摘要:

This retrospective study analyzed the pattern of injury among rear seat occupants in automobile collisions and compared the incidence and type of injury with that of front seat occupants. During a 2-year study period, 253 persons involved in automobile collisions were admitted to our hospital. Among these patients 168 were drivers, 54 were front seat passengers, and 24 were rear seat occupants. Injuries were classified into the following categories: neurologic, orthopedic, soft tissue, thoracic, and abdominal. No significant differences were observed in the type or extent of injury, in the incidence of permanent disability, or in the mortality rate based on the location of the passengers within automobiles involved in these crashes.

ISSN:0022-5282    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Anesthetized swine were tested for biomechanical and injury responses to lower abdominal steering wheel loading. The lower abdomens of 25 subjects were impacted with a segmented steering wheel. Tests included a wide spectrum of velocities, from 1.7 to 12.4 m/s, and forced abdominal compressions of 7.0%-54.5% of the vertical thickness of the lower abdomen. Lower abdominal injuries included contusions and lacerations of varying severity and frequency in the mesentery, the small and large bowel, the spleen, and the cecum. Logistic regression correlations were performed to assess the probability of severe and greater injury with biomechanical indices such as peak velocity of deformation (Vmax), peak compression (Cmax), peak total force (Fmax), the maximum Viscous criterion (VCmax), and the product of maximum total force and maximum compression (FmaxCmax). Although Cmax, Fmax, and, to a lesser extent, FmaxCmax correlated reasonably well with the probability of severe and greater injury, the maximum Viscous criterion (VCmax) was the best correlate, establishing VCmax as the most effective predictor of an AIS ≥ 4 injury risk for steering wheel loading to the lower abdomen.

ISSN:0022-5282    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

On January 29, 1989, a military aircraft crashed on approach to an airfield in Alaska. The subsequent extraction, evacuation, and casualty resuscitation occurred at temperatures lower than −50° F. Both the medical and military-literature are replete with instructions and advice regarding the handling of trauma victims in the field in the Arctic environment; however; case reviews of such incidents are rare. In this case, the circumstances of the incident, and the organizations on which it fell, argued for almost ideal handling of the care of the victims. Problems that have an impact on the availability of casualty management, generally, in the Arctic such as a widely scattered population and sparse medical facilities, poorly defined evacuation routes, and marginal communication patterns, were not encountered in this review because of the unusual circumstances of this incident. The difficulties of field care in this environment, even under “ideal” conditions, however, are real and evident in this case history. Transportion assets are critical. Rehearsal, critique, refinement, and re-rehearsal of a mass casualty plan can significantly increase victim survival. Proper protocols and confidence in them take on an importance far beyond their benefit in a more temperate environment. Procedures must be worked out in advance, known by all concerned, and practiced, because the “rescuer” is at the same risk of hypothermia as the “victim” and, in addition, is responsible for thinking for the incapacitated patient. Rote-learned drills will be acknowledged far longer in the cold than unspecific guidelines. Survival for trauma victims may depend on those rote actions.

ISSN:0022-5282    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Injuries resulting from falls from heights still constitute a significant portion of urban trauma. At this pediatric trauma center, 70 children were admitted from 1985 to 1988 after sustaining a fall of 10 feet or greater or at least one story. The mean patient age was 5 years and 68% of the patients were boys. Seventy-eight percent of falls occurred from 2 stories or less and usually took place at or near the home. Most patients sustained a single major injury and all survived. The majority of injuries involved the head or skeleton and residual functional deficits were uncommon. The incidence of falls from heights has remained high in urban areas despite public education and building codes that require window guards and safety rails.

ISSN:0022-5282    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The height of a free fall necessary to cause injury to infants and small children is a confusing and controversial issue among health care, law enforcement, and legal professionals responsible for evaluating cases of possible child abuse. To resolve this confusion, the circumstances of falls were recorded prospectively for 398 consecutive victims of falls seen at Children's Hospital, Oakland, California. From these cases, 106 were selected for further analysis where the falls were witnessed by a second person other than the caretaker and the circumstances of the fall were documented. No injuries occurred in 15 patients, including seven falling more than 10 feet. Mild bruises, abrasions, or simple fractures occurred in 77 patients, including 43 falling more than 10 feet. Severe injuries, including intracranial hemorrhages, cerebral edema, depressed skull fractures, and compound or comminuted fractures occurred in 14 patients falling between 5 and 40 feet. However, no life-threatening injuries occurred in the 3 patients who fell less than 10 feet. These three had small, depressed skull fractures without loss of consciousness, from falling against an edged surface. Only one death occurred in this series, resulting from a fall of 70 feet. In conclusion, infants and small children are relatively resistant to injuries from free falls, and falls of less than 10 feet are unlikely to produce serious or life-threatening injury.

