J Trauma
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In spite of the fact that penetrating trauma is an increasingly frequent cause of death and disability in America, little epidemiologic information is available on the recurrence rate or natural history of patients sustaining such injuries. The current study therefore was carried out to determine the recurrence rate of penetrating trauma in our institution. During the 12-month study period (August 1984 through July 1985), 556 (2%) of the 26,728 patients examined in our surgical emergency department had sustained penetrating trauma. ⋯ As of January 1990, 127 (32.6%) of the 389 patients had sustained two or more documented episodes of penetrating trauma. The incidence of recurrent penetrating trauma in the patients treated and released from the emergency department (35%) was similar to that of the patients requiring admission for their index injuries (31%). Based on the fact that the incidence of recurrent trauma was highest in men (p less than 0.01), blacks (p less than 0.01), and the uninsured (p = 0.03), it appears that recurrent penetrating trauma is a major societal as well as a medical problem.
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Comparative Study
A comparison of EMT judgment and prehospital trauma triage instruments.
A number of instruments have been devised to aid in the triage of trauma patients. Little work, however, has been done to demonstrate that these triage instruments offer an advantage over the judgment of an emergency medical technician (EMT) in determining which patients require transportation to a trauma center. The purpose of this study was to compare EMT judgment against three scoring systems; the triage-revised Trauma Score, the Prehospital Index, and the CRAMS scale. ⋯ We found that the EMT prediction of mortality was as accurate as the various scores. In a subset of patients, we also found that the EMT assessment performed as well as the scoring systems in identifying patients who either died or required emergent operative intervention. We conclude that EMT judgment is as accurate as these three scoring systems in identifying patients at high risk for death or the need for immediate operative intervention.
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The initial hemoglobin (Hb) levels and vital signs of 1,000 patients treated with intravenous infusion in the admission area of Groote Schuur Hospital Trauma Unit were recorded. The mean Hb level of 860 patients with mild or no signs of shock was 12.7 g/dL. Lower mean Hb levels were noted in 91 moderately shocked patients (11.8 g/dL, p less than 0.0001) and 49 severely shocked patients (9.9 g/dL, p less than 0.00001). ⋯ Hypovolemia was judged to be the major factor in causing death in 13 (86.7%) of the 15 patients with a Hb level under 8 g/dL who died. A low Hb level observed soon after injury is usually an indicator of serious ongoing hemorrhage and has important implications for management and prognosis. Measurement of the Hb level may prove useful in prehospital assessment of the level of trauma care required and also in injury severity scoring as a predictor of mortality.
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To determine whether elevations in blood glucose levels were related to neurologic outcomes following severe brain injuries in children, 54 patients 16 years of age or younger admitted to a regional trauma center with a Glasgow Coma Scale score of 8 or less over a 2-year period were retrospectively reviewed. The mean initial blood glucose level on hospital admission was significantly higher in the 16 patients with outcomes of death or vegetative state in comparison with that of the 38 patients with outcomes of good recovery, moderate disability,or severe disability (288 mg/100 mL vs. 194 mg/100 mL, t = -2.74, p = 0.01). Blood glucose levels correlated significantly with indicators of the severity of the brain injury, which were also related to outcome. ⋯ Logistic regression analysis resulted in a model for prediction of outcome which included the Glasgow Coma Scale score on admission and the initial blood glucose level. The odds ratio of a poor outcome in this model in patients with blood glucose levels greater than or equal to 250 mg/100 mL relative to those with lower levels was 8.3 (95% confidence interval 1.3-53.6). A simple prognostic score was derived from the logistic regression which improved upon the prediction of outcome using the Glasgow Coma Scale score alone in those patients with initial blood glucose levels greater than or equal to 250 mg/100 mL.(ABSTRACT TRUNCATED AT 250 WORDS)
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Review Case Reports
Long bone fracture in a spinal-cord-injured patient: complication of treatment--a case report and review of the literature.
Long bone fractures in patients with spinal cord injuries are difficult to manage. A case is presented in which complications arose after a femur fracture in a paraplegic patient was treated by closed fixation in a long leg circular plaster cast and the literature on management of long bone fractures in patients with spinal cord injuries is reviewed.