摘要:

This study analyzed age as a univariate factor in survival in a national group of 46,613 major trauma patients and compared 180 elderly major trauma patients (≥65 years) to a similarly injured group of 3,918 younger patients (<65 years). In the national group, mortality rose sharply between age 45 (10%) and 55 (15%) and doubled at age 75 years (20%). This age-dependent survival decrement occurred at all Injury Severity Score values, for all mechanisms of injury, and for all body regions. In the comparison study, mortality in the elderly group was nearly double that of mortality in the younger group (27% vs. 14%). The older patients had a markedly higher complication death rate, especially for pulmonary (14/100 vs. 6.1/1100) and infectious complications (4.6/100 vs. 0.7/100). The median length of stay was twice as long for the older patients (14 days vs. 7 days). Cost data showed that the DRG prospective payment system grossly underestimated the cost of care for these patients (mean loss of 2,177.14 per patient). To minimize mortality and morbidity, triaging elderly trauma victims to trauma centers at a much lower threshold than similarly injured younger patients is recommended. The current DRG system should be altered to account for age-dependent morbidity. Further study is needed to determine whether more rigorous infection prophylaxis, immunomodulation, and pulmonary therapy will augment survival in elderly patients.

ISSN:0022-5282    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Compartment syndromes occur following lower extremity injuries and have been associated with the use of pneumatic or “medical” antishock trousers (MAST). Review of 12 previously reported cases and 15 new cases suggests that lower extremity trauma and systemic hypotension are cofactors responsible for the development of compartment syndrome but MAST use also contributes to the process by prolonging muscle ischemia. Complications of lower limb compartment hypertension may be averted by early recognition and fasciotomy. Associated amputations and mortality are directly related to the severity of injury, or indirectly to delay in diagnosis and treatment of the compartment syndrome and its complications.

ISSN:0022-5282    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

A 3-year prospective study was conducted to establish the incidence of traumatic brain injury (TBI) and related characteristics of age, sex, length of stay (LOS), intensive care unit LOS (ICU/LOS), direct hospital charges, and reimbursement using a prospective DRG-based reimbursement system. The study identified TBI patients using ICD-9-Codes. The mean LOS for the two groups of patients with intracranial injury differed (p <0.05). Those with such an injury accompanied by a fracture stayed 1.8 days less in the ICU and 6.0 days less overall.Direct hospital charges for all TBI patients were 14,138,036 (mean, 11,645). Using Medicare weights and hospital-specific rates/DRG, the DRG reimbursement was 6,689,293. Thirty-day outliers (those who stayed ten times the geometric mean length of stay) provided an additional 526,389 leaving a total non-reimbursable figure of 6,922,354, or 49% of total charges. Of the 71 DRGs assigned to the study population, 15 reimbursed more than the actual charges.The severity of TBI victims and the complexity of caring for them in a Level I trauma center generates hospital charges of which only half are reimbursed through an all-payor DRG system. Strategies to correct what could be a financial disincentive are: documenting the uniqueness of this population to justify additional reimbursement, caculating a more precise mean LOS for TBI-related DRGs to more accurately identify outliers, and calculating DRG rates for TBI diagnoses derived from a representative sample at varying severity levels and hospitalized in facilities with and without rehabilitation services.

ISSN:0022-5282    

出版商:OVID    

年代:1989

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Early fixation of extremity fractures in polytrauma patients is a well accepted and desirable treatment. In our patient population, the indications for immediate Ender nail fixation was for Grade I and Grade II open long bone fractures and closed long bone fractures in patients with small intramedullary canals. Ender nails were also used in patients in whom reaming was undesirable. This included patients with open physes for immediate fracture fixation and in those with Grade III open wounds in a delayed fashion. These flexible nails were also implemented for use to minimize anesthesia time as a life saving measure in the severely injured. This study is a retrospective review of a 30-month period in which 68 patients with 91 fractures underwent Ender intramedullary nailing. The mean Injury Severity Score (ISS) was 12.4. There were 16 humerus fractures, 26 femur fractures, and 49 tibia fractures. Thirty-three per cent (30 fractures) were open fractures. The average operating time per fracture was 70 minutes (range, 15 to 150 minutes). The estimated blood loss per fracture was 150 cc with a range of 25 to 500 cc. The average followup is currently 19 months (range was 8 to 29 months). This approach achieved an excellent result in 95% of the patients treated. There were no wound, soft-tissue, or bony infections experienced. Major complications were seen in five patients: three nonunions and two malunions.Based on our experience with Ender nails, we feel that this procedure is an excellent alternative for reamed internal fixation in cases where reaming is contraindicated, where the intramedullary canal is very small, and in severely injured polytraumatized patients where the anesthesia time must be minimized.

