Injury
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Multicenter Study
Is routine portable pelvic X-ray in stable multiple trauma patients always justified in a high technology era?
According to the Advanced Trauma Life Support, portable pelvis radiography (PXR) is mandatory in multiple trauma patients, and is performed following initial clinical evaluation. The purpose of an early PXR is to identify pelvic fractures that may have haemodynamic consequences. Today, ultrafast multi-detector CT scanners (MDCT) are readily available and widely used in the evaluation of stable trauma patients. The objective of this study was to determine the impact of PXR in stable blunt multiple trauma patients, who required CT scan for full evaluation of the abdomen and pelvis. ⋯ PXR in stable blunt multiple trauma patients did not change the therapeutic policy in our patients. CTA of the abdomen and pelvis is the imaging modality of choice in blunt multiple trauma, regardless of the findings of PXR. Benefit of routine PXR is questionable in hospitals where MDCT is available. Based on our results, we suggest re-evaluating the current practice of routine mandatory portable pelvis radiography.
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In order to cope with bed shortages in the only neurosurgical unit (NSU) in KwaZulu-Natal, it has become necessary to manage head injured patients in a general surgical unit (GSU) at the referral hospitals in consultation with the NSU. This study was undertaken to assess the outcome of patients with head injuries managed in a GSU in consultation with a regional NSU. ⋯ Head trauma is associated with high morbidity and mortality. Non-surgical treatment of traumatic brain injury at the referral hospital by the GSU is acceptable practice. Outcome is determined primarily by the GCS on presentation. NSU patients had a significantly higher mortality rate. A delay before surgery did not seem to affect outcome.
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Time-critical care of seriously injured patients is gaining more and more significance. The availability of the multi-slice CT allows a complete diagnostic assessment of injured patients in 90-240 s, but is presently carried out only at the conclusion of basic diagnostics. We investigated the effects of a clinical algorithm using multi-slice CT scanning ahead of other measures in the clinical care of seriously injured patients. ⋯ A new algorithm for trauma patient care that integrates high resolution CT scanning into the early diagnostic protocol reduces the length of stay in the trauma room markedly, and will facilitate rapid therapeutic intervention in patients with unstable haemorrhagic shock or neurosurgical emergencies.
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To describe the incidence and characteristics of unintentional fall-related injuries at home resulting in death or hospital inpatient treatment among working-aged New Zealanders. ⋯ A significant proportion of unintentional fall-related injuries among the working-age population occur at home. Until the aetiology of fall-related injury in this age group is better understood, future research should focus on identifying modifiable risk factors that can be targeted to reduce the burden of these injuries and their consequences in a context where the adverse impact on economic productivity is particularly high.
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Acute compartment syndrome represents a severe complication after trauma of the lower extremity. To date, there is limited knowledge about the outcome of compartment syndrome of the lower limb in patients with multiple injuries. We hypothesised that multiple injuries worsen the long term results of compartment syndrome of the lower leg. ⋯ No difference was seen between the two groups regarding pain and function. Polytraumatised patients did not suffer from worse long term effects regarding sensory or motor deficits. Associated injuries did not seem to influence the outcome of the compartment syndrome.