J Trauma
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The "seatbelt syndrome" describes intestinal and spinal injury caused by lap-style automotive restraints. More than 2,600 children were admitted to Children's National Medical Center with blunt injury in 3 years; 395 were involved in a motor vehicle crash. Ninety-five of the crash occupants (24%) were known to be wearing safety belts. ⋯ Lateral radiographs were required for definitive diagnosis in eight of nine children with lumbar spinal injury. CT scan was clearly diagnostic in only one of five children with intestinal injury. Children wearing lap belts are at risk of a "lap belt complex." Lateral spine X-rays, peritoneal lavage, and early laparotomy are recommended to establish an accurate diagnosis and to decrease morbidity.
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A 1-year prospective review of 78 multiply injured patients initially treated at local community hospitals and subsequently transported more than 25 miles to a referral trauma center was completed. Injury mechanisms were blunt in 74 (95%) patients and penetrating in four. Patient ages ranged from 6 to 88 years (mean, 33 years). ⋯ Increased emphasis on stabilization and transport should be added to ATLS training courses. Established transport protocols between institutions would enhance the quality of care and engender improved interhospital communication. The implementation of trauma systems designed specifically for rural areas must be supported.
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This study examined the difference between clinical impressions and autopsy findings in a group of patients dying on a university surgical service after blunt injury, penetrating injury, or thermal burns. Of 215 patients dying between the years 1984 and 1988, 212 were included in this study (autopsy rate, 98.6%). ⋯ These data support the continued practice of obtaining autopsy in all patients dying from trauma. This information is clinically relevant, and, in today's atmosphere of quality assurance, absolutely necessary for a modern trauma center.
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With the institution of Diagnosis Related Groups (DRGs), the economic survival of tertiary care centers may be threatened. Even more worrisome to these institutions is the possibility of other third-party payors following Medicare's lead and converting to this reimbursement plan. This paper examines the present financial status of the Burn Center at the University of New Mexico Hospital, as well as the future impact if all third-party payments were based on the DRG system. ⋯ This resulted in a total loss of $214,101 for the Burn Center during the 3-year study period. With the hypothetical conversion++ of all third-party reimbursement to DRGs, the total 3-year loss would become $1,253,393. The effect of DRG 472, a recent change in burn DRG classification, is discussed, as well as specific recommendations to rectify current problems.
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A method of ICP management is presented based upon maintenance of cerebral perfusion pressure ( CPP = SABP - ICP) at 70-88 mm Hg or in some cases greater. To do this, we have employed volume expansion, nursed patients in the flat position, and actively used catecholamine infusions to maintain the SABP side of the CPP equation at levels necessary to obtain the target CPP. CSF drainage and mannitol have freely been used to maintain the ICP portion of the equation. ⋯ This approach to the management of intracranial hypertension proved safe, rational, and greatly enhanced the therapeutic options available. It was also consistent with optimal care of other organ systems. The results bring into question many of the standard tenets of neurosurgical ICP management and suggest new avenues of investigation.