Annals of emergency medicine
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Multicenter Study Comparative Study
Comparison of the effectiveness of trauma services provided by secondary and tertiary hospitals in Malaysia.
The trauma services provided by 6 hospitals operating at 2 levels of care (4 secondary or district general hospitals and 2 tertiary care hospitals) in Malaysia are compared in terms of mortality and disability for direct admissions to emergency departments to test the hypothesis that care at a tertiary care hospital is better than at a district general hospital. ⋯ Care at a tertiary care hospital was associated with reduced mortality (by 83% in severe injuries), but with a higher likelihood of disability and impairment, which has implications for improving access to trauma services for the severely injured in Malaysia and other low- and middle-income settings.
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Multicenter Study
Effect of intoxication among blunt trauma patients selected for head computed tomography scanning.
We examine the prevalence and types of intracranial injuries sustained by intoxicated blunt trauma patients. ⋯ The prevalence of intracranial injury among intoxicated blunt trauma patients who are selected for head CT is lower than among nonintoxicated patients selected for imaging, which likely represents heightened concern in the presence of intoxication, even without other findings suggestive of intracranial injury. This conclusion is supported by the fact that few intoxicated patients with normal neurologic findings and no evidence of trauma to the calvarium had positive findings on CT imaging.