J Trauma
-
Comparative Study
Supplemental emergent chest computed tomography in the management of blunt torso trauma.
The efficacy of conventional chest X-ray (CXR) in comparison to chest computed tomography (CCT) in acutely injured blunt trauma patients was examined. Over a 21-month period, 50 patients underwent CXR and CCT according to a standard protocol, and their films and records were reviewed retrospectively. Hemo- and/or pneumothorax (HPTX) was noted in 12 patients (five by CXR, 12 by CCT). ⋯ Atelectasis was a common CCT finding (58% incidence). Chest X-ray is less sensitive than chest computed tomography in the detection of HPTX (42% vs. 100%) and PC (40% vs. 100%). Emergent chest computed tomography is recommended in stable patients with: 1) blunt high-energy torso trauma, 2) "cross-body" injury pattern, and/or 3) a mechanism of injury suggestive of chest trauma.
-
To assess patterns of pediatric trauma triage and patient transfer to the pediatric trauma centers, the records of 1,307 patients 14 years old or less who were admitted or died during resuscitation at eight Level II Trauma Centers from January 1987 through December 1988 were reviewed retrospectively. Cases were analyzed according to the following criteria: age, diagnosis, mechanism of injury, admitting service, pediatric trauma score (PTS), length of stay in the intensive care unit (ICU) and in the hospital, and outcome. Forty-three patients were transferred to pediatric trauma centers based on local criteria. ⋯ Two hundred fifty-eight patients (19.7%) required ICU care for an average length of stay of 2.86 days. Twenty-four patients (1.8%) died; all 24 had a PTS less than or equal to 8. In comparing the data to the guidelines in Appendix J of the American College of Surgeons' Hospital and Prehospital Resources for Optimal Trauma Care of the Injured Patient for transfer to a Level I Pediatric Trauma Center, we found that children with a PTS greater than 8 and who either require ICU care and/or have altered states of consciousness can safely be treated in the adult ICU of a Level II Trauma Center.
-
The records of 57 patients presenting with flail chest injury from 1981 through 1987 were reviewed to determine factors affecting morbidity and mortality. Fifteen patients (26%) had 8+ rib fractures with a unilateral flail and seven (12%) had multiple rib fractures with a bilateral flail. Thirty-two (56%) had moderate-severe pulmonary contusions and 44 (77%) required chest tubes for hemo-pneumothorax. ⋯ An adverse outcome occurred in 15 (28%); nine required ventilatory assistance greater than or equal to 14 days and six died of sepsis with pneumonia. The main factors associated with an adverse outcome were: an ISS greater than or equal to 31 (p less than 0.001), moderate-severe associated injuries (p less than 0.001), and blood transfusions (p less than 0.005). Although the primary determinants of an adverse outcome were the associated injuries and blood loss, a bilateral flail (p less than 0.01) and age greater than or equal to 50 years (p less than 0.02) were contributing factors.
-
Inhalation injury, present in approximately one third of burned patients treated at burn centers, increases mortality by a maximum of 20% in relation to age and extent of burn. The development of animal models of inhalation injury has made possible the identification of both the airway and vascular responses evoked by smoke inhalation. ⋯ Pharmacologic agents give promise of ameliorating the deleterious changes of the vasculature. The recent advances in understanding inhalation injury have identified the research needed to further improve patient salvage.
-
The purpose of this study was to evaluate the ability of diagnostic peritoneal lavage (DPL) to predict intra-abdominal injuries that required surgical repair. To do this, we retrospectively reviewed 944 patients with blunt and penetrating abdominal trauma who underwent 975 DPLs. ⋯ Initial DPL in 336 patients with penetrating trauma had a sensitivity of 87%, a specificity of 89%, an accuracy of 89%, a PPV of 75%, and a NPV of 95%. When utilizing final lavage results on the 944 patients, DPL had a sensitivity of 91%, a specificity of 94%, an accuracy of 93%, a PPV of 80%, and a NPV of 98% in predicting intra-abdominal injury requiring surgical repair.