J Trauma
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To determine the current opinion of American trauma surgeons on the use of the open abdomen to prevent the abdominal compartment syndrome (ACS). ⋯ A majority of expert American trauma surgeons have experience with ACS and would leave the abdomen open if ACS occurred. A majority would reopen a closed abdomen in cases of elevated IAP with signs of clinical deterioration. A minority would leave the abdomen open when there was only a risk of developing ACS.
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Trauma registries offer distinct advantages and disadvantages when assessing the effectiveness of trauma systems. Detailed injury data and statistical comparisons that use TRISS methodology and the Major Trauma Outcome Study norms provide advantages over population-based or preventable death studies. However, miscodings and registry differences in injury severity coding limit the validity and generalizability of findings. The purpose of this study was to identify these strengths and weaknesses and to determine whether registry studies provide evidence of trauma system efficacy. ⋯ These studies provide evidence of the effectiveness of trauma systems. However, future studies that use trauma registries would be strengthened by including both prehospital and postdischarge trauma deaths, standardizing trauma registry inclusion criteria and developing a contemporary national reference norm for trauma outcome.
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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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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.