age-adjusted unintentional injury death rates were 54.2% higher in group IV than in group I: 42.7 (35.9–49.5) vs. 27.7 (23.8–31.6). Motor vehicle-related death rates were 93% higher: 23.3 (18.2–28.4) vs. 12.1 (9.5–14.7); and farm machinery-related deaths were 1250% higher: 2.7 (1.0–4.4) vs. 0.2 (-0.1–0.5).Conclusion: Age-adjusted unintentional injury death rates are higher in the rural counties of Nebraska, even though death rates for the four other leading causes of death (heart disease, cancer, cerebral vascular disease, and pneumonia) and intentional injury are lower. Although farm machinery-related deaths have the largest percentage difference between rural and urban counties, motor vehicle-related deaths are the major contributor to the unintentional injury death rate discrepancy in rural Nebraska.

ISSN:0022-5282    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Although tumor necrosis factor (TNF) has been implicated in sepsis-induced mortality, its role in the pathophysiology of hemorrhagic shock (HS) remains ill defined. We studied three groups of acutely anesthetized mice undergoing HS to determine the role of TNF in HS mortality. Shock was initiated in each group after heparinization by arterial bleeding of 4 mL/100 g body weight followed by 12 mL/100 g body weight resuscitation with normal saline at 1 hour. The C3H/HeJ mice (n = 14), characterized by a genetic defect in macrophage production of TNF and other cytokines in response to endotoxin, were compared with the closely related C3H/HeN strain (n = 18), which do produce TNF. A second group of C3H/HeN mice were passively immunized to TNF by pretreatment with 2.5 mg/kg anti-murine TNF antibody (Ab) before HS. In contrast to the high TNF levels measured following HS in C3H/HeN controls, post-HS TNF was undetectable in C3H/HeJ mice. Five-day survival rate and survival time were significantly greater in C3H/HeJ mice when compared with C3H/HeN controls. Anti-TNF Ab pretreatment of C3H/HeN mice abolished the increase in TNF but did not improve survival. The data demonstrate a striking improvement in survival of TNF-deficient C3H/HeJ mice following severe HS. However, the improved survival does not appear to result from deficient TNF production, since Ab pretreatment did not decrease HS mortality. The improved survival in C3H/HeJ mice suggests that cytokines other than TNF may play a role in the pathophysiology of HS.

ISSN:0022-5282    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Occult pneumothorax is defined as a pneumothorax that is detected by abdominal computed tomographic (CT) scanning, but not routine supine screening chest roentgenograms. Forty trauma patients with occult pneumothorax were prospectively randomized to management with tube thoracostomy (n = 19) or observation (n = 21) without regard to the possible need for positive pressure ventilation, to test the hypothesis that tube thoracostomy is unnecessary in this entity. Eight of the 21 patients observed had progression of their pneumothoraces on positive pressure ventilation, with three developing tension pneumothorax. None of the patients with tube thoracostomy suffered major complications as a result of the procedure. Hospital and ICU lengths of stay were not increased by tube thoracostomy. Patients with occult pneumothorax who require positive pressure ventilation should undergo tube thoracostomy.

ISSN:0022-5282    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

A retrospective review of 125 pregnant women with blunt injuries admitted to a level I trauma center over a 35-month period was performed. The usefulness of three diagnostic tests, fetal ultrasound (US), external fetal monitoring (EFM), and Kleihauer-Betke (KB) tests in detecting fetal or pregnancy-associated complications was evaluated. The majority of women (77.6%) were involved in motor vehicle crashes and the mean Injury Severity Score was low (4.7). The most common complications were premature uterine contractions (67%) and abruptio placentae (11%). When used together, EFM and US identified all complications. Moreover, all complications were manifest within 6 hours of admission. The KB tests had a sensitivity of 56%, a specificity of 71%, and an accuracy of 27%. We conclude that EFM and US are more useful in detecting fetal or pregnancy-associated complications after blunt injury. Monitoring can be limited to 6 hours if previous monitoring is normal. The KB test is of little use in the setting of acute trauma.

