J Trauma
-
Patients who undergo emergency craniotomy for head injury require vigilant postoperative (postop) care to obtain the best possible outcome. Although repeat head computed tomography (CT) scans are a key component of the management of these patients, there is no consensus on the optimal timing of the initial postop CT. ⋯ Early, if not immediate, postop CT after emergency craniotomy for head trauma appears to be warranted. We found a significant incidence of unexpected findings on postop CT and encountered avoidable delays in treatment of new or recurrent findings.
-
Randomized Controlled Trial
Trauma training in simulation: translating skills from SIM time to real time.
: Training surgical residents to manage critically injured patients in a timely fashion presents a significant challenge. Simulation may have a role in this educational process, but only if it can be demonstrated that skills learned in a simulated environment translate into enhanced performance in real-life trauma situations. ⋯ : A trauma curriculum incorporating simulation shows promise in developing crisis management skills that are essential for evaluation of critically injured patients.
-
Comparative Study
Isolated cervical spine fractures in the elderly: a deadly injury.
Traumatic injury in the elderly is an increasing problem and studies have shown that elderly patients (>/=65 years old) with cervical spine fractures and spinal cord injury (SCI) carry a mortality rate of 21% to 30%. However, little has been described with regard to outcomes for elderly patients with isolated cervical spine fractures (ICSF). ⋯ ICSFs were associated with an unfavorable outcome in the elderly population regardless of ATI or SCI. These unfavorable outcomes were also associated with long-term mortality. Strategies to reduce morbidity and mortality in this devastating injury will be essential to improve outcomes and maximize resource utilization.
-
Anatomic injury severity scores can be grouped into two classes; consensus-derived and data-derived. The former, including the Injury Severity Score (ISS), the New Injury Severity Score (NISS), and the Anatomic Profile Score (APS), are based on the severity score of the Abbreviated Injury Scale (AIS), assigned by clinical experts. The latter, including the International Classification of Disease Injury Severity Score (ICISS) and the Trauma Registry Abbreviated Injury Scale Score (TRAIS) are based on survival probabilities calculated in large trauma databases. We aimed to compare the predictive accuracy of consensus-derived and data-derived severity scores when considered alone and in combination with age and physiologic status. ⋯ Data-derived scores provide more accurate mortality prediction than consensus-derived scores do when only anatomic injury severity is considered but offer little advantage if age and physiologic status are taken into account. This may be because of the fact that data-derived scores are not an independent measure of anatomic injury severity.