J Trauma
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The purpose of this study was to determine the frequency and significance of computed tomographic (CT) scan-detected pneumoperitoneum in blunt abdominal trauma. We retrospectively reviewed 118 consecutive CT scans of the abdomen in blunt abdominal trauma patients (mean Injury Severity Score 24), performed at our Regional Trauma Unit over a 12-month period. Seven (5.9%) patients had intra-abdominal extraluminal air. ⋯ In the setting of blunt abdominal trauma pneumoperitoneum does not necessarily indicate hollow viscus injury. It frequently is secondary to other etiologies, especially dissection of interstitial air from the chest, as suggested in this study. The decision for laparotomy should be based on a combination of the clinical findings, CT scan results, or other diagnostic tests such as peritoneal lavage.
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Comparative Study
Outcome from critical care in the "oldest old" trauma patients.
This study evaluated the "oldest old" Intensive Care Unit (ICU) trauma patients, defined as patients of age 75 and over, to determine the relationships between age, injury magnitude, physiologic severity of illness, and outcome in this group, compared with younger trauma patients. Of 1,039 consecutive Surgical ICU (SICU) patients with complete data, 45 were in the Oldest group, 54 were in the Elderly group (ages 65 to 74), and 940 were in the Younger group (age < 65). Age, sex, and type of trauma (penetrating versus blunt) did not predict outcome. ⋯ When patients were stratified by ISS, there was a statistically significant difference in day 1 SAPS among age groups for most ISS categories, with higher SAPS associated with advancing age. The oldest old fare worse with trauma because their injury is more severe (higher ISS) and because their physiologic response to a given level of injury is exaggerated (higher SAPS). However, once the oldest old are stratified by SAPS, their outcome parallels that of their younger trauma cohorts.(ABSTRACT TRUNCATED AT 250 WORDS)
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To determine the appropriate methods for the diagnosis and management of gunshot injuries to the external genitalia. ⋯ Successful management of genital GSWs is dependent upon prompt surgical exploration, conservative debridement, and primary repair.
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Long-term outcomes after blunt trauma remain poorly defined. The purpose of this study was to document such outcomes in extremely injured adults (Injury Severity Score > or = 50). From April 1990 to June 1993, 76 patients (5% of all trauma victims) had an ISS > or = 50 at a single trauma center. ⋯ After a mean follow-up of 27 months, 6% had died, 9% refused participation, and the remaining 30 patients (91% of long-term survivors) demonstrated significant residual disabilities in physical, emotional, and mental health status. We suggest that extremely injured patients comprise a small proportion of blunt trauma victims, consume substantial acute care hospital resources, often survive, and yet frequently have residual disability. A reduction in this long-term disability may represent the greatest challenge in modern trauma care.
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Randomized Controlled Trial Comparative Study Clinical Trial
Gastric mucosal pH and oxygen delivery and oxygen consumption indices in the assessment of adequacy of resuscitation after trauma: a prospective, randomized study.
To compare gastric mucosal pH (pHi) and global oxygen variables [Oxygen Delivery Index (DO2I) and Oxygen Consumption Index (VO2I)] as indicators of adequacy of resuscitation after major trauma. ⋯ pHi may be an important marker to assess the adequacy of resuscitation. pHi monitoring may provide early warning for systemic complications in the postresuscitation period.