J Trauma
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The annual number of childhood injury admissions to New England hospitals decreased by more than half from 1991 through 2000. This study was undertaken to determine whether this decrease was caused by decreased injury incidence or changes in the diagnosis and/or management of childhood injury. ⋯ Fewer New England children were hospitalized for injury each year during the past decade. Although the overall rate of childhood injury hospitalization declined by half, the majority of the decrease was secondary to changes in the diagnosis and/or management of pediatric injury. Evaluation of the true effectiveness of injury prevention efforts should take this changing diagnosis and management pattern into account.
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The incidence of child abuse is approximately 10% of all children presenting to an emergency department (ED), with a mortality rate less than 1%. By contrast, the characteristics of the subset of abused children presenting to a pediatric trauma service (PTS) is not well defined. ⋯ Significant characteristics of the abused children in this pediatric trauma service include higher Injury Severity Score (especially in the head and integument), requirement for longer lengths of stay, and a nearly 10-times higher risk of death compared with the ED population. The Diagnostic Index for Physical Child Abuse is proposed as a new tool to assist in the identification of child abuse among pediatric trauma patients. An epidemiologic triangle for child abuse is described, with different prevalence and severity of child abuse seen at different levels of our health care system, starting with primary care providers, followed by the ED, the PTS, and ultimately the medical examiners. The number of cases decreases from the bottom to the top of the health care system, but the mortality rate increases as abuse escalates through the triangle. This establishes the PTS as possibly the final gatekeeper before an abused case becomes a fatality. These data emphasize the need for rigorous registry evaluation and subsequent evidence-based prevention initiatives.
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National surveillance systems have differentiated long guns into rifles and shotguns but fail to do so for handgun type. We sought to determine whether specific gun type data could be collected and whether knowledge of specific gun types (rifle, shotgun, pistol, revolver) could be used to distinguish gun homicide victims with respect to important injury parameters such as number of wounds. ⋯ Our findings demonstrate that information about gun type can be obtained and that significant differences exist in wounds per gun between long guns and handguns and between pistols and revolvers. Classification of long guns into rifles and shotguns and handguns into pistols and revolvers should be included in local, regional, and national data collection systems.
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This study examined the relation between trauma death rates and hospital diversion in the Houston emergency medical service area. ⋯ A possible association between emergency department diversion and death rates in Houston trauma hospitals was found, particularly among the most severe trauma patients transferred from lower-level hospitals. A follow-up study is needed for further investigation of this relation.
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An increase in intramucosal-arterial Pco2 gradient (DeltaPco2) might be caused by tissue hypoxia or by diminished blood flow. Our hypothesis was that DeltaPco2 should not be altered in anemic hypoxia with preserved blood flow. ⋯ DeltaPco2 did not reflect intestinal dysoxia during Vo2/Do2 dependency attributable to hemodilution. Blood flow seems to be the main determinant of DeltaPco2.