摘要:

During a 5-year period from January 1987 through January 1992, 58 patients were admitted to the Allegheny General Hospital trauma center for non-scuba, non-suicidal diving injuries. There were 46 men and 12 women (mean age, 23 years). Forty-five patients were injured in swimming pools. Twenty-two patients had blood alcohol levels > 100 mg/dL. Cervical spine injury was the most common pathologic entity encountered in this group of patients. Closed head injury, pelvic fracture, thoracic vertebral fracture rib fractures were other injury, pelvic fracture, thoracic vertebral fracture rib fractures were other injuries identified. Some patients had multiple organ failure syndrome. Aquatic recretional activities carry a risk for injury that is preventable. The mechanism, clinical data complications of 58 patients are presented and the importance of prevention is discussed.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Among 33 patients with a Galeazzi-type fracture-dislocation of the forearm, there were two children and 26 adults with a classic Galeazzi injury five patients with a Galeazzi-equivalent lesion. The worst results were obtained in type-I lesions. Closed reduction was primarily successful in children. The results of surgical treatment were much better in adults. It is advisable to treat this complex injury by anatomic reduction and internal fixation of the radial shaft fracture. Immobilization in a fully supinated position is recommended to reduce the dislocation of the distal radioulnar joint. Additional temporary radioulnar fixation with Kirschner wires is also necessary in cases of severe derangement of the distal radioulnar joint.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Proximal tibial fractures below an osteoarthritic knee have a greater risk of nonunion. Treatment by cast immobilization alone is problematic. Internal fixation alone means the patient will remain handicapped because of the knee. Total knee replacement with a long-stemmed prosthesis treats both the fracture and arthritic knee.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Cost containent is important in this time of inner-city economic and health-care crisis. This paper examines patients who were treated for gunshot wounds (GSWs) of the extremities. During the study period 1978 through 1992, 16,316 patients (18,349 extremities) were treated for extremity GSWs. Nine patients with asymptomatic injuries in proximity to vascular structures who were treated before the use of duplex Doppler ultrasonography (DDU) were later found to have surgically treatable vascular injuries. These were identified and treated on an outpatient basis with no long-term morbidity or mortality. With the advent of DDU, asymptomatic vascular injuries were no longer missed. A conservative estimate of the cost savings from this study is more than 47,000,000.00. The use of DDU and the enclosed protocols for treating asymptomatic extremity wounds prevented 16,450 needless angiograms, with an additional savings of 32,900,000.00, for a total savings of more than 79,900,000.00. With a more liberal use of DDU and angiography to eliminate the rare missed vascular injuries (0.09%) the use of protocols to analyze patients with asymptomatic injuries, many extremity GSW victims (79% in this study) can be safely treated as outpatients, eliminating the need for expensive in-hospital observation.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Background: Because of the inherent risks of blood transfusions, including the transmission of viral and other infectious diseases, it is important to re-evaluate blood transfusion policies. Methods: The present study compared the results of a new selective transfusion policy in which patients were not transfused unless their hemoglobin levels went below 6–6.5 g/dL versus our previous routine transfusion policy in which the hemoglobin levels were routinely maintained at 10 g/dL. The selectively transfused group consisted of 14 patiets with a mean ± SD burn size of 28% ± 11%, while the routinely transfused group consisted of 38 clinically comparable patients with a mean burn size of 26% ± 12%, Results: The patients managed by selective transfusion received fewer transfusions (2.1 ± 1.7 units) during their hospital stay than patients transfused routinely (7.4 ± 7.6 units) (p > 0.007) and were less likely to receive maintenance transfusions (4 of 29 total units versus 116 of 282 total units) (p > 0.004). No adverse hemodynamic or other adverse effects related to limiting blood transfusions in the selectively transfused group was noted. Conclusion: Routinely transfused patients, on average, received over 5 units more blood than the selective group without any apparent clinical benefit. Thus, the results of this pilot study support a policy of selective blood transfusions in burn patients.