J Trauma
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Trauma outcome variables before and after the institution of the Advanced Trauma Life Support (ATLS) program were compared for the largest hospital in Trinidad and Tobago from July 1981 through December 1985 (pre-ATLS) and from January 1986 to June 1990 (post-ATLS). A total of 199 physicians were ATLS trained by June 1990. Outcome data were analyzed for all dead or severely injured patients (ISS > or = 16; n = 413 pre-ATLS and n = 400 post-ATLS). ⋯ Although there was a higher percentage of blunt injury pre-ATLS (84.0%) versus post-ATLS (68.3%), the mortality rates for both blunt and penetrating injuries were higher in the pre-ATLS group (19.7% pre-ATLS vs. 6.3% post-ATLS for penetrating and 76.6% pre-ATLS versus 46.2% post-ATLS for blunt). For each ISS category, mortality was greater in the pre-ATLS group (ISS > or = 24 pre-ATLS mortality 47.9% vs. 16.7% post-ATLS; ISS 25-40 pre-ATLS mortality 91.0% vs. 71.0% post-ATLS). The overall ratio of observed to expected mortality based on the MTOS data base was lower for the post-ATLS period (pre-ATLS ratio 3.16; post-ATLS ratio 1.94).(ABSTRACT TRUNCATED AT 250 WORDS)
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Fractures of the femur caused by gunshots are increasingly common. There is no standard treatment of these fractures since there are no clear guidelines relating these injuries to open fracture classification. We reviewed our experience with such fractures, which included 65 patients who had an immediate reamed intramedullary nail placed as treatment. ⋯ We found that all patients healed with no infections. The overall morbidity and average hospital stay were decreased compared with studies advocating delayed intramedullary nailing and prolonged intravenous antibiotics. We recommend that patients with fractures of the femur caused by gunshots are candidates for immediate reamed intramedullary nailing providing that there is only mild to moderate soft-tissue contamination and no evidence of major devitalization.