J Trauma
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Previously, we demonstrated that 21% of pediatric (<16 years) trauma deaths in the Province of Ontario during the period 1985 to 1987 were potentially preventable. Since then many trauma system changes have occurred including field triage, designation of trauma centers, and improved injury prevention. This study aims to examine the current preventable trauma death rate in our system using identical methodology to our previous study. ⋯ There has been a threefold decline in the preventable death rate, which we believe is related to improvements in the trauma system. We estimated that, for every seven deaths from fatal injuries, system changes between the two study periods eliminated one preventable death.
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Aeromedical transport of critically ill casualties requires continued safe operation of medical equipment at altitude. We evaluated performance of two ventilators in an altitude chamber. ⋯ The Impact 754 compensates ventilator output to deliver the desired tidal volume regardless of changes in altitude and barometric pressure. The LTV-1000 does not compensate for changes in altitude resulting in delivery of increasing tidal volumes with falling barometric pressure. Clinicians should be aware of ventilator performance and ventilator limitations to provide safe and effective ventilation during transport.
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Forward Surgical Teams (FST) provide forward deployed surgical care within the battle space. The next level of care in theater, the Combat Support Hospitals (CSH), are distinguished from the FST by advanced resource capabilities including more complex diagnostic imaging, laboratory support with blood banking, and intensive care units. This study was intended to assess the effect of FST capability on the outcome of seriously injured casualties in comparison to the CSH. ⋯ The disparity between the availability of the highest level of injury care and the ability to care for injury as soon as possible is an issue of central importance to both the civilian and military trauma care communities. Our analysis demonstrates that despite the operational and logistic challenges that burden the FST, this level of surgical care confers equivalent battlefield injury outcome results compared with the CSH.
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If there are systematic differences in the types of patients captured in registries, then differences in outcomes in centers might be related not to differences in the practice of care, but differences in registry inclusion criteria. We set out to evaluate the effect of variable case ascertainment of dead on arrivals on external benchmarking of risk-adjusted mortality using a form of sensitivity analysis. ⋯ Variable case ascertainment of dead on arrivals does not affect the ability to assess performance. Given that our approach has several assumptions, it is critically important that external validation of trauma registries be performed. If centers are to be judged through the quality of their data, then it is incumbent to first assure that data quality meets expectations.
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Physical assault is common in trauma patients. Penetrating injuries resulting from interpersonal violence have been well described in literature, but there have been few studies examining the injury patterns due to assaults with hands and feet or blunt instruments. ⋯ Injuries due to assault rarely require operative intervention and have a low risk of cervical spine or cord injuries. However, many result in traumatic brain injury. Patients older than 55 years tend to be more severely injured and at higher risk of mortality.