ISSN:0022-5282    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The outcome of injury was determined in 317 children who were brought to a children's trauma center with a history from the caretaker that the child had fallen. Cases in which the clinicians' judgment was that an incorrect history had been given were included along with cases in which the history was not questioned. Seven deaths occurred in 100 children who fell 4 feet or less. One death occurred in 117 children who fell 10 feet to 45 feet. The 7 children who died in short falls all had other factors in their cases which suggested false histories. When children incur fatal injuries in falls of less than 4 feet, the history is incorrect. Long falls with an outdoor component are likely to be reliable data points for studies of children's injuribility.

ISSN:0022-5282    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

To determine whether elevations in blood glucose levels were related to neurologic outcomes following severe brain injuries in children, 54 patients 16 years of age or younger admitted to a regional trauma center with a Glasgow Coma Scale score of 8 or less over a 2-year period were retrospectively reviewed. The mean initial blood glucose level on hospital admission was significantly higher in the 16 patients with outcomes of death or vegetative state in comparison with that of the 38 patients with outcomes of good recovery, moderate disability, or severe disability (288 mg/100 mL vs. 194 mg/100 mL,t−2.74,p= 0.03). Blood glucose levels correlated significantly with indicators of the severity of the brain injury, which were also related to outcome. In contrast, blood glucose levels did not correlate with indicators of the severity of the extracranial injuries, although the latter were significantly related to outcome. Logistic regression analysis resulted in a model for prediction of outcome which included the Glasgow Coma Scale score on admission and the initial blood glucose level. The odds ratio of a poor outcome in this model in patients with blood glucose levels ≥ 250 mg/100 mL relative to those with lower levels was 8.3 (95% confidence interval 1.3–53.6). A simple prognostic score was derived from the logistic regression which improved upon the prediction of outcome using the Glasgow Coma Scale score alone in those patients with initial blood glucose levels ≥ 250 mg/100 mL. Our findings cannot address the questions of whether glucose administration after brain injury in children could be deleterious or of whether controlling hyperglycemia could be beneficial, but raise these issues for further study.

ISSN:0022-5282    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The psychological effects of nonneurologic trauma on children are poorly recognized. We hypothesized that physical trauma in children, with or without head injury, would result in substantial and persistent psychological and behavioral abnormalities. Using a short telephone survey followed by a detailed behavioral checklist, we studied psychobehavioral dysfunction in children who had experienced trauma either with or without minor head injury (n = 40 each) as well as in a comparative group of children after emergency appendectomy (n = 80). Substantial behavioral disability was identified by the detailed checklist in 35% and 28% of children without and with head injury, respectively, but in none after appendectomy. Dysfunctions included phobias, major scholastic difficulties, rage attacks, and episodic depression that continued for a long period. Even in the 67% of children who eventually fully recovered, the duration of symptoms after the time of injury was an average of 19 months. Demographics, socioeconomic status, severity of injury, and length of hospitalization did not correlate with dysfunction, and these traumatized children's siblings had no reported history of trauma or psychological difficulties. Thus, parental opinion about behavioral dysfunction appears sensitive and specific and is therefore a useful screening index. These results suggest that injured children, even after minor trauma, may suffer substantial and long-lasting behavioral changes to a degree hitherto unrecognized.

ISSN:0022-5282    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

A number of instruments have been devised to aid in the triage of trauma patients. Little work, however, has been done to demonstrate that these triage instruments offer an advantage over the judgment of an emergency medical technician (EMT) in determining which patients require transportation to a trauma center. The purpose of this study was to compare EMT judgment against three scoring systems; the triage-revised Trauma Score, the Prehospital Index, and the CRAMS scale. Data were gathered on trauma victims transported by the City of Cleveland EMS system. The EMTs rated the patient's overall severity on a 4-point scale and estimated the probability of patient mortality. We found that the EMT prediction of mortality was as accurate as the various scores. In a subset of patients, we also found that the EMT assessment performed as well as the scoring systems in identifying patients who either died or required emergent operative intervention. We conclude that EMT judgment is as accurate as these three scoring systems in identifying patients at high risk for death or the need for immediate operative intervention.

ISSN:0022-5282    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

The aim of the study reported here was to assess the effects of some clinically relevant factors on the incidence and outcome of postburn bacterial translocation. Miniature pigs in 8 groups (n = 6 in each) underwent: (1) general anesthesia (GA); (2) operation (insertion of Swan-Ganz, arterial, and portal catheters) under GA; (3) burn (40% total body surface area, third degree, under GA); (4) burn and operation; (5) burn, operation, and resuscitation (Parkland); (6) burn, operation, and resuscitation plus endotoxin (100 μUg/kg IV bolus, 2nd day). Groups 1–6 were killed at 48 hours and tissue samples were harvested for bacteriologic culture. Groups 7 and 8 were the same as 2 and 5, respectively, but were killed at 96 hours. Resuscitation and endotoxin increased postburn bacterial translocation but only endotoxin promoted systemic sepsis. In the absence of additional trauma, translocated bacteria were cleared by 96 hours postburn.

ISSN:0022-5282    

出版商:OVID    

年代:1991

数据来源: OVID