J Trauma
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To evaluate functional recovery after suture of the sciatic nerve after missile injury. ⋯ We advocate exploration of the sciatic nerve at any level within 3 months if no spontaneous recovery occurs after a missile injury. We do not advocate exploration of the sciatic nerve at the buttock level if only peroneal function is lost except in children.
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Although computed tomography has been considered the diagnostic modality of choice for pediatric patients with blunt abdominal trauma (BAT), it is costly, time-consuming, requires sedation, and may be associated with complications in young children. Abdominal ultrasonography (US) is a promising modality in the evaluation of BAT that is quick, noninvasive, repeatable, and cost-effective. We hypothesized that emergency department US, performed by trauma surgeons, is a useful triage tool for pediatric BAT that reduces the need for computed tomography. ⋯ Using US as a triage tool may dramatically reduce the cost of pediatric BAT evaluation while being able to quickly identify significant intraperitoneal fluid that requires further evaluation and possible laparotomy.
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Pregnancy imposes significant physiologic demands that may confuse and complicate the evaluation, resuscitation, and definitive management of pregnant women who sustain trauma. Accurate prediction of fetal outcome after trauma remains elusive. The objective of this study was to characterize patterns of injury in pregnant women, to determine if pregnancy affects maternal morbidity and mortality after trauma, and to identify predictors of fetal death. ⋯ There appears to be a group of pregnant women in San Diego at high risk for traumatic injury who should be targeted for preventative strategies including improved seat belt use. Pregnancy does not increase mortality or morbidity after trauma but influences the pattern of injury. Maternal death, high Injury Severity Score, serious abdominal injury, and hemorrhagic shock are risk factors for fetal loss.
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National guidelines recommend that patients with Glasgow Coma Scale (GCS) scores of less than 14 be triaged to trauma centers. We hypothesized that the motor component of the GCS (GCSM) would be equally sensitive as the total GCS in head injury triage. ⋯ GCSM is equivalent to GCS for prehospital triage, and in view of its simplicity it should replace the GCS in triage schemes.
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This study was designed to determine whether out-of-hospital clinical signs could be associated with functional survival for pulseless, unconscious victims of penetrating trauma. ⋯ Functional survival was rare but did occur with penetrating trauma presenting pulseless and unconscious in the out-of-hospital setting. Although the presence of a pulseless sinus rhythm or tachycardia and stabbing as a mechanism seemed to indicate better survival rates, our study failed to identify reliable out-of-hospital criteria to separate salvageable penetrating trauma victims from those who are nonsalvageable. With this lack of reliable criteria, aggressive prehospital resuscitation efforts and rapid transport to the nearest trauma center for pulseless, unconscious victims of penetrating injury seem indicated.