J Trauma
-
Comparative Study
Pelvic trauma imaging: a blinded comparison of computed tomography and roentgenograms.
To determine the sensitivity for detecting pelvic pathology and instability, roentgenograms and computed tomographic (CT) scans from 59 patients with pelvic injuries that had been admitted to a Level I trauma center were randomly reviewed by a orthopedic surgeon blinded to the study. Normal control roentgenograms and CT scans were included to decrease observer bias. The anteroposterior (AP) roentgenogram detected 66% of all pelvic injuries, 78% of those involving the anterior ring, and 53% of those involving the posterior pelvic ring. ⋯ The mechanism of injury could be ascertained with 73% sensitivity by plain films and with 79% sensitivity by inlet and outlet views; trauma CT scans were 96% and high-definition pelvic CT scans were 100% sensitive. When combined, the AP pelvis roentgenograms and trauma CT scans identified 96% of the injured structures and were 100% sensitive in determining injury force patterns and instability. The data suggested that a good quality AP pelvis roentgenogram in conjunction with a complete trauma CT scan of the abdomen/pelvis should identify both the injury mechanism and pelvic instability with a high degree of sensitivity.
-
To review our experience with craniocerebral injuries caused by plastic bullets, and to delineate prognostic factors for outcome. ⋯ Plastic bullet-induced craniocerebral injuries carry a lower morbidity and mortality rate compared with other gunshot wounds. However, plastic bullets do incur a significant risk of injury. Their use should be carefully regulated.
-
Comparative Study
Diaspirin cross-linked hemoglobin resuscitation improves cerebral perfusion after head injury and shock.
Shock associated with traumatic brain injury (TBI) doubles the mortality of TBI alone by inducing a secondary ischemic injury. Rapid correction of cerebral perfusion pressure (CPP) is thought to be essential to improving outcome. Diaspirin cross-linked hemoglobin (DCLHb) has been shown to improve cerebral blood flow, increase mean arterial pressure (MAP), and reduce lesion size in models of occlusive cerebral ischemia but has not been evaluated in a model of TBI combined with hemorrhagic shock. ⋯ These data suggest that DCLHb is beneficial in the early resuscitation of head injury and shock and that further investigation is warranted. Key Words: Diaspirin cross-linked hemoglobin, Head injury, Shock, Cerebral perfusion pressure.
-
To examine hospital, trauma system, and reimbursement factors that offset the financial burdens of trauma care delivery and to assess how proposed Medicaid and Medicare budget cuts may affect the ability of hospitals to alleviate financial pressures related to trauma care delivery. ⋯ Proposed Medicaid and Medicare payment cuts are likely to eliminate the delicate financial balance that many urban hospitals have achieved in providing trauma care. The erosion in funding from public programs may portend a new wave of trauma center closures as hospitals seek to deal with reduced reimbursement by eliminating unprofitable services.