J Trauma
-
We conducted a retrospective review to determine the early effects of implementing the American College of Surgeons (ACS) level II criteria on the number of transferrals and survival rates of trauma patients in a rurally based hospital. Data were collected from time period "B" (13 months before) and time period "A" (14 months after) implementing ACS criteria. Patient data parameters included age, sex, Revised Trauma Score, Glasgow Coma Scale score, Injury Severity Score, number of days hospitalized, diagnoses, place of injury (i.e., local county or transfer from another county), outcome, and probability of survival. ⋯ A much higher percentage of these patients were transfers from out of county (period B = 33% vs. period A = 59.5%, p = 0.0001). Despite a higher percentage of transferred patients with probability of survival < or = 25% (period B = 25% vs. period A = 58%, p = 0.002), the survival rate in this group improved from 7.5% during time period B to 25.5% after implementing level II criteria (p = 0.0303). This data suggest that implementing level II ACS guidelines has the early beneficial effects of increasing transfers of seriously injured patients and improving survival in the most critically injured group.
-
Comparative Study
Right ventricular end-diastolic volume as a measure of preload.
Right ventricular (RV) end-diastolic volume index (RVEDVI) measured by a modified thermodilution pulmonary artery catheter has been proposed as an improved measure of cardiac preload, compared with pulmonary capillary wedge pressure (PCWP). This study compared the correlation of RVEDVI and PCWP with cardiac index (CI) to determine which parameter better reflected ventricular preload. Modified thermodilution catheters were placed in 38 critically ill patients. ⋯ In individual patients, a significant, uncorrected correlation (p < 0.05) was found between RVEDVI and CI in 27 of the 38 patients, whereas 11 patients had a significant correlation between PCWP and CI. RVEDVI correlated more closely with CI than did PCWP, even after correlation for mathematical coupling. In both the group as a whole and in individual patients, RVEDVI was a better indicator of cardiac preload.
-
Comparative Study
A prospective study of emergent abdominal sonography after blunt trauma.
In North America, the role of emergent abdominal sonography [ultrasonography (US)] after blunt trauma requires further definition. The purpose of this prospective study was to compare US to the gold standards, diagnostic peritoneal lavage (DPL), and computed tomography (CT), in a population of adults after blunt trauma. In 206 adults who required either CT or DPL to assess possible abdominal injury, US was performed, before DPL or CT, and was aimed at the detection of intraperitoneal fluid. ⋯ Of the six false-negative USs, only one required surgery. The US examinations required 2.6 +/- 1.4 min. Emergent abdominal sonography is an accurate, rapid test for the presence of intraperitoneal fluid in adult blunt trauma victims and in these patients may prove valuable as a screening test for abdominal injury.
-
Health care reform will affect the relationship of trauma centers to health maintenance organizations and other managed care plans. We studied Kaiser Permanente Medical Center (Kaiser) members admitted to the Trauma Center at San Francisco General Hospital (SFGH) to determine: (1) variables predicting transfer from SFGH to a Kaiser Hospital (repatriation), (2) the length of hospital stay (LOS), and (3) the cost of their care. The SFGH trauma registry provided data on 7,794 patients admitted before 1994. ⋯ A relatively small number of severely injured patients account for a large percentage of costly trauma care. Analyses of patient subsets are necessary for trauma centers to negotiate suitable relationships with managed care plans. A prospective study is needed to examine the cost efficiency of early transfer of managed care patients.
-
Comparative Study
Cultured epithelial autograft: five years of clinical experience with twenty-eight patients.
Cultured epithelial autograft (CEA) has been used as an adjunct in burn wound coverage at the Vancouver Hospital and Health Sciences Centre since 1988, and has been available to all patients admitted with significant burn injuries. During the 5-year period from 1988 to 1992 inclusive, 28 patients treated with CEA survived long enough for assessment. The mean age was 35.3 years with a mean total body surface area burn of 52.2% and a mean total full thickness injury of 42.4%. ⋯ The anterior trunk and thighs were the best recipient sites. Subjective differences between CEA and meshed autograft were noted. The results show that after 5 years of use, CEA engraftment continues to be unpredictable and inconsistent, and hence, it should be used as only a biologic dressing and experimental adjunct to conventional burn wound coverage with split thickness autograft.