摘要:

From January 1989 through December 1990, 74 patients were admitted to our urban level I trauma center with injuries inflicted by baseball bats. We investigated the demographics and dynamics of injury in these patients by retrospective analysis of the patient's medical record and Trauma Registry data. The average victim was 30 years old. Ninety-two percent of the patients were male, and approximately 89% tested positive for substance abuse. Injury to both the head and body occurred in 80% of our patients, isolated head injury occurred in 42%. Twenty percent suffered injury to the body only. On admission, 7% went directly to the operating suite, 16% were admitted to the trauma ICU, one patient was admitted to the pediatric ICU, and the remainder were admitted to the floor shock/trauma unit. These patients had a length of stay (LOS) that was not significantly different than the LOS for patients with penetrating trauma or the general trauma population. The mean Trauma Score was 13.8 (range, 6–16), and the average Injury Severity Score was 10.5 (range, 1–34). The mortality in our study was 3%. Four percent of the patients were left with some degree of permanent disability. Intentionally inflicted injury is most commonly seen in the thorax and abdomen. In contrast, head injury was evident in 80% of our patients with baseball bat injury. This represents a departure from classic patterns of violent injury.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The capacity to induce immunoglobulin (Ig) secretion by soluble T-cell-replacing (TCR) factors derived from alloantigen-stimulated T lymphocytes of blunt trauma patients (n = 15, mean ISS = 24) was examined in Staphylococcus aureus (SAC)-activated normal B-cell cultures. The majority of the patients studied demonstrated a profound suppression of the T-cell-dependent, pokeweed-mitogen-induced Ig production. However, the activity to induce Ig secretion associated with TCRs from the same patients was not reduced compared with that of TCRs from normal subjects. IgM synthesis was normal and IgG secretion induced by TCRs was within the control range (in 6 of 15 patients) or significantly higher (p < 0.05) than that in the remaining patients. Both patient-derived and control TCRs failed to induce Ig synthesis in cultures of resting B cells and had comparable mitogenic effects on normal SAC-activated and phytohemagglutinin A-activated B and T lymphocytes, respectively. Thus, the intrinsic ability of T lymphocytes to produce B-cell helper factors appears to be unaffected following blunt trauma. Suppression of the T-cell-regulated Ig secretion in traumatized patients may therefore reflect an altered B lymphocyte response to such factors.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Thirty-six patients with Allman group-2 fractures of the clavicle were treated by ORIF with 2.7-mm ASIF dynamic compression plates. The indications for surgery were an open fracture in one patient, ipsilateral fractures of the arm or the ribs in five patients, bilateral clavicular fractures in one patient, and an inability to reduce the fracture in all other patients. There were no instances of deep infection. One patient suffered a refracture after plate removal; three patients developed pseudarthrosis because plates that were too short were used. The total failure rate was 12%. It is concluded that the 2.7-mm DCP is the method of choice for internal fixation of midshaft clavicular fractures and that a minimum of three screws should be placed in each fragment.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Traumatic injury to the diaphragm is a relatively uncommon injury with potential for considerable morbidity if the diagnosis is delayed or missed. This review of cases of traumatic diaphragmatic injury was undertaken in order to emphasize methods and timing of diagnosis and treatment. From 1986 through 1990, 43 cases of traumatic diaphragmatic injury were admitted to the trauma unit at Sunnybrook Health Sciences Centre, for an incidence of 2% of all new multiple trauma admissions. All patients were evaluated and treated by a dedicated trauma team. The left hemidiaphragm was injured in 32 patients, the right hemidiaphragm was injured in eight cases, and the injury was bilateral in three patients. Thirty-four patients had blunt trauma. The mean Injury Severity Score for all patients was 32. The diagnosis of diaphragmatic injury was made radiologically in 21 cases and at surgery in 22 cases. The diagnosis in all cases with penetrating trauma was made at the time of surgery. The interval between injury and definitive surgery was less than 12 hours in 39 of 43 patients. The diagnosis of diaphragmatic injury was delayed by more than 12 hours in only one patient. The other three patients were diagnosed soon after injury but their definitive surgery was delayed for other reasons. Surgical repair of the diaphragm was performed via laparotomy in 40 of 43 cases. Only one patient was repaired in a delayed fashion by thoracotomy for thoracic complications. A clear contrast can be drawn between blunt injuries and penetrating trauma. The injuries from blunt trauma were associated with other injuries and thus higher injury severity. The penetrating injuries were associated with hypotension and were operated on more quickly. The overall death rate was 30% (13 of 43). The causes of death were severe head injury (n = 8), hypovolemic shock (n = 3), and multiple organ failure (n = 3). No death was directly related to the diaphragmatic injury.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The Integrated Trauma Program (ITP) is the cooperative trauma triage service of the University of Toronto trauma and burn hospitals and the Ontario Ministry of Health. It provides physicians in referring hospitals direct access to a trauma team leader (TTL) in one of several trauma centers through a single phone number. Three adult trauma centers, one pediatric trauma center, and one burn center, all affiliated with the University of Toronto, participate in this program. This article describes the system during the first two years of operation. From July 1989 to June 1991, 1530 requests for patient transfers from a total of 97 hospitals were processed. Of these transfer requests, 77% were accepted by the TTL to a trauma service as multiple trauma cases, 16% were accepted directly to a surgical service without involving the trauma team, 4% were refused by the TTL as inappropriate referrals, and 3% of requests were cancelled by the referring physician. The transfer requests are distributed to a specific trauma center by request of the referring physician (10%), according to a rotation (70%), or as selected by the ITP (20%) when the scheduled hospital is not readily available. Closure of all adult trauma centers occurred on 43 occasions. During these closures, 48 patients bypassed the Toronto trauma centers and were transferred to other cities. The ITP office also keeps an ongoing data base of patients transferred. The mechanism of injury in the majority of cases is vehicular crashes. The mean Injury Severity Score is 24 for adults and 17 for children. During the first two years of operation the ITP has provided a simple, rapid, and effective service for trauma referrals. Some of the frustration faced by referring physicians forced to make multiple enquiries in order to place a trauma patient has been removed. Cooperation among trauma centers for sharing the distribution of trauma cases has resulted in no appreciable change in trauma volumes at each of the centers. The system allows for efficient use of all trauma center resources. This program serves as a model for cooperative trauma case triage and distribution.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Flora's Z statistic and standardized mortality ratios (SMRs) as indicators of excess mortality were calculated for a sample of 355 patients with major trauma. A statistically significant overall excess mortality was observed in this sample (Z = 6.77, SMR = 1.81, p < 0.05). Advanced life support provided by physicians at the scene (MD-ALS) was not associated with reduced excess mortality. A significant trend toward lower excess mortality was associated with a higher level of trauma care at the receiving hospital (p < 0.05). Total prehospital time over 60 minutes was associated with a significant increase in excess mortality (p < 0.001). These results support regionalization of trauma care and failed to show any benefit associated with MD-ALS.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Pediatric trauma centers often do not meet the guidelines requiring a trauma team as recommended by the American Academy of Pediatrics (AAP). We reviewed our experience with a team consisting of a pediatric emergency physician, resident, nurse, and respiratory therapist. The surgical and pediatric critical care residents and staff were available within 5 minutes. We conducted a retrospective chart review of 146 patients (aged 8.1 ± 4.8 years) between 1987 and 1989, with Injury Severity Scores (ISS) ≥ 16 or admitted to the pediatric critical care unit. The time of presentation, surgical services consulted, and the nature of the injury were obtained from chart review. The Pediatric Trauma Score (PTS), the Revised Trauma Score (RTS), the Injury Severity Score (ISS), Glasgow Coma Scale (GCS) score, and Pediatric Risk of Mortality (PRISM) were used to determine the severity of insult and physiologic derangement on admission. The Modified Injury Severity Score (MISS) was determined and the Delta score for Disability Assessment was assigned at discharge. The Delta score was also determined at 3-month intervals up to one year. The probability of survival (Ps) was calculated, using the ISS and RTS. The Z statistic for this group of patients was then determined, using the Major Trauma Outcome Study (MTOS) methodology. The percentages of patients who were normal, disabled, and dead were 61%, 31.5%, and 7.5%, respectively, at 6 months follow-up. Eleven deaths were expected based on PRISM and TRISS analysis. Our mortality and morbidity figures were comparable with those of centers with teams based on AAP guidelines. Further studies are required to define the necessity for a full team in the initial management of pediatric trauma patients.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The ability of level I trauma units to operate efficiently may be hampered by the presence of a number of patients with an excessive length of stay (LOS). In an attempt to determine causes for and suggest potential solutions to the long-term occupation of beds in an acute care trauma facility, the cases of patients with extended LOSs in a level I trauma unit were examined. Study patients were survivors admitted between January 1, 1986, and December 31, 1989. Patients with a LOS greater than one standard deviation above the mean (n = 221) were assigned to the Long LOS group, and the remaining 1250 patients to the Short LOS group. Long and Short LOS patient groups were compared on a number of variables including Injury Severity Score, number of body systems injured, surgical procedures required, blood products used, AIS scores per body region, and patient wait days. Both an increased severity of injury and a lack of available chronic and rehabilitation beds for the head-injured patients contributed to excessive patient LOS in this acute care setting. Additional rehabilitation and chronic care beds are required to free acute care beds for the efficient operation of a level I trauma unit.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