ISSN:0022-5282    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The pattern and associations of 62 instances of external birth trauma (EBT) in 57 of 2222 consecutive hospital-born neonates were studied. Macrosomia and vaginal instrumental or breech delivery were identified as significant risk factors for EBT. In contrast to previous reports, subgaleal hemorrhage (SGH) was the predominant form of trauma (n = 33) and it was associated with vacuum application in 28 of 33 (85%) neonates. Brachial plexus palsy (BPP) (n = 10) occurred with the highest frequency (6.4%) after breech delivery. Fractures were uncommon. Multiple injuries (10 items in 5 babies) were mainly associated with vacuum extraction. The high rate of vacuum extraction (VE) and problems with its use including a high VE failure rate (30/242 = 12.4%) were considered contributory to the unusual pattern of EBT seen in the study. Regular audit of delivery practices, greater care in excluding cephalopelvic disproportion and judicious use of VE are recommended to reduce the morbidity from EBT.

ISSN:0022-5282    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Twenty-eight patients with large burn injuries (mean total body surface area burned, 47.1%) who underwent 112 wound cleaning and staged early excision procedures were studied prospectively for bacteremia and fungemia induced by wound manipulation. The patients were given an aminoglycoside preoperatively, perioperatively, and postoperatively. Blood samples were obtained immediately before removal of dressings, after wound cleaning, after 30 minutes of surgery, at the end of each procedure, and 1 hour after surgery was completed. In a group of control patients blood samples were obtained immediately before the dressings were removed, after wound cleaning was completed, and 1 hour afterward. In a second group of control patients blood samples were obtained serially while the burn wounds remained undisturbed. None of the control patients received prophylactic aminoglycosides. Induced bacteremia or fungemia was documented in 50 instances of burn wound cleaning and excision; 31 cases of bacteremia or fungemia occurred after wound cleaning alone. Spontaneous bacteremia, i.e., that occurring in the absence of burn wound manipulation, was demonstrated in 3 of 18 blood culture series, whereas induced bacteremia was observed after 11 of the 17 burn wound cleaning procedures alone. The frequency of bacteremia tended to be higher for patients with inhalation injury than for those with no lung involvement. However, lung infection did not seem to account for many of the positive results of blood culture in this study. In contrast, burn wound infection contributed significantly to both spontaneous and induced bacteremia or fungemia. The micro-organisms most frequently isolated were staphylococci (50%) and enterococci (15.1%). Except for three isolates, all micro-organisms were cultured from the burn wounds within 48 hours before each procedure. The induced bacteremia and fungemia were in most cases short lived, and 1 hour after surgery only 9 of 50 blood culture procedures produced positive results. Following three of these procedures, one patient developed pneumonia, whereas two experienced a brief temperature rise, rigors, and slight hypotension without manifesting postoperative sepsis. In the control group undergoing wound cleaning alone, positive blood culture results were demonstrated in 5 of the 11 instances of induced bacteremia. None of these patients showed clinical signs of sepsis during the first 12 hours after wound cleaning. Thus wound cleaning and staged early excision in patients with large burns induced a high frequency of bacteremia or fungemia. The bacteremia and fungemia were transient and caused no serious postoperative infections.

ISSN:0022-5282    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Mice of the C57BL/6 strain were studied to investigate the effects of a 20% total body surface area full-thickness burn on class-specific immunoglobulin synthesis. Five days after injury single cell suspensions of spleen and mesenteric lymph node cells were made. The number of class-specific immunoglobulin-bearing cells were counted by flow cytometry using Texas-red-labelled antibody to class-specific mouse immunoglobulin. The remaining cells were cultured with lipopolysaccharide for 4 days. The supernatant was tested for class-specific immunoglobulin by enzymelinked immunosorbent assay (ELISA). There was no change in the number of classspecific IgG and IgA lymphocytes, but there was a significant increase in IgM lymphocytes. Synthesis of immunoglobulin by 105lymphocytes was significantly increased in IgG and IgA cells, but decreased in IgM cells. Similar results were shown in spleen and mesenteric lymph node cells. Because the IgM response was much greater than others in the number of cells and immunoglobulin synthesis, we conclude that the decrease in responsiveness of IgM may contribute significantly to increased host susceptibility to infection after burn.

