Injury
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The records of 324 children who were injured in road traffic accidents (RTA) between January 1992 and December 1995 were reviewed to determine the pattern, severity and outcome of their injuries. This represented 2% of all attendances at the emergency room. Pedestrians represented the largest group of patients. ⋯ In 306 children the ISS was 1-25 with no mortality but significant morbidity. Eighteen patients had an ISS of 26-54 with a 61% mortality rate (11 patients). The highest ISS were found in the group of patients who were passengers in a motor vehicle.
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In clinical practice efforts are made to apply a fixation plate on the side opposite the strongest muscle pull. This achieves an optimal distribution of compression between the fragment ends (principle of tension band plating). This is however frequently impossible for anatomical or surgical reasons. ⋯ Later, it may be an indication of secondary instability. The time at which osteons appear, their number and location provides information on the stability of the osteosynthesis. At a time when indirect fracture reduction and stabilization using minimally invasive techniques and implants is being propagated, additional ways and means must be sought to assess clinically the load on the implants and the risk of implant failure.
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Disability following trauma has profound personal, social and economic costs. Currently, measurement of disability is not standardised and no agreed time interval between injury and disability measurement exists. This study was designed to define the best time at which to measure disability following trauma. ⋯ For GOS there was significant change between 3 and 6 months (p < 0.002) and 6 and 12 months (p < 0.002) but not beyond 12 months (p > 0.2). Disability measurements should be performed 12 months after injury, when patients have reached a steady state. This time of measurement should be adopted as the standard for trauma databases and outcome studies.
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Disability and handicap outcome measures are fundamental components of trauma system evaluation. These outcomes are described for survivors of major trauma, attended by the HEMS, London system. Together with measures of injury severity, three functional instruments (Functional Independence Measure (FIM), Glasgow Outcome Scale (GOS) and return to pre-injury work status (RTW)) were used to measure outcome in 201 trauma patients. ⋯ Division according to severity of principal injury confirmed the greatest disability and handicap resulted from the severest injuries (AIS 4-5): 68.9% achieved independence in Motor FIM, 73% in Cognitive FIM and only 40% returned to work. When grouped according to body region of principal injury, neurological injury, particularly severe injury (AIS 4-5) to head and spinal cord regions showed the poorest outcomes. FIM, GOS and RTW are recommended as standard indicators of disability and handicap for trauma registries and outcome studies.