The bacterial translocation hypothesis was tested in two studies (acute and subacute) in a porcine model of hemorrhagic shock. Male pigs (30–40 kg each) under general anesthesia had their femoral vein, femoral artery, and portal vein catheterized. After stabilization (1 hour) they were bled (40% of blood volume) over 30 minutes, then maintained in the hypotensive state (MAP = 30–40 mm Hg) for 2 hours, following which, according to randomization, they entered the control group or were resuscitated with whole blood (WB group) or with lactated Ringer's solution (LR group). In the acute study, the mesenteric efferent lymphatic was also cannulated, the control group was not resuscitated, and the animals remained under general anesthesia to the end of the experiment (8.5 hours), when gut tissue was obtained for histologic study and measurement of lipid peroxidation. In the subacute study, the control group was not bled, the animals were awakened at 6.5 hours, and the portal vein catheter remained in situ until 48 hours. In both studies, samples of portal blood were obtained for culture at regular intervals and on completion, samples from mesenteric lymph nodes (MLNs) for culture were taken in the acute study, and in the subacute study samples from MLNs, spleen, and liver were obtained. In the acute study significant bacterial translocation to the MLNs and portal blood did not occur among the controls (n = 3), the LR group (n = 5), and the WB group (n = 6). Significant evidence of lipid peroxidation was found in both the LR and WB groups. Histologic assessment showed no difference among the groups. In the subacute study, bacterial translocation to the MLNs occurred in all groups. While bacterial translocation to the liver, spleen, and portal blood occurred sporadically, there was no significant difference among the controls (n = 5) and the groups resuscitated with WB (n = 4) and LR (n = 6). In this model, significant bacterial translocation to the liver, spleen, and portal blood did not occur as a result of ischemia or reperfusion, despite profound shock and significant evidence of lipid peroxidation after resuscitation. Late translocation to MLNs did occur in all groups, but its importance in the development of multiorgan failure remains to be elucidated.

ISSN:0022-5282    

出版商:OVID    

年代:1992

数据来源: OVID