J Trauma
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To analyze the demographics, hospital course, functional outcome, and reimbursement for elderly patients sustaining multisystem trauma. ⋯ Mortality rates are high for elderly patients who sustain multisystem trauma. Most deaths occur within the first 24 hours, and most injuries are severe CHIs. More than half of survivors are discharged home, and most are independent at long-term follow-up. Reimbursement is not commensurate with the functional outcome achieved and the care provided.
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The incidence of rib fractures secondary to trauma has not been clearly reported. Of the 7147 patients seen by our trauma service from January 1987 to June 1992, 711 (10%) had rib fractures. ⋯ Thirty-five percent of the patients required discharge to an extended care facility and 35% developed a pulmonary complication. We conclude that rib fractures are a marker of severe injury in which (1) 12% will die because of their injuries, (2) more than 90% will have associated injuries, (3) one half will require operative and ICU care, (4) one third will develop pulmonary complications, and (5) one third will require discharge to an extended care facility.
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Seventy-two open fractures associated with arterial injury requiring vascular repair (Gustilo type IIIC injuries) were treated at the University of Louisville from May 1983 and through 1992. The involved anatomic areas were the humerus (four), forearm (ten), femur (eight), tibia (31), ankle (ten), and foot (nine). Fracture management consisted of careful débridement, wound irrigation, fasciotomy, and fracture stabilization. ⋯ The wound infection rate was 13.9% (10 of 72) and the rate for osteomyelitis was 4.2% (3 of 72). The local use of the antibiotic bead chains was of significant benefit in lowering infectious complications. Primary coverage of soft-tissue defects with free tissue transfer had an infection rate of 66%; temporary wound coverage with the "antibiotic bead pouch" technique until wound closure can be obtained in a sterile and viable environment appears to be a better option.
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To evaluate the relative accuracy of right ventricular end-diastolic volume index (RVEDVI) and pulmonary artery wedge pressure (PAWP) for determining cardiac preload. ⋯ The RVEDVI more accurately predicted preload recruitable increases in CI than did the PAWP.
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To examine the mechanisms of injury and death in a commercial airline disaster and to propose preventative safety measures based on this analysis. ⋯ Fatal blunt injury secondary to deceleration forces was the most common cause of death seen in this analysis. The use of a lap belt restraint system alone is not adequate to protect passengers against these forces as shown convincingly in the automotive industry literature. What impact a better passenger restraint system may have had on survival in this disaster is unknown, however, at a minimum, it would have significantly improved survival for 6 of 28 passengers dying of isolated blunt head trauma. Minor alterations in aircraft design (secure bolting of passenger seats to the airplane superstructure) and passenger restraints (3-point lap and shoulder harness system) is proposed to positively influence survival during an airplane crash at negligible increased airline expense or passenger inconvenience.