J Trauma
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Comparative Study
Comparison of alternative methods for assessing injury severity based on anatomic descriptors.
There is mounting confusion as to which anatomic scoring systems can be used to adequately control for trauma case mix when predicting patient survival. ⋯ Results support the integrity of the AIS and argue for its continued use in research and evaluation. The modified Anatomic Profile, Anatomic Profile, and New Injury Severity Score, however, should be used in preference to the Injury Severity Score as an overall measure of severity.
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Comparative Study
Thoracic epidural analgesia versus intravenous patient-controlled analgesia for the treatment of rib fracture pain after motor vehicle crash.
Pain from rib fracture pain may affect pulmonary function, morbidity, and length of intensive care unit stay. Previous trials have varied epidural technique within the study and have used several outcome variables. ⋯ Thoracic epidural analgesia with bupivacaine and fentanyl provided superior analgesia than intravenous patient-controlled analgesia morphine.
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Comparative Study
Trauma faculty and trauma team activation: impact on trauma system function and patient outcome.
To determine the impact of the presence of an attending trauma surgeon during trauma team activation on system function and patient outcome. ⋯ The presence of a trauma surgeon on the trauma team reduced resuscitation time and reduced time to incision for emergent operations, particularly in penetrating trauma. However, it had no measurable impact on mortality based on Trauma and Injury Severity Score probability of survival. Attending trauma surgeon presence on the trauma team improves in-hospital trauma system function without affecting patient outcome.
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The objective was to determine the average cost per quality-adjusted life year (QALY) gained of treating trauma victims at a tertiary trauma hospital and to determine the cost-effectiveness of trauma care at this center. The setting was a tertiary trauma center in the province of Ontario, Canada. The study population consisted of consecutive trauma admissions with ISS > 12 from April, 1994 to April, 1996. The study was of a retrospective cohort design with a cross-sectional survey. ⋯ This is the first economic evaluation of tertiary trauma care which includes both costs as opposed to charges as well as estimates of the QALYs gained. The results suggest that tertiary trauma care is cost-effective and less costly than treatment programs for other disease conditions when the quality-adjusted life years gained are included in the evaluation.