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Trauma patients with orthopedic injuries transferred to Harborview Medical Center (HMC) were compared with all trauma patients directly admitted to HMC and with a set of matched controls regarding Injury Severity Score (ISS) and age, if ≥50 years old. Groups were compared on ISS, Revised Trauma Score (RTS), ICU stay, length of stay (LOS), total charges, reimbursement, payors outcome. Comparison of all transferred patients and directly admitted patients showed significant differences in ISS, LOS, ICU stay total charges. Despite a higher ISS, transferred patients had no differences in RTS or survival outcome. Comparison of matched transferred patients and directly admitted patients on ISS and age if ≥50 years old showed a statistically significant increase in LOS, reimbursement charges. The survival rate of all transferred and directly admitted trauma patients was approximately 95% for both groups despite a slightly higher degree of injury in transferred patients. The reimbursement rate for both groups was low, 65% for transferred patients and 59% for directly admitted patients. The percentage of transfer patients on Medicaid was 34% and for direct admissions was 37% (p = 0.552). This is a large percentage of indigent care, since only 8.1% of Washington State residents are Medicaid dependent.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Complications in trauma care occur because of provider-related or patient disease-related events, Strictly defined standardized definitions of both types of complications are needed to develop strategies for problem resolution. The frequency and characteristics of 135 disease-related and provider-related complications were examined for a 3-year period in a level I university trauma service in all patients meeting Major Trauma Outcome Study (MTOS) criteria. Provider-related complications were analyzed for recurrent process errors to be targeted for corrective action. Complication events occurred in 2764 of 3327 patients, with provider-related complications in 759. Twenty-three percent (175) of complications were judged unjustified and 16 patterns of recurrent process-of-care errors were identified. Delay in trauma team activation was caused by insensitivity of field triage protocols and inadequate recognition of injury patterns. Delays in diagnosis or surgery were caused by inadequate performace of standard work-up, inadequate recognition of injury severity by providers, diagnostic procedure interpretation errors errors in prioritizing the order of diagnositic procedures. Errors in technique were attributed to inexperience, haste, unfamiliarity with devices, lack of developed institutional techniques failure of providers to use recognized endpoints. Errors in judgement were attributed to failure to access available patient information, proceeding despite available information failure to utilize available care guidelines. Further reduction in provider-related morbidity in an organized trauma system requires this type of analysis, which identifies the need to change the process of care through education or adjustment of protocols for standardized care delivery in addition to the traditional focus on outcomes.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Seventy adult and pediatric patients with blunt splenic injury were managed nonsurgically using previously published clinical criteria without regard to the appearance of the spleen on computed tomographic (CT) scans. Seven patients (10%) who underwent delayed surgery were considered failures of nonsurgical therapy; all recovered after total splenectomy. Two radiologists, blinded to patient outcome, retrospectively reviewed the admission CT scans of all 70 patients and graded them according to three published scoring systems. Higher grades of splenic injury on CT were not associated with an increased risk of failure (Fisher's exact test, (p > 0.05). Nine of ten patients with very high scores on each of the scales were successfully managed without surgery; conversely, three patients with very low scores required urgent surgery. An elevated Injury Severity Score significantly increased the risk of failure of nonsurgical management (Chi-square test of trend, p = 0.001). No failures occurred in patients can be safely observed regardless of the magnitude of splenic injury on CT scans. A decision to undergo early exploration should be based on clinical criteria, including the patient's age and associated injuries.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Over a 9-year period (July 1981-December 1985-pre-ATLS period; January 1986-June 1990-post-ATLS period), the hospital charts of 813 trauma patients with ISS ≥ 16 were reviewed (n = 413, pre-ATLS and n = 400, post-ATLS) in order to assess the impact of the ATLS program. The frequency of endotracheal intubation (ET), nasogastric tube insertion (NG), intravenous access (IV), Foley catheterization of the bladder (Foley) and chest tube insertion (CT) were compared by Pearson Chi-square analysis. Overall, pre-ATLS vs. post-ATLS frequencies (%) were 83.5 vs. 65.3 for ET, 97.3 vs. 98.0 for IV, 74.6 vs. 96.3 for Foley, 68.3 vs. 91.3 for NG 18.4 vs. 47.0 for CT. In the emergency room these frequencies (%) were 26.1 vs. 36.4 for ET, 98.8 vs. 98.7 for IV, 11.0 vs. 97.1 for Foley, 3.2 vs. 95.9 for NG 3.9 vs. 95.2 for CT. The differences in the application of these life saving procedures between the pre-ATLS and post-ATLS periods were statistically significant (p < 0.05) except IV access, which showed no difference between the pre-ATLS and post-ATLS groups. Of the patients with severe chest injuries (AIS ≥ 3) 87.7% had chest tubes post ATLS (94.4% in ER) compared with 48.1% pre ATLS (3.2 % in ER). These differences were associated with significant improvement in trauma patiet outcome post ATLS. We conclude that the frequency of lifesaving interventions, particularly in the ER, was increased post ATLS. This, as well as environmental changes which improved accessibility to such items as chest tubes in the ER, may account for the improved post-ATLS trauma patient outcome.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID