J Trauma
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Even though development of Level I trauma centers is thought to improve outcome of injury treatment, the political barriers in communities where two capable hospitals compete for designation can be formidable. This report documents the initial experience of a Level I trauma center developed in a two-hospital setting whereby each hospital hosted the trauma center on an alternating annual basis. ⋯ The community medical resources are commonly polarized between two large hospitals but need not prevent centralized trauma center development if preagreed community support can be achieved. Annual site change is not an impediment and could be successfully used in other similar communities, provided they are receptive to the concept of sharing Level I trauma center site designation.
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Increasing geriatric trauma is producing disproportionate use of resources. In burn victims, age and burn extent correlate with mortality, yielding the establishment of criteria for futile resuscitation. Such criteria would be useful to trauma patients and their families in making withdrawal-of-care decisions while reducing resource use. Our objective, therefore, was to identify injury and physiologic parameters that would indicate a high probability of futile resuscitation among geriatric trauma patients. ⋯ Geriatric trauma patients with severe chest and/or abdominal trauma with moderate shock and mild to moderate head injury have an exceedingly low probability of survival. These data support early withdrawal of care in these individuals.
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Multicenter Study Comparative Study
The New Injury Severity Score: a more accurate predictor of in-hospital mortality than the Injury Severity Score.
The purpose of this study was to determine whether the New Injury Severity Score (NISS) is a better predictor of mortality than the Injury Severity Score (ISS) in general and in subgroups according to age, penetrating trauma, and body region injured. ⋯ The NISS is a more accurate predictor of in-hospital death than the ISS and should be chosen over the ISS for case-mix control in trauma research, especially in certain subpopulations such as head/neck-injured patients.
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Comparative Study
Prospective evaluation of computed tomographic scanning for the spinal clearance of obtunded trauma patients: preliminary results.
Screening methods for detecting cervical spine injury in obtunded ventilated patients continue to evolve. This study compared the use of plain radiography to computed tomographic (CT) scanning of cervical spines in the obtunded blunt trauma patient. The accuracy of plain radiography and CT scanning in detecting clinically significant cervical spine injury in the obtunded blunt trauma patient was evaluated. ⋯ CT scanning in conjunction with plain films enhances the number of cervical spine injuries seen radiographically. Application of a protocol of plain radiographs and CT scanning may be used to clear cervical spines in the obtunded trauma patient. Ongoing evaluation of this protocol is required.