ISSN:0022-5282    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Nineteen patients with 20 clinically occult arterial injuries were prospectively followed without surgery in order to define the natural history of these lesions. The patients were predominantly male (74%), with a mean age of 31 years. The mechanism of injury was penetrating in 13 cases and blunt in seven cases. The arterial injuries were located in the lower extremity (45%), upper extremity (35%), neck (15%), and abdominal aorta (5%). Neurologic trauma (55%) and musculoskeletal trauma (40%) were the most common associated injuries. There was no clinical manifestation of vascular injury in any case. All lesions were identified by arteriography, which was performed for high-risk blunt trauma and proximity of penetrating wounds to major vessels. Intimal flap was the most commonly demonstrated form of injury (65%), followed by focal narrowing (30%) and false aneurysm (5%). Followup of 19 injuries (95%) was obtained for periods ranging from 3 days to 19 months (mean, 3.8 months). Arteriographic followup was obtained in 15 cases (79%). One injury (5%), a false aneurysm, enlarged after 10 weeks and was surgically repaired without clinical sequelae. All other lesions either resolved (53%), improved (16%), or remained unchanged (26%). These results suggest that nonoperative observation may be a safe and feasible method of managing clinically occult arterial injuries.

ISSN:0022-5282    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Between January 1, 1984, and June 30, 1987, we performed percutaneous catheter drainage (PCD) of 28 intra-abdominal abscesses in 21 postoperative trauma patients. During this period only three patients had abdominal reexploration for drainage of abdominal abscess. The PCD patients were predominantly young men who had sustained penetrating abdominal injuries (81% GSW or SW; 19% MVA). Seventeen (81%) patients had multiple abdominal organ injuries with the colon being the most frequently injured (57%). Multiple abscesses were identified in 33% of the patients.All 21 patiants had successful treatment of their abscesses by PCD alone. There was one complication (4.8%) from PCD (pneumothorax) and no deaths in this group. Our data suggest that in most cases, PCD can be safe, effective, and definitive treatment for postoperative intra-abdominal abscesses following abdominal trauma. We recommend PCD in all postoperative trauma patients who develop accessible abdominal abscesses before resorting to re-exploration.

ISSN:0022-5282    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Two hundred fifty consecutive children hospitalized with severe injuries (at least one injury with an Abbreviated Injury Score [AIS] ≥ 4 or two or more injuries with AIS scores ≥ 2) were studied to determine their functional status at discharge and 6 months later using questions from the RAND Health Insurance Study (HIS) and the Glasgow Outcome Scale (GOS). Of the 217 surviving patients, 190 (88%) had one or more functional limitations by the HIS scale at discharge. Ten (5%) were in a vegetative state, 40 (18%) severely disabled, 97 (45%) moderately disabled, and 70 (32%) healthy by the GOS. Six-month followup was complete for 156 patients. Of these, 84 (54%) had one or more functional limitations by the HIS scale. Seven (4%) were in a vegetative state, 17 (11%) severely disabled, 50 (32%) moderately disabled, and 82 (53%) healthy by the GOS. A substantial proportion of the whole group of children hospitalized for the treatment of severe injuries had ongoing physical disabilities that limited their participation in normal activities 6 months after they were discharged. This suggests a need for greater emphasis on the rehabilitation of pediatric trauma patients.

ISSN:0022-5282    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Spinal cord injury can be devastating. Cervical spine roentgenography has been recommended in all severe multisystem trauma patients but little attention has been given to the thoracic spine. In a series of 266 motorcycle accident victims, seen over a 42-month period, 13 cases of thoracic spine injury were identified. During this same time interval four cases of cervical spine injury were idntified. Eleven of the 13 cases involved a catapulting ejection from the motorcycle and resultant axial loading to the thoracic spine. Thoracic spine injuries are more common in these patients and therefore the thoracic spine should be immobilized until full thoracic spine roentgenography can be carried out.

ISSN:0022-5282    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Twenty years ago, we reviewed the pediatric surgical experience with traumatic pancreatitis and pseudocysts at a large children's hospital. That series encompassed 13 years, during which time 23 cases were found. Six of these had pseudocysts, five of which were managed by external catheter drainage and one by excision. The present series spans 10 years and consists of nine cases of post-traumatic pediatric pancreatitis, seven of which progressed to pseudocysts. Four of these were externally drained, one was excised, and two resolved spontaneously. We have reviewed this recent experience in order to re-evaluate the efficacy of external drainage of pseudocysts in pediatric patients. We continue to believe that external drainage is the most effective method of therapy. Internal drainage is usually unnecessary unless the drainage from the ductal disruption does not resolve.

ISSN:0022-5282    

出版商:OVID    

年代:1989

数据来源: OVID