摘要:

The weapons used in blunt head trauma cases were identified to determine if a particular weapon was associated with a specific type of intracranial injury or a poorer neurologic outcome. A consecutive sample of 178 patients was examined. Forty-seven percent of patients beaten with baseball bats and 63% of patients beaten with fists had positive computed tomographic (CT) findings. Twenty five percent of patients beaten with bats and 48% of those beaten with fists had poor neurologic outcomes (p< 0.056). Of those with positive CT findings, 30% of patients beaten with bats and 59% of patients beaten with fists had a poor outcome (p= 0.511). No weapon was associated with a particular intracranial injury. Of assault victims who survive an attack and require admission to the hospital, those beaten with bats are less likely to have significant neurologic dysfunction upon hospital discharge than those beaten with fists.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The position of transcondylar small-caliber drill tunnels after reinsertion of femoral avulsions of the anterior cruciate ligament (ACL) including avulsions with bone or cartilage fragments, which escape objective verification by conventional roentgenography, was determined in 20 patients by an examination procedure using computed tomography. Coronary tomograms were used for three-dimensional reconstruction of the distal end of the femur and assessment of the position of the perforation sites in the area of the medial aspect of the lateral condyle as well as the distance between them in patients in whom two Kirschner wires had been used (16 patients). A correct position had been achieved only in 4 of the 16 cases with double reinsertion and in one of four cases in which a single Kirschner wire had been used. With exception of one only partially correct placement, localization was found ventrally from the transition line with a predominantly caudally directed component. Assuming a mean thickness of the anterior cruciate ligament of 5 mm, the distance of the drill tunnels in five cases met the anatomic requirements, was too small in six cases, too large in three cases, and could not be evaluated adequately in two cases. The results of the present study illustrate vividly the problems of the surgical technique of Palmer.

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

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

In a retrospective study of 476 surgical orthopedic trauma patients, we compared postoperative infection rates between individuals seropositive for the human immunodeficiency virus (HIV) and with no associated clinical symptoms with HIV-seronegative patients. Overall, the surgical postoperative infection rate was 16.7% in seropositive patients and 5.4% in the seronegative group (Chi-square,p= 0.035). When open fractures were considered separately, the seropositive group had a 55.6% infection rate compared with 11.3% in the seronegative group (Fisher's exact test,p= 0.004). Similarly, seropositive patients also had significantly increased rates of postoperative non-wound infections and complications (Chi-squarep< 0.001). Asymptomatic HIV-seropositive orthopedic trauma patients are at significantly higher risk for postoperative infections than their seronegative counterparts. For HIV-seropositive patients with open fractures, this risk is especially pronounced.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

A possible way to circumvent the continuing decline in the number of autopsies is to perform computed tomography after death. The present study compares the pathologic findings of postmortem CT tomography (PMCT) in trauma fatalities with those disclosed upon conventional forensic autopsy. Within 6 hours of death, the bodies of 25 trauma victims underwent total body CT scanning, all with permission of the relatives, followed by conventional autopsy in 13 cases under court order. The pathologist and roentgenologist were unaware of each other's findings. The pathologic findings of PMCT plus conventional autopsy provided more information than either examination alone. Of the total 127 pathologic findings, 44.9% were diagnosed by both conventional autopsy and PMCT, 29.9% were not revealed by PMCT, whereas conventional autopsy missed 25.2%, and PMCT detected more bone injuries than did autopsy, whereas the latter was superior to PMCT in discovering soft-tissue pathologic states. In all, PMCT revealed 70.5% and autopsy 74.8% of the pathologic states. Although PMCT was not more effective than conventional autopsy in exposing pathologic entities, it increased the yield of findings when combined with conventional autopsy. Where conventional autopsy is unattainable, PMCT may be effective in shedding light on the pathologic state and mechanism of death in trauma fatalities.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

