J Trauma
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To determine if trauma patients qualifying by a 1990 American College of Surgeons (ACS) audit filter have the same outcomes and resource utilizations as similar (matching) patients not qualifying by the filter. ⋯ Additional studies of the efficacy and efficiency of trauma quality assurance filters are needed. Objective criteria should be established for the definition, evaluation, modification, and adoption of trauma audit filters.
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Great emphasis is placed on the lethality of modern high-powered street weapons, and their impact on mortality from firearm injuries. Presented is a case of an air rifle BB injury to the chest, resulting in a penetrating injury of the right heart, with apparent retrograde embolization to the inferior vena cava. ⋯ This case exemplifies three important principles regarding penetrating chest trauma and air guns: (1) Modern air rifles, capable of muzzle velocities as high as 900 fps, are intrinsically lethal weapons; (2) missiles within the cardiovascular system have a propensity for embolization, and often follow an intuitively unexpected course; and (3) young healthy patients with potentially lethal penetrating cardiac injuries, particularly those caused by low velocity firearms, may appear stable and minimally injured in the emergency room. A strong suspicion of cardiac injury and prompt intervention should be extended to airgun injuries of the thorax.
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Open reduction and internal fixation of unstable posterior pelvic ring injury provides better bony stability and less long term morbidity than nonoperative treatment. However, open reduction and internal fixation of the posterior pelvis may involve substantial intraoperative blood loss, reported infection rates of 6 to 25%, and wound complications in 25%. Our hypothesis was that percutaneous cannulated iliosacral screws placed by fluoroscopic control would provide early, rapid, definitive stabilization with minimal blood loss, infection, and wound complications. ⋯ Percutaneous iliosacral screw fixation for unstable posterior pelvic disruption provided early fixation with minimal operative time, minimal blood loss, and wound-related morbidity.
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This study sought to determine if violence against women is accurately documented in the trauma registry, and if poor documentation in the medical record is associated with incorrect coding in the registry. ⋯ Violence against women often goes undocumented in hospital data systems.
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Based on the findings in computed tomography scans, we defined a grading system that is well correlated to the changes of the brainstem and its perimesencephalic cistern during intracranial hypertension. ⋯ Our grading system is easy to use, and is well correlated to give an accurate prediction of outcome in cases with severe head injury based primarily on the results of an initial computed tomography scan, even without clinical information, and it should play a role in the classification of head injury.