ISSN:0022-5282    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The effect of skeletal muscle injury (SMI) on cardiovascular and O2transport responses to hemorrhage (HS) were examined in anesthetized pigs. Bilateral hindlimb muscle was injured 75 minutes before HS was started at a rate of 0.75 mL/min kg until a total of 30 mL/kg (40% estimated total blood volume) had been removed. The reductions in cardiac index (CI), left ventricular stroke work, and oxygen delivery (Do2) and the increase in plasma lactate concentration following HS were exacerbated by SMI such that although oxygen consumption was maintained after HS it fell after SMI + HS. The deleterious effect of SMI on the response to HS was greater than that recorded previously following somatic brachial nerve stimulation (BNS). Thus, in order to achieve a given reduction in CI and Do2or a rise in Shock Index (heart rate divided by systolic blood pressure) to approximately 3, a blood loss of 40% was needed after HS; this was reduced to 36% by the addition of BNS, whereas a loss of only 29% was needed when SMI was introduced. The mechanism of the deleterious effect of SMI is unclear although a change in the distribution of regional blood flow and a rise in the critical oxygen delivery may be implicated.

ISSN:0022-5282    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The laparoscope offers a novel avenue for the diagnosis of intra-abdominal injury and the use of fibrin glue (FG) as a treatment for hemorrhage in trauma patients. This study was undertaken to assess the practicality and effectiveness of FG injection under laparoscopic direction to arrest hemorrhage in solid viscera. Twenty dogs were randomized into a control group (CG) and a treatment group (TG). All animals underwent laparotomy to surgically induce uniform injuries to the hepatic and splenic parenchyma. The TG animals (n = 12) were allowed to hemorrhage for 30 minutes. The injuries were then visualized and FG injected intraparenchymally under laparoscopic direction. The average duration of the procedure was 25 minutes (range, 15–50). No hemostatic interventions were performed on the CG animals (n = 8). Mortality in the CG was 63% (5 of 8); there were no deaths in TG animals prior to sacrifice. Necropsy of TG animals revealed progressively healing hepatic and splenic injuries with no gross evidence of pulmonary FG emboli, intraparenchymal microemboli, or increased adhesion formation. No other complications were noted. This study demonstrates that hemorrhage from the liver and spleen can be successfully controlled using the laparoscope to direct the intraparenchymal injection of FG. In this experimental model, the procedure can be performed expeditiously. It is associated with reduction of mortality to zero when compared with controls. No complications associated with laparoscopy or FG injection were recognized. This technique may have potential for application in the management of stable patients who manifest evidence of intraperitoneal hemorrhage as a result of solid organ injury.

ISSN:0022-5282    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

A retrospective review of 80 consecutive patients treated at a county hospital for ankle fracture/dislocations (initial displacement > 10 mm) was undertaken. Seventy-seven patients fulfilled the requirements for documentation and follow-up. Eighteen patients were transferred from another facility and 59 patients were seen at our institution primarily. The transfer and no-transfer groups were similar in age, sex, follow-up, type of ankle fracture, and number of concomitant injuries. The no-transfer group had a slightly higher Injury Severity Score and incidence of active medical problems. Patients were transferred to this public hospital for financial considerations in 89% of the cases. The patients seen in transfer had a higher rate of overall complications (67% vs. 26%;p= 0.0001), including deep infections (11% vs. 1.7%) and major reduction failures (17% vs. 7%). Higher rates of complications were also found in patients with delayed time to operation, psychiatric or substance abuse problems, and those with skin abrasions or blisters. Analysis of variance indicated that transfer status was the strongest predictor of complications. Hospital stays were also longer in the transferred group.

ISSN:0022-5282    

出版商:OVID    

年代:1993

数据来源: OVID