J Trauma
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Comparison of trauma survival rates between institutions and reference data bases is hampered by different injury severity mixes. To overcome this, a standardized comparison using a stratified W statistic (Ws) has been proposed. Ws enables comparisons but does not represent actual survival rates at an institution. ⋯ Ws is useful for comparison between centers. Trauma and Injury Severity Score methodology overpredicts survival in certain probability of survival intervals. Adjustment can be made to estimate the actual survival rate. When applied to an integrated trauma system, such adjustments demonstrate overall improved survival, most noticeable in a more severely injured subgroup.
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Salvage of lower-extremity Gustilo type IIIC fractures is difficult, time-consuming for the patients and physicians, and not universally successful because of poor functional outcomes. Even if successful with limb salvage, the functional result may be unsatisfactory because of mutilating injuries to muscle and nerve, bone loss, and the presence of chronic infection. From July 1991 until July 1994, revascularizations of open IIIC fractures were attempted for wounds with Mangled Extremity Severity Score (MESS) < or = 10. ⋯ Using statistical analysis, we found that the salvaged limbs with MESS < or = 9 exhibited a significant difference in achieving adequate function compared with limbs with MESS > 9. Using our protocol for treatment for IIIC fractures, the threshold for immediate amputation can be raised from MESS = 7 to MESS = 9. Our conclusions are (1) more severely injured limbs have poor functional results, (2) every patient needs subsequent reconstructive surgery, and (3) the MESS may be helpful in decision-making.
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Head, face, and neck injuries (HFNI) occur during animal-related trauma. We compared patients with HFNI and without HFNI after animal-related injuries to determine the significance of these injuries. ⋯ HFNI occur in females and young people and produce lower GCS score, higher ISS, higher AIS Head/Neck, higher AIS Face, and higher mortality. Most occur during recreational horseback riding. Protective headgear should be mandated.
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Use of mechanical ventilation is associated with several major complications despite its lifesaving potential. Timely discontinuation of mechanical ventilation is critical to control of duration of intensive care unit stay and reduction of complications associated with mechanical ventilation. Difficulty in discontinuation (or weaning) of patients from mechanical ventilatory support is in part attributable to inadequate understanding of the mechanisms responsible for unsuccessful outcome and a lack of guidelines regarding the optimal approach to the process of discontinuation of mechanical ventilation. ⋯ In either case, the above weaning techniques appear to be superior to intermittent mandatory ventilation in separating patients from mechanical ventilatory support. Based on available clinical trials, pressure support ventilation or T-piece trials appear to be the preferred methods for discontinuation of mechanical ventilatory support. A method using a simple T-piece trial technique is described.