J Trauma
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Lodox/Statscan is a new digital X-ray machine with a low dose of radiation exposure that provides rapid, whole-body scans. In the setting of acute trauma management, the importance of image study is well recognized. Here, we report the accuracy of diagnoses made using Lodox/Statscan in patients with multiple injuries. We analyze the cost effectiveness, biohazard safety, and detection rate for treatment using the Lodox/Statscan and evaluate whether it is a viable alternative to the conventional trauma X-ray. ⋯ In our series, the Lodox/Statscan provided similar quality images and conventional series to the CT scans. Although the Lodox/Statscan missed some injuries, most of the subsequent treatments were not changed. Overall, there were several advantages to using this system, including the short interval of study, low-radiation exposure, and low cost. The Lodox/Statscan could therefore be used as an alternative to the traditional trauma X-ray for evaluation of acute trauma patients.
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A survey of all Canadian residents training in general surgery was conducted to determine the prevalence and nature of focused assessment with sonography in trauma (FAST) training. ⋯ The situation with FAST training in Canada seems inadequate with few general surgery residents being trained, and of those trained, only a few are comfortable with the technique. If FAST skills are to be expected of future surgeons, initiatives must be put in place to address barriers and improve training opportunities.
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Falls from height are considered to be high risk for multisystem injury. Ground-level falls (GLF) are often deemed a low-energy mechanism of injury (MOI) and not a recommended triage criterion for trauma team activation. We hypothesize that in elderly patients, a GLF may represent a high-risk group for injury and concurrent comorbidities that warrant trauma service evaluation and should be triaged appropriately. ⋯ Patients older than 70 years and with GCS score <15 represent a group with significant inhospital mortality.
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Comparative Study
A comparative analysis of serious injury and illness among homeless and housed low income residents of New York City.
Delivery of effective primary, secondary, and tertiary injury prevention in homeless populations is complex and could be greatly aided by an improved understanding of contributing factors. ⋯ Although homelessness presents unique, highly complex social and health issues that tend to overshadow the need for and the value of injury prevention, this study highlights potentially fruitful areas for primary, secondary, and tertiary prevention.
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Anecdotally, laparoscopy has been used for the diagnosis and therapy of pediatric abdominal trauma, but only few studies have been published. We performed a systematic analysis of our experience concerning indications, procedures, and outcomes using laparoscopy in pediatric abdominal trauma patients. ⋯ Laparoscopy is useful in the management of the hemodynamically stable pediatric patient with abdominal trauma but may be less valuable in cases with delayed presentation. Many intraabdominal injuries are amenable to laparoscopic repair. In patients with penetrating trauma, laparoscopy avoided laparotomy is more likely than in those with blunt abdominal trauma. Laparoscopy is currently underutilized in the management of pediatric abdominal trauma.