This study was designed to document the reasons hospitals have been unsuccessfully peer reviewed as potential trauma centers.Method: 120 trauma center reviews were performed by a peer review program between September 1987 and December 1992 using the American College of Surgeons (ACS) criteria. Fifty-four hospitals had criteria deficiencies. These reviews were studied for criteria deficiencies for each hospital with documentation of frequency and relationship to re-review outcome.Results: There are 108 ACS criteria. The 54 hospitals had various combinations of 28 different criteria deficiencies. Deficiencies ranged from 1 to 15 per hospital. Thirty-one hospitals underwent a second review. Twenty-five hospitals had corrected the deficiencies and were verified. No hospital with over 8 deficiencies was subsequently verified. The Quality Improvement program was the most common deficiency (74%) and was correctable (50%). Other frequent deficiencies were no trauma service (46%), no surgeons in ED (41%), inadequate neurosurgeon response (35%), no trauma corrdinator (31%), no trauma registry (28%), lack of surgical commitment (26%), and lack of 24 hour OR availability (24%). The lack of surgeon or hospital commitment accounted for most of the 28 criteria deficiencies. Subsequent verification was notably poorer for hospitals seeking verification for the purpose of designation versus verification only (29% versus 75%). Only 1 hospital with a prior ACS consultation visit failed the first verification review.Conclusions: A limited but critical set of criteria enable a hospital to function as a trauma center. Trauma quality improvement is a poorly understood but a correctable issue. Surgical and hospital commitment are essential for verification. Prior consultation may be of benefit.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Quality assurance/quality improvement (QA-QI) is a priority for maintaining the highest standards of care in trauma systems. To be an effective tool for system review, the QA-QI indicators should identify patients with higher rates of morbidity and mortality from injury. While the American College of Surgeons (ACS) and the Joint Commission on Accreditation of Health Care Operations have identified certain audit filters within the trauma system, there are few data to substantiate the value of these audit filters for trauma care. The purpose of this study was to outcome following injury requiring review. The study population consisted of 44,019 patients from the North Carolina State Trauma Registry from 1987 to 1992. Of the 22 audit filters nine were available for analysis. Mortality rate, length of stay, and total charges were used as measures of outcome. The hypotheses tested were that patients who met the indicator criteria would have higher mortality rates and worse outcomes than the non-indicator group. Student'sttest and Chi-square analysis were used to test the differences between the group which met the criteria for the indicator and those without. Of the nine audit filters tested, only three were found to have significantly worse outcomes than their non-indicator comparison group: gunshot wound to the abdomen with non-surgical management, femur fracture without fixation, and complications from pulmonary embolism-deep vein thrombosis-decubitus ulcer (p< 0.05). Contrary to expectations, four of the audit filters, coma without intubation, laparotomy > 2 hours, transfer > 6 hours, and admission to non-surgical service, actually had significantly better outcomes than their non-indicator counterpart. Scene time > 20 minutes, laparotomy > 2 hours after arrival, and craniotomy > 4 hours after arrival may be indicators of patients at risk for morbidity. This study demonstrates that several ACS clinical indicators, as currently written, are not useful in identifying patients at higher risk for poor outcome. The indicators need further definition to be of value in the quality review process. Specifically, the study suggests that audit filters should be data driven and based upon analyses of large populations of injured patients and their outcomes to be valid QA-QI tools.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The National Acute Spinal Cord Injury Study II concluded in 1990 that high-dose methylprednisolone (MP) improved neurologic recovery after acute spinal cord injry (ASCI). We tested this conclusion by analysis of 54 patients with ASCI; 25 patients were treated without MP before 1990 whereas 29 patients were treated with MP after 1990. Neurologic deficit was assessed regularly, in most cases daily. Motor and sensory scores on admission, and best results at one-half week (days 2 to 4), 1 week (days 6 to 10), 2 weeks (days 11 to 21), 1 month, and 2 months were noted for both groups. Motor assessment was recorded in 22 muscle segments on a scale of 0 (complete deficit) to 5 (normal); the range, thus, was 0 to 110. The 23 patients with closed injuries demonstrated no difference in improvement with or without MP. In contrast, MP was associated with impaired improvement in the patients with penetrating wounds; the 15 patients with no MP therapy had an admission motor score of 49, which increased by 6.9 at one-half week, whereas the 16 patients treated with MP had an admission motor score of 48, which decreased by 0.3 at one-half week (p= 0.03). The neural status seen by day 4 persisted throughout the next 2 months. Changes in sensation paralleled the changes in motor function. We conclude that MP therapy for penetrating ASCI may impair recovery of neurologic function.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Early nutrition is advocated for patients with head injury to counter the postinjury hypermetabolic state. The gastric route of feeding often leads to vomiting and aspiration pneumonitis. This study was designed to identify the role of lower esophageal sphincter (LES) function in this complication. The LES function was assessed within 72 hours of admission in 16 patients with a head injury and a Glasgow Coma Scale (GCS) score less than 12 (range, 3–11). Other admission assessments included an APACHE II score of 11.7, Injury Severity Score (ISS) of 30.5, and a Revised Trauma Score (RTS) of 6.4. These studies were repeated 1 week postinjury in five patients. Dysfunction of the LES was present in all 16 patients; the average gastric-to-esophageal pressure difference was −0.49 mm Hg (range, −0.59 to 2.5) compared with a normal value of greater than 20 mm Hg. The five patients restudied at 1 week had a gastric-to-esophageal pressure difference of 13.3 mm Hg (range, −3.4 to 36.6 mm Hg). The single patient with a GCS score below 12 at 1 week had a low LES tone. These data show that LES dysfunction accompanies acute head injury and contributes to aspiration pneumonitis after early gastric feeding. Nutrition in patients with low GCS scores should be parenteral or via the jejunum.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID