J Trauma
-
Hospitalization for observation is the current standard of practice for patients who have sustained blunt abdominal trauma and who do not require emergent operation, despite having undergone diagnostic studies that exclude the presence of an intra-abdominal injury. The reasons for this practice are multifactorial and include the perceived false-negative rate of all standard diagnostic tests, the belief that hospitalization will allow for the prompt diagnosis of occult injuries, and medicolegal considerations about the risk of early discharge. The focus of this study was to determine whether hospitalization for observation is necessary after a negative diagnostic evaluation after blunt abdominal trauma, to determine the negative predictive value of abdominal computed tomographic (CT) scanning in a prospective series of patients, and to identify which patients can be safely released from the emergency department without observation or hospitalization after blunt abdominal trauma. ⋯ These data indicate that abdominal tenderness is not predictive of an abdominal injury and that patients with a negative CT scan after suspected blunt abdominal trauma do not benefit from hospital admission and prolonged observation.
-
Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Hypertonic saline resuscitation of patients with head injury: a prospective, randomized clinical trial.
Experimental and clinical work has suggested that hypertonic saline (HTS) would be better than lactated Ringer's solution (LRS) for the resuscitation of patients with head injuries. No clinical study has examined the effect of HTS infusion on intracranial pressure (ICP) and outcome in patients with head injuries. We hypothesized that HTS infusion would result in a lower ICP and fewer medical interventions to lower ICP compared with LRS. ⋯ As a group, HTS patients had more severe head injuries. HTS and LRS used with other therapies effectively controlled the ICP. The widely held conviction that sodium administration will lead to a sustained increase in ICP is not supported by this work.
-
Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Multicenter, randomized, prospective trial of early tracheostomy.
Determine the effect of early (days 3-5) or late (days 10-14) tracheostomy on intensive care unit length of stay (ICU LOS), frequency of pneumonia, and mortality, and evidence of short-term or long-term pharyngeal, laryngeal, or tracheal injury in head trauma, non-head trauma, and critically ill nontrauma patients. ⋯ Physician bias limited patient entry into the study. Although there were higher AIII scores in the head trauma early tracheostomy patients, there were no differences in the primary end points of ICU LOS, pneumonia, or death in any of the groups studied. Long-term endoscopic follow-up was poor, but no known late tracheal stenosis was seen.
-
Multicenter Study
Probability model of hospital death for severe trauma patients based on the Simplified Acute Physiology Score I: development and validation. Archivio Diagnostico.
We evaluated whether or not the Simplified Acute Physiology Score (SAPS) I is a suitable audit system for trauma patients admitted to general intensive care units (ICUs). A probability model for SAPS I was retrospectively assessed on trauma patients admitted to general ICUs from 1990 to 1992. Because it was determined that SAPS did not fit the data well, we developed a customized probability model of SAPS I for trauma patients and validated it prospectively on an independent data set (patients admitted to general ICU in 1993-1994). Measures of calibration (goodness of fit) and discrimination (receiver operating characteristic curve) were adopted to assess the performance of the model. ⋯ Customization of SAPS I for trauma patients has shown good calibration and high discriminatory power in Italian ICUs and when applied to an independent data base. The advantage of customization would be the collection of the same set of variables for all patients admitted to ICUs against the use of specific scoring systems.
-
Multicenter Study
Magnetic resonance imaging: utilization in the management of central nervous system trauma.
To determine the availability, use, and perceived value of magnetic resonance imaging (MR) in the management of acute central nervous system (CNS) trauma in United States Level I (or equivalent) trauma centers (TCs). ⋯ Most trauma directors consider MR important in the acute evaluation of spinal trauma and, to a lesser extent, for traumatic brain injury. Despite these opinions, the vast majority of these centers reported only "rare" to "occasional" use of MR in the setting of acute CNS trauma. Our results show that most TCs have on-site and continuously available MR facilities capable of cardiac and pulmonary monitoring. Other factors such as the higher relative cost of MR may be responsible for the discrepancy between the perceived value and the actual utilization of MR imaging in the setting of CNS trauma.